Partner violence before and after couples-based alcoholism treatment for male alcoholic patients: the role of treatment involvement and abstinence.
- O'Farrell TJ, Murphy CM, Stephan SH, Fals-Stewart W, Murphy M. J Consult Clin Psychol 2004; 72(2): 202-217.
Correspondence: Timothy O'Farrell, Families and Addiction Program and Department of Psychiatry, Harvard Medical School, Boston, MA, USA; (email: timothy_ofarrell@hms.harvard.edu).
This study examined partner violence before and after behavioral couples therapy (BCT) for 303 married or cohabiting male alcoholic patients and used a demographically matched nonalcoholic comparison sample. In the year before BCT, 60% of alcoholic patients had been violent toward their female partner, 5 times the comparison sample rate of 12%. In the 1st and 2nd year after BCT, violence decreased significantly from the year before BCT, and clinically significant violence reductions occurred for patients whose alcoholism was remitted after BCT. Structural equation modeling indicated that greater treatment involvement (attending BCT sessions and using BCT-targeted behaviors) was related to lower violence after BCT and that this association was mediated by reduced problem drinking and enhanced relationship functioning.
National Association of Medical Examiners position paper on the certification of cocaine-related deaths.
- Stephens BG, Jentzen JM, Karch S, Wetli CV, Mash DC. Am J Forensic Med Pathol 2004; 25(1): 11-13.
Correspondence: Boyd Stephens, Office of the Chief Medical Examiner, City and County of San Francisco, San Francisco, California 94103-4603, USA; (email: boyd.stephens@sfov.gov).
The National Association of Medical Examiners Committee on Cocaine-related Deaths recommends that the following guidelines be applied in the process of documenting, interpreting, and certifying potential cocaine-related fatalities. The committee cautions that the investigation of any drug-related death requires a complete investigation of the circumstances of death, the death scene, and past medical history. It is also necessary to have the results of the forensic toxicological analysis and those of a complete forensic autopsy examination prior to formulating an opinion as to the cause and manner of death. Cocaine should be considered the underlying cause of the death when 1 or more of the following is true: (1). the circumstances surrounding the death can be associated with an acute cocaine exposure and there are no supervening causes of death; (2). the immediate cause of death is directly due to a readily identifiable mechanism or disease such as a gunshot wound or a stroke, yet the acute use of cocaine was the direct underlying cause of the trauma or the disease process; and (3). chronic cocaine use leads to a disease that results in an ultimately fatal pathologic process leading to organ injury and death. The committee further cautions that reported drug levels may not directly relate to the toxic or lethal effects of the drug upon the patient. These guidelines are intended for use by practicing medical examiners and physicians who certify drug deaths, as well as providing education tools for students.
Fights among adolescents from the ethnic majority and from immigrant groups: the impact of alcohol consumption and participation in youth-based out-of-home activities.
Fighting among adolescents was tested for association with alcohol/drug use and out-of-home activities without adult control (such as 'hanging out' on the streets). A survey was used to collect data from the majority of 13 to 15-year-olds in a Norwegian town (N > 1400). Structural equation modelling resulted in a high regression weight for the latent variable of participation in out-of-home activities (beta = 0.54), supporting routine activities theory, and only a moderate regression weight for the latent variable of alcohol consumption (beta = 0.19). An assumption that the two exogenous variables would demonstrate an interaction effect was not supported by the data. However, subgroup analyses suggested that routine activities theory should not be applied to the exclusion of subcultural theories. As one might expect, differences between boys' and girls' experience of fighting could only partially be explained by the variables investigated. More significant, however, was that participation in the out-of-home activities investigated appeared not to be associated with fighting among girls from non-Western immigrant groups -- a finding that questions routine activities theory. The article concludes that routine activities theory has merits as far as the investigation of general tendencies in delinquent behaviour is concerned, but it should not replace investigations of subcultural differences.
Compliance to a workplace violence prevention program in small businesses.
- Peek-Asa C, Casteel C, Mineschian L, Erickson RJ, Kraus JF. Am J Prev Med 2004; 26(4): 276-283.
Correspondence: Corinne Peek-Asa, Department of Occupational and Environmental Health, Injury Prevention Research Center, University of Iowa (Peek-Asa), Iowa City, Iowa, USA; (email: corinne-peek-asa@uiowa.edu).
BACKGROUND: Robberies are the leading motive for work-related homicide and assault. Interventions to reduce robberies and related injuries have been limited to convenience stores, and evaluations have not addressed compliance as a factor in program effectiveness.
SETTING/PARTICIPANTS: A total of 314 intervention and 96 control businesses were included in this intervention evaluation.
INTERVENTION: The Workplace Violence Prevention Program provided a customized robbery and violence prevention program to a stratified random sample of 314 small, high-risk businesses in Los Angeles City. An additional 96 comparison businesses did not receive the intervention. The intervention included individualized consultation, printed materials, training brochures, and a video. Interventions were conducted from August 1997 through August 2000.
MAIN OUTCOME MEASURES: For both intervention and comparison businesses, a comprehensive security program assessment was conducted at baseline and at 3- and 12-month follow-up visits. Crime rates in intervention and comparison businesses were examined for 12 months pre- and post-intervention with the use of police reports.
FINDINGS: By the second follow-up visit, compliance to the intervention program was significant for each program component. Employee training was the most frequently implemented intervention component. Neighborhood crime level, primary language spoken by the business owner, and the number of employees were all related to compliance. Although crime rates generally increased for all businesses from the pre- to post-intervention periods, businesses with high compliance to the program experienced a decrease in overall violent crime and robbery.
COMMENTS: Participating businesses were willing to voluntarily implement components of the intervention program, and greater implementation was related to reductions in robbery and violent crime.
Correspondence: Aryonod Pusponegoro, Department of Surgery, School of Medicine, University of Indonesia, Jakarta, INDONESIA; (email: aryonodp@rad.net.id).
Indonesia has had its share of natural and manmade disasters. From 1997 to 2002, Indonesia has experienced 90 incidents of terrorist bomb attacks. In 13 (14.4%) of the terrorist attacks, the bombs did not explode. A total of 224 persons have been killed, and 340 persons have been injured. Most of those killed or injured were the result of the bombings in Jakarta and Bali. Besides bombings, there have been riots, especially in Jakarta. The Indonesian Surgeons Association established the 1-1-8 Emergency Ambulance Service Foundation to develop the Prehospital Emergency Medical Services in Indonesia. Despite difficulties, this service has been implemented in 18 cities. The occurrence of disasters, riots, ethnic conflicts, terrorist attacks, and the introduction of the Advanced Trauma Life Support (ATLS) course in 1995, have helped to convince the people and the government that it was important to develop this 1-1-8 Emergency Ambulance Services system, and agreed to accept a Safe Community Program. With the Safe Community Program, Jakarta with its Integrated 1-1-8 Emergency Ambulance Service managed to provide proper emergency medical care to the casualties caused by terrorist bombings, riots, and in the three weeks of floods during which 75% of Jakarta was submerged.
