Changes in alcohol consumption following a reduction in the price of spirits: a natural experiment in Switzerland.
- Heeb JL, Gmel G, Zurbrugg C, Kuo M, Rehm J. Addiction 2003; 98(10): 1433-1446.
Correspondence: Jean-Luc Heeb, Swiss Institute for the Prevention of Alcohol and other Drug Problems, Avenue de Ruchonnet 14, CH-1001 Lausanne, SWITZERLAND; (email: jlheeb@sfa-ispa.ch).
OBJECTIVES: To discover what changes in alcohol consumption had occurred in subgroups defined by age, sex, volume of drinking and drinking occasions, following a reduction in the price of spirits in Switzerland in July 1999.
DESIGN: Quasi-experimental. Longitudinal general-population survey with baseline 3 months before and follow-up 3 months after price change.
PARTICIPANTS: Probabilistic telephone sample of 1347 individuals with at least monthly consumption on average in the previous 6 months at both interviews. The response rate at baseline was 74,8% and the attrition rate from baseline to follow-up 20.2%.
MEASUREMENTS: Alcohol consumption was assessed by means of a beverage-specific graduated-frequency measure. High volume of drinking was defined as 40 + g/day for men and 20 + g/day for women. Binge drinking was defined as six + drinks on an occasion for men and four + drinks for women.
FINDINGS: Spirits consumption increased significantly (by 28.6%) in the total sample, and specifically in young males and in individuals who were low-volume drinkers at baseline. Consumption of alcohol overall, or of wine or beer, did not change significantly. No indication of effects of substitution was found.
COMMENTS: Spirits consumption showed price-responsiveness in the early postintervention period. This finding is of particular interest, as (a) the increase in spirits consumption took place at a time of generally declining consumption of alcohol in Switzerland; and (b) in contrast to the findings of most studies, the intervention, namely price reduction, increased availability.
Imagery and associations of adolescents reflected in their behavior.
Correspondence: Miroslava Kyasova, Department of Geriatrics, Nursing and General Practice, Faculty of Medicine, Masaryk University, Brno, CZECH REPUBLIC; (email: mkyasova@med.muni.cz).
In adolescent girls, by means of imagery and associations it was studied, which images and associations produce concepts expressing activities which, on the one hand, protect and promote health (exercises, use of seat belts, and condoms) and, on the other hand, represent a health risk (drinking beer and liquor, cigarette smoking, marijuana smoking and cocain use, and sexual intercourse) and how they influence the respondents' behavior. Nursing school students were interviewed by means of a questionnaire published by the Oregon Research Institute, USA. The respondents gave a total number of 15,760 images for nine concepts. The associations for smoking cigarettes and cocain were evaluated only negatively although 35% respondents had smoked in the past six months. The associations for exercising were given mainly positive ratings and, in some cases, neutral ratings although the respondents mentioned low regular physical activities. Drinking liquor and the using of seat belts were evaluated positively, negatively and neutrally. Nearly three quarters of the respondents had consumed alcoholic drinks occasionally or frequently during the past six months. Drinking beer and smoking marijuana were associated with negative or neutral images. Sexual intercourse and condom use were prevailingly associated with positive images. Our results have shown that images and associations tend to contradict the adolescents' behavior. However, the results can form a basis for a particular application in primary preventive programs which should make use of and promote the development of desirable attitudes and behavior.
The marketing of alcohol to college students. The role of low prices and special promotions.
- Kuo M, Wechsler H, Greenberg P, Lee H. Am J Prev Med 2003; 25(3): 204-211.
Correspondence: Henry Wechsler, Harvard School of Public Health, Department of Health and Social Behavior, Boston, Massachusetts, USA; hwechsle@hsph.harvard.edu).
Heavy episodic or binge drinking has been recognized as a major problem on American college campuses affecting the health, safety, and education of students. The present study examines the alcohol environment surrounding college campuses and assesses the impact on students' drinking. This environment includes alcohol promotions, price specials, and advertising at drinking establishments that serve beer for on-premise consumption as well as retail outlets that sell beer for off-premise consumption.The study used student self-report data from the 2001 College Alcohol Study (CAS) and direct observational assessments by trained observers who visited alcohol establishments in communities where the participating colleges were located. The analytic sample included more than 10,000 students as well as 830 on-premise and 1684 off-premise establishments at 118 colleges.Alcohol specials, promotions, and advertisements were prevalent in the alcohol outlets around college campuses. Almost three quarters of on-premise establishments offered specials on weekends, and almost one half of the on-premise establishments and more than 60% of off-premise establishments provided at least one type of beer promotion. The availability of large volumes of alcohol (24- and 30-can cases of beer, kegs, party balls), low sale prices, and frequent promotions and advertisements at both on- and off-premise establishments were associated with higher binge drinking rates on the college campuses. In addition, an overall measure of on- and off-premise establishments was positively associated with the total number of drinks consumed.The regulation of marketing practices such as sale prices, promotions, and advertisements may be important strategies to reduce binge drinking and its accompanying problems.
Correspondence: Jon S. Vernick, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Baltimore, MD 21205, USA; (email: JVernick@jhsph.edu).
Injuries and the law are connected in many important ways. The law can be a powerful tool for reducing the risk of injury. Laws can compel certain individual behaviors, such as seatbelt use, and prohibit other behaviors, such as speeding, to protect the safety of us all. Laws can also require product manufacturers to design and market their products in a manner that will reduce the likelihood of injury.
Product safety rules are enacted at all levels of government -- federal, state, and local. Sometimes these laws, called statutes, are enacted directly by a legislature. Often, however, the details of safe design are delegated to administrative agencies, such as the National Highway Traffic Safety Administration (NHTSA) or the Consumer Product Safety Commission, for promulgation and enforcement. These administrative rulings are referred to as "regulations." There is a substantial body of literature that evaluates the effectiveness of a variety of product safety statutes and regulations, and often they have been proven effective in controlling the risk of injury.
Another aspect of the law, litigation, is sometimes seen (inaccurately) as applying only to the aftermath of an injury, when prevention has failed. A primary purpose of litigation is indeed to assess and assign liability for injury causation, and litigation can result in the compensation of the injured party. However, litigation can serve as a powerful tool for prevention as well. It has long been argued that transferring the cost of injuries through litigation, from the damaged person to the person or corporation who could have but did not prevent the injury, creates a motivation to invest in prevention rather than to pay the penalty of neglect.
The conceptual basis by which litigation, actual or threatened, can foster injury prevention involves the direct link that lawsuits create between faulty products or risky behaviors and the imposition of liability for damages. Civil litigation for private wrongs (much of which is called "tort" litigation), rather than criminal prosecution for wrongs committed against society, has as its primary desired outcome a judgment involving money. For obvious reasons, the desire to avoid paying monetary damages can be a powerful motivation. As William Prosser, one of the leading scholars of tort law, recognized, ". . . there is of course a strong incentive to prevent the occurrence of the harm. . . . Not infrequently one reason for imposing liability is the deliberate purpose of providing that incentive".
