A population-based case-crossover and case-control study of alcohol and the risk of injury.
- Vinson DC, Maclure M, Reidinger C, Smith GS. J Stud Alcohol 2003; 64(3): 358-366.
Correspondence: Daniel C. Vinson, Department of Family and Community Medicine, M231 Health Sciences, University of Missouri-Columbia, Columbia, Missouri 65212, USA; (email: VinsonD@health.missouri.edu).
OBJECTIVES: This study investigated the relationship between alcohol and the risk of acute injury, examining both short-term (drinking over a few hours) and long-term exposures (past-month hazardous drinking and current alcohol use disorders).
METHODS: The study was a case-crossover and population-based case control study. Cases (N = 2,517; 1,432 men) were injured patients recruited from all three emergency departments in Boone County, Missouri. Each case's alcohol consumption in the 6 hours prior to injury was compared to his or her consumption the day before in a case-crossover analysis. Community controls (N = 1,856; 948 men) were recruited by telephone and matched to cases by age, gender, day of week and hour. Case-control analyses examined recent alcohol consumption (past 6 hours), past-month hazardous drinking and past-year alcohol use disorders.
FINDINGS: The odds ratios (ORs) for injury associated with short-term alcohol exposure were similar, whether cases were compared with themselves (case-crossover analyses) or with others (case-control analyses). After 1 or 2 drinks in a 6-hour interval, the ORs were 1.8 (95% confidence interval [CI]: 1.3-2.6) and 1.5 (0.96-2.2), respectively. Similar dose-response curves were seen in the two comparisons, with ORs of 6.2 and 3.7, respectively, after 3 or 4 drinks and 9.5 and 13.5 after 5 or 6 drinks. For past-month hazardous drinking, the OR was 1.7 (95% CI: 1.2-2.3). Current alcohol dependence was associated with injury (OR = 1.9; 95% CI: 1.5-2.6), but alcohol abuse was not (OR = 0.9; 95% CI: 0.8-1.1).
DISCUSSION: Alcohol's effect on injury risk is related more strongly to acute exposure than to measures of long-term exposure. The risk is significant even at low levels of consumption.
The risk of intentional injury with acute and chronic alcohol exposures: a case-control and case-crossover study.
- Vinson DC, Borges G, Cherpitel CJ. Vinson DC, Maclure M, Reidinger C, Smith GS. J Stud Alcohol 2003; 64(3): 350-357.
Correspondence: Daniel C. Vinson, Department of Family and Community Medicine, M231 Health Sciences, University of Missouri-Columbia, Columbia, Missouri 65212, USA; (email: VinsonD@health.missouri.edu).
CONTEXT: Alcohol is associated with intentional injury, but most studies have operationalized it as alcoholism and have not examined acute exposure.
OBJECTIVES:The study aimed to clarify the relative contributions of drinking over a few hours and of alcohol use disorders to the risk of intentional injury inflicted by another person.
METHODS: The study used a case-control design with two control groups: (1) Community controls matched to cases, and (2) the cases themselves, comparing consumption on the day of injury with consumption on previous days, in a case-crossover comparison. Cases were patients with an acute injury presenting to any of the three emergency departments in one county; 102 had an intentional injury. Community controls (N = 1,856) were recruited by random-digit dialing. Recent alcohol consumption was recorded in self-reported standard drinks. Current alcohol use disorders were defined using DSM-IV criteria.
FINDINGS: In the case-control analysis, drinking in a 6-hour window was associated with risk of intentional injury (odds ratio [OR] = 10, 95% confidence interval [CI]: 4.7-22). In case-cross-over comparison of the cases' own drinking in the 6 hours prior to injury with their own drinking the day before, the OR was 34 (95% CI: 4.7-250). In case-control analyses, alcohol dependence was associated with intentional injury (OR = 6.0, 95% CI: 3.5-10), but alcohol abuse was not (OR = 0.7, 95% CI: 0.4-1.3).
DISCUSSION: Drinking over a few hours is strongly associated with intentional injury. Current alcohol dependence is also, but with a lower OR. The findings may have implications for efforts to prevent intentional injury.
Posttraumatic distress and coping strategies among rescue workers after an earthquake.
- Chang CM, Lee LC, Connor KM, Davidson JR, Jeffries K, Lai TJ. J Nerv Ment Dis 2003; 191(6): 391-398.
Correspondence: T.J. Lai, Department of Psychiatry and Graduate Institute of Medicine, Chung Shan Medical University, No. 110, Sec 1, Chien Kuo N. Road, Taichung, TAIWAN, PRC; (email: unavailable).
