Marijuana use and injury events resulting in hospitalization.
- Gerberich SG, Sidney S, Braun BL, Tekawa IS, Tolan KK, Quesenberry CP. Ann Epidemiol 2003; 13(4): 230-237.
Correspondence: Susan Goodwin Gerberich, Division of Environmental and Occupational Health, Regional Injury Prevention Research Center and Center for Violence Prevention and Control, School of Public Health, University of Minnesota, Minneapolis, MN, USA; (email: gerbe001@umn.edu).
BACKGROUND: Information on the potential relation between marijuana use and the incidence of hospitalized injury is extremely limited. The purpose of this effort was to investigate the potential for this association.
METHODS: A retrospective study was conducted in a large prepaid Northern California health care program cohort (n = 64,657) that completed baseline questionnaires about health behaviors, including marijuana use, and health status between 1979 and 1985. All injury hospitalizations through December 31, 1991 (n = 965) were identified and validated.
FINDINGS: Using Poisson regression modeling, increased rate-ratios and 95% confidence intervals were identified for all-cause injury hospitalizations for both men and women among current users (1.58; 1.29 to 1.94 and 1.55; 1.12 to 2.10, respectively) relative to nonusers, adjusted for age, cigarette and alcohol use, and other potential confounders. Increased rates of motor vehicle (2.31, 1.44 to 3.72), assault (2.63, 1.56 to 4.46), and self-inflicted (3.43, 1.54 to 7.87) injuries were identified among men who were current users; an increased rate of self-inflicted injuries (2.13, 1.05 to 4.10) was also identified in women who were current users.
DISCUSSION: Though the results must be viewed cautiously, they suggest that marijuana use may be independently associated with increased risk of hospitalized injury. Further study of the physiological and behavioral mechanisms is warranted.
Point-of-purchase alcohol marketing and promotion by store type --- United States, 2000--2001.
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Alcohol consumption is the third leading preventable cause of death in the United States, accounting for approximately 100,000 deaths annually. Efforts to reduce the adverse health and social consequences from alcohol use include policies to restrict access to alcohol among underaged persons (i.e., persons aged < 21 years) and to reduce alcohol-impaired driving among persons of all ages. Recent studies have focused on alcohol marketing as a potentially important contributor to alcohol consumption, particularly among underage drinkers. Point-of-purchase (POP) (i.e., on-site) marketing, including alcohol advertising and placement, can increase alcohol sales and consumption substantially, thereby increasing the risk for various alcohol-related health outcomes, including alcohol-impaired driving and interpersonal violence. To assess the type and frequency of POP alcohol marketing, researchers with the ImpacTeen Project* collected and analyzed store observation data during 2000--2001 from 3,961 alcohol retailers in 329 communities throughout the United States. This report summarizes the results of the study, which indicate that POP alcohol marketing is extensive in certain store types frequented by teenagers and young adults. Public health agencies and policy makers should work with liquor control boards to reduce POP marketing that could promote risky or underage drinking.
Communities with one or more public schools that participated in either the 2000 or 2001 Monitoring the Future surveys (nationally representative surveys of 8th-, 10th-, and 12th-grade students) were eligible to be included in the study. Private and magnet schools (comprising approximately 20% of the original sample) were not included in this study. Community boundaries were defined by the area from which each school drew >80% of its student population. Retailers selling tobacco and alcohol products in each community were selected randomly for observation from lists of all potential alcohol and/or tobacco retailers as identified by their Standard Industrial Classification codes. Of the total 6,031 observed stores, 3,961 (66%) were alcohol retailers and were included in this study.
In each alcohol retail establishment, field staff observed the presence of various POP alcohol marketing characteristics in a standardized manner, including 1) exterior and interior advertisements for alcoholic beverages and the intensity of such advertising, 2) alcohol beverage control signage (e.g., health warnings), 3) alcohol-branded functional objects provided free to retailers (e.g., counter change mats with an alcohol company logo), 4) beer placement (e.g., single cans or bottles chilled in buckets near checkout locations (Figure) or not chilled on shelf), and 5) the presence of low-height advertisements (i.e., advertisements placed within 3.5 feet of the floor, in the sight line of children and adolescents as opposed to adults).
The GENMOD procedure in SAS v.8 was used to determine generalized estimating equations that accounted for community clustering, specifying a binomial distribution and a logit link function. For all analyses, weights were included to account for community sampling procedures and store selection probabilities; supermarkets were the referent category.
The majority of stores (94%) had some form of POP alcohol marketing (i.e., store exterior, store interior, and/or parking lot or other property advertising and/or alcohol-branded functional objects). Exterior alcohol advertisements were observed in 39% of stores; 27% of stores had high-intensity exterior advertising. Compared with supermarkets, liquor stores (odds ratio [OR] = 176.8), convenience stores (OR = 48.2), convenience/gas stores (OR = 42.3), small grocery stores (OR = 24.5), and drug stores/pharmacies (OR = 15.5) were more likely to have high-intensity exterior alcohol advertising.
Interior alcohol advertisements were observed in 92% of stores, and 37% of stores had high-intensity interior advertising. Liquor stores (OR = 18.5), convenience/gas stores (OR = 4.8), convenience stores (OR = 3.9), and small grocery stores (OR = 3.5) were more likely than supermarkets to have high-intensity interior advertisements. Low-height advertisements were found in 44% of stores. Low-height advertising was more common in liquor stores (OR = 5.1) and in convenience/gas stores (OR = 2.2) than in supermarkets. Less than half (48%) of the stores in the sample had alcohol control or counter-alcohol signage, with no statistically significant differences by store type.
Approximately half (51%) of the stores provided at least one alcohol-branded functional object. These objects were more likely to be in liquor stores (OR = 4.2), convenience stores (OR = 1.8), and small grocery stores (OR = 2.0) than in supermarkets.
Among all types of stores, beer was located most commonly in coolers (96%), in floor displays (44%), on shelves (23%), and as singles in ice buckets (16%). Single beers in ice buckets, located most often near checkout locations, were most likely to be found in convenience stores (27%), convenience/gas stores (18%), and small grocery stores (27%). Shelf displays of beer were most common in supermarkets (47%) and drug stores (43%); 1% of stores placed beer behind a counter or in a closed or locked cabinet.
* A policy research partnership supported by the Robert Wood Johnson Foundation for reducing youth substance use. Member institutions include the University of Illinois at Chicago, the University of Michigan, Andrews University, and Roswell Park Cancer Institute.
Correspondence: Stephen C. Waring, University of Texas Health Sciences Center at Houston, School of Public Health, PO Box 20186, Houston, Texas 77225, USA; (email: swaring@sph.uth.tmc.edu).
BACKGROUND: Tropical Storm Allison, which hit landfall near Galveston, Texas, on June 5, 2001, caused the most severe flood-related damage ever recorded in the Houston metropolitan area. The main goal of the public health response to tropical storm Allison was to evaluate the immediate health needs of the community.
METHODS: To estimate damage and household needs, we conducted a rapid needs assessment in the areas most affected by flooding with use of a modified cluster sampling method facilitated by Geographical Information Systems methodology. A total of 420 households participated in the survey, 210 each from the 2 sampling areas.
