Risk of injury after alcohol consumption: a case-crossover study in the emergency department.
- Borges G, Cherpitel C, Mittleman M. Soc Sci Med 2004; 58(6): 1191-1200.
Correspondence: Guilherme Borges, Dept de Investigac Servicio de Salud, Div de Investigac Epidemiol Sociales, Instituto Nacional de Psiquiatria & Universidad Autonoma Metropolitana-Xochimilco, Calzada Mexico Xochimilco No. 101, Col. San Lorenzo Huipulco, DF, 14370, MEXICO; (email: guibor@imp.edu.mx).
This paper reports a case-crossover analysis in a sample of 961 patients who consulted the emergency department (ED) due to an injury in Santa Clara, California, and in Pachuca, Mexico. In the analysis in which usual alcohol consumption during the last 12 months served as the control value, the estimated relative risk of injury in the hour after alcohol consumption, as compared with no alcohol consumption during that time, was 4.33 (CI, 3.55-5.27). After controlling for alcohol use in the 1-h period before injury, the relative risks for consecutive 1-h periods (2-6h) before the injury were not significantly greater than one, indicating that the induction time was less than 1h. The relative risk varied greatly depending on race-ethnicity and acculturation among the Hispanics in Santa Clara, with Mexicans in Pachuca showing the highest risk and the high acculturation group in Santa Clara showing the lowest risk. Violence-related injuries were associated with higher relative risk. Relative risk also varied depending on the presence of alcohol dependence and usual frequency of drunkenness: patients with alcohol dependence and patients with high frequency of usual drunkenness had lower risks than patients without alcohol dependence and with lower self-reported episodes of drunkenness in the last year. When blood alcohol content at ED admission was used instead of self-reported alcohol consumption, similar results were obtained. These findings have important public health consequences. Each episode of alcohol consumption results in an increase in the short-term risk for an injury, especially for a violence-related injury. Patients with the lowest usual involvement with alcohol are subject to a higher elevation in their risk for an injury immediately after alcohol consumption compared to patients who drink more heavily.
Correspondence: Steven J. Berkowitz, Child Study Center, Yale University School of Medicine, 230 South Frontage Road, New Haven, Connecticut 06520-7900, USA; (email: steven.berkowitz@yale.edu).
Children are exposed to violence in their homes and communities at extraordinarily high rates. Given the alarming rates of exposure and its known impact on child developmental outcomes, crisis intervention geared at interrupting the negative effects of violence exposure are increasingly important. This review provides a rationale for the implementation of early and crisis intervention strategies for children exposed to community violence and recommends principles for applying these interventions. These principles are based on the body of research concerning risk and protective factors for children who have been exposed to violence. Relevant factors are reviewed and recommended principles are explicated that correlate to these factors. Issues concerning developmentally informed crisis intervention, support of parental executive functioning, and the need for active community partnership to help ameliorate risk factors are highlighted.
World Trade Center rescue worker injury and illness surveillance, New York, 2001.
- Berrios-Torres SI, Greenko JA, Phillips M, Miller JR, Treadwell T, Ikeda RM. Am J Prev Med 2003; 25(2): 79-87.
Correspondence: Robin M. Ikeda, Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30333, USA; (email: rikeda@cdc.gov).
BACKGROUND: The September 11, 2001, terrorist attacks on the World Trade Center in New York City, New York, prompted an unprecedented rescue and recovery response. Operations were conducted around the clock, involved over 5000 workers per day, and extended into months following the attacks. The City of New York Department of Health and Mental Hygiene and the Centers for Disease Control and Prevention implemented prospective surveillance to characterize rescue worker-related injury and illness and to help guide public health interventions.
METHODS: From September 11 to October 11, 2001, personnel reviewed medical records at four Manhattan hospital emergency departments (EDs), and healthcare providers completed data collection forms at five temporary Disaster Medical Assistance Team (DMAT) facilities located at the site. Rescue workers included construction workers, police officers, firefighters, emergency medical service technicians, or Urban Search and Rescue workers. Data collected included demographic characteristics, injury type, illness, and disposition.
FINDINGS: Of 5222 rescue worker visits, 89% were to DMAT facilities and 12% to EDs. Musculoskeletal conditions were the leading cause of visits (19%), followed by respiratory (16%) and eye (13%) disorders. Incidence rates were estimated based on total injuries and/or illnesses reported times 200,000 (100 equivalent full-time workers in 1 year at 40 hours per week x 50 weeks per year), then divided by the total number of hours worked. Eye disorders (59.7) accounted for the highest estimated injury and illness rate, followed by headache (46.8). One death, 52 hospital admissions, and 55 transports were reported. Findings underscored the need to coordinate distribution and enforcement of personal protective equipment use, purchase of diagnostic equipment to diagnose corneal abrasions, and distribution of health advisories.
COMMENTS: This system provided objective, timely information that helped guide public health interventions in the immediate aftermath of the attacks and during the prolonged rescue and recovery operations. Lessons learned can be used to guide future surveillance efforts.
Correspondence: Denise Kendrick, Division of General Practice, Floor 13, Tower Building, University Park, Nottingham NG7 2RD, UK; (email: denise.kendrick@nottingham.ac.uk).
Pediatricians were surveyed about baby walker knowledge, attitudes, and practice. Advising about walkers was associated with working in community pediatrics, treating walker related injuries, knowledge about walkers, and positive attitudes towards walker health promotion. Greater knowledge about walkers was associated with more negative attitudes to walkers. Educating pediatricians and parents about the risks of, and alternatives to using walkers is important.
Correspondence: Soufiane Boufous, NSW Injury Risk Management Research Centre, Building B10, University of New South Wales, 2052, AUSTRALIA; (email: soufiane@unsw.edu.au).
OBJECTIVE: To undertake a comparative analysis of the New South Wales (NSW) Inpatient Statistics Collection (ISC) and Workers' Compensation Scheme Statistics (WCSS) for the 1999/2000 financial year in an attempt to evaluate their respective roles in the surveillance and monitoring of work-related injuries in NSW.
METHODS: Work-related injuries in ISC were identified mainly by using the ICD-10 activity code and payment status and were compared with injury-related claims reported in WCSS.
FINDINGS: In 1990/2000, the majority of hospital separations for work-related injury involved males (86.2%) who came into contact with various objects, including machinery and tools, representing the most common mechanisms of injury, and open wounds and fractures of the upper and lower limbs as the most common injury nature/location. Injuries reported in the WCSS were also dominated by males (70%), with muscular stress while handling objects as the most common mechanism of injury and sprain and strain of the lower back as the leading nature/location of injury. The proportion of workers aged 15-19 years in the WCSS (1.2%) was over five times lower than the proportion of the same age group recorded in the ISC.
COMMENTS: The analysis indicates that the ISC and WCSS complement each other in characterizing the burden of work-related injuries in NSW. Linking compensation and outcomes data, including hospital admissions and emergency presentations, will provide a more comprehensive picture of the nature and the factors contributing to work-related injuries. Such data will inform policy and program development aimed at reducing the burden of this type of injury in the community.
A case-control study of eye injuries in the workplace in Hong Kong.
- Yu TS, Liu H, Hui K. Ophthalmology 2004; 111(1): 70-74.