Disaster workers are at high risk for developing psychiatric morbidity. This study examined the prevalence rates of psychiatric and posttraumatic distress and the relationship between psychiatric and posttraumatic morbidity and coping strategies among rescue workers following an earthquake in Taiwan on September 21, 1999. Eighty-four male fire fighters who had been exposed to earthquake rescue work were assessed 5 months after the event. The Chinese Health Questionnaire (CHQ), the Impact of Event Scale (IES), and the Ways of Coping Questionnaire (WCQ) were used to assess psychiatric morbidity, posttraumatic morbidity, and coping strategies. The observed prevalence rates were 16.7% and 21.4% for general psychiatric morbidity and posttraumatic morbidity, respectively. Results from multivariate logistic regression indicated that job experience and confrontive coping were significant predictors of psychiatric morbidity, while job experience, distancing, escape-avoidance, and positive reappraisal were significant predictors of posttraumatic morbidity. Rescue workers with longer job experience were at the highest risk for developing psychiatric and posttraumatic distress.
Afyon Sultandagi earthquake.
- Akbulut G, Yilmaz S, Polat C, Sozen M, Lebelebicioglu M, Dilek ON. Turk J Trauma 2003; 9(3): 189-193.
CONTEXT: Ninety-six percent of Turkey is in the earthquake zone. Consequently the results of every earthquake should
be presented and discussed.
OBJECTIVES: The aim of this study was to evaluate the results of Afyon Sultandagi earthquake.
METHODS: The records from Governorship of Afyon, local hospitals and Public Work Directorate have been evaluated retrospectively and compared with current literature.
FINDINGS: An earthquake was detected with the magnitude of 6.0 at 9:11 A.M. at February 3rd , 2002, in the Sultandagi town,
which is localized in Afyon city of Turkey. Bolvadin and Cay towns were also affected from the disaster. This earthquake,
caused 39 deaths (23 of them were older than 65 year-old; 15 male and 24 female), 325 injured persons; 315 cows and
water buffalos and 3,176 sheep, 14,328 poultry were dead, and 15,032 buildings were damaged. The causes of deaths in
human beings were: myocardial infarction in three patients and traumatic cerebral hematoma in one; the others expired
from respiratory insufficiency due to dust inhalation because of the traditional architecture of the rural area. Health professionals reached the victims in about four hours, 35 of the injured patients were treated with hospital care and the
remaining did not require health support.
The media have a profound influence on the actions of children and adults. Burns and burn prevention tend to be ignored or even mocked. The purpose of this presentation is to reveal the callousness of the media in its dealings with burns and burn prevention. Printed materials with a relationship to burns, risk of burning, or disrespect for the consequences of burns were collected. The materials were tabulated into four categories: comics, advertisements (ads), articles that made light of burns, and television shows that portrayed behavior that would risk burn injury. Most burn-related materials were found in comics or advertisements. Several comics made light of high-risk behavior with flames, scald injury, contact injury, or burns. In addition, several advertisements showed people on fire or actions that could easily lead to burns. Several articles and televisions shows portrayed high-risk behavior that, in some instances, led to copycat injuries. Flames are frequently used to sell items that target adolescent boys or young men. The high incidence injuries that frequent this population parallel the high-risk behaviors portrayed by the media. The media portrays flames and high-risk behavior for burn injury as being cool, funny, and without consequence. The use of flames on clothing and recreational equipment (skateboards, hot rods) particularly targets the high-risk adolescent male. The burn community should make the media aware of the harm it causes with its callous depiction and glorification of burns.
Playing with fire: images of fire on toy packaging.
Correspondence: Tina L. Palmieri, MD, Shriners Hospitals for Children Northern California, 2425 Stockton Boulevard, Suite 718, Sacramento, California 95817, USA; (email: tlpalmieri@ucdavis.edu).
Despite prevention efforts designed to teach children that fire is not a toy, each year hundreds of children, primarily male, are injured while playing with fire. Mass-produced toys and games shape children's behaviors, and the fire images on toy packaging may send the message that fire is fun rather than dangerous. The purpose of this study was to determine the frequency of male fire-related injuries at our burn center and to investigate the use of fire images in toy packaging. An aisle-by-aisle search was conducted at a national toy store. Toys with fire images on their packaging were identified. Target gender and the setting in which the fire was displayed also were recorded. Only toys with clearly visible flames on their packaging were included. We reviewed our TRACS database from April 1997 to May 1999 for fire-related injuries to children admitted to our institution as a result of playing with fire. Review of toy stores revealed 404 toys with packaging containing fire images. Of these, 97% (393 of 404) were targeted to males. Video games were the leading category of flame-related packaging (208 of 404), followed by toy car/truck displays (84 of 404). Packaging for girls' toys had safe and contained settings, whereas boys' toys used settings that were uncontrolled and associated with speed and weapons. A total of 59 children, 52 males and 7 females, with a mean age of 10 +/- 0.6 years and mean TBSA burn of 12.3 +/- 2.1% were admitted to our facility with fire-related injuries during the study interval. Children imitate life with toys and use play to experiment with new behavior. Boys are receiving a powerful, consistent message from images of fire on toy packaging. These advertisements may help to contribute to the higher incidence of fire-related injuries in boys.
