The aim of this survey was to determine levels and severity of self-reported alcohol and drug misuse and associated physical and mental health problems in Greek male prisoners. The sample consisted of 80 randomly selected convicted and remanded male prisoners in a prison in northern Greece. The Mini International Neuropsychiatric Interview (MINI) was used to assess psychiatric disorders including substance abuse and dependence. All prisoners who participated completed the Alcohol Use Disorders Identification Test (AUDIT). Those who reported daily use of opiates and stimulants completed the Severity of Dependence Scale (SDS). Information was obtained from medical notes about the prisoners' hepatitis B and HIV status. The MINI identified 27.5% of the prisoners as dependent on opiates, 26.3% on alcohol and 73.8% as cannabis users, while 13.8% were misusing both alcohol and illicit drugs. Severity of dependence was rated, using SDS, as serious for all opiate and stimulant users. In terms of physical health examination of medical records indicated that no prisoner was HIV-positive but 26.5% were hepatitis-B-positive. Of those who had a previous history of substance misuse, 31.2% fulfilled the criteria for depression and 37.5% for antisocial personality disorder. Similarly, 15% of those misusing substances had a previous history of deliberate self-harm and 16% were assessed to have moderate to high suicide risk.
US emergency department visits for alcohol-related diseases and injuries between 1992 and 2000.
- McDonald AJ 3rd, Wang N, Camargo CA Jr. Arch Intern Med 2004; 164(5): 531-537.
Correspondence: Alden J. McDonald, Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA; (email: unavailable).
BACKGROUND: Alcohol-related diseases and injuries pose a significant burden on hospital emergency departments (EDs). Recognized limitations of self-reported data suggest that previous single-year national studies may have underestimated the magnitude of this burden.
METHODS: Data were obtained from the National Hospital Ambulatory Medical Care Survey for 1992 through 2000. Thirty-seven alcohol-related diagnoses and their corresponding alcohol-attributable fractions (AAFs) were used to estimate the number of ED visits attributable to alcohol. Diagnoses with an AAF of 1 were analyzed by age, sex, and race. Disposition to inpatient settings and alcohol screening also were examined.
FINDINGS: During these 9 years, there were an estimated 68.6 million (95% confidence interval [CI], 65.6 million to 71.7 million) ED visits attributable to alcohol, a rate of 28.7 (95% CI, 27.1-30.3) per 1000 US population. The number of alcohol-related visits increased 18% during this period. Visit rates for diagnoses with AAFs of 1 were highest for those who were aged 30 through 49 years, male, and black. From 1992 to 2000, these disparities remained stable for age group but significantly changed for sex (+22%) and race (-76%). Most patients with diagnoses with AAFs of 1 were not admitted to an inpatient unit, and the percentage of patients who underwent blood alcohol concentration testing was substantially lower than corresponding AAFs.
COMMENTS: Alcohol-related ED visits are approximately 3 times higher than previous estimates determined by physician documentation or patient disclosure of alcohol involvement. Rising trends, changing disparities, and suboptimal ED management of such visits are a call to action.
In 1960, Sheldon described the literature on falling as "meagre." Now so much has been published on the topic that it is difficult to make sense of the evidence and identify clear messages for policy and practice. We know that more than 30% of people aged 65 or older living in the community fall each year, many fall more than once, and the risk of falling increases with age. Although only 3-10% of these falls result in serious injury, they have serious implications for healthcare resources. What do we know about how to prevent falls?
The capacity of communities to prevent violence is examined from three perspectives: youth violence, child maltreatment, and intimate partner violence. The analysis suggests that community social control and collective efficacy are significant protective factors for all three types of violence, but these need to be further distinguished for their relationships to private, parochial, and state controls. It is argued that strong interpersonal ties are not the only contributor to collective efficacy and violence prevention. Weak ties, including those outside the community, and organizational ties are also seen as necessary. Violence prevention programs should be structured in ways that contribute to the communities' own capacity to prevent violence.
Putting public health evidence into practice: increasing the prevalence of working smoke alarms in disadvantaged inner city housing.
- Roberts H, Curtis K, Liabo K, Rowland D, DiGuiseppi C, Roberts I. J Epidemiol Community Health 2004; 58(4): 280-285.
Correspondence: K Curtis, Child Health Research and Policy Unit, Institute of Health Sciences, City University, 20 Bartholomew Close, London EC1A 7QN, UK; (email: k.curtis@city.ac.uk).
OBJECTIVE: The UK government recommends that local authorities install battery operated smoke alarms to prevent fire related injury. However, a randomised controlled trial of smoke alarm installation in local authority housing found a low level of working alarms at follow up. Qualitative work, which accompanied the trial explored barriers and levers to the use of this public health intervention.
DESIGN: Semi-structured group and individual interviews were conducted with a sample of the adult participants in a randomised controlled trial of free smoke alarm installation. Group interviews and "draw and write" exercises were conducted with children at a local primary school.
PARTICIPANTS: A sample of trial participants and primary school children in the trial neighbourhood.
SETTING: An inner city housing estate in central London.
FINDINGS: The main barrier to smoke alarm use was the distress caused by false alarms. Although trial participants considered themselves to be at high risk for fires and would recommend smoke alarms to others, respondents' reports on the distress caused by false alarms suggest that people balance immediate and longer term risks to their health and wellbeing when they disable alarms.
COMMENTS: This study identified some of the reasons for the low level of functioning smoke alarms, and problems experienced with alarms. The results have implications for the implementation of this public health intervention. The effectiveness of smoke alarm installation could be improved if alarm manufacturers and those responsible for implementation programmes considered ways of tackling the issues raised in this study.
Increased incidence of inflicted traumatic brain injury in children after a natural disaster.
- Keenan HT, Marshall SW, Nocera MA, Runyan DK. Am J Prev Med 2004; 26(3): 189-193.
Correspondence: Heather T. Keenan, University of North Carolina Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA (email: hkeenan@med.unc.edu).
BACKGROUND: The incidence of child abuse following natural disasters has not been studied thoroughly. However, parental stress and decreased social support have been linked to increased reports of child maltreatment. We hypothesized that a large-scale natural disaster (North Carolina's Hurricane Floyd) would increase the incidence of inflicted traumatic brain injury (TBI) in young children.
METHODS: An ecologic study design was used to compare regions affected to those regions unaffected by the disaster. Cases of inflicted TBI resulting in admission to an intensive care unit or death from September 1998 through December 2001 in North Carolina were ascertained. Poisson regression modeling was employed to calculate rate ratios of injury for each geographic area by time period.