Correspondence: Tak Sun Ignatius Yu, Department of Community and Family Medicine, The Chinese University of Hong Kong, Hong Kong, CHINA; (email: iyu@cuhk.edu.hk).
OBJECTIVE: Eye injury in the workplace is common worldwide. This study proposed to explore both risk and preventive factors re eye injuries in Hong Kong.
DESIGN: Case-control study.
PARTICIPANTS: A total of 239 work-related eye injury patients, and 253 subjects without a history of any eye injury as controls.
METHODS: Patients with all incident cases of work-related eye injuries attending the ophthalmology clinics of 3 major public hospitals in Hong Kong during the first 3 months of 2000 were invited to participate. Controls were selected from the general population and were frequency matched to patients based on gender. Patients were interviewed face-to-face by trained interviewers in the ophthalmology clinics, using a structured questionnaire. Telephone interviews were used for controls.
MAIN OUTCOME MEASURES: Risk and protective factors associated with eye injuries.
FINDINGS: Among eye injury cases, 158 patients (66.1%) reported having incurred 1 episode of eye injury during employment, 49 (20.5%) having suffered 2 episodes, and 32 (13.4%) having experienced >/==" BORDER="0">3 eye injuries at work. Most of the patients (85.4%) did not wear any protective devices at the time of injury. Subjects who wore safety glasses regularly were less likely to have eye injuries (odds ratio [OR] = 0.29, 95% confidence interval [CI] = 0.14-0.62). Having a safety requirement for wearing safety glasses was negatively associated with eye injuries (OR = 0.31, 95% CI = 0.15-0.62). Multivariate analysis indicated that exposures to certain work hazards and working in the construction industry were positively associated with eye injuries. Subjects who worked longer in their current job, who reported having received job safety training before employment, or whose machines or equipment were maintained or repaired regularly by employers were at lower risk of experiencing eye injuries.
COMMENTS: Construction workers and those exposed to multiple hazards may get eye injuries at work. They should be provided with protective devices that are effective in preventing such exposures. Health education and safety training are important in preventing eye injuries. Maintenance and repair of machines and equipment may effectively reduce or eliminate the sources of exposures.
How willing are parents to improve pedestrian safety in their community?
- Bishai D, Mahoney P, DeFrancesco S, Guyer B, Carlson Gielen A. J Epidemiol Community Health 2003; 57(12): 951-955.
Correspondence: David Bishai, Department of Population and Family Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21030, USA; (email: dbishai@jhu.edu).
STUDY OBJECTIVE: To determine how likely parents would be to contribute to strategies to reduce pedestrian injury risks and how much they valued such interventions.
DESIGN: A single referendum willingness to pay survey. Each parent was randomized to respond to one of five requested contributions towards each of the following activities: constructing speed bumps, volunteering as a crossing guard, attending a neighborhood meeting, or attending a safety workshop.
SETTING: Community survey.
PARTICIPANTS: A sample of 723 Baltimore parents from four neighborhoods stratified by income and child pedestrian injury risk. Eligible parents had a child enrolled in one of four elementary schools in Baltimore City in May 2001.
FINDINGS: The more parents were asked to contribute, the less likely they were to do so. Parents were more likely to contribute in neighborhoods with higher ratings of solidarity. The median willingness to pay money for speed bumps was conservatively estimated at $6.43. The median willingness to contribute time was 2.5 hours for attending workshops, 2.8 hours in community discussion groups, and 30 hours as a volunteer crossing guard.
COMMENTS: Parents place a high value on physical and social interventions to improve child pedestrian safety.
Factors influencing injury severity of motor vehicle-crossing pedestrian crashes in rural Connecticut.
The ordered probit model was used to evaluate the effect of roadway and area type features on injury severity of pedestrian crashes in rural Connecticut. Injury severity was coded on the KABCO scale and crashes were limited to those in which the pedestrians were attempting to cross two-lane highways that were controlled by neither stop signs nor traffic signals. Variables that significantly influenced pedestrian injury severity were clear roadway width (the distance across the road including lane widths and shoulders, but excluding the area occupied by on-street parking), vehicle type, driver alcohol involvement, pedestrian age 65 years or older, and pedestrian alcohol involvement. Seven area types were identified: downtown, compact residential, village, downtown fringe, medium-density commercial, low-density commercial, and low-density residential. Two groups of these area types were found to experience significantly different injury severities. Downtown, compact residential, and medium- and low-density commercial areas generally experienced lower pedestrian injury severity than village, downtown fringe, and low-density residential areas.
Correspondence: Michael A. McGuigan, American Association of Poison Control Centers, 3201 New Mexico Avenue SW, Suite 330, Washington, DC 20016, USA; (email: aapcc@poison.org).
All substances are capable of producing toxicity, so nothing is completely non-toxic. Minimally toxic substances are those which produce little toxicity, minor self-limited toxicity, or clinically insignificant effects at most doses. Examples include silica gel, A&D ointment, chalk, lipstick, and non-camphor lip balms, watercolors, hand dishwashing detergents, non-salicylate antacids (excluding magnesium or sodium bicarbonate containing products), calamine lotion, clay, crayons, diaper rash creams and ointments, fabric softeners/sheets, glow products, glue (white, arts, and crafts type), household plant food, oral contraceptives, pen ink, pencils, starch/sizing, throat lozenges without local anesthetics, topical antibiotics, topical antifungals, topical steroids, topical steroids with antibiotics, and water-based paints. Minimally toxic exposures have the following characteristics: (1) The information specialist has confidence in the accuracy of the history obtained and the ability to communicate effectively with the caller. (2) The information specialist has confidence in the identity of the product(s) or substance(s) and a reasonable estimation of the maximum amount involved in the exposure. (3) The risks of adverse reactions or expected effects are acceptable to both the information specialist and the caller based on available medical literature and clinical experience. (4) The exposure does not require a healthcare referral since the potential effects are benign and self-limited. However, decisions regarding patient disposition should take into account the patient's intent, symptoms, and social environment. In addition, individual patient circumstances (e.g., pregnancy, pre-existing medical conditions, therapeutic interventions) need to be considered. Minimally toxic exposures may vary in route (dermal, inhalation, ingestion, ocular), chronicity (acute, chronic), and substance composition (single or multi-ingredient, single or multiple product). Future categorization of substances as "minimally toxic" should be based on a process involving review of current knowledge, a thorough analysis of poisoning experience, and prospective validation.
Poisoning: an unnatural cause of morbidity and mortality in rural India.
Correspondence: A.K. Batra, Department of Forensic Medicine and Toxicology, Shri Vasantrao Naik Government Medical College, Yavatmal, MS, INDIA; (email: unavailable).
BACKGROUND: Ninety-nine percent of fatal poisonings occur in developing countries, particularly among agricultural workers. In a particular area, it is important to known the magnitude and pattern of acute poisonings, as it is important for early diagnosis and treatment and also for preventive measures.
METHODS: Hospital records of all unnatural causes of deaths were reviewed at Shri Vasantrao Naik Government Medical College, Yavatmal, Maharashtra during the five years period, 1997-2001. Autopsy records in fatal poisonings were studied for age, sex, residence, marital status, type of poison and manner of poisoning (accidental, suicidal or homicidal). Admission and death rates of acute poisonings were compared with those from other unnatural causes.