There are, however, additional ways in which tort litigation can promote injury prevention. The process of discovery, through which a plaintiff -- the person bringing the lawsuit -- learns about the conduct and products of the defendant, can reveal information of critical importance to injury prevention. Anecdotal or epidemiologic information developed during discovery can assist in the formulation of prevention strategies. For example, an injury that might seem to be a rare, "freak accident," such as an incident where a young child suffered severe burns on more than 30 percent of her body when a vaporizer that was called "tip-proof" by its manufacturer overturned, was better understood as a foreseeable and preventable injury when discovery revealed that the manufacturer had information on other children who had suffered similar injuries with this product. A redesign of the vaporizer in question was developed and its use compelled by the manufacturer's insurance company in this case.
For some products, there has been a failure of government to regulate adequately for the safety of the public, and when regulation is effectively absent, litigation becomes even more important as a tool for prevention. Firearms provide a good example. Congress has expressly forbidden the Consumer Product Safety Commission from exercising any jurisdiction over guns or ammunition. No other federal agency is charged with making certain that guns are designed in a safe manner. As a result, gun manufacturers have failed to utilize century-old technologies such as loaded chamber indicators and magazine disconnect devices that would likely save lives lost to inadvertent gunfire. Litigation against gun makers for their failure to provide technologically feasible, inexpensive safety devices holds promise for filling the injury prevention void left by regulatory inactivity.
This article will 1) review some of the empirical evidence examining the effect of litigation on product safety decisions, 2) provide two recent case examples of different ways that litigation can affect product safety, and 3) discuss several recent legal developments that may affect the ability of litigation to serve as an injury prevention intervention.
The Public Health Response to the Chi-Chi Earthquake in Taiwan, 1999.
- Chen KT, Chen WJ, Malilay J, Twu SJ. Public Health Rep 2003; 118(6): 493-499.
Correspondence: Kow-Tong Chen, Center for Disease Control, Department of Health, No. 6-8F, LinShen South Rd., Taipei, Taiwan, R.O.C; (email: ktchen@cdc.gov.tw).
OBJECTIVE: On September 21, 1999, at 1:47 a.m., an earthquake measuring 7.3 on the Richter scale struck the middle Chi-Chi region of Taiwan. The present study examines the response of the public health sector to the earthquake.
METHODS: A community needs assessment using modified cluster sampling was performed in shelters of Nantou and Taichung Counties five days after the earthquake struck. Twenty-five temporary medical service systems (TMSSs) conducted surveillance for selected diseases and mortality within one week post-earthquake aided by a buddy system that allowed unaffected counties to provide support to affected counties.
FINDINGS: The number of cases of acute respiratory infections and acute gastroenteritis in the affected area was higher than that of neighboring unaffected counties in the post-earthquake phase (p < 0.001). Earthquake-related deaths were estimated at 2,347 deaths (death rate 116 per 100,000 population); the mean age of the decedents was 49.7 years. No significant difference was observed between males (120/100,000) and females (110/100,000) (risk ratio [RR]=1.09; 95% confidence interval [CI] 0.84, 1.42; p > 0.05). The age-adjusted mortality rate was significantly higher in 1999 (odds ratio [OR]=2.11; 95% CI 1.99, 2.24) than in a comparable period in 1998.
COMMENTS: Emergency preparedness must be based on carefully conceived priorities, information, and communications, and improved capabilities must be developed to rapidly implement an emergency public health network. The emergency response to this event-consisting of TMSSs, a buddy system, and a communication system-should be considered in planning for future disaster events in Taiwan.
The Bali bombing: civilian aeromedical evacuation.
- Tran MD, Garner AA, Morrison I, Sharley PH, Griggs WM, Xavier C. Med J Aust 2003; 179(7): 353-356.
Correspondence: Alan A Garner, NRMA CareFlight, PO Box 159, Westmead, NSW 2145, AUSTRALIA; (email: alang@careflight.org).
Minh D Tran, Alan A Garner, Ion Morrison, Peter H Sharley, William M Griggs and Colin Xavier
After the Bali bombing on 12 October 2002, many injured Australians required evacuation to Darwin, and then to burns units around Australia. Many patients were evacuated from Denpasar by Qantas, with assistance from staff of civilian medical retrieval services. The transport of patients from Darwin to specialist burns units involved a coordinated response of civilian and military services. Some issues in responding to such disasters were identified, and a national coordinating network could improve future responses.
Unintentional home injury in preschool-aged children: looking for the key-an exploration of the inter-relationship and relative importance of potential risk factors.
- Ramsay LJ, Moreton G, Gorman DR, Blake E, Goh D, Elton RA, Beattie TF. Public Health 2003; 117(6): 404-411.
Correspondence: Dermot Gorman, Public Health Directorate, Lothian Health Board, Deaconess House, 148 The Pleasance, EH8 9RS, Edinburgh, UK; (email: dermot.gorman@lhb.scot.nhs.uk).
CONTEXT: To investigate the physical, social and psychological environment of families with preschool-age children to identify the most significant risk factors for unintentional injury.
DESIGN: A 1-year prospective case-control study, using a health-visitor-administered questionnaire.
SETTING: East and Midlothian, Scotland.
SUBJECTS: Seventy-nine children under 5 years of age presenting to an accident and emergency (A&E) department during 1998-1999 with an unintentional home injury and 128 matched controls.
FINDINGS: Of 264 families, 207 responded (78.4% response rate). The main carers of cases had a lower level of educational attainment than controls (P<0.01). This factor explained the case carer leaving fulltime education earlier, being less likely to be married and more often in receipt of government benefits. Cases lived in households with larger numbers of children, were more likely to have a physical illness, were less likely to have had a non-medically attended injury in the previous year (P<0.01) but more likely to have had another A&E injury attendance. Case households had lower electrical socket cover utilization (P<0.01) and fewer thought their child had adequate access to safe play areas. The main carers of cases tended to have a more negative life event experience in the preceding 6 months, but showed no significant differences in physical or mental well-being or social support. Cases seemed to be slightly more deprived members of their community.
COMMENTS: The main carer's educational attainment and socket cover utilization were lower in case families. These risk factors could be used to target families for injury-prevention work. Initiatives to raise educational achievement in the general population could lead to reductions in childhood injuries.
Pediatric friction hand injuries caused by domestic vacuum cleaners-a review from one unit.
Correspondence: M. Grob, Department of Plastic Surgery, Welsh Centre for Burns & Plastic Surgery, Morriston Hospital, Swansea NHS Trust, SA6 6NL, Swansea, UK; (email: unavailable).
The management of seven children with vacuum cleaner friction burns is described. Six of the children sustained full thickness burns. Four were treated operatively. Indications for surgery are outlined and important accident prevention strategies are highlighted.
Although many occupational safety programs are targeted toward large firms, the construction industry is dominated by smaller firms. This study examines the differential effect of firm size on the risk and the reporting of over 3000 serious and minor nonfatal elevation fall injuries in Danish construction industry trades (1993 to 1999). Small firms (<20 employees) accounted for 93% of all firms and 55% of worker-years. There was an inverse relationship between firm size and serious injury rates and a direct relationship between firm size and minor injury rates. An inverse relationship between firm size and injury severity odds ratios (serious versus minor) was found for carpentry, electrical work, general contracting, and the remaining other trades. Health and safety issues, legislation, and enforcement in the construction industry should, to a greater degree, be focused on smaller firms.
