OBJECTIVES: To identify correlates of beer advertising awareness among adolescents at an age when most initiate use of alcohol.
DESIGN: We conducted a cross-sectional analysis of an in-school survey about alcohol advertising. Structural equation modeling was used to test for independent predictors of a latent beer advertising awareness construct, separately among boys and girls.
SETTING: Twenty middle schools in South Dakota, USA participated during their spring semester. PARTICIPANTS: A total of 1530 eighth graders.
MEASUREMENTS: A latent advertisement awareness variable was derived based on recognition of six masked beer advertisements, knowledge of beer brands and knowledge of beer slogans. Tested predictors included measures of exposure to alcohol advertising in various venues, social norms regarding drinking, drinking beliefs and behavior and gender.
FINDINGS: Adolescents with greater exposure to advertisements in magazines, at sporting and music events and on television were more advertisement aware than those with less exposure, as were teens who watch more TV, pay attention to beer advertisements and know adults who drink. Beer advertisement awareness was dramatically higher among boys, and was associated with drinking only among boys.
COMMENTS: Each of a variety of advertising venues appears to influence independently the extent to which beer advertising is incorporated into an adolescent's cognitive world. Boys are more likely to be aware of and remember beer marketing, and may be more likely to drink as a result of this awareness than girls.
Increasing evidence shows that atmospheric carbon dioxide levels are rising and are causing global warming. Record air temperatures were recorded in Britain during the last month. Accurate estimates of the consequences of these must wait until daily mortality data are available, but press reports indicate that the hot weather caused around 1000 deaths during one week alone in Britain and perhaps 10,000 overall in France, where temperatures were higher.
Mortality in Britain is lowest when the mean daily temperature is 17-18°C. The number of heat related deaths per year, obtained as the number of excess deaths on days hotter than this, has averaged around 800 in recent years. Most of those deaths are of people over 70 years of age, and most occur in the first day or two of a period of high temperature.
Few of these deaths are recognisable clinically as being due to heat. Heat stress causes loss of salt and water in sweat, causing haemoconcentration, which in turn causes increases in coronary and cerebral thrombosis. Other deaths in heat waves are probably due to overload of already failing hearts, unable to meet the need for increased cutaneous blood flow in the heat. Very few heat related deaths in British conditions are caused by hyperthermia, overheating sufficient to cause denaturation of the body tissues, but patients unable to sweat because they have diabetic peripheral neuropathy or are taking anticholinergic drugs are known to be at risk in American heat waves. So are patients taking drugs such as barbiturates or phenothiazines, which depress reflex regulation of body temperature. Alcohol can also be dangerous in the heat, both through depression of the central nervous system and by causing diuresis and consequent dehydration.
According to some predictions heat related mortality will increase drastically as global warming develops, but recent evidence is relatively reassuring. Heat related mortality is similar in hot and cold parts of western Europe and in hot and cold parts of the United States. This implies that the populations of hot regions have adjusted by physiological or other means to their hotter summers. In Britain annual heat related deaths are in any case far fewer than cold related deaths, so that the initial effect of increased temperatures all year round, before such adjustment, would be to reduce net annual mortality.
Analysis of actual changes in heat related mortality during global warming since 1971 is even more reassuring. Despite rises in mean summer temperatures of at least 1°C in southeast England and North Carolina heat related mortality has not risen in southeast England and has virtually disappeared in North Carolina. The latter represents something more than adaptation as it could prevent the mortality rising with higher temperatures but could not make it fall. The likely explanation is the increase in air conditioning (from 57% to 72% between 1978 and 1997) that has occurred in households in that region of the United States and is in turn attributable to increasing prosperity.
However reassuring these facts may be, they do not mean that nothing needs to be done. As the recent hot weather has reminded us climatic warming is not continuous but is interrupted by unpredictable fluctuations. As in the recent heat wave these can suddenly present populations with temperatures that they have never encountered before and are not prepared for. People with heat exhaustion need to be given fluids by mouth and sometimes intravenous saline and dextrose, but by far the most important measures are preventive ones.
Air conditioning can allow people to continue to work effectively in hot weather and may become necessary to prevent mortality, but it uses a large amount of energy, which can itself accelerate global warming. Simpler measures can be very effective in protecting elderly and other vulnerable people from the levels of heat likely to occur in Britain over the next decade. Continuing to eat regular meals and drink enough water will normally prevent dehydration during heat stress. An open window, fan, light and loose fitting clothing, avoidance of unnecessary exertion, and if necessary sprinkling water on the clothing, can prevent the heat stress.
Such action is effective only if it is taken in time, and it needs to be taken by the general public as well as staff working in homes caring for elderly people. The time to check that windows can be opened, and that a fan is available, is when hot weather is forecast, not when it occurs; delay until temperature reaches a peak may mean that nobody can free a jammed window, or find a fan, for many hours. Elderly people unable to do this themselves, or to get help from relatives or neighbours, need to be given a number to call for help. Brief messages, giving simple advice on these lines in news broadcasts and daily press when hot weather is forecast, could be the most effective way to reduce illness and death in heat waves.
Sarasota, Fla, used Crime Prevention Through Environmental Design (CPTED) principles to guide revitalization efforts in its crime-ridden North Trail area. A team of city planners, police officers, and architects examined land use and crime data and sought input from local businesses, residents, and community leaders.
Beginning in 1990, interventions included increased police patrols to reduce prostitution and the creation of a new zoning district to encourage area redevelopment based on CPTED principles. Compared with the rest of Sarasota, from 1990 to 1998 the North Trail Corridor experienced decreases in calls for police service (P < .005), crimes against persons and property (P = not significant), and prostitution (P < .05).
These results suggest that community design may be a useful tool for decreasing crime and improving community health.
Injury status and perspectives on developing community safety promotion in China.
Correspondence: Leif Svanstrom, Karolinska Institutet, Department of Public Health Sciences, Division of Social Medicine, SE-171 76 Stockholm, SWEDEN; (email: leif.svanstrom@phs.ki.se).
The objective of this paper is to introduce the epidemiology of injuries in China, and then consider the development of safe communities in regard to injury prevention and safety promotion. The disease spectrum has changed in recent decades in the People's Republic of China. Both in cities and rural areas, injury has become the fifth leading cause of death. At least 800,000 people die from injury each year, and 50 million non-fatal injuries occur, of which 2.3 million lead to disability of varying degrees of severity. The average injury-related death rate in China from 1990 to 1997 was 66 per 100 000, which accounts for 11% of total deaths. The potential years of life lost (PYLL) of injury accounts for 24% of the total, and disability-adjusted life years (DALYs) account for 17%. Main injury causes of death, in descending order, are: suicide, traffic accident, drowning, falling, poisoning, homicide, burn and scald, and iatrogenic injury. Considering China's current injury status and its rapid societal change, injury prevention and safety promotion need to be strengthened further, and there is a special need for the development of Safe Communities programmes. The prevention of injuries through safety promotion has been increasingly focussed on over recent decades. The WHO Safe Community model is recognized as representing an effective and long-term approach to the prevention of injuries at a local level, and has been beneficially applied all over the world. A programme may cover several aspects of injury prevention and safety promotion simultaneously, or only include one or two aspects. In a Safe Community programme in China, children, the elderly, cyclists and their passengers, and farmers should be among the prioritized target populations. However, multi-focussed inter-sectoral programmes have been shown to have additional effects to distinct sectoral programmes.
