BACKGROUND: Injured patients presenting to the ED have been identified as an important group in which to target alcohol screening and intervention. The rate of at risk drinking in this group is unknown.
OBJECTIVE: To determine the rate of at risk drinking among injured older adults presenting to the ED.
METHODS: Cross-sectional survey of injured adults presenting to a university hospital ED 8/99-2/02. Injured patients were prospectively identified; consenting, cognitively intact patients completed survey via hand-held computer including questions regarding quantity/frequency of alcohol use. Major trauma patients were excluded. Demographic and injury information and patient medications were obtained from the medical record. Older adults were defined as those 60 years of age or older; patients who exceeded NIAAA quantity/frequency guidelines for adults 65 years of age or older were defined as at risk drinkers. Analysis utilized Student's t for continuous variables, and frequency (95% CI) and chi-square analysis for categorical variables.
FINDINGS: 4476 patients were enrolled, 284 [6%(6-7%)] were older adults. 275(97%) lived independently, 114(40%) were male. Fall (66%) was the most common injury mechanism, the most common injury types were fracture/dislocation (34%), laceration (23%), and contusion/abrasion (23%). 30(11%) patients were admitted. 31 older adults [11%(8-15%)] were at risk drinkers. Injury mechanisms and mean ages of at risk drinkers (67 years) and non at risk drinkers (70 years) were not significantly different. At risk drinkers were more likely to be male (71% vs. 36%, p </=.001). Among at risk drinkers, 10 [30%(17-51%)] were taking one or more medications which may cause a moderate or severe drug interaction with alcohol.
DISCUSSION: Approximately 1 in 10 injured older adults presenting to our ED are at risk drinkers, a significant minority of such patients are taking medications which may result in a moderate or severe adverse drug reaction with alcohol.
OBJECTIVES: Motor vehicle collisions involving alcohol are a leading cause of mortality for children over age one in the United States. This study examines characteristics of child passenger fatalities involving drinking drivers to identify trends and opportunities for injury prevention.
METHODS: Design/Setting/Participants. Epidemiological analysis of 1991-2000 Fatal Analysis Reporting System (FARS) data of crashes involving child passenger deaths. This is a retrospective cohort study. Interventions/Observations. Study authors employed SAS, version 8.2, for statistical analysis using multiple imputed blood alcohol concentration (BAC) values provided by the National Highway Traffic Safety Administration (NHTSA). Main outcome measures are driver, passenger and crash characteristics (e.g. age, use of restraints, driver BAC, single versus multiple vehicle collisions). Comparison is made to previously reported FARS data (1985 to 1996) using revised multiple imputed BAC values.
FINDINGS: In 1991-2000, there were 17,381 child passenger deaths, with 4,519 (26%) involving a drinking driver (95% confidence interval 24-28%). Among these drinking driver-related child passenger deaths, 62% were unrestrained and 38% were killed in single-vehicle collisions. In 66% of these fatalities, the child was riding with the drinking driver. The proportion of child passenger deaths involving drinking drivers declined over the past sixteen years, from 32% (95% confidence interval 29-35%) in 1985, to 23% (95% confidence interval 20-26%) in 2000. The proportion of child passenger fatalities involving a child transported by a drinking driver also declined over this period.
DISCUSSION: Revised NHTSA data show that drinking drivers contribute to one in four child passenger deaths in the United States. Most of these fatalities involve a child being transported, unrestrained, by a drinking driver. Aggressive public health interventions are needed.
Brouzas D, Charakidas A, Papagiannakopoulos D, Koukoulomatis, P. Injury 2003; 34(5): 323-326.
Correspondence: A. Charakidas, Department of Ophthalmology, "Hippocration" General Hospital of Athens, 114 Vas. Sofias Av., Athens, GREECE; (email:acharakidas@yahoo.com).
OBJECTIVE: To evaluate the incidence and severity of ocular injuries caused by elastic cords.
METHODS: A retrospective review of patients' records from the Emergency Department was conducted to identify cases of elastic cord-induced ocular injuries. Over a 67-month period starting in October 1996, 28 patients (24 males and 4 females, mean age 38.6 years) with elastic cord-associated ocular trauma were identified. Patient demographics, mechanism of injury, presenting and final visual acuity,ocular injuries, medical and surgical intervention and length of follow-up were noted.
FINDINGS: The most common anterior and posterior segment injuries were hyphaema/microhyphaema (71.4%) and commotio retinae (60.7%), respectively. The most severe injuries sustained were corneal or scleral lacerations (7.1%), formation of retinal tears (10.7%) or retinal detachment (3.6%), lens subluxation (7.1%) and traumatic cataract (7.1%). Eight patients (28.6%) were admitted for surgical or medical treatment. Mean visual acuity was 20/40 on presentation and 20/25 at the end of the follow-up period.
