Correspondence: Olaf H. Drummer, Department of Forensic Medicine, Victorian Institute of Forensic Medicine, Monash University, 57-83 Kavanagh Street, Vic. 3006, Southbank, AUSTRALIA; (email: olaf.drummer@med.monash.edu.au).
A multi-center case-control study was conducted on 3398 fatally-injured drivers to assess the effect of alcohol and drug use on the likelihood of them being culpable. Crashes investigated were from three Australian states (Victoria, New South Wales and Western Australia). The control group of drug- and alcohol-free drivers comprised 50.1% of the study population. A previously validated method of responsibility analysis was used to classify drivers as either culpable or non-culpable. Cases in which the driver "contributed" to the crash (n=188) were excluded. Logistic regression was used to examine the association of key attributes such as age, gender, type of crash and drug use on the likelihood of culpability. Drivers positive to psychotropic drugs were significantly more likely to be culpable than drug-free drivers. Drivers with Delta(9)-tetrahydrocannabinol (THC) in their blood had a significantly higher likelihood of being culpable than drug-free drivers (odds ratio (OR) 2.7, 95% CI 1.02-7.0). For drivers with blood THC concentrations of 5ng/ml or higher the odds ratio was greater and more statistically significant (OR 6.6, 95% CI 1.5-28.0). The estimated odds ratio is greater than that for drivers with a blood alcohol concentration (BAC) of 0.10-0.15% (OR 3.7, 95% CI 1.5-9.1). A significantly stronger positive association with culpability was seen with drivers positive to THC and with BAC >/=0.05% compared with BAC >/=0.05 alone (OR 2.9, 95% CI 1.1-7.7). Strong associations were also seen for stimulants, particularly in truck drivers. There were non-significant, weakly positive associations of opiates and benzodiazepines with culpability. Drivers positive to any psychoactive drug were significantly more likely to be culpable (OR 1.8, 95% CI 1.3-2.4). Gender differences were not significant, but differences were apparent with age. Drivers showing the highest culpability rates were in the under 25 and over 65 age groups.
It has been argued that developing community projects is an effective means by which to reduce injury. Two pilot community injury prevention projects (CIPPs) were established in small communities in New Zealand based on the World Health Organization (WHO) Safe Community model. The process and impact of the implementation of these CIPPs was monitored over 3 years. The setting was two small New Zealand communities with populations of <10,000. An external process and impact evaluation was conducted, with data gathered from written documentation, informant interviews and observation. The WHO Safe Community criteria formed the basis of the evaluation framework used. Other essential factors included were identified through the literature and the projects themselves. Findings from each CIPP were considered independently, followed by an examination of the differences observed. The findings from the evaluation of the implementation of these CIPPs are reported in relation to the themes identified in the evaluation framework, namely: community context, ownership and participation, focus and planning, data collection, leadership, management, sustainability and external links. Despite the different contexts, a common conclusion was that if the CIPPs' success was dependent on achieving a meaningful reduction of injury, they were unlikely to succeed. There were, however, a number of strategies and outputs for achieving change that could contribute to increasing safety for the population of interest. These were closely linked to community development strategies and needed greater acknowledgement in the evolution of the CIPPs. Critical to the development of the CIPPs were community capacity and the context in which the projects were operating. These conclusions are likely to apply to other projects in such settings, irrespective of the health outcomes sought.
Seismic, structural, and individual factors associated with earthquake related injury.
- Peek-Asa C, Ramirez M, Seligson H, Shoaf K. Inj Prev 2003; 9(1): 62-66.
Correspondence: Corinne Peek-Asa, Iowa Injury Prevention Research Center, University of Iowa College of Public Health, Iowa City, Iowa 52242-5000, USA; (email: corinne-peek-asa@uiowa.edu).
CONTEXT: Earthquakes cause thousands of deaths worldwide every year, and systematic study of the causes of these deaths can lead to their prevention. Few studies have examined how multiple types of risk factors are related to physical injury during an earthquake.
METHODS: A population based case-control study was conducted to examine how individual characteristics, building characteristics, and seismic features of the 1994 Northridge, California, earthquake contributed to physical injury. Cases included fatal and hospital-admitted injuries caused by the earthquake. Controls were drawn from a population based phone survey of county residents. Cases were individually matched to two sets of controls: one matched by age and gender and one matched by location at the time of the earthquake.
FINDINGS: Individuals over age 65 had 2.9 times the risk of injury as younger people (95% confidence interval (CI) 1.2 to 7.4) and women had a 2.4 times greater risk than men (95% CI 1.2 to 5.1). Location in multiple unit residential and commercial structures each led to increased injury risk compared with single unit residential structures, but the exact estimate varied depending on the control group used. With every increase in ground motion of 10%g, injury risk increased 2.2 times (95% CI 1.6 to 3.3).
COMMENTS: Controlling for other factors, it was found that individual, building, and seismic characteristics were independently predictive of increased injury risk. Prevention and preparedness efforts should focus on each of these as potential points of intervention.
The Bristol Stress and Health Study: accidents, minor injuries and cognitive failures at work.
- Wadsworth EJ, Simpson SA, Moss SC, Smith AP. Occup Med (Lond) 2003; 53(6): 392-397.
