A model for alcohol-mediated violence in an Australian Aboriginal community.
- Shore JH, Spicer P. Soc Sci Med 2004; 58(12): 2509-2521.
Correspondence: Jay H. Shore, Department of Psychiatry, American Indian and Alaska Native Programs, University of Colorado Health Sciences Center, Nighthorse Campbell Native Health Building, Mail Stop F800 PO BOX 6508, Aurora, CO 80045-0508, USA; (email: jay.shore@uchsc.edu).
This study introduces a new model for understanding alcohol use and violence in a contemporary Australian Aboriginal community. Based on ethnographic and survey data collected in the community, which is not further identified in this manuscript, the model examines circumstantial, community- and individual-level factors surrounding alcohol use and its associated violence. Community member's beliefs about the effect of alcohol on individual behavior and emotion bring about the expectation that intoxicated individuals will remember past grievances and act upon them. Individual's actions are affected by community members' beliefs about alcohol as well as the individual's own more idiosyncratic beliefs and expectations, the disinhibiting qualities of alcohol, the individual's emotional state, and the circumstances surrounding a drinking episode. These factors interact to construct a situation in which "being drunk" encourages an individual to bring out grievances and conflicts and address them through physical confrontation. In this manner, alcohol acts as a conduit for the playing out of conflicts and tensions within the community. But this system represents a relatively ineffectual form of conflict mediation and tension reduction, thus suggesting an important critique of the classic "time out" thesis of drunken comportment. Drunken confrontations, rather than being a "time out," represent an integrated part of the way in which conflicts are played out in the community. This model provides a useful framework for future research to examine alcohol-mediated conflict in indigenous communities.
OBJECTIVE: The terrorist attacks of September 11, 2001, caused mass destruction in Lower Manhattan, the Pentagon, and rural Pennsylvania and resulted in the death of >3000 people. Children were prominent among those affected. Given the wide impact of the attacks, we hypothesized that primary care professionals would see the broad population of affected children but would feel ill-prepared to respond to children's mental health needs. METHODS: One year after the September 11th disaster, a hyperlink to a web-based 42-item survey was sent to all New York, Connecticut, and New Jersey American Academy of Pediatrics members with e-mail addresses (N = 4330), and a paper version of the survey was sent via postal mail to a random sample of those without e-mail (N = 1320). The survey requested demographic data, personal and practice experience of 9/11, perceived knowledge and skills regarding mental health, and perceived barriers to accessing mental health services for their patients. Both groups were contacted a total of 3 times at 2-week intervals, resulting in 1396 completed surveys from providers who were actively seeing patients. RESULTS: Twenty-nine percent of respondents stated that they were seeing affected patients, and 32.6% reported seeing children who were exposed to at least 1 9/11 event. Sixty-four percent of the respondents identified behavioral problems in directly affected children: 41.6% identified acute stress disorder, and 26.3% identified posttraumatic stress disorder (PTSD). However, a majority of these professionals indicated that they either lacked or were uncertain (50.8% PTSD, 51.7% acute stress disorder) of their skills to identify children with mental health problems and that they were "not" or only "somewhat" knowledgeable (76.8% PTSD) in these areas. The majority agreed that child health professionals should be trained to screen for these 2 disorders. Generalists as compared with specialists were more likely to report seeing patients who were affected by 9/11. Gender, race/ethnicity, and geographic location were associated with reported effects of 9/11 on respondents' practice and perceived skills and knowledge related to the psychological effects of community disasters. CONCLUSIONS: Pediatric practitioners in the tristate area reported that children/families sought care for an array of mental health-related concerns. Generalists in the areas affected and those who identified gaps in knowledge or skills in responding to the psychological effects of community disasters should be targeted for additional education.
Psychotherapeutic interventions for survivors of terrorism.