FINDINGS: Inflicted TBI in the most affected counties increased in the 6 months post-disaster in comparison to the same region pre-disaster (rate ratio 5.1, 95% confidence interval [CI]=1.3-20.4), as did non-inflicted TBI (rate ratio 10.7, 95% CI=2.0-59.4). No corresponding increased incidence was observed in counties less affected or unaffected by the disaster. The rate of inflicted injuries returned to baseline in the severely affected counties 6 months post-hurricane; however, the rate of non-inflicted injuries appeared to remain elevated for the entire post-hurricane study period.
COMMENTS: Families are vulnerable to an elevated risk of inflicted and non-inflicted child TBI following a disaster. This information may be useful in future disaster planning.
The Circadian Alertness Simulator (CAS) was developed as a practical tool for assessing the risk of diminished alertness at work. Applications of CAS include assessment of operational fatigue risk, work schedule optimization, and fatigue-related accident investigation. Based on the documented work schedules of employees, sleep and alertness patterns are estimated and a cumulative fatigue score is calculated. The risk assessment algorithms are based on physiological sleep/wake principles including homeostatic and circadian processes. The free parameters of the algorithms were optimized using over 10,000 d of sleep and alertness data sets collected from transportation workers performing their regular jobs. The validity and applicability of the CAS fatigue score was then tested using work/rest and accident data from three trucking operations. Heavy truck drivers involved in DOT-recordable or high-cost accidents were found to have significantly higher CAS fatigue risk scores than accident-free drivers. Implementing a risk-informed, performance-based safety program in a 500 power-unit trucking fleet, where dispatchers and managers were held accountable for minimizing driver CAS fatigue risk scores, significantly reduced the frequency and severity of truck accidents. Further examination of CAS risk assessment validity using scenarios provided in a fatigue modeling workshop indicated that the CAS Model also performed well in estimating alertness with a real-world transportation scenario of railroad locomotive engineer work/rest patterns.
OBJECTIVE: The purpose of this study was to describe the collaboration among occupational therapy graduate students, faculty, and managers of an industrial organization in developing safety-training materials for workers.
METHOD: Three managers from an industrial organization sought collaboration from the School of Occupational Therapy. The occupational therapy faculty developed fieldwork experiences and implemented a qualitative research study where data were gathered through interviews, observations, key events, artifacts, and immersion in the field.
FINDINGS: Changing workers' behaviors required influence from an organizational level, including manager support and role modeling, safety committee involvement, and a strong presence of occupational therapy in the organizational environment.
COMMENTS: Occupational therapists who provide safety training in industrial settings must become partners with workers and managers, and immerse themselves in the organization to plan strategies that compliment the culture. Occupational therapists' interventions for safety training should match the needs and values of the managers.
Correspondence: Guzin Yeim Ozgenel, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical Faculty of Uludag University, El Cerrahisi Bilim Dali, 16059 Gorukle, Bursa, TURKEY; (email: gozgenel@yahoo.com).
This study was designed to evaluate the epidemiology and outcome of burn injuries due to paint thinner in a local burn center. During a 10-year period, 32 patients were admitted to our Burn Unit for paint thinner thermal burn. Patients were reviewed regarding the age, sex, etiologic factors, extent and localization of burn, treatment methods, length of hospitalization, and results. There were 30 males and 2 females. The mean age of patients was [Formula: see text] years. The most common etiologic factor was kindling a fire with paint thinner. The mean extent of burn was [Formula: see text] % of the total body surface area. All patients sustained burn injury on the face, arms, and hands and five patients among them had extended burn areas on the trunk and/or lower extremity. The mean length of hospitalization for the survivors was [Formula: see text] days. Twenty-eight patients were treated by early excision and split-thickness skin grafting. In four patients, burn wounds were healed by conservative management. Five patients with burn size of over 75% of the total body surface area died. In conclusion, paint thinner may be the cause of a catastrophic thermal injury and should not be used for the purpose of kindling fire.
Interventions for the prevention of falls in older adults: systematic review and meta-analysis of randomised clinical trials.
Correspondence: John T Chang, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California at Los Angeles, 911 Broxton Avenue, Los Angeles, CA 90095-1736, USA; (email: johnchang@mednet.ucla.edu).
Objective: To assess the relative effectiveness of interventions to prevent falls in older adults to either a usual care group or control group.
Design: Systematic review and meta-analyses.
Data sources: Medline, HealthSTAR, Embase, the Cochrane Library, other health related databases, and the reference lists from review articles and systematic reviews.
Data extraction: Components of falls intervention: multifactorial falls risk assessment with management programme, exercise, environmental modifications, or education.
Findings: 40 trials were identified. A random effects analysis combining trials with risk ratio data showed a reduction in the risk of falling (risk ratio 0.88, 95% confidence interval 0.82 to 0.95), whereas combining trials with incidence rate data showed a reduction in the monthly rate of falling (incidence rate ratio 0.80, 0.72 to 0.88). The effect of individual components was assessed by meta-regression. A multifactorial falls risk assessment and management programme was the most effective component on risk of falling (0.82, 0.72 to 0.94, number needed to treat 11) and monthly fall rate (0.63, 0.49 to 0.83; 11.8 fewer falls in treatment group per 100 patients per month). Exercise interventions also had a beneficial effect on the risk of falling (0.86, 0.75 to 0.99, number needed to treat 16) and monthly fall rate (0.86, 0.73 to 1.01; 2.7).
Comments: Interventions to prevent falls in older adults are effective in reducing both the risk of falling and the monthly rate of falling. The most effective intervention was a multifactorial falls risk assessment and management programme. Exercise programmes were also effective in reducing the risk of falling.
Bedsharing and sudden infant death in Scotland, UK.
Correspondence: David m. Tappin, Paediatric Epidemiology and Community Health (PEACH) Unit, Department of Child Health, Royal Hospital for Sick Children, Glasgow, G3 8SJ, UK (DT, HB); 36 Prospect Hill Road, Glasgow, UK (e-mail: goda11@udcf.gla.ac.uk).
A recent report by Carpenter and colleagues (Lancet, Jan 17, p 185)1 points to a small risk of infant death syndrome for infants younger than 8 weeks who bedshare with a non-smoking mother. Data were from 1992-96. Methodological issues may have minimized the apparant risk.
To examine the risk of bedsharing, we did a national study in Scotland, UK (population 5.1 million, 53 000 births per year), which included 123 infants who died of SIDS between Jan 1, 1996, and May 31, 2000, and 263 controls. Our data showed a strong interaction between bedsharing during the last sleep (compared with parents' room not bedsharing), and infant age, for the risk of SIDS (p=0.01). Infants younger than 11 weeks who bedshared were at far greater risk (multivariate odds ratio 12.78, 95% CI 3.61-45.22) than older infants (0.75, 0.22-2.56).
