OBJECTIVES: (a) detect possible demographic and behavioral differences among young episodic heavy drinkers and other young drinkers; (b) investigate the association of youth drinking patterns with other health-compromising behaviors.
METHODS: The data presented are part of a health behavior survey, which used a modified version of the Youth Health Risk Behavior Survey (YHRBS) questionnaire. Students from public (n = 993) and private schools (n = 815), from 7th to 11th grades were investigated in Sao Paulo city. Multivariate logistic regression analyses were employed to investigate the association among different drinking practices and the various health-compromising behaviors, controlling for age group, gender, and school system. Odds Ratios (OR) and their 95% Confidence Intervals (CI) were calculated. Episodic Heavy Drinking was defined as having five or more drinks in a 2-hour interval, at least once in the last 30 days.
FINDINGS: Episodic Heavy Drinkers (EHDs) tend to be older and males and prefer to drink with friends at commercial facilities instead of drinking with their relatives at home. EHDs also reported higher percentages of adverse consequences, such as physical fights, accidents, and school absenteism after drinking. EHDs are more likely to engage in other high-risk behaviors. In the public schools, they were more likely to carry guns (OR = 17.0; CI = 3.9-74.8), get involved in physical fights (OR = 8.9; CI = 4.4-18.0), attempt suicide (OR = 4.2; CI = 2.0-8.7), and use inhalants (OR = 2.7; CI = 1.3-5.7) than abstainers. They are also more likely to use marijuana (OR = 4.7; CI = 2.2-9.9) and smoke cigarettes (OR = 5.3; CI = 2.7-10.4) than moderate drinkers. The results were similar for private schools, with even higher ratios of inhalant use (OR = 15.2; CI = 6.2-37.1), when EHDs were compared with abstainers and cigarette (OR = 64.5; CI = 8.6-481.0) and marijuana use (OR = 6.5; CI = 4.3-9.7), when EHDs were compared with moderate drinkers.
DISCUSSION: EHDs display different drinking habits than other adolescents who drink. Also, they are at increased risk for a range of health-compromising behaviors, when compared with both abstainers and moderate drinkers.
Alcohol and domestic violence in a sample of incidents reported to the police of Zurich City.
The purpose of the study is to examine episodes of domestic violence reported to the police, focusing on the drinking behavior of the individuals involved. Over a period of 110 days, (November 1999-February 2000) a total of 53 calls to the emergency line of the police of the city of Zurich (Switzerland), related to domestic violence, were registered. Detailed data concerning the forms of violence, the persons involved, their alcohol intake, and the context of the incidents were collected in 42 cases by means of structured interviews of the officers who achieved the interventions and inquiries. Moreover, interviews by agreement of victims were performed in 12 cases, providing complementary data. Evidence of alcohol involvement was found in 40% of the investigated situations. Police officers thus believed there was a clear link between alcohol and violence in at least 26% of the 42 cases. The interviews of the victims suggest a wide range of attributions made to the role of alcohol in situations of domestic violence.
Why do they do it? A qualitative study of adolescent drinking and driving.
- Nygaard P, Waiters ED, Grube JW, Keefe D. Subst Use Misuse 2003; 38(7): 835-863.
Correspondence: Peter Nygaard, Prevention Research Center, Berkeley, California 94704, USA; (email: pnygaard@prev.org).
Despite a decline in the prevalence of fatal traffic crashes involving adolescent drinking drivers in recent years, underage drinking and driving (DD) and riding with drinking drivers (RWDD) remain serious problems. This article reports the findings of a qualitative study investigating the influence of beliefs and expectancies on adolescents' decisions to participate in DD or RWDD. Forty-four adolescents, who in a previous survey admitted to having been involved in either DD or RWDD, were interviewed in 2000 about their experiences concerning either driving after drinking or getting into a car with a driver who had been drinking. Findings indicate that adolescent DD and RWDD are complex behaviors. Expectancies and control beliefs do not seem to influence the decision, whereas normative beliefs to some extent do. However, findings also indicate that increased enforcement of the laws may be helpful in preventing young people from getting involved in drinking and driving.
International policies on alcohol impaired driving: are legal blood alcohol concentration (BAC) limits in motorized countries compatible with the scientific evidence?
- Desapriya EB, Iwase N, Brussoni M, Shimizu S, Belayneh TN. Nihon Arukoru Yakubutsu Igakkai Zasshi 2003; 38(2): 83-102.
