Correspondence: Madeline A Dalton, Department of Paediatrics, Dartmouth Medical School, One Medical Center Drive, Lebanon, NH 03756, USA (email: madeline.dalton@Dartmouth.edu).
(Copyright 2003, Lancet Publishing Group)
CONTEXT: Among children and adolescents, media exposure to risky behavior has been suggested as a contributor to initiation of these behaviors. Exposure to smoking in movies has been linked with adolescent smoking initiation in cross-sectional studies. We undertook a prospective study to ascertain whether exposure to smoking in movies predicts smoking initiation.
METHODS: We assessed exposure to smoking shown in movies in 3547 adolescents, aged 10-14 years, who reported in a baseline survey that they had never tried smoking. Exposure to smoking in movies was estimated for individual respondents on the basis of the number of smoking occurrences viewed in unique samples of 50 movies, which were randomly selected from a larger sample pool of popular contemporary movies. We successfully re-contacted 2603 (73%) students 13-26 months later for a follow-up interview to determine whether they had initiated smoking.
FINDINGS: Overall, 10% (n=259) of students initiated smoking during the follow-up period. In the highest quartile of exposure to movie smoking, 17% (107) of students had initiated smoking, compared with only 3% (22) in the lowest quartile. After controlling for baseline characteristics, adolescents in the highest quartile of exposure to movie smoking were 2.71 (95% CI 1.73-4.25) times more likely to initiate smoking compared with those in the lowest quartile. The effect of exposure to movie smoking was stronger in adolescents with non-smoking parents than in those whose parent smoked. In this cohort, 52.2% (30.0-67.3) of smoking initiation can be attributed to exposure to smoking in movies.
COMMENTS: Our results provide strong evidence that viewing smoking in movies promotes smoking initiation among adolescents.
Leadership and culture are basic concepts for improving safety performance. The two are inextricably linked and must be studied together. This article explores seven key points that provide safety health & environmental professionals with a clear picture of their role as leaders.
- Peleg K, Michaelson M, Shapira SC, Aharonson-Daniel L. Adv Ren Replace Ther 2003; 10(2): 117-121.
Correspondence: Kobi Peleg, Israel National Center for Trauma and Emergency Medicine Research, Sheba Medical Center, Tel Hashomer; Trauma Unit, Rambam Medical Center, Haifa; and Hadassah University Hospital Jerusalem, ISRAEL; (email: unavailable).
The organizational and medical conduct in disaster situations is complex and presents a challenge to every manager in the prehospital setting. The handling of such situations is characterized by the need to make decisions under uncertainty in real time, with deficient medical and support forces. The approach used in mass casualty incident situations is cycles of treatment, commonly known as the "butterfly system." There are serious logistic problems involved, both industrial and structural, physical obstacles that may interfere with rescue treatment and evacuation, disruption in communications, and many other difficulties. On top of these, there are other obstacles such as interruption with the cooperation and coordination of different force, enforcement and rescue teams, the press, inquisitive people, and others. However, the most serious problem of all is the tendency in complex situations to attempt to work with fixed preformed guidelines or protocols for operation. One disaster differs from another, regarding location, number of casualties, distribution, severity, type of injury and the nature of injury, size of available rescue teams, time and equipment needs, damage to roads, distance from hospital, and other variables. One of the most important lessons learned from the management of such incidents is do not set fixed protocols but rather principles only. By applying principles adapted to the situation, managers will be able to perform better.
Reported level of supervision of young children while in the bathtub.
- Simon, H. K., Tamura, T., and Colton, K. Ambul Pediatr (2003); 3(2): 106-108.
Correspondence: Department of Pediatrics, Division of Pediatric Emergency Medicine, Emory University School of Medicine, Hughes Spalding Children's Hospital/Grady Health System, Children's Healthcare of Atlanta, Ga 30329, USA; hsimon@emory.edu).
CONTEXT: Unintentional drownings cause over 600 deaths annually among children < or =5 years of age. Bathtubs are one of the leading sites for such drownings for children < or = 2 years of age and especially for children 1 year or younger.
OBJECTIVE: To determine reported levels of supervision of children while they are in the bathtub.
METHODS: A face-to-face questionnaire was administered to a convenience sample of parents or guardians of children < or =5 years of age who presented to the emergency centers of 2 children's hospitals. The investigators developed a 17-point survey that included items related to general demographics and bathtub supervision. Parents and guardians were asked details concerning who supervised while the child was bathing, any unsupervised periods, length of unsupervised periods, and activities during any unsupervised periods.
FINDINGS: A total of 259 families participated in the survey (16% Caucasian, 79% African American, 1% Hispanic, 3% Asian, and 1% biracial). The mean caregiver age was 29.1 years (SD 7.9). The mean age of the child was 30.5 months (SD 22). Overall, 31% of the respondents reported leaving their child unsupervised for some period of time in the bathtub. The mean age of children left alone was 37.5 months, with the youngest being 5 months old. Seventeen percent of children < or =24 months of age (N = 123, mean age 12.7 months) and 15% of children < or =12 months of age (N = 60, mean age 6.7 months) were reportedly at times left unsupervised in the bathtub. Common caregiver activities when leaving the child unsupervised included getting a towel or diapers, answering a phone, and cooking. A 5-month-old child was left unsupervised for > 2 minutes, and an 8-month-old child was reportedly left unsupervised for > 5 minutes to cook a meal. In addition, 20 of 259 respondents (7.7%) reported that their children bathed alone before the age of 5 years, and 4 respondents (1.5%) reported that their children bathed alone before the age of 2 years. Although most primary supervisors were adults, 5 children were at times supervised by children <10 years of age. No significant differences were seen based on the hospital, race, or educational level of the families.
COMMENTS: Many parents reported leaving their young children at times inadequately supervised in the bathtub. This occurred in children as young as 5 months of age. Given the potential risk of drowning when their children are inadequately supervised, parents should be advised concerning proper supervision in early anticipatory guidance
Reducing the risk of choking hazards: mouthing behaviour of children aged 1 month to 5 years.
Correspondence: Stuart A. Smith, Product Safety and Testing Group, Institute for Occupational Ergonomics, School of MMMEM, University Park, University of Nottingham, Nottingham, NG5 2RD, ENGLAND; (email: stuart.smith@nottingham.ac.uk).
Young children have a natural tendency to mouth items to explore their environment. Mouthing carries mechanical and chemical hazard potential for injury to the child, for example if they swallow an item they may choke, they may cut themselves on sharp items, and certain chemicals are present in plastic items which may pose a risk to children. Few data are available on the time that young children mouth items, how they mouth, and what they mouth. This study gathered data on 236 children aged between 1 month and 5 years to supplement and extend existing data. Findings are presented of estimated average and maximum daily mouthing times for children, how they mouth, what they mouth, and whether the items mouthed were intended to be. A validation study was carried out to determine the accuracy of the parental observation method used to gather the data. The implications of the findings of this study are discussed with respect to reducing the potential for mechanical accidents in the home.
Evaluating the effectiveness of a multimedia program on home safety.
- Sweeney MA, Chiriboga DA. Gerontologist 2003; 43(3): 325-334.
Correspondence: David A. Chiriboga, Department of Aging and Mental Health, University of South Florida, 13301 Bruce B. Downs Boulevard, Tampa, FL 33612, USA; (email: dchiriboga@fmhi.usf.edu).
