OBJECTIVES: To determine rates of alcohol and tobacco use among independent elder emergency department (ED) patients and assess the extent of health care use of this population.
METHODS: A convenience sample of independent elders (age >/==" BORDER="0">65 years) in an urban academic ED was enrolled. Patients were excluded if they were medically unstable or had a change in mental status. The Fagerstrom Test for Nicotine Dependence, and the Alcohol Use Disorders Identification Test (AUDIT) scales were used to measure tobacco and alcohol use. Subjects completed questionnaires about their health and use of the health care system. Data were analyzed by using t-tests to compare independent variables.
FINDINGS: A total of 565 subjects completed the study. Of these, 296 (52.4%) were male and 269 (47.6%) were female; mean age was 77.1 years. Fifty-four (9.5%) were smokers, and 22 (3.9%) were nicotine-dependent by the Fagerstrom test (Fagerstrom+). Alcohol use was reported at least once monthly by 176 (31.2%) and twice monthly by 76 (13.5%) patients; 12 (2.1%) were alcohol-dependent by the AUDIT scale (AUDIT+). Two (0.35%) were both Fagerstrom+ and AUDIT+. Fagerstrom+ subjects visited a physician less often than Fagerstrom- subjects (3.9 vs. 4.6 annual visits, p < 0.0009). AUDIT+ subjects visited a primary care physician less (3.3 vs. 4.2 annual visits, p < 0.007) or "any" physician less (3.9 vs. 4.6 annual visits, p < 0.01) than AUDIT- subjects. AUDIT+ and Fagerstrom+ subjects did not differ from AUDIT- and Fagerstrom- subjects in number of annual ED visits, self-reported general health, physical symptoms (except nervousness, p < 0.004), comorbid illnesses, hospital admissions, and injuries requiring treatment.
COMMENTS: Elder ED patients have low rates of nicotine and alcohol dependence. Nicotine- or alcohol-dependent elders use outpatient providers less often than nondependent elders but use EDs at the same rate and report similar health patterns.
Alcohol drinking behaviors among Turkish high school students.
- Alikasifoglu M, Erginoz E, Ercan O, Uysal O, Albayrak-Kaymak D, Ilter O. Turk J Pediatr 2004; 46(1): 44-53.
Correspondence: M. Alikasifoglu, Department of Pediatrics, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, TURKEY; (email: unavailable).
The aim of this study was to evaluate the prevalence, behavioral patterns and correlates of regular alcohol drinking in high school students. This cross-sectional study involved the completion of a modified version of "Health Behavior in School Age Children" (HBSC 1997/1998) questionnaire by 4,153 grade 9-11 students from 26 randomly selected high schools in Istanbul. Chi-square test, Spearman correlation test and forward stepwise multiple logistic regression model were used for statistical analyses as appropriate. Overall, 61% of students were experimental drinkers, and 46% of the students were current drinkers. There was a significant difference between female and male students with respect to reporting current alcohol drinking at grade 9 and 11 (p > 0.05 for each comparison). Regular drinking was reported by 6% of students. Male students were more likely than female students to report regular drinking at each grade (p < 0.01 for each comparison). Nineteen percent of the students reported that they had been really drunk at least once during their lifetime. Male students were more likely than female students to report an occasion of drunkenness at each grade (p < 0.05 for each comparison). All types of drinking behavior rates tended to increase across grades for both genders (p < 0.05 for each comparison). In logistic regression analysis the following were all independently associated with regular drinking: being in grade 11, smoking cigarettes currently, lifetime drug use, bullying others, being sexually active, playing computer games > or = 4 h/week, exercising < or = 1 h/week, spending > or = four evenings with friends, at ease in talking to same gender friends, tiredness in the morning, perceived as good-looking/beautiful, higher educational level of the mother and perceived poor academic achievement. The results of this study showed that alcohol consumption is prevalent among high school students. There is therefore a need for school-based alcohol prevention programs which also deal with family and peer influences on drinking.
Fall prevention in residential care: a cluster, randomized, controlled trial.
- Kerse N, Butler M, Robinson E, Todd M. J Am Geriatr Soc 2004; 52(4): 524-531.
Correspondence: Ngaire Kerse, Department of General Practice and Primary Health Care, University of Auckland, Auckland, NEW ZEALAND; (email: unavailable).
OBJECTIVES: To establish the effectiveness of a fall-prevention program in reducing falls and injurious falls in older residential care residents.
DESIGN: Cluster, randomized, controlled trial.
SETTING: Fourteen randomly selected residential care homes in Auckland, New Zealand.
PARTICIPANTS: All older residents (n=628, 95% participation rate).
INTERVENTION: Residential care staff, using existing resources, implemented systematic individualized fall-risk management for all residents using a fall-risk assessment tool, high-risk logo, and strategies to address identified risks.
MEASUREMENTS: Number of residents sustaining a fall, falls, and injurious-falls incidence rates.
RESULTS: During 12 months of follow-up, 103 (43%) residents in the control group and 173 (56%) residents in the intervention group fell (P<.018). There was a significantly higher incidence rate of falls in intervention homes than in control homes (incident rate ratio=1.34, 95% confidence interval=1.06-1.72) during the intervention period after adjusting for dependency level (type of home), baseline fall rate, and clustering. There was no difference in the injurious fall incidence rate or incidence of serious injuries.
COMMENTS: This fall-prevention intervention did not reduce falls or injury from falls. Low-intensity intervention may be worse than usual care.
Correspondence: Azhar Abdul Aziz, Department of Emergency Medicine, National University Hospital, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, MALAYSIA; (email: azhar@mail.hukm.ukm.my).
In the peace-loving, moderate and progressive country of Muslim-dominated Malaysia, violence generally is alien to the culture. Terrorism initially took shape during the post-independence, communist era by jungle recalcitrant actions. In recent years, this has been superceded by a more internationally related trend of violence. Only very few incidents were based locally, while the majority were linked to international groups or organizations abroad, including the Kumpulan Mujahidin Malaysia (KMM), Jemaah Islamiyah (JI), and the Abu Sayyaf Group (ASG). Kidnapping with ransom seemed to have been the most commone modus operandi, while killing and robbery accounted for very few of these incidents. The number of victims in each event so far has been small, and smaller for those physically harmed or killed. This pattern of terrorist attacks suggests that the current level of provision of emergency medical services is sufficient to handle such incidents. Recent advances in local emergency medicine also have witnessed the establishment of various teaching and training modules, a pivotal role played by university hospitals and supported by the Ministry of Health. However, the spate of ongoing events of mass destruction such as the conflict in Israel/Palestine, wars in Afghanistan and Iraq, the World Trade Center and Pentagon tragedies of 11 September 2001, and the Bali bombing in Indonesia, remain as great concerns to Malaysians. Both the government and the people of Malaysia abhor such unjustified uses of terror, and take every measure to curtail them. The National Security Council policies of Arahan No. 18 and Arahan No. 20 detail specific roles and responsibilities of various agencies in managing terrorism and disasters respectively, while the use of the stern Internal Security Act that allows indefinite detention without trial, evidently has been an efficient intelligence and security apparatus. With more recent developments of terrorist events regionally and globally, Malaysia continues to face an ongoing threat from such activities. Various measures have been and will be actively undertaken both by government and non-governmental agencies in facing these challenges.
