The causal attribution of injury to alcohol consumption: a cross-national meta-analysis from the emergency room collaborative alcohol analysis project.
- Cherpitel CJ, Ye Y, Bond And J, Borges G. Alcohol Clin Exp Res 2003; 27(11):1805-1812.
Correspondence: Cheryl J. Cherpitel, Public Health Institute, Alcohol Research Group, 2000 Hearst Ave., Berkeley, CA 94709, USA; (email: ccherpitel@arg.org).
CONTEXT: Whereas a substantial literature exists documenting the association of alcohol and injuries, causal associations are less well established.
METHODS: The relationship of drinking-in-the-event variables with attributing a causal association of alcohol consumption and the injury event was examined by using meta-analysis across 13 emergency room studies from 8 countries included in the Emergency Room Collaborative Alcohol Analysis Project.
FINDINGS: Pooled odds ratios for both log-transformed blood alcohol concentration at the time of the emergency room visit and the amount of alcohol consumed in the 6 hr before injury were positively predictive (1.19 and 1.80, respectively) and heterogeneous across studies. Effect size changed little when age and gender were controlled. When stratifying on reporting five or more drinks on an occasion during the last year (5+ yearly drinkers), the amount consumed was positively predictive of reporting a casual association of drinking and injury only for 5+ yearly drinkers. The effect size of feeling drunk at the time of injury, controlling for the amount of alcohol consumed, was positively predictive (2.04) but heterogeneous across studies. Meta-analysis regression found the level to which alcohol is consumed in a detrimental pattern to be a significant predictor of blood alcohol concentration, and of the amount consumed and feeling drunk at the time of injury, on causal attribution, with a lower detrimental pattern level with a larger effect size.
COMMENTS: The association of acute use of alcohol on causal attribution may be affected by chronic use to some extent, but this association is negatively affected by the degree to which a society exhibits harmful drinking patterns.
Beliefs about drinking behavior predict drinking consequences.
Cognitions about drinking, such as positive expectancies and self-efficacy, have been found to profoundly influence drinking behavior. Although the relationship of self-efficacy and positive expectancies with drinking consumption has been established, the relationship of self-efficacy and alcohol expectancies with the number of reported drinking related consequences has not been examined. One hundred thirteen participants who met criteria for alcohol abuse or dependence were administered the Situational Confidence Questionnaire, the Alcohol Expectancies Questionnaire, the Drinker Inventory of Consequences-Recent, and the Losses of Significance Self-report Questionnaire-Revised. As predicted, lower self-efficacy and greater positive alcohol expectancies predicted greater recent drinking consequences beyond those accounted for by alcohol consumption alone. Greater numbers of positive alcohol expectancies also predicted greater numbers of recent important alcohol related losses. Correcting errant assumptions about alcohol expectancies and strategies designed to increase self-efficacy may reduce harmful drinking consequences even if a client is unwilling to reduce consumption.
Do people attending clinics at our health center know the amount of alcohol consumption that becomes detrimental to health?
- Teruel Gonzalez FE, Martinez Arandigoyen A, Baleztena Gurrea J, Fuertes Goni C, Garcia De La Noceda MD. Aten Primaria 2003; 32(8): 451-456.
Correspondence: Francisco E. Teruel González, C/ Itaroa 48, 31620 Gorráiz-Egüés, Navarra, SPAIN; (email: pacotg@wanadoo.es).
OBJECTIVES: To evaluate our patients' knowledge of the effects of excess drinking; b) to compare this with their awareness of the effects of their day-to-day drinking habits.
DESIGN: Descriptive, randomized, cross-sectional questionnaire-based study. Information on alcohol consumption was obtained from medical records.
SETTING: Primary care center in Chantrea (Navarra province, northern Spain).
PARTICIPANTS: 351 persons older than 14 years who came to the health center.
OUTCOME MEASURES: Number of units of alcohol consumed per day that participants considered harmful to health, and number of units consumed per day according to information in their medical record.
FINDINGS: Perception of problems associated with excess drinking was good, particularly among women. In general, the participants' awareness (including excess drinkers) of the amounts of alcohol that could damage their health was good. Although younger persons tended to identify as harmful to health limits that were above the recommended figures, we found that their consumption was low but was overrecorded. Comparison of the intakes that persons identified as harmful with the amounts of alcohol they actually consumed showed that the latter was generally related with the former, although in 10% of the participants, recorded intake was higher than the limit they identified as harmful. This group contained 80% of the drinkers in our sample who were considered at risk.
COMMENTS: It appears necessary to increase the information given to young persons about harmful levels of alcohol intake. We found no clear evidence of risk drinking among younger persons; this will require questioning about their week-end drinking habits. Risk drinkers know the limits of consumption that can damage their health, but their alcohol consumption is incongruent with this knowledge.
Health promotion policy and politics: lessons from childhood injury prevention.
- Sleet DA, Schieber RA, Gilchrist J. Health Promot Pract 2003; 4(2): 103-108.
Correspondence: David A. Sleet, Division of Unintentional Injury Prevention Centers for Disease Control and Prevention, Atlanta, GA, USA; (email: dds6@cdc.gov).
Health promotion policies--including laws that regulate safe products, environments, and behaviors--are among the most effective mechanisms for reducing childhood injuries for large segments of the population. In this article, five examples of safety legislation and regulation to reduce childhood injury are described. Two such efforts are aimed at preventing injury-producing events from occurring: child-resistant packaging for medications and hazardous substances, and graduated licensing for teen drivers. Three other examples illustrate the value and complexities of policies designed to prevent an injury once a hazardous event has occurred: bicycle helmet legislation, children's sleepwear standards, and child safety seat laws. One important role of health promotion is to tackle not only how health promotion policies and politics can improve child health, but also how to educate legislators and policy makers in the process.
Early community outreach intervention in children with acquired brain injury.
- Emanuelson I, Wendt LV, Hagberg I, Marchioni-Johansson M, Ekberg G, Olsson U, Larsson J, Egerlund H, Lindgren K, Pestat C. Int J Rehabil Res 2003; 26(4): 257-264.
Correspondence: I. Emanuelson, Regional Paediatric Rehabilitation Centre, Queen Silvia Children's Hospital, Gothenburg, SWEDEN; (email: unavailable).
Ten patients with acquired brain injury were recruited over an 18 month period in the south-western health care region of Sweden in order to evaluate the costs and effectiveness of a multidisciplinary community outreach intervention program. An experienced multidisciplinary project team was involved and patients underwent detailed functional, cognitive and motor assessments following initial contact within two weeks of injury, within six weeks of injury and at a 12-month follow-up. An individualized counseling program was also offered. Of an expected recruitment number of 50 patients (based on epidemiological and population based figures) 10 children were reached, evaluated and followed; eight patients with traumatic brain injury (five severe, two moderate and one mild), and two patients with non-traumatic brain injury (both severe). At follow-up there was a significant improvement in motor function. No significant changes were seen in other areas of functional assessment or on neuropsychological measures although there were mild improvements in communication and behavior functions. The financial costs per patient in the program were deemed relatively modest compared with cost estimates of shorter-term in-patient rehabilitation. Time intensive interventions included supporting caregivers and school staff and the direct and indirect patient interventions were shown to enhance support and promote active involvement of local services.
Correspondence: J. David Yale, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA; (email: daveyale@email.unc.edu).