Terrorist attacks combine features of criminal assaults, disasters, and acts of war. Accordingly, much of our clinical knowledge in treating this relatively new kind of traumatic event is adapted from experiences in treating victims of criminal assault, homicidal bereavement, natural and man-made disasters, war and political violence, workplace homicide, and school shootings. This paper reviews the pertinent literature on these types of trauma and combines this information with the author's own experience in treating direct and indirect victims and survivors of recent terrorist attacks. The paper describes the psychological syndromes resulting from terrorism and discusses individual and family modalities for treating victims and survivors of terrorism.
The purpose of this study was to assess the effects of reducing driving fatigue with magnitopuncture stimuli on Dazhui (DU14) point and Neiguan (PC6) points using heart rate (HR), reaction time (RT) testing, right rate (RR), critical flicker fusion frequency (CFF) and subjective evaluation. Forty healthy subjects were randomly divided into two groups: study and control groups. All subjects were required to be well rested before the experiment. The subjects were engaged in high speed driving at a constant vehicle velocity of 80km/h continuously for 3h on a test course simulating an expressway. During the driving magnitopunctures (Haci Five Elements Needle, 250mT, made by Haci Company limited) were applied to the Dazhui (DU14) point and Neiguan (PC6) points for the study group when the subject performed the task for 2.5h, and for the control group magnitopunctures were applied to non-acupuncture points during the same time session. The results of this study show a significant effect of magnitopuncture stimuli on RT, RR and CFF. Subjective evaluation also exhibited significant differences ( [Formula: see text] ) between the two groups after the driving task. The findings showed that magnitopuncture stimuli on DU14 point and PC6 points could reduce the effects of driving fatigue.
Correspondence: David J. Ball, Centre for Decision Analysis and Risk Management, School of Health and Social Sciences, Middlesex University, Queensway, Enfield, Middlesex EN3 4SF, UK; (email: d.ball@mdx.ac.uk).
The case for the universal application of 'safer surfacing' in playgrounds is assessed in terms of absolute risk, cost-benefit, and qualitative factors, and found to be open to question on each front. In parallel, it is noted that members of the child welfare and play communities are increasingly of the view that playgrounds are losing their appeal for children, which in turn has its own health, safety and developmental consequences. In part, this loss of attractiveness may have linkages with the recent concern over play safety and the imposition of measures such as 'safer surfacing'. It is proposed that the drive for play safety, which has existed for some 20 years, should be succeded by a more holistic approach which, rather than considering play safety in isolation, acknowledges the importance of all attributes of play including child safety both on and off playgrounds, potential beneficial aspects of childhood risk exposure, adventure, and play value.
Environmental hazards for falls in elders in low income housing.
Correspondence: I. Lamontagne, Unite de Recherche en Sante Publique, Centre Hospitalier Universitaire de Quebec, 945, Ave. Wolfe, Sainte-Foy, Quebec, CANADA; (email: unavailable).
BACKGROUND: About 35% of elders living at home fall each year. The objectives of this study were to evaluate the environmental hazards associated with falls in 58 low income housings for elders and to determine the contribution of environmental factors to these falls.
METHODS: Participants were interviewed to document their health problems, their knowledge concerning the Issue of falls, and their history of falls during the last Year. Environmental hazards were identified and evaluated with a standardised checklist. The levels of hazards (percentage of factors identified which represent a hazard) were measured for the different sectors and for the entire dwelling and communal spaces. The hazards were also evaluated according to four main variables (structure of the building, characteristics of the floor surface, environmental obstacles, risk-taking behaviour).
FINDINGS: A total of 172 participants were recruited for the study. For dwellings and communal spaces, the hazards were respectively higher in bathrooms (mean=27.0%; p<0.05) and interior stairs (mean=22.5%; p<0.05). For the communal spaces of buildings of less than 20 Years, the global hazard was higher in the smaller buildings (<=three stories, mean=14.2%;>three stories, mean=12.6%; p<0.001). For dwellings of the larger buildings, the global hazard was higher for younger buildings (<20 Years, mean=16.6%; >=20 Years, mean=13.5%; p<0.001). Among the variables documented, risk-taking behaviour was the more frequent factor for the dwellings (mean=32.0%; p<0.05) as for the communal spaces (mean=42.5%; p<0.05). Finally, only 34% of the participants mentioned receiving information concerning the falls among elders. Among the 27 falls documented, an environmental factor was identified in 55% of the cases.