Visual experience, which is defined by brief saccadic sampling of complex scenes at high contrast, has typically been studied with static gratings at threshold contrast. To investigate how suprathreshold visual processing is related to threshold vision, we tested the temporal integration of contrast in the presence of large, sudden changes in the stimuli such occur during saccades under natural conditions. We observed completely different effects under threshold and suprathreshold viewing conditions. The threshold contrast of successively presented gratings that were either perpendicularly oriented or of inverted phase showed probability summation, implying no detectable interaction between independent visual detectors. However, at suprathreshold levels we found complete algebraic summation of contrast for stimuli longer than 53 ms. The same results were obtained during sudden changes between random noise patterns and between natural scenes. These results cannot be explained by traditional contrast gain-control mechanisms or the effect of contrast constancy. Rather, at suprathreshold levels, the visual system seems to conserve the contrast information from recently viewed images, perhaps for the efficient assessment of the contrast of the visual scene while the eye saccades from place to place.
OBJECTIVE: To present a practical approach for preventing running injuries.
CONTEXT: Much of the research on running injuries is in the form of expert opinion and comparison trials. Recent systematic reviews have summarized research in orthotics, stretching before running, and interventions to prevent soft tissue injuries. The most common factors implicated in running injuries are errors in training methods, inappropriate training surfaces and running shoes, malalignment of the leg, and muscle weakness and inflexibility. Runners can reduce risk of injury by using established training programs that gradually increase distance or time of running and provide appropriate rest. Orthoses and heel lifts can correct malalignments of the leg. Running shoes appropriate for runners' foot types should be selected. Lower-extremity strength and flexibility programs should be added to training. Select appropriate surfaces for training and introduce changes gradually.
COMMENTS: Prevention addresses factors proven to cause running injuries. Unfortunately, injury is often the first sign of fault in running programs, so patients should be taught to recognize early symptoms of injury.
See also final item under Risk Factor Prevalence, Injury Occurrence & Costs
Race/Ethnicity, gender, and monitoring socioeconomic gradients in health: a comparison of area-based socioeconomic measures-the public health disparities geocoding project.
- Krieger N, Chen JT, Waterman PD, Rehkopf DH, Subramanian SV. Am J Public Health 2003; 93(10): 1655-1671.
Correspondence: Nancy Krieger, Department of Society, Human Development, and Health, Harvard School of Public Health, 677 Huntington Ave, Boston, MA 02115, USA; (email: nkrieger@hsph.harvard.edu).
Use of multilevel frameworks and area-based socioeconomic measures (ABSMs) for public health monitoring can potentially overcome the absence of socioeconomic data in most US public health surveillance systems. To assess whether ABSMs can meaningfully be used for diverse race/ethnicity-gender groups, we geocoded and linked public health surveillance data from Massachusetts and Rhode Island to 1990 block group, tract, and zip code ABSMs. Outcomes comprised death, birth, cancer incidence, tuberculosis, sexually transmitted infections, childhood lead poisoning, and nonfatal weapons-related injuries. Among White, Black, and Hispanic women and men, measures of economic deprivation (e.g., percentage below poverty) were most sensitive to expected socioeconomic gradients in health, with the most consistent results and maximal geocoding linkage evident for tract-level analyses.
Preventive strategy of fall for the prevention of fractures in older people: a review of the evidence.
- Kanari Y, Yasumura S. Nippon Eiseigaku Zasshi 2003; 58(3): 347-356.
Correspondence: Y. Kanari, Department of Public Health, Fukushima Medical University, School of Medicine, 1 Hikariga-oka, Fukushima City, 960-1295 Fukushima, JAPAN; (email: y-kanari@fmu.ac.jp).
This review aims to examine the effectiveness of fall-related strategies for fracture prevention among elderly population. Previous studies were reviewed using PubMed and Japan Centra Revuo Medicina databases. Our five research questions concerned prediction of fracture using history of accidental falls, fracture risk management, and effectiveness of exercise programs, home modification and usage of hip protector. We used "accidental falls" and "fractures" as search strategies. Obtained results were as follows: a) History of falls predicts future hip fracture. b) Exercise programs including balance training have positive effects for fracture prevention. c) Fracture risk evaluation and management reduce the number of hip fractures among elderly population. d) Environmental hazard assessment and necessary home modification are effective in preventing fractures especially among elderly population with the history of falls. e) The hip protector is a beneficial device for the prevention of hip fractures among elderly people at high risk of falling.
CONTEXT: The distribution of fractures in the spine reported in the literature is quite variable. Application of such data to the pediatric population needs to take into account differences between children and adults, including overall decreased fracture frequency in children, developmental and physiological differences, and mechanism of injury. Knowledge of specific regions of injury may alter search patterns and protocols.
OBJECTIVE: To determine if the distribution of spinal injuries in pediatric patients is related to age, mechanism of injury, or gender.
PATIENTS AND METHODS: All pediatric patients (<18 years old) referred to our trauma service over a 5-year period were retrospectively reviewed. All patients with vertebral fracture and/or neurological injury were included. The levels of the spinal fractures were tabulated. Correlation was then made with age, gender, and mechanism of injury (motor vehicle accident versus non-motor vehicle accident).
FINDINGS: Of the 2614 pediatric patients, 84 sustained vertebral fracture and 50 had neurological injury without radiographic abnormality. A total of 164 fractures were identified. The thoracic region (T2-T10) was most commonly injured, accounting for 47 fractures (28.7%) followed by the lumbar region (L2-L5) with 38 fractures (23.2%), the mid-cervical region with 31 fractures (18.9%), the thoracolumbar junction with 24 fractures (14.6%), the cervicothoracic junction with 13 fractures (7.9%), and the cervicocranium with 11 fractures (6.7%). There was no relationship to gender or mechanism of injury.
CONCLUSIONS: Regardless of gender or mechanism of injury, the thoracic spine (T2-T10) is the most common region of fracture in pediatric trauma patients.
An epidemiologic study of elderly burn patients in Ain Shams University Burn Unit, Cairo, Egypt.
- Mabrouk A, Maher A, Nasser S. Burns 2003; 29(7): 687-690.
Correspondence: Amr Mabrouk, Department of Plastic and Reconstructive Surgery, Ain Shams University, 6 Mahmod Sadek Street, Golf Zone, Heliopolis, 11341, Cairo, EGYPT; (email: amrmabrouk@hotmail.com).
Recent statistics from Egypt indicate that elderly persons comprise 5.8% of the general population. Elderly patients remain a high-risk group in all burn units. This prospective study investigated geriatric burn patients (defined as 60 years and older) who were present at our center between May 1995 and October 2001. Of the 4220 patients who were present during this period, 97 (2.3%) were elderly, and 63 (7.1%) of the 880 total admitted were geriatrics. Of the 97 elderly burn patients who were present during the study period, 31 died (mortality rate 31.9%). Other epidemiological data, including duration of hospitalization, seasonal and day/hour variation in burn incidence and burn causes and accident site are presented. Ideas for management and prevention are also presented.