DISCUSSION: Elastic cords may cause a wide range of ocular traumas of varying severity. Appropriate design modifications that would prevent the spontaneous release of their hooks are likely to make their use significantly safer.
Medical emergencies at sea and injuries among Scottish fishermen.
- Lawrie T, Matheson C, Murphy E, Ritchie L, Bond C. Occup Med (Lond) 2003; 53(3): 159-164.
Correspondence: Thane Lawrie, Department of General Practice and Primary Care, Foresterhill Health Centre, Westburn Road, Aberdeen AB25 2AY, UK; (email:t.lawrie@abdn.ac.uk).
BACKGROUND: It has long been known that fishing is one of the most dangerous occupations. In 2001, 33 boats were lost and 10 fishermen killed in UK waters. Despite the dangerous nature of the occupation, very little research has been conducted on fishermen's health and safety. Aims To address this gap in current knowledge, research was conducted to gain an understanding of health and lifestyle issues affecting Scottish fishermen. It was hoped that the study would identify aspects of fishermen's health that could be improved. This paper considers medical emergencies at sea and injuries among fishermen.
METHODS: Data were collected using a postal questionnaire sent to the Scottish fishermen population and health diaries in a small sub-sample.
FINDINGS: In total, 1157 usable responses were received, giving a response rate of 57%. One-fifth of respondents had been involved in a medical emergency at sea that required them to be evacuated to shore for immediate treatment. The incidence of injuries was high, and one-third of the injuries experienced were to the back. The likelihood of evacuation for a medical emergency or experiencing an injury was increased both for certain occupations and with increasing number of boats worked on during the fisherman's career.
DISCUSSION: Groups identified as being at a high risk of experiencing medical emergencies or injuries should be targeted in training initiatives or accident awareness and prevention initiatives.
Prevention and treatment of common eye injuries in sports.
- Rodriguez JO, Lavina AM, Agarwal A. Am Fam Physician 2003; 67(7): 1481-1488.
Correspondence: Jorge O. Rodriguez, Department of Family Medicine, East Carolina University/Brody School of Medicine, Greenville, North Carolina, 27858-5434, USA; (email: harleysden@direcway.com).
Sports have become increasingly popular and account for numerous eye injuries each year. The sports that most commonly cause eye injuries, in order of decreasing frequency, are basketball, water sports, baseball, and racquet sports. Sports are classified as low risk, high risk, and very high risk. Sports-related eye injuries are blunt, penetrating, and radiation injuries. The use of eye protection has helped to reduce the number and severity of eye injuries. The American Society for Testing and Materials has established performance standards for selected eyewear. Consultation with an eye care professional is recommended for fitting protective eyewear. The functionally one-eyed, or monocular, athlete should take extra precautions. A preparticipation eye examination is helpful in identifying persons who may be at increased risk for eye injury. Sports-related eye injuries should be evaluated on site with an adequate examination of the eye and adnexa. Minor eye injuries may be treated on site. The team physician must know which injuries require immediate referral to an ophthalmologist and the guidelines for returning an athlete to competition.
Factors associated with triathlon-related overuse injuries.
STUDY DESIGN: Descriptive correlational investigation.
OBJECTIVES: To assess the incidence of, and potential risk factors associated with, overuse injury in triathlon.
BACKGROUND: The sport of triathlon is rapidly increasing in popularity with a concomitant rise in the prevalence of injuries sustained by triathletes.
METHODS: The training and injury patterns of 131 triathletes were surveyed over a 10-week prospective period during the triathlon competition season. A complementary retrospective 6-month analysis of training history and prior overuse injuries was conducted.
FINDINGS: Fifty percent of triathletes sustained an injury in the 6-month preseason at an injury exposure rate of 2.5 per 1000 training hours. Thirty-seven percent were injured during the 10-week competition season at an injury exposure rate of 4.6 per 1000 training hours. Overuse accounted for 68% of preseason and 78% of competition season injuries reported. Increased years of triathlon experience, high running mileage, history of previous injury, and inadequate warming-up and cooling-down regimes appeared to have individual associations with injury incidence. When interactions were included in a multiple logistic regression model, increasing years of triathlon experience was the most significant predictor of preseason injury risk and a previous history of injury and high preseason running mileage increased the risk of injury during the competition season.
DISCUSSION: The results indicate that in assessing triathletes, a full training and competition history is required by the sports clinician for a comprehensive assessment of the factors that may contribute to overuse injury.
BACKGROUND: Snowmobiling is a popular form of wintertime recreation but can be associated with significant morbidity and mortality. To better understand snowmobile trauma in children, medical records were reviewed, evaluating the relationships between demographic data, mechanisms, and resultant injuries. In addition, because prior studies of childhood snowmobile fatalities have reviewed only national databases, state and national data were combined to evaluate possible underreporting.
