Children and adolescents in Germany show a high rate of substance use, esp. concerning tobacco and alcohol. Taking these and other drugs can be seen as a juvenile risk behavior associated with adverse effects, e. g. violence, unsafe sexuality, early pregnancy, under-achievement in school. Prevention and interventive measures should begin early and be designed comprehensively in order to gain decisive and long-lasting effects. Children and adolescents of addicted parents and those with substance abusing peers have to be viewed as especially in danger for increased substance abuse and associated risk behaviors. One of the main preventive tasks is the acquisition of affective self-control and self-management competencies.
Drug driving among injecting drug users in Sydney, Australia: prevalence, risk factors and risk perceptions.
- Darke S, Kelly E, Ross J. Addiction 2004; 99(2): 175-185.
Correspondence: Shane Darke, National Drug and Alcohol Research Centre, University of New South Wales, AUSTRALIA; (email: s.darke@unsw.edu.au).
OBJECTIVE: To examine the prevalence of drug driving, the prevalence of drug-related motor vehicle accidents, risk perceptions of drug driving and factors associated with drug driving among injecting drug users (IDU).
DESIGN: Cross-sectional survey.
SETTING: Sydney, Australia.
PARTICIPANTS: Three hundred current IDU.
FINDINGS: Ninety-five per cent had driven a vehicle, 74% in the previous 12 months ('current drivers'). Eighty-seven per cent of life-time drivers reported having drug driven, and 88% of current drivers had drug driven in the previous 12 months. There were no significant sex differences in life-time or recent drug driving. The most common drugs used before driving in the preceding year were: cannabis, heroin, amphetamines and cocaine. A third of life-time drivers reported having had a drug driving accident, with males more likely to have done so, and 9% of current drivers reported a drug driving accident in the previous year. The most common drugs that had been used before the most recent drug driving accident were heroin, cannabis and alcohol. Alcohol was perceived to be the most dangerous substance for driving performance and cannabis the least dangerous. Recent drug drivers perceived drug driving to be less dangerous than non-drug drivers. Recent drug drivers had driven more frequently over the preceding 12 months, had significantly higher levels of dependence, higher frequency of drug use, more extensive polydrug use and were more likely to have used and/or injected a drug in a car in the previous 12 months.
COMMENTS: Drug driving and drug-related accidents are large-scale public health problems among IDU. These behaviors pose serious risks to IDU themselves and to the broader community.
- Shults RA, Centers for Disease Control and Prevention (CDC). MMWR 2004; 53(4): 77-79.
On February 13th the Centers for Disease Control published an erratum notice for this report included in the 9 February 2004 SafetyLit. We corrected the information on the 9 February 2004 update page. If you plan to use this report you should review the corrected version.
Adolescent suicidal behavior and mental health service provision - Letter.
- Keeley HS. Ir Med J 2003; 96(10): Letters to the Editor.
Correspondence: Helen S Keeley, Brothers of Charity, Southern Region, Lota, Glanmire, Cork.
National Suicide Research Foundation; IRELAND; (email: unavailable).
"Sir - In the report of the National Parasuicide Registry based on data collected over the year 2002 from each health board region in the Republic of Ireland, adolescent girls were identified as the group with the highest rate of self-harm in the country. With near complete coverage of acute hospitals, the peak rates for women are in the 15-19 year age group, with rates at the staggeringly high figure of 626/100,000. Almost 1,000 hospital presentations were recorded by the registry for girls aged 15-19 years in the republic of Ireland. This makes up one-fifth of all female presentations. This indicates that last year in Ireland, one in every 160 girls aged 15-19 years old was treated in hospital following a suicide attempt. The peak rates for boys come a little later in the 20-24 year-olds but the rates for 15-19 year olds is still high at 284/100,000.
This information is vital when one considers the lack of appropriate services available to this very age group. Recently the lack of mental health services in Ireland for older adolescents was the subject of a very critical Amnesty International Report. Currently, there are no appropriate outpatient services available for those children who present with mental health difficulties after their 16th birthday. Adult psychiatric services are not the best service to meet the needs of these children and their families and there are obvious concerns regarding the legality of managing a minor in an adult service. The developing Child and Adolescent Mental Health Services have no tradition of managing older adolescents and are wary of taking on this group in the absence of extra resources. This is even more understandable when one considers that there are only twenty in-patient beds for children with mental health problems in the country, located in the Western Health Board and Eastern Regional Health Authority areas. The Report of the Working Group on Child and Adolescent Psychiatric Services in 2001, estimated that a total of 144 beds was required. At present, children requiring admission are managed on general pediatric wards, where they pose considerable management difficulties, especially given the absence of training and facilities needed to deal appropriately with such a volatile group. Alternatively, children as young as 14 or 15 years of age are admitted to Adult Psychiatric wards, a practice with obvious problems, which particularly drew the opprobrium of Amnesty International. Such an incidence was reported in Medicine Weekly on 8th October 2003.
This situation clearly cannot be allowed to continue. The National Parasuicide Registry Annual Report identifies the need to prioritize the care and treatment of older adolescents displaying mental health difficulties."
Correspondence: J. Boscarino, Division of Health and Science Policy, Room 552, New York Academy of Medicine, 1216 Fifth Avenue, New York, NY 10029-5293, USA; (email: jboscarino@nyam.org).
