BACKGROUND: To compare the strength of evidence provided by the epidemiological literature on the association between alcohol consumption and the risk of 14 major alcohol-related neoplasms and non-neoplastic diseases, plus injuries.
METHODS: A search of the epidemiological literature from 1966 to 1998 was performed by several bibliographic databases. Meta-regression models were fitted considering fixed and random effect models and linear and nonlinear effects of alcohol intake. The effects of some characteristics of the studies, including an index of their quality, were considered.
FINDINGS: Of the 561 initially reviewed studies, 156 were selected for meta-analysis because of their a priori defined higher quality, including a total of 116,702 subjects. Strong trends in risk were observed for cancers of the oral cavity, esophagus and larynx, hypertension, liver cirrhosis, chronic pancreatitis, and injuries and violence. Less strong direct relations were observed for cancers of the colon, rectum, liver, and breast. For all these conditions, significant increased risks were also found for ethanol intake of 25 g per day. Threshold values were observed for ischemic and hemorrhagic strokes. For coronary heart disease, a J-shaped relation was observed with a minimum relative risk of 0.80 at 20 g/day, a significant protective effect up to 72 g/day, and a significant increased risk at 89 g/day. No clear relation was observed for gastroduodenal ulcer.
COMMENTS: This meta-analysis shows no evidence of a threshold effect for both neoplasms and several non-neoplastic diseases. J-shaped relations were observed only for coronary heart disease.
Drinking patterns and problems in emergency services in Poland.
Correspondence: Cheryl J. Cherpitel, Public Health Institute, Alcohol Research Group, 2000 Hearst Avenue, Berkeley, CA 94709, USA; (email: ccherpitel@arg.org).
OBJECTIVE: To examine drinking patterns and problems in emergency services in Poland, where both alcohol consumption and the health care system have undergone enormous recent change.
METHODS: A probability sample of 734 emergency service patients was breathalyzed and interviewed in a large public hospital in Warsaw, Poland.
FINDINGS: 2.5% of the sample was breathalyzer positive; all were male and injured. Injured males were significantly more likely to report heavy problem drinking than non-injured, but no differences were found for females. Among injured males who reported drinking prior to the event, close to 50% reported feeling drunk, and over 75% attributed a causal association of their drinking with injury.
COMMENTS: These data point to substantial alcohol-involvement on the part of injured males in this population, and suggest emergency services may be a productive venue for identifying those patients who would benefit from a brief intervention.
OBJECTIVE: To test the efficacy of 2 programs designed to reduce high-risk behaviors among inner-city African American youth.
DESIGN: Cluster randomized trial.
SETTING: Twelve metropolitan Chicago, Ill, schools and the communities they serve, 1994 through 1998.
PARTICIPANTS: Students in grades 5 through 8 and their parents and teachers.
INTERVENTIONS: The social development curriculum (SDC) consisted of 16 to 21 lessons per year focusing on social competence skills necessary to manage situations in which high-risk behaviors occur. The school/community intervention (SCI) consisted of SDC and school-wide climate and parent and community components. The control group received an attention-placebo health enhancement curriculum (HEC) of equal intensity to the SDC focusing on nutrition, physical activity, and general health care.
MAIN OUTCOME MEASURES: Student self-reports of violence, provocative behavior, school delinquency, substance use, and sexual behaviors (intercourse and condom use).
FINDINGS: For boys, the SDC and SCI significantly reduced the rate of increase in violent behavior (by 35% and 47% compared with HEC, respectively), provoking behavior (41% and 59%), school delinquency (31% and 66%), drug use (32% and 34%), and recent sexual intercourse (44% and 65%), and improved the rate of increase in condom use (95% and 165%). The SCI was significantly more effective than the SDC for a combined behavioral measure (79% improvement vs 51%). There were no significant effects for girls.
COMMENTS: Theoretically derived social-emotional programs that are culturally sensitive, developmentally appropriate, and offered in multiple grades can reduce multiple risk behaviors for inner-city African American boys in grades 5 through 8. The lack of effects for girls deserves further research.
Although the 1995 Tokyo subway sarin attack probably was the most widely reported terrorist event in Japan to date (5,500 injured, 12 dead), the country has suffered numerous other large terrorism-related events in recent decades, including bombings of the headquarters of Mitsubishi Heavy Industries in Tokyo in 1974 (207 injured, 8 dead), the Hokkaido Prefectural Government office building in Sapporo in 1976 (80 injured, 2 dead), and the Yosakoi-Soran Festival in Sapporo in 2000 (10 injured, none dead). Japan also has experienced two other mass-casualty terrorist events involving chemical releases, including the 1994 Matsumoto sarin attack (600 injured, 7 dead) and the 1998 Wakayama arsenic incident (67 injured, 4 dead). Until 1995, emergency management in Japan focused on planning and preparedness at the local level for the frequent disasters caused by natural events. Since that time, substantial progress has been made in advancing emergency planning and preparedness for terrorism-related events, including the designation of disaster centers in each prefecture, the implementation of several education and training programs for nuclear, biological, and chemical terrorism, and the establishment of a national Anti terrorism Office within the Ministry of Health, Labor, and Welfare.
Pediatric Considerations in Chemical Exposures: Are We Prepared?
Correspondence: Elizabeth Lea Lynch, 11234 Anderson Street, A-108, Department of Emergency Medicine, Loma Linda University Medical Center, Loma Linda, CA 92354, USA; (email: llynch@ahs.llumc.edu).
Manmade disasters have risen over the past decade. Specifically, chemical weapons used in acts of aggression pose an increasing threat to our society. These potential disaster situations raise concerns regarding preparedness for both adults and children. This article's purpose is to review general principles of chemical exposure and treatment of specific chemical agents, and to identify specific pediatric considerations involved.
Suicide bombing attacks: update and modifications to the protocol.
- Almogy G, Belzberg H, Mintz Y, Pikarsky AK, Zamir G, Rivkind AI. Ann Surg 2004; 239(3): 295-303.
Correspondence: Gidon Almogy, Department of Surgery, University of Southern California, 1510 San Pablo Street, HCC-514, Los Angeles, CA, 90033-4612, USA; (email: galmogy@hotmail.com).
OBJECTIVE: To review the experience of a large-volume trauma center in managing and treating casualties of suicide bombing attacks.
BACKGROUND: The threat of suicide bombing attacks has escalated worldwide. The ability of the suicide bomber to deliver a relatively large explosive load accompanied by heavy shrapnel to the proximity of his or her victims has caused devastating effects.
METHODS: The authors reviewed and analyzed the experience obtained in treating victims of suicide bombings at the level I trauma center of the Hadassah University Hospital in Jerusalem, Israel from 2000 to 2003.
FINDINGS: Evacuation is usually rapid due to the urban setting of these attacks. Numerous casualties are brought into the emergency department over a short period. The setting in which the device is detonated has implications on the type of injuries sustained by survivors. The injuries sustained by victims of suicide bombing attacks in semi-confined spaces are characterized by the degree and extent of widespread tissue damage and include multiple penetrating wounds of varying severity and location, blast injury, and burns.
COMMENTS: The approach to victims of suicide bombings is based on the guidelines for trauma management. Attention is given to the moderately injured, as these patients may harbor immediate life-threatening injuries. The concept of damage control can be modified to include rapid packing of multiple soft-tissue entry sites. Optimal utilization of manpower and resources is achieved by recruiting all available personnel, adopting a predetermined plan, and a centrally coordinated approach. Suicide bombing attacks seriously challenge the most experienced medical facilities.
