Does Alcohol Make a Difference?: Within-participants Comparison of Incidents of Partner Violence.

- Testa M, Quigley BM, Leonard KE. J Interpers Violence 2003; 18(7): 735-743.

Correspondence: Maria Testa, Research Institute on Addictions, University at Buffalo, USA; (email: testa@ria.buffalo.edu).

doi: unavailable -- What is this?

(Copyright © 2003, SAGE Publications)

Episodes of husband-to-wife violence in which the husband consumed alcohol were compared with episodes of husband-to-wife violence, reported by the same individuals, in which the husband was not drinking. Among this community sample of newly-weds, wife reports, but not husband reports, indicated that violent episodes in which the husband was drinking included more acts of violence and were more likely to involve severe violence. Both wife and husband reports indicated that wives were more likely to be physically aggressive in husband drinking episodes compared to sober episodes. However, whereas wives reported that their aggressive behavior was a response to husband aggression, husbands reported that wives were more likely to initiate violence in these episodes. Violent episodes that include alcohol may be more severe and more mutually violent than sober episodes. Discrepancies between husband and wife reports may reflect differences in recall or self-serving biases.

Being "at fault" in traffic crashes: does alcohol, cannabis, cocaine, or polydrug abuse make a difference?

- Chipman ML, Macdonald S, Mann RE. Inj Prev 2003; 9(4): 343-348.

Correspondence: Mary L Chipman, Department of Public Health Sciences, 12 Queens Park Crescent West, Toronto, Ontario M5S 1A8, CANADA; (email: mary.chipman@utoronto.ca).

doi: unavailable -- What is this?

(Copyright © 2003, BMJ Publishing Group)

OBJECTIVE: To compare associations of alcohol, cannabis, and cocaine abuse and traffic crash risk for "at fault" crashes and all crashes.

DESIGN: A historical cohort study.

SETTING: Toronto, Ontario. Patients or subjects: Subjects beginning treatment at the Center for Addictions and Mental Health (CAMH) in 1994 for abuse of alcohol, cannabis, cocaine, and all combinations of these substances (n = 590, with 411 drivers). A control group consisted of 518 records from the Ontario registry of registered drivers, frequency matched for age and sex and residence.

INTERVENTIONS: CAMH subjects took part in therapeutic programs. Pre-intervention (11 115 driver-years) and post-intervention intervals (8550 driver-years) were defined and compared.

MAIN OUTCOME MEASURES: Crash and collision rates, adjusted relative risks (ARRs) of crash involvement and of "at fault" crashes were computed using Poisson regression to control for variations in time at risk, age, and sex of participants.

FINDINGS: Pre-treatment, significant ARRs of 1.49 to 1.79 for all crashes were found for abusers of cannabis, cocaine, or a combination. ARRs increased by 10%-15% for "at fault" crashes. Post-treatment, all associations were very modest for all abuse types. Only younger and male drivers had a significantly increased risk, which was stronger for "at fault" than for all crashes.

COMMENTS: Abuse of cannabis and cocaine pre-treatment was more strongly related to "at fault" crashes than to all crashes. Interaction between these substances means that the effects of combined abuse cannot be predicted from simple main effects.

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See item under Sensing and Response issues

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"We are all public health": September 11 and its aftermath through the eyes of public health educators at Ground Zero.

- Azar CF, Ruiz Y. Health Promot Pract 2003; 4(4): 362-366.

Correspondence: C.F. Azar, New York City, Department of Health and Mental Hygiene Bureau of Tobacco Control, New York City, USA; (email: unavailable).

doi: 10.1177/1524839903255771 -- What is this?

(Copyright © 2003, SAGE Publications)

No one could have predicted the events of September 11. The days following this tragic event put public health educators' skills to the test as they transferred theory to practice to assist rescue workers, victims, and community residents to cope and rebuild their lives. As health educators working in New York City at that time, the authors were quickly thrust into experiences, roles, and responsibilities for which they thought they had little preparation. But as they worked at Ground Zero in the days immediately after the attack and later in the neighborhoods of lower Manhattan, they realized their health promotion practice and research training provided them with what they needed to play their part. This article briefly illustrates their experiences and describes the skills and knowledge they tapped into to assist the community.

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Reducing drivers' mental workload by means of an adaptive man-machine interface.

- Piechulla W, Mayserb C, Gehrkec H, Königc W. Transp Res: F Traf Psychol Beh 2003, 6(4): 233-248.

Correspondence: Walter Piechulla, Institut für Experimentelle Psychologie, Universität Regensburg, GERMANY; (email: piechulla@psychologie.uni-wuerzburg.de).

10.1016/j.trf.2003.08.001 -- What is this?

(Copyright © 2003 Elsevier)

Modern in-vehicle information and communication devices are changing the nature of the driving task. Drivers take it for granted that they are able to divide their attention between the primary task of driving and secondary tasks like monitoring information displays or using mobile phones. While it is commonly accepted that driver information overload can compromise traffic safety, attempts to introduce attention management within the vehicle are nowadays limited to restrictive decisions by legislative bodies. In an increasing number of countries, the use of hands-free phones is enforced by law. In some countries, the use of phones while driving is prohibited altogether. We argue that there is a more intelligent solution to the information overload issue, namely an adaptive man-machine interface that filters information presentation according to situational requirements. We implemented such a filter as a projective real-time computational workload estimator which is based on the assessment of traffic situations detected from an on-board geographical database. Workload estimates are refined by data from sensors that monitor the traffic environment and variables of driving dynamics. The prototype system is operational in a demonstrator vehicle. Whenever the workload estimate exceeds a threshold value, incoming telephone calls are automatically redirected to the telephone mailbox without notifying the driver. An evaluation field experiment that employed objective and subjective methods of assessing workload yielded promising results in terms of the possibilities of reducing workload by means of the adaptive interface. The results are in favor of the idea of a futuristic, situation-aware vehicle which has the potential to enhance comfort and safety while driving.

Driving experience, attentional focusing, and the recall of recently inspected events.

- Underwood G, Chapman P, Berger Z, Crundall D. Transp Res: F Traf Psychol Beh 2003, 6(4): 289-304.

Correspondence: Geoffrey Underwood, School of Psychology, University of Nottingham, Nottingham NG7 2RD, UK; (email: geoff.underwood@nottingham.ac.uk).

10.1016/j.trf.2003.09.002 -- What is this?

(Copyright © 2003 Elsevier)

How does a driver's perception of roadway events change with experience? A laboratory study addressed this question by comparing novice and experienced drivers as they watched video recordings taken from a moving vehicle. While watching the recordings, the drivers had their eye movements monitored. When the recording was paused, memory for immediately prior events was tested, and recall performance related to what the viewer had been inspecting. The recordings were taken from a vehicle as it traveled along a series of roads, and questions were asked about other road users and about roadway features. The experiment asked about the relationship between driving experience and attentional capture, and about the recall of events recently seen. What attracted attention were objects of central interest such as other road users appearing close to the camera, and moving objects. When the memory test was administered immediately after a hazardous event had occurred, such as a pedestrian stepping into the path of the camera vehicle, then there was evidence of attentional focusing and reduced availability of details about incidental objects. Recall performance generally reflected the pattern of eye fixations, but viewers did not always recall details about fixated objects, and were sometimes able to recall information about objects that were not fixated. Experienced drivers recalled more of the incidental events than the novices, but they were similar in their recall of central events. This supports the association between driving experience and the extent of the effective perceptual field.

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See item 1 under Distraction and Attentional Issues

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Brominated Flame Retardants: Cause for Concern?

- Birnbaum LS, Staskal DF. Environ Health Perspect 2004; 112(1): 9-17.

Correspondence: Daniele Staskal, U.S. EPA, ORD, NHEERL, ETD, PKB, MD B143-05, Research Triangle Park, NC 27711 USA; (email: staskal.daniele@epa.gov).

doi: 10.1289/ehp.6559 -- What is this?

(Copyright © 2003, National Institute of Environmental Health Sciences)

Brominated flame retardants (BFRs) have routinely been added to consumer products for several decades in a successful effort to reduce fire-related injury and property damage. Recently, concern for this emerging class of chemicals has risen because of the occurrence of several classes of BFRs in the environment and in human biota. The widespread production and use of BFRs; strong evidence of increasing contamination of the environment, wildlife, and people; and limited knowledge of potential effects heighten the importance of identifying emerging issues associated with the use of BFRs. In this article, we briefly review scientific issues associated with the use of tetrabromobisphenol A, hexabromocyclododecane, and three commercial mixtures of polybrominated diphenyl ethers and discuss data gaps. Overall, the toxicology database is very limited; the current literature is incomplete and often conflicting. Available data, however, raise concern over the use of certain classes of brominated flame retardants.