METHODS: Medical records were reviewed of children </=17 years old admitted to one trauma center between 1991 and 2000 with snowmobile-related injuries. Demographics, helmet usage, driver versus passenger, mechanism, injuries, injury severity score (ISS), and outcome data were recorded. Statistical analyses were performed to identify relationships between potential causative factors and ISS. State mortality data were acquired from state agencies and 2 databases of the U.S. Consumer Product Safety Commission (CPSC). Data from the 3 sources were compared, and a single list of fatalities was compiled and evaluated.
FINDINGS: Thirty-one children (65% boys; mean age, 12 years) were admitted with snowmobile-related injuries. Fifty-two percent were driving the snowmobile. Helmet usage was 68%. The most common mechanisms were collisions with a fixed object (42%) and with a motor vehicle (35%). The head was the most commonly injured site (71%) followed by the extremities (58%). ISS ranged from 1 to 38 (median, 10). Increased age and the child driving were the only factors associated with increased ISS (P <.05). One child died of a massive head injury. Twenty-two fatalities (70% boys; mean age, 14 years) statewide were identified from state and national databases, only 12 of which were identified by the CPSC Death Certificate file. Head injury was the most common cause of death.
DISCUSSION: Reckless snowmobiling leads to significant morbidity and mortality among children. Prior reports based on CPSC data likely underestimated the number of snowmobile-related fatalities. Our findings support previous American Academy of Pediatrics recommendations, including the restriction of snowmobile driving by children under 16, graduated licensing for older children, and universal helmet usage.
Identification of injury clusters using emergency medical services dispatch data and a geographic information system.
- Lerner EB, D'Agostino J, Shah MN. Acad Emerg Med 2003; 10(5): 506.
Correspondence: E Brooke Lerner, University of Rochester: Rochester, NY, Rural/Metro Medical Services: Rochester, NY, USA; (email:brooke_lerner@urmc.rochester.edu).
BACKGROUND: Use of emergency medical services data with a Geographic Information System (GIS) for public health has become more common, especially in monitoring for bioterrorism. These data and methodology could also be helpful for disease or injury cluster identification and prevention.
OBJECTIVE: To locate all 9-1-1 requests for aid due to injury in a Northeastern City and to identify clusters of specific injury mechanisms that could be investigated by an injury coalition and form the basis for evidence-based prevention efforts.
METHODS: The locations of all 9-1-1 requests for aid due to injury, based on emergency medical dispatch codes, occurring in the study City over a 3.5 year period were plotted on a map using ArcGIS. Location information and dispatch code were obtained from the dispatch database. Kernel analysis was used to identify areas with the highest density of injury requests. Injury dispatch codes were then stratified by type and Kernel analysis was repeated to identify areas with a high density of specific codes (i.e, violence, motor vehicle crash, or bicycle-related).
FINDINGS: 49,724 requests for aid due to injury occurred during the study period (1999-2002). 84% (41,960) of the requests had sufficient location information to be plotted. Overall, there were 3 injury code clusters identified within the City. 5,458 requests for aid that were related to violence were received and 3 areas with a high density were identified. 4,674 requests for aid that were related to motor vehicle crashes were received and 2 areas with a high density of motor vehicle crashes were identified. 124 bicycle-related requests for aid were received and 3 areas of high density were identified.
DISCUSSION: 9-1-1 requests for aid due to injury can be plotted by geographic location. Clusters of specific injury mechanisms can be identified. These clusters can then be referred to a community coalition for evaluation and the establishment of evidence-based prevention efforts.
Correspondence: Everett R. Rhoades, Native American Prevention Research Center, University of Oklahoma College of Public Health, Oklahoma City, USA; (email:everett-rhoades@ouhsc.edu).
OBJECTIVES: This study summarizes current health status information relating to American Indian and Alaska Native (AI/AN) males compared with that of AI/ANfemales.
METHODS: I analyzed published data from the Indian Health Service for 1994 through 1996 to determine sex differences in morbidity and mortality rates and use of health care facilities.
FINDINGS: AI/AN males' death rates exceed those of AI/AN females for every age up to 75 years and for 6 of the 8 leading causes of death. Accidents, suicide, and homicide are epidemic among AI/AN males. Paradoxically, AI/AN males contribute only 37.9% of outpatient visits, versus 62.1% for females, and only 47% of hospitalizations excluding childbirth.
DISCUSSION: AI/AN males suffer inordinately from a combination of increased burden of illness and lack of utilization of health care services. Programs targeted to anomie, loss of traditional male roles, and violence and alcoholism are among the most urgently needed.
Age-related outcomes in persons with spinal cord injury: A summary paper.
- McKinley W, Cifu D, Seel R, Huang M, Kreutzer J, Drake D, Meade M. NeuroRehabilitation 2003; 18(1): 83-90.
