Criminality in Drug Addicts: A Follow-Up Study over 25 Years.
- Rogne Gjeruldsen S, Myrvang B, Opjordsmoen S. Eur Addict Res 2004; 10(2): 49-55.
Correspondence: Susanne Rogne Gjeruldsen, Department of Infectious Diseases, Ulleval University Hospital, Oslo, NORWAY; (email: s.m.r.gjeruldsen@ioks.uio.no).
BACKGROUND/AIMS/METHOD: 214 drug addicts were included in a 25-year study on criminality using data from the National Register of Convictions, and 84% of those still living in Oslo attended a follow-up examination.
FINDINGS: 89% of the 214 had committed offences, compared to 25% in a control group without drug use. 83% had been imprisoned. Males showed more criminal behavior than females and committed the most serious crimes. Male gender and more than two convictions were risk factors for reduced survival. At the follow-up examination 65% had abandoned illegal drugs and the majority had simultaneously stopped their criminal activities. There were significantly less drug offenders, thieves and people committing fraud or violations of traffic laws among the former drug addicts, but not less violent criminals. Criminality diminished with increasing age.
COMMENTS: Drug addicts were heavily involved in criminal affairs. Abandonment of illegal drugs and increasing age were associated with discontinuation of criminality.
Bibliography of Behavioral Science Research in Unintentional Injury Prevention.
- Sleet DA, Hopkins K, editors. National Center for Injury Prevention and Control, Centers for Disease Control and Prevention (producer). Atlanta, GA: CDC; 2004.
The Bibliography of Behavioral Science Research in Unintentional Injury Prevention includes more than 900 citations of journal articles, book chapters, government reports, and other publications. Designed as a tool for researchers, practitioners and students, this bibliography documents the contributions of behavioral and social sciences to unintentional injury prevention and control from 1980�2003. The CD-Rom includes the complete bibliography in two formats: (1) alphabetical by author; and (2) by injury topic. Citations are also indexed by keyword.
The Bibliography is part of a CDC effort to take an interdisciplinary approach to injury prevention and to identify innovative strategies from the behavioral and social sciences.
Unintentional injury topics include: bicycle injuries; child occupant protection; consumer product safety; drowning; falls; fire and burns; impaired driving; motor vehicle injuries; motorcycle safety; occupational injuries; pedestrian injuries; playground injuries; poisoning; seat belts; sports injuries; and sun-related injuries.
Positive interpersonal and community factors were examined as predictors of psychological outcomes. Over 200 African-American adolescents participated in four assessments across 2 years. Self-report surveys were administered to 5th through 8th grade students from three schools, and data were analyzed through hierarchical linear regressions. Results suggest that having a role model, school-belonging, community involvement, and church attendance predicted better psychological outcomes.
BACKGROUND: Chemical, biological, radiological and nuclear terrorism poses considerable threat throughout the world.
OBJECTIVE: To provide occupational physicians with an understanding of this threat and its main forms and what action can be taken to counter this threat.
METHODS: Presenters at a conference on chemical, biological, radiological and nuclear terrorism were asked to contribute their evidence-based opinions in order to produce a review article.
FINDINGS: This paper presents a summary of the different forms of chemical, biological, radiological and nuclear terrorism and the effective counter-measures and also provides a review of current scientific literature.
COMMENTS: The threat of chemical, biological, radiological and nuclear terrorism is present throughout the world and is one that occupational physicians should be aware of, as well as the action that can be taken to counter it.
Correspondence: S. Folkard, Body Rhythms and Shiftwork Centre, Department of Psychology, University of Wales Swansea, Swansea, Wales, UK; (email: S.Folkard@Swansea.ac.uk).
Models based on measures of fatigue and performance make the implicit assumption that they will be successful in predicting risk. The present paper reviews the available literature on shiftwork safety in which real measures of accidents or injuries could be pinpointed in time and in which the a priori risk appeared to be constant. Three main problems for the models emerged from this review: 1) risk was significantly higher on the afternoon shift than on the morning shift; 2) the dominant peak in risk over the course of the night shift occurred at about midnight; and 3) risk increased substantially over spans of four successive nights. It is suggested that the relationship between risk and fatigue may be non-linear, that models may have overestimated the recovery during short sleeps, and that day sleeps between night shifts may be less recuperative than normally timed night sleeps of the same length.
Firework-related childhood injuries in Greece: a national problem.
- Konte V, Petridou E, Trichopoulos D. Burns 2004; 30(2): 151-153.
Correspondence: Konte Vassilia, Department of Hygiene and Epidemiology, Athens University Medical School, 75 M. Asias Street, Goudi, P.O. Box 115-27, Athens, GREECE; (email: epetrid@med.uoa.gr).
During a 5-year period, out of 110,066 children with injuries recorded in the Greek Emergency Department Injury Surveillance System (EDISS), 91 had firework-related injuries. Descriptive analyses and the Barrell matrix were used to determine risk factors and extrapolated national firework childhood injury figures were calculated. The estimated annual incidence of childhood firework injuries treated in the emergency departments of hospitals countrywide, was 7 per 100,000 children years. Seventy percent of injuries concerned older children (10-14 years), mostly boys with self-inflicted injuries, whereas girls suffered injuries as bystanders. A sharp peak in spring was noted, when the Greek Orthodox Easter is celebrated. Illicitly sold fireworks caused most injuries, but in eight instances homemade firecrackers were responsible.
Burns caused by steam inhalation for respiratory tract infections in children.
Correspondence: Siun M Murphy, Department of Plastic and Reconstructive Surgery, Our Lady's Hospital for Sick Children, Crumlin, Dublin 12, Republic of IRELAND; (email: siunm@hotmail.com).
Steam inhalation is a common home remedy for infections of the upper respiratory tract. Between 1 July and 31 December 2002 seven children were admitted to the burns unit of a children's hospital in Dublin with scalds sustained during the course of such treatment.