Fatal drowning of children in whirlpool baths in Japan (letter).
- Hitosugi M, Kawato H, Matsushima K, Nagai T, Tokudome S. Lancet 2003; 361(9376): 2248.
Correspondence: Masahito Hitosugi, Department of Legal Medicine, Dokkyo University School of Medicine, Tochigi 321-0293 JAPAN; (email: hitosugi@dokkyomed.ac.jp)
Japanese people have traditionally bathed in extremely hot water. In the past few years, whirlpool baths have become popular and, by 2000, about 400 000 whirlpool baths had been sold in Japan. However, fatal accidental drowning in these baths has become a nationwide problem. In 2000, 3429 people, including 38 children younger than 10 years, drowned in whirlpool baths. A recent fatal accident in a whirlpool bath highlights the need to prevent drowning of children in Japan.
A healthy 6-year-old Japanese girl had been bathing alone in a whirlpool bath when her hair became trapped in the suction intake and could not be released. After 15 min, the girl's mother found her with her head beneath the water and her hair trapped in the suction intake. Although the mother cut the girl's hair and removed her from the water, she was in cardiopulmonary arrest. Despite aggressive resuscitation attempts, she was pronounced dead and forensic investigation showed the cause of death was drowning.
The police investigated this accident; when they placed a hairpiece near the suction intake, they saw that it was immediately sucked in and could not be pulled out by a force of 10 kg. According to an investigation by the Ministry of International Trade and Industry of Japan, in December, 2000, two 7-year-old girls and one 6-year-old girl had died in similar accidents.
To prevent such accidents, the National Consumer Affairs Center of Japan requested that manufacturers of whirlpool baths install covers on all intakes to prevent hair from being trapped. Furthermore, they warned customers not to allow young children to bathe unattended. After this warning, no similar accidental drownings have occurred.
Occupational injury and illness among migrant and seasonal farm workers in New York State and Pennsylvania, 1997-1999: pilot study of a new surveillance method.
- Earle-Richardson G, Jenkins PL, Slingerland DT, Mason C, Miles M, May JJ. Am J Ind Med 2003; 44(1): 37-45.
Correspondence: Giulia Earle-Richardson, NYCAMH/NEC, Bassett Healthcare, One Atwell Rd., Cooperstown, NY 13326, USA; (email: gearlerichardson@NYCAMH.com)
CONTEXT: Traditional worksite injury surveillance methods are often ineffective for Northeastern farms employing seasonal harvest labor. Many are small farms, exempt from mandatory injury reporting. The high proportion of foreign workers and the temporary nature of the work further discourages reporting. Therefore, an alternative migrant health center-based occupational injury and illness surveillance system was piloted during 1997-1999.
METHODS: Anonymous medical chart data from nine migrant health centers and four regional hospital emergency rooms was collected during 1997-1999.
FINDINGS: There were 516 injury/illness cases over two seasons. Joint/muscle straining (31%), falling (18%), poison ivy contact (10%), and object strikes (8%) were most common injurious events. The participation rate of health care was 75%; 130 cases were reported by hospital emergency rooms; and optimal health center participation was associated with: being a farmworker-dedicated program, and including the chart reviewer in the health center's decision to participate.
DISCUSSION: Further development of a medical records-based surveillance system should include hospital emergency rooms and focus on identified health center performance factors.
Work-related injury in NSW hospitalization and workers' compensation datasets: a comparative analysis.
Correspondence: Soufiane Boufous, The NSW Injury Risk Management Research Centre, Building B10, University of New South Wales 2052, AUSTRALIA; (e-mail: soufiane@unsw.edu.au)
OBJECTIVES: To undertake a comparative analysis of the New South Wales (NSW) Inpatient Statistics Collection (ISC) and Workers' Compensation Scheme Statistics (WCSS) for the 1999/2000 financial year in an attempt to evaluate their respective roles in the surveillance and monitoring of work-related injuries in NSW.
METHODS: Work-related injuries in ISC were identified mainly by using the ICD-10 activity code and payment status and were compared with injury-related claims reported in WCSS.
FINDINGS: In 1990/2000, the majority of hospital separations for work-related injury involved males (86.2%) who came into contact with various objects, including machinery and tools, representing the most common mechanisms of injury, and open wounds and fractures of the upper and lower limbs as the most common injury nature/location. Injuries reported in the WCSS were also dominated by males (70%), with muscular stress while handling objects as the most common mechanism of injury and sprain and strain of the lower back as the leading nature/location of injury. The proportion of workers aged 15-19 years in the WCSS (1.2%) was over five times lower than the proportion of the same age group recorded in the ISC.
DISCUSSION: The analysis indicates that the ISC and WCSS complement each other in characterizing the burden of work-related injuries in NSW. Linking compensation and outcomes data, including hospital admissions and emergency presentations, will provide a more comprehensive picture of the nature and the factors contributing to work-related injuries. Such data will inform policy and program development aimed at reducing the burden of this type of injury in the community.
