Correspondence: Ole-J�rgen Skog, Centre for Advanced Study, The Norwegian Academy of Science and Letters, Drammensveien 10, 0271 Oslo, NORWAY; (email: o.j.skog@sosiologi.uio.no).
OBJECTIVES: To evaluate the effects of changes in aggregate alcohol consumption on overall fatal accidents, motor vehicle accidents, fatal falling accidents and drowning accidents in Canadian provinces after 1950.
DESIGN: Time-series analysis of annual mortality rates (15-69 years) in relation to per capita alcohol consumption, utilizing the Box-Jenkins technique. All series were differenced to remove long-term trends.
MEASUREMENTS: Gender-specific and age-adjusted mortality rates for the age group 15-69 years were calculated on the basis of mortality data for 5-year age groups, using a standard population. Data on per capita alcohol consumption was converted to consumption per inhabitant 15 years and older. In the analysis of motor vehicle accidents, the number of motor vehicles was used as a control variable.
FINDINGS: Statistically significant associations between alcohol consumption and overall fatal accident rates were uncovered in all provinces for males, and in all provinces except Ontario for females. For Canada at large, an increase in per capita alcohol consumption of 1 litre was accompanied by an increase in accident mortality of 5.9 among males and 1.9 among females per 100 000 inhabitants. Among males there was a significant association with alcohol for both falling accidents, motor vehicle accident and other accidents, but the association was insignificant for drowning accidents. Among females, the association with falling accidents and other accidents was significant.
DISCUSSION: Changes in alcohol consumption have had substantial effects on most of the main types of fatal accidents in Canada during the second half of the 20th century. The size of the association is comparable to the one previously reported from Northern Europe.
Coping and adjustment strategies used by emergency services staff after traumatic incidents: Implications for psychological debriefing, reconstructed early intervention and psychological first aid.
- �rner RJ, King S, Avery A, Bretherton R, Stolz P, Ormerod J. Australas J Disaster Trauma Stud 2003, 2003-1 (online journal: Full text available free online HERE)
Correspondence: R. J. �rner, Lincoln District Healthcare NHS Trust, UK. (email: rorner@cix.co.uk).
(Copyright 2003, R. J. �rner, S. King, A. Avery, R. Bretherton, P. Stolz and J. Ormerod. Published by Australasian Journal of Disaster and Trauma Studies at Massey University.)
This survey reports few points of convergence between post incident coping and adjustment strategies used by 217 experienced emergency services and the principles that inform delivery of debriefing services. Officers prefer immediate access to colleagues and those with whom they feel close. Most wish to talk freely and flexibly about events and prefer to be consulted about a possible need for early intervention. Cluster analysis identified five core components of deliberate coping strategies; wait and see, rest and relaxation, finding relief from somatosensory sequelae, re-establish routines and a sense of control, and graded confrontation with distressing reminders.
Validation of a home safety questionnaire used in a randomized controlled trial.
- Watson M, Kendrick D, Coupland C. Inj Prev 2003; 9(2): 180-183.
(All material published in Injury Prevention is available online at no cost.)
Correspondence: Michael Watson, Division of General Practice, University of Nottingham, Floor 13, Tower Building, University Park, Nottingham NG7 2RD, UK;
OBJECTIVE: To measure the validity of self reported safety practices from a questionnaire, completed by families participating in a home safety randomized controlled trial.
METHODS: The postal questionnaire was used to measure secondary outcomes in a randomized controlled trial. The answers to 26 questions that could be assessed by observation were checked by a home visit. Families were invited to take part in a "home safety check"; they were not told that the visit was part of a validation study. At the time of the visit the researcher was blind to the self reports in the questionnaires.
FINDINGS: Sixty four questionnaires were validated by visits to 64 households. Percentage agreement ranged from 58% to 100%. Sensitivity was high (68% or above) for most safety practices. The positive predictive value was also high for most safety practices (78% or above for 15 of the 16 practices).
DISCUSSION: This study found a fairly high degree of consistency between self reported data and actual observations. The findings from this relatively small study need confirmation from larger studies.
Evaluation of Safe Kids Week 2001: prevention of scald and burn injuries in young children.
OBJECTIVE: To evaluate Safe Kids Week 2001-a national public awareness campaign on scald and burn prevention-run by Safe Kids Canada. DESIGN: Random digit dial telephone survey.
METHODS: Setting- Canada. Subjects- Parents or guardians of children under 9 years. Two groups of parents were compared, those "exposed" to the campaign (defined as having "seen, heard, or read anything about scald and burn prevention during the period 28 May to 3 June 2001") and those "unexposed" to the campaign. Intervention- Burn safety information was disseminated via the media, 5000 retail stores, and 348 community partners across Canada. The campaign emphasized four key messages: (1) Lower your water temperature, hot tap water could burn your child! (2) Make sure your child is safe in the kitchen. (3) Keep hot drinks away from your child. (4) Check your smoke alarms regularly. Outcome Measures- Change in parental knowledge and behavior.
FINDINGS: A total of 29 871 telephone numbers were called, with a household refusal rate of 27%. Nationally, 14% of parents were exposed to the campaign and 504 parents were interviewed, 251 in the "exposed" group and 253 in the "unexposed" group. Parents exposed to Safe Kids Week 2001 were 1.5-5 times more likely to be aware of key campaign messages, and 2-3 times more likely to test and lower the water heater temperature, compared with unexposed parents.
DISCUSSION: Safe Kids Week 2001 reached a significant proportion of parents of young children. In addition, the campaign appeared to increase burn safety knowledge and lead to behavior changes among exposed parents, compared with unexposed parents.
A randomized trial of hip protector use by frail older women living in their own homes.
- Cameron ID, Cumming RG, Kurrle SE, Quine S, Lockwood K, Salkeld G, Finnegan T. Inj Prev 2003; 9(2): 138-141.
(All material published in Injury Prevention is available online at no cost.)
Correspondence: Ian Cameron, Rehabilitation Studies Unit, University of Sydney, P.O. Box 6, Ryde NSW 1680, AUSTRALIA;
(email: ianc@mail.usyd.edu.au).
OBJECTIVES: To investigate the efficacy and effectiveness of hip protectors in frail community living older women.
METHODS: Design- Randomized controlled trial. Setting- Aged care health services in New South Wales, Australia. Patients- 600 women 74 years of age or more (mean age 83 years), who had two or more falls or one fall requiring hospital admission in the previous year, and who lived in their own homes. Intervention- Use of hip protectors. Main Outcome Measures- Adherence with use of hip protectors, falls, incidence of hip fracture, and adverse effects of use of hip protectors.
FINDINGS: Adherence was approximately 53% over the duration of the study and hip protectors were worn at the time of 51% of falls in the intervention group. The risk of hip fracture when falling while wearing hip protectors, compared with a fall with no hip protectors in place, was significantly reduced (relative risk (RR) 0.23, 95% confidence interval (CI) 0.08 to 0.67). On an intention to treat analysis, 21 and 22 hip fractures occurred in the intervention and control groups respectively (adjusted RR 0.92, 95% CI 0.51 to 1.68). Three users of hip protectors sustained a hip fracture while wearing properly applied protectors, while 16 hip protector users (5%) developed minor local complications.
