OBJECTIVES: We studied the relationship between drunk driving offences, school performance and adult educational achievements.
METHODS: Data from the Northern Finland 1966 Birth Cohort were linked with official criminality files and National Education registers. The cohort members were studied prospectively covering the period from pregnancy to 31 years of age. Drunk driving (one to two arrests) and recidivist drunk driving (three or more arrests) were treated as outcome variables and their relation to school performance was studied by cross-tabulation and to adult educational achievements (two levels of education) by logistic regression analysis, adjusting for parental social class and psychiatric morbidity.
FINDINGS: Drunk drivers had a statistically significantly worse school performance compared with controls. Male cohort members who had remained at the basic educational level had an elevated risk for drunk driving [odds ratio (OR) 3.0, 95% confidence interval (CI) 2.3-3.8]. The corresponding adjusted ORs for recidivist drunk driving and female drunk driving were 8.6 (95% CI 5.1-14.4) and 7.0 (95% CI 3.3-14.8), respectively.
DISCUSSION: These results are unlikely to be directly causal; however, educational failures seem to be part of the complex causal pathway to drunk driving and even to alcohol-related disorders.
Hospitalization and mortality succeeding drunk driving and risky driving.
- Karlsson G, Halldin J, Leifman A, Bergman H, Romelsjo A. Alcohol Alcohol 2003; 38(3): 281-286.
Correspondence: Gunilla Karlsson, Addiction Centre Stockholm, Box 125 60, SE-102 29 Stockholm, Karolinska, SWEDEN; (email: gunilla.karlsson@bekl.csso.sll.se).
OBJECTIVES: The association between drunk driving (DD) and/or risky driving (RD) offences and subsequent hospitalization and mortality was studied during a 25-year period.
METHODS: Information about drinking habits and psychosocial factors for the 8122 conscripts from Stockholm County in 1969-1970 was linked to register data on hospitalization, mortality, DD and RD.
FINDINGS: Analyses comparing background characteristics of DD and RD groups showed that the prevalence of problem behaviour and drug use was highest in the RD group. The relative risk (RR) for hospitalization after DD and/or RD was significantly elevated in multivariate logistic regression analysis for all the studied diagnostic categories (alcohol diagnoses, narcotic diagnoses, suicide attempts, psychoses, E-codes, all diagnoses), and was especially high for alcohol (RR = 7.2) and diagnosis of drug misuse (RR = 9.2). The RR of all hospitalization was 1.5 for the DD group, 1.8 for the RD group, and 1.9 for those who had been sentenced both for drunk driving and risky driving (DRD), all of which were significantly increased. The RR of death was significantly elevated in all three groups.
DISCUSSION: The results show a significantly increased risk of hospitalization and mortality both in the DD and the RD group. From a public health and traffic safety perspective, this implies a need for developing and implementing better prevention strategies.
Epidemiology of U.S. Army cold weather injuries, 1980-1999.
- DeGroot DW, Castellani JW, Williams JO, Amoroso PJ. Aviat Space Environ Med 2003; 74(5): 564-570.
Correspondence: David W. DeGroot, U.S. Army Research Institute of Environmental Medicine, Thermal and Mountain Medicine Division, Natick, MA 01760-5007, USA; (email: david.degroot@na.amedd.army.mil).
BACKGROUND: Cold weather injuries (CWI) are of great military concern due to their wide-ranging impact on military readiness. Previous short-term studies have identified CWI to be more prevalent in African-Americans, infantrymen, and lower-ranking soldiers. The purpose of this cross-sectional study was to determine the occurrence of CWI hospitalizations in the U.S. Army from 1980 to 1999, and to identify possible trends, high-risk groups and/or activities.
METHODS: The U.S. Army Research Institute of Environmental Medicine Total Army Injury and Health Outcomes Database was searched for hospitalizations with ICD-9-CM codes for frostbite, hypothermia, immersion foot, chilblains, and other. Information concerning each soldier included: gender, age, ethnicity, rank, occupation, type of injury, home of record, duty station, principle diagnosis, trauma code, and cause of injury. Data was available on the demographic composition of the Army, by year, and was used as the denominator when calculating the frequency of occurrence.
FINDINGS: During the study period there were 2143 hospitalizations due to CWI. African-American men and women were injured approximately 4 times and 2.2 times as often as their Caucasian counterparts, respectively. Trauma and cause of injury codes indicate that about 80% of all CWI hospitalizations result on-duty and during organized training. The yearly rate of CWI hospitalization has declined from 38.2/100,000 in 1985 to 0.2/100,000 in 1999.
DISCUSSION: Our data are consistent with previous research concerning the increased rate of CWI among African-Americans though further investigation appears warranted. The occurrence of most CWI during on-duty training suggests preventability. The decline in the overall rate of CWI hospitalizations is multifactorial.
Terrorism Preparedness Training for Nonclinical Hospital Workers: Empowering Them to Take Action
- Thorne CD, Curbow B, Oliver M, Al-Ibrahim M, McDiarmid M. JOEM 2003; 45(3): 333-337.
