Japanese national survey of adolescent drinking behavior: comparison between 1996 and 2000 surveys.
- Suzuki K, Osaki Y, Minowa M, Wada K, Ohida T, Doi Y, Tanihata T. Nihon Arukoru Yakubutsu Igakkai Zasshi
(Jpn J Alc Stud Drug Depend) 2003; 38(5): 425-433.
Correspondence: K. Suzuki, Kurihama National Hospital, 5-3-1 Nobi, Yokosuka, Kanagawa 239-0841, JAPAN; (email: unavailable).
This report shows Japanese adolescent drinking behavior from the national surveys conducted in 1996 and 2000. We randomly selected 120 junior high schools and 100 senior high schools nationwide. We requested the cooperation of the principals of these schools and sent questionnaires to each school. Students answered anonymously the questionnaires during school time, and sealed in envelopes by themselves; then teachers collected the envelopes. The questionnaire focused on adolescent drinking behavior. Valid responses numbered 42,798 (1996) and 47,246 (2000) from the junior high schools and 73,016 (1996) and 59,051 (2000) from the senior high schools. The number of students surveyed represented about 1% of all Japanese junior high school students, and about 2% of all senior high school students. This report covers only students who gave answers on both drinking frequency and drinking quantity. It compares adolescent drinking behavior between the 1996 and 2000 surveys, such as drinking frequency, drinking quantities, drinking occasions, methods of obtaining alcohol, kinds of alcohol drunk, alcohol-related problems, opinions on the law that prohibits minors under 20 years of age from drinking alcohol, and distribution of drinking status of the subjects by the Quantity-Frequency Scale (QF scale). In a comparison of adolescent drinking behavior between the 1996 survey and 2000 survey, non-drinkers among junior high school students increased from 45% to 55%, and those among senior high school students increased from 27% to 33%. On the other hand, ratios of female students in both junior and senior high schools who drank 1 or more times per week were higher in the 2000 survey than in the 1996 survey. Comparison of the 1996 survey and 2000 survey did not indicate that Japanese adolescent drinking has increased or decreased.
The Relationship Between the Quantity of Alcohol Consumed and the Severity of Sexual Assaults Committed by College Men.
Correspondence: Antonia Abbey, Community Medicine Department, Wayne State University, 4201 St. Antoine, 9D UHC, Detroit, Michigan 48201, USA; (email: aabbey@wayne.edu).
Researchers have suggested that intoxicated perpetrators may act more violently than other perpetrators, although empirical findings have been mixed. Past research has focused on whether or not alcohol was consumed, rather than the quantity consumed, and this may explain these inconsistent findings. The authors hypothesized that the quantity of alcohol consumed would have a curvilinear relationship to the severity of the assault. Data were collected from 113 college men who reported that they had committed a sexual assault since the age of 14. The quantity of alcohol that perpetrators consumed during the assault was linearly related to how much aggression they used and was curvilinearly related to the type of sexual assault committed. The quantity of alcohol that victims consumed during the assault was linearly related to the type of sexual assault committed. Strategies for improving assessment of alcohol consumption in sexual assault research are discussed.
Applying a Developmental Approach to Injury Prevention.
- Mercy JA, Sleet DA, Doll LS. Am J Health Educ 2003, 34(5 Suppl): s6-s12.
Correspondence: James A. Mercy, National Center for Injury Prevention and Control, US National Centers for Disease Control and Prevention, Mailstop K68, 4770 Buford Highway NE, Atlanta, GA 30341-3724, USA; (email: jam2@cdc.gov).
(Published by American Association for Health Education)
The epidemiology of unintentional injury and violence, including likely causes and
individuals' abilities to respond to risks, are closely related to the stages of human
development. The epidemiology and prevention of injury are also influenced by the
social contexts (i.e., family, community, and socio-cultural) in which human
development occurs. The purpose of this article is to describe injury risk and prevention
strategies across the developmental stages of childhood and adolescence and associated
social contexts. Viewing injury prevention from this perspective suggests that
developmentally appropriate interventions conducted over several stages may be more
likely to motivate and sustain injury prevention behavior change across a lifetime than a
single intervention or a single policy change.
Parachute use to prevent death and major trauma related to gravitational challenge: systematic review of randomized controlled trials.
- Smith GCS, Pell JP. BMJ 2003; 327(7429): 1459-1461.
Correspondence: Gordon C S Smith, Department of Obstetrics and Gynecology, Cambridge University, Cambridge CB2 2QQ, 2 Department of Public Health, Greater Glasgow NHS Board, Glasgow G3 8YU, UK; (email: gcss2@cam.ac.uk).
OBJECTIVES: To determine whether parachutes are effective in preventing major trauma related to gravitational challenge.
DESIGN: Systematic review of randomized controlled trials.
DATA SOURCES: Medline, Web of Science, Embase, and the Cochrane Library databases; appropriate internet sites and citation lists.
STUDY SELECTION: Studies showing the effects of using a parachute during free fall.
MAIN OUTCOME MEASURE: Death or major trauma, defined as an injury severity score > 15.
FINDINGS: We were unable to identify any randomized controlled trials of parachute intervention.
COMMENTS: As with many interventions intended to prevent ill health, the effectiveness of parachutes has not been subjected to rigorous evaluation by using randomized controlled trials. Advocates of evidence based medicine have criticised the adoption of interventions evaluated by using only observational data. We think that everyone might benefit if the most radical protagonists of evidence based medicine organized and participated in a double blind, randomized, placebo controlled, crossover trial of the parachute.
Distribution and care of shipboard blast injuries (USS Cole).
- Davis CT, Alexander CB, Lambert LE, Simpson CR, Unger CD, Lee CJ, Snyder CM, Liston CW, Hirsch EF. J Trauma 2003; 55(6): 1022-1028.
Correspondence: Thomas P. Davis, General Surgery Department, 0511 Charette Health Care Center, United States Naval Medical Center, 27 Effingham Street, Portsmouth, VA 23708, USA; (email: tpdavis@mar.med.navy.mil).
On October 12, 2000, the destroyer USS Cole was anchored in a foreign port and was severely damaged by explosives in a small craft adjacent to the ship at the port side waterline. Seventeen crew members were killed in the incident. The wounded were evacuated to several medical facilities for their initial care and then to the military hospital in Landstuhl, Germany, and subsequently to the Charette Health Care Center (Naval Medical Center) in Portsmouth, Virginia. There were 35 surviving patients who had sustained 81 total injuries associated with the explosion. The distribution of the injuries included orthopedic, ophthalmologic, soft tissue, otolaryngologic, burns, inhalation, and other miscellaneous injuries. Twenty-seven of the patients were discharged after 24-hour observation. This article reviews the distribution of injuries found in the fatalities and the wounded crew members and the subsequent care required to prepare the military medical community for potential future incidents of this type.
The ability to self-monitor performance during a week of simulated night shifts.
- Dorrian J, Lamond N, Holmes AL, Burgess HJ, Roach GD, Fletcher A, Dawson D. Sleep 2003; 26(7): 871-877.
Correspondence: Jill Dorrian, The Centre for Sleep Research, The University of South Australia, Level 5, The Basil Hetzel Institute, The Queen Elizabeth Hospital, Woodville Rd., Woodville, SA 5011, AUSTRALIA; (email: jill.dorrian@unisa.edu.au).