Drivers and passengers who drown while trapped in their vehicles or exiting from vehicles account for most flood-related deaths in the United States, yet little has been known about crash circumstances or risk factors for flood-related motor vehicle injury. We conducted a case-control study of all occupants of single-vehicle crashes in flood-affected North Carolina counties where drowning deaths occurred on 15, 16, and 17 September 1999 (the days before, during, and after landfall of Hurricane Floyd); a descriptive study of deaths using medical examiner records; and a survey of proxy respondents for persons who drowned. In 66 crashes vehicles hit puddles and went off the road, went off the road in rain, drove into water and stalled, hit trees in the road, or drove into collapsed sections of road; 19 of these vehicles were partially or fully submerged in water. Occupants of submerged vehicles were more likely to have drowned if their vehicles were fully submerged (14 of 19, 73.7%) than if their vehicles were partly submerged (0 of 8, 0%). According to proxy informants, most of the persons who drowned were familiar with the roads traveled during the study period, and all 16 had received severe weather warnings. Motor vehicle occupants in weather-related crashes are more likely to drown if their vehicles are submerged or swept away. Vehicle submersion may often be a consequence of deliberately driving into flooded roadways. However, in flood-affected areas, crashes and injuries may also occur when motorists encounter flooded roadways unexpectedly.
Preparation for response to an industrial disaster in Spain.
- Castro Delgado R, Arcos Gonzalez P, Cuartas Alvarez T, Del Busto Prado F. Public Health. 2003; 117(4): 260-261.
Correspondence: R. Castro Delgado, Unidad de Investigación en Emergencias y Desastres, Área de Medicina Preventiva y Salud Pública, Facultad de Medicina, C/ Julián Clavería, s/n, Oviedo 33006, SPAIN; (email: uied@correo.uniovi.es).
In Spain, the resources to respond to major incidents are controlled by the National Civil Defense System, regulated by Act 2/1985 on Civil Defense. The System anticipates the creation and use of industrial emergency plans according to European Directives Seveso I and Seveso II. The latter is still in development following a risk analysis. This will enable public health officials to optimize and coordinate the available resources.
An effective response requires a system that may be accessed rapidly by a simple, universal telephone number. Currently, the directive of the European Commission (approved in 1989) is implementation of the 112 telephone number as the only emergency telephone contact for fire service, emergency health care, and police. In some regions of Spain, access to emergency service is still made using two different telephone numbers, according to the nature of the emergency (061 and 112).
In Asturias, Spain, a high concentration of industrial sites are close to population centers. For that reason, it was important to study the training of health care workers and facilities to see if preparation for an industrial disaster was sufficient.
This study found that health care workers had insufficient knowledge regarding how to respond to an industrial incident.
Ball lightning burn: a case report and review.
- Selvaggi G, Monstrey S, von Heimburg D, Hamdi M, Van Landuyt K, Blondeel P. Ann Plast Surg 2003; 50(5): 541-544.
Correspondence: Gennaro Selvaggi, Department of Plastic Surgery, UZ Gent, De Pintelaan 185, B 9000 Gent, BELGIUM; (email: unavailable).
Ball lightning is a rare physical phenomenon, which is not yet completely explained. It is similar to lightning but with different, peculiar characteristics.
During a great storm, a 28-year-old man and his 5-year-old daughter sustained burn wounds after ball lightning came from the outdoors through a chimney. These two patients demonstrated signs of fire and electrical injuries. The father, who lost consciousness, sustained superficial second-degree burn wounds bilaterally on the zygomatic area and deep second-degree burn wounds on his right hand (total body surface area, 4%). His daughter demonstrated superficial second-degree burn wounds on the left part of the face and deep second-degree and third-degree burn wounds (total body surface area, 30%) on the left neck, both upper arms, and the back.
Each year, approximately 150 to 300 people die and as many as 1,500 are injured after a lightning accident. Consequences are death, burn wounds, and various cutaneous, neurological, vascular, and psychiatric manifestations. Flash discharges are the most frequent mechanism of injury and occur when a lightning strikes an object and then jumps from this primary strike site to a nearby person. Related to the phenomenon of lightning, but much less known, is the rare phenomenon of ball lightning. Witnesses to ball lightning have described round, glowing objects moving at fast and slow speeds. Ball lightning is a poorly understood phenomenon. It usually appears during thunderstorms and usually is spherical and 0.1 to 0.2 m in diameter, with reported diameters ranging from 0.01 to 1.00 m. Its lifetime varies widely, ranging from a few seconds to minutes, with the average duration being approximately 25 seconds. Usually, there is no discernible heat production and sometimes the ball emits a hissing sound. Several people have reported the smell of ozone and nitrogen oxide associated with ball lightning.
Ball lightning usually moves parallel to the earth (at approximately 2 m/s), but it can jump vertically. Sometimes it descends from the clouds; other times, it materializes suddenly either indoors or outdoors, or it enters a room through a closed or open window, through thin nonmetallic walls, or through the chimney. When it passes through closed windows, the lightning ball may damage the glass with small holes in approximately one-third of cases. It ends in an explosion or simply fades from view. The energy of the bang in the case of an explosion is estimated to be approximately 1 kJ. Ball lightning has been seen by 5% of the world's population. This percentage is approximately the same as the fraction of the population that has seen an ordinary lightning strike at close range-that is, close enough to see the direct point of the lightning impact.
The uncertain nature of ball lightning is demonstrated by the numerous theories proposed to explain the phenomenon, including a standing wave of electromagnetic radiation, atomic energy, matter-antimatter interaction, burning material, or the electrical field from a cloud. However, none of these models has succeeded in explaining all of the observed characteristics.
The newest model proposed by Abrahamson and Dinniss potentially accounts for all these properties and has some experimental support. When normal lightning strikes soil, chemical energy is stored in nanoparticles of silicone, SiO or SiC, which are ejected into the air as a filamentary network. As the particles are oxidized slowly in air, the stored energy is released as heat and light.
In this article, the authors report two cases of burn injuries resulting from ball lightning contact indoors. The literature on this rare phenomenon is reviewed to elucidate the nature of ball lightning.
Driver sleepiness and risk of car crashes in Shenyang, a Chinese northeastern city: population-based case-control study.
- Liu GF, Han S, Liang DH, Wang FZ, Shi XZ, Yu J, Wu ZL. Biomed Environ Sci 2003; 16(3): 219-226.
Correspondence: Gaifen Liu, Department of Epidemiology, School of Basic Medicine, Peking Union Medical College, Institute of Basic Medicine, Chinese Academy of Medical Sciences, Beijing 100005, CHINA; (email: liugaifen1997@sohu.com).
CONTEXT: To estimate the association of driver sleepiness with the risk of car crashes.
METHODS: A population-based case-control study was conducted in Shenyang, a northeastern city in China, between November 2001 and July 2002. The case group comprised 406 car drivers involved in crashes, and 438 car drivers recruited at randomly selected sites, and on the day of week, and the time of day when they were driving on highways in the study region during the study period were used as control groups. Face-to-face interviews with drivers were conducted according to a well-structured questionnaire covering the circumstances of their current trip and their background information. Stanford sleepiness scale and Epworth sleepiness scale were used to quantify acute sleepiness and chronic sleepiness respectively.
FINDINGS: There was a strong association between chronic sleepiness and the risk of car crash. Significantly increased risk of crash was associated with drivers who identified themselves as sleepy (Epworth sleepiness score > or = 10 vs < 10; adjusted odds ratio 2.07, 95% confidence interval 1.30 to 3.29), but no increased risk was associated with measures of acute sleepiness.