A cluster analysis of road traffic-related childhood knee injuries.
- Iakovakis I, Dessypris N, Dalamaga M, Petridou E. Child Care Health Dev 2003; 29(4): 297-301.
Correspondence: Eleni Petridou, Department of Hygiene and Epidemiology, Athens University Medical School, 75 M. Asias Str., 115 27 Athens, GREECE; (email: epetrid@med.uoa.gr).
CONTEXT: Knee injuries represent an important category of road traffic injuries among children, and they are heterogeneous in their etiology.
OBJECTIVES: The aims of this study were to estimate the incidence of road traffic childhood knee injuries in Greece by age and gender, point out their time, place and person co-ordinates and identify clusters with distinct characteristics with a view to potential preventive interventions.
METHODS: During a 3-year period, 305 children with knee injuries resulting from a road traffic accident were identified among the 66 870 children with injuries recorded in the Emergency Department Injury Surveillance System (EDISS) of Greece. Using previously derived sampling ratios and national data on childhood population, incidence data by age and gender were estimated. Hierarchical analysis was undertaken for cluster identification.
FINDINGS: The incidence of road traffic knee injuries was 97.5 per 100 000 children-years. The incidence increased with age and was higher among boys than among girls. Most childhood knee injuries (50.2%) occur among pedestrians, and the majority (90.9%) of the children or their guardians admitted responsibility in crossing the road. Of the 31 children injured as car passengers, the vast majority (87.1%) were unrestrained, and a large fraction (38.7%) were front seat passengers. Two clusters were identified: the first consisted of younger children who resided mostly in the Athens area and suffered less serious knee injuries as pedestrians or car passengers during the colder months; the second consisted of older children, frequently tourists, who suffered more serious injuries as cyclists while vacationing.
DISCUSSION: Many of the children who suffered road traffic knee injuries as pedestrians admitted responsibility in road crossing, whereas a large proportion of children who were injured as car passengers were injured while improperly seated in the front and without seatbelt protection. Older children, frequently tourists, were at high risk of knee injuries while using motorcycles and bicycles.
Choosing a safe place to cross the road: the relationship between attention and identification of safe and dangerous road-crossing sites.
CONTEXT: Safe pedestrian behavior relies on cognitive skills, including the ability to focus attention on the traffic environment and ignore irrelevant stimuli. An important pedestrian skill that young children find difficult is the ability to find a safe place to cross the road.
OBJECTIVES: The aim of this study was to examine the relationship between attention and children's ability to identify safe and dangerous road-crossing sites.
METHODS: Participants were 95 children (aged 6.5 years, 8.6 years and 10.4 years) and 33 adults. Ability to identify safe and dangerous road-crossing sites was assessed using computer presentations of five safe and five dangerous sites. Attention was assessed using the Stroop test for resistance to interference. Correlations were calculated between Stroop test measures and pedestrian task measures (accuracy and speed of identifying safe and dangerous road-crossing sites) for each age group separately.
FINDINGS: The ability to identify safe and dangerous road-crossing sites and the ability to resist interference increased with age. Significant correlations were observed between identification of safe and dangerous road-crossing sites and performance on the Stroop test for children but not for adults.
DISCUSSION: The results indicated that attention is required for identifying road-crossing sites quickly and accurately, especially for younger children. Road safety training programs for children may need to take into account the development of children's attention.
Hydrocarbon poisoning in children: a 5-year retrospective study.
- Lifshitz M, Sofer S, Gorodischer R. Wilderness Environ Med 2003; 14(2): 78-82.
Clinical Toxicology Unit, A. Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, ISRAEL; (email: matyl@bgumail.bgu.ac.il).
OBJECTIVE: To investigate the demographics, incidence, and symptoms and signs of hydrocarbon poisoning in admitted children from the Negev Desert area of Israel.
METHODS: The medical records of all children admitted for hydrocarbon poisoning from 1995 to 1999 were reviewed retrospectively.
FINDINGS: Of the 274 admitted children, 61% were boys and 39% were girls, with ages ranging from 6 months to 18 years (median, 1.58 years). Ninety-four percent of the patients were Moslem Arab Bedouins, and 6% were Jews. The largest group of patients (106) was admitted during the summer months (P < .003). Also, more patients were admitted in spring (63) and autumn (67) than in winter (38) (P < .013). Thirty-two percent of the cases were seen in the Pediatrics Ambulatory Unit and then discharged, while 68% were hospitalized. The most commonly observed symptoms were tachypnea (73.7%), fever (63.5%), vomiting (51.1%), and cough (38.0%). About one third of the patients showed signs of central nervous system (CNS) impairment, including drowsiness, restlessness, stupor, and convulsions. These symptoms were significantly correlated with pneumonia, hypoxemia, and fever (P < .001). Of 274 patients, 43% (118 children) had pneumonia--usually interstitial pneumonitis (90%). Vomiting was significantly correlated with pneumonia (P < .05).