A proposed universal medical and public health definition of terrorism.
- Arnold JL, Ortenwall P, Birnbaum ML, Sundnes KO, Aggrawal A, Anantharaman V, Al Musleh AW, Asai Y, Burkle FM Jr, Chung JM, Cruz-Vega F, Debacker M, Della Corte F, Delooz H, Dickinson G, Hodgetts T, Holliman CJ, MacFarlane C, Rodoplu U, Stok E, Tsai MC. Prehospital Disaster Med 2003; 18(2): 47-52.
Correspondence: J.L. Arnold, Yale New Haven Center for Emergency and Terrorism Preparedness, 1 Church Street, 5th floor, New Haven, CT 06510, USA; (email: arnoldmdcs@cs.com).
The lack of a universally applicable definition of terrorism has confounded the understanding of terrorism since the term was first coined in 18th Century France. Although a myriad of definitions of terrorism have been advanced over the years, virtually all of these definitions have been crisis-centered, frequently reflecting the political perspectives of those who seek to define it. In this article, we deconstruct these previously used definitions of terrorism in order to reconstruct a definition of terrorism that is consequence-centered, medically relevant, and universally harmonized. A universal medical and public health definition of terrorism will facilitate clinical and scientific research, education, and communication about terrorism-related events or disasters. We propose the following universal medical and public definition of terrorism: The intentional use of violence--real or threatened--against one or more non-combatants and/or those services essential for or protective of their health, resulting in adverse health effects in those immediately affected and their community, ranging from a loss of well-being or security to injury, illness, or death.
Numerous governments have introduced regulations governing the use of mobile (cellular) telephones while driving. Despite significant research into the "objective" risks, there is relatively little research into risk perceptions either in relation to other in-car distractions or with respect to the factors underlying such perceptions. The current article reports on two studies addressing these issues. Study 1 (N= 199) found that whereas the use of hand-held sets is seen as one of the riskiest activities to perform while driving, the risks of using a hands-free kit are perceived to be relatively small. Study 2 (N= 1,320) found that nearly half of all drivers in the sample with a mobile phone reported having used it while driving and that, overall, the probability of having an accident was perceived to be less for oneself than for one's peers, indicating an optimistic bias. Two factors underpinned risk perceptions, "impact" including perceived severity and equitability, and "controllability" including immediacy, detectability, and probability. While higher "impact" scores were associated with increased preferences for restrictions on the use of hand-held mobiles while driving, the "controllability" scores moderated this relationship such that when perceived "controllability" was low, restriction preferences were high irrespective of perceived "impact." However, when "controllability" was high, restriction preferences remained high when "impact" was high but were low when "impact" was low. Given the growing number of in-car technological innovations, it is suggested that regulators act strategically, rather than finding themselves developing a series of "hazard-specific" regulations, which may ultimately lack coherence.
Correspondence: David R. Ragland, University of California Traffic Safety Center, University of California at Berkeley, 140 Warren Hall, Berkeley, CA 94720-7360, USA; (email: davidr@uclink4.berkeley.edu).
OBJECTIVE: To understand the driving behavior of older adults, this study examines self-reported reasons for driving limitation or avoidance.
METHODS: Baseline interviews were conducted (n = 2,046) as part of a community-based study of aging and physical performance in persons aged 55 years or older in Sonoma, California. Twenty-one medical and nonmedical reasons for limiting or avoiding driving were examined by age and gender.
FINDINGS: Most older people continue to drive; however, many, especially older women, report one or more reasons to limit or avoid driving. Among medical reasons, problems with eyesight are by far the most often cited; no other health problem was identified as a major reason for limitation. Among nonmedical reasons, being concerned about an accident, being concerned about crime, and having no reason to drive were often cited. Important predictors of reported driving limitations were low income, limited functional status, and self-report of poor vision.
COMMENTS: Understanding factors that affect driving patterns in older adults, including medical and nonmedical reasons, will assist in developing both enhancements to extend safe driving years and responses to the consequences of driving reduction.
In this report, the authors reviewed the backyard trampoline orthopedic injuries in children admitted to the Winnipeg Children's Hospital. They made up 1.6% of all trauma admissions. The charts, x-rays, and operative reports for 80 children (40 boys and 40 girls), from 2 to 15 years (mean, 9 years, with 18% between 2 and 4 years and 49% in the 5 to 9 years age group) were reviewed, covering January 1996 to October 1997 (21 months). They noted the mechanism, type, severity, and treatment of the orthopedic injury. Fifty-two (65%) children were injured on the trampoline mat, and 24 (30%) were injured when they were ejected from the trampoline. Sixty (75%) children sustained a fracture or fracture/dislocation, and 25% reported only soft-tissue injury. Forty-eight (80%) of these orthopedic injuries occurred in the upper extremity. Not surprisingly, most (74%) injuries occurred during the summer months (June to September), and the majority (51%) were at a neighbor's home. One third said the injury occurred when they were alone on the trampoline, whereas 35% sustained their injury while on the mat with 1 to 5 other children, although the actual incidence may have been underestimated, as reported by others. In only 10% of cases was an adult "supervising" the trampoline use. Nonetheless, the authors speculate that because most children sustained their injury from a simple fall on the mat even with adult supervision, the injury may not have been preventable. A number of children were injured throught imaginative uses of the trampoline (eg, jumping from the roof onto the trampoline). These innovative mechanisms might have been preventable had adult supervision been available. The most common fracture sites were the forearm (45%) followed by the humerus and elbow (35%); supracondylar fractures (81%) and fracture-dislocations of the elbow accounted for the 21 injuries, about and above the elbow. There were no associated vascular injuries and no knee dislocations. The most serious injury was a fracture-dislocation of the cervical spine, with paralysis, in an 8 year old boy, who was ejected from the mat. There were no deaths. The rare deaths that did happen in the 1996 statistics from the Consumer Product Safety Committee in the United States (US) were all secondary to severe head and neck trauma. The Canadian Hospital Injury Reporting and Prevention Program, (a computerized information database) records injuries in children's hospitals in Canada. In 1996, 1,042 trampoline injuries in children were seen in emergency departments: (36% fractures, 12% involved head and neck, 64% occurred on home trampolines). There were several limitations to this study, according to the authors: (1) It was a retrospective study. (2) They could not obtain information on the number of and overall use of trampolines in Winnipeg; therefore, no conclusion could be made about the relative risk of injury from the backyard trampoline versus other childhood activities. 3. Because histories were obtained from the injured child or witnesses of similar age, a reporting bias may have been present. Finally, the authors suggested the following guidelines for the use of backyard trampolines: (1) Physicians should advise children and their families of the potential dangers of trampoline use, (2) children younger than 6 years should not use the trampoline, (3) children should not use the trampoline without adult supervision, (4) no more than 1 person should be on the trampoline at any time, (5) no flips or other advanced maneuvres should be attempted. In children, a trampoline is a high-risk activity, and the backyard trampoline has the potential for significant orthopedic injury.