Paintball Injuries in Children: More Than Meets the Eye.

- Listman DA. Pediatrics 2004; 113(1): 15-18.

Correspondence: David A. Listman, Department of Pediatrics, St Barnabas Hospital, Bronx, New York, USA; (email: david.listman@yale.edu).

doi: unavailable -- What is this?

(Copyright © 2004, American Academy of Pediatrics)

OBJECTIVE: To describe the increasing incidence of ocular injuries in the pediatric population caused by paintballs. The awareness of this trend will help the physician who treats the child to give appropriate care as well as educate physicians, who counsel children, about this growing mechanism of pediatric injuries.

METHODS: Previously unpublished data from the US Consumer Product Safety Commission were analyzed to find the frequency of ocular injuries in children. A review of the English-language literature was also conducted to describe trends with regard to age, sex, location at the time of injury, use of eye protection, types of injuries sustained, and long-term visual outcome.

RESULTS: The incidence of paintball eye injuries treated in emergency departments has risen from an estimated 545 in 1998 to >1200 in 2000. The proportion of these injuries that occurred in the pediatric population may be well over 40%. These injuries are seen predominantly in boys, a growing proportion of whom are playing informally in unsupervised settings and not wearing eye protection. The cases previously reported include large numbers of hyphemas, retinal detachments, cataracts, corneal abrasions, vitreous hemorrhages, and commotio retina. Many of the patients in these cases sustained permanent visual impairment, with 43% having best vision at follow-up of 20/200 or worse.

COMMENTS: Pediatric eye injuries caused by paintballs are an unrecognized cause of severe injury and permanent visual loss. The advances in eye protection for participants in "war games" have had little if any effect on the youngest population. Children and teens are unlikely to wear eye protection voluntarily when playing at undesignated or unsupervised locations. Changes should be made to restrict availability of these very dangerous but easily acquired guns and ammunition. Practitioners must counsel young people and their caregivers to avoid injuries by wearing appropriate eye protection. Parents should supervise the use of paintball equipment as they would other activities that involve high-speed projectiles.

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Work-related injury among south Texas middle school students: prevalence and patterns.

- Weller NF, Cooper SP, Tortolero SR, Kelder SH, Hassan S. South Med J 2003; 96(12): 1213-1220.

Correspondence: N.F. Weller, Center for Health Promotion and Prevention Research, School of Public Health, Mental Sciences Institute, University of Texas Health Science Center at Houston, Houston, TX, USA; (email: nweller@bcm.tmc.edu).

doi: unavailable -- What is this?

(Copyright © 2003, Lippincott, Williams & Wilkins)

OBJECTIVE: Work experiences among early adolescents are largely undocumented. Our purpose was to document the prevalence of work and work-related injury among lower-income Hispanic South Texas middle school students.

METHODS: Anonymous surveys were conducted in classrooms of sixth- through eighth-grade students, and 3,008 students reported current or recent employment.

FINDINGS: The prevalence of work was 56%; mean weekly work hours were 7.7. Increasing weekly work hours were significantly related to work injury (11-20 hours, odds ratio [OR], 1.5; 95% confidence interval [CI], 1.1-1.9; 21+ hours, OR, 2.4; 95% CI, 1.8-3.2, compared with 1-10 hours). The odds of injury were highest for agriculture (OR, 4.4; 95% CI, 3.3-6.0), followed by restaurant (OR, 3.8; 95% CI, 2.7-5.4), construction (OR, 3.6; 95% CI, 2.4-5.2), and yard work (OR, 1.7; 95% CI, 1.4-2.2).

COMMENTS: Working more than 20 hours weekly increased the likelihood of injury among middle school students. Parents and professionals should monitor weekly school-year work hours.

Safety and Insecurity: Exploring the Moderating Effect of Organizational Safety Climate.

- Probst TM. J Occup Health Psychol 2004; 9(1): 3-10.

Correspondence: Tahira M. Probst, Washington State University, Vancouver, WA, USA; (email: probst@vancouver.wsu.edu).

doi: unavailable -- What is this?

(Copyright © 2003, APA)

This research reconciled disparate findings regarding the relationship between job insecurity and safety by examining organizational safety climate as a potential moderator. It was predicted that a strong organizational safety climate would attenuate the negative effects of job insecurity on self-reported safety outcomes such as safety knowledge, safety compliance, accidents, and injuries. Data collected from 136 manufacturing employees were consistent with these predictions. Results are discussed in light of escalating interest in how organizational factors can affect employee safety.

Trauma from tire and rim explosions: A retrospective analysis.

- Sheperd RS, Ziccardi VB, Livingston D, Lavery R. J Oral Maxillofac Surg 2004; 62(1): 36-38.

Correspondence: Vincent B. Ziccardi, University of Medicine and Dentistry of New Jersey, New Jersey Dental School, Department of Oral and Maxillofacial Surgery, 110 Bergen St, Room B 854, Newark, NJ 07103-2400,USA; (email: ziccarvb@umdnj.edu).

doi: 10.1016/j.joms.2003.08.007 -- What is this?

(Copyright © 2004, American Association of Oral and Maxillofacial Surgeons)

OBJECTIVE: The purpose of this study is to review injuries occurring as a result of tire and rim explosions treated at a level I trauma center.

METHODS: The retrospective audit evaluated the university hospital trauma database based on ICD-9 code to isolate patients sustaining tire and rim explosion injuries. A total of 12 complete patient records were derived from this search to allow determination of injuries and outcome assessments.

FINDINGS: Injury patterns from tire and rim explosions were categorized in terms of anatomic region, treatment and hospitalization, disposition, and outcome assessment. Maxillofacial injuries were further subdivided into specific injuries involving a total of 7 patients from this case series.

COMMENTS: Significant blast injuries can result from tire and rim explosions, which can often involve the maxillofacial region due to proximity to the source. Reductions in injuries have been seen since the implementation of physical safety measures by the Occupational Safety and Health Administration and the National Highway Transportation Safety Board.

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Pedestrian behaviors at and perceptions towards various pedestrian facilities: an examination based on observation and survey data.

- Sisiopiku VP, Akin D. Transp Res: F Traf Psychol Beh 2003, 6(4): 249-274.

Correspondence: Virginia Sisiopiku, Department of Civil and Environmental Engineering, University of Alabama at Birmingham, Hoehn 311, 1530 3rd Avenue S., Birmingham, AL 35294-4440, USA; (email: vsisiopi@uab.edu).

10.1016/j.trf.2003.06.001 -- What is this?

(Copyright © 2003 Elsevier)

This paper presents findings from an observational study of pedestrian behaviors at various urban crosswalks and a pedestrian user survey which sought pedestrian perceptions toward various pedestrian facilities in a divided urban boulevard located next to a large university campus, Michigan State University, East Lansing, MI, USA. Such facilities included signalized and unsignalized intersection crosswalks, unsignalized marked and non-striped midblock crosswalks, physical barriers (vegetation and two-foot high concrete wall), midblock crosswalk shelters, colored paving (red brick pavement) at medians and curbs, and pedestrian warning signs at midblock crossing locations, messaging "cross only when traffic clears." Pedestrian behavior data were obtained from the reduction of video images of pedestrian movements recorded throughout the study site. Pedestrian perceptions information was obtained through a user survey completed by pedestrians using the study site. It was found that unsignalized midblock crosswalks were the treatment of preference to pedestrians (83% reported a preference to cross) and also showed high crossing compliance rate of pedestrians (71.2%). It was also evident that the crosswalk location, relative to the origin and destination of the pedestrian, was the most influential decision factor for pedestrians deciding to cross at a designated location (90% said so). Proper traffic control can further encourage pedestrian crossings at designated locations since the effect of the availability of pedestrian signal to influence pedestrians' decisions to cross at a specific location was quite high (74% said so). Moreover, vegetation and concrete barriers influenced the decision to cross of a significant number of pedestrians surveyed (65%). It is expected that the findings from this study will help traffic engineers, urban planners and policy makers understand pedestrian behaviors and attitudes at/towards pedestrian crosswalks.

Pedestrian traffic injuries in Mexico: a country update.

- Hijar M, Vazquez-Vela E, Arreola-Risa C. Inj Control Saf Promot 2003; 10(1-2): 37-43.

Correspondence: Martha Hijar, National Institute of Public Health of Mexico, Av. Universidad 655 Col Sta Ma. Ahuacatitlan, Cuernavaca Morelos, MEXICO; (email: mhijar@correo.insp.mx).

doi: unavailable -- What is this?