OBJECTIVES: Research has indicated that individuals are able to accurately monitor the performance decrements they experience during unitary periods of acute sleep deprivation. The aim of the current study was to investigate the ability to self-monitor performance during a week of simulated night shifts. DESIGN: Subjects completed 7 consecutive 8-hour night shifts (11 pm-7 am).
SETTING: University sleep laboratory. SUBJECTS: Fifteen young (7 men, 8 women, 19-25 years) healthy volunteers.
INTERVENTIONS: During the night shifts, performance was measured hourly on 4 performance parameters: psychomotor vigilance test (PVT), tracking, and grammatical reasoning (GRG) accuracy and response latency. Before and after each test, subjects completed visual analogue scales, which required them to rate their alertness and their performance speed and/or accuracy.
FINDINGS: Analysis indicated that GRG response latency and tracking were significantly impaired (P < 0.05) during the first 2 shifts only. The PVT performance displayed consistent impairment, with significant (P < 0.05) declines during all but the final shift. The pattern of deterioration in subjective ratings of alertness was similar to that of the PVT data. Correlations between subjective alertness and self-ratings of performance were significant (P < 0.01) for all parameters (r=0.39-0.69). Significant (P < 0.05) correlations were found across the week between pretest performance ratings and actual performance for all parameters except GRG accuracy (r=0.29-0.58) and between posttest ratings and actual performance for all parameters (r=0.52-0.75). Correlations between pretest ratings and actual performance were also conducted separately for each shift. Highest correlations were found during the first shift, with r-values that were low for GRG accuracy (r=0.32) and GRG response latency (r=0.20), moderate for tracking (r=0.41), and high for PVT (r=0.82). In general, lower correlations were found later in the week.
COMMENTS: Overall, results indicate that individuals have only a moderate ability to predict performance impairment during a week of night shifts. It is likely that performance ratings are based, at least to a certain extent, on subjective alertness levels. Furthermore, it seems that rating accuracy is improved on tasks providing performance feedback, such as the PVT. Finally, it appears that after testing, individuals have a more accurate perception of their performance.
Television tipovers as a significant source of pediatric head injury.
- Jea A, Ragheb J, Morrison G. Pediatr Neurosurg 2003; 38(4): 191-194.
Correspondence: Andrew Jea, Department of Neurological Surgery, University of Miami School of Medicine,Lois Pope LIFE Center, Miami, Fla 33136, USA; (email: babybrain@mindspring.com).
OBJECTIVE: To highlight the rising number and nature of pediatric head injuries secondary to falling television sets and correlate this with the increasing number of home TVs sold per year.
METHODS: National statistics for the past 10 years for the number of head traumas from falling television sets in children less than the age of 18 were obtained from the US Consumer Product Safety Commission. Statistics for the number of TV sales were obtained from the Consumer Electronic US Sales Report for the same time period. A retrospective chart review overlapping the same period of time was performed at our local institution.
FINDINGS: National statistics show a steady rise in the number of pediatric head injuries, from 31 in 1992 to 117 in 2001. The number of TVs sold by year increased from 20,384,000 to 23,776,000 in a 10-year period from 1990 to 2000. Six of the 7 patients in our series (average age 22 months, range 18-36 months) suffered a skull fracture; 2 of those 6 were basilar skull fractures. The average length of hospital stay was 5 days (range 1-13 days).
COMMENTS: The number of pediatric head injuries from falling televisions has been steadily increasing. A similar, yet more modest rise in the number of televisions manufactured and sold per year has also been noted. From our series, the most common type of pediatric head injury sustained from falling television sets was skull fracture, seen mostly in children less than 2 years of age.
Healthcare organizations, like all organizations, are increasingly more concerned about workplace violence. This paper discusses the collision of a cultural context that encourages macho posturing and moral panic related to highly publicized violence in schools and workplaces. At issue is the need for healthcare organizations to react to evidence of potential workplace violence but not to overreact.
Occupational mortality in British commercial fishing, 1976-95.
Correspondence: Stephen A. Roberts, Unit of Health-Care Epidemiology, Department of Public Health, University of Oxford, Old Road, Oxford OX3 7LF, UK; (email: stephen.roberts@uhce.ox.ac.uk).
AIMS: To establish the causes and circumstances of all deaths occurring at work or related to work among fishermen in British commercial fishing between 1976 and 1995. METHODS: A retrospective study, based on official mortality files, with a population of 440 355 fishermen-years at risk. RESULTS: Of 616 deaths in British fishing, 454 (74%) were due to accidents at work, and 394 (87%) of these fishermen drowned. A total of 270 accidents were caused by casualties to vessels and 184 by personal accidents. There was no significant decline in the fatal accident rate, 103.1 per 100 000 fishermen-years, between 1976 and 1995. The fatal accident rate was 52.4 times higher (95% CI 42.9 to 63.8) than for all workers in Great Britain during the same period, and this relative risk increased through the 1980s up to 76.6 during 1991-95. Relative risks with the construction (12.3) and manufacturing (46.0) industries were higher than 5 and 20 respectively, during 1959-68. Trawlers foundering in adverse weather was the most frequent cause of mortality from casualties to vessels (115 deaths), and 82 of 145 personal accidents at sea arose during operations involving trawling nets. CONCLUSIONS: When compared with shore based industries, fishing remains at least as hazardous as before. Prevention should be aimed, most importantly, at the unnecessary operation of small vessels and trawling net maneuvers in hazardous weather and sea conditions. Other measures should focus on preventing falls overboard, reducing fatigue, a more widespread use of personal flotation devices, and improvements in weather forecast evaluation.
Finite Element Analysis of Knee Injury Risks in Car-to-Pedestrian Impacts.
- Nagasaka K, Mizuno K, Tanaka E, Yamamoto S, Iwamoto M, Miki K, Kajzer J. Traffic Inj Prev 2003; 4(4): 345-354.
Correspondence: Koji Mizuno, Department of Mechano-Informatics and Systems, Graduate School of Engineering, Nagoya University, Furo-cho, Chikusa-ku, Nagoya 464 8603, JAPAN; (email: kmizuno@mech.nagoya-u.ac.jp).
In vehicle-pedestrian collisions, lower extremities of pedestrians are frequently injured by vehicle front structures. In this study, a finite element (FE) model of THUMS (total human model for safety) was modified in order to assess injuries to a pedestrian lower extremity. Dynamic impact responses of the knee joint of the FE model were validated on the basis of data from the literature. Since in real-world accidents, the vehicle bumper can impact the lower extremities in various situations, the relations between lower extremity injury risk and impact conditions, such as between impact location, angle, and impactor stiffness, were analyzed. The FE simulation demonstrated that the motion of the lower extremity may be classified into a contact effect of the impactor and an inertia effect from a thigh or leg. In the contact phase, the stress of the bone is high in the area contacted by the impactor, which can cause fracture. Thus, in this phase the impactor stiffness affects the fracture risk of bone. In the inertia phase, the behavior of the lower extremity depends on the impact locations and angles, and the knee ligament forces become high according to the lower extremity behavior. The force of the collateral ligament is high compared with other knee ligaments, due to knee valgus motions in vehicle-pedestrian collisions.