FINDINGS: We found a 4-fold increase in illness among persons living in flooded homes compared with those living in nonflooded homes. These findings suggest a need for rapid resolution of flood-related damage and the possibility that residents should seek temporary housing during clean-up and repair. In addition, we obtained reliable estimates of damage and household needs to help guide relief efforts.
DISCUSSION: The findings underscore the usefulness of a rapid-needs assessment as a tool to identify actual health threats and to facilitate delivery of resources to those with the greatest and most immediate need.
Disaster preparedness at the University of Pittsburgh School of Nursing: application of Haddon's 10 countermeasures to assess and plan.
Correspondence: Lisa Marie Bernardo, University of Pittsburgh School of Nursing, 415 Victoria Building, Pittsburgh, PA 15261, USA; (email: lbe100@pitt.edu).
No building is invulnerable to a terrorist attack. However, countermeasures can be put into place to minimize or perhaps prevent a serious threat. Shortly after September 11, 2001, Jacqueline Dunbar-Jacob, professor and dean of the University of Pittsburgh School of Nursing, convened an Emergency Preparedness Task Force to assess the school's readiness in the event of a natural or manmade disaster. The task force comprised faculty from each department and division within the school; a staff representative from the dean's office; the building manager; and an undergraduate and graduate student representative. The task force convened in October 2001 and developed goals and objectives.
William Haddon Jr. is considered the "founding father" of injury prevention. Haddon used the epidemiologic triad of agent, host, and environment to analyze injury events. He created a method to assess the event according to preinjury, injury, and postinjury phases. He further evaluated human, agent or vehicle, physical environment, and sociocultural environment factors. From this matrix, he identified 10 categories of injury prevention countermeasures; each countermeasure represents ways in which energy transfer is controlled, modified, or interrupted. The task force used each countermeasure as a framework for conducting assessments and interventions, and are described in the report.
Risk factors for falls in the Thai elderly in an urban community.
- Assantachai P, Praditsuwan R, Chatthanawaree W, Pisalsarakij D, Thamlikitkul V. J Med Assoc Thai. 2003; 86(2): 124-130.
Correspondence: P. Assantachai, Department of Preventive and Social Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, THAILAND; (email: unavailable).
BACKGROUND: Instability or falls in the elderly are a health condition meeting all criteria for prevention i.e. high frequency, evidence of preventability and a high burden of morbidity. The consequences of a fall affect not only the elderly per se such as fractures and various kinds of physical and mental impairment, but also the family and the society as a whole in terms of the financial expenditure involved. The need for a comprehensive study to identify the risk factors for falls among the Thai elderly is, therefore, crucial for further management.
OBJECTIVE: To identify the significant risk factors for falls among the Thai elderly for further prevention and management.
METHOD: A cross-sectional study in the urban community around Siriraj Hospital, Bangkok. 1,043 community-dwelling people aged > or = 60 years were recruited. A structured questionnaire, including mental test and physical examinations as well as various laboratory tests, were used to identify the risk factors for falls between faller and control groups.
FINDINGS: The overall prevalence of falls among elderly Thais in an urban area was 19.8 per cent during a period of 6 months. However, the prevalence was 24.1 per cent in women but only 12.1 per cent in men. Older people who were likely to fall also had a lower bone mass which predisposed them to future fractures. The independent risk factors for falls after multiple logistic regression analysis were: female gender,hypertension, deafness, poor memory, poor self-perceived health status, poor performance in the instrumental activities of daily living, kyphoscoliosis, use of spectacles, rapid pulse rate after a 5 minute rest, higher serum transferrin and poor nutrition in terms of low lean body mass and reduced serum albumin level.
DISCUSSION: Special sense, activity of daily living, nutritional status, kyphoscoliosis, hypertension and cognitive ability were six important factors determining the likelihood of fall among the elderly in an urban area.
Use of clinical and impairment-based tests to predict falls by community-dwelling older adults.
Correspondence: L.K. Boulgarides, Kinesiology and Health Science Department, California State University, Sacramento, 6000 J St, Sacramento, CA 95819-6073, USA; (email: Boulgarides@csus.edu).
BACKGROUND AND PURPOSE: Few tests have been found to be strongly predictive of falls in community-dwelling older adults. The purpose of this study was to determine whether data from 5 balance tests-combined with data regarding fall history, number of medications, dizziness, visual problems, use of an assistive device, physical activity level, sex, and age-could predict falls in community-dwelling older adults who were independent.
SUBJECTS: Ninety-nine community-dwelling older adults aged 65 to 90 years ( =74.02, SD=5.64) were tested.
METHODS: Subjects were tracked for falls over a 1-year period following testing. Impairment-based tests, which are tests that attempt to specifically identify which sensory systems are impaired or how motor control is impaired (eg, speed, accuracy of movement), were the Modified Clinical Tests of Sensory Interaction for Balance (Modified CTSIB) and the 100% Limits of Stability Test, both of which were done on the Balance Master 6.1. Performance-based tests, which are functional tests that identify functional limitations without necessarily identifying their causes, were the Berg Balance Scale, the Timed "Up Go" Test, and the Dynamic Gait Index. Demographic and health data included age, sex, number of medications, physical activity level, presence of dizziness, vision problems, and history of falls over the previous year. Logistic regression was used to determine which combinations of data from balance tests, demographics, and health factors were predictive of falls.
FINDINGS: Two models-(1) the "standing on a firm surface with eyes closed" (FEC) condition of the Modified CTSIB and (2) the FEC combined with age and sex-were predictive of falls, but predicted only 1 and 2 subjects who were at risk for falling, respectively, out of 20 people who were at risk for falling.
DISCUSSION: Five balance tests combined with health and demographic factors did not predict falls in a sample of community-dwelling older adults who were active and independent.
Selecting appropriate toys for young children: the pediatrician's role.
- Glassy D, Romano J; Committee on Early Childhood, Adoption, and Dependent Care. Pediatrics 2003; 111(4 Pt 1): 911-913.
Correspondence: Danette Glassy, PO Box 1930, Seattle, WA 98111, USA; (email: unavailable).
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Play is essential for learning in children. Toys are the tools of play. Which play materials are provided and how they are used are equally important. Adults caring for children can be reminded that toys facilitate but do not substitute for the most important aspect of nurture-warm, loving, dependable relationships. Toys should be safe, affordable, and developmentally appropriate. Children do not need expensive toys. Toys should be appealing to engage the child over a period of time. Information and resources are provided in this report so pediatricians can give parents advice about selecting toys.
An exploratory study on occupational stress and work-related unintentional injury in off-shore oil production
- [Article in Chinese with English abstract]
Chen W, Huang Z, Yu D, Lin Y, Ling Z, Tang J. Zhonghua Liu Xing Bing Xue Za Zhi 2002; 23(6): 441-444.
Correspondence: W. Chen, Department of Community and Family Medicine, the Chinese University of Hong Kong, Hong Kong, CHINA; (email: unavailable).
OBJECTIVE: To explore the association between occupational stress and other socio-psychological factors and work-related unintentional injury in off-shore oil production.
METHODS: A cross-sectional survey was conducted among 561 Chinese off-shore oil workers. They were inquired with a self-administered questionnaire involving in socio-demographic characteristics, occupational stress, type A behavior personnel, social support and coping style, and work-related unintentional injury in the past year.