A cross-sectional study on injuries in residents at the community level of Zhejiang.
- Yu M, Cong LM, Xu LR, Xia ZC, Han CX, Ma Y, Zhong JM. Zhonghua Liu Xing Bing Xue Za Zhi 2003; 24(8): 681-683.
Correspondence: M. Yu, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310009, CHINA; (email: unavailable).
OBJECTIVE: To study the incidence of injuries among residents living in the communities in Zhejiang.
METHODS: A household questionnaire survey was conducted to 16 899 residents in four communities.
FINDINGS: The incidence of injuries was 16.11% in total, higher in urban area than in rural area and higher in men than in women. The leading causes of injuries were falls (4.80%), knife-cutting or by sharp articles (3.86%), traffic accident (2.07%), collision (1.99%), scalds (1.13%) and animal bites (1.06%). Peak incidence of age group was different in different injuries, such as traffic accident was high in 45 - 60 age group and falls was high in 5 and 60 age group. Direct economic loss for each case with injury would cost 324.21 RMB yuan.
COMMENTS: Injury was common and frequently occurred among residents at the community level which seriously on danger their health and families.
Childhood injuries in Israel: status and prevention strategies.
- Hemmo-Lotem M, Danon Y. Harefuah 2003; 142(8-9): 609-611, 646, 645.
Correspondence: Michal Hemmo-Lotem, Beterem, The National Center for Child Safety, on the premises of Schneider Children's Medical Center of Israel, ISRAEL; (email: chldsafe@netvision.net.il).
CONTEXT: In Israel, as in other developed countries, injuries are a leading cause of death and disabilities among children and youth between 1-19 years of age and the leading cause for Potential Years of Life Lost up to 65 years of age. In 1997, 225 children died as a result of accidental injuries, compared to 151 cases of death due to other internal causes. The most prevalent cause of death being motor vehicle accidents, rating 3:100,000: drowning--1:100,000 and falls, burns, suffocation and poisonings--less than 1:100,000 each. Mortality rates are just the tip of the iceberg, the most extreme outcome of an injury. Hospitalization rates and emergency room visits are higher. Injury was the cause for one out of 3 children to visit the emergency department. Hence, in 2001, there were 187,531 visits due to trauma, an annual rate of 712:10,000. The hospitalization rate due to injuries was 67:10,000 and the mortality rate was 8:100,000. Injuries in the community: Data concerning injuries in the community are relatively rare since no surveillance system exist. In their article "Childhood injuries in northern Israel--prevalence and risk factors", Miron at al. describe the prevalence, demographic variables and risk factors of injuries in the community of northern Israel. The article contributes to our knowledge of accidental injuries at the level of the primary care physician in the community. The findings indicate that falls and blows are the most common causes for mild injuries that usually occur in the home and backyard, and Arab children are at special risk for injuries, in general, and falls, in particular. These findings are consistent with existing data. Prevention is the way: 71-95% of all injuries can be prevented by simple means. This has been proven in many countries that managed to reduce mortality from accidental injuries by 10-20%. In the USA, for example, the percentage was reduced to about 35% in a decade. In Sweden, 3 decades of constant preventive efforts combined with close monitoring of the data have proven effective in reducing rate of mortality due to accidental injuries in children by 80%. The strategies which have proven to be effective are education and publicity, safer products and surroundings, promoting public policy, enforcement, data collection, research and evaluation and empowerment. A combination of strategies is most effective. National Vision: Despite the dismal picture, accidental injuries in children can be prevented and are not inevitable. It is wise to look at injuries as a heterogeneous group of illnesses, with different etiology, risk groups, and 'preventive treatments'--a group of diseases which are all preventable. It is very important that a national strategy for child safety be established accompanied by an adequate budget. Above all, it requires a lot of faith and commitment for the only vision: making the world a safer place for children.
Childhood injuries in northern Israel--prevalance and risk factors.
- Miron D, Shinnawi F, Meenes R, Avishai I, Sarid Y, Rotem M. Harefuah 2003; 142(8-9): 579-82, 648.
Correspondence: Dan Miron, Pediatric Department A, HaEmek Medical Center, Afula, ISRAEL; (email: unavailable).
CONTEXT: Injuries resulting from accidents in the home are among the most common causes of morbidity in children. Preventing these accidents by educating parents has proved to be the most successful way of reducing such accidents and protecting children.
OBJECTIVE: To study the prevalence, demographic variables and risk factors of childhood injuries in Northern Israel and to determine risk groups for preventive activities.
METHODS: The study was prospective and conducted during the year 2000 in 36 urban (not including Arab clinics) and rural community clinics of Clalit Health Services in Northern Israel that provided health care for approximately 62,000 children (about 55% of all children residing in these communities). The survey included all children 0-18 years of age admitted to the clinics with home injuries during the study period. Data regarding clinical, demographic and socioeconomic variables was obtained from parents or guardians by a detailed questionnaire. Statistical analysis of the data was conducted using Chi-Square to compare the different groups and logistic regression for analysis of risk factors for injury.
FINDINGS: An overall number of 2,086 (prevalence of 3.2%) children were included in the study of whom 61.5% and 38.5% were non Jews and Jews, respectively, (prevalence of 4.2% and 2.2% respectively) and 66.5% of all the children were boys (p < 0.01). The most common injuries among both populations were falls, blows, burns, and cuts (43%, 23%, 15%, and 13% respectively). The injuries occurred at home, or close to the home (31%), at school or kindergarten (32%), or elsewhere (37%). Seventy eight percent and 49% of the injuries in the non-Jewish and Jewish populations, respectively, occurred at or around the home (p < 0.001). Logistic regression analysis revealed that falling was most prevalent outside the home in non-Jewish males older than 3 years. Burns were more prevalent at home in non-Jewish girls under the age of 3, and blows were prevalent in the Jewish population outside the home in children over the age of 3.
COMMENTS: This study provides data that could direct preventive measures in the community in order to decrease the prevalence of injury to children. In order to be effective and have significant impact, these preventive activities should concentrate on specific risk groups.
Fatal falls from heights in and around Diyarbakir, Turkey.
- Goren S, Subasi M, Tyrasci Y, Gurkan F. Forensic Sci Int 2003; 137(1): 37-40.
Correspondence: Suleyman Goren, Department of Forensic Medicine, Faculty of Medicine, Dicle University, Diyarbakir, TURKEY; (email: sgoren@dicle.edu.tr).
