Drinking pattern and mortality in middle-aged men and women.
- Tolstrup JS, Jensen MK, Tjonneland A, Overvad K, Gronbaek M. Addiction 2004; 99(3): 323.
Correspondence: Janne S. Tolstrup, Centre for Alcohol Research, National Institute of Public Health,
Svanemollevej 25, DK-2100, Copenhagen, DENMARK; (email: jst@niph.dk).
OBJECTIVE: To address the prospective association between alcohol drinking pattern and all-cause mortality.
DESIGN: Population-based cohort study conducted between 1993 and 2003.
SETTING: Denmark.
PARTICIPANTS: A total of 26 909 men and 29 626 women aged 55-65 years.
MEASUREMENTS: We obtained risk estimates for all-cause mortality for different levels of quantity and frequency of alcohol intake adjusted for life-style factors, including diet.
FINDINGS: During follow-up, 1528 men and 915 women died. For the same average consumption of alcohol, a non-frequent intake implied a higher risk of death than a frequent one.
COMMENTS: Drinking pattern and not just the total amount of alcohol consumed is important for the association between alcohol intake and mortality. These results suggest that future public guidelines concerning sensible alcohol drinking should include messages about drinking pattern together with quantity of alcohol.
Do parents still matter? Parent and peer influences on alcohol involvement among recent high school graduates.
Correspondence: Mark Wood, Department of Psychology and Cancer Prevention Research Center, University of Rhode Island, Kingston, RI, USA; (email: mark_wood@uri.edu).
This study investigated the influences of peer and parent variables on alcohol use and problems in a sample of late adolescents in the summer immediately prior to entry into college. Participants (N = 556) completed a mail survey assessing peer influences (alcohol offers, social modeling, perceived norms), parental behaviors (nurturance, monitoring), and attitudes and values (disapproval for heavy drinking, permissiveness for drinking), and alcohol use and alcohol-related consequences. Hierarchical regression analyses indicated significant associations between both peer and parental influences and alcohol involvement, and showed that parental influences moderated peer-influence-drinking behavior, such that higher levels of perceived parental involvement were associated with weaker relations between peer influences and alcohol use and problems. These findings suggest that parents continue to exert an influential role in late adolescent drinking behavior.
Episodic alcohol use and risk of nonfatal injury.
- Borges G, Cherpitel CJ, Mondragon L, Poznyak V, Peden M, Gutierrez I. Am J Epidemiol 2004; 159(6): 565-571.
Correspondence: Guilherme Borges, Universidad Autonoma Metropolitana-Xochimilco, Xochimilco, MEXICO; (email: guibor@imp.edu.mx).
Usual and acute alcohol consumption are important risk factors for injury. Although alcohol-dependent people are thought to be at increased risk of injury, there are few reports suggesting that their risk is greater than that of nondependent alcohol users in a given episode of alcohol use. The authors conducted a case-crossover analysis of data on 705 injury patients from a hospital emergency department in Mexico City, Mexico, collected in 2002. The majority of the sample was male (60%) and over 30 years old (51%). With use of a multiple matching approach that took into account three control time periods (the day prior to the injury, the same day in the previous week, and the same day in the previous month), the estimated relative risk of injury for patients who reported having consumed alcohol within 6 hours prior to injury (17% of the sample) was 3.97 (95% confidence interval: 2.88, 5.48). This increase in the relative risk was concentrated within the first 2 hours after drinking; there was a positive association of increasing risk with increasing number of drinks consumed. These data suggested that relative risk estimates were the same for patients with and without alcohol use disorders.
Correspondence: Lorraine E Ferris, Department of Public Health Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, M5S 1A8, CANADA; (email: lorraine.ferris@utoronto.ca).
Courtesy of the British Medical Journal, the full editorial (with references, and an illustrative table) is available free to most Internet users by clicking the doi link below.
Intimate partner violence is a major public health and human rights issue. The statistics on its physical, sexual, reproductive, emotional, and financial consequences are alarming. Although men may be abused, women are overwhelmingly the victims of intimate partner violence. Shortly we will have reliable estimates of its international prevalence, determinants, and consequences when the World Health Organization reports on its multi-country study on women's health and domestic violence against women. However, as Taft et al remind us (See item 8 under Violence, below), intimate partner violence affects entire families, including children, making the statistics even more shocking. We need effective interventions to promote the necessary individual and societal changes to tackle current cases of intimate partner violence and to prevent new ones. Unfortunately, there are only a few examples of rigorous evaluations of interventions, and this paucity holds for both developed and developing countries. Without knowledge about whether interventions against intimate partner violence do more good than harm, what should doctors do about offering referrals for confirmed or likely intimate partner violence?
Many of those who are struggling with this question have asked the important corollary question -- is there sufficient evidence about the benefits and lack of harm of screening for intimate partner violence to warrant its use? Unfortunately, the answer is complex. On the one hand, universal screening for intimate partner violence is generally endorsed by international guidelines because of the desire to cast a wide net, given the adverse effects of intimate partner violence. On the other hand, case identification methods based on presentation of specific signs or symptoms of abuse (diagnostic method) are recommended because this focuses time and resources on identifying the people who are in immediate need of health care. Several systematic reviews favour the diagnostic method, given the lack of evidence for the universal screening approach. Debate about universal screening versus the diagnostic method will continue until there is evidence about which is more effective and less harmful. What is clear is that if intimate partner violence is detected, a risk assessment needs to be done immediately, and a plan for safety considered. In addition, clinicians should assess the patient for current mental health conditions, particularly depression, since this is strongly associated with intimate partner violence and evidence exists for the effectiveness of screening for and treating depression (see item 9 under Violence, below).
Two recent systematic reviews examine the effectiveness of intimate partner violence interventions. Referral to interventions for victim support seems to be a logical pathway, especially if emergency shelter and counselling are needed. Unfortunately, these interventions have not been critically evaluated despite their widespread implementation, although one randomised controlled trial from the United States with two years' follow up indicates that a specific intervention of post-shelter advocacy and counselling services shows promise. Legal remedies such as mandating arrest of alleged abusers and providing court protection through restraining orders have been evaluated, but the results are conflicting. The findings indicate there may be confounders -- future studies will need adequate power to detect differences in subpopulations. Studies of abuser treatment programmes show mixed results. However, one large multi-site study from the United States showed a moderate effect in reducing recidivism, although dropout rates were high. Community based outreach programmes in the United Kingdom and Australia offer promise in dealing with individuals and families, and more studies would prove useful. We do not yet have effectiveness studies of coordinated community interventions.
Clearly, rigorous trials evaluating the effectiveness of interventions against intimate partner violence are urgently needed. Studies of demonstration projects are required, as are multi-site and multinational studies of similar interventions. All studies ought to articulate clearly the target population and characteristics of the intervention to allow for replicability. In terms of effectiveness, these studies need objective and valid measures for short and long term follow up of individuals and of the family. Variation in the definition of intimate partner violence, programme structure, and outcome measures may create challenges in discerning which components lead to success or failure, but determining overarching predictive characteristics of effectiveness may be feasible.