Correspondence: Craig Thorne, Occupational Health Program, University of Maryland School of Medicine
405 West Redwood Street, 2nd Floor, Baltimore, Maryland 21202, USA; (email: cthorne@medicine.umaryland.edu).
While aspects of the national response to the last years' terrorist attacks have included preparedness training for health care institutions, much of the focus has been on clinician recognition of biologic exposures. However, many hospital workers have nonclinical responsibilities (such as housekeepers and mailroom workers) and many more, though active in clinical care, are para-professionals with limited medical training (such as nursing assistants). These workers are critical to the achievement of our institution's mission to provide competent and compassionate medical care, even during an emergency. In recognition of this, and to understand their attitudes and concerns, we conducted focus groups. The process provided a forum to receive immediate feedback from the workers, and will be used to design customized knowledge and skills training sessions that empower them to take proper responsive action should a terrorist attack occur. Our experience may be useful to others who are planning terrorism preparedness training programs.
Correspondence: Mark R. Stevenson, Injury Research Centre, Department of Public Health, The University of Western Australia, Crawley, WA 6009, AUSTRALIA; (email: unavailable).
Death and injury from residential fires remains a major public health challenge in the United States and operable smoke alarms on each level of a home have been estimated to reduce the risk of death and injuries from residential fires. A multiple-group analytic ecologic study was undertaken with ecologic data at both the group- and individual-level for each state of the United States. The age standardized mortality rates for residential fire in the US was 1.61 per 100,000, with the highest fire-mortality rates occurring in the southeastern states of the US. An estimated 93.6% of US households have a smoke alarm. The findings of the analysis highlight that smoke alarms, when represented at an ecologic-level, have a significant, negative, association with residential fire mortality (eRR=0.92, 95% CI=0.85-0.99). The finding of a negative ecologic association between smoke alarms and residential fire mortality reflects findings reported in studies using individual-level data, namely, that operable smoke alarms provided adequate warning and protection against death in residential fires. The ecologic association identified in this study is not strong and this may be due, in part, to the fact the prevalence rates for smoke alarms used in the study do not reflect the functional status of the alarms.
Fall-related upper body injuries in the older adult: a review of the biomechanical issues.
- DeGoede KM, Ashton-Miller JA, Schultz AB. J Biomech 2003; 36(7): 1043-1053.
Correspondence: A. Ashton-Miller, Department of Mechanical Engineering, University of Michigan, G.G. Brown 3208, Ann Arbor, MI, USA; (email: jaam@umich.edu).
Although the epidemiology of fall-related injuries is well established for the elderly population over 65 years of age, the biomechanics of how, when and why injuries do and do not occur when arresting a fall have received relatively little attention. This paper reviews the epidemiological literature in the MEDLINE data base pertinent to the biomechanics of fall-related injuries, including data on fall rates, fall-related injury rates, fall directions and types of injuries available. It also covers primary sources not listed on MEDLINE, along with the pertinent biomechanics literature. Many falls in older adults are in a forward direction, and as a result the upper extremities are one of the most commonly injured structures, presumably in protecting the head and torso. In this review emphasis is placed on what is, and what is not, known of the biomechanical factors that determine the impact forces and injury risk associated with upper extremity injuries in forward falls. While decreased bone mineral density may be contributory, it is not a reliable predictor of fracture risk. Evidence is presented that fall-related impact forces can be reduced by appropriate volitional arrest strategies. Further theoretical and experimental research is needed to identify appropriate fall-arrest strategies for the elderly, as well as the physical capacities and skills required to do so. Inexpensive interventions might then be developed to teach safe fall-arrest techniques to older individuals.
Is a Fall Just a Fall: Correlates of Falling in Healthy Older Persons. The Health, Aging and Body Composition Study.
- De Rekeneire N, Visser M, Peila R, Nevitt MC, Cauley JA, Tylavsky FA, Simonsick EM, Harris TB. J Am Geriatr Soc 2003; 51(6): 841-846.
Correspondence: N. De Rekeneire, Laboratory of Epidemiology, Demography and Biometry and Gerontology Research Center, National Institute on Aging, Bethesda, Maryland, USA; (email: unavailable).
OBJECTIVES: To identify factors associated with falling in well-functioning older people. DESIGN: Cross-sectional analyses of report of falls over the past 12 months using baseline data from the Health, Aging and Body Composition Study.
SETTING: Clinic examinations in Pittsburgh, Pennsylvania, or Memphis, Tennessee.
PARTICIPANTS: Three thousand seventy-five high-functioning black and white elderly aged 70 to 79 living in the community.
MEASUREMENTS: Physical function assessed using self-report and performance measures. Health status indicators included diseases, medication use, and body composition measures.
FINDINGS: Almost one-quarter (24.1%) of women and 18.3% of men reported at least one fall within the year before the baseline examination. Fallers were more likely to be female; white; report more chronic diseases and medications; and have lower leg strength, poorer balance, slower 400-meter walk time, and lower muscle mass. In men, multivariate logistic regression models showed white race (adjusted odds ratio (OR) = 1.4, 95% confidence interval (CI) = 1.2-1.6), slower 6-meter walk speed (OR = 1.1, 95% CI = 1.0-1.3), poor standing balance (OR = 1.2, 95% CI = 1.0-1.4), inability to do 5 chair stands (OR = 1.7, 95% CI = 1.3-1.9), report of urinary incontinence (UI) (OR = 1.5, 95% CI = 1.1-2.0), and mid-quintile of leg muscle strength (OR = 0.6, 95% CI = 0.4-0.9) to be independently associated with report of falling. In women, benzodiazepine use (OR = 1.6, 95% CI = 1.0-2.6), UI (OR = 1.5, 95% CI = 1.2-1.9), and reported difficulty in rising from a chair (OR = 1.4, 95% CI = 1.2-1.6) were associated with past falls.