Falls from high places, such as from a building, are frequently encountered in suicides, in some accidents, and sometimes in homicides. In this study, we evaluated the demographic data, mortality rates, fall causes, and post-mortem findings of individuals who fell from heights.Our cases were collected retrospectively from the files of the Branch of the Council of Forensic Medicine in Diyarbakir between 1996 and 2001.There were 431 accidental and 53 suicidal deaths due to blunt injury resulting from falls. Of the victims, 188 were female and 296 were male. The average age of the 484 victims was 27.05 years (range: 4 months-100 years). For buildings, the height ranged from 3 to 8 storeys for suicides and from 1 to 8 storeys for accidents. We proceeded to analyse the characteristics of accidental falls as follows. The majority of falls were from balconies or rooftops due to the tendency of people to sit and sleep on these places during the hotter months of the year. Some 54.5% of all falls occurred in May-August. The 53 suicidal jumps all occurred off buildings. The victims ranged in age from 15 to 70 years, and comprised 29 women and 24 men. One of the deceased jumped from the roof of a school in which he was boarding, and another from the seventh storey of a hospital in which he was receiving treatment. The remaining 51 jumped from heights ranging from 3 to 8 storeys. Psychiatric illness was reported in 18 (33.9%) of the suicide deaths, while 10 (18.8%) of the 53 suicides were single women. The results of this study were at variance with literature data with respect toi the following: falls from heights were most common in the 0-5 year age group, females had a higher suicide rate than males, and the majority of accidental falls occurred at home rather than in the workplace.
Increasing mortality among adults in Scotland 1981 to 1999.
Correspondence: Philip McLoone, MRC Social and Public Health Sciences Unit, University of Glasgow, 4 Lilybank Gardens, Glasgow G12 8RZ, UK; (email: p.mcloone@msoc.mrc.gla.ac.uk).
CONTEXT: The aim of the study was to describe the change in overall and cause-specific mortality in Scotland between the early 1980s and late 1990s, with particular reference to the mortality experience of young adults.
METHOD: The study was based on death records for Scottish residents. Changes in age and cause-specific death rates between 1981-83, 1989-91 and 1997-99 were compared.
FINDINGS: Between 1981-83 and 1989-91 death rates in Scotland began to rise among young men aged 20-24 while for those aged over 25 rates declined. The greatest fall in rates was experienced at ages 40 to 59. When death rates during 1997-99 were compared to rates in 1989-91 this pattern had changed. During the 1990s death rates among 20 to 34-year-olds increased, with a slight rise at ages 35-44. At older ages overall mortality continued to decline but the greatest fall was at ages 60 and over. Trends among women shared similarities with men. For both men and women falls in mortality from heart disease, stroke, and cancers were being differentially offset by increases in other causes of death across all age groups. The causes of death that contributed to the increased death rate among young adults include to various degrees, suicides, drug deaths, alcohol and violence.
COMMENTS: In Scotland changes in mortality result from a complex combination of different trends in mortality from various causes of death. The rate of decline in mortality among men aged 59 and below is slowing down, and death rates among young men aged 15-44 are increasing. If these trends continue there is a suggestion that future death rates may begin to rise at older ages.
Long-term disabilities and handicaps following sports injuries: outcome after outpatient treatment.
- R D, Jw G, Ck Vd VS, Wh E, Hj TD. Disabil Rehabil 2003; 25(20): 1153-1157.
Correspondence: R. Dekker, Department of Rehabilitation Medicine Groningen University Hospital Groningen THE NETHERLANDS; (email: unavailable).
CONTEXT: The aim was to investigate whether long-term disabilities and handicaps arise from a sports injury requiring outpatient treatment and to identify the potential risk factors.
METHODS: A representative sample was taken from a population of patients treated as outpatients due to a sports injury. The selected patients were sent a questionnaire, 2 - 5 years after the injury.
FINDINGS: Thirty-nine percent of the patients studied were unable to work for up to 1 month after the injury, 19% were not able to work for up to 3 months and another 5% could not work for a maximum of 8 months. Participation in sporting activities was hampered for up to 1 year in 76% of the patients and 11% had not resumed sports participation at all. In addition, 20% of the population stated that they still suffered from disabilities and handicaps following the sports injury. The outcome of the SIP68 underlines these results. Nine percent of the patients had a sumscore larger than 0. The variables which could be identified as risk factors were the body region: knee and sex: female.
COMMENTS: Sports injuries requiring outpatient treatment can lead to long-term disabilities and handicaps, especially in patients with knee injuries and injuries in women. On average these consequences are less severe than those associated with inpatients; however, this finding is of great value since the number of outpatients is much higher than in patients admitted to a hospital.
The effects of witnessing community violence on aggressive cognitions and behavior were investigated in an ethnically diverse sample of 4,458 children living in urban neighborhoods. Prior violence exposure had a significant effect in increasing aggression, normative beliefs about aggression, and aggressive fantasy. Although exposure to violence predicted aggressive behavior both in Grades 1 through 3 (ages 5-8) and Grades 4 through 6 (ages 9-12), the effects on social cognition were only evident in the later grades. Furthermore, the effect of violence exposure on aggression in the later grades was partially mediated by its effect on social cognition. These findings suggest that witnessing community violence has an effect on children's aggressive behavior through both imitation of violence and the development of associated cognitions as children get older.
A prospective cohort study on injuries among school-age children with and without behavior problems.
- Peng YC, Ni JF, Tao FB, Wu XK. Zhonghua Liu Xing Bing Xue Za Zhi 2003; 24(8): 684-688.
Correspondence: Y.C. Peng, Department of Social Medicine and Health Service Management, Capital University of Medical Sciences, Beijing 100054, CHINA; (email: unavailable).
OBJECTIVE: To study the annual incidence of injuries and the relationship between behavior problems and injuries among school-age children.
METHODS: A prospective cohort study on injuries for 1-year follow-up period was conducted among 2,005 school-age children selected by cluster sampling from three primary schools in Maanshan city. They subjects were divided into two groups with or without exposure according to behavior problems rated by the Rutter Child Behavior Questionnaire at the beginning of the study. Nonparametric test was performed to analyze the differences in injuries between the two groups of children, and the influential factors for injuries were analyzed with multi-classification ordinal response variable logistic regression model.
FINDINGS: The overall incidence rate for injuries in school-age children was 42.51%, while among children with and without behavior problems were 64.87% and 38.85%, respectively. There were significant differences between the two groups (u = -6.054, P = 0.000). However, the incidence rates of injuries in school-age children with antisocial (A) behavior, neurotic (N) behavior and mixed (M) behavior were 66.99%, 67.41% and 61.40%, respectively. No significant differences were found among them (u(A,N) = -0.052, P = 0.958; u(A,M) = -0.400, P = 0.689; u(N,M) = -0.364, P = 0.716). Mutivariate analysis indicated that injuries in school-age children were associated with children behavior problems, maternal age at childbirth, bad conditions during mother pregnancy, education background of mother, prevention measures for safety at home and the child accompanyed to fravel between school and home by adults. Behavior problems of children seemed to be the major risk factors for injuries.
COMMENTS: Children with behavior problems represented a significant risk group for injuries among school-age children. When planning intervention strategies on injuries, behavior problems should be emphasized to ensure optimal effectiveness of intervention.
Correspondence: Annette Erlangsen, Max Planck Institute for Demographic Research, Rostock, Germany. Strandgade 46, Haarby, Denmark. Institute of Public Health and Aging Research Center, University of Southern Denmark, ODENSE; (email: erlangsen@demogr.mpg.de).
OBJECTIVE: The purpose of our study is to examine suicide trends among the old (65-79 years) and oldest old (80+ years).