Correspondence: Mary F. Lesch, Liberty Mutual Research Institute for Safety, 71 Frankland Road, Hopkinton, MA 01748, USA; (email: mary.lesch@libertymutual.com).
Prior research has documented the manner in which a variety of driving performance measures are impacted by concurrent cell-phone use as well as the influence of age and gender of the driver. This current study examined the extent to which different driver groups are aware of their associated performance decrements. Subjects' confidence in dealing with distractors while driving and their ratings of task performance and demand were compared with their actual driving performance in the presence of a cell-phone task. While high confidence ratings appeared to be predictive of better driving performance for male drivers (as confidence increased, the size of the distraction effects decreased), this relationship did not hold for females; in fact, for older females, as confidence increased, performance decreased. Additionally, when drivers were matched in terms of confidence level, brake responses of older females were slowed to a much greater extent (0.38 s) than were brake responses of any other group (0.10s for younger males and females and 0.07 s for older males). Finally, females also rated the driving task as less demanding than males, even though their performance was more greatly affected by distraction. These results suggest that many drivers may not be aware of their decreased performance while using cell-phones and that it may be particularly important to target educational campaigns on driver distraction towards female drivers for whom there tended to be a greater discrepancy between driver perceptions and actual performance.
More than 300 all-terrain vehicle (ATV) trauma deaths occur annually. Most experience to date focuses on the pediatric trauma. However, senior citizens constitute the fastest growing segment of ATV enthusiasts. We queried our trauma registry from January 1988 to December 2002 and found 200 total ATV accidents. There were 8 patients over age 60. We compared geriatric and nongeriatric riders for presentation and outcome data. The anatomic distribution of injury was similar. Younger patients were more likely to have used ethanol or drugs. Tachypnea and hypotension were generally absent at presentation. The geriatric patients had worse predictive physiologic scores. Clinical outcomes for the geriatric group trended toward longer hospital stays, and they had significantly worse functional outcomes. The geriatric group nonsignificantly trended toward a higher mortality (12.5% vs 3.45%). Our study reflects the recent national trend toward a dramatic rise in geriatric ATV-related trauma. We recommend that geriatric ATV safety programs be instituted.
Downstairs falls frequently occur within domestic environments and are mainly associated with elderly and intoxicated individuals, often feature multiple injuries on various parts of the body. In most cases it is not possible to determine the cause of the fall and/or death solely by means of external examination. In this retrospective study, which covers a period of 11 years, all cases of death which included a fall downstairs in their case history, were collected from the Forensic Institutes of the Universities of Bonn and Greifswald, Germany. Falls downstairs made up to 2% (166 cases) of all postmortem examinations carried out within this period. Interestingly, almost double of the amount of such falls applied to males as to females. The primary cause of death was cranio-cerebral trauma and the vast majority of skull injuries associated with falls downstairs were found above 'the hat brim line'. Injuries were also often found on several other parts of the body at once. Nineteen of the 116 examined individuals exhibited agonal injuries. In these cases, postmortem examination revealed pre-existing disease or intoxication to be the cause of death and thus, cause of the fall. The injury pattern only allows a tendency towards vital or agonal incident as a conclusion.
Lessons learned from an emergency medical services fire safety intervention.
OBJECTIVE: The authors conducted a pilot study, finding that many households that experienced fires had received prior emergency medical services (EMS) visits, but few had operational smoke alarms. The study hypothesis is that dwellings that received smoke alarms and/or batteries during an EMS call were more likely to have an operational alarm, less property dollar loss, and decreased morbidity and mortality at the time of a subsequent fire.
METHODS: Smoke detectors and batteries were provided to an urban fire department for placement in unprotected homes at the time of an EMS call from March 1, 1999, through January 31, 2001. After addressing the reason for the 911 EMS call, verification or installation of an operational smoke alarm was performed. The authors examined records for dwellings that had a subsequent fire for outcomes of smoke alarm status, estimated property dollar loss, and number of injuries and fatalities.
FINDINGS: This program placed 1,335 smoke detectors. Of these, 99 dwellings were found to have a fire or smoke condition with 20 exclusions. Our final number was 79; 28 (35%) still had an operating smoke alarm. In homes with operational alarms, the mean dollar loss was $2,870 (U.S. 2001) (95% confidence interval [CI], 143-5,596). In homes without operational alarms, mean loss was $10,468 (U.S. 2001) (95% CI, 5,875-15,061). No injuries or fatalities occurred in either group.
COMMENTS: This program was successful in placing 1,335 smoke alarms in at-risk dwellings and reaffirmed that an operational smoke alarm significantly decreases property dollar loss. However, if the goal is to have all homes protected by smoke alarms, this program has long-term effectiveness limitations.
Self-reported injuries among seafarers. Questionnaire validity and results fron an international study.
- Jensen OC, Sorensen JF, Kaerlev L, Canals ML, Nikolic N, Saarni H. Accid Anal Prev 2004; 36(3): 405-413.
Correspondence: Olaf C. Jensen, Research Unit of Maritime Medicine, University of Southern Denmark, Niels Bohrs Vej 9, DK-6700 Esbjerg, DENMARK; (email: ocj@fmm.sdu.dk).
International surveys of occupational injuries among seafarers have so far been missing. It was the aim to test the method of self-report of injuries and length of time at risk during the latest duty period and second to study the injury incidence rate among seafarers by use of the method. A pilot study was conducted (n = 1068) in Finland, Denmark, the Philippines, Croatia and Spain using self-completed questionnaires with questions about the person, the ship, the duration of latest duty period and injuries. The duration of the self-reporting duty period was in the Danish part compared with information from the crew register of the Maritime Authority. For seafarers from merchant ships in the Danish sub-study there was acceptable correspondence between the information from the seafarers and the Maritime Authority, but not when referring to ferries and non-specified types of ship. Unadjusted and adjusted injury incidence rates-ratios (IRRs) based on number of injuries per number of work hours were calculated. Adjusted IRRs for ordinary seamen/officers: IRR = 2.43 (95% CI: 1.25-4.72); for age < 35/35+ years: IRR = 1.97 (1.02-3.81); length of tour: 117 days or longer compared with < 117 days: IRR = 0.46 (95% CI: 0.22-0.95); 57-70 working hours per week compared with < 57 h: IRR = 1.26 (0.48-3.29), 71+h compared with < 57 h: IRR = 2.12 (0.84-5.36). Non-significant IRRs >1.00 were found for ships under 10,000 GT compared with larger ships and for own flagged ships compared with ships under flag of convenience. In conclusion, more than 70 h of work per week was related to a higher rate of injuries for seafarers on merchant ships, but the result was not statistically significant. Self-report of the duration of the latest tour of duty is useful for seafarers from merchant ships with short-term employments, but not for ferries and other, non-specified types of ship with other or permanent employment.
All-cause and cause specific mortality in a cohort of 20,000 construction workers; results from a 10 year follow up.
- Arndt V, Rothenbacher D, Daniel U, Zschenderlein B, Schuberth S, Brenner H. Occup Environ Med 2004; 61(5): 419-425.
Correspondence: V. Arndt, German Centre for Research on Ageing, Department of Epidemiology, Bergheimer Strasse 20, D-69115 Heidelberg, GERMANY; (email: arndt@dzfa.uni-heidelberg.de).