Correspondence: William McKinley, Virginia Commonwealth University, Department of Physical Medicine and Rehabilitation, Richmond, VA, USA; (email:wmckinle@hsc.vcu.edu).
Etiology and level of injury often discriminate between age groups for persons with spinal cord injury, complicating the understanding of what role age actually has on outcomes. The age of the patient is sometimes used as a factor in determining the appropriateness of a referral to inpatient rehabilitation. When role of age is unclear or misunderstood, though, the referral and admission decision is subject to discrimination and ageism. This paper presents information that may assist in making more appropriate decisions. By reviewing the results of four studies examining the role of age-at-injury on the outcomes of persons with spinal cord injury, including such factors of functional improvement and discharge disposition, the overall effects of age can better be understood and more appropriate conclusions drawn.
Deaths of Texas adolescents from injury, 1996 through 1998.
From studying the deaths of Texas adolescents from injury during 1996 through 1998, we compiled data showing major causes. Injuries accounted for 3760 deaths and 75% of all adolescent deaths. Unintentional injuries (accidents) accounted for 65% of injury deaths and 49% of all deaths. Motor vehicle traffic accidents accounted for 74% of deaths from unintentional injuries and 36% of all deaths. Homicide accounted for 18% of deaths from injury and 14% of all deaths. Suicide accounted for 15% of deaths from injury and 11% of all deaths. The major single cause of adolescent death, assault with unspecified firearm, accounted for 483 deaths, 13% of injury deaths, and 10% of all deaths. Several age, gender, and ethnic differences were identified in risk of death from the various causes of injury, and these analyses may help target specific populations of Texas adolescents for strategies to prevent injuries.
- Little DC, Vermillion JM, Dikis EJ, Little RJ, Custer MD, Cooney DR. J Pediatr Surg 2003; 38(5): 804-807.
Correspondence: Danny C. Little, Texas A&M University System Health Science Center, Scott and White Memorial Hospital, and Scott, Sherwood and Brindley Foundation, Temple, TX, USA; (email: unavailable).
(Copyright 2003 Elsevier Inc. All rights reserved.)
BACKGROUND: More than 1 million children live, play, and work on farms, surrounded by animals and machinery. This symbiotic relationship between work and home exposes children to unique risks.
METHODS: Children presenting with a farm-related injury (November 1994 to August 2001, 82 months) were included. Trauma registry parameters included injury severity score (ISS); Glascow Coma Scale (GCS); time to presentation; season and day of injury; emergency room, intensive care unit, and total length of stay type; and mechanism of injury; and operations.
FINDINGS: A total of 1,832 pediatric trauma patients were evaluated. Ninety-four children were identified with farm-related injuries. Mean age was 10.75 years. Mean ISS was 7.38. Three children died. Four children wore protective equipment. Forty-four percent of injuries occurred during summer, 31% during spring, and 55% on weekends. Average time to initial presentation was 39 minutes. A total of 177 minutes elapsed before transfer to regional trauma center. Seventy-two children required admission. LOS was 0 to 28 days, mean, 2.76 days. Twenty-six children (28%) required operations. Injuries included dislocations/fractures (52%), lacerations/avulsions (38%), concussions (31%), contusions (30%), and burns (14%). Mechanism included animals (41%), falls (34%), motor vehicles (28%), all-terrain vehicles (20%), and firearms (4%).
DISCUSSION: Farm injuries occur most commonly during weekends, summer, and spring months, resulting in significant morbidity. Most injuries required hospitalization. Unless unstable, initial transfer to a regional pediatric trauma center should result in the most cost-effective, prompt, and highest quality of care.
Correspondence: H. Koivumaa-Honkanen, Department of Psychiatry, 4977, Kuopio University Hospital, P. O. Box 1777, 70211 Kuopio, FINLAND; (email: heli.koivumaa@kuh.fi).
OBJECTIVE: The aim of this study was to investigate the relationship between self-reported unhappiness and suicide.
METHODS: A sample of adult Finns unselected for health status (N = 29,067) responded to a question on happiness in life with five alternatives: very happy (15.9 %), fairly happy (63.4 %), cannot say (12.9 %), fairly unhappy (6.9 %), very unhappy (1 %). Cox regression was used to study the suicide risk.
FINDINGS: From 1976 to 1995, 182 suicides occurred. At baseline, unhappiness was associated with older age, male gender, sickness, living alone, smoking, heavy alcohol consumption, physical inactivity and belonging to intermediate social class. The risk of suicide increased with decreasing happiness. The very unhappy compared with the very happy had an age-adjusted hazard ratio (HR) of 10.84 (95 % CI 3.93-29.94) for suicide. After adjusting for the above-mentioned factors this HR was 7.01 (95% CI 2.44-20.08).