Paola Michelozzi, Environmental Epidemiology Unit, Local Health Authority of Rome, Department of Epidemiology, 00185, Rome ITALY; (email: michelozzi@asplazio.it).
Italy has been one of the European countries most affected by the record high temperatures of summer 2003. A definitive assessment of heat- related mortality in Italy is being carried out by the National Institute of Health. At least in Rome, even in presence of a warning system described below, we have calculated an excess of 708 deaths in the ageing population during the period 1 June- 15 August. The greatest impact was in the most deprived areas. It is clear from this summer that most European countries are unprepared to cope with this emergency. Heat stress conditions may be predictable, and with the appropriate prevention measures heat-related mortality may be reduced. In order to avoid dramatic episodes, like that of summer 2003, appropriate prevention programmes need to be established. This is achievable if efficient and effective warning systems are introduced to alert urban residents of the oppressive weather conditions. Rome was the first city in Europe to adopt a warning system (Heat/Health Watch/Warning System, HHWWS) to lessen the effects of heat on health. The Rome system was developed as part of a World Meteorological Organization (WMO) project related to cities at high risk of heat/health impact, as dramatic peaks in mortality are usually observed during summer. The system is unique because alarm thresholds are based on actual weather/human health relationships for Rome.
In 2002, the Department of Epidemiology and the Health and Social Policy Municipality of Rome collaborated on the HHWWS, and established an intervention plan aimed at the elderly and other susceptible groups. Public and private institutions and organisations were identified and acted as mediators between the warning system and the population. Specific guidelines were developed by the Department of Epidemiology in collaboration with the Association of General Practitioners for the general population, for patients suffering from specific diseases, and for general practitioners, who play an important role because they are the direct link between the system and the individual. Intervention activities include a tele-assistance programme, where registered users call an operation centre, open 24 hours a day, which provides various levels of assistance. Some of these include counselling, regular check up phone calls, home assistance and delivery services.
During the period 1 June-15 August 2003 the HHWWS predicted 39/ days (51%) of alarm, on days when peaks in mortality were observed. On those days intervention activities were activated. An estimate of health benefits has not yet been quantified, and the next step will be to evaluate the effectiveness of HHWWS and public health measures in the mitigation of heat related mortality.
In 2002 started the European project PHEWE "Assessment and prevention of heath Effects in Europe," a collaborative study which include partners from 16 European cities. The principal aim of the study is to evaluate the acute health effects of weather, both during the warm and the cold season in Europe. One of the main objective of the project will be to implement heat/health watch warning system in a subgroup of pilot cities, to develop preventive strategies to minimise adverse health effects, and to define guide-lines for public health interventions in Europe.
Correspondence: Chia-Fen Chi, Department of Industrial Management, National Taiwan University of Science and Technology, 43 Keelung Road, Section 4, Taipei, TAIWAN; (email: chris@mail.ntust.edu.tw).
This research reanalyzed 1230 work-related single fatalities from the years 1989, 1990, and 1992 with a model free approach. Each single fatality was analyzed in terms of the victim's age, gender, industry, and the accident type. The standardized mortality ratio (SMR) was calculated to compare the SMR among various demographic groups and to cross validate the results obtained from our previous work using analysis of variance (ANOVA). The Chi-square Automatic Interaction Detector (CHAID) was used to divide the working population into segments based on whether the worker was a victim in any fatality. Predictor variables mainly focus on the demographic variables including the victim's age, gender and industry. But different from our previous finding [Safety Science 27 (1997) 1] of an insignificant gender effect, gender was found to be the second critical factor and it was nested under the most critical variable, type of industry. Age is the least critical variable and it is nested under the gender effect. Five different interactive patterns were identified correlating the age, gender, and industries of the victims. A comparison among ANOVA, SMR and CHAID proved that CHAID outperforms other methods for it not only reveals the complex and hierarchical interactive patterns but also prioritizes the importance of the predictor variables.
Influence of socioeconomic status on the effectiveness of bicycle helmet legislation for children: a prospective observational study.
- Parkin PC, Khambalia A, Kmet L, Macarthur C. Pediatrics 2003; 112(3 Pt 1): e192-e196.
Correspondence: Patricia Parkin, Department of Paediatrics, University of Toronto Faculty of Medicine, Ontario, CANADA; (email: patricia.parkin@sickkids.ca).
OBJECTIVE: To evaluate the influence of average family income in a geographic area on the effectiveness of helmet legislation on observed helmet use by children (5-14 years).
METHODS: The study was conducted in East York, a health district of Metropolitan Toronto, in collaboration with the East York Health Unit. In 1996, the total population was 107,822, 11,340 of which were children 5 to 14 years. Census data were used to group the 21 census tracts in East York into 7 geographically distinct areas. The boundaries of these areas are natural barriers to travel, such as expressways, ravines, railway tracks, and hydroelectric power lines. The areas were also ranked according to average family income (based on Statistics Canada data). For analytical purposes, areas were defined as low-, mid-, and high-income areas. Census data profiles of the areas have been previously described. For each consecutive year from 1990 to 1997 inclusive, direct observations of children riding bicycles in East York during the months of April through October were made. In 1995, observations were completed before the introduction of the law on October 1, 1995. Only children who were between 5 and 14 years of age and riding a 2-wheeled bicycle were included in the study. In total, 111 sites across all 7 areas were selected for observation. Observational sites included school yards of all elementary and middle schools (kindergarten to grade 8) and all parks in East York. In addition, 5 major intersections and 5 residential streets from each area were randomly selected. Observers were trained and used a standardized data collection form. A pilot study showed that the data collected by observers were reliable and valid. Observers remained at each site for 1 hour and collected data on helmet use and sex. Ethical approval for the study was obtained from the Hospital for Sick Children Research Ethics Board, the East York Board of Education, and the Metropolitan Separate School Board. The proportion of children who were wearing a bicycle helmet was estimated by year (1990-1997, inclusive), sex (male, female), location (school, park, major intersection, residential street), and income area (low, mid, high). For estimating the effect of legislation on helmet use, data from the year immediately after legislation (1996) were compared with data from the year preceding legislation (1995). The relative risk (RR) of helmet use (after vs before legislation) was calculated along with a 95% confidence interval (CI). Logistic regression analysis was used to adjust for potential confounding variables (sex and location).