To examine the public's response to future terrorist attacks, we surveyed 1,001 New Yorkers in the community one year after the September 11 attacks. Overall, New Yorkers were very concerned about future terrorist attacks and also concerned about attacks involving biological or nuclear weapons. In addition, while most New Yorkers reported that if a biological or nuclear attack occurred they would evaluate available information before evacuating, a significant number reported they would immediately evacuate, regardless of police or public health communications to the contrary. The level of public concern was significantly higher on all measures among New York City and Long Island residents (downstate) compared to the rest of the state. A model predicting higher fear of terrorism indicated that downstate residents, women, those 45 to 64 years old, African Americans and Hispanics, those with less education/income, and those more likely to flee, were more fearful of future attacks. In addition, making disaster preparations and carefully evaluating emergency information also predicted a higher level of fear as well. A second model predicting who would flee suggested that those more likely to evaluate available information were less likely to immediately evacuate, while those with a higher fear of future attacks were more likely to flee the area. Given these findings and the possibility of future attacks, mental health professionals need to be more involved in preparedness efforts, especially related to the psychological impact of attacks involving weapons of mass destruction.
Time-lapsed microstructural imaging of bone failure behavior.
- Nazarian A, Müller R. J Biomech 2004; 37(1): 55-65.
Correspondence: Ralph Müller, Institute for Biomedical Engineering, Swiss Federal Institute of Technology (ETH) and University of Zürich, Moussonstrasse 18, , Zürich 8044, SWITZERLAND; (email: rmueller@biomed.ee.ethz.ch).
Many bones within the axial and appendicular skeleton are subjected to repetitive loading during the course of ordinary daily activities. If this loading is of sufficient magnitude or duration, failure of the bone tissue may result. Until recently the structural analysis of these fractures has been limited to two-dimensional sections. Due to the inherent destructiveness of this method, dynamic assessment of fracture progression has not been possible. An image-guided technique to analyze structural failure has been developed utilizing step-wise micro-compression in combination with time-lapsed micro-computed tomographic imaging. This technique allows, for the first time, direct three-dimensional visualization and quantification of fracture initiation and progression on the microscopic level and relates the global failure properties of trabecular bone to those of the individual trabeculae. The goals of this project were first to design and fabricate a novel micro-mechanical testing system, composed of a micro-compression device and a material testing and data acquisition system; and second, to validate the testing system to perform step-wise testing of trabecular bone specimens based on image-guided failure analysis. Due to the rate dependant properties of bone, stress relaxation was a concerning factor with respect to the step-wise testing method. In order to address these concerns, the results of the step-wise testing method were compared to those obtained from a conventional continuous test (considered to be the gold standard for the step-wise compressive mechanical testing) over the same total strain range and testing conditions. This was performed using porous aluminum alloy samples with highly reproducible and homogenous structural properties as well as trabecular bone samples from a single whale vertebra. Five cylinders from aluminum foam and trabecular whale bone each were compressed and imaged in a step-wise fashion from 0% to 20% strain at intervals of 2%, 4%, 8%, 12%, 16% and 20%. Mechanical properties obtained from the continuous and step-wise methods were not significantly different for both aluminum foam and whale bone specimens (p>0.05). Both testing methods yielded very similar stress-strain graphs with almost identical elastic and plastic regions with overlaying standard error bars for both whale bone and aluminum foam specimens. This was further concurred by performing regression analyses between the stress data from both testing methods (r2=0.98 for whale bone and aluminum foam specimens). Animations of fracture initiation and progression revealed that failure always occurred in local bands with the remaining regions of the structure largely unaffected independent of structure type. In conclusion, we found step-wise micro-compression to be a valid approach for image-guided failure assessment (IGFA) with high precision and accuracy as compared to classical continuous testing. We expect findings from upcoming studies of IGFA of human vertebral bone to improve our understanding of the relative importance of densitometric, morphological, and loading factors in the etiology of spontaneous fractures of the spine. Eventually, this improved understanding may lead to more successful approaches to the prevention of age-related fatigue fractures.
An intervention to reduce television viewing by preschool children.
- Dennison BA, Russo TJ, Burdick PA, Jenkins PL. Arch Pediatr Adolesc Med 2004; 158(2): 170-176.
Correspondence: Barbara A. Dennison, Research Institute, Bassett Healthcare, Cooperstown, NY; Human Ecology, State University of New York at Oneonta, USA; (email: unavailable).
BACKGROUND: Television viewing has been associated with increased violence in play and higher rates of obesity. Although there are interventions to reduce television viewing by school-aged children, there are none for younger children.
OBJECTIVE: To develop and evaluate an intervention to reduce television viewing by preschool children.
DESIGN: Randomized controlled trial conducted in 16 preschool and/or day care centers in rural upstate New York. Patients Children aged 2.6 through 5.5 years. Intervention Children attending intervention centers received a 7-session program designed to reduce television viewing as part of a health promotion curriculum, whereas children attending the control centers received a safety and injury prevention program. Outcome Measurements Change in parent-reported child television/video viewing and measured growth variables.
FINDINGS: Before the intervention, the intervention and control groups viewed 11.9 and 14.0 h/wk of television/videos, respectively. Afterward, children in the intervention group decreased their television/video viewing 3.1 h/wk, whereas children in the control group increased their viewing by 1.6 h/wk, for an adjusted difference between the groups of -4.7 h/wk (95% confidence interval, -8.4 to -1.0 h/wk; P =.02). The percentage of children watching television/videos more than 2 h/d also decreased significantly from 33% to 18% among the intervention group, compared with an increase of 41% to 47% among the control group, for a difference of -21.5% (95% confidence interval, -42.5% to -0.5%; P =.046). There were no statistically significant differences in children's growth between groups.