DISCUSSION: Hip protectors prevent hip fractures in community dwelling older women if worn at the time of a fall. The overall effectiveness of hip protectors was not established in this study, because of incomplete adherence with use of the protectors, and limited statistical power.
- Zhou Y, Baker TD, Rao K, Li G. Inj Prev 2003; 9(2): 124-127.
(All material published in Injury Prevention is available online at no cost.)
Correspondence: Timothy D Baker, Johns Hopkins University Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD 21205, USA; (email: tbaker@jhsph.edu).
OBJECTIVE: To examine the productivity losses and costs of injury and disease in China using an improved approach.
METHODS: Potentially productive years of life lost (PPYLL) were calculated for injury and four major disease groups (respiratory, cardiovascular, infectious, neoplastic). The mortality data are from the 1999 National Health Statistics Report and the morbidity data from the 1998 Second National Health Service Survey Report.
FINDINGS: Injuries caused an annual PPYLL of 12.6 million years, more than for any disease group. The estimated annual economic cost of injury is equivalent to US$12.5 billion, almost four times the total public health services budget of China. Motor vehicle fatalities accounted for 25% of the total PPYLL from all injury deaths.
DISCUSSION: Injury control and prevention programs merit priority to reflect the social and economic burden of injury in China.
Forklift Stability and Other Technical Safety Issues.
- Lambert, J. Report from the Accident Research Center, Monash University, Victoria, Australia, (April, 2003).
Full document (21 pages) is available online: ( Download Document ).
Correspondence: John Lambert, John Lambert & Associates Pty Ltd, 235 Wandana Drive, Wandana Heights, Victoria, 3216 AUSTRALIA; (email: lambertj235@bigpond.com).
Forklifts or industrial trucks are highly flexible and productive materials handling machines. However each year 100's of people are killed and 1000's seriously injured in forklift involved incidents world wide. The international standards for design of forklift trucks include requirements in relation to stability. The stability of forklifts has impacts on safety in respect of the likelihood of forward tipover and of side tipover, the maximum levels of braking that can be applied for any loading situation, and the maximum levels of rearward acceleration - too high a level will initiate forward tipover.
Testing, computer simulations and modeling was undertaken to quantify the limits to stability.
It was confirmed that forklifts designed to comply with Australian and ISO standards are inherently unstable. Operators have to moderate their braking, accelerating and other behaviors to compensate for this inherent instability. A more effective system from a safety point of view would be to design stability hazards out of the system.
Recommendations to reduce counterbalance forklift stability related risk in the workplace include: 1) continuing to work with the Standards Association to have Australian standards produced which provide a higher level of safety in respect of stability. For instance by requiring stability tests be undertaken under the worst case scenario; 2) having single tired forklifts speed limited to 8 km/h and dual tired forklifts to 9 km/h - except that where forklift manufacturers can provide stability figures and analysis to prove that empty forklifts are safe at higher speeds; 3) having manufacturers or others develop an intelligent speed limiter that reduces maximum speed depending on the load, its height, and the turning radius defined by the steering wheel position; 4) advising that pneumatic tires significantly erode safety margins in the dynamic situation; 5) requiring that small single drive tired forklifts be limited to lifts of around 4000 - 4500 mm, and small dual tired forklifts be limited to lifts of around 5000 - 5500 mm; 6) setting the maximum hydraulic pressure in the mast cylinders of each forklift to about 110% of the rated load at full height with the mast vertical; and 7) requiring forklifts have a system to prevent full forward tilt above about 1600 - 2000 mm lift. Alternately proof would be needed that changes to forklift design and/ or rating had overcome the stability issues the initiatives above aim to address. Further work will be required to determine the degree to which deaths and injuries will be reduced. Elimination of tipovers would reduce fatalities by 20% with no other changes to forklift operations.
Risk compensation theory and voluntary helmet use by cyclists in Spain.
- Lardelli-Claret P, De Dios Luna-Del-Castillo J, Jimenez-Moleon JJ, Garcia-Martin M, Bueno-Cavanillas A, Galvez-Vargas R. Inj Prev 2003; 9(2): 128-132.
(All material published in Injury Prevention is available online at no cost.)
Correspondence: 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).
OBJECTIVE: To obtain empirical data that might support or refute the existence of a risk compensation mechanism in connection with voluntary helmet use by Spanish cyclists.
DESIGN: A retrospective case series.
SETTING: Spain, from 1990 to 1999.
SUBJECTS: All 22 814 cyclists involved in traffic crashes with victims, recorded in the Spanish Register of Traffic Crashes with Victims, for whom information regarding helmet use was available.
MAIN OUTCOME MEASURES: Crude and adjusted odds ratios for the relation between committing a traffic violation and using a helmet.
FINDINGS: Fifty four percent of the cyclists committed a traffic violation other than a speeding infraction. Committing a traffic violation was associated with a lower frequency of helmet use (adjusted odds ratio (aOR) 0.63, 95% confidence interval (CI) 0.58 to 0.69). Cycling at excessive or dangerous speed, a violation observed in 4.5% of the sample, was not significantly associated with helmet use either alone (aOR 0.95, 95% CI 0.56 to 1.61) or in combination with any other violation (aOR 0.97, 95% CI 0.79 to 1.20).
DISCUSSION: The results suggest that the subgroup of cyclists with a higher risk of suffering a traffic crash are also those in which the health consequences of the crash will probably be higher. Although the findings do not support the existence of a strong risk compensation mechanism among helmeted cyclists, this possibility cannot be ruled out.
Children's bicycle helmet use and injuries in Hillsborough County, Florida before and after helmet legislation.
- Liller KD, Nearns J, Cabrera M, Joly B, Noland V, McDermott R. Inj Prev 2003; 9(2): 177-179.
(All material published in Injury Prevention is available online at no cost.)
Correspondence: Karen DeSafey Liller, University of South Florida College of Public Health, 13201 Bruce B Downs Blvd, Tampa, FL 33612, USA; (email: kliller@hsc.usf.edu).
The purpose of this research was to explore the changes in children's bicycle helmet use and motor vehicle bicycle related injuries in Hillsborough County, Florida before and after passage of the Florida's bicycle helmet law for children under the age of 16. The results show a significant increase in bicycle helmet use among children, ages 5-13, in the post-law years compared with the pre-law years. Also, there has been a significant decline in the rates of bicycle related motor vehicle injuries among children in the post-law years compared with the pre-law years. Although there have been complementary educational and outreach activities in the county to support helmet use, it appears that the greatest increase in use occurred after the passage of the helmet law. It is recommended that educational efforts continue to sustain helmet use rates and decreases in injuries.
- Roldan J, Frauca C, Duenas A. An Sist Sanit Navar 2003; 26(Suppl 1): 129-139.
Correspondence: Jose Roldan, Servicio de Medicina Intensiva, Hospital de Navarra, Irunlarrea 3, 31008 Pamplona, SPAIN; (email: joseroldanetna@hotmail.com).