FINDINGS: During the 8-year study period, 9768 observations were made (range: 914-1879 observations per year). The proportion of child cyclists who wore a bicycle helmet increased steadily during the first 4 years of the study period, from 4% in 1990 (34 of 914), to 16% in 1991 (303 of 1879), to 25% in 1992 (383 of 1563), and to 45% in 1993 (438 of 984). During 1994 (460 of 1083) and 1995 (568 of 1227), helmet use remained relatively stable at approximately 44%. Helmet use rose markedly in 1996 (the first year after helmet legislation was introduced) to 68% (818 of 1202) and remained stable at 66% (609 of 916) in 1997. Throughout the study period, girls were consistently more likely to wear helmets than were boys. In total, 47% (1420 of 3047) of girls wore helmets, compared with 33% (2193 of 6721) of boys (RR: 1.43; 95% CI: 1.36-1.50). In addition, children who were riding to school were more likely to use helmets, compared with children who were riding on residential streets, major intersections, and parks. Overall, 48% (1497 of 3129) of children who were riding to school wore bicycle helmets, compared with 32% (2116 of 6639) of children who were riding at other locations (RR: 1.50; 95% CI: 1.43-1.58). Children in the high-income areas were consistently more likely to wear helmets, compared with children in the mid- and low-income areas. Helmet legislation was associated with a significant increase in helmet use by children in East York. In 1995, 46% (ast York. In 1995, 46% (568 of 1227) of children wore bicycle helmets, compared with 68% (818 of 1202) of children in 1996 (RR: 1.47; 95% CI: 1.37-1.58). The effect of legislation, however, varied by income area. In low-income areas, helmet use increased by 28% after legislation, from 33% (213 of 646) in 1995 to 61% (442 of 721) in 1996 (RR: 1.86; 95% CI: 1.64-2.11). In mid-income areas, helmet use increased by 29% after legislation, from 50% (150 of 300) in 1995 to 79% (185 of 234) in 1996 (RR: 1.58; 95% CI: 1.39-1.80). In high-income areas, helmet use increased by only 4%, from 73% (205 of 281) in 1995 to 77% (191 of 247) in 1996 (RR: 1.06; 95% CI: 0.96-1.17). This finding of a significant increase in helmet use after legislation in low- and mid-income areas but not in high-income areas remained even after logistic regression analysis adjusted for sex and location.
COMMENTS: This study showed that bicycle helmet use by children increased significantly after helmet legislation. In this urban area with socioeconomic diversity and in the context of prelegislation promotion and educational activities, the legislative effect was most powerful among children who resided in low-income areas.
Divided attention and visual search for simple versus complex features.
- Davis ET, Shikano T, Peterson SA, Keyes Michel R. Vision Res 2003; 43(21): 2213-2232.
Correspondence: Elizabeth T. Davis, Georgia Institute of Technology, School of Psychology, Atlanta, GA 30332-0170, USA; (email: ed15@prism.gatech.edu).
Under what search conditions does attention affect perceptual processes, resulting in capacity limitations, rather than affecting noisy decision-making processes? Does parallel or serial processing cause the capacity limitations? To address these issues, we varied stimulus complexity, set size, and whether distractors were mirror images of the target. Both target detection and localization produced similar patterns of results. Capacity limitations only occurred for complex stimuli used in within-object conjunction searches. Parallel processing, rather than serial processing, probably caused these capacity limitations. Moreover, although mirror-image symmetry adversely affected early visual processing, it did not place additional demands on attention.
Temporal characteristics of binocular rivalry: visual field asymmetries.
- Chen X, He S. Vision Res 2003; 43(21): 2207-2212.
Correspondence: Sheng He, Department of Psychology, University of Minnesota, 75 East River Road, Minneapolis, MN 55455, USA, (email: sheng@umn.edu).
Very little is known about the mechanisms that drive the alternation between the two views during binocular rivalry. A key property of the rivalry process is the rate at which the two views alternate. Understanding the factors that affect the rate of the alternation is critical to the final understanding of the underlying process. Using a circular and a radial grating as the rivalry stimuli, we observed a significantly faster binocular rivalry when stimuli were presented in the right visual field than that in the left visual field for the right-handed observers, and a reversed asymmetry for the left-handed observers. In both groups, rivalry was faster for stimuli presented in the lower visual field than that in the upper visual field. This pattern of results suggests that (1) rivalry is likely a locally driven process and (2) the visual brain in the left hemisphere may be the faster one of the two hemispheres in right-handed people.
The examination of mushroom poisonings at Akita University.
- Gonmori K, Yoshioka N. Leg Med (Tokyo) 2003; 5 Suppl: S83-S86.
Correspondence: Kunio Gonmori, Department of Forensic Medicine, Akita University School of Medicine, 010-8543, Akita, JAPAN; (email: gonmori@med.akita-u.ac.jp).
In the past 10 years from 1991 to 2000, the number of consultations to the Japan Poison Information Center were 947 concerning mushroom poisonings. However, those from the hospital cases were not analyzed toxicologically. We examined toxicologically 20 cases (35 patients) of mushroom poisonings from 1993 to 2001. Investigation of amanita toxin poisoning was requested in 19 cases. We could detect the amanita toxin, amanitin, and phalloidin, in two cases, which resulted in concluding the cause of death. A fatal case by the magic mushroom poisoning was analyzed in the blood, urine, and mushroom, and we detected the hallucinogenic substances from the body fluids and ingested mushrooms. We report the results of our examinations, and point out the usefulness of the examination of the mushroom itself and biological samples toxicologically for forensic practice.
Risk taking behaviour has been identified as an important host-related determinant of injury in young adults. The aim of this study is to clarify the relationship between the two key elements of risk taking behaviour--ie, risk assessment and risk acceptance--in participants of a high risk sporting activity. Skydivers registered with the Australian Parachute Federation were sampled at several jump meetings held at three "drop-zones" in North Eastern Australia. A cross sectional survey of 215 skydivers ascertained each subject's risk assessment of each of nine hypothetical sky diving scenes and whether or not they would jump in the described conditions. Variables which independently predicted an individual's risk assessment were age group (p < 0.05). gender (p < 0.05) and scene details (p < 0.001). Risk assessment was found to be a statistically significant predictor of the decision to jump, with a 22% decrease in the odds of jumping with every unit increase in risk assessment (OR = 0.78: 95% CI: 0.76, 0.80). Gender was also found to be a statistically significant predictor of the decision to jump, with males being 19% more likely to jump than females, after controlling for age, experience, currency and risk assessment (OR = 1. 19: 95% CI; 1.04, 1.38). The importance of these results is that, by quantifying the relationship between two key elements of risk taking behaviour and several important host factor determinants, they facilitate more informed discussion about the possible role of risk taking behaviour in the causation of injury.