FINDINGS: Seventy-six (13.5%) workers experienced work-related unintentional injury for once time or more in the past year. A total 141 number of person-times were counted including 18 person-times being serious injury, 26 person-times moderate, and 97 person-times light. After adjustment for age, educational level, marital status, duration of off-shore work and job title,logistic regression indicated that perceived stress from "management problem and relationship with others" were significantly associated with work-related unintentional injuries in the past year (OR = 1.33, 95% CI: 1.05 - 1.68; P < 0.05). Workers lack of emotional support from friends seemed to less reporting on work-related unintentional injuries (OR = 0.37, 95% CI: 0.22 - 0.63).
DISCUSSION: The results implied emphasizing on that the training and guidance as well as better cooperation among the workers might reduce work-related unintentional injuries in off-shore oil industry.
Nonfatal injuries to young workers in the retail trades and services industries in 1998.
Correspondence: Anne L Mardis, Division of Safety Research, National Institute for Occupational Safety and Health, Mail Stop P04/H1808, 1095 Willowdale Road, Morgantown, WV, USA; (email: amardis@pol.net).
We estimate the incidence and describe patterns of work-related injuries during 1998 to youth in retail trades and services industries. Data from the National Electronic Injury Surveillance System and the Current Population Survey were analyzed. The highest number of work-related injuries to youth younger than 18 years occurred in eating and drinking establishments and food stores. Injuries occurring in these industries accounted for 44% of all young worker injuries. Injury rates were similar during summer and school months. Youth continue to experience high numbers and rates of injuries in retail trades and services. Improvements in safety training and injury prevention in these industries, particularly eating and drinking establishments, food stores, and health services, need to be addressed for youth.
Ageing effects on the attention demands of walking.
- Sparrow WA, Bradshaw EJ, Lamoureux E, Tirosh O. Hum Mov Sci 2002; 21(5-6): 961-72.
Correspondence: William A. Sparrow, School of Health Sciences, Deakin University, 221 Burwood Hwy, Burwood 3125, Vic., AUSTRALIA; (email: sparrow@deakin.edu.au).
Attention demands of walking were determined in six male and six female young adults (mean 26.3 yr) and 12 gender-matched healthy, active older adults (mean 71.1 yr) using a dual task procedure with a reaction time (RT) secondary task. In three conditions an auditory stimulus, a visual stimulus and both stimuli (auditory/visual) were presented. Relative to no-walking baselines, increased RT was found in all conditions revealing an attentional cost of normal walking. When participants traversed the laboratory walkway and also positioned one of their feet within a target area on the ground, attention demands were greater than in unconstrained walking. In the targeting task, RTs to the visual stimulus were longer than for the auditory stimulus due to the interference associated with viewing both the stimulus monitor and the foot-target. Older participants' RTs in the visual and auditory/visual conditions, but not in the auditory condition, were significantly longer than for the young group in both walking tasks but RTs for young and older adults were not different in no-walking baseline trials. Inspection of mean RT functions at time intervals following gait initiation (0-3000 ms from the first step) suggested a fluctuating attentional cost of walking with increased demands associated with contingencies requiring step length regulation. The findings have applied significance in demonstrating the possibility of increased falls and pedestrian accident risk in older individuals in dual task situations such as road crossing.
Correspondence: Jeffrey W. Muttart, Accident Dynamics Research Center, P. O. Box 261, Uncasville, Connecticut 06382, USA; (email: jmuttart@99main.com).
The goal of this research was to develop mathematical equations that would estimate the response times of drivers in various situations. This research involved two studies.
The first study involved the development of a series of equations that predict driver response times [DRTs]. Compiling a database of over 130 studies that measured DRT and coding for over 20 methodology and substantive variables was the source from which the equations were developed. Multiple Stepwise Linear Regression analysis was performed on the database. The analysis produced an empirical equation that revealed which variables and methods were statistically significant predictors of DRTs. The analysis showed that when all research data was analyzed together an accurate predictor could not be developed. However, when the database was divided into smaller sets based upon where the target emerged, empirical equations were developed. Each of six equations reached statistical significance.
The second study compared the prediction results of the equations from the first study, to the results obtained from time/position analysis of the video record of actual traffic incidents at an intersection in Kentucky. The meaning, limitations and significance of the analysis results are discussed and compared to previously published prediction models.
The equations predicted response times within 1/2 of a second 74 percent of the time, and within 3/4 of a second 90 percent of the time.
Between January 1996 and November 2000, 4,251 autopsies were performed at the Council of Forensic Medicine, Morgue Specialization Office, Izmir, Turkey. Among these medicolegal autopsies, 331 fatal poisoning cases (206 men and 125 women) were evaluated retrospectively for their legal investigation results, autopsy findings, and reports of toxicological analyses. The most common cause of fatal poisoning was insecticides (43%). Then followed carbon monoxide (27%) and alcohol (20%). Among the insecticides, the organophosphorus insecticides comprised 78%; all insecticide poisoning cases were suicidal oral ingestions. In fatal alcohol poisoning cases the cause of death was ethanol, methanol and both with 34, 15 and 51% respectively. Drug related deaths were rare.
Correlation of revised trauma score and injury severity score (TRISS) predicted probability of survival with peer-reviewed determination of trauma deaths.
- Shanti CM, Tyburski JG, Rishell KB, Wilson RF, Lozen Y, Seibert C, Steffes C, Carlin AM. Am Surg 2003; 69(3): 257-260.
Correspondence: C.M. Shanti, Department of Surgery, Detroit Receiving Hospital, 6C-University Health Center, Detroit, Michigan 48201, USA; (email: unavailable).
Trauma deaths at our institution are evaluated by a multidisciplinary trauma committee. The purpose of this study was to evaluate preventable trauma deaths (PRDs) as determined by our review committee and correlate them with the Revised Trauma Score and Injury Severity Score (TRISS) probability of survival (PS). A total of 10,002 patients were identified. The PS was calculated using the TRISS method. The Z scores were calculated and the predicted number of deaths was established. The actual number of deaths was compared with the predicted number of deaths. PRDs were compared with the actual and predicted deaths. The Z score was 0.79, which meant we observed more deaths than predicted by TRISS. We had 281 deaths compared with 271 deaths predicted by TRISS. Peer review characterized 45 deaths as preventable. Although we performed well when our outcomes were compared with TRISS predicted outcomes our PRD rate was higher. The higher the PS the more likely the death was found preventable by peer review. We conclude that for our patient population the peer review process is very sensitive and may be more discerning in identifying PRD than TRISS.
Prediction of mortality from catastrophic burns in children.
- Spies M, Herndon DN, Rosenblatt JI, Sanford AP, Wolf SE. Lancet 2003; 361(9362): 989-994.
Correspondence: David Herndon, Shriners Hospitals for Children and Department of Surgery, The University of Texas Medical Branch, Galveston, TX, USA; (email:dherndon@utmb.edu).
Background: We previously developed a model to predict survival in massive pediatric burns (>80% total body surface area [TBSA]). This model included not only demographic variables, but also variables obtained throughout the hospital course. We aimed to prospectively validate our model for accuracy of outcome prediction.
Methods: We admitted 33 pediatric burn patients with burns greater than 80% TBSA. We recorded age, burn size, inhalation injury, resuscitation, packed-cell volume at admission, base deficit, serum osmolarity, sepsis, inotropic support, platelet count, creatinine, and ventilator dependency. We entered these data into our previous models.