Alcohol intoxication is the principal drug addiction in many countries of the world. It affects all age groups, both sexes and almost all social groups. Mortality associated with acute alcohol poisoning on its own is exceptional, but it can be an important factor if it coexists with recreational drugs. It is directly responsible for more than half of traffic accidents. Diagnosis is easy by means of anamnesis and clinical examination, and can be confirmed by determining the level of ethanol in the bloodstream. Supportive care is the best therapy in order to protect the patient from secondary complications. Methanol, or alcohol fuel, is used as a solvent, and can also be found as an adulterant of alcoholic drinks. Poisoning by oral means is the most frequent. Oxidized in the liver through dehydrogenase enzyme alcohol, toxicity is due to its metabolites, formaldehyde and formic acid. The clinical picture basically consists of cephalea, nausea, vomiting, hypotension and depression of the central nervous system. The optic nerve is especially sensitive, with total and irreversible blindness as a possible result. Ethylenglicol is used as a solvent and as an antifreeze; toxicity is due to an accumulation of its metabolites. The clinical picture includes symptoms that are held in common with methylalcohol intoxication. Kidney failure due to tubular necrosis and the deposit of oxalate crystals can occur.
(All material published in Injury Prevention is available online at no cost.)
Correspondence: Judith M Conn, Office of Statistics and Programming, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Hwy (MS-K59), Atlanta, GA 30341-3724, USA; (email: jconn@cdc.gov).
OBJECTIVE: To characterize sports and recreation related (SR) injury episodes in the US population. SR activities are growing in popularity suggesting the need for increased awareness of SR injuries as a public health concern for physically active persons of all ages in the US population.
METHODS: Medically attended injury events reported in the 1997-99 Injury Section of the National Health Interview Survey (NHIS), a face-to-face household survey conducted yearly by the National Center for Health Statistics, were categorized according to the associated sport or recreational activity using a classification scheme based on the International Classification of External Causes of Injury system. Episodes where the injured person received any type of medical attention (that is, medical advice or treatment) from any health care provider were used to report the incidence, severity, and nature of SR injuries sustained by US citizens.
FINDINGS: Annually, an estimated seven million Americans received medical attention for SR injuries (25.9 injury episodes per 1000 population). For 5-24 year olds, this national estimate was about 42% higher than estimates based on SR injuries seen only in emergency departments over a similar time frame. The highest average annual SR injury episode rates were for children ages 5-14 years (59.3 per 1000 persons) and persons aged 15-24 years (56.4 per 1000 persons). The SR injury episode rate for males was more than twice the rate for females. The age adjusted injury rate for whites was 1.5 times higher than for blacks (28.8 v 19.0 per 1000 population). Basketball was the most frequently mentioned SR activity when the injury episode occurred, with a rate of about four injury events per 1000 population. Strains and sprains accounted for 31% of injury episodes. An estimated 1.1 million SR episode related injuries involve the head or neck region, of which 17% were internal head injuries. The most common mechanisms of injury were struck by/against (34%), fall (28%), and overexertion (13%).
DISCUSSION: As physical activity continues to be promoted as part of a healthy lifestyle, SR injuries are becoming an important public health concern for both children and adults. Prevention efforts aimed at reducing SR injuries through targeting high risk activities, places of occurrence, activity, risk behaviors, and use of protective devices need to go beyond focusing on children and also consider physically active adults.
Characteristics of drowning by different age groups.
- Quan L, Cummings P. Inj Prev 2003; 9(2): 163-168.
(All material published in Injury Prevention is available online at no cost.)
Correspondence: Linda Quan, Emergency Services CH04, Children's Hospital and Regional Medical Center, 4800 Sand Point Way NE, Seattle, WA 90105, USA; (email: Linda.quan@seattlechildrens.org).
CONTEXT: While it is known that the risk of unintentional drowning varies with age, the manner in which drowning episode characteristics vary by age has not been well described. Such information might be useful for prevention. OBJECTIVE: To describe characteristics of drowning by age group.
METHODS: Design- Retrospective review of the characteristics of drowning victims and their drowning incidents obtained from death certificates, medical examiner, pre-hospital, emergency department, and hospital records. Setting- Three counties in Western Washington state. Subjects- Residents who died (n=709) of unintentional drowning within the study region during 1980 through 1995. Outcomes- Age specific counts, proportions, and rates per million person years were estimated for and compared among six age groups.
FINDINGS: Rates varied by age group: 0-4 (30.5), 5-14 (11.6), 15-19 (29.9), 20-34 (21.5), 35-64 (12.5), and 65 years or older (21.2). Among those 0-4 years, the proportions that drowned in pools, bathtubs, and open water were nearly equal. But from age 5-64 years, over 69% of deaths were in open water. Among those 65 years and older, the deaths were almost evenly divided between bathtub and open water; bathtub drowning rates were highest in this age group, 10.9. Pre-drowning activities were divided into boating, swimming, car passenger, bathing, and fell in while doing something else. Most (64/89, 76%) victims aged 0-4 years drowned while bathing or after falling in. Among those 15-19 years, most occurred while swimming (24/79, 34%) or boating (22/79, 31%). The drowning event was least often witnessed among those 0-4 years (10/36, 28%), and most often witnessed (44/58, 76%) among those 15-19 years. Medical care (pre-hospital, emergency department, or hospital) was most often involved in drownings of those 0-4 years (70/89, 79%) and least among those over 65 years (11/86, 13%).
DISCUSSION: The characteristics of drowning episodes vary greatly by age. Different prevention strategies may be needed for different age groups.
Injury registration in a developing country. A study based on patients' records from four hospitals in Dar es Salaam, Tanzania.
- Mutasingwa DR, Aaro LE. Cent Afr J Med 2001; 47(8): 203-209.
Correspondence: D.R. Mutsaingwa, Department of Community Health Sciences, Faculty of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta, T2N 4N1, CANADA; (donatusm@hotmail.com).
CONTEXT: A recent study conducted in some parts of Tanzania has revealed that injuries rank as the third major leading cause of death among the adult population only after tuberculosis and HIV/AIDS. Critical to any injury prevention activities is a reliable surveillance system. Such a system may for instance be based on hospital registration of injuries.
OBJECTIVES: The aim of this study was to evaluate available hospital records for the purpose of describing the epidemiology of injuries among inpatients in four hospitals in Dar es Salaam, Tanzania.
METHODS: The study utilized patients' medical records for the year 1998. The final sample included 1098 cases from four hospitals. Data handling and analysis was performed using statistical software SPSS for windows version 10.0. Cross tabulations with Chi-square testing for independence, t-test for difference between means (independent groups) and one way analysis of variance was used.
FINDINGS: The age group 21 to 30 years formed the largest proportion of injury-related admissions. The male to female ratio was 2.3 to 1. The largest categories of injuries were road traffic injuries (43.7%), violence and assaults (23.5%), and falls (13.8%). Burns accounted for 6.5% of the cases. The following variables were routinely recorded in case notes: gender (100%), nature of injury/principal diagnosis (99.6%), body part injured (99.4%), and age (96.4%). CONCLUSIONS: There is a need for improving the way injuries are recorded in hospitals. Hospitals' records could provide a useful tool for monitoring injury preventive activities in developing countries like Tanzania.
Trauma system evaluation using the fatality analysis reporting system.
- Clark DE, Mullins RJ. J Trauma 2003; 54(6): 1199-1204.
Correspondence: David E. Clark, 887 Congress Street, Suite 210, Portland, ME 04102, USA; (email: clarkd@mmc.org).
