CONTEXT: Alcohol consumption has been identified as one of the most important risk factors for youth suicide. Previous research has shown a strong, empirical link between alcohol use and suicide. If alcohol use is a contributing factor in determining suicidal behaviors, then policies designed to reduce the alcohol consumption may succeed in reducing youth suicides as well.
OBJECTIVES: This paper looks at the role of alcohol-related policies in reducing completed suicides by American youths and young adults. This hypothesis comes from two well established relationships: i) the observed correlation between alcohol consumption and incidents of suicide, and ii) the negative relationship between the full price of alcohol and consumption. The alcohol policies examined are excise taxes on beer, measures of alcohol availability, and drunk driving laws.
METHODS: Data on completed suicides for each state in the United States are analyzed for the period 1976-1999. Negative binomial regressions are used to estimate a reduced form model of youth suicide. Suicides are analyzed by gender and age groups (ages 10-14, 15-19 and 20-24).
FINDINGS: The results indicate that increases in the excise tax on beer are associated with a reduced number of male suicides. This tax, however, has no impact on female suicides. Suicides by males ages 20-24 are positively related to the availability of alcohol, and negatively related to the presence of a 0.08 BAC (blood alcohol concentration) law and a zero tolerance law for drunk driving. Female suicides are not impacted by the availability of alcohol, although the drunk driving laws may impact suicides by teenage females. COMMENTS: Policies designed to reduce alcohol consumption may have the unintended benefit of reducing suicides, particularly among young males. While this research shows that alcohol policies may be successful in reducing male suicides, such policies have little impact on female suicides. Future research should explore other potential types of policies and programs to reduce female suicides. Also, illegal drug use has been linked to suicides in a similar manner as alcohol consumption. Future research should consider the role of illegal drug consumption and related policies in determining youth suicides.
Correspondence: E.B. Blanchard, Center for Stress and Anxiety Disorders, State University of New York, Albany, New York 12203, USA; (email: jar@cnsunix.albany.edu).
A. E. Stewart and J. H. Lord (2002) call for abandoning the term motor vehicle accident and substituting motor vehicle crash on definitional and patient care grounds. We disagree on definitional grounds and because of the absence of empirical data from accident survivors to support their contentions.
The single most common age of murderers in Japan is 49. Individuals aged between 45 and 54 are, however, likely to commit not offenses but suicides comparing with other generations. One factor behind this phenomenon is the trend toward company downsizing, which is thought to affect the mental attitude of workers. This trend is destroying the Japanese lifetime employment system and undermining worker's loyalty to the company. On the other hand, in the broader category of felony crimes (assault, burglary, arson, murder), offenders aged 17 are the most common in Japan. This is thought to be partly due to the effect of so-called "school collapse" (school system failure) on the mental attitude of students. "School collapse" implies dysfunction of educational practice as a result of chattering, bullying and violence in the classroom. It is the reflection of students' dissatisfaction with the group-oriented school system. Therefore, students are unable to find any purposes in school and exhibit aggressive behaviors. In terms of mental health for both middle-age and teenage generations, it is necessary to devise new strategies whereby people can break away from the pressure of loyalty to the group. For both "normal" and "disabled" workers, rights of recuperations, adequate unemployment benefits policy, and support system for occupational change should be established. Simultaneously, for both "normal" and "disabled" students, reform of the school system under the concepts of diversity of education, rights of selection, and rights of refusal is urgently necessary. With respect to forensic psychiatry, without the provision of social supports, labeling of conduct disorder as well as other disorders should be avoided. In particular, instead of introducing security hospitals, drastic improvements of medical reformatories and medical prisons are necessary to provide adequate medical and social supports for offenders with psychiatric disorders.
Interventions for preventing falls in elderly people.
- Gillespie L, Gillespie W, Robertson M, Lamb S, Cumming R, Rowe B. Cochrane Database Syst Rev 2003; 4:CD000340.
Correspondence: Lesley Gillespie, Dept of Health Sciences, Area 4, Seebohm Rowntree Building, Alcuin College, The University of York, Heslington, York, UK; (email: ldg2@york.ac.uk).
CONTEXT: Approximately 30 per cent of people over 65 years of age and living in the community fall each year; the number is higher in institutions. Although less than one fall in 10 results in a fracture, a fifth of fall incidents require medical attention.
OBJECTIVES: To assess the effects of interventions designed to reduce the incidence of falls in elderly people (living in the community, or in institutional or hospital care).
METHODS: We searched the Cochrane Musculoskeletal Group specialized register (January 2003), Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 1, 2003), MEDLINE (1966 to February 2003), EMBASE (1988 to 2003 Week 19), CINAHL (1982 to April 2003), The National Research Register, Issue 2, 2003, Current Controlled Trials (www.controlled-trials.com accessed 11 July 2003) and reference lists of articles. No language restrictions were applied. Further trials were identified by contact with researchers in the field. Randomized trials of interventions designed to minimize the effect of, or exposure to, risk factors for falling in elderly people. Main outcomes of interest were the number of fallers, or falls. Trials reporting only intermediate outcomes were excluded. Two reviewers independently assessed trial quality and extracted data. Data were pooled using the fixed effect model where appropriate.
FINDINGS: Sixty two trials involving 21,668 people were included. Interventions likely to be beneficial: Multidisciplinary, multifactorial, health/environmental risk factor screening/intervention programs in the community both for an unselected population of older people (4 trials, 1651 participants, pooled RR 0.73, 95%CI 0.63 to 0.85), and for older people with a history of falling or selected because of known risk factors (5 trials, 1176 participants, pooled RR 0.86, 95%CI 0.76 to 0.98), and in residential care facilities (1 trial, 439 participants, cluster-adjusted incidence rate ratio 0.60, 95%CI 0.50 to 0.73) A programmed of muscle strengthening and balance retraining, individually prescribed at home by a trained health professional (3 trials, 566 participants, pooled relative risk (RR) 0.80, 95% confidence interval (95%CI) 0.66 to 0.98) Home hazard assessment and modification that is professionally prescribed for older people with a history of falling (3 trials, 374 participants, RR 0.66, 95% CI 0.54 to 0.81) Withdrawal of psychotropic medication (1 trial, 93 participants, relative hazard 0.34, 95%CI 0.16 to 0.74) Cardiac pacing for fallers with cardioinhibitory carotid sinus hypersensitivity (1 trial, 175 participants, WMD -5.20, 95%CI -9.40 to -1.00) A 15 week Tai Chi group exercise intervention (1 trial, 200 participants, risk ratio 0.51, 95%CI 0.36 to 0.73). Interventions of unknown effectiveness: Group-delivered exercise interventions (9 trials, 1387 participants) Individual lower limb strength training (1 trial, 222 participants) Nutritional supplementation (1 trial, 46 participants) Vitamin D supplementation, with or without calcium (3 trials, 461 participants) Home hazard modification in association with advice on optimizing medication (1 trial, 658 participants), or in association with an education package on exercise and reducing fall risk (1 trial, 3182 participants) Pharmacological therapy (raubasine-dihydroergocristine, 1 trial, 95 participants) Interventions using a cognitive/behavioral approach alone (2 trials, 145 participants) Home hazard modification for older people without a history of falling (1 trial, 530 participants) Hormone replacement therapy (1 trial, 116 participants) Correction of visual deficiency (1 trial, 276 participants). Interventions unlikely to be beneficial: Brisk walking in women with an upper limb fracture in the previous two years (1 trial, 165 participants).