The 'lids For kids' Project Team. Inequalities in cycle helmet use: cross sectional survey in schools in deprived areas of Nottingham.
The 'lids For kids' Project Team. Inequalities in cycle helmet use: cross sectional survey in schools in deprived areas of Nottingham. Kendrick D & Royal S. (2003) Archives of Disease in Childhood, 88, 876-880.
OBJECTIVE: To describe cycle helmet owning and wearing among children in a deprived area and to investigate the association between helmet ownership and wearing and socioeconomic deprivation.
METHODS: Cross-sectional survey in 28 primary schools in deprived areas of Nottingham; 1061 year 5 school children were studied.
FINDINGS: All year 5 children attending school on the day of the survey completed the questionnaire (87% of children registered at participating schools). Children residing in a deprived area were less likely to own a bike and more likely to ride it 4 days a week or more. Half the children owned a helmet (52%), but only 29% of these always wore their helmet. Children in deprived areas were less likely to own a helmet, but those that owned a helmet were not less likely to always wear one. Family encouragement and parental warning of dangers of not wearing a helmet were associated with increased helmet ownership rates. Family encouragement and best friends wearing a helmet were associated with higher rates of helmet wearing.
COMMENTS: Programs aimed at preventing head injury among child cyclists will need to address the inequality in helmet ownership that exists between children residing in deprived and non-deprived areas. Strategies to increase family encouragement to wear a helmet may be useful, as may those recognizing the importance of the attitudes and behaviors of peers, such as peer education programs. Further work is required to assess how exposure to risk of cycling injury varies with deprivation.
Acute methanol poisonings reported to the Drug and Poison Information Center in Izmir, Turkey.
- Kalkan S, Cevik AA, Cavdar C, Aygoren O, Akgun A, Ergun N, Tuncok Y. Vet Hum Toxicol. 2003; 45(6): 334-337.
Correspondence: Sule Kalkan, Department of Pharmacology, Dokuz Eylul University School of Medicine, Department of Pharmacology 35340 Balcova, Izmir, TURKEY; (email: Sule.Kalkan@deu.edu.tr).
The demographics, sources and outcomes of methanol poisoning have not been described in Turkey. Our study identified the profile of acute methanol exposures reported to Drug and Poison Information Center (DPIC) in Izmir, Turkey, from 1993 to 2002. Data analysis included patient demographics, sources of methanol, reason for the exposure, clinical effects and outcomes of methanol poisoning. The DPIC recorded 30,485 calls concerning poisoning; 996 (3.3%) alcohol poisonings were recorded and 113 (11.3%) of them were methanol poisonings. There were 91 (80.5%) males and 22 (19.5%) females with a mean age of 34.7+/-1.3 y (range 19-65) and 4.8+/-0.9 y (range 1-18) in adults and children, respectively. The sources of methanol were eu de cologne (72.6%), spirits (10.6%) and antifreeze (2.7%). Accidental poisoning occurred in all children between 0 and 12 y old, abuse (55.7%) and intentional poisoning (27.3%) were predominant in adults. Clinical signs in all cases were central nervous system symptoms (45.1%), metabolic acidosis (23.0%), visual symptoms (21.2%) and gastrointestinal symptoms (10.6%). Sixteen patients (14.1%) died, 63 (55.8%) had complete recovery and 1 (0.9%) had irreversible visual problems. Most patients with methanol poisoning may die or present serious morbidity without appropriate treatment in a health care facility. Methanol for producing cheap "eu de colognes" in Turkey is the principal reason for severe poisoning and deaths. Public education about colognes and legislative control of cologne production are important in preventing methanol poisoning.
Health and safety implications of injury in professional rugby league football.
- Gissane C, White J, Kerr K, Jennings S, Jennings D. Occup Med (Lond) 2003; 53(6): 512-517.
Correspondence: Conor Gissane, Department of Health and Social Care, Brunel University, Osterley Campus, Isleworth, Middlesex TW7 5DU, UK; (email: conor.gissane@brunel.ac.uk).
CONTEXT: Professional sport is characterized by high injury rates but is also covered by health and safety legislation. Aim To examine the incidence of injury in professional rugby league as defined by the Reporting of Diseases and Dangerous Occurrences Regulations 1995 (RIDDOR 95).
METHODS: All injuries received during playing and training to both first-team and 'academy' (<19 years old) players during two playing seasons at one professional club were recorded. The length of time a player was unable to take part in full training and playing was used as a measure of severity. Injuries were classified into minor injuries (0-3 days), over 3 day injuries or major injuries, in which the final two categories corresponded with RIDDOR 95.
FINDINGS: Thirty-two per cent (95% confidence interval = 26-39%) of all injuries received satisfied the RIDDOR 95 criteria. The overall injury rate was 8.5 per 1000 h (7.2-9.9) for the first team and 4.1 per 1000 h (3.2-5.4) for the academy team. During match play the first-team injury rate was 157.7 per 1000 h (133.5-185.1) and 67.7 (51-81.1) for the academy team. Training injury rates were lower, at 0.5 per 1000 h (0.2-1.0) and 0.3 per 1000 h (0.1-0.8), respectively.
COMMENTS: The injury rate for professional rugby league is much higher than reported in other high-risk occupations such as mining and quarrying. The large differences in injury rates between first and academy teams have implications for young players likely to progress to first-team status.
Snowmobile Fatalities --- Maine, New Hampshire, and Vermont, 2002--2003.
- Acerno T, Pelletier A, Johnson J, Sawyer M, Ramsay L. MMWR 2003; 52(50): 1221-1224.
The full document that includes tables, figures, editorial note, and references is available online ( Download Document ).
During the 2002--2003 winter season in northern New England, 28 deaths in three states were associated with the use of snowmobiles, more than reported during any of the previous 12 winter seasons. The New Hampshire Department of Health and Human Services conducted a study to characterize these fatal injuries. This report describes the results of that study, which indicated that the leading contributors to snowmobile fatalities were excessive speed, inattentive or careless operation, and inexperience. Efforts to reduce snowmobile fatalities should focus on improving safety measures, including establishing speed limits, strengthening enforcement of snowmobile operating rules, and promoting safety education.
A case was defined as a fatality involving a person either riding on or struck by a snowmobile in Maine, New Hampshire, or Vermont during December 16, 2002--April 30, 2003. Cases were identified by reviewing reports from the Maine Department of Inland Fisheries and Wildlife, New Hampshire Fish and Game Department, and Vermont Department of Public Safety. The following three case descriptions summarize fatality reports from the three state agencies, based on investigations by enforcement officers.
Case Reports
Maine: In early January 2003, driver A, a male aged 17 years, was operating a snowmobile with a 600 cubic centimeter (cc) engine when he collided with another snowmobile at approximately 4:30 p.m., 4 minutes after sunset. According to the investigative report, driver A was speeding when he crested a small rise on a state trail at the same time as driver B, who was traveling in the opposite direction. Driver A, who was wearing a helmet, was struck in the head by the oncoming snowmobile; he died from head injuries. Driver B was not injured.