CONTEXT: The Fatality Analysis Reporting System (FARS) has recorded detailed data on fatal traffic crashes since 1975. At least three prior studies have used declining mortality rates derived from FARS as evidence of regional trauma system effectiveness.
METHODS:FARS and census data were obtained at no cost through the Internet. Previously published studies were replicated graphically including data from additional years before and after the previously reported time periods, and with rates also calculated for control populations.
FINDINGS: The association of trauma system organization with observed decreases in mortality rates was less convincing when all available data were displayed and other potential factors were considered. Death after traffic crashes, and especially death in hospitals, is becoming less frequent throughout the country.
DISCUSSION: FARS is an excellent resource available to all injury researchers, but provides little evidence that some regions have decreased traffic mortality more than others because of trauma systems.
A new approach to the analysis of multiple injuries using data from a national trauma registry.
- Aharonson-Daniel L, Boyko V, Ziv A, Avitzour M, Peleg K. Inj Prev 2003; 9(2): 156-162.
(All material published in Injury Prevention is available online at no cost.)
Correspondence: Limor Aharonson-Daniel, Israel National Center for Trauma and Emergency Medicine Research, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, ISRAEL 52621; (email:
limorad@gertner.health.gov.il).
OBJECTIVE: To present a new systematic approach for summarizing multiple injury diagnosis data into patient injury profiles.
METHODS: Design- International Classification of Diseases, ninth revision, clinical modification injury diagnosis codes were classified using a modification of the Barell body region by nature of injury diagnosis matrix, then grouped by body region, injury nature, or a combination of both. Profiles were built which describe patients' injury combinations based on matrix units, enabling the analysis of patients, and not only the study of injuries. Setting- The Israeli national trauma registry was used to retrieve patient demographic data, injury details, and information on treatment and outcome. Patients or subjects: All hospitalized patients injured in road traffic accidents and included in the trauma registry from January 1997 to December 2000 were included. Main Outcome Measures- Patient profiles consisting of body regions, injury natures, their combination, and their clinical outcomes.
FINDINGS: The study population comprised 17 459 patients. Head and neck injuries were the most frequent in all subpopulations except for motorcyclists who sustained most injuries in the extremities. Fractures were the most common injury nature (60%). Pedestrians and drivers had the highest proportion of multiple injuries in both profiles. Forty eight percent of the patients had a single cell profile. The most frequent conditions as a sole condition were extremity fractures (14%), internal injuries to the head (11%), and injuries of other nature to the torso (6%). Mortality, length of stay, and intensive care unit treatment varied dramatically between profiles and increased for multiple injury profiles. Inpatient death was an outcome for 3.3% overall; however, in patients with an internal injury to the head and torso, inpatient death rate was nine times higher, at 31%.
DISCUSSION: Profiles maintain information on body region and nature of injury. The use of injury profiles in describing the injured improves the understanding of case mix and can be useful for efficient staffing in multidisciplinary trauma teams and for various comparisons.
Regression to the mean: a threat to exercise science?
Correspondence: Roy Shephard, Department of Public Health Sciences, Faculty of Physical Education & Health, and Faculty of Medicine, University of Toronto, Toronto, Ontario, CANADA; (email: roy.shephard@utoronto.ca).
Regression to the mean (RTM) can bias any investigation where the response to treatment is classified relative to initial values for a given variable without the use of an appropriate control group. The phenomenon and resulting errors of interpretation have been recognized by clinicians in a number of disciplines. The causes of RTM include both intra-individual variance and measurement error. The magnitude of RTM can be estimated quite simply, given a knowledge of intra- and inter-individual variance. RTM can be avoided by using a fully controlled experimental design. Difficulties can also be minimized by making duplicate measurements prior to the experimental manipulation, the first measurement serving for classification, and the second (with randomly distributed variance) allowing an assessment of the response to treatment. Less satisfactorily, surrogate measurements (for example, plasma volume for maximal oxygen intake [V-dotO(2max)]) can assess the bias introduced by an initial non-random sorting of study participants. The impact of RTM on the design and interpretation of investigations has as yet received little consideration by exercise scientists and sports physicians. The response to training is often related to initial measurements of a dependent variable such as heart size, ST segmental depression, fitness or level of physical activity. In particular, analyses of this type have been adduced to support the belief that the response to aerobic training is inversely related to an individual's V-dotO(2max). In fact, RTM may account for a major part of this apparent relationship.
Routine narrative analysis as a screening tool to improve data quality.
- Jones SJ, Lyons RA. Inj Prev 2003; 9(2): 184-186.
(All material published in Injury Prevention is available online at no cost.)
Correspondence: Sarah Jones, Department of Epidemiology, Statistics and Public Health, University of Wales College of Medicine, Heath Park, Cardiff CF14 4XN, UK; (email: jonessj3@cardiff.ac.uk).
OBJECTIVES: To determine whether narrative information in emergency department surveillance systems can be systematically interrogated to improve our understanding of the causes of injury.
METHODS: Screening algorithms for location, intent, and activity were developed from structured analysis of narrative data from 98 999 records. The algorithms were then tested on a 50 000 record database containing entries in both of the two narrative fields. A proxy gold standard was defined as the total extract using both code and narrative. Sensitivity and specificity of the emergency department coding and narrative algorithms was calculated.
FINDINGS: The proportion of records carrying an informative emergency department code was higher in records containing narrative-the percentage of causes coded "not known" dropped by 28.3%. The sensitivity of coded data varied from 42% to 98 % and from 33% to 99% for narrative data. Narrative analysis increased the percentage of home injuries identified by 19%, assaults by 26%, and rugby injuries by 137%.
DISCUSSION: Using a small amount of narrative is a practical and effective means of developing more informative injury causation data in an emergency department based surveillance system. It allows for internal validation of the codes and for the identification of emerging hazards without adding more "tick boxes" or further burdening data entry clerks.
Correspondence: Demetrios Demetriades, MD, FACS, Department of Surgery, Healthcare Consultation Center, 1510 San Pablo Street, Suite 514, Los Angeles, CA 90033, USA; (email: demetria@hsc.usc.edu).
CONTEXT: Many aspects of pediatric trauma are considerably different from adult trauma. Very few studies have performed comprehensive comparisons between pediatric and adult pelvic fractures. The purpose of this study was to compare the incidence of pelvic fracture, the epidemiologic characteristics, type of associated abdominal injuries, and outcomes between pediatric (age </= 16 years) and adult (age > 16 years) patients.
METHODS: This was a trauma registry study that included all blunt trauma admissions at a Level I trauma center during an 8-year period. The incidence and severity of pelvic fractures, associated abdominal injuries, need for blood transfusion, and mortality in the two age groups were compared with the two-sided Fisher's exact test. Stepwise logistic regression analysis was used to identify independent risk factors for associated abdominal injuries in pelvic fractures in the two age groups.