Results: 20 male and 13 female children with mean age 7.6 (SD 1) years with TBSA burns of 88% (SD 1; full thickness 86% [SD 1]) were admitted. Mortality was 39.4% (13 of 30). When all variables were integrated into our final model, we predicted outcome with 97% accuracy. When we used a model based only on demographic characteristics of age, burn size, and presence of inhalation injury, outcome was correctly predicted in only 51% of patients.
Conclusions: We show prospectively that mortality in severely burned children can be reliably estimated at a burn center, and that outcome cannot be reliably predicted on the basis of demographic and injury characteristics alone. These data suggest that all severely burned children should be given a course of treatment before consideration of treatment futility.
Mortality and injury from motorcycle collisions in Phetchaburi Province.
- Sirathranont J, Kasantikul V. J Med Assoc Thai. 2003; 86(2): 97-102.
Correspondence: J. Sirathranont, Phra Chom Klao Hospital, Phetchaburi 76000, THAILAND; (email: unavailable).
A retrospective analysis was done in 3,225 injured motorcyclists treated at Phra Chom Klao Hospital between April 1, 1999 and March 31, 2000. The peak of all motorcycle crashes was found between 6 p.m. and 9 p.m. Male motorcycle riders accounted for 69 per cent of the accident population, and most riders were under 21 years of age. Approximately 21 per cent of the accident-involved riders had been drinking alcohol and about half of the riders were unlicensed. Only 4 per cent of the riders were wearing helmets at the time of the accident. Helmet usage was much lower among passengers, only about 1 per cent. The upper and lower extremities were injured most frequently, although these injuries were not life threatening. The most fatal injuries to the motorcyclists were to the head, abdomen, and chest in decreasing frequency.
National Hospital Ambulatory Medical Care Survey: 2000 outpatient department summary.
Correspondence: Nghi Ly, Division of Health Care Statistics, Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics, Hyattsville, Maryland 20782-2003, USA; (email: nchsquery@cdc.gov).
OBJECTIVES: This report describes ambulatory care visits to hospital outpatient departments (OPDs) in the United States. Statistics are presented on selected hospital, clinic, patient, and visit characteristics. Highlights of trends in OPD utilization from 1997 through 2000 are also presented.
METHODS: The data presented in this report were collected from the 2000 National Hospital Ambulatory Medical Care Survey (NHAMCS). NHAMCS is part of the ambulatory care component of the National Health Care Survey that measures health care utilization across various types of providers. NHAMCS is a national probability sample survey of visits to emergency and outpatient departments of non-Federal, short-stay, and general hospitals in the United States. Sample data are weighted to produce annual national estimates. Trends are based on NHAMCS data from 1997 through 2000.
FINDINGS: During 2000, an estimated 83.3 million visits were made to hospital OPDs in the United States, about 30.4 visits per 100 persons. Females had higher OPD visit rates than males (35.3 versus 25.2 visits per 100 persons). The OPD utilization rate for black persons was higher than for white persons (48.3 versus 28.0 visits per 100 persons). Of all visits made to hospital OPDs in 2000, private insurance (38.5 percent), Medicaid (22.1 percent), and Medicare (16.9 percent) were listed as the leading primary expected source of payment. Approximately 21 percent of OPD visits reported that patients belonged to an HMO. There were an estimated 9.5 million injury-related OPD visits in 2000. Since 1997, the percent of OPD visits that were for injuries increased by 24% (from 9.2 percent to 1.4 percent). Most of these visits were for unintentional injuries (57.6 percent), including those caused by falls (12.9 percent). Medications were prescribed at 64.0 percent of visits. On average, 1.6 medications were ordered at each OPD visit. In 2000, patients saw one or more physicians (i.e., staff physician, resident/intern, or other physician) at approximately 79 percent of visits. Most patients were given an appointment to return to the clinic (57.2 percent).
Prevalence of traumatic brain injury amongst children admitted to hospital in one health district: a population-based study.
- Hawley CA, Ward AB, Long J, Owen DW, Magnay AR. Injury 2003; 34(4): 256-260.
Correspondence: Carol A. Hawley, Centre for Health Services Studies, University of Warwick, CV4 7AL, Coventry, UK; (email:c.a.hawley@warwick.ac.uk).
There is a dearth of information regarding the prevalence of brain injury, serious enough to require hospital admission, amongst children in UK. In North Staffordshire, a register of all children admitted with traumatic brain injury (TBI) has been maintained since 1992 presenting an opportunity to investigate the incidence of TBI within the region in terms of age, cause of injury, injury severity and social deprivation. The register contains details of 1553 children with TBI, two-thirds of whom are male. This population-based study shows that TBI is most prevalent amongst children from families living in more deprived areas, however, social deprivation was not related to the cause of injury. Each year, 280 per 100,000 children are admitted for>/=24h with a TBI, of these 232 will have a mild brain injury, 25 moderate, 17 severe, and 2 will die. The incidence of moderate and severe injuries is higher than previous estimates. Children under 2 years of age account for 18.5% of all TBIs, usually due to falls, being dropped or non-accidental injuries (NAIs). Falls account for 60% of TBIs in the under 5 years. In the 10-15 age group road traffic accidents (RTAs) were the most common cause (185, 36.7%). These findings will help to plan health services and target accident prevention initiatives more accurately.
Rehabilitation outcomes in traumatic spinal cord injury in Australia: functional status, length of stay and discharge setting.
OBJECTIVES: To describe patients' length of stay (LOS), functional status and discharge setting after rehabilitation and how degree of impairment (complete/incomplete paraplegia/tetraplegia) impacts on these outcomes. To compare actual LOS with estimated LOS. Estimated LOS was based on an Australian model, the Australian National Sub-acute and Non-acute Patient Classification System (AN-SNAP), which classifies patients using admission Functional Independence Measure (FIM trade mark ) scores. To further describe outcomes for each AN-SNAP class by degree of impairment.
SETTING: Spinal Injuries Unit of major Metropolitan hospital in Brisbane, Australia.
METHODS: Retrospective chart review of 167 patients with traumatic spinal cord injury (SCI). Main outcome measures were rehabilitation LOS, discharge FIM trade mark scores and discharge setting. Injury measures were degree of impairment, acute LOS and rehabilitation admission FIM trade mark scores. Standard demographic measures were also collected.
FINDINGS: The median rehabilitation LOS was 83 days and mean discharge FIM trade mark scores 102 for all patients. These differed by impairment (incomplete paraplegia LOS 43, FIM 117; complete paraplegia LOS 96, FIM 109; incomplete tetraplegia LOS 64, FIM 100; complete tetraplegia LOS 206, FIM 78). Patients discharged to the community (noncare facility) ranged from 93% with incomplete paraplegia to 73% with complete tetraplegia. For patients in the three AN-SNAP classes with the lowest FIM scores, the actual LOS was up to twice the estimated LOS. A large variability in discharge outcomes was found within individual AN-SNAP classes, despite similar FIM trade mark scores on admission.
DISCUSSION: Rehabilitation outcomes differed substantially by impairment. The variability in outcomes for patients within the same AN-SNAP class questions the ability of this system to accurately predict LOS, and therefore cost of rehabilitation services, for patients with traumatic SCI in Australia.
