Metropolitan-area estimates of binge drinking in the United States.
- Nelson DE, Naimi TS, Brewer RD, Bolen J, Wells HE. Am J Public Health 2004; 94(4): 663-671.
Correspondence: David E. Nelson, Centers for Disease Control and Prevention, 4770 Buford Hwy, NE, Mail Stop K-50, Atlanta, GA 30341, USA; (email: den2@cdc.gov).
OBJECTIVE: We estimated adult binge drinking prevalence in US metropolitan areas.
METHODS: We analyzed 1997 and 1999 Behavioral Risk Factor Surveillance System data for 120 metropolitan areas in 48 states and the District of Columbia.
FINDINGS: The prevalence of binge drinking varied substantially across metropolitan areas, from 4.1% in Chattanooga, Tenn, to 23.9% in San Antonio, Tex, (median = 14.5%). Seventeen of the 20 metropolitan areas with the highest estimates were located in the upper Midwest, Texas, and Nevada. In 13 of these areas, at least one third of persons aged 18 to 34 years were binge drinkers. There were significant intrastate differences for binge drinking among metropolitan areas in New York, Tennessee, and Utah.
Alcohol use among adolescents and adults--New Hampshire, 1991-2003.
Alcohol abuse is the third leading preventable cause of death in the United States. Because binge and heavy drinking increase the risk for cirrhosis, cancer, heart disease, stroke, injury, and depression, public health efforts have focused on reducing these patterns of alcohol use. The Council of State and Territorial Epidemiologists, the Association of State and Territorial Chronic Disease Program Directors, and CDC developed Indicators for Chronic Disease Surveillance, which provides a standard set of measures for alcohol surveillance. The New Hampshire Department of Health and Human Services used these measures to facilitate statewide trend analysis of alcohol use among adolescents and adults. This report summarizes the results of that analysis, which indicated that, in 2003, a total of 30.6% of adolescents reported binge drinking. In 2001, a total of 15.8% of adults reported binge drinking, and 6.3% reported heavy drinking. Interventions are needed to prevent adolescent drinking and to reduce excessive alcohol use among adults.
Progress report on the development of child abuse prevention, identification, and treatment systems in Eastern Europe.
- Lewis O, Sargentd J, Chaffin M, Friedrich WN, Cunningham N, Cantor P, Coffey PS, Villani S, Beard PR,Clifft MA, Greenspun D and The Network Child Abuse Prevention and Treatment Program. Child Abuse Negl 2004; 28(1): 93-111.
Correspondence: Owen Lewis, The Children's Mental Health Alliance, New York, NY, USA; (email: unavailable).
OBJECTIVE: After the Soviet Union dissolved in 1989, it became apparent that there was little recognition of the problems of child abuse and neglect, professionally, legally, or societally. There were no effective systems or laws in place to deal with these problems.
METHODS: Beginning in 1995 the Children's Mental Health Alliance, in conjunction with the Open Society Institute began conducting trainings in Eastern Europe [Journal of the American Academy of Child Adolescent Psychiatry 39 (2000) 660]. Originally 18 countries from the Baltics to the Balkans participated. A program was elaborated which would proceed in several stages: (1) training mental health professionals to deal with child abuse and neglect (CAN); (2) teaching multidisciplinary team work and fostering the development of multidisciplinary NGOs focused on CAN; (3) promoting the self-sufficiency of these NGO's which would then facilitate social and legal reform and increase public awareness of the problem. Specific methods included multi-national trainings, assignment of mentors to the developing teams who maintained weekly contact with the teams and made yearly site visits to their countries, and overseeing project grants from OSI.
FINDINGS: NGO's had been established and registered in 11 countries, many establishing a network of programs within their countries. By 2000, over 3800 mental health professional had been trained, either directly by the program or by the trainees of the program. By the end of 2000, over 17,000 other professionals (lawyers, police, judges, educators, other physicians, etc.) had been trained by the network.
COMMENTS: While more work needs to be in this region, the teams in 11 countries have made solid starts.
BACKGROUND: Although social inequality in health has been an argument for community-based injury prevention programmes, intervention outcomes with regard to differences in social standing have not been analysed. The objective of this study was to investigate rates of injuries treated in health-care among members of households at different levels of labour market integration before and after the implementation of a WHO Safe Community programme.
METHODS: A quasi-experimental design was used with pre- and post-implementation data collection covering the total populations <65 years of age during one year in the programme implementation municipality (population 41,000) and in a control municipality (population 26,000). Changes in injury rates were studied using prospective registration of all acute care episodes with regard to social standing in both areas during the study periods.
FINDINGS: Male members of households categorized as not vocationally active displayed the highest pre-intervention injury rates. Also after the intervention, males in households classified as not vocationally active displayed notably elevated injury rates in both the control and study areas. Households in the study area in which the significant member was employed showed a post-intervention decrease in injury rate among both men (P < 0.001) and women (P < 0.01). No statistically significant change was observed in households in which the significant member was self-employed or not vocationally active. In the control area, only an aggregate-level decrease (P < 0.05) among members of households in which the significant member was employed was observed.