METHODS: All persons aged 50 or older who committed suicide in Denmark during 1972-1998 are included in the analysis. Suicide trends are analyzed by sex, age, civil status, and methods. Age, period, and cohort effects are examined graphically.
FINDINGS: In all, 17,729 persons (10,479 men and 7,250 women) committed suicide. During the study period, the suicide trends among the middle-aged and the old adults decreased. The trend among the oldest old, by contrast, remained stable. Marriage ceases to have a preventive effect among the oldest old. The oldest old tend to use more determined suicide methods.
COMMENTS: Distinct differences in suicide mortality between the old and the oldest old were found. The suicide trend of the oldest old does not reflect the recent improvements found in their overall mortality. Interestingly, it seems that the preventive effect of marriage seems to be ceasing with increasing age.
Suicidal behavior in a young offender population.
- Howard J, Lennings CJ, Copeland J. Crisis 2003; 24(3): 98-104.
Correspondence: John Howard, Ted Noffs Foundation, AUSTRALIA; (email: howardj@noffs.org.au).
Young offenders have numerous problems, including increased psychopathology, housing, and psycho-social stresses and increased rates of substance abuse. The current study investigated the contribution that substance use might make to a particularly vulnerable group of young people. Of the 300 young people approached for the study, 23.7% reported a prior suicide attempt. For this group, the most significant predictors of a prior suicide attempt were negative affect, prior exposure to violence, and housing stress. Life-time substance-use variables were most predictive of the number of suicide attempts a young person might make. Self-reported lethality (the expectation that on the last attempt the young person expected to die) was not strongly predicted by any variable. The research identifies the important role that dynamic risk factors (such as mood, substance use, and psychosocial stressors) play in increasing the risk of self-harm for young offenders, and raises the need to provide for more comprehensive discharge planning and support in order to manage these needs.
Seasonality in suicide: a study of farming suicides in England and Wales.
Correspondence: Sue Simkin, Centre for Suicide Research, University of Oxford Department of Psychiatry, Warneford Hospital, Headington, Oxford, UK; (email: sue.simkin@psych.ox.ac.uk).
Seasonality in suicide rates has long been reported. Spring peaks in suicide deaths have been positively correlated with the proportion of the workforce engaged in agriculture. Some studies have indicated that suicides using violent methods are more likely to show seasonality. Recent research has suggested that seasonal patterns have diminished. This study examined deaths in male farmers, an occupational group which might be expected to be more vulnerable to seasonal influences because of the nature of their work and the relatively high proportion of farmers using violent methods for suicide. Data on suicides between 1982 and 1999 by males in England and Wales aged 15 years and over were provided by the Office for National Statistics. Seasonal patterns of suicide in farmers and nonfarmers were examined by nonparametric tests and harmonic analysis. No significant seasonal variation was found for farmers. For nonfarmers, although a chi-square test showed significant variation in monthly distribution, this was not found when a harmonic analysis was applied. There was no significant difference in the variation of violent suicides throughout the year. This study reinforces recent findings that seasonal variation in suicide appears to be diminishing, even in an occupational group where this might be expected.
Correspondence: Susan Hart-Hester, Department of Family Medicine, University of Mississippi Medical Center, USA; (email: shart-hester@familymed.umsmed.edu).
Every 18 minutes a life is lost to suicide. Approximately every hour and a half, an elderly adult age 65 and over takes his/her life by suicide. Despite a decline in the rate of suicides over the past several years, suicides by elderly white males remains high. This paper provides a descriptive epidemiology of elderly suicides in a southern rural population and discusses implications for preventive health services that must be implemented to decrease the number of successful elderly suicides.
Association between side air bags and risk of injury in motor vehicle collisions with near-side impact.
- McGwin G Jr, Metzger J, Porterfield JR, Moran SG, Rue LW 3rd. J Trauma 2003; 55(3): 430-436.
Correspondence: Gerald McGwin, Center for Injury Sciences at the University of Alabama-Birmingham, 120 Kracke Building, 1922 7th Avenue South, University of Alabama at Birmingham, Birmingham, AL 35294-0016, USA; (email: gerald.mcgwin@ccc.uab.edu).
COMMENTS: Side air bags (SABs) have been introduced in an attempt to reduce the risk of injury in near-side-impact motor vehicle collisions (MVCs). The impact of SABs on MVC-related mortality and morbidity has yet to be evaluated with a large population-based study. The objective of this study was to assess the effectiveness of SABs in reducing the risk of injury or death in near-side-impact MVCs.
METHODS: A retrospective study investigated outboard front seat occupants involved in police-reported, near-side-impact MVCs using data from the General Estimates System (1997-2000). The risk of MVC-related nonfatal and fatal injury for occupants of vehicles with and without SABs was compared.
RESULTS: Front seat occupants of vehicles with SABs had a risk of injury similar to that of occupants of vehicles without SABs (risk ratio [RR], 0.96; 95% CI confidence interval [CI], 0.79-1.15). Adjustment for the potentially confounding effects of age, gender, seat belt use, seating position, damage severity and location, and vehicle body type did not meaningfully affect the association (RR, 0.90; 95% CICI, 0.76-1.08).
COMMENTS: There is no association between the availability of SABs and overall injury risk in near-side-impact MVCs. Future research is necessary to determine the effectiveness of SABs in preventing the injuries for which they were specifically designed.
Influence of driver sex on road accidents is assessed in this article. Accident records for 3 years and for three different income regions were analyzed. Annual distance traveled, social and economic participation, and effect of public vehicle accidents were considered. Effects of environmental factors and driver age were also included. Driver faults analysis identified possible reasons for accident differences. Analysis of accident severity was used to assess degree of harm. Statistical analysis at the 5% significance level was used to evaluate all differences. The results show that male accident rates are significantly higher. This trend is consistent through all the analyses. Accident differences are significant only in normal driving conditions. Drivers over age 50 had the lowest accident rates. Accident rate differences were caused by lack of attention and impatience among male drivers. Appropriate means of communication should alert concerned populations to these findings.
Risk of injury to restrained children from passenger air bags.
- Durbin DR, Kallan M, Elliott M, Cornejo RA, Arbogast KB, Winston FK. Traffic Inj Prev 2003; 4(1): 58-63.
Correspondence: Dennis Durbin, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA; (email: ddurbin@cceb.med.upenn.edu).
The objectives of this study were to estimate the prevalence of children's exposure to passenger air bag (PAB) deployments and to determine the relative risk of both minor and more serious nonfatal injuries to restrained children exposed to PABs in frontal impact collisions. Data were collected from 1 December 1998 to 30 November 2001 from a large-scale, child-specific crash surveillance system based on insurance claims, a telephone survey, and on-site crash investigations. Vehicles qualifying for inclusion were State Farm-insured, model year 1990 or newer, and involved in a crash with at least one child occupant </=15 years of age. Qualifying crashes were limited to those that occurred in 15 states and the District of Columbia. A stratified cluster sample was designed in order to select vehicles (the unit of sampling) for the conduction of a telephone survey with the driver. For cases in which child occupants were seriously injured or killed, in-depth crash investigations were performed. The prevalence of exposure to PABs was calculated as the number of children occupying the right front seat in a PAB deployment crash among all children occupying the right front seat in vehicles equipped with PABs. Complete interview data were obtained on 9,779 vehicles involving 15,341 children. Among PAB-exposed children, 175 (14%) suffered serious injuries versus 41 (7.5%) of those in the comparison group (OR 2.0; 95% CI, 1.1-3.7). The overall risk of any injury (both minor and serious) was 86% among children exposed to PABs, compared to 55% among the comparison group (OR 5.3; 95% CI, 2.1-13.4). Exposure to PABs increased the risk of both minor injuries, including facial and chest abrasions, and more serious injuries, particularly upper extremity fractures.