DISCUSSION: 1) There is a higher risk of hydrocarbon poisoning during the hot months of the year; 2) the respiratory system is the main target organ affected; 3) pneumonia is in most cases interstitial and bilateral; 4) vomiting after hydrocarbon ingestion is related to the rate of development of pneumonia; 5) symptoms of CNS impairment were correlated with hypoxemia, pneumonia, and fever; and 6) CNS toxicity may occur without hypoxemia, concurrent pulmonary pathology, or other pathology.
Correspondence: Sonja E. Hall, School of Population Health, University of Western Australia, 35 Stirling Highway, Crawley, Western Australia 6009, AUSTRALIA; (email: shall@sph.uwa.edu.au).
OBJECTIVES: To establish the hospital cost and three-month, post-hospital community and personal costs associated with older adults discharged to the community after a fall. The timing, incidence and the determinants of these costs to the various sectors were also examined.
METHODS: Patients who attended the Emergency Department of a teaching hospital in Perth, Western Australia, were asked to complete a daily diary for three months of all community and informal care they received due to their fall and any associated expenses. Unit costs were collected from various sources and used to estimate the cost of community and informal care. Hospital inpatient costs were estimated using a patient-based costing system.
FINDINGS: Seventy-nine patients participated with a total estimated falls-related cost for the three-month period of $316,155 to $333,648 (depending on assumptions used) and a mean cost per patient of between $4,291 and $4,642. The hospital cost accounted for 80%, community costs 16% and personal costs 4% of the total. Of community and personal costs, 60% was spent in the first month. Type of injury was the most significant determinant of hospital and community costs. Extrapolating these figures to the WA population provided an estimate of the total hospital and three-month, post-hospital cost of falls of $24.12 million per year, with $12.1 million funded by the Federal Government, $10.1 million by State/local government and $1.7 million in out-of pocket expenses by patients.
DISCUSSION: In the acute and immediate post-discharge period, hospital costs accounted for most of the cost of care for older adults discharged to the community after a fall. Community and personal costs, however, were also incurred. The cost estimates provide useful information for planners of hospital and community care for older people who have sustained a fall.
Alcohol consumption patterns and work-related injuries among Colorado farm residents.
- Stallones L, Xiang H. Am J Prev Med 2003; 25(1): 25-30.
Lorann Stallones, PhD, Professor and Director, Colorado Injury Control Research Center, Department of Psychology, Colorado State University, , Fort Collins CO 80523-1876, , USA; (email: lorann@colostate.edu).
Few studies have assessed the relationship between alcohol consumption patterns among farm populations and work-related injuries. The purpose of this study was to assess the role of alcohol consumption patterns on farmwork-related injuries. Prospective cohort study of Colorado farm residents, 1993 to 1995. Self-reported injuries, alcohol consumption, and demographics were assessed over 3 years. A stratified probability sample of farms was selected to include approximately 2.6% of Colorado farm residences with a farm operator living on the property. A total of 485 farms, including 872 individuals, were recruited in the initial cohort. In the second year, 746 individuals were re-interviewed, and in the third year, 653 of the original group participated. Injuries during the study period were assessed in relationship to alcohol consumption. During the 3 years, 150 farm residents reported a total of 215 farmwork-related injuries. An increased risk of injury was associated with increased alcohol consumption. Compared to abstainers, farm residents who drank more frequently had higher farmwork injury incidence rates (3.09 and 3.35 injuries per 10,000 person-days of observation versus 1.94 injuries per 10,000). Farm residents who typically drank three or more drinks per day had a farmwork injury rate of 3.62 per 10,000 person-days (95% confidence interval [CI]=2.38-4.85). Farm residents who typically drank one to two drinks per day had a farmwork-related injury rate of 3.02 per 10,000 person-days (95% CI=2.44-3.60). In multivariate models, alcohol consumption frequency and quantity were significantly associated with farmwork-related injuries. Alcohol consumption should be considered in studies of agricultural injuries.
Agricultural motorcycle injuries in WA adolescents.
Correspondence: Tony Lower, Combined Universities Centre for Rural Health, PO Box 109, Geraldton, Western Australia 6531, AUSTRALIA; (email: tonylo@spc.int).
OBJECTIVES: To determine and compare the prevalence, nature and predictors of agricultural motorcycle injuries (2,3 and 4 wheels) in a high-risk cohort of Western Australian adolescents.
METHODS: A cross-sectional survey of 326 students (Years 11 and 12) was drawn from the six designated agricultural colleges in Western Australia. The survey instrument was assessed as reliable and measured riding exposure, vehicle type and maintenance, use of protective equipment, training and injury experience.