COMMENTS: Interventions to prevent falls that are likely to be effective are now available; less is known about their effectiveness in preventing fall-related injuries. Costs per fall prevented have been established for four of the interventions and careful economic modeling in the context of the local healthcare system is important. Some potential interventions are of unknown effectiveness and further research is indicated.
Correspondence: John P. Pryor, Division of Traumatology and Surgical Critical Care, University of Pennsylvania School of Medicine, 3440 Market Street, Philadelphia, PA 19104, USA; (email: pryorj@uphs.upenn.edu).
OBJECTIVES: To collect and analyze data from deaths and injuries, and from evaluation of the responses by medical services and by fire-, rescue-, and police-services one year after the terror attack on the New York World Trace Center.
METHODS: Epidemiologic data were collected from all involved agencies and analyzed. The authors' personal experience from working at the scene during the event and several other personal testimonies were also included in this analysis.
FINDINGS: Totally, 2,762 death certificates were issued by the state of New York for victims of the attack. 1,361 (49.9%) of these were issued for victims whose remains could not be identified. All but nine of these died the day of the attack. 77% of the victims were male, median age 39 years. Of the dead were 342 fire-fighters and paramedics and 60 police officers. A total of 1,103 patients were treated during the first 48 days in the five key-hospitals that received the majority of the injured. 29% of these were rescue workers. 66% of the injured were male, average 39 years. The most common injuries were respiratory impairment (49%) and oocular affection (26%), many severe. The most common trauma was lacerations (14%) and sprains (14%). Of those admitted to the hospital, 19% had trauma and 19% had burns. Hed injuries were registered in 6% and crush injuries in 4%.
All available fire-rescue units in Manhattan were sent to the scene, a total of 121 engine companies, 62 ladder companies, 4 rescue squads, and other specialty companies -- a force equivalent to 22 alarms and almost half of the entire Fire Department of New York. With regard to response from involved agencies, communication failure was the most common and difficulties in command operations and scene control were also prevalent. There was a mutual aid call from neighboring districts. The original plan was for them to staff outlying fire houses near the city border. Tis would free New York firefighters to go to the scene. Instead, the mutual aid companies went to the scene.
The initial EMS response was 36 ambulances. The majority of these units, along with the EMS command post, were destroyed in the first tower collapse. Communications that were marginal at the beginning of the response (due to extensive radio traffic) became even worse after the tower collapse. radio repeaters (booster antennas) that were situated on the roof of the tower were destroyed, inactivating local communication on the EMS agency's frequencies -- there was no effective communication between EMS command, dispatch, and responding units -- an additional 97 ambulances and 22 EMS supervisors.
COMMENTS: The difficulties encountered were very similar to those commonly seen in major incidents, although on a great scale. Response plans have to be critically reviewed based on experiences from this and other event, in order to pre-empt difficulties such as here described in future responses to major urban incidents.
Time estimation during prolonged sleep deprivation and its relation to activation measures.
- Miro E, Cano MC, Espinosa-Fernandez L, Buela-Casal G. Hum Factors 2003; 45(1): 148-519.
Correspondence: Elena Miró, Department of Personality, Assessment, and Psychological Treatment, University of Granada, Granada, SPAIN, (email: emiro@platon.ugr.es).
This is the first study to analyze variations in time estimation during 60 h of sleep deprivation and the relation between time estimation performance and the activation measures of skin resistance level, body temperature, and Stanford Sleepiness Scale (SSS) scores. Among 30 healthy participants 18 to 24 years of age, for a 10-s interval using the production method, we found a lengthening in time estimations that was modulated by circadian oscillations. No differences in gender were found in the time estimation task during sleep deprivation. The variations in time estimation correlated significantly with body temperature, skin resistance level, and SSS throughout the sleep deprivation period. When body temperature is elevated, indicating a high level of activation, the interval tends to be underestimated, and vice versa. When the skin resistance level or SSS is elevated (low activation), time estimation is lengthened, and vice versa. This lengthening is important because many everyday situations involve duration estimation under moderate to severe sleep loss. Actual or potential applications of this research include transportation systems, emergency response work, sporting activities, and industrial settings in which accuracy in anticipation or coincidence timing is important for safety or efficiency.
Predicting falls within the elderly community: comparison of postural sway, reaction time, the Berg balance scale and the Activities-specific Balance Confidence (ABC) scale for comparing fallers and non-fallers.
Correspondence: Yves Lajoie, School of Human Kinetics, University of Ottawa, 125 University St, Ont., K1N6N5, Ottawa, CANADA; (email: ylajoie@uottawa.ca).
Simple reaction time, the Berg balance scale, the Activities-specific Balance Confidence (ABC) scale and postural sway were studied in order to determine cut-off scores as well as develop a model used in the prevention of fallers within the elderly community. One hundred and twenty-five subjects, 45 fallers and 80 non-fallers were evaluated throughout the study and results indicated that non-fallers have significantly faster reaction times, have higher scores on the Berg balance scale and the ABC scale as well as sway at slower frequencies when compared to fallers. Furthermore, all risk factors were subsequently entered into a logistic regression analysis and results showed that reaction time, the total Berg score and the total ABC score contributed significantly to the prediction of falls with 89% sensitivity and 96% specificity. A second logistic regression was carried out with the same previous variables as well as all questions of the Berg and ABC scales. Results from the logistic analysis revealed that three variables were associated with fall status with 91% sensitivity and 97% specificity. Results from the following study would seem rather valuable as an assessment tool for health care professionals in the identification and monitoring of potential fallers within nursing homes and throughout the community.
Correspondence: Kim M. Thompson, Harvard School of Public Health, Departments of Health Policy and Management and Maternal and Child Health, Boston, Massachusetts, USA; (email: kimt@hsph.harvard.edu).
CONTEXT: The objective of this study was to quantify and characterize the role of bath seats in infant mortality from bathtub drowning.
METHOD: Risk analysis of bathtub drowning deaths for infants aged 6-10 months was performed using data available from the US Consumer Product Safety Commission (CPSC), birth and mortality data from the National Center for Health Statistics (NCHS) for US resident infants from 1990-1998, and bath seat ownership from the American Baby Group and industry sales data compiled by NPD to estimate bath seat use. The analysis computes the relative risks of infant drowning based on estimates of bath seat use with a cohort design and explores the potential confounding by a range of factors.