Correspondence: Emma J. Wadsworth, Centre for Occupational and Health Psychology, Cardiff University, 63 Park Place, Cardiff CF10 3AS, UK; (email: wadsworthej@cardiff.ac.uk).
CONTEXT: Accidents and injuries at work account for several million working days lost each year. Cognitive failures (problems of memory, attention or action) can lead to accidents and injuries in certain contexts.
OBJECTIVE: This work describes the prevalence and associations of workplace accidents, minor injuries and cognitive failures reported by respondents to a follow-up postal questionnaire as part of the community-based Bristol Stress and Health Study.
METHODS: Postal questionnaires were sent to 4673 people who participated in the first phase of the study (in which questionnaires were sent to individuals selected at random from the electoral roll).
FINDINGS: Four per cent of workers reported an accident at work, 8% reported quite or very frequent minor injuries and 13% reported quite or very frequent cognitive failures. Accidents at work were associated with being male, smoking and higher negative job characteristics. Respondents reported workplace accidents at a level similar to the overall UK rate. Accidents and minor injuries, and minor injuries and cognitive failures, shared common associations and all three outcomes were associated with each other.
COMMENTS: Information about cognitive failures is important in the study of accidents and injuries at work. In addition, negative job characteristics represent part of the context in which human error is translated into injury.
- Purvis JM, Hirsch SA. Clin Orthop 2003; (409): 11-19.
Correspondence: John Purvis, Pediatric Orthopaedic Specialists of Mississippi, and the University of Mississippi Medical School, Jackson, MS 39202, USA; (email: jpurvis@mbmc.org).
Playground safety recently has received increasing attention from parents and municipalities. Orthopaedic surgeons treat a large number of the more than 350,000 injuries per year sustained on the play areas of this country's school, home, and community play areas. A parent brings a child to the playground for fun, healthy exercise, and imaginative play. Unfortunately, most parents may not be aware of recommended injury prevention methods. Data from the Consumer Product Safety Commission and other epidemiologic studies document frequency, identify at-risk activities and equipment, give direction for additional research, and guide regulations. It is appropriate for the medical community to lead in this safety effort and to contribute to additional research and advocacy efforts.
Rates of At-risk Drinking among Patients Presenting to the Emergency Department with Occupational and Nonoccupational Injury.
- McLean SA, Blow FC, Walton MA, Gregor MA, Barry KL, Maio RF, Knutzen SR. Acad Emerg Med 2003; 10(12): 1354-1361.
Correspondence: Samuel A. McLean, University of Michigan Department of Emergency Medicine, TCB 1354 Taubman Center Box 0303, 1500 E. Medical Center Drive, Ann Arbor, MI 48109-0303, USA; (email: samclean@umich.edu).
OBJECTIVES: To compare the characteristics and rates of at-risk drinking among patients presenting to the emergency department (ED) with occupational and nonoccupational injury.
METHODS: Cross-sectional survey of injured patients presenting to a university hospital ED. Injured patients were prospectively identified, and consenting patients completed a survey including questions regarding quantity/frequency of alcohol use, TWEAK, CAGE, and work-relatedness of injury. Major trauma and motor-vehicle collisions were excluded. Demographic and injury information was obtained from the medical record. Patients with a TWEAK score ≥ 3, CAGE score ≥ 2, or who exceeded NIAAA quantity/frequency guidelines were defined as at-risk drinkers. Analysis utilized the Student t-test for continuous variables, and frequency and chi-square analysis for categorical variables.
FINDINGS: Among 3,476 enrolled patients, 766 (22%) had work injuries and 2,710 (78%) had nonwork injuries. Patients with work injuries were as likely as patients with nonwork injuries to be at-risk drinkers; 35% of patients with an occupational injury and 36% of those with a nonoccupational injury were at-risk drinkers (odds ratio = 0.96).
COMMENTS: Patients presenting to the ED with an occupational injury have rates of at-risk drinking similar to other injury patients, and may be an important group in which to target brief alcohol interventions.
Relationships of job and some individual characteristics to occupational injuries in employed people: a community-based study.
- Bhattacherjee A, Chau N, Sierra CO, Legras B, Benamghar L, Michaely JP, Ghosh AK, Guillemin F, Ravaud JF, Mur JM. J Occup Health 2003; 45(6): 382-391.
Correspondence: Ashis Bhattacherjee, Department of Mining Engineering, Indian Institute of Technology at Kharagpur, Kharagpur - 721302, West Bengal, INDIA; (email: ashisb@mining.iitkgp.ernet.in).
This study assessed the associations of job and some individual factors with occupational injuries among employed people from a general population in north-eastern France; 2,562 workers were randomly selected from the working population. A mailed auto-questionnaire was filled in by each subject. Statistical analysis was performed with loglinear models. The annual incidence rate of at least one occupational injury was 4.45%. Significant contributing factors for occupational injuries were job category (60.8%), sex (16.2%), regular psychotropic drug use (8.5%), age groups (7.5%), and presence of a disease (7.0%). The men had higher risk than the women (adjusted odds-ratio 1.99, 95% CI 1.43-2.78). Compared to executives, intellectual professionals and teachers, labourers had the highest risk (6.40, 3.55-11.52). They were followed by farmers, craftsmen and tradesmen (6.18, 2.86-13.08), technicians (3.14, 1.41-6.70), employees (2.94, 1.59-5.48) and other subjects (3.87, 1.90-7.88). The young (</=29 yr) showed an increased risk. Similar odds-ratios were observed for regular psychotropic drug use (1.54, 1.16-2.05) and the presence of a disease (1.50, 1.11-2.02). Univariate analysis showed that smoking habit, overweight and excess alcohol use were also associated with injuries. The loglinear model results showed that there were associations between some of these independent factors. It was concluded that job, sex, young age, smoking habit, excess alcohol use, overweight, psychotropic drug use, and disease influenced the occupational injuries. Preventive measures concerning work conditions, risk assessment and job knowledge should be conducted in overall active population, especially in men, young workers, smokers, alcohol users, overweight workers and in individuals with a disease or psychosomatic disorders.