Driver distraction is recognized as being one of the central causes of road traffic incidents and mobile telephones are tangible devices (among many other electronic devices) that can distract the driver through changes in workload. Forty participants completed a motorway route characterized by a low level of road complexity in the form of vehicle handling and information processing. A peripheral detection task (PDT) was employed to gauge mental workload. We compared effects of conversation type (simple versus complex) and telephone mode (hands-free versus handheld) to baseline conditions. The participants' reaction times increased significantly when conversing but no benefit of hands-free units over handheld units on rural roads/motorways were found. Thus, in regard to mobile telephones, the content of the conversation was far more important for driving and driver distraction than the type of telephone when driving on a motorway or similar type of road. The more difficult and complex the conversation, the greater the possible negative effect on driver distraction.
Evidence on equalisation in health in youth from the West of Scotland.
- West P, Sweeting H. Soc Sci Med 2004; 59(1): 13-27.
Correspondence: Patrick West, MRC Social and Public Health Sciences Unit, 4 Lilybank Gardens, Glasgow G12 8RZ, UK; (email: patwest@msoc.mrc.gla.ac.uk).
Many studies report few socioeconomic (SES) differences in health in youth, a pattern contrasting with that of health inequalities in childhood and adulthood. This paper focuses on the child-youth transition to examine the hypothesis of equalisation in health over this period. Specifically, we test two hypotheses: (a) that equalisation is more likely for health state measures (physical and malaise symptoms and accidents) than health status ([limiting] longstanding illness and self-rated health) or health potential (height), and (b) that the patterning of health over this period is similar between occupational (social class) and non-occupational (deprivation, housing tenure and family affluence) SES measures. Data are derived from the West of Scotland 11 to 16 cohort, followed from late childhood (aged 11) through early (13) to mid (15) adolescence. The results showed very little evidence of SES differences in (limiting) longstanding illness at any age for both sexes, while self-rated health exhibited some differentiation, and height (as expected) consistent gradients throughout. By contrast, among males evidence of equalisation was found for both physical and malaise symptoms and pedestrian road traffic accidents (RTAs). Among females, equalisation was confined to specific physical symptoms, pedestrian RTAs, sports injuries and burns/scalds, while for malaise symptoms a reverse gradient at age 11 strengthened with age. These patterns were generally unaffected by the SES measure used. We conclude that while some of the evidence is consistent with the equalisation hypothesis, it needs extending to accommodate patterns of no SES differences, and particularly reverse gradients, in childhood. These patterns may reflect the increasingly pervasive influence of youth culture, suggesting that in the UK the boundary between childhood and youth should be set at an earlier age. This in turn suggests that international comparisons have considerable analytic potential for identifying the conditions under which equalisation does and does not occur.
Pediatric electrical burn: outlet injury caused by steel chopstick misuse.
- Lee JW, Jang YC, Oh SJ. Burns 2004; 30(3): 244-247.
Correspondence: Jong-wook Lee, The Bum Unit, Department of Plastic & Reconstructive Surgery, Hangang Sacred Heart Hospital, Hallym University, Seoul, SOUTH KOREA; (email: jwlpsdoc@yahoo.co.kr).
Electrical burn in children in compared with adults is rare due to less chance of exposure to electricity. Although studies have been reported regarding pediatric electrical injury, there are no reports concerning outlet injury, especially those suffered by placing a steel chopstick as conducting material into the wall socket. Steel chopsticks are widely used for eating food in Korea. Children have sometimes injured themselves by inserting these into wall sockets (220V). A retrospective study was conducted to obtain information about the characteristics of pediatric electrical injury resulting from steel chopstick misuse between January 1996 to June 2002. A total of 57 children with outlet injury were involved. Wounds were multiple and localized within the hand. The prevalent age was about 3 years old. The children studied with low voltage minor electrical injuries were deeply injured, had a high operation rate and remarkable sequelae, although wounds were small and localized.
Falls and fall-related injuries among the elderly: a survey of residential-care facilities in a Swedish municipality.
- Sadigh S, Reimers A, Andersson R, Laflamme L. J Community Health 2004; 29(2): 129-140.
Correspondence: Siv Sadigh, Karolinska Institutet, Department of Public Health Sciences, Division of Social Medicine, Norrbacka, SE-171 76 Stockholm, SWEDEN; (email: siv.sadigh@smd.sll.se).
Injurious falls among the elderly are an increasing public-health problem in Sweden. One group particularly vulnerable to falls consists of elderly people living in residential-care facilities. The purpose of this study was to investigate the extent to which falls lead to injury within a defined population of elderly people in institutionalized care. All the elderly persons living in residential-care facilities in an urban Swedish municipality during the year 1997 (n = 469 institutional places). Falls and fall-related injuries were registered over a one-year period. Data were gathered by personnel at the time of the falls, using a form specifically designed for surveillance purposes. Of the 865 falls reported during the study period, 375 were among men, with an average age of 82 years, and 490 among women, with an average age of 85 years. Men were subject to falling to a greater extent than women. The most common location was the individual's own bedroom. Injuries were incurred in approximately one in four falls, and the head was the body part most frequently injured. Only 24 falls (2.8%) resulted in a fracture, of which 18 were hip fractures. Although elderly people living in residential-care facilities fall fairly often, serious injuries, in the form of fractures, are incurred to a relatively limited extent.
Effect of Vitamin D on falls: a meta-analysis.
- Bischoff-Ferrari HA, Dawson-Hughes B, Willett WC, Staehelin HB, Bazemore MG, Zee RY, Wong JB. JAMA 2004; 291(16): 1999-2006.
Correspondence: Heike A. Bischoff-Ferrari, Division of Aging, Department of Medicine, Center for Cardiovascular Disease Prevention, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass 02120, USA; (email: hbischof@hsph.harvard.edu).
CONTEXT: Falls among elderly individuals occur frequently, increase with age, and lead to substantial morbidity and mortality. The role of vitamin D in preventing falls among elderly people has not been well established.
OBJECTIVE: To assess the effectiveness of vitamin D in preventing an older person from falling.
DATA SOURCES: MEDLINE and the Cochrane Controlled Trials Register from January 1960 to February 2004, EMBASE from January 1991 to February 2004, clinical experts, bibliographies, and abstracts. Search terms included trial terms: randomized-controlled trial or controlled-clinical trial or random-allocation or double-blind method, or single-blind method or uncontrolled-trials with vitamin D terms: cholecalciferol or hydroxycholecalciferols or calcifediol or dihydroxycholecalciferols or calcitriol or vitamin D/aa[analogs & derivates] or ergocalciferol or vitamin D/bl[blood]; and with accidental falls or falls, and humans.