COMMENTS: Chronic sleepiness in car drivers significantly increases the risk of car crash. Reductions in road traffic injuries may be achieved if fewer people drive when they are sleepy.
Correspondence: S.B. Hoffman, Interprofessional Team Training and Development, James A. Haley Veterans' Hospital (11J), 13000 Bruce B. Downs Blvd., Tampa, FL 32612, USA; (email: unavailable).
In response to heightened awareness of patient safety, restraint reduction, and the potential for life-threatening entrapment caused by bed rails, a quality improvement program entitled BedSAFE was conducted to systematically and safely decrease the use of bed rails in three nursing home care units. This article describes an interdisciplinary process of individualized patient assessment, selection of appropriate alternatives for residents, compliance monitoring, training, and monitoring of patient outcomes including falls and injuries related to falls from bed.
Falls in workers during pregnancy: Risk factors, job hazards, and high risk occupations.
- Dunning K, LeMasters G, Levin L, Bhattacharya A, Alterman T, Lordo K. Am J Ind Med 2003; 44(6): 664-672.
Correspondence: Kari Dunning, Department of Rehabilitation Sciences, University of Cincinnati, PO Box 670056, Cincinnati, OH 45267-0056, USA; (email: kari.dunninG@uc.edu).
CONTEXT: Although falls are a major source of trauma during pregnancy and 70% of pregnant women are employed, information on falls among pregnant workers is lacking. Study objectives were to estimate fall prevalence and risk factors among pregnant workers.
METHODS: This retrospective cohort study used birth certificates to identify recently pregnant women. Data were collected via phone, internet, and mail surveys. The primary outcome investigated was a fall at work during pregnancy. Adjusted odds ratios (aOR) and confidence intervals (CI) were calculated.
FINDINGS: Of the 2,847 employed women, 26.6% (757) fell during their pregnancy and 6.3% (179) fell at work. Walking on slippery floors, hurrying, or carrying an object occurred in 66.3% of work falls.
COMMENTS: The service and teaching industry should be evaluated for risk reduction. Future research should determine if counseling during pregnancy will reduce falls in the workplace.
The effectiveness of bicycle helmets in preventing head injuries is well documented. There are different opinions about the effectiveness of helmets in preventing face injuries, and few studies have analyzed the effect of different types of helmets. This study was performed to examine the effect of different helmet types to head and face injuries. The use of helmets was analyzed in cyclists with head or face injuries and compared with two control groups. The main control group was cyclists that had injuries not including the head or neck, and another control group was cyclists that had been involved in an accident, regardless of whether they had sustained any injury. Cross-table and logistic regression analyses were applied to analyze the protective effect of helmets. A total of 991 injured patients served as a basis for this study. Most of the accidents, (82%) were single accidents with no other persons involved. Of patients with injuries to the head, excluding face, 11.4% had been using hard shell helmets, and 9.6% had been using foam helmets at the time of the accident. Among the emergency room controls, the proportion of hard shell helmet users and foam helmet users was 26.4% and 11.4%, respectively. Compared to non-helmet users, this gave an odds ratio of 0.36 (CI = 0.21-0.60) for getting head injuries if the cyclists had been using hard shell helmets at the time of the injury, and 0.83 (CI = 0.41-1.67) for users of foam helmets. The odds ratio for getting face injuries was 0.90 (CI = 0.58-1.41) among users of hard shell helmets, and 1.87 (CI = 1.03-3.40) for users of foam helmets. The use of hard shell helmets reduced the risk of getting injuries to the head. Children less than nine years old that used foam helmets had an increased risk of getting face injuries. All bicyclists should be recommended to use hard shell bicycle helmets while cycling.
Pedestrian casualties and fatalities in road traffic crashes in a South African municipality.
A study of the pedestrian casualties and fatalities in road traffic crashes in Durban, a South African municipality, for 1999 was undertaken using official road traffic accident data. The pedestrians age 25 to 44, although only 23.9% of the population, were 39.3% of the casualties and 48.2% of the fatalities. The most vulnerable pedestrians were those 30 to 34 years old who were 6.1% of the population, 11.7% of the casualties, and 14.6% of the fatalities; 35- to 39-year-olds who were 6% of the population, 8.8% of the casualties, and 13.5% of the fatalities; and the 40- to 44-year-olds who were 4.9% of the population, 7.5% of the casualties, and 10.2% of the fatalities. Cars were involved in 52% of the vehicle-pedestrian crashes but had fewer crashes than minibuses and buses, and fewer casualties and fatalities than minibuses, buses, and motorcycles. Minibuses recorded the most crashes at 1,037 per 100 million km, the highest casualty rate of 268 per 100 million km, and highest fatality rate of 17 per 100 million km. Buses, which were involved in 3% of the vehicle-pedestrian crashes, had 951 crashes per 100 million km, 182 casualties per 100 million km, and 11 fatalities per 100 million km. Motorcycles were involved in 1% of the vehicle-pedestrian crashes and had per 100 million km 508 crashes, 192 casualties, and 7 fatalities. There was no statistically significant difference in the monthly distribution of the road traffic crashes.
Effects of vehicle impact velocity and front-end structure on dynamic responses of child pedestrians.
Correspondence: Xuejun Liu, Crash Safety Division, Department of Machine and Vehicle Systems, Chalmers University of Technology, SE-412 96 Göteborg, SWEDEN; (email: xuejun.liu@me.chalmers.se).
To investigate the effects of vehicle impact velocity and front-end structure on the dynamic responses of child pedestrians, an extensive parametric study was carried out using two child mathematical models at 6 and 15 years old. The effect of the vehicle impact velocity was studied at 30, 40, and 50 km/h in terms of the head linear velocity, impact angle, and head angular velocity as well as various injury parameters concerning the head, chest, pelvis, and lower extremities. The variation of vehicle front-end shape was determined according to the shape corridors of modern vehicles, while the stiffness characteristics of the bumper, hood edge, and hood were varied within stiffness corridors obtained from dynamic component tests. The simulation results show that the vehicle impact speed is of great importance on the kinematics and resulting injury severity of child pedestrians. A significant reduction in all injury parameters can be achieved as the vehicle impact speed decreases to 30 km/h. The head and lower extremities of children are at higher injury risks than other body regions. Older children are exposed to higher injury risks to the head and lower leg, whereas younger ones sustain more severe impact loads to the pelvis and upper leg. The results from factorial analysis indicate that the hood-edge height has a significant effect on the kinematics and head impact responses of children. A higher hood edge could reduce the severity of head impact for younger children, but aggravate the risks of head injury for older ones. A significant interaction exists between the bumper height and the hood-edge height on the head impact responses of younger child. Nevertheless, improving the energy absorption performance of the hood seems effective for mitigating the severity of head injuries for children.
Correspondence: David Reith, Senior Lecturer, Dunedin School of Medicine, 3rd Floor, Children's Pavilion, Dunedin Hospital, Great King St, Dunedin 9001, NEW ZEALAND; (email: david.reith@stonebow.otago.ac.nz).
CONTEXT: To ascertain the sources of information accessed by parents/caregivers following an incident of child poison ingestion, prior to their presentation to an ED.
METHODS: A questionnaire based survey of the parents/caregivers of children presenting to the Mater Children's Hospital Emergency Department with poisoning from March to October 2001.