How to keep children safe in traffic: find the dare-devils early.
- Hoffrage U, Weber A, Hertwig R, Chase VM. J Exp Psychol Appl 2003; 9(4): 249-260.
Correspondence: Ulrich Hoffrage, Max Planck Institute for Human Development, Center for Adaptive Behavior and Cognition, Berlin, GERMANY; (email: hoffrage@mpib-berlin.mpg.de).
Crossing the street in front of oncoming vehicles poses serious danger to young children. But is each young pedestrian similarly at risk? The authors aimed to identify children who are particularly prone to making risky and potentially harmful crossing decisions. They used a simple game involving risk to classify 5- to 6-year-olds as risk takers or risk avoiders. Children classified as risk takers made more crossing decisions at a busy 1-way street than risk avoiders, tolerated shorter time intervals between initiation of the crossing decision and arrival of the next vehicle, and were more likely to cause a (hypothetical) accident. Finally, they made decisions more quickly than risk avoiders. The authors discuss the implication of these results for traffic safety programs.
Bicycle helmet campaigns and head injuries among children. Does poverty matter?
Correspondence: Richard Reading, School of Medicine, Health Policy and Practice, University of East Anglia, Norwich NR4 7TJ, UK; (email: r.reading@uea.ac.uk).
OBJECTIVES: To assess the impact of a community-based bicycle helmet programme aimed at children aged 5-12 years (about 140 000) from poor and well-off municipalities.
METHODS: A quasi-experimental design, including a control group, was used. Changes in the risk of bicycle-related head injuries leading to hospitalization were measured, using rates ratios.
FINDINGS: Reductions in bicycle-related head injuries were registered in both categories of municipalities. Compared with the pre-programme period, the protective effect of the programme during the post-programme period was as significant among children from poor municipalities (RR 0.45; 95% CI 0.26-0.78) as among those from richer municipalities (RR 0.55; 95% CI 0.41-0.75).
COMMENTS: Population-based educational programmes may have a favourable impact on injury risks in poor areas despite lower adoption of protective behaviours.
Correspondence: Harald J. Meyer, Institute of Forensic Medicine, Salzburg University, Ignaz Harrerstr. 79, A-5020, Salzburg, AUSTRIA; (email: harald.meyer@sbg.ac.at).
In November 2000, a tunnel-bound cable car in Kaprun caught fire, with the subsequent death of 155 persons. No passenger list was in existence and bodies were burnt to such an extent that morphological identification was not feasible. A full post-mortem examination was performed on all bodies. All bodies were positively identified within 19 days after the incident by DNA analysis. Cause of death was determined to be carbon monoxide poisoning in combination with suffocation due to inhalation of smoke. The organisational aspects of processing are portrayed.
Correspondence: Ismail E Goga, Department of Orthopaedic Surgery, Faculty of Medicine, University of Natal,Nelson Mandela School of Medicine, Private Bag 7, Room 403, 179 Umbilo Road, Congella, Durban 4013, SOUTH AFRICA; (email: gogai@nu.ac.za).
OBJECTIVES: To ascertain the number and type of severe soccer injuries admitted to King Edward Hospital in South Africa over 42 months.
METHODS: This was a retrospective study of all patients admitted for treatment or observation to the orthopaedic unit only. Patients treated as outpatients, irrespective of severity, are also presented for comparison.
FINDINGS: Thirty two patients were admitted with severe injuries. The injuries included 18 fractures of the tibial and femoral shaft. Two tibial shaft fractures were compound. Four tibial plateau fractures and five epiphyseal injuries were identified. One patient had a fracture-dislocation of the hip. One patient with a popliteal artery injury presented 48 hours after the injury had occurred. He had an above knee amputation. In the same period 122 patients were treated as outpatients. The types of injury in this group were similar to soccer injuries reported in other countries.
COMMENTS: Very serious injuries are sustained by casual soccer players in South Africa. Urgent measures need to be taken to prevent such injuries.
CONTEXT: To develop design criteria for consumer products, based on foreign body injury and fatality data, to prevent airway obstruction injuries to children.
METHOD: Beginning in 1988, RAM Consulting has created a worldwide database of foreign body injuries. This ongoing project now includes approximately 7000 data points from 51 children's hospitals in 15 countries located on five continents. Statistical analysis of these data, especially in terms of size, shape and consistency of the object and obstruction location and severity of injury for the patient has allowed the creation of an injury prevention criterion.