In the interim, doctors should be referring patients to one or more interventions against intimate partner violence, based on the perceived needs of the patient(s). Individual responses to interventions will vary, and a vigilant approach is appropriate. Ongoing follow up is needed to determine if the violence has ended and if appropriate care is being provided to deal with its aftermath and to prevent its recurrence. Being willing to consider other referral options is essential, as is continuing to provide a supportive and a non-judgmental environment. Intimate partner violence creates great challenges, but regardless of the difficulty, doctors must recognise and respond to it. Hopefully, we will soon be able to offer best practices with respect to interventions, which will be helpful to patients and doctors struggling with this endemic issue.
Correspondence: Masahiro Kokaid, Department of Neuropsychiatry, Hyogo College of Medicine, Nishinomiya, Department of Psychiatry and International Center for Medical Research, Kobe University School of Medicine, Kobe, JAPAN; (email: unavailable).
The purpose of the present article was to review the literature on disaster mental health in relation to natural disasters such as earthquakes, volcanic eruptions, typhoons and cyclones throughout Asia. Articles reviewed show that disaster psychiatry in Asia is beginning to emerge from and leave behind the stigma attached to mental health. The emergence of the acceptance of disaster mental health throughout Asia can be attributed in part to the acceptance of the notion of post-traumatic stress disorder (PTSD). This has allowed greater involvement of mental health professionals in providing ongoing support to survivors of natural disasters as well as providing greater opportunities for further research. Also, articles reviewed in the present paper commonly suggested the need for using standardized diagnostic tools for PTSD to appropriately interpret the discrepancy of results among studies. The importance of post-disaster support services and cultural differences is highlighted.
Correspondence: Angi M. Christensen, The University of Tennessee, Department of Anthropology, 250 South Stadium Hall, Knoxville, TN, USA; (email: angi@utk.edu).
Case studies of freefall injuries suggest that most falls from heights result in lower extremity, pelvic, and vertebral fractures. These injuries are largely a consequence of the fact that most falls are accidental with victims landing feet first. This study investigates whether human behavioral response affects body orientation at impact and whether the human body tends to align in a particular way as a result of physical laws. The investigation was undertaken by observing nine experimental falls of an anthropomorphic dummy from a height of 65 ft (9.8 m). In all nine falls, the dummy landed horizontally, suggesting that the human form has a tendency to align horizontally during freefall for falls greater than 50 ft (15.24 m). This has important implications for the potential use of injury patterns in the deduction of pre-fall circumstances, which are discussed here with respect to a case study of a fall victim.
Creating safer workplaces: assessing the determinants and role of safety climate.
- DeJoy DM, Schaffer BS, Wilson MG, Vandenberg RJ, Butts MM. J Safety Res 2004; 35(1): 81-90.
Correspondence: David M. DeJoy, Workplace Health Group, Department of Health Promotion and Behavior, University of Georgia, 315 Ramsey Center, Athens, GA 30602-6522, USA; (email: ddejoy@coe.uga.edu).
OBJECTIVE: Although there has been considerable interest in safety climate, relatively little attention has been given to the factors that determine safety climate or to testing the hypothesized mediating role of safety climate with respect to safety-related outcomes.
METHOD: Questionnaire responses were obtained from 2,208 employees of a large national retail chain in 21 different locations.
FINDINGS: After controlling for demographic variables, three factors: environmental conditions, safety-related policies and programs, and general organizational climate, accounted for 55% of the variance in perceived safety climate. Interestingly, organizational climate made a significant contribution to safety climate, even after controlling for the other more safety-relevant variables. Partial correlations showed that safety policies and programs had the largest observed correlation with safety climate, followed by two of the dimensions of organizational climate (communication and organizational support). Using Baron and Kenny's (J. Pers. Soc. Psychol. 51 (1986) 1173) procedures, the principal effects of the various work situation factors on perceived safety at work were found to be direct rather than mediated by safety climate. Safety climate influenced perceived safety at work, but its role as a mediator was limited.
COMMENTS: These results are discussed in terms of other recent findings on safety climate and the growing interest in understanding management and organizational factors in the context of workplace safety.
Blasting injuries in surface mining with emphasis on flyrock and blast area security.
OBJECTIVE: Blasting is a hazardous component of surface mining. Serious injuries and fatalities result from improper judgment or practice during rock blasting. This paper describes several fatal injury case studies, analyzes causative factors, and emphasizes preventive measures.
METHODS: This study examines publications by MSHA, USGS, and other authors. The primary source of information was MSHA's injury-related publications.
FINDINGS: During the 21-year period from 1978 to 1998, the mean yearly explosive-related injuries (fatal and nonfatal) for surface coal mines was 8.86 (95% CI: 6.38-11.33), and for surface metal/nonmetal mines 10.76 (95% CI: 8.39-13.14). Flyrock and lack of blast area security accounted for 68.2% of these injuries. This paper reviews several case studies of fatal injuries. Case studies indicate that the causative factors for fatal injuries are primarily personal and task-related and to some extent environmental. A reduction in the annual injuries in surface coal mines was observed during the 10-year period of 1989-1998 [5.80 (95% CI: 2.71-8.89) compared to the previous 10-year period of 1979-1988 [10.90 (95% CI: 7.77-14.14)]. However, such reduction was not noticed in the metal/nonmetal sector (i.e., 9.30 [95% CI: 6.84-11.76] for the period 1989-1998 compared with 11.00 [95% CI: 7.11-14.89] for the period 1979-1988).
COMMENTS: A multifaceted injury prevention approach consisting of behavioral/educational,administrative/regulatory,and engineering interventions merits consideration. The mining community, especially the blasters, will find useful information on causative factors and preventive measures to mitigate injuries due to flyrock and lack of blast area security in surface blasting. Discussion of case studies during safety meetings will help to mitigate fatal injuries and derive important payoffs in terms of lower risks and costs of injuries.
Quality of life: a case report of bullying in the workplace.
Correspondence: Said Shahtahmasebi, School of Mathematics and Statistics, Faculty of Health and Sciences, Christchurch Polytechnic Institute of Technology, Christchurch, NEW ZEALAND; (email: saids@cpit.ac.nz).
The literature on bullying in the workplace describes the mental and physical ill health suffered by the victims and their families as the consequences of the bullying. The literature also discusses methods of bullying such as overt and covert physical and psychological abuse. The implications are that the consequences of abuse go far beyond the intended target; from impact on the working environment to individuals' health to economic and financial loss. The literature suggests various recommendations to employers and managers to combat bullying at work. However, the common assumption within the literature has been that the bullying is done by a colleague, a line manager, or middle manager. Furthermore, it is often assumed that the executive/vice-chancellor, human resources, the trustees, or the governing board are unaware of bullying in their workplace. In this article, it is argued that cases of bullying (whether due to isolated individuals, competition, rivalry, power, or pure meanness as is reported in the literature) can only thrive in a bullying management culture. Therefore, debate and policy formulation must be directed at government level in the first instance. The case report is intended to raise some relevant issues to stimulate a debate and more research in this area.