FINDINGS: Acute poisoning is the leading most cause of unnatural deaths and third common cause of emergency hospitalizations in this rural part of India. Of all fatal cases, 67% were males, 63% married, 83% with rural residence and 63.4% suicides. Responsible poison could not be ascertained in 16% of clinical and 9.9% of fatal cases. Insecticides were responsible for 35% of clinical and 55.4% of fatal cases.
COMMENTS: Young married males of rural background with agricultural occupation and failure of monsoon are the risk factors associated with poisoning cases.
Unreported concussion in high school football players: implications for prevention.
- McCrea M, Hammeke T, Olsen G, Leo P, Guskiewicz K. Clin J Sport Med 2004; 14(1): 13-17.
Correspondence: Michael McCrea, Neuroscience Center, Waukesha Memorial Hospital, 721 American Avenue, Suite 501, Waukesha, WI 53188, USA; (email: michael.mccrea@phci.org).
OBJECTIVE: To investigate the frequency of unreported concussion and estimate more accurately the overall rate of concussion in high school football players.
DESIGN: Retrospective, confidential survey completed by all subjects at the end of the football season.
SETTING AND PARTICIPANTS: A total of 1,532 varsity football players from 20 high schools in the Milwaukee, Wisconsin, area were surveyed.
MAIN OUTCOME MEASUREMENTS: The structured survey assessed (1) number of concussions before the current season, (2) number of concussions sustained during the current season, (3) whether concussion during the current season was reported, (4) to whom concussion was reported, and (5) reasons for not reporting concussion.
FINDINGS: Of respondents, 29.9% reported a previous history of concussion, and 15.3% reported sustaining a concussion during the current football season; of those, 47.3% reported their injury. Concussions were reported most frequently to a certified athletic trainer (76.7% of reported injuries). The most common reasons for concussion not being reported included a player not thinking the injury was serious enough to warrant medical attention (66.4% of unreported injuries), motivation not to be withheld from competition (41.0%), and lack of awareness of probable concussion (36.1%).
COMMENTS: These findings reflect a higher prevalence of concussion in high school football players than previously reported in the literature. The ultimate concern associated with unreported concussion is an athlete's increased risk of cumulative or catastrophic effects from recurrent injury. Future prevention initiatives should focus on education to improve athlete awareness of the signs of concussion and potential risks of unreported injury.
Injuries associated with whitewater rafting and kayaking.
Correspondence: David C. Fiore, University of Nevada School of Medicine, Department of Family and Community Medicine, Reno, NV 89557, USA; (email: fiore@unr.edu).
Whitewater rafting and kayaking are growing exponentially in popularity, with almost 10 million rafters and 2 to 3 million kayakers, yet little has been published concerning the safety or hazards of these activities. This article reviews the demographics of such injuries and the types of injuries commonly encountered. Fortunately, fatalities are uncommon in these activities, with rafting and kayaking fatalities occurring at a rate of 0.55 and 2.9 per 100000 user days, respectively. Injury rates for kayaking and rafting are 3 to 6 and 0.26 to 2.1 per 100000 boating days, respectively. Acute injuries in kayaking are usually due to the transferred force of the water on the upper extremity, most often the shoulder, or the impact on an object while "swimming." Acute rafting injuries are more often due to contact with another rafter's paddle or other equipment; the next most common injury is the rafter hitting an object while "swimming." Chronic injuries are very uncommon in rafting but account for 25% to 40% of all kayaking injuries and are most often either shoulder or wrist complaints.
Impact injuries in baseball : prevalence, etiology and the role of equipment performance.
- Nicholls RL, Elliott BC, Miller K. Sports Med 2004; 34(1): 17-25.
Correspondence: Karol Miller, School of Mechanical Engineering, The University of Western Australia, Crawley, Perth, Western Australia, AUSTRALIA; (email: kmiller@mech.uwa.edu.au).
Baseball has one of the highest impact injury rates of all sports. These injuries are primarily attributed to impact by a ball after it has been hit, pitched or thrown. This paper will review the incidence and causal factors for impact injuries in baseball. Attention is given to the design and material properties of bats, in light of evidence suggesting balls hit into the infield from metal bats can reach velocities potentially lethal to defensive players. The distribution of bat mass along the long axis of the implement appears a major factor in the greater performance potential of metal bats over wooden bats of equal length and mass. The dynamic behavior of baseballs has also been implicated in the severity of head and chest injuries experienced by players. Balls of greatly reduced stiffness have been introduced for junior play, but debate still remains over their performance and impact characteristics. The behavior of the ball during high-speed impact with the bat has been the subject of relatively limited research, and the effect of manipulating baseball material properties to decrease batted-ball velocity is unclear. The value of batting helmets is evident in the observed reduction of head injuries in baseball, but the use of protective vests to decrease the incidence and severity of cardio-thoracic trauma appears to be contraindicated.
We performed a postal survey to assess the ability of intensive care unit directors and Her Majesty's Coroners to recognize deaths that should be reported to the local coroner. The survey questionnaire consisted of 12 hypothetical case scenarios. Coroners were significantly better at identifying reportable deaths than intensive care unit directors (median correct recognition scores of 11 (interquartile range 9.25-11) vs. 8 (interquartile range 7-10), respectively, p < 0.01). Deaths associated with an accident, medical treatments, industrial disease, neglect and substance abuse were significantly under-reported by intensive care unit directors (p < 0.01). Results show that significant numbers of deaths on intensive care units in England and Wales may not be being referred for further investigation, and that wide variation in local coroners' practices exists. Improvements in postgraduate medicolegal education about deaths reportable to a coroner are required. National regulations need to be more detailed and standardized so that regional variation is eliminated.
Why the elderly fall in residential care facilities, and suggested remedies.
Correspondence: Kristina Kallin, Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umea University, SE-901 87 Umea, SWEDEN; (email: kristina.kallin@germed.umu.se).
OBJECTIVE: To study precipitating factors for falls among older people living in residential care facilities.
DESIGN: Prospective cohort study.
SETTING: Five residential care facilities.
PARTICIPANTS: 140 women and 59 men, mean age 82.4 (range, 65-97).
MEASUREMENTS: After baseline assessments, falls in the population were tracked for 1 year. A physician, a nurse, and a physiotherapist investigated each event, and reached a consensus concerning the most probable precipitating factors for the fall.
FINDINGS: Previous falls and treatment with antidepressants were found to be the most important predisposing factors for falls. Probable precipitating factors could be determined in 331 (68.7%) of the 482 registered falls. Acute disease or symptoms of disease were judged to be precipitating, alone or in combination in 186 (38.6%) of all falls; delirium was a factor in 48 falls (10.0%), and infection, most often urinary tract infection, was a factor in 38 falls (7.9%). Benzodiazepines or neuroleptics were involved in the majority of the 37 falls (7.7%) precipitated by drugs. External factors, such as material defects and obstacles, precipitated 38 (7.9%) of the falls. Other conditions both related to the individual and the environment, such as misinterpretation (eg, overestimation of capacity or forgetfulness), misuse of a roller walker, or mistakes made by the staff were precipitating factors in 83 (17.2%) of falls.