Reliability of police-reported information for determining crash and injury severity.
Posted speed limit and police-reported injury codes are commonly used by researchers to approximate vehicle impact and occupant injury severity. In-depth crash investigations, however, produce more precise measures of crash and injury severity: change in velocity (delta-V) for crash severity and Abbreviated Injury Scale (AIS) scores for injury severity. A comparison of data from police crash reports with that gathered by National Automotive Sampling System (NASS) investigators highlighted the inadequacy of speed limit and police injury codes as proxies for delta-V and AIS injury severity. In general, delta-V increased with speed limit and higher values of AIS were associated with higher police-coded injury severity, but there were a number of anomalies. In particular, 49% of the drivers coded by police as having incapacitating injuries actually had sustained no more than minor injuries. This overstatement of injury severity was less frequent among male (44%) and elderly (37%) drivers than among female (53%) and nonelderly (50%) drivers. Also, 79% of the investigated vehicles that crashed on roads posted at 60 mph (96 km/h) or higher experienced a delta-V less than 25 mph (40 km/h). Safety studies depending on data from only police reports to establish injury or crash severity therefore could produce erroneous results.
How future trends in societal aging, air bag availability, seat belt use, and fleet composition will affect serious injury risk and occurrence in the United States.
- Kent R, Funk J, Crandall J. Traffic Inj Prev 2003; 4(1): 24-32.
Correspondence: Richard Kent, Department of Mechanical and Aerospace Engineering, University of Virginia, Charlottesville, Virginia, USA; (email: rwk3c@VIRGINIA.EDU).
The objective of this study was to quantify the importance of societal aging relative to other factors that are known to affect injury risk. An aging population's effect on Maximum Abbreviated Injury Scale (MAIS) 3+ injury trends for passenger car drivers in frontal crashes was projected and compared to the effects of projected changes in fleet composition, changes in seat belt usage, and changes in air bag availability. It was determined that increased frailty due to an aging population will result in 19,816 to 43,568 additional injuries to passenger car drivers in frontal crashes from 1996 to 2012. Aging was shown to have an effect similar to the increased presence of light trucks in the fleet (a cumulative increase of approximately 47,428 injuries). Aging and changing fleet composition were shown to have a smaller effect than the projected increases in seat belt use or air bag availability, though the effect of increased belt use is not much greater than the effect of aging. After 2012, however, air bag availability and seat belt use will plateau, while societal aging will continue.
Effects of red light cameras on violations and crashes: a review of the international literature.
Red light running is a frequent cause of motor vehicle crashes and injuries. A primary countermeasure for red light running crashes is police traffic enforcement. In recent years, many police agencies have begun using automated red light cameras as a supplement to conventional enforcement methods. The present study reviewed and evaluated available evidence in the international literature regarding the effectiveness of cameras to reduce both red light violations and crashes. Camera enforcement generally reduces violations by an estimated 40-50%. In terms of crash effects, most studies contain methodological flaws that, to varying degrees, either overestimate (failure to adjust for regression to the mean) or underestimate (comparison with nearby signalized intersections affected by cameras) crash effects. Mindful of these limitations, the research generally indicates that camera enforcement can significantly reduce injury crashes at signalized intersections, in particular right-angle injury crashes. Most studies reported increases in rear-end crashes following camera installation. Taken together the studies indicate that, overall, injury crashes, including rear-end collisions, were reduced by 25-30% as a result of camera enforcement.
An overview of research advances in road traffic trauma in China.
Correspondence: Zhengguo Wang, Research Institute of Surgery, Institute for Traffic Medicine, Daping Hospital, Third Military Medical University, Chongqing, CHINA; (email: unavailable).
With rapid development of social economies, road traffic accidents (RTAs) have continued to increase, and have become the "primary public hazard" to humans. Road traffic trauma (RTT) is a major cause of death in young people of all motorized countries. This article reviews the current advances in RTT research, in order to find some approaches to improving traffic administration and reducing RTAs and RTT. All available data were collected from government, literature, our own research, and conference proceedings. Statistical analysis from every country showed that human factors were still the main cause of RTAs, accounting for more than 90%. Vehicle and road factors caused 3-5% and less than 2% of the total RTAs, respectively. Approximately 85% of RTAs were caused by 21 to 45-year-olds. About 50% of deaths due to RTAs in the United States were related to drinking. In China, RTAs due to driver drinking accounted for 0.29-1.48%. About 6-8% of drivers were prone to RTA, causing 30-40% of RTAs. Seat belts are an effective way to prevent casualties, reducing mortality and morbidity by 13-50%. In China, about 70% of RTAs were related to bicycles. Prehospital emergency treatment is very important. About 35% of deaths may be avoided if the injured receive early and effective treatment. From 1983 to 1992 the mortality of RTT increased by 13% in 18 developing countries, while it decreased by 18% in 13 developed countries, indicating the importance of comprehensive treatment of traffic administration. In addition many advances have been made in basic scientific research of RTT, such as development of serial bioimpact machines and investigation of biomechanical and biochemical mechanisms of impact injuries. In this century, RTAs and RTT are predicted to continue to increase in many countries, especially in developing ones. Full cooperation and comprehensive treatment should be performed in order to improve traffic safety.
Epidemiology of child homicide in Jefferson County, Alabama.
- Lyman JM, McGwin G, Malone DE, Taylor AJ, Brissie RM, Davis G, Rue LW. Child Abuse Negl 2003; 27(9): 1063-1073.
Correspondence: Gerald McGwin, Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA; (email: mcgwin@eyes.uab.edu).
OBJECTIVE: The purpose of this study was to present the epidemiology of homicide among children younger than 6 years of age in Jefferson County, Alabama. This study focused on obtaining great detail on homicides and suspicious deaths occurring within a fixed population.
METHODS: For purposes of this study, cases included Jefferson County deaths attributed to "homicide" or that were "undetermined" as noted in the coroner files among children younger than 6 years of age who were born and died between January 1, 1988 and December, 31, 1998. Victim and offender characteristics were obtained from the Jefferson County Coroner/Medical Examiner Office records. Environmental factors and circumstances surrounding the death were noted as well.
FINDINGS: The 53 study subjects were mainly female (55%), Black (69%), younger than 2 years of age (85%), had single mothers (38%), and a history of abuse (53%). Offenders were more likely to be male (64%), Black (73%), and a parent of the victim (53%). Homicides primarily resulted from an angry impulse (61%), with hands the most common weapon (61%).