OBJECTIVES: This study was designed to test the effectiveness and acceptance of multimedia home safety programming by community-dwelling seniors.
METHODS: A prototype CD-ROM was produced that required no reading or computer skills because the program included an audio narration of content and directions for operating the program on a touchscreen computer monitor. Volunteers (N = 126) from a senior center aged 55 and older were randomly assigned to (1) a multimedia group that used the interactive program to learn about home safety, (2) a traditional learning group that read well-established booklets on home safety, and (3) a control group that received no instruction on safety between the pre- and posttests.
FINDINGS: Repeated-measures multivariate analysis of variance showed that the multimedia group was the only group to improve in knowledge. The group was also very satisfied with the approach.
COMMENTS: Multimedia formats can effectively and economically provide information to older clients.
Restaurants are one of the nation's largest employers. Despite the industry's below-average incidence rate, substantial numbers of restaurant workers are injured each year. The authors review the typical types of disabling injuries encountered and offer practical control measures for their prevention. They also discuss how restaurants can develop an integrated approach to occupational safety.
Work-related injuries in Lebanon: Does nationality make a difference?
- Nuwayhid I, Fayad R, Tamim H, Kassak K, Khogali M. Am J Ind Med 2003; 44(2):172-181.
Correspondence: Iman Nuwayhid, American University of Beirut, Faculty of Health Sciences, Beirut, LEBANON; (email: nuwayhid@aub.edu.lb).
CONTEXT: To compare the type, severity, cause, and cost of work-related injuries between Lebanese and non-Lebanese workers in insured workplaces in Lebanon.
METHODS: A total of 4,186 claims and medical reports for 3,748 work-related injuries filed in 1998 at five major insurance companies were reviewed.
FINDINGS: Non-Lebanese workers (46%) were younger (29 vs. 31 years), belonged mainly to the construction sector (62% vs. 29%), and were paid less ($365 vs. $438/month) than Lebanese workers. Non-Lebanese construction workers reported more feet and eye injuries. Falls were more common among Lebanese workers while non-Lebanese workers commonly reported being struck by an object. No differences were noted in the severity of injuries (workdays lost; hospitalization) between the two groups, but, overall cost per injury was higher among the Lebanese workers.
COMMENTS: There were no salient differences between Lebanese and non-Lebanese workers regarding severity of work injuries, which may reflect the disparity in access to the Lebanese heath care system by nationality. Syrian migrant workers appear to represent a special group in Lebanon. Additional, in-depth analysis of the social, political, and workplace mechanisms leading to work injuries is recommended.
Falls among union carpenters.
- Lipscomb HJ, Li L, Dement JM. Am J Ind Med 2003; 44(2): 148-156.
Correspondence: Hester J. Lipscomb, First Union Bldg, Suite 600A, 2200 W. Main Street, Durham, NC 27705, USA; (email: hester.lipscomb@duke.edu).
CONTEXT: Falls are a leading cause of morbidity and mortality in the construction trades.
METHODS: We identified a cohort of 16,215 active union carpenters, hours worked, and their workers' compensation claims for a 10-year period. The data on this well-defined cohort were used to describe their work-related falls; to define rates of injury and the associated costs; and to identify high-risk groups.
FINDINGS: Same level falls occurred at a rate of 1.8/200,000 hours worked; falls from elevations at a rate of 2.3/200,000 hours worked. These injuries resulted in direct payments of $0.30 per hour of work or $2.40 per 8-hr day. Mean costs per fall increased with increasing age. Age was not associated with risk of falls from elevations; younger carpenters had modestly reduced rates of falls from the same level. Rates of falls decreased with increasing time in the union. Carpenters whose usual work involved drywall installation or residential work were at highest risk.
COMMENTS: Falls are a significant public health risk for carpenters and they are responsible for a significant burden of work-related injury costs. While there is a need for prevention of falls from elevations-through training, enforcement of fall protection regulations, improved safety climate, or engineering changes-there is also the need to prevent falls from lower elevations. Differences in risk likely reflect varying exposures and safety practices in different areas of carpentry, as well as training, experience, and job assignments based on longevity in the union.
Work-related falls among union carpenters in Washington State before and after the Vertical Fall Arrest Standard.
- Lipscomb HJ, Li L, Dement J. Am J Ind Med 2003; 44(2): 157-165.
Correspondence: Hester J. Lipscomb, First Union Bldg, Suite 600A, 2200 W. Main Street, Durham, NC 27705, USA; (email: hester.lipscomb@duke.edu).
CONTEXT: Washington State enacted a change in their fall standard for the construction industry in 1991, preceding the Safety Standard for Fall Protection in the Construction Industry promulgated by Federal OSHA in 1994.
METHODS: We evaluated changes in the rate of falls from elevations and measures of severity among a large cohort of union carpenters after the fall standard change in Washington State, taking into account the temporal trends in their overall injury rates.
FINDINGS: There was a significant decrease in the rate of falls from height after the standard went into effect, even after adjusting for the overall decrease in work-related injuries among this cohort. Much of the decrease was immediate, likely representing the publicity surrounding fatal falls and subsequent promulgation of the standard. The greatest decrease was seen between 3 and 3(1/2) years after the standard went into effect. There was a significant reduction in mean paid lost days per event after the standard change and there was a significant reduction in mean cost per fall when adjusting for age and the temporal trend for costs among non-fall injuries.
COMMENTS: Through the use of observational methods we have demonstrated significant effects of the Washington State Vertical Fall Arrest Standard among carpenters in the absence of a control or comparison group. Without controlling for the temporal trend in overall injury rates, the rate of decline in falls appeared significantly greater, but the more pronounced, but delayed, decline was not seen. The analyses demonstrate potential error in failing to account for temporal patterns or assuming that a decline after an intervention is related to the intervention.
Fatal occupational injuries among self-employed workers in North Carolina.
- Mirabelli MC, Loomis D,Richardson DB Am J Ind Med 2003; 44(2): 182-190.
Correspondence: Dana Loomis, Department of Epidemiology (CB #7435), The University of North Carolina at Chapel Hill - School of Public Health, Chapel Hill, North Carolina 27599-7435, USA; (email: Dana.Loomis@unc.edu).
CONTEXT: Research suggests that rates of occupational injury and death may be higher among self-employed workers than in the wage and salaried population.
OBJECTIVES: This analysis was conducted to describe the demographic and occupational characteristics, as well as injuries, activities, and occupations of self-employed workers who are fatally injured on the job.
METHODS: Characteristics of workers by type of employment were compared using data from the North Carolina Office of the Chief Medical Examiner, 1978-1994. Age-, activity-, and industry-specific fatality rates in self-employed workers (N = 395) were contrasted to those privately employed (N = 1,654).
FINDINGS: Highest fatal injury rates among the self-employed occurred in agriculture, retail, and transportation industries. Homicide deaths occurred more frequently among self-employed workers; deaths resulting from unintentional injuries occurred more frequently among non-self-employed workers.
COMMENTS: Elevated occupational fatality death rates among self-employed workers, especially in retail and transportation industries, provide justification for addressing work-related conditions of self-employed workers in North Carolina.
Injury surveillance in construction: What is an injury, anyway?
- Welch LS, Hunting K. Am J Ind Med 2003; 44: 191-196.