COMMENTS: The study helped to document the presence of environmental factors which could be a hazard for falls in elders' housing and to suggest preventive and remedial actions.
Human resources managers have reported increased violence (1) stating it can happen anywhere (2). One million workers are assaulted each year (3), and in some years more than 1,000 workers have been killed (4). Almost 25% of workplace violence incidences occur in the health-care industry (5). Women commit nearly one fourth of all threats or attacks (6). Have you ever gotten angry at work? Have you ever had to deal with an angry patient or coworker? Has there been any violence where you work? The key to preventing workplace violence is to deal with anger and recognize and handle suspicious behavior before it turns violent.
An accident-risk assessment study of temporary piece rated workers.
- Saha A, Ramnath T, Chaudhuri RN, Saiyed HN. Ind Health 2004; 42(2): 240-245.
Correspondence: A. Saha, Occupational Medicine Division, National Institute of Occupational Health, Meghani Nagar, Ahmedabad-380 016, Gujarat, INDIA; (email: unavailable).
An occupational injury surveillance study (record study of five years duration) was conducted involving the workers of a fertilizer producing industry in eastern India to assess whether the risk of occupational accidents in temporary piece rated workers was higher in comparison to the permanent time rated workers. At the same time, to collect the personal details of the workers who have worked in the industry in the study period, an interview was also conducted. Mean age of temporary piece rated workers and permanent time rated workers were (35.9 +/- 12.5) and (35.3 +/- 11.4) respectively. Distribution of other variables like nature of work, level of education, experience, habits were also very similar between the two worker groups. Accident incidence rate, accident frequency rate and accident severity rate were found to be significantly higher in temporary piece rated workers. This difference was more prominent in case of time-loss accidents than in no time-loss accidents. Relative risk has varied from 2.3 to 18.0 in case of time-loss accidents. In case of no time-loss accidents, it has varied from 1.1 to 2.6. When relative risk is considered after taking both types of accidents together, it has ranged from 1.2 to 3.5. This study concluded that the temporary piece rated workers are more vulnerable to occupational accidents.
Within the framework of a bicycle helmet research program, we have set up a database of bicycle accident victims, containing both accident and clinical data. The database consists of a consecutive series of 86 victims of bicycle accidents who underwent a neurosurgical intervention in our hospital between 1990 and 2000. Data were obtained from police files, medical records, computed tomography head scans and a patient questionnaire. In only three victims, the wearing of a helmet was documented. In this study, the head injuries are analysed and the relation between the different types of head injuries and outcome is assessed. Forty-four accidents were collisions with a motor vehicle and 42 accidents were falls. Most impacts occurred at the side (57%) or at the front (27%) of the head. The most frequent injuries were skull fractures (86%) and cerebral contusions (73%). Age was negatively correlated with outcome and positively correlated with the number and volume of contusions and the presence of subdural haematomas. The injuries with the strongest negative effect on outcome were: subarachnoid haemorrhage, multiple or large contusions, subdural haematoma and brain swelling ( [Formula: see text] ). A significant coexistence of these four injuries was found. We hypothesise that in many patients the contusions may have been the primary injuries of this complex and should therefore be considered as a main injury determining outcome in this study. We believe that such findings may support a rational approach to optimising pedal cyclist head protection.
Correspondence: Rebecca Demorest, The Department of Pediatrics, The Children's Hospital of Philadelphia, The University of Pennsylvania School of Medicine, Philadelphia, PA, USA; (email: unavailable).