COMMENTS: The study displayed areas for improvement in the civic network-based WHO Safe Community model. Even though members of non-vocationally active households, in particular men, were at higher pre-intervention injury risk, they were not affected by the interventions. This fact has to be addressed when planning future community-based injury prevention programmes.
Estimating capacity requirements for mental health services after a disaster has occurred: a call for new data.
- Siegel CE, Laska E, Meisner M. Am J Public Health 2004; 94(4): 582-585.
Correspondence: Carole E. Siegel, Epidemiology and Health Services Research Laboratory, Nathan S. Kline Institute for Psychiatric Research, 140 Old Orangeburg Rd, Orangeburg, NY 10962 (email: siegel@nki.rfmh.org).
OBJECTIVES: We sought to estimate the extended mental health service capacity requirements of persons affected by the September 11, 2001, terrorist attacks.
METHODS: We developed a formula to estimate the extended mental health service capacity requirements following disaster situations and assessed availability of the information required by the formula.
RESULTS: Sparse data exist on current services and supports used by people with mental health problems outside of the formal mental health specialty sector. There also are few systematically collected data on mental health sequelae of disasters.
COMMENTS: We recommend research-based surveys to understand service usage in non-mental health settings and suggest that federal guidelines be established to promote uniform data collection of a core set of items in studies carried out after disasters.
In the present paper the literature bearing on the association between sleepiness and driving is reviewed and the current state of prevention is discussed. Sleepiness may be a factor in about 20% of motor vehicle accidents and studies carried out in controlled environments suggest that the most common changes in driving performance attributable to sleepiness include increased variability of speed and lateral lane position. Higher-order functions including judgement and risk taking may also deteriorate. Moreover, prolonging wakefulness even by a few hours may produce deterioration in driving performance comparable to that seen in drivers with blood alcohol concentrations at levels deemed dangerous by legislation. The majority of prevention efforts to date have focussed on short-term solutions that only mask underlying sleepiness and it is suggested that more emphasis be directed toward primary prevention efforts such as educating drivers about the importance of getting sufficient sleep and avoiding circadian performance troughs. Finally, the important role that health professionals can play in the identification, treatment, and education of sleepy drivers is highlighted.
OBJECTIVE: The objectives of our study were to assess biomechanics associated with feet-first free falls in 3-year-old children and to investigate the influence of impact surface type and fall height on key biomechanical measures associated with injury risk.
METHODS: Repeatable feet-first free fall experiments were conducted in a laboratory mock-up environment using an instrumented Hybrid II 3-year-old test dummy. Impact surface type and fall height were varied to examine their influence on biomechanical measures.
FINDINGS: Feet-first falls from short distances (27in.) (0.69m) were found to have a low risk of contact-type head injury, regardless of impact surface type. When comparing different types of impact surfaces in a 27in. (0.69m) fall, head acceleration associated with falls onto playground foam was significantly less than that associated with falls onto wood, linoleum or padded carpet. For falls onto playground foam, femoral compressive loads and bending moments were found to significantly increase as fall height increased.
COMMENTS: Impact surface type and fall height were found to influence biomechanics associated with injury risk in feet-first free falls as assessed through experimental mock-ups using an instrumented child test dummy. Feet-first falls from short distances (27in.) (0.69m) were associated with a low risk of contact-type head injury as assessed using HIC, irrespective of impact surface type.
- Horrocks AR, Nazare S, Kandola B. Fire Saf J 2004; 39(4): 259-276.
Correspondence: A. Richard Horrocks, The Centre for Materials Research and Innovation, Bolton Institute, Deane Road, Bolton BL3 5AB, UK; (email: arhl@bolton.ac.uk).
This work examines the pre- and post-UK Nightwear (Fire) (Safety) Regulation (1965 and 1985) trends in available UK fire and burns statistics. Retrospective analysis of the pre-regulation statistics and prospective analysis of the post-regulation statistics indicates that clothing fire fatalities have fluctuated about an almost constant level since the early 1980s. Major conclusions of this study are similar to those of previous studies in the UK and the US in that the very young and very old are at greatest risk, with females involved in 55% of the incidences and loose-fitting garments posing the highest risk. Currently national and international standards for flammability of nightwear garments have been reviewed and reported. Published and unpublished UK fire statistics of clothing-related fire incidences have been collated and evaluated. Finally, potential textile hazards and factors contributing to burn injuries and deaths in which clothing items are involved are reviewed.
Parental awareness regarding childhood injuries.
- Sehgal A, Jain S, Jyothi MC. Indian J Pediatr 2004; 71(2): 125-128.
Correspondence: A. Sehgal, Department of Neonatal Intensive Care, Royal Hospital for Women & Sydney Children's Hospital, South Eastern Sydney Area, Health Service, Sydney, New South Wales, AUSTRALIA; (email: unavailable).
OBJECTIVE: To assess parental awareness regarding common childhood injuries and to focus on preventive issues.
METHODS: Two hundred parents of children each grouped into 2 attending OPD of government hospital and private clinic respectively were enrolled, interviewed and responses analyzed.
FINDINGS: The commonest potential mode of injuries identified in both groups was falls (53% vs 84%). None of the households in group 1 and less than 2/3rd in group 2 had provision of restraints at stairs. Awareness was found to be greater in the group with higher educational background and socioeconomic status.