Risk propensity in commercial and military pilots.
CONTEXT: Flight safety is dependent on the quality of the decision-making process, which is closely related to risk taking. The purpose of this descriptive study was to evaluate risk propensity among commercial and military pilots.
OBJECTIVES: Since commercial and military flights are conducted in different environments with different safety policies, our hypothesis was that risk propensity levels observed in these different settings will not be the same.
METHODS: We tested 96 French pilots, 63 who were flying commercial aircraft (mean age 43 yr) and 33 serving in military aviation (mean age 33 yr), with the Evaluation of Risk (EVAR) visual analog scale, designed to rate risk proneness, and the Barrat impulsiveness scale. EVAR is composed of 24 items distributed among 5 factors: "self-control," "danger-seeking," "energy," "impulsiveness," and "invincibility."
FINDINGS: We observed significantly higher scores in all EVAR factors except "impulsiveness" in military pilots compared with commercial pilots. This different risk profile was corroborated by Barrat scores and was not explained by the significant age difference.
COMMENTS: The observed difference in risk propensity cannot be explained by this descriptive study. A prospective evaluation of risk proneness beginning with the selection process and continuing through training and military and commercial flying is necessary to assess how a risk proneness profile is determined.
Correspondence: Richard A. Wennberg, Division of Neurology, University Health Network, Toronto Western Hospital, University of Toronto, Toronto, ON, CANADA; (email: unavailable).
OBJECTIVES: To examine the longitudinal media reported rate of concussions in the National Hockey League (NHL) over the period 1986-87 to 2001-02.
METHODS: All injury reports published in the weekly sports newspaper The Hockey News for the 16 seasons 1986-87 through 2001-02 were reviewed for reported concussions. The Hockey News reports are based on weekly injury reports released by the NHL, which derive from reports submitted to the league by individual team offices.
FINDINGS: Adjusted for changes in the number of teams and games per season over the 16 year study period, and expressed as: number of concussions per 1000 games, results by season (starting with 1986-87) were 4, 8, 7, 7, 5, 5, 7, 7, 6, 8, 13, 20, 30, 27, 30, 25. Comparing each season with the prior season, significant increases were reported in 1997-98 and 1998-99 (p < 0.05 and 0.025, respectively), with no change since 1998-99.
COMMENTS: The reported concussion rate in the NHL during the last five years is more than triple that of the previous decade. Bigger, faster players, new equipment and harder boards and glass have all theoretically increased the risk of concussion in the NHL in recent years. However, the abrupt increase and subsequent plateau in concussion rate since 1997 suggests that increased recognition and reporting may be primarily responsible for the apparent increase in incidence.
Evaluation of cricket helmet performance and comparison with baseball and ice hockey helmets.
- McIntosh AS, Janda D. Br J Sports Med 2003; 37(4): 325-330.
Correspondence: A.S. McInstosh, School of Safety Science, University of New South Wales, Sydney, NSW, AUSTRALIA; (email: a.mcintosh@unsw.edu.au).
CONTEXT: Protective helmets in sport are important for reducing the risk of head and facial injury. In cricket and other sports with projectiles, national test standards control the minimum helmet performance. However, there are few field data showing if helmets are effective in reducing head injury.
OBJECTIVES: (a) To examine the performance of cricket helmets in laboratory tests; (b) to examine performance with regard to test standards, game hazards, and helmet construction; (c) to compare and contrast these findings with baseball and ice hockey helmets.
METHODS: Impact tests were conducted on a selection of helmet models: five cricket, two baseball, and two ice hockey. Ball to helmet impacts at speeds of 19, 27, 36, and 45 m/s were produced using an air cannon and a Hybrid III dummy headform and neck unit. Free fall drop tests with a rigid headform on to a selection of anvils (flat rigid, flat deformable, and hemispherical rigid) were conducted. Resultant headform acceleration was measured and compared between tests.
FINDINGS: At the lower speed impacts, all helmets produced a good reduction in headform acceleration, and thus injury risk. At the higher speed impacts, the effectiveness was less. For example, the mean maximum headform accelerations for all cricket helmets at each speed were: 67, 160, 316, and 438 g for 19, 27, 36, and 45 m/s ball speeds respectively. Drop tests on to a hemispherical anvil produced the highest accelerations. The variation in performance increased as the magnitude of the impact energy increased, in both types of testing.
COMMENTS: The test method used for baseball helmets in which the projectile is fired at the helmet may be superior to helmet drop tests. Cricket helmet performance is satisfactory for low speed impacts, but not for impacts at higher, more realistic, speeds. Baseball and ice hockey helmets offer slightly better relative and absolute performance at the 27 m/s ball and puck impacts.
Correspondence: William H. Lucy, School of Architecture, University of Virginia, PO Box 400122, Charlottesville, VA 22903, USA; (email: whl@virginia.edu).
OBJECTIVES: I analyzed traffic fatalities and homicides related to leaving home for routine activities, and considered connections between these fatalities and the built environment.
METHODS: I analyzed city, county, state, and federal data for traffic fatalities and homicides by strangers for 15 metropolitan areas, and classified deaths as occurring in the central city, in inner suburbs, or in outer suburbs (exurbs).
FINDINGS: Traffic fatality rates were highest in exurban areas. Combined traffic fatality and homicide-by-stranger rates were higher in some or all outer counties than in central cities or inner suburbs in all of the metropolitan areas studied.
COMMENTS: Traffic fatalities are largely unrecognized as a danger to be factored into residential location decisions. Land use controls that deter sprawl along narrow exurban roads can reduce the mortality risks associated with leaving home.
The epidemiology of assault across the West Midlands.
- Downing A, Cotterill S, Wilson R. Emerg Med J 2003; 20(5): 434-437.
Correspondence: A. Downing, Department of Public Health and Epidemiology, University of Birmingham, Birmingham, UK; (email: a.downing@bham.ac.uk).
OBJECTIVES: The purpose of this study is to look at accident and emergency (A&E) attendances and admissions after assault in the West Midlands NHS region across a wide range of acute units.
METHODS: This study used data from two sources, the A&E Minimum Data Set and the Hospital Episode Statistics database. Analyses were based on data from 12 of the 21 acute trusts in the West Midlands NHS region for the period 1 April 1999 to 31 March 2000.