(Copyright © Swets & Zeitlinger)

Road traffic injuries in general and pedestrian injuries in particular are a major public health problem in Mexico, especially in large urban areas. Analysis of mortality and road crashes at the national level was done using routine data recorded on death certificates. Fatality rates for different age groups were estimated by region for the year 2000. These data were supplemented by a cross-sectional study of pedestrian injuries in Mexico City based on death certificates information for pedestrians who lived and died in Mexico City between 1994 and 1997. Participant observation of physical spaces where crashes occurred was carried out. The spaces were filmed and in-depth interviews of survivors conducted. Road traffic crashes were responsible for approximately 17,500 deaths in Mexico during 2000. The mean age of the victims was 37 years. Mexico lost an average of 30 years of productive life for each individual who died in a traffic crash--525,000 years in 2000. An estimated 9500 (54.3%) of all fatalities were pedestrians, and for every pedestrian death there were 13 others who sustained nonfatal injuries requiring medical care. The overall crude mortality rate for pedestrian injuries in Mexico City was 7.14 per 100,000 (CI 6.85-7.42). A concentration of deaths was observed in 10 neighborhoods at specific types of street environments. The underlying factors included dangerous crossings and the absence or inadequacy of pedestrian bridges, as well as negative perceptions of road safety by pedestrians. In conclusion, this study demonstrates the importance of elucidating the underlying contextual determinants of pedestrian injuries.

Causes and consequences of pedestrian injuries in children.

- Mayr JM, Eder C, Berghold A, Wernig J, Khayati S, Ruppert-Kohlmayr A. Eur J Pediatr 2003; 162(3): 184-190.

Correspondence: Johannes Mayr, Department of Paediatric Surgery, Austrian Committee for Injury Prevention in Childhood, University of Graz, Auenbruggerplatz 34, 8036 Graz, AUSTRIA; (email: johannes.mayr@kfunigraz.ac.at).

doi: 10.1007/s00431-002-1099-1 -- What is this?

(Copyright © 2003, Springer Verlag)

Pedestrian-car collisions are in motorized countries one of the leading causes of unintentional-injury-related death and morbidity among children. The objective of this study was to assess correlations between the mode and the severity or post-traumatic sequels of the injury. A 12-year (1989-2001) retrospective study of children aged 0-16 years injured in pedestrian-motor-vehicle collisions was undertaken. An anonymous survey with questionnaires completed by families was conducted. In this time period, 501 children (average age: 7.9 years) were injured. The lack of visibility of the vehicle (45%) and/or the pedestrian (39%) was the leading cause of injury. The mean injury severity score was 6.0 (1-75) and the mortality rate was 0.8% ( n=4, injury severity scores 47, 75, 75, 75). In this study, 217 questionnaires were analyzed. When the children were injured, 37% of them were alone, 32.3% were in the presence of accompanying adults, and 24.0% were in the presence of other children. The latter group suffered the highest injury severity score ( P=0.016). Positive correlations were noted between injury severity score and impact speed ( r=0.31, P<0.001) and the distances that the children were thrown off or transported on the vehicle front ( r=0.29, P<0.001). Physical sequels were reported by 27% of the families, and 23% noted psychological disturbances. A positive correlation was noted between impact speed and the occurrence of physical sequels ( P<0.001). The number of deformed parts per vehicle was correlated to the occurrence of behavioral disturbances ( P<0.004). The incidence of post-traumatic sequels seems to be associated with higher speed at impact, lack of braking attempts, and higher numbers of vehicle parts deformed.

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Childhood and adolescence poisoning in NSW, Australia: an analysis of age, sex, geographic, and poison types.

- Lam LT. Inj Prev 2003; 9(4): 338-342.

Correspondence: Lawrence T Lam, Royal Alexandra Hospital for Children, Locked Bag 4001, Westmead, NSW 2145, AUSTRALIA; (email: lawrencl@chw.edu.au).

doi: unavailable -- What is this?

(Copyright © 2003, BMJ Publishing Group)

OBJECTIVE: This study aims to investigate whether there is any association between the types of poison substances and geographic locations for different age groups and sex.

DESIGN: This is a population based epidemiological study utilizing routinely collected inpatient statistics.

SETTING: Data are collected as part of the routine vital health information system via all hospitals in New South Wales (NSW), Australia.

PATIENTS: All patients aged between 0-19 years who were admitted to a hospital because of poisoning by the four major types of substances that were defined in the study in NSW in 2000.

FINDINGS: The standardized incidence ratios of poisoning related hospitalization between metropolitan and rural areas varied across different poison types when compared with the NSW average. While there are few differences between metropolitan and rural areas for analgesic and chemical related poisoning admissions across different age groups and sex, differences in the standardized incidence ratios between geographic locations for psychotropic and venom related poisoning admissions were found. No significant difference in standardized mortality ratios were found between metropolitan and rural areas except for females in the 10-14 years age group (standardized mortality ratio 3.24, 95% confidence interval 1.69 to 6.21).

COMMENTS: The results obtained in this study, on the whole, provide some evidence for an association between poison types and geographic locations for psychotropic and venom related poisoning.

Self-reported therapeutic errors to a poison control center.

- McGoodwin L. J Okla State Med Assoc 2003; 96(11): 522-525.

Correspondence: Lee McGoodwin, Oklahoma Poison Control Center, Children's Hospital, OU Medical Center, 940 NE 13th St, Oklahoma City, OK 73104, USA; (email: Lee-Mcgoodwin@ouhsc.edu).

doi: unavailable -- What is this?

(Copyright © 2003, Oklahoma State Medical Association).

BACKGROUND: The techniques for avoiding medication errors in healthcare settings can be extrapolated to improving pharmaceutical care and medication safety in the patient's home. Understanding patient self-dosing errors in self dosing is important in the development of prevention strategies.

OBJECTIVE: To examine cases of therapeutic errors in patient self dosing as reported to the Oklahoma Poison Control Center, with the goal of proposing prevention strategies and education.

METHODS: A retrospective study of self-dosing errors was performed examining root cause, patient age, and pharmaceutical agent.

FINDINGS: Patient self-dosing errors accounted for 8.75% of all poison control exposures as compiled by the Oklahoma Poison Control Center in 2001. The most common reasons for therapeutic errors in all age groups involved taking or giving the wrong formulation or concentration, inadvertently taking/giving medication twice and another incorrect dose.

COMMENTS: Patient education is the key to preventing therapeutic errors in the home.

Deaths due to absence of an affordable antitoxin for plant poisoning.

- Eddleston M, Senarathna L, Mohamed F, Buckley N, Juszczak E, Sheriff MH, Ariaratnam A, Rajapakse S, Warrell D, Rajakanthan K. Lancet 2003; 362(9389): 1041-1044.

Correspondence: Michael Eddleston, Ox-Col Collaboration, Department of Clinical Medicine, Faculty of Medicine, PO Box 271, 25 Kynsey Road, Colombo-08, SRI LANKA; (email: eddlestonm@eureka.lk).

doi: 10.1016/S0140-6736(03)14415-7 -- What is this?

(Copyright © 2003, Elsevier)

There is a severe shortage of affordable antivenoms and antitoxins in the developing world. An anti-digoxin antitoxin for oleander poisoning was introduced in Sri Lanka in July, 2001, but because of its cost, stocks ran out in July, 2002. We looked at the effect of its introduction and withdrawal on case fatality, and determined its cost-effectiveness. The antitoxin strikingly reduced the case fatality; its absence resulted in a three-fold rise in deaths. At the present price of US2650 dollars per course, every life saved cost 10209 dollars and every life year cost 248 dollars. Reduction of the antitoxin's price to 400 dollars would reduce costs to 1137 dollars per life gained; a further reduction to 103 dollars would save money for every life gained. Treatments for poisoning and envenoming should be included in the present campaign to increase availability of affordable treatments in the developing world.

See also item 1 under Suicide

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Trends in emergency department reported head and neck injuries among skiers and snowboarders.

- Hagel BE, Pless B, Platt RW. Can J Public Health 2003; 94(6): 458-462.

Correspondence: I. Barry Pless, Joint Department of Epidemiology and Biostatistics, McGill University, Montreal, QC, CANADA; (email: barry.pless@mcgill.ca).

doi: unavailable -- What is this?

(Copyright © 2003, Canadian Public Health Association)

OBJECTIVE: Reports from the U.S. suggest increases in the proportion and rate of head and neck injuries in skiers and snowboarders. It is important to determine if the same is true in Canada.

METHODS: Skiers and snowboarders (< 18 years) presenting to 16 selected emergency departments from 1991 to 1999 were assigned one body region of injury in the following order: i) brain and spine-spinal cord, ii) head and neck, iii) face, iv) other body region (i.e., controls). Crude and adjusted (age, gender, helmet use and hospital admission) odds ratios indicating the proportion of head, brain, face, and neck injury relative to controls by calendar year were estimated. Injury rates were examined for 12 to 17 year olds over the last 4 years of the study.