COMMENTS: This study is the first to show that a preschool-based intervention can lead to reductions in young children's television/video viewing. Further research is needed to determine the long-term effects associated with reductions in young children's television viewing.
The effects of a Laban-based movement program with music on measures of balance and gait in older adults.
Correspondence: Janet Hamburg, Laban/Bartenieff Institute of Movement Studies, Department of Music and Dance, University of Kansas, Lawrence, KS, 66045, USA; (email: jhamburg@ku.edu).
A group of 36 healthy older adults (Males = 10, Females = 26), who ranged in age from 63 to 86 years, participated in a movement program designed to enhance balance and gait characteristics. The program, designed by a Laban movement analyst, consisted of 14 movement sequences set to music especially composed to reflect the dynamics, rhythm, timing, and phrasing of the movements. After five weeks, individuals showed statistically significant increases in measures of balance and gait characteristics. For those persons (N = 7) who extended their involvement, improvements continued but were not statistically significant.
Assessment and management of roof fall risks in underground coal mines.
- Duzgun HSB, Einstein H. Safety Science 2004; 42(1): 23-41.
Correspondence: H. S. B. Duzgun, Middle East Technical University, Geodetic and Geographic Information Technologies, ODTU Insaat Muh. Bol., Room K4-123 06531, Ankara, TURKEY; (email: duzgun@metu.edu.tr).
Accidents caused by roof falls are commonly faced problems of underground coal mines. These accidents may have detrimental effects on workers in the form of injury, disability or fatality as well as mining company due to downtimes, interruptions in the mining operations, equipment breakdowns, etc. This study proposes a risk and decision analysis methodology for the assessment and management of risk associated with mine roof falls in underground coal mines. In the proposed methodology, risk assessment requires the determination of probabilities, possible consequences and cost of consequences. Then the risk is managed by the application of decision-making principles. The probabilities are determined by the analysis of 1141 roof fall data from 12 underground mines in the Appalachian region. The consequences are assessed based on the type of injuries observed after roof falls and the place of the mining activity. The cost of consequences is modeled by the so-called "relative cost criterion". A decision analysis framework is developed in order to manage the evaluated risk for a single mine. Then this model is extended to a regional model for the management of the roof fall risks in the mines of whole Appalachia. The proposed model is illustrated with an example and it is found to be a powerful technique for coping with uncertainties and the management of roof fall risks.
OBJECTIVE: This report aims to increase awareness of an unusual mechanism of orbital injury sustained by bicycle riders.
METHODS: In this retrospective small case series, we describe two cases of orbital injury caused by upper eyelid penetration. A 5-year-old boy (patient 1) and a 6-year-old boy (patient 2) presented to our service within a 2-week period. Both had been injured by similarly styled, handlebar-mounted bicycle hand brake levers. Patient 1 had an orbital roof fracture and penetrating brain injury and underwent repair of a left upper eyelid laceration, craniotomy for pseudoencephalocele, and ptosis repair. Patient 2 had orbital hemorrhage and underwent repair of left upper eyelid laceration.
FINDINGS: In both cases, a handlebar-mounted bicycle hand brake lever perforated the left eyelid when the rider fell onto it. Neither patient was wearing protective headwear or eyewear. Two months after surgery, patient 1 had 20/25 visual acuity OU and excellent cosmetic appearance. Patient 2 had baseline amblyopic vision 2 days after surgery but moved from town and was lost to follow-up.
COMMENTS: Orbit injuries from bicycle brake levers are rare, and helmets or protective eyewear probably would not have prevented these injuries. However, a change in the design and/or mounting location of handlebar-mounted brake levers might help prevent further injuries of this type.
Correspondence: Paul Echlin, Department of Family Medicine, Indiana University Center for Sports Medicine, Long Hospital, 1110 West Michigan Street, Indianapolis, IN 46202-5102, USA; (email: p_echlinfp@hotmail.com).
Maxillofacial injuries occur in contact and noncontact sports. Despite advancements in protective equipment and rule changes, there is still an unacceptably high rate of maxillofacial injuries. These injuries are clinically challenging. The significant morbidity, deformity, and disability associated with these injuries can be avoided by their prompt diagnosis and appropriate management. It is important for the sports medicine professional to be competent in the correct diagnosis and management of maxillofacial injuries. This article reviews some of the major maxillofacial injuries, along with their emergent examinations and treatments.
BACKGROUND: Wakeboarding is a popular water sport that has the potential to produce serious injuries. To date, there has been only one article describing an injury caused by wakeboarding.
STUDY DESIGN: Analysis of data obtained from physician and patient questionnaires.
METHODS: Analysis of questionnaire data obtained from 156 orthopedic surgeons and 86 wakeboarders.
FINDINGS: Of 156 orthopedic surgeons completing a wakeboarding injuries questionnaire, 49% reported no wakeboarding injuries, 36% (57) reported treating at least 1 wakeboarding injury, and 15% had never heard of wakeboarding. Fifty-seven orthopedic surgeons reported 122 injuries, of which 47% were either anterior cruciate ligament (ACL) tears (31%) or shoulder dislocations (15%). In addition, 21% of all the injuries were some type of fracture. Of 86 wakeboarders completing the injuries survey, 77% reported sustaining an injury. There were 82 reported injuries in this group, of which 34% were either ACL tears (17%) or ankle sprains (17%).