When we analysed the data further, taking account of the interaction with infant age by stratification, a strong association remained for SIDS and bedsharing between non-smoking mothers and infants younger than 11 weeks (8.51, 1.18-62.26). Where neither parent smoked, there were five SIDS deaths (4% of all SIDS cases) among infants younger than 11 weeks who slept in the parents' room (two were breastfed). All five had bedshared during their last sleep (compared with seven of 33 controls). An associated risk was present for young breastfed infants who bedshared (odds ratio 15.50, 1.68-142.86).
The difference in the level of associated risk between Carpenter's study and our own might be due to the comparison group for our study being parents' room not bedsharing, and Carpenter and colleagues' being simply not bedsharing, which included infants who slept in a separate room--a previously described risk factor for SIDS, which Carpenter and colleagues confirmed. Carpenter and colleagues' study might therefore have underestimated the associated risk of bedsharing compared with not bedsharing in the parents' room.
The proportion of the control population who had non-smoking bedsharing mothers was 5.8% (139 of 2411) in Carpenter and colleagues' study during 1992-96, whereas in our study it had risen to 11% (29 of 263) during 1996-2000. Since 2000, this proportion has probably increased further due to active promotion of bedsharing to encourage breastfeeding.
In the early 1970s, prone sleeping was unusual (7.4% in Norway in 1970), and a significant risk for SIDS could not be seen in early case-control studies. Advice was given that prone was safe. The prevalence increased (49.1% in Norway in 1989), and as a consequence so did the power of studies to show a risk. It is obvious now that the inability of those early studies to show a risk did not mean prone sleeping was safe. With the memory of the tragic effect the gradual adoption of prone sleeping had on SIDS rates of the 1970s and 1980s, we should be very wary of tampering with our own culturally derived infant care practices until we are sure that a new practice such as bedsharing is safe for our infants. Until then, we suggest that parents should not be encouraged to bedshare for sleep with young infants.
Correspondence: Everette J. Freeman, University of Indianapolis, Office of the President, 1400 East Hanna Avenue, Indianapolis, IN 46217, USA; (email: efreeman@uindy.edu).
As the US workforce continues to age, organized labor and management will have to work creatively to redesign jobs, workflow, and work pace to accommodate older workers. Union-management cooperation in developing safety strategies have been largely unsuccessful because of mutual distrust, animosity left over from contract negotiations and administration, the absence of strong labor legislation that promotes shared governance, injury concealment, and world-wide competitive pressures to reduce labor costs at the expense of worker safety. If workplace injury prevention that focuses on cost-effective and efficient workplace modifications for older as well as for all workers is to become reality, then employers and their unions will need to develop solutions to forge new, more expansive approaches to accommodation.
Underreporting of fatal occupational injuries in Catalonia (Spain).
- Benavides FG, Perez G, Martinez J, Martinez JM, Gispert R, Benach J. Occup Med (Lond) 2004; 54(2): 110-114.
Correspondence: Fernando G. Benavides, Occupational Health Research Unit. Department of Experimental and Health Sciences. Universitat Pompeu Fabra, Doctor Aiguader, 80, 08003 Barcelona, SPAIN; (email: fernando.benavides@upf.edu).
BACKGROUND: Thoroughness in a given health information system is one of its most important quality indicators. In Spain, in approximately 30% of serious occupational injuries, there is no information on the final outcome.
OBJECTIVE: To assess underreporting of fatal occupational injuries in Catalonia.
METHODS: All serious occupational injuries (excluding commuting injuries) reported in Catalonia (Spain) between 1994 and 1998 (n = 7330) were linked with data from the Catalonian Mortality Register, 117 deaths being identified during the year following the injury date. In order to assess whether death could or could not have been related to the prior occupational injury, two experts examined these cases independently.
FINDINGS: The experts concluded (kappa = 0.98) that 69 (59%) of these deaths were probably related to occupational injuries; the vast majority (n = 65) occurred within 3 months of the injury. This represents an accumulated risk of dying of approximately 1% for the total of serious injuries, not varying with economic activity or job category. However, this risk varied depending on the form of accident, and the site and nature of the injury.
COMMENTS: Occupational injury cases, especially serious ones, should be followed up over at least 3 months. These results suggest the importance of carrying out active case-finding and of incorporating the death certificate as one of the documents to be systematically reviewed in order to complete the statistics.
Injuries to Scottish farmers while tagging and clipping cattle: a cross-sectional survey.
Correspondence: David J. Godden, Highlands and Islands Health Research Institute, University of Aberdeen, The Green House, Inverness IV2 3ED, UK; (email: d.godden@abdn.ac.uk).
BACKGROUND: Anecdotal reports suggested that farmers were sustaining significant injuries while ear tagging newborn calves or clipping cattle prior to slaughter. Aims This national survey was designed for determining the incidence and nature of self-reported injuries to farmers that were sustained while tagging calves and clipping cattle.
METHODS: A cross-sectional, anonymous, postal questionnaire survey was sent to all members of the National Farmers Union of Scotland with beef or dairy cattle (n = 4495).
FINDINGS: In total, 2439 (54%) usable questionnaires were received and 1341 injuries were reported by 591 (24%) respondents. Tagging-related injuries were reported by 297 (12%) respondents. The most commonly described injury was bruising, but lacerations (3%) and fractures (3%) also occurred. Fifty-eight (20%) individuals lost time from work, with a median of 3 days [interquartile range (IQR) = 2-7 days]. Four hundred and eighteen (17%) respondents reported clipping-related injuries. The most common injury was bruising, but lacerations (6%) and fractures (7%) also occurred. Ninety-five (23%) individuals lost time from work, with a median of 4 days (IQR = 2-14 days). Tagging injuries more commonly affected lower limbs and the trunk, while clipping injuries affected the upper limbs. Tagging injuries were associated with working alone, in an open field and with a vehicle nearby, while clipping injuries were associated with working alone, with beef cattle and with younger age. Both types of injury were associated with injuries from livestock in other circumstances.
COMMENTS: Tagging calves and clipping cattle prior to slaughter are associated with a significant risk of injury, which may be severe, necessitating treatment and time lost from work. Policy makers, safety advisers and the farming community should reconsider whether these procedures are necessary and whether current guidelines should be modified in order to improve safety.
Children at risk in traffic: improvement potentials in the Swedish context.
- Hasselberg M, Laflamme L. Acta Paediatr 2004; 93(1): 113-119.
Correspondence: Marie Hasselberg, Department of Public Health Sciences, Division of Social Medicine, Karolinska Institutet, Stockholm, SWEDEN; (email: marie.hasselberg@smd.sll.se).