Institute of Social Sciences, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba-Shi, Ibaraki 305-8571, JAPAN; (email: unavailable)
Borkenstein et al. (1974) study indicated that drivers with BACs of 0.05 to 0.09 per cent were twice as likely to crash as drivers with a zero BAC. Drivers with BACs from 0.10 to 0.14 per cent were ten times as likely to have a fatal crash in 1964. There have been numerous efforts during the history of motorized countries to control the consumption of alcohol and the problems associated with it through legislative mandate, it was not until the 1970s that acceptance of legal BAC (Blood Alcohol Concentration) limits laws became widespread. In particular, as more and more people drive automobiles, the number of traffic accidents involving drunken drivers has soared, and many of these are known to be related to the consumption of alcohol. Thus, legislators find themselves under increasing pressure to find a reasonable and fair solution to the question of alcohol impaired driving, as the scientific evidence about alcohol consumption level and psycho motor functions impairment came to clear. A landmark event in the development of policies regarding impaired driving was the establishment of the fact that consumption of alcohol does, in fact, increase the probability of traffic crashes. Legal limit laws specify a maximum permissible BAC limit for drivers. Currently, a BAC laws range from zero tolerance and 0.02 to 0.10% constitutes prima facie evidence in most countries for 'Driving under Influence of Alcohol.' This latter standard is too permissive, as driving skills deteriorate and crash involvement risk increases beginning at 0.02%. There are consequences attached to setting a BAC limit so high that a 72 kg man can drink five bottles of beer and still be under legal limit. In this sense high legal BAC limit may influence people to make bad estimates of their relative risk of injury or death while driving. Provided there is adequate political will, millions of lives could be saved in the coming years. This review is an attempt to examine in detail the available information about legal BAC limit laws, and issue of considerable interest to both policy makers and the public.
DUI recidivism. A comparison of Mexican Americans and whites in a northern California county.
- Cherpitel CJ, Bond J. Addict Behav 2003; 28(5): 963-969.
Correspondence: Cheryl J. Cherpitel Alcohol Research Group, Public Health Institute, 2000 Hearst Avenue, 94709, Berkeley, CA, USA; c.cherpitel@arg.org).
OBJECTIVE: While Hispanic offenders for driving under the influence of alcohol (DUI) in California are more likely to have a history of multiple offenses compared to whites, little is known about characteristics associated with DUI recidivism in either ethnic group. Demographic and DUI conviction characteristics associated with DUI recidivism are analyzed among Mexican American and white DUI offenders in a Northern California county.
METHODS: A sample of 459 primarily Mexican Americans and 490 whites were randomly selected from records supplied by the California Department of Motor Vehicles (DMV) on over 16,000 DUI offenders in the county during a 3-year period. DMV data on DUI convictions in the 1- and 5-year period preceding the identifying DUI offense and the year following the identifying offense (the recidivism conviction) were analyzed.
FINDINGS: Rates of recidivism were significantly lower for Mexican Americans (5%) compared to whites (11%) who were arrested for DUI but not convicted, but higher for those convicted (12% vs. 5%). While conviction status of the identifying DUI offense was not predictive of recidivism among Mexican Americans, a DUI conviction in the preceding year was significantly predictive. Among white arrestees, receiving a conviction was significantly, and negatively, predictive of recidivism, but among those who were convicted, a previous DUI conviction in the last year was predictive of recidivism. Referral to a DUI treatment program was not a significant predictor of recidivism among those convicted in either ethnic group.
DISCUSSION: The data suggest that conviction for a DUI may not play the same role in the likelihood of subsequent DUI convictions for Mexican Americans as for whites, and this difference may need to be considered in DUI treatment programs. Additional research on ethnic differences in DUI offenses and recidivism over longer periods of follow-up is needed to determine ethnic-specific intervention and prevention strategies for DUI.
Occupational accidents among middle and high school students of the state of Sao Paulo, Brazil.
- Fischer FM, Martins IS, Oliveira DC, Teixeira LR, Latorre Md Mdo R, Cooper SP. Rev Saude Publica 2003; 37(3):351-356.