COMMENTS: Among older people in residential care facilities, acute diseases and side effects of drugs are important precipitating factors for falls. Falls should therefore be regarded as a possible symptom of disease or a drug side effect until proven otherwise. Timely correction of precipitating and predisposing factors will help prevent further falls.
Toward an empirical taxonomy of suicide ideation: a cluster analysis of the youth risk behavior survey.
In this study we examined adolescent risk behaviors, giving special attention to suicide ideation. Cluster analysis was used to classify adolescents (N = 2,730) on the Youth Risk Behavior Survey. Six clusters of adolescent risk behavior were identified. Although each risk cluster was distinct, some clusters shared overlapping risk behaviors. Suicide ideation was central to two clusters: the Silent Suicide cluster and the Multiple Risk cluster. The findings demonstrate that suicide ideation is both a unique risk behavior for some adolescents and part of a generalized risk syndrome for other adolescents. A multiple subgroup framework is recommended for understanding adolescent risk behaviors.
The full document, including tables, references and editorial note is available online: ( Download Document ).
Published by US Centers for Disease Control and Prevention (CDC).
In the United States, injuries (i.e., unintentional and intentional) are the leading cause of death among persons aged <35 years and the fourth leading cause of death among persons of all ages. Injuries create a substantial burden on society in terms of medical resources used for treating and rehabilitating injured persons, productivity losses caused by morbidity and premature mortality, and pain and suffering of injured persons and their caregivers. To estimate annual injury-attributable medical expenditures in the United States, CDC analyzed data on injury prevalence and costs from the 2000 Medical Expenditure Panel Survey (MEPS) and the National Health Accounts (NHA). This report summarizes the results of that analysis, which indicated that injury-attributable medical expenditures cost as much as $117 billion in 2000, approximately 10% of total U.S. medical expenditures. This finding underscores the need for innovative and effective interventions to prevent injuries.
A prospective study of the costs of falls in older adults living in the community.
Correspondence: S. Hall, School of Population Health, University of Western Australia, 35 Stirling Highway, Crawley, AUSTRALIA; (email: shall@sph.uwa.edu.au).
OBJECTIVE: To establish the hospital cost and three-month, post-hospital community and personal costs associated with older adults discharged to the community after a fall. The timing, incidence and the determinants of these costs to the various sectors were also examined.
METHODS: Patients who attended the Emergency. Department of a teaching hospital in Perth, Western Australia, were asked to complete a daily diary for three months of all community and informal care they received due to their fall and any associated expenses. Unit costs were collected from various sources and used to estimate the cost of community and informal care. Hospital inpatient costs were estimated using a patient-based costing system.
FINDINGS: Seventy-nine patients participated with a total estimated falls-related cost for the three-month period of $316,155 to $333,648 (depending on assumptions used) and a mean cost per patient of between $4,291 and $4,642. The hospital cost accounted for 80%, community costs 16% and personal costs 4% of the total. Of community and personal costs, 60% was spent in the first month. Type of injury was the most significant determinant of hospital and community costs. Extrapolating these figures to the WA population provided an estimate of the total hospital and three-month, post-hospital cost of falls of $24.12 million per year, with $12.1 million funded by the Federal Government, $10.1 million by State/local government and $1.7 million in out-of pocket expenses by patients.
COMMENTS: In the acute and immediate post-discharge period,hospital costs accounted for most of the cost of care for older adults discharged to the community after a fall. Community and personal costs, however, were also incurred. The cost estimates provide useful information for planners of hospital and community care for older people who have sustained a fall.
Estimating nonfatal traumatic brain injury hospitalizations using an urban/rural index.
Correspondence: S.R. Kegler, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA; (email: snk6@cdc.gov).
OBJECTIVE: To develop state-level estimates of the annual number of nonfatal cases of traumatic brain injury (TBI) resulting in hospitalization.
METHODS: The estimation process incorporates annual nonfatal TBI hospitalization case counts from 15 states funded by the Centers for Disease Control and Prevention to conduct TBI surveillance; annual fatal TBI case counts based on National Center for Health Statistics data for all 50 states; and an index reflecting the urban/rural character of each state. These data are used to develop a negative binomial regression model that yields estimates of the annual number of nonfatal TBI hospitalization cases for each state not funded to conduct TBI surveillance.
FINDINGS: Sensitivity analysis suggests that on average the estimates fall within +/-15% of the case counts that would be obtained directly from surveillance.
COMMENTS: In combination, the TBI case count data and the urban/rural index support effective modeling and estimation of annual nonfatal TBI hospitalization case counts at the state level.
How adolescents use technology for health information: implications for health professionals from focus group studies.
- Skinner H, Biscope S, Poland B, Goldberg E. J Med Internet Res 2003; 5(4): e32.
Correspondence: Harvey Skinner, Department of Public Health Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, CANADA; (email: harvey.skinner@utoronto.ca).
CONTEXT: Adolescents present many challenges in providing them effective preventive services and health care. Yet, they are typically the early adopters of new technology (eg, the Internet). This creates important opportunities for engaging youths via eHealth.
OBJECTIVES: To describe how adolescents use technology for their health-information needs, identify the challenges they face, and highlight some emerging roles of health professionals regarding eHealth services for adolescents.
METHODS: Using an inductive qualitative research design, 27 focus groups were conducted in Ontario, Canada. The 210 participants (55% female, 45% male; median age 16 years) were selected to reflect diversity in age, sex, geographic location, cultural identity, and risk. An 8-person team analyzed and coded the data according to major themes.
FINDINGS: Study participants most-frequently sought or distributed information related to school (89%), interacting with friends (85%), social concerns (85%), specific medical conditions (67%), body image and nutrition (63%), violence and personal safety (59%), and sexual health (56%). Finding personally-relevant, high-quality information was a pivotal challenge that has ramifications on the depth and types of information that adolescents can find to answer their health questions. Privacy in accessing information technology was a second key challenge. Participants reported using technologies that clustered into 4 domains along a continuum from highly-interactive to fixed information sources: (1) personal communication: telephone, cell phone, and pager; (2) social communication: e-mail, instant messaging, chat, and bulletin boards; (3) interactive environments: Web sites, search engines, and computers; and (4) unidirectional sources: television, radio, and print. Three emerging roles for health professionals in eHealth include: (1) providing an interface for adolescents with technology and assisting them in finding pertinent information sources; (2) enhancing connection to youths by extending ways and times when practitioners are available; and (3) fostering critical appraisal skills among youths for evaluating the quality of health information.
COMMENTS: This study helps illuminate adolescent health-information needs, their use of information technologies, and emerging roles for health professionals. The findings can inform the design and more-effective use of eHealth applications for adolescent populations.
Risk management frameworks for human health and environmental risks.
Correspondence: Cindy Jardine, Department of Public Health Sciences - Human Ecology, University of Alberta, Edmonton, Alberta T6G 2N1, CANADA; (email: cindy.jardine@ualberta.ca).
A comprehensive analytical review of the risk assessment, risk management, and risk communication approaches currently being undertaken by key national, provincial/state, territorial, and international agencies was conducted. The information acquired for review was used to identify the differences, commonalities, strengths, and weaknesses among the various approaches, and to identify elements that should be included in an effective, current, and comprehensive approach applicable to environmental, human health and occupational health risks.