FINDINGS: The incidence of pelvic fractures was 10.0% (1,450 of 14,568) in the adult group and 4.6% (95 of 2,062) in the pediatric group (p < 0.0001). In motor vehicle and pedestrian injuries, adults were twice as likely and in falls from heights > 15 ft seven times as likely as children to suffer pelvic fractures. However, age group was not a significant predictor of the severity of pelvic fracture. Only 9.5% of pediatric fractures and 8.8% of adult fractures had a pelvis Abbreviated Injury Scale (AIS) score >/= 4. The incidence of associated abdominal injuries was high but similar in the two age groups (16.7% in adults and 13.7% in children, p = 0.48). Motor vehicle crash, pelvis AIS score >/= 4, and fall from height > 15 ft were significant predictors of associated abdominal injuries in the adult but not the pediatric group. The incidence of associated gastrointestinal injuries was similar in the two age groups (5.3% in children and 3.3% in adults, p = 0.37). The incidence of solid organ injuries was nearly identical in both groups (11.6% in children and 11.5% in adults). The need for blood transfusions and angiographic intervention was not significantly different between the two age groups. Exsanguination because of bleeding related to the pelvic fracture was responsible or possibly responsible in 42 deaths (2.9%) in the adult group and no deaths in the pediatric group.
DISCUSSION: Pediatric trauma patients are significantly less likely than adults to suffer pelvic fractures, although the age group is not a significant risk factor for the severity of pelvic fracture. The incidence of associated abdominal injuries is high and similar in the two age groups. Motor vehicle crash, fall from a height, and pelvis AIS score >/= 4 were significant predictors of associated abdominal injuries in the adult but not the pediatric patients. The need for blood transfusion is similar in both groups irrespective of Injury Severity Score and pelvis AIS score. The mortality resulting from exsanguination related to pelvic fractures is very low, especially in pediatric patients.
Risk factors and characteristics of falls resulting in hip fracture in the elderly.
- Aizen E, Dranker N, Swartzman R, Michalak R. Isr Med Assoc J 2003; 5(5): 333-336.
Correspondence: E. Aizen, Dept. of Geriatrics, Fliman Geriatric Hospital, P.O. Box 2263, Haifa 31021, ISRAEL; (email: eaizen_il@yahoo.com).
CONTEXT: Risk factors for injurious falls among elderly people differ from those for falls in general. The characteristics of falls play an important role in determining the risk of hip fracture.
OBJECTIVE: To investigate the risk factors associated with the fall characteristics known to be associated with the majority of hip fractures, e.g., a lateral fall and a subsequent impact on the greater trochanter.
METHODS: In this 6 month prospective observational case-control study, 101 individuals aged 65 years and over hospitalized following a hip fracture were interviewed 7-14 days after the accident. Data were also obtained from medical records, focusing on known predisposing and situational risk factors for the fall. We compared the risk factors between two groups: patients who suffered a lateral fall and subsequent impact on the greater trochanter of the femur, and patients who suffered other types of falls.
FINDINGS: Only 51.5% of the hip fracture patients reported that they had fallen directly to the side. Apart from age, there were no significant differences between the groups in other factors studied. When considering both fall direction and the area that took the main impact, we found that the majority of patients (85%) reported having fallen onto the posterolateral aspect and/or a fall with an impact on the greater trochanter.
DISCUSSION: Our findings did not show differences (except for age) in the factors studied between the groups. This study suggests that both fall direction and the area that takes the main impact should be considered in the characteristics of falls that might cause a hip fracture. Characteristics associated with greatest fracture risk include a fall onto the posterolateral aspect and/or a fall with an impact on the greater trochanter. More studies are needed to evaluate potential risk factors associated with this type of injury.
Differential ranking of causes of fatal versus non-fatal injuries among US children.
(All material published in Injury Prevention is available online at no cost.)
Correspondence: Michael F Ballesteros, Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway, NE, Mailstop K-63, Atlanta, GA 30341, USA;
(email: mballesteros@cdc.gov).
(Published by BMJ Publishing Group)
OBJECTIVES: Leading causes of fatal and non-fatal injury among US children aged < 15 years were compared.
METHODS: A descriptive study was conducted using nationally representative data on injury related deaths (National Vital Statistics System) and on non-fatal injury related emergency department visits (IEDV; National Electronic Injury Surveillance System-All Injury Program). Data were accessed using a publicly available web based system.
FINDINGS: Annually, an estimated 7 100 000 pediatric IEDV and 7400 injury deaths occurred. The overall non-fatal to fatal ratio (NF:F) was 966 IEDV:1 death. Among deaths, the leading causes were motor vehicle traffic occupants (n = 1700; NF:F = 150:1), suffocations (n = 1037; NF:F = 14:1), and drownings (n = 971, NF:F = 6:1). Among non-fatal injuries, falls (estimated 2 400 000) and struck by/against (estimated 1 800 000) were the most common causes, but substantially less lethal (NF:F = 19 000:1 and 15 000:1, respectively).
DISCUSSION: The leading causes of pediatric fatal and non-fatal injuries differed substantially. This study indicates the need for consideration of common causes of non-fatal injury, especially falls.
Changes in postural stability in women aged 20 to 80 years.
CONTEXT: A study of postural stability was undertaken to identify the relationship between vision and support surface across age decades. Understanding when reliance on vision for postural stability emerges and the support conditions contributing to this instability may provide the evidence required to introduce falls-prevention strategies in younger age decades.
METHODS: We measured postural stability in 453 women aged 20 to 80 years using the Balance Master force-plate system while the women performed the modified Clinical Test for the Sensory Interaction and Balance (firm and foam surfaces, eyes open and closed) and the Single-Limb Stance Test (eyes open and closed).
FINDINGS: Women in their 60s and 70s were more unstable than younger women in bilateral stance on a firm surface with the eyes closed. This instability was evident from the 50s when a foam surface was introduced and from the 40s when single-limb stance was tested with eyes closed. A further decline in stability was demonstrated for each subsequent decade when the eyes were closed in single-limb stance.
DISCUSSION: Age, visual condition, and support surface were significant variables influencing postural stability in women. Reliance on vision for postural stability was evident for women from the 40s when single-limb stance was tested, from the 50s when bilateral stance on foam was tested, and from the 60s when a firm surface was used. The cause(s) of this decline in stability requires further investigation, and screening for postural instability between the ages of 40 and 60 is advocated.
Injuries and mortality in motorcycle and moped accidents in Sweden 1987-1994. Advanced age and male sex are risk factors of fatal moped and motorcycle accidents.
- Wladis A, Bostrom L, Nilsson B. Lakartidningen 2003; 100(14): 1238-1241.
Correspondence: A. Wladis, Department of Surgery, Sodersjukhuset, SE-118 83 Stockholm, SWEDEN; (email: awla@yahoo.com).
Data from the Swedish Hospital Discharge Registry were analyzed, years 1987-1994 inclusive. The registry includes all living patients admitted to Swedish hospitals. Patients admitted after moped or motor-cycle accidents were studied. A total of 4,716 mopedists and 8,927 motor-cycle riders were admitted in the given time frame. The median age of mopedists was 16 and that of motor-cycle riders 22 years. 85% of mopedists were male, while 95% of motor-cycle drivers and 55% of motor-cycle passengers were male. The injury distribution in both groups was quite similar with fractures and cerebral concussion dominating, although fractures of the arm and vertebrae were considerably more common in motor-cycle riders. The incidence of hospital admission after accidents did not change over time in mopedists, but decreased in motorcyclists. Accidents involving both types of vehicles occurred more commonly in the countryside. High age and male sex was associated with increased mortality in mopedists, while high age and being a passenger was associated with higher death rates in admitted motor-cyclists.