SPONSORSHIP: Some of this research was supported by a grant from Queensland Health. Leigh Tooth was supported by a National Health and Medical Research Council of Australia Public Health Fellowship (#997032) while some of this research was undertaken.
A review of 2,517 childhood injuries seen in a Singapore emergency department in 1999 - mechanisms and injury prevention suggestions.
- Ong MEH, Ooi SBS, Manning PG. Singapore Med J 2003; 44(1): 12-19.
Correspondence: Marcus Ong Eng Hock, Department of Emergency Medicine, Singapore General Hospital, 1 Hospital Drive, Outram Road, Singapore, 169608; (email: gaeoeh@sgh.com.sg)
BACKGROUND: Childhood Injuries cause significant
mortality and morbidity in Singapore. With
injury surveillance, patterns of repeated injury
can be identified and injury prevention strategies
devised.
METHODS: We conducted a retrospective study
of all children aged 12 and below seen for trauma
in an Emergency Department over one year.
Data captured in the real-time computer system
was studied with regards to patient profile,
mechanism of injury and patient disposition.
Clinical summaries were extracted with followup
telephone interviews done.
FINDINGS: Two thousand five hundred and seventeen
children aged 12 and below were seen for
accidental trauma in 1999, accounting for 37.1%
of the total attendance for that age. Mean age
was 7.7 years with males making up 62.7%.
Home injuries (56.4%) were the most common,
followed by road-related (14.4%), sports (8.2%)
and playground injuries (7.4%). 48.5% sustained
head and face injuries. Pre-school children (age <5)
were more likely to sustain home injuries (p<0.0001),
a higher proportion of head injuries (p<0.0001),
foreign bodies, burns and poisoning compared to
school-going children (age 6-12), who were more
likely to sustain injuries in road accidents, sports,
at playgrounds or schools, with more limb, trunk
and multi-trauma.
DISCUSSION: We highlight drownings, falls from height, rollover
falls from beds, slamming door injuries, the
low use of child car restraints, bicycle injuries and
playground falls as areas of concern. Several injury prevention strategies
have been suggested and it is hoped these may
contribute to addressing preventable childhood
injuries in Singapore. We also advocate the
establishment of a national childhood injury
surveillance database.
Injuries experienced by infant children: a population-based epidemiological analysis.
OBJECTIVE: Injuries to infant children are an important health concern, yet there are few population-based analyses from which to develop prevention initiatives. This study describes the external causes, natures, and disposition from an emergency department of infants with injuries for a geographically distinct population in Eastern Ontario.
METHODS: Epidemiologic analysis of emergency-based surveillance data (1994-2000) for infants (<12 months old) from the Kingston sites of the Canadian Hospitals Injury Reporting and Prevention Program.
FINDINGS: A total of 990 cases of injury to infants were identified, of which 217 (21.9%) required significant medical intervention. Leading causes of injury were falls (605/990; 61.1%), ingestion injuries (65/990; 6.6%), and burns (56/990; 5.7%). Common types of falls experienced were: from furniture (229/605; 37.9%), being dropped (92/605; 15.2%), in car seats (73/605; 12.1%), down stairs (63/605; 10.4%), or in a child walker (42/605; 6.9%). The observed patterns of injury changed according to the ages of the children. Vignettes are used to illustrate recurrent injury patterns (falls, physical vulnerability, burns and ingestions, equipment injuries).
DISCUSSION: The results indicate the relative importance of several external causes of injury and how these vary by age group. This population-based information is also useful in establishing rational priorities for prevention, and the targeting of interventions toward responsible authorities.
Comparing unintentional and intentional injuries in a school setting.
- Limbos MA, Peek-Asa C. J Sch Health 2003; 73(3): 101-106.
Correspondence: M.A. Limbos, USC Keck School of Medicine, Division of General Pediatrics, Children's Hospital of Los Angeles, 4650 Sunset Blvd., MS# 76, Los Angeles, CA 90027, USA; (email: mlimbos@chla.usc.edu).
This study determined the incidence of violence-related injuries in an urban school district, and compared characteristics of unintentional and intentional school injuries. A sample of student Accident Report Forms completed for a school district in 1997 were reviewed for demographic characteristics of the student and injury characteristics. Injuries were categorized as unintentional, intentional, or of unknown intent. Annual incidence rates of injury per 100 students were calculated by intention, grade, and gender. Comparisons between unintentional and intentional injuries were made using odds ratios and 95% confidence intervals. Of 11,674 annualized injuries, 77.2% were unintentional, 16.8% were intentional, and 6.0% were of unknown intent. The overall annualized injury rate was 1.74 injuries per 100 students/year. The unintentional injury rate was almost five times the intentional injury rate of 0.29 injuries per 100 students/year. High school students had both the highest unintentional and intentional injury rates. Males in all grade levels had the highest rates of injury. Most injuries occurred during school hours. Intentional injuries were almost three times more likely to be associated with unstructured play or after school playground hours; were less likely to be witnessed events; and were more likely to occur on the surrounding school grounds than unintentional injuries. Unintentional injuries represent a greater risk to school children than do intentional injuries. A potential area to focus interventions for intentional injuries are modifications of the school environment and surrounding grounds to improve supervision and monitoring.
Describes adolescents who attempt suicide and their risk for ongoing suicidal behavior. Fifty-eight adolescents (53 female) who attempted suicide received a baseline evaluation that was analyzed to identify factors that were associated with continued suicidal ideation and reattempt. At a 3-month follow-up assessment, 45% reported continued suicidal ideation and 12% reported a repeat attempt. Baseline measures of family functioning, feelings of hopelessness, and abilities to regulate affect were associated with suicidal ideation at follow-up but not as strongly as depressed mood. After controlling for depressive symptoms, the association between family functioning and continued suicidal behavior was no longer significant. Depressed mood at baseline was most strongly associated with both continued suicidal ideation and reattempt.
Predictors of psychosocial distress after suicide, SIDS and accidents.
- Dyregrov K, Nordanger D, Dyregrov A. Death Stud 2003; 27(2): 143-165.
Correspondence: Kari Dyregrov, Center For Crisis Psychology, Bergen, NORWAY; (email: kdyregro@online.no).
This article compares the outcome and predictors of psychosocial distress of parents bereaved by young suicides, sudden infant death syndrome (SIDS), and child accidents. One objective is to explore whether suicide bereavement is more difficult for those left behind than other forms of bereavement. Data have been collected from 140 families, consisting of 232 parents, by the use of the Impact of Event Scale, the General Health Questionnaire, and the Inventory of Traumatic Grief. Qualitative aspects of bereavement are assessed by in-depth interviews with family members from 40 families. The results show that the similarities between the samples on outcome and predictors are more striking than the differences, which is explained by the common traumatic aspect of unexpected and violent deaths. One and a half years post-loss, 57-78% of the survivors scored above the cut-off levels for traumatic grief reactions. Although no significant differences are found between survivors of suicide and accidents, both groups evidence significantly greater subjective distress than the survivors of SIDS. Self-isolation is by far the best predictor of psychosocial distress in all three samples. Rather than focusing on the exceptional position of suicide survivors, it seems important to call attention to sudden and traumatic death in general as a factor to be associated with post-traumatic reactions and complicated mourning.