Matched analysis of parent's and children's attitudes and practices towards motor vehicle and bicycle safety: an important information gap.
- Ehrlich PF, Helmkamp JC, Williams JM, Haque A, Furbee PM. Inj Control Saf Promot 2004; 11(1): 23-28.
Correspondence: P. Ehrlich, Department of Surgery and Pediatrics, Children's Hospital of West Virginia, and Center for Rural Emergency Medicine, West Virginia University, Morgantown 26506, USA; (email: pehrlich@hsc.wvu.edu).
The purpose of this study was to compare parents' and children's attitudes and habits towards use of bicycle helmets and car seat belts. We hypothesized that parental perception of their children's safety practices did not reflect actual behavior and further, that parental practices, rather than their beliefs about a particular safety practice, have a greater affect on their child's risk-taking behavior. The study population consisted of children in grades four and five and their parents/guardians. Participation in the cross-sectional study was voluntary and confidential anonymous questionnaires were used. In separate and independent surveys, children and parents were questioned in parallel about their knowledge, habits and attitudes toward bicycle helmet use and car safety practices. In the study, 731 students participated with 329 matched child-parent pairs. Ninety-five percent of the children own bicycles and 88% have helmets. Seventy percent of parents report their child always wears a helmet, while only 51% of children report always wearing one (p < 0.05). One-fifth of the children never wear a helmet, whereas parents think only 4% of their children never use one (p < 0.05). Parents report their children wear seat belts 92% of the time while 30% of children report not wearing one. Thirty-eight percent of children ride bicycles with their parents and wear their helmets more often than those who do not ride with their parents (p < 0.05). Parents who always wear a seat belt are more likely to have children who sit in the back seat and wear a seat belt (p < 0.05). Parents' perceptions of their children's safety practices may not be accurate and their actions do affect their children's. Injury prevention programs that target both parents and children may have a greater impact on reducing risk-taking behaviors than working with each group in isolation.
Hospital discharges and 30-day case fatality for drug poisoning: a Danish population-based study from 1979 to 2002 with special emphasis on paracetamol.
Correspondence: Gunnar Lauge Nielsen, Department of Clinical Epidemiology, Aalborg and Aarhus University Hospitals, Stengade 10, 9000, Aalborg, DENMARK; (email: uxgln@aas.nja.dk).
OBJECTIVE. To examine the number of hospital discharges and 30-day case fatalities due to drug poisoning based on data from a Danish County Hospital Discharge Registry from 1979 to 2002.
METHODS. All patients with a hospital discharge diagnosis of drug poisoning were identified and separated into groups taking: (1) opioid analgesics; (2) non-opioid analgesics; (3) anxiolytics; (4) antidepressants; (5) antipsychotics; or (6) non-specified. Paracetamol and salicylate were analysed separately. From 1994 to 2001, the total amount of drugs sold in the county was identified from a national drug database.
FINDINGS. A total of 13,432 patients with a median age 41.5 years at discharge of whom 59% were females accounted for 20,249 discharges for drug poisoning. The overall number of discharges remained essentially stable around 170 discharges per 100,000 inhabitants per year. From the mid-1990s, paracetamol became the most frequently used drug in poisoning with the largest increase in female teenagers. Thirty-day case fatality in poisoning with opioids was 3.6% compared with around 1% in other drug categories. For most drug categories, a sale of around 80,000 defined daily doses was associated with one hospital discharge due to drug poisoning.
COMMENTS. The overall number of hospital discharges remained stable and seems primarily related to amount of drugs available. With almost 10 years delay, the easier access to paracetamol was followed by an increase in hospitalisation due to poisoning with paracetamol. However, although the majority of hospitalisations were found in the younger age group, the highest mortality was seen among the elderly.
The American Academy of Pediatrics and American Academy of Ophthalmology strongly recommend protective eyewear for all participants in sports in which there is risk of eye injury. Protective eyewear should be mandatory for athletes who are functionally 1-eyed and for athletes whose ophthalmologists recommend eye protection after eye surgery or trauma.
Sledding accidents in children: potential for serious injury, risk of fatality.
Though a pastime rarely considered rough or dangerous, sledding is not risk-free. The presentation of several serious injuries to Rainbow Babies and Children's Hospital in Cleveland, Ohio, led us to examine our emergency department and admitting records to determine the incidence of neurological injury among children involved in sledding accidents. We discovered 24 children who had sustained brain or spine injuries as sequelae to sledding mishaps during a 5-year period. The ages ranged from 3 months to 15 years. Injuries included multiple skull fractures, 2 epidural hematomas, 1 subdural hematoma, 1 odontoid fracture and 1 anoxic brain injury. There was 1 death. Twenty-one of 24 patients incurred their injuries by colliding with fixed objects. Both improvised crafts and models intended for sledding were involved in the injuries. Only 3 sleds possessed steering capability. Eight of the 9 children who sustained a serious neurosurgical injury were supervised by an adult. Only 2 children had received instruction before sledding. The lack of awareness of the potential for injury together with the dearth of instruction and lack of control over a vehicle dashing down a hill studded with obstacles can change a carefree pastime into a hazardous activity.
During the 14-year period from 1990-2003, West Virginia experienced 220 deaths related to All Terrain Vehicles (ATVs). Death rates in West Virginia however, were significantly higher than the national rate or those of any of the its five surrounding states. About 25% of the West Virginia deaths occurred in children less than 18 years of age. Ninety-five percent of the victims were not wearing helmets and 15% were passengers. Nearly one-third of the ATV crashes occurred on public roads, streets, and highways--surfaces on which ATVs are not designed nor recommended to be used. The cost of ATV-related deaths is estimated to be over dollar 100 million annually. The number of non-fatal injuries resulting from ATV crashes is difficult to ascertain because of a lack of a centralized and standardized state-based surveillance mechanism. The 44 states that have some level of ATV safety requirements have a collective death rate half that of states, like West Virginia, who do not have ATV safety requirements. Due to the continuing public health burden caused by ATV deaths and injuries, as well as their associated costs, it is important that West Virginia policymakers pass strong ATV safety legislation during the current session.
Head injuries presenting to emergency departments in the United States from 1990 to 1999 for ice hockey, soccer, and football.
Correspondence: J. Scott Delaney, Department of Emergency Medicine, McGill University Health Centre, and McGill Sport Medicine Clinic, West Montreal, CANADA; (email: j.delaney@staff.mcgill.ca).