FINDINGS: Compared with 1997-1999, there was a lower proportion of skier head injuries from 1991-93 (adjusted odds ratio (AOR) = 0.16; 95% Confidence Interval (CI) = 0.09-0.30) and from 1995-97 (AOR = 0.71; 95% CI = 0.49-1.04). The proportion of skier brain injuries was lower from 1993-95 (AOR = 0.69; 95% CI = 0.44-1.07) and from 1995-97 (AOR = 0.56; 95% CI: 0.35-0.91). In snowboarders, however, compared with 1997-99, there was evidence that although the proportion of head injuries was lower from 1991-93 (AOR = 0.19; 95% CI = 0.05-0.80), the opposite was true for facial injuries. For 12 to 17 year olds, skier brain and snowboarder head and neck injury rates increased from 1995-99.

COMMENTS: The results suggest that head and brain injuries in skiers and head and neck injuries in snowboarders may be increasing, particularly in adolescents.

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Is a Type A behavior pattern associated with falling among the community-dwelling elderly?

- Zhang JG, Ishikawa-Takata K, Yamazaki H, Ohta T. Arch Gerontol Geriatr 2004; 38(2): 145-152.

Correspondence: Kazuko Ishikawa-Takata, Division of Health Promotion and Exercise, National Institute of Health and Nutrition, 1-23-1 Toyama Shinjuku, 162-8636, Tokyo, JAPAN; (email: kazu@nih.go.jp).

doi: 10.1016/j.archger.2003.09.001 -- What is this?

(Copyright © 2004, Elsevier Publishing)

The aim of this report is to investigate the relationship between Type A behavior patterns and the likelihood of falling among community-dwelling elderly, and to compare differences in the prevalence, reasons, locations, injuries and frequency of falls between Type A and non-Type A personalities. Persons aged 60 or older living in 3 communities of Nanjing, China participated in a baseline survey conducted in 2000 (n=879), and falling incidents were followed for 1 year. The survey employed a self-administered questionnaire designed to elicit demographic data, current health problems and medications taken, intake of alcohol, exercise habits, physical function, environmental hazards and Type A behavior patterns. Several factors associated with falling such as health condition, physical function and environmental factors did not differ between the Type A and non-Type A groups except in the male tendency toward heart disease and their inability to walk fast. The results of logistic regression analyses showed that a Type A behavior pattern was independently associated with falling in males but not in females. Findings in the present study suggest that a Type A behavior pattern might play an important role in the rate of falling incidents in elderly males, since some characteristics of this personality pattern might lead to risk-taking behavior. More studies are needed to evaluate the association of certain behavior patterns with falling incidents.

Severity of injury and mortality associated with pediatric blunt injuries: Hospitals with pediatric intensive care units versus other hospitals.

- Szypulski FL, Hannan EL, Cooper A. Pediatr Crit Care Med 2004; 5(1): 5-9.

Correspondence: Edward L Hannan, Department of Health Policy, Management and Behavior, School of Public Health, University at Albany, Rensselaer, NY, USA; (email: elh03@health.state.ny.us).

doi: unavailable -- What is this?

(Copyright © 2004, Lippincott Williams & Wilkins)

OBJECTIVE: To a) compare in-hospital mortality rates for pediatric (age <13 yrs) patients with blunt injuries in the New York State Trauma Registry based on hospital type (dedicated pediatric intensive care unit [PICU] and designated trauma centers and noncenters that do not have a dedicated PICU) for the purpose of determining whether there is a reduction in mortality at a specialty hospital and b) determine the extent to which high-risk patients are admitted to specialty hospitals. Data Source: Inpatient data for the years 1994-1998 in the New York State Trauma Registry.

METHODS: A total of 8,180 pediatric inpatients who suffered blunt injury were selected to examine where patients were treated (PICU, regional trauma center without PICU, area trauma center without PICU, or noncenter without PICU) as a function of injury severity. Data were extracted for inpatients aged <13 yrs who suffered blunt injury.

FINDINGS: The injury severity of inpatients treated at PICUs and regional centers without PICUs was significantly higher than at other hospitals. Risk factors that were independently related to survival of pediatric trauma inpatients were age <5 yrs, motor component of one to five, abnormal systolic blood pressure relative to age, and International Classification of Disease, Ninth Revision-Based Injury Severity Score. Of the total 136 deaths, 133 were among the patients <5 yrs old, motor score <6, and age-related abnormal systolic blood pressure. A total of 66.8% of these patients were treated at PICUs, and 9.9% were treated at regional centers without PICUs. No statistically significant differences in risk-adjusted mortality rates were found by hospital type, but rates at PICUs were lower than for other types of hospitals except for noncenters without PICUs, whose patients were considerably less severely injured.

COMMENTS: There is significant triaging of the most seriously injured pediatric trauma inpatients to PICUs, and there is evidence that this policy is effective.

Consequences of falling in older men and women and risk factors for health service use and functional decline.

- Stel VS, Smit JH, Pluijm SM, Lips P. Age Ageing 2004; 33(1): 58-65.

Correspondence: P. Lips, Department of Endocrinology, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, THE NETHERLANDS; (email: p.lips@vumc.nl).

doi: unavailable -- What is this?

(Copyright © 2004, British Geriatrics Society)

OBJECTIVES: (1) to examine consequences of falls in older men and women and (2) to examine risk factors for health service use and functional decline among older fallers.

METHODS: the study was performed within the Longitudinal Aging Study Amsterdam. In 1998/1999, potential risk factors were assessed during the third data collection. In 1999/2000, 204 community-dwelling persons (>/==" BORDER="0">65 years) who reported at least one fall in the year before the interview, were asked about consequences of their last fall, including physical injury, health service use, treatment and functional decline (i.e. decline in functional status, social and physical activities).

FINDINGS: as a consequence of falling, respondents reported physical injury (68.1%), major injury (5.9%), health service use (23.5%), treatment (17.2%), and decline in functional status (35.3%), and social (16.7%) and physical activities (15.2%). Using multivariate logistic regression, specific risk factors for health service use after falling could not be identified. Female gender (OR = 2.8, 95% CI = 1.5-5.1), higher medication use (OR = 1.5, 95% CI = 1.0-2.2) and depressive symptoms (OR = 1.9, 95% CI = 1.3-2.8) were independently associated with functional decline after falling. Depressive symptoms (OR = 2.0, 95% CI = 1.2-3.3) and falls inside (OR = 2.6, 95% CI = 1.1-6.5) were risk factors for decline in social activities, while female gender (OR = 2.7, 95% CI = 1.1-7.0) and depressive symptoms (OR = 1.9, 95% CI = 1.2-3.0) were risk factors for decline in physical activities after falling.

COMMENTS: almost 70% of the respondents suffered physical injury, almost one-quarter used health services and more than one-third suffered functional decline after falling. No risk factors were found for health service use needed after falling. Female gender, higher medication use, depressive symptoms and falls inside were risk factors for functional decline after falling.

Trauma fatalities. time and location of hospital deaths.

- Demetriades D, Murray J, Charalambides K, Alo K, Velmahos G, Rhee P, Chan L. J Am Coll Surg 2004; 198(1): 20-26.

Correspondence: Demetrios Demetriades, Department of Surgery, Division of Trauma and Critical Care, University of Southern California, Los Angeles, CA, USA; (email: demetria@usc.edu).

doi: 10.1016/j.jamcollsurg.2003.09.003 -- What is this?

(Copyright © 2004, Elsevier Publishing)

Analysis of the epidemiology, temporal distribution, and place of traumatic hospital deaths can be a useful tool in identifying areas for research, education, and allocation of resources. Trauma registry-based study of all traumatic hospital deaths at a Level I urban trauma center during the period 1993 to 2002. The time and hospital location where deaths occurred were analyzed according to mechanism of injury, age, Glasgow Coma Score, and body areas with severe injury (Abbreviated Injury Scale [AIS] >/= 4). Logistic regression analysis was used to identify risk factors associated with death at various times after admission. During the study period there were 2,648 hospital trauma deaths. The most common body area with critical injuries (AIS >/= 4) was the head (43%), followed by the chest (28%) and the abdomen (19%). Overall, 37% of victims had no vital signs present on admission. Chest AIS >/= 4, penetrating trauma, and age greater than 60 years were significant risk factors associated with no vital signs on admission. Patients with severe chest trauma (AIS >/= 4) reaching the hospital alive were significantly more likely to die within the first 60 minutes than were patients with severe abdominal or head injuries (17% versus 11% versus 7%). In patients reaching the hospital alive, the time and place of death varied according to mechanism of injury and injured body area. Deaths caused by severe head trauma peaked at 6 to 24 hours, and deaths caused by severe chest or abdominal trauma peaked at 1 to 6 hours after admission. The temporal distribution and location of trauma deaths are influenced by the mechanism of injury, age, and the injured body area. These findings may help in focusing research, education, and resource allocation in a more targeted manner to reduce trauma deaths.