COMMENTS: This survey of wakeboarding injuries demonstrates that serious injuries can occur from participation in this sport. The most common injuries reported were ACL tears, shoulder dislocations, and ankle sprains. In addition, 21% of all the injuries were some type of fracture.
Increased injury risk among first-day skiers, snowboarders, and skiboarders.
-Langran M, Selvaraj S. Am J Sports Med 2004; 32(1): 96-103.
BACKGROUND: Inexperience predisposes skiers, snowboarders, and skiboarders to a higher risk of injury.
OBJECTIVE: To determine whether individuals on their very 1st day's experience of skiing, snowboarding, or skiboarding are at greater risk of injury.
STUDY DESIGN: Case control study.
METHODS: All individuals injured at the three largest ski areas in Scotland during the three winter seasons 1999-2000 through 2001-2002 were included. First-day participants were identified. Individual demographic details and snow sports-related parameters were recorded. Control data were collected from uninjured individuals. Factors associated with injury were explored in univariate and multivariate analyses.
FINDINGS: First-day participants were overrepresented in the injured population by a factor of 2.2. Participant age younger than 17 years or older than 26 years, snowboarding, taking professional instruction, and the use of rented or borrowed gear were all independently associated with increased injury risk among 1st-day participants.
COMMENTS: First-day participants are at increased risk of injury. Several independent risk factors for injury have been identified. First-day participants should be targeted in any future educational programs with emphasis on gear selection, use of protective gear, and the risks of exceeding the limits of their ability.
Child safety education and the world wide web: an evaluation of the content and quality of online resources.
- Isaac D, Cusimano MD, Sherman A, Chipman M. Inj Prev 2004; 10(1): 59-61.
Correspondence: Michael Cusimano, Injury Prevention Research Centre, St. Michael's Hospital, 38 Shuter Street, Suite 2-018, Toronto, Ontario, M5B 1A6, CANADA; (email: injuryprevention@smh.toronto.on.ca).
The purpose of this study was to assess the content, quality, and type of internet resources available for safety education. Using 19 search engines with search strings targeting major forms of injury, identified resources were classified by audience group, accessibility, and authorship. Two independent reviewers rated each resource on the basis of its content and a set of quality criteria using a three point scale. Overall, 10 (18.2%) resources were of highest quality, four (7.3%) were intermediate, and 41 (74.5%) were not recommended. Eighteen months after the original search, 67.3% of all resources and 90% of the highest quality resources were still on the internet. This study provides a methodology for evaluating child safety resources on the world wide web and demonstrates that most internet resources for safety education are of dubious quality. A rating system such as the one developed for this study may be used to identify valuable internet materials.
The Impact of Major Trauma: Quality-of-Life Outcomes Are Worse in Women than in Men, Independent of Mechanism and Injury Severity.
BACKGROUND: The importance of gender differences in quality of life and psychologic morbidity after major trauma is a newly recognized focus of trauma outcomes research. The Trauma Recovery Project is a large, prospective, epidemiologic study designed to examine multiple outcomes after major trauma, including quality of life (QoL), and psychologic sequelae such as depression and early symptoms of acute stress reaction (SASR). The specific objectives of the present report are to examine gender differences in QoL outcomes and the early incidence of combined depression and SASR after injury, controlling for injury severity, specific body area injured, and mechanism.
METHODS: Between December 1, 1993, and September 1, 1996, 1,048 eligible trauma patients triaged to four participating trauma center hospitals in the San Diego Regionalized Trauma System were enrolled in the study. The enrollment criteria for the study included age 18 years and older, admission Glasgow Coma Scale score of 12 or greater, and length of stay greater than 24 hours. QoL outcome after trauma was measured after injury using the Quality of Well-being scale, a sensitive index to the well end of the functioning continuum (range, 0 = death to 1.000 = optimum functioning). Depression was assessed using the Center for Epidemiologic Studies scale. SASR was assessed using the Impact of Events scale. Patient outcomes were assessed at discharge and at 6, 12, and 18 months after discharge.
FINDINGS: Women (n = 313) were significantly more likely to have poor QoL outcomes at follow-up than men (n = 735) (women vs. men: 12-month follow-up odds ratio [OR] = 2.2, p < 0.001; 18-month follow-up OR = 2.0, p < 0.001). Quality of Well-being scores at each of the 6-, 12-, and 18-month follow-up time points were markedly and significantly lower in women compared with men, independent of injury severity, serious and moderate injury status, lower extremity injury, intentional or unintentional injury type, and blunt or penetrating injury. Women were also significantly more likely to develop early combined depression and SASR at discharge (OR = 1.7, p < 0.01) and to have continuous depression throughout the 18-month follow-up period (OR = 2.3, p < 0.001).
COMMENTS: These analyses provide further important and more detailed evidence that women are at risk of worse QoL outcomes and early psychologic morbidity after major trauma than men, independent of mechanism and injury severity. A better understanding of the impact of major trauma in men and women will be an important component of efforts to improve trauma care and long-term outcome in mature trauma systems.
The child maltreatment log: a computer-based program for describing research samples.
- Sternberg KJ, Knutson JF, Lamb ME, Baradaran LP, Nolan CM, Flanzer S. Child Maltreat 2004; 9(1): 30-48.
Correspondence: Kathleen J. Sternberg, National Institute of Child Health and Human Development, National Institutes of Health, Department of Health and Human Services, Bethesda, MD 20892, USA; (email: unavailable).