FINDINGS: Analysis of these data reveals that adoption of an injury prevention criteria based on the use of a 1.50in. (38.10mm) diameter gauge for non-spherical objects and a 1.75in. (44.50mm) diameter gauge for spherical objects would greatly reduce airway obstruction injuries to children. Furthermore, the data show that this criterion is independent of country and culture. However, the data suggest that a child's exposure to the "mix" of objects that may cause airway obstruction varies with the country and culture of the child. For example, coins are well represented in the database, however, some countries make more coins than other countries and the exposure level may have made the difference in the occurrence of incidents.
COMMENTS: Airway obstruction injuries from consumer products could be greatly decreased by the adoption of the presented injury prevention criteria that is founded in a statistical analysis of known objects that have caused injury. This criteria is dependant on object characteristics and is independent of the country or culture of the child.
Falls and injury reduction in residential aged care: translating research into practice.
Correspondence: Chris Shanley, Faculty of Health Sciences, Centre for Education and Research on Ageing, C22 - Repatriation General, Concord, The University of Sydney, Sydney, NSW 2006 AUSTRALIA; (email: cshanley@medicine.usyd.edu.au).
Falls and falls-related injuries are a major problem in residential aged care. While there are many factors contributing to falls in this group, there are also a number of strategies that can help reduce falls and associated injuries. While programs to prevent falls must be multifactorial and multidisciplinary, nurses in residential aged care will play a central role in setting up and coordinating such programs. This paper reviews a broad range of nursing, medical and allied health literature. It then synthesises the research findings to outline a comprehensive series of recommendations that nurses can use to improve clinical practice in this area.
Assessing patient safety risk before the injury occurs: an introduction to sociotechnical probabilistic risk modelling in health care.
Since 1 July 2001 the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has required each accredited hospital to conduct at least one proactive risk assessment annually. Failure modes and effects analysis (FMEA) was recommended as one tool for conducting this task. This paper examines the limitations of FMEA and introduces a second tool used by the aviation and nuclear industries to examine low frequency, high impact events in complex systems. The adapted tool, known as sociotechnical probabilistic risk assessment (ST-PRA), provides an alternative for proactively identifying, prioritizing, and mitigating patient safety risk. The uniqueness of ST-PRA is its ability to model combinations of equipment failures, human error, at risk behavioral norms, and recovery opportunities through the use of fault trees. While ST-PRA is a complex, high end risk modelling tool, it provides an opportunity to visualize system risk in a manner that is not possible through FMEA.
Correspondence: Margie M. Peden, Department of Injuries and Violence Prevention, World Health Organization, Geneva, SWITZERLAND; (email: pedenm@who.int).
The purpose of this analysis was to quantify the magnitude of death and disability from drowning and near-drowning worldwide and to provide epidemiological data on which to base prevention efforts. All data are from the Global Burden of Disease 2000 (Version 1) estimates in which deaths and disabilities are based on the WHO International Classification of Diseases. Extrapolations were made by age, sex, and WHO region. The six WHO regions of the world were further divided into high-income, and low- and middle-income based on the 1998 World Development indicators. According to the GBD 2000 data, an estimated 449,000 people drowned worldwide (7.4 per 100,000 population) and a further 1.3 million Disability Adjusted Life Years (DALYs) were lost as a result of premature death or disability from drowning. 97% of drownings occurred in low- and middle-income countries. Although 38% of drownings occurred in the Western Pacific Region, Africa had the highest drowning mortality rate (13.1 per 100,000 population). Males had higher drowning mortality rates than females for all ages and in all regions. Children under the age of 5 years had the highest drowning mortality rate for both sexes in all of the WHO regions except for Africa, where children aged 5 to 14 years had the highest mortality rate. Worldwide, for children under the age of 15 years, drowning accounted for a higher mortality rate than any other cause of injury. Drowning is a significant problem worldwide particularly for children under the age of 15 years. Low- and middle-income countries have the highest rates of drowning and account for more than 90% of such fatalities. Primary prevention efforts should thus be focused on these countries where many children who cannot swim drown in large bodies of water.
Death and injury on duty--a study of South African police officers.
- Plani F, Bowley DM, Goosen J. S Afr Med J 2003; 93(11): 851-853.
Correspondence: Frank Plani, Department of Surgery, University of the Witwatersrand, Johannesburg, SOUTH AFRICA; (email: unavailable).
OBJECTIVES: Sections of contemporary South African society are characterised by high levels of crime and interpersonal conflict. The South African Police Service (SAPS) is in the front line, with many deaths and injuries occuring among serving officers in recent years. The circumstances and nature of the injuries sustained by these officers have received little attention in the medical literature.
DESIGN: A retrospective review of all injured SAPS members was undertaken at a single level one trauma centre in Johannesburg between June 1993 and June 2002. The following factors were recorded: demographics, mechanism and anatomical site of injury, mode of transportation to hospital, whether personal protection had been used, mortality, and return to work.
FINDINGS: One hundred and thirty-four SAPS personnel were admitted over a 9-year period. The majority (95%) were male and the median age was 31 years. One hundred and thirty-two were on duty and two were in transit to a place of duty when injured. Ninety-two (69%) were injured by gunshot, (including 3 attempted suicides and 9 injuries due to negligent discharge), 2 members were stabbed, 31 were involved in motor vehicle accidents, 2 in motorbike accidents, 1 member was struck by a car while directing traffic, 3 officers were injured by falls from a height, 2 members were injured in helicopter crashes, and 1 member required treatment for gas inhalation. Documentation on whether some form of personal protection was worn at the time of injury was only available for 43 of the 92 cases of gunshot wounds (47%); of these, only 15 (35%) were wearing a bulletproof vest. Use or non-use of a seat belt was documented by hospital staff for only 6 of the 31 officers (19%) injured in motor vehicle accidents. None of the 6 officers had been restrained by a seatbelt. Nineteen SAPS personnel (14%) died of their injuries, but the majority of surviving members returned to duty.