FINDINGS: For those subjects with access to an agricultural motorcycle (n=240), a total of 53% (n=127) had incurred an injury. Of these, 73% (n=92) resulted from two wheelers and 24% (n=31) from ATVs, with 3% (n=4) not specified. No significant differences in the nature of injury or body parts injured was observed. Approximately one-third of those injured required medical treatment. Predictors of injury were maximum traveling speed exceeding 101 km/hour (OR 4.53) and only sometimes wearing a helmet (OR 4.10).
DISCUSSION: Agricultural motorcycle injuries are a significant issue in rural areas, with potential intervention points relating to improving rider training and reducing specific risk-taking behaviors. Further work to investigate the efficacy of rider training interventions for agricultural motorcycles are warranted.
Suicidal ideation and suicide attempts in a sample of homeless people with mental illness.
- Desai RA, Liu-Mares W, Dausey DJ, Rosenheck RA. J Nerv Ment Dis 2003; 191(6): 365-371.
Correspondence: Rani A. Desai, Department of Psychiatry, Yale University School of Medicine and North East Program Evaluation Center (NEPEC), NEPEC/182, West Haven VAMC, 950 Campbell Avenue, West Haven, Connecticut 06516, USA; (email: desai@biomed.med.yale.edu).
This study utilized data from the national ACCESS program (N = 7224) to investigate the prevalence of suicidal ideation and suicide attempts in a sample of homeless people with mental illness. The prevalence of suicidal ideation in this sample was high (66.2% lifetime prevalence). In addition, 51.3% of the sample reported that they had ever attempted suicide, 26.9% reported an attempt that resulted in a nonpsychiatric hospitalization, and 8% reported an attempt in the previous 30 days. Youth, substance abuse, and psychiatric symptoms were all significantly associated with suicide attempts. Those who reported a recent attempt also reported higher rates of mental health care utilization, particularly inpatient care. The authors conclude that homeless people with mental illness are at particularly high risk for suicidal behavior, however, only in part because of the high prevalence of traditional risk factors.
The suicide risk of discharged psychiatric patients.
- Ho TP. J Clin Psychiatry. 2003; 64(6): 702-707.
Correspondence: Ting Pong Ho, Department of Psychiatry, Queen Mary Hospital,102 Pokfulam Rd., Hong Kong, CHINA; (email: unavailable).
CONTEXT: The suicide risk of psychiatric patients fluctuated along the course of their illness and was found to be high in the immediate post-discharge period in some settings. The epidemiology and psychiatric services for the suicide population in Hong Kong have differed from those of the West (i.e., low youth suicide rate, high elderly suicide rate, high female/male ratio, and heavily government-subsidized psychiatric service). This study examined the suicide rates within a year of discharge from psychiatric inpatient care in Hong Kong.
METHODS: Discharges from all psychiatric hospitals or psychiatric wards in general hospitals in Hong Kong from 1997 through 1999 were followed up for suicides (ICD-9, E950-E959) and "undetermined" causes of deaths (E980-E989) by record linkage with the Coroner's Court until their deaths or Dec. 31, 2000. The suicide rates (/1000 person-years at risk) and standardized mortality ratios (SMRs; assigning a value of 1 to the same age- and sex-specific suicide rates in the general population) were calculated.
FINDINGS: 21,921 patients (aged over 15 years) were discharged from psychiatric hospitals from 1997 through 1999. Two hundred eighty patients committed suicide within 1 year of discharge; 85 suicides (30%) occurred within 28 days after discharge. The SMRs for suicide in the first 28 days after discharge were 178 (95% CI = 132 to 235) for females and 113 (95% CI = 86 to 147) for males. These rates were 4.0 (95% CI = 2.7 to 5.6) times higher for females and 4.6 (95% CI = 3.2 to 6.3) times higher for males than the rate in the rest of the year. Young adults had higher SMRs than the elderly. No specific diagnoses had higher suicidal risk than others. Calculations including undetermined causes of deaths (N = 53) gave similar results.
DISCUSSION: The immediate post-discharge period carries a high risk of suicide for psychiatric patients. The high-risk groups are young adults and females. No diagnosis appears to carry a particularly high risk.
Traffic-law enforcement and risk of death from motor-vehicle crashes: case-crossover study.
- Redelmeier DA, Tibshirani RJ, Evans L. Lancet 2003; 361(9376): 2177-2182.
Correspondence: Donald A Redelmeier, Sunnybrook and Women's College Health Sciences Centre, G-151, 2075 Bayview Avenue, Toronto, ON, Canada M4N 3M5 (e-mail: dar@ices.on.ca).
CONTEXT: Driving offenses and traffic deaths are common in countries with high rates of motor-vehicle use.
OBJECTIVES: We tested whether traffic convictions, because of their direct effect on the recipient, to determine any association with a reduced risk of fatal motor-vehicle crashes.
METHODS: We identified licensed drivers in Ontario, Canada, who had been involved in fatal crashes in the past 11 years. We used the case-crossover design to analyse the protective effect of recent convictions on individual drivers.