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Acoustic, semantic and phonetic influences in spoken warning signal words.

- Edworthy J, Hellier E, Walters K, Clift-Mathews W, Crowther M. Appl Cogn Psychol 2003; 17A(8): 915-933.

Correspondence: Judy Edworthy, Department of Psychology, University of Plymouth, Drake Circus, Plymouth PL4 8AA, UK; (email: jedworthy@plymouth.ac.uk).

doi: 10.1002/acp.927 -- What is this?

(Copyright © 2003, John Wiley & Sons)

Three experiments are reported which explore the relationship between semantic, acoustic and phonetic variables in the judgment of eight warning signal words. Experiment 1 shows that listeners can distinguish very clearly between urgent and non-urgent versions of the words when spoken by real speakers, and that some signal words such as deadly and danger score more highly than words such as attention and don't. It also shows that the three dimensions of perceived urgency, appropriateness and believability of these words are highly correlated. Experiment 2 replicates Experiment 1 using synthesized voices where acoustic variables are controlled. The semantic effects are replicated, and to some extent appropriateness and believability are found to function differently from that of perceived urgency. Experiment 3 compares the same set of eight signal words with a set of phonetically similar neutral words, showing that warning signal words are rated significantly higher, and largely maintain their previous rank ordering.

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Agricultural tasks and injuries among Kentucky farm children: results of the Farm Family Health and Hazard Surveillance Project.

- Browning SR, Westneat SC, Donnelly C, Reed D. South Med J 2003; 96(12): 1203-1212.

Correspondence: Steven R. Browning, College of Nursing, Department of Preventive Medicine and Environmental Health, University of Kentucky, Lexington, KY 40536-0232, USA; (email: srbrown@pop.uky.edu).

doi: unavailable -- What is this?

(Copyright © 2003, Lippincott, Williams & Wilkins)

OBJECTIVE: This population-based study reports the prevalent agricultural tasks and the 1-year cumulative incidence of injuries in a sample of 999 children < or = 18 years old living on family farms in Kentucky.

METHODS: Data were collected in 1994 to 1995 for the National Institute for Occupational Safety and Health Farm Family Health and Hazard Surveillance Project. A random sample of farm children in 60 Kentucky counties was selected using a cross-sectional, two-stage cluster design. Respondents, primarily mothers, completed a 30-minute telephone interview about work-related tasks and injuries experienced by their children while working on the farm.

FINDINGS: Participation in chores related to tobacco and beef cattle production was common for children aged 5 to 18 years. In a 1-year period, 29 children were injured while performing farm work, yielding a crude rate of 2.8 per 100 children (95% confidence interval, 1.7-3.8). Boys aged 16 to 18 years had the highest injury rate (9.2 per 100 children). Farm machinery, cattle and horses, falls from heights, and contact with inanimate objects were the primary external causes of nonfatal farm work injuries.

COMMENTS: Rates of farm work injuries among adolescent boys may be higher than previously reported for Kentucky and other states. Injury prevention interventions targeted to chores related to tobacco and beef cattle production are particularly relevant for this population of young workers.

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An Elementary School Violence Prevention Program.

- Scheckner SB, Rollin SA. Journal of School Violence 2003; 2(4): 3-42.

Correspondence: Stephen A Rollin, Florida State University, Tallahassee, FL 32306, USA; (email: rollin@coe.fsu.edu).

doi: 10.1300/J202v02n04_02 -- What is this?

(Copyright © 2003, Haworth Press)

This article details the implementation and empirical evaluation of an elementary school violence program. The problem of school violence and the significance and focus of the study are discussed. The general research question in this study was to examine the potential for a computer-mediated anger management program to enhance or improve the conflict resolution skills of youth with aggressive behavior problems in an elementary school setting. This study employed an 8-week computer-mediated anger management program, called SMART Talk (Students Managing Anger Resolution Together), for teaching conflict resolutions skills. This program was derived from a meta-analysis (Scheckner et al., 2002) due to its large effect size, statistical significance, and computer-mediated execution in order to verify past results with a more specifically defined population of at-risk (i.e., aggressive) students. Overall, the results suggest that participants in the intervention group significantly reported more intentions to use nonviolent strategies in a future conflict than students in the control group. Further research is recommended in order to assess the replicability of this study to other populations. Recommendations include longer intervention duration, larger sample size, multiple school settings, and multi-systemic implementation (i.e., teacher and parent workshops) as well as longitudinal studies.

See item 1 under Violence Issues

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The efficacy of a specific balance-strategy training program for preventing falls among older people: a pilot randomized controlled trial.

- Nitz JC, Choy NL. Age Ageing 2004; 33(1): 52-58.

Correspondence: Jenny C. Nitz, Department of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia 4072, AUSTRALIA; (email: j.nitz@shrs.uq.edu.au).

doi: unavailable -- What is this?

(Copyright © 2004, British Geriatrics Society. )

BACKGROUND: older people participate in exercise programs to reduce the risk of falls but no study has investigated a specific balance strategy training intervention presented in a workstation format for small groups.

OBJECTIVE: to determine whether a specific balance strategy training program delivered in a workstation format was superior to a community based exercise class program for reducing falls.

METHODS: a randomized controlled trial model. Neurological Disorders, Ageing and Balance Clinic, Department of Physiotherapy, The University of Queensland. 73 males and females over 60 years, living independently in the community and who had fallen in the previous year were recruited.

METHODS: all subjects received a falls risk education booklet and completed an incident calendar for the duration of the study. Treatment sessions were once a week for 10 weeks. Subject assessment before and after intervention and at 3 months follow-up included number of falls, co-morbidities, medications, community services and activity level, functional motor ability, clinical and laboratory balance measures and fear of falling.

FINDINGS: all participants significantly reduced the number of falls (P < 0.000). The specific balance strategy intervention group showed significantly more improvement in functional measures than the control group (P = 0.034). Separate group analyses indicated significantly improved performance in functional motor ability and most clinical balance measures for the balance group (P < 0.04). The control group only improved in TUG and TUGcog.

COMMENTS: the results provide evidence that all participants achieved a significant reduction in falls. Specific balance strategy training using workstations is superior to traditional exercise classes for improving function and balance.

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Self poisoning with pesticides.

- Eddleston M, Phillips MR. BMJ 2004; 328(7430): 42-44.

Correspondence: Michael Eddleston, Ox-Col Collaboration, Department of Clinical Medicine, Faculty of Medicine, PO Box 271, 25 Kynsey Road, Colombo-08, SRI LANKA; (email: eddlestonm@eureka.lk).

The complete report including tables, figures, case reports, and linkable references is available via the doi link below.

doi: 10.1136/bmj.328.7430.42 -- What is this?

(Copyright © 2004, BMJ Publishing Group)

Self inflicted violence accounts for around half of the 1.6 million violent deaths that occur every year worldwide. About 63% of global deaths from self harm occur in the Asia Pacific region. Most of these deaths occur in rural areas, where easy access to highly toxic pesticides turns many impulsive acts of self poisoning into suicide. The World Health Organization's recent World Report on Violence and Health recommends that suicide prevention strategies focus on the identification and treatment of people with mental disorders. However, as impulsive self poisoning is often not associated with mental illness, this may not be the most effective approach for rural Asia.

Self harm is a major problem in many nations in the Asia Pacific region, from the Pacific islands of Fiji and Samoa, to Asian nations as different as China and Sri Lanka. Suicide accounted for 71% (512 000/722 000) of all violent deaths in South East Asia and the Western Pacific region in 2000. Most deaths occur in rural communities: the incidence of fatal self harm in rural China is three to five times that in urban China,4 and self poisoning is the commonest cause of inpatient death in some rural Sri Lankan districts but a rare cause in the capital city.

Some experts believe that a distinction exists, particularly in terms of intent, between people who harm themselves (attempt suicide) and those who die (commit suicide). WHO's report on violence and health, however, acknowledges that, although an intent to die is a key element of suicide, determining the level of intent for an individual is difficult.

Self harm, in particular self poisoning, is used for many reasons -- to gain attention, express distress, or get revenge -- not just for ending life. We think that many deaths from self poisoning in Asia Pacific occur in people who do not intend to die; they die because the poisons ingested are very toxic and patients are difficult to treat.