OBJECTIVE: To examine the number and rates of head injuries occurring in the community as a whole for the team sports of ice hockey, soccer, and football by analyzing data from patients presenting to US emergency departments (EDs) from 1990 to 1999.
DESIGN: Retrospective analysis.
MAIN OUTCOME MEASURES: Data compiled for the US Consumer Product Safety Commission using the National Electronic Injury Surveillance System were used to generate estimates for the total number of head injuries, concussions, internal head injuries, and skull fractures occurring on a national level from the years 1990 to 1999. These data were combined with yearly participation figures to generate rates of injuries presenting to the ED for each sport.
FINDINGS: There were an estimated 17,008 head injuries from ice hockey, 86,697 from soccer, and 204,802 from football that presented to US EDs from 1990 to 1999. The total number of concussions presenting to EDs in the United States over the same period was estimated to be 4820 from ice hockey, 21,715 from soccer, and 68,861 from football. While the rates of head injuries, concussions, and combined concussions/internal head injuries/skull fractures presenting to EDs per 10,000 players were not always statistically similar for all 3 sports in each year data were available, they were usually comparable.
COMMENTS: While the total numbers of head injuries, concussions, and combined concussions/skull fractures/internal head injuries presenting to EDs in the United States are different for ice hockey, soccer, and football for the years studied, the yearly rates for these injuries are comparable among all 3 sports.
The effects of KinesioTM Taping on proprioception at the ankle.
- Halseth T, McChesney JW, DeBeliso M, Vaughn R, Lien J. J Sports Sci Med 2004; 3: 1-7.
Correspondence: John W. McChesney, Athletic Training/Motor Control Research Laboratory,Department of Kinesiology, Boise State University, 1910 University Drive, Boise, Idaho 83725, USA; (email: jmcches@boisestate.edu).
An experiment was designed to determine if KinesioTM taping the anterior and lateral portion of the ankle would enhance ankle proprioception compared to the untaped ankle. 30 subjects, 15 men, 15 women, ages 18-30 participated in this study. Exclusion criteria: Ankle injury < 6 months prior to testing, significant ligament laxity as determined through clinical evaluation by an ATC, or any severe foot abnormality. Experiment utilized a single group, pretest and posttest. Plantar flexion and inversion with 20° of plantar flexion reproduction of joint position sense (RJPS) was determined using an ankle RJPS apparatus. Subjects were barefooted, blindfolded, and equipped with headphones playing white noise to eliminate auditory cues. Subjects had five trials in both plantar flexion and inversion with 20° plantar flexion before and after application of the Kinesio tape to the anterior/lateral portion of the ankle. Constant error and absolute error were determined from the difference between the target angle and the trial angle produced by the subject. The treatment group (Kinesio taped subjects) showed no change in constant and absolute error for ankle RJPS in plantar flexion and 20° of plantar flexion with inversion when compared to the untaped results using the same motions. The application of Kinesio tape does not appear to enhance proprioception (in terms of RJPS) in healthy individuals as determined by our measures of RJPS at the ankle in the motions of plantar flexion and 20° of plantar flexion with inversion.
Shock absorbing effects of various padding conditions in improving efficacy of wrist guards.
Correspondence: Kyu-Jung Kim, Department of Mechanical Engineering, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA; (email: kimk2@uwm.edu).
The use of wrist guards has limited efficacy in preventing wrist injuries during falling in many sports activities. The objectives of this study were to measure the ground reaction force of the hand under simulated impact of the forearm and hand complex with different padding conditions of wrist guards and to analyze their impact force attenuation and maximum energy absorption for improved functional efficiency. A total of 15 subjects, wearing a commercial wrist guard, participated in a cable-released hand impact experiment to test four different conditions on the volar aspect of the hand, which include a wrist guard without a volar splint (bare hand), with a volar splint (normal use), with a volar splint and additional viscoelastic polymeric padding, and a volar splint and additional air cell padding. The ground reaction force and acceleration of the hand were measured using a force platform mounted on an anti-vibration table and a miniature accelerometer, respectively. Additional padding on the bare hand could substantially improve the maximum energy absorption by more than 39%, with no differences with each other. However, only the air cell padding could simultaneously improve the impact force attenuation by 32% compared with the bare hand impact without compromising the maximum energy absorption. It is recommended that common wrist guard design should provide more compliant padding in the volar aspect to improve the impact force attenuation through optimal material selection and design.
Jumping and landing techniques in elite women's volleyball.
- Tillman MD, Hass CJ, Brunt D, Bennett GR. J Sports Sci Med 2004; 3: 30-36.
Correspondence: Mark D. Tillman, Department of Exercise and Sport Sciences, University of Florida, Gainesville, Florida, USA; (email: mtillman@hhp.ufl.edu).
Volleyball has become one of the most widely played participant sports in the world. Participation requires expertise in many physical skills and performance is often dependent on an individual's ability to jump and land. The incidence of injury in volleyball is similar to the rates reported for sports that are considered more physical contact sports. Though the most common source of injury in volleyball is the jump landing sequence, little research exists regarding the prevalence of jumping and landing techniques. The purpose of this study was to quantify the number of jumps performed by female volleyball players in competitive matches and to determine the relative frequency of different jump-landing techniques. Videotape recordings of two matches among four volleyball teams were analyzed for this study. Each activity was categorized by jump type (offensive spike or defensive block) and phase (jump or landing). Phase was subcategorized by foot use patterns (right, left, or both). Each of the players averaged nearly 22 jump-landings per game. Foot use patterns occurred in unequal amounts (p < 0.001) with over 50% of defensive landings occurring on one foot. Coaches, physical educators, and recreation providers may utilize the findings of this inquiry to help prevent injuries in volleyball.
A case-control study to determine the causes of accidents in children aged 0-14 years and to analyse family environment risk factors was carried out. The variables analysed in the children were age, gender, mechanism and type of accidental injury, number of siblings, birth order of the injured child, history of sibling injury and family type. Variables analysed in the parents were mother's age, history of alcoholism, maternal and paternal education level, time mother spent at home with the child, presence or absence of parents at the time of the accident and parents' occupations. The most important risk factors were gender, time mother spends at home, level of maternal education, paternal alcoholism, birth order, more than five siblings and previous injury to a sibling.
Actual causes of death in the United States, 2000.
Correspondence: Ali H. Mokdad, Division of Adult and Community Health, Centers for Disease Control and Prevention, Atlanta, Ga, USA; (email: amokdad@cdc.gov).
BACKGROUND: Modifiable behavioral risk factors are leading causes of mortality in the United States. Quantifying these will provide insight into the effects of recent trends and the implications of missed prevention opportunities.
OBJECTIVES: To identify and quantify the leading causes of mortality in the United States.