OBJECTIVE: Childhood poisoning represents a major public health problem that can be prevented through educational efforts. Commonly, young children experiencing a first poisoning episode will have a second occurrence. The aim of this study is to assess whether caretakers of children evaluated in an emergency department for acute poisoning exposure recall receiving poisoning prevention education as part of the medical encounter.
METHODS: Consecutive poisoning exposures reported to a regional Poison Control Center concerning children under the age of 6 years were identified. Inclusion criteria were an emergency department referral and subsequent discharge. Within 10 days of emergency department visit, a single trained interviewer administered by telephone a scripted questionnaire concerning the provision of poisoning prevention education. Poison control center logs were reviewed for demographic and treatment data.
FINDINGS: Of 102 eligible subjects, 77 families were contacted and 75 participated. The median age of poison exposure was 2 years; 45% were male. Seventy-three percent (95% CI: 61% to 83%) of caregivers reported receiving no poisoning prevention education. Among the minority receiving some information, only 25% received verbal instruction. Caregivers of children treated in urban academic centers were more likely to recall prevention education than those treated at suburban and rural hospitals (RR = 5.4; 1.8 to 16.2). Caregivers of children treated at specialized children's hospitals were more likely recall prevention education than general hospitals (RR = 5.3; 1.6 to 17.7).
COMMENTS: Emergency department personnel are missing a potentially important opportunity to provide poisoning prevention education to families of children at high risk for repeat occurrence.
- Grellner W, Buhmann D, Giese A, Gehrke G, Koops E, Puschel K. Forensic Sci Int 2004; 142(1): 17-23.
Correspondence: W. Grellner, Institute of Forensic Medicine, Saarland University, Building 42, DE-66421 Homburg/Saar, GERMANY; (email: grellner@uni-mainz.de).
Today in modern times, traumatic injuries caused by crossbows are a rarity. The largest collection of cases so far is presented in this study, consisting of four fatalities (two homicides and two suicides) and two non-fatal injuries (grievous bodily harm and an accident). All the victims were male having an age between 31 and 54. The weapons, which were used, were mainly high-performance precision crossbows with telescopic sights and hunting bolts. The parts of the body involved were the facial/head area in three of the cases and the thorax in three of them. There were either deep or total penetration injuries to the cranium and thorax with the bolt remaining in the wound in four out of six cases. The persons with non-fatal crossbow injuries exhibited comparatively few symptoms, despite the sometimes extensive involvement of the interior of the cranium (cerebrocranial penetration, in one instance). The two cases of suicide favoured the body areas often found with gun-users. The aetiological classification of crossbow injuries may be difficult after the removal of the bolt. The external morphology is strongly dependent on the type of tip used. Multiple-bladed hunting broadheads produce radiating incised wounds, whereas conical field tips produce circular to slitlike defects. Correspondingly, the external injuries can be reminiscent of the effects of a violent attack by sharp force or of a gunshot wound. The possibility, supported by clinical data, that the victim might have the ability to act or even to survive for a period of time, even with penetration of the brain, should be taken into account when the cause of death is being investigated.
Visual outcome and ocular survival after sports related ocular trauma in playing golf.
- Weitgasser U, Wackernagel W, Oetsch K. J Trauma 2004; 56(3): 648-650.
Correspondence: Ursula Weitgasser, Department of Ophthalmology, Karl Franzens University of Graz), AUSTRIA; (email: uweitgasser@hotmail.com).
OBJECTIVE: To study eye injuries. More specifically, to study the visual performance and ocular findings in people generating the eye trauma while golfing and to define the main mechanisms of injury.
METHODS: We retrospectively reviewed a case series of seven patients with golf-related eye injuries treated at Austrian hospitals over the last seven years in a multicenter setting.
FINDINGS: Five men and two women received treatment. The mean age was 46 (range, 29-63), and three of the patients had blunt close globe trrauma and four suffered from a ruptured globe. Following the injuries, the patients' initial visual acuity ranged from no light perception to 20/40. All of the patients recquired surgery, with the resulting visual acuily ranging from moving hands to 20/20. It should be noted that three eyes required enucleation.