WHO's report supports the common view that fatal self harm is always associated with a mental disorder. It does not consider the issue of impulsive suicides in people without mental illness. A meta-analysis by Bertolote and Fleishmann reported that 98% of fatal deaths from self harm occur in people with definite mental illness.10 But studies from China, India, and Malaysia suggest that a substantial proportion of people who die from self harm do not have a diagnosable mental illness.

Self poisoning often occurs immediately after an acute relationship crisis not after long hours of premeditation. In one study of 326 people who had carried out serious but non-fatal acts of self harm in China,14 83% had ingested pesticides, only 40% had a diagnosable mental illness, and 35% reported that they first considered harming themselves 10 minutes or less before making the attempt.

Comparison with Britain

Self harm, in particular self poisoning, is common in the United Kingdom. However, most of the 3000-4000 deaths that occur each year from self harm are the result of gassing or physical acts such as hanging, not poisoning. A high proportion of people who carry out such acts die, usually outside hospital. The premeditation required for these methods of self harm suggests that intent to die is high.

British hospitals deal with over 100 000 cases of self poisoning with medicines each year. Intent to die among people who self poison, unlike those who gas or hang themselves, is generally low and the case fatality very low: fewer than one in 300 people (0.3%) who reach hospital die. The poisons are not particularly toxic, effective antidotes are widely available, and medical management is simple. In 2000, only 712 people died from intentional self poisoning in Britain.

By contrast the case fatality for self poisoning in rural Asia is 10-20%. As a result, most deaths from self harm are due to poisoning and not physical acts (figure). A study from China that examined a nationally representative sample of 519 suicides found that 62% of deaths were due to pesticide ingestion and only 27% to physical methods. Moreover, 89% of the pesticide deaths occurred in rural farming households. Thus, in China alone, an estimated 175 000 (62% of 287 0004) deaths occur each year from pesticides, most in farming communities. Tens of thousands more rural deaths from self poisoning with pesticides occur in other Asia Pacific countries.

Since 1960, the Sri Lankan suicide rate has increased by over 700%. This has been almost entirely due to an increase in the incidence of fatal self poisoning with pesticides because the incidence of all other methods (except plant poisoning) has remained stable. This rise in suicide rate has been much studied; suggested reasons include the civil war and frustration felt by educated young people because of lack of opportunity. A simpler reason may be the introduction of pesticides into everyday use during the green revolution.

In our ongoing study of self poisoning with pesticides in Sri Lanka, 12% of patients required intubation. Half of the patients died and entered the suicide statistics. Many of the survivors would also have died if there had been no endotracheal tubes, laryngoscope, or doctor capable of intubating them. Such situations are common across the developing world. Patients die from aspiration or respiratory failure because doctors in small rural hospitals do not have the equipment or skills to intubate or the ventilators to support heavily sedated patients.

Essential antidotes are often lacking: atropine has been unavailable in parts of Nepal for many months. It is impossible to manage serious organophosphate pesticide poisoning without atropine. A similar situation currently exists with yellow oleander poisoning in Sri Lanka: the lack of an affordable antitoxin means that patients must be transferred across the island to access pacing facilities. Many die during transfer.

Thus, the factor determining whether self poisoning is fatal or not is often medical, and nothing to do with the attempt itself. A parallel situation could occur in Britain if, for example, no antidote was available for paracetamol poisoning. The resulting higher case fatality for this common method of self harm would produce a substantial rise in overall suicide rate without a change in the degree of intent to die.

Recommendations for reducing deaths from self harm

WHO's report makes several recommendations to reduce the incidence of suicide -- for example, improving recognition and management of mental disorders and strengthening community based support systems. Although these are important strategies for reducing fatal self harm globally, their ability to reduce deaths in rural Asia is questionable.

The report also suggests restricting the availability of methods for self harm (such as fencing in high bridges and restricting access to dangerous medicines or pesticides). This approach could have a rapid effect, but the report qualifies that access to pesticides should be controlled for only people "other than farmers." Since over 80% of households in the developing world farm some land, most people in rural Asia would not be affected by the recommended restrictions. Indeed, most fatal pesticide ingestions occur in farming households.

Primary and secondary prevention strategies relevant to the rural developing world are possible. However, pesticide regulation has to be nationwide and must apply to everyone, particularly farming households. It could include deregistering highly toxic pesticides or only allowing the use of the safer pesticide when two pesticides do the same job. Other methods might be to give legal authority to use pesticides to just a few people in each community (thus taking pesticides out of most households) or to provide lockers for storing pesticides away from houses so that they are not close at hand during moments of stress.

Improved medical management of self poisoning could also reduce suicide rates rapidly since most patients with pesticide poisoning reach hospital alive. Improvement will come from clinical research, implementation of findings into clinical practice, and improved supply of essential antidotes.

Halving the case fatality of pesticide poisoning in Sri Lanka from 20% to 10% would reduce the annual number of inpatient pesticide deaths by about a 1000. The national number of suicides would consequently fall from 4500 to 3500, a 22% reduction. Our ongoing study of the management of pesticide poisoning indicates that such a reduction is possible by using standardized protocols and good supportive care.

A similar reduction could be expected in China, where 59% of people who die after self poisoning receive medical treatment before dying.9 This represents 36.6% of all Chinese suicides, or 105 000 suicides annually. Thus halving the case fatality among people who receive treatment after ingesting pesticides would save over 50 000 lives a year and result in an 18% drop in the overall suicide rate.

COMMENTS: Strategies to reduce the prevalence of mental illness and to increase the level of psychological and social support in rural communities should reduce the incidence of fatal self harm. However, such approaches will take time. We believe that national pesticide regulation and improved medical management will have a rapid effect possibly producing 100 000 fewer deaths a year in the Asia Pacific region alone. We hope that WHO will incorporate these approaches into its strategy to deal with this major global public health problem.

Parasuicide and suicide in the south-west of Ireland.

- Corcoran P, Keeley HS, O'Sullivan M, Perry IJ. Ir J Med Sci 2003; 172(3): 107-111; discussion 105-106.

Correspondence: Paul Corcoran, National Suicide Research Foundation, Cork, IRELAND; (email: paul.nsrf@iol.ie).

doi: unavailable -- What is this?

(Copyright © 2003, Royal Academy of Medicine in Ireland)

BACKGROUND: Suicidal behavior has become recognized as a major public health problem.

OBJECTIVE: To examine hospital-treated parasuicide and suicide in the Southern and Mid-Western Health Boards.

METHODS: Parasuicide data were derived from independent data collection in general and psychiatric hospitals and prisons between 1995 and 1997. The corresponding suicide data were obtained electronically from the Central Statistics Office.

FINDINGS: Respectively, the annual person-based male, female and total European age-standardized rates were 128.9, 154.3 and 141.3 per 100,000 for parasuicide compared to 22.7, 5.5 and 14.1 per 100,000 for suicide. The parasuicide/suicide ratio varied markedly by age, gender, area and marital status. The majority of suicides were by hanging or drowning whereas drug overdose made up the vast majority of parasuicide acts. Parasuicide was largely a city phenomenon confined to the young of both genders whereas suicide was a significant problem for city and county men, especially young adult men.

COMMENTS: There are striking differences between the patterns of fatal and non-fatal suicidal behavior in Ireland, which should be considered in prevention initiatives.

Perceived causes of suicide attempts by U.K. South Asian women.

- Hicks MH, Bhugra D. Am J Orthopsychiatry 2003; 73(4): 455-462.

Correspondence: Madelyn Hsiao-Rei Hicks, Institute of Psychiatry, Department of Health Services Research, London, UK; (email: MJHHicks@aol.com).

doi: unavailable -- What is this?

(Copyright © 2003, Educational Publishing Foundation)

Perceived causes of suicide attempts were examined in 180 ethnic South Asian women living in the London area. The 3 factors endorsed most frequently and strongly as causes of suicide attempts in South Asian women were violence by the husband, being trapped in an unhappy family situation, and depression.

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Injuries in pediatric patients with seatbelt contusions.

- Campbell DJ, Sprouse LR 2nd, Smith LA, Kelley JE, Carr MG. Am Surg 2003; 69(12): 1095-1099.

Correspondence: D.J. Campbell, Department of Surgery, The University of Tennessee College of Medicine-Chattanooga Unit, Chattanooga, Tennessee 37403, USA; (email: unavailable).

doi: unavailable -- What is this?