Injury prevention training: a cluster randomised controlled trial assessing its effect on the knowledge, attitudes, and practices of midwives and health visitors.
- Woods A, Collier J, Kendrick D, Watts K, Dewey M, Illingworth R. Inj Prev 2004; 10(2): 83-87.
Correspondence: Amanda Woods, Division of Primary Care, 1401 Tower Building, University Park, Nottingham NG7 2RD, UK; (email: amanda.woods@nottingham.ac.uk).
OBJECTIVE: To evaluate the effectiveness of injury prevention training.
DESIGN: Cluster randomised controlled trial.
SETTING: Primary care facilities in the East Midlands area of the United Kingdom.
SUBJECTS: Midwives and health visitors.
INTERVENTION: Evidence based training session on the risks associated with baby walkers.
MAIN OUTCOME MEASURES: The primary outcome measures were knowledge of baby walker use and walker related injury, attitudes towards walkers and towards walker education, and practices relating to walker health education.
FINDINGS: Trained midwives and health visitors had greater knowledge of the risks associated with baby walkers than untrained midwives and health visitors (difference between the means 0.22; 95% confidence interval (CI) 0.12 to 0.33). Trained health visitors had more negative attitudes to baby walkers (difference between the means 0.35; 95% CI 0.10 to 0.59) and more positive attitudes towards baby walker health education (difference between the means 0.31; 95% CI 0.00 to 0.62) than untrained health visitors. Midwives who had been trained were more likely to discuss baby walkers in the antenatal period than those who were not trained (odds ratio 9.92; 95% CI 2.02 to 48.83).
COMMENTS: Injury prevention training was associated with increased knowledge, more negative attitudes towards walkers, and more positive attitudes towards walker education. Trained midwives were more likely to give advice antenatally. Training did not impact on other practices. Larger trials are required to assess the impact of training on parental safety behaviours, the adoption of safety practices, and injury reduction.
Correspondence: Irwin B. Horwitz, University of Texas, School of Public Health at Houston, 1200 Herman Pressler, W310, Houston TX 77030, USA; (email: ihorwitz@sph.uth.tmc.edu).
One of the most serious occupational problems in the workplace is the occurrence of violent assaults. This study examined 2028 workers' compensation claims of workplace violence from Oregon between 1990 and 1997, and used Current Population Survey data for risk analysis. The rate of workplace violence was 1.86 per 10,000 employees annually (95% confidence interval, 1.78-1.94), with females and workers under 35 years of age experiencing the most violence. The average claim resulted in approximately 40 days of indemnity and $6200 in costs. Workers on evening and night shifts had significantly higher rates of being victims of violence, as did those working on weekends. Preventative interventions should be targeted at younger workers and those with less tenure. Special measures should be focused on ensuring the safety of evening/night-shift workers and weekend employees.
Occupational deaths due to penetrating chest injuries from sledgehammer fragments: two case reports and review of the literature.
Correspondence: Michael E. Smith, Office of the Medical Investigator, University of New Mexico, Albuquerque, New Mexico, USA; (email: msmith012670@hotmail.com).
Occupational deaths due to projectiles from hand tools are rare. We report 2 unusual cases of individuals killed by metallic projectiles produced by the fragmentation of the head of a sledgehammer. At initial examination, these wounds appear similar to atypical gunshot or stab wounds. Proper evaluation requires radiographic examination, scene correlation, and, when possible, comparison of metallic fragments retrieved at autopsy and tools from the scene.
Correspondence: Irene Kwan, Cochrane Injuries Group, Department of Epidemiology and Population Health, London School of Health and Tropical Medicine, London, UK; (email: ikwan@rcog.org.uk).
This study aims to quantify the effect of visibility aids on the occurrence of pedestrian and cyclist-motor vehicle collisions and injuries, and drivers' responses in detection and recognition. Trial reports were systematically reviewed according to predefined eligibility criteria, including randomised controlled trials or controlled before-and-after trials comparing visibility aids and no visibility aids, and of different visibility aids on pedestrian and cyclist safety, and drivers' responses in detection and recognition. This included trials in which the order of interventions was randomised, or balanced using a Latin square design. Two reviewers independently assessed validity of trials and abstracted data. The main outcome measures were pedestrian and cyclist-motor vehicle collisions and injuries, and drivers'/observers' responses in the detection and recognition time, distance and frequency. No trials which assessed the effect of visibility aids on pedestrian and cyclist-motor vehicle collisions and injuries were identified. Twelve trials examined the effectiveness of daytime visibility aids and 25 trials on night time visibility aids, including 882 participants. Drivers' and observers' detection and recognition improved with visibility aids. For daytime, fluorescent materials in yellow, red and orange colours enhanced detection and recognition. "Biomotion" markings enhanced recognition. Substantial heterogeneity between the trials limits the possibility for meta-analysis. Visibility aids have the potential to improve detection and recognition and would merit further development to gain public acceptance. However, the impact of visibility aids on pedestrian and cyclist safety is unknown and needs to be determined.
The effects of daylight and daylight saving time on US pedestrian fatalities and motor vehicle occupant fatalities.
Correspondence: Douglas Coate, Department of Economics, Rutgers University, 360 Dr. Martin Luther King Jr. Blvd., Newark, NJ 07102, USA; (email: coate@andromeda.rutgers.edu).
This paper analyzes the effects of daylight and daylight saving time (DST) on pedestrian and motor vehicle occupant fatalities in the United States. Multivariate analyses of county level data from the Fatality Analysis Reporting System for 2-week periods in 1998 and 1999 are used. Results show that full year daylight saving time would reduce pedestrian fatalities by 171 per year, or by 13% of all pedestrian fatalities in the 5:00-10.00 a.m. and in the 4:00-9:00 p.m. time periods. Motor vehicle occupant fatalities would be reduced by 195 per year, or 3%, during the same time periods.
Epidemiologic characteristics of death by poisoning in 1991-2001 in Korea.
- Shin SD, Suh GJ, Rhee JE, Sung J, Kim J. J Korean Med Sci 2004; 19(2): 186-194.
Correspondence: Sang Do Shin, Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, KOREA; (email: suhgil@snu.ac.kr).
The purpose of this study was to investigate the epidemiologic characteristics of the death by poisoning in Korea. We recoded the Death Certificates Database by injury based on the short version of the International Classification of External Causes of Injuries (ICECI). We evaluated the mortality rate by total injury and poisoning, and analyzed the mortality rate by age, gender, year and month, toxic agent, and intent. Adjusted odds ratios were calculated to evaluate the effects of socioeconomic factors on suicidal poisoning death. The total number of death cases by injury was 346,656. The proportion of death cases by injury decreased from 13.53% of all death cases in 1991 to 11.89% in 2001. However, the mortality rate by poisoning increased rapidly from 1998, and then remained stable. The number of suicidal poisoning deaths has gradually increased, and its mortality rate was 6.41 (per 100,000) in 2001. Major toxic agents were pesticides and herbicides (50.90%) in 2001. Adjusted odds ratios of suicidal poisoning versus other poisonings showed significant differences in education attainment, region, and marital status. In conclusion, the mortality rate by poisoning has increased, and the proportion of suicidal poisoning also has increased compared to that of accidental poisoning.