Vermont: In late January 2003, a man aged 45 years was operating a snowmobile with a 600 cc engine at 4:25 p.m., 20 minutes before sunset, when he attempted to make a right turn while traveling at high speed. The snowmobile overturned, throwing the driver onto the trail. The driver was wearing a helmet; his death was caused by blunt trauma to the chest and abdomen.
New Hampshire: In late February 2003, a man aged 30 years was operating a snowmobile with a 700 cc engine on a frozen lake when he fell off his snowmobile at 5:00 p.m., approximately 30 minutes before sunset. Reportedly, the driver was speeding toward an open channel in an attempt to ride the snowmobile over open water, (i.e., "skimming.") The driver's blood alcohol concentration (BAC) was 0.06 mg/dL (New Hampshire's BAC limit for snowmobile operators is < 0.08 mg/dL). The driver was not wearing a helmet. He struck his head on ice and fell into the water; death was caused by a basal skull fracture.
The 28 deaths associated with snowmobile use during the winter of 2002--2003 were the most reported annually by the three states during the previous 12 winter seasons (range: 6--24 deaths; median: 14 deaths). Sixteen (57%) of the 2002--2003 fatalities occurred in Maine, eight (29%) in New Hampshire, and four (14%) in Vermont. The fatality rate was 1.7 deaths per 10,000 registered snowmobiles in Maine, 1.2 per 10,000 registered snowmobiles in New Hampshire, and 1.0 per 10,000 snowmobiles with trail maintenance passes sold in Vermont.
Of the 28 fatalities, 26 (93%) were drivers, one (4%) was a passenger, and one (4%) was a pedestrian. Twenty-six (93%) of the fatalities involved males (Table). The median age was 39 years (range: 15--58 years). Of the 20 fatalities for which BAC was tested, five (25%) involved BACs of > 0.08 mg/dL. A total of 22 (81%) of the 27 riders fatally injured were wearing a helmet. None of the drivers in New Hampshire or Vermont had taken an operator safety course. Of the 21 snowmobiles with known engine size, 17 (81%) had > 500 cc engines. Four (14%) of the 28 fatalities occurred in December, 12 (43%) in January, seven (25%) in February, four (14%) in March, and one (4%) in April; 17 (61%) of the fatalities occurred on Saturday or Sunday. Of the 26 fatal accidents with known time of occurrence, 14 (54%) occurred after sunset. Of the 25 fatalities with known weather condition, 18 (72%) occurred when the weather was clear, five (25%) when it was cloudy, and two (8%) when it was snowing.
According to investigative reports of enforcement officers, 18 (64%) of the fatalities involved excessive speed (i.e., driving too fast for conditions); six (21%), inattentive or careless operation (e.g., driving on the wrong side of trails, attempting to jump embankments, and negotiating curves improperly); six (21%), inexperience; two (7%), mechanical problems; and one (4%), a heart attack; six (21%) fatalities involved more than one risk factor. Thirteen (46%) fatalities were caused by hitting fixed objects (e.g., trees, rocks, and chains across trails), four (14%) by head-on collisions with other snowmobiles, three (11%) by going through ice, three (11%) by going over an embankment, and five (14%) by other causes. Of the 13 fatalities caused by hitting fixed objects, nine (69%) occurred after sunset. Blunt trauma caused 23 (i.e., 14 head and neck, six chest and abdomen, and three other) (82%) of the deaths, two (7%) were caused by drowning, one (4%) by heart attack, and two (7%) were unknown.
Prediction of mortality in pediatric trauma patients: new injury severity score outperforms injury severity score in the severely injured.
- Sullivan T, Haider A, DiRusso SM, Nealon P, Shaukat A, Slim M. J Trauma 2003 ; 55(6): 1083-1088.
Correspondence: Stephen C. M. DiRusso, Department of Surgery, New York Medical College, Munger Pavilion, Valhalla, NY 10595, USA; (email: sdirusso@worldnet.att.net).
CONTEXT: The Injury Severity Score (ISS) is a widely accepted method of measuring severity of traumatic injury. A modification has been proposed-the New Injury Severity Score (NISS). This has been shown to predict mortality better in adult trauma patients, but it had no predictive benefit in pediatric patients. The aim of this study was to determine whether the NISS outperforms the ISS in a large pediatric trauma population.
METHODS: Admissions in the National Pediatric Trauma Registry between April 1996 and September 1999 were included. The ISS and NISS were calculated for each patient. The study endpoints were mortality at hospital discharge, functional outcome in three domains (expression, locomotion, and feeding), and discharge disposition for the survivors. Predictive ability of each score was assessed by area under the receiver operating characteristic curve.
FINDINGS: The NISS and ISS performed equally well at predicting mortality in patients with lower injury severity (ISS < 25), but the NISS was significantly better at predicting mortality in the more severely injured patients. Both scores performed equally well at predicting expression and feeding ability. The NISS was superior to the ISS in predicting locomotion ability at discharge. Thirty-seven percent of patients had an NISS that was higher than their ISS. These patients had a significantly higher mortality and suffered worse functional outcomes.
COMMENTS: The NISS performs as well as the ISS in pediatric patients with lower injury severity and outperforms the ISS in those with higher injury severity.
Change in health risk perception following community intervention in Central Havana, Cuba.
- Tate RB, Fernandez N, Yassi A, Canizares M, Spiegel J, Bonet M. Health Promot Int 2003; 18(4): 279-286.
Correspondence: Robert B. Tate, Department of Community Health Sciences, University of Manitoba, T148-770 Bannatyne Avenue, Winnipeg, MB, R3E 0W3 CANADA; (email: tate@ms.umanitoba.ca)
It is increasingly recognized that individual values, beliefs and behavior operate within a social context. There is growing consensus that local perceptions and indigenous knowledge should be important elements in the evaluation of programs aimed at improving health. Thus, an assessment of changes in health risk perception was included in the evaluation of a multi-component intervention project undertaken between 1996 and 1999 aimed at improving the health and well-being of residents in the inner city community of Cayo Hueso, in Centro Havana, Cuba. The community intervention involved a tremendous mobilization of government and non-governmental organizations, to promote social and cultural activities and address deficiencies in housing, water supply, waste disposal and street illumination. Prior to the interventions, 365 adults were surveyed regarding their perceived health risks regarding 41 health determinants, scored on four-point Likert scales ranging from 'without risk' to 'very risky'. A factor analysis of these data classified perception of risk into five areas: social environment, threats to personal health, lifestyle choices, environmental sanitation and housing conditions. The objective of the current analysis was to determine if there were changes in the level of perceived risk to health over the 5 years pre- versus post-intervention in Cayo Hueso, and if so, whether these changes were significantly different from changes seen during the same 5-year period in Colon, another community in Centro Havana not receiving focused interventions. During the first quarter of 2001, 1703 individuals living in 654 households in Cayo Hueso and Colon were interviewed in their homes using an enhanced version of the 1996 risk perception instrument. Ordinal logistic regression models, adjusted for age, gender and years of education, were fit to assess change in health risk perception between 1996 and 2001. Significant declines in perceived health risk were found in both Cayo Hueso and Colon within all five domains, with significantly greater declines in many areas in Cayo Hueso compared with Colon, particularly with respect to housing-related health risks, indeed the main target of the intervention. Risk perception surveys are useful characterizations of widely held views in a target population. Our findings of decreased perceived health risk following public health, physical and social interventions to improve health suggests that this line of inquiry merits consideration in planning evaluations of multi-sectoral community-based health promotion interventions.