FINDINGS: In-depth analysis of the unintentional bathtub drowning deaths of American infants aged 6-10 months for the years 1994 through 1998 revealed 40 infant drowning deaths associated with bath seats and 78 deaths not associated with bath seats. Based on available data on sales and use that suggest approximately 45% of infants in this age group use bath seats, the existing data do not support a hypothesis that bath seats increase the risk of bathtub drowning for infants. Bath seats are not intended or marketed as safety devices, and analysis of the existing, albeit limited, data suggests that they either have no effect or they may provide some slight unexplained protection against unintentional bathtub drowning risks (with an odds ratio for the risk of drowning with a bath seat vs without a bath seat of approximately 0.6 [95% confidence interval (CI) 0.4-0.9]). Although all potential confounders cannot be fully explored due to incomplete data and large uncertainties remain, this analysis suggests that the US CPSC made the appropriate decision not to ban bath seats in response to petitions it received in 1994 and 2001.
COMMENTS: Increasing market sales and surveys of reported bath seat use were associated with decreasing unintentional infant bathtub drowning risks. Rigorous risk analyses should be conducted when considering regulating products to ensure that regulation does not inadvertently increase injury risks. Analysis of the factors associated with these deaths suggests that additional efforts are needed to ensure that caregivers do not leave infants unattended in the bathtub and to collect data that will further improve our understanding and management of these risks.
CONTEXT: The construction industry produces the highest number of occupational injuries in Spain (25.6%). Of these, 98.5% were minor injuries with 5 million workdays lost in 2000. This occurred even after the recent introduction of numerous health and occupational safety regulations. The objective of the present study was to identify the specific mechanisms of minor occupational injuries in the construction sector.
METHODS: In 2000, there were 235,853 minor occupational injuries in the construction industry. From these, injuries in general construction and civil engineering were selected (n = 155,044). These injuries affected both the total number of workers in the sector as well as bricklayers and unskilled construction workers. Insurance and financial activities (n = 2,019) were selected as a reference economic sector. Minor occupational injuries due to nontraumatic processes (heart attack, etc.) were taken as a control group (n = 167), assuming that the risk of nontraumatic processes was independent of economic activities. Odds ratios (OR) were adjusted by age, sex, years of work experience, type of employment and company size through nonconditional logistic regression models.
FINDINGS: The mechanisms with the highest risk of minor occupational lesions in construction workers as a group compared with employees in the financial sector were projection of fragments (OR = 33.0; 95% CI, 15.3-70.8) and being struck by objects (OR = 18.2; CI 95%, 9.7-34.1). These were also the most specific mechanisms of injury in the subgroup of bricklayers and unskilled construction workers.
COMMENTS: Activities aimed at preventing minor occupational injuries in the construction sector should be orientated towards these mechanisms, especially projection of fragments despite the low frequency of this mechanism compared with that of other mechanisms. Case-control design is a useful alternative approach for research into occupational injuries.
Age and sex of drivers associated with child pedestrian injuries.
- Thompson R, Choonara I, Hewitt S, Holt M; Derbyshire Road Safety Partnership. J Child Health Care 2003; 7(3): 184-190.
Correspondence: Richard Thompson, Academic Division of Child Health, University of Nottingham, Derbyshire Children's Hospital, UK; (email: unavailable).
In 2002 there were 237 road traffic collisions (RTCs) involving a child pedestrian in Derbyshire. Complete details were available for 200 RTCs. There was a significantly lower proportion of female drivers (34.5%) than expected according to the number of female drivers registered nationally (43%). Similarly, there was a greater proportion of drivers under the age of 40 years involved in RTCs with children as pedestrians (58.5%) than anticipated (42.1%). Drivers between the ages of 17-20 and 31-40 years were significantly more likely to be involved in an RTC with a child as a pedestrian. Male drivers and drivers under the age of 40 years are more likely to be involved in RTCs with children as pedestrians. Educational publicity campaigns to reduce driver speeds in urban areas need to be targeted at those drivers most likely to be involved in an RTC with a child.
The ingestion of a potentially poisonous substance by a young child is a common event, with the American Association of Poison Control Centers reporting approximately 1.2 million such events in the United States in 2001. The American Academy of Pediatrics (AAP) has long concerned itself with this issue and has made poison prevention an integral component of its injury prevention initiatives. A key AAP recommendation has been to keep a 1-oz bottle of syrup of ipecac in the home to be used only on the advice of a physician or poison control center. Recently, there has been interest regarding activated charcoal in the home as a poison treatment strategy. After reviewing the evidence, the AAP believes that ipecac should no longer be used routinely as a home treatment strategy, that existing ipecac in the home should be disposed of safely, and that it is premature to recommend the administration of activated charcoal in the home. The first action for a caregiver of a child who may have ingested a toxic substance is to consult with the local poison control center.
Home syrup of ipecac use does not reduce emergency department use or improve outcome.
Correspondence: Randy Bond, Drug and Poison Information Center, Department of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA; (email: randy.bond@cchmc.org).
CONTEXT: The usefulness of syrup of ipecac as a home treatment for poisoning and the need to keep it in the home has been increasingly challenged. Many poison centers do not recommend any use of syrup of ipecac.
OBJECTIVE: To determine if use of syrup of ipecac in children at home is associated with reduced utilization of emergency department (ED) resources or improved outcome after unintended exposure to a pharmaceutical.
DESIGN: Cohort comparison.
SETTING: American Association of Poison Control Centers' Toxic Exposure Surveillance System Database.
PATIENTS: Blinded data for each of the 64 US poison centers included ED referral recommendation rate, actual rate of ED use, actual home use of syrup of ipecac, and outcome. These data were derived from cases in 2000 and 2001 involving children <6 years of age who unintentionally ingested a pharmaceutical agent and in which the call to a poison center came from home (752 602 children).
OUTCOME MEASURES: Correlation between rate of home use of syrup of ipecac and rate of recommendation for ED referral was the primary outcome sought. Rate of adverse outcome was also compared. In addition, the actual ED use and home syrup of ipecac utilization rates at 7 specific centers were identified and compared with the published rates from these same centers from 1990 data to look for the trend in practice for this subgroup.
FINDINGS: Mean rate of referral to ED was 9% (range: 3%-18%). Mean home use of syrup of ipecac was 1.8% (range: 0.2%-14%). Increased home use of syrup of ipecac was not associated with referral to ED (r = 0.18; 95% confidence interval of r = -0.06-0.41). Adverse outcome was rare: 0.6% (range: 0.2%-2.1%). There was no difference in referral rate or adverse outcome rate between 2 groups of 32 centers divided by relative syrup of ipecac use. In the 7 centers, ED use decreased from a mean of 13.5% in 1990 to a mean of 8.1% in 2000-2001. Ipecac use decreased from a mean of 9.6% to 2.1%.
COMMENTS: This study suggests there is no reduction in resource utilization or improvement in patient outcome from the use of syrup of ipecac at home. Although these data cannot exclude a benefit in a very limited set of poisonings, any benefit remains to be proven.
Correspondence: Rebecca A. Demorest, Department of Pediatrics, University of Wisconsin-Madison, 2870 University Avenue, Suite 200, Madison, WI 53705, USA; (email: ra.demorest@hosp.wisc.edu).