FINDINGS: Analyses were performed on 15,969 A&E attendances and 1596 admissions. Some 67.4% of attenders and 84.2% of those admitted were male. The mean age of the patients was between 27 and 29 years. Attendance peaked between 2100 and 0259, especially on Friday and Saturday night. The most common injury was to the head. Some 75.3% of A&E attenders were discharged home. The average stay in hospital was two days and six deaths were recorded. Those living in the most deprived areas were nearly four times more likely to be admitted than those in the least deprived areas (175.9 per 1000 compared with 45.1 per 1000).
COMMENTS: This study shows assault is predominately a male phenomenon, worst in the evenings and at weekends, and is positively related to deprivation. It is probable that the levels recorded will be an underestimate, however with some additions to the information collected hospital records could create the basis for a comprehensive surveillance system.
Predictors of falls in a high risk population: results from the prevention of falls in the elderly trial (PROFET).
- Close JC, Hooper R, Glucksman E, Jackson SH, Swift CG. Emerg Med J 2003; 20(5): 421-425.
Correspondence: J.C.T. Close, Kings College Hospital (Dulwich), East Dulwich Grove, London SE22 8PT, UK; (email: jacqueline.close@kcl.ac.uk).
OBJECTIVES: The prevention of falls in the elderly trial (PROFET) provides evidence of the benefits of structured interdisciplinary assessment of older people presenting to the accident and emergency department with a fall. However, the service implications of implementing this effective intervention are significant. This study therefore examined risk factors from PROFET and used these to devise a practical approach to streamlining referrals from accident and emergency departments to specialist falls services.
METHODS: Logistic regression analysis was used in the control group to identify patients with an increased risk of falling in the absence of any intervention. The derived predictors were investigated to see whether they also predicted loss to follow up. A second regression analysis was undertaken to test for interaction with intervention.
FINDINGS: Significant positive predictors of further falls were; history of falls in the previous year (OR 1.5 (95%CI 1.1 to 1.9)), falling indoors (OR 2.4 (95%CI 1.1 to 5.2)), and inability to get up after a fall (OR 5.5 (95%CI 2.3 to 13.0)). Negative predictors were moderate alcohol consumption (OR 0.55 (95%CI 0.28 to 1.1)), a reduced abbreviated mental test score (OR 0.7 (95%CI 0.53 to 0.93)), and admission to hospital as a result of the fall (OR 0.26 (95%CI 0.11 to 0.61)). A history of falls (OR 1.2 (95%CI 1.0 to 1.3)), falling indoors (OR 3.2 (95%CI 1.5 to 6.6)) and a reduced abbreviated mental test score (OR 1.3 (95%CI 1.0 to 1.6)) were found to predict loss to follow up.
COMMENTS: The study has focused on a readily identifiable high risk group of people presenting at a key interface between the primary and secondary health care sectors. Analysis of derived predictors offers a practical risk based approach to streamlining referrals that is consistent with an attainable level of service commitment.
Rural sports and recreational injuries in Australia: what do we know?
- Finch C, Mahoney M, Townsend M, Zazryn T. Aust J Rural Health 2003; 11(3): 151-158.
Correspondence: Caroline Finch, Department of Epidemiology and Preventive Medicine, Monash University, Central and Eastern Clinical School, Alfred Hospital, Commercial Road, Melbourne 3004, Victoria, AUSTRALIA; (email: Caroline.Finch@med.monash.edu.au).
OBJECTIVE: It is widely recognised that individuals residing in regional or rural areas have poorer health outcomes than those from metropolitan areas. Factors associated with these poorer health outcomes include geographical isolation, population declines, limited health care provision and higher levels of inactivity compared to urban areas. The mental, social and physical health of individuals and communities in rural areas can be improved through active participation in sport and recreation activities. Unfortunately, participation in such activities can potentially lead to injury. There is a suggestion that there is an increased risk of sports injuries in rural areas due to the lack of health professionals and coaching personnel, fewer available volunteers to organise and deliver sport, and the general attitude towards injuries in rural settings.
FINDINGS: There is very limited information about the number and types of injuries sustained during participation in sports activities in rural and regional settings. This is largely related to a lack of formal sporting structures and support mechanisms including research funding and trained personnel.
COMMENTS: A range of factors need to be implemented to improve safety for sporting and recreational participants in these areas. These include improved monitoring of injury occurrence, stronger promotion of safety initiatives and wider implementation of education strategies.
WHAT IS ALREADY KNOWN: It has been speculated that there is an increased risk of injury during sport in rural areas, compared to metropolitan centres. However, there is very little information about the actual levels of sports injury risk in rural communities.
WHAT THIS STUDY ADDS: This review of formal and informal sources has identified significant gaps in our knowledge about sports injuries in rural Australia. It is likely that this lack of information, and the injury risk, is related to a lack of formal sporting structures and support mechanisms in these areas.
Promoting Safe Walking and Biking to School: The Marin County Success Story.
- Staunton CE, Hubsmith D, Kallins W. Am J Public Health 2003; 93(9): 1431-1434.
Correspondence: Catherine E. Staunton, MD, Centers for Disease Control and Prevention, Mail Stop K-30, 4770 Buford Hwy NE, Atlanta, GA 30341-3717, USA; (email: cstaunton@cdc.gov).
Walking and biking to school can be an important part of a healthy lifestyle, yet most US children do not start their day with these activities. The Safe Routes to School Program in Marin County, California, is working to promote walking and biking to school. Using a multipronged approach, the program identifies and creates safe routes to schools and invites communitywide involvement. By its second year, the program was serving 4,665 students in 15 schools. Participating public schools reported an increase in school trips made by walking (64%), biking (114%), and carpooling (91%) and a decrease in trips by private vehicles carrying only one student (39%).
Personal persistence, identity development, and suicide: a study of Native and Non-native North American adolescents.
- Chandler MJ, Lalonde CE, Sokol BW, Hallett D. Monogr Soc Res Child Dev 2003; 68(2): vii-viii, 1-130; discussion 131-138.
Correspondence: M.J. Chandler, Department of Psychology, University of British Columbia, 2136 West Mall, Vancouver, British Columbia V6T 1Z4, CANADA; (email: chandler@interchange.ubc.ca).