DISCUSSION: Self-reported unhappiness is strongly associated with subsequent suicide in a long follow-up. Moreover, it seems to indicate also cumulative health hazards.
OBJECTIVE: To investigate the possible associations between smoking and nonfatal traffic accidents,and to evaluate the possible influence of other factors on traffic accidents.
METHODS: Cross-sectional study of associations.Setting. Eight health centers in the city of Zaragoza.
PARTICIPANTS: 1,214 drivers between 25 and 65 years of age, who visited the health center during the months of July to September 2001, and who drove on at least 2 days of the week.
MAIN MEASURES: We recorded data on sex, age, marital status, level of education, profession, diseases, use of prescription and nonprescription drugs, drinking, smoking, illegal drug use, accidents and traffic infractions.
FINDINGS: We found accidents to be most common among unmarried men between 25 and 29 years of age. There were no significant differences in accident rates between drinkers and nondrinkers. The accident rate was 50% higher in smokers than in nonsmokers (OR, 2.22; 95% CI, 1.49%-3.09%), and there were no significant differences between smokers who smoked while driving and those who refrained from smoking while driving.
DISCUSSION: The prevalence of accidents is highest in unmarried men younger than 45 years of age. In statistical terms, smokers have twice as many accidents as nonsmokers. The absence of significant differences between smokers who do and do not smoke while driving suggests that smoking increases the risk of being involved in traffic accidents regardless of whether drivers refrain from smoking at the wheel.
Sleepy drivers have a high frequency of traffic accidents related to respiratory effort-related arousals
- Masa Jimenez JF, Rubio Gonzalez M, Findley LJ, Riesco Miranda JA, Sojo Gonzalez A, Disdier Vicente C. Arch Bronconeumol 2003; 39(4): 153-158.
Correspondence: J.F. Masa Jimenez, Seccion de Neumologia, Hospital San Pedro de Alcantara, Caceres, SPAIN; (email: unavailable).
BACKGROUND: Respiratory effort-related arousals (RERA) are secondary to subtle obstructions of the upper airway during sleep and can appear in the absence of a predominance of apneas and hypopneas,causing excessive daytime sleepiness. Analyzing the possible consequences of these new respiratory events is of increasing interest. Habitually sleepy drivers are at high risk of having traffic accidents related to sleep disorders (apneas, hypopneas and RERA).
OBJECTIVE: The aim of this study was to determine whether excess RERA alone is an independent risk factor among sleepy drivers.
METHODS: We studied 40 habitually sleepy drivers and 23 age- and sex-matched controls selected from a sample of 4,002 automobile drivers. We surveyed sleep habits, daytime sleepiness and traffic accidents. Sleep studies of esophageal pressure were performed.
FINDINGS: The sleepy drivers with apneas (apnea/hypopnea index > 10) had a higher 5-year accident rate (0.33 0.50) than did control drivers (0.004 0.21; p < 0.05). However, a high RERA index, but not sleep apnea, was an independent risk factor among the habitually sleepy drivers. The adjusted odds ratio (OR) for a RERA index = 10 was 7.6 (confidence interval [CI], 1.2 to 48); for a RERA index = 15, the OR was 17 (CI 1.5 to 91).
DISCUSSION: The high risk of traffic accidents among sleepy drivers is mainly determined by the presence of RERA rather than the presence of apneas and hypopneas. These findings verify the importance of identifying RERA in routine sleep laboratory studies.
OBJECTIVE: To investigate the lived experience of violence of nurses in one A&E department. Following an extensive literature review, it was elicited that there was very little evidence of the psychological impact of violence in A&E.
BACKGROUND: Violence in the health service has increased over the last decade associated with a corresponding increase in the published literature on this topic. While violence in A&E departments would appear common, little evidence exists on the psychosocial impact of these incidents on A&E nurses.
METHODS: A qualitative domain using a phenomenological philosophy was utilised. Sampling was of a volunteer nature and data were collected using interview. Nurses were sampled from one major acute hospital in Northern Ireland.
FINDINGS: Participants expressed feelings of frustration, anger, and fear. Support from colleagues was greatly valued and lack of feedback from management was cited as being common.
DISCUSSION: Frustration and anger were synthesised into the "why me" principle with nurses not knowing why they were the focus for attack. Violent incidents were associated with a sense of isolation but colleague support developed a sense of belonging. Whilst a useful insight was provided, more research is essential into this emotive topic.
OBJECTIVE: The aim of the study was to know the extent of violent deaths among females in Peshawar, the most vulnerable age group, weapons of infliction and the mode of death.
DESIGN: Non interventional (descriptive) type study.
PLACE AND DURATION OF STUDY: This study was conducted from 1st January, 2001 to 31st December, 2001 in the Department of Forensic Medicine and Toxicology, Khyber Medical College, Peshawar.