FINDINGS: A total of 121 parents/caregivers were surveyed. In 117 cases (97%), information was sought prior to presentation. The Poisons Information Centre (PIC) was the initial source of information in 39 cases (32%), the ED in 25 cases (21%) and the family doctor (by telephone or consultation) in 21 cases (17%). Poisons Information Centres, emergency departments and family doctors were the sole sources of information for 18%, 15% and 12% of cases, respectively. For 46% of cases multiple sources of information were accessed, and overall, in 57 cases (47%) the Poisons Information Centre was accessed, the ED in 38 cases (31%) and the family doctor in 34 cases (28%).
COMMENTS: Poisons Information Centres are under-utilized as the first point of contact after childhood poisoning but in nearly all cases of poison ingestion that presented to the ED, information was sought prior to presentation and in most cases this was from direct contact with a health professional.
Risk factors for injury in high school (American) football players.
- Turbeville SD, Cowan LD, Owen WL, Asal NR, Anderson MA. Am J Sports Med 2003; 31(6): 974-980.
Correspondence: Sean D. Turbeville, The University of Oklahoma, Biostatistics & Epidemiology, 413 Northwest 46th Street, Oklahoma City, OK 73118, USA; (email: sean-turbeville@ouhsc.edu).
CONTEXT: Many studies have reported the frequency and types of injuries in high school football players. However, few have assessed the relationship between player characteristics and risk of injury.
OBJECTIVE: To describe the epidemiologic characteristics of and risk factors for injury in high school football players and to determine whether players' characteristics could be used to predict subsequent injury.
STUDY DESIGN: Prospective cohort study.
METHODS: This study was part of a 2-year prospective investigation (1998 to 1999) of risk factors for injury in 717 (343 in the 1998 season and 374 in the 1999 season) high school football players in the Oklahoma City, Oklahoma, School District. Player characteristics (playing experience, position, injury history) and physical parameters (body mass index, weight, height, grip strength) were measured at the beginning of each season. Logistic regression analysis was used to determine whether any of the baseline variables were associated with the odds of subsequent injury.
FINDINGS: The physical characteristics of players, such as body mass index and strength, were not associated with risk of injury. More playing experience and a history of injury in the previous season were significantly related to increased risk. Linemen were at the highest risk of injury, particularly knee injuries and season-ending injuries.
COMMENTS: Future research should focus on decreasing the risk of injury to linemen.
Injury rates in rugby league football: impact of change in playing season.
- Gissane C, Jennings D, Kerr K, White J. Am J Sports Med 2003; 31(6): 954-958.
Correspondence: Conor Gissane, MS, 27 Maple Grove, Woburn Sands, Bucks TW7 5DU, UK; (email: conor.gissane@brunel.ac.uk).
CONTEXT: In 1996, the professional rugby league moved its playing season from the autumn and winter months to the spring and summer.
OBJECTIVE: To determine whether the change in playing season altered the risk of player injury.
METHODS: Prospectively collected data comparing two cohorts. Injuries incurred by all players in one club during match play were recorded over 9 seasons: 4 winter (138 games) and 5 summer (144 games). Each injury was classified according to site, type, player position, activity at the time of injury, and number of games missed as a result of injury.
FINDINGS: The total exposure time during this study was 4876 player-hours (winter, 2386, summer, 2490). The relative risk of injury doubled after the move from winter to summer. Winter rugby accounted for 72 injuries, and summer rugby, for 150 injuries.
COMMENTS: Risk of injury to players in a professional rugby league club greatly increased as a result of changing the playing calendar, possibly as a result of environmental factors. However, other factors, such as increased conditioning levels, which have been a direct consequence of players moving to full-time professionalism, may have increased injury potential.
Catastrophic cheer leading injuries.
- Boden BP, Tacchetti R, Mueller FO. Am J Sports Med 2003; 31(6): 881-888.
Correspondence: Barry P. Boden, The Orthopaedic Center, 9711 Medical Center Drive, #201, Rockville, MD 20850, USA: (email: unavailable).
CONTEXT: There are few epidemiologic studies of cheer leading injuries.
OBJECTIVE: To develop a profile of catastrophic injuries in cheer leading and to describe relevant risk factors. METHODS: Retrospective cohort study. We reviewed 29 of 39 incidents of cheer leading injuries reported to the National Center for Catastrophic Sports Injury Research from 1982 to 2002.
FINDINGS: Twenty-seven of the injured cheer leaders were women. There were 1.95 direct catastrophic injuries per year or 0.6 injuries per 100,000 participants. The rate of injuries among college cheer leaders was five times that of high school participants. The most common stunts performed at the time of injury were a pyramid (9) or a basket toss (8). Catastrophic injuries included 17 severe head injuries, resulting in 13 skull fractures and 2 deaths; 8 cervical fractures or major ligament injuries; 3 spinal cord contusions; and 1 concomitant head injury and cervical fracture.
COMMENTS: Suggestions for reducing catastrophic injuries in cheer leaders include enhancing the number and training of spotters, mandating floor mats for complex stunts, restricting complex stunts when surfaces are wet, and encouraging safety certification of coaches. Pyramids and basket tosses should be limited to experienced cheer leaders who have mastered all other skills and should be performed with spotters and landing mats.
Correspondence: John Langley, Injury Prevention Research Unit, Department of Preventive and Social Medicine, University of Otago Medical School, Dunedin, NEW ZEALAND; (email: john.langley@ipru.otago.ac.nz).
Traditional indicators used to monitor trends in nonfatal injury are influenced by a range of factors other than the incidence of injury. Indicators based on threat-to-life scales offer a means of addressing this problem. The aim of the research described in this article was to compare trends in the official indicators with trends in selected threat-to-life indicators. We compared indicators based on the New Injury Severity Score and the International Classification of Diseases-based Injury Severity Score with the official New Zealand indicators; namely, (1) reported injuries, (2) reported injuries per 10,000 vehicles, (3) reported injuries per 100,000 people, and (4) number hospitalized (discharges). All the official indicators suggest that there has been a substantive decline in nonfatal Motor Vehicle Traffic Crashes (MVTCs) for the period 1988-2000, but a notable increase in 2001. The latter appear to be artifactual increases due to changes in patterns of data collection and do not reflect any real changes in incidence. Further support for this is provided by the results for the two threat-to-life indicators, which suggest that the decline observed for 1988-98 may have been attributable to a decline in the ascertainment or occurrence of minor injuries since those injuries, which represent a significant threat to life, have not declined to the same degree. Given the prominence of motor vehicle crashes as a cause of unnecessary morbidity, more thought needs to be given to deriving valid indicators for measuring trends in serious nonfatal injury.
FiGHTS: A preliminary screening tool for adolescent firearms-carrying.
- Hayes DN, Sege R. Ann Emerg Med 2003; 42(6): 798-807.
Correspondence: D. Neil Hayes, 750 Washington Street, NEMC #245, Boston, MA 02111, USA; (email: nhayes@tuft-nemc.org).
CONTEXT: Adolescent firearms-carrying is a risk factor for serious injury and death. Clinical screening tools for firearms-carrying have not yet been developed. We present the development of a preliminary screening test for adolescent firearms-carrying based on the growing body of knowledge of firearms-related risk factors.
METHODS: A convenience sample of 15,000 high school students from the 1999 National Youth Risk Behavior Survey was analyzed for the purpose of model building. Known risk factors for firearms-carrying were candidates for 2 models predicting recent firearms-carrying. The "brief FiGHTS score" screening tool excluded terms related to sexual behavior, significant substance abuse, or criminal behavior (Fi=fighting, G=gender, H=hurt while fighting, T=threatened, S=smoker). An "extended FiGHTS score," which included 13 items, was developed for more precise estimates.