Correspondence: Laura S. Welch, Center to Protect Workers Rights, 8484 Georgia Ave., Silver Spring, MD 20910, USA; (email: lwelch@cpwr.com).
CONTEXT: Over the last decade, there has been a decline in injuries with days away from work in construction, associated with an increase in injuries with restricted work activity only.
METHODS: We abstracted demographics, diagnosis, cause-of-injury, and hospital discharge information for 481 workers from one large construction project treated in an urban Emergency Department (ED). The project safety team provided data on all injuries from this site, including first aid cases.
FINDINGS: This site had fewer injuries with days away from work than expected from national rates. Two hundred and fifty-six injuries were reported on the OSHA log, and of those 93 entailed days away from work; 1,515 injuries were considered first aid/medical only. We used a sample of the data to estimate that the site classified as recordable 128 of the 481 ED-treated injuries from this site (27%).
COMMENTS: The pattern of injury varies depending on the subset of injuries examined. Lost time injuries, as reported in BLS data, record fewer lacerations and eye injuries, and more strains and sprains. No one surveillance system presents the full spectrum of occupational injury. Tracking all injuries allow early recognition of injury risks, and therefore can lead to more effective prevention.
Improving safety results with process flowcharts & maps.
A major part of every Safety, Health &Environmental professional's responsibility is monitoring workplace activity to identify and eliminate special and common causes of accidents and illnesses before anyone is injured or becomes ill. One effective way to achieve this, the author explains, is safety process analysis, a technique that uses flowcharting and mapping to examine and improve work processes and procedures.
Walking trends among U.S. adults: the Behavioral Risk Factor Surveillance System, 1987-2000.
- Simpson ME, Serdula M, Galuska DA, Gillespie C, Donehoo R, Macera C, Mack K. Am J Prev Med 2003; 25(2): 95-100.
Correspondence: Mary Ellen Simpson, Epidemic Intelligence Service, Division of Applied Public Health Training, Epidemiology Program Office (Simpson), Centers for Disease Control and Prevention, Atlanta, Georgia, USA; (email: DHSHPCD@DHS.state.il.us).
To examine trends in walking among adults in 31 states.Trends by sociodemographic strata were analyzed from respondents who participated in the Behavioral Risk Factor Surveillance System (BRFSS).The prevalence of walking among men increased 3.8% (95% confidence interval [CI]=2.4-5.2), from 26.2% (95% CI=25.1-25.3) in 1987 to 30.1% (95% CI=29.4-30.8) in 2000. In women, walking increased 6.6% (95% CI=5.4-7.8), from 40.4% (95% CI=-39.4-41.1) to 46.9% (95% CI=46.2-47.6) during the same time period. However, the prevalence of walking three times a week for 30 minutes duration remained constant across all years. The largest increases occurred in minority subpopulations: 8.7% (95% CI=3.2-14.2) in Hispanic women, 8.5% (95% CI=4.4-12.6) non-Hispanic black women, and 7.0% (95% CI=2.3-11.7) in non-Hispanic black men. Walking was the most frequently reported activity among adults who met the national recommendations for regular physical activity (defined as five or more times a week for >/=30 minutes per session).Given the acceptability of walking across all sociodemographic subgroups, efforts to increase the frequency of walking could markedly increase the percentage of U.S. adults who engage in regular physical activity, a national priority identified in the Healthy People 2010 objectives for the nation.
Obstacle avoidance during human walking: H-reflex modulation during motor learning.
- Hess F, Van Hedel HJ, Dietz V. Exp Brain Res 2003; 151(1): 82-89.
Correspondence: H. J. A. van Hedel, Balgrist University Hospital, Spinal Cord Injury Center, Forchstrasse 340, CH-8008, Zurich, SWITZERLAND; (email: hvanhede@balgrist.unizh.ch).
The goal of this study was to investigate changes of H-reflex amplitudes during a motor learning task. Subjects with reduced vision were instructed to step over an obstacle on a treadmill as low as possible, while the soleus H-reflex was elicited. Acoustic warning and feedback signals about performance were provided. Performance improvement was associated with a decrease of muscle activity, needed to step over the obstacle (rectus femoris, biceps femoris, tibialis anterior and gastrocnemius medialis muscles), and of foot clearance, while joint angle trajectories from knee and ankle became more stable. The experiment consisted of five runs, three with normal treadmill walking and two with randomly stepping over the obstacle (100 times). H-reflexes were elicited at early and late stance phase before stepping over the obstacle. H/M ratio, latency and duration were determined. The values of these measures were calculated for the onset and end of a run and their course over time was evaluated using a correlation coefficient. The largest adaptations with a significant increase of reflex amplitude occurred during the first obstacle run. This increase lasted only briefly and the reflex amplitudes decreased to their previous values. During the later obstacle run, no H-reflex modulation occurred. It is concluded that a motor learning task causes adaptational effects not only on performance, but also on H-reflex responses. The results indicate that most of the modulation of H-reflexes is probably due to supraspinal influences on reflex transmission. The observations made are probably less specific for this motor task (stepping over the obstacle), but rather associated with the increased attention required by the motor learning task during the first obstacle run.
Correspondence: Nathalie Fouilhe Sam-Lai, Unite de Toxicologie Clinique, Departement de Veille Sanitaire, Centre Hospitalier, Universitaire de Grenoble, Grenoble, FRANCE; (email: NFouilhe@chu-grenoble.fr).
CONTEXT: In France, the epidemiological situation of acute carbon monoxide (CO) poisoning is only partially known. The purpose of this study was to assess the epidemiological situation of household poisonings in two French regions where a regional toxicovigilance network was active.
METHODS: During five years, we studied, by means of a standardized data collection form, cases of acute CO poisoning admitted to regional hospitals and notified by hospital physicians.
FINDINGS: From 1997 to 2001, 1,458 people were involved in 489 places. Household poisonings represented the first circumstance of CO poisoning with 811 people involved in 293 places. So, analysis was performed only for household poisonings. The mean age was 33.3 years. Twenty patients died (2.6%), 16 patients were in coma (2.1%), and 11 patients had an initial isolated loss of consciousness (14.4%). Responsible appliances in household poisonings were identified in 84% of places. The appliances most often involved were vented heating systems (46.4%), mobile heaters (13.2%), and thermal motors (8.7%). In 63% of the 293 places, investigation showed that poisoning occurred because of a faulty installation. Vented gas heaters and mobile heaters were responsible for half of the severe household CO poisonings.
COMMENTS: In the countries of Rhone-Alpes and Auvergne, most of household CO poisonings are no longer caused by waterheaters but by gas heating systems. Poisonings caused by mobile heaters more frequently led to coma and death and thermal motors played a large part in moderate poisonings. These recently emerging trends justify the efforts focused on ongoing monitoring and the introduction of preventive measures.
Information sources accessed by parents following childhood poisoning.
- Rush JA Reith DM. Emerg Med 2003; 15(4): 348-352.
Correspondence: David Reith, Dunedin School of Medicine, 3rd Floor, Children's Pavilion, Dunedin Hospital, Great King St, Dunedin 9001, NEW ZEALAND; (email: david.reith@stonebow.otago.ac.nz).
OBJECTIVES: To ascertain the sources of information accessed by parents/caregivers following an incident of child poison ingestion, prior to their presentation to an ED.
METHODS: A questionnaire based survey of the parents/caregivers of children presenting to the Mater Children's Hospital Emergency Department with poisoning from March to October 2001.