STUDY SELECTION: We included only double-blind randomized, controlled trials (RCTs) of vitamin D in elderly populations (mean age, 60 years) that examined falls resulting from low trauma for which the method of fall ascertainment and definition of falls were defined explicitly. Studies including patients in unstable health states were excluded. Five of 38 identified studies were included in the primary analysis and 5 other studies were included in a sensitivity analysis.
DATA EXTRACTION: Independent extraction by 3 authors using predefined data fields including study quality indicators.
DATA SYNTHESIS: Based on 5 RCTs involving 1237 participants, vitamin D reduced the corrected odds ratio (OR) of falling by 22% (corrected OR, 0.78; 95% confidence interval [CI], 0.64-0.92) compared with patients receiving calcium or placebo. From the pooled risk difference, the number needed to treat (NNT) was 15 (95% CI, 8-53), or equivalently 15 patients would need to be treated with vitamin D to prevent 1 person from falling. The inclusion of 5 additional studies, involving 10 001 participants, in a sensitivity analysis resulted in a smaller but still significant effect size (corrected RR, 0.87; 95% CI, 0.80-0.96). Subgroup analyses suggested that the effect size was independent of calcium supplementation, type of vitamin D, duration of therapy, and sex, but reduced sample sizes made the results statistically nonsignificant for calcium supplementation, cholecalciferol, and among men.
CONCLUSIONS: Vitamin D supplementation appears to reduce the risk of falls among ambulatory or institutionalized older individuals with stable health by more than 20%. Further studies examining the effect of alternative types of vitamin D and their doses, the role of calcium supplementation, and effects in men should be considered.
Do smoke alarms still function a year after installation? A follow-up of the get-alarmed campaign.
- Thompson CJ, Jones AR, Davis MK, Caplan LS. J Community Health 2004; 29(2): 171-181.
Correspondence: Corleen J. Thompson, Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, Georgia, USA; (email: esfunccjt@mybluelight.com).
The Get-Alarmed Campaign Follow-up Study was the second phase of an initiative to assure that homes of families at high risk of fire-related injury and death had functioning smoke alarms. Smoke alarms and/or batteries were installed in over 94 percent of 454 participating households in Schley and Henry Counties, Georgia, in 2000. Before the study began, 60.6 percent of these homes had smoke alarms, but only 36.6 percent had functioning smoke alarms. The follow-up study was designed to determine the experiences of participants with smoke alarms and whether participating households had functioning smoke alarms a year after baseline. Participants were phoned or visited and asked about their experiences with smoke alarms since the baseline study. During the interview, they were asked to test a smoke alarm, the results of which could frequently be heard. Respondents included 237 from Schley County and 113 from Henry County, for an overall 77.1 percent response rate. While 80.3 percent of respondents had a smoke alarm that was heard by the interviewer when it was tested, 6.6 percent reported that their smoke alarm had been disabled or had a dead battery. Over 75 percent of respondents had smoke alarm sound offs in the prior year, predominately due to cooking smoke, but only about 5 percent reported removing the battery or otherwise disabling it to prevent sound offs. However, the measures taken may render a household unprotected at a critical time. Efforts to increase protection with smoke alarms should be augmented with programs to insure adequate and timely testing and maintenance of existing smoke alarms.
This paper examines relations among safety climate (safety attitudes and communication), psychological strains (psychological distress and job satisfaction), and safety performance (self-reported accident rates and occupational injuries). A questionnaire was administered to construction workers from 27 construction sites in Hong Kong (N = 374, M = 366, F = 8, mean age =36.68 years). Data were collected by in-depth interviews and a survey from February to May 2000. A path analysis using the EQS-5 was employed to test the hypothesized model relating safety climate, safety performance, and psychological strains. The results provide partial support for the model, in that safety attitudes predict occupational injuries, and psychological distress predicts accident rates. Furthermore, psychological distress was found to be a mediator of the relationship between safety attitudes and accident rates. The implications of these results for psychological interventions in the construction industry are discussed.
Work-related injury sustained by foreign workers in Singapore.
BACKGROUND: Singapore has a resident population of 3.26 million and 0.53 million foreign workers. The objective of the study was to compare the injuries sustained by foreign and local workers presenting to an emergency department (ED).
METHODS: Adult victims of work-related injury who presented to an urban public hospital ED from 1 December 1998 to 31 May 1999 were interviewed. Chart reviews were done for those hospitalised. Data collected were those of demographic, nature of injury, ambulance care, ED and hospital care, outcome and final diagnoses.
FINDINGS: There were 1244 local workers and 1936 foreign workers, giving a ratio of 1 local:1.6 foreign workers. The mean age of foreign workers was 29.6 years [standard deviation (SD) 6.2], which was younger (P < 0.0001) than the mean age 37.8 years (SD 14) of local workers. Fridays and Saturdays were the common days for injuries among foreign workers as opposed to Wednesdays and Mondays for local workers. Falls from height > or = 2m occurred among 9.1% of foreign workers, more (P < 0.0001) common than 4.3% of local workers, resulting in 2 out of 3 foreign workers death. Though the pattern of injuries was similar between foreign and local workers, foreign workers needed longer (P = 0.03) sick leave and more (P = 0.01) foreign workers were hospitalised, giving a ratio of 2 foreign workers for every 1 local worker hospitalised.
COMMENTS: Foreign workers had no difficulty accessing ED and hospital care for work-related injuries. The pattern and severity of injuries were similar between foreign and local workers but more foreign workers were hospitalised.
Correspondence: Yinhai Wang, Department of Civil Engineering, University of Washington, P.O. Box 352700, Seattle, WA 98195-2700, USA; (email: yinhai@u.washington.edu).
Collisions between bicycles and motor vehicles have caused severe life and property losses in many countries. The majority of bicycle-motor vehicle (BMV) accidents occur at intersections. In order to reduce the number of BMV accidents at intersections, a substantial understanding of the causal factors for the collisions is required. In this study, intersection BMV accidents were classified into three types based on the movements of the involved motor vehicles and bicycles. The three BMV accident classifications were through motor vehicle related collisions, left-turn motor vehicle related collisions, and right-turn motor vehicle related collisions. A methodology for estimating these BMV accident risks was developed based on probability theory. A significant difference between this proposed methodology and most current approaches is that the proposed approach explicitly relates the risk of each specific BMV accident type to its related flows. The methodology was demonstrated using a 4-year (1992-1995) data set collected from 115 signalized intersections in the Tokyo Metropolitan area. This data set contains BMV accident data, bicycle flow data, motor vehicle flow data, traffic control data, and geometric data for each intersection approach. For each BMV risk model, an independent explanatory variable set was chosen according to the characteristics of the accident type. Three negative binomial regression models (one corresponding to each BMV accident type) were estimated using the maximum likelihood method. The coefficient value and its significance level were estimated for each selected variable. The negative binomial dispersion parameters for all the three models were significant at 0.01 levels. This supported the choice of the negative binomial regression over the Poisson regression for the quantitative analyses in this study.