The impact of stretching on sports injury risk: a systematic review of the literature.
- Thacker SB, Gilchrist J, Stroup DF, Kimsey CD Jr. Med Sci Sports Exerc 2004; 36(3): 371-378.
Correspondence: Stephen B. Thacker, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA; (email: sbt1@cdc.gov).
OBJECTIVE: We conducted a systematic review to assess the evidence for the effectiveness of stretching as a tool to prevent injuries in sports and to make recommendations for research and prevention.
METHODS: Without language limitations, we searched electronic data bases, including MEDLINE (1966-2002), Current Contents (1997-2002), Biomedical Collection (1993-1999), the Cochrane Library, and SPORTDiscus, and then identified citations from papers retrieved and contacted experts in the field. Meta-analysis was limited to randomized trials or cohort studies for interventions that included stretching. Studies were excluded that lacked controls, in which stretching could not be assessed independently, or where studies did not include subjects in sporting or fitness activities. All articles were screened initially by one author. Six of 361 identified articles compared stretching with other methods to prevent injury. Data were abstracted by one author and then reviewed independently by three others. Data quality was assessed independently by three authors using a previously standardized instrument, and reviewers met to reconcile substantive differences in interpretation. We calculated weighted pooled odds ratios based on an intention-to-treat analysis as well as subgroup analyses by quality score and study design.
FINDINGS: Stretching was not significantly associated with a reduction in total injuries (OR = 0.93, CI 0.78-1.11) and similar findings were seen in the subgroup analyses.
COMMENTS: There is not sufficient evidence to endorse or discontinue routine stretching before or after exercise to prevent injury among competitive or recreational athletes. Further research, especially well-conducted randomized controlled trials, is urgently needed to determine the proper role of stretching in sports.
Snowdome, skiers and boarders: accident and emergency experience.
A prospective case series was compiled of all people presenting to the accident and emergency department with an injury caused by snowboarding or skiing, during the first year of opening of the Milton Keynes snowdome. The aim was to analyse the types of injuries associated with recreational snowboarding and to compare these with the injuries seen in skiing. Of the snowboarders, 23 (86%) were males, and the mean age was 24 years. Of the skiers, 13 (81%) were males, and the mean age was 34 years. Forty-three injuries required orthopaedic review, and 12 were admitted for further management. Significant differences were noted between the patterns of injuries in snowboarding and skiing. The snowboarders had a higher incidence of upper limb injuries (96 vs. 62%) and a lower incidence of lower limb injuries (4 vs. 38%) compared to the skiers. This study demonstrates that the opening of a leisure facility has a significant impact on the local accident and emergency department. Snowboarding is associated with a unique pattern of injuries, the knowledge of which should influence education and accident prevention.
All-terrain vehicle legislation for children: a comparison of a state with and a state without a helmet law.
- Keenan HT, Bratton SL. Pediatrics 2004; 113(4): e330-334.
Correspondence: H. Keenan, Department of Social Medicine, University of North Carolina, Chapel Hill, North Carolina 27599-7240, USA; (email: hkeenan@med.unc.edu).
BACKGROUND: All-terrain vehicles (ATVs) continue to be a source of morbidity and mortality in the pediatric population despite recommendations from the American Academy of Pediatrics that children <16 years old not ride in or drive ATVs. ATV injuries have increased significantly in both children and adults most years since 1997.
OBJECTIVE: To assess the effectiveness of ATV regulations for children on serious injuries by comparing ATV-related admissions to level I and II trauma hospitals in a state with and a state without ATV regulations.
DESIGN: Ecologic study.
PATIENTS: Children <16 years old who died and/or were treated in the trauma system of Pennsylvania or North Carolina after ATV crashes.
OUTCOME MEASURES: Injury types and cause of death were examined for all children. Comparisons were made by state (Pennsylvania [regulated] and North Carolina [unregulated]) for patterns of injury, place of injury, helmet use, and death.
FINDINGS: There were 1080 children identified in the trauma registries between January 1997 and July 2000. Forty-four percent required intensive care. Head injuries were the primary cause of death (45.7%). Fewer North Carolina children than Pennsylvania children (16.7% vs 35.8%) wore helmets, and they were more likely to be <11 years old (35.1% vs 27.8%). Living in North Carolina was an independent predictor for not wearing a helmet.
COMMENTS: Living in Pennsylvania was associated with decreased risk factors for ATV injury such as young age and riding unhelmeted. However, despite regulations, many children suffered serious morbidity and mortality. These data support the recommendation that children <16 years old should be prohibited from riding or driving ATVs.
A quantification of preventable unintentional childhood injury mortality in the United States.
- Philippakis A, Hemenway D, Alexe DM, Dessypris N, Spyridopoulos T, Petridou E. Inj Prev 2004; 10(2): 79-82.
Correspondence: E Petridou, Department of Hygiene and Epidemiology, Athens University, Medical School, 75 M Asias Str, Goudi, PO Box 11527, Athens, GREECE; (email: epetrid@med.uoa.gr).
OBJECTIVE: To calculate the preventable fraction of unintentional childhood injury deaths in the United States.
DESIGN: Ecological study of cause specific unintentional childhood injury mortality rates across the 50 states (and the District of Columbia) of the United States (US) over the 10 year period 1989-98.
METHODS: The internet accessible database from the National Center for Injury Prevention and Control was used in order to estimate unintentional childhood (0-14 years) injury mortality rates by external cause and time trends over the study period for each of the US states and for the four major geographical regions of the country. In the principal analysis, a calculation was made of the fraction and absolute number of unintentional childhood injury deaths that could have been prevented annually if the mortality rate in the region with the lowest rate also existed in the remaining three. In another scenario, the lowest external cause specific unintentional childhood injury mortality rates from the 50 US states and the District of Columbia were summed to provide the "ideal" lowest conceivable unintentional childhood injury mortality rate from all causes. Ecological correlations between unintentional childhood injury mortality rates from specified external causes, median income, and percent of the population with a college degree were made.
MAIN OUTCOME MEASURES: Unintentional childhood injury mortality rates by cause.
FINDINGS: Unintentional childhood injury mortality rate declined by 3.5% per year in the country as a whole. If every region of the US had experienced the same injury rate as the Northeast, then one third of all unintentional childhood injuries would not have occurred. More optimistic scenarios indicate that up to two thirds of all unintentional childhood injury deaths could be prevented. Across states, unintentional childhood injury mortality is strongly inversely related to median income.