We saw seven children over six months who had sustained scalds directly associated with steam inhalation. The children ranged in age from nine months to 10 years. The scalding ranged in extent from 3% to 6% of the total body surface area. Six children sustained burns to the face after direct contact with steam or hot water. Two children had burns caused by the bowl of water spilling on to their chest or lap. Four children will have permanent scarring, although only one required a skin graft. All of the burns were sufficient to cause extensive blistering (partial thickness or second degree). None of the children needed fluid resuscitation or intervention to protect the airway. These children represented 9% of all children admitted with burns or scalds during the six months and accounted for 78 inpatient days. The parents of two of the children spontaneously reported that their general practitioner had recommended steam inhalation as a treatment.
Although steam inhalation is commonly recommended as a treatment for infection of the upper respiratory tract in children, the evidence that it has any beneficial effect on the course of the illness is limited. A Cochrane review of the use of heated humidified air for the common cold concluded that although there was evidence that symptoms were relieved, there was no objective improvement in outcome measures such as viral shedding or viral titres in nasal washings. The trials included in this review involved the use of a rhinotherm device. A rhinotherm is a system that delivers hot humidified air at a set temperature to the nasal mucosa and raises its temperature. The air is delivered by nasal prongs. The common technique of steam inhalation, in which the head is held under a towel over a bowl of very hot water to which a nasal decongestant may be added, carries a substantial risk of scalding or even direct steam burns. The risk of injury must be greater for young children who do not understand what is happening and who cannot explain that the steam may be burning their face.
Other preventable domestic injuries resulting in scalds in children have been reported, highlighting the hazards of common practices in the home. Jeffery and colleagues reported scalds in 23 children sustained after they knocked or pulled over jugs or bowls of hot water that were being used to heat bottles of milk. Two cases of burns in children who were treated for inflammation of the upper respiratory tract by inhalation of steam from camomile tea have been reported. However, to our knowledge no reports have been made of scalds from direct contact with steam or hot water used to treat a cold.
Quite apart from the immediate pain and suffering, these injuries may cause permanent disfigurement and contractures that worsen with growth. On rare occasions, even small scalds can be fatal if complicated by staphylococcal toxic shock syndrome.
We would recommend that if steam inhalation is to be used for the relief of symptoms healthcare professionals must be explicit about its mode of delivery. Modell and colleagues advise parents to "sit in the bathroom with a hot shower running, the child on their lap, being read a story." Techniques involving kettles or bowls of boiling water should be actively discouraged, because of the dangers shown in this report.
BACKGROUND: The average age of nurses is projected to be 50 years in 2010 [17]. Because nurses are older, a work injury prevention program should change how nurses lift patients. The purpose of this evidence-based practice improvement project was to examine a new lifting intervention.
METHOD: An evidence-based process was used to implement an effective lifting intervention, including a back school, a lift team, and mechanical lifting equipment, on the orthopedic and neurology units in a Minnesota hospital. A two-week pilot determined if enough work would be generated to justify hiring a permanent lift team. Then the entire lifting intervention was studied on the two units.
FINDINGS: The injuries for the two units decreased from 21 to 9 injuries, while the salary and work replacement costs were $48,220 and $2,560 in 2001 and 2002, respectively. The lift team averaged 80 lifts per day and 95% of the nursing staff attended the back school.
COMMENTS: The lift team and new mechanical lifting equipment were successfully disseminated resulting in significant reductions in costs. Suggested improvements include additional supervision and lift team scheduling changes, regular staff meetings, and ongoing education.
A case-crossover study of transient risk factors for occupational acute hand injury.
- Sorock GS, Lombardi DA, Hauser R, Eisen EA, Herrick RF, Mittleman MA. Occup Environ Med 2004; 61(4): 305-311.
Correspondence: David Lombardi, Liberty Mutual Research Institute for Safety, 71 Frankland Road, Hopkinton, MA 01748, USA; (email: david.lombardi@libertymutual.com).
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BACKGROUND: Workers with acute hand injuries account for over 1,000,000 emergency department visits annually in the United States.
OBJECTIVE: To determine potential transient risk factors for occupational acute hand injury.
METHODS: Subjects were recruited from 23 occupational health clinics in five northeastern states in the USA. In a telephone interview, subjects were asked to report the occurrence of seven potential risk factors within a 90-minute time period before an acute hand injury. Each case also provided control information on exposures during the month before the injury. The self-matched feature of the study design controlled for stable between-person confounders.
FINDINGS: A total of 1166 subjects were interviewed (891 men, 275 women), with a mean age (SD) of 37.2 years (11.4). The median time interval between injury and interview was 1.3 days. Sixty three per cent of subjects had a laceration. The relative risk of a hand injury was increased when working with equipment, tools, or work pieces not performing as expected (11.0, 95% CI 9.4 to 12.8), or when using a different work method to do a task (10.5, 95% CI 8.7 to 12.7). Other transient factors in decreasing order of relative risk were doing an unusual task, being distracted, and being rushed. Wearing gloves reduced the relative risk by 60% (0.4, 95% CI 0.3 to 0.5). Occupational category, job experience, and safety training were found to alter several of these effects.
COMMENTS: The results suggest the importance of these transient, potentially modifiable factors in the aetiology of acute hand injury at work. Attempts to modify these exposures by various strategies may reduce the incidence of acute hand injury at work.
OBJECTIVE: To assess the effectiveness of two different educational interventions plus free cycle helmets, in increasing cycle helmet ownership and use.
METHODS: A cluster randomised controlled trial was carried out in 28 primary schools in deprived areas of Nottingham, involving 1213 year 5 schoolchildren (age 9 and 10). Children received either a helmet + educational pack (educational pack and order form for free cycle helmet) or a helmet + multifaceted intervention (educational pack, order form for free cycle helmet, school assembly, lesson devoted to cycle helmet education, and an invitation to a school based cycling event).