Urban/rural variation in children's bicycle-related injuries.
Correspondence: Alison K. Macpherson, Department of Geography, Faculty of Arts and Science, University of Toronto, 100 St. George Street, Toronto, Ont., CANADA; (email: alison.macpherson@sickkids.ca).
The objective of this study was to examine bicycle-related injury rates for children living in urban and rural areas. Data on all Canadian children hospitalised because of bicycling-related injuries (1994-1998) were obtained from the Canadian Institute for Health Information (CIHI). Injured children were classified as residing in urban, mixed urban, mixed rural or rural areas. Incidence rates for bicycle-related head injuries and other bicycle-related injuries were calculated. Logistic regression was used to estimate the odds of head injury, controlling for age, sex, socio-economic status (SES), collision with a motor vehicle, and the presence of provincial helmet legislation. In total, 9367 children were hospitalised for a bicycling-related injury over the 4-year-study period. Of these, 21% occurred in rural areas, 18% in mixed rural, 17% in mixed urban, while the remaining 44% occurred in urban areas. The average annual incidence rate for bicycle-related head injuries in children was 18.49 per 100,000 for children living in rural areas compared with 10.93 per 100,000 for those living in urban areas, 15.49 for children in mixed urban areas and 17.38 for children living in mixed rural areas. This variation may be explained by differences in bicycling exposure, helmet use, hospital admission criteria, or road environments across geographic areas.
Patterns of animal poisonings reported to the Texas Poison Center Network: 1998-2002.
- Forrester MB, Stanley SK. Vet Hum Toxicol 2004; 46(2): 96-99.
Correspondence: Mathias B. Forrester, Texas Department of Health, 1100 W 49th Street, Austin, Texas 78756, USA; (email: mathias.forrester@tdh.state.tx.us).
A portion of calls handled by poison centers involve poisonings of animals; however, information on such calls is limited. This study used data from poison centers in Texas collected during 1998-2002 to document the epidemiology of animal poisoning calls. There were a total of 24,467 animal poisoning calls, representing 2.0% of all calls. Dogs were affected in 87% of the calls and cats in 11%. The exposures were unintentional in 99% of the cases, occurred via ingestion in 95% and involved dermal exposure in 5% of the cases. Exposures occurred at the owner's own residence 91% of the time and were handled outside of health care facilities 61% of the time. The outcome involved no clinical effect for 60% of the cases involving dogs and 39% of the cases involving cats. Reported exposures occurred more often during the summer, and the most frequently reported exposures involved pesticides and plants. These findings were consistent with the limited reports from on poison center regarding animal poisonings.
Poisoning trends and the importance of educating patients about poison prevention.
Correspondence: Lee McGoodwin, Oklahoma Poison Control Center, 940 NE 13th Street, Room 3510, Nicholson Tower, Oklahoma City, Oklahoma 73104, USA; (email: Lee-McGoodwin@ouhsc.edu).
Medical professionals are recognized as a vital link in communities for education and treatment of poisoning exposures. The Oklahoma Poison Control Center (OPCC) is a resource for medical professionals as well as the public. Nationally and in Oklahoma, among all age groups, analgesics are responsible for the most fatalities. Trends in common exposures in the age 5 and younger age group and the 13 through 19 age group, an acetaminophen protocol, information about the poison center and HIPPA privacy regulations, poison prevention tips and where to obtain educational materials are outlined. National Poison Prevention Week, March 21-27, 2004, is an excellent time to educate all age groups about poison prevention techniques and what to do when there is a poisoning emergency. Board certified toxicologists, pharmacists and registered nurses are available 24 hours a day, 7 days a week by calling 1-800-222-1222.
- Matz SO, Nibbelink G. Am J Sports Med 2004; 32(3): 608-611.
Correspondence: Samuel O. Matz, Advanced Centers for Orthopaedic Surgery and Sports Medicine, 1 Village Square, Westminster, MD 21157, USA; (email: smatz@acossm.com).
BACKGROUND: Historically, the sport of women's lacrosse has required little or no protective equipment. Recently, there has been increasing concern over trauma to the face and head incurred during play. A rule change passed in spring 2003, during the course of this study, mandates goggles in 2005.
OBJECTIVE: To survey injuries in women's lacrosse over multiple seasons and institutions and to categorize injury rates and patterns.
STUDY DESIGN: A prospective survey.
METHODS: A standard report-of-injury form was sent to participating institutions. Injuries were defined by athletic training staff as any event resulting in the athlete missing one or more games or practices.
FINDINGS: The overall injury rate for women's lacrosse for the 2001-2002 and 2002-2003 seasons from participating schools was 3.8 per 1000 athlete exposures. The rate of head and face injuries was 1.4 per 1000 athlete exposures, representing 38.5% of all injuries incurred. The rate of eye injuries was 0.43 per 1000 athlete exposures, accounting for 11.5% of the total injuries. The practice injury rate was 2.7 per 1000 athlete exposures, and the competition injury rate was 8.8 per 1000 athlete exposures.
COMMENTS: Data support the future requirements for protective eyewear. There is significant and increasing exposure for head and face trauma. Further investigation is needed to monitor injury patterns in women's lacrosse as rules for protective gear evolve.
Active living and injury risk.
- Parkkari J, Kannus P, Natri A, Lapinleimu I, Palvanen M, Heiskanen M, Vuori I, Jarvinen M. Int J Sports Med 2004; 25(3): 209-216.
Correspondence: Jari Parkkari, Tampere Research Center of Sports Medicine, UKK Institute, Tampere, FINLAND; (email: mejapa@uta.fi).
The purpose of this study was to get reliable insight into injury risk in various commuting and lifestyle activities, as well as recreational and competitive sports. A cohort of 3,657 persons was randomly selected from the 15- to 74-year-old Finnish population. Ninety-two percent (n = 3,363) of the subjects accepted to participate the one-year follow-up, record all their physical activities that lasted 15 min or more, and register all acute and overuse injuries that occurred during these activities. To collect the information, the study subjects were interviewed by phone by the trained personnel of the Statistics Finland three times in four-month intervals. The individual injury risk per exposure time was relatively low, ranging from 0.19 to 1.5 per 1,000 hours of participation, in commuting and lifestyle activities including walking and cycling to work, gardening, home repair, hunting and fishing, and, in sports such as golf, dancing, swimming, walking, and rowing. The risk was clearly higher in squash, orienteering, and contact and team sports, such as judo, wrestling, karate, rinkball, floorball, basketball, soccer, ice hockey, volleyball, and Finnish baseball ranging from 6.6 to 18.3 per 1 000 hours of participation. However, the highest absolute number of injuries occurred in low-risk activities, such as gardening, walking, home-repair, and cycling, because they are performed so often. In conclusion, individual injury risk per exposure hours is relatively low in commuting and lifestyle activities compared to many recreational and competitive sports. However, at a population level, these low-to-moderate intensity activities are widely practised producing a rather high absolute number of injuries, and thus, preventive efforts are needed in these activities, too.
