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The differential disinhibition effect of marijuana use on violent behavior: a comparison of this effect on a conventional, non-delinquent group versus a delinquent or deviant group.
- Friedman AS, Terras A, Glassman K. J Addict Dis 2003; 22(3): 63-78.
Correspondence: A.S. Friedman, Belmont Center for Comprehensive Treatment, 4200 Monument Road, Philadelphia, PA 19131, USA; (email: unavailable).
The following Kaplan/Damphouse hypothesis was tested and cross validated: The use of marijuana either predicts to or has a greater effect on increasing the degree of violent behavior for a group that is low on delinquent behavior, than it does for a group that scores high on these behaviors. For the conventional, non-delinquent sub-group, a higher degree of significant relationship between degree of marijuana use and degree of violent behavior was found, compared to the degree of this type of relationship than was found for either cocaine/crack use, amphetamine use, or tranquilizer/sedative use. For example, for the commission of the offense of Attempted Homicide/Reckless Endangerment: for the conventional, non-delinquent group there was a highly significant relationship to the degree of marijuana use; but there was a non-significant relationship between this type of offense and the degree of use of each of the other types of drugs. Thus, this special disinhibition effect was found only for marijuana, and not for other drugs, regardless of whether they were stimulant types of drugs, or were sedative drugs.
Controlling alcohol-related violence: a treatment program.
CONTEXT: Control Of Violence for Angry Impulsive Drinkers (COVAID) is a structured, cognitive-behavioral treatment program for people in the community. The importance of the program is that it addresses the link between two major problems areas drinking and aggression while emphasizing the reduction of the latter.
OBJECTIVE: To conduct a pilot study of the effectiveness of COVAID.
METHOD: Six COVAID participants were assessed using psychometric measures and self-reported alcohol consumption and aggression, before and after a 10-session COVAID program. They and 10 other men regarded as potentially suitable but who had not completed COVAID were compared for reconviction over a period of 18 weeks from referral.
FINDINGS: Six of the 17 referrals to COVAID completed the program; one was not accepted for the program, one is still in treatment, three became unavailable for COVAID, three did not attend the first interview, and three dropped out of treatment. The six completers showed improvement on alcohol-related aggression beliefs, social problem solving, anger control and impulsiveness. Improvements in alcohol consumption were not uniformly observed, although self-reported aggression was low. Reconvictions for violence were lower in the COVAID group (one reconvicted out of six men) compared with those referred but who did not participate in COVAID (three reconvicted out of 10 men).
COMMENTS: This preliminary information shows that COVAID holds promise as an intervention for alcohol-related aggression and violence. While the indicators are positive, given the small numbers, the short follow-up period and the lack of an adequate control group, further evaluation is necessary. Given the difficulties in recruiting suitable candidates, a multi-center study is recommended.
The effects of drinking-driving laws: a test of the differential deterrence hypothesis.
- Mann RE, Smart RG, Stoduto G, Adlaf EM, Vingilis E, Beirness D, Lamble R, Asbridge M. Addiction 2003; 98(11): 1531-1536.
Correspondence: Robert E. Mann, Social, Prevention and Health Policy Research Department, Centre for Addiction and Mental Health, Toronto, Ontario, CANADA; (email: robert_mann@camh.net).
CONTEXT: Ontario introduced an Administrative Driver's Licence Suspension (ADLS) law in 1996, whereby a person with a blood alcohol level over the legal limit of 80 mg%, or who refused to provide a breath sample, would have his or her driver's licence suspended immediately for a period of 90 days.
OBJECTIVES: We test the differential deterrence hypothesis which would predict that social or lighter drinkers would be more affected by the Administrative Driver's License Suspension law than heavier drinkers.
METHODS: Data from the 1996 and 1997 cycles of the Ontario Drug Monitor, a general population survey of Ontario adults (monthly cross-sectional surveys), were employed (response rate 64-67%). Analyses were restricted to drivers who reported at least some drinking during the last year (n = 3827). The total number of drinks consumed during the past 12 months was analyzed with analysis of variance.
FINDINGS: We found that the mean alcohol consumption of those who reported drinking-driving increased significantly after the ADLS was introduced, whereas the alcohol consumption of those who did not drive after drinking remained the same.
COMMENTS: The limits of this study include a lack of comparison data from regions without ADLS, a reliance on self-report measures, possible age restrictions of the findings and the fact that only an inferential test of the differential deterrence hypothesis is permitted by the data. Despite these limitations, these findings are consistent with the prediction that lighter or more moderate drinkers will tend to stop driving after drinking completely, and thus drop out of the drinking-driving population when the ADLS law was introduced, leaving heavier drinkers in this population. It will be important to continue to examine the dynamics of differential deterrence over a longer interval.
The objective of this article is to propose the launch of a prevention campaign against hand-related accidents. This effort is motivated by: 1) epidemiological studies which, despite their disparate and inhomogeneous character, show that hand and wrist accidents are the primary cause of traumatic lesions -- they occur two-thirds of the time during daily activities; and they are also the primary cause of work stoppages as well as permanent invalidities; 2) current legal and regulatory prevention measures have reached their efficacy limits -- these can not be applied to errors of individuals by inattention, negligence or a lack of information; 3) sensibilization efforts in public education, professional training programs or direct to the public are still much too limited in scope and are never included in a global strategy.
The objective of the prevention campaign will be to increase public awareness as a function of one's milieu (school, workplace, leisure, household) to identify the risks of hand injuries and to provide advice on how to avoid them. In this context, the operationalization of the campaign will pass, at the level of each region, by the coordination of each traditional agencies (public health, local government, corporations), of new partners (insurers, renters or sellers of handwork and gardening equipment, etc.), as well as FESUM centers.
The effectiveness of community-based occupational therapy education and functional training programs for older adults: a critical literature review.
- Wilkins S, Jung B, Wishart L, Edwards M, Norton SG. Can J Occup Ther 2003; 70(4): 214-225.
Correspondence: Seanne Wilkins, School of Rehabilitation Science, McMaster University, IAHS, 4th floor, 1400 Main Street West, Hamilton, ON L8S 1C7, CANADA; (email: swilkins@mcmaster.ca).
CONTEXT: This paper examines the results of a critical literature review describing the provision of education and functional training programs by occupational therapists with older adults to maximize their occupational performance.
OBJECTIVE: The critical review addressed the following question: What is the effectiveness of education and functional training programs in improving occupational performance and quality of life for older adults? Review methods are described and the outcomes of the critical review discussed.
FINDINGS: The results indicate that there is evidence that programs are effective in three areas: prevention of functional decline and falls, stroke and rheumatoid arthritis. Methodological limitations exist in some studies. There are several randomized controlled studies in this area, though the description of specific occupational therapy interventions is often vague and the programs could not be easily duplicated by occupational therapists.
COMMENTS: Occupational therapists are provided with information through this critical review to facilitate evidence-based practice when working with older adults.
Investigation of a ricin-containing envelope at a postal facility -- South Carolina, 2003.
- Gibson J, Drociuk D, Fabian T, Brundage S, Ard L, Fitzpatrick N, Moorhead W, Schwartz M, Kilbourne E, Schier J, Patel M, Belson M, Rubin C, Osterloh J, Dietchman S, Kiefer M, Meyer R. MMWR 2003; 52(46): 1129-1131.