FINDINGS: The helmet + educational pack was as effective as the helmet + multifaceted intervention in terms of helmet ownership (OR 1.51, 95% CI 0.50 to 4.58) and wearing (OR 0.98, 95% CI 0.57 to 1.68). Helmet ownership significantly increased from baseline with both interventions, and wearing significantly increased from baseline with the helmet + educational pack. The interventions reduced the inequality in helmet ownership between children residing in deprived and non-deprived areas that had been present prior to the study.
COMMENTS: An educational pack plus a form to order a free cycle helmet is an effective way of increasing bicycle helmet ownership and use and reduces inequalities in helmet ownership among children in deprived areas. Further work is needed to determine the length of the effect of such interventions.
Correspondence: B. Bar-Oz, The Motherisk Program, Division of Clinical Pharmacology, The Hospital for Sick Children and The University of Toronto, Ontario, CANADA; (email: unavailable).
OBJECTIVE: To provide an updated list of the highly toxic medications in North America that can kill a 10kg toddler upon ingestion of 1-2 dose units.
METHODS: All drugs available in North America were reviewed and their reported lethal doses in children or adults (where no pediatric data existed) were identified. The dose units of drugs available in North America were subsequently identified, followed by those dose units that could kill a toddler upon ingestion of 1-2 dose units or teaspoonfuls.
FINDINGS: Tricyclic antidepressants, antipsychotics, quinine derivatives, calcium channel blockers, opioids, and oral hypoglycemics can kill a toddler with 1-2 dose units. This list of drugs was responsible for 40% of toddler fatalities reported to the American Association of Poison Control Center Toxic Exposure Surveillance System between 1990-2000.
COMMENTS: Drugs that can kill a toddler with 1-2 dose units should be known to clinicians as such exposures warrant immediate and intensive management. A new system of special labeling of these drugs should be considered.
Unintentional and Undetermined Poisoning Deaths ---11 States, 1990--2001.
- Centers for Disease Control and Prevention (CDC). MMWR Morb Mortal Wkly Rep 2004; 53(11): 233-238.
The complete report including tables, figure, editorial note, and references is available online: ( Download Report ).
During 1990--2001, the death rate from poisoning in the United States increased 56%, from 5.0 per 100,000 population in 1990 to 7.8 in 2001. In 2001, of 22,242 poisoning deaths, 14,078 (63%) were unintentional. To describe trends in poisoning deaths, state health professionals in 11 states analyzed vital statistics data for 1990--2001. This report summarizes the results of that analysis, which indicated that increases in state death rates from unintentional and undetermined poisonings varied, but increased by an average of 145%; a total of 89% of poisonings involved drugs and other biologic substances. State public health professionals can use local, state, and national surveillance data to monitor trends in drug misuse and to develop effective interventions that can reduce deaths from drug overdoses.
Wrist Fractures From Snowboarding: A Prospective Study for 3 Seasons From 1998 to 2001.
- Matsumoto K, Sumi H, Sumi Y, Shimizu K. Clin J Sport Med 2004; 14(2): 64-71.
Correspondence: Kazu Matsumoto, Department of Orthopaedic Surgery, Gifu University School of Medicine, 40 Tsukasamachi, Gifu, 500-8705, JAPAN; (email: kazu-ma@db3.so-net.ne.jp).
OBJECTIVES: To elucidate the epidemiology and the mechanisms of snowboarding wrist injuries, especially distal radial fractures.
DESIGN: A prospective survey of snowboarders with distal radial fractures.
PARTICIPANTS: From November 21, 1998, to April 22, 2001, we analyzed and interviewed 5110 injured snowboarders, and a total of 740 snowboarders with distal radial fractures were studied. On the basis of the medical records and radiographs, the severity of distal radial fracture was analyzed according to the AO classification.
FINDINGS: Distal radial fractures occurred at a rate of 0.31 per 1000 snowboarder visits and were assessed in 740 snowboarders in this study. Most of the injured snowboarders were either of beginner (42.0%) or intermediate level (48.1%). The most common events leading to an injury in snowboarding were falling (59.6%) and jumping (36.1%). Comminuted and articular fractures classified as AO types A3, B, and C, which required surgical treatment, made up 63.2% of distal radial fractures in snowboarders. The most remarkable differences between the first-time or beginner group and the intermediate or expert group were that the former had a significantly higher proportions of extra-articular fractures classified as AO type A (P < 0.05), and the latter were significantly more likely to have compression or complex intra-articular fractures such as AO type C (P < 0.05). Furthermore, first-time or beginner snowboarders were more likely to be injured because of a simple fall than were the intermediates or experts (P < 0.05). Over 60% of distal radial fractures classified as AO type C in the intermediate or expert group resulted from jumping. Furthermore, the side opposite to the snowboarder's preferred direction of stance was more often affected. A high incidence of injury during opposite-side edging, which is used more frequently in snowboarding, was found in novice female snowboarders.
COMMENTS: This study suggested several patterns in the nature of wrist injuries sustained while snowboarding, and these facts should be taken into consideration in the diagnosis of wrist injuries in snow-boarders.
Predictors of Lower Extremity Injuries at the Community Level of Australian Football.
- Gabbe BJ, Finch CF, Wajswelner H, Bennell KL. Clin J Sport Med 2004; 14(2): 56-63.
Correspondence: Belinda Gabbe, Trauma and Sports Injury Prevention Research Unit, Department of Epidemiology and Preventive Medicine, Monash University, Central and Eastern Clinical School, Alfred Hospital, Melbourne, Victoria, AUSTRALIA; (email: Belinda.Gabbe@med.monash.edu.au).
OBJECTIVE: To identify risk factors for general lower extremity injury at the community level of Australian football. DESIGN: Prospective cohort study.