What picture is worth a thousand words? A comparative evaluation of a burn prevention program by type of medium in Israel.
- Shani E, Ayalon A, Hammad IA, Sikron F. Health Promot Int 2003; 18(4): 361-371.
Correspondence: Esther Shani, Plastic Surgery Department, Soroka University Medical Center, Beer-Sheva, Israel, E-mail: geshani@netvision.net.il).
Burns are associated with longer hospital stay, permanent disfigurement and emotional stress disorders, and represent a health problem, especially among economically and socially deprived populations, such as the Bedouin population in Israel, hence the importance of intervention programs. The objective of this research was to examine the extent to which the effect of a visual one-session burn prevention program was determined by the type of medium used. We also examined the possibility that fear motivates action only when someone feels confident in his/her ability to control the threat. Data were based on the pre-/post-program self-report questionnaires administered to a randomly selected three-group sample of 12- to 13-year-old Bedouin children (n = 179). All three sessions were identical, but differed in the type of medium used: slides (S), video (V), or slides and video consecutively (S + V). We measured health beliefs (perceived threat, internal/external control, self-efficacy) and sense of coherence (SOC), both before and 2 months after completion of the intervention. We also measured post-program fear reaction and the improvement in burn-related knowledge, understanding and safety behavior as the outcome measure. No significant post-program differences between intervention groups were found, either in terms of outcome measure or in terms of health beliefs and SOC. However, within- person analysis indicated that the S group participants had the highest level of post-exposure fear and a decrease in luck control over injuries. The S + V group demonstrated the lowest within change. The hierarchical regression analysis revealed that self-efficacy, fear, higher socio-economic status and female gender predicted improvement. As hypothesized, the interaction between fear and self-efficacy added significantly to prediction. It seems that health beliefs and demographic characteristics were more powerful in predicting the effect of the intervention than the choice of medium per se. A multifaceted approach and more comprehensive interventions are needed in order to promote health among disadvantaged populations.
It's good to talk: the power of stories over statistics.
Correspondence: Thomas B Newman, Department of Epidemiology and Biostatistics, University of California, San Francisco, UCSF Box 0560, San Francisco, CA 94143-0560, USA; (email: newman@itsa.ucsf.edu).
The author uses two examples, neonatal jaundice and infant safety in airplane passenger seats, to describe the power of stories over statistics. In his example about children riding in aircraft seats he discusses the endorsement by the American Academy of Pediatrics of a proposed new requirement that children under 2 years of age ride in infant safety seats on airplanes, rather than being allowed to travel free on a parent's lap. The complete report includes tables, charts, and references that are important for understanding the nuances of this issue.
The history of the safety seat issue dates back at least to 1989, when an unrestrained child died in the potentially survivable crash of United Airlines flight 232 outside of Sioux City, Iowa. The US National Transportation Safety Board then recommended a regulation requiring universal child restraint to the US Federal Aviation Administration (FAA). In 1994, another "lap child" died in a potentially survivable crash, and the board again asked the FAA to take action. This time the FAA agreed to study the issue, and in 1995 it presented a report to Congress. The FAA estimated that only about five airplane crash deaths could be prevented over 10 years by adopting universal child restraint on aeroplanes.14 On the other hand, because the additional cost of an airplane ticket for a child is likely to lead some families to drive rather than to fly, the FAA estimated the regulation would cause an increase of about 87 deaths over 10 years, due to road deaths resulting from diversion to travel by car.
The FAA analysis was not accepted by the safety board and received a hostile reception at a congressional hearing. A major point of dispute was the FAA's estimate that 20% of families with children under 2 years old would choose to drive rather than fly if they needed to buy a ticket for their young child.
Brian Johnston, David Grossman, and I decided to take our own look at the proposed regulation. To avoid the contentious estimate of the proportion of families that would switch to car travel, we left that variable as an unknown and simply estimated numbers of deaths that might be saved or caused as a function of this unknown proportion. Even assuming 70% lower than average fatality rates per hundred million vehicle miles traveled, we found that if more than about 5-10% of families chose to drive rather than fly the policy would lead to a net increase in fatalities. Even ignoring these possible highway deaths, the estimated cost per death prevented was about $6.4 million for each $1 cost of the round trip airplane ticket for the child, or $1.3 billion if the ticket cost $200.
Further, the policy will lead to a net increase in deaths if more than about 6% of families choose to drive.
Unlike the case with neonatal jaundice and kernicterus, we have excellent data about the risks of plane crashes. However, as was the case with jaundice, the stories are more powerful than the statistics. In this case, Jan Brown Lohr, chief flight attendant on United flight 232, told a particularly compelling story in testimony before Congress:
It was a golden July day when disaster struck. The number two engine exploded, severing all hydraulic lines and leaving the pilots with only the number one and number three wing engines to maneuver the airplane. I have never known such terror...
As we waited for the brace signal from the cockpit, I mentally reviewed if everything had been covered and remembered that we had several lap children. I picked up the microphone again and instructed those parents to place their children on the floor, which would give some advance time to brace themselves, as well as their children...
What followed has been viewed countless times -- an unbelievable impact that mere words could never adequately describe -- the plane breaking into three sections, being engulfed in a flash fire, and my section finally stopping upside down in a corn field.
I was finally forced to leave the wreckage due to prohibitive and deadly smoke. The first person I encountered was a mother of a 22 month old boy -- the same mother I had comforted and reassured right after the engine exploded. She was trying to return to the burning wreckage to find him, and I blocked her path, telling her she could not return. And when she insisted, I told her that helpers would find him.
Sylvia Tsao then looked up at me and said, "You told me to put my baby on the floor, and I did, and he's gone."
What makes these stories so powerful? Firstly, the brains of human beings seem built to process stories better than other forms of input. Secondly, the storytellers themselves are important. It's not just that these awful things happened, it's that they happened to the person telling the story. This enables a connection with the listener or reader beyond what would be possible if the story were recounted by a dispassionate observer, and it infuses the storyteller with a passion to tell the story over and over again, thus multiplying its influence.
Thirdly, the powerful effect of these stories relates to the way people estimate probabilities. If we are trying to estimate the risk of kernicterus, one method we use is to base the estimate on how readily we can recall or imagine a case, and in what level of detail. This technique, called the availability heuristic, leads us to overestimate probabilities of events that we can easily and vividly imagine. It presents a challenge to subspecialists who, if they write guidelines, are likely to write them with a distorted sense of probabilities.
Finally, these stories are compelling because they describe particularly tragic outcomes and because they seem to offer a solution -- a way to extract some meaning and redemption from tragedy by preventing its reoccurrence.
The trouble with these compelling stories, however, is that their apparent simplicity and focus can lead to the neglect of complicated considerations of what else we might do with our resources, and how we should make these decisions. A problem for those promoting evidence based policies is that we are at a disadvantage when we cannot identify the specific people who would benefit or be harmed. As David Bishai wrote in an editorial that accompanied our paper on child safety seats on airplanes, "The infants who die in these car crashes do not crash and die statistically. They really crash. They really die... [But] the name and photo of the dead infant in the car crash will not haunt anybody in the world of aviation safety."