We examine whether reported roles in school bullying, and victimization in the workplace, are connected; the influence of victim coping strategies at school; and sex differences. A questionnaire was completed by 5,288 adults from various workplace venues in Great Britain. We analyzed two questions on school experiences (participant role; coping strategies if bullied) and questions on workplace bullying (experiences of being bullied). We found a significant relationship between reported roles in school bullying, and experience of workplace victimization. The highest risk of workplace victimization was for those who were both bullies and victims at school (bully/victims), followed by those who were only victims. An analysis of relative risk of workplace bullying, given being a victim at school plus using various coping strategies, revealed an increased risk for the strategies 'tried to make fun of it', and 'did not really cope'. Women were at slightly higher risk of getting bullied at work, but there were no interactions with roles at school, and only one interaction with coping strategies. This is the first study to report an association between school and workplace bullying. Victims at school are more at risk of workplace victimization, but the especial risk for 'bully/victims' supports other indications that this particular category of school pupils should be a focus of concern. The findings also suggest that school pupils who consistently cannot cope with bullying, or try to make fun of the bullying, are more at risk for later problems in the workplace. However, associations are modest; many victims of school bullying are not being victimized in later life, and the results also suggest important contextual or environmental effects on risks of victimization.
The relevance of suicidal behavior in jail and prison suicides.
- Fruehwald S, Frottier P, Matschnig T, Eher R. Eur Psychiatry 2003; 18(4): 161-165.
Correspondence: Stefan Fruehwald, Clinical Department of Social Psychiatry, Vienna University Medical School, Waehringer Guertel 18-20, 1090, Vienna, AUSTRIA; (email: stefan.fruehwald@univie.ac.at).
OBJECTIVES: Suicide rates in correctional institutions have been increasing during the last decades. There has been little interest in whether suicidal ideation and intent has been documented by non-medical prison staff (reports of attempted suicide, suicide threats, self-harm), and whether these signs of suicidality had the consequence of adequate intervention efforts.
METHODS:The personal files of inmates who committed suicide in the 29 Austrian jails and prisons during the last 25 years (1975-1999) were included. We analyzed personal characteristics, criminological data, circumstances of custody and information about psychiatric disorders and treatment.
FINDINGS: Of a total of 250 suicides, 220 personal files were available and included. Suicide attempts were known in 50% of all suicides and 37% had expressed suicidality. In > 20%, non-medical staff had documented signs of suicidality, but no further preventive action (e.g. referral to psychiatric care) had taken place.
DISCUSSION: Signs of suicidality play an important role in vulnerability profiles for jail and prison suicides and should have the minimal consequence of further psychiatric care.
The share of suicide in injury deaths in the South African context: sociodemographic distribution.
- Burrows S, Vaez M, Butchart A, Laflamme L. Public Health 2003; 117(1): 3-10.
Correspondence: Stephanie Burrows, Department of Public Health Sciences, Division of Social Medicine, Karolinska Institute, Norrbacka, Stockholm SE-171 76, SWEDEN; (email: stephanie.burrows@smd.sll.se).
This study describes the sociodemographic distribution of suicide deaths compared with other injury deaths in South Africa. Cross-sectional data for 26,354 cases were extracted from an injury surveillance database. These included all manners of injury death from 10 mortuaries for 1999-2000 (approximately 18-20% coverage of all injury deaths per year). They were used to examine the distribution of suicide across different sex, race and age groupings, and the relative involvement of alcohol across manners of death. The share of suicide as a cause of death was comparable for males and females, but varied considerably across races and age groups. It was twice as high for Whites as for Asians, and four times as high as for Coloureds and Blacks. For all races except Whites, suicides were concentrated in the younger age groups. Only among Whites was the proportion of alcohol-positive suicides higher or comparable with that for other manners of death. While homicides and unintentional injury deaths outnumbered suicides overall, the relative importance of suicide in some social groups is reason for concern. South Africa is a country undergoing profound transformations, and differences in the distribution of suicide across sociodemographic groups deserve attention.
OBJECTIVE: To determine the proportion of first time driving while alcohol impaired (DWI) offenders who drive while their driver's license is suspended.
METHODS: Design- Systematic, unobtrusive observations were conducted by surveillance professionals from Pinkerton Investigative Services, Inc, of first time offenders in the City of Milwaukee, Wisconsin, and Bergen County, New Jersey. Observations included two four hour periods during suspension (one weekday morning, one Friday/Saturday evening) and two four hour periods after license reinstatement (matched by day of week and time of day). Focus groups of first time offenders were conducted in each site. Setting- New Jersey laws pertaining to license suspension for DWI and driving while suspended are stronger than Wisconsin laws. Subjects- 93 recently convicted first time DWI offenders (57 in Milwaukee and 36 in Bergen County). Main outcome measures- Proportion of subjects observed driving during suspension and after license reinstatement, with reference to all subjects and subjects observed traveling by any means.
FINDINGS: Of subjects observed traveling while suspended, 88% of Milwaukee subjects compared with 36% of Bergen County subjects drove. Five percent of Milwaukee subjects and 78% of Bergen County subjects reinstated their driver's license. Bergen County subjects were significantly more likely to drive after reinstatement (54%) than during suspension (25%).
DISCUSSION: Prevalence of driving while suspended among first time offenders is high and can vary substantially between jurisdictions. However, the license suspension can have a positive impact on the driving patterns of offenders during suspension, relative to after license reinstatement. Lower prevalence of driving while suspended in New Jersey may partly be attributable to that state's tougher laws.
Persistence of effects of a brief intervention on parental restrictions of teen driving privileges.
(All material published in Injury Prevention is available online at no cost.)
Correspondence: Bruce Simons-Morton, Prevention Research Branch, National Institute of Child Health and Human Development, 6100 Executive Blvd Rm 7B05, Bethesda, MD 20892-7510, USA; (email: mortonb@mail.nih.gov).
OBJECTIVE: The purpose of this study was to determine the extent to which effects of exposure to a brief intervention designed to increase parental restrictions on teen driving privileges persisted over time.
METHODS: A total of 658 parents and their 16 year old adolescents were recruited from a local motor vehicle administration (MVA) site as adolescents successfully tested for provisional licenses. At the MVA, parents completed written surveys about expected teen driving during the first month of provisional licensure. Afterwards, on weeks assigned as intervention, parents watched a video and were given the video and a driving agreement to take home. Both parents and teens completed follow up telephone interviews about communication, amounts, and limits on teen driving at one month (579 dyads), four months (529 dyads), and nine months (528 dyads).
FINDINGS: The results indicated that both intervention parents and teens were much more likely to report using a driving agreement at each follow up during the nine month period. Significant treatment group differences persisted for communication about driving, but effects related to limits on teen driving that were evident at one month declined over time. Reports for passenger, road, and overall limits remained significant at four months; fewer were present at nine months. There were no differences in amounts of teen driving at four or nine months.
DISCUSSION: It is possible to reach parents through brief interventions at the MVA and successfully promote increases in initial parental restrictions on teen driving with modest persistence for at least four months.
Does periodic vehicle inspection reduce car crash injury? Evidence from the Auckland Car Crash Injury Study.