OBJECTIVE: To determine and compare the prevalence, nature and predictors of agricultural motorcycle injuries (2, 3 & 4 wheels) in a high-risk cohort of Western Australian adolescents.
METHODS: A cross-sectional survey of 326 students (Years 11 and 12) was drawn from the six designated agricultural colleges, in Western Australia. The survey instrument was assessed as reliable and measured riding exposure, vehicle type and maintenance, use of protective equipment, training and injury experience.
FINDINGS: For those subjects with access to an agricultural motorcycle (n = 240), a total of 53% (n = 127) had incurred an injury. Of these, 73% (n = 92) resulted from two wheelers and 24% (n = 31) from ATVs, with 3% (n = 4) not specified. No significant differences in the nature of injury or body parts injured was observed. Approximately one-third of those injured required medical treatment. Predictors of injury were maximum traveling speed exceeding 101 km/hour (OR 4.53) and only sometimes wearing a helmet (OR 4.10).
COMMENTS: Agricultural motorcycle injuries are a significant issue in rural areas, with potential intervention points relating to improving rider training and reducing specific risk-taking behaviors. Further work to investigate the efficacy of rider training interventions for agricultural motorcycles are warranted.
Sexual harassment on the school bus: supporting and preparing bus drivers to respond appropriately.
- Allen M, Young EL, Ashbaker BY, Heaton E, Parkinson M. Journal of School Violence 2003, 2(4): 101-109.
Correspondence: Melissa Allen, Department of Counseling Psychology and Special Education, Brigham Young University, Provo, UT 84602-5093, USA; (email: melissa_allen@byu.edu).
Sexual harassment is commonplace in schools, particularly among adolescents. Although information on this topic is typically gathered from students and teachers, this study collected information from school bus drivers. Based on feedback from 58 school bus drivers, 39 (67%) reported observing students making sexual comments or jokes. Almost half of the bus drivers reported observing students "mooning" and/or "flashing." Of the bus drivers observing sexual harassment, almost 80% intervened and confronted the students' inappropriate behavior. About half (46%) of the bus drivers reported incidents of sexual harassment to an authority figure in the school, most commonly a principal or assistant principal. Suggestions are offered to train school bus drivers to identify, intervene appropriately, and report incidents of sexual harassment.
Bullying among young adolescents: the strong, the weak, and the troubled.
Correspondence: Jaana Juvonen, Department of Psychology, School of Medicine, University of California, Los Angeles 90095, USA; (email: juvonen@psych.ucla.edu).
OBJECTIVES: Bullying and being bullied have been recognized as health problems for children because of their association with adjustment problems, including poor mental health and more extreme violent behavior. It is therefore important to understand how bullying and being bullied affect the well-being and adaptive functioning of youth. We sought to use multiple data sources to better understand the psychological and social problems exhibited by bullies, victims, and bully-victims.
DESIGN, SETTING, AND PARTICIPANTS: Analysis of data from a community sample of 1985 mostly Latino and black 6th graders from 11 schools in predominantly low socioeconomic status urban communities (with a 79% response rate).
MAIN OUTCOME MEASURES: Peer reports of who bullies and who is victimized, self-reports of psychological distress, and peer and teacher reports of a range of adjustment problems.
FINDINGS: Twenty-two percent of the sample was classified as involved in bullying as perpetrators (7%), victims (9%), or both (6%). Compared with other students, these groups displayed school problems and difficulties getting along with classmates. Despite increased conduct problems, bullies were psychologically strongest and enjoyed high social standing among their classmates. In contrast, victims were emotionally distressed and socially marginalized among their classmates. Bully-victims were the most troubled group, displaying the highest level of conduct, school, and peer relationship problems.
COMMENTS: To be able to intervene with bullying, it is important to recognize the unique problems of bullies, victims, and bully-victims. In addition to addressing these issues directly with their patients, pediatricians can recommend school-wide antibullying approaches that aim to change peer dynamics that support and maintain bullying.
Correspondence: Joy Renfro, Associate Professor , Department of Health Promotion and Administration , Eastern Kentucky University , Richmond , KY, 40475, USA; (email: joy.renfro@eku.edu).
Despite the fact that many incidents of extreme violence have taken place in rural areas there is still some resistance on the part of rural school administrators to admit that violence is a problem in their schools. This article provides a comparison of rural and urban student and staff self-report of school violence (perpetration, victimization and weapon carrying) and discusses the implications of these findings.
Bullies and victims among polish school-aged children.
- Mazur J, Malkowska A. Med Wieku Rozwoj 2003; VII(1 Pt 2): 121-134.
Correspondence: Joanna Mazur, Zaklad Epidemiologii, Instytut Matki i Dziecka, ul. Kasprzaka 17a, 01-211 Warszawa, POLAND; (email: epid@imid.med.pl).
The objective of the study was to determine the prevalence of bullying in Polish schools and to evaluate the relationship between bullying and substances abuse. Data obtained through HBSC (Health Behavior in School-Aged Children. A WHO Cross-National Study) conducted in Poland in 2002 were used. The representative sample comprised 6383 students 11, 13 and 15 years of age. The indicators of total and frequent bullying were defined and five main ways of bullying were described. Relationship between bullying and substance abuse was evaluated by logistic regression models adjusted for age and gender with frequent (at least 2-3 times a month) bullying as dependent variable. Results showed that 20% of students were involved in frequent bullying; 10% as perpetrator, 8% as victim and 2% as both. More boys than girls reported being involved in bullying both as victims and perpetrators. The prevalence of victimization decreased with age while the prevalence of bullying increased. Verbal bullying was the main way of bullying reported by students. 10% of students suffered from physical violence and 16% reported bullying others in physical ways. The difference between boys and girls was higher for physical bullying. Frequent episodes of drunkenness (more than 10 times in the lifetime) increased the risk of bullying about 7 times (OR=6.8; CI=4.9-9.4). Every day tobacco smoking and frequent marihuana use resulted in three fold increase in the risk of bullying. The positive results of the Norwegian anti-bullying program provided by D. Olweus as well as other examples of anti-bullying strategies developed recently within the European Community and model approaches from Australia are described. (Article in Polish)
Bullying behavior and associations with psychosomatic complaints and depression in victims.
OBJECTIVES: To assess the association between bullying behavior and a wide variety of psychosomatic health complaints and depression.
METHODS: In a cross-sectional study, 2766 elementary school children age 9 to 12 years filled out a questionnaire on bullying behavior and health complaints. Three groups-bullied children, active bullies, and children who both bully and are bullied-were compared with the group of children not involved in bullying behavior. Subsequently, risks for psychosomatic symptoms and depression were calculated by means of odds ratios.
FINDINGS: Bully victims had significantly higher chances for depression and psychosomatic symptoms compared with children not involved in bullying behavior. Odds ratios were as follows: headache, 3.0; sleeping problems, 2.4; abdominal pain, 3.2; bed-wetting, 2.9; feeling tired, 3.4; and depression, 7.7. Children who actively bullied did not have a higher chance for most of the investigated health symptoms.
COMMENTS: Being bullied is strongly associated with a wide range of psychosomatic symptoms and depression. These associations are similar to the complaints known to be associated with child abuse. Therefore, when such health complaints are presented, pediatricians and other health care workers should also be aware of the possibility that a child is being bullied to take preventive measures.