With over 30 million children participating in sports each year across the United States, a number of significant injuries are to be expected. Although mild injuries such as strains, sprains, and contusions predominate, catastrophic injuries do occur. Young athletes are at an increased risk for growth plate and apophyseal injuries, overuse injuries, and heat illness. Many of these sports injuries can be prevented. Prevention strategies include protective equipment, rule changes, preseason and season prevention interventions, safety measures, better coaching, education, and a societal awareness of injury and prevention. This article discusses current injury prevention for children participating in baseball, football, soccer, and ice hockey.
Correspondence: Deborah L Benzil, Department of Neurosurgery, New York Medical College, Munger Pavilion, Valhalla, NY 10595, USA; (email: unavailable).
CONTEXT: Age has long been recognized as a critical factor in predicting outcomes after head injury, with individuals older than 60 years predicted to have a worse outcome than those younger than 60. The object of this study was to determine the effect of age by decade of life beginning at birth in patients with head injuries of all levels of severity.
METHODS: The New York State Trauma Registry was searched for head injuries from January 1, 1994 to December 31, 1995; the 13,908 cases found were placed into age groups by decade. Data were sought for each patient on demographics, Glasgow Coma Score, ICD-9 injury code, New Injury Severity Score (NISS), and mechanism of injury. These data were analyzed with chi-square and one-way ANOVA tests, with significance set at p < 0.05.
FINDINGS: The risk of dying was significantly increased in patients beginning at 30 years of age compared with those in the younger age groups, with the greatest increases occurring after age 60 (p < 0.001). For the population with available Glasgow Coma Score data (n = 12,844), the mortality rate for patients ages 0 to 30 was 10.9%, and for patients ages 31 to 50 was 12.4%. The mean Glasgow Coma Score for nonsurvivors ages 0 to 20 (3.9) and for nonsurvivors ages 31 to 50 (5.1) were significantly different, with a risk ratio of 1.3 (p < 0.001).
COMMENTS: The risk of dying for patients suffering head injuries increases as early as 30 years of age, making it necessary for health-care providers to consider increased monitoring and treatment for patients in this younger age group.
Of the total 411 cases of accidents occurring in the State of Israel during 1999, the 314 which were hospitalized at the Edith Wolfson Medical Center, constituting 7.2% of the total pediatric hospitalizations in that regional hospital, were analyzed and summarized. Mean age of the children was 6.6+/-4.4, and ratio of boys to girls was 65:35. Accidents were classified by location of occurrence: home (52.3%); road (19.3%); sports (17.4%); and school (11.6%). Grades of severity were as follows: light (children were discharged without handicaps) (13.2%); moderate (children had undergone surgical intervention with prolonged or permanent disability) (74%); severe (children were treated in intensive care units and had permanent irreversible handicaps) (12.9%). Loss of conscientiousness occurred in 13.3% of cases. Affected body parts included: limbs (52.7%); head and face (32.7%); spine (7%); and multisystem injury (14.6%). Mean duration of hospitalization was 3.1 (+/-2.6 days). Accidental injuries most often occurred in the afternoon and in the absence of parental supervision. These findings generate conclusions for preventive interventions.
Pediatric transport related injuries in Tehran: the necessity of implementation of injury prevention protocols.
- Zargar M, Sayyar Roudsari B, Shadman M, Kaviani A, Tarighi P. Injury 2003; 34(11): 820-824.
Correspondence: Moosa Zargar, Department of Tehran University of Medical Sciences, Sina Trauma Research Center, Sina General Hospital, Hasan Abad SQ Iman Khomeini St., 11634, Tehran, IRAN; (email: roudsari@sina.tums.ac.ir).
Prehospital and hospital data was prospectively gathered on all hospitalized trauma patients admitted to six major trauma hospitals in Tehran from August 1999 to September 2000. Data from patients of under 19 years of age was analyzed for this article. From 8000 hospitalized trauma patients, 2354 cases (29%) belonged to this age group. Fall and transport related injuries (TRIs) with 1074 (46%) and 921 (39%) cases respectively, were the most common mechanism of injury. In TRIs, boys were affected 3.5 times as often as girls. Younger children were more prone to pedestrian-related injuries while teenagers were more prone to motorcycle related injuries. Head trauma was the most common cause of death and 28 out of 32 trauma deaths were attributed to this kind of injury. Lower extremity (513) and head injuries (322) were the most common injuries. Only a few of motorcyclists and car passengers used safety devices (helmet and seat belt respectively) at the time of accident.
Fall-related injuries in the elderly in Tehran.
- Ghodsi SM, Roudsari BS, Abdollahi M, Shadman M. Injury 2003; 34(11): 809-814.
Correspondence: Bahman Sayyar Roudsari, Sina Trauma Research Center, Sina General Hospital, Tehran University of Medical Sciences, Hasan Abad Square, 11364, Tehran, IRAN; (email: roudsari@sina.tums.ac.ir).
During 13 months of data gathering, all injury-related information concerning trauma patients was gathered according to International Classification of Diseases, 10th revision (ICD-10). The severity of the injury was calculated according to Abbreviated Injury Scale (AIS-90) in six major university hospitals in Tehran. Twelve percent of 8000 hospitalized trauma patients were elderly (65 years or older) and 70% of them (675 patients) had suffered from fall-related injuries. Falling on the ground and falling on stairs were the most common kinds of injury (with 462 (68%) and 122 (18%) cases, respectively). In the home and on the street were the most common sites of fall occurrence (with 520 cases (77%) and 91 cases (13.5%), respectively).After adjustment for the gender, kind of fall and Injury Severity Score, it was shown that the elderly were more prone to death than their younger counterparts (odds ratio=5.8, 95% CI for odds ratio: 2.3-7.2), but there was no significant difference in mortality rate between elderly men and women. Further studies are needed to evaluate personal and environmental risk factors for falls in our population. Furthermore, significantly higher mortality rate in our elderly trauma victims necessitates prudent attention to elderly trauma care in our teaching hospitals.
Epidemiology of falls among community-dwelling elderly people.
- Niino N, Kozakai R, Eto M. Nippon Ronen Igakkai Zasshi. 2003; 40(5): 484-486.
Correspondence: N. Niino, Department of Nursing Community Health, Nagoya University School of Health Sciences, JAPAN; (email: unavailable).
The purpose of the present study was to report the prevalence and circumstances of falls among community-dwelling elderly people in order to contribute to prevention of falls in the community. The subjects were 2,774 elderly people who participated in health examinations conducted by Tokoname-shi, Aichi Prefecture in 2002. The variables investigated in the present study were demography and history of falls in the past one-year. Circumstances of falls, e.g. time, location, activities associated with falls, cause of falls and degree of injury due to falls were asked when the subjects experienced a fall. The prevalence of falls among 2,774 subjects was 13.7%. It was significantly higher among women (17.2%) than men (8.3%, chi 2 = 48.1, p < 0.001). Prevalence increased as subjects get older. Circumstances of falls were assessed in 655 subjects. The distribution of time, location, activity associated with falls, cause and injury due to falls corresponded with previous fall studies among community dwelling elderly people. The incidence of falls was extremely high during the daytime and outdoors. Falls occurred most frequently while walking. The majority of falls were due to extrinsic factors. About 10% of all falls caused fracture.