Full article with tables, figures, references, and editorial note is available online: ( DOWNLOAD DOCUMENT ).
On October 15, 2003, an envelope with a threatening note and a sealed container was processed at a mail processing and distribution facility in Greenville, South Carolina. The note threatened to poison water supplies if demands were not met. The envelope was isolated from workers and other mail and removed from the facility, and an investigation was begun. On October 21, laboratory testing at CDC confirmed that ricin was present in the container. To assess the human health effects related to possible ricin exposure, the South Carolina Department of Health and Environmental Control (SCDHEC) and CDC interviewed all workers at the postal facility and initiated statewide surveillance for illness consistent with ricin exposure during October 15--29. On October 22, the facility was closed for a detailed epidemiologic and environmental investigation. This report summarizes the results of the investigation, which found no evidence of environmental contamination and no cases of ricin-associated illness. Clinicians and public health officials should be vigilant for illnesses suggestive of ricin exposure.
SCDHEC asked emergency departments, clinicians, health departments, and the local postal facility to report any cases consistent with ricin exposure to the state health department and CDC. State poison control center records and intensive care unit charts at seven hospitals in the Greenville, Spartanburg, and Anderson areas were reviewed daily for illness consistent with ricin exposure. A CDC medical toxicologist and state and local health department epidemiologists interviewed all 36 workers at the postal facility to identify ricin-related illnesses.
CDC conducted environmental assessment and sampling at the postal facility, consisting of 70 wipe samples and five surface dust samples (collected by sampling pumps and sampling filter media). Wipe samples were obtained by using Dacron swabs moistened with sterile buffered solution and were collected from specific surfaces in the facility, including storage bins, surfaces, conveyor belts, and sorting tables that had been in contact with the letter. All environmental samples were analyzed at CDC and were negative for ricin.
No workers had illness suggestive of ricin exposure. Statewide surveillance did not identify any cases of ricin-associated illness. However, two cases of multisystem organ failure and several nonspecific illnesses, which likely were detected because of increased surveillance and reporting, were investigated within the state. The postal facility was reopened after 1) all workers who had worked at the facility since the package was discovered had been contacted and confirmed to be well and 2) environmental samples for ricin were negative. As of November 19, no ricin-associated cases had been identified.
Regional and national surveillance for illness consistent with ricin poisoning was initiated through an ongoing collaboration between CDC, ATSDR, and the American Association of Poison Control Centers' Toxic Exposure Surveillance System (TESS). Surveillance for potential cases was accomplished by monitoring call volumes at 62 of the 63 poison control centers in the United States for clinical effects consistent with ricin poisoning and for cases referring to the specific product code ("Contaminated Water") because water had been stated as a potential target by the note in the package. During October 15--29, approximately 97,000 human exposure calls were reported to TESS. No ricin-associated syndromes or events were identified.
The US Federal Bureau of Investigation (FBI) and local law enforcement authorities are conducting an investigation to identify the illegal source of this toxin. However, until a source is identified and eliminated, health-care providers and public health officials must consider ricin to be a potential public health threat and be vigilant about recognizing illness consistent with ricin exposure.
Safety at the interface: making sure your development project doesn't create hazards for the surrounding community.
- Somers RL, Bowden A, Thomas HM. South Australian Department of Human Services, 27 pages, 2003.
Correspondence: Ronald L. Somers, Injury Surveillance & Control Unit, South Australian Department of Human Services, P.O. Box 6 - Rundle Mall, Adelaide, SA 5000, AUSTRALIA; (email: ron.somers@dhs.sa.gov.au).
There is no shortage of excellent standards for building, construction and engineering. These standards help ensure conformity to accepted practices of safe design. However, problems may be created at the interface where new safe structures meet existing, less-safe infrastructure. This issue is further compounded when the social interface is considered -- the way that different (often unusual) people interact with the facility.
This document was prepared to assist in applying the principles of risk management, as outlined in AS/NZS 4360:1999 to decisions about design that are typically outside the scope of specific standards. IN particular, the aims of the document are to 1) encourage early recognition and avoidance of potential hazards, and 2) facilitate the adoption of designs that are appropriate and defensible on more than a single dimension.
Doing everything right, in a piecemeal way, can lead to a very wrong outcome. This well-illustrated document introduces a comprehensive approach to issues of environmental and interpersonal safety. The authors' approach is to help the reader to learn the capacity to follow Erwin Schrödinger recommends, "Think what nobody has yet thought about that which everybody sees."
Correspondence: Marie S O'Neill, Environmental Epidemiology Program, Department of Environmental Health, Harvard School of Public Health, Boston, MA, USA; (email: moneill@hsph.harvard.edu).
The Earth's climate is expected to continue a warming trend over the next decades, resulting in increased frequency of hot weather and potentially negative effects on human health as a result. Air conditioning has been cited as a preventive intervention strategy in several research reports. This article discusses the evidence regarding air conditioning and heat-related health effects and raises questions about the broader implications of recommending widespread use of this technology. Potential drawbacks of air conditioning, including equity concerns, energy use and indoor air quality, are described. Finally, approaches are suggested that could advance the dual goals of slowing the pace of climate change while still protecting vulnerable populations from the health consequences of increasing global temperatures.
Modifiers of the temperature and mortality association in seven US cities.
- O'Neill MS, Zanobetti A, Schwartz J. Am J Epidemiol 2003; 157(12): 1074-1082.
Correspondence: Marie S O'Neill, Environmental Epidemiology Program, Department of Environmental Health, Harvard School of Public Health, Boston, MA, USA; (email: moneill@hsph.harvard.edu).
This paper examines effect modification of heat- and cold-related mortality in seven US cities in 1986-1993. City-specific Poisson regression analyses of daily noninjury mortality were fit with predictors of mean daily apparent temperature (a construct reflecting physiologic effects of temperature and humidity), time, barometric pressure, day of the week, and particulate matter less than 10 micro m in aerodynamic diameter. Percentage change in mortality was calculated at 29 degrees C apparent temperature (lag 0) and at -5 degrees C (mean of lags 1, 2, and 3) relative to 15 degrees C. Separate models were fit to death counts stratified by age, race, gender, education, and place of death. Effect estimates were combined across cities, treating city as a random effect. Deaths among Blacks compared with Whites, deaths among the less educated, and deaths outside a hospital were more strongly associated with hot and cold temperatures, but gender made no difference. Stronger cold associations were found for those less than age 65 years, but heat effects did not vary by age. The strongest effect modifier was place of death for heat, with out-of-hospital effects more than five times greater than in-hospital deaths, supporting the biologic plausibility of the associations. Place of death, race, and educational attainment indicate vulnerability to temperature-related mortality, reflecting inequities in health impacts related to climate change.
The human health consequences of flooding in Europe and the implications for public health: a review of the evidence.
