Correspondence: Mogens Nygaard Christoffersen, Danish National Institute of Social Research, Herluf Trollesgade 11, DK-1052 Kobenhavn K, DENMARK; (email: mc@sfi.dk).
The aim of this study is to consider whether parents' abuse of alcohol has an impact on children during their formative years. The research is based on data from 84,765 children born in Denmark in 1966. These children and their parents were followed between 1979 and 1993. Information was analyzed from government registers covering health, education, family separation, suicidal behavior, criminality, and unemployment, using a discrete time Cox-regression model. Results showed that the parents' alcohol abuse may frame the childhood with parental violence, very high occurrence of family separations, and often foster care. The parental abuse of alcohol may influence several long-term consequences for their 15- to 27-year-old children such as increased mortality, self-destructive behaviors (e.g. attempted suicide or drug addiction). Hospitalization due to violence, an increased risk of teenage pregnancy and unemployment were also seen more frequently among cases where the parents were alcohol abusers. Mothers' alcohol abuse seemed to be associated with higher occurrences of all the mentioned disadvantages.
Head injury among drug abusers: an indicator of co-occurring problems.
- Walker R, Hiller M, Staton M, Leukefeld CG. J Psychoactive Drugs 2003; 35(3): 343-353.
Correspondence: Robert Walker, University of Kentucky Center on Drug and Alcohol Research, Bowman Hall, Room 333, Lexington, Kentucky, USA; (email: krieger@uky.edu).
Alcohol and other drug use has been associated with traumatic brain injury both as a contributing factor to the injury and as a complicating factor for rehabilitation. Brain injury is associated with an increase in mental health and other problems that may be related to drug and alcohol abuse and that may influence recovery. This study examined self-reports of 661 drug-abusing inmates with self-reported head injury, health problems and mental health problems. Three groups were examined for this study: those having no head injury, one head injury, and two or more head injuries. Results indicate that inmates with head injuries had a significantly greater number of health problems, higher levels of alcohol and marijuana use, and significantly more mental health problems including depression, anxiety, suicidal thinking, and difficulties in concentrating and controlling violent behavior. This study suggests that questions regarding head injuries during assessment may identify drug abusers who need a treatment approach that accommodates their co-occurring problems and difficulties with processing and complying with treatment interventions.
Does community-level Australian football support injury prevention research?
- Gabbe B, Finch CF, Wajswelner H, Bennell K. J Sci Med Sport 2003; 6(2): 231-236.
Correspondence: Belinda Gabbe, Centre for Sports Medicine Research and Education, School of Physiotherapy, University of Melbourne, Victoria, AUSTRALIA; (email: b.gabbe@pgrad.unimelb.edu.au).
The progress of injury prevention research in Australian football to date has been slow despite its recognition as a public health goal. In particular, field-based studies to identify injury risk factors and evaluate the effectiveness of injury prevention strategies need to be undertaken to ensure safety gains in this sport. For these types of studies to be successful and complied with, considerable support is required from clubs, coaches and players. To date, the actual level of support for injury prevention research at the community-level of football has not been established. A survey of 82 club administrators and coaches from the Victorian Amateur Football Association was undertaken to determine the level of support for injury prevention research, along with incentives for, and barriers towards, participation in such research. The highest priorities for injury prevention research were given as the prevention of knee, hamstring and concussion injuries and investigation into the content of training programs. The most common incentives reported as being necessary for participation in injury prevention research were financial assistance (59.5%), more club staff (57.0%) and further education (36.7%). The most commonly reported barriers to research were the expertise (50.0%) and number of (48.8%) of club medical staff members. Overall community-level football club administrators and coaches rank the importance of injury prevention research highly. The findings of this study are positive for injury prevention researchers and suggest that clubs are keen to participate in such research.
Public health's response to a changed world: September 11, biological terrorism, and the development of an environmental health tracking network.
- Marmagas SW, King LR, Chuk MG. Am J Public Health 2003; 93(8): 1226-1230.
Correspondence: Susan Marmagas, Environmental and Health Program, Physicians for Social Responsibility, Washington, DC 20009, USA; (email: swest@psr.org).
Historically, the importance of public health has often been recognized during or as a result of major tragedy. The attacks that occurred in the United States in 2001 are no exception. These events have raised awareness of our vulnerability and the need for emergency preparedness, the need for a flexible and sustainable public health infrastructure, and the importance of linkages between environmental exposures and health outcomes. The authors encourage the public health community, along with policymakers, to develop a national environmental health tracking system that can improve our overall public health capacity and prepare us to investigate the critical issues of the day, whether they be emerging infectious diseases, terrorist attacks, or chronic illnesses.
The purpose of the present study was to evaluate how much cell phones and just speaking (similar to speaking to someone in the car vs a hands-free cell phone task) interfere with visual attention skills as might be required in a driving situation. Influence of cell phones on attention has been noted but little research has been completed. Licensed adult drivers were divided into three groups (ns = 15) with all subjects taking the Connors Continuous Performance Test II. Group 1 performed without any distractions: those in Group 2 performed with someone in the same room talking to them: Group 3 engaged in a cell phone conversation during the task. Overall, there were substantial differences among groups on all variables, but primarily between the control group and the two experimental groups. While the cell phone group had lower mean scores than the talking group overall, the differences were not significant. Thus, while cell phones were distracting to visual attention functions on the Connors task, they were not more distracting than a similarly active conversation without a cell phone.
Correspondence: N. J. Scheers, Office of Planning and Evaluation, the Consumer Product Safety Commission, Bethesda, Maryland, USA; (email: unavailable).
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 < or =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.
The systematic accident cost analysis (SACA) project was carried out during 2001 by The Aarhus School of Business and PricewaterhouseCoopers Denmark with financial support from The Danish National Working Environment Authority. It focused on developing and testing a method for evaluating occupational costs of companies for use by occupational health and safety professionals. The method was tested in nine Danish companies within three different industry sectors and the costs of 27 selected occupational accidents in these companies were calculated. One of the main conclusions is that the SACA method could be used in all of the companies without revisions. The evaluation of accident cost showed that 2/3 of the costs of occupational accidents are visible in the Danish corporate accounting systems reviewed while 1/3 is hidden from management view. The highest cost of occupational accidents for a company with 3,600 employees was estimated to approximately US$682,000. The paper includes an introduction regarding accident cost analysis in companies, a presentation of the SACA project methodology and the SACA method itself, a short overview of some of the results of the SACA project and a conclusion. Further information about the project is available at http://www.asb.dk/saca.
Injuries and illnesses from wood framing in residential construction, Washington State, 1993-1999.