COMMENTS: About one third of all unintentional childhood injury deaths in the US are preventable with the means and resources available in the Northeastern states. Among the relevant characteristics in the Northeast region, in comparison with other US regions, are the higher education level of parents, the lower gun ownership, the higher population density that implies shorter distances traveled by cars, a better developed emergency medical system, and the existence of several injury prevention programs.
Crash costs by body part injured, fracture involvement, and threat-to-life severity. United States, 2000.
- Zaloshnja E, Miller T, Romano E, Spicer R. Accid Anal Prev 2004; 36(3): 415-427.
Correspondence: Edward Zaloshnja, Pacific Institute for Research and Evaluation, 11710 Beltsville Drive, Suite 300, Calverton, MD 20705-3102, USA; (email: zaloshn@pire.org).
This paper presents costs per US motor vehicle crash victim differentiated into many more diagnostic categories than prior estimates. These unit costs, which include the first keyed to the 1990 edition of Abbreviated Injury Scale (AIS) threat-to-life severity scores, are reported by body part, whether a fracture/dislocation was involved, and the maximum AIS score among the victim's injuries. This level of detail allows for a more accurate estimation of the social costs of motor vehicle crashes. It also allows for reliable analyses of interventions targeting narrow ranges of injuries. The paper updates the medical care data underlying the US crash costs from 1979 to 1986 to the mid 1990s and improves on prior productivity cost estimates. In addition to presenting the latest generation of crash victim costs, this paper analyzes the effects of applying injury costs classified by AIS code from the 1985 edition to injury incidence data coded with the 1990 edition of AIS. This long-standing practice results in inaccurate cost-benefit analyses that typically overestimate benefits. This problem is more acute when old published costs adjusted for inflation are used rather than the recent costs.
The changes of characteristics of burn injuries and treatment data of burned adults in Kaunas University of Medicine Hospital in 1981-2001.
Correspondence: Vytautas Jankunas, Clinic of Surgery, Kaunas University of Medicine Hospital, Eiveniu 2, 3007 Kaunas, LITHUANIA; (email: vjankunas@hotmail.com).
About 8,000 people get burned in Lithuania every year; over 2000 of them have to be hospitalized. About 500 adults and children, who have heavy burn accidents, are treated in the specialized burn centers in Kaunas and Vilnius. With the flow of time, causes of burn accidents change; new treatment methods appear and are applied, the duration of treatment in the hospital as well as other burn accident data change. Consequently we can conclude that in Lithuania as well as all over the world burns are considered to be a serious medical, psychological, economic and social problem. A retrospective 723 in-patient case study was carried out in order to analyze accident and treatment data. The article deals with accident and in-patient treatment data analysis of the adults hospitalized in 1981, 1985, 1991, 1995 and 2001 at the Department of Plastic Surgery and Burns of Kaunas University of Medicine. In 1981, 1985, 1991, 1995 and 2001, respectively 156, 116, 174, 173 and 106 burn accident adult patients were treated. In all years number of burned male patients was twice higher than of female patients. It was noticed that in most cases people of the employable age got burned; the average age of patients 41.3 years. The main source of burns was flame (47.2%); town inhabitants got burned two times more frequently than villagers. It was found that the number of burns with hot liquids increased. The number of unemployed patients increased as well. The absolute majority of patients were treated due to deep burns (87.55%), the total average of burned area decreased from 12.66% in 1981 to 10.99% in 2001. The number of patients undergoing an operation has grown. Active surgery tactics and early operations gave the possibility to decrease almost twice the duration of in-patient treatment in 2001 in comparison to 1981. The time till the first operation decreased from 19.1 days in 1981 to 7 days in 2001.
There is growing attention to the importance of violence risk communication, and emerging empirical evidence of how evaluating clinicians who conduct risk assessments communicate their conclusions about the risk of violence toward others. The present study addressed the perceived value of different forms of risk communication through a national survey of practicing psychologists (N = 1,000). Responses were received from a total of 256 participants, who responded to eight vignettes in which three factors relevant to risk communication were systematically varied in a 2 x 2 x 2 within-subjects design, counterbalanced for order: (i) risk model (prediction oriented versus management oriented), (ii) risk level (high risk versus low risk), and (iii) risk factors (static versus dynamic). Participants were asked to rate the value of six styles of risk communication for each of eight vignettes. The most highly valued style of risk communication involved identifying risk factors applicable to the individual, and specifying interventions to reduce risk. These results were consistent with findings from several previous studies in this area, and reflect an emerging trend in preferences for style and context of risk communication of violence.
On-farm falls among youth less than 20 years old in the U.S.
- Hendricks KJ, Goldcamp EM, Myers JR. J Agric Saf Health 2004; 10(1): 27-38.
Correspondence: K. J. Hendricks, NIOSH/Division of Safety Research, 1095 Willowdale Road, M/S 1808, Morgantown, WV 26505, USA; (email: khendricks@cdc.gov).
This article examines the magnitude and characteristics of fall-related injuries on U.S. farms for youth less than 20 years old for work and non-work exposures at a national level. To examine the problem, data from the Childhood Agricultural Injury Survey (CAIS) and Census of Fatal Occupational Injuries (CFOI) were used. Findings indicate that falls are an important contributor to on-farm injuries, with youth appearing to be at considerable risk. Thus, a reduction of the exposure of youth to fall-related hazards on farms is needed. Strategies such as providing safe play areas for young children and continuing efforts to prevent extra riders on farm equipment will help in reducing these hazardous fall exposures.
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.
This study tested the efficacy of a generic social skills intervention, Social Skills Group Intervention (S.S.GRIN), for children experiencing peer dislike, bullying, or social anxiety. Third-grade children were randomly assigned to treatment (n = 187) or no-treatment control (CO; n = 194) groups. Examination of the direction and magnitude of change in functioning revealed that S.S.GRIN increased peer liking, enhanced self-esteem and self-efficacy, and decreased social anxiety compared to controls. S.S.GRIN was equally efficacious for all subtypes of peer problems targeted. Particular benefits were found for aggressive children who showed greater declines in aggression and bullying behavior and fewer antisocial affiliations than aggressive control participants. Discussion focuses on the benefits of heterogeneous versus homogeneous groups of participants and the potential value of utilizing generic social skills training protocols.
Practicing school psychologists' perceived role in prevention of school violence.
- Dean VJ, Burns MK. Psychol Rep 2004; 94(1): 243-250.
Correspondence: V.J. Dean, Michigan State University, USA; (email: deanvinc@msu.edu).
School psychologists have been called upon to take a leadership role in school-violence prevention, but little is known about their involvement in this issue, especially in states where school shootings have occurred. The current study surveyed 258 Michigan school psychologists about their role in prevention of school violence. Analysis suggested respondents felt prepared to address violence prevention but do not have a leadership role and are not sought for advice about prevention. The number of annual special education evaluations was significantly associated with frequency of being sought for advice on violence prevention but was not related to perceptions of leadership or preparedness. Modest relationships were noted between feeling prepared, knowledge of risk factors, and self-perceptions of a leadership role. Suggestions for research are included.
Modeling rear-end collisions including the role of driver's visibility and light truck vehicles using a nested logit structure.