SETTING: Community-level Australian football.
PARTICIPANTS: One hundred twenty-six adult players from 4 community-level Australian football clubs.
METHODS: During the 2000 preseason period, all participants underwent a baseline assessment involving a self-report questionnaire and a battery of musculoskeletal screening tests to collect information about potential risk factors for lower extremity injury. Over the course of the season, injury surveillance and exposure data collection were undertaken at each club.
MAIN OUTCOME MEASURE: A lower extremity injury, resulting in missed participation and/or treatment from a health professional, as the first injury during the season.
FINDINGS: For 59 players, a lower extremity injury was the first injury sustained during the season. Only ankle dorsiflexion range of movement, measured using the weightbearing lunge test, was significantly associated with sustaining a lower extremity injury through univariate analyses. Using survival analyses, and after adjusting for exposure, age, frequency of weight training participation, and the past injury status of players were identified as independent, but not significant, predictors of time to sustaining a lower extremity injury.
CONCLUSIONS: Despite the large number of potential risk factors studied and the high incidence of lower extremity injuries in the cohort, a definitive individual injury risk profile for all lower extremity injuries was not identified, potentially due to the heterogeneity of the outcome of interest. Further research should focus on the identification of risk factors for the most common and costly individual injuries in Australian football.
Non-participation in sports injury research: why football players choose not to be involved.
- Braham R, Finch C, McCrory P. Br J Sports Med 2004; 38(2): 238-239.
Correspondence: Caroline Finch,University of New South Wales, NSW Injury Risk Management Research Centre, Sydney 2052, AUSTRALIA; (email: c.finch@unsw.edu.au).
OBJECTIVE: To ascertain the reasons behind players not participating in a sports safety research project.
METHODS: During the preseason, 10 Australian football clubs volunteered 23 teams to participate in a protective equipment randomised controlled trial, the Australian Football Injury Prevention Project (AFIPP). All players from these teams were invited to participate. Players who did not agree to participate in AFIPP were surveyed about their reasons for non-involvement.
FINDINGS: 110 football players (response rate 63.6%) completed the non-responder survey and cited the two main reasons behind non-involvement in the project as "I did not know about the project" (39.4%) and "I was not at training when the research team visited" (36.5%).
COMMENTS: Preseason may not be the best time for maximal player recruitment in community based sports safety research. Enhanced communication between researchers and players at community level football clubs during the recruitment phase is likely to improve response rates.
Many thermal injuries are minor and can be effectively treated in a primary care setting. A cross-sectional survey was conducted to examine how emergency department physicians care for minor burns in the Canadian province of Ontario. Respondents were provided with a colour photograph of a patient with a minor burn and asked to comment about history, physical examination, investigations, treatment plan and follow-up care. A 37% response rate was attained (141/380). Of all respondents, 70% failed to record the burn extent, and 45% failed to discuss analgesia. No significant differences existed between emergency physicians in teaching and non-teaching hospitals ( [Formula: see text] ), with the exception that teaching hospital physicians referred significantly more to burn centres ( [Formula: see text] ). This suggests that educational interventions focussing on burn extent, pain control and referral criteria may be beneficial to emergency physicians.
Burn injuries in children with attention-deficit/hyperactivity disorder.
Correspondence: R. S. Mangus, Department of Surgery, School of Medicine, Indiana University, Emerson Hall, 545 Barnhill Drive, Indianapolis, IN 46202, USA; (email: unavailable).
OBJECTIVE: Children with attention-deficit/hyperactivity disorder (ADHD) are at increased risk for traumatic injury than non-ADHD-children. Burn injuries in ADHD-children have not been studied. This study was conducted to determine differences in burn injuries between these groups.
METHODS: The charts of all children ages 5-18, admitted over a 7-year period to a single regional pediatric burn center, were reviewed. ADHD-children were compared to non-ADHD-children regarding age and gender, type and extent of burn, and burn injury outcome.
FINDINGS: There were 278 children included, 35 (13%) having ADHD. ADHD-children were more likely male but did not differ in age compared to non-ADHD-children. ADHD-children were more likely to experience a thermal rather than flame burn (83% versus 58% thermal, [Formula: see text] ) and had more extensive burn injury (10% versus 5% median TBSA, [Formula: see text] ). The ADHD group had a longer length of stay (11 versus 7 days, [Formula: see text] ) and was less likely to be discharged to home (86% versus 93%, [Formula: see text] ).
COMMENTS: ADHD-children do differ from non-ADHD-children in their pattern and extent of burn injury. The impulsivity and vigilance deficits that characterize ADHD may place these children at higher risk for specific types of burn injuries.
OBJECTIVES: To describe the epidemiology of injuries among children in Karachi, Pakistan.
STUDY DESIGN: Retrospective case series.
METHODS: Data on children aged < or =15 years who were injured between October 1993 and January 1996 were extracted from the logs of the main provider of emergency medical transportation, and were classified according to the World Health Organization's basic data set for information on injuries.
FINDINGS: We identified 1320 cases of injuries in children < or =15 years old. The major causes were: motor vehicle crashes (MVC) (80%), falls other than from vehicles (5%), burns (5%) and drowning (3%). One in six of these children (15%) died either at the scene of the accident or during transportation to the hospital. The majority of deaths were either due to MVCs (67%) or drowning (18%) Large vehicles (buses, minibuses and trucks) were involved in 54% of all childhood road traffic injuries. Almost one-third (33%) of burns took place in the kitchen at home, and half (51%) of all drowning cases occurred in the sea.
COMMENTS: The majority of children transported by the ambulance service were male and were victims of MVCs. Prevention efforts aimed at stricter enforcement of driving laws and family/child education geared towards pedestrian safety could potentially reduce morbidity and mortality. This study also highlights the role of the prehospital transport system in injury surveillance.