COMMENTS: Awareness regarding common childhood injuries and their prevention was lacking. There was a felt need that the pediatricians must counsel the parents on this aspect during visits. Since the sample size is small, a larger community based study is needed.
OBJECTIVES: To focus on one possible predictor of reported work related injuries--the role of living in building-site camps versus daily commuting from home to construction sites.
METHODS: A cohort of construction workers was collected, based on personnel files from contractors involved in the building of the Great Belt Bridge. The files included information on employment periods and whether or not the employees lived in building-site camps. The cohort was followed up for injuries reported to the National Work Environment Authority.
FINDINGS: Construction workers living in camps reported 217 accidents, of which 24 were serious or fatal. Among those not living in camps we found 262 accidents, of which 29 were serious or fatal. The relative risk for all accidents for camp versus non-camp was 0.84 (95% CI 0.69 to 1.00). The respective figure for serious or fatal accidents was RR = 0.85 (95% CI 0.47 to 1.52).
COMMENTS: Results suggest that high accident rates at large construction sites may be reduced, if commuting is replaced by living on-site.
The relationship between workers' safety culture and accidents, near accidents and health problem.
Correspondence: Malgorzata Milczarek, Central Institute for Labour Protection-National Research Institute, ul. Czerniakowska 16, 00-701 Warsaw, POLAND; (email: mamil@ciop.pl).
One of the dimensions treated as part of a company's safety culture or climate is workers' attitudes towards risk and safety. In the present study these personal aspects are defined as workers' safety culture, which is understood as a way of acting focused on life and taking care of one's health. A questionnaire on safety culture was filled out by 200 employees of a metallurgical enterprise. Factor analysis was used to determine empirical scales of the questionnaire, whereas variance analysis was used to test hypotheses. The results confirmed the hypotheses that people who experienced accidents, dangerous situations, and--to a lesser extent--health problems had a lower level of safety culture. Nevertheless not all of the scales determined during factor analysis turned out to be significant as far as all kinds of those undesirable situations are concerned. Proposals for future studies are formulated in the conclusion.
Cost analysis of the built environment: the case of bike and pedestrian trials in Lincoln, Nebraska.
- Wang G, Macera CA, Scudder-Soucie B, Schmid T, Pratt M, Buchner D, Heath G. Am J Public Health 2004; 94(4): 549-553.
Correspondence: Guijing Wang, Division of Nutrition and Physical Activity, Centers for Disease Control and Prevention, 4770 Buford Hwy, Mail Stop K-46, Atlanta, GA 30341, USA; (email: gbw9@cdc.gov).
We estimated the annual cost of bike and pedestrian trails in Lincoln, Neb, using construction and maintenance costs provided by the Department of Parks and Recreation of Nebraska. We obtained the number of users of 5 trails from a 1998 census report. The annual construction cost of each trail was calculated by using 3%, 5%, and 10% discount rates for a period of useful life of 10, 30, and 50 years. The average cost per mile and per user was calculated. Trail length averaged 3.6 miles (range = 1.6-4.6 miles). Annual cost in 2002 dollars ranged from $25,762 to $248,479 (mean = $124,927; median = $171,064). The cost per mile ranged from $5,735 to $54,017 (mean = $35,355; median = $37,994). The annual cost per user was $235 (range = $83-$592), whereas per capita annual medical cost of inactivity was $622. Construction of trails fits a wide range of budgets and may be a viable health amenity for most communities. To increase trail cost-effectiveness, efforts to decrease cost and increase the number of users should be considered.
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, Children's Hospital Oakland, 747 52nd St, Oakland, CA 94609, 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.
OBJECTIVES: The authors sought to examine the nature of calls to poison information centers by adults ages 50 and over.
METHODS: The authors used data from the national Toxic Exposure Surveillance System and conducted a retrospective review of all cases reported to an American Association of Poison Control Centers Certified Regional Poison Information Center in 1998 and 1999 (N = 6,365).
FINDINGS: The results indicated that females' poison experiences were more likely the result of therapeutic error, adverse drug reactions, ingestions, and the acute-on-chronic class. The authors found that older age was inversely associated with acute class, suspected suicide, food poisoning, and inhalation and dermal exposures.
COMMENTS: Older adults are the greatest consumers of over-the-counter drugs, take multiple medications for various medical conditions, and are experiencing biological changes that affect drug metabolism. Older women may be at especially high risk because of high drug use. Poison prevention education should target older adults.
Correspondence: A.M. Carr, Department of Neurosurgery, Robert C. Byrd Health Sciences Center, West Virginia University, Morgantown, West Virginia, USA; (email: unavailable).
OBJECTIVE: The purpose of this study was to profile all-terrain vehicle crash victims with neurological injuries who were treated at a Level I trauma center.
METHODS: We retrospectively reviewed trauma registry data for 238 patients who were admitted to the Jon Michael Moore Trauma Center at the West Virginia University School of Medicine after all-terrain vehicle crashes, between January 1991 and December 2000. Age, helmet status, alcohol and drug use, head injuries, length of stay, disposition, and hospital costs were studied. Death rates, head injuries, age, helmet use, and safety legislation in all 50 states were compared.