BACKGROUND: Construction workers are potentially exposed to many health hazards, including human carcinogens such as asbestos, silica, and other so-called "bystander" exposures from shared work places. The construction industry is also a high risk trade with respect to accidents.
METHODS: A total of 19 943 male employees from the German construction industry who underwent occupational health examinations between 1986 and 1992 were followed up until 1999/2000.
FINDINGS: A total of 818 deaths occurred during the 10 year follow up (SMR 0.71; 95% CI 0.66 to 0.76). Among those were 299 deaths due to cancer (SMR 0.89; 95% CI 0.79 to 1.00) and 312 deaths due to cardiovascular diseases (SMR 0.59; 95% CI 0.51 to 0.68). Increased risk of mortality was found for non-transport accidents (SMR 1.61; 95% CI 1.15 to 2.27), especially due to falls (SMR 1.87; 95% CI 1.18 to 2.92) and being struck by falling objects (SMR 1.90; 95% CI 0.88 to 3.64). Excess mortality due to non-transport accidents was highest among labourers and young and middle-aged workers. Risk of getting killed by falling objects was especially high for foreign workers (SMR 4.28; 95% CI 1.17 to 11.01) and labourers (SMR 6.01; 95% CI 1.63 to 15.29).
COMMENTS: Fatal injuries due to falls and being struck by falling objects pose particular health hazards among construction workers. Further efforts are necessary to reduce the number of fatal accidents and should address young and middle-aged, semi-skilled and foreign workers, in particular. The lower than expected cancer mortality deserves careful interpretation and further follow up of the cohort.
Occupational fatalities during trenching and excavation work --- United States, 1992--2001.
-T Lentz, D Votaw, H Ahlers, Education and Information Div; K Hendricks, S Pratt, Div of Safety Research; P Coleman, Spokane Research Laboratory; M Gillen, R Ehrenberg. MMWR 2004; 53(15): 311-314.
The full report with tables, editorial note, and references is available online: Download Document).
Fatalities associated with trench collapses and other excavation hazards continue to occur despite Occupational Safety and Health Administration (OSHA) standards that specify safe work practices to reduce such hazards to workers. To assess the hazards of trenching and excavation work in the United States, CDC reviewed data from national occupational fatality records and investigative reports of fatal injuries. This report summarizes the results of that analysis, which indicated that 76% of the deaths were caused by cave-ins and 47% of the deaths occurred among employees of companies with <10 workers. Employers can reduce the risk for future deaths by adhering to OSHA standards and by using education and training resources on safe excavation and trenching practices offered by the National Institute for Occupational Safety and Health (NIOSH), OSHA, and labor and trade organizations.
CDC reviewed data for 1992--2001 (the most recent data available to CDC) from the Census of Fatal Occupational Injuries (CFOI) maintained by the Bureau of Labor Statistics (BLS) and reviewed reports from the NIOSH Fatality Assessment and Control Evaluation (FACE) program. CFOI is a national reporting system for occupational deaths that derives data from multiple sources (e.g., death certificates, medical examiner/coroner reports, workers' compensation reports, and police reports). The CFOI research file provided to CDC does not include data for New York City. Trenching and excavation cases were identified in the CFOI database by using specific codes and keywords. After the initial case selection, a manual review of narratives was performed to select appropriate cases.
Trenching and Excavation Fatalities, 1992--2001
During 1992--2001, CFOI data identified 542 fatalities associated with trenching and excavation. Annual totals ranged from a low of 44 in 1993 to a high of 65 in 1996 and averaging 54 fatalities per year. The average age of decedents was approximately 38 years (range: mid teens to late 70s). Of the fatalities, 256 (47%) occurred among employees of companies with <10 workers, and 381 (70%) occurred in companies with <50 workers. The industries most frequently reporting fatalities were those involved in "excavation work," followed by "water, sewer, pipeline, and communications and power-line construction". A total of 507 (94%) decedents were employed in private industry, 31 (5%) decedents were local government workers, and the remaining four (1%) were employed elsewhere. Although excavation and trenching fatalities occurred in various occupations, the largest proportion of deaths occurred among construction laborers. Cave-ins accounted for 76% of fatalities. Among decedents, the average length of employment with their employer was 6.7 years (range: <1--40 years); 86 (16%) deceased workers had been with their employer for <1 year.
Self-reported experiences of incidents and injury events in traffic among hearing impaired people as pedestrians and cyclists. A follow-up study of mobility and use of hearing equipment.
Correspondence: Jorgen Lundalv, Department of Social Work, G�teborg University, P.O, Box 720, SE 405 30 Goteborg, SWEDEN; (email: Jorgen.Lundalv@socwork.gu.se).
Patients with hearing impairments have no self-reported experiences of feeling insecure in the traffic environment. A follow-up study was conducted with 21 patients after the rehabilitation process at the Hearing Centre and the Accident Analysis Group, University Hospital in Umea, Sweden and 90 per cent of the respondents reported feeling safe in traffic. However, the hearing impaired are more vulnerable than others because they find it difficult to identify in which direction sounds made by cyclists and motorists are actually coming from. In the future, professionals would gain more knowledge about mobility and injury prevention if they tried to detect the coping strategies used by patients with hearing impairments.
Bicycle-related injuries to children and parental attitudes regarding bicycle safety.
Correspondence: H.W. Ortega, Division of Emergency Medicine, Department of Pediatrics, The Ohio State University College of Medicine and Public Health, Children's Hospital, Columbus, Ohio, USA; (email: unavailable).
This study was designed to evaluate bicycle-related injuries among children requiring emergency treatment, assess the use of safety measures before and after injuries, and determine parental attitudes regarding bicycle safety. Six hundred fifty-eight children were treated for bicycle-related injuries during the study period. Follow-up contact with patients' families was made by telephone or mail within 2 months. Use of safety equipment other than brakes and reflectors occurred in less than 7% of cases. Less than 25% of children used hand signals. Sixty-eight percent of children reportedly owned a bicycle helmet before the injury, but only 26.1% "always" and 29.7% "never" wore a helmet. Given the high parental understanding of the importance of bicycle helmet use, more education and warnings alone are unlikely to increase helmet usage. Parents support a mandatory helmet use law, and therefore, local and state bicycle helmet ordinances and laws should be combined with education.
Providing service to non-English speaking populations is a common challenge facing Poison Centers (PC). Previous studies have identified that people who do not speak functional English are unlikely to call a PC. We developed a survey to determine the language preferences of poison center callers and to identify if we were failing to offer services in languages other than English to callers who felt they needed them. We surveyed 322 parents during routine callbacks about language spoken at home, first and second languages, country of birth, and satisfaction with language used by the PC. We found that 93% primarily spoke English, 5% spoke English and Spanish, and 5% spoke other languages at home in a region where approximately 10% of the population speak English poorly. The majority of respondents were born in the US and were comfortable using English when using the PC. There were 6 cases where callers would have preferred using a different language. Our study supports data suggesting that poison centers are underutilized by people that are recent immigrants and speak English poorly. Awareness programs and educational efforts should be directed toward this sub-population.
Carbon monoxide poisonings resulting from open air exposures to operating motorboats --- Lake Havasu City, Arizona, 2003.