COMMENTS: Visual outcome from surgery is frequently very poor in golf related injuries. This is further complicated by these traumas frequently being accompanied by a high enucleation rate. Among the patients reviewed, it was observed that ruptured globe trauma has a worse prognosis than close blunt trauma. Due to the severe resulting complications of golf-related ocular injuries, we believe eye protection should be considered and emphasized.
Correspondence: Richard Rowe, MRC Social, Genetic, and Developmental Psychiatry Research Center, Box P046, Institute of Psychiatry, De Crespigny Park, Denmark Hill, London SE5 8AF, UK; (email: r.rowe@iop.kcl.ac.uk).
OBJECTIVE:We set out to examine the relationship between unintentional injury and common child psychiatric disorders, including both internalizing and externalizing diagnoses.
METHODS:The 1999 British Child and Adolescent Mental Health Survey provided a nationally representative sample of over 10,000 children aged 5-15 years. Measures included assessment of diagnoses of psychiatric disorder from the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, unintentional injury, and a range of potentially related psychosocial factors.
FINDINGS: Children with psychiatric disorders had higher rates of unintentional injury. After accounting for psychosocial risk factors and comorbid psychopathology, oppositional defiant disorder (ODD) was independently associated with burns and poisoning. Attention deficit hyperactivity disorder (ADHD) was related to fractures, and depression and anxiety also showed independent links to some injury types.
COMMENTS: ODD and ADHD, rather than conduct disorder, appear to be the externalizing disorders associated with unintentional injury. We discuss possible models of the relationships between internalizing disorders and unintentional injury.
Health risk-factors for gay American Indian and Alaska Native adolescent males.
Having multiple identities as a homosexual American Indian or Alaska Native adolescent male increases the likelihood for poorer health and diminished well-being. This study assessed the differences in self-perceived health status between gay adolescent males and their heterosexual counterparts. A national nonrepresentative sample of 5,602 Indian and Native adolescent males was surveyed about issues of sexual behavior, physical and sexual abuse, mental health status, substance use, attitudes about school, participation in violence, and access to health care. Results indicate that there were no real differences between gay and heterosexual male respondents for substance use or attitudes about school. Statistically significant differences were found, however, in areas of mental health, as well as physical and sexual abuse. Gay adolescents were twice as likely to have thought of or attempted suicide. Gay adolescents were twice as likely to have been physically abused and nearly six times more likely to have been sexually abused. Gay American Indian or Alaska Native adolescent males constitute a very vulnerable population and are clearly in need of targeted health and social services. Unfortunately, the benefits seen by adults of the "two-spirited" gay and lesbian American Indian movement have not been accessible to Indian and Native adolescents.
Into hot water head first: distribution of intentional and unintentional immersion burns.
- Daria S, Sugar NF, Feldman KW, Boos SC, Benton SA, Ornstein A. Pediatr Emerg Care 2004; 20(5): 302-310.
Correspondence: Sonia Daria, Department of Pediatrics, General Pediatric Division, University of Washington School of Medicine, Seattle, WA, USA; (email: unavailable).
INTRODUCTION: Experience with several, previously unreported, intentional face-first immersion burns led us to evaluate the distribution of inflicted and unintentional immersion scald burns in a hospital series.
SETTING: (1) Authors' clinical and legal practices; (2) Burn center at regional Level 1 trauma hospital.
SUBJECTS: (1) Case series of face-first, inflicted immersion burn victims; (2) Consecutive hospitalized scald burn victims younger than 5 years old, 1/3/1996 to 3/25/2000.
METHODS: (1) Individual case reports; (2) Retrospective records review. Simple descriptive statistics, Fisher Exact test and t test.