COMMENTS: There is an unacceptably high level of violence in South African society today and SAPS members regularly have to deal with dangerous or violent situations. There is a clear need to introduce a reporting system within the SAPS to record the use of personal protection by officers. Education needs to target SAPS members in order to enhance their use of personal protection. There is a further need to design and implement personal protection that will be universally acceptable by SAPS members.
Exploring variables among medical center employees with injuries: developing interventions and strategies.
- Brown ND, Thomas NI. AAOHN J 2003; 51(11): 470-481.
Correspondence: Norman DePaul Brown, John McClellan Veterans Affairs Medical Center, Employee Wellness Initiative (VAMC Wellness Initiative), North Little Rock, USA; (email: unavailable).
Data for this study were collected via retrospective chart review. The study shows the variables associated with work related injury (WRI) in Central Arkansas Veterans Healthcare System medical center employees from 1998 to 2000 in terms of age, gender, employment type, employment status, shift length, body mass index (BMI), workers' compensation claims prior to current employment, employee health and wellness activity attendance, lost time claims, medical/loss of productivity costs. Notable characteristics of injured employees included advancing age, female gender, long working hours, increased BMI, history of prior back and upper extremity injuries, no health and wellness activity attendance, and lost time with injury. Back and shoulder strain, falling accidents, and repetitive motion injuries were the most severe and costly injuries. Further study of medical center employees is warranted to determine risk factors for WRI and develop appropriate protective interventions and safety promotion strategies.
OBJECTIVE: To examine suicidality among urban youth and its relationship to patterns of adult support.
METHODS: Study surveyed 879 adolescents. Suicide ideation and attempts, perceived adult support, family and formal network availability, and network activation were assessed.
FINDINGS: Only half of those reporting a suicide attempt had spoken with an adult about their distress. Suicide attempters were more likely than nonattempters to report they would not go to family members in the future, although they were more likely to report a past discussion.
COMMENTS: Improving communication among youth, families, and service providers should be a focus of suicide prevention planning.
On May 21, 1198 Kipland Kinkel entered Thurston High School in Springfield, Oregon, gunned down two students and injured scores more, after mudering his parents the night before. There is a dearth of research focused on the effects of such violence in school settings where the perpetrator is a peer of his victims. We do not know if, how, or under what circumstances adolescents exposed to this violence are psychologically changed, or if the changes are temporary or long-lasting. This study explores the incidence of post-traumatic effects of such an incident. These effects are hypothesized to be influenced by both distal (physical) (Pynoos & Nader, 1986) and emotional proximity (Terr, 1990). Emotional proximity is, in this study, measured by connectedness to the school. Effects of peritrauma dissociative responses in the immediate aftermatch of the incident on longitudinal effects are also explored. Participants include 80 respondents who completed a lengthy survey at two to three years post incident. The sample was predominantly recruited from three Oregon institutes of higher learning. It includes adolescents who were enrolled at Thurston High School at the time, young adults who had graduated from Thurston in the five years prior to the incident and a control group from another college town 40 miles away. Findings support the hypotheses that distal proximity at the time of the event predicts the longitudinal direct effects of distress from hyper arousal, intrustions, and avoidance. Controlling for distal proximity, emotional proximity to Thurston High School predicts peritrauma dissociative response and alexithymia. Further, elevated peritrauma scores predicts distress from intrustions at two to three years. These results suggest there can be long-lasting effects from one instance of acute violence. Limitations of the study and future research are discussed.
Teachers' Perceptions of School Violence Issues: A Case Study.
Although incidents such as Columbine focused the world's attention on school violence issues, research to date has generally focused on administrators' understanding of school problems. Teachers' perceptions have rarely been included in the literature. This is a glaring omission, as teachers play an integral role in creating a healthy school environment that can prevent or control violent disruptions. This paper presents results of focus group sessions conducted with high school teachers in a small, rural school district. It addresses their understanding of school violence, reactions to actual incidents or the fear of such occurrences, and their perceptions of the role of school climate.
Traffic signal color recognition is a problem for both protan and deutan color-vision deficients.
- Atchison DA, Pedersen CA, Dain SJ, Wood JM. Hum factors 2003, 45(3): 495-503.
Correspondence: David A. Atchison, School of Optometry, Queensland University of Technology, Victoria Park Road, Kelvin Grove, Queensland 4059, AUSTRALIA; (email: d.atchison@qut.edu.au).