Traumatic brain injury in U.S. Army paratroopers: prevalence and character.
CONTEXT: This study presents self-reported traumatic brain injury (TBI) prevalence rates for 2,337 active duty U.S. Army soldiers who underwent baseline testing as part of a larger study of military TBI.
METHODS: A computerized self-report questionnaire was administered to a convenience sample of 2,337 highly functioning active-duty soldiers at Fort Bragg, North Carolina, who underwent baseline testing during a 13-month period in 1999 and 2000 as part of a larger ongoing Institutional Review Board-approved study examining the consequences of brain injuries among paratroopers.
FINDINGS: Approximately 23% of all of the soldiers surveyed reported sustaining a TBI after joining the Army. More than twice as many paratroopers reported sustaining TBI after joining the Army than did nonparatroopers (p < 0.001). Parachute-related TBI accounted for this difference. Nearly all of these injuries were mild. Less than 2% of paratroopers and no nonparatroopers reported loss of consciousness lasting more than 20 minutes. It was also shown that paratroopers with a history of TBI before joining the Army had a higher prevalence of TBI while serving in the Army (35%) than paratroopers without prior TBI (27.2%) (p = 0.002).
COMMENTS: This study demonstrates that parachuting appears to be a risk factor for mild TBI in the U.S. Army and that paratroopers with a history of TBI before joining the Army might be at somewhat increased risk of sustaining additional TBI while serving in the Army.
Traumatized permanent teeth in 11-16-year-old Saudi Arabian children with a sensory impairment attending special schools.
- AlSarheed M, Bedi R, Hunt NP. Dent Traumatol 2003; 19(3): 123-125.
Correspondence: Raman Bedi, Department of Transcultural Oral Health, Eastman Dental Institute for Oral Health Care Sciences, University College London, 256 Gray's Inn Road, London WC1 X 8LD, UK; (email: R.Bedi@eastman.ucl.ac.uk).
The aim of this study was to determine the prevalence of traumatized permanent teeth among sensory (visual (VI) and hearing (HI)) impaired children attending special schools in Riyadh, Saudi Arabia. All the dental injuries involved incisor teeth, and trauma was noted in 33 (6.7%) children attending government schools (control group) compared to 7 (9%) VI children and 24 (11.4%) HI children. Differences in the dental trauma only reached statistical significance between the HI and control group (P < 0.05). Gender differences were only apparent in the HI group, with males having higher levels of traumatized teeth. In addition, HI children aged 11-12 years were more prone to trauma than children in the control group of the same age (P < 0.05). In conclusion, sensory impaired children do have a tendency for more dental trauma. However, this was only statistically significant for HI children. Whereas a gender difference was most noticeable for the HI group, with males having higher levels of trauma, this was noticeable by its absence among VI children.
CONTEXT: Agricultural injuries are an important and understudied category of occupational injuries.
OBJECTIVE: This study estimated the economic burden of agricultural machinery injuries that occurred in Ontario, Canada's largest province, between 1985 and 1996.
METHODS: Conventional methodology for estimating economic burden, as embodied in a computer program previously developed for this purpose, was applied to hospitalized, nonhospitalized, and fatal agricultural machinery injuries.
FINDINGS: The total economic burden of these injuries over the 12-year study period was estimated to be 228.1 million dollars, or 19.0 million dollars annually (1995 Canadian dollars, 3.0% discount rate). By extrapolation, the economic burden of all farm injuries in Canada is estimated to be between 200 and 300 million dollars annually.
COMMENTS: Costing information about agricultural injuries provides support for the prioritization and development of injury-control initiatives.
Correspondence: Julie Meeks Gardner, University of the West Indies, Mona, Tropical Medicine Research Institute, Epidemiology Research Unit, Mona, Kingston, JAMAICA; (email: jmeeks@uwimona.edu.jm).
CONTEXT: To obtain information on the perceptions and experiences of violence among secondary school students in Kingston, Jamaica, and its environs.
METHODS: Data collection was carried out from September through December 1998. Two researchers administered questionnaires in 11 randomly selected secondary schools, to a total of 1 710 students who were in either grade 7 or grade 9 and who were aged 9-17 years old (mean of 13.2 years). Frequency distributions of the responses were compared by gender, age, grade level, socioeconomic status, and school type.
FINDINGS: Seventy-five percent of the students thought that someone who was reluctant to fight would be "picked on" more, 89% thought it generally wrong to hit other people, and 91% thought it wrong to insult other people. Eighty-four percent knew of students who carried knives or blades from such items as a scalpel or a utility knife to school, and 89% were worried about violence at school. Thirty-three percent had been victims of violence, and 60% had a family member who had been a victim of violence. Eighty-two percent thought that violent television shows could increase aggressive behavior. Factor analysis of selected responses was carried out, yielding five factors: neighborhood violence, school violence, perceptions of acceptable behaviors, level of concern about violence, and general experiences and perceptions of violence. The factors varied with gender, age, grade level, socioeconomic status, and school type.
COMMENTS: These results will help focus interventions aimed at reducing violence, provide a baseline for later comparisons of perceptions and experiences of violence, and offer a basis for comparing the experiences of young people in urban Jamaica with those of young persons elsewhere.
Epidemiology of school accidents during a six school-year period in one region in Poland.
CONTEXT: The aim of the study was to analyse the incidence of school accidents in relation to school size, urban/rural environment and conditions of physical education classes.
METHODS: 202 primary schools with nearly 50,000 students aged 7-15 years were studied during a 6-year period in the Wloclawek region in Poland.
FINDINGS: There were in total 3,274 school accidents per 293,000 student-years. Accidents during breaks (36.6%) and physical education (33.2%) were most common. Most frequently accidents took place at schoolyard (29.7%), gymnasium (20.2%), and in the corridor and stairs (25.2%). After adjustment for students' age and sex, student-staff ratio and duration of school hours, urban environment increased the probability of accident (OR: 1.25; 95% CI: 1.14-1.38). Middle-size schools (8-23 classes) had similar accident rate as small schools (OR: 0.93; 95% CI: 0.83-1.04), while schools with 24-32 classes (OR: 1.26; 95% CI: 1.10-1.43) and with > or = 33 classes (OR: 1.36; 95% CI: 1.17-1.58) had increased accident rate. Presence of a gymnasium was also associated with increased probability of accident (OR: 1.49; 95% CI: 1.38-1.61).
COMMENTS: Urban environment, larger school-size and equipment with full-size gymnasium are important and independent risk factors for school accidents. These findings provide some new insights into the epidemiology of school-related accidents and may be useful information for the planning of strategies to reduce accident incidence in schools.