FINDINGS: The brief FiGHTS score had a sensitivity of 82%, a specificity of 71%, and an area under the receiver operating characteristic (ROC) curve of 0.84. The extended FiGHTS score had an area under the ROC curve of 0.90. Both models performed well in a validation data set of 55,000 students.
COMMENTS: The brief and extended FiGHTS scores have high sensitivity and specificity for predicting firearms-carrying and may be appropriate for clinical testing.
Correspondence: Belinda J Gabbe, Trauma and Sports Injury Prevention Research Unit, Department of Epidemiology and Preventive Medicine, Monash University, Central and Eastern Clinical School, Alfred Hospital, Prahran, Victoria 3181, AUSTRALIA; (email: Belinda.Gabbe@med.monash.edu.au).
The Glasgow Coma Scale (GCS) was first introduced in the 1970s to provide a simple and reliable method of recording and monitoring change in the level of consciousness of head injured patients. Since its introduction, the GCS has been widely utilized in the trauma community and its use expanded beyond the original intentions of the score. In the context of traumatic injury, this paper discusses the use of the GCS as a predictor of outcome, the limitations of the GCS, the reliability of the GCS and potential alternatives through a critical review of the literature. The relevance to Australian trauma populations is also addressed.
Correspondence: R.N. Anderson, Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System, USA; (email: unavailable).
CONTEXT: This report presents final 2001 data on the 10 leading causes of death in the United States by age, race, sex, and Hispanic origin. Leading causes of infant, neonatal, and postneonatal death are also presented. This report supplements the annual report of final mortality statistics.
METHODS: Data in this report are based on information from all death certificates filed in the 50 States and the District of Columbia in 2001. Causes of death classified by the International Classification of Diseases, Tenth Revision are ranked according to the number of deaths assigned to rankable causes.
FINDINGS: In 2001, the 10 leading causes of death were (in rank order) Diseases of heart; Malignant neoplasms; Cerebrovascular diseases; Chronic lower respiratory diseases; Accidents (unintentional injuries); Diabetes mellitus; Influenza and pneumonia; Alzheimer's disease; Nephritis, nephrotic syndrome and nephrosis; and Septicemia and accounted for nearly 80 percent of all deaths occurring in the United States. Differences in the rankings are evident by age, sex, race, and Hispanic origin. Leading causes of infant death for 2001 were (in rank order) Congenital malformations, deformations and chromosomal abnormalities; Disorders related to short gestation and low birth weight, not elsewhere classified; Sudden infant death syndrome; Newborn affected by maternal complications of pregnancy; Newborn affected by complications of placenta, cord and membranes; Respiratory distress of newborn; Accidents (unintentional injuries); Bacterial sepsis of newborn; Diseases of the circulatory system; and Intrauterine hypoxia and birth asphyxia. Important variation in the leading causes of infant death is noted for the neonatal and postneonatal periods.
Eye injuries in childhood: a retrospective investigation of 88 cases from 1988 to 2000.
CONTEXT: To assess the frequency, causes, mechanisms, and functional outcomes of eye injuries in childhood.
METHODS: A retrospective analysis of the hospital files of patients younger than 12 years admitted to the Institute of Ophthalmology of Verona University for eye injuries from January 1, 1988, to December 31, 2000.
FINDINGS: Eighty-eight cases of eye injuries (69 [78%] boys, 19 [22%] girls) were identified. The mean age at admission was 7.2 years. The most frequent causes of eye injuries were domestic accidents in patients younger than 6 years (25%) and accidents at play in those older than 6 years (35%). Scissors were the most frequent causative agents in children under 6 and toys, stones, and ball injuries in those over 6. Diagnoses, therapies implemented, ocular complications, and outcomes are reported.
COMMENTS: The major causes of eye injuries in childhood are preventable; thus more adequate adult supervision and educational and legislative measures are necessary and useful in order to reduce prevalence and morbidity of these accidents.
Correspondence: M.J. Perry, Occupational Health Program, Harvard School of Public Health, 665 Huntington Ave., Boston, MA 02115, USA; (email: mperry@hsph.harvard.edu).
CONTEXT: Farming is one of the most hazardous occupational industries in the USA, and farms pose numerous health risks for youth visiting, living in, or working in the farm environment. PURPOSE: This review discusses both potential traumatic injuries and hazardous inorganic exposures that are common in agricultural settings.
FINDINGS: An estimated 2 million youth under the age of 20 currently live or work on US farms. Approximately 103 farm fatalities occur in this age group each year; over 32,000 nonfatal youth injuries occurred on farms in 1998. Children working in US agriculture make up only 8% of the population of working minors overall, yet they account for 40% of work-related fatalities among minors. Farm children and youth are also exposed to potentially harmful chemicals, such as pesticides and solvents, and many of these exposures go undetected. The long-term health effects of exposure to pesticides or solvents are not known, but the developmental vulnerabilities of children and youth are of particular concern.
COMMENTS: Clinical and epidemiologic research in pediatric populations is needed to expand the empirical data, particularly for inorganic and organic exposures, musculoskeletal trauma, skin disorders, occupation-induced hearing loss, and psychosocial stress. Rural health professionals can work to reduce these risks to farm youth by becoming more aware of the problem, by conducting clinical and epidemiologic research, and by engaging in advocacy at state and local levels.
In the last 2 decades, school bullying has become a topic of public concern and research around the world. This has led to action to reduce the problem. We review interventions targeted at the school level (for example, whole school policy, classroom climate, peer support, school tribunal, and playground improvement), at the class level (for example, curriculum work), and at the individual level (for example, working with specific pupils). Effectiveness of interventions has been sporadically assessed. We review several systematically evaluated, large-scale, school-based intervention programs. Their effectiveness has varied, and we consider reasons for this. We suggest ways to improve the evaluation and comparability of studies, as well as the effectiveness of future interventions.
Correspondence: Ken Rigby, School of Education, University of South Australia, Underdale Campus, Holbrooks Road, Underdale, South Australia, AUSTRALIA; (email: Ken.Rigby@unisa.edu.au).
For the most part, studies of the consequences of bullying in schools have concentrated upon health outcomes for children persistently bullied by their peers. Conclusions have been influenced by how bullying has been conceptualized and assessed, the specific health outcomes investigated, and the research method and data analysis employed. Results from cross-sectional surveys suggest that being victimized by peers is significantly related to comparatively low levels of psychological well-being and social adjustment and to high levels of psychological distress and adverse physical health symptoms. Retrospective reports and studies suggest that peer victimization may contribute to later difficulties with health and well-being. Longitudinal studies provide stronger support for the view that peer victimization is a significant causal factor in school children's lowered health and well-being and that the effects can be long-lasting. Further evidence from longitudinal studies indicates that the tendency to bully others at school significantly predicts subsequent antisocial and violent behavior.
Balancing Safety and Security in the School Environment.
Correspondence: Alex L. Szachnowicz, Anne Arundel County, Maryland, Board of Education, 2644 Riva Road, Annapolis, Maryland 21401, USA; (email: unavailable).
Schools should be safe and secure places for students, staff, and visitors alike. Without a safe, orderly, and conducive learning environment, students cannot learn, teachers cannot teach, and the fundamental mission of the school system has essentially been thwarted. The responsibility of creating safe schools lies not only with school administrators, but on the entire community in which the school resides.