Correspondence: Frida Marina Fischer, Departamento de Sa�de Ambiental, Faculdade de Sa�de P�blica - USP, Av. Dr. Arnaldo, 715 - 2� andar, 01246-904 Sao Paulo, SP, BRAZIL, (email: fmfische@usp.br).
OBJECTIVES: To estimate the prevalence of occupational injuries and identify their risk factors among students in two municipalities.
METHODS: A cross-sectional survey was conducted in public schools of the municipalities of Santo Antonio do Pinhal and Monteiro Lobato, Brazil. A stratified probabilistic sample was drawn from public middle and high schools of the study municipalities. A total of 781 students aged 11 to 19 years participated in the study. Students attending middle and high school answered a comprehensive questionnaire on living and working conditions, as well as aspects of work injuries, and health conditions. Multiple logistic regression models were fitted to estimate risk factors of previous and present occupational injuries.
FINDINGS: Of 781 students, 604 previously had or currently have jobs and 47% reported previous injuries. Among current workers (n=555), 38% reported injuries on their current job. Risk factors for work injuries with statistically significant odds ratio > 2.0 included attending evening school, working as a housekeeper, waiter or brickmaker, and with potentially dangerous machines.
DISCUSSION: The study results reinforce the need of restricting adolescent work and support communities to implement social promotion programs.
Position on the moped, risk of head injury and helmet use: an example of confounding effect.
- Lardelli-Claret P, Luna-del-Castillo Jde D, Jimenez-Moleon JJ. Int J Epidemiol 2003; 32(1): 162-164.
Pablo Lardelli-Claret, Departamento de Medicina Preventiva y Salud P�blica, Facultad de Farmacia, Campus de Cartuja s/n, 18071 Granada, SPAIN; (email: lardelli@ugr.es).
The example of confounding described below is of potential interest both from a teaching perspective and in the field of epidemiological research on the risk of head injury in moped riders.
We took data from the Spanish Registry of Traffic Crashes with victims to study the strength of association between position of the rider on the moped (the driver or the passenger) and risk of head injury in all 187 353 moped riders involved in a traffic crash with victims between 1990 and 1999 in Spain, and for whom information about helmet use was available. In the crude analysis (Table), the frequency of head injury was similar for drivers and passengers; accordingly, the crude odds ratio (OR) for the association between being the driver and receiving a head injury was only 1.06. But when we stratified this estimate depending on helmet use, the corresponding values were considerably higher in both helmeted (1.40) and non-helmeted riders (1.41). As a result the OR estimate adjusted by helmet use (using unconditional logistic regression) was 1.41.
Careful assessment of the role of helmet use showed that this variable satisfied all three classical requirements for a confounder:
It is causally related with the effect: for both drivers and passengers, the risk of head injury was much higher for non-helmeted than for helmeted riders.
It is associated with exposure, in the absence of effect. The OR for the association between helmet use and being the driver of the moped was 2.61 in non-head-injured riders, a value similar to that obtained for head-injured riders (2.59).
It is not an intermediate step in the causal path between exposure and effect, as the strength of the association between being the driver of the moped and the risk of head injury was the same for helmeted as for non-helmeted riders.
Put simply, drivers of mopeds are at an intrinsically higher risk of suffering head injury than are passengers, but this increase is masked (confounded) by helmet use, because helmets (a device which strongly reduces the risk of head injury) are more frequently used by drivers than by passengers.
We have found no studies of the risk of head injury in moped riders that took this possible source of confusion into account. It is disappointing that we must usually resort to hypothetical data to teach our students how a confounding factor operates. For these reasons we hope that the real data presented in this letter will be useful for both teaching and research purposes.
- Little DC, Vermillion JM, Dikis EJ, Little RJ, Custer MD, Cooney DR. J Pediatr Surg 2003; 38(5): 804-807.
Texas A & M University System Health Science Center, Scott and White Memorial Hospital, and Scott, Sherwood and Brindley Foundation, Temple, TX, USA; (email: unavailable).
CONTEXT: 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.
In elementary schools, the prevalence of bullying ranges from 11.3% in Finland to 49.8% in Ireland. The only United States study of elementary students found that 19% were bullied. Bullying behavior declines as students progress through the grades. School bullying is associated with numerous physical, mental, and social detriments. A relationship also exists between student bullying behavior and school issues such as academic achievement, school bonding, and absenteeism. Prevention of school bullying should become a priority issue for schools. The most effective methods of bullying reduction involve a whole school approach. This method includes assessing the problem, planning school conference days, providing better supervision at recess, forming a bullying prevention coordinating group, encouraging parent-teacher meetings, establishing classroom rules against bullying, holding classroom meetings about bullying, requiring talks with the bullies and victims, and scheduling talks with the parents of involved students. Finally, this review suggests further studies needed to help ameliorate the bullying problem in US schools.