DESIGN: Comprehensive MEDLINE search of English-language articles that identified epidemiological, clinical, and laboratory studies linking risk behaviors and mortality. The search was initially restricted to articles published during or after 1990, but we later included relevant articles published in 1980 to December 31, 2002. Prevalence and relative risk were identified during the literature search. We used 2000 mortality data reported to the Centers for Disease Control and Prevention to identify the causes and number of deaths. The estimates of cause of death were computed by multiplying estimates of the cause-attributable fraction of preventable deaths with the total mortality data.
MAIN OUTCOME MEASURES: Actual causes of death.
FINDINGS: The leading causes of death in 2000 were tobacco (435 000 deaths; 18.1% of total US deaths), poor diet and physical inactivity (400 000 deaths; 16.6%), and alcohol consumption (85 000 deaths; 3.5%). Other actual causes of death were microbial agents (75 000), toxic agents (55 000), motor vehicle crashes (43 000), incidents involving firearms (29 000), sexual behaviors (20 000), and illicit use of drugs (17 000).
COMMENTS: These analyses show that smoking remains the leading cause of mortality. However, poor diet and physical inactivity may soon overtake tobacco as the leading cause of death. These findings, along with escalating health care costs and aging population, argue persuasively that the need to establish a more preventive orientation in the US health care and public health systems has become more urgent.
Four-Year Review of the Use of Race and Ethnicity in Epidemiologic and Public Health Research.
Correspondence: R. Dawn Comstock, Epidemic Intelligence Service, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, GA, USA; (email: unavailable).
To determine how current researchers address the use of race and ethnicity as variables in epidemiologic and public health studies, the authors conducted a comprehensive review of 1,198 articles published in the American Journal of Epidemiology and the American Journal of Public Health from 1996 to 1999. Seventy-seven percent (n = 919) of the articles referred to race or ethnicity. The number of variable categories ranged from 0 to 24, with an average of 3.14 per article. An enormous diversity of terms was used to describe the concepts of race and ethnicity as variables as well as to describe the categories used to assess these variables. Researchers frequently failed to differentiate between the concepts of race and ethnicity, to state the context in which these variables were used, to state the study methods used to assess these variables, and to discuss significant study results based on race or ethnicity. Continued professional commitment is needed to ensure the scientific integrity of race and ethnicity as variables. At a minimum, researchers should clearly state the context in which these valuable epidemiologic and public health study variables are being used, describe the method used to assess and categorize these variables, and discuss all significant findings.
Correspondence: Celio Ferreira, Centre for Public Sector Research (CEFOS) University of Göteborg Box 720 SE 405 30 Göteborg, SWEDEN; (email: celio.ferreira@cefos.gu.se).
Ideas of transparency and trust have become more and more in fashion in public policy discourse. However, these ideas do not make much sense without an understanding of what lack of transparency and distrust may involve. The theme of deliberate and intended 'cover up' by governments, officials or by industry that want to hide known risks or negative effects from the public constitutes an essential component of media stories of controversy over facility siting. Such stories tell of tendencies to play down, silence and even conceal events that may lead to harm. This paper attempts to single out the bits and pieces of visual imagery from which the theme of risk-related 'cover up' is culturally constructed by using a made-in-Hollywood film as an empirical example. Film is regarded here as a form of vicarious interaction with other people, where viewers closely identify with the portrayed human, social, and environmental conflicts. It is suggested that risk communication among the public, technical experts and decision makers can be improved by an understanding of how people respond to and think about visual representations of risk.
Comparison of visual acuity in reduced lumination and facility of ocular accommodation in table tennis champions and non-players.
- E. Jafarzadehpur, Yarigholi MR. J Sports Sci Med 2004; 3: 44-48.
Correspondence: Ebrahim Jafarzadehpur; Optometry Department of Iran University of Medical Science (IUMS), Tehran, IRAN; (email: jafarzadehpur@iums.ac.ir).
A table tennis player should fixate at different distances; track the objects with different speed, and in different visual environment. Their visual skills must be well developed for these capabilities. Therefore, visual acuity in reduced lumination and facility of ocular accommodation those are two criteria for visual skills have been compared in table tennis players and normal non-players. Twenty-nine young table tennis champions and 29 normal matched non-players (did not take part in any racket sports game) were evaluated. Basic visual and eye examinations were done for both of them. Normal results in basic examination were fundamental requirement for all the subjects. +/-2.00 sphere lenses for accommodation facility are used. An electrical current regulator changed the output light intensity of a conventional chart projector (Topcon). Light intensity decreased to 10 cd·m-2 and visual acuity tested. In comparison of visual acuity in reduced lumination and facility of ocular accommodation in table tennis champions and non-players there are significant differences (p < 0.001). In the preliminary visual tests there was not any significant different in the two groups but the results in the top level table tennis player was very uniform and in every test and the standard deviation was lesser in tennis player group than non-players. These results show that motor and sensorial functions of expert players are well developed. That is consistent with other researchers. This result was interpreted as reflecting a better perceptual system of experts to the constraints encountered during table tennis and its use in practical settings for evaluating athletes or detecting sport talents. However some visual and perceptual training that usually used in orthoptics can be used for novice table tennis player to improve their abilities.
OBJECTIVE: Attempted suicide is the strongest known predictor of completed suicide. However, suicide risk declines over time after an attempt, and it is unclear how long the risk persists. Risk estimates are almost exclusively based on studies of less than 10 years of follow-up.
METHOD: The authors followed a cohort of 100 consecutive self-poisoned patients in Helsinki in 1963, for whom forensically classified causes of death during the following 37 years were investigated.
FINDINGS: They found that suicides continued to accumulate almost four decades after the index suicide attempt.
COMMENTS: A history of a suicide attempt by self-poisoning indicates suicide risk over the entire adult lifetime.
Health care contacts before and after attempted suicide among adolescent and young adult versus older suicide attempters.
- Suominen K, Isometsa E, Martunnen M, Ostamo A, Lonnqvist J. Psychol Med 2004; 34(2): 313-321.
Correspondence: Kalle-Antti Suominen, Department of Mental Health and Alcohol Research, National Public Health Institute, Helsinki, FINLAND; (email: k.suominen1@physics.ox.ac.uk).
BACKGROUND: The pattern of all health care contacts among young people before and after attempted suicide is not well documented. Neither is it known if the health care contacts of young suicide attempters differ from those of older suicide attempters. This study investigated the age-related clinical characteristics of suicide attempters and the pattern of their contacts with health care before and after attempted suicide in different age groups, particularly adolescence and young adulthood.
METHOD: All consecutive 1198 suicide attempters treated in hospital emergency rooms in Helsinki between January 1997 and January 1998 were identified and divided into three age groups (15-24 years, 25-39 years, 40 years and over). Data were gathered on all health care contacts 1 year before and after the index attempt.
FINDINGS: Although adolescent and young adult suicide attempters suffered from severe mental disorders, a remarkable proportion of them were left without psychiatric consultation and aftercare recommendation following the attempt. Two-thirds of 15-19-year-old male suicide attempters had no treatment contact during the month before the attempt, while a quarter of them were referred to psychiatric consultation and a half had no healthcare contact in the month following the attempt.