OBJECTIVE: To improve surveillance for deaths and injuries associated with potential motor vehicle safety defects.
DESIGN: Vehicles in fatal crashes can be studied for indications of potential defects using an "early warning" surveillance statistic previously suggested for screening reports of adverse drug reactions. This statistic is illustrated with time series data for fatal, tire related and fire related crashes. Geographic analyses are used to augment the tire related statistics.
FINDINGS: A statistical criterion based on the Poisson distribution that tests the likelihood of an expected number of events, given the number of events that actually occurred, is a promising method that can be readily adapted for use in injury surveillance.
COMMENTS: Use of the demonstrated techniques could have helped to avert a well known injury surveillance failure. This method is adaptable to aid in the direction of engineering and statistical reviews to prevent deaths and injuries associated with potential motor vehicle safety defects using available databases.
Correspondence: George N. Appenzeller, Department of Combat Medic Training, 3151 W.W. White Road, Fort Sam Houston, TX 78234, USA; (email: unavailable).
Proper medical deployment planning requires projecting injuries. For this reason, the injury patterns and mechanism of injury were reviewed for an 18-month period in Kosovo, and injury rates and mechanisms were extracted for review. Overall, there were 404 trauma patients treated during the study period. Isolated head and neck injuries accounted for 29.5% (119) of injuries, chest wounds 5.7% (23), abdominal wounds 4.5% (18), and extremities 33.4% (135). Multiply injured patients accounted for the remaining 27.0% (109). When subdivided by mechanism, penetrating injury made up 36.9% (149), whereas blunt trauma accounted for 63.1% (255). Motor vehicle accidents made up the majority of blunt trauma (72.2%). Of penetrating injuries, gunshot wounds accounted for 55%, blast wounds 38%, and stabbings 6.7%. The data clearly demonstrate that humanitarian and peacekeeping missions require preparation for a wide variety of mechanisms of injury beyond the typical penetrating trauma of combat situations.
Cultural differences in young children's vulnerability to injuries: a risk and protection perspective.
- Vaughan E, Anderson C, Agran P, Winn D. Health Psychol 2004; 23(3): 289-298.
Correspondence: Elaine Vaughan, Department of Psychology and Social Behavior, University of California, Irvine, Irvine, CA, USA; (email: evaughan@uci.edu).
Interview data from 100 lower income Hispanic and 50 White mothers from a nutritional service clinic extended prior research on cultural differences in the risk for unintentional pediatric injuries. Group differences were expected in reported injury incidence and in the prevalence and impact of contributing factors. As predicted, White mothers reported more injuries for a young child, and among Hispanic mothers, English language preference and use were associated with more reported injuries. Hierarchical regression analysis revealed that risky behaviors, mother's judgment about child compliance, and stressful life events were better predictors of injuries than housing quality, but among Hispanics, the impact of certain factors (e.g. child temperament) was qualified by mother's acculturation level. Stress and child temperament explained injury differences between more- and less-acculturated Hispanic families but only partially accounted for differences between White mothers and less-acculturated Hispanics. Pediatric injury risk and protective factors seemed to operate in concert with cultural processes.
Recovery of injured children: Parent perspectives on family needs.
Correspondence: Mary E. Aitken, Dept of Pediatrics, Arkansas Children's Hospital, 800 Marshall St, Slot 512-26, Little Rock, AR 72202-3591, USA; (email: AitkenMaryE@uams.edu).
OBJECTIVE: To study the broader impact of emotional and financial burdens of injury in children on their families, along with solutions to these problems.
DESIGN: Focus groups were conducted to reveal the needs of parents and children after injury. Audiotaped semistructured interviews were conducted by a team of qualitative researchers.
SETTING: Tertiary care children's hospital.
PARTICIPANTS: Mothers of children who had sustained traumatic injury.
MAIN OUTCOME MEASURES: Summary of reported themes of experience and suggested interventions. Data were analyzed by using content analysis software.
FINDINGS: Overall satisfaction with care was high. Parents expressed concerns with communication, access to care, and the transition both within the phases of medical care and from medical care into the community. Consistent financial and social stressors were voiced, along with the need for peer support during all phases of care.
COMMENTS: Parents provided valuable insight into their needs after their child's injury. Attention to constructive communication, clarification of the system of care, continued family-centered care, and development of peer support programs may meet the needs of caregivers and therefore facilitate improvement in pediatric injury recovery.
In every school some boys will display such extensive rule-breaking behaviour during their 13th year that each appears to be a candidate for the diagnosis of anti-social personality disorder. When a selection of such boys were studied as participants in a social landscape in and out of a school with a multi-ethnic body of students, their involvement in rule-breaking turned out to be a collective way of producing masculinity in their transitional change of subjectivity by age - out of middle childhood and into their teens. In repeated interviews during a two-year period the boys told how they participated in events designed to expand their own limits and how they tried to maintain loyalty towards each other. The leading participants were mostly of Norwegian origin. They were involved in border work where they had to enforce their own code of conduct, which was based on unspoken, but shared, assumptions about the necessity of gender divides and about the maintenance of ethnic contrasts - by ignoring the girls and by failing the boys they marked as 'foreigners'.
- Frank AL, McKnight R, Kirkhorn SR, Gunderson P. J Agric Saf Health 2004; 10(1): 27-38.
Correspondence: A.L. Frank, Environmental and Occupational Health, Drexel University School of Public Health, Philadelphia, Pennsylvania 19102, USA; (email: alf13@drexel.edu).
Agricultural work is the most prevalent type of employment in the world. In the United States only a few are engaged in creating food and fiber for many. Agriculture includes farming, ranching, fishing, and forestry, and together they carry significant risk for the development of injury or illness. There are numerous special-population issues related to agriculture. Farmers are old and growing older, many workers are children, and migrant and seasonal help, often foreign born, make up a large percentage of the workforce. It has been only relatively recently that concerns of agricultural safety and health have become a major research focus in the United States.
BACKGROUND: Transactional models of coping (Lazarus & Folkman, 1984) can contribute to our understanding of why some children cope effectively with bullying while others suffer negative outcomes. However, previous research has relied on coping measures that are not comparable with adult measures, restricting investigation of developmental trends. Additionally, previous research has not included appraisals when measuring coping using an established coping measure.
OBJECTIVES: To examine the factor structure of a coping measure that is directly comparable with the adult literature; to examine the content of pupils' threat and challenge appraisals concerning bullying; and to examine the relationships between appraisals and coping strategy use within the victims of school bullying. SAMPLE: Participants were 459 children aged 9 - 14 years.
METHODS: A self-report bullying questionnaire, incorporating Halstead et al.'s (1993) adolescent version of the Ways of Coping Checklist, was completed by participants. Also included were control, threat and challenge appraisal items.