FINDINGS: A total of 121 parents/caregivers were surveyed. In 117 cases (97%), information was sought prior to presentation. The Poisons Information Centre (PIC) was the initial source of information in 39 cases (32%), the ED in 25 cases (21%) and the family doctor (by telephone or consultation) in 21 cases (17%). Poisons Information Centres, emergency departments and family doctors were the sole sources of information for 18%, 15% and 12% of cases, respectively. For 46% of cases multiple sources of information were accessed, and overall, in 57 cases (47%) the Poisons Information Centre was accessed, the ED in 38 cases (31%) and the family doctor in 34 cases (28%).
DISCUSSION: Poisons Information Centres are under-utilized as the first point of contact after childhood poisoning but in nearly all cases of poison ingestion that presented to the ED, information was sought prior to presentation and in most cases this was from direct contact with a health professional.
Correspondence: Doug Zatzick, Department of Psychiatry & Behavioral Sciences, and Harborview Injury Prevention & Research Center, University of Washington School of Medicine, Seattle, Washington, USA; (email: unavailable).
Each year in the United States approximately 2.5 million Americans incur injuries so severe that they require inpatient admissions to acute care medical settings. This article reviews the development of posttraumatic stress disorder (PTSD) and related comorbid medical conditions among injured trauma survivors. Between 10% and 40% of injured trauma survivors appear to develop PTSD in the weeks and months after their injury. The symptoms of PTSD are clearly linked to a broad spectrum of functional impairment and diminished well-being in injured patients. Although PTSD, depression, somatic amplification, and recurrent substance use are common disturbances after injury, it appears that few symptomatic trauma survivors receive formal mental health evaluation or treatment. Substantial perceived and structural barriers to accessing care exist for injured trauma survivors. The public health significance of these findings is discussed and implications for future intervention development are explored in the following chapters.
OBJECTIVES: To determine the method of sliding that propels the baseball athlete to the desired base in the shortest amount of time. To assess the athlete's perception of the quickest, safest, and preferred sliding technique.
DESIGN: A single occasion with repeated measures design was used. The independent variable was slide type, and the dependent variable was time.
SETTING: The study was conducted in October 2000 at the University of Kentucky baseball complex.
PARTICIPANTS: Twenty collegiate baseball players.
INTERVENTIONS: High-speed video (to 1/200th of second) analysis of 20 collegiate baseball players performing 3 trials each of both head-first and feet-first sliding techniques. Additionally, each participant was asked to complete a sliding survey.
MAIN OUTCOME MEASURES: The videotape of each slide performed was reviewed separately (using the same viewing equipment) by 2 of the study investigators. Slide type and time were recorded for each slide.
FINDINGS: There was no significant difference between head-first versus feet-first slide times (P = 0.357). The average time for feet-first slides was 3.67 seconds, while that for head-first was 3.65 seconds. Sixty-eight percent of the players felt that head-first slides were faster than feet-first slides. Seventy-four percent identified the feet-first slide as the technique they most used, while 90% of the athletes perceived the feet-first technique to be safer.
COMMENTS: On average, head-first and feet-first sliding techniques employed at the end aspect of base running propel the baseball player to the base in similar times. The head-first sliding technique is perceived to be faster and more dangerous
Job titles and work areas as surrogate indicators of occupational exposure.
- Sun, Y., Taeger, D., Weiland, S. K., Keil, U., and Straif, K. Epidemiology (2003); 14(3): 361 - 367.
Correspondence: Dirk Taeger, Institute of Epidemiology and Social Medicine, University of Münster, Domagkstr. 3, D-48129 Münster, GERMANY; (email: taegerd@uni-muenster.de).
CONTEXT: Job titles or work areas are often used as surrogate indicators of exposure in occupational epidemiological studies. In this article, we assess the validity and comparability of commonly used surrogate indicators.
METHODS: We analyzed lung cancer mortality among a hypothetical and an actual cohort of rubber workers. Surrogate indicators of exposure were defined according to jobs in which workers were "only," "ever," "longest" or "last" employed, or in which they were employed at the "census" of the study. Occupational risks were estimated using standardized mortality ratios. Validity of surrogate indicators was assessed in the simulated data by comparison between estimated effects and the known underlying associations. Comparisons of surrogate indicators were conducted in both simulated and empirical data.
FINDINGS: Use of the definition "only" as the surrogate indicator gave valid but imprecise results. For all other definitions, we observed a moderate overestimation of risks in no-risk or low-risk jobs and attenuation of underlying dose-response relationships, without substantial differences among the applied definitions.
DISCUSSION: Our results demonstrate a limitation of using surrogate indicators of exposure in occupational epidemiological studies. However, they suggest that the inconsistencies of published study findings in the rubber industry are unlikely to be attributable to the use of different surrogate indicators
An application for measuring vehicle travel by visitors.
Correspondence: Xuehao Chu, Center for Urban Transportation Research, University of South Florida, 4202 East Fowler Avenue, CUT 100, tampa FL 33620, USA; (email: xchu@cutr.eng.usf.edu).
(Published by US Department of Transportation, Bureau of Transportation Statistics)
This paper develops a simple approach to estimating annual vehicle travel by visitors to individual states. Domestic and foreign visitors are considered separately. The approach uses local or national surveys for domestic visitors but federal surveys for foreign visitors. The approach is applied to Florida for the 15-year period from 1984 through 1998. Visitors accounted for about 9.8% to 12.7% of all vehicle travel in the state during this period. Variations over time result from changes in the number of visitors and their characteristics such as the length of stay and party size.
Review article: the status of the Glasgow Coma Scale.
Correspondence: Belinda J Gabbe, Trauma and Sports Injury Prevention Research Unit, Department of Epidemiology and Preventive Medicine, Monash University, Central and Eastern Clinical School, Alfred Hospital, Prahran, Vic. 3181, AUSTRALIA; (email: belinda.gabbe@med.monash.edu.au).
The Glasgow Coma Scale (GCS) was first introduced in the 1970s to provide a simple and reliable method of recording and monitoring change in the level of consciousness of head injured patients. Since its introduction, the GCS has been widely utilized in the trauma community and its use expanded beyond the original intentions of the score. In the context of traumatic injury, this paper discusses the use of the GCS as a predictor of outcome, the limitations of the GCS, the reliability of the GCS and potential alternatives through a critical review of the literature. The relevance to Australian trauma populations is also addressed.
OBJECTIVES: The purpose of the present study was to evaluate the variability in the annual head injury incidence rate in Sweden from 1987 to 2000. It was hypothesized that the annual incidence rate would decrease over time due to a variety of primary preventive strategies that have been introduced in Swedish society.
METHODS: We used the Hospital Discharge Register at the National Board for Health and Welfare and head injury codes 800-804, and 850-854 from ICD9 system and S2.0-S2.9, and S6.0-S6.9 codes from ICD-10 system. We evaluated the patterns of age, gender, external cause of injury (E-code), type of injury, length of hospital stay, and trends over time.