The cross-cultural program of research presented here is about matters of temporal persistence--personal persistence and cultural persistence--and about solution strategies for solving the paradox of "sameness-in-change." The crux of this paradox resides in the fact that, on threat of otherwise ceasing to be recognizable as a self, all of us must satisfy at least two constitutive conditions. The first of these is that selves are obliged to keep moving or die, and, so, must continually change. The second is that selves must also somehow remain the same, lest all notions of moral responsibility and any commitment to an as yet unrealized future become nonsensical. Although long understood as a problem demanding the attention of philosophers, we argue that this same paradox arises in the ordinary course of identity development and dictates the different developmental routes taken by culturally mainstream and Aboriginal youth in coming to the identity-preserving conclusion that they and others are somehow continuous through time. Findings from a set of five studies are presented. The first and second studies document the development and refinement of a method for parsing and coding what young people say on the topic of personal persistence or self-continuity. Both studies demonstrate that it is not only possible to seriously engage children as young as age 9 or 10 years in detailed and codable discussions about personal persistence, but that their reasoning concerning such matters typically proceeds in an orderly and increasingly sophisticated manner over the course of their early identity development. Our third study underscores the high personal costs of failing to sustain a workable sense of personal persistence by showing that failures to warrant self-continuity are strongly associated with increased suicide risk in adolescence. Study four documents this same relation between continuity and suicide, this time at the macrolevel of whole cultures, and shows that efforts by Aboriginal groups to preserve and promote their culture are associated with dramatic reductions in rates of youth suicide. In the final study we show that different default strategies for resolving the paradox of personal persistence and change--Narrative and Essentialist strategies--distinctly characterize Aboriginal and non-Aboriginal youth.
Effect of 11 September 2001 on suicide and homicide in England and Wales.
CONTEXT: The tragic events of 11 September 2001 and televised scenes of the terrorists' homicidal and suicidal acts could have had an impact on the behaviour of some people, who harbour suicidal ideation or homicidal tendencies.
OBJECTIVE: To assess the effect of 11 September 2001 on the rate of suicide and homicide in England and Wales.
METHODS: Analysis of the number of suicides (ICD-9 codes: E950-E959), undetermined injury deaths (E980-E989) and homicides (E960-E969) in England and Wales in the 12 weeks before and after 11 September 2001 and during a similar period in the previous two years.
FINDINGS: The number of suicides reported in the month of September 2001 was significantly lower than other months in the same year and any September of the previous 22 years in England and Wales. A suicide reduction in men, regardless of age, occurred in the week starting Tuesday 11 September 2001. A reduction in female suicide occurred during the four weeks following the attack.There was no evidence of a similar effect on homicide.
COMMENTS: The tragic events of 11 September 2001 appear to have had a brief but significant inverse effect on suicide.The finding of this study supports Durkheim's theory that periods of external threat create group integration within society and lower the suicide rate through the impact on social cohesion.
Correspondence: Michael J. Kallan, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA; (email: mkallan@cceb.upenn.edu).
In the United States, passenger cars are the most common passenger vehicle, yet they vary widely in size and crashworthiness. Using data collected from a population-based sample of crashes in State Farm-insured vehicles, we quantified the risk of injury to child occupants by passenger car size and classification. Injury risk is predicted by vehicle weight; however, there is an increased risk in both Large vs. Luxury and Sports vs. Small cars, despite similar average vehicle weights in both comparisons. Parents who are purchasing passenger cars should strongly consider the size of the vehicle and its crashworthiness.
Shifts in child restraint use according to child weight in the United States from 1999 to 2002.
Correspondence: Flaura K. Winston, TraumaLink: The Interdisciplinary Pediatric Injury Control Research Center, The Children's Hospital of Philadelphia, Philadelphia, PA, USA; (email: flaura@mail.med.upenn.edu).
From 1999 to 2002, 32% fewer US children between 9 and 36.4 kg (20-80 lb) were restrained inappropriately in seat belts and the most prevalent form of restraint shifted from seat belts to child restraints with harnesses. There was a significant increase in the use of combination child restraint/booster seats with harnesses by children 9.1-18.1 kg (20-40 lb). Among children weighing 14.1-18.1 kg (31-40 lb), the inappropriate use of seat belts and shield boosters decreased. Among children weighing 18.6-27.2 kg (41-60 lb), the use of belt-positioning booster seats increased while the inappropriate use of seat belts decreased. Of note, by the end of 2002, 27% of children weighing between 18.6 and 22.7 kg (41-50 lb) were restrained in child restraints with harnesses. These children were of weights typically above the manufacturer's recommended limit. Despite progress, substantial inappropriate restraint still remains and continued investment in outreach efforts is necessary. The risk of injury for heavier children in child restraints with harnesses should be monitored.
Injury severity in motor vehicle occupants.
- Hitosugi M, Takatsu A. Leg Med (Tokyo) 2000; 2(3): 166-170.
Correspondence: Masahito Hitosugi, Department of Forensic Medicine, Jikei University School of Medicine, 105-8461, Tokyo, JAPAN; (email: hitosugi@jikei.ac.jp).
We performed a retrospective analysis of injury severity and the effect of seat belt use with findings from forensic autopsies of 50 persons who had died in motor vehicle accidents. From autopsy findings and accident reports, the abbreviated injury scale (AIS) and the injury severity score (ISS) were calculated and analyzed epidemiologically. Among unrestrained occupants, drivers usually sustained more severe chest and abdominal injuries. Furthermore, three-point seat belts significantly decreased the severity of drivers' chest and abdominal injuries. Our results may be useful for forensic pathologists and clinicians and for mechanical engineers who investigate new safety devices for vehicle occupants.
Trends in early and late deaths due to motor vehicle accidents in Japan.
- Hitosugi M, Takatsu A. Leg Med (Tokyo) 2002; 4(3): 174-177.
Correspondence: Masahito Hitosugi, Department of Forensic Medicine, Jikei University School of Medicine, 3-25-8 Nishi-shimbashi, Minato-ku, Tokyo 105-8461, JAPAN; (email: hitosugi@jikei.ac.jp).
To clarify trends and urban-rural differences in the early death rate (deaths within 24 h divided by the deaths within 1 year after motor vehicle accident x100 [%]) due to motor vehicle accidents (MVAs) in Japan. Mortality data were collected from the annual statistics of traffic accident research and vital statistics in Japan from 1980 through 1998 and analyzed. Early death rates were nearly constant (73.9-78.0%) from 1980 through 1998. Early death rates were lower in younger and elderly groups. As regards to geographic variations, early death rates and 1-year death rates per 100,000 vehicles were significantly higher in rural areas (population density <1000/km(2)) than in urban areas. To investigate MVA deaths, both early and late deaths should be examined. Decreasing the early death rate, a new index for MVA death, which reflects the reduction of injury severity is important for preventing MVA deaths.
The injury pattern to children involved in lethal traffic accidents in Berlin.
- Bockholdt B, Schneider V. Leg Med (Tokyo) 2003; 5 Suppl: S390-S392.
Correspondence: Britta Bockholdt, Department of Legal Medicine, Free University Berlin, Hittorfstrasse 18, 14195, Berlin, GERMANY; (email: bboc@zedat.fu-berlin.de).