FINDINGS: Confirmatory factor analysis confirmed that Halstead et al.'s four-factor model of coping is valid for a population of school bullying victims. Content validity of items used to measure threat and challenge appraisal was demonstrated. Ambiguity of challenge appraisal influenced the use of Wishful Thinking, Seeks Social Support and Problem Focused coping. Wishful Thinking was also influenced by control appraisal. Avoidance coping was not influenced by the appraisals measured.
COMMENTS: Halstead et al.'s Revised Ways of Coping Checklist can be used to measure coping amongst child and adolescent victims of bullying. Furthermore, including appraisal variables improves our understanding of individual differences between victims' coping strategy choices.
Correspondence: Li-Shan Chou, Department of Exercise and Movement Science, University of Oregon, Eugene, OR 97403-1240, USA; (email: chou@uoregon.edu).
Accidental falls are a leading cause of injury and death in the growing elderly population. Traumatic falls are frequent, costly, and debilitating. Control of balance during locomotion is critical for safe ambulation, but relatively little is known about the natural effect of aging on dynamic balance control. Samples of healthy young subjects were compared in the interactive measures of center of mass (COM) and center of pressure (COP) during level walking and obstacle crossing conditions. Obstacle heights were normalized to individual body height (2.5%, 5%, 10%, and 15%). Temporal-distance (T-D) variables of gait were also compared. Statistical analyses were conducted using a two-way ANOVA for subject group and obstacle height. T-D parameters were not significantly different between groups; nor were frontal plane COM and COP parameters. Significant age differences did exist for antero-posterior (A/P) motion of the COM (decreased motion in the elderly), and its relationship with the COP (reduced separation between the two variables in the elderly). Anterior COM velocities were also significantly lower in the elderly group. The results confirm the ability of healthy elderly adults to maintain dynamic balance control in the frontal plane during locomotion. Reduced A/P distances between the COM and COP indicate a conservative reduction of the mechanical load on joints of the supporting limb. This conservative strategy may be related to a reduction in muscle strength as it occurs in the natural aging process.
OBJECTIVE: The aim of this study was to comprehensively examine clinical risk factors, including suicide intent and hopelessness, for suicide and risk of death from all causes after attempted suicide over a 12-year follow-up period.
METHODS: A systematic sample of 224 patients from consecutive cases of attempted suicide referred to health care in four Finnish cities between 1 January and 31 July 1990 was interviewed.
FINDINGS: After 12 years of follow-up 22% of these patients had died, 8% by committing suicide. The only statistically significant risk factor for eventual suicide was high scores on Beck's Suicidal Intention Scale. Male gender, older age, physical illness or disability and high scores on Beck's Suicidal Intention Scale predicted death overall.
COMMENTS: Following attempted suicide, high intention to kill oneself is a significant risk factor for both death from all causes and suicide.
Youth suicide: insights from 5 years of Arizona Child Fatality Review Team data.
- Azrael D, Hemenway D, Miller M, Barber CW, Schackner R. Suicide Life Threat Behav 2004; 34(1): 36-43.
Correspondence: D. Azrael, Harvard Injury Control Research Center, Harvard School of Public Health, Boston, MA 02115, USA; (email: azrael@hsph.harvard.edu).
Data on 153 youth suicides in Arizona (1994-1999) were used to explore demographic, behavioral, and experiential factors that distinguish between firearm suicide and suicide by other means. In bivariate analyses, White youths were more likely than non-White youths to use a firearm to commit suicide as were youths who had not experienced a life crisis or expressed suicidal thoughts in the past, relationships that hold in multivariate analyses at the p < 0.2 level. Targeted suicide prevention activities should supplement interventions focused on restricting access to highly lethal means of suicide such as firearms.
Suicidal deaths in childhood and adolescence.
- Agritmis H, Yayci N, Colak B, Aksoy E. Forensic Sci Int 2004; 142(1): 25-31.
Correspondence: Hasan Agritmis, Institute of Forensic Medicine, Ministry of Justice, 31243 Cerrahpasa, Istanbul, TURKEY; (email: unavailable).
Suicide has been reported as the second or third most common cause of death in children and adolescents worldwide. In this study, cases of under the age of 19 years submitted to the Institute of Forensic Medicine, First Specialization Board between 1996 and 2000 as suicides by the Board were evaluated retrospectively. The cases included in this study were the cases bearing locally questionable components, so had been submitted to the evaluations by the Board in order to eradicate the doubts. A total of 43 cases were investigated regarding age, gender, cause of death, manner of death, place of death, time of death, and the risk factors. Of the 43 cases evaluated, 31 cases were female and 12 cases were male. The notable suicide method was found to be firearms. Although it was clear that that not all of the suicide cases in this age group had been submitted to the Institute of Forensic Medicine, the most striking result of this study, nevertheless, was that girls constituted the 72% of suicidal deaths in this age group.
Are suicides by jumping off bridges preventable? An analysis of 50 cases from Sweden.
- Lindqvist P, Jonsson A, Eriksson A, Hedelin A, Bjornstig U. Accid Anal Prev 2004; 36(4): 691-694.
Correspondence: Per Lindqvist, Section of Forensic Medicine, Department of Community Medicine and Rehabilitation, Umea University, Umea SE-907 12, SWEDEN; (email: per.lindqvist@spo.sll.se).
This is a community-based sequential case series of 50 individuals who committed suicide by jumping from bridges in two regions of Sweden. Of the 50 subjects, 32 were men and 18 women, with a median age of 35 years. At least 40 had psychiatric problems. The frequency of suicide was highest during the summer months and during the weekends. A total of 27 bridges were used, with a total length of just under 9km. Three bridges accounted for almost half of all suicides. Limiting the availability of one method of committing suicide is reported to reduce the overall suicide rate; why suicide and injury suicide preventive measures might be considered. Since this study demonstrates that few bridges attract suicide candidates, this injury mechanism needs to be acknowledged by the road system owners and included in the safety work.
Correspondence: Greg Shaw, Department of Mechanical and Aerospace Engineering, Center for Applied Biomechanics, University of Virginia, Charlottesville, VA 22902, USA; (email: cgs5w@virginia.edu).
Securement of wheelchairs and occupant restraint for wheelchair riders on buses is one of the most difficult problems facing transit providers. The primary findings of this literature review show that (1) very little information has been published regarding transit bus safety and crash environment; (2) the focus of most reported wheelchair incidents involved noncollision events, in which inappropriate wheelchair securement or rider restraint resulted in minor injuries; and (3) studies spanning 30 years indicate that the large transit bus is an exceedingly safe form of transportation, so that wheelchair riders do not face undo risk of injury in this transportation environment. Further study is required to characterize the rare-occurring severe transit bus crashes. The resulting information is needed to establish an appropriate level of crash protection so that the next generation of U.S. wheelchair securement and occupant restraint systems not only are reasonably safe but also are easy to use and acceptable to wheelchair riders and transit bus operators.