In Europe, floods are the most common natural disaster. The adverse human health consequences of flooding are complex and far-reaching. The main health effects include drowning, injuries and, perhaps most importantly with floods in Europe, an increased incidence of common mental health disorders. Anxiety and depression may last for months and possibly even years after the flood event and so the true health burden is rarely appreciated. The effect of floods increasing the risk of communicable diseases appears relatively infrequent in Europe. The vulnerability of a person or group to a natural hazard is defined in terms of their capacity to anticipate, cope, resist and recover from the impact of the disaster. Determining vulnerability is a major challenge. What little research literature there is on this subject indicates that certain groups within communities (eg the elderly, disabled, children, women, ethnic minorities and those on low incomes) may be more vulnerable to the effects of flooding than others. However, there is a need for more good-quality epidemiological data before vulnerability indices could be used operationally to minimize the effects of flooding. With better information available, the emphasis in disaster management could shift from post-disaster improvisation to pre-disaster planning. A comprehensive, risk-based emergency management program of preparedness, response and recovery has the potential to reduce the adverse health effects of floods, but there is currently inadequate evidence of the effectiveness of such schemes.
Hazardous materials emergency incidents in South Australia, 1997-2000.
- Edwards JW, Pisaniello DL, Barton RT, Tkaczuk M, Orfanos A, Steer C. Appl Environ Sci Public Health 2003; 1(1): 63-67.
Correspondence: John W. Edwards, Department of Environmental Health, School of Medicine, Flinders University, Adelaide, SA, AUSTRALIA; (email: john.edwards@flinders.edu.au).
Incidents such as spills, leaks and fires that involve hazardous chemicals have the potential to affect human health whether they occur in metropolitan or rural areas. Emergency services and authorities respond to these chemical incidents, and in many cases they rely on professional teams to provide expert advice during and following the incident. In South Australia (SA), technical advice coordinators (TACs) provide this support to the two combatant authorities: the Metropolitan Fire Service (MFS) and the Country Fire Service (CFS). This paper describes the prevalence of these incidents in SA between March 1997 and December 2000, during which time the TACs provided advice. These incidents have been categorized depending upon the combatant authority, amount of advice provided by the TACs, the nature and quantity of chemicals involved, and the location of incidents in metropolitan and rural areas. The data show that the TACs responded to incidents approximately weekly, and that most would be classified as small- to medium-scale, with few reports of injury. Pesticides were involved in 20%-27% of incidents, followed by gases (refrigerants and chlorine), acids, fuels and oils, solvents, and alkalis. Most metropolitan incidents occurred in suburbs of lower socioeconomic status; rural and metropolitan incidents occurred on major transport routes. Transport-related incidents represented 33%-40% of all incidents, with the greatest proportion involving road vehicles. The authors suggest that adoption of a national surveillance scheme for hazardous chemical incidents should be considered.
Disaster victim identification of military aircrew, 1945-2002.
Correspondence: Adrian Smith, SO3Aviation Medicine, Institute of Aviation Medicine, RAAF Base Edinburgh, South Australia 5111, AUSTRALIA; (email: Adrian.Smith1@defence.gov.au).
CONTEXT: Aviation accident fatalities are characterized by substantial tissue disruption and fragmentation, limiting the usefulness of traditional identification methods. This study examines the success of disaster victim identification (DVI) in military aviation accident fatalities in the Australian Defense Force (ADF).
METHODS: Accident reports and autopsy records of aircrew fatalities during the period 1945-2002 were examined to identify difficulties experienced during the DVI process or injuries that would prevent identification of remains using non-DNA methods.
FINDINGS: The ADF had 301 aircraft fatalities sustained in 144 accidents during the period 1945-2002. The autopsy reports for 117 fatalities were reviewed (covering 73.7% of aircrew fatalities from 1960-2002). Of the 117 victims, 38 (32.4%) sustained injuries which were severe enough to prevent identification by traditional (non-DNA) comparative scientific DVI techniques of fingerprint and dental analysis.
COMMENTS: Many of the ADF fatalities who could not be positively identified in the past could be identified today through the use of DNA techniques. Successful DNA identification, however, depends on having a reference DNA profile. This paper recommends the establishment of a DNA repository to store reference blood samples to facilitate the identification of ADF aircrew remains without causing additional distress to family members.
Correspondence: Juergen Sauer, Institute of Psychology, Darmstadt University of Technology, Hochschulstrasse 1, D-64289 Darmstadt, GERMANY; (email: sauer@psychologie.tu-darmstadt.de).
This study examined the environmental impact of low-complexity electrical consumer products during their use in a domestic context. In the experimental scenario, 48 users were asked to use a kettle under different conditions. On-product information (OPI), task instruction, and kettle design were employed as independent variables in a mixed multi-factorial design to examine their effects on different parameters of ecological performance (e.g., water and electricity consumption). Measures of user variables (environmental concern, knowledge, domestic habits, environmental control beliefs) were also taken to examine their relationship with performance parameters. The results revealed main effects of ecological task instruction, OPI and (partly) kettle design on ecological user behavior. Habits, environmental concern and control beliefs were found to be related to performance parameters whereas knowledge was not. The implications of the results for product design are discussed against the background of a strong prevalence of habits and low ecological user motivation.
Correspondence: James S. Kemp, Pulmonary Division, Department of Pediatrics, St. Louis School of Medicine, 1465 South Grand Blvd., St. Louis, MO 63104-1095, USA; (email: kempj@slu.edu).
OBJECTIVES: To ascertain whether the number of sudden infant deaths as a result of suffocation in cribs, in adult beds, on sofas or chairs, and on other sleep surfaces was increasing whether attributable to increased reporting, diagnostic shift, or an actual increase in suffocation deaths and to compare the risk of reported accidental suffocation for infants on sleep surfaces designed for infants with the risk on adult beds.
METHODS: We reviewed all accidental suffocation deaths among infants ≤ 11 months of age reported to the United States Consumer Product Safety Commission from 1980 through 1983 and 1995 through 1998. We compared infants' ages and other demographic data, the sleep location and surface used, and the reported mechanism or pattern of death. For 1995-1998, we used data on sleep location from an annual survey of randomly selected households of living infants younger than 8 months, collected as part of the National Infant Sleep Position Study at the National Institute of Child Health and Human Development, to calculate risk for death as a result of suffocation in cribs, in adult beds, and on sofas or chairs. The number of reported suffocation deaths by location were compared between the 1980s and 1990s using logistic regression modeling to calculate odds ratios (OR), 95% confidence intervals (CI), and P values. Comparative risks for suffocation deaths on a given sleep surface for infants in the 1990s were examined by calculating rates of death per 100 000 exposed infants and comparing the 95% CI for overlap.
FINDINGS: From the 1980s, 513 cases of infant suffocation were considered; from the 1990s, 883 cases. The number of reported suffocation deaths in cribs fell from 192 to 107, the number of reported deaths in adult beds increased from 152 to 391, and the number of reported deaths on sofas or chairs increased from 33 to 110. Using cribs as the reference group and adjusting for potential confounders, the multivariate ORs showed that infant deaths in adult beds were 8.1 times more likely to be reported in the 1990s than in the 1980s (95% CI: 3.2-20.3), and infant deaths on sofas and chairs were 17.2 times more likely to be reported in the 1990s than in the 1980s (95% CI: 5.0-59.3). The sleep location of a subset of cases from the 1990s, 348 infants younger than 8 months at death, was compared with the sleep location of 4220 living infants younger than 8 months. The risk of suffocation was approximately 40 times higher for infants in adult beds compared with those in cribs. The increase in risk remained high even when overlying deaths were discounted (32 times higher) or the estimate of rates of bedsharing among living infants doubled (20 times higher).