COMMENTS: These findings indicate considerable scope for improvement in the assessment of young suicide attempters and their referral to aftercare.
The prediction of thoughts of death or self-harm in a population-based sample of female twins.
- Fanous AH, Prescott CA, Kendler KS. Psychol Med 2004; 34(2): 301-312.
Correspondence: Correspondence: Carol Prescott, Virginia Institute for Psychiatric and Behavioral Genetics, Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA; (email: cprescott@vcu.edu).
BACKGROUND: Although suicide is a leading cause of death, few studies have attempted to predict suicidal ideation prospectively using epidemiological samples or multivariate methods.
METHOD: Discrete-time event history analysis was used to model the onset of thoughts of death or self-harm (TD/SH) in a population-based sample of female twins (N=2164) using variables from the demographic, psychopathological, childhood adversity, personality and life event domains. Univariate, multivariate-within domain and multivariate-across domain regression analyses were performed.
FINDINGS: Most variables predicted TD/SH in the univariate analyses. However, the only variables to predict TD/SH independently were obsessive symptoms, childhood sexual abuse, rural residence, unemployment, older age, lifetime history of cocaine misuse and low levels of education, personal religious devotion and altruism, as well as divorce/separation, loss of confidant, assault, job loss and financial problems in the previous month. This final model explained 16% of the variance in TD/SH. Lifetime histories of major depression, panic disorder and alcohol misuse had no significant independent effect.
COMMENTS: Many variables, from all five domains of risk factors, are associated with the risk of TD/SH, but many of these effects may be mediated by other risk factors. Proximal life events and psychopathology may have more independent effects than other domains. The overall ability of these risk factors to predict TD/SH is modest. We cannot rule out that differences between these analyses and previous reports were due to our use of TD/SH as the dependent variable instead of thoughts of committing suicide per se.
Discriminating deliberate self-harm (DSH) in young prison inmates through personality disorder.
Correspondence: S. Justes, Mohino, Catalan Institute of Forensic Medicine of Higher Court of Justice, Clinica Medico-Forense de Barcelona, Ronda de San Pedro, 35, bajos, 08010 Barcelona, SPAIN; (email: unavailable).
This study investigated deliberate self-harm (DSH) in young inmates. The objectives are twofold: first, to identify the social and clinical characteristics of inmates who commit DSH; and secondly, to ascertain the types of personality who are vulnerable in order to be able to predict future inmates who may harm themselves. A cross-sectional design was used to study psychosocial correctional personality characteristics and clinical pictures in inmates with DSH versus a control group without DSH. The measures used to evaluate different variables were a standard protocol and a self-report questionnaire (MCMI-II). Although the two groups compared are homogeneous and similar in terms of different psychosocial variables, inmates with DSH presented a significant background of maltreatment. Borderline, passive-aggressive, and antisocial personality disorders best discriminated both groups. The detection of borderline, negativistic, and antisocial disorders may help the medical services of penitentiary centers to predict youths with a possible risk of DSH. Despite the results obtained, longitudinal studies are needed to help clarify other risk factors, as well as other risk factors leading to self-harm behavior.
An outcome evaluation of the SOS suicide prevention program.
- Aseltine RH Jr, DeMartino R. Am J Public Health 200; 94(3): 446-451.
Correspondence: Robert H. Aseltine Jr, Department of Behavioral Sciences and Community Health, MC 3910, University of Connecticut Health Center 263 Farmington Ave, Farmington, CT 06030-3910, USA; (email: aseltine@uchc.edu).
OBJECTIVE: We examined the effectiveness of the Signs of Suicide (SOS) prevention program in reducing suicidal behavior.
METHODS: Twenty-one hundred students in 5 high schools in Columbus, Ga, and Hartford, Conn, were randomly assigned to intervention and control groups. Self-administered questionnaires were completed by students in both groups approximately 3 months after program implementation.
FINDINGS: Significantly lower rates of suicide attempts and greater knowledge and more adaptive attitudes about depression and suicide were observed among students in the intervention group. The modest changes in knowledge and attitudes partially explained the beneficial effects of the program.
COMMENTS: SOS is the first school-based suicide prevention program to demonstrate significant reductions in self-reported suicide attempts.
OBJECTIVE: In the United States, teenage drivers have a higher crash risk and lower observed seat belt use than other age groups.
METHODS: Seat belt use was examined for teenage (16-19 years) drivers who were fatally injured in traffic crashes occurring in the United States during the years 1995-2000. Vehicle, driver, and crash factors potentially related to belt use were examined. State differences in belt use rates among fatally injured teenage drivers were related to states' observed belt use rates for all ages and other state-level variables.
FINDINGS: During 1995-2000, mean belt use was 36% among fatally injured teenage drivers and 23% among fatally injured teenage passengers. One of the strongest predictors of higher belt use for both drivers and passengers was whether the crash occurred in a state with a primary seat belt law. Belt use rates for 1995-2000 for fatally injured teenage drivers ranged from 20% or less in six states to more than 60% in two states. States with the highest use rates were those with strong primary belt use laws and those with high rates of observed belt use for all ages. Lower belt use among fatally injured teenage drivers was associated with increasing age; male drivers; drivers of SUVs, vans, or pickup trucks rather than cars; older vehicles; crashes occurring late at night; crashes occurring on rural roadways; single vehicle crashes; and drivers with BACs of 0.10 or higher. Teenage driver belt use declined as the number of teenage passengers increased, but increased in the presence of at least one passenger 30 years or older.
COMMENTS: It is suggested that to increase teenage belt use, states should enact strong primary belt use laws and mount highly publicized efforts to enforce these laws. Graduated driver licensing systems should incorporate strong provisions that require seat belt use by teenage drivers and passengers.
Types and characteristics of ramp-related motor vehicle crashes on urban interstate roadways in Northern Virginia.
Correspondence: Anne T. McCartt, Insurance Institute for Highway Safety, 1005 North Glebe Road, Arlington, VA 22201-4751, USA; (email: research@iihs.org).
OBJECTIVE: Freeway entrance and exit ramp interchanges are the sites of far more crashes per mile driven than other segments of interstate highways, but the characteristics and circumstances of ramp crashes have been the subject of relatively little recent research.
METHOD: This study examined a sample of 1,150 crashes that occurred on heavily traveled urban interstate ramps in Northern Virginia. Based on a review of diagrams and narrative descriptions from police crash reports, the most common crash types were identified and examined for different roadway locations and ramp designs and by whether at-fault drivers were entering or exiting the freeway.