FINDINGS: Head injuries due to transportation collision were reduced over the 14-year period analysis. Falls persisted as the dominant cause of head injury. Overall, men had 2.1 times the incidence of head injury compared to women. There was a decline in younger ages experiencing a head injury over this interval, while the number of head injuries among elderly people increased over time. Concussion was about three times more frequent than fractures. Hematoma and diffuse or focal contusions had a much lower incidence rate than concussion. Concussions and fractures decreased over time. Diffuse or focal injuries showed a steady rate of occurrence over the study interval while hematoma increased. Although length of hospital stay varied widely from zero to more than 50 days, 73.6% of hospital days were confined to two days or less. The incidence rate is stable over this time frame. While head injuries attributable to transportation accidents decreased, falls made up an increasing proportion of head injuries.
COMMENTS: Since we observed an increase in head injuries among elderly, primary prevention strategies may need to be targeted at this age group, and at preventing falls.
CONTEXT: Neck injuries are some of the most important injuries as they have the potential to influence the spinal cord. A previous national survey of neck injuries in Sweden revealed that injury incidence was increasing for the population over 65 years of age, although it was decreasing for the population as a whole.
OBJECTIVES: The aim of this study was therefore to further clarify the magnitude, severity, and external causes of neck injuries in the elderly people in Sweden.
METHODS: A national incidence study, with focus on the age group above 65 years, was undertaken with data from the injury surveillance program at the Swedish National Board of Health and Welfare. The investigation includes cervical vertebral fractures reported between 1987 and 1999, and cervical soft tissue injuries from 1997 to 1999. Data in the hospital discharge register were reported in ICD9 from 1987 to 1996, while data from 1997 to 1999 were reported in ICD10.
FINDINGS: During the study period 4168 cervical injuries occurred of which 341 were fatal. People above 65 years of age made up 17% of the population and sustained 30% of all cervical injuries and 43% of all fatal cervical injuries. Half of the cervical injuries were axis (C2) fractures. Lower vertebral fractures occurred in 16% of the cases and atlas (C1) fractures in 11%. The cervical soft tissue injuries amount to 19% of all injuries. Fall accidents account for the majority (71%) of the accidents. There is an increasing trend for fall accidents resulting in neck injuries. The male population has a higher incidence for neck fractures than females, disregarding the external cause of injury. The upper cervical injuries are the most common, have the longest hospital treatments, and seem to be caused mainly by low energy falls.
COMMENTS: Further research is needed to understand the mechanisms of these injuries and in this aspect engineering could contribute with valuable knowledge, through accident simulations with numerical models. The increasing incidence of fall injuries calls for further preventive actions. The public sector should implement preventive strategies to reduce the number of extrinsic accidents, while the health care sector should focus on preventing intrinsic accidents with individual actions for each patients.
Examining geographic patterns of mortality: The Atlas of mortality in small areas in Spain (1987-1995).
- Benach J, Yasui Y, Borrell C, Rosa E, Pasarín MI, Benach N, Español E, Martínez JM and Daponte A. Eur J Public Health 2003; 13(2): 115-123.
Correspondence: Joan Benach, Department of Experimental Sciences and Health, Occupational Health Research Unit, Universitat Pompeu Fabra, Barcelona, SPAIN; (email: joan.benach@cexs.upf.es).
CONTEXT: Small-area mortality atlases have been demonstrated to be a useful tool for both showing general geographical patterns in mortality data and identifying specific high-risk locations. In Spain no study has so far systematically examined geographic patterns of small-area mortality for the main causes of death. This paper presents the main features, contents and potential uses of the Spanish Atlas of Mortality in small areas (1987-1995).
METHODS: Population data for 2,218 small areas were drawn from the 1991 Census. Aggregated mortality data for 14 specific causes of death for the period 1987-1995 were obtained for each small area. Empirical Bayes-model-based estimates of age-adjusted relative risk were displayed in small-area maps for each cause/gender/age group (0-64 or 65 and over) combination using the same range of values (i.e. septiles) and colour schemes.
FINDINGS: The 'Spanish Atlas of Mortality' includes multiple choropleth (area-shaded) small-area maps and graphs to answer different questions about the data. The atlas is divided into three main sections. Section 1 includes the methods and comments on the main maps. Section 2 presents a two-page layout for each leading cause of death by gender including 1) a large map with relative risk estimates, 2) a map that indicates high- and low-risk small areas, 3) a graph with median and interquartile range of relative risk estimates for 17 large regions of Spain, and 4) relative-risk maps for two age groups. Section 3 provides specific information on the geographical units of analysis, statistical methods and other supplemental maps.
COMMENTS: The 'Spanish Atlas of Mortality' is a useful tool for examining geographical patterns of mortality risk and identifying specific high-risk areas. Mortality patterns displayed in the atlas may have important implications for research and social/health policy planning purposes.
Traumatic eye injuries due to large unusual foreign bodies: a Singapore case series.
- Pan JC, Yap EY, Yip CC. Eur J Ophthalmol 2003; 13(4): 398-402.
Correspondence: James Pan, The Eye Institute, National Healthcare Group, Tan Tock Seng Hospital, SINGAPORE; (email: James_Pan@ttsh.com.sg).
OBJECTIVES: Traumatic eye injuries due to large foreign bodies (FB) are rare. The visual prognosis is often poor in these cases because of severe ocular damage. Staged surgical procedures with eventual enucleation or evisceration are often indicated.
METHODS: Case series.
FINDINGS: The authors describe two patients with eye injury due to large FB with visual acuity of no light perception at presentation. Both had initial repair of the ocular injuries and removal of the FB. One patient with an intraocular FB eventually underwent enucleation; the other, with intraorbital FB, had evisceration as a secondary procedure. Orbital implantations were done in both. Neither of the patients had developed sympathetic ophthalmia at the last review.
COMMENTS: The visual outcome of eye injuries due to large FB is poor. Both enucleation and evisceration can be performed with low risk of sympathetic ophthalmia. Prevention remains the best approach to such devastating injuries.
CONTEXT: Early intervention to decrease violent and aggressive behavior in preschool-age children.
PURPOSE: To describe a model of an on-site early identification and intervention program for children under 6 in child care and preschool settings.
METHODS: Literature review, authors' experiences in preschool prevention services, and pre/post intervention data using standardized tools.
COMMENTS: An on-site secondary prevention program is an effective strategy to decrease violent and aggressive behavior in very young children. This model can be replicated in most communities through collaborations among childhood mental health professionals and early childhood educators.
Early puberty is associated with mental health problems in middle adolescence.
- Kaltiala-Heino R, Marttunen M, Rantanen P, Rimpela M. Soc Sci Med 2003; 57(6): 1055-1064.
Correspondence: Riittakerttu Kaltiala-Heino, Tampere School of Public Health, 33014 University of Tampere, Box 607, 33101, Tampere, FINLAND; (email: merihe@uta.fi).
This study set out to assess the relationship between pubertal timing and emotional and behavioural problems in middle adolescence. The study involved a school based survey of health, health behaviour and behaviour in school as well as questions about emotional and behavioural problems (the School Health Promotion Study). Secondary schools in four regions and 13 towns in Finland participated in the study in 1998. The respondents were 36,549 adolescents aged 14-16. The study included questions on depression, bulimia nervosa, psychosomatic symptoms, anxiety, drinking, substance use, smoking, bullying and truancy. Among girls, both internalising and externalising symptoms were more common the earlier puberty occurred. Among boys, externalising symptoms only were associated with early puberty. It is concluded that early pubertal timing is associated with increased mental health problems. Professionals working with adolescents should consider the mental health needs of early maturing adolescents.