A statistical investigation of causes of death of children in Berlin, as well as in the rest of Germany shows, that 'accidents' are the most frequent causes of death in children. Nearly 50% of all child fatalities (0-15 years old) are due to traffic accidents. The reports of 30 children (19 boys, 11 girls) that were investigated in one of the three Institutes of Legal Medicine in Berlin over a period of 5 years were studied. In nearly 40% of all cases the children were pedestrians, in ten cases they died as passengers in cars, five children were bicyclists and in one case the child was a skateboarder. In 60% of all cases the principal injuries were severe injuries of the skull and brain; skull and brain trauma was the most frequent cause of death. In the group pedestrians (n=11), the cause of death in ten cases was the severe head-injury. Over 60% of all injured children died at the scene or in the first 24h after the accident, none of the children survived more than 30 days.
The effect of height on injury outcome for drivers of European passenger cars.
Statistical analysis of the UK in-depth accident database has been used to establish the characteristics of the 'small driver' at increased risk of injury. Drivers less than 160 cm in height are shown to have a significantly higher than average probability of AIS 2+ head and AIS 2+ pelvis and lower extremity injury. Subject trials have been used to establish the seating preferences of small stature drivers together with a comparison group drawn from the population as a whole.
The interaction between speed camera enforcement and speed-related mass media publicity in Victoria, Australia.
Correspondence: Max H. Cameron, Accident Research Centre, Monash University, Melbourne, Victoria, AUSTRALIA; (email: Max.Cameron@general.monash.edu.au).
The objective was to measure the presence of any interaction between the effect of mobile covert speed camera enforcement and the effect of intensive mass media road safety publicity with speed-related themes. During 1999, the Victoria Police varied the levels of speed camera activity substantially in four Melbourne police districts according to a systematic plan. Camera hours were increased or reduced by 50% or 100% in respective districts for a month at a time, during months when speed-related publicity was present and during months when it was absent. Monthly frequencies of casualty crashes, and their severe injury outcome, in each district during 1996-2000 were analysed to test the effects of the enforcement, publicity and their interaction. Reductions in crash frequency were associated monotonically with increasing levels of speed camera ticketing, and there was a statistically significant 41% reduction in fatal crash outcome associated with very high camera activity. High publicity awareness was associated with 12% reduction in crash frequency. The interaction between the enforcement and publicity was not statistically significant.
Graduation from a zero to .05 BAC restriction in an Australian graduated licensing system: a difficult transition for young drivers?
In Victoria, Australia, 21-26-year-old drivers are over-represented in alcohol-related fatal crashes. At this age drivers generally transfer from intermediate to full licensure, correspondingly experiencing an increase in legal BAC limit from zero to.05. This study used telephone surveys to compare drinking-driving profiles of 21-26-year-old fully-licensed, 18-20-year-old intermediate and 31-40-year-old experienced drivers ( N congruent with 700) to identify potential crash-risk factors. High driving and drinking exposure was a likely contributor to the over-involvement of male 21-26-year-olds, but not females. A tendency by 21-26-year-olds to rely on other drivers was both successful and unsuccessful in avoiding drink-driving. When driving themselves, there was a tendency to count or space drinks - less successful than abstaining from alcohol. The need to return home, convenience and lack of transport options were common reasons for drink-driving. Fear of crashes/injuries, licence loss and detection/arrest were common motivators to avoid drink-driving. Findings suggest the increase in BAC limit is a difficult transition for some drivers and may contribute to their crash involvement.
NASS 1998-2000 was queried to determine the frequency of serious injuries in multiple impact crashes and the distribution of injuries by crash sequence. The data set included all passenger cars and light trucks in NASS/CDS. The results showed that 42% of the MAIS 3+ injuries were in crashes that involved more than one harmful event. Approximately 24% of the MAIS 3+ injuries involved two harmful events, and 18% involved 3 or more harmful events. For multiple crashes with serious injuries, the most frequent initial impact direction was frontal (50%) followed by side (44.9%). The most frequent second impact was side (48.4%) followed by frontal (27.6%). The most harmful sequences were side-side (27.7%), front-side (15.8%) and front-front (14.9). The data suggests the need for further investigation and classification complex multiple impact crashes to aid in the in the design of safety systems.
The evidence of carbohydrate metabolism disturbances in traffic delinquents.
- Kernbach-Wighton G, Puschel K. Leg Med (Tokyo) 2003; 5 Suppl: S237-S239.
Correspondence: Gerhard Kernbach-Wighton, Institute of Legal Medicine, University of Gottingen, Windausweg 2, D-37073, Gottingen, GERMANY; (email: gkernba@gwdg.de).
Hypoglycaemia may have forensic importance concerning the ability of running a car and possible imputability. This study is based on an analysis of anamneses and clinical symptoms of traffic delinquents. Furthermore were estimated biochemical parameters such as glucose and lactic acid (additionally ethanol and toxicological screening). There is proposed a sum value (glucose+lactate) on blood samples taken, on behalf of the police, to be a reliable equivalent of the actual state of glucose metabolism.
Correspondence: Judith M. McFarlane, College of Nursing, Texas Woman's University, 1130 John Freeman Blvd, Houston, TX 77030, USA; (email: jmcfarlane@twu.edu).
OBJECTIVE: To compare the behaviors of black, white, and Hispanic children who were 18 months to 18 years of age and exposed to intimate partner violence with an age- and ethnically similar sample of children who were not exposed to violence and to compare both exposed and nonexposed children to normative samples.
METHODS: As part of a study on treatments for abused women in primary care public health clinics and Women, Infants and Children clinics in a large urban area, 258 abused mothers completed the Child Behavior Checklist (CBCL) on 1 of their randomly selected children between the ages of 18 months and 18 years. An ethnically similar sample of 72 nonabused mothers also completed the CBCL. The CBCL is a standardized instrument that provides a parental report of the extent of a child's behavioral problems and social competencies. The CBCL consists of a form for children 18 months to 5 years and a version for ages 6 to 18 years. The CBCL is orally administered to a parent, who rates the presence and frequency of certain behaviors on a 3-point scale (0 = not true, 1 = somewhat or sometimes true, and 2 = very true or often true). The time period is the last 6 months for the child 6 to 18 years of age and 2 months for the child 18 months to 5 years of age. Examples of behaviors for the child age 6 to 18 years include "gets in many fights," "truancy, skips school." Examples of behaviors for the child 18 months to 5 years of age include "cruel to animals," "physically attacks people," and "doesn't want to sleep alone." Both forms of the CBCL consist of 2 broadband factors of behavioral problems: internalizing and externalizing with mean scale scores for national normative samples as well as clinically referred and nonreferred samples of children. Internalizing behaviors include anxiety/depression, withdrawal, and somatic complaints. Externalizing behaviors include attention problems, aggressive behavior, and rule-breaking actions. Behavior scales yield a score of total behavioral problems. Scores are summed and then converted to normalized T scores. T scores >or=60 are within the borderline/clinical referral range-higher scores represent more deviant behavior. Multivariate analyses of variance (MANOVAs) were used to determine whether children from abused mothers differed significantly in their internalizing behaviors, externalizing behaviors, and total behavior problems from children of nonabused mothers. One sample t tests were used to compare children from abused and nonabused mothers to the matched clinically referred and nonreferred normative sample. Four pair-wise comparisons were considered: 1) children from abused women to referred norm, 2) children from abused women to nonreferred norm, 3) children from nonabused women to referred norm, and 4) children from nonabused to nonreferred norm. The internal, external, and total behavior problem T scores were dichotomized into a referral status: nonreferred = T score < 60, referred = T score >or= 60. Frequencies and percentages were used to describe the distribution of referral status among the children from the abused and nonabused women, and chi(2) tests of independence were used to determine whether the groups were significantly different.