Youth risk behaviour in a Chinese population: a territory-wide youth risk behavioural surveillance in Hong Kong.
- Lee A, Tsang CK. Public Health 2004; 118(2): 88-95.
Correspondence: A. Lee, Centre for Health Education and Health Promotion, and Healthy Schools Program, School of Public Health, The Chinese University of Hong Kong, 4th Floor, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, CHINA; (email: alee@cuhk.edu.hk).
This cross-sectional study investigated the prevalence rates of different categories of youth risk behaviour by age, sex and parental education. The study population consisted of 26,111 Hong Kong students, aged 10-19 years, recruited from 48 primary (primary grades 4-6) and secondary schools (secondary grades 1-7). Less than one-third of subjects participated in vigorous exercise regularly, about one-third consumed an unhealthy diet frequently, 18% had tried smoking, and 14.5% had seriously considered attempting suicide. Although only 3.4% of students reported experience of sexual intercourse, less than half used a contraceptive device. Older students had higher prevalence rates of health-compromising behaviours than younger students. Female students were more likely to report suicide-related behaviour, attempting weight loss, and non-participation in vigorous physical activities. Students with parents of a lower educational background were more likely to report rarely or never wearing seat belts and bicycle helmets, suicide-related behaviour, smoking, sexual intercourse before 13 years of age, and attempting weight loss. The availability of data on youth health risk behaviours would enable health educators, public health practitioners and clinicians to plan appropriate screening and counselling for risk behaviours in early adolescents.
Operational characteristics of tractors driven by children on farms in the United States and Canada.
- Marlenga B, Pickett W, Berg RL, Murphy D. J Agric Saf Health 2004; 10(1): 17-25.
Correspondence: Barbara Marlenga, National Children's Center for Rural and Agricultural Health and Safety, Marshfield Clinic Research Foundation, 1000 North Oak Avenue, Marshfield, WI 54449, USA; (email: marlenga.barbara@mcrf.mfldclin.edu).
Farm tractors are an important source of traumatic injury for children on farms. There is, however, no documentation about the age and size of tractors that children are operating and little information about the frequency with which rollover protective structures (ROPS) are used. This study described tractors that children on farms in the U.S. and Canada were operating by age, horsepower, and the presence of ROPS, according to the age and gender of the farm children involved. As a sub-analysis of data compiled during a randomized controlled trial, a descriptive analysis was completed on work exposure data collected by telephone interview. Of the 1,113 children involved in the trial, 522 (47%) were reported to perform at least one job that involved the operation of a farm tractor, and 408 (36.7%) were operating tractors of at least 20 horsepower. The majority of these children were male. There was a wide range of ages and sizes of tractors operated. However, the majority of tractors were between 20 and 70 horsepower and manufactured after 1970. Nearly one-half of the tractors were equipped with ROPS, and these tended to be newer and larger tractors. This analysis provides new data about the broad range of tractors driven by farm children in the U.S. and Canada. The findings point to a need to re-examine the reliance on a single voluntary standard to mitigate the hazard of tractor rollovers and the need for an enhanced safety policy requiring all tractors operated by children be equipped with ROPS.
Knowledge of sleep in Italian high school students: pilot-test of a school-based sleep educational program.
- Cortesi F, Giannotti F, Sebastiani T, Bruni O, Ottaviano S. J Adolesc Health 2004; 34(4): 344-351.
Correspondence: Flavia Cortesi, Center of Pediatric Sleep Disorders, Department of Developmental Neurology and Psychiatry, University of Rome"La Sapienza," Rome, ITALY; (email: flavia.cortesi@uniroma1.it).
OBJECTIVE: To evaluate knowledge about sleep and the effect of a sleep educational program on a group of Italian adolescents.
METHODS: The program consisted of a 2-hour interactive sleep educational course. To assess students' sleep patterns and habits, the School Sleep Habits Survey was completed by 540 students, aged 17 to 19 years, who were attending three secondary public schools. Students were randomly assigned to the control and intervention group. Only the latter participated in the educational program. A pre-test evaluated baseline knowledge about sleep, a post-test measured the gain in knowledge after the course, and a 3-month follow-up test evaluated long-term retention of information. Improvement in knowledge was measured by increase in correct answers and comparisons of means between baseline and follow-up mean scores. Control group completed only baseline and 3-month follow-up tests. Data were analyzed using repeated measures analysis of variance, Cochran Q, and McNemar tests.
FINDINGS: Paired data were available for 425 students. Results showed unhealthy sleeping habits in 34% of students associated with high level of subjective sleepiness, increased vulnerability to injuries, and poor daytime functioning. Pre-test score showed a value of 4.2, post-test of 8.6 and 3-month follow-up of 6.7. Low baseline knowledge about sleep, an increase in knowledge, with an average of 50% gain in the percentage of correct answers immediately after the course, with a good long-term retention of information were found for the students who received the intervention as compared with control group.
COMMENTS: Sleep educational programs for secondary students are recommended to improve information about sleep.
This study tested a 3-month ankle-strengthening and walking program designed to improve or maintain the fall-related outcomes of balance, ankle strength, walking speed, risk of falling, fear of falling, and confidence to perform daily activities without falling (falls efficacy) in elderly nursing home residents. Nursing home residents (N = 81) between the ages of 64 and 100 years participated in the study. Two of the fall-related outcomes, balance and fear of falling, were maintained or improved for the exercise group in comparison to the control group.
In response to the NHS Plan, crisis and home treatment teams will be developed across the UK in order to provide intensive home treatment as an alternative to inpatient admission for individuals with severe, acute mental health problems. This study describes aspects of the work of two teams in Hertfordshire. A total of 293 individuals were taken on for intensive home treatment in a 12-month period. A range of social and demographic variables was recorded at the point of initial assessment regarding each individual, as well as two rating scales: the Brief Psychiatric Rating Scale and the Scale for Suicide Ideation. Sixty-two individuals (21.1%) required admission to hospital after a median period of home treatment of 11 days. The most frequently recorded reason for admission taking place was 'risk to self' (n = 33, 53.2%). Two variables were identified by logistic regression analysis as being predictive of an increased risk of hospitalization: high suicidal ideation at initial assessment (P < 0.01) and previous hospital admission (P < 0.01). Although statistically significant, these variables were only weakly predictive of whether admission would actually take place.