Lacking specific stories, we are reduced to impersonal numbers and calculations that are often viewed with distrust. As Congressman Jim Lightfoot of Iowa, whose district includes the site of the flight 232 crash, said during the congressional hearing at which the FAA presented its report: "The question, I think, Mr Chairman, comes down to how many more children must die, how many more have to be hurt before we reach the threshold of FAA's ghoulish cost-benefit ratio?"
Correspondence: R.C. Franklin, Australian Centre for Agricultural Health and Safety, Department of Rural Health, University of Sydney, New South Wales, AUSTRALIA; (email: rfranklin@health.usyd.edu.au).
OBJECTIVE: Data concerning farm-related injuries were collected from the Emergency Department at Tamworth Base Hospital over a 12-month period from 1 September 1997. The aim of the study was to collect information at a local level to establish baselines with a view to developing prevention strategies. All people who presented with a farm injury or illness to the emergency department participated in the study.
FINDINGS: During this period there were 384 injuries, of which nearly three-quarters were males (72.2%). Four injuries were fatal. The average rate of injury per 100 farms per annum in the service area of the Hospital was 30 per 100 farms (range 9-80 per 100 farms, per annum). Half (54.1%) of the people injured were employed at the time of the injury. Horses (21.1%) and motorcycles (15.8%) were the two most common injury agents.
COMMENTS: The information gained can be used to direct injury prevention at a local level and may be also used at the national level as a guide when grouped with other similar studies of different commodity groups.
Preventing unintentional injuries in schools: how to use data to build
partnerships and develop programs.
- Spicer RS, Young XJ, Sheppard MA, Olson LM, Miller TR. Am J Health Educ 2003, 34(5 Suppl): s13-s17.
Correspondence: Monique A. Sheppard, Children's Safety Network Economics and Data Analysis Resource Center, Pacific Center for Research and Evaluation, 11710 Beltsville Drive, Suite 300, Calverton, MD 20705, USA; (email: sheppard@pire.org).
(Published by American Association for Health Education)
Academic achievement and high test scores are not the only indicators of a successful
school. A good school is also a safe school. Unfortunately, every year in the United
States, approximately 3.7 million students suffer an injury at school severe enough to
require medical attention or to limit activity. Most of the injuries are preventable. Data
can be extremely effective in convincing school decision makers to take action to prevent
injuries. Several state and local school systems in the United States have used either
ongoing surveillance systems or a one time data collection effort to describe and
highlight the school injury problem, leading to the design and evaluation of injury
prevention programs. This article provides examples of some of these school-related
injury surveillance efforts. It illustrates how health educators can make a difference by
getting involved in the creation of surveillance systems and using the generated data to
make a convincing argument for school injury prevention. By forming partnerships and
developing prevention programs based on local data, a health educator can lead the way
to safe schools.
Monitoring school violence: linking national-, district-, and school-level data over time.
National monitoring of school violence is essential for needs assessments, policymaking, and evaluation at the national level. As informative and important as national monitoring is, the data generated at the national level is often not useful at the district or school site levels. There is therefore a need for a feasible method of monitoring school violence on the district and school level; furthermore, we need to find ways to effectively apply national-level information to schools and school districts. The authors have expanded the national model of monitoring to the district and school site level. We argue that monitoring violence systematically on the school level and linking to national and district-level data over time should be the foundation for the design, implementation, and evaluation of interventions in this area. In this article, we propose an expanded concept of monitoring that links comparable data on school violence at the grade, school site, district, and national levels. The paper presents our conceptual framework and methodology and illustrates its implementation in a district in Israel. We present examples of reports generated to monitor school violence for the district as a whole and for each of the school sites. Finally, we conclude that this is a feasible and useful model that social services could adopt to monitor practice in many other areas.
A comparison of 9th and 10th grade boys' and girls' bullying behaviors in two states.
Correspondence: Jody Isernhagen, University of Nebraska-Lincoln, Department of Educational Administration, Lincoln, NE, 68588-0360, USA;(email: jisernhagen3@unl.edu).
This paper compared the bully behaviors of 250 9th and l0th grade boys and girls in four schools in Texas and Nebraska. Nearly one-third of girls and one-fifth of boys observed bullying often. The most common kind of bullying for both boys and girls was hurtful teasing and name-calling. Boys bullied using more physical violence, while girls reported less; however, both boys and girls indicated they were threatened with harm more than 26% of the time when bullied.
School violence prevention: the effects of a university and high school partnership
Correspondence: Joy Renfro, Eastern Kentucky University, Department of Health Promotion and Administration, Richmond , KY 40475, USA; (email: joy.renfro@eku.edu).
OBJECTIVE: This study was designed to describe the level of violence in three high schools and to test the effects of universal and targeted strategies to reduce this violence.
DESIGN: A repeated measures design with two baseline scores and two intervention scores was used during a two year period. Two rural high schools served as control schools with a single intervention high school.
PARTICIPANTS: All freshmen at the three high schools completed a self-report measure of school violence; 420 completed the study at the end of their sophomore year.
METHODS: Multiple universal and targeted interventions to prevent school violence were used for slightly more than one year. Scores on student Victimization and Perpetration, gathered one year apart, were compared using a pre-test post-test model.
FINDINGS: Student reports of perpetration at the intervention school were significantly lower than the combined scores at the control school. Students, teachers, and administrators reported improved awareness, knowledge, and skills to implement violence prevention programs.
COMMENTS: A comprehensive program that includes university and high school partnerships has the capability to reduce school violence during a short period. Despite limitations to the study, continued use of research partnerships to decrease school violence is warranted.
Correspondence: James D. Unnever, Department of Sociology and Anthropology, Radford University, Box 6948, Young Hall 210, Radford, VA 24142, USA; (email: junnever@runet.edu).
We investigated the influence of low self-control and attention-deficit hyperactivity disorder (ADHD) on bullying and bully victimization in a sample of 1,315 middle school students using a school survey. Students who reported taking medication for ADHD were at increased risk for bullying as well as victimization by bullies. The correlation between ADHD status and bullying could be explained by low self-control, a construct theorized by Gottfredson and Hirschi (1990) to be the most important determinant of criminality. In contrast, the correlation between ADHD status and bullying victimization was independent of self-control. Subsequent analyses found that self-control influenced bullying victimization through interactions with student gender and measures of physical size and strength. These findings identify low self-control and ADHD as potential risk factors for bullying and victimization, and have implications for research on self-control in young adolescents.
Do monthly or seasonal variations exist in suicides in a high-risk setting?
- Fruehwald S, Frottier P, Matschnig T, Koenig F, Lehr S, Eher R. Psychiatry Res 2004; 121(3): 263-269.
Correspondence: Stefan Fruehwald, Clinical Department of Social Psychiatry, Vienna General Hospital, Waehringer Guertel 18-20, A-1090, Vienna, AUSTRIA; (email: stefan.fruehwald@univie.ac.at).