FINDINGS: No significant differences in demographic characteristics between children from the abused women and nonabused women were observed. The sample consisted of a large number of Hispanic children (68.9%) and slightly more girls (53.6%), and nearly half (45.2%) had annual household incomes <10,000 dollars. Means, standard deviations, and results from the MANOVAs performed on internal, external, and total behavior problem scores between children from abused and nonabused women revealed no significant differences (F[3,139] = 1.21) for children ages 18 months through 5 years. Results from the MANOVA performed for ages 6 through 18 years revealed a significant group difference (F[3,183] = 3.13). Univariate tests revealed significant group differences for internalizing behavior (F[1,185] = 6.81), externalizing behav = 6.81), externalizing behavior (F[1,185] = 7.84), and total behavior problems (F[1,185] = 9.45). Overall, children of abused mothers had significantly higher internalizing (58.5 +/- 12.1), externalizing (55.5 +/- 12.4), and total behavior problems (57.6 +/- 12.3) scores than the internalizing (52.9 +/- 13.7), externalizing (49.7 +/- 10.6), and total behavior problems (51.0 +/- 13.0) scores exhibited for children of nonabused mothers. Most comparisons of children from the abused women to the referred and nonreferred norms are significant. The mean internal, external, and total behavior problem scores from children of abused women were significantly higher than the nonreferred norms and significantly lower than the referred norms. In contrast, all comparisons for children from nonabused women were not significantly different from the nonreferred norms.
COMMENTS: Children, ages 6 to 18 years, of abused mothers exhibit significantly more internalizing, externalizing, and total behavior problems than children for the same age and sex of nonabused mothers. In addition, the mean internalizing behavior score for boys 6 to 11 years of age as well as girls and boys 12 to 18 years of age of abused mothers were not significantly different from the clinical referral norms. Internalizing behaviors of anxiety, withdrawal, and depression are consistent with suicidal risk. The association of a child's exposure to intimate partner violence and subsequent attempted and/or completed suicide demands research. Our data demonstrate that children of abused mothers have significantly more behavioral problems than the nonclinically referred norm children but also, for most children, display significantly fewer problems than the clinically referred children. These children of abused mothers are clearly suspended above normal and below deviant, with children ages 6 to 18 being at the greatest risk. If abused mothers can be identified and treated, then perhaps behavior problems of their children can be arrested and behavioral scores improved. The American Academy of Pediatrics Committee on Child Abuse and Neglect recommends routine screening of all women for abuse at the time of the well-child visit and implementation of a protocol that includes a safety plan for the entire family. Clinicians can use this research information to assess for intimate partner violence during child health visits and inform abused mothers of the potential effects on their children's behavior. Early detection and treatment for intimate partner violence against women has the potential to interrupt and prevent behavioral problems for their children.
Attitudes towards corporal punishment and reporting of abuse.
- Tirosh E, Shechtera SO, Cohenc A, Jaffea M. Child Abuse Negl 2003; 27(8): 929-937.
Correspondence: The Hannah Khoushy Child Development Center, Bnai Zion Medical Center, POB 4940, Haifa 31048, ISRAEL; (email: unavailable).
OBJECTIVES: To assess physicians' attitudes towards corporal punishment in childhood and their subsequent actions regarding the reporting of child abuse.
PARTICIPANTS: 107 physicians (95 pediatricians and 12 family practitioners) who work in hospitals and community clinics in northern Israel were interviewed. Of the participants, 16% were new immigrants.
METHODS: A structured interview was conducted by one of two pediatric residents.
FINDINGS: Attitudes towards corporal punishment were not influenced by the physicians' sex or specialty. Corporal punishment was approved by 58% of the physicians. A significant difference in attitudes towards corporal punishment between immigrants and Israeli born physicians was found (p=.004). Family practitioners and especially senior ones were found significantly less tolerant towards corporal punishment than pediatricians (p=.04). While reporting behavior was not found to be associated with parental status and the past experience of the physicians with child abuse, a significant effect of attitudes towards corporal punishment on reporting behavior was found (p=.01).
COMMENTS: (1) Corporal punishment is still perceived as an acceptable disciplinary act by a significant proportion of physicians responsible for the health care of children in our area. (2) Attitudes towards corporal punishment are different between immigrants and native born Israeli trained doctors and, unexpectedly, pediatricians were more tolerant of corporal punishment than family practitioners.
Women's perspectives on intimate partner violence services: the hope in Pandora's box.
- Petersen R, Moracco KE, Goldstein KM, Clark KA. J Am Med Womens Assoc 2003; 58(3): 185-190.
Correspondence: R. Peterson, Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill, USA; (email: unavailable).
OBJECTIVE: To explore women's perspectives about how to enhance services for those who experience intimate partner violence (IPV) and how to improve the links between such services and the health care setting.
METHODS: We conducted 6 focus groups involving 67 women in both rural and urban settings in North Carolina. A standardized interview guide was used to investigate the women's perspectives on the study objectives. Coding and theme analyses were conducted to assess new ideas and/or common themes among the groups.
FINDINGS: Participants identified currently available services for women experiencing IPV, including health care providers, police and the legal system, domestic violence shelters, and churches. Participants discussed existing barriers to addressing violence within the health care system, including cost of medical services, risk of having social services remove their children, violence being too personal to discuss, and doctors' inability to provide what they thought victims really needed. Participants agreed that the most important role for providers would be referrals to useful services (advocacy, job training, and financial support). Participants also emphasized the need for community-based prevention efforts.
COMMENTS: We found a striking lack of support among women participants in our study for using the health care setting as part of the service response to IPV. Participants believed that the health care system is not set up to allow providers to provide the level of individual assistance that they thought would be most useful. Participants did have hope that women's risk of future IPV would decrease if they were provided with useful community-based services and if community-wide prevention efforts were implemented.
See Item 1 Under Suicide
See Item 2 under Risk Factor, Prevalence, Injury Occurrence, and Costs