Useful field of view, a measure of processing speed and spatial attention, can be improved with training. We evaluated the effects of this improvement on older adults' driving performance. Elderly adults participated in a speed-of-processing training program (N = 48), a traditional driver training program performed in a driving simulator (N = 22), or a low-risk reference group (N = 25). Before training, immediately after training or an equivalent time delay, and after an 18-month delay each participant was evaluated in a driving simulator and completed a 14-mile (22.5-km) open-road driving evaluation. Speed-of-processing training, but not simulator training, improved a specific measure of useful field of view (UFOV), transferred to some simulator measures, and resulted in fewer dangerous maneuvers during the driving evaluation. The simulator-trained group improved on two driving performance measures: turning into the correct lane and proper signal use. Similar effects were not observed in the speed-of-processing training or low-risk reference groups. The persistence of these effects over an 18-month test interval was also evaluated. Actual or potential applications of this research include driver assessment and/or training programs and cognitive intervention programs for older adults.
Correspondence: Anthony Spirito, Department of Psychiatry and Human Behavior, Brown Medical School, Box G-BH Providence, RI 02912, USA; (email: Anthony_Spirito@brown.edu).
It has been estimated that for each completed suicide, there are 15 to 20 nonfatal suicide attempts. A prior suicide attempt can create a major elevation in the risk of subsequent attempt. A prior suicide attempt also is a strong predictor for eventual completed suicide. Consequently, management of an adolescent who attempts suicide is important. In this article, the authors examine various issues related to suicide risk in adolescents. The article focuses on key issues that should be included in a thorough assessment of adolescents who are referred for an evaluation during a suicidal crisis. The empirical literature is used as a guide for identifying risk factors that should be monitored and managed as part of a comprehensive treatment plan.
Sexual Abuse and Suicidal Behavior: A Model Constructed From a Large Community Sample of Adolescents.
Correspondence: Graham Martin, The University of Queensland, Mental Health Center, K floor, Royal Brisbane Hospital, Herston, QLD 4029, AUSTRALIA; (email: graham.martin@uq.edu.au).
CONTEXT: To investigate relationships between self-reported sexual abuse, depression, hopelessness, and suicidality in a community sample of adolescents.
METHODS: In 1995, students (mean age 13 years) from 27 high schools in Australia (n = 2,603) completed a questionnaire including measures of depressive symptoms (Center for Epidemiologic Studies Depression Scale), hopelessness, sexual abuse, and suicidality. Data analysis included logistic regression.
FINDINGS: Sexual abuse is associated with suicidality, both directly and indirectly through hopelessness and depressive symptoms in the model developed. High suicide risk (behavior exceeding thoughts such as plans and threats, or deliberate self-injury) is strongly correlated with suicide attempts (odds ratio 28.8, 95% CI 16-52, p <.001). Hopelessness is associated with high suicide risk only, whereas depressive symptoms are associated with high suicide risk and attempts. Hopelessness is more strongly associated with sexual abuse in boys than girls. Depressive symptoms are more strongly associated with high suicide risk in girls than boys. Controlling for other variables, sexual abuse is independently associated with suicide attempts in girls but not boys.
COMMENTS: Clinical assessment should consider gender differences in relationships between sexual abuse, depressive symptoms, hopelessness, and suicidality. Sexually abused girls may be at increased risk of attempting suicide, independent of other psychopathology.
Safety strategies to prevent suicide in multiple health care environments.
- Dlugacz YD, Restifo A, Scanlon KA, Nelson K, Fried AM, Hirsch B, Delman M, Zenn RD, Selzer J, Greenwood A. Jt Comm J Qual Saf 2003; 29(6): 267-278.
Correspondence: Yosef D. Dlugacz, North Shore-Long Island Jewish Health System, Great Neck, New York, USA; (email: unavailable).
CONTEXT: Patient suicide is one of the primary sentinel events reported throughout the United States. North Shore-Long Island Jewish Health System undertook a series of performance improvement efforts to identify suicide risk factors and develop a series of strategies and tools to maximize the safety of all vulnerable patients.
METHODS: A multidisciplinary task force conducted root cause analyses of 17 attempted and completed suicides and targeted inadequate patient assessment, poor communication, and knowledge deficits. A protocol was designed to ensure appropriate assessment, monitoring, and treatment of patients at risk for alcohol withdrawal and suicide. Poor communication as patients moved throughout the continuum of care was addressed through targeted education, a centralized intake model, and an inter-institutional transfer summary form. A continuous suicide risk assessment tool was incorporated into the inpatient behavioral health rounds.
COMMENTS: The new tools have raised awareness, improved accountability, and encouraged best practices throughout the health system.
Suicidal ideation and aggressiveness in school-aged youths.
- Miotto P, De Coppi M, Frezza M, Petretto D, Masala C, Preti A. Psychiatry Res 2003; 120(3): 247-255.
Correspondence: Antonio Preti, Department of Drugs and Alcohol Dependence, ULSS 7, TV, Conegliano, ITALY; (email: apreti@tin.it).
This study set out to explore the frequency and correlates of suicidal ideation in a community sample of school-aged adolescents living in a northeastern area of Italy. The study involved a mixed male-female sample of 1000 adolescents, corresponding to 10% of the young population aged 15-19 in the district. We investigated psychological distress through the revised Symptom Checklist (SCL-90-R), from which we also derived our indicators on suicidality (items concerning hopelessness and suicidal ideation). Propensity to aggression was measured with an Italian version of the Aggression Questionnaire. Females scored significantly higher than males on all SCL-90-R subscales, with the exception of the hostility subscale. In our sample, 30.8% of females and 25.3% of males reported having thought about suicide; one adolescent out of 20 reported suicidal ideation of high intensity (5% out of the total sample in both genders). Males scored significantly higher than females on the Aggression Questionnaire. Both males and females who reported suicidal feelings had significantly higher scores on the Aggression Questionnaire than did those who denied suicidal ideation. Suicidal ideation is a rather widespread occurrence among adolescents and correlates with other indicators of psychological distress. Psychological distress in adolescence might also be expressed through turbulent behaviors and conduct disorders. Identification of the mental disorders underlying a higher propensity to aggression might help to prevent other negative outcomes such as suicide.
Evaluation of the repeal of the motorcycle helmet laws in Louisiana and Kentucky.
- Ulmer RG, Preusser DF. Report Number DOT HS 809 530. US National Highway Traffic Safety Administration, Office of Research and Traffic Records, 400 7th Street, S.W., Washington, DC 20590.
Published online: October 28, 2003. The full 52 page document is available online: ( Download Document )
Correspondence: Robert G. Ulmer, Preusser Research Group, Inc., 7100 Main Street, Trumbull, CT 06611, USA; (email: rulmer@preussergroup.com).
At the end of 2001, 20 states and the District of Columbia had laws requiring all motorcycle riders to wear helmets; 27 states had laws requiring helmet use only by riders under a certain age (usually 18); and 3 states had no laws regarding motorcycle helmet use. Mandatory helmet use laws first came into being following the issuance of highway safety program standards in 1967.