SUBJECTS AND METHODS: Out of 679 deaths, presented for autopsy at the Department of Forensic Medicine and Toxicology, Khyber Medical College, Peshawar 89 were females. These were grouped according to age, mode of death and weapons of infliction.
FINDINGS: Females formed 13% of all the autopsies done in Peshawar. The age group most commonly involved was 21-40 years (50.56%). Firearms were the predominant weapons of infliction (70.78%) and the intent was mostly homicidal (77.52%).
DISCUSSION: Fatal violence against women is uncommon in Peshawar. Suicide is rare. Young women are mostly killed by firearms.
A review of 101 homicide cases in jos, Nigeria.
- Mohammed AZ, Mandong BM, Manasseh AN. Niger Postgrad Med J. 2003; 10(1): 13-15.
Correspondence: A.Z. Mohammed, Departments of Pathology, Jos University Teaching Hospital, Jos, NIGERIA; (email: unavailable).
A five-year retrospective analysis of 101 homicide cases in Jos, Nigeria was carried out between 1995 and 1999. Of the total number, 47 were killed with sharp cutting or piercing instruments, 28 with firearms and 21 died from physical assaults. Five of the victims sustained fatal burn injuries. Majority of the cases (62.4%) were aged between 21 and 40 years and males outnumbered females by a ratio of 7.4:1. It is concluded that although a significant proportion of homicides are not premeditated, communal violence and robbery attacks remain the most frequent precipitating events that result in homicide in this environment.
Men who kill their own children: paternal filicide incidents in contemporary Fiji.
Correspondence: Mensah Adinkrah, Department of Sociology, Anthropology and Social Work, Central Michigan University, 138 Anspach Hall, 48859, Mount Pleasant, MI, USA; (email: unavailable).
OBJECTIVE: Filicide, or parental murder of offspring, constitutes a major portion of lethal violence perpetrated against children worldwide. Despite the global nature of the phenomenon, researchers have focused their studies on the developed industrialized societies with the consequent neglect of small, developing societies. Second, there is a paucity of empirical data on child homicide committed by fathers. This study therefore explores the nature and extent of paternal filicides in Fiji, a non-Western society, and the social and cultural forces underlying them in order to enhance our knowledge of the phenomenon.
METHOD: Information was obtained from a number of sources, including (a) a police homicide logbook, (b) newspaper reports of homicide, and (c) detailed interviews conducted with criminal justice and medical personnel. Information from these data sources were consolidated to construct case histories of paternal filicides. These cases were then analyzed for dominant themes. Case illustrations are presented in the text.
FINDINGS: Several of the study's findings are congruent with other studies of paternal filicides: poor, working class fathers were the offenders in all cases. As a corollary, their victims were from low socioeconomic backgrounds. Regarding location, paternal filicides occurred in the home of the offender and victim. The filicides were the culmination of stresses and strains associated with marital disharmony and excessive corporal child-control strategies.
DISCUSSION: The general conclusion of this study is that further research in non-Western societies has the potential to increase our understanding of the social factors and processes involved in paternal child murders. We will then be better positioned to craft effective intervention strategies.
OBJECTIVE: To describe the clinical, social and demographic features of mentally ill patients charged with homicide. DESIGN: Retrospective study.
PLACE AND DURATION OF STUDY: The study was based on the review of case notes of the patients who were charged with homicide and referred to the mental hospital, Peshawar, between 1988 and 1998 for psychiatric evaluation.
PATIENTS AND METHODS: The case notes of all the patients referred for psychiatric assessment between 1988 and 1998 were retrieved. Fifty cases with complete essential information were selected for the study. The details of patients, demographic, clinical characteristics, diagnosis, events leading to the homicide, opinion of the medical board, details of the victim and possible provoking factors were recorded on a performa designed for this purpose.
FINDINGS: Out of 50 patients referred for psychiatric assessment with homicide, majority (49) were males, while only one was female. The mean age of the sample was 32.4 years and 30 patients (60%) were educated. Schizophrenia was the most frequent diagnosis (72%). Duration of illness in 96% of the patients was more than one year. Only 12 patients had received some form of treatment before the index crime. Thirty-eight (76%) patients were involved in single murder, while 12 patients were involved in multiple homicides. Majority of the victims (39 out of 64) were close relatives of the patients.
DISCUSSION: Young male patients are mostly referred for psychiatric assessment after homicide. Close relatives are major victims. Lack of adequate psychiatric treatment is one of the contributing factors. Lack of adequate forensic psychiatric services are also highlighted by this study.
The criminalization of domestic violence: what social workers need to know.