The Child Maltreatment Log (CML) is a computer-based program designed to record information about children's maltreatment experiences and associated life events. Addressing concerns posed by scientific panels and grant review panels, the CML was designed to improve upon existing instruments to facilitate collaboration among researchers interested in maltreatment. The CML encourages researchers to collect information from multiple sources and informants concerning children's maltreatment experiences. Rather than classifying types of maltreatment a priori, the CML allows researchers to describe children's experiences using objective descriptors pertaining to potential acts of abuse, potential perpetrators, frequency, onset, consequential injuries, and treatment. The CML can be downloaded by interested agencies and groups without charge.
Behavioral and psychological risk factors for traumatic injury.
- Field CA, O'Keefe G. J Emerg Med 2004; 26(1): 27-35.
Correspondence: Craig A. Field, School of Public Health, University of Texas Houston Health Science Center, Dallas Regional Campus, Dallas, Texas, USA; (email: unavailable).
The objectives of the present study were to determine the behavioral and psychological risk factors associated with injury. The most widely investigated risk factor for injury is alcohol use. However, other behavioral and psychological risk factors may also contribute to injuries. This study examined the association of alcohol use, injury-related risk behaviors, and psychological characteristics with injury status. A hospital-based case control study of 177 patients admitted for treatment of traumatic injury, and 195 general surgery patients as controls, was conducted. Alcohol use, injury-related risk behaviors, impulsivity, sensation seeking, and risk perception were assessed. The results from a multivariate analysis controlling for age, gender, and ethnicity indicated that, in addition to alcohol consumption (OR = 2.2, 95% CI = 1.1-4.5), driving (OR = 2.4, 95% CI = 1.7-3.5) and violence-related risk behaviors (OR = 1.6, 95% CI = 1.0-2.2) are significantly associated with injury. In conclusion, the engagement in injury-related risk behaviors, including alcohol use, is strongly associated with injury status. Brief interventions that directly address these behavioral risk patterns in injured patients may reduce their risk of future injury.
Previous research on framing effects has largely focused on how choice information framed by external sources influences the response of a decision maker. This research examined how decision makers framed choice options and how the hedonic tone of self-framing influenced their risk preference. By using pie charts and a complementary sentence-completion task in Experiment 1, participants were able to interpret and frame the expected choice outcomes themselves before making a choice between a sure option and a gamble in either a life-death or a monetary problem. Each of these self-frames (phrases) was then rated by a group of independent judges in terms of its hedonic tone. The hedonic tone of self-frames was mostly positive and was more positive in the life-death than the monetary context, suggesting a motivational function of self-framing. However, positive outcomes were still more likely to be framed positively than negative outcomes. In Experiment 2, choice outcomes were depicted with a whole-pie chart instead of a pie slice in order to emphasize positive and negative outcomes equally. The results showed that the hedonic tone of self-framing was still largely positive and more positive in the life domain than the monetary domain. However, compared to Experiment 1, the risk preference in the life-death domain was reversed, showing an outcome salience effect: when the pie-slice chart emphasized only survival outcomes, participants were more risk taking under positive hedonic frames whereas when the whole-pie chart depicted both survival and mortality outcomes, they became risk averse under positive frames. In sum, self-framing reflected a positive bias in encoding risk information and affected the risk preference of the decision maker. Like the tone of voice used in communication, the hedonic tone of self-framing, either positive or negative, can affect risk perception of a choice problem.
Agriculture is one of the most hazardous industries in Finland. The aim of this study was to describe and analyze fatal farm injuries in Finland in 1988 to 2000. The information regarding farm-related fatalities was collected by the Kuopio Regional Institute of Occupational Health. The material of this study consisted of all fatal injuries that occurred on a farm or away from a farm in the course of agricultural work. A total of 217 farm-related fatalities occurred in Finland between 1988 and 2000. Of these, 120 were tractor-related, and 97 were other fatal farm injuries. Most of the injuries involved middle-aged or older male farmers. The most typical fatalities with tractors were tractor overturns during driving on a road or working in a field. Other fatal farm incidents occurred mainly in construction work, animal husbandry, or forest work. Elderly farmers and children proved to be risk groups for fatal injuries.
A community-based telephone survey of work and injuries in teenage agricultural workers.
- Bonauto DK, Keifer M, Rivara FP, Alexander BH. J Agric Saf Health 2003; 9(4): 303-317.
Correspondence: D.K. Bonauto, Safety and Health Assessment and Research for Prevention Program, Washington State Department of Labor and Industries, Olympia, Washington, USA; (email: bone235@lni.wa.gov).
In order to estimate the one-year cumulative incidence of work-related injuries in teenage agricultural workers and to characterize the patterns and types of agricultural work performed by teenagers, we performed a community-based random-digit dialing telephone survey. We used a sampling frame of farm and non-farm households to access information on teenage agricultural workers. An agricultural community in eastern Washington State was selected due to the high number of teenage youth and its agricultural economy. Teenage agricultural workers who worked for an agricultural business owned by one of their family members were more likely to work a greater number of seasons, work fewer hours per week, perform tasks involving driving, animal care, and mechanic work, and were less likely to be seasonal workers or work in the harvest than teenagers who did not work for a family member. A similar pattern of work differences was seen when comparing non-Hispanic to Hispanic agricultural workers. Teenagers working for a family member in agriculture had a higher injury rate than teenagers working for an agricultural business not owned by a family member. The injury rate among Hispanic teenage agricultural workers was also higher than that of non-Hispanics.