FINDINGS: About half of all crashes occurred when at-fault drivers were in the process of exiting interstates, 36% occurred when drivers were entering, and 16% occurred at the midpoints of access roads or on ramps connecting two interstate freeways. Three major crash types-run-off-road, rear-end, and sideswipe/cutoff-accounted for 95% of crashes in the study. The crash type most frequently associated with exiting was run-off-road, and the types most common with entering drivers were rear-end or sideswipe/cutoff. Crashes most common on ramps-run-off-road crashes-frequently occurred when vehicles were exiting interstates at night, in bad weather, or on curved portions of ramps. Speed was often a factor. Crashes occurring on ramp margins (where ramps or access roads enter or exit) were most commonly of the sideswipe/cutoff type. These often involved at-fault passenger vehicles merging from entrance ramps into the sides of large trucks already on the freeway. The predominant crash type on access roads was rear-end crashes; congestion was a factor in these crashes. Alcohol was a reported factor in a sizeable proportion of run-off-road crashes occurring on ramps (14%) and ramp margins (30%).
COMMENTS: Candidate countermeasures for run-off-road crashes include geometric design changes to increase ramp design speed such as increasing curve radii. Speed-related crashes may be reduced by the use of speed cameras accompanied by publicity. Rear-end crash countermeasures could include surveillance systems that quickly detect unexpected congestion, incident response programs, and variable message signs to alert drivers to traffic congestion ahead. Countermeasures for sideswipe/cutoff crashes could include extending the length of acceleration lanes.
Psychological consequences of road traffic accidents for children and their mothers.
- Bryant B, Mayou R, Wiggs L, Ehlers A, Stores G. Psychol Med 2004; 34(2): 335-346.
Correspondence: Richard Mayou, Department of Psychiatry, University of Oxford, Oxford, UK; (email: richard.mayou@psych.ox.ac.uk).
BACKGROUND: Little is known about the psychological and behavioural consequences of road traffic accidents for children. The study aimed to determine the outcome of road traffic accidents on children and their mothers.
METHOD: A 1-year cohort study of consecutive child attenders aged 5-16 years at an Accident and Emergency Department. Data were extracted from medical notes and from interview and self-report at baseline, 3 months and 6 months.
FINDINGS: The children had an excellent physical outcome. Fifteen per cent suffered acute stress disorder; 25% suffered post-traumatic stress disorder at 3 months and 18% at 6 months. Travel anxiety was frequent. Post-traumatic consequences for mothers were common.
COMMENTS: Psychological outcome was poor for a minority of children and associated with disability, especially for travel. There were significant family consequences. There is a need for changes in clinical care to prevent, identify and treat distressing and disabling problems.
An emergency department-based program to change attitudes of youth toward violence.
- Zun LS, Downey L, Rosen J. J Emerg Med 2004; 26(2): 247-251.
Correspondence: Leslie S. Zun, Department of Related Health Sciences, Finch University/Chicago Medical School, Chicago, Illinois, USA; (email: unavailable).
Interpersonal violence continues to be a problem in the United States with a recurrence rate for repeat violence of 6 to 44%, with a 5-year mortality of 20%. This study describes the attitudinal changes of youth enrolled in a program to reduce violence risk. Patients aged 10 to 24 years at a community, teaching Level 1 trauma center who were victims of interpersonal violence (excluding child abuse, sexual assault, and domestic violence) were randomly enrolled in the study. The control group was simply provided a list of available services, whereas the treatment group received an assessment and case management for 6 months. The study examined the change in attitude and behavior of the youths in the treatment and control groups over time, using a combination of chi-square and ANCOVA. A total of 188 victims, 96 subjects in the treatment group and the 92 in the control group, had an average age of 18.6 years and were mostly (82.5%) males. A majority were African-Americans (65.4%), followed by Hispanic (31.4%). There was no significant difference found in mother involvement, father involvement, mother support, father support, peer support or peer delinquency. There was a decrease in support from both parents over time, which was not affected by the program. There was a decrease in peer delinquency for both the treatment group (67 to.41) and the control group (63 to.50). The results of this study demonstrate a lack of attitudinal changes. This may be attributed to limitations of study design and an inherent difficulty in dealing with high-risk inner city youth.
Urban youth disruptive behavioral difficulties: exploring association with parenting and gender.
- Schiff M, McKay MM. Fam Process 2003; 42(4): 517-529.
Correspondence: M. Schiff, Hebrew University of Jerusalem, School of Social Work, Jerusalem, ISRAEL; (email: msschiff@mscc.huji.ac.il).
The current study will examine behavioral difficulties among a sample of African American urban youth who were exposed to violence. Possible gender differences in disruptive behavioral difficulties, as well as possible associations between parental practices, family relationships, and youth disruptive behavioral difficulties are examined. A secondary data analysis from baseline data for 125 African American urban mothers and their children collected as part of a large-scale, urban, family-based, HIV prevention research study was analyzed. Findings reveal that externalizing behavioral problems in youth are associated with exposure to violence. Girls displayed significantly higher levels of externalizing behavioral difficulties than boys. Mothers' parenting practices and family relationships were associated with youths' externalizing behavior problems. Implications for interventions to reduce youths' exposure to violence and to develop gender sensitive interventions for youth and supportive interventions for their parents are discussed.
A review of 187 gunshot wound admissions to a teaching hospital over a 54-month period: training and service implications.
- Cowey A, Mitchell P, Gregory J, Maclennan I, Pearson R. Ann R Coll Surg Engl 2004; 86(2): 104-107.
Correspondence: A. Cowey, Department of Surgery, Manchester Royal Infirmary, Manchester, UK; (email: unavailable).
BACKGROUND: Violence involving the use of firearms has increased in the UK over the past decade. This study assesses the implications of such injuries for service provision and training by reviewing the experience at one hospital.
METHODS: Accident and emergency triage data were searched for patients presenting with gunshot wounds over a 54-month period. Case notes were reviewed and patterns of care established. The resources required for clinical management were ascertained, and the financial consequences determined at contemporary full cost.
RESULTS: There were 187 attendances with 247 wounds. Mean age was 21 years (range, 8-63 years). Of the attendances, 69% were out of normal working hours. Of the 187 cases, 97 patients were admitted to one hospital (83 of whom required surgery) and 10 patients were transferred to other hospitals (6 for plastic surgery not available at the Manchester Royal Infirmary and 4 due to lack of beds). Of the 80 patients who were not admitted, 4 died in accident and emergency, the rest were either air gun wounds or relatively simple higher calibre injuries. A wide range of surgical specialties was involved (limb injury, 53; thoraco-abdominal and vascular, 28; head and neck, 5; and orbit, 2), and combinations of injuries transgressed specialty and sub-specialty boundaries. The total cost of patient care was pound 267,000.
COMMENTS: Gunshot wounds present a heavy demand on the clinical and financial resources of the receiving hospital, and surgeons responsible for unselected acute admissions in 'general surgery' should be capable of dealing with these indiscriminate injuries. Current training and service trends towards increasing sub-specialisation may mitigate against them achieving or retaining this capability.
Through a public health lens -- preventing violence against women: An update from the U.S. Centers for Disease Control and Prevention.