Representational momentum and the flash-lag effect.
- Munger MP, Owens TR. Vis Cogn 2004, 11(1): 81-103.
Correspondence: Margaret P. Munger, Davidson College, Department of Psychology, PO Box 7001, Davidson, NC 28035-7001, USA; (email: mamunger@davidson.edu).
Representational momentum (RM) is a distortion where the final orientation of a moving object is misremembered as further along its trajectory. Experiments reported here examine RM when an additional object was flashed just as the moving object disappeared. When the task was to judge the flashed object, participants reported that the flash appeared to lag behind (flash-lag effect; FLE). When the task was to judge the moving object, larger forward distortions for the moving object were found when the flash was present, despite previous evidence that the FLE depends on the moving object's continued presence. The results suggest that some part of the FLE depends upon what precedes the flash. In addition, equivalent RM was observed for implied and smoothly animated events, a possible limit to the velocity effect for RM was found, and larger positive distortions were found for downward rotations.
Brightness contrast and assimilation from patterned inducing backgrounds.
- Hong SW, Shevell SK. Vis Res 2004; 44(1): 35-43.
Correspondence: Steven K. Shevell, Department Ophthalmology and Visual Science, Visual Science Laboratories, University of Chicago, 940 East 57th Street, Chicago, IL 60637, USA; (email: shevell@uchicago.edu).
Theories of induction propose that the brightness of a test patch within a complex surround is explained by local contrast or by integrating contrasts from various regions within the surround, weighted inversely with the distance from the test. Results here corroborate that brightness induction from a patterned background depends on both contiguous and non-contiguous surrounding light, but the measurements were inconsistent with any linear integration of contrast at edges within the scene. In some conditions, assimilation rather than contrast to contiguous surrounding light was observed, depending on the luminance of the light in non-contiguous regions. This finding implies that brightness induction from patterned backgrounds depends on neural processes that can cause contrast and/or assimilation, depending on the luminance relation between contiguous and non-contiguous regions. A model in the literature postulating that the influence of a non-contiguous edge is regulated by the amount of contrast at the contiguous edge can accommodate brightness induced by these patterned backgrounds.
Spatial attention and object-based attention: a comparison within a single task.
Correspondence: Manuel J. Blanco, Departamento de Psicologia Social y Basica, Facultad de Psicologia, University of Santiago de Compostela, Santiago de Compostela 15706, SPAIN; (email: psmblanc@usc.es).
There is now much experimental evidence supporting the idea that visual attention can be deployed in at least two ways: one space-based and other object-based. However, it is not clear whether space- and object-based attention work in an integrated way within the visual system. In this article, we present two experiments in which we compare both components of attention within a cueing paradigm. Participants had to discriminate the orientation of a line that appeared within one of four moving circles, differing in color. A cue appearing close to one of the four circles indicated the location or circle where the target stimulus was likely to appear. Spatial and object cueing effects were observed: responses were faster when target appeared either at the precued location or within the precued object. In addition, the object-cueing effect occurred only when the cue was spatially invalid and not when it was spatially valid. These results suggest that object- and space-based attention interact, with selection by location being primary over object-based selection.
Correspondence: Kirsi Suominen, Department of Mental Health and Alcohol Research, National Public Health Institute, Helsinki, FINLAND; (email: kirsi.suominen@ktl.fi).
OBJECTIVE: No previous study has comprehensively investigated the pattern of health care contacts among elderly subjects attempting suicide. The present study compared elderly suicide attempters with younger attempters, before and after attempted suicide, in terms of health care contacts, clinical diagnoses of mental disorders, and characteristics predicting lack of treatment contact after the index attempt.
METHODS: All consecutive 1198 suicide attempters treated in hospital emergency rooms in Helsinki, Finland, from 15.1.1997 to 14.1.1998 were identified and divided into two age groups: (1) elderly suicide attempters aged 60 years or more (n = 81) and (2) suicide attempters aged under 60 years (n = 1117).
FINDINGS: During the final 12 months before the attempt, the majority of elderly suicide attempters had a contact with primary health care, but their mood disorders were likely to have remained undiagnosed before the index attempt. In primary health care, only 4% had been diagnosed with a mood disorder before the attempt, but 57% after (p < 0.001). After the suicide attempt, most elderly suicide attempters were referred for aftercare, two thirds having contact with psychiatric care.
COMMENTS: For purposes of preventing suicidal behavior, screening for depression, plus further education on recognition, diagnosis and treatment of mood disorders among the elderly in primary health care setting are needed.
Effects of urbanization, economic development, and migration of workers on suicide mortality in Japan.
- Otsu A, Araki S, Sakai R, Yokoyama K, Scott Voorhees A. Soc Sci Med 2004; 58(6): 1137-1146.
Correspondence: Akiko Otsu, Department of Public Health and Occupational Medicine, Graduate School of Medicine and School of Medicine, The University of Tokyo, Bunkyo-ku, 113-8654, Tokyo, JAPAN; (email: araki@niih.go.jp).
The relationships between male or female age-adjusted suicide mortality and social life factors for all 47 Japanese prefectures in 1980, 1985 and 1990 were investigated by stepwise multiple regression analysis after classification of 20 social life indicators by factor analysis. During this period, Japan experienced the second economic crisis (the so-called secondary oil crisis) in 1980-1983 and economic prosperity (bubble economy) in 1986-1990. In all the three years, male suicide mortality was significantly related inversely to the urbanization and economic development factor, the result of which was consistent with the data in our previous study for the years 1970 and 1975. Similarly, the male mortality was positively related to the factor of migration of workers in the three years. No factor significantly related to female mortality for all the three years was found. It is suggested that (1) urbanization was a major determinant which prevented male suicide mortality during the past 20 years (1970-1990) in Japan; (2) migration of workers became an important factor for male suicide mortality during these 10 years; and (3) female suicide mortality was less vulnerable to social life factors for these 20 years than the male mortality.
Affective, behavioral, and cognitive functioning in adolescents with multiple suicide attempts.
Correspondence: Christianne Esposito-Smythers, Brown University Center for Alcohol and Addiction Studies, Providence, RI 02912, USA; (email: christianne_esposito@brown.edu).
The purpose of this study was to examine affective, behavioral, and cognitive functioning in adolescents with multiple suicide attempts. Forty-seven adolescents with a history of multiple suicide attempts (MA) were compared to 74 single suicide attempters (SA) on psychiatric diagnosis, depressive symptoms, affect regulation, self-mutilation, alcohol use, and hopelessness. Results revealed that the MA group was more likely to be diagnosed with a mood disorder, and reported more severe depressive symptoms and anger, in comparison to the SA group. Behaviorally, the MA group had higher rates of disruptive behavior disorders and higher levels of affect dysregulation and serious self-mutilation than the SA group. Further, greater levels of hopelessness were reported by the MA than the SA group. After controlling for a mood disorder diagnosis, only differences in anger, affect dysregulation, and serious self-mutilation remained significant. Overall, results suggest that treatment with adolescent suicide attempters might specifically target anger and affect dysregulation to reduce risk for future suicidal behavior.
Telephone counseling for adolescent suicide prevention: changes in suicidality and mental state from beginning to end of a counseling session.