- Blows S, Ivers RQ, Connor J, Ameratunga S, Norton R. Aust N Z J Public Health 2003; 27(3): 323-327.
Correspondence: Stephanie Blows, Institute for International Health, PO Box 576, Newtown, New South Wales 2042, AUSTRALIA; (((email: sblows@iih.usyd.edu.au).
OBJECTIVES: This paper examines the association between periodic motor vehicle inspection and frequent tyre pressure checks, and the risk of car crash injury.
METHODS: Data were analysed from the Auckland Car Crash Injury Study, a population-based case-control study in Auckland, NZ, where vehicles are required to undergo six-monthly safety inspections. Cases were all cars involved in crashes in which at least one occupant was hospitalised or killed, which represented 571 drivers. Controls were randomly selected cars on Auckland roads (588 drivers). Participants completed a structured interview.
FINDINGS: Vehicles that did not have a current certificate of inspection had significantly greater odds of being involved in a crash where someone was injured or killed compared with cars that had a current certificate, after adjustment for age, sex, marijuana use, ethnicity and licence type (OR 3.08, 95% CI 1.87-5.05). Vehicles that had not had their tyre pressure checked within the past three months also had significantly greater odds of being involved in a crash, compared with those that had a tyre pressure check, after adjustment for age, sex, ethnicity, seatbelt use, licence type, self-reported speed and hours per week of driving exposure (OR 1.89, 95% CI 1.16-3.08).
DISCUSSION: This study provides new evidence, using rigorous epidemiological methods and controlling for multiple confounding variables, of an association between periodic vehicle inspections and three-monthly tyre pressure checks and reduced risk of car crash injury. This research suggests that vehicle inspection programs should be continued where they already exist and contributes evidence in support of introducing such programs to other areas.
Car seatbelt use during pregnancy in Japan: determinants and policy implications.
- Ichikawa M, Nakahara S, Okubo T, Wakai S. Inj Prev 2003; 9(2): 169-172.
(All material published in Injury Prevention is available online at no cost.)
Correspondence: Masao Ichikawa, Department of Community Health, School of International Health, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, JAPAN; (email: masao@m.u-tokyo.ac.jp).
CONTEXT: Pregnant women are exempted from the current seatbelt legislation in Japan despite the fact that seatbelt use is essential to reduce the risk of fatalities for these women and their fetuses in car crashes.
OBJECTIVE: To examine factors that might influence seatbelt use during pregnancy.
METHODS: A cross sectional study, with data collected via an anonymous, self administered questionnaire at obstetric clinics in suburban areas of Japan. Altogether 880 pregnant women receiving prenatal care in July 2001 were recruited. The relative effects of factors that might influence seatbelt use during pregnancy were estimated using logistic regression analysis.
FINDINGS: Almost 70%-80% of pregnant women were consistent seatbelt wearers before pregnancy but seatbelt compliance was reduced by about half at 20 weeks or more gestation. Only 20% had received information on maternal seatbelt use, with one third reporting that seatbelt use is beneficial during pregnancy. Those who perceived that maternal seatbelt use is beneficial tended to maintain use, but daily car users and those who knew that they were exempted from seatbelt legislation were more likely to reduce use.
DISCUSSION: Knowledge of the legislative exemption for pregnant women, misunderstanding of the benefits, and daily car use contributed to the reduction in seatbelt use after pregnancy.
Correspondence: Maria Cec�lia de Souza Minayo, Centro Latino-Americano de Estudos sobre Viol�ncia e Sa�de, Escola Nacional de Sa�de P�blica, Funda��o Oswaldo Cruz. Av. Brasil 4036, Rio de Janeiro, RJ, 21040-361 BRAZIL; (email: cecilia@claves.fiocruz.br).
This article presents data on morbidity and mortality due to "external causes" among the Brazilian elderly and a review of the Brazilian and international literature on the theme. The data refer to the period from 1980 to 1998. The main sources were the Mortality Information System (SIM) and the Hospital Information System of the Unified National Health System (SIH-SUS). The basic cause of death was evaluated according to the 9th Review of the International Classification of Diseases (ICD9) for 1980 to 1995 and based on the 10th Review since then. The Brazilian and international literature review was based on texts from MEDLINE, LILACS, and Informa. Accidents and violence are the 6th most common cause of death among individuals 60 years of age and older in Brazil. The majority of hospitalizations from external causes involve lesions from falls and injuries to older pedestrians by motor vehicles. However, violence against elderly Brazilians is more widespread and varied than this, as reflected by cases of physical, psychological, sexual, and financial abuse and neglect that fail to reach the health care system; rather, such cases are "taken for granted", seen as basically natural within the daily routine of family relations and various forms of social and public policy neglect.
Risk profiles of adolescent girls who were victims of dating violence.
- Howard DE, Wang MQ. Adolescence 2003; 38(149): 1-14.
Correspondence: D.E. Howard, Department of Public and Community Health, College of Health and Human Performance, University of Maryland, Suite 2387 Valley Drive, College Park, Maryland 20742, USA; (email: dh192@umail.umd.edu).
The prevalence of dating violence, as well as its relationship to potential risk factors, was examined among a nationally representative sample of 9th-through 12th-grade U.S. females (N = 7,824) who completed the 1999 Youth Risk Behavior Survey. The dependent variable was physical dating violence; the independent variables were violence, suicide, substance use, and sexual risk behavior. Unadjusted odds ratios (OR) and 95% confidence intervals were examined, and multivariate logistic regression analysis was conducted to identify the most significant risk factors. It was found that nearly one in ten of the adolescent girls reported dating violence. Twelfth-grade girls had the highest prevalence of dating violence. Girls who were victims of dating violence were more likely to be involved in other violent behaviors, to report extreme sadness and suicidal actions, to use illicit substances, and to engage in risky sexual behavior. Multivariate analysis revealed that dating violence was associated with sad/hopeless feelings (OR = 2.13), binge drinking (OR = 1.96), cocaine or inhalant use (OR = 2.90), multiple sex partners (OR = 2.38), nonuse of condoms (OR = 1.53), and ethnicity, specifically being Black (OR = 2.32) or Hispanic (OR = 1.82). These findings provide further evidence that there is a clustering of risk factors among certain adolescents, specifically girls who experience dating violence.
Violent attacks on Middle Easterners in the United States during the month following the September 11, 2001 terrorist attacks.
(All material published in Injury Prevention is available online at no cost.)
Correspondence: Monica H Swahn, Division of Violence Prevention, Mailstop K 60, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway, Atlanta, GA 30341-3724, USA; (mswahn@cdc.gov).
OBJECTIVES: To document and describe hate related violent attacks on Middle Easterners or those perceived to be Middle Easterners during the month following the September 11, 2001 terrorist attacks in New York City and Washington, DC.
METHODS: The LexisNexis database of newspaper reports were used to identify incidents of hate related violent acts against Middle Easterners or those perceived to be Middle Easterners in the US between September 1 and October 11, 2001. A total of 100 incidents of hate related violence were identified in the 2659 news articles that were reviewed.
FINDINGS: Of the 100 incidents of violent victimization that took place during the period September 1 to October 11, only one incident occurred before September 11. The 99 incidents that occurred after September 11 involved at least 128 victims and 171 perpetrators. Most violent victimizations occurred within 10 days of the attacks, involved male perpetrators and male victims, and occurred in convenience stores, on the streets, at gas stations, at schools/colleges, and at places of worship.