OBJECTIVE: To investigate the social risk distribution and improvement potentials for road traffic injuries among Swedish children by considering three categories of road users.
METHODS: A population-based cohort study of children aged 1-14 y was carried out. Subjects were taken from the Swedish Population and Housing Census of 1990 (n = 1406405), and followed-up in the National Hospital Discharge Register for the years 1991-1999 focusing on injuries incurred as pedestrians, bicyclists or car passengers (n = 16084). Household socio-economic position was measured using social class, education and disposable income. Relative risks were calculated using Poisson regression for each measure of socio-economic position and by combining them, adjusting for sex, age of child and age of mother at delivery. Population-attributable risks were compiled for each category of road user and each measure of socio-economic position.
FINDINGS: Children of farmers and the self-employed are at greater risk for injuries as car passengers (RR 2.40, CI 1.79-3.20 and RR 1.44, CI 1.16-1.79, respectively), but not for pedestrian- and bicycle-related injuries. Children of unskilled workers are at greater risk for pedestrian injuries (RR 1.39, CI 1.15-1.67). Controlling for education and disposable income did not affect the relative risks to the same extent according to the social class and category of road user. The highest population-attributable risks were related to family disposable income and were indicated for pedestrians and car passengers (19-20%).
COMMENTS: By taking children's limited ability to deal with different types of traffic situations into consideration, considerable improvements in children's risk levels have been observed. Now there is a need to add equity in the road traffic safety equation.
Use of carbon monoxide alarms to prevent poisonings during a power outage--North Carolina, December 2002.
- Lavonas EJ, Kerns WP II, Tomaszewski CA, Blackwell TH, Galaska PN, Hay TL, McCormick GE, Brown AS, Mott JA. MMWR Morb Mortal Wkly Rep 2004; 53(9): 189-192.
The complete report with editorial comments, tables, chart, and photograph is available online: ( Download Document ).
Each year in the United States, approximately 500 persons die from unintentional carbon monoxide (CO) poisoning, often during electric power outages caused by severe storms. Use of residential CO alarms has been recommended to reduce the incidence of CO poisoning. In September 2000, Mecklenburg County, North Carolina (2002 population: 722,367), adopted a public health ordinance requiring a CO alarm in the majority of residences; all-electric residences without attached garages (35.4% of all homes) were exempt. The ordinance also permitted use of alarms without battery back-up. On December 4, 2002, an ice storm caused 78.9% of county households to lose power. During the next 9 days, 124 cases of symptomatic CO poisoning were reported. To characterize these poisonings and the effectiveness of the CO alarm ordinance, local emergency physicians, fire department authorities, and CDC conducted an investigation. This report summarizes the results of that investigation, which determined that 96.2% of the severe poisonings occurred in homes with no reported functioning CO alarm. As a result of these findings, on October 8, 2003, Mecklenburg County officials amended the ordinance to require alarms with battery back-ups in all residences. Officials in other communities should consider enacting such alarm ordinances to prevent CO poisonings.
A paucity of literature exists on the subject of youth football with the majority of research concentrating on athletes of high-school age or older. Youth football participants include those athletes who compete in organised football prior to high school. Injury rate and severity for youth players is surprisingly low when compared with those competitors who have passed through puberty. As children mature they become bigger, faster and stronger, which is accompanied by an increased injury risk. Quarterbacks and running backs are injured almost five times more often than offensive linemen and linebackers. The knee is the most common site of injury followed by the ankle, wrist and hand. Fortunately, traumatic brain and cervical spine injuries are exceedingly rare. In this article, we review the youth football literature, identify the most common injuries by anatomical location, discuss the differential diagnoses and outline treatment options.
A prospective cohort study of injury incidence and risk factors in North Carolina high school competitive cheerleaders.
- Schulz MR, Marshall SW, Yang J, Mueller FO, Weaver NL, Bowling JM. Am J Sports Med 2004; 32(2): 396-405.
Correspondence: Mark Schulz, University of North Carolina-Greensboro, PO Box 26170, Greensboro, NC 27402-6170, USA; (email: mrschulz@uncg.edu).
BACKGROUND: Cheerleaders suffer nearly half of catastrophic injuries observed in female scholastic athletes in the United States. However, incidence of noncatastrophic injury in this population has not been described.
HYPOTHESIS: Coach, athlete, and injury circumstance variables may predict the injury rate among cheerleaders.
STUDY DESIGN: Prospective cohort.
METHODS: The authors investigated injury incidence in a sample of North Carolina female cheerleaders who competed inter-scholastically from 1996 to 1999. Injury, exposure, and demographic data were collected from squads that participated in the North Carolina High School Athletic Injury Study.
FINDINGS: Cheerleaders suffered 133 injuries during 1701 athlete seasons. More than 21% of the injuries were ankle sprains. The injury rate was 8.7; the 95% confidence interval (CI) was 6.5 to 11.7 per 10,000 athlete exposures. In a multivariate Poisson regression model, cheerleaders supervised by coaches with the most education, qualifications, and training (coach EQT) had a nearly 50% reduction in injury risk (rate ratio [RR], 0.5; 95% CI, 0.3-0.9), and cheerleaders supervised by coaches with medium coach EQT had a nearly 40% reduction in injury risk (RR = 0.6; 95% CI, 0.3-1.2) compared to cheerleaders supervised by coaches with low coach EQT.
Domestic accidental deaths in the Niger Delta Region, Nigeria.
- Seleye-Fubara SD, Ekere AU. East Afr Med J 2003; 80(12): 622-626.
Correspondence: S.D. Seleye-Fubara, Department of Anatomical Pathology, University of Port Harcourt Teaching Hospital, Port Harcourt, NIGERIA; (email: unavailable).
BACKGROUND: Domestic accidental deaths constitute a public health burden in the Niger Delta Region of Nigeria. This study is aimed at highlighting this public health burden.
OBJECTIVE: This is study is aimed at highlighting this public health burden.
DESIGN: A six year retrospective study using mortuary records.
SETTING: University of Port Harcourt Teaching Hospital, Port Harcout, Nigeria.
PATIENTS AND METHODS: Coroner's forms data were used from University of Port Harcout Teaching Hospital, Anatomical Pathology Department, which is the foremost health institution in the region serving a core population of about six million people.
FINDINGS: Eighty three domestic accidental deaths seen at the University of Port Harcourt Teaching Hospital in the Niger Delta Region of Nigeria between January 1995 and December 2001 were analysed. The 83 deaths occurred in 63 males and 20 females, giving a ratio of 3:1, between the ages of six months and 86 years. There was a bimodal age distribution, with 20 cases (24.1%) occurring in preschool age children, and 22 cases (26.5%) occurring in the elderly over 70 years. Fifty one deaths (61.4%) occurred in the urban areas, while 32 cases (36.8%) occurred in the rural areas. Seventeen cases (20.5%) occurred from falls from height or same level, thereby, constituting the commonest mechanism of injuries that lead to death in the elderly. In children, the commonest mechanism of injuries leading to death was poisoning. The yearly incidence of these deaths is decreasing with the peak of 26.5% in 1995, and 6.0% in 1999.