- Abdel-Aty M, Abdelwahab H. Accid Anal Prev 2004; 36(3): 447-456.
Correspondence: Mohamed Abdel-Aty, Department of Civil and Environmental Engineering, University of Central Florida, Orlando, FL 32816-2450, USA; (email: mabdel@mail.ucf.edu).
This paper presents an analysis of the effect of the geometric incompatibility of light truck vehicles (LTV)--light-duty trucks, vans, and sport utility vehicles--on drivers' visibility of other passenger cars involved in rear-end collisions. The geometric incompatibility arises from the fact that most LTVs ride higher and are wider than regular passenger cars. The objective of this paper is to explore the effect of the lead vehicle's size on the rear-end crash configuration. Four rear-end crash configurations are defined based on the type of the two involved vehicles (lead and following vehicles). Nested logit models were calibrated to estimate the probabilities of the four rear-end crash configurations as a function of driver's age, gender, vehicle type, vehicle maneuver, light conditions, driver's visibility and speed. Results showed that driver's visibility and inattention in the following (striker) vehicle have the largest effect on being involved in a rear-end collision of configuration CarTrk (a regular passenger car striking an LTV). Possibly, indicating a sight distance problem. A driver of a smaller car following an LTV, have a problem seeing the roadway beyond the LTV, and therefore would not be able to adjust his/her speed accordingly, increasing the probability of a rear-end collision. Also, the probability of a CarTrk rear-end crash increases in the case that the lead vehicle stops suddenly.
Correspondence: Agneta Ojehagen, Department of Clinical Neuroscience, Division of Psychiatry, University Hospital, 22185,Lund, SWEDEN; (email: Agneta.Ojehagen@psykiatr.lu.se).
OBJECTIVE: This study aims to investigate suicide risk factors after attempted suicide and whether and how these risk factors differ between the sexes.
METHOD: A total of 1052 suicide attempters admitted to the Medical Emergency Inpatient Unit, Lund University Hospital, Sweden were followed up concerning suicide and death from other causes after a median period of 6 years and 5 months. In all, 50 persons committed suicide during follow-up. At the index suicide attempt, socio-demographic data and information about clinical characteristics were gathered in a standardised manner. Risk factors were identified among these data using survival analyses for the whole sample and for each sex separately.
FINDINGS: Men had a higher frequency of suicide and a greater overall mortality than women. Cox regressions showed that suicide attempt(s) prior to the index attempt and the use of a violent method for the index attempt were risk factors for men only, whereas older age and a high suicidal intent (Beck SIS score) were female ones. Major depression was a risk factor for both sexes.
COMMENTS: More attention probably needs to be paid to the importance of gender in assessment of suicide risk and treatment of suicide attempters.
Social, psychological and physical background of suicides during the lifetime--from the research of whole number of suicides during a year in Fukushima prefecture.
We performed a questionnaire survey of the bereaved families of decedents in 523 cases of suicide which occurred during the year beginning July 17, 1997, in Fukushima prefecture in Japan. The questionnaire consisted of 33 items which indicated decedents' behavior changes and stress factors before death. Of the 523 cases, 420 questionnaires were completed by the surviving family members. The risk factors for suicide which are conventionally accepted were found with high frequency in the data. Common stress factors were occupational and financial problems in males and difficulties with human relationships and family problems in females. The sexes were clearly differentiated in this respect. Common changes preceding suicide were expressed as "becoming depressed" or "social isolation." These statements were common and tended to be associated with depression. Hanging was the most frequent method of committing suicide in both sexes and at all ages. Thirty one percent of the victims were diagnosed and treated for mental diseases, and 39% for physical diseases. Many of the 39% who had physical diseases also showed depressive behaviors. The screening and treatment of depression is a matter of highest priority in the strategy of suicide prevention. It is therefore important that general practitioners, occupational physicians and public health nurses improve their skills in managing depressive disorder as a common condition. Psychiatrists should undertake their role of education in the diagnosis and treatment of depressive disorders more seriously.
Correspondence: Karen Rich, School of Nursing, The University of Southern Mississippi, Hattiesburg, 2701 Hardy Street,
MS 39406, USA; (email: krich00@att.net).
BACKGROUND: The ambiguities involving end-of-life issues, such as physician-assisted suicide and voluntary stopping of eating and drinking, have caused a blurring of the definition of rational suicide and have prompted rich dialogue with moral deliberations that seem to be on disparate paths among bioethicists and other health care professionals. With the evolution of advanced medical technology extending life expectancy in older, disabled, and terminally ill people, rational suicide has become a critical issue of debate.
OBJECTIVE: The purpose of this article is to address the ethical positions supporting and opposing rational suicide and to consider whether coherence can be achieved through an ethic of care.
FINDINGS: Attitudes towards suicide have been controversial, varying from acceptance to non-acceptance depending on social, political and religious influences. Nursing attitudes are no different from general societal attitudes and, consequently, nurses are treading on uncertain moral ground. Nurses who have not reflected on the moral issues involved with rational suicide may be unprepared psychologically and professionally when working with patients who may be contemplating such actions.
Adolescent suicide problems.
- Hammond D, Whittlesey S, Kearns L, Bennett S, Allen SF. J Okla State Med Assoc 2004; 97(2): 78-82.
Correspondence: Donna Hammond, Oklahoma University College of Medicine, Department of Psychiatry and Behavioral Sciences, University of Oklahoma Health Sciences Center, Oklahoma City 73120, USA; (email: unavailable).
Adolescent suicide is a growing problem despite increased awareness and programs to counter the destruction. There are myths surrounding adolescent suicide that contribute to our alarm at the increasing numbers. However, risk and protective factors along with prevention strategies and resources for help are available. Finally, the primary care physician has critical and pivotal opportunities for screening patients for referral and further treatment. Simple, discerning questions can allow the busy physician good insight into patients' mental health.
Analysis and prediction of traffic fatalities resulting from angle collisions including the effect of vehicles' configuration and compatibility.
- Abdel-Aty M, Abdelwahab H. Accid Anal Prev 2004; 36(3): 457-469.
Correspondence: Mohamed Abdel-Aty, Department of Civil & Environmental Engineering, University of Central Florida, Orlando, FL 32816-2450, USA; (email: mabdel@mail.ucf.edu).
Although the rapid growth in light truck vehicle (LTV) sales, including minivans, sports utility vehicles (SUVs), and light-duty trucks, has not been associated with an overall increase in collisions or traffic deaths in the US, there is a need for a research program to determine whether particular types of collisions have become more frequent or injurious because of the increase in the percent of LTVs in traffic. This paper presents an analysis of the effect of the increasing number of LTV registrations on fatal angle collision trends in the US. The analysis investigates the number of annual fatalities that result from angle collisions as well as collision configuration (car-car, car-LTV, LTV-car, and LTV-LTV). The analysis uses the Fatality Analysis Reporting System (FARS) crash databases covering the period 1975-2000. Results showed that death rates differ based on the collision configuration. Time series modeling results showed that fatalities in angle collisions will increase in the next 10 years, and that they are affected by the expected increase in the percentage of LTVs in traffic. Forecast showed that the total number of annual deaths is expected to reach 6300 deaths by the year 2010 (an increase of 12% over 2000). Analysis into the configuration of the collision indicated the seriousness of angle collisions involving an LTV striking a common passenger car (LTV-car). A time series model illustrated the significance of time lag and percent of LTVs in traffic on the increase of this type of fatal collisions. Forecasts from the time series model indicated a 32% increase in deaths due to this type of collisions in the next 10 years.