- Shah SM, Bonauto D, Silverstein B, Foley M, Kalat J. J Occup Environ Med 2003; 45(11): 1171-1182.
Correspondence: Syed Mahboob Ali Shah, Safety and Health Assessment & Research for Prevention (SHARP), Washington State Department of Labor and Industries, Olympia, Washington 98504, USA; (email: shaq235@lni.wa.gov).
The construction industry is associated with high rates of work-related injury. We used workers compensation data to describe the injuries and illnesses, claim rates, and claim costs associated with wood framing activities in construction. From 1993 to 1999, there were 33,021 accepted state fund workers compensation claims with direct costs of over $197 million. The average annual claim rate was 45 per 100 full-time equivalent. Statistically significant downward trends were noted in claim rates for all injuries and illnesses, compensable time loss claims, eye and fall injuries. However, these trends were not statistically significantly different from those observed in all other construction risk classes combined. The information in this report can be used to guide prevention efforts and to evaluate the effectiveness of Washington state initiatives to reduce injury and illness rates in wood frame construction.
Contracting with children and helmet distribution in the emergency department to improve bicycle helmet use.
- Bishai D, Qureshi A, Cantu N, Parks C. Acad Emerg Med 2003; 10(12): 1371-1377.
Correspondence: David Bishai, Department of Population and Family Health Sciences, Johns Hopkins University, Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21030, USA; (email: dbishai@jhu.edu).
OBJECTIVES: To determine whether injury prevention counseling and behavioral counseling delivered in the emergency department (ED) could result in increases in self-reported bicycle helmet use.
METHODS: The authors undertook a trial of counseling in 222 children recruited in an urban ED between August 2000 and October 2001. All consenting patients in the ED aged 5 to 15 years who did not have life-threatening conditions were eligible. One hundred nine children were assigned to the control group on the basis of attendance on an odd-numbered day, and they received a photocopied photograph of the hospital. One hundred thirteen children were assigned to the intervention group, and they received a personal counseling session and signed a contract promising to wear their bicycle helmets. In addition, 57 of the intervention children were assigned (based on having an even-numbered birthday) to be fitted with helmets if they did not already own them. Parents were telephoned four weeks after the ED encounter for follow-up.
FINDINGS: Follow-up data were obtained for 148 children (67% follow-up rate), of whom only 69 reported riding a bicycle in the four weeks after their ED visit. Of the final sample of 69 children, 38 belonged to one of the intervention groups, and 25 of these (66%) reported always wearing a helmet while cycling during the four weeks after their ED visit, versus 13 of 31 (42%) in the control group (odds ratio, 2.66; p < 0.05). The effect of the intervention was independent of whether the children owned a helmet at baseline.
COMMENTS: Injury prevention counseling in the ED using "The Injury Prevention Program" (TIPP) sheet, behavioral contracting, and helmet distribution may have a significant effect on reports of subsequent bike helmet use.
The fatality and injury risk of light truck impacts with pedestrians in the United States.
In the United States, passenger vehicles are shifting from a fleet populated primarily by cars to a fleet dominated by light trucks and vans (LTVs). Because light trucks are heavier, stiffer, and geometrically more blunt than passenger cars, they pose a dramatically different type of threat to pedestrians. This paper investigates the effect of striking vehicle type on pedestrian fatalities and injuries. The analysis incorporates three major sources of data, the Fatality Analysis Reporting System (FARS), the General Estimates System (GES), and the Pedestrian Crash Data Study (PCDS). The paper presents and compares pedestrian impact risk factors for sport utility vehicles, pickup trucks, vans, and cars as developed from analyses of US accident statistics. Pedestrians are found to have a two to three times greater likelihood of dying when struck by an LTV than when struck by a car. Examination of pedestrian injury distributions reveals that, given an impact speed, the probability of serious head and thoracic injury is substantially greater when the striking vehicle is an LTV rather than a car.
Correspondence: Margaret O'Mahony, Department of Civil, Structural & Environmental Engineering, University of Dublin, Trinity College, Dublin 2, IRELAND; (email: margaret.omahony@tcd.ie).
The paper reports on research using a new type of pedestrian waiting countdown timer to influence pedestrian behavior at signalized pedestrian crossings in Dublin. The aim was to evaluate the impact of the timers on pedestrian crossing behavior and in particular to see if it had any impact on the number of illegal crossings (during red man -- do not walk signal). The timers inform the pedestrian how many seconds they have to wait until the green man appears. Two surveys were used to evaluate the impact: an attitude survey to evaluate the perception of the users and a video survey to estimate quantitatively the impacts on pedestrian behavior but also to evaluate the awareness levels of the pedestrians towards the countdown timers. Some of the results include observance of more compliant behavior by females and that pedestrians tend to overestimate their waiting time. Before the timers were installed 65% of pedestrians started to cross during the green man and amber phases but this rose to 76% after the timers were installed.
Pedestrian behaviors at and perceptions towards various pedestrian facilities: an examination based on observation and survey data.
Correspondence: Virginia P Sisiopiku, Department of Civil and Environmental Engineering, University of Alabama at Birmingham, Hoehn 311, 1530 3rd Avenue S., Birmingham, AL 35294-4440, USA; (email: vsisiopi@uab.edu).
This paper presents findings from an observational study of pedestrian behaviors at various urban crosswalks and a pedestrian user survey which sought pedestrian perceptions toward various pedestrian facilities in a divided urban boulevard located next to a large university campus, Michigan State University, East Lansing, MI, USA. Such facilities included signalized and unsignalized intersection crosswalks, unsignalized marked and non-striped midblock crosswalks, physical barriers (vegetation and two-foot high concrete wall), midblock crosswalk shelters, colored paving (red brick pavement) at medians and curbs, and pedestrian warning signs at midblock crossing locations, messaging "cross only when traffic clears." Pedestrian behavior data were obtained from the reduction of video images of pedestrian movements recorded throughout the study site. Pedestrian perceptions information was obtained through a user survey completed by pedestrians using the study site. It was found that unsignalized midblock crosswalks were the treatment of preference to pedestrians (83% reported a preference to cross) and also showed high crossing compliance rate of pedestrians (71.2%). It was also evident that the crosswalk location, relative to the origin and destination of the pedestrian, was the most influential decision factor for pedestrians deciding to cross at a designated location (90% said so). Proper traffic control can further encourage pedestrian crossings at designated locations since the effect of the availability of pedestrian signal to influence pedestrians' decisions to cross at a specific location was quite high (74% said so). Moreover, vegetation and concrete barriers influenced the decision to cross of a significant number of pedestrians surveyed (65%). It is expected that the findings from this study will help traffic engineers, urban planners and policy makers understand pedestrian behaviors and attitudes at/towards pedestrian crosswalks.