DISCUSSION: Falls history needs to be screened in healthier older adults. Even for well-functioning older persons, specific correlates of falling can be identified to define those at risk.
Fall and injury prevention in residential care-effects in residents with higher and lower levels of cognition.
- Jensen J, Nyberg L, Gustafson Y, Lundin-Olsson L. J Am Geriatr Soc 2003; 51(5): 627-635.
Correspondence: J. Jensen, Department of Community Medicine and Rehabilitation, Geriatric Medicine and Physiotherapy, Umea University, SWEDEN; (email: unavailable).
OBJECTIVES: To evaluate the effectiveness of a multifactorial fall and injury prevention program in older people with higher and lower levels of cognition.
DESIGN: A preplanned subgroup comparison of the effectiveness of a cluster-randomized, nonblinded, usual-care, controlled trial.
SETTING: Nine residential facilities in Umea, Sweden.
PARTICIPANTS: All consenting residents living in the facilities, aged 65 and older, who could be assessed using the Mini-Mental State Examination (MMSE; n = 378). An MMSE score of 19 was used to divide the sample into one group with lower and one with higher level of cognition. The lower MMSE group was older (mean +/- standard deviation = 83.9 +/- 5.8 vs 82.2 +/- 7.5) and more functionally impaired (Barthel Index, median (interquartile range) 11 (6-15) vs 17 (13-18)) and had a higher risk of falling (64% vs 36%) than the higher MMSE group.
INTERVENTION: A multifactorial fall prevention program comprising staff education, environmental adjustment, exercise, drug review, aids, hip protectors, and postfall problem-solving conferences.
MEASUREMENTS: The number of falls, time to first fall, and number of injuries were evaluated and compared by study group (intervention vs control) and by MMSE group.
FINDINGS: A significant intervention effect on falls appeared in the higher MMSE group but not in the lower MMSE group (adjusted incidence rates ratio of falls P =.016 and P =.121 and adjusted hazard ratio P <.001 and P =.420, respectively). In the lower MMSE group, 10 femoral fractures were found, all of which occurred in the control group (P =.006).
DISCUSSION: The higher MMSE group experienced fewer falls after this multifactorial intervention program, whereas the lower MMSE group did not respond as well to the intervention, but femoral fractures were reduced in the lower MMSE group.
Workplace health and safety regulations: Impact of enforcement and consultation on workers' compensation claims rates in Washington State.
- Baggs J, Silverstein B, Foley M. Am J Ind Med 2003; 43(5): 483-494.
Correspondence: Barbara Silverstein, Safety and Health Assessment and Research for Prevention (SHARP) Program, Washington State Department of Labor and Industries, PO Box 44330, Olympia, WA 98504-4330, USA; (email: silb235@lni.wa.gov).
BACKGROUND: There has been considerable debate in the public policy arena about the appropriate mix of regulatory enforcement and consultation in achieving desired health and safety behavior across industries. Recently there has been a shift in federal policy toward voluntary approaches and constraining the scope of enforcement programs, although there is little evidence that this might improve health and safety outcomes. To address this, we examined changes in lost time workers compensation claims rates for Washington State employers who had (1) no OSHA State Plan (WISHA) activity, (2) enforcement, (3) consultation, and (4) both types of visits.
METHODS: Compensable claims rates, hours, and WISHA activity were determined for each employer account with a single business location that had payroll hours reported for every quarter from 1997-2000 and more than 10 employees. We used a generalized estimating equations (GEE) approach to Poisson regression to model the association between WISHA activity and claims rate controlling for other external factors.
FINDINGS: Controlling for previous claims rate and average size, claims rates for employers with WISHA enforcement activity declined 22.5% in fixed site industry SIC codes compared to 7% among employers with no WISHA activity (P < 0.05), and in non-fixed site SICs (e.g., construction) claims rates declined 12.8% for employers with enforcement activity compared to a 7.4% decline for those with no WISHA activity (P > 0.10). WISHA consultation activity was not associated with a greater decline in compensable claims rates (-2.3% for fixed sites and +3.5% for non-fixed sites). WISHA activity did not adversely affect worksite survivability through the study period.
DISCUSSION: Enforcement inspections are significantly associated with decreasing compensable workers compensation claims rates especially for fixed site employers. We were unable to identify an association between consultation activities and decreasing claims rates.
Two bistable apparent-movement displays (i.e. ones that generate two qualitatively different kinds of movement percepts under different conditions) were compared. They were designed to be as similar as possible spatially, and were studied with identical stimulus manipulations to see whether changes in balance between their bistable percepts would be similar. Results show that the two displays had different response characteristics to the same stimulus manipulations. Two models of motion perception that have previously predicted at least one kind of bistable apparent motion were considered in terms of how well they address the current data. As yet, neither model has been shown to predict the motion states and bistable behavior of the two displays studied here. It is concluded that results of the type described here (specifically, differences in the psychophysical functions yielded by two structurally similar but qualitatively different bistable displays) present a challenge for theories of motion perception.
Orientation discrimination in visual noise using global and local stimuli.
- Jones DG, Anderson ND, Murphy KM. Vision Res 2003; 43(11): 1225-1235.