"How can we stay healthy when you're throwing all of this in front of us?" Findings from focus groups and interviews in middle schools on environmental influences on nutrition and physical activity.
- Bauer KW, Yang YW, Austin SB. Health Educ Behav 2004; 31(1): 34-46.
Correspondence: K.W. Bauer, Division of Adolescent and Young Adult Medicine, Children's Hospital Boston, Boston, MA 02115, USA; (email: unavailable).
This study aimed to identify factors in school physical and social environments that may facilitate or compete with programs and policies to improve student physical activity and nutrition. Focus groups and interviews were conducted with students, faculty, and staff of two public middle schools. Participants identified numerous aspects of the school environments as significant. Competition, teasing and bullying, time, and safety were described as major barriers for students to be physically active during physical education class, on sports teams, and before and after school. The quality of the food served, easy access to nonnutritious snacks, limited time for lunch period, and weight concerns emerged as significant reasons why students do not eat nutritious meals in school. When developing programs and policies to improve the health of students, environmental influences that undermine efforts to improve student health behaviors must be addressed.
Correspondence: Brian H. Rowe, Division of Emergency Medicine, University of Alberta, 1G1.43 Walter Mackenzie Health Sciences Center, 8440-112 Street, Edmonton, Alberta T6G 2B7, CANADA; (email: brian.rowe@ualberta.ca).
OBJECTIVES: To compare emergency department (ED) utilization by individuals who present with self-inflicted injuries with utilization by control populations. Individuals with self-inflicted injuries commonly present to the ED, yet little research has been conducted on this population in this setting.
METHODS: Individuals who had an ED presentation in 1995-1996 for a self-inflicted injury were tracked prospectively for three to four years of follow-up. This group was matched by age and gender to two groups: individuals who presented with asthma and individuals who presented with other complaints. Data on return visits to the ED were collected from an administrative database. Groups were compared on rates of return visits.
FINDINGS: There were 478 individuals randomly selected for each group. Individuals in the self-inflicted injury group had higher rates of return visits to the ED over the follow-up period: 232.7 visits per 100 person-years for the self-inflicted injury group, compared with 117.6 for the asthma group, and 83.0 for the "other" group (p < 0.001). The self-inflicted injury group had higher rates for many types of diagnoses: self-inflicted injuries, mental disorders, substance abuse, unintentional injuries, assault, headache pain, and other complaints (all p < 0.001). Patients with more than three repeat visits per year were more common in the self-inflicted injury group (20.1%) than the asthma or "other" groups (9.2% and 5.6%, respectively).
COMMENTS: Individuals who harm themselves are chronic users of the ED. The ED represents an opportune setting from which individuals can be directed to appropriate treatment programs.
Many traffic crashes are side impact collisions resulting in significant death and injury. A review was conducted of the evidence of driver, road, and vehicle characteristics affecting either the risk of occurrence or the severity of injury in such crashes for papers published from 1996 to early 2003. For drivers, evidence was found of increased crash risk or injury severity only for age and age-related medical conditions (e.g., dementia). Traffic roundabouts and other traffic control devices--stop signs, traffic lights, and so on--had mixed results; traffic controls were better than no controls, but their effectiveness varied with circumstance. Most vehicle characteristics have had little or no effect on crash occurrence. Antilock braking systems (ABS) in the striking vehicle had been anticipated to reduce the risk of crashes, but so far have demonstrated little effect. The primary emphasis in vehicle design has been on protective devices to reduce the severity of injury. Disparity in the size of the two vehicles, especially when the struck vehicle is smaller and lighter, is almost a consistent risk factor for occupant injury. The occupants of light trucks, however, when struck by passengers cars on the opposite side, were at higher risk of injury. Wearing seat belts had a consistently protective effect; airbags did not, but there were few studies, and no field studies, of lateral airbags found. Of all the characteristics examined, vehicle design, including occupant restraints, is the most easily modified in the short term, although road design, traffic control, and the monitoring of older drivers may also prove effective in reducing side impact crashes in the longer term.
Older driver crash rates in relation to type and quantity of travel.
It is a well-established phenomenon that, notwithstanding their overall good crash record, older drivers have a higher than average rate of involvement in injury crashes when the rate is calculated by dividing crash numbers by distance driven. It has been hypothesized that at least some of this higher crash rate is an artefact of the different nature of driving undertaken by many older drivers. For example, driving in congested urban environments provides more opportunities for collisions than driving the same distance on a motorway. However, there have been few opportunities to investigate this theory, as relevant data are difficult to acquire. High-quality data from the New Zealand Travel Survey (1997/1998) were combined with crash data to enable a statistical model to estimate the risk of driver groups under various driving conditions characterized by the type of road used, time of day, day of week, and season of year. Despite elevated crash risks per distance driven compared with middle-aged drivers for most road types, older drivers were as safe as any other age group when driving on motorways. Accounting for the fragility of older drivers and their passengers in the risk estimates for other road types, older drivers appeared to have daytime risks comparable to 25-year-olds and night-time risks as low as any other age group. The driving patterns of older drivers (in terms of when and where they drive) were estimated to minimize their risks in comparison with the driving patterns of other age groups. These results are of interest to both policy makers and transportation planners working against the background of inevitable increases in the number of older drivers as the population ages.
Car occupant death according to the restraint use of other occupants: a matched cohort study.