CONTEXT: Slovenia has been experiencing a very high suicide rate (30 per 10,000 inhabitants per year or higher) and there are no data on public attitudes towards suicide in Slovenia.
OBJRCTIVES: To identify public attitudes towards suicide in order to expand the basis for prevention.
METHODS: A Suicide Attitudes Questionnaire (SUIATT) was sent to a representative sample of adult Slovenian citizens.
FINDINGS: Some 5.2% of respondents had at least one previous suicidal attempt and 21.6% reported suicidal ideation (SI). More respondents with SI than respondents without SI reported: 1) the suicidal act as deliberated, 2) less importance attached to the mental illness in suicidal behaviour, 3) that a person has the right to commit suicide, and 4) the suicidal act as an act of cowardice.
DISCUSSION: Results do not allow a general statement whether attitudes towards suicide are permissive or restrictive. However, in the subgroup of respondents with SI we found a tendency towards permissiveness regarding suicide.
The need for improved operational definition of suicide attempts: illustrations from the case of street youth.
The use of inadequate operational definitions of suicidal behavior is often a limitation of suicide research. In this article, the results of an exploratory qualitative study of street youth suicidality is contrasted with the existing literature to highlight the problems associated with defining suicidal behaviors. It is argued through the use of the case example of street youth that accurate and detailed assessment of suicidal history, context, and intent is necessary to avoid substantial threats to the validity and clinical use of research findings.
Suicide mortality: gender and socioeconomic differences
OBJECTIVES: To describe suicide mortality trend and sociodemographic patterns identifying gender and socioeconomic differences.
METHODS: The trend of crude rates of suicide mortality by sex in the city of Campinas, Brazil, for the period 1976-2001 was assessed. Data from the Mortality Registry were used for sociodemographic analyses in the period 1996-2001. An ecological approach was used to examine socioeconomic differences and the 42 city areas of health care units were classified into 4 homogeneous strata. Rates were age-adjusted using direct method.
FINDINGS: The city has a low suicide rate (less than 5/100,000) in comparison with other countries. Male excess mortality was over 2.7 male suicides for each female suicide. While in 1980-1985 the older group (55 years and older) had the highest suicide rates, in 1997-2001 the middle-aged adult group (35-54 years old) showed the highest ones. As for suicide methods, men used hanging (36.4%) and firearms (31.8%), while women used poisoning (24.2%) and firearms and hanging (21.2% each). Hangings led to death at home, while firearms or poisoning deaths took place more often in hospitals. Suicide is different from homicide in that there is no rate increase with lower socioeconomic level.
DISCUSSION: Suicide rates are low with successive increments and decrements without consistent growing or lowering trends. The risk of dying by suicide is higher among men and does not increase with lower socioeconomic condition.
Suicidal behaviours among adolescents in northern Nova Scotia.
- Wang J, Hughes J, Murphy GT, Rigby JA, Langille DB. Can J Public Health 2003; 94(3): 207-211.
OBJECTIVES: To estimate the 12-month prevalence of suicidal behaviours by gender and to investigate the gender-specific factors associated with suicidal behaviours and to describe health service utilization by suicidal adolescents.
METHODS: This was a cross-sectional study. The baseline data of the Adolescent Health Study conducted in northern Nova Scotia were used.
FINDINGS: Female students were more likely to report suicidal behaviours than male students (p < 0.005). There was no gender difference in injurious suicide attempts. Depression was the strongest risk factor for suicidal behaviours in the two genders (p < 0.005). Female students who reported drug use and living in a non-intact family were at higher risk of suicide attempts. Low self-esteem was positively associated with suicidal ideation and suicide planning among male students. Suicidal girls were more likely to seek professional help for emotional disturbance than boys. Family doctors were the most frequently contacted professional by suicidal adolescents.
DISCUSSION: Some factors associated with suicidal behaviours among adolescents may be gender specific. Suicidal behaviours have been considered a depressive symptom. Most suicidal students, however, had not contacted a health professional for an emotional problem in this population. This presents challenges for prevention of suicidal behaviours among adolescents.