DISCUSSION: Most violent victimizations occurred in the 10 days immediately following the terrorist attacks indicating that interventions that promote tolerance and understanding of diversity need to be implemented quickly in order to be effective. In addition, patrolling by police and Neighborhood Watch programs around convenience stores and gas stations may also be effective strategies for reducing hate related violent crimes.
Review of evaluations of educational approaches to promote safe storage of firearms.
(All material published in Injury Prevention is available online at no cost.)
Correspondence: Kara S McGee, World Health Organization, Department of Injuries and Violence Prevention, NMH/VIP, 20 Avenue Appia, CH-1211 Geneva 27, SWITZERLAND; (email: mcgeek@who.int).
OBJECTIVE: To systematically review evaluation studies of educational interventions promoting safe firearm storage.
METHODS: Medline, ERIC, PsycINFO, Criminal Justice Periodicals Index, Cumulative Index of Nursing and Allied Health Literature, and Sociofile were searched. The references from each potentially eligible study were checked, and experts in the field were contacted for additional reports. In addition, an internet search was performed to identify programs not published in the conventional literature. Sources relevant to safe firearm storage promotion were selected and evaluated.
FINDINGS: Seven studies met inclusion criteria: adult subjects, program description was included, and firearm storage outcomes were measured. One was a randomized controlled trial and the other six were one group pre-test and/or post-test. The studies were classified into the following categories based on the intervention strategies used: (1) counseling and firearm safety materials (n=3); (2) counseling/educational message (n=3); and (3) firearm safety materials distribution (n=1).The outcomes were safe firearms storage (firearms locked up and unloaded or removal from home) after intervention. Four studies, three using counseling and materials distribution, reported improved storage after the interventions.
DISCUSSION: It is not yet clear what types of interventions, or which specific intervention components, prompt gun owners to securely store their weapons. Increased understanding of gun storage behaviors and stronger evaluation designs will aid further understanding of this important issue.
Buying a handgun for someone else: firearm dealer willingness to sell.
- Sorenson SB, Vittes KA. Inj Prev 2003; 9(2): 147-150.
(All material published in Injury Prevention is available online at no cost.)
Correspondence: Susan B Sorenson, UCLA School of Public Health, 650 C E Young Drive South, Los Angeles, CA 90095-1772, USA;
sorenson@ucla.edu).
OBJECTIVE: To examine firearm dealer willingness to sell when a handgun is being purchased for another person. US law requires a background check of the purchaser but not the end user of a firearm.
METHODS: A total of 120 handgun dealers (six from each of the 20 largest US cities with 10 or more dealers) participated in telephone interviews. Dealers within each city were randomly assigned to a male or female interviewer and then randomly assigned to one of three purchase conditions-when the consumer said that the handgun was for him/herself, a gift for a girl/boyfriend, or for a girl/boyfriend "because s/he needs it".
FINDINGS: Most dealers were willing to sell a handgun regardless of the end user (self: 87.5%; gift: 70.8%; "need": 52.5%). Multivariate analyses indicate that dealers in the Midwest, South, and West were more willing to sell than those in the Northeast (adjusted odds ratio (AOR) = 21.30, 18.74, and 8.93, respectively) and that willingness to sell is lower when the sale would be illegal, that is, under the "need" condition (AOR = 0.20).
DISCUSSION: Dealers are in a position to exercise judgment when a customer is explicit about buying a firearm for someone else. Some appeared willing to ignore or sidestep relevant information even when told that the end user was prohibited from purchasing a firearm him/herself. In the absence of federal handgun registration, which would track ownership changes, resources with which to conduct compliance checks (for example, as are conducted to identify retailers who sell tobacco or alcohol to under-age persons) seem warranted.
Impact of handgun types on gun assault outcomes: a comparison of gun assaults involving semiautomatic pistols and revolvers.
(All material published in Injury Prevention is available online at no cost.)
Correspondence: Christopher S Koper, Jerry Lee Center of Criminology, University of Pennsylvania, 3814 Walnut Street, Philadelphia, PA 19104, USA; (email: ckoper@sas.upenn.edu).
OBJECTIVE: To examine whether gun assaults committed with semiautomatic pistols are more injurious and lethal than those committed with revolvers.
METHODS: Using police records on fatal and non-fatal handgun assaults (Jersey City, New Jersey from 1992 through 1996), t tests and chi(2) tests were employed to determine if attacks with pistols result in more shots fired than those with revolvers, leading to more gunshot victims and more severely wounded victims.
FINDINGS: More shots were fired in attacks with pistols (average = 3.2 to 3.7) than in attacks with revolvers (average = 2.3 to 2.6). Although pistol use was unrelated to the probability that an incident resulted in any injury or death, it was associated with a 15% increase in the number of wounded victims in those cases in which people were shot (1.15 per pistol case, 1.0 per revolver case), implying that the total number of gunshot victims may have been 9.4% lower had pistols not been used in any attacks. Pistol use was not related to the number of wounds per gunshot victim.
DISCUSSION: The findings provide limited evidence that recent growth in the production and use of pistols has contributed to higher levels of gunshot victimizations. However, available data did not permit an assessment of whether the associations between gun types and assault outcomes are mediated by characteristics of incidents and actors.
Emotional, physical, and sexual abuse in patients visiting gynaecology clinics: a Nordic cross-sectional study.
- Wijma B, Schei B, Swahnberg K, Hilden M, Offerdal K, Pikarinen U, Sidenius K, Steingrimsdottir T, Stoum H, Halmesm�ki E. Lancet 2003; 361: 2107-2113.
Correspondence: Barbro Wijma, Division of Women's Health, Department of Molecular and Clinical Medicine, Faculty of Health Sciences, Link�ping University, S-581 85 Link�ping, Sweden (e-mail: barwi@imk.liu.se).
CONTEXT: Abuse against women causes much suffering for individuals and is a major concern for society. We aimed to estimate the prevalence of three types of abuse in patients visiting gynaecology clinics in five Nordic countries, and to assess the frequency with which gynaecologists identify abuse victims.
METHODS: We did a cross-sectional, multicentre study of women attending five departments of gynaecology in Denmark, Finland, Iceland, Norway, and Sweden. We recruited 4729 patients; 3641 (77%) responded and were included in the study. Participants completed a postal questionnaire (norvold abuse questionnaire) confidentially. Primary outcome measures were prevalences of emotional, physical, and sexual abuse, and whether abused patients had told their gynaecologist about these experiences. We assessed differences between countries with Pearson's chi-sq test.
FINDINGS: The ranges across the five countries of lifetime prevalence were 38-66% for physical abuse, 19-37% for emotional abuse, and 17-33% for sexual abuse. Not all abused women reported current ill-effects from the abusive experience. Most women (92-98%) had not talked to their gynaecologist about their experiences of abuse at their latest clinic visit.
DISCUSSION: Despite prevalences of emotional, physical, and sexual abuse being high in patients visiting gynaecology clinics in the Nordic countries, most victims of abuse are not identified by their gynaecologists. This lack of discussion might increase the risk of abused patients not being treated according to their needs. Gynaecologists should always consider asking their patients about abuse.