- Roberts P, Ward M, Baron RL, MD, Humble W, Hadzihasanovic M, Cox R, Tapp L, McCammon J, McCleery R. MMWR 2004, 53(15);314-318.
The full report with tables, references, editorial note, and photographs is available online: ( Download This Report ).
During February 1997--August 2002, two fatal and six nonfatal cases of carbon monoxide (CO) poisoning occurred in vacationers who were wading in or boating near the Bridgewater Channel of Lake Havasu (Lake Havasu City [LHC], Arizona). The vacationers were near operating motorboats, primarily in the channel area, where large numbers of boaters congregate during holiday weekends (Figure). One person had a carboxyhemoglobin (%COHb) level of 40% on autopsy. To evaluate CO exposure among municipal employees working in the channel, CDC and the Havasu Regional Medical Center Emergency Department (HRMCED) conducted an initial investigation during Labor Day weekend 2002 (August 31--September 1). CO concentrations in channel air exceeded all short-term exposure criteria; four of 12 patients reporting to HRMCED because of boating-related activities had %COHb levels of >9%. In May 2003, LHC requested assistance from CDC, the Mohave County Department of Public Health (MCDPH), the Arizona Department of Health Services (ADHS), and a private consulting firm to assess CO exposures in the channel during Memorial Day weekend 2003 (May 23--26). Follow-up environmental surveys were conducted during June--September 2003. This report summarizes the findings of these surveys, which documented excessive CO exposure and confirmed the health risk among vacationers and employees working in the channel near crowded motorboat gatherings. Community leaders and safety officials should 1) be aware that employees and vacationers in close proximity to operating motorboats can be exposed to potentially lethal levels of CO, 2) evaluate exposures, and 3) take steps to prevent poisonings.
Exposure Monitoring
During May 23--26, 2003, CDC and MCDPH conducted workshift CO-exposure monitoring and exhaled breath CO analyses among municipal employees and administered questionnaires to determine prevalence of CO-related symptoms. Exhaled breath CO concentrations (measured as parts per million [ppm] by direct-reading instruments) were measured in the morning and evening to determine changes during the day. Concentrations were then converted to estimated %COHb by using the American Conference of Governmental Industrial Hygienists (ACGIH) calculation. During May 24--25, ADHS investigators measured exhaled breath CO concentrations by using comparable instruments and administered brief questionnaires to a convenience sample of 62 vacationers in the channel. Vacationers' CO concentrations were measured once and converted to an estimated %COHb by using a breath analysis conversion chart.
Of 40 LHC employees, 36 (90%) participated during one or more workshifts, accounting for 78 monitored workshifts. Of these workshifts, 19 (25%) involved CO exposures equal to or exceeding the NIOSH recommended exposure limit (REL); 54 (69%) involved short-term CO exposures that exceeded the NIOSH ceiling limit. Of 63 workshifts involving nonsmoking employees, 42 (67%) had estimated post-shift %COHb levels that equalled or exceeded the ACGIH biologic exposure index of 3.5%�. CO exposures decreased on the last day of the holiday weekend, when many of the boaters left the channel. During the 66 workshifts of the 3 days of heaviest boating (May 23--25), the post-shift symptoms reported most frequently by employees were headache, fatigue or weakness, visual disturbances, and dizziness. The average estimated %COHb among nonsmoking employees increased during the day, from 1% in the morning to 6% in the afternoon. Among smokers, the average increase was from 3% to 7%. The maximum estimated %COHb level among employees was 13% in nonsmokers and 11% in smokers.
Among 46 nonsmoking vacationers, the estimated %COHb increased from a mean of 1% in the morning to 11% in the afternoon. Among 16 smoking vacationers, the average estimated %COHb increased from 3% in the early afternoon to 13% in the late afternoon. The maximum estimated %COHb level among vacationers was 23% for nonsmokers and 26% for smokers.
Since the initial investigation in September 2002 (Labor Day weekend), one fatal and four nonfatal, hospital-treated CO poisonings involving loss of consciousness have occurred among channel vacationers, with %COHb levels ranging from 19% to 47% (P. Mead, MCDPH, and M. Ward, D.O., HRMCED, personal communications, 2003). One poisoning occurred on the back of a boat; the other four (including the fatality) occurred while persons were wading near boats in the channel.
Ambient Air Monitoring
During June 26--September 9, 2003, meteorologic conditions and CO concentrations were measured at fixed locations on the banks of the channel, on police and fire boats operating in and near the channel, and on police four-wheel, all-terrain vehicles patrolling the east and west banks of the channel. Concentrations in the channel and nearby onshore were higher (maximum 8-hour averages of 20--40 ppm at a typical onshore site) on the holiday weekends, when many boats were in the channel. Concentrations were highest when wind speeds were lower (<1.5 meters per second [<3.4 miles per hour]) and temperatures were higher (>90� F [>32� C]). Concentrations declined considerably with distance from the channel (e.g., maximum 8-hour averages of <1 ppm were measured at a busy intersection 350 meters from the channel). The highest CO concentrations occurred in the late afternoon and early evening, usually during 5 to 9 p.m., when wind speeds typically decreased.
Correspondence: Brent Hagel, Alberta Centre for Injury Control and Research, Department of Public Health Sciences, University of Alberta, 4075 RTF, 8308-114 Street, Edmonton, Alberta T6G 2E1, CANADA; (email: brent.hagel@ualberta.ca).
BACKGROUND: Snow sports such as skiing and snowboarding are recognized as hazardous, but population-based injury rates or specific risk factors have been difficult to estimate as a result of a lack of complete data for both numerator and denominator.
METHODS: We used data from 3 surveys to estimate the number of participants and annual number of outings in Quebec by age, sex, activity, and calendar year. Injuries reported by ski patrollers were used to estimate injury rates among skiers and snowboarders for the head and neck, trunk, upper extremity, and lower extremity.
FINDINGS: Head-neck and trunk injury rates increased over time from 1995-1996 to 1999-2000. There was a steady increase in the rate of injury with younger age for all body regions. The rate of head-neck injury was 50% higher in snowboarders than in skiers (adjusted rate ratio [ARR] = 1.5; 95% confidence interval = 1.3-1.8). Women and girls had a lower rate of head-neck injury (0.73; 0.62-0.87). Snowboarders were twice as likely as skiers to have injuries of the trunk (2.1; 1.7-2.6), and more than 3 times as likely to have injuries of the upper extremities (3.4; 2.9-4.1). Snowboarders had a lower rate of injury only of the lower extremities (0.79; 0.66-0.95). Snowboarder collision-related injury rates increased substantially over time.
COMMENTS: Except for lower extremity injuries, snowboarders have a higher rate of injuries than skiers. Furthermore, collision-related injury rates have increased over time for snowboarders. Targeted injury prevention strategies in this group seem justified.
Ophthalmic Injuries in Children Involved in All-Terrain Vehicle Crashes.
Correspondence: Matthew W. Wilson, Department of Ophthalmology, University of Tennessee Health Science Center, 956 Court Avenue, D228, Memphis, TN 38163, USA; (email: mwilson5@utmem.edu).
PURPOSE: To describe the spectrum of ophthalmic injuries in children involved in all-terrain vehicle (ATV) crashes.
METHODS: We retrospectively reviewed the medical records of a level 1 children's trauma center to identify cases with ICD-9 codes pertaining to crashes involving ATVs and cross-referenced for ophthalmic trauma. From these cases, we documented the nature of the crash, patient's age, ophthalmic injuries received, and length of hospitalization.