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.
An investigation of factors reducing seat belt use amongst Spanish drivers and passengers on urban roads.
- Cunill M, Gras ME, Planes M, Oliveras C, Sullman MJ. Accid Anal Prev 2004; 36(3): 439-445.
Correspondence: Monica Cunill, Department of Psychology, University of Girona, Pl Sant Domenech 9, Girona 17071, SPAIN; (email: monica.cunill@udg.es).
Seat belt use on Spain's highways is more than 80%, while on the urban roads this figure is around 50%. As there was little information available to explain the difference in seat belt use rates, the main aim of this study was to investigate why there is a lower rate of seat belt use on urban roads. A number of perceptions, beliefs and expectancies about seat belt use were examined to identify variables that discriminated between seat belt users and non-users on urban roads. The subjects were 398 undergraduate students (aged 17-47) studying at the University of Girona, Spain. On the urban roads reported discomfort from using the seat belt was higher, while perceptions of risk (for non-users), safety perceptions (for those using a seat belt), beliefs about the seriousness of a crash or the effectiveness of the seat belt were all lower than on the highway. Perceptions of safety, discomfort, and social influence predicted seat belt use on urban roads. Concern about being fined for not using a seat belt did not predict seat belt use. The results of this research suggest that in order to increase seat belt use on urban roads, the issue of discomfort must be addressed. In addition, prevention campaigns should include information about the effectiveness of the seat belt in preventing/reducing injuries or deaths on urban roads. The results also highlight the importance of social influence for determining seat belt use/non-use and the potential role social influence could play in increasing seat belt usage.
Aggressive driving: an observational study of driver, vehicle, and situational variables.
Correspondence: Industrial Engineering and Management, Ben Gurion University of the Negev, P.O. Box 653, Beer-Sheva 84105, ISRAEL; (email: shinar@bgumail.bgu.ac.il).
Over 2000 aggressive driving behaviors were observed over a total of 72 h at six different sites. The behaviors selected for observation were those that are commonly included in "aggressive driving" lists, and they consisted of honking, cutting across one or more lanes in front of other vehicles, and passing on the shoulders. In addition, an exposure sample of 7200 drivers were also observed at the same times and places. Relative risks (RRs) and odds ratios (ODs) were calculated to show the relative likelihood that different drivers under different conditions will commit aggressive behaviors. The rate of aggressive actions observed in this study decreased from the most frequent behavior of cutting across a single lane, through honking, and to the least frequent behaviors of cutting across multiple lanes and passing on the shoulders. Relative to their proportion in the driving population, men were more likely than women to commit aggressive actions, and the differences increased as the severity of the action increased. Drivers who were 45 years old or older were less likely to drive aggressively than younger ones. The presence of passengers was associated with a slight but consistent reduction in aggressive driving of all types; especially honking at other drivers. There was a strong linear association between congestion and the frequency of aggressive behaviors, but it was due to the number of drivers on the road. However, when the value of time was high (as in rush hours), the likelihood of aggressive driving--after adjusting for the number of drivers on the road--was higher than when the value of time was low (during the non-rush weekday or weekend hours). The results have implications for driver behavior modifications and for environmental design.
Evaluation of effectiveness of safety seatbelt legislation in the United Arab Emirates.
- El-Sadig M, Sarfraz Alam M, Carter AO, Fares K, Al-Taneuiji HO, Romilly P, Norman JN, Lloyd O. Accid Anal Prev 2004; 36(3): 399-404.
Correspondence: Mohammed El-Sadig, Department of Community Medicine, Faculty of Medicine and Health Sciences, UAE University, P.O. Box 17666, Al-Ain, UNITED ARAB EMIRATES; (email: msadig@uaeu.ac.ae).
Seatbelt legalisation was implemented in the United Arab Emirates (UAE) in January 1999. This provided the opportunity to evaluate the effectiveness of the legislation in the Eastern District of Abu Dhabi Emirate in the UAE by establishing levels of injury severity from motor vehicle crashes (MVC) before and after the legislation and the rate of compliance with the legislation. Data were obtained from a major hospital in the Eastern District of Abu Dhabi Emirate, UAE. Subjects were a systematic sample of MVC victims who arrived alive at hospital in either the pre-implementation period (January-June 1998) or the post-implementation period (February-August 2000). The main measures of outcome were injury severity codes, numbers of hospital bed days and rates of admission and discharge at hospital. The analysis of injury severity from MVCs, from the pre- to the post-implementation period, revealed a significant declining trend (chi-square = 77.68, P < 0.001). While the proportion of minor injuries increased from 42% (95% CI: 36-48%) in the pre-implementation period to 77% (95% CI: 71-83%) in the post-implementation period, the proportion of "moderate to fatal injuries" declined from 54% (95% CI: 48-60%) to 17% (P = 0.001) and the median number of hospital bed days declined from 5 days (25% = 2; 75% = 8 ) to 3 days (25% = 1; 75% = 4 ). The rate of seatbelt compliance reported by occupants involved in MVCs in the post-implementation period was 59% (95% CI: 52-67%). The implementation of the seatbelt legislation in the Eastern District of Abu Dhabi Emirate was associated with statistically significant reduction in morbidity in those arriving alive at hospital following MVC, including reduced severity of injury, admission rate to hospital and the duration of hospital stay. More active implementation of seatbelt law would most likely further reduce severity of MVC injuries and fatalities in the Eastern District of Abu Dhabi Emirate, UAE.
OBJECTIVE: The aim of this study was to assess the use of mental health services and predictors of use among men injured through community violence.
METHODS: This one-year prospective study examined use of mental health services in a sample of 231 men who were injured through community violence and hospitalized at an urban trauma center. Predictors of mental health service use that were examined included age, ethnicity, income, neuroticism, injury severity, previous mental health service use, and need for services. Need for services was defined objectively by self-report of symptoms of posttraumatic stress disorder (PTSD) and subjectively by perception of an injury-related emotional problem.
FINDINGS: Univariate logistic regression analysis showed that older age, non-Latino ethnicity, previous use of services, and need for services predicted service use in the year after the injury. In a multivariate logistic regression analysis, objective and subjective need for services and older age predicted postinjury service use. In the subset of men who were symptomatic postinjury, only older age and objective need predicted use of mental health services.
COMMENTS: Despite high rates of need for services related to PTSD after violent injury in this sample, the rate of mental health service use was low. Psychoeducation about postinjury reactions and attention to structural barriers to services may help increase rates of care in this population.
Domestic violence against women before, during and after pregnancy.
- Guo SF, Wu JL, Qu CY, Yan RY. Zhonghua Liu Xing Bing Xue Za Zhi 2004; 25(1): 9-11.
Correspondence: S.F. Guo, National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, Beijing 100083, CHINA; (email: unavailable).