Correspondence: Robert King, Department of Psychiatry, The University of Queensland, K-Floor, Mental Health Centre, Royal Brisbane Hospital, Queensland 4029, AUSTRALIA; (email: robertk@psychiatry.uq.edu.au).
Telephone counseling is an accessible and confidential means by which distressed young people can seek help. Telephone counseling services were funded under Australia's National Youth Suicide Prevention Strategy between 1997 and 2000. In this study, the effectiveness of telephone counseling for young people seeking help in the context of suicidal ideation or intent was evaluated in an investigation of calls made by suicidal young people to a telephone counseling service. Independent raters measured callers' suicidality and mental state at the beginning and end of 100 taped counseling sessions. Changes in suicidality and mental state were measured using a reliable rating scale developed for the study. Significant decreases in suicidality and significant improvement in mental state were found to occur during the course of counseling sessions, suggesting positive immediate impact. Limitations of the study with respect to longer-term outcomes and the relevance of the results for suicide prevention are discussed. Notwithstanding the study limitations, the results lend support for continuing development of hotline services.
Uncovering the mystery: factors of African American suicide.
Correspondence: Leigh A. Willis, Department of Sociology, African-American Studies, University of Georgia, Athens 30602-1611, USA; (email: lawillis@uga.edu).
Traditionally, African Americans have registered lower rates of suicide than other ethnic groups. In the last 20 years this pattern has changed, particularly among young African Americans. To date, the research conducted regarding this phenomenon has been limited for a variety of reasons and previous research has been inconclusive in determining risk factors of African American suicide. The purpose of this paper is to identify risk and protective factors specific to African American suicide. To determine the factors, the 1993 National Mortality Follow-back Survey was analyzed. The risk factors identified include being under age 35, southern and northeastern residence, cocaine use, firearm presence in home, and threatening others with violence. Some of the protective factors associated with African American suicide include rural residence and educational attainment. These results provide valuable information about completed African American suicides in relation to Whites. Several of these factors are unique to African Americans.
African American and Caucasian attempters compared for suicide risk factors: a preliminary study.
Correspondence: Alec Roy, Psychiatry Service (116A), Department of Veterans Affairs, New Jersey Healthcare System, 385 Tremont Avenue, East Orange, NJ 07018, USA; (email: alec.roy@med.va.gov).
The aim of the study was to compare African American and Caucasian substance dependent suicide attempters for risk factors for suicidal behavior. One hundred and fifty-eight African American and 95 Caucasian substance dependent patients who had attempted suicide were interviewed and their family history of suicidal behavior recorded. Patients completed the Childhood Trauma Questionnaire, the Eysenck Personality Questionnaire, and the Foulds Hostility and Direction of Hostility Questionnaire. The results revealed that there were no significant differences between the African American and Caucasian suicide attempters for marital status, age, childhood abuse, or for personality scores for neuroticism, extraversion, psychoticism, or hostility. However, the African American attempters had significantly lower childhood emotional neglect scores. Also, significantly more of the Caucasian attempters had a family history of suicide and current legal problems. Further studies seem warranted examining for differences between African Americans and Caucasians for risk factors for suicidal behavior.
Correspondence: Ronan Lyons, Clinical School, University of Wales Swansea, Grove Building, Singleton Park, Swansea SA2 8PP, UK; (email: r.a.lyons@swansea.ac.uk).
OBJECTIVE: To identify the most appropriate metric to determine the effectiveness of mobile speed cameras in reducing road traffic related injuries.
DESIGN: Controlled before and after study which compares two methods for examining the local effectiveness of mobile speed cameras-a circular zone around the camera and a route based method to define exposure at various distances from sites.
SETTING: South Wales, UK.
SUBJECTS: Persons injured by road traffic before and after intervention.
INTERVENTION: Use of mobile speed cameras at 101 sites.
MAIN OUTCOME MEASURES: Rate ratio of injurious crashes at intervention and control sites.
FINDINGS: Camera sites had lower than expected numbers of injurious crashes up to 300 meters using circles and up to 500 meters using routes. Routes methods indicated a larger effect than the circles method except in the 100 meters nearest sites. A 500 meter route method was used to investigate the effect within strata of time after intervention, time of day, speed limit, and type of road user injured. The number of injurious crashes after intervention was substantially reduced (rate ratio 0.49, 95% confidence interval 0.42 to 0.57) and sustained throughout two years after intervention. Significant decreases occurred in daytime and night time, on roads with speed limits of 30 and 60-70 miles/hour and for crashes that injured pedestrians, motorcycle users, and car occupants.
COMMENTS: The route based method is the better method of measure effectiveness at distances up to 500 meters. This method demonstrates a 51% reduction in injurious crashes.
Optimal restraint reduces the risk of abdominal injury in children involved in motor vehicle crashes.
- Nance ML, Lutz N, Arbogast KB, Cornejo RA, Kallan MJ, Winston FK, Durbin DR. Ann Surg 2004; 239(1): 127-131.
Correspondence: Michael L. Nance, Department of Surgery, Children's Hospital of Philadelphia, 34th and Civic Center Boulevard, Philadelphia, PA 19104, USA; (email: nance@email.chop.edu).
BACKGROUND: The American Academy of Pediatrics has established guidelines for optimal, age-appropriate child occupant restraint. While optimal restraint has been shown to reduce the risk of injuries overall, its effect on specific types of injuries, in particular abdominal injuries, has not been demonstrated.
METHODS: Cross-sectional study of children aged younger than 16 years in crashes of insured vehicles in 15 states, with data collected via insurance claims records and a telephone survey. A probability sample of 10,927 crashes involving 17,132 restrained children, representing 210,926 children in 136,734 crashes was collected between December 1, 1998 and May 31, 2002. Restraint use was categorized as optimal or suboptimal based on current American Academy of Pediatrics guidelines. The outcome of interest, abdominal injury, was defined as any reported injury to an intra-abdominal organ of Abbreviated Injury Scale >/=2 severity.
FINDINGS: Among all restrained children, optimal was noted in 59% (n = 120,473) and suboptimal in 41% (n = 83,555). An associated abdominal organ injury was noted in 0.05% (n = 62) of the optimal restrained group and 0.17% (n = 140) of the suboptimal group. After adjusting for age and seating position (front vs. rear), optimally restrained children were more than 3 times less likely [odds ratio 3.51 (95% confidence interval, 1.87-6.60, P < 0.001)] as suboptimally restrained children to suffer an abdominal injury. Of note, there were no abdominal injuries reported among optimally restrained 4- to 8-year-olds.
COMMENTS: Optimally restrained children are at a significantly lower risk of abdominal injury than children suboptimally restrained for age. This disparity emphasizes the need for aggressive education efforts aimed not only at getting children into restraint systems, but also the importance of optimal, age-appropriate restraint.
Road traffic injuries in Colombia.
- Rodriguez DY, Fernandez FJ, Acero Velasquez H. Inj Control Saf Promot 2003; 10(1-2): 29-35.
Correspondence: Deysi Yasmin Rodriguez, Research Program on Traffic and Transport, National University of Colombia, Ciudad Universitaria, Edificio 214 (Antonio Narino) oficina 418, Bogota D.C., COLUMBIA; (email: p293149@ing.unal.edu.co).