Correspondence: David G. Jones, Department of Electrical and Computer Engineering, McMaster University, 1280 Main Street West, Ont., L8S 4K1, Hamilton, CANADA; (email: djones@mcmaster.ca).
We have investigated orientation discrimination in visual noise using two types of high contrast, broadband stimuli. Discrimination thresholds are better for Local stimuli, in which the orientation signal is spatially limited, than for Global stimuli, in which the orientation signal extends across the entire stimulus. Performance improves with increasing stimulus area, reaching an optimum threshold of about 11% orientation signal. Thresholds were not influenced by brief presentation times or practice. These results, along with results from a simple computational model, suggest that human orientation discrimination for this kind of pattern is mediated by pooling local responses of low-level neural mechanisms and is limited by two stages of intrinsic neural noise.
Oblique stimuli are seen best (not worst!) in naturalistic broad-band stimuli: a horizontal effect.
- Essock EA, DeFord JK, Hansen BC, Sinai MJ. Vision Res 2003; 43(12): 1329-1335.
Correspondence: Edward A. Essock, Department of Psychological and Brain Sciences, University of Louisville, 40292, Louisville, KY, USA; (email: essock@louisville.edu).
People with normal eyesight typically see horizontal and vertical gratings better than oblique gratings (Psychological Bulletin 78 (1972) 266; Perception 9 (1980) 37). In the present study we investigated whether this oblique effect anisotropy is still observed when viewing more complex visual stimuli that better correspond to the content encountered in everyday viewing of the world. We show that the ability to see oriented structure in an image consisting of broadband spatial content is indeed anisotropic, but that the pattern of this orientation bias is completely different from that obtained with simpler stimuli. Horizontal stimuli are seen worst and oblique stimuli are seen best when tested with more realistic broadband stimuli. We suggest that this "horizontal effect" would be useful in an evolutionary capacity by serving to discount the horizon and other oriented content that tends to dominate natural scenes and thereby increase the salience of objects contained in typical outdoor scenes.
Unintentional ingestion of over the counter medications in children less than 5 years old.
- Chien C, Marriott J, Ashby K, Ozanne-Smith J. J Paediatr Child Health 2003; 39(4): 264-269.
Correspondence: C. Chien, Department of Pharmacy Practice, Victorian College of Pharmacy, Monash University and Monash University Accident Research Centre, Melbourne, Victoria, AUSTRALIA; (email: unavailable).
OBJECTIVE: Childhood ingestion of medications remains a substantial problem. Medication available over the counter (OTC) is widely used and has significant toxicity. The present study aims to investigate the nature and extent of unintentional ingestion of OTC medication in children < 5 years old in Victoria, Australia, during the period 1996-2000, in order to highlight critical factors.
METHODS: Numbers of enquiries relating to unintentional ingestion of OTC medication in children < 5 years old and medication types were obtained from the Victorian Poisons Information Centre for 1998-2000. Emergency Department presentations involving poisoning of children < 5 years old, the medication types and subsequent admissions were obtained from the Victorian Emergency Minimum Dataset for 1996-2000.
FINDINGS: Numbers of enquiries and Emergency Department attendances for poisoning were substantially higher for OTC medication than for prescription medication; however, a lower proportion of cases involving ingestion of OTC medication (24.8%) required hospital admission during the study period compared with cases involving ingestion of prescription medications (33.8%). Overall, the peak incidence was at 2 years of age, with a slight male over-representation. Paracetamol and cough/cold preparations were the most common agents.
DISCUSSION: The causes of unintentional ingestion of OTC medications by children might include lack of child-resistant closure (CRC), inadequate design of CRC, attitudes concerning the toxicity of OTC medications, or lack of vigilance by parents and carers in the storage and administration of OTC medications. Consideration should be given to restricting sales of toxic OTC medications to pharmacies, and increasing counselling of consumers concerning the toxicity and safe storage of OTC medications and the correct usage of CRC. The adequacy of CRC design and OTC medications warranting CRC should be reviewed by the relevant authorities.
A social network contagion theory of risk perception.
- Scherer CW, Cho H. Risk Anal 2003; 23(2): 261-267.
Correspondence: Cliff Scherer, Department of Communication, Social and Behavioral Research Unit, Cornell University, Ithaca, NY 14853, USA; (email: CWS4@Cornell.edu).
Risk perceptions have, to a great extent, been studied exclusively as individual cognitive mechanisms in which individuals collect, process, and form perceptions as atomized units unconnected to a social system. These individual-level theories do not, however, help explain how perception of risk may vary between communities or within a single community. One alternative approach is based on a network theory of contagion. This approach, emerging largely from organizational and community social network studies, suggests that it is the relational aspects of individuals and the resulting networks and self-organizing systems that influence individual perceptions and build "groups or communities of like-minded" individuals. These social units, it is argued, behave as attitude, knowledge, or behavioral structures. The study reported in this article tests one aspect of this theoretical perspective. The central hypothesis proposes the existence of risk perception networks--relational groupings of individuals who share, and perhaps create, similar risk perceptions. To test this idea, data were collected from individuals involved in a community environmental conflict over a hazardous waste site cleanup. The statistical analysis used a matrix of relational social linkages to compare with a matrix of individual risk perceptions The analysis confirmed the hypothesis suggesting that social linkages in communities may play an important role in focusing risk perceptions.