Potential of transferring car trips to bicycle during winter.
Correspondence: Anna Bergström, Royal Institute of Technology, Division of Highway Engineering, S-100 44, Stockholm, SWEDEN; (email: anna.bergstrom@vti.se).
In this Swedish study, the attitudes towards cycling during winter in general, and in relation to winter maintenance of cycleways in particular, is examined. Questionnaires were answered by a thousand employees at four major companies in two Swedish cities. There was a clear difference in mode choice between seasons. The number of car trips increased by 27% from summer to winter while the number of bicycle trips decreased by 47%. The number of car trips increased with distance while the number of bicycle trips decreased, and the decrease was even more significant in winter than in summer. There was a difference in opinion between different categories of cyclists, on what factors influenced the choice of transport mode for the journey to work. Temperature, precipitation, and road condition were the most important factors to those who cycled to work in summer but not in winter. Exercise was the most important to those who cycled frequently in winter, and travel time the most important to those who never cycled to work. By improving winter maintenance service levels on cycleways, it might be possible to increase the number of bicycle trips during winter by 18%, representing a corresponding decrease in the number of car trips of 6%. To increase cycling during winter, snow clearance was found to be the most important maintenance measure. Skid control was not considered as important for the choice of mode, although important to attend to for safety reasons.
A study of childhood poisoning at national poisons information center, all India institute of medical sciences, New Delhi.
- Gupta SK, Peshin SS, Srivastava A, Kaleekal T. J Occup Health 2003; 45(3): 191-196.
Correspondence: Suresh Kumar Gupta, National Poisons Information Centre, Department of Pharmacology, All India Institute of Medical Sciences, INDIA; (email: skgup@hotmail.com).
A retrospective analysis of the poisoning calls received by the National Poisons Information Centre (NPIC) showed a total of 2,720 calls during a period of three years (April 1999-March 2002). Poisoning in children was reported in 995 calls (36.6%). The age ranged from less than 1 yr to 18 yr and the age groups involved were divided into four categories (0-6 yr, >6-12 yr, >12-16 yr, >16-18 yr). The most vulnerable age group included children from less than one year to 6 yr old. Males outnumbered females (M=628, F=367). Although the accidental mode was the commonest (79.7%), intentional attempts were also noticed (20.2%) in the >12-16 yr and >16-18 yr age groups. In the majority of cases, the route was oral (96.8%) followed by dermal exposure (3.2%) comprising bites and stings. Various types of agents belonged to classes of household products (47.0%), drugs (21.8%), industrial chemicals (7.9%), agricultural pesticides (9.1%), bites and stings (3.2%), plants (1.5%), miscellaneous products (5.3%) and unknown products (4.0%). The incidence of poisoning was highest due to household products comprising mainly pyrethroids, parad/thermometer mercury, rodenticides, phenyl, detergents and corrosives, etc. Poisoning due to drugs mainly included anticonvulsants, thyroid hormones, benzodiazepines, analgesics and oral contraceptives. Among the agricultural pesticides aluminum phosphide was the most commonly consumed, followed by organochlorines and organophosphates, etc. Paint thinners were common among industrial chemicals. Bites and stings were mainly snake bites and scorpion stings. Poisoning due to plants was low and Datura was commonly ingested. Although these data may not give an exact picture of the incidence rate in our country, due to underreporting of calls to the Centre and because the actual incidence might be higher or even variable, but they do give the trend in India, indicating that a strong emphasis should be placed on a prevention campaign which can at least reduce the occurrence of accidental pediatric poisoning.
Initial impact of toll-free access on poison center call volume.
- Krenzelok EP, Mrvos R. Vet Hum Toxicol 2003; 45(6): 325-327.
Correspondence: Edward P. Krenzelok, Pittsburgh Poison Center, 3705 Fifth Avenue, Children's Hospital of Pittsburgh, Pittsburgh, PA 15213, USA; (email: krenzee@chplink.chp.edu).
Prior to the implementation of the nationwide toll-free telephone number, most poison centers already provided toll-free service; therefore, the impact of toll-free access to a poison center on call volume is difficult to assess in the majority of poison centers. This analysis examined the effect that the new nationwide toll-free telephone number had on total call volume (exposures and information calls) in a poison center without previous toll-free access and serving a large urban and rural population. All calls received by a Regional Poison Information Center (RPIC) over a consecutive 27-mo period (2000, 2001, Jan-Jun 2002) were analyzed. April 2001 was the first full month of toll-free service. Data from January-March and January-June for 2000, 2001 and 2002 served as 3 and 6-mo benchmark and study periods. The 3 and 6-mo periods for each of the 3 years were used to conduct comparative trend analysis. Over 1.1 million pieces of literature and sheets of stickers that contained the toll-free number were distributed throughout the region over the study period. Use of the toll-free number increased from 590 calls in July 2001 to 2,157 in June 2002. Total call volume increased by 11.2%. Trend analysis revealed a 9.9% increase in exposure volume when comparing 2001 and 2002 data. There was a significant increase in utilization of the toll-free number for information purposes from people residing in rural counties. Toll-free access to the RPIC increased the volume of information calls dramatically. Initial trend analysis indicated that the availability of toll-free access has reversed the erosion of exposure-related calls.
An analysis of hip dislocations among snowboarders and skiers: a 10-year prospective study from 1992 to 2002.
- Matsumoto K, Sumi H, Sumi Y, Shimizu K. J Trauma 2003; 55(5): 946-948.
Correspondence: Kazu Matsumoto, Department of Orthopedic Surgery, Gifu University School of Medicine, 40 Tsukasamachi, Gifu 500-8705, JAPAN; (email: kazu-ma@db3.so-net.ne.jp).
CONTEXT: We evaluated the types and mechanisms of hip dislocation sustained while snowboarding and skiing, a subject about which there have been few studies.
METHODS: In a prospective cohort study between 1992 and 2002, we studied 30 snowboarders and 8 skiers with hip dislocations.
FINDINGS: The incidence of dislocation with or without fracture of the hip joint in snowboarders was five times higher than in skiers (0.45 per 100,000 visits for snowboarders vs. 0.09 for skiers). The most remarkable differences between skiing and snowboarding hip injuries were that in the former there was a significantly higher incidence of anterior hip dislocation (p < 0.05) and in the latter there was a significantly higher incidence of posterior hip dislocation (p < 0.05). Furthermore, the rate of type V hip dislocation (with fracture of the femoral head) was higher in snowboarders (9 of 30 cases [30.0%]) than in skiers (1 of 8 cases [12.5%]).