- Birt C, Bille-Brahe U, Cabecadas M, Chishti P, Corcoran P, Elgie R, Van Heeringen K, Horte LG, Marchi AG, Ostamo A, Petridou E, Renberg ES, Stone DH, Wiik J and Williamson E. Eur J Public Health 2003; 13(2): 108-114.
Correspondence: Christopher Birt, University of Birmingham, Collaboration for Public Health in Europe, UK; (email: unavailable).
CONTEXT: There are an estimated one million completed suicides per year worldwide.
OBJECTIVES: As a response to increasing concern about suicide within Europe, the EUROSAVE (European Review of Suicide and Violence Epidemiology) study was undertaken to examine recent trends in the epidemiology of suicide and self-inflicted injury mortality in the European Union (EU).
METHODS: Suicide and self-inflicted injury mortality data for the 15 EU countries for the years 1984-1998 were obtained from the World Health Organisation (WHO), the European Statistical Office of the European Commission (EUROSTAT) and national statistical agencies. Data were also obtained for a second group of deaths classified as 'undetermined' or 'other violence'. Age-standardized mortality rates were calculated and examined for trends over time.
FINDINGS: Finland had the highest suicide rate, while Greece had the lowest for the latest available year (1997). Age-standardized suicide rates tended to be lowest in the Mediterranean countries. Significant downward linear time trends in suicide mortality were observed in most countries, although rates varied markedly between countries. Both Ireland and Spain displayed significant upward linear trends in suicide mortality. Portugal had the highest rate of undetermined deaths both in 1984 and 1998 while Greece had the lowest in both 1984 and 1997. Five countries (including Ireland and Spain) showed significant downward trends in deaths due to undetermined causes whereas Belgium and Germany showed borderline significant upward linear trends in deaths due to undetermined causes.
COMMENTS: Although suicide rates in most countries seem to be decreasing, the validity of the data is uncertain. Misclassification may contribute to the geographical and temporal variation in suicide rates in some EU countries but it does not explain the phenomenon. More detailed research comparing suicide-recording procedures and practices across the EU is required. In the absence of adequate EU wide data on suicide epidemiology, effective prevention of this distressing phenomenon is likely to remain elusive.
Pathological gambling and suicidality: an analysis of severity and lethality.
Correspondence: Alex Blaszczynski, Department of Psychology, transient Building F12, The University of Sidney, Sidney, NSW 2006, AUSTRALIA; (email: alexb@psych.usyd.edu.au).
Pathological gambling represents a major public health issue. Risk factors for suicide such as major depression, substance abuse, marital breakdown, unemployment, financial crises, and legal difficulties are commonly found in populations of pathological gamblers. The objective of this study was to systematically investigate the nature of suicidal behavior among treatment-seeking pathological gamblers and its relationship to gambling characteristics and depression. Indices of suicidality were assessed in a sample of 85 treatment-seeking diagnosed pathological gamblers. High rates of suicidal ideation, suicidal plans, and attempts were found; however, no clear relationship was observed between suicidality and indices of gambling behavior. Depression rather than gambling specific characteristics, marital difficulties, or the presence of illegal behaviors appear to be related to the risk of suicidality.
A population-based study of the association between pathological gambling and attempted suicide.
Correspondence: Stephen Newman, Department of Psychiatry, Mackenzie Centre, University of Alberta, Edmonton, Alberta, CANADA; (email: stephen.newman@ualberta.ca).
The association between pathological gambling and attempted suicide was examined using data from a prevalence study conducted in Edmonton, Alberta, Canada. The sample size was 7,214, the questionnaire was the Diagnostic Interview Schedule, and diagnoses were made on a lifetime basis according to DSM-III criteria. Logistic regression analysis was performed, with attempted suicide as the dependent variable. The odds ratio for pathological gambling was statistically significant (odds ratio = 4.91; 95% confidence interval = [1.41,17.1]) when major depression was the only comorbid mental disorder in the model. As terms for additional mental disorders were included, pathological gambling ceased to be statistically significant. It was concluded that a history of pathological gambling is associated with previous attempted suicide, and that the association may be due to a common factor--"mental illness."
Risk-taking behavior and adolescent suicide attempts.
Correspondence: Anthony Spirito, Browen University Clinical Psdychology Consortium, Potter Building, Box G-BH, Brown University School of Medicine, Providence, RI 02912, USA; (email: anthony_spirito@brown.edu).
This study examined the overall rates of common risk-taking behaviors in a sample of 109 adolescents, aged 13 to 18 years, who made a suicide attempt, compared to a matched control sample of 218 adolescents in the community. No differences in either the total number of risk-taking behavior or the frequency of individual risk-taking behaviors were found. These findings suggest that suicide attempts in adolescents are not a function of risk-taking behavior.
The number of older drivers on the road and the amount of driving they do continues to increase. However, along with
this increase in the number of older drivers and their level of driving has come a sharp increase in the number of fatalities involving older drivers. Traffic safety improvements designed to make it easier for older drivers to navigate traffic are becoming increasingly important, as the largest generation in American history ages and seeks to maintain a
level of mobility that matches their active lifestyles. Roadway improvements can help make driving safer for older Americans, as well as for the population at large.
Older drivers are defined in this study as persons aged 70 or older, based on the age when most people start to experience some diminished physical capabilities associated with driving, such as vision, hearing, reaction times and flexibility.
The major findings of this report are:
Statistics show that the number of older drivers being killed in motor vehicle
crashes is increasing.
The number of Americans aged 70 and older killed in traffic crashes increased by
27 percent between 1991 and 2001 -- from 2,494 fatalities to 3,164. By
comparison, the number of overall motor vehicle fatalities increased only 2
percent during the same time.
Florida led the nation in the number of older drivers killed in traffic accidents in
2001, with 268 older drivers killed.
In 2001, crashes involving at least one older driver caused 5,113 fatalities nationwide.
This is up from 4,261 persons killed in crashes involving an older driver in
1991 -- a 20 percent increase.
From 1991 to 2001, the number of licensed drivers age 70 and older increased 32
percent, from 14.5 million to 19.1 million. Approximately 10 percent of all
drivers are 70 and older, compared to 8.6 percent a decade ago.
The number of older Americans who continue to drive is increasing. In 2001, 75
percent of Americans 70 and older still drove -- an increase from 73 percent in
1995.
The 2001 National Household Travel Survey (NHTS) found that the average
American aged 70 or older spends approximately 37 minutes daily driving a
private vehicle. This level of driving is a 28 percent increase since 1995, when
the average person aged 70 or above drove an average of approximately 29
minutes daily.
The average person aged 70 or above drives 15.3 miles per day according to the
2001 NHTS -- a 20 percent increase from 1995 when the average older person in
the U.S. drove an average of 12.7 miles daily. The increase in older drivers killed in traffic accidents is occurring as older Americans form a greater portion of the overall population.
The older segment of the population (those 65 and older) grew nearly twice as
fast as the total population between 1990 to 2000, according to the Census
Bureau.
The number of older Americans will only increase, as baby boomers will start to
turn 65 in 2011. Estimates show that one in five people will be aged 65 or older
by 2020.
The latest Census Bureau data also shows that Florida, West Virginia,
Pennsylvania, Iowa and North Dakota have the highest proportion of their
populations aged 65 or older.