Although the best time to address facility security concerns is in the design phase, renovations or targeted initiatives that improve the level of safety and security should always be considered.
In years past, safety in the classroom was not such a high priority for school administrators. Schools were thinking education, not safety, when schools were built years ago. Schools were designed to achieve an open and inviting campus style setting with multiple entrances, expansive windows, and many opportunities for privacy. While there may have been the occasional fight or theft, issues like guns, snipers, bombs, terrorism, and other violent crimes were not at the forefront of most educational facilities planners. School administrators know too well that those days have passed. As everyone struggles to come to grips with the recent string of high-profile troubling events, school safety has gathered more attention.
This report addresses the need for balancing the need for safety from external or internal threats of violence with the need to rapidly evacuate the school building or school ground in the event of a fire or hazardous materials exposure.
Viewing another person directing his or her gaze can produce automatic shifts of covert visual attention in the same direction. This holds true even when the task-relevant target is much more likely to occur at the uncued location. These findings, along with other evidence, have been taken to suggest that gaze represents a 'special' stimulus--the foundation of a social cognition system that can make inferences about the mental states of other people. However, gaze-driven cueing effects could simply be due to spatial compatibility between cue and target. We compared the attentional effects of gaze shifts to a face with the tongue extended laterally to the left or right. When tongue direction was a nonpredictive cue, we found cueing effects from tongues that were indistinguishable from those produced by gaze. However, in contrast to previous findings with gaze, tongue cues did not overcome a validity manipulation in which targets were four times more likely to appear at the uncued location. We conclude that simple attentional cueing effects from gaze may be better explained by spatial compatibility, and that more complex, unique features of cueing from gaze may be better indices into perceptual systems specialized for social cognition.
Effects of field viewing angles on object judgment in virtual environment.
- Zhou QX, Jiang GH, Qu ZS, Zhu YJ. Space Med Med Eng 2003; 16(4): 292-295.
Correspondence: Qian-xiang Zhou, Institute of Space Medico-Engineering, Beijing 100094, CHINA; (email: zqxg@sjtu.edu.cn).
OBJECTIVES: To investigate the effect of viewing angle on the reliability of human judgment of the position of objects in the environment.
METHODS: First, pre-tests were done with the PC virtual reality ergonomic system to determine difference among observed object and values of viewing angle. Then, one factor, 4-levels full random experiments were done with 45 health human subjects (male and female nearly 1:1).
FINDINGS: It was shown that the reliability of human judgment was significantly influenced by the setting of the viewing angle of virtual environment, and the object judgment including size and angle judgment was the best when the viewing angle of virtual environment was 60 degrees.
COMMENTS: When virtual reality was used in ergonomic design, operation training and other related research, the effect of field viewing angle should be taken into consideration, and 60 degrees is recommended to be optimal for human judgment task.
The Finno-Ugrian suicide hypothesis: variation in European suicide rates by latitude and longitude.
- Voracek M, Fisher ML, Marusic A. Percept Mot Skills. 2003; 97(2): 401-406.
Correspondence: Martin Voracek, Department of Psychoanalysis and Psychotherapy, University of Vienna Medical School, AUSTRIA; (email: martin.voracek@akh-wien.ac.at).
The marked variation regarding the suicide rate in 34 European countries is well described by regressing the national suicide rate on the capital cities' latitudes and on an interaction term of squared latitude multiplied with longitude. The interaction term explains 40.8% and 29.1% of men's and women's suicide rate, respectively, and latitude explains a further significant increment of 10.9% and 10.6% variance of men's and women's suicide rate, respectively. This regression model quantifies the Finno-Ugrian suicide hypothesis of Kondrichin and of Marusic and Farmer. The European countries highest in suicide rate constitute a contiguous, J-shaped belt, spanning from Finland to Austria. This area maps onto the second principal component identified for European gene distribution, representing ancestral adaptation to cold climates and the Uralic language dispersion. Thus, population differences in genetic risk factors may account for the spatial pattern in European suicide rates.
Suicidal behavior of adolescent girls: profile and meaning.
- Joseph HB, Reznik I, Mester R. Isr J Psychiatry Relat Sci. 2003; 40(3): 209-219.
Correspondence: Hanna B. Joseph, District Outpatient Mental Health Clinic, 80 Remez Street, Rehovot, ISRAEL; (email: hannabarjoseph@netscape.net).
In the last two decades the incidence of adolescent suicides has been very high (though it has been on the decrease in the U.S.A. over the last four years), giving rise to a multitude of empirical and theoretical studies. The extensive knowledge that has accumulated regarding adolescent suicidal behavior has led to a more differentiated attitude. Many studies try to clarify specific needs, motivations and the conceptualization of death and suicide in various adolescent subgroups (minorities, females, homosexuals), thereby enabling more specific and exact methods of evaluation, prevention and intervention. Adolescent girls' suicidal behavior is different in many aspects from boys' suicidal behavior: Girls mortality rate from suicide is a 3-5 times lower rate than boys, but their attempted suicide rate is four to hundreds time higher. Girls suicide mainly by drugs and their suicide is mainly in reaction to interpersonal difficulties. Their motivation is often a cry for help. The comorbidity of suicide and depression is much higher for adolescent girls than boys. These differences generate a different understanding and separate treatment strategies. Two theoretical approaches that may explain the profile which characterizes suicidal girls will be presented. One has a psychological developmental context, and the other a social cultural context. Implications for specific prevention measures include legal action on pack sizes of analgesics, compulsory registration of attempted suicide and more gender specific treatment and prevention programs.
Suicidal ideation in adolescence--an indicator of actual risk?
- Groleger U, Tomori M, Kocmur M. Isr J Psychiatry Relat Sci. 2003; 40(3): 202-208.
Correspondence: Urban Groleger, University Psychiatric Hospital, Studenec 48, 1000 Ljubljana, SLOVENIA; (email: urban.groleger@psih-klinika.si).
CONTEXT: The aim of the study was to assess both the frequency of suicidal ideation and also its link to other risk factors for suicidal behavior in the community population of adolescents.
METHOD: In the study, we have used a structured questionnaire for assessing the risk factors for suicidal behavior, and self-assessment scales for measuring depression and self-esteem. The research included 4,692 adolescents aged from 14 to 19 years. The sample is representative of the population of Slovene high school students.
FINDINGS: The prevalence of suicidal ideation was 44% at anytime in respondent's life, and 10.3% during the recent month, and statistically significantly more frequent in girls than in boys. Suicidal ideation proved to be linked to high level of depression and low self-esteem, and also to the important psychosocial risk factors for suicidal behavior, such as: tendency to react on stress by consuming alcohol, alcohol and substance abuse, frequent conflicts with parents and frequently running away from home, pessimism about the future and self estimation of high probability of suicide in the future.
COMMENTS: Suicidal ideation is an important suicide risk factor in adolescence, and requires adequate attention among all other relevant risk factors.
A prevalence study of suicide ideation among older adults in Hong Kong SAR.
- Yip PS, Chi I, Chiu H, Chi Wai K, Conwell Y, Caine E. Int J Geriatr Psychiatry 2003; 18(11): 1056-1062.
Correspondence: Paul S F. Yip, The Hong Kong Jockey Club Centre for Suicide Research and Prevention, The University of Hong Kong, Hong Kong, CHINA; (email: sfpyip@hku.hk).