COMMENTS: Hip dislocations are much more common in snowboarders than in skiers. Furthermore, the causes and types of hip dislocation differ between snowboarding and skiing.
The prevalence and predictors of helmet use by skiers and snowboarders at ski areas in western North America in 2001.
CONTEXT: Helmets may protect the heads of skiers and snowboarders. The prevalence of helmet use by these groups was estimated.
METHODS: Helmet use was observed in face-to-face surveys (N = 2,978) on sun protection at 28 ski areas in Alaska, California, Colorado, Idaho, Montana, New Mexico, Nevada, Oregon, Utah, and British Columbia (0.7% refusal rate) from January to April 2001.
FINDINGS: Helmets were worn by 12.1% (95% confidence interval [CI], 11.0-13.3) of the sample. Use was highest among guests who skied or snowboarded more frequently (fourth quartile vs. first quartile, odds ratio [OR] = 11.998 [95% CI, 6.774-21.251]; third vs. first, OR = 5.556 [95% CI, 3.119-9.896]; second vs. first, OR = 2.186 [95% CI, 1.162-4.112]), were experts (OR = 3.326 [95% CI, 1.297-8.528]), used snowboards (OR = 2.301 [95% CI, 1.731-3.058]), and were more educated (college graduate, OR = 2.167 [95% CI, 1.271-3.695]; some college, OR = 1.969 [95% CI, 1.130-3.431]).
COMMENTS: Helmet use was generally low but may be high enough by experts, snowboarders, and in the central Rocky Mountains to produce a norm stimulating further adoption.
Bullying is a relationship problem in which power and aggression are used to cause distress to a vulnerable person. To assess and address bullying and victimization, we need to understand the nature of the problem, how the problem changes with age and differs for boys and girls, the relevant risk factors (those individual or environmental indicators that may lead to bullying and victimization), and the protective factors that buffer the impact of risk. For children involved in bullying, we need to assess its extent and the associated social, emotional, psychological, educational, and physical problems. Bullying is a systemic problem; therefore, assessments of bullying need to extend beyond the individual child to encompass the family, peer group, school, and community. We recommend that assessments at each of these levels reflect the scientific research on bullying and victimization. With attention to the problems associated with bullying, we can work collectively to make schools and communities safer for children and youth.
Computerized coding of injury narrative data from the National Health Interview Survey.
- Wellman HM, Lehto MR, Sorock GS, Smith GS. Accid Anal Prev 2004; 36(2): 165-171.
Correspondence: Helen M. Wellman, Liberty Mutual Research Institute for Safety, 71 Frankland Road, 01748, Hopkinton, MA, USA; (email: helen.wellman@libertymutual.com).
OBJECTIVE: To investigate the accuracy of a computerized method for classifying injury narratives into external-cause-of-injury and poisoning (E-code) categories.
METHODS: This study used injury narratives and corresponding E-codes assigned by experts from the 1997 and 1998 US National Health Interview Survey (NHIS). A Fuzzy Bayesian model was used to assign injury descriptions to 13 E-code categories. Sensitivity, specificity and positive predictive value were measured by comparing the computer generated codes with E-code categories assigned by experts.
FINDINGS: The computer program correctly classified 4695 (82.7%) of the 5677 injury narratives when multiple words were included as keywords in the model. The use of multiple-word predictors compared with using single words alone improved both the sensitivity and specificity of the computer generated codes. The program is capable of identifying and filtering out cases that would benefit most from manual coding. For example, the program could be used to code the narrative if the maximum probability of a category given the keywords in the narrative was at least 0.9. If the maximum probability was lower than 0.9 (which will be the case for approximately 33% of the narratives) the case would be filtered out for manual review.
COMMENTS: A computer program based on Fuzzy Bayes logic is capable of accurately categorizing cause-of-injury codes from injury narratives. The capacity to filter out certain cases for manual coding improves the utility of this process.
Major findings from the Canadian incidence study of reported child abuse and neglect.
- Trocmé NM, Tourigny M, MacLaurin B, Fallon B. Child Abuse Negl 2003; 27(12): 1427-1439.
Correspondence: Nico M. Trocmé, Faculty of Social Work, University of Toronto, 246 Bloor St. West, Ont., M5S 1A1, Toronto, CANADA; (email: nico.trocme@utoronto.ca).
OBJECTIVE: To present key findings from the Canadian Incidence Study of Reported Child Maltreatment (CIS) in sufficient detail to provide a basis for international comparisons in terms of forms and severity of maltreatment and the age and sex of victims.
METHOD: A survey conducted in a random sample of 51 child welfare service areas across Canada tracked child maltreatment investigations conducted during the months of October to December 1998, produced a national sample of 7,672 child maltreatment investigations. Information was collected directly from investigating workers on child and family background, perpetrator characteristics, severity and types of maltreatment and service and court outcomes of investigations.
FINDINGS: Forty-five percent of investigations were substantiated and in a further 22% of investigations maltreatment remained suspected. Primary reasons for investigation were physical abuse (31%), sexual abuse (11%), neglect (40%), and emotional maltreatment (19%). A larger proportion of physical abuse cases are isolated incidents involving older children and are more likely to lead to injuries. Sexual abuse, neglect and emotional maltreatment involve more chronic situations with children showing signs of emotional harm. Rates of investigated and substantiated maltreatment are lower in Canada compared to the United States, but are higher than rates reported in Australia.
COMMENTS: The CIS provides much needed information for developing a better understanding of the profile and needs of children and families investigated by child welfare authorities in Canada. The study also serves as a point from which international comparisons can be made.
Cost of medications in patients admitted to a burn center.
- Cornish P, Mittmann N, Gomez M, Cartotto RC, Fish JS. Am J Clin Dermatol 2003; 4(12): 861-867.
Correspondence: P. Cornish, Department of Pharmacy, Sunnybrook and Women's College Health Sciences Centre, Toronto, Ontario, CANADA; (email: unavailable).
CONTEXT: Few studies have examined the cost associated with burn patients, and those which have been conducted have generally focused on overall hospitalization costs associated with these patients. No studies to date have examined the overall drug utilization and costs of medications used in the treatment of burn patients.
OBJECTIVE: To describe the pattern of drug utilization and associated costs for the treatment of patients admitted to the Ross Tilley Burn Centre at Sunnybrook and Women's College Health Sciences Centre, Toronto, Ontario, Canada.