We investigated the effect of color vision deficiency upon reaction times and accuracy of identification of traffic light signals. Participants were 20 color-normal and 49 color-deficient males, the latter divided into subgroups of different severity and type. Participants performed a tracking task. At random intervals, stimuli simulating standard traffic light signals were presented against a white background at 5° to right or left. Participants identified stimulus color (red / yellow / green) by pressing an appropriate response button. Mean response times for color normals were 525, 410, and 450 ms for red, yellow, and green lights, respectively. For color deficients, response times to red lights increased with increase in severity of color deficiency, with deutans performing worse than protans of similar severity: response times of deuteranopes and protanopes were 53 percent and 35 percent longer than those of color normals. A similar pattern occurred for yellow lights, with deuteranopes and protanopes having increased times of 85 percent and 53 percent, respectively. For green lights, response times of all groups were similar. Error rates showed patterns similar to those of response times. Contrary to previous studies, deutans performed much worse than protans of similar severity. Actual or potential applications of this research include traffic signal design and driver licensing.
OBJECTIVES: The aim of this study is to review gender differences in elderly suicide in relation to specific social aspects of the suicidal process and health care contact before death. Such information may have practical value in identifying and targeting vulnerable elderly in whom suicide may be potentially preventable.
METHODS: Data were extracted from the records of coroner's inquests into all reported suicide of persons aged 60 and over, in Cheshire over a period of 13 years 1989-2001. The Coroner's office covers the whole county of Cheshire (population 1 000 000).
FINDINGS: Men were less likely to have been known to psychiatric services (Odds Ratio [OR] 0.4 95% 0.2-0.6) and with less frequently reported history of previous attempted suicide compared to women (OR 0.5 95% Confidence Intervals [CI] 0.2-1). All deceased from ethnic minorities were men, none of whom had been known to psychiatric services. There was no significant difference between women and men in relation to, physical or psychiatric morbidity, GP contact prior to suicide, intimation of intent or living alone. Of suicide victims not known to services a surprisingly high proportion of 38% and 16% were found to have psychiatric morbidity in men and women respectively.
COMMENTS: Suicide is an important problem in the elderly with gender playing an important part in their social behaviour but a high proportion of the deceased were not known to local services. Primary Care professionals have an important role to play in reducing elderly suicide as most contact with the health service in elderly suicide seem to be with GPs.
Cyclic time patterns of death from suicide in northern Finland.
- Partonen T, Haukka J, Viilo K, Hakko H, Pirkola S, Isometsa E, Lonnqvist J, Sarkioja T, Vaisanen E, Rasanen P. J Affect Disord 2004; 78(1): 11-19.
Correspondence: Timo Partonen, Department of Mental Health and Alcohol Research, National Public Health Institute, Mannerheimintie 166, FIN-00300, Helsinki, FINLAND; (email: timo.partonen@ktl.fi).
CONTEXT: Time patterns of suicide have been attributed not only to social and psychological factors but also to direct geophysical effects. Seasonal variations in day length and temperature seem likely to contribute to the timing of the suicide process.
METHODS: We analysed all suicides (n=1658) committed in a northern province of Finland during a period of 153 months. Daily data on the number of suicides, local weather conditions and geomagnetic storms were compiled and modelled with Poisson regression using the province population as the denominator, and with the means of harmonic series for seasonal variation. Time series analysis of monthly numbers of suicides was carried out using the seasonal-trend decomposition procedure based on loess.
FINDINGS: Marked fluctuations in the number of suicides occurred during the study period (P=0.01). There was significant seasonal variation in death from suicide (P=0.01), but analysis of the meteorological data showed no evidence of effect on the risk of suicide.
LIMITATIONS: Assessment of mental disorder or alcohol consumption was missing, since only data derived from death certificate was available for each case.
COMMENTS: The seasonal effect was significant, but remained modest compared to sex and age as risk factors for suicide. Preventive measures need to be tailored according to time of the year.
Risk of suicide and related adverse outcomes after exposure to a suicide prevention programme in the US Air Force: cohort study.
Correspondence: Kerry Knox, University of Rochester Center for the Study and Prevention of Suicide, University of Rochester Medical Center, Rochester, NY 14642, USA; (email: Kerry_knox@urmc.rochester.edu).
OBJECTIVE: To evaluate the impact of the US Air Force suicide prevention programme on risk of suicide and other outcomes that share underlying risk factors.
DESIGN: Cohort study with quasi-experimental design and analysis of cohorts before (1990-6) and after (1997-2002) the intervention. PARTICIPANTS: 5,260,292 US Air Force personnel (around 84% were men).
INTERVENTION: A multilayered intervention targeted at reducing risk factors and enhancing factors considered protective. The intervention consisted of removing the stigma of seeking help for a mental health or psychosocial problem, enhancing understanding of mental health, and changing policies and social norms.
MAIN OUTCOME MEASURES: Relative risk reductions (the prevented fraction) for suicide and other outcomes hypothesised to be sensitive to broadly based community prevention efforts, (family violence, accidental death, homicide). Additional outcomes not exclusively associated with suicide were included because of the comprehensiveness of the programme.
FINDINGS: Implementation of the programme was associated with a sustained decline in the rate of suicide and other adverse outcomes. A 33% relative risk reduction was observed for suicide after the intervention; reductions for other outcomes ranged from 18-54%.
COMMENTS: A systemic intervention aimed at changing social norms about seeking help and incorporating training in suicide prevention has a considerable impact on promotion of mental health. The impact on adverse outcomes in addition to suicide strengthens the conclusion that the programme was responsible for these reductions in risk.