CONTEXT: The objective of this paper is to ascertain estimates of the prevalence, and associated risk factors for, suicidal ideation among community-dwelling older adults in Hong Kong.
METHOD: The study was conducted as part of the General Household Survey (GHS), using face to face interviews of ethnic Chinese people aged 60 or above living in the community. Elders living in institutions or elderly homes were excluded from the study.
FINDINGS: Six percent of the sample was found to have ever had suicide ideation. The results showed that poor physical health, including poor vision, hearing problems, and a greater number of diseases; and poor mental health, especially in the form of depression, are predictors of suicidal ideation in the elderly population. Also, statistical analysis by linking individual factors to depression showed that financial and relationship problems are significant risk factors as well. Older adults who engaged in active coping, that is, those who actively seek to manage or control the negative events in their lives, fare better with lower levels of suicidal ideation than those who use passive coping styles.
COMMENTS: The prevalence of suicidal ideation is similar among elders in Hong Kong and western countries. Factors that contribute to risk for suicidal ideation span physical and mental health, social, and psychological domains. Although the association of suicidal ideation to self-destructive acts remains to be determined, these findings indicate a variety of potential foci for late life suicide prevention efforts.
Association of meteorological factors with suicide.
Correspondence: Eberhard A. Deisenhammer, Department of General Psychiatry, University of Innsbruck, Innsbruck, Austria Central Institute of Meteorology and Geodynamics, Innsbruck, AUSTRIA; (email: Eberhard.Deisenhammer@uibk.ac.at).
CONTEXT: To identify weather factors associated with an increased risk of suicide. In a number of prior studies an influence of meteorological conditions on the incidence of suicide or attempted suicide has been suggested.
METHOD: Official data on the suicide cases of the state of Tyrol, Austria, assessed over a period of 6 years (n = 702) were correlated with a number of meteorological factors assessed at eight weather stations.
FINDINGS: The risk of committing suicide was significantly higher on days with high temperatures, low relative humidity or a thunderstorm and on days following a thunderstorm. The multiple logistic regression analysis left 'temperature' and 'thunderstorm on the preceding day' as significant factors, even after adjustment for sociodemographic and geographical variables.
COMMENTS: Within the interaction of psychological and environmental influences in the development of suicidal ideation and behavior, specific meteorological conditions may additionally contribute to the risk of suicide in predisposed individuals.
Weather and suicide: the present state of knowledge on the association of meteorological factors with suicidal behavior.
Correspondence: Eberhard A. Deisenhammer, Department of General Psychiatry, University of Innsbruck, Innsbruck, AUSTRIA; (email: Eberhard.Deisenhammer@uibk.ac.at).
CONTEXT: To review the available literature on the association between daily and longer-term weather data and the incidence of attempted and completed suicide.
METHOD: A computerized search supplemented by a cross-check of the references sections of the thereby identified papers was performed.
FINDINGS: A total of 27 studies looking for a relationship between attempted or completed suicide and weather or climate data were found. Most of the papers reported a statistical association of suicidal acts with at least one weather factor. However, the results are not conclusive and in part contradictory.
COMMENTS: Possibly due to the high variance in methodological approaches of the studies it is not possible to identify a specific weather condition associated with a generally higher risk for suicide. Weather and seasonal effects may interact with each other. Environmental effects on brain function and weather-related interactions of people may be involved in the occurrence of suicidal behavior.
Seat performance in retaining an occupant, transferring energy, and controlling neck responses is often questioned after severe rear crashes when fatal or disabling injury occur. It is argued that a stiffer seat would have improved occupant kinematics. However, there are many factors in occupant interactions with the seat. This study evaluates four different seat types in 26 and 32 mph (42 and 51 km/h), rear crash delta Vs. Two seats were yielding with k = 20 kN/m occupant load per displacement. One represented a 1970s yielding seat with j = 3.4 degrees /kN frame rotation per occupant load, and 3 kN maximum load (660 Nm moment), and the other a high retention seat phased into production since 1997 with j = 1.4 degrees /kN, and 10 kN maximum load (2200 Nm). Two seats were stiff with k = 40 kN/m. One represented a 1990s foreign benchmark with j = 1.8 degrees /kN and a 7.7 kN maximum load (1700 Nm), and the other an all belts to seat (ABTS) with j = 1.0 degrees /kN and 20 kN maximum load (4400 Nm). The crash was a constant acceleration of 11.8 g, or 14.5 g for 100 ms. Occupant interactions with the seat were modeled using a torso mass, flexible neck and head mass. By analysis of the equations of motion, the initial change in seatback angle (Deltatheta) is proportional to jk(y - x), the product jk and the differential motion between the vehicle (seat cushion) and occupant. The transition from 1970s-80s yielding seats to stronger seats of the 1990s involved an increase in k stiffness; however, the jk property did not change as frame structures became stronger. The yielding seats of the 1970s had jk = 68 degrees /m, while the stiff foreign benchmark seat had jk = 72 degrees /m. The foreign benchmark rotated about the same as the 1970s seat up to 50 ms in the severe rear crashes. While it was substantially stronger, it produced higher loads on the occupant, and the higher loads increased seatback rotations and neck responses. The ABTS seat had the lowest rotations but also caused high neck responses because of the greater loads on the torso. Neck displacement (d) is initially proportional to (k/m(T)) integral integral y, seat stiffness times the second integral of vehicle displacement divided by torso mass. As seat stiffness increases, head-torso acceleration, velocity, and neck displacement increase. This study shows that the jk seat property determines the initial seatback rotation in rear crashes. If a stronger seat has a higher stiffness, it rotates at higher loads on the occupant, reducing the overall benefit of the stronger frame, while increasing neck responses related to whiplash or neck extension prior to subsequent impacts. The aim of seat designs should be to reduce jk, provide pocketing of the pelvis, and give head-neck support for the best protection in severe rear crashes. For low-speed crashes, a low k is important to reduce early neck responses related to whiplash.
Assessment of Red Light Running Cameras in Fairfax County, Virginia.
Correspondence: Antoine G. Hobeika, Department of Civil and Environmental Engineering, Virginia Polytechnic Institute and State University, Patton Hall 301-H, Blacksburg, VA 24061, USA; (email: hobeika@vt.edu).
A study was conducted to assess the Red Light Running (RLR) cameras in Fairfax County, Virginia. The RLR camera enforcement program involved 10 cameras that were installed around the county. Intersections were chosen based on police and community recommendations in high commuter traffic areas. Warning signs were also erected upstream from the monitored intersections. All 10 cameras utilized the same basic setup. The typical setup included a dual loop system for detecting the vehicles entering the intersection and calculating their speed. Once the camera system detected a violator, it recorded two pictures from the rear of the vehicle, showing it enter and proceed through the intersection. These pictures were used to identify the registered owner by the license plate and give evidence for a citation. The automated detection system is designed for the through movements of traffic. Violation data, accident data, and traffic data were collected from the Virginia Department of Transportation, the Fairfax County Department of Transportation, and the Fairfax County Police Department. The data analysis has identified improvements in violation rates on the order of 36% over the first three months of automated enforcement and 69% reductions after six months of camera operation. The accident rates data also showed a reduction of 40% in accidents. This reduction in accidents, accounting for expenses of implementation and operation of the system, could lead to a benefit to the community of approximately $8.75 million over the next eight years. Public opinion in the Fairfax County jurisdiction was found to be strongly supportive of the automated enforcement. The results found in this study show that the implementation of red light running cameras in Fairfax County, Virginia, have been successful in providing benefits with respect to traffic, economy, and safety.