METHODS: A retrospective chart review was conducted based on the medical records of 30 adult patients (>18 years old) consecutively admitted to the burn center between 1 August 1999 and 30 September 1999. Charts were examined to determine drugs administered, doses and duration of use. Medications administered in the operating room were excluded from the analysis. Drug costs were calculated using hospital acquisition costs (1999 Canadian dollars [$Can]) and medications were categorized by pharmacological class according to the American Hospital Formulary Service. Demographic information for the patients was extracted from the burn center's database. The economic analysis was performed from the perspective of the hospital burn center. A descriptive statistical analysis was completed for all variables; the Pearson correlation coefficient was used to examine the relationship between certain variables. A sensitivity analysis was conducted to examine the impact of patient subgroups on certain variables.
FINDINGS: Of the 28 patients included in the analysis, 19 were admitted with acute burn injuries, two with toxic epidermal necrolysis and seven for post-burn reconstructive surgery. Patients admitted for acute burns or toxic epidermal necrolysis had the highest associated drug costs. On average, patients received 13 different drugs representing four different pharmacological categories. The mean daily drug cost per patient was $Can18.39 and the mean expenditure per admission was $Can792.97. Opioid analgesics and sedatives accounted for the largest expenditure (50.9%), followed by anti-infective agents (23.4%). For patients admitted with acute burns, there was a good correlation between daily drug costs and mortality risk (r = 0.82, p < 0.001). The findings from this study group were used to extrapolate annual expenses for medications in the burn center and these were estimated to exceed $Can280 300 in 2003.
COMMENTS: The findings of this retrospective analysis serve to elucidate the patterns of drug utilization within a population of burn patients and confirm the significant impact of a burn center on an institution's drug expenditure.
Firearm-related mortality: a review of four hundred-forty four deaths in Diyarbakir, Turkey between 1996 and 2001.
- Goren S, Subasi M, Tirasci Y, Kemaloglu S. Tohoku J Exp Med 2003; 201(3): 139-145.
Correspondence: Süleyman Gören, Department of Forensic Medicine, Faculty of Medicine, Dicle University, Diyarbakir, TURKEY; (email: sgoren@dicle.edu.tr).
The current study is based on a retrospective investigation of firearm deaths in Diyarbakir, which were autopsied by the Diyarbakir Branch of the Council of Forensic Medicine during the 6- year period. Four hundred-forty four deaths were investigated from January 1996 through December 2001, including homicide (296 cases, 66.7%), suicide (120 cases, 27%) and accidental shootings (28 cases, 6.3%). The age range of all firearm deaths in the study period was 5 to 75 years with a median age of 29.8 years. The majority were in the groups aged 16-25 years (38.7%). In the homicide group, 248 subjects (83.8%) were male, and 48 (16.2%) were female. The 31.1% of the homicide victims were in the group aged at 20-30 years. Of the 120 suicide victims, 56 (46.7%) were in the group aged 16-20 years. The head was by far the favored site, accounting for 82 (68.3%) deaths: entry wounds in the right temple accounted for 72 of these. Twenty-eight cases were accidental shootings and 18 of them were male (64.3%). Twelve of the 28 accidental victims (42.9%) were in the group aged 0-10 years. The eight cases were due to their own accidental shootings, and the remaining 20 cases were shot by others. Our findings show that the contributing factors for increasing death by firearm are terrorists' activities, traditional habits of obtaining and using guns and blood feuds.
Assessment of factors affecting the validity of self-reported health-risk behavior among adolescents: evidence from the scientific literature.
- Brener ND, Billy JO, Grady WR. J Adolesc Health 2003; 33(6): 436-457.
Correspondence: Nancy D. Brener, Division of Adolescent and School Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, (N.D.B.), Atlanta, Georgia, USA; (email: nad1@cdc.gov).
We reviewed the existing empirical literature to assess cognitive and situational factors that may affect the validity of adolescents' self-reports of alcohol and other drug use, tobacco use, behaviors related to unintentional injuries and violence, dietary behaviors, physical activity, and sexual behavior. Specifically, we searched for peer-reviewed journal articles published in 1980 or later that examined the factors affecting self-report of the six categories of behavior listed above. We also searched for studies describing objective measures for each behavior. Self-reports of each of six types of health-risk behaviors are affected by both cognitive and situational factors. These factors, however, do not threaten the validity of self-reports of each type of behavior equally. The importance of assessing health-risk behaviors as part of research activities involving adolescents necessitates the use of self-report measures. Researchers should familiarize themselves with the threats to validity inherent in this type of assessment and design research that minimizes these threats as much as possible.
Risk perception in a developing country: the case of Chile.
Correspondence: Luis A. Cifuentes, Departamento de Ingeniería Industrial y de Sistemas, Pontificia Universidad Católica de Chile, Santiago, CHILE; (email: lac@ing.puc.cl).
In this work we characterize risk perception in Chile, based on the psychometric paradigm, exploring the difference between perceived social and personal risk. For this purpose, we conducted a survey including 54 hazards, 16 risk attributes, and 3 risk constructs. The survey, divided into four parts, was administered to 508 residents of Santiago, Chile. Using factor analysis, three main factors, which accounted for 80% of the sample's variance, were identified: factor 1, commonly called "Dread Risk" in the literature, explained 37% of variance; factor 2, "Unknown Risk," explained 28%; and factor 3, which we called "Personal Effect," explained 15% of the variance. On average, individuals perceived themselves as less exposed to risk and with more control and knowledge about them than the general population. OLS regression models were used to test the association of perceived risk with the three main factors. For social risk, factor 1 had the greatest explanatory power, while factor 2 had a negative sign. For personal risk, only factors 2 and 3 were significant, with factor 3 having the greatest explanatory power. Risk denial (defined as the difference between perceived personal and social risk) was associated with factors 1 and 2 only, with factor 2 having a negative sign. The difference between desired and actual regulation levels proved positive for all hazards, thus indicating that Chileans are dissatisfied with the current regulation level for all the hazards analyzed. The comparison of data at the aggregate and at the individual subject's level suggests that while the aggregate analysis overestimates the magnitude of the correlations it still reflects the tendency of the individual responses.
The knowledge and attitude of rural children about poisonings.
- Mandiracioglu A, Bayik A, Luleci E. Vet Hum Toxicol 2003; 45(6): 331-334.
Correspondence: Aliye Mandiracioglu, Department of Public Health, Ege University, Faculty of Medicine, Bornova, Izmir, TURKEY; (email: mandirac@med.ege.edu.tr).
Childhood poisonings are an important problem. The goal of the study was to implement and evaluate poisoning prevention training for primary school students. The study was carried out in 3 rural schools Kemalpasa, Izmir, Turkey. Fourth and 5th grade students completed age appropriate questionnaires pre- and post-education. There were significant differences in mean scores of the knowledge responses given pre- and post-test (p<0.05). with more questions answered correctly post-education.