An unequal distribution of suicides over months and seasons has been a consistent finding in epidemiological surveys on suicide. Jails and prisons are a high-risk setting for suicide all over the world. The high prevalence of both outward and self-directed violence in prison populations indicates dysfunctional central serotonin (5-HT) neurotransmission and, therefore, could account for an unequal distribution of suicides over months and seasons due to underlying bioclimatic factors. Within a total survey of suicides in the Austrian penitentiary system, the weekly, monthly and seasonal distribution of custodial suicides between 1947 and 1999 was studied. After an explorative comparison of suicide distribution over weekdays, months and seasons of the year by chi(2)-tests, a harmonic Poisson regression model was performed to detect seasonality of suicides. No unequal distribution of suicides was evident over the 53-year period. A limitation of this study was its sample size of 412, a low number compared with population-based samples, where a spring suicide peak was consistently found. An explanation for lacking seasonality could be that bioclimatic factors are less relevant in urban, industrialized areas, where jails and prisons usually are located. One of the core characteristics of penal institutions is the limited possibility for communication and social interaction. This social isolation is independent of seasonal changes. If the individual's possibilities for social interactions are limited, the influence of seasonal changes in social activities may be less relevant. This could explain the absence of seasonal changes in custodial suicide incidence.
Factors that influence emergency department doctors' assessment of suicide risk in deliberate self-harm patients.
- Cooper JB, Lawlor MP, Hiroeh U, Kapur N, Appleby L. Eur J Emerg Med 2003; 10(4): 283-287.
Correspondence: Jayne Cooper, Centre for Suicide Prevention, University of Manchester, Williamson Building, Oxford Road, Manchester M13 9PL, UK; (email: jayne.cooper@man.ac.uk).
OBJECTIVES: To determine the patient factors influencing UK Emergency Department doctors' assessment of suicide risk. To establish whether immediate clinical management is consistent with perceived risk.
METHODS: The Manchester and Salford Self-Harm project is a multi-center deliberate self-harm monitoring study. Data collected were used to analyse risk assessments made by Emergency Department doctors between September 1997 and August 1999. We used univariate and logistic regression analyses to determine the factors Emergency Department doctors used to make suicide risk assessments.
RESULTS: A total of 3220 deliberate self-harm assessment forms were completed in two years by Emergency Department doctors; 2922 (91%) included a clinical assessment of risk; 28 out of 48 variables were associated with perceived suicide risk. Multiple logistic regression analyses showed that current mental state, high suicidal intent (including medical seriousness of attempt), and male sex were the most important independent predictors of suicide risk. Being referred to psychiatric services directly from the Emergency Department or to surgical/medical services was also strongly associated with a perceived high risk.
COMMENTS: In contrast to the negative findings of previous research, we found that Emergency Department doctors were influenced by key risk factors for suicide in their assessment of deliberate self-harm patients. Emergency Department doctors' assessments reflected the immediate risk of suicide, indicated by factors such as current mental state and strong suicidal intent. Background risk factors such as social adversity and psychiatric history were less influential. We would recommend that training for emergency doctors should emphasize the importance of both immediate and background risk factors.
The analysis of epidemiological characteristics of road traffic crashes in a mountain city in western China.
- Zhou JH, Zhao XC, Wang ZG, Zhu PF, Jian HG, Liu DW, Zhou JL, Liu L. Chin J Traumatol 2003; 6(6): 355-358.
Correspondence: J.H. Zhou, The Institute for Traffic Medicine, Research Institute of Surgery, Third Military Medical University, Chongqing 400042, CHINA; (email: unavailable).
OBJECTIVE: To study the epidemiological characteristics and preventive methods of road traffic crashes in a mountain city in western China through sampling investigation of traffic crashes in different regions of Chongqing city in recent years.
METHODS: Two police teams of traffic management in downtown, two teams in suburb, one team in county and one freeway team were randomly selected, and road traffic crashes between 1988 and 1997 were investigated and analyzed.
FINDINGS: A total of 13,121 road traffic crashes with 6201 crashes with casualties were analyzed. The incidence of crashes was higher in May, June and July, and on Friday and Wednesday and at 8:00-12:00 and 14:00-18:00 within a day. Casualties were 44.0% in pedestrians and 42.5% in passengers of total casualties. The deaths and severe injuries in pedestrians were 59.1% of total deaths and 56.4% of total severe injuries. The age of drivers and passengers were mainly at 18-30 years, followed by 31-40 years. People over 60 years old accounted for 24.1% of total pedestrian casualty. Head injury was the most common reason for deaths. The main reasons for these crashes were improper driving and violating traffic laws. Violating traffic laws by pedestrian was one of the main reasons for pedestrian casualty.
COMMENTS: The crashes are related to the characteristics of geography, climate, society activity of people, and the sense of traffic safety, the basic traffic construction and management in Chongqing. The traffic casualty of pedestrian is a big problem in Chongqing. To prevent and decrease road traffic injuries effective methods should be worked out and propaganda on traffic safety and traffic management should be strengthened according to different characteristics of different regions. To strengthen the first aid and treatment of cranium-brain injury and chest-back injury is also helpful in decreasing traffic deaths.
Speed-of-processing and driving simulator training result in improved driving performance.
Useful field of view, a measure of processing speed and spatial attention, can be improved with training. We evaluated the effects of this improvement on older adults' driving performance. Elderly adults participated in a speed-of-processing training program (N = 48), a traditional driver training program performed in a driving simulator (N = 22), or a low-risk reference group (N = 25). Before training, immediately after training or an equivalent time delay, and after an 18-month delay each participant was evaluated in a driving simulator and completed a 14-mile (22.5-km) open-road driving evaluation. Speed-of-processing training, but not simulator training, improved a specific measure of useful field of view (UFOV), transferred to some simulator measures, and resulted in fewer dangerous maneuvers during the driving evaluation. The simulator-trained group improved on two driving performance measures: turning into the correct lane and proper signal use. Similar effects were not observed in the speed-of-processing training or low-risk reference groups. The persistence of these effects over an 18-month test interval was also evaluated. Actual or potential applications of this research include driver assessment and/or training programs and cognitive intervention programs for older adults.
Psychiatric distress among road rage victims and perpetrators.
- Smart RG, Asbridge M, Mann RE, Adlaf EM. Can J Psychiatry 2003; 48(10): 681-688.
Correspondence: Reginald Smart, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, ON M5S 2S1, CANADA; (email: Reg_Smart@camh.net).
OBJECTIVE: To investigate the relation between psychiatric distress and road rage, paying particular attention to the potential link between psychiatric illness and frequent involvement in serious forms of road rage.
METHOD: This study reports data on road rage involvement, demographic characteristics, and mental health for a representative sample of 2610 adults in Ontario. The mental health indicator was the 12-item General Health Questionnaire.
FINDINGS: A cluster analysis revealed 5 distinct groups of people affected by road rage. The most serious offenders (referred to hereafter as the hard core road rage group), representing 5.5% of those affected, exhibited frequent involvement in the most severe forms of road rage and were the most likely (27.5%) to report psychiatric distress.
COMMENTS: Road rage, particularly experiences of victimization, is related to psychiatric distress. Evidence of psychiatric distress was highest among hard core road rage perpetrators, individuals noted for frequent involvement in serious aggressive and violent conduct. Further research is needed on violence and road rage and its link to mental health.
Correspondence: Robin A. Mason, Violence and Health Research Program, Centre for Research in Women's Health, Department of Public Health Sciences, University of Toronto, CANADA; (email: robin.mason@sw.ca).