This paper is concerned with how people make meaning of the risks they face. It explores certain assumptions of the risk perception approaches, which dominate the area. It argues that despite changes currently taking place in the field, such models still focus on static, intrapersonal processes, with many viewing human thinking as analogous to erroneous information processing. In the place of an individual 'deficit' focus, the paper proposes a more intersubjective theory of the response to risk. Social representations theory is evaluated and its validity assessed by highlighting empirical work on representations of biotechnological and health risks. The review reveals that the response to risk is a highly social, emotive and symbolic entity. Therefore a theory and methods appropriate to such qualities are proposed, to produce a valid psychology of risk.
- Kakavelakis KN, Vlazakis S, Vlahakis I, Charissis G. Scand J Med Sci Sports 2003; 13(3): 175-178.
Correspondence: K.N. Kakavelakis, Department of Pediatric Surgery, Medical School, University Hospital of Heraklion, University of Crete, Voutes 71110, Crete, GREECE; (email: unavailable).
A prospective study of soccer injuries, involving 287 male youth players, from the ages of 12-15 was conducted in 24 Greek soccer clubs, during the course of one year. A total of 193 players sustained 209 injuries. The incidence of injuries was 4.0 injuries per 1000 h of soccer time per player, and the most common types of injuries were sprains and strains. Surprisingly, it was found that an increase of injury incidences occurred during practice. Fifty-eight injuries required medical assistance. The majority of injuries (80%) were located in the lower extremities. Collision with other players was the most common activity at the time of injury, accounting for 40% of all injuries. The conclusion of this study and the evidence from other studies suggests that youth soccer is a relatively low risk sport. However, a substantial amount of injuries could be prevented. It is necessary to identify the risk factors, which are associated with these types of injuries.
Spinal and spinal cord injuries in horse riding: the New South Wales experience 1976-1996.
- Roe JP, Taylor TK, Edmunds IA, Cumming RG, Ruff SJ, Plunkett-Cole MD, Mikk M, Jones RF. ANZ J Surg 2003; 73(5): 331-334.
Correspondence: T. K. F. Taylor, Department of Orthopaedics and Traumatic Surgery, The Royal North Shore Hospital, St Leonards, New South Wales 2065, AUSTRALIA; (email: tktaylor@med.usyd.edu.au).
OBJECTIVES: The objective of the present study was to determine the incidence of acute spinal cord injuries (ASCI) in all forms of horse riding in New South Wales (NSW) for the period 1976-1996. Other aims of the present study were to compare and contrast ASCI with vertebral column injuries (VCI) without neurological damage and to define appropriate safety measures in relation to spinal injury in horse-riding.
DESIGN: A retrospective review was done of all ASCI cases (n = 32) admitted to the two acute spinal cord injury units in NSW for the cited period. A comparable review of VCI cases (n = 30) admitted to these centres for the period 1987-1995 was also undertaken.
FINDINGS: A fall in flight was the commonest mode of injury in both groups. Occupational and leisure riding accounted for 88% of ASCI and VCI. The incidence of ASCI is very low in those riding under the aegis of the Equestrian Federation of Australia - two cases in 21 years; and there were no cases in the Pony Club Riders or in Riding for the Disabled. The difference in the spinal damage caused by ASCI and VCI is in degree rather than kind. Associated appendicular/visceral injuries were common.
DISCUSSION: No measures were defined to improve spinal safety in any form of horse riding. The possible role of body protectors warrants formal evaluation. Continued safety education for all horse riders is strongly recommended.
OBJECTIVE: To investigate the clinical conditions of the in-patients with motor-vehicle injury and survey the distribution features of the injuries.
METHOD: The clinical records of 2,353 patients with motor-vehicle injuries who were hospitalized in a hospital in Shaoyang City of Hunan Province, China, within the period from 1997 to 2001, were collected and surveyed. The patients were diagnosed according to International Classification of Diseases-9th Revision (ICD-9) codes and statistical analysis was performed in an attempt to define the injury features of this cohort of patients.
FINDINGS: The patients with motor-vehicle injuries took up a fraction 3.16% of the total in-patients treated in this hospital (74 368) within the defined period, with a male to female ratio of 2.37 1.00. Subjects in the age range of 15 to 44 years were most likely to be involved in the accidents (55.9%), and in terms of occupation, farmers who lived outside the urban regions had the highest ratio in the total injured patients (34.0%). In the motor-vehicle accidents, the major injuries occurred in the head, usually with moderate severity when admitted into hospital (69.9%).
DISCUSSION: Traffic accident is a crucial public health issue that severely affects the life quality of the wounded. Effective legislation and regulations should therefore be instituted, and relevant health education program be launched to control and prevent the occurrence of these accidents.
Early predictors of long-term disability after injury.
- Richmond TS, Kauder D, Hinkle J, Shults J. Am J Crit Care 2003; 12(3): 197-205.
Correspondence: Therese S. Richmond, School of Nursing (TSR) and School of Medicine, University of Pennsylvania, Philadelphia, Pa., USA; (email: unavailable).
BACKGROUND: Improving outcomes after serious injury is important to patients, patients' families, and healthcare providers. Identifying early risk factors for long-term disability after injury will help critical care providers recognize patients at risk.
OBJECTIVES: To identify early predictors of long-term disability after injury and to ascertain if age, level of disability before injury, posttraumatic psychological distress, and social network factors during hospitalization and recovery significantly contribute to long-term disability after injury.