CONCLUSION: Enforceable legislation by government coupled with public education to reduce occurrence should be encouraged. Safety at home must be taken very seriously.
Traumatic deaths during U.S. Armed Forces basic training, 1977-2001.
- Scoville SL, Gardner JW, Potter RN. Am J Prev Med 2004; 26(3): 194-204.
Correspondence: Stephanie L. Scoville, Armed Forces Institute of Pathology, Division of Mortality Surveillance, Rockville, Maryland, USA; (email: Stephanie.Scoville@na.amedd.army.mil).
BACKGROUND: A Recruit Mortality Registry, linked to the Department of Defense Medical Mortality Registry, was created to provide comprehensive medical surveillance data for deaths occurring during enlisted basic military training.
METHODS: Recruit deaths from 1977 through 2001 were identified and confirmed through redundant sources. Complete demographic, circumstantial, and medical information was sought for each case and recorded on an abstraction form. Mortality rates per 100,000 recruit-years were calculated by using recruit accession data from the Defense Manpower Data Center.
FINDINGS: There were 276 recruit deaths from 1977 through 2001 and age-specific recruit mortality rates were less than half of same-age U.S. civilian mortality rates. Only 28% (77 of 276) of recruit deaths were classified as traumatic (suicide, unintentional injury, and homicide), in comparison to three quarters in both the overall active duty military population and the U.S. civilian population (ages 15-34 years). The age-adjusted traumatic death rates were highest in the Army (four times higher than the Navy and Air Force, and 80% higher than the Marine Corps). The majority (60%) of traumatic deaths was due to suicide, followed by unintentional injuries (35%), and homicide (5%). The overall age-adjusted traumatic mortality rate was more than triple for men compared with women in all military services (rate ratio=3.9; p=0.01).
COMMENTS: There was a lower proportion of traumatic deaths in recruits compared to the overall active duty military population and same-age U.S. civilian population. This finding could be attributed to close supervision, emphasis on safety, and lack of access to alcohol and motor vehicles during recruit training.
Child sexual abuse: a study among 892 female students of a medical school.
- Chen JQ, Han P, Dunne MP. Zhonghua Er Ke Za Zhi 2004; 42(1): 39-43.
Correspondence: J. Chen, Institute of Child and Adolescent Health, Peking University, Beijing 100083 CHINA; (email: unavailable).
OBJECTIVE: This study was designed to ascertain the prevalence of child sexual abuse (CSA) among female students of a medical school and to explore the impact of CSA on the mental health and health related risk behaviors of the victims being sexually abused and to provide useful reference for CSA prevention.
METHODS: A cross-sectional survey was carried out among 892 female students from a medical school by anonymous self-administered questionnaire during Oct. 2002. The questionnaire used for this study mainly included (1) general demographic information; (2) sexual experiences; (3) 12 forms of CSA. In this study, cases of CSA were defined as those who answered positively to one or more of the 12 questions relating to childhood sexual experiences (including non-physical contact CSA and physical contact CSA) occurring before age 16 with a person when a child did not want to. (4) Center for Epidemiologic Studies (CES)-Depression Scale; (5) Self Esteem Scale; (6) Risk Behaviors; (7) Health status' self-evaluation. Survey procedures were designed to protect students' privacy by allowing anonymous and voluntary participation. Students were seated separately, completed the self-administered questionnaire in their classrooms during a regular class period. Respondents were encouraged to participate in this survey, but given the sensitive nature of the subject, they could skip portion of the questionnaire if they were not comfortable with the questions. The completed questionnaires were sealed in envelopes by students themselves (the envelope was distributed with questionnaire at the same time), and then collected together. Data were analysed by using the Statistical Package for the Social Sciences software. Frequency, percentage, Chi-square test and t-test of statistics were used to analyze the CSA prevalence and explore the influence of CSA on mental health of students.
FINDINGS: Among 892 female students, 25.6% reported having experienced CSA (any one of 12 forms non-physical contact and physical contact CSA) before the age of 16 years. The median age at first episode was 12 years. Comparing the rates of CSA of female students in different parents' education level, between one-child in a family and more than one-child in a family, among rural area, county and city, there were no significant differences. Compared to the students who had not experienced CSA, the students who had experienced CSA reported higher levels of depression (CES-D score 18.78 vs. 16.68, t = 2.81, P = 0.005), lower levels of health status self-evaluation (score 3.53 vs. 3.78, t = 2.94, P = 0.003); higher proportion of subjects who reported drinking alcohol and having ever smoked during the past 30 days (drinking 32.7% vs. 22.9%, chi(2) = 8.51, P = 0.004; smoking 8.8% vs. 4.4%, chi(2) = 6.17, P = 0.013); a higher percentage engaged in sexual intercourse (19.3% vs. 5.9%, chi(2) = 33.48, P = 0.000); ever seriously considered attempting suicide (23.7% vs. 15.4%, chi(2) = 8.09, P = 0.004), making a plan about how would attempt suicide (17.9% vs. 9.7%, chi(2) = 10.62, P = 0.001), being threatened or injured by someone with a weapon such as a knife, or club on school property (3.5% vs. 1.1%, chi(2) = 6.17, P = 0.013), being involved in physical fight (16.7% vs. 5.6%, chi(2) = 27.05, P = 0.000) during the 12 months preceding the survey.
COMMENTS: The results further showed that the CSA of girls in our country is not uncommon, as reported before in our country and in the other countries and is associated with poor mental health and risky behaviors. The findings highlight the urgent need for the further research into CSA epidemiological characteristics, health services for the victims abused sexually, sexual abuse prevention programs in schools and the general community in China.
- Rautiainen RH, Lange JL, Hodne CJ, Schneiders S, Donham KJ. J Agric Saf Health 2004; 10(1): 51-63.
Correspondence: Risto Rautiainen, Great Plains Center for Agricultural Health, University of Iowa, 103 IREH, Oakdale Campus, Iowa City, IA 52242-5000, USA; (email: ristorautiainen@uiowa.edu).