Recent trends in elderly suicide rates in a multi-ethnic Asian city.
CONTEXT: There are a few reports on the trends of elderly suicide rates in western countries but none from Asian countries.
OBJECTIVES: To describe the trends of elderly suicide rates of Chinese, Malays and Indians in Singapore from 1991 to 2000.
METHODS: Data obtained from the National Department of Statistics were used in the analysis of sex- and age-standardized suicide rates and relative risks.
FINDINGS: Overall, the suicide rates for the elderly showed a decline from 40.1 per 100,000 in 1990 to 17.8 per 100,000 in 2000, with the most pronounced decline occurring from 1995 to 2000. The suicide rate for elderly Chinese was at a peak of 52 per 100,000 in 1995 and declined to 20 per 100,000 in 2000. The rates for elderly Malays were consistently low at 2.2 per 100,000 for the 10 years; for elderly Indians the rates were between the other two ethnic groups.
DISCUSSION: In the 10-year period, the elderly suicide rates in Singapore declined markedly, especially for elderly Chinese.
Correlates of youth suicide attempters in Australian community and clinical samples.
Correspondence: Gregory L. Carter, Department of Consultation-Liaison -Psychiatry, Newcastle Mater Hospital, Edith Street, Waratah, 2298, New South Wales, AUSTRALIA; (email: carter@mail.newcastle.edu.au).
OBJECTIVES: This study (i) explores differences between a clinical sample of deliberate self-poisoning (DSP) patients and a community sample who reported previous attempted suicide (AS); and (ii) examines correlates of suicidal behaviour in these groups compared with a community control group (CC) with no suicidal behaviour.
METHODS: The study design was: case-case, case-control and cross-sectional population studies. A clinical sample of DSP (n = 51), a community sample of AS (n = 31) and a community sample with no suicidal behaviour (n = 842) were used, all aged 18-24 years. The DSP and AS groups were compared on several variables and two logistic regression models were developed for risk of (i) DSP and (ii) AS compared to community controls.
FINDINGS: The adjusted odds ratios for DSP were: female gender (OR = 5.7, CI = 1.7-19.4), anxiety (OR = 7.4, CI = 2.2-25.1), affective (OR = 23.0, CI = 6.9-76.5), or substance-use disorder (OR = 19.2, CI = 5.6-65.4) and greater mental health related disability (OR = 0.5, CI = 0.3-0.7 for 1 SD decrease). For AS the results were: anxiety (OR = 9.4, CI = 1.7-52.8) or substance-use disorder (OR = 3.0, CI = 1.1-8.7) and greater mental health disability (OR = 0.5, CI = 0.4-0.7). Affective disorder was close to significant for the AS group (OR = 4.0, CI = 0.9-17.1).
DISCUSSION: Correlates of DSP/AS were usually more powerful in the clinical group, but showed a similar pattern of psychiatric disorder and disability factors in both groups, supporting a continuum of risk factors across these groups. Interventions based on modifiable risk factors could target the same factors for public health, primary care or hospital populations: anxiety, depression and substance use disorders and mental health related disability.
Patient characteristics associated with nonprescription drug use in intentional overdose.
- Lo A, Shalansky S, Leung M, Hollander Y, Raboud J. Can J Psychiatry 2003; 48(4): 232-236.
Correspondence: Andre Lo, Department of Pharmacy, St Paul's Hospital, Providence Health Care, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, CANADA; (email: alo2@providencehealth.bc.ca).
OBJECTIVES: Over-the-counter (OTC) medications remain freely available to suicidal patients, despite their potential lethality and common use in suicide. The study's main objective was to identify patient characteristics, particularly psychiatric diagnosis associated with the use of OTC medications in intentional overdose.
METHODS: We retrospectively reviewed 95 charts from patients who presented to St Paul's Hospital from August 1, 1997, to July 31, 1998, with a discharge diagnosis of intentional drug overdose. Univariate analysis was carried out to identify potential risk markers for OTC medication use, and logistic regression was performed using these variables.