FINDINGS: Eighty percent of victims were male, with an average age of 27.3 years. Only 22% of all patients were wearing helmets. Alcohol and/or drugs were involved in almost one-half of all incidents. Fifty-five of 238 patients sustained spinal axis injuries; only 5 were wearing helmets. One-third of victims (75 of 238 victims) were in the pediatric population, and only 21% were wearing helmets. Only 15% of victims less than 16 years of age were wearing helmets. There were a total of eight deaths; only one patient was wearing a helmet.
COMMENTS: In the United States, all-terrain vehicles caused an estimated 240 deaths/yr between 1990 and 1994, which increased to 357 deaths/yr between 1995 and 2000. Brain and spine injuries occurred in 80% of fatal crashes. West Virginia has a fatality rate approximately eight times the national rate. Helmets reduce the risk of head injury by 64%, but only 21 states have helmet laws. Juvenile passengers on adult-driven vehicles are infrequently helmeted (<20%) and frequently injured (>65%). We conclude that safety legislation would save lives.
Injuries in youth amateur soccer and rugby players-comparison of incidence and characteristics.
- Junge A, Cheung K, Edwards T, Dvorak J. Br J Sports Med 2004; 38(2): 168-172.
Correspondence: Schulthess Klinik, FIFA-Medical Assessment and Research Centre (F-MARC), Zurich, SWITZERLAND; (email: ajunge@kws.ch).
OBJECTIVES: In reviewing the literature on sports injuries, few studies could be found in which exposure related incidences of injury in different types of sport were compared. These studies indicated that ice hockey, handball, basketball, soccer, and rugby are popular team sports with a relatively high risk of injury. The aim of the study was to compare the characteristics and incidence of injuries in male youth amateur soccer and rugby players.
METHODS: This prospective cohort study comprised an initial baseline examination to ascertain the characteristics of the players and their level of performance, and a one season observation period during which a physician visited the team weekly and documented all occurring injuries. Twelve soccer and 10 rugby school teams with male amateur players aged 14-18 years were selected for the study. 145 soccer and 123 rugby players could be followed up over one season.
FINDINGS: Comparison of the incidence of soccer and rugby injuries indicated that rugby union football was associated with a significantly higher rate of injury than soccer. The differences were pronounced for contact injuries, injuries of the head, neck, shoulder, and upper extremity, as well as for concussion, fractures, dislocations, and strains. Rugby players incurred 1.5 times more overuse and training injuries in relation to exposure time, and 2.7 times more match injuries than soccer players. Three rugby players but no soccer players had to stop their participation in sport because of severe injury.
COMMENTS: The incidence of injury in New Zealand school teams playing soccer or rugby union is high, probably in part because of the low ratio of hours spent in training relative to hours spent playing matches. The development and implementation of preventive interventions to reduce the rate and severity of injury is recommended.
Epidemiology of wilderness search and rescue in New Hampshire, 1999-2001.
OBJECTIVE: To describe the epidemiology of wilderness search and rescue in a region with easily accessible, heavily used wilderness areas.
METHODS: We conducted a retrospective review of New Hampshire Fish and Game Department wilderness search-and-rescue reports between January 1999 and December 2001. The study group consisted of all the subjects of the New Hampshire Fish and Game Department search and rescue in the state of New Hampshire during the study period. Demographics, types of incidents, type and location of injuries, environmental factors, fatalities, and use of medical services for all the subjects were analyzed.
FINDINGS: Three hundred twenty-one incidents involving 457 subjects were analyzed. The mean age of the subjects in the incidents was 35.6 years, with 64.5% men and 35.4% women; 73% of the subjects resided in New Hampshire and Massachusetts. At the time of the incident, 57.3% of the subjects were hiking. Injuries precipitated 39.3% of the rescues, whereas lost and missing persons accounted for 41.4%. Fractures accounted for 33.7% of the reported injuries; 49.7% of the injuries were to the lower extremities. Sixty-four of the subjects (14%) died; 32.8% drowned, and 23.4% died from cardiac events. Volunteers were used in 53.3% of the rescues, a rescuer was injured in 2.5% of the incidents, and at least 36.4% of the subjects were transported to a hospital.
COMMENTS: The most prevalent demographic group requiring search-and-rescue efforts in New Hampshire was men aged 30 to 40 years who were hiking and who resided within a 4-hour drive of the area where they encountered difficulty. To decrease the number of people involved in most search and rescue, efforts should be focused on preventing wilderness users from getting lost and preventing lower extremity musculoskeletal injuries. Wilderness deaths may be prevented by focusing attention on cardiac health in wilderness users older than 50 years and on water safety.
Is risk of fast bowling injury in cricketers greatest in those who bowl most? A cohort of young English fast bowlers.
Correspondence: Peter Gregory, Centre for Sports Medicine, Orthopaedic and Accident Surgery, C Floor West Block, Queen's Medical Centre, University Hospital, Nottingham NG7 2UH, UK; (email: peter.gregory@nottingham.ac.uk).
OBJECTIVES: To determine whether young fast bowlers are exceeding directives limiting bowling and how incidence of fast bowling injury varies with amount of bowling.