(Copyright © 2003, Southeastern Surgical Congress)

Children restrained with lap belts may sustain severe injuries. We investigated the frequency of each type of injury associated with seatbelt contusions. The medical records of all trauma patients with ICD-9 codes for abdominal wall contusions from January 1, 1999, to December 31, 2001, were reviewed. All patients with seatbelt contusions were included in the study. Age, seat position, weight, restraint-type, sex, and mechanism of injury were noted. There were 1447 admissions for trauma over the 3-year period. Forty-six patients (ages 4-13) had a seatbelt contusion. Thirty-three wore lap belts, and 13 wore lap and shoulder harnesses. Twenty-two children required abdominal exploration. Small bowel injuries were the most common intra-abdominal injuries. Facial injuries were the most common associated injuries. Forty-eight per cent of children with seatbelt contusions in our institution required surgery. The smaller patients tend to have higher frequency of abdominal injuries. The presence of seatbelt contusion indicates the possibility of severe internal injuries.

When technology tells you how you drive--truck drivers' attitudes towards feedback by technology.

- Roetting M, Huang Y-H, McDevitt JR, Melton D. Transp Res: F Traf Psychol Beh 2003, 6(4): 275-287.

Correspondence: Matthias Roetting, Liberty Mutual Research Institute for Safety, 71 Frankland Road, Hopkinton, MA 01748, USA; (email: matthias.roetting@libertymutual.com).

10.1016/j.trf.2003.09.001 -- What is this?

(Copyright © 2003 Elsevier)

Behavior based safety approaches have proven effective in reducing accidents in industrial settings, but cannot easily be extended to commercial driving. For considerable periods of working time, truck drivers are alone, and do not interact with peers. It might be possible to use data gathered by new in-vehicle technology to provide real-time and post-shift feedback to drivers about their driving behavior. This paper reports the results of focus group interviews conducted with subject matter experts from the trucking industry (truck drivers, supervisors, managers, and other involved persons, such as insurance industry safety professionals). The focus groups discussed safety critical behaviors in commercial driving, the best way to provide feedback to truck drivers, and benefits of feedback by technology as well as concerns drivers and operators may have regarding monitoring and feedback systems. The focus group discussions showed that, in general, drivers would like to receive more feedback and that feedback by technology is acceptable, if designed and implemented properly. In addition, the participants had many suggestions on how to properly design and implement such systems.

MaryPODS revisited: updated crash analysis and implications for screening program implementation.

- Staplin L, Gish KW, Wagner EK. J Safety Res. 2003; 34(4): 389-97.

Correspondence: Loren Staplin, TransAnalytics, Kulpsville, PA 18104, USA; (email: lstaplin@transanalytics.com).

doi: 10.1016/j.jsr.2003.09.002 -- What is this?

(Copyright © 2003, National Safety Council, Published by Elsevier)

CONTEXT: Due to the relative scarcity of crashes, there has consistently been a problem with analyses that use crashes as a criterion measure in their analyses.

METHODS: Previous analyses of the relationships between functional capacity measures and at-fault crash involvement for older drivers as reported in the NHTSA Model Driver Screening and Evaluation Program Final Technical Report have been updated to include one additional year of driving experience. Eighteen new at-fault crashes involving drivers who previously had no crash involvement were recorded for the Maryland Motor Vehicle Administration (MVA) test sample during this interval. The method of odds ratio (OR) calculation was used to examine the relationships between functional status predictors and the most salient among the safety outcome measures identified in the Maryland research. Peak valid OR values for the prior and current analyses were contrasted, and the stability of candidate pass-fail cut-points for each predictor relative to values identified in the Final Technical Report was examined.

FINDINGS: Results indicate that the predictive value of functional tests appears to decrease over time, particularly for the perceptual-cognitive measures.

COMMENTS: The impact of these findings on programs and policies is to underscore a need for periodic reevaluation, spaced at the shortest practical intervals but not more than 2 years apart, in order for functional capacity screening to be applied effectively by licensing authorities, health care professionals, and others to reduce personal risk and enhance public safety.

Older women drivers: fatal crashes in good conditions.

- Baker TK, Falb T, Voas R, Lacey J. J Safety Res 2003; 34(4): 399-405.

Correspondence: Tara Kelley Baker, Pacific Institute for Research and Evaluation, 11710 Beltsville Drive, Suite 300, Calverton, MD 20705, USA; (email: kelley-b@pire.org).

doi: 10.1016/j.jsr.2003.09.012 -- What is this?

(Copyright © 2003, National Safety Council, Published by Elsevier)

CONTEXT: By 2030, there will be approximately 70 million older people (65+) in the United States, more than twice their number in 2000. This increase also represents an increased percentage of older licensed drivers. Thus, it is important to understand the special circumstances of how they may be involved in traffic crashes.

METHODS: This study used the Fatality Analysis Reporting System (FARS), which is a census of all fatal crashes occurring in the United States over the last two decades maintained by the National Highway Traffic Safety Administration (NHTSA), to study the special characteristics of fatal crashes involving females older than 70 years.

FINDINGS: The results indicate that senior women are overrepresented in crashes that occur under the "safest" conditions, on roads with low speed limits, in daylight, when traffic is low (not at rush hour), when the weather is good, and when the roads are dry.

Driving and alternatives: older drivers in Michigan.

- Kostyniuk LP, Shope JT. J Safety Res 2003; 34(4): 407-414.

Correspondence: Lidia P. Kostyniuk, Transportation Research Institute, University of Michigan, 2901 Baxter Road, Ann Arbor, MI 48109-2150, USA; (email: lidakos@umich.edu).

doi: 10.1016/j.jsr.2003.09.001 -- What is this?

(Copyright © 2003, National Safety Council, Published by Elsevier)

A statewide telephone survey of Michigan drivers and former drivers aged 65 and older collected information on transportation mode choices, experience with alternatives to driving, and whether drivers planned for when they could no longer drive. Results showed that most older adult households owned at least one automobile, and that the automobile was the primary mode of transportation. Most former drivers obtained rides from relatives and friends. Use of public transportation was low, and some seniors were not aware of available public transportation services. Older drivers did not plan for driving cessation. Over half the drivers who perceived a likelihood of driving problems within 5 years expected to keep driving beyond 5 years. Because of their lifelong reliance on the automobile, their desire to drive themselves, and their lack of experience with public transportation, efforts to enhance the mobility of older people should consider this background while alternatives to the personal automobile are developed.

Assessment of older drivers: relationships among on-road errors, medical conditions and test outcome.

- Di Stefano M, Macdonald W. J Safety Res 2003; 34(4): 415-429.

Correspondence: Marilyn Di Stefano, School of Human Biosciences, La Trobe University, Melbourne 3086, AUSTRALIA; (email: m.distefano@latrobe.edu.au).

doi: 10.1016/j.jsr.2003.09.001 -- What is this?

(Copyright © 2003, National Safety Council, Published by Elsevier)

CONTEXT: It is essential that driver licensing authorities have a valid and reliable system for evaluating older drivers' continuing competency; road tests are usually required as part of such a system. This study sought to find information about the nature of driving errors made during license review tests, and about relationships between error type and test outcome for older drivers.

METHODS: Data from licensing authority files from 533 road tests during a 12-month period were analyzed; medical and other referral information was included. Average driver age was 76 years. Performance scores were generated for intersection negotiation, lane changing, low speed maneuvers, positioning and speed control, safety margin, and car control.

FINDINGS: Logistic regression analysis showed that test outcome was well predicted by a subset of driving performance scores; adding driver age to the model explained very little variance. Age alone was strongly associated with outcome. Relationships between referral information and test outcome are also reported.

COMMENTS: Results highlight several factors relevant to the development of more valid and reliable road tests for older drivers.

Intelligent transport systems and occupational therapy practice.

- Di Stefano M, Macdonald W. Occup Ther Int 2003; 10(1): 56-74.

Correspondence: Marilyn Di Stefano, School of Human Biosciences, La Trobe University, Melbourne 3086, AUSTRALIA; (email: m.distefano@latrobe.edu.au).

doi: unavailable -- What is this?

(Copyright © 2003, Whurr Publishing).

This paper explores some of the most widely available in-vehicle information technology systems (intelligent transport systems, or ITSs) and discusses their implications for occupational therapy practice. Therapists often evaluate the impact of functional impairment on driving ability and, with an ageing population, the need for such assessments is increasing. Concurrently, ITSs are becoming increasingly common and it is important that their potential effects on both driving task demand and crash risk are considered by therapists when assessing drivers. Interactions between drivers and ITSs are analyzed in an information processing framework, highlighting the importance of drivers' cognitive functioning. It is evident that the ability to use an ITS while driving is influenced by a driver's sensory, perceptual, cognitive and motor capacities and skills, all of which are likely to vary with age, disability and/or driving experience. The compatibility of ITS interface design with drivers' capacities and needs is crucial in determining how effectively, and safely, a particular system will be used. Therapists need to analyse interface demands in relation to the ability of individual drivers to cope with or benefit from an ITS, and to consider the potential for calibrating particular products to the specific requirements of individual drivers. It is concluded that many ITSs are at an early stage of development and should not be recommended without critical evaluation of their utility, usability and safety for the intended users. Therapists face the challenge of understanding the parameters and implications of ITSs so that they can assist their clients to optimize their occupational performance despite functional limitations, while also protecting the safety of other road users. Standards related to interface design are still undergoing development, and there is an urgent need for further research to evaluate the impact of vehicle technologies on human behavior and road safety.