Mechanism of injury in the unrestrained child in a school bus collision.
- P.C. Lapner, D. Nguyen, M. Letts. J Pediatr Surg 2004; 39(4): 648-649.
The most common type of school bus crash resulting in injury and death involves the "rollover" mechanism, which may be linked to bus design. The purpose of the current study was to identify injury patterns in rollover school bus crashes, and to determine if injuries occurring in these crashes were related to school bus design and, hence, are preventable. This study was from the Division of Orthopedic Surgery. Children's Hospital of Eastern Ontario (CHEO), Ottawa, Ontario, Canada, and was undertaken jointly by the authors and engineers experienced in studying crash dynamics. They carried out a detailed investigation of a severe school bus crash, which involved a full-sized school bus and a pickup truck. There were 12 unrestrained children on the bus (9 to 14 years) seated in rows 6 to 12. Most injuries were minor lacerations and confusions. There were 3 fractures around the shoulder; 1 child had O(2-3) subluxation, and 1 child died of a severe head injury. The authors discuss the use of seat belts for children in school buses and conclude that their use is controversial. The mechanism of injury produced in children in different seating positions was determined by correlating the injuries with an engineering analysis of the crash site and vehicle. Their analysis included the determination of the crash dynamics by examination of physical evidence at the crash site and damage sustained by the structure of the bus and the other vehicle involved. The mechanism of injury was determined by comparing physical evidence collected inside the bus with injuries sustained by the children. Correlation of injury to physical evidence indicates that these injuries resulted from contact with side panels and headers. There was no evidence of passenger injury resulting from contact with the edge of the seat in the opposite aisle, a mechanism that has been previously suggested. The strategy currently in use in Canadian school buses involves compartmentalization, that is, the passenger is "cocooned" in the compartment with surrounding passive restraints: padded seat backs; a steel inner structure that bends to absorb energy; strong anchoring points; high, wide, and thick backing; even spacing to keep children inside the compartments. In this study, fractures occurred in children seated on the side to which the bus rolled. The authors believe this is a significant finding, suggesting that compartmentalization failed to contain and protect passengers along the sides of the compartment in this type of rollover crash. In the compartmentalization model, protection exists in the event of head-on or rear-end collisions; however, little protection exists along the sides of the compartment, over window headers, and on paneling between windows. The authors agree with the principle of compartmentalization but feel that extending the padding to the sides, over the window headers, and on the paneling between the windows, would minimize the number and severity of injuries seen in this common type of bus crash.
Community pediatricians' counseling patterns and knowledge of recommendations relating to child restraint use in motor vehicles.
- Rothenstein J, Howard A, Parkin P, Khambalia A, Macarthur C. Inj Prev 2004; 10(2): 103-106.
Correspondence: Colin C Macarthur, Division of Paediatric Medicine, Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8, CANADA; (email: colin.macarthur@sickkids.ca).
BACKGROUND: Road traffic injury is the leading cause of death among Canadian children and youth. Transport Canada recommends four types of child restraint depending on the size of the child, and recent studies have demonstrated the effectiveness of recommended restraint use.
OBJECTIVES: To determine community pediatricians' knowledge of Transport Canada recommendations for child restraint use in vehicles, and to examine pediatricians' counseling patterns in relation to child passenger safety.
METHODS: A mailed questionnaire survey of all community pediatricians affiliated with the Hospital for Sick Children, Toronto was conducted. A 16 item questionnaire gathered information on knowledge of Transport Canada recommendations for child restraint use, general counseling patterns in relation to child passenger safety, and demographic information.
FINDINGS: In total, 60 community pediatricians in active practice were identified. Of these, 48 (80%) responded to the mailed questionnaire. Almost all pediatricians (92%) correctly identified the recommended weight for transition to a forward-facing car seat, whereas fewer pediatricians (63%) correctly identified the recommended weight for transition to a booster seat from a forward-facing car seat, and only one third of pediatricians correctly identified the recommended weight for transition from a booster seat to a seat belt.
COMMENTS: Community pediatricians' knowledge of Transport Canada recommendations for child restraint use in vehicles is incomplete. There is a need for such recommendations to be better disseminated to pediatricians and parents so that information on child restraint use is delivered in a clear and consistent manner.
Short and long term effects of moped rider training: a field experiment.
In a field experiment on moped rider training, young moped riders were tested one week before, two weeks after and eleven months after participation in a practical moped riding training course. As a result of rider training the group trainees performed considerably better at a riding task than the group non-trainees two weeks after the training. However, this performance difference was not present anymore at follow-up testing 11 months later. The group that did not follow the course significantly improved their driving skill. However, the group that had already improved their driving skill with the training, did not improve any further. Those moped riders that improved most from the 16-h training course at the post-test also declined in performance considerably at the long term follow-up. Knowledge that relies of an understanding of how behaviour should change in a dynamic situation was more strongly related to actual riding skill than knowledge that was based on memorising fairly straightforward situation-rule connections. Implications for moped training are discussed.
Social influence from the back-seat: factors related to adolescent passengers' willingness to address unsafe drivers.
The aim of the present paper was to examine factors that may affect the likelihood of adolescent passengers asking a driver to drive more carefully when they feel unsafe as a car passenger. The paper is based on a questionnaire survey carried out among 4397 Norwegian adolescents. The results showed that the factors influencing adolescents' willingness to address unsafe driving were several. Female passengers were most likely to report that they spoke out to the driver when feeling unsafe in the car. This could to some extent be explained by gender differences in certain beliefs. That is, males seemed to perceive more negative consequences of addressing unsafe drives, to be less confident in their ability to influence an unsafe driver, to be more likely to accept risk taking from other drivers, and perceive less risk than females. In turn, these beliefs affected the likelihood of confronting an unsafe driver. Passengers disposed to experience anxiety felt most unsafe in their friend's car, an experience that increased the tendency of addressing unsafe driving. The results also demonstrated that a relatively large proportion of the adolescents thought that it was acceptable to ride with an unsafe driver. This kind of belief lessened the likelihood of passengers addressing unsafe driving, as well as being most prominent among those who rode with friends who displayed the most risky driving style.
Accuracy of household planning of car use: comparing prospective to actual car logs.