The aims of this article are to assess injury characteristics and risk factors in the Iowa Certified Safe Farm (CSF) program and to evaluate the effectiveness of CSF for reducing injuries. This intervention program includes a health screening, on-farm safety review, education, and monetary incentives. Cohorts of farmers in an intervention group (n = 152) and control group (n = 164) in northwestern Iowa were followed for a three-year period. During the follow-up, there were 318 injuries (42/100 person-years), of which 112 (15/100 person-years) required professional medical care. The monetary cost of injuries was $51,764 ($68 per farm per year). There were no differences in the self-reported injury rates and costs between the intervention and control groups. Raising livestock, poor general health, and exposures to dust and gas, noise, chemicals and pesticides, and lifting were among risk factors for injury. Most injuries in this study were related to animals, falls from elevation, slips/trips/falls, being struck by or struck against objects, lifting, and overexertion. Machinery was less prominent than generally reported in the literature. Hurry, fatigue, or stress were mentioned as the primary contributing factor in most injuries. These findings illustrate the need for new interventions to address a multitude of hazards in the farm work environment as well as management and organization of farm work.
On-farm falls among youth less than 20 years old in the U.S.
- Hendricks KJ, Goldcamp EM, Myers JR. J Agric Saf Health 2004; 10(1): 27-38.
Correspondence: K. Hendricks, NIOSH/Division of Safety Research, 1095 Willowdale Road, M/S 1808, Morgantown, WV 26505, USA; (email: khendricks@cdc.gov).
This article examines the magnitude and characteristics of fall-related injuries on U.S. farms for youth less than 20 years old for work and non-work exposures at a national level. To examine the problem, data from the Childhood Agricultural Injury Survey (CAIS) and Census of Fatal Occupational Injuries (CFOI) were used. Findings indicate that falls are an important contributor to on-farm injuries, with youth appearing to be at considerable risk. Thus, a reduction of the exposure of youth to fall-related hazards on farms is needed. Strategies such as providing safe play areas for young children and continuing efforts to prevent extra riders on farm equipment will help in reducing these hazardous fall exposures.
The objective of the study was to find out whether the school-based prevention programme 'Initiated abstinence' is suitable to induce pupils to change their consumer behavior and attitudes. The participants of the prevention programme commit themselves 'per contract' to abstain from or considerably reduce their consumption of at least one of their currently used substances (e.g. sweets, cigarettes) or media (TV, computer games) for a period of 2 weeks. The main goal of the programme is to sharpen their problem and health consciousness concerning addiction and pleasure seeking. The programme was evaluated by a longitudinal study. At three given times, the 12- to 15-year-old pupils of the experimental classes were interviewed by standardized self-completion questionnaires (n = 2,267). The control classes were submitted to two surveys (n = 586). The study was carried out in the areas of Innsbruck (Austria), Schleswig-Holstein (Germany) and South Tyrol (Italy). Not all pupils were able to keep their intentions submitted in their contract, but 4 of 5 pupils had at least one positive experience with the renunciation (82%). There were 'overall effects': The actual renunciation of the pupils was much higher than stated in their agreement. The experimental group showed significant reduction effects for pupils, who had successfully reduced or stopped use of a substance or medium. In a further step, it should be explored whether the programme is suitable also for older groups, i.e. for pupils older than 15 years. Moreover, the long-term effects of the programmes should be tested.
See item 2 under Recreation and Sports Related Issues
Impact of an educational program on the safety of high-risk, visually impaired, older drivers.
- Owsley C, McGwin G Jr, Phillips JM, McNeal SF, Stalvey BT. Am J Prev Med 2004; 26(3): 222-229.
Correspondence: Cynthia Owsley, Department of Ophthalmology, School of Medicine (Owsley, McGwin, Phillips, McNeal), University of Alabama at Birmingham, Birmingham, Alabama, USA; (email: owsley@uab.edu).
BACKGROUND: Older drivers (licensed drivers aged 60 years and older) have among the highest rates of motor vehicle collision involvement per mile driven of all age groups. Educational programs that promote safe driving strategies among seniors are a popular approach for addressing this problem, but their safety benefit has yet to be demonstrated. The objective of this study was to determine whether an individualized educational program that promoted strategies to enhance driver safety reduces the crash rate of high-risk older drivers.
DESIGN/ SETTING: Randomized, controlled, single-masked intervention evaluation at an ophthalmology clinic.
PARTICIPANTS: A total of 403 older drivers with visual acuity deficit or slowed visual processing speed or both who were crash-involved in the previous year, drove at least 5 days or 100 miles per week or both, and were at least 60 years old.
INTERVENTION: Patients were randomly assigned to usual care (comprehensive eye examination) or usual care plus an individually tailored and administered educational intervention promoting safe-driving strategies.
MAIN OUTCOME MEASURE: Police-reported vehicle collision rate, expressed both in terms of person-years of follow-up and person-miles of travel for 2 years postintervention.
FINDINGS: The intervention group did not differ significantly from the usual care only group in crash rate per 100 person-years of driving (relative risk [RR], 1.08; 95% confidence interval [CI], 0.71-1.64) and per 1 million person-miles of travel (RR, 1.40; 95% CI, 0.92-2.12). The intervention group reported more avoidance of challenging driving maneuvers and self-regulatory behaviors during follow-up than did the usual care only group (p<0.0001).
COMMENTS: An educational intervention that promoted safe-driving strategies among visually impaired, high-risk older drivers did not enhance driver safety, although it was associated with increased self-regulation and avoidance of challenging driving situations and decreased driving exposure by self-report.
History of multiple suicide attempts as a behavioral marker of severe psychopathology.
- Forman EM, Berk MS, Henriques GR, Brown GK, Beck AT. Am J Psychiatry 2004; 161(3): 437-443.
Correspondence: Evan Forman, Department of Psychology, Drexel University, 245 N, 15th Street, MS 515, Philadelphia, PA 19102, USA; (email: evan.forman@drexel.edu).
OBJECTIVE: Individuals with a differing number of past suicide attempts are generally considered a homogeneous group, despite emerging evidence to the contrary. The current study aimed to test the hypothesis that multiple suicide attempters would exhibit a more severe clinical profile than single suicide attempters.
METHOD: A series of self-report batteries and clinical interviews was administered to 39 single attempters and 114 multiple attempters who came to an urban hospital emergency room after a suicide attempt. The participants were predominantly poor and nonwhite.
FINDINGS: Multiple suicide attempters versus single attempters exhibited a greater degree of deleterious background characteristics (e.g., a history of childhood emotional abuse, a history of family suicide), increased psychopathology (e.g., depression, substance abuse), higher levels of suicidality (e.g., ideation), and poorer interpersonal functioning. Profile differences existed even after control for borderline personality disorder.
COMMENTS: Results indicate that multiple attempters display more severe psychopathology, suicidality, and interpersonal difficulties and are more likely to have histories of deleterious background characteristics than single attempters. Moreover, these differences cannot be explained by the diagnosis of borderline personality disorder. Results suggest that the identification of attempt status is a simple, yet powerful, means of gauging levels of risk and psychopathology.