According to the National Highway Traffic Safety Administration (NHTSA), 50
percent of all older driver fatalities in 2001 occurred at intersections, while only
23 percent of younger driver fatalities (those 69 and under) occur at intersections.
Left hand turns are also more problematic for older drivers, as they must make
speed, distance, and gap judgments in a limited amount of time in order to enter
or cross the through roadway.
Small or complex signage may be misunderstood or not seen quickly enough to
alert older motorists about upcoming exits, obstacles, or changes in traffic
patterns.
Based primarily on its analysis of the Federal Highway Administration (FHWA)
report, "Older Driver Highway Design Handbook," The Road Information
Program (TRIP) recommends the following comprehensive set of safety
improvements for improving older driver safety:
Signage and lighting: 1) clearer and less complex signage that is easier to follow; 2) larger lettering on signs and larger pavement markings; 3) better street lighting, particularly at intersections; and 4) higher-performing retroreflective material in signs and pavement markings for better nighttime visibility.
Intersections: 1) bright, luminous lane markings and directional signals; 2) overhead indicators for turning lanes; 3) overhead street-name signs; and 4) adding or widening left-turn lanes.
Streets and Highways: 1) wider lanes and shoulders to reduce the consequences of driving mistakes; 2) longer merge and exit lanes; 3) rumble strips to warn motorists when they are running off roads; 4) curves that are not as sharp; 5) Improvements to pedestrian features at intersections; 6) Improved intersection design; and 7) Improved standards for acceptable stopping and reaction sight distances.
Factors associated with the likelihood of injury resulting from collisions between four-wheel drive vehicles and passenger cars.
Correspondence: Lutchmie Narine, Department of Health Administration and Policy, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA; lutchmie-narine@ouhsc.edu).
The specific effects of vehicular type on the likelihood of an injury occurring are relatively unexplored. This study sought to assess the relative risk of injury to occupants of four-wheel drive vehicles and their counterparts in passenger cars.Data for 1143 occupants from all of the 454 crashes in Oklahoma, in 1995 that involved a four-wheel drive vehicle were used. Multiple logistic regression analysis determined the association between potential predictive factors and vehicular injury. Odds ratios revealed occupancy in a passenger car to be a major predictor of the likelihood of injury. Other factors include the driver being female, driving too fast, travel on curved or level roadways, and being hit laterally or from the rear.
Accident involvement among learner drivers-an analysis of the consequences of supervised practice.
It is a well-known fact that experience is important for safe driving. Previously, this presented a problem since experience was mostly gained during the most dangerous period of driving-the first years with a licence. In many countries, this "experience paradox" has been addressed by providing increased opportunities to gain experience through supervised practice. One question, however, which still needs to be answered is what has been lost and what has been gained through supervised practice. Does this method lead to fewer accidents after licensing and/or has the number of accidents in driving practice increased? There were three aims in the study. The first was to calculate the size of the accident problem in terms of the number of accidents, health risk and accident risk during practising. The second aim was to evaluate the solution of the "experience paradox" that supervised practice suggests by calculating the costs in terms of accidents during driving practice and the benefits in terms of reduced accident involvement after obtaining a licence. The third aim was to analyse conflict types that occur during driving practice. National register data on licence holders and police-reported injury accidents and self-reported exposure were used. The results show that during the period 1994-2000, 444 driving practice injury accidents were registered, compared to 13,657 accidents during the first 2 years with a licence. The health risk during the period after licensing was 33 times higher and the accident risk 10 times higher than the corresponding risk during practice. The cost-benefit analysis showed that the benefits in terms of accident reduction after licensing were 30 times higher than the costs in terms of driving practice accidents. It is recommended that measures to reduce such accidents should focus on better education of the lay instructor, but not on introducing measures to reduce the amount of lay-instructed practice.
Correspondence: Booi Hon Kam, School of Marketing, Royal Melbourne Institute of Technology, G.P.O. Box 2476v, Vic. 3000, Melbourne, AUSTRALIA; (email: b.kam@rmit.edu.au).
This paper presents a disaggregate approach to crash rate analysis. Enumerating crash rates on a per trip-kilometer basis, the proposed method removes the linearity assumption inherent in the conventional quotient indicator of accidents per unit travel distance. The approach involves combining two disparate datasets on a geographic information systems (GIS) platform by matching accident records to a defined travel corridor. As an illustration of the methodology, travel information from the Victorian Activity and Travel Survey (VATS) and accident records contained in CrashStat were used to estimate the crash rates of Melbourne residents in different age-sex groups according to time of the day and day of the week. The results show a polynomial function of a cubic order when crash rates are plotted against age group, which contrasts distinctly with the U-shape curve generated by using the conventional aggregate quotient approach. Owing to the validity of the many assumptions adopted in the computation, this study does not claim that the results obtained are conclusive. The methodology, however, is seen as providing a framework upon which future crash risk measures could be based as the use of spatial tracking devises become prevalent in travel surveys.
Assessing the validity of road safety evaluation studies by analysing causal chains.
This paper discusses how the validity of road safety evaluation studies can be assessed by analysing causal chains. A causal chain denotes the path through which a road safety measure influences the number of accidents. Two cases are examined. One involves chemical de-icing of roads (salting). The intended causal chain of this measure is: spread of salt -> removal of snow and ice from the road surface-> improved friction-> shorter stopping distance -> fewer accidents. A Norwegian study that evaluated the effects of salting on accident rate provides information that describes this causal chain. This information indicates that the study overestimated the effect of salting on accident rate, and suggests that this estimate is influenced by confounding variables the study did not control for. The other case involves a traffic club for children. The intended causal chain in this study was: join the club -> improve knowledge -> improve behaviour -> reduce accident rate. In this case, results are rather messy, which suggests that the observed difference in accident rate between members and non-members of the traffic club is not primarily attributable to membership in the club. The two cases show that by analysing causal chains, one may uncover confounding factors that were not adequately controlled in a study. Lack of control for confounding factors remains the most serious threat to the validity of road safety evaluation studies.
Behavioural attitude of the young as regards road accident prevention: a survey carried out among high school students in two Sicilian towns.
- Vinci C, Coniglio MA, Di Nuovo S, Pignato S, Giammanco G. Ig Sanita Pubbl 2002; 58(5): 302-314.
[Article in Italian]
Correspondence: C. Vinci, Facolta di Scienze della Formazione, Universita degli Studi di Catania, ITALY; (email: unavailable).
This survey is aimed at assessing young peoples awareness as regards car accident prevention and misleading behaviours. The survey concerned a sample of 829 high school students of both genders, aged 17 to 23, from a chief town (Catania) and a country town (Noto, Siracusa). In addition to a good level of awareness as regards road accidents and misleading behaviours, the investigation also showed an opposite trend to disregard basic safety rules such as the use of helmets, safety belts and abstention from alcohol intake. Dangerous behaviours have shown to be higher in Noto than Catania, and more frequent among male than female of both towns. In the light of such results, some educational actions have been discussed for road safety.
The prevalence of road rage: estimates from Ontario.
Correspondence: Reg Smart, Social, Prevention and Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, CANADA; (email: Reg_smart@camh.net).
CONTEXT: "Road rage" has increasingly generated public concern, however, the prevalence of this behaviour has not been available. We examine the prevalence and demographic correlates of road rage victimization and perpetration based on a population survey of adults in Ontario.