Correspondence: Corinne Graffunder, Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA; (email: com5@cdc.gov).
Over the past two decades, the Centers for Disease Control and Prevention (CDC) has been a key contributor to the growing public health effort to prevent violence. Although CDC and its partners are proud of their many successes, much work remains to be done. Violence continues to be a leading cause of death worldwide for people aged 15-44. Moreover, although many forms of violence garner national concern and resources, much more violence occurs in private domains and receives less attention. These hidden health hazards silently drain our nation's human, economic, and health resources. In this paper, we highlight the current efforts of the Division of Violence Prevention (DVP), housed within CDC's National Center for Injury Prevention and Control (NCIPC), to use a public health approach to the prevention of one key hidden health hazard: violence against women (VAW). Building from a recently developed strategic plan and a research agenda, we explain how four core public health principles-emphasizing primary prevention, advancing the science of prevention, translating science into effective programs, and building on the efforts of others-drive current programmatic activities in VAW prevention. Several current programs and projects are described. Finally, we conclude with recommendations for future prevention work by deepening our vision of leadership, expanding our partnerships, pursuing comprehensive approaches, and using evidence-based strategies.
Adolescent dating violence: do adolescents follow in their friends', or their parents', footsteps?
Correspondence: Ximena B. Arriaga, Department of Psychological Sciences, Purdue University, West Lafayette, IN 47907-1364, USA; (email: arriaga@purdue.edu).
Past research suggests that adolescents whose parents are violent toward one another should be more likely to experience dating violence. Having friends in violent relationships also may increase the odds of dating violence. The authors examined which antecedent, friend dating violence or interparental violence, if either, is more strongly predictive of own dating violence perpetration and victimization. Five hundred and twenty-six adolescents (eighth and ninth graders) completed self-report questionnaires on two occasions over a 6-month period. Consistent with hypotheses, friend dating violence and interparental violence each exhibited unique cross-sectional associations with own perpetration and victimization. However, only friend violence consistently predicted later dating violence. The authors explored influence versus selection processes to explain the association between friend and own dating violence.
Pregnancy and domestic violence: a review of the literature.
Pregnancy-related violence is a serious public health issue. Although there is a growing body of research on this subject, there are still many unanswered questions regarding the prevalence of this type of victimization, the risk factors, and the consequences. The purpose of this literature review is to organize and synthesize the interdisciplinary empirical research on pregnancy-related violence and to provide direction for both researchers and practitioners for future work in this area.
Dissuading state support of terrorism: Strikes or sanctions? (an analysis of dissuasion measures employed against Libya)
Correspondence: Stephen D. Collins, School of Arts & Sciences, Political Science Department, Homewood - Mergenthaler 338, The Johns Hopkins University, Baltimore, MD, USA; (email: unavailable).
This study examines the efficacy of various strategies of dissuading state support for terrorism. Libya represents the principle case study employed to test the impact of military force, unilateral economic sanctions, and multilateral economic sanctions against states which provide support to international terrorist organizations. The frequency of Libyan-supported terrorist attacks declined after the application, in 1986, of U.S. unilateral economic sanctions and military force against the regime of Muammar Qaddafi. However, these measures were unable to reduce the lethality of Libyan-supported terrorism, as the number of individuals killed by Libyan terrorism escalated substantially in the years following American airstrikes and sanctions. After the application of multilateral sanctions in 1992, however, Libya essentially dismantled its terrorist support program. In the decade since the imposition of UN sanctions on Libya, the Qaddafi regime has not been linked to a single attack against Americans. The significant economic and political pressures generated by the broadly multilateral sanctions appear to have induced Libya's departure from the ranks of terrorism sponsors.
General practitioner management of intimate partner abuse and the whole family: qualitative study.
- Taft A, Broom DH, Legge D. BMJ 2004; 328(7440): 618.
Correspondence: Angela Taft, Centre for the Study of Mothers' and Children's Health, La Trobe University, 251 Faraday Street, Carlton, Vic 3053, AUSTRALIA; (email: a.taft@latrobe.edu.au).
OBJECTIVE: To explore management by general practitioners of victimised female patients, male partners who abuse, and children in the family.
DESIGN: Triangulated qualitative study comparing doctors' reported management with current recommendations in the literature.
PARTICIPANTS: 28 general practitioners attending continuing medical education about management of domestic violence.
FINDINGS: Doctors perceived partner abuse in diverse ways. Their gender, perceptions, and attitudes could all affect identification and management of this difficult problem. A few doctors practised in recommended ways, but many showed stress and aversion, difficulties in resolving the tensions involved in managing all family members, and neglect of the risks to children. Some doctors used contraindicated practices, such as breaking confidentiality and undertaking or referring for couple counselling. Doctors who were not familiar with community based agencies were reluctant to use them. A lack of expertise and support could have a negative impact on doctors themselves.
COMMENTS: General practitioners managing partner abuse need to be more familiar with and apply the central principles of confidentiality and safety of women and children. Recommended guidelines for managing the whole family should be developed. Doctors should consider referring one partner elsewhere and avoid couple counselling; always ask about and act on the children's welfare; refer to specialist family violence agencies; and seek training, supervision, and support for the inherent stress. Medical education and administration should ensure comprehensive training and support for doctors undertaking this difficult work.
Association between depression and abuse by partners of women attending general practice: descriptive, cross sectional survey.
- Hegarty K,Gunn J, Chondros P, Small R. BMJ 2004; 328(7440): 621-624.
Correspondence: Kelsey Hegarty, Department of General Practice, University of Melbourne, Vic 3053, AUSTRALIA; (email: k.hegarty@unimelb.edu.au).
OBJECTIVES: To explore the association between depression and physical, emotional, and sexual abuse by partners or ex-partners of women attending general practice.
DESIGN: Descriptive, cross sectional survey.
SETTING: 30 general practitioners in Victoria, Australia.
PARTICIPANTS: 1257 consecutive female patients.
MAIN OUTCOME MEASURES: Some type of abuse in an adult intimate relationship (composite abuse scale), depression (Beck depression inventory or Edinburgh postnatal depression scale), and physical health (SF-36).
FINDINGS: 18.0% (218/1213) of women scored as currently probably depressed and 24.1% (277/1147) had experienced some type of abuse in an adult intimate relationship. Depressed women were significantly more likely to have experienced severe combined abuse than women who were not depressed after adjusting for other significant sociodemographic variables (odds ratio 5.8, 95% confidence interval 2.8 to 12.0). These variables included not being married, having a poor education, being on a low income, being unemployed or receiving a pension, pregnancy status, or being abused as a child.
COMMENTS: Physical, emotional, and sexual abuse are strongly associated with depression in women attending general practice. Doctors should sensitively ask depressed women about their experiences of violence and abuse in intimate relationships. Research into depression should include measures of partner abuse in longitudinal and intervention studies.