Measures aiming at changing car use are frequently based on the assumption that car use is under motivational and volitional control. The aim of this study is to investigate the degree to which this is the case and how it relates to different purposes of car trips and characteristics of car users. Data obtained from 1-week prospective car logs made by 40 adult households living in G�teborg, Sweden, were compared to subsequent actual car use. In line with previous results suggesting that households have a modest degree of motivational and volitional control over their car use, it was found that 80% more car trips were made the following seven days than indicated in the prospective car logs. The largest discrepancies were observed for shopping and chauffeuring trips, the least discrepancy for work trips. Households having more than one car made more shopping trips than planned, households with children more chauffeuring trips than planned, and households with a higher income more leisure trips than planned. Weather conditions, illnesses, mode switches, and unspecified unexpected events were reported as reasons for the discrepancies between planned and actual trips.
The likelihood of becoming a pedestrian fatality and drivers' knowledge of pedestrian rights and responsibilities in the Commonwealth of Virginia.
Correspondence: Bryan E. Porter, Department of Psychology, Old Dominion University, Mills Godwin Building, Room 250, Norfolk, VA 23529-0267, USA; ( email: bporter@odu.edu).
Pedestrian�vehicle crashes represent a small percentage of all Virginia crashes (less than 2% over the past 10 years). However, approximately 10% of crash fatalities are pedestrians. We analyzed pedestrian crash trends from 1990�1999 and investigated variables believed to predict these crashes, such as location (urban versus rural setting), sex, age, pedestrian drinking, driver drinking, driver violation, and time of day. A logistic regression analysis, controlling for year, found all of these variables significantly predicted the odds of dying versus being injured in a pedestrian crash. The typical fatality victim was an older male who had been drinking and was walking in a rural area between 12:00 and 5:59 a.m. A driver who had been drinking but would not be cited for a violation more likely struck this pedestrian. Crash data do not tell us about the knowledge drivers and pedestrians have regarding pedestrian laws, and how such knowledge suggested typical self-reported behaviors. Thus, we conducted a telephone survey of licensed Virginia drivers to assess such self-reported knowledge and behaviors. Most respondents reported knowing and following state laws regarding driver yielding and walking across streets. However, we found one area of particular concern. Respondents tended to believe pedestrians had the right-of-way at all times even when not crossing at crosswalks or intersections when Virginia law does not yield right-of-way to pedestrians in all cases. Virginia does not assign right-of-way in all cases to any group; rather the context determines who may proceed while others yield. Additional analyses from the crash trends and survey are reported in the text. The authors also draw parallels between their US research and that of the international community.
See item under Distraction and Attentional Issues
See item under Ergonomics and Human Factors
See item 1 under Risk Factor Prevalence, Injury Occurrence and Costs
The objective of this study was to determine if a neural network model can identify victims of intimate partner violence (IPV). A custom neural network model was constructed and trained using the 1995 ED databases at Truman Medical Center of all female visits. The input vector developed was an array of 100 binary elements containing, in coded form, the patient's age, day of week, primary diagnosis (excluding 995.81), disposition, race, time, and E-code. The trained network was then presented with a series of 19,830 female patients from the 1996 ED database to determine if it could discriminate cases from control subjects. The neural network identified 231 of 297 known IPV victims (sensitivity 78%) in the 1996 database. It also categorized 2234 false-positive patients out of 19,533 IPV-negative patients (specificity 89%). A computer-based neural network model, when supplied with information commonly available in the ED medical record, can identify victims of IPV.
Gender differences in long-term health consequences of physical abuse of children: data from a nationally representative survey.
- Thompson MP, Kingree JB, Desai S. Am J Public Health 2004; 94(4): 599-604.
Correspondence: Martie P. Thompson, Department of Public Health Sciences, Clemson University, 511 Edwards Hall, Clemson, SC 29634�0745, USA; (email: mpthomp@clemson.edu).
OBJECTIVES: This study investigated the effects of physical abuse in childhood on health problems in adulthood and assessed gender differences in these associations.
METHODS: We used data from 8000 men and 8000 women who were interviewed in the National Violence Against Women Survey. We used multivariate logistic regression to test for main and interactive effects and conducted post hoc probing of significant moderational effects.
FINDINGS: Men were more likely than women to have experienced physical abuse during childhood. Whereas abuse had negative consequences for both boys and girls, it was generally more detrimental for girls.
COMMENTS: Findings suggest the need to consider gender differences and long-term adverse health consequences in the development of intervention strategies to address physical abuse in childhood.
The midwives' experiences in the identification of battered women in pregnancy.
- Valdez-Santiago R, Arenas-Monreal L, Hernandez-Tezoquipa I. Salud Publica Mex 2004; 46(1): 56-63.
Correspondence: R. Valdez-Santiago, Instituto Nacional de Salud Publica, Cuernavaca, Morelos, MEXICO; (email: rvaldez@insp.mx).
OBJECTIVE: To explore the experiences of midwives in the identification of battered women during pregnancy and to describe the types of violence they identify most easily.
METHODS: A qualitative study was conducted between January and September 2001 among twelve midwives from a group of midwives ascribed to the Instituto Nacional de Antropologia e Historia (INAH, National Institute of Anthropology and History), in Morelos, Mexico. Participants were selected from those living in Cuernavaca City and surrounding areas.
FINDINGS: Study findings show that: a) the identification of battered pregnant women in prenatal care should be triggered by a pattern of behaviors and attitudes of battered women, such as being unkempt, shyness, and above all, poor control over decisions on their health care; b) physical and emotional violence were the most frequently types of violence identified by midwives during prenatal care visits. Sexual violence was more difficult to identify.
COMMENTS: It is necessary to incorporate midwives in the national plans and programs to prevent domestic violence. Midwives' practices provide opportunities to care for battered women. Specialized training strategies must be directed to midwives caring for pregnant women in Mexico.
Analysis on the occurrence of violence among the injury surveillance program in the Emergency Department.
- Li LP, Cui HZ, Chen B, Wang S. Zhonghua Liu Xing Bing Xue Za Zhi. 2004; 25(1): 12-17.
Correspondence: L.P. Li, Medical College of Shantou University, Shantou 515031, CHINA; (email: unavailable).
OBJECTIVE: To explore the characteristics of violence events occurred at the Emergency Department in the hospital and to provide evidence for prevention and control of the problem.
METHODS: Surveillance on injuries was performed on those patients who first visited the Emergency Department in a general hospital in Shantou from January 1st 2000 to December 31th 2002.
FINDINGS: A total number of 11 472 injured patients registered in a 3-year surveillance program at the Emergency Department. Among the patients under surveillance, 29.0% of them were injured by violence events. The ratio of male to female was 3.8:1. The high risk age groups of violence patients were 15 - 44 years (77.1%) with workers as the majority. Home was the most common place for suicide/self-hurt (occupied 42.2%), and highway seemed to be the most common place for homicide/be injured (occupied 44.7%) to occur. Pre-hospital care for the injured patients was mostly taken care by other people (80.1%). Opening trauma appeared to be the most common injury caused by the violence.
COMMENTS: Our study on violence surveillance program at the Emergency Department provided information for identifying the main problems and population at high risk. Violence surveillance in the emergency department of different areas needs to be carried out in order to take preventive measures accordingly.