FINDINGS: (1) Six cases of inflicted head and neck immersion injury are described. Four were tap water and 2 food/drink scalds. (2) 22/195 hospitalized victims had sustained immersion burns, 13 from tap water and 9 from other fluids. Six (46%) tap water immersions and no (0%) other immersions had inflicted injuries (P = 0.05). Two of the tap water immersions and one other source immersion included burning of the head and neck. Of these, one tap water immersion, but no other immersion, was inflicted. In no patients were head and neck injuries the sole or predominant site of scalding. In all, 9 children sustained inflicted scalds. Bilateral lower extremity tap water immersion scalds occurred in 100% (6/6) of abusive and 29% (2/7) of unintentional injuries (P = 0.02). Buttock and perineal injuries occurred in 67% (4/6) inflicted versus 29% (2/7) unintentional tap water immersion scalds (P = 0.28). Other fluids caused bilateral lower extremity immersion burns in 3/9 (33 %) unintentionally injured patients, but no abused children (NS).
COMMENTS: Craniofacial immersion injury, although seen by the authors in legal cases, is infrequent. It was present incidentally in one inflicted tap water burn in the consecutive hospital series. This series affirms the predominance of bilateral lower extremity burns in inflicted tap water immersions. Buttock/perineal immersions were more common with abuse than with unintentional injury.
Willingness-to-pay for reducing fatal accident risk in urban areas: an Internet-based Web page stated preference survey.
- Iraguen P, De Dios Ortuzar J. Accid Anal Prev 2004; 36(4): 513-524.
Correspondence: Juan de Dios Ortuzar, Department of Transport Engineering, Pontificia Universidad Catolica de Chile, Casilla 306, Cod. 105, Santiago 22, CHILE; (email: jos@ing.puc.cl).
Contemporary transport project evaluation requires the ability to value reductions in the number of estimated fatal and non-fatal accidents after project implementation. In this quest, we designed a stated preference (SP) experiment to estimate willingness-to-pay (WTP) for reducing fatal accident risk in urban areas. The survey was implemented in a Web page allowing rapid turnover and a complete customisation of the interview. The sample was presented with a series of route choice situations based on travel time, cost and number of car fatal accidents per year. With this data we estimated Multinomial Logit (MNL) and Mixed Logit (ML) models based on a consistent microeconomic framework; the former with linear and non-linear utility specifications and allowing for various stratifications of the data. The more flexible ML models also allow to treat the repeated observations problem common to SP data and, as expected, gave a better fit to the data in all cases. Based on these models, we estimated subjective values of time, that were consistent with previous values obtained in the country, and also sensible values for the WTP for reductions in fatal accident risk. Thus, the Internet appears as a potentially very interesting medium to carry out complex stated choice surveys.
Acute healthcare utilization by children after motor vehicle crashes.
Correspondence: Flaura K. Winston, The Center for Clinical Epidemiology and Biostatistics, The University of Pennsylvania, Blockley Hall, Room 818, 423 Guardian Drive, Philadelphia, PA 19104, USA; (email: Flaura@mail.med.upenn.edu).
This study, describing the overall patterns of acute healthcare resource utilization by child crash victims (age 15 years and younger), was conducted between 28 July 1999 and 30 November 2000 as part of an on-going large-scale, child-specific crash surveillance system, Partners for Child Passenger Safety: insurance claims from 15 states and the District of Columbia function as the source of subjects, with telephone survey and on-site crash investigations serving as the primary sources of data. A probability sample of 4,862 eligible crashes with 7368 child occupants formed the study sample. Our results suggest that for every 1000 children involved in crashes, 3 are hospitalized; 108 are treated and released from an emergency department (ED); 48 are evaluated in a physician's office, urgent care center, or other facility; and 841 receive no care at all. Comprehensive surveillance systems for motor vehicle crashes must capture children treated in physicians' offices, emergency departments, and other healthcare facilities in order to provide accurate estimates of the impact on the health care system related to motor vehicle trauma.