The aim of the present study was to investigate if the original factorial structure of the Manchester Driver Behaviour Questionnaire (DBQ) was replicated in Finland and The Netherlands. A postal questionnaire survey of drivers was carried out in Britain, Finland and The Netherlands. Exploratory factor analysis together with target (Procrustes) rotation and factorial agreement indexes were calculated to investigate the applicability of Finnish and Dutch versions of DBQ. Results of the factor comparisons showed that the DBQ four-factor structures found in Finland and The Netherlands were congruent but not perfect with the target structure found in Britain. Reliabilities of the scales were around the same level as in the British data. In addition to the four first-order factors, two second-order factors (deliberate violations and unintentional errors) were found in all three countries which supports the original structure by Reason et al. [Ergonomics 33 (1990) 1315]. Issues related to cross-cultural use of traffic behaviour questionnaires are discussed.
The effect of crash experience on changes in risk taking among urban and rural young people.
- Lin MR, Huang W, Hwang HF, Wu HD, Yen LL. Accid Anal Prev 2004; 36(2): 213-222.
Correspondence: Mau-Roung Lin, Institute of Injury Prevention and Control, Taipei Medical University, 250 Wu-Hsing St., 110, ROC, Taipei, TAIWAN; (email: mrlin@tmu.edu.tw).
A 20-month prospective study was conducted to investigate the effect of motorcycle crash experience on changes in risk taking among 2514 urban and 2304 rural students in Taiwan. Risk taking was assessed using a 14-item self-administered questionnaire at the beginning and end of the study. A risk-taking score for each student at the initial and the last follow-up assessments was generated from adding up points across all 14 items. For exposure variables, the study documented past motorcycle crash history at the initial assessment and collected detailed information about any motorcycle crash involvement that occurred during the study period. A general linear mixed model was applied to assess the effects of prior and recent crash involvements on the path of risk-taking behavior. The results show that at the initial assessment, students with crash experience had higher risk-taking levels than those without crash experience. However, crash experience, irregardless of whether it was measured in terms of crash history prior to the study, crash frequency, time elapsed since the last crash, or crash severity, did not significantly change the risk-taking path among students, even though its effect differed between urban and rural areas.
Transportation safety in Botswana.
Proceedings: NATIONAL ROAD ACCIDENT SYMPOSIUM, Gaborone International Convention Centre, 13 and 14 February, 2003.
This document is intended to convey the principal recommendations garnered from a two-day National Symposium on Road Traffic Accidents held in Gaborone on the 13th and 14th February, 2003. Although a verbatim recording of the entire proceedings is held on magnetic tape by the Department of Road Transport and Safety, the present report is compiled solely from the actual recommendations made either by speakers or members of the public. More than 180 of these were noted. The full report (available via the link above) contains additional details of the recommendations for action under three time-frames: immediate (< 6 months), Short-term (6 to 18 months); and long-term (> 18 months). Specific recommendations are made concerning government agencies (Department of Roads, Department of Transport and Safety, Ministries of Finance and Health), legislation, court structure and action, Botswana Railways, insurance companies, and the liquor industry.
All contributing aspects of Botswana's accident rate require urgent attention and it is difficult to place one above any other but the major priority areas appear to be: Education, Legislation, Enforcement, and Supervision.
Education: Most agreed that individual attitude underlies our horrifying and tragic traffic accident rate: the attitude of motorists to safety, to speed, to alcohol, to the very vehicles they drive and to other road users. Most opinion demanded a change in attitudes and, to this end, suggested a 'carrot and stick' approach: increased enforcement on the one hand with more effective education on the other. For adults, use is to be made of driver training manuals, higher standards of general driver training and the media, including cinema and television as well as radio and the printed media on a scale hitherto unseen in this country. The objective must be to make individuals realise that responsibility for our high accident rate rests with them: not with road or vehicle design, lack of Police enforcement or 'other drivers': individuals cause accidents - nothing else. Primary and secondary schools (both public and private) must also be engaged in this ongoing effort. Public transport was heavily criticised with many of the recommendations being aimed at achieving better control of and self-discipline among the various 'Combi' operators.
Enforcement: Better enforcement was seen by many as an immediate need: speeding, drunken driving, jumping red traffic lights and control of traffic on the roads being the areas of principal concern. Better discipline among and control of Combi drivers is also strongly recommended as is the need to resolve with determination the question of domestic animals on the road.
It was strongly recommended that: 1) A stand alone traffic department (an initiative found effective and recommended by the Swedish delegate) be created so that they could focus exclusively on traffic work and not get drawn constantly to other duties; 2) There be an increase in traffic officer and traffic vehicle establishment (508 officers for the whole country the Commissioner felt to be insufficient); and 3) There be a shifting to the private sector, specifically insurance companies, of some of the burden in investigating minor accidents and claims which currently tie up large portions of police time.
Legislation: The Road Traffic Act is said to be old and very much out of date, despite some amendments. It is understood that a completely revised act is under consideration so it is recommended that this act be 'fast tracked' so as to become operative as quickly as possible. At the moment issues such as: cattle on the roads and responsibility for the accidents they cause, as well as individual responsibility for damage to traffic lights, streetlights and guard rails is ambiguous. Legal apportionment of responsibility is possible and must be decided and enforced. The apparently haphazard allocation of liquor licenses with regard to density, times of operation and proximity to main roads needs to be urgently reconsidered. Inadequacies in existing legislation also make it difficult to secure convictions for drunken driving: this situation must be rectified quickly. Many recommendations called for stricter penalties in order to regain some respect for the authority of the law and it was also felt there is a need for the courts to find faster ways of dealing with traffic matters.