COMMENTS: The majority of deaths in this study occurred among children younger than age 2, with a high proportion of fatalities among Black children of unmarried mothers. The offender most often knew the victim, with half of all homicides and two-thirds of all infant homicides involving a parent. More than half of the homicides resulted from an angry impulse, while the most common scenario for deaths with undetermined intent involved the caretaker finding the child unresponsive.
Preventive care in the emergency department: screening for domestic violence in the emergency department.
- Anglin D, Sachs C. Acad Emerg Med 2003; 10(10): 1118-1127.
Correspondence: Deirdre Anglin, Department of Emergency Medicine, Room 1011, LAC + USC Medical Center, 1200 North State Street, Los Angeles, CA 90033, USA; (email: anglin@hsc.usc.edu).
OBJECTIVES: The most effective methods for identification and management of domestic violence (DV) victims in health care settings are unknown. The objective of this study was to systematically review screening for DV in the emergency department (ED) to identify victims and decrease morbidity and mortality from DV.
METHODS: Using the terms "domestic violence" or "partner violence," and "identification" or "screening," and "emergency," the authors searched MEDLINE, the Cochrane Database, and Emergency Medical Abstracts from 1980-2002. They selected articles studying screening tools, interventions, or determining the incidence or prevalence of DV among ED patients. The studies were analyzed using evidence-based methodology.
FINDINGS: Three hundred thirty-nine articles resulted from the literature search. Based on selection criteria, 45 were reviewed in detail and 17 pertained to the ED. From references of these 17 articles, three additional articles were added. Screening can be conducted using a brief verbal screen and existing ED personnel. A randomized, controlled trial did not demonstrate a difference in screening rates between experimental and control hospitals. No studies assessed the effect of ED screening for DV on morbidity or mortality of domestic violence. An ED-based advocacy program resulted in increased use of shelters and counseling.
COMMENTS: Because of the paucity of outcomes research evaluating ED screening and interventions, there is insufficient evidence for or against DV screening in the ED. However, because of the high burden of suffering caused by DV, health care providers should strongly consider routinely inquiring about DV as part of the history, at a minimum for all female adolescent and adult patients.
Adolescent Assault Injury: Risk and Protective Factors and Locations of Contact for Intervention.
Correspondence: Tina L. Cheng, Department of General Pediatrics and Adolescent Medicine, Children's National Medical Center, Washington, DC, USA; (email: tcheng@cnmc.org).
CONTEXT: Violence is a large contributor to morbidity and mortality among adolescents. Most studies assessing markers for violent injury are cross-sectional. To guide intervention, we conducted a case-control study to explore factors associated with assault injury and locations to reach at-risk adolescents.
OBJECTIVE: 1) To assess risk and protective factors for adolescent assault injury compared with 2 control groups of youth with unintentional injuries and noninjury complaints presenting to the emergency department and 2) to assess locations of contact with assault-injured youth for prevention programs.
METHODS: Face-to-face and phone interviews were conducted with systematic samples of youth aged 12 to 19 years presenting to the emergency department with assault injury, unintentional injury, and noninjury complaints. Youth with intentional injuries were matched to youth in the 2 control groups on age +/-1 year, gender, race, and residency.
FINDINGS: One hundred forty-seven 147 assault-injured youth completed interviews. One hundred thirty-three assault-injured youth were matched to 133 unintentionally injured and 133 noninjured youth presenting to the emergency department. Compared with the 2 control groups, assault-injured youth were more likely to have had more fights in the past year (odds ratio [OR]: 3.91; 95% confidence interval [CI]: 2.02, 7.58; OR: 4.00; 95% CI: 2.23, 7.18) and fights requiring medical treatment (OR: 35.49; 95% CI: 8.71, 144.68; OR: 80.00; 95% CI: 11.13, 574.80). Eighty percent of assault-injured youth had been in 1 or more fights in the last 12 months compared with 55% and 46% in unintentional and noninjured controls, respectively. Assault-injured youth were more likely to have had previous weapon injuries (OR: 9.50; 95% CI: 3.39, 26.6; OR: 8.50; 95% CI: 3.02, 23.95) and have seen someone shot (OR: 2.00; 95% CI 1.12, 3.58; OR: 2.00; 95% CI: 1.12, 3.58). Eighty-six percent of assault-injured youth had a regular health care provider with 82% reporting a visit within the last year. There were no differences between cases and controls with regard to physician contact, extracurricular activity involvement, school or church attendance, police contact, weapon access or weapon-carrying, or witnessing nonweapon-related violence.
COMMENTS: Fighting was common among all groups. Assault-injured youth were more likely to have had previous weapon injuries and were high-risk for future injury. Past fights, past fight injuries, and seeing someone else shot were markers associated with assault injury. Health providers do have access to at-risk teens for clinical risk assessment and intervention.
Do responses to an intimate partner violence screen predict scores on a comprehensive measure of intimate partner violence in low-income black women?
- Heron SL, Thompson MP, Jackson E, Kaslow NJ. Ann Emerg Med 2003; 42(4): 438-491.
Correspondence: Sheryl L. Heron, Department of Emergency Medicine, Emory University, 69 Jesse Hill Jr. Drive, Atlanta, GA 30303, USA; (email: sheron@sph.emory.edu).
OBJECTIVES: Screening for intimate partner violence has been advocated as an emergency department (ED) procedure. This study aimed to ascertain whether a 5-item intimate partner violence screening questionnaire could be used effectively in the ED with low-income black women to accurately predict partner abuse status.
METHODS: Data were collected from 200 black women who answered in the affirmative to at least 1 item on the intimate partner violence screener questionnaire, the Universal Violence Prevention Screening Protocol. The women completed a comprehensive battery of measures, including the Index of Spouse Abuse, a commonly used and psychometrically sound measure of intimate partner violence.
FINDINGS: Bivariate logistic regression analyses revealed that, compared with women below the physical-intimate partner violence cut point on the Index of Spouse Abuse, women above the cut point on physical-intimate partner violence on the Index of Spouse Abuse were more likely to answer yes to Universal Violence Prevention Screening Protocol screening questions related to physical, sexual, and emotional abuse; threats to be harmed physically; and being afraid. Compared with women below the nonphysical-intimate partner violence cut point on the Index of Spouse Abuse, women above the cut point on nonphysical intimate partner violence on the Index of Spouse Abuse were more likely to answer yes to each screening question on the Universal Violence Prevention Screening Protocol. The 2 Universal Violence Prevention Screening Protocol screening items related to physical abuse best predicted the 2 Index of Spouse Abuse scales. Accurate prediction of physical and nonphysical abuse on the Index of Spouse Abuse required affirmative responses to 4 or more screening questions on the Universal Violence Prevention Screening Protocol.
COMMENTS: A brief intimate partner violence screening device in the emergency care setting can identify abused, low-income, black women. The study is limited by the fact that universal screening was not conducted, the inclusion of only women who acknowledged some form of intimate partner violence, a reliance on retrospective self-reports, and the questionable generalizability of the findings to groups other than low-income black women.