FINDINGS: When the variables age, sex, and concurrent psychiatric diagnoses were controlled, use of OTC medications in overdose was significantly lower in patients with a DSM-IV diagnosis of substance abuse (OR 0.11, P = 0.005) and in those who possessed prescription medications at the time of overdose (OR 0.18, P = 0.007). Most patients in this cohort (82%) had at least 1 of these 2 traits. Although not statistically significant, younger patients appeared more likely to choose OTC medications for overdose.
DISCUSSION: Suicide-prone patients with a diagnosis of substance abuse and who possess prescription medications are unlikely to use OTC medications in overdose. For this cohort, this represents a relatively small proportion of patients whom clinicians should consider to be at greater risk for attempting suicide when using OTC medication, especially acetaminophen.
OBJECTIVES: This study was undertaken to evaluate the risk of eye injury in motor vehicle accidents in which airbags deploy. An attempt was made to assess the possible associations between eye injuries and eyewear in these accidents. DESIGN: Retrospective observational case series and literature review with analysis.
PARTICIPANTS/METHODS: We conducted a literature review of 62 case reports and articles describing 110 adult cases of eye injury after deployment of an airbag and examined two Finnish accident cohorts. The fatal accident series (FAS; fatal injuries with one or more cars involved) included 121 individuals sitting behind an airbag that deployed (65 survivors), and the Airbag study (AB; nonfatal, relatively serious accidents) included 210 individuals (survivors).
MAIN OUTCOME MEASURES: The type of eye injury, eyewear, and crash dynamics were studied in each of the reviewed case reports. The fatal accident series and AB studies were analyzed to disclose the eye injuries and use of eyewear and to estimate their possible relation to deployment of airbags.
FINDINGS: Analysis of the published reports revealed that airbag-induced eye injuries were not more frequently reported among wearers of eyeglasses than among nonwearers. However, open-eye injuries were reported three times more often among eyeglass wearers (P = 0.04), whereas all injuries from airbag chemicals occurred among nonwearers. With the exception of one orbital fracture with hyphema, all eye traumas (n = 7) in the FAS and AB cohorts were mild (eyebrow laceration, lid contusion, bruising). The risk of airbag-related eye injury was 2.5% for any eye injury and 0.4% for severe eye injury. In single accidents when seat belts were used, the risks were 2.0% and 0.5%, respectively. In the accidents from the FAS data no difference was observed in the risk for eye injury between survivors in incidents involving airbag deployment and incidents not involving airbags. This risk was not found to be greater among eyeglass wearers.
DISCUSSION: Despite reported cases in the literature, we found that the risk of severe eye injury from airbags was very low (0.4%) in fatal or relatively serious accidents. Eyewear did not seem to increase this risk but might interfere with the injury pattern.
How to modify the risk-taking behaviour of emergency medical services drivers?
- De Graeve K, Deroo KF, Calle PA, Vanhaute OA, Buylaert WA. Eur J Emerg Med 2003; 10(2): 111-116.
Paul A. Calle, University Hospital, Department of Emergency Medicine, De Pintelaan 185, B-9000 Ghent, Belgium (email: paul.calle@rug.ac.be).
High speed and an aggressive style of driving are major risk factors for serious traffic accidents. Consequently, frontline emergency medical services vehicles have an increased collision risk. We report on two studies designed to modify the risk-taking behaviour of emergency medical services drivers. In the first study, we compared the travel intervals for a second tier unit using two different types of vehicles. We found that the replacement of a sports estate by an ambulance, which can be considered more or less as a change from a speedy and aggressive style of driving to a cautious style of driving with respect for the speed limits, resulted in an increase of the travel interval of only 10-20%. In the second study we found that the installation of a 'black box' in an emergency medical services vehicle, combined with well-defined guidelines for the drivers and a close monitoring system, provides fair but still not optimal results with regard to maximum speed and the occurrence of harsh braking events. Despite some limitations in the study designs, we conclude that for second tier units only a small amount of time is gained by high speed and an aggressive style of driving. Furthermore, we are convinced that a 'black box' is a good tool to modify the risk-taking behaviour of emergency medical services drivers.
Helmet use by motorcyclists injured in traffic accidents in Londrina, southern Brazil.
- Liberatti CL, de Andrade SM, Soares DA, Matsuo T. Rev Panam Salud Publica 2003; 13(1): 33-38.
Artigo baseado em dissertacao de mestrado apresentada ao Programa de Pos-Graduacao em Saude Coletiva, Universidade Estadual de Londrina (PR), BRAZIL; (email: unavailable).