The authors report preliminary findings of a national survey on school violence in Israel. The national representative sample was stratified on school type--elementary, middle, and high schools--and ethnicity--Jewish and Arab students. A total of 15,916 students from 603 classes and 232 schools participated in the study, resulting in a 91 percent response rate. Findings revealed high rates of violence in all areas and among all age groups, but relatively higher rates of low-level violent behaviors and lower rates of more severe violent events. The authors report on age-related, gender, and cultural differences and discuss social workers' roles in shaping national policy and professional discourse on school violence.
The purpose of this study was to assess the nature and extent of student attitudes toward bullying. We investigated the consistency and prevalence of student attitudes across gender, race, socioeconomic status, and grade level. We also assessed whether students with positive attitudes toward peer aggression and students with higher trait anger were especially prone to support a normative structure that encourages bullying. Based on a data set including 6 middle schools and over 2,400 students, our results indicate that a culture of bullying is a pervasive phenomenon among middle school students and should be an important consideration in bullying prevention efforts.
What have we learned from Columbine: the impact of the Self-System on suicidal and violent ideation among adolescents.
This study first examined a model of the predictors and mediators of both suicidal ideation and violent ideation, particularly since both types of ideation were highly correlated (r=.55) among our young adolescent participants. The variables in the model were those identified in media accounts of the histories of the 10 high-profile school shooting cases, and that have also been included in our earlier model of the predictors of suicidal ideation, which we expanded to include violent ideation. Perceptions of competence or adequacy and social support from peers and parents predicted two mediators in the model, an adjustment/depression composite (self-esteem, hope to hopelessness, and affect, along a continuum from cheerful to depressed) and anger-induced physical aggression. These variables, in turn, predicted both suicidal and violent ideation. Secondly, we examined adolescents' reactions to vignettes that described harassing events, at the hands of peers and teachers simulating the type of audience-observed ridicule experienced by the school shooters. We were particularly interested in the emotional reaction of humiliation, an effect that has received surprisingly little attention in the emotion literature. Humiliation was related to other emotions such as anger and depression, consistent with the co-occurrence of internalizing and externalizing symptoms demonstrated in the overall model. Next we compared those who reported that they would respond violently to the events in vignettes compared to those reporting nonviolent reactions. Examining the variables in the general model, those who reported violent ideation reported markedly lower perceptions of adequacy, lower levels of social support, lower self-esteem, greater hopelessness, depressed affect, and anger-induced aggression. The violent ideators also reported higher levels of both homicidal and suicidal ideation. Discussion focused on the fact that thoughts of violence toward others as well as toward the self have similar psychosocial origins that should be considered in the prevention and intervention efforts.
The paper discusses the results of extensive measurements of drivers' stopping behavior during signal programs with and without flashing green before amber. Ten locations in Switzerland, Austria, and Germany were recorded with a video camera and analyzed using an image-processing system. About 5000 cycles were documented. The analysis shows that the flashing green increases the number of early stops, as drivers tend to underestimate the duration of the time to the end of amber. Discrete choice models of the stopping behavior are estimated for inclusion in suitable microsimulation models of traffic flow. The model results show that speed and distance to stop line, and their interaction (potential time to the stop line with unchanged speed) explain the stopping process.
Visual impairment and unintentional injury mortality: the national health interview survey 1986-1994.
- Lee DJ, Gomez-Marin O, Lam BL, Zheng DD. Am J Ophthalmol 2003; 136(6): 1152-1154.
Correspondence: David J. Lee, Department of Epidemiology and Public Health (D.J.L., O.G.M., D.D.Z.), University of Miami School of Medicine, Miami, Florida, USA; (email: d.lee1@miami.edu).
The objective of this study was to examine the relationship between reported visual impairment and unintentional injury mortality. Mortality linkage through 1997 of 116,796 adult participants, aged 18 years and older, from the 1986 to 1994 National Health Interview Survey was analyzed with respect to reported visual impairment using Cox regression models. The average follow-up was 7.0 years, and 295 unintentional injury deaths were identified. After controlling for survey design, age, sex, and the presence and number of eye diseases, participants with severe, bilateral visual impairment were at increased risk of death relative to participants without visual impairment (hazard ratio: 7.4; 95% confidence interval: 3.0-17.8). Our data provide evidence that severe, bilateral visual impairment is associated with an increased risk of unintentional mortality among adults in the United States.
Deliberate self-harm in adolescents: a study of characteristics and trends in Oxford, 1990-2000.
- Hawton K, Hall S, Simkin S, Bale L, Bond A, Codd S, Stewart A. J Child Psychol Psychiatry 2003; 44(8): 1191-1198.
Correspondence: Keith Hawton, Centre for Suicide Research, University of Oxford Department of Psychiatry, Warneford Hospital, Headington, Oxford, UK; (email: keith.hawton@psych.ox.ac.uk).
CONTEXT: Deliberate self-harm (DSH) is a major healthcare problem in adolescents. Identification of targets for prevention and treatment requires ongoing monitoring of trends and characteristics of those involved.
METHOD: Using data from the Oxford Monitoring System for Attempted Suicide, we have examined trends and characteristics in adolescents aged 12-18 years presenting to a general hospital because of DSH between 1990 and 2000.
FINDINGS: The numbers of presentations by females increased during the study period. An association of DSH with school stress was suggested by there being fewer presentations during the school holiday periods, the largest number in term times occurring on Mondays, and study problems being common. Self-poisoning was involved in more than 90% of episodes. Paracetamol overdoses decreased following legislation on pack sizes of analgesics. Antidepressant overdoses increased during the study period, in keeping with the rise in prescriptions. Drug misuse increased markedly in the boys, as did a history of violence to others. Being a victim of violence increased in girls. Suicide intent was higher in males. Problems faced by the adolescents showed marked gender differences, and differed between age groups and between those carrying out their first DSH episode and repeaters.
COMMENTS: Clinical management of DSH in adolescents requires a range of responses, often involving multiservice and multidisciplinary input. Preventive initiatives in schools are also required.