METHODS: Data are based on the CAMH Monitor, a repeated cross-sectional telephone survey of Ontario adults (n = 1,395). The contribution of demographic factors to road rage was examined with logistic regression analysis.
FINDINGS: About half of respondents (46.6%) were shouted at, cursed at or had rude gestures directed at them in the past year, and 7.2% were threatened with damage to their vehicle or personal injury. Nearly a third of respondents (31.7%) admitted to shouting, cursing, etc. at someone, and 2.1% threatened to hurt someone or damage their vehicle. Being a Toronto resident, being younger, and earning a higher income were associated with greater likelihood of being a victim of shouting, cursing and rude gestures; however, income was not associated with being threatened with vehicle damage or injury. The likelihood of admitting to shouting, etc. at someone was greater for males, younger respondents, Toronto residents, higher income earners, and never married respondents; however, threatening someone was associated with younger age and lower education level.
COMMENTS: These results provide a first indication of the prevalence of road rage in Ontario. Road rage, in its milder forms, appears to be common, involving between a third and a half of respondents as either a victim or a perpetrator. Nearly 1 in 10 Ontario residents were threatened with damage or personal injury.
Myocardial infarction among professional drivers.
- Bigert, C., Gustavsson, P., Hallqvist, J., Hogstedt, C., Lewne, M., Plato, N., Reuterwall, C., and Scheele, P. Epidemiology (2003); 14(3): 333 - 339.
Correspondence: Carolina Bigert, Department of Occupational and Environmental Health, Norrbacka, Karolinska Hospital, SE-171 76 Stockholm, SWEDEN; (email: carolina.bigert@smd.sll.se).
BACKGROUND: Professional drivers are at an increased risk of myocardial infarction but the underlying causes for this increased risk are uncertain. METHODS: We identified all first events of myocardial infarction among men age 45-70 years in Stockholm County for 1992 and 1993. We selected controls randomly from the population. Response rates of 72% and 71% resulted in 1067 cases and 1482 controls, respectively. We obtained exposure information from questionnaires. We calculated odds ratios (ORs), with and without adjustment for socioeconomic status, tobacco smoking, alcohol drinking, physical inactivity at leisure time, overweight status, diabetes and hypertension. RESULTS: The crude OR among bus drivers was 2.14 (95% confidence interval = 1.34-3.41), among taxi drivers 1.88 (1.19-2.98) and among truck drivers 1.66 (1.22-2.26). Adjustment for potential confounders gave lower ORs: 1.49 (0.90-2.45), 1.34 (0.82-2.19) and 1.10 (0.79-1.53), respectively. Additional adjustment for job strain lowered the ORs only slightly. An exposure-response pattern (by duration of work) was found for bus and taxi drivers. CONCLUSIONS: The high risk among bus and taxi drivers was partly explained by unfavorable life-style factors and social factors. The work environment may contribute to their increased risk. Among truck drivers, individual risk factors seemed to explain most of the elevated risk
Correspondence: David B. Estell, Department of Counseling and Educational Psychology, Indiana University, Bloomington, Indiana, USA; (email: destell@indiana.edu).
The researchers examined 345 6th-grade rural African American youth (189 boys, 156 girls) over 3 years with regard to carrying weapons in school. Recent investigations with nationally representative and urban samples have shown that carrying weapons in school fits into a larger pattern of problem behaviors, including aggression and substance use, which are supported by affiliations with other deviant youth. Very little work to date has specifically examined weapon carrying in rural African American youth. This study found that weapon carriers in the first year were primarily male, more aggressive, and had higher rates of substance use than noncarriers. Concurrent peer affiliations were not related to weapon carrying in the first year. However, among those who were not carriers in the 1st year, transitioning into weapon carrying was related to both individual marijuana use and peer-group aggression and marijuana use. Finally, over the 3 years of the study, weapon carriers tended to maintain their high levels of aggression, drinking, and marijuana use.
Acute stress disorder in children related to violence.
CONTEXT: Unidentified and untreated acute stress responses in children may result in chronic posttraumatic stress disorder (PTSD), other serious psychiatric disorders, and/or developmental arrest.
PURPOSE: To review and identify gaps in current literature on acute stress disorder (ASD) in children and examine current treatments.
METHODS: Review of the literature.
COMMENTS: More developmentally appropriate, standardized measurement instruments are needed. Future research must focus on prospective studies of children exposed to trauma in order to better understand the association between ASD and PTSD. Future studies must include children at different developmental stages.
Violence against pregnant women in developing countries Review of evidence.
Correspondence: Khurram Nasir, Bloomberg School of Public Health, Department of International Health, The Johns Hopkins University, USA; (email: unavailable).
Domestic violence among pregnant women is a global health issue. This study systemically reviews the literature to estimate the prevalence of violence against pregnant women in developing countries. Prevalence of violence among pregnant women in developing countries ranges from 4% to 29%. The main risk factors found for abuse during pregnancy were belonging to a low-income group, low education in both partners, and unplanned pregnancy. Low birth as a consequence of violence is observed. The vulnerability of pregnant women to violence, and to their consequences is an alarming public health issue in developing countries and calls for the design and implementation of better preventive strategies.
Homicide-suicides in Fiji: offense patterns, situational factors, and sociocultural contexts.
Correspondence: Mensah Adinkrah, Department of Sociology, Anthropology & Social Work, Central Michigan University, Mt. Pleasant, MI 48859, USA; (email: adink1m@cmich.edu).
Although there is growing literature on lethal violence in developing nations, homicide-suicides have rarely been studied. Addressing this issue, this paper analyzes all homicide-suicides that occurred in Fiji between 1982 and 1992. The study's results are consistent with prior research in Western developed nations, demonstrating that homicide-suicides constitute a minuscule proportion of all homicides, occur primarily between intimate relations, are precipitated by intrafamilial discord, and occur in the domestic setting. Contrary to prior research, however, perpetrators of homicide-suicide were equally divided between men and women and no firearms were utilized.
Domestic violence education and reporting: Public attitudes about the roles of EMS.
- Singleton A, Brewer KL, Goodman P. Prehosp Emerg Care 2003; 7(3): 312-315.
Correspondence: Kori L. Brewer, Brody School of Medicine, Department of Emergency Medicine, Division of Research, Physician's Quadrangle, Building M, Greenville, NC 27858, USA; (e-mail: brewerk@mail.ecu.edu).
OBJECTIVES: This study assessed domestic violence (DV) exposure, awareness, education, and reporting within a specific geographic region. The goal was to determine what the public perceives as the role of emergency medical services (EMS) in dealing with domestic violence.
METHODS: A prospective, randomized telephone survey with random dialing pattern was used by the institution's Survey Research Laboratory in the Department of Sociology. Households from the region, which was rural with a military subset, were contacted during a four-month study period. Demographic data and opinions about DV exposure and reporting practices were collected.
FINDINGS: A total of 1,057 individuals completed the survey. A total of 51.3% knew someone who was a DV victim. Although 73% stated they would report DV to law enforcement, 36.2% stated that 9-1-1/EMS providers are the most appropriate contact when reporting DV.
COMMENTS: Over one third of the people surveyed believed that EMS was the most appropriate contact when reporting DV. Because of the frequency with which EMS professionals may potentially encounter DV, and the fact that they are likely to be the first contact in DV situations, more education may be warranted in the EMS curriculum.