FINDINGS: Twenty children, 5 to 16 years of age (mean, 11.1 years), involved in ATV crashes were admitted between June 1997 and April 2002. One was riding with an adult and 3 with other children; 16 were operating the vehicles alone at the time of their crashes. None was wearing a helmet, and all had head trauma. Nine patients had ophthalmic injuries, including lacerations of the eyelid (n = 5), orbital fractures (n = 9), and traumatic optic neuropathies (n = 2). The latter two had final visual acuities of count fingers and no light perception. The average length of hospitalization was 6.6 days.
COMMENTS: Ophthalmic trauma is a frequent complication of ATV crashes involving children. Injuries may range from minor lacerations to complex orbital fractures; visual loss may be severe. We believe that the age of the vehicles' operators and their failure to wear protective helmets contribute to the severity of injuries.
Correspondence: Charles N. Paidas, Department of Pediatric Surgery, 600 North Wolfe St, CMSC 7-116, Baltimore, MD 21287, USA; (email: cpaidas@jhmi.edu).
OBJECTIVE: Traumatic spinal injury (TSI) is an uncommon source of morbidity and mortality in children. The aim of this study was to describe childhood TSI in a single level 1 urban pediatric trauma center.
METHODS: The authors retrospectively analyzed all children younger than 14 years with TSI, treated at a level I pediatric trauma center between 1991 and 2002 (n = 406, 4% total registry). All children were stratified according to demographics, mechanisms, type and level of injury, radiologic evaluations, associated injuries, and mortality.
FINDINGS: The mean age was 9.48 +/- 3.81 years. The most common overall mechanism of injury was motor vehicle crash (MVC; 29%) and ranked highest for infants. Falls ranked highest for ages 2 to 9 years. Sports ranked highest in the 10 to 14 year age group. Paravertebral soft tissue injuries were 68%. The most common injury level was the high cervical spine (O-C4). The incidence of spinal cord injury without radiologic abnormality (SCIWORA) was 6%. Traumatic brain injury (37%) was the most common associated injury. Overall mortality rate was 4% in this urban catchment.
COMMENTS: TSI in children requires a different preventive and therapeutic logarithm compared with that of adults. The potential devastating nature of TSI warrants that the health care team always maintains a high index of suspicion for injury. Future prospective studies are needed to further elucidate injury patterns.
Epidemiology of electrical and lightning related deaths and injuries among Canadian children and youth.
Among burn injuries, electrical injuries constitute a small but devastating fraction. To describe the epidemiology of electrical injuries in Canadian children, data on deaths and emergency department visits related to electrical injuries, including lightning strikes, were obtained from provincial coroners' offices and the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP) respectively, for the years 1991-96. Twenty one deaths and 606 emergency visits highlight that electrical related deaths, more frequent among school age children, are more likely the result of high voltage and lightning strike, while emergency department visits, more frequent among younger children, are more likely the result of low voltage. While the introduction of legislated standards for child safe outlets and educational programs for parents, children, and youth are recommended strategies toward reducing the frequency of these incidents, these strategies require further evaluation before their effectiveness can be estimated.
Childrens' rights and a sample study on accidents in children groups aged 0-5 years old in the light of parents' responsibility in Turkey.
- Elcioglu O, Aksoy S, Gunduz T. Saudi Med J 2004; 25(4): 470-473.
Correspondence: Omur Elcioglu, Department of Medical Ethics and History of Medicine, Faculty of Medicine, Osmangazi University, Eskisehir, TURKEY; (email: elcioglu@ogu.edu.tr).
OBJECTIVE: The most frequent reasons for accidents seen in children under 5 years of age who have a right to be cared and protected are negligence and carelessness. In this study, judicial cases were compiled from children between the age of 0 to 5, who had been injured due to severe family negligence.
METHODS: Files of cases were obtained from archives with file numbers, indicating cases obtained from the records of the hospital and police were studied retrospectively. The gender, age, and type of application of patients, the type of interference, and the results obtained from the procedure were studied. This study encompasses the results of cases at Osmangazi University Training, Practice and Research Hospital, Eskisehir, Turkey, between September 1999 and March 2001.
FINDINGS: Forty of 113 cases (35.4%) were due to poisoning from drugs. The main reasons were unawareness of children regarding the harm of drugs, putting drugs in reach of children and easy access to drugs from pharmacies without prescription. On the other hand, the recognition of international measures by the Turkish government is a guarantee for the children's rights.
COMMENTS: Our study implies that, as suggested by other researchers, the investigation of measures to prevent injuries due to negligence and the application of these measures will certainly improve the welfare of society.
Population-based estimates of outcomes after hospitalization for traumatic brain injury in Colorado.
- Whiteneck G, Brooks Ca C, Mellick D, Harrison-Felix C, Terrill MS, Noble K. Arch Phys Med Rehabil 2004; 85(4 Suppl 2): 73-81.
Correspondence: CA Brooks, Research Department, Craig Hospital, 3425 S Clarkson St, Englewood, CO 80113 USA; (email: cabrooks@craighospital.org).
OBJECTIVE: To determine statewide, population-based outcomes of persons hospitalized with traumatic brain injury (TBI) at 1 year postinjury.
DESIGN: Follow-up survey of a representative cohort.
SETTING: A statewide, population-based registry and follow-up system for persons hospitalized with TBI.
PARTICIPANTS: A total of 1591 adult Coloradoans with moderate and severe injury oversampled, but weighted to be representative of persons hospitalized with TBI (1996-1999) who survived their injuries and completed follow-up telephone interviews at 1 year postinjury.
INTERVENTIONS: Not applicable.
MAIN OUTCOME MEASURES: Checklists of symptoms and service utilization, the FIM instrument trade mark, the Craig Handicap Assessment and Reporting Technique Short Form, a single-item quality of life (QOL) measure, and a needs assessment checklist.
FINDINGS: Problematic outcomes occurring at 1 year postinjury included one third or more being bothered by fatigue, feeling irritable or grouchy, having headaches, and experiencing trouble sleeping more frequently than preinjury; 37% reported needing the assistance of another person in physical and/or cognitive activities of daily living; substantial participation restrictions were noted in areas of occupation (30%) and social integration (22%); and 29% responded that their QOL was only fair or poor. Negative outcomes were reported more frequently among individuals who were more severely injured, older, or female.
COMMENTS: Substantial percentages of people hospitalized with TBI in a population-based sample reported a variety of problematic outcomes at 1 year postinjury.
This study examined the relationships between two groups of Canadian preschool children (injured and noninjured) and their parents' risk perceptions, safety behaviors, parenting stress, and children's risk behaviors. Data analysis revealed significantly higher numbers of injury behaviors in the group of injured children (t = -2.46, p =.015). Contrary to the investigators' hypothesis, parents' perceptions of risk and hazard were not found to be significantly less among those parents of injured children. However, the parents of injured children had a higher score for perceived dangers for their children (t = -2.38, p =.01) and less parent stress (t = 3.38, p =.001).
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.
OBJECTIVE: To explore the features of violence among primary and secondary school students in Hefei, and to set up intervention measures for violence prevention.
METHODS: Four schools in Hefei were randomly sampled in the study. A total of 3064 students completed a questionnaire.