COMMENTS: Reported deaths of infants who suffocated on sleep surfaces other than those designed for infants are increasing. The most conservative estimate showed that the risk of suffocation increased by 20-fold when infants were placed to sleep in adult beds rather than in cribs. The public should be clearly informed of the attendant risks.
- Missoni E, Kern J. Croat Med J 2003; 44(5): 610-613.
Correspondence: E. Missoni, Department of Traffic Medicine, Zagreb University Faculty of Transport and Traffic Engineering, Vukeliceva 4, 10000 Zagreb, CROATIA; (email: missoni@fpz.hr).
CONTEXT: To present the epidemiology of fatal bicyclist injuries in traffic accidents in Croatia.
METHODS: Between January 1, 1997 and December 31, 2000, there were 253 bicyclist fatalities in Croatia. The data were collected from the police reports of the Department of Traffic Police, Ministry of the Interior, written at the place of the accident. The data were processed by descriptive epidemiology and compared by tests of significance.
FINDINGS: The percentage of bicyclist fatalities among total road fatalities showed a decreasing trend over the years, from 11.6% in 1998 to 8.2% in 2000. The most frequent type of accident involving bicyclist fatalities were accidents in car-bicycle collisions (lowest: 74.7% in 1998; and highest: 81.3% in 1997). Most accidents occurred at the beginning and at the end of the bicycle season--months of April and October. Elderly people were involved in accidents occurring mainly in the morning hours--from 6 to 12 a.m., whereas the youngest and the middle-aged got injured or killed mainly in the evening - 6 to 9 p.m. This association between the age and the part of day when the accident happened was statistically significant (chi square=36.51, p<0.0001).
COMMENTS: Bicycle-related fatal injuries as a part of total road fatalities showed a gradual decrease. Regulation of bicycle traffic, more stringent protection measures and their implementation, as well as preventive measures regarding the time of day are needed to further decrease bicyclist fatalities in traffic.
Self-poisoning by ingestion or inhalation is common, and it is important to study its various epidemiological manifestations with clear definitions. Data on fatal self-poisonings are recorded nationally within the UK and are codified according to the International Classification of Diseases (ICD) revision relevant at the time. Most fatal self-poisonings are codified as suicides, accidental deaths or undetermined deaths ('open verdicts'). Non-fatal self-poisoning data, whether accidental or as a manifestation of deliberate self-harm, are recorded through hospital discharge information nationally but are not routinely published in the same way as mortality data. The bulk of the UK's published epidemiological information on nonfatal self-poisoning episodes is largely based on individual hospitals' admission or discharge records ('special studies'). After establishing definitions for different self-poisoning categories we discuss the published data on self-poisoning as they relate to suicide, accidental self-poisoning and deliberate self-harm in the UK.
See item 2 under Disasters and Environmental Issues.
CONTEXT: Lack of empirical data on recovery time following sport-related concussion hampers clinical decision making about return to play after injury.
OBJECTIVES: To prospectively measure immediate effects and natural recovery course relating to symptoms, cognitive functioning, and postural stability following sport-related concussion.
METHODS: Prospective cohort study of 1631 football players from 15 US colleges. All players underwent preseason baseline testing on concussion assessment measures in 1999, 2000, and 2001. Ninety-four players with concussion (based on American Academy of Neurology criteria) and 56 noninjured controls underwent assessment of symptoms, cognitive functioning, and postural stability immediately, 3 hours, and 1, 2, 3, 5, 7, and 90 days after injury. The main outcome measures were scores on the Graded Symptom Checklist (GSC), Standardized Assessment of Concussion (SAC), Balance Error Scoring System (BESS), and a neuropsychological test battery.
FINDINGS: No player with concussion was excluded from participation; 79 players with concussion (84%) completed the protocol through day 90. Players with concussion exhibited more severe symptoms (mean GSC score 20.93 [95% confidence interval {CI}, 15.65-26.21] points higher than that of controls), cognitive impairment (mean SAC score 2.94 [95% CI, 1.50-4.38] points lower than that of controls), and balance problems (mean BESS score 5.81 [95% CI, -0.67 to 12.30] points higher than that of controls) immediately after concussion. On average, symptoms gradually resolved by day 7 (GSC mean difference, 0.33; 95% CI, -1.41 to 2.06), cognitive functioning improved to baseline levels within 5 to 7 days (day 7 SAC mean difference, -0.03; 95% CI, -1.33 to 1.26), and balance deficits dissipated within 3 to 5 days after injury (day 5 BESS mean difference, -0.31; 95% CI, -3.02 to 2.40). Mild impairments in cognitive processing and verbal memory evident on neuropsychological testing 2 days after concussion resolved by day 7. There were no significant differences in symptoms or functional impairments in the concussion and control groups 90 days after concussion.
COMMENTS: Collegiate football players may require several days for recovery of symptoms, cognitive dysfunction, and postural instability after concussion. Further research is required to determine factors that predict variability in recovery time after concussion. Standardized measurement of postconcussive symptoms, cognitive functioning, and postural stability may enhance clinical management of athletes recovering from concussion.
Cumulative effects associated with recurrent concussion in collegiate (American) football players: the NCAA Concussion Study.
- Guskiewicz KM, McCrea M, Marshall SM, Cantu RC, Randolph C, Barr W, Onate JA, Kelly JP. JAMA 2003; 290(19): 2549-2555.
Correspondence: Kevin M. Guskiewicz, Department of Exercise and Sport Science, 211 Fetzer Gym
CB#8700, University of North Carolina, Chapel Hill, NC 27599, USA; (email: gus@email.unc.edu).
CONTEXT: Approximately 300 000 sport-related concussions occur annually in the United States, and the likelihood of serious sequelae may increase with repeated head injury.
OBJECTIVES: To estimate the incidence of concussion and time to recovery after concussion in collegiate football players.
METHODS: Prospective cohort study of 2905 football players from 25 US colleges were tested at preseason baseline in 1999, 2000, and 2001 on a variety of measures and followed up prospectively to ascertain concussion occurrence. Players injured with a concussion were monitored until their concussion symptoms resolved and were followed up for repeat concussions until completion of their collegiate football career or until the end of the 2001 football season. Outcome measures were incidence of concussion and repeat concussion; type and duration of symptoms and course of recovery among players who were injured with a concussion during the seasons.
FINDINGS: During follow-up of 4251 player-seasons, 184 players (6.3%) had a concussion, and 12 (6.5%) of these players had a repeat concussion within the same season. There was an association between reported number of previous concussions and likelihood of incident concussion. Players reporting a history of 3 or more previous concussions were 3.0 (95% confidence interval, 1.6-5.6) times more likely to have an incident concussion than players with no concussion history. Headache was the most commonly reported symptom at the time of injury (85.2%), and mean overall symptom duration was 82 hours. Slowed recovery was associated with a history of multiple previous concussions (30.0% of those with 3 previous concussions had symptoms lasting >1 week compared with 14.6% of those with 1 previous concussion). Of the 12 incident within-season repeat concussions, 11 (91.7%) occurred within 10 days of the first injury, and 9 (75.0%) occurred within 7 days of the first injury.