METHODS: A prospective cohort study of injuries sustained by 70 fast bowlers (mean (SD) age 15.3 (2.4) years) was undertaken. Bowlers were recruited from the Centres of Excellence of three "First Class" counties in England in January 1998. Details of injuries were collected by telephone questionnaire every six weeks for six months from each bowler. The number of balls bowled in matches and practices by each bowler was recorded. The cohort was divided into groups according to the number of balls bowled in the study period, and bowling injury incidences were calculated for each group.
MAIN OUTCOME MEASURES: All injuries caused by bowling and interfering with bowling.
FINDINGS: Telephone follow up was achieved when planned on 97.9% of occasions. There were 23 bowling injuries reported in the study period that met the inclusion criteria. The overall incidence of bowling injury in the study period was 32.8 per 100 fast bowlers. The incidence of bowling injury for the 15 bowlers who bowled less than 1000 balls in the study period was 20.0 per 100 fast bowlers. The incidence for the 32 who bowled 1000-2000 balls was 37.5 per 100 fast bowlers. The incidence for the 14 who bowled 2000-3000 balls was 35.7 per 100. The incidence for the nine who bowled more than 3000 balls was 33.3 per 100.
COMMENTS: The expected increased incidence of bowling injury in young fast bowlers who bowl most was not observed, although more than 12% exceeded the recommended limit.
Ladder fall injuries are associated with a wide spectrum of injury patterns. However, the healthcare cost of these injuries is unknown. The aim of this study was to determine the healthcare cost and duration of the morbidity associated with ladder fall injuries. A retrospective observational study involving patients with ladder injuries who presented to a Level 1 Trauma Centre over a 3-year period was performed. Patients then underwent a structured telephone interview to provide information about the duration of their disability and unemployment. There were 72 patients in the study, of whom 89% were male. Thirteen patients (18%) required hospital admission. The median length and cost of hospital stay was 1 week and 3555 (US$ 3950), respectively. The median duration of disability and unemployment was 6 weeks. The longest duration of disability was associated with foot fractures. The majority of patients fell between 5 and 10ft, and fell at work. The upper extremity was the most commonly injured anatomical region. There were no fatalities. Ladder injury falls are expensive to the health service and may warrant investment in their prevention.
Epidemiology of major injury in the population of Friuli Venezia Giulia-Italy.
- Di Bartolomeo S, Sanson G, Michelutto V, Nardi G, Burba I, Francescutti C, Lattuada L, Scian F; The Regional Study-Group on Major Injury. Injury 2004; 35(4): 391-400.
Correspondence: Stefano Di Bartolomeo, Italian Resuscitation Council, Trauma Committee, c/o ICU 2nd Service, Az. Osp. SM della Misericordia, 33100 Udine, ITALY; (email: dibartolomeo.stefano@aoud.sanita.fvg.it).
OBJECTIVE: To provide reliable and comparable information on major injury (MIJ) (Injury Severity Score [Formula: see text] ) by establishing a comprehensive and Utstein-style compliant registry of all occurrences in a defined geographical area.
METHODS: Prospective, population-based, 12-month study targeting the 1,200,000 inhabitants of the Italian region Friuli Venezia Giulia (FVG). Deliberate self-harm was excluded.
FINDINGS: The total number of MIJ cases was 627, the resulting incidence 522 per million per year. Trauma was mostly blunt (98.4%). Young (15-44 years) adults (54.8%) and males (78.6%) were most affected. Leading mechanisms of injury were traffic accidents (81%) and falls (9.1%). Most events occurred in rural (80.9%) areas despite one third of the regional population living in major urban centres. Summer and weekends carried the highest frequency. The mean ISS ( [Formula: see text] ) was 30.0, median 25. On-scene vital parameters were often subnormal, e.g. 53.9%, [Formula: see text]. The Emergency Medical System was nearly always activated (98.4%). The time intervals were within standards although in part susceptible of improvement. The percentage of direct triage to the definitive hospital was 79.8%. Overall mortality was 45.6% or 238 per million per year. Most fatalities were found already dead (171/300) and no trimodal distribution was verified. Only 1.5% of the patients found alive died outside hospital. Mean GOS was [Formula: see text] (S.D.), median 5.
COMMENTS: A considerable amount of information on MIJ in FVG has been gathered, of both local and general interest because it can help to assess the local trauma system and also, given the relative scarcity of prospective, population-based information on MIJ, contribute to scientific research.
Fear-related avoidance of activities, falls and physical frailty. A prospective community-based cohort study.
- Delbaere K, Crombez G, Vanderstraeten G, Willems T, Cambier D. Age Ageing 2004; Epub ahead of print.
Correspondence: Kim Delbaere, Department of Rehabilitation Sciences And Physiotherapy, Faculty of Medicine And Health Sciences, USA; (email: Kim.Delbaere@UGent.be).
OBJECTIVE: to investigate the relationship between fear-related avoidance of activities and physical frailty.
METHODS: Fear-related avoidance of activities, physical performance, maximal isometric muscle strength and postural control were assessed in 225 community-living elderly (94 men and 131 women), aged between 61 and 92 years of age.
FINDINGS: Bivariate analyses revealed significant correlations between avoidance of activities on the one hand, and physical performance, muscle strength, forward endpoint excursion of the centre of gravity, and previous falls on the other hand. Logistic regression analysis revealed that fear of falling and avoidance of activities in daily life were predictive of falls within a 1-year follow-up, together with general fear of falling, old age and being female.