The Impact of Gun Control (BILL C-51) on Suicide in Canada
- Leenaars AA, Moksony F, Lester D, Wenckstern S. Death Stud 2003; 27(2): 103-124.
Correspondence: A Leenaars, Windsor, Ontario, CANADA; (email: unavailable).
Suicide is a multiply determined behavior, calling for diverse prevention efforts. Gun control has been proposed as an important component of society's response, and an opportunity for studying the effects of legislative gun control laws on suicide rates was provided by Canada's Criminal Law Amendment Act of 1977 (Bill C-51). This article reviews previous studies of the impact of this act on the total population of Canada and subpopulations by age and gender and, in addition, presents the results of 2 new studies: a different method of analysis, an interrupted time-series analysis, and the results of a multiple regression analysis that controls for some social variables. It appears that Bill C-51 may have had an impact on suicide rates, even after controls for social variables.
Suicide in the Highlands of Scotland.
- Stark C, Matthewson F, O'Neill N, Oates K, Hay A. Health Bull (Edinb) 2002; 60(1): 27-32.
Correspondence: C. Stark, Highland NHS Board, Assynt House, Beechwood Park, Inverness, SCOTLAND; (email: unavailable).
OBJECTIVE: The Highlands have one of the highest suicide rates in Scotland. This paper describes suicide and deliberate self-harm in the Highlands in the last 20 years and explores possible reasons for the differences from the Scottish average.
DESIGN: Retrospective analysis of routine data from the SMRI/SMR01 scheme and information on deaths from the Registrar General. Suicide and undetermined deaths were combined in the analysis.
SETTING: Highland and Scotland 1978-98.
FINDINGS: The high rates in Highland are caused by an excess of male deaths. Highland has had consistently high male suicide rates over the 20 year period compared to Scotland. These differences do not disappear when deaths of non-Highland residents are excluded. By comparison, deliberate self-harm admissions follow a similar pattern to Scotland as a whole. Causes of death differed from Scotland as a whole, with an over-representation of drowning, gases and firearm deaths.
DISCUSSION: Highland suicide rates are elevated compared to Scotland. This is mainly due to an excess of deaths in men up to the age of 74 years, and is not accounted for by deaths of non-residents. Female deaths are not elevated in comparison to the rest of Scotland. Male attempted suicide rates do not differ from Scotland. Lethality of method--drowning, car exhausts and firearms--may contribute to the elevated male death rates.
Increased suicide rate in the middle-aged and its association with hours of sunlight.
- Lambert G, Reid C, Kaye D, Jennings G, Esler M. Am J Psychiatry 2003; 160(4):793-795.
Correspondence: Gavin Lambert, Human Neurotransmitter Laboratory and Alfred and Baker Medical Unit, Baker Heart Research Institute, P.O. Box 6492, St Kilda Road Central, Victoria 8008, Melbourne, AUSTRALIA; (email: gavin.lambert@baker.edu.au).
OBJECTIVE: Aside from diminished daily functional capacity, individuals with depression are at greatly higher risk of suicide. Given that both endogenous depression severity and the incidence of suicide peak during the spring and summer months, it would seem that an environmental cue-one that generates alterations in brain neuronal activity that result in depressed affect or suicidal ideation-might be important.
METHOD: The authors examined the frequency of suicide and its relation to meteorological factors in the state of Victoria between January 1990 and April 1999.
FINDINGS: The incidence of suicide had its nadir in winter and zenith in the spring and summer and paralleled closely the number of bright sunlight hours. This pattern was particularly marked for violent suicide. During the decade, the suicide rate significantly increased among men between 21 and 60 years of age and women between 41 and 60.
DISCUSSION: The incidence of suicide in southeastern Australia displays a clear seasonal pattern, being positively linked with prevailing levels of sunlight. The rate of suicide increased in the latter half of the last decade.
Suicide Rates in Clinical Trials of SSRIs, Other Antidepressants, and Placebo: Analysis of FDA Reports.
- Khan A, Khan S, Kolts R, Brown WA. Am J Psychiatry 2003; 60(4): 790-792.
Correspondence: Arif Khan, 1900 166th AVE NE # 112, Bellevue, WA 98004, USA; (email: akhan@nwcrc.net).
OBJECTIVE: Previous reports suggesting that selective serotonin reuptake inhibitor (SSRI) use is associated with increased suicidal risk have not assessed completed suicides. The authors analyzed reports from randomized controlled trials to compare suicide rates among depressed patients assigned to an SSRI, other antidepressants, or placebo.
METHOD: Food and Drug Administration (FDA) summary reports of the controlled clinical trials for nine modern FDA-approved antidepressants provided data for comparing rates of suicide.
FINDINGS: Of 48,277 depressed patients participating in the trials, 77 committed suicide. Based on patient exposure years, similar suicide rates were seen among those randomly assigned to an SSRI (0.59%, 95% confidence interval [CI]=0.31%-0.87%), a standard comparison antidepressant (0.76%, 95% CI=0.49%-1.03%), or placebo (0.45%, 95% CI=0.01%-0.89%).
DISCUSSION: These findings fail to support either an overall difference in suicide risk between antidepressant- and placebo-treated depressed subjects in controlled trials or a difference between SSRIs and either other types of antidepressants or placebo.
Cigarette smoking, suicidal behavior, and serotonin function in major psychiatric disorders.
- Malone KM, Waternaux C, Haas GL, Cooper TB, Li S, Mann JJ. Am J Psychiatry 2003; 160(4): 773-779.
Correspondence: Kevin M. Malone, Department of Psychiatry, St. Vincent's University Hospital/UCD, Dublin,IRELAND; (email:k.malone@st-vincents.ie).
OBJECTIVE: Cigarette smoking is associated with a higher risk for suicide and attempted suicide, but psychopathological or biological explanations for this association have not been explored. Lower serotonin function and impulsive/aggressive traits are associated with suicidal acts, including completed suicide. The authors hypothesized that the relationship that may exist between cigarette smoking and suicidal behavior may be associated with lower serotonin function and the presence of impulsive/aggressive traits.
METHOD: Study subjects were 347 patients with a psychiatric disorder (175 with depression, 127 with schizophrenia, and 45 with other disorders). Fifty-three percent of the subjects (N=184) had a lifetime history of suicide attempt, and 47% (N=163) had never attempted suicide. Smoking behavior, lifetime suicidal behavior, and psychopathology were assessed. Serotonin function was assessed in a subgroup of patients with depression (N=162) by using a fenfluramine challenge test and/or measurement of CSF levels of 5-hydroxyindoleacetic acid.
FINDINGS: Among all patients, smokers were more likely to have made a suicide attempt (adjusted odds ratio=2.60, 95% confidence interval=1.60-4.23) and had higher suicidal ideation and lifetime aggression scores, compared with nonsmokers. An inverse relationship was observed between amount of cigarette smoking and both indices of serotonin function.
DISCUSSION: The association between cigarette smoking and the presence and severity of suicidal behavior across major psychiatric disorders may be related to lower brain serotonin function in smokers with depression. Further investigation is required to replicate these findings, to measure serotonin function in patients with disorders other than depression, and to test potential therapeutic effects of serotonin-enhancing treatments on both smoking behavior and suicide risk.
Suicide risk in relation to socioeconomic, demographic, psychiatric, and familial factors: a national register-based study of all suicides in Denmark, 1981-1997.