OBJECTIVE: To describe helmet use among motorcyclists injured in traffic accidents in Londrina, a medium-sized city in Parana, a state in southern Brazil, and to identify factors associated with not wearing a helmet at the time of the accident.
METHODS: We analyzed data concerning motorcycle users (drivers and passengers) who received care in 1998 from the only pre-hospitalization trauma and emergency care ambulance service in Londrina. The following variables were assessed: helmet use at the time of the accident; age; sex; seating position (driver or passenger); smell of alcohol on the breath; time of the day, day of the week, and month when the accident happened; and location of the accident (in the downtown area or outside of it).
FINDINGS: The average rate of helmet use was 63.2%. Factors independently associated with not using a helmet were (according to strength of association): being younger than 18 years of age (odds ratio (OR) = 6.61), having alcohol on the breath (OR = 3.93), accident occurring at night (OR = 2.51), accident happening outside the city's downtown area (OR = 2.27), and accident taking placing during the weekend (OR = 2.25).
DISCUSSION: It is imperative to implement public policies aimed at promoting safety for motorcyclists, ongoing education in defensive driving, and the use of helmets and other safety equipment. Interventions should take into account that driving behaviors depend not just on individuals but also on the overall social and historical context.
Experimental injury study of children seated behind collapsing front seats in rear impacts.
- Saczalski KJ, Sances A Jr, Kumaresan S, Burton JL, Lewis PR Jr. Biomed Sci Instrum 2003; 39: 259-265.
Correspondence: K.J. Saczalski, Environmental Research & Safety Technologists, Inc., Newport Beach, CA, USA; (email: unavailable).
CONTEXT:In the mid 1990's the U.S. Department of Transportation made recommendations to place children and infants into the rear seating areas of motor vehicles to avoid front seat airbag induced injuries and fatalities. In most rear-impacts, however, the adult occupied front seats will collapse into the rear occupant area and pose another potentially serious injury hazard to the rear-seated children.
METHODS: Since rear-impacts involve a wide range of speeds, impact severity, and various sizes of adults in collapsing front seats, a multi-variable experimental method was employed in conjunction with a multi-level "factorial analysis" technique to study injury potential of rear-seated children. Various sizes of Hybrid III adult surrogates, seated in a "typical" average strength collapsing type of front seat, and a three-year-old Hybrid III child surrogate, seated on a built-in booster seat located directly behind the front adult occupant, were tested at various impact severity levels in a popular "minivan" sled-buck test set up. A total of five test configurations were utilized in this study. Three levels of velocity changes ranging from 22.5 to 42.5 kph were used. The average of peak accelerations on the sled-buck tests ranged from approximately 8.2 G's up to about 11.1 G's, with absolute peak values of just over 14 G's at the higher velocity change. The parameters of the test configuration enabled the experimental data to be combined into a polynomial "injury" function of the two primary independent variables (i.e. front seat adult occupant weight and velocity change) so that the "likelihood" of rear child "injury potential" could be determined over a wide range of the key parameters.The experimentally derived head injury data was used to obtain a preliminary HIC (Head Injury Criteria) polynomial fit at the 900 level for the rear-seated child.
FINDINGS: Several actual accident cases were compared with the preliminary polynomial fit.
DISCUSSION: This study provides a test efficient, multi-variable, method to compare the injury biomechanical data with actual accident cases.
Biomedical engineering analysis of glass impact injuries.
- Sances A Jr, Carlin FH, Kumaresan S, Enz B. Crit Rev Biomed Eng 2002; 30(4-6): 345-377.
Correspondence: Anthony Sances, Jr., Biomechanics Institute Santa Barbara, California 93109, USA; (email: biocal@gte.net).
This article outlines the history, development, and safety aspects of glass and its use in motor vehicles. It traces the manufacture and describes the characteristics of laminated and tempered glass. It further compares the differences in injuries caused by impact with laminated and tempered glass. The development, use, and results of high penetration resistance (HPR) laminated glass for windshields are examined. Head and neck injuries from impact with glass and glazing structures are delineated. Results of studies with laminated and tempered glass are presented. The probability and severity of injuries occurring secondary to partial or full ejection of vehicle occupants are discussed, and the differences between the performance of laminated and tempered glass are highlighted. Current research to quantify head and neck injury parameters caused by glass impact during rollover is described. The biomechanics of head and neck injury assessment and the development of injury prediction parameters and reference values, respectively, are reviewed.