FINDINGS: 8975 licensed drivers had fatal crashes during the study period. 21 501 driving convictions were recorded for all drivers from the date of obtaining a full licence to the date of fatal crash, equivalent to about one conviction per driver every 5 years. The risk of a fatal crash in the month after a conviction was about 35% lower than in a comparable month with no conviction for the same driver (95% CI 20-45, p=0.0002). The benefit lessened substantially by 2 months and was not significant by 3-4 months. The benefit was not altered by age, previous convictions, and other personal characteristics; was greater for speeding violations with penalty points than speeding violations without points; was no different for crashes of differing severity; and was not seen in drivers whose licenses were suspended.
DISCUSSION: Traffic-law enforcement effectively reduces the frequency of fatal motor-vehicle crashes in countries with high rates of motor-vehicle use. Inconsistent enforcement, therefore, may contribute to thousands of deaths each year worldwide.
A cohort study of drink-driving motor vehicle crashes and alcohol-related diseases.
- Stevenson M, D'Alessandro P, Bourke J, Legge M, Lee AH. Aust N Z J Public Health 2003; 27(3): 328-332.
Correspondence: Mark Stevenson, Injury Research Centre, School of Population Health,
The University of Western Australia, 35 Stirling Highway, Crawley, Western Australia 6009, AUSTRALIA; (email: marks@dph.uwa.edu.au).
OBJECTIVES: To elicit whether drivers involved in alcohol-related motor vehicle crashes are more likely to have future alcohol-related hospital admissions.
METHODS: A population-based cohort study of 3,286 drivers involved in a motor vehicle crash between 1988 and 1992 were followed over an eight to 13-year period.
FINDINGS: The findings from the study suggest a twofold increased risk associated with an alcohol-related motor vehicle crash and future alcohol-related hospital admission. The average time between an alcohol-related motor vehicle crash and future alcohol-related hospital admission was 12 years. Men and Indigenous Australian drivers were more likely to have a future alcohol-related hospital admission.
DISCUSSION: It is evident from this study that drink-driving resulting in a motor vehicle crash and hospitalization could be considered an indicator of a less overt problem of alcohol dependency. It is important that penalties for drink-driving go beyond merely punitive action and provide rehabilitation.
Risky driving behavior in young people: prevalence, personal characteristics and traffic accidents.
Correspondence: David Fergusson, Christchurch Health and Development Study, Christchurch School of Medicine, PO Box 4345, Christchurch, NEW ZEALAND; (email: david.fergusson@chmeds.ac.nz).
OBJECTIVES: This research aimed to examine the prevalence of risky driving behavior among young people, the characteristics of those who engage in risky driving behavior, and the association between risky driving behaviors and accident risk.
METHODS: Data were gathered during the course of the Christchurch Health and Development Study. As part of this longitudinal study, data were gathered on self-reported risky driving behaviors (18-21 years), traffic accidents (18-21 years) and a variety of individual characteristics for 907 participants who reported having driven a motor vehicle.
FINDINGS: More than 90% of drivers engaged in some form of risky driving behavior. Those most likely to engage in frequent risky driving behaviors were: males (p < 0.0001), who exhibited alcohol (p < 0.0001) or cannabis abuse (p < 0.001) in adolescence, who were involved in violent/property crime (p < 0.01) and who affiliated with delinquent or substance-using peers (p < 0.05). There was a strong (p < 0.0001) association between the extent of risky driving behavior and traffic accident risk.
DISCUSSION: Risky driving behaviors are common among young people, particularly among young males prone to externalizing behaviors (substance abuse, crime and affiliations with deviant peers). Risky driving is strongly linked to traffic accident risk. There is a continued need to target risky driving behaviors among young people. Efforts to reduce risky driving should be targeted in particular at the high-risk group of young males prone to externalizing behaviors. More generally, the results suggest the need for a multi-strategy approach to the reduction of traffic accidents that focuses on the full spectrum of risky driving behaviors.
Risk factors for physical assault. State-managed workers' compensation experience.
- Islam SS, Edla SR, Mujuru P, Doyle EJ, Ducatman AM. Am J Prev Med 2003; 25(1): 31-37.
Correspondence: Syed S. Islam, Department of Community Medicine, West Virginia University, School of Medicine, P.O. Box 9190, Morgantown WV 26506, USA; (email: sislam@hsc.wvu.edu).