COMMENTS: Our study suggests that players with a history of previous concussions are more likely to have future concussive injuries than those with no history; 1 in 15 players with a concussion may have additional concussions in the same playing season; and previous concussions may be associated with slower recovery of neurological function.
Correspondence: P. Volpi, Centro di Traumatologia dello Sport e Chirurgia Artroscopica, Istituto Ortopedico Galeazzi, Via Galeazzi, 4, 20161, Milan, ITALY; (email: volpi.sozzi@libero.it).
For 4 years we followed a group of football players in the youth division of a professional club, ranging in age from 9 to 19 years, and analyzed the major injuries, i.e., those which required them to be sidelined for at least 4 weeks. We observed 23 sprains, 16 fractures, 16 cases of osteochondrosis, 7 muscle lesions, 6 cases of groin pain (athletic pubalgia), and 4 tendonopathies. The most frequent sites were the knee ( n=30) and the ankle ( n=11); the trauma factor was predominant (65.2%) with respect to overuse; noncontact traumas were more numerous (63.8%) than those resulting from contacts. Of a total 72 cases 8 regarded goalkeepers, and the remaining 64 cases were distributed among the other positions. As regards the age categories we detected a prevalence of osteochondrosis, traumatic detachments, and some fractures in the younger players, while in the older athletes we observed more sprains, muscle lesions, and tendonopathies.
Comparison of two intervention programs in young female players in European handball - with and without ankle disc.
- Wedderkopp N, Kaltoft M, Holm R, Froberg K. Scand J Med Sci Sports 2003; 13(6): 371-375.
Correspondence: Niels Wedderkopp, Accident Analysis Group, Department of Orthopaedics, Odense University Hospital. Sdr. Boulevard, DK-5000 Odense C, DENMARK; (email: nwedderkopp@health.sdu.dk).
CONTEXT: : The prevention of injuries in all sports calls for a structured plan. The plan consists, as earlier described, of four steps. We have previously presented studies incorporating all four steps. The studies have shown that it is possible to prevent most injuries in young female players in European handball by applying a training program combining the use of an ankle disc with functional strength training. In the previous studies we were not able to discriminate whether the preventive effect was due to the functional strength training or the training with the ankle disc. The aim of this study was to compare a program with ankle disc and functional strength training with a program with functional strength training only.
METHODS: : Twenty handball teams were asked to participate, and 16 of 20 handball teams agreed to participate. The teams were cluster randomized to either the program with or without an ankle disc.
FINDINGS: : The group using the program without the ankle disc had a significantly higher number of traumatic injuries (16 vs. 6). The incidences of traumatic injuries in the ankle disc group were 2.4 (95% CI 0.7; 6.2) injuries per 1000 h of match and 0.2 (95% CI 0.02; 0.7) injuries per 1000 h of practice. In the group without ankle disc the incidences were 6.9 (95% CI 3.3; 12.7) injuries per 1000 h of match and 0.6 (95% CI 0.2; 1.3) injuries per 1000 h of practice. A significantly higher multivariate odds ratio (4.8) was found in the group not using the ankle disc. In addition the group using the ankle disc had significantly fewer moderate and major injuries.
COMMENTS: : By adding ankle disc training to a training program with functional strength training, it is possible to reduce the number of injuries significantly, especially the number of moderate and major injuries.
Exposure and injury risk in Swedish elite football (soccer): a comparison between seasons 1982 and 2001.
The long-term development of injury risk in Swedish male elite football was studied. Two prospective cohort studies from seasons 1982 and 2001 were compared with respect to exposure to football, injury incidence and injury severity. The mean number of training sessions during the season had increased by 68% between 1982 and 2001 (142 vs. 238, P<0.001), whereas teams played more matches in 1982 (49 vs. 41, P=0.02). The total exposure to football had increased by 27%. Three out of four players incurred an injury in both seasons. In 2001, players suffered more training injuries due to an increased training exposure. Accounting for risk exposure, there was no difference in injury incidence or severity between the two seasons. The incidence was 8.3 injuries/ 1000 h of total exposure (4.6 in training and 20.6 in matches) in 1982, compared to 7.8 1000 h-1 (5.2 in training and 25.9 in matches) in 2001. Major injuries accounted for 9% of all injuries, corresponding to an incidence of 0.8 /1000 h of football, in both seasons. A trend from semi-professionalism to full professionalism in Swedish elite football was seen during the last two decades. The injury risk did not change over the same period.
Comparison of two sources of U.S. Air Force injury mortality data.
- Copley GB, Smith GS, Grayson JK, Gibson RL. Mil Med 2003; 168(10): 792-796.
Correspondence: G.B. Copley, Air Force Safety Center, Research, and Epidemiology Branch, 9700 G Avenue SE, Building 24499, Kirtland Air Force Base, NM 87117-5670, USA; (email: unavailable).
Is the military's casualty (mortality) reporting system a reliable surrogate for International Classification of Diseases-coded death certificate information? To answer this question, the investigators compare official casualty data to the Air Force Mortality Registry for injury-related deaths occurring in 1991-1997. The investigators first derived International Classification of Diseases, Ninth Revision and Supplementary Classification of External Causes of Injury and Poisoning (E) codes for each death from casualty data and then compared the precision of those codes with the registry's E codes derived and medically coded from death certificates and autopsy reports. Sixty-five percent of registry E codes were "precise<" vs. 35% from casualty data. The registry listed nonspecific E codes for 1% (12 deaths) vs. 6% (81 deaths) for casualty data. Unlike casualty data, the registry included expectant deaths that occurred within 120 days after medical retirement. The study concludes that casualty information compares poorly with that of the registry. Air Force Mortality Registry data should be used instead of casualty data for epidemiological research.
CONTEXT: Electrical accidents are potentially fatal incidents with effect on the cardiovascular, nerve and musculoskeletal systems and on the skin (burns). The electrical engineering industry points out that the follow-up of injured persons from site of accident to hospital is quite random. This paper gives a review of the current literature and proposes guidelines for the follow-up of victims of electrical accidents.
METHODS: A search of the literature was conducted on Medline, Embase, Biosis, Healthline, the Cochrane Library, the ISI citation databases, and on several other search engines. The revised guidelines were developed in consultation with 23 medical and industry institutions.
FINDINGS: Serious acute effects of electrical accidents include cardiac arrest, respiration failure, burns (aldo "internal burns" with necrosis of e.g. muscle tissue), injuries to the nerve system, and renal failure. Traumas caused by falls are also frequent. Possible chronic effects are mostly seen in the nerve system as encephalopathy and psychological sequelae or as spinal cord and peripheral nerve injury. Most importantly, long latent periods are possible for some chronic nerve injuries.
COMMENTS: This paper suggest guidelines for acute "on the spot" action and criteria for referral to hospital, observation in hospital and further follow-up.
Adolescent Health in the Caribbean: A Regional Portrait.
- Halcon L, Blum RW, Beuhring T, Pate E, Campbell-Forrester S, Venema A. Am J Public Health 2003; 93(11): 1851-1857.