The 2001 National Household Travel Survey (NHTS) confirms most of the same travel trends and variations among socioeconomic groups documented by its predecessors, the Nationwide Personal Transportation Surveys (NPTS) of 1969, 1977, 1983, 1990, and 1995. The private car continues to dominate urban travel among every segment of the American population, including the poor, minorities, and the elderly. By comparison, public transport accounts for less than 2% of all urban travel. Even the lowest-income households make only 5% of their trips by transit. The most important difference in the 2001 NHTS is the doubling in modal share of walk trips in cities, due to a much improved survey technique that captured previously unreported walks. While the private car dominates travel, there are important variations in auto ownership and travel behavior by income, race, ethnicity, sex, and age. Overall, the poor, racial and ethnic minorities, and the elderly have much lower mobility rates than the general population. Moreover, the poor, blacks, and Hispanics are far more likely to use transit than other groups. Indeed, minorities and low-income households account for 63% of the nation's transit riders. Different socioeconomic groups also have different rates of carpooling, taxi use, bicycling, and walking. In addition, they travel different distances and at different times of day. Many of these socioeconomic variations in travel behavior have important consequences for public policy.
Passenger seating position and the risk of passenger death or injury in traffic crashes.
- Smith KM, Cummings P. Accid Anal Prev 2004; 36(2): 257-260.
.
Correspondence: Kathleen M. Smith, Department of Emergency Medicine, Mary Bridge Children's Hospital, 315 Martin Luther King Jr. Way, 98405-0987, Tacoma, WA, USA; (email: kaths@u.washington.edu).
OBJECTIVE: To estimate the association of passenger seat position with the risk of death and serious injury for passengers in traffic crashes.
METHODS: Using 1993-2000 data from the National Highway Traffic Safety Administration's Crashworthiness Data System (CDS), the risk ratio for death and serious injury was estimated for rear seat passengers compared with front seat passengers in motor vehicle crashes.
FINDINGS: The adjusted risk ratio for death of passengers in the rear seat in a crash was 0.61 (95% confidence interval (CI) 0.46-0.81). Rear seat passenger position was also associated with a decrease in the risk of death and serious injury compared with the front seat passenger position: risk ratio=0.67 (95% CI 0.57-0.78).
COMMENTS: We estimated that the rear seat passenger position may reduce the risk of death in a motor vehicle crash by about 39% and reduce the risk of death or serious injury in a crash by 33%, compared with the front seat passenger position. If the associations that we report are causal, sitting in the rear seat, compared with the front seat, may prevent about 4 in 10 passenger deaths, or 3 in 10 passenger deaths and injuries, that might otherwise occur.
Effect of repeal of the national maximum speed limit law on occurrence of crashes, injury crashes, and fatal crashes on Utah highways.
- Vernon DD, Cook LJ, Peterson KJ, Michael Dean J. Accid Anal Prev 2004; 36(2): 223-239.
.
Correspondence: Donald D. Vernon, University of Utah, 615 Arapeen Drive, 410 Chipeta Way, Suite 222, 84108-1284, Salt Lake City, UT, USA; (email: don.vernon@hsc.utah.edu).
Speed limits were increased in Utah and other States after repeal of the national maximum speed limit law (NMSL) in 1995. This study analyzed effects of the increased speed limit on Utah highways on crash rates, fatality crash rates, and injury crash rates. Annual (1992-1999) rates of crashes, fatality crashes, and injury crashes for the following highway categories were calculated: urban Interstate segments (current speed limit 60-65miles per hour (mph)); rural Interstate segments (current speed limit 70-75mph); 55mph rural non-Interstate highway segments; and high-speed non-Interstate highways (current speed limit 60-65mph). Data were analyzed using autoregressive integrative moving average intervention time series analysis techniques. There were significant increases in total crash rates on urban (60-65mph) Interstate segments (confounded by extensive ongoing highway construction on these highways), and in fatal crash rates on high-speed (60-65mph) rural non-Interstate segments. The following variables were unaffected: total, fatality, and injury crash rates on rural Interstate segments; fatality and injury crash rates on urban Interstate segments; total and injury crash rates on high-speed non-Interstate segments. These results show an adverse effect on crash occurrence for subsets of crash types and highways, but do not show a major overall effect of NMSL repeal and increased speed limit on crash occurrence on Utah highways.
Differences in male and female injury severities in sport-utility vehicle, minivan, pickup and passenger car accidents.
.
Correspondence: Fred L. Mannering, Department of Civil and Environmental Engineering, University of Washington, 98195-2700, Seattle, WA, USA; (email: flm@purdue.edu).
This research explores differences in injury severity between male and female drivers in single and two-vehicle accidents involving passenger cars, pickups, sport-utility vehicles (SUVs), and minivans. Separate multivariate multinomial logit models of injury severity are estimated for male and female drivers. The models predict the probability of four injury severity outcomes: no injury (property damage only), possible injury, evident injury, and fatal/disabling injury. The models are conditioned on driver gender and the number and type of vehicles involved in the accident. The conditional structure avoids bias caused by men and women's different reporting rates, choices of vehicle type, and their different rates of participation as drivers, which would affect a joint model of all crashes. We found variables that have opposite effects for the genders, such as striking a barrier or a guardrail, and crashing while starting a vehicle. The results suggest there are important behavioral and physiological differences between male and female drivers that must be explored further and addressed in vehicle and roadway design.
The mobility and accessibility expectations of seniors in an aging population.
Correspondence: David A. Hensher, Institute of Transport Studies, The University of Sydney, Faculty of Economics and Business, Sydney, NSW 2006, AUSTRALIA; (email: davidh@its.usyd.edu.au).
Populations of post-industrial nations are aging. With a growing number of people living well into their 80s and maintaining active lives, the transportation system will have to start focusing more closely on understanding their mobility and accessibility needs, so as to ensure that specific requirements of this large segment are not being ignored through the promotion of traditional `solutions' and historical assumptions. This paper takes a close look at the evidence on the mobility needs and travel patterns of individuals over 64, distinguishing between the "young" elderly (aged 65-75 years) and the "old" elderly (over 75 years). This distinction is particularly useful in recognizing the threshold of health change that impacts in a non-marginal way on mobility needs. This distinction also focuses transport planning and policy on a commitment to understanding the different needs of these sub-groups of the population, identifying services and facilities that better cater for these groups. We review the evidence, in particular, on the mobility characteristics of the over 75 years age group, including how they secure support through migration and settlement patterns. We use the empirical evidence from a number of western nations to identify the role of conventional and specialized public transport as an alternative to the automobile in meeting mobility and accessibility needs.
Improving older driver knowledge and self-awareness through self-assessment: the driving decisions workbook.
- Eby DW, Molnar LJ, Shope JT, Vivoda JM, Fordyce TA. J Saf Res 2003; 34(4): 371-381.
Correspondence: David W. Eby, Transportation Research Institute, University of Michigan, 2901 Baxter Road, Ann Arbor, MI 48109-2150, USA; (email: eby@umich.edu).