Road traffic injuries are a leading public health problem in Colombia. Pedestrians are the most vulnerable road users, especially in the main urban centers of Bogota, Medellin and Cali. Data analyzed in this report include official statistics from the National Police and the National Institute of Legal Medicine and Forensic Sciences for 1996-2000, and results of a study conducted at the National University of Colombia in 2000. Methods from the Highway Capacity Manual were used for determining physical and technical variables, and a Geographical Information System tool was used for the location and spatial analysis of the road traffic crashes. Pedestrians accounted for close to 32% of injuries and 40% of the deaths from road traffic crashes. The problem of road traffic crashes existed predominately in urban areas. In the main urban centers, pedestrians constituted nearly 68% of road traffic crash victims. The high level of risky road use behaviors demonstrated by pedestrians and drivers, and inadequate infrastructure for safe mobility of pedestrians in some sections of the road network were the main contributing factors. Major improvements were achieved in Bogota following enhancements to the municipal transport system and other policies introduced since 1995. In conclusion, policies and programs for improving road safety, in particular pedestrian safety, and strengthening urban planning are top priority.
A contemporary analysis of road traffic crashes, fatalities and injuries in Trinidad and Tobago.
Correspondence: Godfrey St. Bernard, Sir Arthur Lewis Institute of Social and Economic Studies, University of the West Indies, St. Augustine, Trinidad and Tobago, WEST INDIES; (email: gstbiser@tstt.net.tt).
Road safety, in particular pedestrian safety, is a problem in Trinidad and Tobago. Data were derived from the database of the Traffic and Highway Patrol Unit of the Trinidad and Tobago Police Service. Road traffic crashes in Trinidad and Tobago are largely an urban problem. Four urban areas accounted for nearly three-quarters of reported road traffic crashes, fatalities and injuries. Pedestrians, passengers and drivers accounted for 93% of fatalities and 95% of injuries due to road traffic crashes in 2000. Pedestrians alone accounted for 42% of fatalities and 34% of injuries in 2000. Trends over time show that there has been a decline in fatality rates from 17 deaths per 100,000 population in 1960 to 10 deaths per 100,000 population in 2000, despite rapid motorization. Motorization increased four-fold from 63 registered vehicles per 1000 population in 1960 to 250 vehicles per 1000 population in 2000. In conclusion, effort should be intensified to ensure safety for all road users and, in particular, pedestrians, passengers and drivers. Improved data collection and operational research would improve monitoring and evaluation of policy interventions.
Permits to carry concealed firearms in public (CCW permits) remain controversial. A small scale natural experiment with shall-issue CCW permit policy in California, a may-issue state, is reported. During the mid-1990s, the chief of police of the Sacramento County town of Isleton issued permits to all county residents who applied and passed a standard background check. This program received national publicity. The incidence of subsequent criminal activity among 691 persons applying for CCW permits through Isleton's program in 1995 and that in a statewide sample of 965 CCW applicants from 1993-94 were compared. Subjects were followed up for three years from their application dates. The arrest rates for violent crime among Isleton and statewide applicants were 291 and 104 per 100 000 person-years, respectively (relative risk 2.8, 95% confidence interval 0.7 to 11.2, p = 0.18). This suggests that a shall-issue policy for CCW permits may result in higher rates of violent crime among permit holders, but the results do not reach statistical significance; larger studies are needed.
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.
Correspondence: Karen M. Sheehan, Division of Pediatric Emergency Medicine, Children's Memorial Hospital, the Department of Pediatrics, Feinberg School of Medicine, Northwestern University, USA; (email: ksheehan@northwestern.edu).
OBJECTIVE: To determine how preadolescent urban children conceptualize and experience violence in their lives.
DESIGN: This qualitative study reports the results of focus groups designed to examine perceptions of violence among preadolescent urban children. Program directors were trained to conduct the sessions using a semi-structured script. All groups were audiotaped or videotaped. The summaries were analyzed for recurring themes.
SETTING: A community-based visual arts program for children designed to be a secondary violence-prevention program.
PARTICIPANTS: There were 12 focus groups of volunteer participants. Each consisted of 3 to 6 children aged 8 to 12 years, separated by sex and age. Fifty children participated: 27 boys and 23 girls.
FINDINGS: These children defined violence in a broader way than most adults would. Not only did the children identify shootings and stabbings as examples of violence, but they also considered violence to be any act that might hurt someone's feelings (such as cheating and lying) or any act accompanying violence (such as cursing and yelling). The boys and girls were very similar in their views except regarding the issue of intimate-partner violence. The girls were almost universally concerned about this issue, but the boys seemed noticeably unaware that intimate-partner violence was considered a form of violence. Most children felt safe at home, and almost no child felt safe at school. They looked to trusted adults to keep them safe.
COMMENTS: Future investigators measuring the effect of violence-prevention activities on preteen children should be aware that their definition of violence may differ from that of young children and should be cognizant of potential sex differences, especially around the topic of intimate-partner violence. Those designing violence-prevention programs for children should consider engaging adult family members as well because children usually turn to them for safety.
Correspondence: Danny G. Willis, Louisiana State University Health Sciences Center, School of Nursing, New Orleans, Louisiana, USA; (email: dwilli4@lsuhsc.edu).
As the United States has become more multicultural and diverse, there has been an increase in violence motivated by hate. Hate crimes against gay males are the most prevalent of the hate crimes based on sexual orientation. Hate crimes have their roots in normative, individual, and societal attitudes and ideologies that lead to intimidation, bullying, teasing, physical assault, rape, and murder. This paper provides an overview of the issues specific to hate crime assaults against gay males. Mental health nurses may find this knowledge useful in developing further nursing inquiry, education, and clinical practice related to hate crime and violence prevention.
Violence perpetration across peer and partner relationships: co-occurrence and longitudinal patterns among adolescents.
- Ozer EJ, Tschann JM, Pasch LA, Flores E. J Adolesc Health 2004; 34(1): 64-71.
Correspondence: Emily J. Ozer, School of Public Health, University of California, California (E.J.O.), Berkeley, USA; (email: eozer@uclink.berkeley.edu).
To examine the co-occurrence and consistency over time of peer violence, sexual aggression, and dating violence among European American and Mexican-American adolescent boys and girls. One-hundred-twelve girls and 135 boys who were either European American or Mexican-American were recruited from a large health maintenance organization. They were interviewed by telephone at baseline (at ages 16 to 20 years) and at one-year follow-up. Variable-centered and person-centered analyses examined the co-occurrence of violent behavior across domains, and whether adolescents who engaged in violent behavior at baseline also engaged in violent behavior during the following year. Results indicated that adolescent boys who engaged in violence in one domain were more likely to engage in violence in other domains during the same time period. Results for girls were less consistent. For boys but not girls, perpetration of either sexual aggression or peer violence was a significant predictor of the same behavior at follow-up. Person-centered analyses indicated that boys who perpetrated both peer violence and sexual aggression at baseline were most likely to perpetrate later violence. These results suggest that adolescent boys who engage in peer violence are also at risk for perpetrating sexual aggression or dating violence. Boys who perpetrate peer violence and sexual aggression are at high risk for later violence. Interventions with a dual focus on peer and partner violence may be valuable.