- Qin P, Agerbo E, Mortensen PB. Am J Psychiatry 2003; 160(4): 765-772.
OBJECTIVE: Suicide risk was addressed in relation to the joint effect of factors regarding family structure, socioeconomics, demographics, mental illness, and family history of suicide and mental illness, as well as gender differences in risk factors.
METHOD: Data were drawn from four national Danish longitudinal registers. Subjects were all 21,169 persons who committed suicide in 1981-1997 and 423,128 live comparison subjects matched for age, gender, and calendar time of suicide by using a nested case-control design. The effect of risk factors was estimated through conditional logistic regression. The interaction of gender with the risk factors was examined by using the log likelihood ratio test. The population attributable risk was calculated.
FINDINGS: Of the risk factors examined in the study, a history of hospitalization for psychiatric disorder was associated with the highest odds ratio and the highest attributable risk for suicide. Cohabiting or single marital status, unemployment, low income, retirement, disability, sickness-related absence from work, and a family history of suicide and/or psychiatric disorders were also significant risk factors for suicide. Moreover, these factors had different effects in male and female subjects. A psychiatric disorder was more likely to increase suicide risk in female than in male subjects. Being single was associated with higher suicide risk in male subjects, and having a young child with lower suicide risk in female subjects. Unemployment and low income had stronger effects on suicide in male subjects. Living in an urban area was associated with higher suicide risk in female subjects and a lower risk in male subjects. A family history of suicide raised suicide risk slightly more in female than in male subjects.
DISCUSSION: Suicide risk is strongly associated with mental illness, unemployment, low income, marital status, and family history of suicide. The effect of most risk factors differs significantly by gender.
Receipt of psychological or emotional counseling by suicidal adolescents.
- Pirkis JE, Irwin CE Jr, Brindis CD, Sawyer MG, Friestad C, Biehl M, Patton GC. Pediatrics 2003; 111(4 Pt 1): e388-93.
Correspondence: Jane E. Pirkis, Division of Adolescent Medicine, University of California San Francisco, San Francisco, California, USA; (email: j.pirkis@unimelb.edu.au).
OBJECTIVE: This study examined utilization of psychological or emotional counseling by suicidal adolescents to answer questions about the extent to which health services can contribute to the prevention of adolescent suicide.
METHOD: The study used data from Wave 1 of the National Longitudinal Study of Adolescent Health, which involved a household-based interview with a nationally representative sample of 15 483 adolescents from grades 7 to 12. Of these, 2482 adolescents were classified as suicidal, as indicated by an affirmative response to the question "During the past 12 months, did you ever seriously think about committing suicide?" For this group, the study asked the following questions: 1) What proportion receives psychological or emotional counseling? 2) What are the sources of this counseling? 3) What factors are associated with receipt of such counseling?
FINDINGS: Less than one third (28%) of suicidal adolescents received psychological or emotional counseling. The most common sources of care were private doctors' offices (37%) and schools (34%). Factors associated with receipt of counseling in the past 12 months included age, race, degree of suicidality, depression status, and having had a physical examination during the same period.
DISCUSSION: Only one third of those who report suicidal ideation and behavior receive psychological or emotional counseling. Although not all of these young people may identify a need for counseling, this finding still suggests that many of those at risk of harming themselves do not receive professional help. However, on the positive side, those who do use counseling services tend to do so on the basis of their being in the greatest need, rather than their parents' capacity to pay for services. Counseling services have an important role to play in suicide prevention, and a variety of sources of care need to be available. Although counseling services are vital, a range of other strategies is necessary to reduce the youth suicide rate.
Correspondence: Linda Scheetz, Rutgers, The State University of New Jersey, College of Nursing, Newark, NJ, USA; (email:scheetz@nightingale.rutgers.edu).
INTRODUCTION: Undertriage of older trauma victims has been a persistent and serious problem. Because of physiologic changes and pre-existing disease, blunt trauma in older persons is often covert. Prehospital trauma triage guidelines developed for use with a general adult population may not be sensitive enough to detect covert injuries in elderly trauma patients. This study examined the sensitivity and specificity of one state's prehospital trauma triage guidelines for adults, with a particular focus on the triage of elderly persons.
METHODS: This retrospective study used patient discharge data to examine the sensitivity (a measure of undertriage) and specificity (a measure of overtriage) of the adult prehospital trauma triage guidelines in 3 counties with level I trauma centers. Sensitivity and specificity of young and middle-aged adults was compared with that of older adults.
FINDINGS: Undertriage was 8% for young and middle-aged men, 12% for young and middle-aged women, 18% for older men, and 15% for older women. Overtriage was present in all age groups, indicating that many motor vehicle crash victims who were admitted to trauma centers could have been admitted to nontrauma center hospitals.
DISCUSSION: Low sensitivity and specificity of trauma triage guidelines results in undertriage and overtriage. These guidelines should include age as a decision point to avoid placing older persons at risk for undertriage. Although some degree of overtriage is unavoidable without increasing undertriage, efforts should be made to minimize this costly occurrence.
BACKGROUND: The morbidity and mortality among motorcyclists involved in road traffic accidents (RTA) in Singapore is high. Due to their relatively small size, they represent a vulnerable group of road-users. Many reports from studies performed overseas have shown that both lower limb and head injuries appear to be common among motorcyclists.
OBJECTIVES: To study the characteristics of lower limb injuries among motorcyclists involved in RTA, who present to the Department of Emergency Medicine of an urban, tertiary, teaching hospital for treatment.
METHODS: The study was conducted prospectively from 1 July 2000 to 30 June 2001. Demographic data was collected together with details of the type of injuries, mechanism involved, management and disposition. SPSS (Chicago, Inc.) was utilized for data management and statistical analysis.
FINDINGS: Of the 1,809 motorcyclists studied, 1,056 (58.3%) sustained lower limb injuries, 328 (18.1%) had head injuries and 256 (14.2%), sustained facial injuries. The mean age was 26.4 +/- 7.2 years and males made up the majority of the patients (1,733, 95.8%). Helmet usage was 100%.The commonest type of lower limb injury was fractures (531, 50.3%).The most common type of fracture was that of the shaft of the tibia and fibula (231, 43.5%), followed by fractures around the ankle (186, 35.0%). For those with more than one body region injured, head injury was noted to be not commonly associated with lower limb injuries. The commonest mechanism of injury was collision with another vehicle, while approaching a turn (769, 42.5%).There were 96 motorcyclists (5.3%) who had clinical evidence of alcohol consumption on their breath at presentation. There were 533 (29.5%) patients who were admitted for in-patient management and the mean duration of stay was 4.8 +/- 4.5 days. Amongst those with lower limb injuries, the admission rate was 30.5% (322 of 1,056) and the mean duration of hospitalization was 5.3 +/- 3.9 days.
DISCUSSION: Lower limb injuries represent the commonest form of injury among motorcyclists involved in RTA. Improved training via motorcycle rider education, better design of future motorcycles and protective footwear may help to reduce this problem.
Too small for a seatbelt: predictors of booster seat use by child passengers.
Correspondence: Beth E. Ebel, Department of Pediatrics, Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington 98104, USA; (email: bebel@u.washington.edu).