On-road driving evaluations: a potential tool for helping older adults drive safely longer.

- Stutts JC, Wilkins JW. J Safety Res 2003; 34(4): 431-439.

Correspondence: Jane C. Stutts, Highway Safety Research Center, University of North Carolina, 730 Airport Road, Campus Box 3430 Chapel Hill, NC 27599-3430, USA; (email: jane_stutts@unc.edu).

doi: 10.1016/j.jsr.2003.09.014 -- What is this?

(Copyright © 2003, National Safety Council, Published by Elsevier)

CONTEXT: This paper explores the potential use of on-road driving evaluations as a tool for helping older adults extend their safe driving years.

METHODS: Three separate research activities were carried out. The first was a national telephone survey of current and former older drivers. The results of this survey provide information relevant to the potential market for on-road driving evaluations. The second was a series of focus groups with potential stakeholders in the process: driver educators, occupational therapists, and physicians. These groups explored the feasibility and requirements of offering on-road driving evaluations to the wider public. Supplemental data were also collected from a mail survey of driving schools nationwide.

FINDINGS: Based on the results of these efforts, a number of recommendations are presented for expanding the availability of on-road driving evaluations, specifically to help older adults make more responsible decisions about continuing or stopping driving, and more generally to help them drive safely longer.

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Role of School Psychologists in Violence Prevention and Intervention.

- McKellar, NA, Sherwin HD. Journal of School Violence 2003; 2(4): 43-45.

Correspondence: Nancy A. McKellar, Department of Administration Counseling, Educational and School Psychology, Wichita State University, Wichita, KS, 67260, USA; (email: nancy.mckellar@wichita.edu ).

doi: 10.1300/J202v02n04_03 -- What is this?

(Copyright © 2003, Haworth Press)

Kansas school psychologists were extremely accurate in their estimates of violence in their own schools and viewed school violence prevention as an important part of their job, regardless of the rates of violence in their districts. Most had at least some involvement in their own school's violence prevention program, although many reported that they had little or no training. Despite the fact that the majority of respondents work in districts with relatively low rates of violence, over half reported that fighting, bullying, and substance abuse, early warning signs of school violence, occur a lot or a fair amount in their districts.

An Evaluation of Two Procedures for Training Skills to Prevent Gun Play in Children.

- Himle MB, Miltenberger RG, Gatheridge BJ, Flessner CA. Pediatrics 2004; 113(1): 70-77.

Correspondence: Raymond G Miltenberger, Department of Psychology, North Dakota State University, Fargo, North Dakota, USA; (email: Ray.Miltenberger@ndsu.nodak.edu).

doi: unavailable -- What is this?

(Copyright © 2004, American Academy of Pediatrics)

OBJECTIVE: Unintentional firearm injuries threaten the safety of children in the United States. Despite the occurrence of these injuries, few studies have evaluated the effectiveness of child-based programs designed to teach children gun-safety skills. This study compared 2 programs that were designed to reduce gun play in preschool children.

METHODS: A between-groups no-treatment control design was used. Children were randomly assigned to either 1 of 2 firearm-injury prevention programs or a no-treatment control condition. Participant recruitment, training, and data collection occurred in preschools and children's homes located in a Midwestern city with a population of approximately 80 000. Thirty-one 4- and 5-year-old children participated in the study. The effectiveness of the National Rifle Association's Eddie Eagle GunSafe Program and a behavioral skills training program using instruction, modeling, rehearsal, and feedback was evaluated. Children were issued 0 to 3 ratings on the basis of their ability to say correctly the safety message and similar ratings on the basis of observations of their ability to perform correctly the skills in the classroom and when placed in a realistic simulation.

FINDINGS: Both programs were effective for teaching children to reproduce verbally the gun-safety message. The behavioral skills training program but not the Eddie Eagle GunSafe Program was effective for teaching children to perform gun-safety skills during a supervised role play, but the skills were not used when the children were assessed via real-life (in situ) assessments.

COMMENTS: Existing programs are insufficient for teaching gun-safety skills to children. Programs that use active learning strategies (modeling, rehearsal, and feedback) are more effective for teaching gun-safety skills as assessed by supervised role plays but still failed to teach the children to use the skills outside the context of the training session. More research is needed to determine the most effective way to promote the use of the skills outside the training session.

Domestic violence among homosexual partners.

- Cameron P. Psychol Rep 2003; 93(2): 410-416.

Correspondence: Paul Cameron, Family Research Institute, Inc., Colorado Springs, CO 80962, USA; (email: unavailable).

doi: unavailable -- What is this?

(Copyright © 2003, Southern Universities Press)

Is domestic violence more frequent in homosexual partnerships? The 1996 National Household Survey of Drug Abuse, based upon a random sample of 12,381 adults aged 18 to 59 years, estimated that 828,900 men and 828,678 women engaged in homosexuality in the prior 12 months. Random surveys indicated that at any given time, 29% of homosexual men and 32% of homosexual women are in same-sex partnerships. The National Criminal Victimization Survey for 1993 to 1999 reported that 0.24% of married women and 0.035% of married men were victims of domestic violence annually versus 4.6% of the men and 5.8% of the women reporting same-sex partnerships. Domestic violence appears to be more frequently reported in same-sex partnerships than among the married.

An Arresting Experiment: Domestic Violence Victim Experiences and Perceptions.

- Miller J. J Interpers Violence 2003; 18(7): 695-716.

Correspondence: JoAnn Miller, Purdue University, IN, USA; (email: millerj@soc.purdue.edu).

doi: unavailable -- What is this?

(Copyright © 2003, SAGE Publications)

This study looks at the experiences and perceptions that domestic violence victims reported with Mills's power model. The victims' partners were the primary research participants in an arrest experiment. The following were empirically examined: the occurrence of violence following suspect arrest, victim perceptions of personal and legal power, victim satisfaction with the police, and victim perceptions of safety following legal intervention. Race and two victim resource measures (i.e.,employment status and income advantage) explained variance in perceptions of independence. A police empowerment scale was used to measure legal power. It was found that arrest affected the probability of reoccurring domestic violence. Suspect arrest and the victim's perceptions of legal power were related to perceptions of safety following police intervention. The study concludes with some implications for domestic violence research, programs, and perspectives.

Community Violence Exposure in Young Adults.

- Scarpa A. Trauma Violence Abus 2003; 4(3): 210-227.

Correspondence: Angela Scarpa, Virginia Polytechnic Institute and State University, USA; (email: ascarpa@vt.edu).

doi: unavailable -- What is this?

(Copyright © 2003, SAGE Publications)

The United States is one of the most violent countries in the world, and this is being reflected in rates of young adults' lifetime exposure ranging from 76% to 82% for victimization and 93% to 96% for witnessing. These high rates are found despite these studies being conducted on relatively low-risk samples from rural areas, and the majority of violent acts reported being less life threatening than those reported by high-risk urban adolescents. Nonetheless, young adults with high levels of exposure report more psychological maladjustment including depressed mood, aggressive behavior, post-traumatic stress disorder symptomatology, and interpersonal problems. The cycle from exposure to later perpetration of aggression is discussed in terms of psychophysiological processes that may emerge from chronic violence exposure or interact with victimization to increase risk. Last, theoretical, clinical, and policy implications are suggested that include intervention and prevention programs targeting all forms of violence in urban and rural areas.

Research And Interventions To Reduce Domestic Violence Revictimization.

- Mears DP.Trauma Violence Abus 2003; 4(2): 127-147.

Correspondence: D.P. Mears, The Urban Institute, USA; (email: unavailable).

doi: unavailable -- What is this?

(Copyright © 2003, SAGE Publications)

Despite decades of research on domestic violence, considerable challenges must be addressed to develop sound, theoretically and empirically based interventions for reducing domestic violence revictimization. Many basic and applied research issues remain unaddressed by existing studies, and evaluations frequently do not sufficiently highlight their limitations or program or policy implications. Nonetheless, progress has been made, and practitioners and policy makers increasingly have a wide range of promising interventions from which to select. This article reviews research on domestic violence and focuses particular attention on interventions aimed at reducing revictimization among individuals known to have been abused. It also provides a conceptual framework for practitioners and policy makers to situate existing evaluation research and highlights the need for better data to understand and assess efforts to reduce domestic violence revictimization. The author concludes by discussing directions for future research and recommendations for practice and policy.

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