OBJECTIVES: 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.
A radio-based approach to promoting gun safety: process and outcome evaluation implications and insights.
Three radio public service announcements (PSA) were created to increase knowledge of 10 gun-safety practices in a mid-Michigan county. Concurrently, a direct-mail coupon highlighting the same gun-safety practices was disseminated to over 70,000 households in the same county. Results of a telephone survey indicate that, compared to unexposed individuals, those who were exposed to the PSA were able to name significantly more gun-safety practices. Specifically, significant differences between those exposed to the PSA versus those not exposed were found for 5 gun-safety practices, as well as for a 4-item index measuring gun locking and storage behaviors, and a 9-item index that included all gun-safety practices.
Guns and dolls: an exploration of violent behavior in girls.
Pam DiNapoli, Department of Nursing, School of Health of and Human Services, University of New Hampshire, Durbam, NH 03824, USA; (email: ppdn@cisunix.unh.edu).
As demonstrated by several studies, there is an increase in levels of female violence.This study attempts to more fully understand the increasing phenomenon of violence in girls by exploring motivations to engage in violent behavior. The hypothesis that a girl's perceived sense of competence is influenced by social and environmental variables that motivate her to engage in violent behavior is tested. Research studies of female adolescent violence have focused on the study of risk factors predisposing the individual to violent behavior. This study uses a health behavior framework (C.L. Cox, Advances in Nursing Science, October 1982, 41-56) to explore the links between perceived sense of competence and both the risk and protective factors that motivate girls to act violently.
Secular trends in self-reported violent activity among Ontario students, 1983-2001.
Centre for Addiction and Mental Health, Population and Life Course Studies, Toronto, ON, CANADA; (email: angela_paglia@camh.net).
(Copyright 2003, Canadian Public Health Association)
OBJECTIVES: This paper examines secular trends in violence among Ontario students between 1983 and 2001, and variation by sex.
METHODS: Using data from the Ontario Student Drug Use Survey, we examined self-reports of assault, weapon carrying, and gang fighting based on 10 cross-sectional surveys from 1983 to 2001. Respondents were derived from representative samples of Ontario students in grades 7, 9, 11, and 13 (OAC) who completed in-class anonymous self-administered surveys. Data were weighted to account for the complex survey design and analyzed using logit trend analyses.
FINDINGS: Short-term trends (1991-2001) showed assault, weapon carrying, and gang fighting have been on downward trajectories since the mid-1990s, reaching the lowest prevalence in 2001 among males and females. Long-term trends (1983-2001) among 11th-graders showed assault increased between 1985 and 1999, but declined in 2001. Gang fighting among males increased during the late 1980s and again during the mid-1990s, but declined between 1997 and 2001. Gang fighting among females remained at a stable, low level.
DISCUSSION: Future monitoring is necessary to understand whether the decline in self-reported violent behaviour among adolescents is robust.
Self-reported delinquency among Alberta's youth: findings from a survey of 2,001 junior and senior high school students.
Canadian Research Institute for Law and the Family, c/o Faculty of Law, University of Calgary, 2500 University Drive N.W., Calgary, Alberta, Canada T2N 1N4, CANADA; (email: jtgomes@ucalgary.ca).
This article draws on data from a 1999 survey on youth victimization, crime and delinquency in Alberta conducted by the Canadian Research Institute for Law and the Family in collaboration with researchers from the University of Alberta. The survey included 2,001 youth attending Grades 7 to 12 in public and Catholic schools in selected urban and rural areas in the province. Analyses focus on self-reported past-year delinquency. Statistically significant results were found for relationships between extent of delinquency and gender, grade level, psychosocial problems (as measured by conduct, hyperactivity, and emotional problems), and extent of past-year victimization. For low/moderate delinquency, females were comparable to males, and even reported slightly higher rates for low/moderate violence-related delinquency. Younger students were more likely to indicate engaging in violence-related delinquency, while older students were more likely to report property-related delinquent acts. Overall, Grade 9 students had the highest rates of delinquency. For personal characteristics, a high score on conduct problems was most strongly correlated with moderate/high delinquency. The relationship between high levels of delinquency and victimization was stronger for violence-related delinquency than for property-related delinquency.