Suicide by prisoners: National clinical survey.
- Shaw J, Baker D, Hunt IM, Moloney A, Appleby L. Br J Psychiatry 2004; 184: 263-267.
Correspondence: Jenny Shaw, National Confidential Enquiry into Suicide and Homicide by People with Mental Illness, Centre for Suicide Prevention, Williamson Building, University of Manchester, Manchester M13 9PL, UK; (email: Jennifer.J.Shaw@man.ac.uk).
BACKGROUND: The number of suicides in prison has increased over recent years. This is the first study to describe the clinical care of a national sample of prison suicides.
OBJECTIVE: To describe the clinical and social circumstances of self-inflicted deaths among prisoners.
METHOD: A national clinical survey based on a 2-year sample of self-inflicted deaths in prisoners. Detailed clinical and social information was collected from prison governors and prison health care staff.
FINDINGS: There were 172 self-inflicted deaths: 85 (49%; 95% CI 42-57) were of prisoners on remand; 55 (32%; 95% CI 25-39) occurred within 7 days of reception into prison. The commonest method was hanging or self-strangulation (92%; 95% CI 88-96). A total of 110 (72%; 95% CI 65-79) had a history of mental disorder. The commonest primary diagnosis was drug dependence (39, 27%; 95% CI 20-35). Eighty-nine (57%; 95% CI 49-64) had symptoms suggestive of mental disorder at reception into prison.
COMMENTS: Suicide prevention measures should be concentrated in the period immediately following reception into prison. Because hanging is the commonest method of suicide, removal of potential ligature points from cells should be a priority.
Economic slump and suicide method: Preliminary study in Kobe.
- Abe R, Shioiri T, Nishimura A, Nushida H, Ueno Y, Kojima M, Kitamura H, Akazawa K, Someya T. Psychiatry Clin Neurosci 2004; 58(2): 213-216.
Correspondence: Toshiki Shioiri, Department of Psychiatry, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi, Niigata 951-8510, JAPAN; (email: tshioiri@med.niigata-u.ac.jp).
During the recent half decade, Japan's suicide rate at approximately 25 deaths per 100 000 people has been one of the highest rates in the world. From the perspective of suicide prevention by restricting access to suicidal means, the aim of the present study was to examine what kind of suicidal method increased during prolonged economic slump. During 21 years (1981-2001), for all suicide victims (5161 cases) the gender, age, and suicide methods were investigated. The yearly full unemployment rate was also used as a representative socioeconomic factor during the same periods in Japan using government statistics, and the relationship between methods of suicide and full unemployment rate was investigated. Pearson's correlation suggested that there was a significant correlation only for hanging rate (r = 0.736, P < 0.001), but not for the percentages of other methods of suicide. This finding that unemployed persons may have a susceptibility towards certain suicide methods could help in the prevention of suicides. Mental health in Japan should be given more attention, especially for the working population, and social programs offering help should be considered widely.
Elderly suicide in Hong Kong - a case-controlled psychological autopsy study.
- Chiu HF, Yip PS, Chi I, Chan S, Tsoh J, Kwan CW, Li SF, Conwell Y, Caine E. Acta Psychiatr Scand 2004; 109(4): 299-305.
Correspondence: Helen F. K. Chiu, Department of Psychiatry, G/F, Multi-centre, Tai Po Hospital, Tai Po, HONG KONG; (email: helenchiu@cuhk.edu.hk).
OBJECTIVE: To examine some of the risk factors for late life suicide in Hong Kong Chinese using a case-controlled psychological autopsy approach.
METHOD: Informants of 70 subjects aged 60 or above who had committed suicide as well as a community sample of 100 elderly controls were interviewed. Subjects and controls were assessed for the presence of mental illness, history of suicide attempt and data on health care utilization.
FINDINGS: Eighty-six per cent of suicide subjects suffered from a psychiatric problem before committing suicide, compared with 9% of control subjects. Among the psychiatric problems, major depression was the commonest diagnosis. Seventy-seven per cent of suicide subjects had consulted a doctor within 1 month of suicide. One-third of suicide subjects had a history of suicide attempt. Rates of current psychiatric diagnosis, rates of medical consultation and history of suicide attempt are all significantly higher in suicide subjects than controls.
COMMENTS: Our findings support the view that depressive disorders and a past history of suicide attempt are risk factors of late-life suicide in the Chinese population of Hong Kong, similar to findings in western studies.
OBJECTIVE: To assess whether prehospital triage guidelines, based on mechanistic criteria alone, accurately identify victims of motor vehicle accidents (MVA) with major injury.
METHODS: Retrospective analysis of the Royal Melbourne Hospital trauma database. Mechanisms analysed were those outlined by the American College of Surgeons Committee on Trauma and Advanced Trauma Life Support/Early Management of Severe Trauma prehospital triage guidelines.
FINDINGS: There were 621 MVA analysed, 253 with major injury (40.7%). Multivariate logistic regression indicated prolonged extrication time (P < 0.0001), cabin intrusion (P = 0.047), high speed (P = 0.003) and ejection from vehicle (P = 0.04) were statistically associated with major injury. Vehicle rollover and fatality in the same vehicle were not statistically associated with major injury.
COMMENTS: These data suggest that existing guidelines for the prehospital triage of MVA victims, based on mechanistic criteria alone may need revision.
Efficacy of side air bags in reducing driver deaths in driver-side collisions.
- Braver ER, Kyrychenko SY. Am J Epidemiol 2004; 159(6): 556-564.
Correspondence: Elisa R. Braver, Insurance Institute for Highway Safety, Arlington, VA, USA; (email: research@iihs.org).
Side air bags, a relatively new technology designed to protect the head and/or torso in side-impact collisions, are becoming increasingly common in automobiles. Their efficacy in preventing US driver deaths among cars struck on the near (drivers) side was examined using data from the Fatality Analysis Reporting System and the General Estimates System. Risk ratios for driver death per nearside collision during 1999 to 2001 were computed for head/torso and torso only side air bags in cars from model years 1997 to 2002, relative to cars without side air bags. Confounding was addressed by adjusting nearside risk ratios for front and rear impact mortality, which is unaffected by side air bags. Risk ratios were 0.55 (95% confidence interval: 0.43, 0.71) for head/torso air bags and 0.89 (95% confidence interval: 0.79, 1.01) for torso-only air bags. Risk was reduced when cars with head/torso air bags were struck by cars/minivans (significant) or pickup trucks/sport utility vehicles (nonsignificant). Risk was reduced in two-vehicle collisions and among male drivers and drivers aged 16 to 64 years. Protective effects associated with torso-only air bags were observed in single vehicle crashes and among male and 16 to 64 year old drivers. Head/torso side air bags appear to be very effective in reducing nearside driver deaths, whereas torso-only air bags appear less protective.