Domestic violence is a crosscutting issue that affects clients seeking social work services. The criminalization of domestic violence refers to efforts to address domestic violence through the passage and enforcement of criminal and civil laws. This article reviews the social science, legal, and criminal justice literature regarding interventions used to stop domestic violence. The theoretical foundations and effectiveness of police interventions, the use of protective orders, prosecution and victim advocacy, court responses, batterers' intervention as a condition of probation, and coordinated community responses to domestic violence are examined. Implications for social work practice are given, along with basic information for assisting clients who are victims of violence in their own homes.
The hidden health menace of elder abuse. Physicians can help patients surmount initimate partner violence.
As many as 2 million elderly persons in the United States experience physical, psychologic, or sexual abuse each year. Nationally spouses or intimate partners commit between 13% and 50% of elder abuse. Physicians can be instrumental in preventing and intervening in intimate partner violence in their elderly patients.
Child head injuries: review of pattern from abusive and unintentional causes resulting in hospitalization.
- Brown GW, Malone P. Alaska Med 2003; 45(1): 9-13.
Correspondence: Dept. of Pediatrics, University of Vermont College of Medicine, USA; (email: bro1406@acsalaska.net).
OBJECTIVE: Comparison of patterns of hospitalized child head injuries among unintentionally injured with intentional Shaken Baby Syndrome and Abused victims.
METHODS: Medical records of children birth to 4 years of age admitted to the Fletcher Allen Health Care Hospital in the years 1993 to 1999 for head injury due to any cause were reviewed. Reviews which included age, gender, site of injury, caretaker of child, mechanism of injury, time of injury, severity of injury, CNS sequelae, and quality of investigation were completed for each child.
FINDINGS: Of the total of 85 records reviewed, 49 were male and 36 female with a mean age of 18.9 months. Seventy-three children were injured unintentionally. Twelve were victims of intentional actions. Fifty-three percent of the unintentionally injured were male and 83% of the abused were male. Falls caused 53%, motor vehicles 17%, abuse 14%, of all the 85 hospitalized children. Only three deaths occurred among the 85 children, all from motor vehicle crashes. Forty-two percent of the 12 abused victims suffered serious CNS injury compared to only 10% among the unintentionally injured. Earlier symptoms and signs of abuse were missed in four of the 12 abused children.
DISCUSSION: Demographic patterns of children hospitalized in Vermont for head injuries are similar to other state and national studies. Severity of injury is significantly higher for abused children. Primary health care providers should receive training emphasizing higher diagnostic index of suspicion for abusive head injuries.
Underdiagnosis of child abuse in emergency departments.
- Kunen S, Hume P, Perret JN, Mandry CV, Patterson TR. Acad Emerg Med 2003; 10(5): 546.
Correspondence: Seth Kunen, Earl K. Long Medical Center: Baton Rouge, LA, USA; (email: skunen@lsuhsc.edu).
OBJECTIVES: To determine: 1) the incidence and types of child abuse in four ED's; 2) the extent of child abuse coding errors; 3) the number of suspicious but non-diagnosed cases of fractures and dislocations in children two and under.
METHODS: We surveyed ICD-9 child abuse diagnoses (995 codes) and E-codes of 21,203 patients 18 and under attending four ED's over a six-month period. In a subset of 7,827 infants two and under, 127 had fractures and dislocations that were not diagnosed as abuse. Of these 127 infants, we randomly selected 50 and had physicians rate the injuries as not suspicious, moderately suspicious, or highly suspicious of child abuse.
FINDINGS: Among ED patients age 18 and under, 57 or.27% were diagnosed with child abuse (well below the national rate of about 1.12%). Of these 57 cases, 55% were diagnosed with physical abuse; 28% with sexual abuse; 7% with neglect; and 10% with unspecified abuse. More than 25% of the child abuse cases were improperly coded (e.g., only E-codes were given and no 995 codes). Approximately 30% of the infant cases with fractures and dislocations were rated as highly suspicious of abuse.
DISCUSSION: It is likely that more than 75% of all child abuse cases presenting to ED's are being missed, and many of these missed cases involve fractures and dislocations in infants. These results indicate that residency programs need to better train residents how to recognize symptoms of child abuse and how to question parents who give implausible explanations of their children's injuries. The high coding error rate could lead to significant underestimates of child abuse rates in ED's, since abuse cases documented only by E-codes would be missed in epidemiological studies that select cases using only ICD 995 abuse codes. The failure to diagnose child abuse in the present is also a failure to protect the child in future, since a substantial percentage of undiagnosed abused children will be reabused in the future.
Emergency medical services responses to shootings and stabbings as predictors of homicide.
OBJECTIVES: To determine if localized escalating violence as measured by Emergency Medical Services (EMS) responses to shootings and stabbings can be used as a predictor of homicide events.