COMMENTS: Fear-related avoidance of activities may have negative effects on physical abilities and may also be predictive for future falls. Avoidance of activities is therefore an important additional psychological variable in the development of physical frailty and falling in community-living elderly.
The organizational injury theory focusing on management issues could provide new viewpoints on causes and prevention of injuries in agriculture. The objective of this study was to test whether the quality of farm management is associated with farm injuries. A cohort of 134 farms was used to examine the relationship between farm injuries and selected management, farm, and farm operator characteristics. The number of machines and musculoskeletal disorders were found to be risk factors for injuries (RR = 2.34, 95% CI 1.27-4.31, and RR = 1.75, 95% CI 1.14-2.69). Management quality (significant work delays) was associated with injuries (RR = 1.59, 95% CI 1.00-2.52) in univariable analysis but not in the multivariable model. Although the results for the association between injury and management quality were not conclusive, this line of research should be continued.
This study investigated the prevalence of bullying and victimization among students in grades 7 and 8. It also explored the relationship of bullying and victimization to gender, grade level, ethnicity, self-esteem, and depression. Three survey instruments were used to obtain data from a convenience sample of 454 public school students. Twenty-four percent reported bullying involvement. Chi-square tests indicated significantly more male than female bullying involvement, seventh graders reported more involvement than did eighth graders, and there were no statistically significant differences in involvement based on ethnicity. Both bullies and victims manifested higher levels of depression than did students who were neither bullies nor victims. There were no significant differences between groups in terms of self-esteem.
- Matsumoto T, Azekawa T, Yamaguchi A, Asami T, Iseki E. Psychiatry Clin Neurosci 2004; 58(2): 191-198.
Correspondence: Toshihiko Matsumoto, Department of Psychiatry, Yokohama City University School of Medicine, Yokohama, Kanagawa, JAPAN; (email: unavailable).
The purpose of the present study was to clarify the relationship between bulimic behavior, dissociative phenomenon and sexual/physical abuse histories in Japanese subjects with habitual self-mutilation. Subjects consisted of 34 female outpatients who had cut their wrists or arms on more than 10 occasions. Two age-matched groups, which consisted of 31 general psychiatric outpatients and 26 non-clinical volunteers, served as controls. They were assessed with the Beck Depression Inventory-II, Bulimia Investigatory Test of Edinburgh, Adolescent Dissociative Experience Scale, and an original self-reporting questionnaire concerning various problematic behaviors and sexual/physical abuse histories. The habitual self-mutilation and the two control groups were compared. The habitual self-mutilation group had significantly higher scores on the Beck Depression Inventory-II, Bulimia Investigatory Test of Edinburgh, and Adolescent Dissociative Experience Scale than either of the two control groups (P < 0.001). Furthermore, the habitual self-mutilation group more frequently had a history of illicit psychoactive drug use (P = 0.001), shoplifting (P < 0.001), suicide attempts (P < 0.001), overdosing with medicine (P < 0.001), sexual abuse (P = 0.011), and childhood physical abuse (P = 0.001) than the general psychiatric controls. These results are consistent with those in Western studies. Habitual self-mutilation is likely to coexist with depression, bulimia, and dissociation. Such patients frequently have clinical features similar to those of 'multi-impulsive bulimia'. Evidence supports the association between habitual self-mutilation and sexual/childhood physical abuse in Japan.
A multivariate study of predictors of repeat parasuicide.
Correspondence: Stephen C. Newman, Department of Psychiatry, University of Alberta, Walter Mackenzie Health Sciences Center, 8440 - 112 Street, Edmonton, Alberta T6G 2B7, CANADA; (email: stephen.newman@ualberta.ca).
OBJECTIVE: To identify variables which differentiate future repeaters of parasuicide from non-repeaters in a multivariate analysis.
METHODS: Interviews were conducted with 507 parasuicide cases; data were collected on precipitating factors for the index parasuicide, psychiatric and medical history, stressful life events, prior history of parasuicide, hopelessness, anger, self-esteem and social adjustment. Individuals were followed for 1-2 years to determine if a repeat parasuicide occurred.
FINDINGS: A logistic regression model identified four significant predictors of repeat parasuicide: prior history of parasuicide, a history of depression, a history of schizophrenia and poor physical health. A risk factor scale constructed from these four variables showed that the risk of repeat parasuicide increases as the number of risk factors increases.
COMMENTS: This study identifies four key predictors of repeat parasuicide, and provides evidence that the risk of repeat parasuicide increases when multiple risk factors are present.
Knowledge and attitudes about suicide in 25-year-olds.
- Beautrais AL, John Horwood L, Fergusson DM. Aust N Z J Psychiatry 2004; 38(4): 260-265.
OBJECTIVE: To examine knowledge and attitudes about suicide in a New Zealand sample of young people aged 25 years.
METHOD: The sample was a birth cohort of 1265 young people born in New Zealand in 1977 who have been followed in a longitudinal study for 25 years. At age 25, participants were asked a series of questions designed to assess their knowledge and attitudes about suicide.