METHODS: A prospective, correlational design was used. Injury-specific information on 63 patients with serious, non-central nervous system injury was obtained from medical records; all other data were obtained from interviews (3 per patient) during a 2 1/2-year period. A model was developed to test the theoretical propositions of the disabling process. Predictors of long-term disability were evaluated using path analysis in the context of structural equation modeling.
FINDINGS: Injuries were predominately due to motor vehicle crashes (37%) or violent assaults (21%). Mean Injury Severity Score was 13.46, and mean length of stay was 12 days. With structural equation modeling, 36% of the variance in long-term disability was explained by predictors present at the time of injury (age, disability before injury), during hospitalization (psychological distress), or soon after discharge (psychological distress, short-term disability after injury).
DISCUSSION: Disability after injury is due partly to an interplay between physical and psychological factors that can be identified soon after injury. By identifying these early predictors, patients at risk for suboptimal outcomes can be detected.
Correspondence: Laura A. Nabors, Department of Psychology, Mail Location 376, Room 429 Dyer Hall, University of Cincinnati, Cincinnati, OH 45221-0376, USA; (email: naborsla@email.uc.edu).
School-Based Health Centers (SBHCs) are ideal primary care settings for improving children's access to and utilization of health care services. In this era of shrinking funding for social service programs, SBHCs may provide services to youth from low-income families, who otherwise might lack access to health care services. However, the growth of SBHCs has outpaced evaluation efforts. More information is needed about what services are being provided, and for whom services are effective. This article reviews information that will assist in the development of evaluation efforts for SBHCs. A review of evaluation theory, ideas for evaluation in SBHCs, challenges to implementing research in schools, and future directions for evaluation efforts are presented.
School-based health centers: Strategies for meeting the physical and mental health needs of children and families
- Brown MB, Bolen LM Psychol Schs 2003; 40: 279-287.
Correspondence: Michael B. Brown, Department of Psychology, East Carolina University, Greenville, NC 27858-4353, USA; (email: brownmi@mail.ecu.edu).
School-based health centers are fast becoming a part of mainstream health care in the United States. The centers provide enhanced access to comprehensive physical and mental health services for children and families. Although originally established in urban areas, they can also have a significant impact on service delivery for children in rural and suburban areas. This manuscript describes the role and primary functions of school-based health centers, describes several important issues in developing and implementing the centers, and reviews the effectiveness of services provided through school-based health centers. School psychologists are in an excellent position to provide leadership for the establishment of school-based health centers. Participation in school-based health services delivery enables school psychologists to expand their role and broadens both their client population and the range of services.
Implementing a school-based health center: The Winston-Salem/Forsyth County experience
- Trivette PS, Thompson-Drew, C Psychol Schs 2003; 40: 289-296.
Correspondence: Paul S. Trivette, Psychological Services, Winston-Salem/Forsyth County Schools, Box 2513, Winston-Salem, NC 27102-2513, USA; (email: ptrivett@wsfcs.k12.nc.us).
This article traces the inception and implementation of school-based health centers in the Winston-Salem/Forsyth County (NC) school system. The challenges that arose during implementation are discussed, along with the opportunities that SBHCs provide to enhance the provision of comprehensive services for children. The involvement of the several school psychologists in the initial planning, organization and implementation of these centers is delineated as an example for other school psychologists who are interested in working with school-based health centers. School-based health centers represent an opportunity for school psychologists to assume a leadership role in the delivery of enhanced health and mental health services for children and families.
Integrating expanded school mental health programs and school-based health centers
- Weist MD, Goldstein A, Morris L, Bryant T. Psychol Schs 2003; 40: 297-308.
Correspondence: Mark D. Weist, Center for School Mental Health Assistance, Department of Psychiatry, University of Maryland School of Medicine, 680 West Lexington Street, 10th Floor, Baltimore, MD 21201,USA; (email: mweist@psyc.umaryland.edu).
This article provides background on national movements toward expanded school mental health (ESMH) programs and school-based health centers (SBHCs), and presents advantages and challenges of joining these two systems of child and adolescent health care. Delivering ESMH through SBHCs promotes an interdisciplinary approach, health-mental health care integration, and benefits including enhancing referral bases, improving screening of problems, and enhanced confidentiality and privacy. But this integrated approach also presents challenges including managing referrals and significant needs, handling crises, building a focus on prevention and mental health promotion, handling administrative demands, and coping with limited resources. These challenges, ideas for overcoming them, and future directions for this promising service delivery approach are discussed.
Suicidal behaviour in young people. An epidemiological study in the Verbano-Cusio-Ossola Province (years 1988-2000)
- Torre E, Zeppegno P, Usai C, Rudoni M, Ammirata G, De Donatis O, Manzetti E, Marangon D, Migliaretti G. Minerva Pediatr 2003; 55(2): 157-162.
Correspondence: E. Torre, Cattedra di Psichiatria, Facolta di Medicina e Chirurgia, Universita del Piemonte Orientale A. Avogadro di Novara, Novara, ITALY; (email: unavailable).
BACKGROUND: The aim of the present study is to investigate the suicide and attempted suicide phenomenon among young people (<25 years old) in the Verbano-Cusio-Ossola province from January 1988 to December 2000.
METHODS: This epidemiological-descriptive survey is based on the acquisition of data through the examination of model 45 registered at the Verbania Public Prosecutor's office. The data obtained were analysed with SPSS 8.0 software for Windows. The significance of the differences between the rates observed in our group and those observed in Italy in the same period was estimated by calculating SMR and SIR (Standardized Mortality Rates and Standardized Incidence Rates respectively).