Supervision: A key recommendation is the formation of, or the allocation to an existing committee, of responsibility to see that the recommendations contained in the main body of this report are acted upon or formally discarded. There was a strong feeling among delegates that: "we have been down this road before" and that there is a danger that nothing will happen unless such responsibility is clearly allocated. As our Chief Justice remarked: "The mood of (the public) is for urgent action." It is thus important to be able to convince a critical and cynical public that something is being done and that things really are going to change.
The effects of children's exposure to domestic violence: a meta-analysis and critique.
- Wolfe DA, Crooks CV, Lee V, McIntyre-Smith A, Jaffe PG. Clin Child Fam Psychol Rev 2003; 6(3): 171-187.
Correspondence: David A. Wolfe, Centre for Research on Violence Against Women and Children, The University of Western Ontario, London, Ontario, CANADA; (email: dawolfe@uwo.ca).
A wide range of children's developmental outcomes are compromised by exposure to domestic violence, including social, emotional, behavioral, cognitive, and general health functioning. However, there are relatively few empirical studies with adequate control of confounding variables and a sound theoretical basis. We identified 41 studies that provided relevant and adequate data for inclusion in a meta-analysis. Forty of these studies indicated that children's exposure to domestic violence was related to emotional and behavioral problems, translating to a small overall effect (Zr = .28). Age, sex, and type of outcome were not significant moderators, most likely due to considerable heterogeneity within each of these groups. Co-occurrence of child abuse increased the level of emotional and behavioral problems above and beyond exposure alone, based on 4 available studies. Future research needs are identified, including the need for large-scale longitudinal data and theoretically guided approaches that take into account relevant contextual factors.
A media violence-inspired juvenile sexual homicide offender 13 years later.
Correspondence: Wade C. Myers, Division of Forensic Psychiatry, University of Florida Health Science Center, Box 100256, Gainesville, FL 32610-0256, USA; (email: wmyers@psychiatry.ufl.edu).
No follow-up studies exist on how minors who commit sexual homicides adjust once released back into the community. This is an important question given the extreme nature of their crimes, lack of recidivism data, and the expectation that one-half of them will be freed from prison by mid-life. Likewise, no studies exist on the role our culture's pervasive media violence plays in these offenses. This report describes a 13-year-old boy who committed a witnessed media violence-inspired sexual homicide. Follow-up information is provided on his community adjustment as an adult four years after release from prison. He had multiple indicators of brain dysfunction, and watched a "slasher" film just before committing the blitz style crime upon a female neighbor. Media violence literature is reviewed--against a backdrop of developmental abnormalities, neuropsychiatric vulnerabilities, family dysfunction, and mental illness. This case illustrates how the confluence of such variables, combined with the tinder of erotic screen violence, may lead to sexual murder.
Psychopathological Profile of Men Convicted of Gender Violence: A Study in the Prisons of Spain.
In this article, a description of the demographic, penal, and psychopathological characteristics of 54 men who are in prison because of having committed a serious offense of gender violence was carried out. Furthermore, a comparison of all the variables studied between the participants with homicide and those without homicide was done. The results showed the existence of irrational beliefs both about women and violence as a strategy to cope with everyday difficulties, as well as a general inadaptation to daily life. However, from a psychopathological point of view, in spite of not observing a high degree of symptomatology in the sample, the psychiatric and penal antecedents and current emotional instability were much more frequent and severe in people who had not committed homicide. Therefore, two possible differential profiles among the violent men are presented.
Characterization of nonfatal events and injuries resulting from youth violence in patients presenting to an emergency department.
- Mollen CJ, Fein JA, Vu TN, Shofer FS, Datner EM. Pediatr Emerg Care 2003; 19(6): 379-384.
Correspondence: Cynthia J. Mollen, DDivision of Emergency Medicine, The Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA, USA; (email: mollenc@email.chop.edu).
CONTEXT: To characterize the circumstances of youth intentional violence in emergency department patients and compare circumstances of events between gender and age groups.
METHODS: Cross-sectional survey and chart review of a 9-month consecutive sample of 8-year to 24-year-old intentionally injured patients (excluding child abuse or domestic violence) in 3 emergency departments.
FINDINGS: Four hundred twenty-six patients were included in the study. Most events were fights and most occurred in the street. Fists, hands, and feet were the most common weapon, and contusions or abrasions the most common injury. Most events involved only 2 people, and most incidents involved friends or acquaintances. Events involving 8 to 14 year olds were more likely to occur in school, to involve only fists, hands, or feet, and involve a friend. Eight to 14 year olds were less likely to use a firearm. Among the younger group, females were more likely than males to be injured in an assault, sustain a contusion or abrasion, and be involved in an incident with multiple participants. Older females were more likely than males to be involved in an event in the home, and sustain a contusion, abrasion, or bite.
COMMENTS: This study characterizes the circumstances of youth intentional violence that result in emergency department visits for injuries. Although similarities exist between different age groups and genders, some key differences between the groups are illustrated. Understanding the differences between violent events in different age groups and genders may help clinicians recognize injury patterns and possibly guide alternative interventions.