FINDINGS: Young people had poor knowledge about youth suicide. They overestimated the number of youth suicide deaths, with a quarter believing that the number of deaths was at least 10x higher than the actual number. They overestimated the fraction of all suicides accounted for by youth suicides with two-thirds believing that 50% or more of all suicides occurred among young people. The most common source of information about suicide was the media. Young people tended to hold mixed attitudes toward suicide, having both liberal and conservative views. Those with lifetime histories of suicidal ideation or suicide attempt and those with family histories of suicide or suicide attempt tended to hold more liberal attitudes. Attitudes toward suicide were unrelated to gender and to knowledge about suicide.
COMMENTS: Young people over-estimate the prevalence of youth suicide and the fraction of suicides accounted for by youth deaths, and hold both conservative and liberal attitudes toward suicide. Their primary source of information about suicide is the media. These findings raise concerns about the potential for media coverage of youth suicide issues to normalize suicide as a common, and thereby acceptable, response among young people, and suggest the need for careful dissemination of accurate information about suicide by knowledgeable, respected and reputable sources.
The themes expressed in suicide calls to a telephone help line.
Correspondence: Jim Barber, Faculty of Social Work, University of Toronto, 246 Bloor Street W, Toronto,Ontario, CANADA; (email: jim.barber@utoronto.ca).
BACKGROUND: Little is known about the suicidal ideation of callers to telephone help lines even though these services are in the front line of suicide prevention efforts. Where thematic data are collected by telephone counseling agencies, it is rarely clear how the categories were constructed and the measurement properties of the instruments are rarely reported.
METHODS: The call sheets kept by counselors on 409 suicide calls were content-analyzed, resulting in a reliable checklist comprising nine major themes. The prevalence of these themes within the sample was then determined and age and gender differences in the themes expressed by first-time callers (n = 189) were examined using logistic regression analysis.
FINDINGS: Almost equal numbers of male and female calls were received and the nine themes were mentioned a total of 981 times. Among first-time callers, males under 35 years were around 75% more likely to refer to relationship breakdown in their calls than were same-age females. Male callers were also around twice as likely to refer to material hardship. Females were four times more likely to refer to being the victim of abuse and nearly 60% more likely to refer to interpersonal and family problems.
COMMENTS: The vast majority of suicide callers expressed dissatisfaction with the quality of their intimate relationships, which suggests that the promotion of intimacy and coping strategies for relationship breakdown are central to the primary prevention of suicide.
On July 1 2000, the State of Florida exempted adult motorcyclist and moped riders from wearing helmets provided they have medical insurance of $10,000. Monthly time series of motorcycle occupant deaths are examined from 1/1994 to 12/2001. The interrupted time series analysis estimates a 48.6% increase in motorcycle occupant deaths the year after the law change. The impact estimate reduces to 38.2% and 21.3% when trends in travel miles and motorcycle registrations are controlled. Our findings suggest that the law's age exemption should be revoked.
Work-Related Roadway Crashes --- United States, 1992--2002.
- Centers for Disease Control and Prevention (CDC). MMWR Morb Mortal Wkly Rep 2004; 53(12): 260-264.
The risk for roadway crashes associated with driving or riding in a motor vehicle at work affects millions of persons in the United States. In 2001, approximately 4.2 million U.S. workers were classified as motor-vehicle operators (Bureau of Labor Statistics [BLS], unpublished data, 2001). Workers who use motor vehicles to perform their jobs include those who operate vehicles owned or leased by their employers and those who drive personal vehicles for work purposes. To characterize fatal occupational roadway crashes and identify workers at highest risk for fatality, CDC analyzed data for 1992--2002 from the Fatality Analysis Reporting System (FARS) of the National Highway Traffic Safety Administration and the Census of Fatal Occupational Injuries (CFOI) of BLS. This report summarizes the results of that analysis, which indicated that roadway crashes were the leading cause of occupational fatalities and that workers in transportation-related occupations were at highest risk. Effective strategies to prevent motor-vehicle--related crashes in the general public also can reduce work-related crashes. Employers should promote safe driving through vehicle selection and company policy.
OBJECTIVES: We examined the association between exposure to violence and asthma among urban children.
METHODS: We obtained reports from caretakers (n = 851) of violence, negative life events, unwanted memories (rumination), caretaker-perceived stress, and caretaker behaviors (keeping children indoors, smoking, and medication adherence). Outcomes included caretaker-reported wheezing, sleep disruption, interference with play because of asthma, and effects on the caretaker (nights caretaker lost sleep because of child's asthma).
FINDINGS: Increased exposure to violence predicted higher number of symptom days (P =.0008) and more nights that caretakers lost sleep (P =.02) in a graded fashion after control for socioeconomic status, housing deterioration, and negative life events. Control for stress and behaviors partially attenuated this gradient, although these variables had little effect on the association between the highest level of exposure to morbidity, which suggests there are other mechanisms.
COMMENTS: Mechanisms linking violence and asthma morbidity need to be further explored.
Understanding the declining Canadian homicide rate: a test of Holinger's relative cohort size hypothesis.
- Leenaars AA, Lester D. Death Stud 2004; 28(3): 263-265.
Correspondence: Antoon A. Leenaars, Windsor, Ontario, CANADA; (email: draalee@wincom.net).