Correspondence: Linda L. Halcon, University of Minnesota School of Nursing, 6-101 Weaver-Densford Hall,308 Harvard Street SE, Minneapolis, MN 55455, USA; (email: halco001@umn.edu).
CONTEXT: This study assessed youth health in the Caribbean Community and Common Market countries and describes the prevalence of health-related factors.
METHODS: We used a self-administered classroom questionnaire; questions addressed general health, health care, nutrition, sexual history, drug use, mental health, violence, family characteristics, and relationships with others.
FINDINGS: Most youths reported good health; however, 1 in 10 reported a limiting disability or significant health problems. Violence was a pervasive concern. Of those who reported history of sexual intercourse, many reported that their first intercourse was forced, and nearly half reported that they were aged 10 years or younger when they first had intercourse.
COMMENTS: Although most young people are healthy, problems indicate the importance of monitoring trends and designing effective youth health programs.
Epidemiological aspect of traumatic brain injury in Northeast Italy.
- Baldo V, Marcolongo A, Floreani A, Majori S, Cristofolettil M, Dal Zotto A, Vazzoler G, Trivello R. Eur J Epidemiol 2003; 18(11): 1059-1063.
Correspondence: Department of Environmental Medicine and Public Health, Institute of Hygiene, University of Padua, Padova, ITALY; (email: vincenzo.baldo@unipd.it).
CONTEXT: Traumatic brain injuries (TBIs) remain an important public health problem in developed countries. Hospital records were reviewed to ascertain the epidemiology of TBIs in Northeast Italy.
METHODS: The annual rates of TBI-associated hospitalization were estimated by analyzing data collected from hospital records from 1996 to 2000. TBIs were identified according to the Centers for Disease Control and Prevention definition and the ICDMAP-90 was used to assess their severity.
FINDINGS: 55,368 TBIs were collected between 1996 and 2000, with an overall 29.4% decline in the number of cases. As for severity, moderate TBIs dropped by 34.1%, whereas a less conspicuous decline was observed for mild injuries. Severe injuries remained stable between 1996 and 1999, but rose in 2000, when the unclassified injuries were better distributed. Concerning outcome, fatal TBIs dropped slightly, but only in 2000. Causes of TBI were recorded in 59.2% of cases: 48.5% were motor vehicle accidents, 8.8% occurred at work and 12.2% at home. There were more males than females in all age groups. The highest number of cases per 100,000 person of motor vehicle accidents was recorded among 16-25 year-old and 36.5% occurred at weekends. Domestic accidents showed two age peaks, in children and the elderly. Occupational accidents occurred at all working ages, tending to decline with older age.
COMMENTS: Better health care and educational campaigns may have contributed to the declining rate of TBI-associated hospitalization. Special efforts should be made to further reduce the motor vehicle accidents involving young people and welfare programs are needed to limit the risk of falls and contain functional impairment in the elderly.
Does patient cognition predict time off from work after life-threatening accidents?
- Schnyder U, Moergeli H, Klaghofer R, Sensky T, Buchi S. Am J Psychiatry 2003; 160(11): 2025-2031.
CONTEXT: Accidental injuries are frequent and their socioeconomic consequences enormous. The present study aimed to identify predictors of the number of days of leave taken in a consecutively selected group of accident victims who sustained severe, mostly life-threatening physical trauma.
METHOD: One hundred patients with severe accidental injuries who were referred to a trauma surgeons' intensive care unit were followed up for 12 months. The main outcome measure was the number of days of leave taken that were attributable to the accident 1 year after the trauma.
FINDINGS: Multiple regression analysis explained 30% of the variance in the number of days of leave taken that were attributable to the accident. Factors contributing to the predictive model were injury severity, type of accident and, most significantly, the patients' subjective self-assessment of accident severity and of their abilities to cope with the accident and its job-related consequences. Patients who perceived the severity of their accident as relatively low and judged their coping abilities as high took a mean 121 days of leave compared to 287 days of leave taken by those who perceived the trauma as relatively severe and were less optimistic regarding their coping abilities. A two-factor analysis of variance showed that patient perceptions of accident severity and their appraisal of their coping abilities made independent contributions to the predicted amount of leave taken.
COMMENTS: In severely injured accident victims, leave taken because of the accident depended to a considerable degree on the patients' accident-related self-assessment.
Follow-up of young road accident victims.
- Gillies ML, Barton J, Di Gallo A. J Trauma Stress 2003; 16(5): 523-526.
Correspondence: Marjorie Gillies, Department of Child and Adolescent Psychiatry, University of Glasgow, Glasgow, SCOTLAND; (email: marjorie.gillies@yorkhill.scot.nhs.uk).
The aim of this study was to follow-up a group of children and young people previously examined for psychological sequelae following road traffic accidents. The group was assessed 18-month post-accident to assess the severity of continuing symptoms and examine any emergence of delayed onset of post-traumatic stress reactions. Participants (N = 31) completed the Revised Impact of Event Scale and the Child Post-traumatic Stress Reaction Index. Parents completed the Child Behavior Check-List and participated in a semistructured interview. Symptoms of PTSD were noted in a quarter of participants as was delayed onset of symptoms. The role of avoidance in symptom reporting and continuing disorder is discussed.
The incidence of distal forearm fractures in Zaragoza (Spain).
- Cuenca J, Martinez AA, Herrera A, Domingo J. Chir Main 2003; 22(4): 211-215.
Service of Orthopaedic and Trauma Surgery, Miguel Servet University Hospital, C/Lasala Valdes no. 25, 1o, 50006 Zaragoza, SPAIN; (email: kpacuen@yahoo.es).
We present the results of a retrospective study of the epidemiology of distal forearm fractures in patients over 15 years of age in Zaragoza (Spain) during 1998-1999. We analyzed a total of 2506 fractures of the distal forearm. Fractures were classified according to age, sex, Frykman classification and mechanism of injury. Fractures were Frykman type III in 23.5% of cases, Frykman II in 17.9%, Frykman IV in 14.5% and Frykman I in 12.8%. The rest of fractures were distributed homogeneously between the remaining fracture types. The mechanisms of injury was low energy in 78.2% of cases and high in 21.8%. Analysis of the age distribution showed an increase in the incidence of this type of fracture over 50 years of age, with a peak between 60 and 69 years as a result of accidental falls. We found an increased incidence in males below 49 years of age, as a result of traffic accidents, and a predominance of females over 50 years of age due to osteoporosis and an increased number of falls.
Dangerousness and risk assessment: the state of the art.
- Bauer A, Rosca P, Khawalled R, Gruzniewski A, Grinshpoon A. Isr J Psychiatry Relat Sci 2003;40(3):182-190.
Correspondence: A. Bauer, Mental Health Services Division, Ministry of Health, 2 Ben Tabai St., Jerusalem, ISRAEL; (email: razek.haled@MOH.health.gov.il).