Correspondence: Peter Cummings, Harborview Injury Prevention and Research Center, University of Washington, Seattle, USA; (email: peterc@u.washington.edu).
BACKGROUND: A car occupant could be killed if struck by another occupant who was catapulted forward, backward, or sideways in a crash.
OBJECTIVE: To estimate the association between death of a car occupant (the target) and restraint use by other occupants.
DESIGN: Matched-pair cohort study comparing the outcomes of 2 target occupants in the same passenger car that crashed.
SETTING: United States traffic crashes in 1988-2000, using data from the Fatality Analysis Reporting System.
SUBJECTS: Target pairs, at least 1 of whom died: 61 834 front-seat pairs, 5278 rear-seat pairs, and 21 127 pairs on the left or right side.
MAIN OUTCOME MEASURES: Adjusted risk ratio (RR) for death within 30 days of a crash.
FINDINGS: The risk of death was greater for a restrained front target occupant in front of an unrestrained occupant compared with a restrained front target in front of a restrained occupant (adjusted RR, 1.20; 95% confidence interval [CI], 1.10-1.31). For a restrained rear target occupant behind an unrestrained occupant compared with a restrained rear target occupant behind a restrained occupant, the adjusted RR was 1.22 (95% CI, 1.10-1.36). For a restrained side target occupant sitting next to an unrestrained occupant compared with a restrained side target occupant sitting next to a restrained occupant, the adjusted RR was 1.15 (95% CI, 1.08-1.22). Among unrestrained target occupants, the adjusted RRs were, for front targets, 1.04 (95% CI, 0.97-1.12), rear targets, 1.22 (95% CI, 1.10-1.36), and side targets, 0.85 (95% CI, 0.80-0.92).
COMMENTS: Persons who wish to reduce their risk of death in a crash should wear their own restraint and should ask others in the same car to use their restraints.
Outcome of motorcycle riders at one year post-injury.
- Hotz GA, Cohn SM, Mishkin D, Castelblanco A, Li P, Popkin C, Duncan R. Traffic Inj Prev 2004; 5(1): 87-89.
Correspondence: Gillian A. Hotz, Department of Surgery, Divisions of Trauma and Surgical Critical Care,and the Department of Epidemiology and Public Health (R.D.), University of Miami School of Medicine, Miami, Florida, USA; (email: ghotz@med.miami.edu).
OBJECTIVE: There is little information about the long-term effects of injury on victims of motorcycle crashes. Following the repeal of the mandatory helmet law in Florida, we studied the impact of crashes on riders and their outcomes one year post-injury.
SUBJECTS: All patients involved in a motorcycle crash over a six-month time period were assessed at one year post-injury. Demographic information, health status, motorcycle and helmet usage, and employability were surveyed.
FINDINGS: There were 94 patients evaluated at our center for the first six-month period following the repeal of the helmet law, where 50 (56%) were wearing a helmet at the time of injury. Of the 94, we were able to contact 45 (48%) at one-year follow up. Fourteen (31%) of those contacted were not wearing a helmet at the time of their crash. At one year post-injury, 23 (51%) reported physical deficits, while 39 (86%) were working. Only 12 (27%) were riding a motorcycle again, and 11 (92%) were wearing a helmet.
COMMENTS: Motorcycle riders at one year post-injury continue to experience physical deficits related to their accidents. There is a small percentage of riders that resume riding a motorcycle after injury. Being involved in a motorcycle accident has deterred the injured rider from riding a motorcycle again at one year post-injury.
Longer term effects of New York State's law on drivers' handheld cell phone use.
Correspondence: Anne T McCartt, Insurance Institute for Highway Safety, 1005 North Glebe Road, Arlington, VA 22201-4751, USA; (email: amccartt@iihs.org).
OBJECTIVE: To determine whether substantial short term declines in drivers' use of handheld cell phones, after a state ban, were sustained one year later.
DESIGN: Drivers' daytime handheld cell phone use was observed in four New York communities and two Connecticut communities. Observations were conducted one month before the ban, shortly after, and 16 months after. Driver gender, estimated age, and vehicle type were recorded for phone users and a sample of motorists.
INTERVENTION: Effective 1 November 2001, New York became the only state in the United States to ban drivers' handheld cell phone use. Connecticut is an adjacent state without such a law.
SAMPLE: 50 033 drivers in New York, 28 307 drivers in Connecticut.
OUTCOME MEASURES: Drivers' handheld cell phone use rates in New York and Connecticut and rates by driver characteristics. RESULTS: Overall use rates in Connecticut did not change. Overall use in New York declined from 2.3% pre-law to 1.1% shortly after (p<0.05). One year later, use was 2.1%, higher than immediately post-law (p<0.05) and not significantly different from pre-law. Initial declines in use followed by longer term increases were observed for males and females, drivers younger than 60, and car and van drivers; use patterns varied among the four communities. Publicity declined after the law's implementation. No targeted enforcement efforts were evident. Cell phone citations issued during the first 15 months represented 2% of all traffic citations.
COMMENTS: Vigorous enforcement campaigns accompanied by publicity appear necessary to achieve longer term compliance with bans on drivers' cell phone use.
OBJECTIVE: To compare the effectiveness of a self-report checklist with a standard set of direct questions in identifying women who are experiencing domestic partner violence.
METHODS: Medical records were reviewed for evidence of positive partner violence for women attending the Royal Brisbane and Women's Hospital prenatal clinic between August and September 2002.