Homicide rates in Canada have shown a decline since 1975, but there has been little empirical study of this trend. P. Holinger (1987) predicted and confirmed that the size of the cohort aged 15-24 in the United States population was associated with the rise and fall of the homicide rate in that country. This study was designed to test this hypothesis in Canada. The results show, even if one controls for other socio-economic variables, the most significant prediction of the decline was, indeed, the proportion of the youth population.
The incidence of infant physical abuse in Alaska.
- Gessner BD, Moore M, Hamilton B, Muth PT. Child Abuse Negl 2004; 28(1): 9-23.
Correspondence: Bradford D. Gessner, Alaska Division of Public Health, Section of Maternal, Child, and Family Health, 3601 C Street Suite 934, P.O. Box 240249, Anchorage, AK 99524-0249, USA; (email: unavailable).
OBJECTIVES: To determine the incidence of and risk factors associated with infant (<1 year of age) physical abuse in Alaska.
METHODS: A population-based retrospective cohort study for the 1994-2000 resident birth cohort was conducted by linking data from birth certificates, Child Protective Services, a statewide hospital-based trauma registry, hospital discharge data, and the Alaska Infant Mortality Review (including death certificates). The main outcome measures were the incidences of overall physical abuse and abuse resulting in hospitalization or death. A case of child abuse was defined as an instance of substantiated physical abuse to an infant identified in the Child Protective Services database or an infant death with homicide identified on the death certificate as the manner of death.
FINDINGS: During the 7-year study period, there were 70,842 births and 325 cases of physical abuse including 72 that led to hospitalization ( [Formula: see text] ), death ( [Formula: see text] ), or both ( [Formula: see text] ); respective incidences for all abuse and abuse leading to hospitalization or death were 4.6 and 1.0 per 1000 live births. Following multivariate analyses, the risk factors with the highest population attributable risks were maternal or paternal education <==12 years, unmarried mother, and maternal prenatal substance use. To determine if the study methodology was likely to have missed cases of severe abuse, we examined information for all 216 infants hospitalized for trauma during the study period who did not have identification of abuse in one of the study databases; of these, at least 39 had injuries inconsistent with the reported mechanism (a long bone or skull fracture that reportedly resulted from a fall of less than 3 feet or from a caretaker's arms or for which the caretaker denied a history of trauma).
COMMENTS: Alaska has one of the highest documented infant physical abuse incidences reported in the literature and abuse is associated with potentially modifiable-primarily social-risk factors. Despite this high incidence, substantial under-reporting of hospitalized cases likely occurs.
An interview study of the impact of domestic violence training on midwives.
- Protheroe L, Green J, Spiby H. Midwifery 2004; 20(1): 94-103.
Correspondence: Josephine Green, Mother and Infant Research Unit (MIRU), University of Leeds, 22 Hyde Terrace, Leeds LS2 9LN, UK; (email: j.m.green@leeds.ac.uk).
OBJECTIVES: To evaluate the impact on midwives of a training programme designed to increase their awareness and understanding of violence against women from men they know.
DESIGN: A cross-sectional survey using semi-structured interviews.
PARTICIPANTS: A stratified sample of 55 midwives who attended training between April 1999 and June 2000 were asked to participate, 26 agreed. SETTING:: midwifery services of the Leeds Teaching Hospital NHS Trust.
FINDINGS: Participants reported greater awareness and understanding of domestic violence, and an increased likelihood of identifying and supporting women, partly through improved knowledge of other helping agencies. However, there was considerable uncertainty over issues of confidentiality and documentation. Practical difficulties were raised in implementing training within the midwifery role; these included time and privacy.
COMMENTS: This research adds to the scarce evidence base related to the effectiveness of health-care professionals' training in domestic violence. Further research should also explore the impact of training on women's experiences of healthcare.
An update on child abuse and neglect.
- Tenney-Soeiro R, Wilson C. Curr Opin Pediatr 2004; 16(2): 233-237.
Correspondence: Rebecca Tenney-Soeiro, Department of Pediatrics and Child Protection Program, Children's Hospital Boston, Boston, Massachusetts, USA; (email: rebecca.tenney@childrens.harvard.edu).
OBJECTIVE: Nonaccidental trauma and neglect continue to be major problems for children, families, and the providers who care for them. Whereas prevention is the key to ending child abuse and neglect, diagnosis and treatment continue to be the mainstays of practice. This article will briefly review the epidemiology, diagnosis, sequelae, and prevention of abuse and neglect in today's world.
FINDINGS: The latest statistics estimate that more than 900,000 children are victims of child maltreatment. Abuse occurs at all ages but is most common in younger children. Child abuse may manifest as skin injuries, skeletal trauma, head injury, or many other forms. Information on abusive head trauma has been published in large amounts in the past year and is reviewed in further depth. The long-term consequences, the keys to prevention, and the role for pediatric providers are also reviewed.
COMMENTS: Whereas great strides have been made in diagnosing and treating child abuse, our work has been cut out for us in preventing child abuse. Pediatric clinicians must continue to screen patients and families, recognize signs and symptoms of abuse and neglect, and find time to advocate for home visits, early intervention programs, and education on this very important topic.