FINDINGS: In the period considered in our study, 13 suicides and 62 attempted suicides were notified to the Court, with a rate of 2.55 and 12.18 per 100,000 inhabitants, respectively. The analysis of SMR and SIR points out that the incidence of suicide and attempted suicide among young people is higher in this province than in Italy. The most frequently used methods to commit suicide are hanging and carbon monoxide poisoning, while drug intoxication prevails in attempted suicide. The most common reasons are disagreements, followed by mental illness, psychosocial factors, loss of a relative and toxic dependence.
DISCUSSION: The present study means to provide a description of suicide behaviour among young people in a geographic and cultural context, in order to point out its problems and to provide useful information for the diagnosis and prevention.
Consumer crash test programs provide comparative information on the crashworthiness of new vehicles which, in turn, should predict the performance of the same vehicles in real-world crashes. However, the detail and quality of available information from tests and real-world crashes differ widely, so identifying meaningful relationships between crash test results and real-world crashworthiness can be difficult. Despite these data limitations, studies in the late 1980s and mid-1990s reported positive correlations between dummy injury measures from the U.S. New Car Assessment Program (USNCAP) and real-world fatality rates. More recent analyses of results from Australian crash tests and real-world crashes also have found positive correlations. This article considers relationships between recent U.S. frontal crash test results from the Insurance Institute for Highway Safety (IIHS) and USNCAP, and real-world crash injury risk estimates computed from police-reported crash data from three U.S. states. The frontal crash test results include dummy injury measures by body region from both IIHS offset tests and USNCAP full-width barrier tests plus measures of structural performance from the IIHS offset tests. Individually, results from the full-width and offset tests were not significantly correlated with the real-world injury risk estimates. Stronger relationships were found when a combination of overall ratings from the full-frontal and offset tests was used. However, the current results find only weak correlations between both full-front and offset frontal crash test performance and the real-world injury risk estimates. These weak relationships likely reflect the lack of detail and fundamental difference in injury information in police crash reports compared to that used in deriving crashworthiness ratings from the crash tests.
Air Bag Effectiveness as Function of Impact Speed
- Nusholtz GS, Famili F, Domenico LD, Shi L, Aoun ZB, Hongsakaphadana Y. Traffic Injury Prevention 2003; 4(2): 128-135.
Correspondence: G.S. Nusholtz, DaimlerChrysler, Auburn Hills, Michigan, USA; (email: unavailable).
An investigation was conducted to estimate the effectiveness of air bags as a function of velocity. The study consisted of three parts: a theoretical idealization, an analysis of National Automotive Sampling System/Crashworthiness Data System (NASS/CDS), and a reanalysis of previously published Fatality Analysis Reporting System (FARS) data. The theoretical analysis looked at idealized risk curves as a function of velocity; assuming that the air bag offers a benefit for both belted and unbelted occupants. Analysis of the NASS/CDS data looked at the effectiveness of air bags as a function of velocity for Maximum Abbreviated Injury Scale (MAIS) 3+ injuries. The reanalysis of the previously published FARS data looked at the effectiveness of the air bag as a function of velocity for fatalities. The theoretical analysis indicates that the air bag effectiveness should be greatest at the low velocities. The field data analysis of both NASS/CDS and FARS were consistent with the theoretical analysis, indicating that air bags are most effective at the lower velocities, below 40 kph (25 mph), for both belted and unbelted occupants. Although it was not possible to estimate a different effect for belted and unbelted for fatalities using FARS, it was possible for MAIS 3+ using NASS/CDS. For unbelted occupants the effectiveness goes to zero or becomes negative above 40 kph (25 mph) for MAIS 3+, and for belted occupants the effectiveness stays positive but with significantly lower magnitude for speeds above 40 kph (25 mph).
The Risk of Whiplash Injury in the Rear Seat Compared to the Front Seat in Rear Impacts
One hundred ninety-five rear impacts with both front- and rear-seat occupants in the struck car, where at least one occupant sustained permanent disability, were selected for study. There was a significantly higher disability risk for the female rear-seat occupant compared with the male driver. Furthermore, a higher risk was found for female rear-seat occupants compared with female front-seat passengers. The disability risk for occupants of the driver's seat was three times higher for females than for males, and four times higher for females in the rear seat. In the future, test methods should consider the risk of whiplash injury in both the front and the rear seat.
Red Light Violations at Rural and Suburban Signalized Intersections in Jordan
This case study investigated red light violations at rural and suburban signalized intersections in Jordan. Field observations were conducted at 15 signalized intersections located in different Jordanian regions: Amman, Irbid, and Zarqa. The results showed that, out of a total of 1,190 drivers who had a chance for violation, 153 (12.9%) drivers ran red lights. It was found that older drivers have less tendency for running red lights. Based on vehicle type, the analysis showed that truck drivers had the highest violation rate followed by small vehicles and then buses. The Y-shaped intersection had a higher percentage of violations as compared to the T- and cruciform-shaped intersections. The percentage of red light violations was found to be directly proportional to the subjects approach speed and inversely proportional to the conflicting traffic volumes.