From the onset, the enactment of helmet laws has been a contentious issue in many states as public policy makers have debated the balance between personal freedoms and the societal cost of crashes. Those opposed to mandatory helmet laws generally argue that their individual rights are or will be infringed upon and that helmet use should be left to the choice of individual riders. Those who advocate for helmet laws note that helmets are effective in reducing injury severity and that society bears a significant portion of motorcycle crash costs, thereby establishing a public interest in requiring the use of reasonable safety equipment. Over the years, states have variously enacted, repealed, and reenacted universal, or all-rider, motorcycle helmet laws.
In 1998, Kentucky repealed its universal motorcycle helmet law to require helmet use only by motorcycle operators and passengers under the age of 21, those who possess a motorcycle instruction permit and those who have had a motorcycle operator�s license for less than one year. A provision requiring helmet use by motorcycle owners who did not have at least $10,000 of medical coverage was repealed effective July 2000. In 1999, Louisiana repealed its universal motorcycle helmet law to require helmet use only by motorcycle operators and passengers under the age of 18, and riders 18 and older who do not have medical insurance coverage of at least $10,000.
Statewide observational surveys show that helmet use decreased following repeal of the universal helmet laws in both states from nearly full compliance to the 50 percent range without the laws.
Motorcyclist fatalities increased in the near term by sizeable amounts -- by over 50 percent in Kentucky and by 100 percent in Louisiana. Injuries also increased substantially in both states. Nationally, motorcyclists killed per 10,000 registered motorcycles increased 18 percent and injures declined by 2.9 percent from 1997 to 2001. The increases in fatalities in Kentucky and Louisiana were more than twice the national average increase and the increase in injuries even greater.
In Kentucky, motorcyclists killed per 10,000 registered motorcycles averaged 6.4 in the two years just before the helmet law repeal and averaged 8.8 in the two years following its repeal, an increase of +37.5 percent. Persons injured per 10,000 registered motorcycles averaged 187 in the preceding two years and averaged 219 in the two years following its repeal, an increase of +17 percent.
In Louisiana, the fatality rate averaged 4.5 in the two years prior to helmet law repeal and rose to 7.9 in the year following, an increase of +75 percent. The injury rate averaged 126 persons in the two years before the helmet law repeal and increased to 152 persons in the year following repeal of the universal motorcycle helmet law, an increase of +20.6 percent.
At the same time, the number of registered motorcycles increased (by 20%), and vehicle miles traveled increased approximately 6%, based on national numbers. Calculating injury and fatality rates based on the number of registered motorcyclists takes into account the increase in the number of motorcycles. These findings are similar to the increases in motorcycle fatal crashes and fatalities in Arkansas (+29%) and Texas (+ 37%) following repeals of their universal helmet laws.
The 1998 universal helmet law repeal in Kentucky and the 1999 repeal in Louisiana produced similar effects. Observed helmet use dropped from nearly full compliance under the law to the 50 percent range without the law. The rate of motorcyclist fatalities per 10,000 registered motorcycles increased more than the national average -- by 37 percent in Kentucky and 75 percent in Louisiana. Injuries per registered motorcycles increased in both states (+17% and +21%) following the law repeals while the national injury rate per registered motorcycles decreased �2.9 percent.
The experience in Kentucky and Louisiana is similar to the experience in Arkansas and Texas, the other states that have repealed universal laws in recent years, leaving little doubt that such repeals have demonstrable negative safety consequences. The weight of the evidence is that motorcycle helmets reduce injury severity, that repeal of helmet laws decreases helmet use, and that states that repeal universal helmet laws experience increased motorcycle fatalities and injuries.
The report includes a review of the legislative history of motorcycle helmet laws, studies of helmets and effectiveness, and national trends in registrations, travel, fatalities, and injuries. One chapter describes the fatal crashes that occurred in Kentucky and Louisiana in the months immediately after the law change. Five crash types classify 86 percent of the fatal motorcycle crashes: Ran off-road crashes (41%) involve a motorcyclist running off the roadway; Ran traffic control crashes (18%) occur when one vehicle fails to stop, remain stopped or yield; Oncoming or head-on crashes (11%) involve two vehicles traveling in opposite directions; Left-turn oncoming crashes (8%) involve a vehicle making a left turn in front of oncoming traffic; Motorcyclist down crashes (7%) involve a motorcyclist losing control and going down in the roadway or deliberately going down to avoid a perceived threat.
Long-term follow-up and consequences for severe road traffic injuries-treatment costs and health impairment in Sweden in the 1960s and the 1990s.
- Maraste P, Persson U, Berntman M. Health Policy 2003; 66(2):147-158.
Correspondence: Ulf Persson, Department of Technology and Society, Lund Institute of Technology, Lund University, Lund, SWEDEN; (email: up@ihe.se).
The purpose of this study is to provide information from two prospective long-term follow-ups for severe road traffic injuries in Sweden. The long-term consequences, in terms of loss of health and costs of care, are presented for severe injuries in Sweden in the early 1990s and are compared with information on injury severity and health care utilization 25 years ago. The follow-up in the 1990s show that, 1 year after the accident 38% of the non-fatal adults were suffering of some functional disability, pain and distress. Adults suffering from long-term loss of health decreased to 23% on average 3.7 years after the accident. The average health care cost was estimated to SEK46200 (in 1995 prices), and the average in-patient care was 10 days. However, when also including subsequent expected life-long care for three severely injured patients, the average incidence-based health care cost was estimated to SEK100300. In the 4-5 year follow-up 25 years ago, severe traffic injuries were treated on average 21 days in hospital and 38% of the adults were still suffering from long-term physical effects. Conclusions to be drawn are that treatment in hospital of severe traffic injuries has shortened by half and long-term consequences have not been worsened. Our results indicate that long-term effects do not cause as serious loss of health nowadays as they did 25 years ago.
Pediatric restraint use is associated with reduced transports by emergency medical services providers after motor vehicle crashes.
- Caviness AC, Jones JL, Deguzman MA, Shook JE. Prehosp Emerg Care 2003; 7(4): 448-452.
CONTEXT: To determine the association between pediatric restraint use during motor vehicle crashes and patient transports by emergency medical services (EMS) providers.
METHODS: Children under 16 years of age who were involved in motor vehicle crashes in Houston or Harris County, Texas, in 1997 were identified from Texas Department of Public Safety (DPS) crash data. DPS data were linked probabilistically to City of Houston Fire Department EMS data to identify whether the children were transported from the scene by EMS. Odds ratios were calculated to determine the association between restraint use and EMS transport. Logistic regression was used to control for age and injury severity in this relationship.
FINDINGS: From the linked data for 1997, 1,696 children were involved in reported automobile or truck crashes to which EMS responded. Of the 1,580 children about whom information concerning restraint use was available, 1,309 (83%) were wearing some type of safety restraint and 1,342 (85%) were transported by EMS. Adjusting for injury severity, children wearing safety restraints during motor vehicle crashes were 60% (95% confidence interval 34-75%) less likely to be transported by EMS than those not wearing safety restraints during such crashes.