FINDINGS: 16.22% of the pupils reported having suffered from violence at least once every month. The rate was higher in boys than that in girls's (chi(2) = 25.13, P = 0.000). The major assaulters were from classmates (45.80%), with hand beating (37.42%), insulting (31.21%), threatening (20.88%), and 10.49% using sticks and sharp weapons. Most violence occurred at school (46.08%), followed by at home (28.41%) and outside of schools (25.51%), with significant difference (P = 0.000). As a result, 3.33% ended up with fractures, and 0.51% with disability. 97 pupils reported having assaulted others frequently (3.21%). Being irritated (47.38%) was the major reason for the violence to occur.
COMMENTS: Violence among primary and secondary school students in Hefei city was serious that called for targeted education be strengthened and school environment be improved.
Is perceived failure in school performance a trigger of physical injury? A case-crossover study of children in Stockholm County.
Correspondence: Lucie Laflamme, Karolinska Institute, Department of Public Health Sciences, Division of Social Medicine, Stockholm, SWEDEN; (email: lucie.laflamme@phs.ki.se).
OBJECTIVES: To investigate whether perceived failure in school performance increases the potential for children to be physically injured.
SUBJECTS: Children aged 10-15 years residing in the Stockholm County and hospitalised or called back for a medical check up because of a physical injury during the school years 2000-2001 and 2001-2002 (n = 592).
METHODS: A case-crossover design was used and information on potential injury triggers was gathered by interview. Information about family socioeconomic circumstances was gathered by a questionnaire filled in by parents during the child interview (response rate 87%).
FINDINGS: Perceived failure in school performance has the potential to trigger injury within up to 10 hours subsequent to exposure (relative risk = 2.70; 95% confidence intervals = 1.2 to 5.8). The risk is significantly higher among pre-adolescents and among children from families at a higher education level.
COMMENTS: Experiencing feelings of failure may affect children's physical safety, in particular among pre-adolescents. Possible mechanisms are perceptual deficits and response changes occasioned by the stress experienced after exposure.
This paper reviews the literature on deliberate self-burning (DSB) and compares patterns in various countries. Fifty-five studies of deliberate self-harm or suicide by fire published in the last 20 years were reviewed. They reported on 3351 cases of DSB, including 2296 deaths. India had the highest absolute number of cases, the highest fatality rate, and the highest contribution of self-harm to burns admissions. The highest reported incidence was from Sri Lanka. Male victims generally predominated in Western countries, and females in the Middle East and the Indian sub-continent. Patients were grossly 10 years older in Europe than in Asia. The use and nature of fire accelerants, the possible roles of ethnicity, religion/faith and imitation are discussed. Three broad groups of victims were identified: psychiatric patients (Western and Middle-Eastern countries); those committing DSB for personal reasons (India, Sri Lanka, Papua-New Guinea, Zimbabwe); and those who are politically motivated (India, South Korea). Self-mutilators and self-immolators seem to be fairly distinct groups of people.
The incidence and repetition of attempted suicide in Ireland.
- Corcoran P, Keeley HS, O'Sullivan M, Perry IJ. Eur J Public Health 2004; 14(1): 19-23.
Correspondence: Ivan J. Perry, Department of Epidemiology and Public Health, Distillery House, University College, Cork, IRELAND; (email: i.perry@ucc.ie).
BACKGROUND: Suicidal behaviour has increasingly become recognized as a major public health problem. This study aimed to establish the extent of hospital-treated attempted suicide in South-west Ireland.
METHODS: Between 1995 and 1997, routine data collection, based on the standardized methodology of the WHO/Euro Multicentre Study on Suicidal Behaviour, took place in all general and psychiatric hospitals and prisons in the Southern and Mid-western Health Boards covering one-quarter (863,709) of the Irish population.
FINDINGS: The annual person-based (aged over 15 years) male and female European age-standardized attempted suicide rates were 163 and 190 per 100,000, respectively. Female rates far exceeded male rates in under 20-year-olds. The peak rates for men and women were in the age range 20-24 (374 per 100,000) and 15-19 (433 per 100,000) years, respectively. One in six (16%) made a repeat attempt within the study period. Adjusting for age, repetition was marginally less common in women. Multivariate analysis investigating the risk of repetition associated with age, method and previous attempts found no age effect for women but an increased risk of repetition among men in their thirties (OR=1.7, 95% CI: 1.2-2.4). An attempt in the preceding 12 months greatly elevated the risk of repetition, particularly for women (female OR=13.7, 95% CI: 9.3-20.4; male OR=5.6, 95% CI: 4.1-7.8).
COMMENTS: Attempted suicide is a significant public health problem in Ireland. Rates are higher in women and highest among the young. An attempt in the past year greatly increases the risk of repetition, especially in women.
Correspondence: Catherine B. Custalow, Department of Emergency Medicine, UVA Health System, P.O. Box 800699, Charlottesville, VA 22908-0699, USA; (email: cbc3d@virginia.edu).
BACKGROUND: Emergency medical vehicle collisions (EMVCs) cause significant injury, death, and property damage every year in the United States and result in significant delays in transporting patients to the hospital.
OBJECTIVE: To identify factors associated with EMVCs that are potentially amenable to preventive intervention.
METHODS: The authors reviewed data from the Paramedic Division of the Denver Health and Hospital Authority (DHHA) on all EMVCs occurring from 1989 through 1997.
FINDINGS: A T-bone mechanism, collision at an intersection, and alcohol intoxication of the civilian driver were all significant predictors of collisions resulting in injury (odds ratios of 29.7, 4.3 and 6.1, respectively, p<0.05, multiple logistic regression). Although only 75% of the division's responses are run with warning lights and sirens (WLS), a disproportionate 91% of response mode collisions were during a WLS response. The responsible EMV driver had a history of multiple EMVCs in 71% of the collisions.
COMMENTS: Potential interventions suggested by this study include the need for EMV drivers to visually clear the intersection before entering it, alerting other drivers with visual and auditory warning systems, and attempting to make eye contact with them at an intersection. The authors recommend continued public education regarding the risks of drunk driving. The authors feel that the WLS driving mode is best reserved for patients in whom the benefits of shorter response and return times outweigh the risk of collision. Finally, the authors advocate careful review of drivers' collision history, frequent emergency vehicle operator's course retraining, and appropriate discipline when necessary.
Raised speed limits, speed spillover, case-fatality rates, and road deaths in Israel: a 5-year follow-up.
- Richter ED, Barach P, Friedman L, Krikler S, Israeli A. Am J Public Health 2004; 94(4): 568-574.
Correspondence: Elihu D. Richter, Unit of Occupational and Environmental Medicine, Hebrew University-Hadassah Medical School, Jerusalem 91120, ISRAEL; (email: elir@cc.huji.ac.il).
OBJECTIVES: We assessed the 5-year, nationwide impact on road deaths of the raise in the speed limit (November 1, 1993) on 3 major interurban highways in Israel from 90 to 100 kph.
METHODS: We compared before-after trends in deaths as well as case fatality-an outcome independent of exposure (defined as vehicle-kilometers traveled).
FINDINGS: After the raise, speeds rose by 4.5%-9.1%. Over 5 years, there was a sustained increase in deaths (15%) and case fatality rates (38%) on all interurban roads. Corresponding increases in deaths (13%) and case fatality (24%) on urban roads indicated "speed spillover."