Impact of impulsiveness, venturesomeness, and empathy on driving by older adults.
- Owsley C, McGwin Jr G, McNeal SF. J Safety Res 2003, 34(4): 353-359.
Cynthia Owsley, Department of Ophthalmology, School of Medicine, University of Alabama at Birmingham, 700 S. 18th Street, Suite 609, Birmingham, AL 35294-0009, USA; (email: owsley@uab.edu).
CONTEXT: Although personality characteristics such as impulsiveness have been linked to the driving safety and driving habits of young and middle-aged adults, little research has focused on the role of personality in older driver behavior.
METHODS: Using the IVE questionnaire in an exploratory study, three personality dimensions (impulsiveness, venturesomeness, and empathy) were measured in 305 older drivers (ages 57�87 years old). In addition, the Driving Habits Questionnaire was used to estimate driving exposure, and the Driver Behavior Questionnaire (DBQ) was used to estimate driving errors and violations. State-recorded crash data were made available by the state public safety agency.
FINDINGS: Subjects who reported four or more driving errors had higher impulsivity and empathy scores and lower venturesomeness scores. Subjects reporting driving violations were more likely to have high impulsivity scores. Driving six or more places per week was associated with lower levels of impulsivity.
COMMENTS: These results suggest that a comprehensive understanding of driving problems among older adults should also include a consideration of personality dimensions. In doing so, the challenges faced in the interpretation of self-report instruments on driving behaviors must be acknowledged, with a move in research toward greater reliance on more objective measures of driving behavior when assessing the impact of personality variables.
Helen S. Cohen, Bobby R. Alford Department of Otorhinolaryngology and Communicative Sciences, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA; (email: hcohen@bcm.tmc.edu).
CONTEXT: People with dizziness caused by vestibular (i.e., inner ear) disorders complain of difficulty driving. Physicians occasionally warn their patients with vestibular disorders not to drive. Few studies have asked patients about their driving performance, so little data are available.
METHODS: Using the Driving Habits Questionnaire, the authors did structured interviews with people with several different vestibular disorders and with normal subjects. The self-reported crash rate and rate of citations for moving violations did not differ between the subject groups.
FINDINGS: Patients report reduced driving skills, particularly in situations when visual information is reduced, rapid head movements are used, and specific path integration or spatial navigation skills are needed.
See item 1 under Disasters and Environmental Exposures
CONTEXT: This study was designed to describe the level of violence in three high schools and to test the effects of universal and targeted strategies to reduce this violence.
METHODS: A repeated measures design with two baseline scores and two intervention scores was used during a two year period. Two rural high schools served as control schools with a single intervention high school. Participants: All freshmen at the three high schools completed a self-report measure of school violence; 420 completed the study at the end of their sophomore year. Multiple universal and targeted interventions to prevent school violence were used for slightly more than one year. Scores on student Victimization and Perpetration, gathered one year apart, were compared using a pre-test post-test model.
FINDINGS: Student reports of perpetration at the intervention school were significantly lower than the combined scores at the control school. Students, teachers, and administrators reported improved awareness, knowledge, and skills to implement violence prevention programs.
COMMENTS: A comprehensive program that includes university and high school partnerships has the capability to reduce school violence during a short period. Despite limitations to the study, continued use of research partnerships to decrease school violence is warranted.
Planning of Youth Violence-Prevention Programs: Development of a Guiding Measure.
- Cooper WO, Lutenbacher M, Faccia K, Hepworth JT. Public Health Nur 2003; 20(6): 432-439.
Correspondence: William O. Cooper Vanderbilt University School of Medicine, Nashville, Tennessee, USA; (email: william.cooper@vanderbilt.edu).
This article describes the development and pilot testing of the Good-Fit Measure (GFM), a measure that public health nurses and other providers involved with planning multidisciplinary violence prevention efforts can use. Themes derived from a series of focus group discussions from a larger study, including individuals (n = 83) from multiple community sectors, guided development of the measure. Participants in three follow-up focus groups (n = 32 participants) reviewed the measure, which was then pilot tested in two phases. Guided by information from the first phase, in which respondents indicated the measure was too complex, the measure was simplified and field tested in phase two. Results from both phases were similar. The GFM score was significantly higher for the program selected by the respondent before completing the measure than the nonselected program (p < 0.01). Participants indicated that the tool was helpful in articulating the specific factors for their decisions. Participants underscored the utility of the tool in facilitating program planning by individual providers and interdisciplinary or multidisciplinary teams. The GFM provides systematic consideration of multiple factors that motivate public health nurses and other community providers in their decision-making process when planning prevention strategies, increasing the likelihood of successful programs.
Children exposed to domestic violence and child abuse: terminology and taxonomy.
Correspondence: George Holden, Department of Psychology, The University of Texas at Austin, 1 University Station A8000, Austin, Texax 78712-0187, USA; (email: holden@psy.utexas.edu).
Three definitional issues regarding children exposed to domestic violence are examined. First, the multiple ways in which a child can be exposed to violence is discussed. A taxonomy of 10 types of exposure is proposed. Nine key characteristics of domestic violence, as they relate to children and children's exposure, are then outlined. The third issue addressed concerns why children who are exposed to domestic violence can be considered victims of child maltreatment. These children, by nature of their experience in the home, are psychologically maltreated and are also at high risk for physical abuse and some risk for sexual abuse. Empirical questions concerning these definitions and taxonomies and their interrelations are discussed.
The nature and circumstances of defensive gun use: A content analysis of interpersonal conflict situations involving criminal offenders.
Correspondence: William Wells, Center for the Study of Crime, Delinquency, and Corrections, Mailcode 4504, Southern Illinois University at Carbondale, Carbondale, IL 62901-4504, USA; (email: wwells@siu.edu).
This study examines defensive gun use (DGU) to inform gun-regulation policy in the United States. Previous analyses of gun-regulation policies have focused on the benefits of firearms, and research has shown that guns are frequently used for defense. An important implication, however, is that restricting gun ownership may increase the net harm in the United States. Data for the analysis consisted of interviews, gathered as part of a larger research project (Horney, forthcoming), that composed a unique set of DGU incidents involving convicted offenders as defenders (N = 166). Overall, DGUs are not likely to provide social benefits, implying that prevalence estimates may not simultaneously estimate social benefits, and that the relationship among gun carrying, entering risky situations, and DGU is more complex than has previously been portrayed. These findings may have limited policy relevance, however, because most people agree that convicted offenders should not be able to possess firearms. The DGU concept must be more clearly elaborated, and further empirical evidence must be gathered before these types of gun uses can be equated with clear social benefits.
Neighborhood disadvantage and the nature of violence.
Correspondence: Eric Baumer, Department of Criminology and Criminal Justice, University of Missouri-St. Louis,8001 Natural Bridge Road, St. Louis, MO 63121, USA; (email: baumer@admiral.umsl.edu).
Although numerous studies have examined the influence of neighborhood socioeconomic disadvantage on the quantity of violence, little attention has been devoted to whether such conditions also shape the quality of violence. Drawing on Anderson's (1999) influential ethnography, we derive several hypotheses about how the nature of violence differs across neighborhoods with varying socioeconomic conditions. Using data on assaults and robberies from the area-identified National Crime Victimization Survey (NCVS), our analyses reveal support for Anderson's description of the nature of violence in different neighborhood contexts, but only mixed support for his argument that those differences are due to neighborhood effects.