Can a nongovernmental organization influence or determine seat belt use in a nation? The problems that implementing such a simple, yet effective, measure for traffic safety may trigger in a developing country are impossible to imagine. Just having the right laws is not enough: A great effort is necessary to create awareness and inform the population, but the governmental authorities in Argentina are not doing this, nor do they show any interest in it. In most of the developing countries, the situation is similar. Starting from a diagnosis of seat belt use by means of systematic observations, a program of awareness and massive education was developed for national radio and TV about the advantages of seat belt use. The first stage of this program was launched at the end of 1991, and it continues to this day. Articles in newspapers and communications and requests on the same subject sent to public officials also have helped mobilize public opinion on seat belt use. After 10 years of systematic and continued work by a nongovernmental organization, seat belt use is now part of the government's agenda and there is a high rate of "almost voluntary" seat belt use. The voluntary seat belt use in the city of Buenos Aires has reached 26.9%, and in national highways 58.9%. The roads that have been traveled in Argentina (documented with follow-up statistics) may be useful as guidelines for other countries that are starting this process, and may help to shorten times, avoid pitfalls, and save lives since it is estimated that 1,100 more lives could be saved every year in Argentina when seat belts become the norm.
This study compares risk factors for intimate partner violence-related injury across two national data sources on violence against women, the Canadian Violence Against Women Survey and the National Violence Against Women Survey in the United States. After equating the data sets as much as possible on the types of violence experienced and risk factors, the authors determined which risk factors in each data source predicted injury and compared the magnitudes of associations between risk factors and injury across the data sets. The article presents results on bivariate and multivariate findings, model fit across the data sets, and statistical comparisons of findings across the data sets. Obtaining convergent findings across data sources on risk factors for injury will allow public health practitioners to intervene more effectively with women at risk for experiencing violence-related injuries perpetrated by spouses.
Male honor and female fidelity: implicit cultural scripts that perpetuate domestic violence.
Two studies explored how domestic violence may be implicitly or explicitly sanctioned and reinforced in cultures where honor is a salient organizing theme. Three general predictions were supported: (a) female infidelity damages a man's reputation, particularly in honor cultures; (b) this reputation can be partially restored through the use of violence; and (c) women in honor cultures are expected to remain loyal in the face of jealousy-related violence. Study 1 involved participants from Brazil (an honor culture) and the United States responding to written vignettes involving infidelity and violence in response to infidelity. Study 2 involved southern Anglo, Latino, and northern Anglo participants witnessing a "live" incident of aggression against a woman (actually a confederate) and subsequently interacting with her.
Exposure to violent media: the effects of songs with violent lyrics on aggressive thoughts and feelings.
- Anderson CA, Carnagey NL, Eubanks J. J Pers Soc Psychol 2003; 84(5): 960-971.
Correspondence: Department of Psychology, Iowa State University, Ames 50011-3180, USA; (email: caa@iastate.edu).
Five experiments examined effects of songs with violent lyrics on aggressive thoughts and hostile feelings. Experiments 1, 3, 4 and 5 demonstrated that college students who heard a violent song felt more hostile than those who heard a similar but nonviolent song. Experiments 2-5 demonstrated a similar increase in aggressive thoughts. These effects replicated across songs and song types (e.g., rock, humorous, nonhumorous). Experiments 3-5 also demonstrated that trait hostility was positively related to state hostility but did not moderate the song lyric effects. Discussion centers on the potential role of lyric content on aggression in short-term settings, relation to catharsis and other media violence domains, development of aggressive personality, differences between long-term and short-term effects, and possible mitigating factors.
Identifying and intervening with girls at risk for violence.
Youth violence has become a prominent national concern, largely focused on boys who have perpetrated highly publicized massacres. Less well-publicized is the rapid increase in arrests of girls for violent crimes and weapons violations. In just 2 decades, violent crime arrests for female juveniles increased by 108%. From research findings, a composite portrait of the violent girl can be drawn. This profile can be used to identify girls at risk for criminal behaviors. In this article, a three-pronged approach to girls' violent behavior is presented: (a) violence prevention and emotional literacy programs that can be implemented by school nurses, (b) parent education programs that can be conducted at Parent-Teacher Association meetings, churches, and community centers, and (c) counseling interventions that can be delivered to troubled girls by psychiatric nurses. Nurses can play vital roles in consultation to teachers and parents and in direct service provision to girls who are on a tragic trajectory of fighting, expulsion from school, and juvenile justice infractions.
Nature of domestic violence against women in a rural area of Bangladesh: implication for preventive interventions.
Correspondence: Abbas Uddin, Social and Behavioural Sciences Unit, ICDDR,B: Centre for Health and Population Research, GPO Box 128, Dhaka 1000, BANGLADESH; (email: abbas@icddrb.org).
This paper reports finding from a study carried out in a remote rural area of Bangladesh during December 2000. Nineteen key informants were interviewed for collecting data on domestic violence against women. Each key informant provided information about 10 closest neighbouring ever-married women covering a total of 190 women. The questionnaire included information about frequency of physical violence, verbal abuse, and other relevant information, including background characteristics of the women and their husbands. 50.5% of the women were reported to be battered by their husbands and 2.1% by other family members. Beating by the husband was negatively related with age of husband: the odds of beating among women with husbands aged less than 30 years were six times of those with husbands aged 50 years or more. Members of micro-credit societies also had higher odds of being beaten than non-members. The paper discusses the possibility of community-centred interventions by raising awareness about the violation of human rights issues and other legal and psychological consequences to prevent domestic violence against women.