OBJECTIVES: Motor vehicle injury is the leading cause of injury death for children 4 to 8 years of age. Although booster seat use in this age group substantially reduces the risk of injury, most children are currently restrained by seatbelts designed for adults. The objective of this study was to measure booster seat use directly, determine factors predictive of proper child restraint, and assess parental reasons for booster use and nonuse.
METHODS: We conducted a cross-sectional, observational study in Seattle, Washington, Spokane, Washington, and Portland, Oregon, from February to April 2000. Drivers were surveyed in their vehicles after picking up children from schools and child care centers. Trained observers recorded child age, weight, and height and directly observed restraint use. Observed restraint use was compared with the recommended restraint method based on the child's weight and age. Data were analyzed using multivariate logistic regression, adjusted for clustering by car and site.
FINDINGS: We observed 2880 children traveling in cars, 1539 of whom were eligible for booster seat use. Eighty-eight percent of drivers agreed to respond to our survey. Only 16.5% of children for whom a booster seat was recommended were properly restrained, compared with 80% of younger children for whom a child safety seat was recommended and 55% of children for whom an adult seatbelt was recommended. Relative to a 4-year-old booster-eligible child, a 6-year-old was only half as likely to use a booster seat (odds ratio [OR]: 0.47; 95% confidence interval [CI]: 0.31-0.71) and an 8-year-old almost never used a booster seat (OR: 0.04; 95% CI: 0.01-0.19). Booster use was more common when the driver wore a seatbelt (OR: 3.1; 95% CI: 1.8-5.4). Parents whose children were using booster seat cited "safety" (61%) and "child comfort and visibility" (12%) as their primary concerns. When a child was not using a booster seat, parents most often believed that their child was "too big for a car seat" (56%), reported that the seat was in another vehicle (9%), or stated that they "had not heard" of booster seats (8%).
DISCUSSION: Many parents still incorrectly believe that children are safe in a seatbelt and have outgrown the need for a car seat. These results demonstrate the need for public education campaigns to educate parents about booster seat use.
The developmental ecology of urban males' youth violence.
- Tolan PH, Gorman-Smith D, Henry DB. Dev Psychol 2003; 39(2): 274-291.
Correspondence: Patrick Tolan, Institute for Juvenile Research, Department of Psychiatry, University of Illinois at Chicago, 60612-7347, USA; (email: tolan@uic.edu).
Data from a longitudinal study of 294 African American and Latino adolescent boys and their caregivers living in poor urban communities were used to test a developmental-ecological model of violence. Six annual waves of data were applied to evaluate the relations between microsystem influences of parenting and peer deviance (peer violence and gang membership), macrosystem influences of community structural characteristics and neighborhood social organization, and individual involvement in violence (level and growth). Structural equation modeling analyses showed that community structural characteristics significantly predicted neighborhood social processes. Parenting practices partially mediated the relation between neighborhood social processes and gang membership. Parenting practices was fully mediated in its relation to peer violence by gang membership. Gang membership was partially mediated by peer violence level in its relation to individual violence level. Although the overall set of relations does not satisfy mediation requirements fully in all instances, the model was validated for the most part, supporting a focus on a multilevel ecological model of influences on risk development.
Developmental trajectories of childhood disruptive behaviors and adolescent delinquency: a six-site, cross-national study.
- Broidy LM, Nagin DS, Tremblay RE, Bates JE, Brame B, Dodge KA, Fergusson D, Horwood JL, Loeber R, Laird R, Lynam DR, Moffitt TE, Pettit GS, Vitaro F. Dev Psychol 2003; 39(2): 222-245.
Correspondence: Lisa Broidy, Department of Sociology, University of New Mexico, Albuquerque 87131, USA; (email: lbroidy@unm.edu).
This study used data from 6 sites and 3 countries to examine the developmental course of physical aggression in childhood and to analyze its linkage to violent and nonviolent offending outcomes in adolescence. The results indicate that among boys there is continuity in problem behavior from childhood to adolescence and that such continuity is especially acute when early problem behavior takes the form of physical aggression. Chronic physical aggression during the elementary school years specifically increases the risk for continued physical violence as well as other nonviolent forms of delinquency during adolescence. However, this conclusion is reserved primarily for boys, because the results indicate no clear linkage between childhood physical aggression and adolescent offending among female samples despite notable similarities across male and female samples in the developmental course of physical aggression in childhood.
Are "accidental" gun deaths as rare as they seem? A comparison of medical examiner manner of death coding with an intent-based classification approach.
- Schaechter J, Duran I, De Marchena J, Lemard G, Villar ME. Pediatrics 2003; 111(4 Pt 1): 741-744.
Correspondence: Judy Schaechter, Department of Pediatrics, University of Miami School of Medicine, Miami, Florida 33101, USA; (email: jschaech@med.miami.edu).
OBJECTIVES: Unintentional firearm death is often considered a nearly negligible proportion of overall gun death. These rates are based on medical examiner (ME) and coroner death classifications, which affect derived epidemiologic data and subsequent prevention measures. The aim of this study was to compare the proportion of pediatric unintentional gun deaths in Miami-Dade County based on manner of death coding by the ME with an intent-based classification of child gun deaths.
METHODS: ME and police records for all pediatric firearm fatalities in Miami-Dade County from 1994 to 1998 were reviewed. The ME's assignment of manner of death as homicide, suicide, or accident was compared with an intent-based classification of intentional homicide, intentional suicide, and unintentional firearm death based on expressed or implied evidence of intent to harm.
FINDINGS: There were 123 pediatric firearm deaths in Miami-Dade County from 1994 to 1998. A significant difference between ME coding and the intent-based classification was found for homicide (94 vs 78) but not for suicide. A significant difference was also found between the ME's coding for "accident" and the investigator's classification of "unintentional" firearm death (4 vs 26).
DISCUSSION: The incidence of unintentional pediatric firearm deaths is significantly under-reported by the Miami-Dade County ME when the classification of "accidental" firearm death is used. Reviewing the manner of death classification criteria or establishing an intent code on official death documentation is recommended. Furthermore, clinicians should be aware that the true incidence of unintentional gun death may be higher than that reported as accidental.
The influence of famous athletes on health beliefs and practices: Mark McGwire, child abuse prevention, and Androstenedione.
- Brown WJ, Basil MD, Bocarnea MC. J Health Commun 2003; 8(1): 41-57.
Correspondence: William J. Brown, College of Communication & The Arts, Regent University, Virginia Beach, VA 23464, USA; (email: willbro@regent.edu).
When Mark McGwire broke Roger Maris's home run record in September of 1998, he was instantly declared an American hero and held up as a positive role model for teenagers and young adults. The extensive media attention focused on McGwire made the general public aware of his use of a muscle-building dietary supplement, Androstenedione. It also increased the public's awareness of McGwire's public service to prevent child abuse. The present research assesses audience involvement with McGwire through parasocial interaction and identification, and the effects of that involvement on audience knowledge of and attitudes toward Androstenedione and child abuse prevention. Results indicate parasocial interaction with an athlete regarded as a public role model likely leads to audience identification with that person, which in turn promotes certain attitudes and beliefs. In this case, parasocial interaction and identification with Mark McGwire was strongly associated with knowledge of Androstenedione, intended use of the supplement, and concern for child abuse. Implications of this research for featuring celebrities in health communication campaigns are discussed.