"Near-fatal" deliberate self-harm: characteristics, prevention and implications for the prevention of suicide.
- Douglas J, Cooper J, Amos T, Webb R, Guthrie E, Appleby L. J Affect Disord 2004; 79(1-3): 263-268.
Correspondence: Louis Appleby, Centre for Suicide Prevention, University of Manchester, Manchester M13 9PL, UK; (email: louis.appleby@man.ac.uk).
BACKGROUND: There have been few studies of the most serious cases of deliberate self-harm (DSH). These cases represent an important clinical problem. They may also be suitable as a "proxy" for suicide in research studies.
METHOD: We developed a definition of "near-fatal" deliberate self-harm (NFDSH) and identified all cases attending accident and emergency departments in an urban area during an 18-month period. We compared them to less severe DSH on social and clinical characteristics, and examined their initial clinical management. We compared their age and gender profile with that of completed suicides. NFDSH cases who agreed to be interviewed were asked about their experiences of seeking help and their views on prevention of suicide.
FINDINGS: 158 cases were identified, 8% of all DSH. The most common method of self-harm was self-poisoning. The most common psychiatric diagnosis was depression. Compared to less severe DSH, near-fatal cases had higher rates of several social and clinical risk factors for suicide and showed evidence of greater suicidal intent. Forty-one percent were allowed home following assessment. Most admissions lasted 2 days or less. The age and gender profile was closer to that of suicide than in DSH generally. Few subjects agreed to be interviewed; those who did described poor previous experiences of services.
LIMITATIONS: We did not assess each case of DSH individually but applied a workable definition of NFDSH. Firm conclusions cannot be drawn from the qualitative part of the study because of the low rate of agreement to interview.
COMMENTS: NFDSH is an important clinical phenomenon associated with indicators of high suicide risk. This high risk is frequently not reflected in clinical management. Further studies of NFDSH could contribute to what is known about suicide prevention but the reluctance of NFDSH subjects to be interviewed may be a difficulty for future research.
Emergency department management of suicidal adolescents.
- Kennedy SP, Baraff LJ, Suddath RL, Asarnow JR. Ann Emerg Med 2004; 43(4): 452-460.
Correspondence: Larry J. Baraff, University of California - Los Angeles Emergency Medicine Center, 924 Westwood Boulevard, Suite 300, Los Angeles, CA 90024, USA; (email: lbaraff@ucla.edu).
Suicide is the third leading cause of death for youths aged 15 to 24 years in the United States. Approximately 2 million US adolescents attempt suicide each year, and 19% report serious consideration of suicide in the past year. Although suicidal adolescents are frequently treated in emergency departments (EDs), there are few publications about their ED management. Therefore, we reviewed the literature for recommendations for the management of adolescents with suicidal ideation or attempts. Hospitalization is recommended for adolescents who have attempted suicide and cannot be adequately monitored and kept safe outside of an inpatient setting. Discharge home can be considered for a subset of adolescents with suicidal thoughts if urgent follow-up mental health care can be ensured and responsible caregivers can adequately supervise and protect the youth. This subset includes adolescents who are not actively suicidal, do not have access to lethal methods, and have a supervising adult who can closely monitor their behavior. A mental health evaluation is recommended before ED discharge whenever feasible.
Suicide risk in small areas in England and Wales, 1991-1993.
Correspondence: Nicos Middleton, Dept. of Social Medicine, University of Bristol Canynge Hall, Whiteladies Road, BS8 2PR, Bristol, UK; (email: nicos.mitletton@bristol.ac.uk).
BACKGROUND: There is growing evidence that areas characterised by high levels of social fragmentation have higher suicide rates. Previous ecological studies have focused on relatively large geographic areas and/or examined associations in all age groups combined.
METHODS: Negative binominal regression was used to assess age- and sex-specific suicide rate ratios for a range of census-derived indicators of the social, health and economic characteristics of small areas (mean population aged > or = 15: 4500) in England and Wales.
FINDINGS: Indicators of social fragmentation (e. g. proportion of people living alone or population mobility) were most consistently associated with suicide risk. For example, across quartiles of wards ranked according to increasing proportions of single-person households, age- and sex-adjusted suicide rate ratios were: 1.00, 1.05 (1.00, 1.11), 1.14 (1.08, 1.19) and 1.42 (1.36, 1.49). Associations were strongest in 15 to 44 and 45 to 64 year-olds. Associations with social fragmentation persisted after controlling for the effect of other area characteristics.
COMMENTS: Targeted mental health promotion and social policy initiatives to reduce area-health inequalities in suicide might usefully focus on areas with high levels of social fragmentation.
Road traffic accidents are considered to be the second highest cause of mortality in Iran. A study was conducted to describe road-traffic-related mortality data in Iran in a given period. All Iranian mortality data on road traffic accidents between March 1999 and 2000 (one complete Iranian calendar year) were obtained. The main variables studied were deceased's gender, age, education level, status (i.e. driver, car occupant, etc.), cause and place of death. A total of 15?482 individuals died from road traffic accidents in Iran in the study period. A disproportionate number of deceased individuals were male (79%), mostly aged 40 years or less (65%), and who were pedestrians or car occupants (62%). Head injury was the most common cause of road-traffic-related mortality (66%) in males and females of all ages. Following road traffic accidents, 57% of deaths occurred pre-hospital. Head injury is the most common single cause of mortality attributable to road traffic accidents in Iran, and since most deaths occur pre-hospital, it seems many are preventable. To overcome this major public health problem,there is an urgent need to develop a comprehensive injury control policy and strategy in Iran.