METHODS: Design: A retrospective population-based case-control study. Setting: urban. Subjects: Records of EMS responses to shootings or stabbings between 12/1/98 and 12/31/00 (n = 2,244) were obtained from the Fire Department Computer Aided Dispatch Incident Response Master File. Homicide data from 1/1/99 through 12/31/00 were obtained from the Medical Examiner's Office, (n = 250). Groups of 50 controls per homicide event (n = 12,500) were randomly sampled from the 2000 Census for the city and assigned an index date corresponding to the date of the event. Observations: Homicides, controls and EMS responses were assigned latitude and longitude coordinates using ArcView GIS 3.2a. The distances between each homicide and each EMS response and between each control and each EMS response were calculated. Time and distance were used to examine the predictive utility of different temporal and spatial measures. Analyses were performed using a logistic regression model while controlling for demographic factors.
FINDINGS: A homicide event was more likely than controls to have EMS activity on the same day within one mile of the homicide victim's injury address (OR = 1.9; 95%CI: 1.7-2.2). An increase in EMS activity in the days leading up to a homicide event was observed at 15-30 (OR = 1.1; 95%CI: 1.06-1.13), 8-14 (OR = 1.1; 95%CI: 1.1-1.2), 3-7 (OR = 1.2; 95%CI: 1.1-1.3) and 1-2 days (OR = 1.3; 95%CI: 1.1-1.4).
DISCUSSION: A relationship between EMS responses to shootings and stabbings and homicide events is suggested. Additional examination of EMS responses 6 to 24 hours prior to homicide events is needed to further define this and may suggest that space-time clustering of EMS responses should trigger a broader community and law enforcement response to potentially preempt homicide events.
Wrestling with reality: are pediatric injuries related to media violence?
OBJECTIVE: To describe the scope and significance of pediatric injuries secondary to imitating behavior seen in the media, particularly TV, video games, and movies.
METHODS: A convenience sample of patients and their caregivers presenting to the emergency rooms at 2 urban pediatric hospitals were interviewed between 3/02-11/02. The investigator-conducted interview consisted of a detailed survey regarding the child's media habits/exposures and history of injury, mainly any sustained while copying behavior seen in the media. Families were also asked about any contacts having sustained media-related injuries. Data is reported using descriptive statistics.
FINDINGS: 44 of 100 children participating reported having known >/=1 incident in which a child had hurt himself copying a media behavior. Of these 44, 25(57%) reported 1 incident, 13(30%) reported 2 incidents, 6(14%) reported >/=3 incidents. 11(25%) of the 44 reporting injuries were either the victim or perpetrator. Overall, 64 separate injuries were described. 47(73%) needed medical care outside of the home. Mean age of the injured was 10yrs (range 2-17yrs), 69% male. Types of media copied included 56(88%) TV, 5(8%) movies, 1(2%) video games, and 2(3%) other. Of the 56 copying TV, 34(61%) copied professional wrestling (stunner, rockbottom), 9(16%) copied cartoons (Spiderman, Power Rangers), 9(16%) copied sports, and 4(7%) copied other shows (Jackass). The 64 reported injuries included 21(33%) extremity fracture/dislocations, 18(28%) head injuries, 11(17%) joint sprains, 5(8%) repaired lacerations, 5(8%) neck injuries (1 being a "broken neck" needing a brace/collar). Other injuries included a MVC vs. pedestrian, a third-degree facial burn with disfiguration, and a testicular injury.
DISCUSSION: The degree and acuity of injuries secondary to children imitating behavior seen in the media appear more dramatic than once thought. Therefore, families with children should be advised of the potential relationship between childhood injuries and media exposure.
Health hazards and risks for abuse among child labor in Jordan.
- Gharaibeh M, Hoeman S. J Pediatr Nurs 2003; 18(2): 140-147.
Correspondence: M. Gharaibeh, Al al-Bayt University, Mafraq, Jordan; and Health System Consultations, International,Naples, Massachusetts, USA; (email: unavailable).
The phenomenon of child labor has become the main concern of developing countries. The literature related to child labor discusses the causes and socioeconomic factors contributing to child labor but few studies examined risks for physical, emotional, and sexual abuse among child labor. Therefore, the purpose of this qualitative study was to identify the characteristics of working children as well as identify health risks and risks for abuse associated with child labor. A convenience sample of 41 children working in the industrial city of Irbid were interviewed by using a semistructured interview guide. Findings revealed that children who were engaged in child labor were poor and dropped out of school to assist their families financially. The findings also showed that children were exposed to health hazards such as inhaling chemicals and physical injuries. Physical, verbal, and sexual abuse also were present among these children. The findings from this study concluded that child labor creates an unhealthy environment for socially disadvantaged children. Health professionals, including pediatric and community health care providers, have an instrumental role that needs to be focused on protecting children, enforcing policies, and implementing strategies to help socially and economically disadvantaged children.