Risk or dangerousness is an issue which burdens the minds of all mental health and law enforcement professionals. Researchers have attempted to define its extent and constituent elements and to predict and assess it. Risk assessment is a complex task, influenced by the interaction of many variables, such as previous pattern of violence, biological, sociological and psychological factors, divided into facilitating and inhibiting factors. In our paper we discuss the theoretical concepts linked with dangerousness prediction and assessment, and then review the "first" and "second" generations of literature on dangerousness and risk assessment, including the actuarial instruments. We then present the current trends in the field, concentrating on the correlation between dangerousness and mental disorders, dangerousness analysis and risk management, a wider concept including prevention, treatment and communication of risk. Although great progress has been made in this field, there are still many unresolved issues, among them the development of valid instruments for the assessment of risk.
In conclusion it can be said that domestic violence in rural populations is a very complex situation in which many rural women find themselves. The nurse or other health care provider, in the rural setting, has to recognize the prevalence of intimate partner violence in their aggregate and find ways to not only screen these women, but also assist them in their plight for freedom from abuse. It is not only a part of the job of nurses and health care providers, but an ethical obligation to empower our clients to leave abusive situations for themselves and their family.
The total US school enrollment of 52.7 million students in 1998 excluded an estimated 1.2 million students educated in their homes. In 1989, some 1,148 home school families enrolled with the Indiana Department of Education. Just over a decade later, some 18,260 home school families had registered, and this number continues to increase. Despite knowledge about the growing numbers of families choosing to home school, limited empirical data exists of how health education is presented in home schools or the needs of home school educators who teach health education. This preliminary study examined health education content areas taught by home school educators in Indiana. An instrument was developed, piloted, and administered to a random sample of 600 home school educators. Results indicated most home school educators taught a variety of health education topics. Three topics--first aid, physical activity and fitness, and nutrition and diet--were taught most frequently in the health curriculum of home schools. Violence prevention, suicide prevention, and consumer health were covered less frequently in the health curriculum. Health was typically taught in a nonstructured, teachable moment format. Implications for coordinated school health programs and suggestions for further research are discussed.
Evaluation of the "Respect Not Risk" firearm safety lesson for 3rd-graders.
Correspondence: Karen D. Liller, University of South Florida, College of Public Health, Department of Community and Family Health, Tampa, FL, USA; (email: kliller@hsc.usf.edu).
The purpose of this study was to evaluate the MORE HEALTH "Respect Not Risk" Firearm Safety Lesson for 3rd-graders in Pinellas County, Florida. Six schools representative of various socioeconomic levels were selected as the test sites. Qualitative and quantitative data were collected. A total of 433 matched pretests/posttests were used to determine the effectiveness of the class in increasing student knowledge about firearm safety. The results revealed a significant increase in the mean scores on the posttest compared with the pretest. Qualitative findings showed the lesson was positively received by both students and teachers, and 65% of responding students reported discussing the lesson with family members. School nurses are encouraged to take a leading role in promoting firearm injury prevention to students.
CONTEXT: Firefighters must work on roofs, in smoky places, and on slippery surfaces while using fire-protective clothing and a self-contained breathing apparatus (SCBA), together termed "fire-protective equipment" (FPE). The aim of this study was to investigate the effects of FPE on the functional and postural balance abilities of younger and older firefighters.
METHODS: The subjects were professional firefighters in age groups 33-38 and 43-56 yr. Postural balance was tested with a force platform, and functional balance was measured during walking on a wooden plank with and without FPE.
FINDINGS: Wearing FPE significantly impaired both postural and functional balance. Postural balance with eyes closed was more negatively affected among the older subjects than the younger ones. Among the older subjects, the mean values for mediolateral velocity were 3.4 +/- 0.8 and 4.8 +/- 2.1 mm x s(-1) without and with FPE, respectively. The corresponding figures for velocity moment were 11.4 +/- 5.1 and 20.7 +/- 15.1 mm2 x s(-1). In the younger age group, the corresponding results were 3.6 +/- 1.0 and 4.1 +/- 1.4 mm x s(-1), in mediolateral velocity and 10.8 +/- 5.0 and 13.9 +/- 8.1 mm2 x s(-1) in velocity moment. SCBA was the most significant single piece of equipment to decrease performance in the functional balance test.
COMMENTS: These findings should be taken into consideration for preventing balance-related injuries in fire fighting and rescue work, especially for older firefighters. Furthermore, balance should be considered in developing FPE and training protocols for firefighter fitness.
Studies of causes of death among people with epilepsy suggest that the lifetime prevalence rate of suicide is elevated. Although not all of the studies have reported an increased risk for suicide, the collective data yield an average rate of approximately 12% among people with epilepsy, compared with 1.1-1.2% in the general population. The increased risk for suicide appears to affect children and adolescents as well as adults. Rates of suicide attempts have also been reported to be elevated among people with epilepsy. A suicide attempt is a significant risk factor for completed suicide. Certain psychiatric disorders, including primary mood disorders, also increase the risk for suicide. Among people with epilepsy, psychiatric comorbidity is common, and rates of mood disorders, particularly major depression, have consistently been reported to be elevated. Other potential risk factors are family issues, physical health, personality, life stress, previous suicidal behavior, and access to firearms. Assessing severity of risk helps to determine the appropriate level of intervention. The suicidality module of the Mini-International Neuropsychiatric Interview is a practical tool to help quantify current suicide risk.
Self-harm among adolescents with developmental disabilities. What are they trying to tell us?
Correspondence: Lee Murray, College of Nursing, University of Saskatchewan, 107 Wiggins Road, Saskatoon, Saskatchewan, CANADA; (email: lee.murray@usask.ca).
Self-harm behavior exhibited by adolescents with developmental disabilities can be the most challenging behavior for caregivers and health care professionals to address. Past interventions have taken a behavioral approach and focused on functional analysis to guide assessment and treatment. However, self-harm behavior is becoming more recognized as a means of communication. Therefore, it is important for health care professionals and caregivers to listen to adolescents' attempts to communicate and try to understand the meaning of the behavior. Early assessment is crucial to understanding the meaning of the behavior, and early intervention is necessary to prevent escalation or chronicity. Thorough assessment guides interventions and must be implemented in the context of clients' families and social world, and the broader community. Establishment of trusting relationships among adolescents, their families, and health care professionals is imperative. This article discusses self-harm behavior from a psychosocial perspective related to prevalence, onset, purpose, maintenance, and escalation. It also introduces a comprehensive framework to guide assessment and intervention.
Association of national cancer mortality and suicide rates.
Correspondence: F. Bridges, Division of Health, Leisure and Exercise Science, The University of West Florida, Pensacola 32514-5750, USA; (email: fbridges@uwf.edu).
Using WHO data from 1996 instead of 1990, the authors replicated and extended Knodrichin and Lester's 2001 study. Like their study, our total rates of cancer mortality and suicide in a similar sample of 37 European nations of the world were estimated to be positively associated.
The suicide beliefs of Jews and Protestants in the UK: how do they differ?
- Loewenthal KM, MacLeod AK, Cook S, Lee M, Goldblatt V. Isr J Psychiatry Relat Sci 2003; 40(3): 174-181.
Correspondence: K.M. Loweenthal, Department of Psychology, Royal Holloway, University of London, Egham, Surrey, UK; (email: c.loewenthal@rhbnc.ac.uk).