COMMENTS: Immediate increases in case fatality predicted and tracked the sustained increase in deaths from increased speeds of impact. Newtonian fourth power models predicted the effects of "small" increases in speed on large rises in case fatality rates. Countermeasures and congestion reduced the impact on deaths and case-fatality rates by more than half.
Primary enforcement seat belt laws are effective even in the face of rising belt use rates.
Correspondence: Ruth A. Shults, Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway, MS K-63, Atlanta, GA 30341, USA; (email: rshults@cdc.gov).
A recent systematic literature review found that primary enforcement laws are more effective at increasing seat belt use than secondary laws in the United States. This report re-examines the studies included in the systematic review to explore whether the benefits of a primary law differ based on: (1) the baseline seat belt use rate; or (2) whether or not the primary law replaces a secondary law. States that directly enacted primary laws showed larger increases in observed seat belt use (median increase of 33 percentage points). These laws were enacted in the mid-1980s, when baseline belt use rates were below 35%. Smaller, but substantial increases in belt use were observed in states that replaced secondary with primary laws (median increase of 14 percentage points). Baseline belt use rates in these states ranged from 47 to 73%. Primary safety belt laws can further increase seat belt use even in states with relatively high baseline levels of belt use.
The influence of passengers on the risk of the driver causing a car collision in Spain. Analysis of collisions from 1990 to 1999.
- Rueda-Domingo T, Lardelli-Claret P, Luna-del-Castillo Jde D, Jimenez-Moleon JJ, Garcia-Martin M, Bueno-Cavanillas A. Accid Anal Prev 2004; 36(3): 481-489.
Correspondence: Pablo Lardelli-Claret, Departamento de Medicina Preventiva y Salud Publica, Facultad de Medicina, Universidad de Granada, Avda. de Madrid 11, 18012 Granada, SPAIN; (email: lardelli@ugr.es).
OBJECTIVE: To determine how the number of passengers, their age and their sex influence the risk of different types of Spanish drivers causing a collision between two or more cars.
METHODS: We selected, from the Spanish database of traffic crashes resulting in personal injuries or death, those collisions between two or more cars that occurred between 1990 and 1999 in which only one of the involved drivers committed a driving infraction. These drivers were considered the cases; non-infractor drivers were considered their matched controls. We collected information on the number, age and sex of the passengers in each vehicle, along with some potential confounding variables of the drivers and the vehicles involved. Crude and adjusted odds ratios were calculated for the main categories of driver and passenger.
FINDINGS: A protective effect for the presence of passengers was detected (adjusted odds ratio: 0.69; 95% CI: 0.67-0.70). The protective effect was higher for drivers aged more than 45 years and lower for the youngest drivers (<24 years old). The strongest association was observed for female passengers who accompanied male drivers. The protective effect was lower for passengers older than 64 years.
COMMENTS: Our results suggest that drivers are less likely to cause a car collision between two or more cars that results in personal injuries or death when they are accompanied by passengers, regardless of driver or passenger characteristics.
Motorcycle rider conspicuity and crash related injury: case-control study.
- Wells S, Mullin B, Norton R, Langley J, Connor J, Lay-Yee R, Jackson R. BMJ 2004; 328(7444): 857-862.
Correspondence: Susan Wells, Section of Epidemiology and Biostatistics, School of Population Health, Private Bag 92019, University of Auckland, Grafton Road, Auckland 1, NEW ZEALAND; (email: s.wells@auckland.ac.nz).
OBJECTIVE: To investigate whether the risk of motorcycle crash related injuries is associated with the conspicuity of the driver or vehicle. DESIGN: Population based case-control study.
SETTING: Auckland region of New Zealand from February 1993 to February 1996.
PARTICIPANTS: 463 motorcycle drivers (cases) involved in crashes leading to hospital treatment or death; 1233 motorcycle drivers (controls) recruited from randomly selected roadside survey sites.
MAIN OUTCOME MEASURES: Estimates of relative risk of motorcycle crash related injury and population attributable risk associated with conspicuity measures, including the use of reflective or fluorescent clothing, headlight operation, and colour of helmet, clothing, and motorcycle.
FINDINGS: Crash related injuries occurred mainly in urban zones with 50 km/h speed limit (66%), during the day (63%), and in fine weather (72%). After adjustment for potential confounders, drivers wearing any reflective or fluorescent clothing had a 37% lower risk (multivariate odds ratio 0.63, 95% confidence interval 0.42 to 0.94) than other drivers. Compared with wearing a black helmet, use of a white helmet was associated with a 24% lower risk (multivariate odds ratio 0.76, 0.57 to 0.99). Self reported light coloured helmet versus dark coloured helmet was associated with a 19% lower risk. Three quarters of motorcycle riders had their headlight turned on during the day, and this was associated with a 27% lower risk (multivariate odds ratio 0.73, 0.53 to 1.00). No association occurred between risk and the frontal colour of drivers' clothing or motorcycle. If these odds ratios are unconfounded, the population attributable risks are 33% for wearing no reflective or fluorescent clothing, 18% for a non-white helmet, 11% for a dark coloured helmet, and 7% for no daytime headlight operation.
COMMENTS: Low conspicuity may increase the risk of motorcycle crash related injury. Increasing the use of reflective or fluorescent clothing, white or light coloured helmets, and daytime headlights are simple, cheap interventions that could considerably reduce motorcycle crash related injury and death.
The authors conducted a retrospective study of 70 cases of homicide and suicide in the Toulouse region to identify the variables that enable us to determine whether a death is a homicide or a suicide. This work showed that the following characteristics-a female victim, numerous wounds, and the presence of 1 or more vertical chest wounds-suggest homicide. It also highlights the importance of inspecting clothing, in particular the position of clothing and the presence or absence of slashes.
Intimate partner violence among female caregivers of children reported for child maltreatment.
Correspondence: Andrea L. Hazen, Child and Adolescent Services Research Center, Children's Hospital and Health Center, 3020 Children's Way, MC 5033, San Diego, CA 92123-4282, USA; (email: unavailable).
OBJECTIVE: The purpose of this study was to determine the prevalence and correlates of intimate partner violence among female caregivers of children reported to child protective services.
METHODS: Data were derived from the National Survey of Child and Adolescent Well-Being, a national probability study of children investigated for child abuse and neglect in the United States. Caregivers were interviewed about demographic characteristics, mental health, substance use, and physical violence by a partner.
FINDINGS: The lifetime and past year prevalence of intimate partner violence was 44.8 and 29.0%, respectively. Caregiver major depression and history of prior reports of child maltreatment were strongly associated with violence against women.
COMMENTS: The findings highlight the need for effective screening and identification of intimate partner violence in families in which child maltreatment has occurred.
Reality check: using newspapers, police reports, and court records to assess defensive gun use.
Correspondence: William V. Fabricius, Department of Psychology, Box 871104, Arizona State University, Tempe, Arizona 85287-1104, USA; (email: William.fabricius@asu.edu).
OBJECTIVE: To identify legitimate defensive gun uses (DGUs), and provide a reality check on previous estimates of the rate of DGUs by using a novel approach based on newspaper reports and police and court records. Previous estimates have relied on self report, differ by a factor of 10 or more, and are viewed as highly controversial.
METHODS: The reported uses of firearms in a newspaper covering roughly the Phoenix metropolitan area over almost a 3.5 month period were examined, supplemented where necessary by police and court records.