COMMENTS: The use of safety restraints during motor vehicle crashes is associated with a reduction in the number of children transported from the scene by EMS providers. This effect is independent of age and injury severity.
Improvements in medical care and technology and reductions in traffic-related fatalities in Great Britain.
Correspondence: Robert B. Noland, Department of Civil and Environmental Engineering, Center for Transport Studies, Imperial College of Science, Technology and Medicine, SW7 2BU, London, UK; (email: r.noland@ic.ac.uk).
Great Britain has one of the lowest levels of traffic-related fatalities in the industrialized world with a current total of about 3,500 fatalities per year. Large reductions have occurred over the last 20-30 years and the government has targets of achieving another 40% reduction by 2010. This paper analyzes some of the factors that have been statistically significant in helping to achieve those reductions with a focus on improvements in medical care and technology. Using a cross-sectional time-series of regional data a fixed effects negative binomial (NB) model is estimated which includes three proxies of medical care and technology changes. These are the average length of inpatient stay in the hospital, the per-capita level of National Health Service (NHS) staff, and number of people per-capita waiting for hospital treatment. All are statistically significant with the expected sign showing that improvements in medical technology have reduced total fatalities with less of an impact from changes in medical care. Other variables are also found to be significant, including the percent of elderly people in the population, per-capita expenditure on alcohol, motorway capacity, and average vehicle age. The latter shows a surprisingly unexpected effect, with more older vehicles in a region leading to fewer fatalities. Models evaluating effects on serious and slight injuries are also estimated and serve to confirm the expected effects of medical care and technology.
Risks for abuse against pregnant Hispanic women. Morelos, Mexico and Los Angeles County, California.
- Castro R, Peek-Asa C, Garcia L, Ruiz A, Kraus JF. Am J Prev Med 2003; 25(4):325-332.
Correspondence: Roberto Castro, Regional Center for Multidisciplinary Research, National Autonomous University of Mexico (Castro, Ruiz), Cuernavaca, MEXICO; (email: rcastro@servidor.unam.mx).
Although violence against women is gaining international attention as a prevention priority, little is known about how risks differ across countries. A comparative study of violence against pregnant Mexican women in Morelos, Mexico, and Latina women in Los Angeles County, California, United States. In 1998 and 1999, women in prenatal clinics were interviewed about psychological abuse and sexual and physical violence by their partner, during and the 1 year prior to the index pregnancy. The overall response rate for Morelos was 99%, with a sample size of 914; Los Angeles County had a response rate of 96.9%, with a sample size of 219.Women in Morelos reported a higher prevalence of violence compared to women in the California (14.8% v 11.9%, respectively). A partner aged <20 years was associated with increased violence in both countries, but the association of violence with other socioeconomic factors differed by country. For example, employed women had higher odds of violence in California but lower odds in Morelos. Women who experienced violence during both the year prior to pregnancy and as a child were more than 25 times more likely to be abused during pregnancy than women not reporting this type of abuse. The identification of factors associated with violence against women, especially as they differ by culture and ethnicity, will help clinicians to better identify victims and to design and implement culturally appropriate prevention programs.
Response of Sudanese doctors to domestic violence.
- Ahmed AM, Abdella ME, Yousif E, Elmardi AE. Saudi Med J 2003; 24(10): 1077-1080.
Correspondence: Awad M. Ahmed, PO Box 102, Khartoum, SUDAN; (email: awad_sd@hotmail.com).
OBJECTIVE: The aim of this study was to assess the awareness, and response of the Sudanese doctors to domestic violence.
METHODS: The study was carried out among the doctors of the Police University Hospital, Khartoum, Sudan. Self-administered questionnaires were distributed to all doctors who were attendants at the hospital, one morning in July 2002. The information required from the surveyed doctors included their familiarity, and views on domestic violence as a health problem, number of cases of abuse encountered, barriers to diagnose or screen cases, their views on intervention beyond physical treatment and if they had been taught or trained in domestic violence.
FINDINGS: Out of 142 doctors who received the questionnaires, 102 returned it giving a response rate of 71.8%. The respondent's ages ranged from 25-54 years; 53 were female (51.9%); and 32 (31.3%) had experience of more than 10 years. Forty-three doctors (42.1%) had a fair knowledge of the concept of domestic violence, 28 (27.4%) viewed it as a worthwhile health problem and 21 (20.5%) reported encountering 1-2 cases in the last year. Barriers to screen cases included a lack of knowledge and training, insufficient time at clinics and fear of problems with perpetrators. The female gender and long professional experience had positive correlations with a better knowledge regarding violence and the desire to intervene beyond physical treatment (P<0.005).
COMMENTS: Our study indicated clearly the missing role of the medial profession in recognition and helping the victims of domestic violence. The authors discussed several suggestions to promote the role of doctors in addressing this problem.
A critical pathway for intimate partner violence across the continuum of care.
Correspondence: Jacqueline P. Dienemann, Adult Health Nursing, College of Health and Human Services, University of North Carolina at Charlotte, 28223-0001, USA; (email: jpdien@bellsouth.net).
CONTEXT: The authors developed an interdisciplinary critical pathway for intimate partner violence (IPV) assessment and intervention for use across health care settings. Intimate partner violence may be emotional, physical, and/or sexual and involves coercion and control by one partner over the other.
METHODS: A pathway developed with input from focus groups of battered women was subjected to a modified Delphi technique to improve the pathway's scientific accuracy and feasibility.
SETTING: The study was conducted in one urban, one suburban, and one rural hospital with IPV advocacy programs in the mid-Atlantic region of the United States.
PATIENTS/PARTICIPANTS: Four researchers and 13 clinicians participated in the validation, with at least one physician, one nurse, and one social worker or IPV counselor from each hospital.
MAIN OUTCOME MEASURES: Each element of the pathway was analyzed for the degree of consensus on scientific accuracy and feasibility.
FINDINGS: Consensus on the scientific accuracy and feasibility of the pathway was achieved after three rounds of the Delphi process. COMMENTS: This is the first known critical pathway for IPV. It addresses physical and mental health and safety and has content validity affirmed by an interdisciplinary panel of experts. Further process and outcome evaluation is warranted and invited.
Funding Public Health: The Public's Willingness to Pay for Domestic Violence Prevention Programming.
Correspondence: Susan B. Sorenson, University of California, Los Angeles School of Public Health, 650 Young Dr S, Los Angeles, CA 90095-1772, USA; (email: sorenson@ucla.edu).
CONTEXT: The author investigated the willingness of the general public to pay for domestic violence prevention programs.
METHODS: An experimental design was used in a telephone survey of 522 California adults. One of 11 funding methods and one of 4 dollar amounts were randomly assigned to each respondent.
FINDINGS: Most respondents (79.4%) reported support for domestic violence prevention programming. They were most willing to pay $5 or less via "user fees" (e.g., increased fines for batterers) and humanitarian "donations" (e.g., sales of special postage stamps).
COMMENTS: Health departments that want to increase their domestic violence prevention programming need to identify widely accepted methods by which funds can be raised. The methods used here can be applied to numerous public health activities and issues.