Using action-research methods and the principles of community development, a small working group initiated an organization-wide process to sensitize the Sunnybrook and Women's College hospital community to the relationship between violence and women's health. In this article, we explore the process by which the initiative was successfully introduced into the newly merged hospital. We describe critical factors for the initiative's success and offer some suggestions on how to maximize opportunities for organizational change.
The risk of offending on homicide victimization: a public health concern.
Correspondence: Adam Dobrin, Department of Criminology and Criminal Justice, Florida Atlantic University, Davie, FL 33314, USA; (email: adobrin@fau.edu).
OBJECTIVE: To determine whether criminal offending increases an individual's risk of becoming a homicide victim. METHODS: A case-control design was used to compare the arrest and demographic attributes of 105 homicide victims to 105 nonvictims. Bi- and multivariate logistic regression models were used to determine differences between the two groups. RESULTS: Significant differences were found between homicide victims and nonvictims using different measures of arrest. CONCLUSIONS: The field of public health needs to take a greater interest in preventing violence, and by recognizing criminal offending as a risk factor to subsequent victimization, it can attempt to reduce fatal encounters.
Violence-related traumatic brain injury: a population-based study.
CONTEXT: Most studies of traumatic brain injury (TBI) and violence are small, focus on one violent mechanism only, and are nonrepresentative. This large, population-based effort examines characteristics, circumstances of injury, treatment pathways, and outcomes of persons with TBI as a result of all types of violence, compares them with other TBI survivors, identifies a risk profile, and examines how a violent cause impacts later outcomes.
METHODS: This study involved medical record abstraction and telephone survey at 1 year postinjury of a weighted sample of 2,771 Coloradans hospitalized with TBI between January 1, 1996, and June 30, 1999.
FINDINGS: People with violently incurred TBI are more likely to be young, male, members of minority groups, single, and premorbid alcohol abusers than other TBI survivors. At 1 year postinjury, they report less community integration and more headaches, confusion, and sensory and attentional disturbances. Predictors of these outcomes included age, gender, injury severity, and employment status.
COMMENTS: It appears that essentially the same factors that increase risk of sustaining a violent TBI negatively impact later outcomes as well.
Current causes and management of violence against women in Nigeria.
- Aimakhu C, Olayemi O, Iwe C, Oluyemi F, Ojoko I, Shoretire K, Adeniji R, Aimakhu V. J Obstet Gynaecol 2004; 24(1): 58-63.
Correspondence: CO Aimakhu, Department of Obstetrics and Gynaecology, University College Hospital, PMB 5116, Ibadan, NIGERIA; (email: unavailable).
Violence against women is an important health and human rights issue. It carries with it both short- and long-term sequelae for women that can affect both their physical and psychological wellbeing. Every day obstetric providers treat patients who have been assaulted. Timely identification can interrupt the cycle of violence, prevent further injury and initiate the help-seeking process. The objectives of this study were to survey how often Nigerian obstetrician - gynecologists see these patients in their practice and to describe the demographics and management of their most recent case so as to give an idea of the extent of the problem. This is especially important as abuse is grossly under-reported because the victims are afraid to report it because of male dominance in society and the fear of losing their homes. We used a self-administered questionnaire survey of 138 practising obstetricians and gynecologists in Nigeria. Questions were asked about the yearly estimation of cases seen and how recently a case was seen. The type of abuse, risk factors and management of their most recent case was also documented. Most (98.6%) obstetricians surveyed had previously managed a case of violence. The mean estimate of abused women seen was 7.0 per year. Details of the last case managed were recollected by 91.3% of respondents. The majority (51.6%) of patients were pregnant. The assailant was the husband in 69.8% of cases and the most common factor for abuse was as a result of women requesting money for the family needs from their husbands. The most common type of abuse was physical (79.4%), with 34.9% of patients sustaining cuts. Treatment and counseling were the forms of management in most cases. The police were informed in 9.5% of cases and one obstetrician had to give evidence in court. Of the pregnant abused women, 73.8% had live births. Better job opportunities and female empowerment can reduce the risk of violence. Obstetricians should screen routinely for battery, provide education about violence, assess the danger, review safety plans and refer women appropriately. We cannot solve the problem alone, but sensitivity and commitment can begin to make a difference.
The changing meaning of small arms in Nuer society
The economic value, social status and symbolic meaning of small arms are particular and temporal in nature. This is demonstrated through a historical account of the dynamics of cultural change and adaptation in Nuer society. Specifically, the article shows how attitudes towards small arms shifted over time from a positive valuation of guns as prestigious objects, to ambivalence between the need for protection and the experience of increased local lawlessness and violence. More generally, it demonstrates how weapon-related activities can only be fully understood when seen against a specific cultural background. Even if the display, use and circulation of weapons appear to carry cross-cultural references, typically as expressions of power and masculine identity, the meaning is always primarily local. Therefore, strategies to reduce the destructive impact of small arms through demand side programs, based on voluntary participation, can only be carried out successfully if built on an in-depth understanding of a particular cultural context.
This article first looks at the relationship between international terrorism and terrorism in Africa. Since sub-state terrorism is already endemic to Africa, the future threat potential in the continent lies in a complex mixture of sub-national and international terrorism. Africa may come to play a central role in international terrorism. The motivation, means and targets all exist and these opportunities will not go unheeded for much longer. Africa presents both a facilitating environment and a target-rich environment for terrorists that seek to attack the United States, and indeed the global system. The article concludes with some remarks on counter-strategies.
Age and Meanings of Violence: Women's Experiences of Partner Violence in Finland.
The first survey carried out in Finland specifically to study men's violence against women showed that partner violence is quite common in Finland and it is directed especially toward young women. The statistical findings don't support the idea that violence has become more widespread in Finland. Life situation factors that are usually viewed as making women vulnerable to spousal violence, such as having children, cohabiting, low educational level, and financial dependency on the male partner, failed to explain partnership violence against women in Finland as such, too. The author's objective is to find out whether meanings of violence have changed and whether this could be one reason why young women report in a survey such cases of violence that other women would not. This could explain why violence in partnerships is so common among young women in Finland.
The epidemiology of female rape victims who seek immediate medical care: temporal trends in the incidence of sexual assault and acquaintance rape.
- Magid DJ, Houry D, Koepsell TD, Ziller A, Soules MR, Jenny C. J Interpers Violence 2004; 19(1): 3-12.
Correspondence: David J. Magid, University of Colorado Health Sciences Center, 4200 E. Ninth Ave. Denver, CO 80262, USA; (email: unavailable).
Women who seek medical care following sexual assault are usually evaluated and treated in an emergency department (ED). Therefore, EDs can be an important source of sexual assault surveillance data. The authors compared the incidence of sexual assault presenting for emergency care in a single county during July to November of 1974 and 1991. Participants included all female sexual assault victims aged 14 and older who presented for ED evaluation. Treating physicians prospectively collected data using standardized forms. The z statistic was used to compare sexual assault incidence. There was a 60% increase in the incidence of sexual assault victims presenting for emergency care in 1991 compared to 1974, primarily due to an increase in the incidence of women presenting to the ED after rapes by known assailants. In contrast, the annual incidence of reported stranger assaults was similar in the two study years.