The estimation of incidence and evaluation of risk factors associated with nonfatal occupational assault injuries have rarely been documented in a statewide population context. A state-managed workers' compensation system can provide estimates of incidence of such injuries and allow evaluation of risk factors. Using claims data from the state-managed West Virginia Workers' Compensation, the incidence rates of workplace injuries resulting from physical assault were estimated for the period 1997-1999. Data on potential risk factors were obtained from the claim-related electronic data files, and the risk associated with each factor was assessed using proportional injury ratios (PIRs).During the study period, 2122 compensated injuries were associated with workplace violence. The incidence of assault injuries was 108.2 cases per 100,000 employee years. Women sustained a higher incidence than men. Healthcare workers, public safety workers, and teachers accounted for almost 75% of all assault injuries. Workers in these occupations also differed from each other with regard to seasonality and timing of assault, perpetrator-victim relationship, and types of injury. Evidence of gender-occupation interaction indicated higher risk of assault injury in men compared to women across the three leading occupations. Nighttime work shifts were associated with greater risk of assault for female healthcare workers (PIR=1.8; 95% confidence interval, 1.09-2.87).The healthcare sector sustained the bulk of assault injuries in West Virginia. Although the majority of healthcare-sector employees were women, the risk of assault injuries was higher in male employees. Risk factors and injury characteristics identified in this study, particularly for three high-risk occupations, should help develop strategies for preventing workplace violence. Protecting female healthcare workers on night-shift duty, especially in nursing home settings, appears to be an important target for intervention.
Child death review. The state of the nation.
- Webster RA, Schnitzer PG, Jenny C, Ewigman BG, Alario AJ. Am J Prev Med 2003; 25(1): 58-64.
Romi A. Webster, MD, MPH, Pediatric Health Associates, Hunnewell Ground, Children's Hospital, 300 Longwood Avenue, Boston MA 02115, USA; (email: romi.webster@tch.harvard.edu).
Child death review (CDR) is a mechanism to more accurately describe the causes and circumstances of death among children. The number of states performing CDR has more than doubled since 1992, but little is known about the characteristics of these programs. The purpose of this study was to describe the current status of CDR in the United States and to document variability in program purpose, scope, organization, and process. Investigators administered a written survey to CDR program representatives from 50 states and the District of Columbia (DC), followed by a telephone interview. All 50 states and DC participated; 48 states and DC have an active CDR program. A total of 94% of programs agreed that identifying the cause of and preventing future deaths are important purposes of CDR. Assistance with child maltreatment prosecution was cited as an important purpose by only 13 states (27%). Twenty-two states (45%) review deaths from all causes, while six states (12%) review only deaths due to child maltreatment. CDR legislation exists in 33 states. Fifty-three percent of the CDR programs were implemented since 1996, and 59% report no or inadequate funding. CDR contributes to the death investigation process in seven states (14%), but the majority (59%) of reviews are retrospective, occurring months to years after the child's death. CDR programs in the United States share commonalities in purpose and scope. Without national leadership, however, the wide variation in organization and process threatens to limit CDR effectiveness.
I could have just done with a little more help: an analysis of women's help-seeking from health visitors in the context of domestic violence.
Correspondence: Sue Peckover, Department of Community Ageing, Rehabilitation Education and Research, School of Nursing and Midwifery University of Sheffield, Samuel Fox House Northern General Hospital, Herries Road Sheffield, S5 7AU UK; (email: S.Peckover@Sheffield.ac.uk).
Domestic violence is a serious issue that adversely affects large numbers of women and children. Despite having an adverse impact upon health and welfare, women experiencing domestic violence face a number of difficulties seeking help about their situation from statutory health and welfare agencies. The present paper is based upon a study of British health visiting in relation to women experiencing domestic violence. Drawing upon interview data from 16 women who experienced domestic violence and were the mothers of small children, this paper explores their accounts of contact with the health visiting service. All of the 16 women who participated in this research described difficulties in seeking help about domestic violence. These included practical concerns such as fears for their own safety, lack of knowledge regarding appropriate sources of support and protection, and concerns about losing custody of their children. Given these concerns, some women concealed their experiences of domestic violence from their health visitors. For those who disclosed the domestic violence to their health visitors, they did not always receive appropriate support or protection. Of particular concern was the absence of information about accessing more specialist services. The research findings suggest that there is considerable scope for practice development in order to ensure that women experiencing domestic violence are able to receive safe and appropriate responses from health visitors.
Correspondence: Maureen Funk, Gundersen Lutheran Medical Center Domestic Abuse/Sexual Assault Program,1900 South Avenue, La Crosse, WI 54601, USA; (email: unavailable).
Strangulation accounts for 10% of all violent deaths in the United States. Many people who are strangled survive. These survivors may have minimal visible external findings. Because of the slowly compressive nature of the forces involved in strangulation, clinicians should be aware of the potential for significant complications including laryngeal fractures, upper airway edema, and vocal cord immobility. Survivors are most often assaulted during an incident of intimate partner violence or sexual assault, and need to be specifically asked if they were strangled. Many survivors of strangulation will not volunteer this information. Accurate documentation in the medical chart is essential to substantiate a survivor's account of the incident. Medical providers are a significant community resource with the responsibility to provide expert information to patients and other systems working with survivors of strangulation. This case study reviews a strangulation victim who exhibited some classic findings.