A matched case-control study evaluating the effectiveness of speed humps in reducing child pedestrian injuries.
- Tester JM, Rutherford GW, Wald Z, Rutherford MW. Am J Public Health 2004; 94(4): 646-650.
Correspondence: June M Tester, University of California, San Francisco, USA; (email: junetester@post.harvard.edu).
OBJECTIVES: We evaluated the protective effectiveness of speed humps in reducing child pedestrian injuries in residential neighborhoods.
METHODS: We conducted a matched case-control study over a 5-year period among children seen in a pediatric emergency department after being struck by an automobile.
FINDINGS: A multivariate conditional logistic regression analysis showed that speed humps were associated with lower odds of children being injured within their neighborhood (adjusted odds ratio [OR] = 0.47) and being struck in front of their home (adjusted OR = 0.40). Ethnicity (but not socioeconomic status) was independently associated with child pedestrian injuries and was adjusted for in the regression model.
COMMENTS: Our findings suggest that speed humps make children's living environments safer.
Rail traffic accidents: a retrospective study.
- Rautji R, Dogra TD. Med Sci Law 2004; 44(1): 67-70.
Correspondence: Ravi Rautji, Department of Forensic Medicine and Toxicology, AIIMS, New Delhi, 110029, INDIA; (email: rautjiravi@hotmail.com).
One hundred and twenty-seven autopsy cases of rail traffic accidents received from South Delhi were studied during the period from 1996-2002. Data for the study was gathered from autopsy reports and hospital records. The cases represented approximately 1.41% of all autopsy cases received from South Delhi at the All India Institute of Medical Sciences, New Delhi (India). Data was analysed with regard to the age and sex of the victim, the part of the body involved and the pattern of injuries in different body regions. Death occurred at the scene of the fatal event in twenty-eight cases; another twenty-eight cases were brought in dead to the hospital. Seventy-one cases died after being admitted to the hospital. Ethanol was detected in the blood of 17.4% of cases.
Injury diagnosis quality of life among motorcyclists, victims of traffic accidents.
This study characterizes motorcyclists living at Maringa-Parana-Brazil, who were victims of traffic accidents and were attended in hospitals for trauma treatments. The injured have been characterized according to trauma severity, body regions affected and the body region with the most serious injury, besides identifying possible differences in the quality of life of the victims who developed traumatic brain injury. While the Injury Severity Score was used to evaluate trauma severity, the Medical Outcomes Study 36-Item Short Form Health Survey was applied to assess the victims' quality of life. With respect to trauma severity, victims with mild injuries (73.14%) were predominant. Most victims (59.70%) were injured in the lower members of the body, followed by injuries in the upper ones (58.21%) and in the head (31.34%). Limbs were most affected when compared to other body regions. There was no difference in the quality of life of post-trauma victims with or without cranium-encephalic trauma.
There has been an apparent shift in majority opinion within psychiatry over the last 20 years on the nature of the relationship between mental illness and violence. Where once there was perhaps widespread scepticism, research, while sometimes producing conflicting results, appears ultimately to have led to the emergence of an almost universal consensus that there is a link. This paper will review the nature of the evidence for such a link between mental illness and violence and explore some of the newer suggestions about why mental illness may sometimes be related to violence.
Informal social support interventions and their role in violence prevention: an agenda for future evaluation.
There is increasing interest among policymakers and practitioners in tapping the potential of family, friends, volunteers, peer support groups, and mutual aid organizations to help prevent violence. The popularity of these informal social support (ISS) interventions stems, in part, from their flexibility, responsiveness to individual needs, and perceived low cost. However, there is still limited understanding of whether and how ISS interventions can improve social support, reduce violence, or save money. Furthermore, mobilizing and sustaining ISS interventions appears to be difficult, particularly for families living in high-risk environments. Rigorous and creative evaluations of ISS interventions are needed to inform policy decisions and refine program development and implementation. Focusing on the field of child maltreatment, we describe different kinds of ISS interventions and outline an evaluation agenda that includes core research questions and evaluation challenges and strategies.
Advancing prevention research on child abuse, youth violence, and domestic violence: emerging strategies and issues.
Prevention research on the related problems of child abuse, youth violence, and domestic violence has grown at an accelerating pace in recent years. In this context, a set of shared methodological issues has emerged as investigators seek to advance the interpersonal violence prevention knowledge base. This article considers some of the persistent methodological issues in these areas and points out emerging research strategies that are forging advances in garnering valid, rigorous, and useful knowledge to prevent interpersonal violence. Research issues and emerging strategies in three key domains of prevention research are considered, including complexities in validly conceptualizing and measuring varying forms of violence as specific targets for preventive intervention, research issues and strategies designed to reliably predict and identify future violence risk to be targeted by preventive intervention, and research issues and emerging strategies in the application of empirical methods to forge specific advances in preventive intervention strategies themselves.
Predictors of future fight-related injury among adolescents.
Correspondence: Iris Wagman Borowsky, Division of General Pediatrics and Adolescent Health, University of Minnesota, Minneapolis, Minnesota 55455-2002, USA; (email: borow004@umn.edu).
OBJECTIVE: Nonfatal fight-related injuries among youths result in lost capacity and high costs of medical care and rehabilitation and constitute a major public health problem. This study identifies factors that predict the occurrence of a fight-related injury that requires medical attention among boys and girls.
METHODS: We analyzed data from 14 787 adolescents who completing 2 interviews, approximately 1 year apart, in the National Longitudinal Study of Adolescent Health, a nationally representative, school-based sample of youths. We identified time 1 factors at the community, family, and individual levels that predicted any self-reported fight-related injury that required medical treatment at time 2.