OBJECTIVES: This study aims to assess whether the Driving Decisions Workbook, a self-assessment instrument for older drivers, increased self-awareness and general knowledge. This study also assessed perceptions regarding its usefulness, particularly as a tool for facilitating discussions within families of older drivers. A secondary purpose of the study was to determine if problems identified by drivers in the workbook related to problems they had with actual driving.
METHODS: The Driving Decisions Workbook was administered along with a questionnaire and a road test. A convenience sample of 99 licensed drivers aged 65 and above was used.
FINDINGS: After completing the workbook, about three fourths of the participants reported being more aware of changes that could affect driving. Fourteen percent reported that they had discovered a change in themselves of which they had not been previously aware. All respondents found the workbook to be at least a little useful and thought the workbook could help facilitate family discussions. Workbook responses were positively correlated with overall road test scores. Significant correlations were also noted between the road test and a majority of workbook subsection responses.
COMMENTS: This study indicates that the workbook may be a useful first-tier assessment instrument and educational tool for the older driver. It may encourage an older driver to drive more safely and/or to seek clinical assessment, and help in facilitating discussions about driving within their families.
Deconstructing a gender difference: Driving cessation and personal driving history of older women.
- Hakamies-Blomqvist L, Siren A. J Saf Res 2003; 34(4): 371-381.
Correspondence: Liisa Hakamies-Blomqvist, Department of Psychology, University of Helsinki, P.O. Box 9, Helsinki 00014, FINLAND; (email: liisa.hakamies-blomqvist@vti.se
OBJECTIVES: The purpose of this study is to understand the reasons behind older women's driving cessation by comparing the driving histories of Finnish women who either gave up or renewed their drivers license at the age of 70.
METHODS: A mail survey was sent to all Finnish women born in 1927 who gave up their license in 1997 (N=1,476) and to a corresponding random sample of women who renewed their license (N=1,494). The total response rate was 42.1%.
FINDINGS: The length and level of activity of personal driving history were strongly associated with driving cessation and continuation. Ex-drivers tended to have an inactive driving career behind them, whereas drivers had a more active personal driving history. In addition, those women with an active, "male-like" driving history who had decided to stop driving gave reasons for driving cessation that were similar to what is known about older men's reasons to give up driving. The results suggest that the decision to stop driving is related to driving habits rather than gender.
Correspondence: Anna C. Baldry, Department of Social Psychology, University of Rome La Sapienza, Via dei Marsi, 78, 00185 Rome, ITALY; (email: Anna.Baldry@uniroma1.it).
OBJECTIVES: The study aimed to investigate the relationship between bullying and victimization in school and exposure to interparental violence in a nonclinical sample of Italian youngsters.
METHODS: A cross-sectional study was conducted with a sample of 1059 Italian elementary and middle school students. Participants completed a self-report anonymous questionnaire measuring bullying and victimization and exposure to interparental violence. The questionnaire also included measures on parental child abuse and socio-demographic variables.
FINDINGS: Almost half of all boys and girls reported different types of bullying and victimization in the previous 3 months, with boys more involved than girls in bullying others. Exposure to interparental physical violence and direct bullying were significantly associated especially for girls: girls exposed to father's violence against the mother and those exposed to mother's violence against the father were among the most likely to bully directly others compared with girls who had not been exposed to any interparental violence. Hierarchical multiple regression analyses revealed that bullying and victimization were predicted by exposure to interparental violence, especially mother-to-father violence, over and above age, gender, and child abuse by the father.
COMMENTS: Exposure to interparental violence is associated with bullying and victimization in school, even after controlling for direct child abuse. Violence within the family has detrimental effects on the child's behavior; schools, in this regard, can play a fundamental role in early detection of maladjustment.
Experiences of seeking help from health professionals in a sample of women who experienced domestic violence.
Correspondence: L. Bacchus, St George's Hospital Medical School, Department of Forensic Psychiatry, London, UK and St Thomas' Hospital, Women's Services Directorate Office, London, UK; (email: unavailable).
The present paper describes a qualitative study of women who suffered domestic violence. The aim was to explore their experiences of seeking help from health professionals and assess their psychological health. Purposive sampling was used to select a subsample from a larger sample of women who were screened for domestic violence as part of a study undertaken at Guy's and St Thomas' Hospitals in London, UK. In-depth, semi-structured interviews were conducted with the subsample of women during the postpartum period (up to 14 months). Interviews were conducted in women's homes and general practitioners' (GPs) surgeries. The sample consisted of 10 women who had experienced domestic violence in the past 12 months (including the current pregnancy), and six women who had experienced domestic violence in the past 12 months but not the current pregnancy. The main outcome measures included: women's experiences of seeking help from health professionals; and assessment for postnatal depression, post-traumatic stress disorder (PTSD) and psychological distress. Women scored highly on measures of postnatal depression and PTSD. With regard to seeking help, there was a tendency for women to regard GPs, and accident and emergency staff as less helpful compared with health visitors in responding to domestic violence. Lack of privacy, continuity of care and time constraints were dominant themes which emerged from women's contacts with health professionals. Very few women voluntarily disclosed domestic violence to a health professional and even fewer were asked directly about domestic violence by one. It is important for health professionals to enquire about domestic violence in a sensitive manner and provide a response that takes into accounts the complexity of women's needs. Domestic violence training is necessary to equip health professionals with the knowledge and skills they need to respond to domestic violence more effectively.
Prevalence of children's exposure to domestic violence and child maltreatment: implications for prevention and intervention.
Correspondence: Joy D. Osofsky, Department of Psychiatry, Louisiana State University Health Sciences Center, 1542 Tulane Avenue, New Orleans, Louisiana 70112, USA; (email: josofs@lsuhsc.edu).
The purpose of this paper is to review research on the prevalence of children's exposure to domestic violence, to consider the available literature on the co-occurrence of domestic violence and child maltreatment, and to gain more understanding about the impact of exposure on children. There is clear evidence indicating that both severe and moderate violence occurs frequently in homes among family members and that children are exposed to this violence. However, because of differing definitions of what constitutes domestic violence and variability in research methodologies for collecting the data, there are significant discrepancies in prevalence reports across studies. Of great concern is the immediate impact on the children and the long-term consequences for their later relationships. Fewer studies have been done on the co-occurrence of domestic violence and child maltreatment. However, it is likely that children who live in homes where domestic violence occurs are more likely to be abused and neglected. On the basis of available research, there is little doubt that vast numbers of children are exposed to domestic violence and that children's responses vary widely depending on their risk and vulnerability, as well as the structure of their environments A developmental risk and protective factors framework will be used to integrate the information on children's exposure to violence.