FINDINGS: Two DGUs involving killing assailants and one involving firing at an assailant were found. The three DGUs stemmed from cases of "mutual combat" or exposed bystanders to gunfire.
COMMENTS: These findings cast doubt on rates of DGUs reported in an influential study by Kleck and Gertz, which predict that the police should have known about 98 DGU killings or woundings and 236 DGU firings at adversaries during the time the newspaper was surveyed. The findings reported here were closer to predictions based on the National Crime Victimization Survey, which suggest that the police should have known about eight DGU killings or woundings and 19 DGU firings at adversaries.
Relations between violence, calendar events and ambient conditions.
- Sivarajasingam V, Corcoran J, Jones D, Ware A, Shepherd J. Injury 2004; 35(5): 467-473.
Correspondence: Vaseekaran Sivarajasingam, Violence Research Group, University of Wales College of Medicine, Heath Park, Cardiff, UK; (email: vassiva@btinternet.com).
National assault injury surveillance has identified major seasonal variation, but it is not clear whether assault injury is a seasonal problem in large cities. Relationships between community violence, calendar events and ambient conditions were investigated with reference to prospective, Accident and Emergency (A&E) derived information obtained from people injured in assaults in Cardiff between 1 May 1995 and 30 April 2000. Records of daily local ambient conditions included data relating to temperature, rainfall and sunshine hours and data of major local sporting events and annual holidays were studied. Pearson correlation coefficients were used to evaluate associations between variables. Overall, 19,264 assault-related A&E attendances were identified over the 5-year period. Almost three-quarters were males. Violence was clustered predominantly on Saturdays and Sundays, New Year and rugby international days. Temperature, rainfall and sunlight hours did not correlate significantly with violence. The findings indicate that injury reduction effort should be intensified at the known risk times for violence and that in a capital city/regional centre violence cannot be predicted on the basis of ambient conditions.
Violent cultural factors and serial homicide by males.
- DeFronzo J, Prochnow J. Psychol Rep 2004; 94(1): 104-108.
Correspondence: James DeFronzo, Sociology Department, University of Connecticut, Storrs, USA; (email: James.DeFronzo@UCONN.EDU).
Explaining the phenomenon of male serial homicide has usually been approached from a psychiatric perspective. However, recent integrative theory suggests that cultural factors may play a role in shaping the psychology of young males with particular psychiatric and possibly neurological vulnerabilities in such ways as to facilitate converting the motivation to kill into actual behavior. Present results indicated that 34-45% of the interstate variation in rates of serial killer activity could be accounted for by three dimensions of local culture. Higher rates of male serial killer activity were associated with a local state culture supportive of game hunting and military training and a local culture supportive of punitive violence. The findings must be viewed with caution since societal variables are complex and the results are based on correlations which cannot be causally interpreted without more direct evidence of validity.
Elder Abuse.
- United Kingdom Parliament, House of Commons Select Committee on Health. Report number HC-111-I. London: The Stationery Office Limited, 20 April 2004.
The full 65 page report is available online: ( Download Report ).
Abuse of older people is a hidden, and often ignored, problem in society. The profile of child abuse has been dramatically raised in the past few years and the Government has acted to introduce controls and measures to identify and tackle that problem; but abuse of older people remains in the background. It has been put to us that 500,000 older people in England are being abused at any one time, yet many people are unaware of the problem and few measures have been taken to address it. Moreover, we are disappointed that the Department has not commissioned research to establish a more precise figure. Abuse occurs in institutional settings, but more often in the home. It can be perpetrated by care staff, relatives, friends and strangers, and can take many forms � sexual abuse, financial abuse, abuse of medication in controlling and sedating patients, physical abuse, neglect and behaviour designed to degrade and humiliate.
Much abuse is not reported because many older people are unable, frightened or embarrassed to report its presence. Often care staff take no action because they lack training in identifying abuse or are ignorant of the reporting procedures. The lack of reporting results in difficulties in determining the true scale of the problem and this is compounded by a dearth of research. Further, varying definitions of 'elder abuse' exist within the health and social care sectors. To enable the extent of the problem to be accurately determined and for uniformity we recommend that an agreed, consistent and comprehensive definition should be applied by all government departments, statutory agencies, independent bodies, charities and organisations. We further recommend that performance indicators should be established as soon as possible to enable accurate measurement to be undertaken. We call for the National Minimum Standards for domiciliary care to require reporting of adverse incidents.
We recommend that the Department reviews the frequency and effectiveness of the inspection of NHS establishments providing care for older people and, in recognising the importance of lay personnel having an input into the inspection process, we urge that further measures are taken to increase user engagement.
The over-prescription of medication is sometimes used in the care environment as a tool for managing residents, and for care staff it can be a means to ease the burden of care of the elderly, especially of those with dementia. The frequency of review of medication and the administration of drugs by unqualified staff is of particular concern to us. We therefore recommend measures are taken to ensure compliance with the National Service Framework target that all people over 75 years of age should normally have their medicines reviewed at least annually, and those taking four or more medicines should have a review every six months. We further recommend that the National Care Standards Commission and its successor body should ensure that medication systems within care homes and domiciliary care reflect good practice and that they disseminate procedures that exceed the national minimum standard.
We have concern about the incidence of financial abuse of older people. We advocate that the prevention, detection and remedying of financial abuse should be included as specific areas of policy development by adult protection committees and we endorse the recommendations in the Draft Mental Incapacity Bill relating to the abuse of powers of attorney.
The lack of training in issues relating to elder abuse (for example, identification, prevention and reporting) is encountered in all the settings in which abuse occurs. We call for mandatory training in the recognition, reporting and treatment of elder abuse for those professionals working and caring for older people. We also recommend that signed-off induction training of domiciliary and other social care workers approved by the appropriate sector skills council should be sufficient for them to apply for registration with the GSCC.
We recognise that there is a case for further guidance to require all local authorities to establish multi-agency vulnerable adults' protection committees and we strongly endorse any measures that make available advocacy services for older people. We further recommend that advocates on elder abuse drawn from black and minority ethnic communities should be identified, trained and deployed. Additionally, we recommend that as a part of the general training of social care workers, issues of ethnicity and culture be included in the curriculum.
While welcoming the introduction of the Single Assessment Process, and the opportunities that it presents for regularly reviewing the care of older people, we believe it is vital that these targets are met in all authorities. We recommend that the Department should monitor the compliance of authorities, and should report on the outcomes of the process. Currently there are no standards for adult protection contained within the National Service Framework. In order to ensure consistent good practice, we recommend that this omission is rectified.
The registration of workers in the care environment was of particular concern to us. We propose that the Government should attend to the issue of registering domiciliary care workers as a matter of the utmost urgency. We urge the Government to expedite the implementation of the Protection of Vulnerable Adults list fully across both health and social care settings. We also recommend that the Department keeps under review the operation of the scheme.
We call for CSCI and CHAI to publish at an early date their joint plans for regulation and to ensure that the health care needs of residents in those settings registered as social care provision are met; for the Minister to require the annual reports of CSCI and CHAI to include details of their joint working and of the experience of the adequacy of the regulation of the health care aspects of care home services provision; and for the Government to keep under review the operation of the respective Commissions.
We call for implementation of stricter controls to ensure that certification of the death of a resident in a care home owned or managed by a GP, or a close relative, should be performed by a GP other than the owner/manager. We further recommend that the practice of the payment of retainer fees to GPs should be abolished.