OBJECTIVE: To examine patterns of abuse before, during, and after pregnancy and the possible factors related to abuse.
METHODS: A community-based face-to-face survey of a representative group of women having a child aged 6 to 18 months in 32 communities of Tianjin, Liaoning, Henan and Shaanxi provinces was carried out between November 1, 2001 and February 28, 2002.
FINDINGS: The prevalence rate of domestic violence (emotional, sexual and physical) occurred in any period (before, during and after pregnancy) against women was 12.6%. The prevalence of domestic violence against women during the approximate 9 months of pregnancy (4.3%) was relatively lower than that during the 12 months before pregnancy (9.1%) and during the mean 11 months postpartum period (8.3%). Domestic violence against women before pregnancy was a strong risk factor for abuse during and post pregnancy. Abused women and perpetrators were more likely to be in lower social class were smoking cigarettes and drinking alcohol. Abused women were more likely to be witnessing violence in the past and having poor relationship with partner.
COMMENTS: The prevalence of domestic violence against women was high which called for in-depth training and improving awareness for all health professionals.
Gunshot and explosion injuries: characteristics, outcomes, and implications for care of terror-related injuries in Israel.
- Peleg K, Aharonson-Daniel L, Stein M, Michaelson M, Kluger Y, Simon D, Noji EK. Ann Surg 2004; 239(3): 311-318.
Correspondence: Kobi Peleg, Center for Trauma & Emergency Medicine Research, Gertner Institute, Sheba Medical Center, Tel Hashomer, ISRAEL; (email: kobip@gertner.health.gov.il).
BACKROUND: An increase of terror-related activities may necessitate treatment of mass casualty incidents, requiring a broadening of existing skills and knowledge of various injury mechanisms.
OBJECTIVE: To characterize and compare injuries from gunshot and explosion caused by terrorist acts.
METHODS: A retrospective cohort study of patients recorded in the Israeli National Trauma Registry (ITR), all due to terror-related injuries, between October 1, 2000, to June 30, 2002. The ITR records all casualty admissions to hospitals, in-hospital deaths, and transfers at 9 of the 23 trauma centers in Israel. All 6 level I trauma centers and 3 of the largest regional trauma centers in the country are included. The registry includes the majority of severe terror-related injuries. Injury diagnoses, severity scores, hospital resource utilization parameters, length of stay (LOS), survival, and disposition.
FINDINGS: A total of 1155 terror-related injuries: 54% by explosion, 36% gunshot wounds (GSW), and 10% by other means. This paper focused on the 2 larger patient subsets: 1033 patients injured by terror-related explosion or GSW. Seventy-one percent of the patients were male, 84% in the GSW group and 63% in the explosion group. More than half (53%) of the patients were 15 to 29 years old, 59% in the GSW group and 48% in the explosion group. GSW patients suffered higher proportions of open wounds (63% versus 53%) and fractures (42% versus 31%). Multiple body-regions injured in a single patient occurred in 62% of explosion victims versus 47% in GSW patients. GSW patients had double the proportion of moderate injuries than explosion victims. Explosion victims have a larger proportion of minor injuries on one hand and critical to fatal injuries on the other. LOS was longer than 2 weeks for 20% (22% in explosion, 18% in GSW). Fifty-one percent of the patients underwent a surgical procedure, 58% in the GSW group and 46% in explosion group. Inpatient death rate was 6.3% (65 patients), 7.8% in the GSW group compared with 5.3% in the explosion group. A larger proportion of gunshot victims died during the first day (97% versus 58%).
COMMENTS: GSW and injuries from explosions differ in the body region of injury, distribution of severity, LOS, intensive care unit (ICU) stay, and time of inpatient death. These findings have implications for treatment and for preparedness of hospital resources to treat patients after a terrorist attack in any region of the world. Tailored protocol for patient evaluation and initial treatment should differ between GSW and explosion victims. Hospital organization toward treating and admitting these patients should take into account the different arrival and injury patterns.
Violent deaths among women of reproductive age in rural Bangladesh.
- Ahmed MK, Van Ginneken J, Razzaque A, Alam N. Soc Sci Med 2004; 59(2): 311-319.
Correspondence: M.K.M. Kapil Ahmed, Health and Demographic Surveillance System, ICDDR, B: Centre for Health and Population Research, GPO Box 128, Dhaka 1000, BANGLADESH; (email: kapillani@yahoo.com).
The objectives of this paper are to investigate levels and trends in mortality due to violence in women of reproductive age and the social and demographic factors associated with such mortality. The study took place in Matlab, a rural sub-district in Bangladesh between 1982 and 1998. The data were furnished by a longitudinal population-based demographic surveillance system located in that area. A case-control design study was used out to identify factors associated with death due to violence, and data from death registration forms were analyzed. The death rate due to violence, defined in terms of suicides and homicides, was higher among women than men. Death rates from violence remained at the same level during the study period while death rates from other causes decreased. Young, not yet married women were a high risk group with respect to death from violence. Oppression, physical and mental abuse by husbands and relatives often preceded suicides and homicides. The disadvantaged position of women in Bangladesh society is the key underlying social cause of the violence that occurred. In order for violence against women to decrease, improvement in the social position of women is essential.
Gender-based violence, relationship power, and risk of HIV infection in women attending antenatal clinics in South Africa.
Correspondence: Kristin L Dunkle, Gender and Health Group, Medical Research Council, Private Bag X385, Pretoria 0001, SOUTH AFRICA; (email: kdunkle@umich.edu).
CONTEXT: Gender-based violence and gender inequality are increasingly cited as important determinants of women's HIV risk; yet empirical research on possible connections remains limited. No study on women has yet assessed gender-based violence as a risk factor for HIV after adjustment for women's own high-risk behaviours, although these are known to be associated with experience of violence.
METHODS: We did a cross-sectional study of 1366 women presenting for antenatal care at four health centres in Soweto, South Africa, who accepted routine antenatal HIV testing. Private face-to-face interviews were done in local languages and included assessement of sociodemographic characteristics, experience of gender-based violence, the South African adaptation of the Sexual Relationship Power Scale (SRPS), and risk behaviours including multiple, concurrent, and casual male partners, and transactional sex.
FINDINGS: After adjustment for age and current relationship status and women's risk behaviour, intimate partner violence (odds ratio 1.48, 95% CI 1.15-1.89) and high levels of male control in a woman's current relationship as measured by the SRPS (1.52, 1.13-2.04) were associated with HIV seropositivity. Child sexual assault, forced first intercourse, and adult sexual assault by non-partners were not associated with HIV serostatus.
COMMENTS: Women with violent or controlling male partners are at increased risk of HIV infection. We postulate that abusive men are more likely to have HIV and impose risky sexual practices on partners. Research on connections between social constructions of masculinity, intimate partner violence, male dominance in relationships, and HIV risk behaviours in men, as well as effective interventions, are urgently needed.