FINDINGS: Factors that predict future injury among both boys and girls in multivariate models were violence-related factors: witnessing or being a victim of violence (odds ratio [OR]: 3.69; 95% confidence interval [CI]: 1.81-7.49 for boys; OR: 5.13; 95% CI: 1.25-21.09 for girls), history of a violence-related injury (OR: 2.30; 95% CI: 1.60-3.29 for boys; OR: 3.18; 95% CI: 1.87-5.41 for girls), and physical fighting (OR: 2.02; 95% CI: 1.44-2.84 for boys; OR: 5.15; 95% CI: 3.18-8.34 for girls). Among boys, illicit drug use was also an independent predictor of future injury (OR: 1.72; 95% CI: 1.24-2.37), whereas excellent perceived general health (OR: 0.48; 95% CI: 0.25-0.93) and a high grade point average (OR: 0.52; 95% CI: 0.29-0.95) were significant protective factors against fight-related injury. Girls who reported a high level of depressive symptoms were much more likely to report fight-related injury than nondepressed girls (OR: 8.98; 95% CI: 2.43-33.25).
COMMENTS: Factors related to violence, substance use, school achievement, and physical and mental health predicted a future fight-related injury that required medical treatment. The results could assist health and social service providers, educators, and others in identifying youths who are at high risk for fight-related injury and may benefit from appropriate intervention.
Grassroots advocacy for gun violence prevention: a status report on mobilizing a movement.
Correspondence: S. Frattaroli, The Johns Hopkins Bloomberg School of Public Health, Center for Gun Policy and Research, Baltimore, Maryland 21205-1996, USA; (email: sfrattar@jhsph.edu).
The recent experience of gun violence prevention advocates with building an active, engaged grassroots holds important lessons for the future of gun violence prevention. However, formal research methods are rarely used to examine the role of grassroots advocacy efforts within public health. In order to assess the state of the grassroots gun violence prevention movement, learn from their experiences, and understand the challenges they face, the author conducted qualitative, semi-structured interviews with eighteen leaders in the gun violence prevention community. The author then assessed the findings from the analysis of interview data within a social health movement framework, and developed recommendations for addressing the identified challenges. Results from this study provide insight into the state of U.S. grassroots gun violence prevention efforts prior to 2001. Grassroots advocacy efforts represent an important, influential component of injury prevention and public health. Understanding the perspective of the grassroots, their contribution to the field, and the challenges to such efforts is critical to ensuring a connection among the research, practice, policy and education efforts aimed at reducing injuries and violence.
Assessing the long-term effects of the Safe Dates program and a booster in preventing and reducing adolescent dating violence victimization and perpetration.
- Foshee VA, Bauman KE, Ennett ST, Linder GF, Benefield T, Suchindran C. Am J Public Health 2004; 94(4): 619-624.
Correspondence: Vangie Foshee, Department of Health Behavior and Health Education, School of Public Health, University of North Carolina at Chapel Hill, 27599-7440, USA; (email: foshee@email.unc.edu).
OBJECTIVES: This study determined 4-year postintervention effects of Safe Dates on dating violence, booster effects, and moderators of the program effects.
METHODS: We gathered baseline data in 10 schools that were randomly allocated to a treatment condition. We collected follow-up data 1 month after the program and then yearly thereafter for 4 years. Between the 2- and 3-year follow-ups, a randomly selected half of treatment adolescents received a booster.
FINDINGS: Compared with controls, adolescents receiving Safe Dates reported significantly less physical, serious physical, and sexual dating violence perpetration and victimization 4 years after the program. The booster did not improve the effectiveness of Safe Dates.
COMMENTS: Safe Dates shows promise for preventing dating violence but the booster should not be used.
Mental illness in people who kill strangers: longitudinal study and national clinical survey.
- Shaw J, Amos T, Hunt IM, Flynn S, Turnbull P, Kapur N, Appleby L. BMJ 2004; 328(7442):734-737.
Correspondence: Jennifer J. Shaw, National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Suicide Prevention, School of Psychiatry and Behavioural Sciences, University of Manchester, Manchester M13 9PL, UK; (email: Jennifer.J.Shaw@man.ac.uk).
OBJECTIVES: To establish changes over time in the frequency of homicides committed by strangers, and to describe the personal and clinical characteristics of perpetrators of stranger homicides. DESIGN: Longitudinal study and national clinical survey. PARTICIPANTS: People convicted of homicide in England and Wales between 1996 and 1999 and whether the victim was known to the perpetrator. SETTING: England and Wales. MAIN OUTCOME MEASURE: Characteristics of perpetrators of homicides according to whether victims were strangers or not. RESULTS: Stranger homicides increased between 1967 and 1997, both in number and as a proportion of all homicides. No increase was found, however, in the number of perpetrators placed under a hospital order after homicide, whether all homicides or stranger homicides only. 358 of 1594 (22%) homicides were stranger homicides. In these cases the perpetrator was more likely to be male and young. The method of killing was more likely to be by hitting, kicking, or pushing (36% (130 of 358) for victims who were strangers to the perpetrator compared with 14% (145 of 1074) for victims who were known). Perpetrators were less likely to have a history of mental disorder (34%, n = 80 nu 50%, n = 142), a history of contact with mental health services (16%, 37 of 234 nu 24%, 200 of 824), and psychiatric symptoms at the time of the offence (6%, n = 14 nu 18%, n = 143). They were more likely to have a history of drug misuse (47%, n = 93 nu 37%, n = 272); alcohol (56%, n = 94 nu 41%, n = 285) or drugs (24% n = 44 nu 12%, n = 86) were more likely to have contributed to the offence. CONCLUSIONS: Stranger homicides have increased, but the increase is not the result of homicides by mentally ill people and therefore the "care in the community" policy. Stranger homicides are more likely to be related to alcohol or drug misuse by young men.