Risk to self versus risk to others; How do older drivers compare to others on the road?
- Dellinger AM, Kresnow MJ, White DD, Sehgal M. Am J Prev Med 2004; 26(3): 217-221.
Correspondence: Ann M. Dellinger, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA; (email: amd1@cdc.gov).
BACKGROUND: The objective of this study was to assess the risk of death or nonfatal injury drivers aged >/=65 pose to themselves and to other road users as compared with drivers in younger age groups.
METHODS: Crash-related deaths and injuries were separated into two categories: those occurring among the drivers themselves, and those occurring among others, such as passengers, bicyclists, or pedestrians.
FINDINGS: The number of deaths among others varied by driver's age, with deaths among others decreasing as the driver's age increased. The proportion of deaths among others compared with deaths among drivers also varied by age. For drivers in the youngest three age groups, about two thirds of the deaths were among others (ages 16 to 19, 63.1%; ages 20 to 34, 68.1%; and ages 35 to 59, 66.6%). This proportion declined with age, reaching a low among drivers aged >/=85 years (ages 60 to 74, 52.2%, ages 75 to 84, 37.9%, ages >/=85, 18.9%). When calculating deaths among others per 100 million miles driven, crashes among young (16 to 19) and older (aged >74) drivers were associated with more deaths to others than were crashes among drivers aged 20 to 74. The number of nonfatal injuries among others also declined as age of the driver increased. The number of injuries among others per 100 million miles driven was highest among the youngest (16 to 19) and oldest (>/=85) drivers.
COMMENTS: Our findings suggest that older drivers make relatively small contributions to crash-related morbidity and mortality; moreover, their contributions are generally a result of injuries to self rather than to others.
Several international agreements set constraints on the legitimate use of firearms as representing lethal force. Their meaning in terms of weapons technology must take into account their operational frame of reference, and legitimate warfare can be regarded as a law enforcement operation with similar principles on the use of force. Changes in weapons technology, such as new types of ammunition, transforming firearms into weapons with less-lethal and even humanitarian options, require new interpretations of the legislation. A division into lethal and non-lethal weapons is an oversimplification and the separation of international humanitarian law into military and law enforcement provisions can be questioned from the technical aspect. The type of technology acceptable for law enforcement use of firearms should be defined. An assessment for weapon injury should not be based on lethality, but rather on the potential for tissue damage and its reversibility.
The role of family-of-origin violence in men's marital violence perpetration.
Correspondence: Catherine Delsol, Department of Psychology, University of Southern California, Los Angeles, CA 90089-1061, USA; (email: catherinedelsol@earthlink.net).
This paper presents overall transmission rates between family-of-origin violence and marital violence, as well as theoretical and empirical work on possible mechanisms of transmission. In identified samples, approximately 60% of the maritally violent men report family-of-origin violence, whereas slightly over 20% of the comparison group of maritally nonviolent men report family-of-origin violence. Modest associations between experiencing violence in the family of origin and marital violence are found in community samples and in studies with prospective and longitudinal designs. Variables that intervene in the association between family-of-origin violence and marital violence are reviewed, with a focus on personal characteristics such as antisocial personality, psychological distress, and attitudes condoning violence, as well as on contextual factors, such as marital problems and conflict resolution style. Variables associated with nonviolence in men who grew up in violent families also are identified, including strong interpersonal connections and the ability to create psychological distance from the family-of-origin violence. Continued empirical investigation of variables that potentiate or mitigate the association between family-of-origin violence and marital violence at different developmental stages is needed to identify explanatory mechanisms and, ultimately, to interrupt the intergenerational transmission of marital violence.
Dissociation and violence: a review of the literature.
Violent acts are sometimes committed by people who do not normally appear violent or aggressive. This simple observation and others have led some to speculate about a relationship between dissociation and violence. However, no systematic review of the literature has so far been published. To address this gap, studies assessing the prevalence of dissociation among violent individuals, and violence among highly dissociative persons, are reviewed. Possible links between dissociation and violent behavior are explored. It is concluded that dissociation predicts violence in a wide range of populations and may be crucial to an understanding of violent behavior. There is a clear need, however, for large scale, well-designed studies using reliable structured instruments in a number of areas reviewed. Recommendations for clinical applications include the routine screening of offenders for dissociative disorders and adequate consideration of dissociation and dissociative disorders in the development and implementation of violence treatment and prevention programs.
A path model of risk factors for intimate partner violence among couples in the United States.
The present study was designed to identify the impact of drinking problems, impulsivity, and a history of childhood physical abuse on both male-to-female (MFIPV) and female-to-male intimate partner violence (FMIPV). The data were collected in 1995 from a representative national sample of couples living in the contiguous 48 states. Using a multistage probability sampling design, face-to-face interviews were conducted in respondent' homes, privately with each member of 1, 635 couples. A complex path model building on earlier work was tested for African American, Hispanic, and White couples separately. Multiple-group path analysis demonstrated that impulsivity, alcohol problems, and childhood physical abuse were differentially associated with reports of MFIPV and FMIPV as a function of ethnicity. This study suggests that a history of being physically harmed by parental figures during childhood, impulsivity, and drinking problems are all risk factors for intimate partner violence in the general household population in the United States.
Racial segregation and county level intentional injury in Pennsylvania: analysis of hospital discharge data for 1997-1999.
Correspondence: A. Fabio, Center for Injury Research and Control, Department of Neurosurgery, University of Pittsburgh, 200 Lothrop Street, Suite B400-PUH, Pittsburgh, PA 15213, USA; (email: fabioa@upmc.edu).
STUDY OBJECTIVE: This study examined whether high levels of racial segregation are associated with high county level intentional injury rates.
DESIGN: Multiple linear regression was used to assess the association between county racial segregation (measured by the Gini coefficient) and intentional injury rates. Multicollinearity was assessed with Eigenvalues and condition indices.
SETTING: State of Pennsylvania.
PATIENTS: County level intentional injury rates for 1995 to 1997 were calculated from hospital discharge data.
FINDINGS: After controlling for other known county level risk factors, higher levels of racial segregation in a county were significantly related to higher intentional injury rates. Multicollinearity was not a problem. Population size and density, family stability and median income, together with the percentage male, unemployed, in poverty, divorced men, and high school graduates of the county were controlled.
COMMENTS: Racial segregation is an important factor in the rate of intentional injury in a community. These results may be important for municipal and state agencies when developing public policies to prevent violence and promote racial integration.