FINDINGS: Records (n = 1,596) were audited, and 937 (58.7%) contained both forms. The self-report check list identified a greater number of "cases" of partner violence (151) than the direct questions (66), with the level of agreement between the two instruments being only "fair" (Kappa coefficient.34). Each of the methods identified 7 cases of major abuse, which would have been missed if only 1 instrument had been used. All cases where women stated that they were afraid of their partner using the direct questions were also identified using the self-report checklist.
COMMENTS: A self-report checklist is an effective alternative to direct questioning in detecting women who are experiencing partner violence and is acceptable to women.
Risk for intimate partner violence and child physical abuse: psychosocial characteristics of multi-risk male and female Navy recruits.
This study examined psychosocial characteristics of individuals at risk for perpetrating both intimate partner violence (IPV risk) and child physical abuse (CPA risk). The sample consisted of 775 female and 592 male Navy recruits. The psychosocial variables assessed included symptoms of dysphoria, post-traumatic stress, self-dysfunction, alcohol-related problems, and drug use. IPV risk and CPA risk were positively associated with approximately 9% of the total sample considered multi-risk (i.e., positive for both IPV risk and CPA risk). Results of regression analyses revealed that patterns of predictors (demographic and psychosocial variables) for IPV-risk only and CPA-risk only differed with multi-risk individuals characterized by the combined predictors of both types of violence risk. Nearly half (47.2%) of the multi-risk individuals were characterized by multiple (i.e., two or more) clinical elevations on the psychosocial characteristics assessed.
Evaluating a statewide home visiting program to prevent child abuse in at-risk families of newborns: fathers' participation and outcomes.
- Duggan A, Fuddy L, McFarlane E, Burrell L, Windham A, Higman S, Sia C. Child Maltreat 2004; 9(1): 3-17.
Correspondence: A. Duggan, Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD 21205-1903, USA; (email: aduggan@jhmi.edu).
This study sought to describe fathers' participation in a statewide home-visiting program to prevent child abuse and to assess program impact on their parenting. This randomized trial followed 643 at-risk families for 3 years. Data were collected through program record review, staff surveys, and annual maternal interviews. Participation in visits varied by the parents' relationship and paternal employment, violence, and heavy drinking at baseline. Overall, the program had no apparent impact on fathers' accessibility to the child, engagement in parenting activities, and sharing of responsibility for the child's welfare. The program promoted parenting involvement for nonviolent fathers in couples who lived together but also for violent fathers in couples with little contact at baseline; it decreased the father's accessibility to the child in couples who lived apart but saw each other frequently at baseline. Infrequent participation in visits and differential program impact on violent versus nonviolent fathers demonstrate the need to consider family context in developing, implementing, and studying home-visiting models.
Patterns of patient presentation to a Dublin urban emergency department with assault related injuries.
- O'Sullivan JM, O'Conor CE. Ir Med J 2003; 96(10): 305-307.
Correspondence: Jean O' Sullivan, Department of Emergency Medicine, St. James's Hospital, Dublin 8, IRELAND; (email: Burgenstock@hotmail.com).
After perceiving an increase in the number of patients attending a large urban Irish Emergency Department (ED) with injuries sustained in assaults, the authors sought to examine the issue. A prospective observational study was conducted to look at the demographic profiles of victim and perpetrator, at rates of crime reporting and at the level of follow-up care arranged in the ED. Those most commonly assaulted were young Irish males who usually sustained head or facial injuries during weekend nights. Glass was the weapon most often used. Less than two-thirds of all victims planned to report the incident to the Garda Siochana (the Irish national police force). Women assaulted by their partners were least likely to involve the police. One fifth of patients required admission. Violence in Dublin's inner city is now a major health issue.
Making justice work: effective legal interventions for domestic violence.
In contrast to a tradition of commentary which has been negative about the law's potential to benefit women who experience men's violence, this paper reports more positive findings about women and men's experiences of legal intervention for domestic violence. The author argues for examination of: the perspectives of both women (as survivors) and men (as perpetrators); the process as well as the outcome of legal intervention; the ways in which women can and do express "agency." Empirical data from a study of 122 men and 134 women are used to demonstrate that women's safety and quality of life can be improved after prosecution and conviction of their abuser. Key aspects of successful legal intervention are highlighted and considered.
Newspaper reporting and the public construction of homicide.
- Peelo M, Francis B, Soothill K, Pearson J, Ackerley E. Br J Criminol 2004; 44(2): 256-275.
Correspondence: Keith Soothill, Department of Applied Social Science, Lancaster University, LA1 4YL, UK; (email: k.soothill@lancaster.ac.uk).
This paper outlines the distorted nature of press reporting of English and Welsh homicides. We investigated the reporting of 2,685 homicides in England and Wales in three national newspapers: The Times, the Mail and the Mirror in the period 1993-97. By systematically charting the nature of reporting distortions, we explore the contribution of newspapers to the social construction of homicide. The study analyzed a wide range of variables to explain homicide story salience: the circumstance of the killing was found to play a crucial role in whether a homicide is reported, with sexual homicides and motiveless acts being more likely to be reported. Homicides involving young children are highly likely to be reported, but infant homicides are not. These public narratives construct homicide differently to the reality of illegal killing, highlighting particular versions of "otherness" and danger. Such distorted contributions to framing criminological problems may, we argue, foster political and social responses to homicide that are not based on statistical reality but media representations of reality.