It has been suggested that Protestant culture has become more tolerant towards suicide in the previous century, while Jewish culture has traditionally not condoned suicide. There have been reports that suicide rates are somewhat lower among Jews than among people of Protestant background. We asked whether there were differences between Jews' and Protestants' beliefs about suicide that might relate to these suggestions and reports. Beliefs about suicide were assessed from the Reasons For Living Inventory (RFL), and with questions about the acceptability of suicide in some circumstances. Self-reported suicide ideation and attempts were also assessed. Some religious-cultural differences were found in beliefs about suicide, but not with regard to ideation and behavior. We discussed the relations between differences in belief, and reported differences in suicide prevalence, and suggested that most of the belief differences were consistent with reported patterns of prevalence. Notably, Jews believed more strongly than Protestants that moral-religious objections to suicide were reasons for living, and that suicide was less acceptable in certain circumstances.
CONTEXT: This study involved a quasi-induced exposure analysis of 4 years of crashes involving older drivers in the state of Kentucky.
METHODS: Single- and multivehicle crashes were disaggregated according to the number of passengers: (a) no passenger, (b) one passenger, and (c) two or more passengers. FINDINGS: Overall, the presence of two or more passengers was found to negatively impact the probability that drivers 75 years of age or older were at fault in crashes. Several potential factors were studied for interactive effects with passengers: vehicle occupant gender mix, time of the day, road curvature, grade, and number of lanes. The negative impact of passengers increased for some geometric road conditions. However, older drivers were found to be safer at night when carrying two or more passengers. The presence or absence of passengers was not found to affect the 65- to 74-year-old driver group. Groups of male vehicle occupants with a 75+ male driver were found to have high single-vehicle crash rates.
COMMENTS: These results are among the first to directly consider the effect of passengers on the crash-causing propensity of older drivers and the findings suggest more work is warranted to consider causes for the crash rate differences.
Effect of vehicle and crash factors on older occupants.
- Austin RA, Faigin BM. J Safety Res 2003,34(4): 441-452.
Correspondence: Rory A. Austin, National Highway Traffic Safety Administration, U.S. Department of Transportation, Room 5320, 400 7th Street, Southwest, Washington, DC 20590, USA, (email: rory.austin@nhtsa.dot.gov).
CONTEXT: The expected substantial increase in people aged 65 or older is important for those concerned about transportation injuries. However, much of the previous research concentrates on older drivers and overlooks the fact that vehicle and crash factors may provide significant explanations of older occupant injury rates.
METHODS: Differences across age groups are explored using two nationwide travel surveys, crash involvement, fatalities, and injuries from crash databases and an ordered probit model of injury severity.
FINDINGS: Two noticeable differences that help explain injury risk are that older people are more likely to travel in passenger cars than younger people who frequently use light trucks, and that seriously injured older occupants are more likely to be involved in side-impact crashes than their younger counterparts.
COMMENTS: Increased attention to vehicle engagement in side-impact crashes and to vehicle technologies that can help drivers avoid side collisions would be particularly helpful for older occupants.
Prioritizing road safety initiatives: fatality versus social cost.
Correspondence: Richard Tay, Centre for Accident Research and Road Safety, Queensland University of Technology, Carseldine, Qld 4034, AUSTRALIA; (email: r.tay@qut.edu.au).
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In an effort to reduce road trauma, traffic authorities in Australia and New Zealand have implemented a series of countermeasures aimed primarily at reducing road fatalities. Although the social cost associated with fatal crashes is significant, it nevertheless constitutes a relatively small portion of the total social cost of road crashes. Since the relative influences of the contributing factors to fatal crashes may not be the same as those for less severe crashes, an overemphasis on fatal crashes may not result in an optimal allocation of scarce road safety resources.
Correspondence: A.A. Levendosky, Department of Psychology, Michigan State University, 129 Psychology Research Building, East Lansing, Michigan 48824, USA; (email: levendo1@msu.edu).
Although preschool-age children are at risk for witnessing domestic violence, the majority of research has focused on children ages 6 to 12 years. This study examines the mediating role of the mother-child relationship on preschool-age children's functioning in families experiencing domestic violence. Maternal report and behavioral observations of mother-child interactions were used to assess relationship quality. Participants consisted of 103 children and their mothers. The data fit the model well but indicated that some of the correlations were not in the expected direction. Although depressed mothers were struggling with parenting, other mothers appeared to be compensating for the violence by becoming more effective parents. Domestic violence negatively impacted children's behavior with their mothers in interactions but did not influence maternal report of problem behaviors, suggesting that the impact of domestic violence begins very early and in the realm of relationships rather than in mental health.
Next steps in research on children exposed to domestic violence.
Correspondence: Margaret M. Feerick, Child Development and Behavior Branch, National Institute of Child Health and Human Development, Bethesda, Maryland, USA; (email: feerickm@mail.nih.gov).
The papers in this special issue of Clinical Child and Family Psychology Review provided an overview of what is known about children's exposure to domestic violence, and include indications of gaps in extant research. These gaps and research needs are summarized in this conclusion. Specifically, there is need for further research in several broad areas: definition and measurement of children's exposure to domestic violence; development of research methods and statistical designs that provide detailed information and provide for evidence of intervention effectiveness; impact of domestic violence on parenting and family functioning; the role of child factors and exposure to violence factors in predicting developmental risk and resilience; medical and health consequences of exposure to violence; and the nature of child-system interaction in response to domestic violence. Research needs in these areas are discussed in greater detail, and specific questions are raised for further development.
National screening policies in general practice: a case study of routine screening for partner abuse.
Correspondence: Felicity Goodyear-Smith, Department of General Practice and Primary Health Care, Faculty of Medical and Health Sciences, University of Auckland, Auckland, NEW ZEALAND; (email: f.goodyear-smith@auckland.ac.nz).
Internationally-recognized criteria for screening for a particular disorder require the following: availability of a clear diagnosis; a suitable validated screening test; acceptability of routine screening by patients and health providers; benefits of earlier detection and application of appropriate interventions to prevent the progression of a disorder, and hence reduction in incidence of morbidity and mortality; identification of possible harm from screening (false positives, false negatives, adverse effects of labeling, early diagnosis or unnecessary treatment of persons with true-positive test results with inconsequential disease) and weighing this against potential benefits; identification of possible sub-populations with the possibility of targeted screening of high-risk populations; good quality evidence of interventions effective in preventing or managing the disorder; and a cost-effectiveness assay. The New Zealand Ministry of Health have launched a best-practice guideline recommending all female general practice patients sixteen years and over be routinely screened for physical and sexual abuse by their partners. Inter-partner violence, especially against women by male partners and ex-partners, is a serious public health problem. However, review of existing research indicates that this guideline meets none of the criteria listed above. Considerable funding is invested in training health providers to implement this screening protocol, but, in the absence of effectiveness studies, cost-effectiveness cannot be assessed. Under current conditions, routine screening of adult women for partner abuse cannot be justified. However, GPs should be encouraged to learn about partner abuse and consider this possibility in patients presenting with physical injuries, psychological disturbance or social dysfunction, especially in high-risk patients. Research should be supported for the development and validation of effective, acceptable screening tools and randomized controlled trials of appropriate interventions. The desire to intervene for the public good should not dictate the implementation of a screening program that disregards accepted screening criteria.