BACKGROUND: Patient falls constitute a major threat to health services' ability to provide care. Previous studies confirm that nurses can identify patients at risk and that a preventative programme can reduce the rate of falls but few studies have been evaluated over time.
OBJECTIVE: A study was undertaken to test a Falls Prevention Programme in an acute medical area that was re-evaluated 5 years later to determine if the effects were sustainable. Design. The design included two groups of patients admitted before and after the programme. Variables such as staffing, equipment, environment and routines were controlled. However, because of ethical approval constraints, some variables such as age, mental status, mobility and gender were not.
METHODS: The programme included a risk assessment tool, a choice of interventions, a graphic that alerted others to 'at risk patients' and simple patient and staff education. Data were collected using incident forms and a formula was used to calculate a rate of falls. A non-paired t-test compared rates and anova examined the relationship of age, gender, mobility and mental status on the incidence of falls. Control graphs determined the stability of the process.
FINDINGS: The falls rate was significantly reduced. Control graphs demonstrate that the process achieved greater control with less variation. In the next 5 years the falls rate increased to preprogramme levels and control graphs demonstrated that the process was no longer controlled. Compliance with the programme had deteriorated.
COMMENTS: The practice review considered skill mix, patient activity and acuity but provided no definitive answers to explain non-compliance. The implications to nursing are discussed. Relevance to clinical practice. Clinicians are called to conduct more rigorous research into falls prevention but it may be more useful to direct research towards examining nursing work and increasing nurse autonomy in falls prevention.
Horse-drawn buggies are rarely used in modern society except among certain religious groups. Northeastern Indiana has one of the largest populations of one such group: the Amish. Although there are papers written about the incidence of buggy crashes, no paper has specifically addressed the specific types of injuries sustained when buggies collide with motorized vehicles. This paper reviews the types of injuries sustained when such events occur.
Associations between overweight and obesity with bullying behaviors in school-aged children.
- Janssen I, Craig WM, Boyce WF, Pickett W. Pediatrics 2004; 113(5): 1187-1194.
Correspondence: Ian Janssen, Department of Community Health and Epidemiology, Queen's University, Kingston, Ontario, CANADA; (email: janssen@post.queensu.ca).
OBJECTIVE: The prevalence of overweight and obesity in children is rising. Childhood obesity is associated with many negative social and psychological ramifications such as peer aggression. However, the relationship between overweight and obesity status with different forms of bullying behaviors remains unclear. The purpose of this article is to examine these relationships.
METHODS: We examined associations between bullying behaviors (physical, verbal, relational, and sexual harassment) with overweight and obesity status in a representative sample of 5749 boys and girls (11-16 years old). The results were based on the Canadian records from the 2001/2002 World Health Organization Health Behaviour in School-Aged Children Survey. Body mass index (BMI) and bullying behaviors were determined from self-reports.
FINDINGS: With the exception of 15- to 16-year-old boys, relationships were observed between BMI category and peer victimization, such that overweight and obese youth were at greater relative odds of being victims of aggression than normal-weight youth. Strong and significant associations were seen for relational (eg, withdrawing friendship or spreading rumors or lies) and overt (eg, name-calling or teasing or hitting, kicking, or pushing) victimization but not for sexual harassment. Independent of gender, there were no associations between BMI category and bully-perpetrating in 11- to 14-year-olds. However, there were relationships between BMI category and bully-perpetrating in 15- to 16-year-old boys and girls such that the overweight and obese 15- to 16-year-olds were more likely to perpetrate bullying than their normal-weight classmates. Associations were seen for relational (boys only) and overt (both genders) forms of bully-perpetrating but not for sexual harassment.
COMMENTS: Overweight and obese school-aged children are more likely to be the victims and perpetrators of bullying behaviors than their normal-weight peers. These tendencies may hinder the short- and long-term social and psychological development of overweight and obese youth.
Higher risk of multiple falls among elderly women who lose visual acuity.
- Coleman AL, Stone K, Ewing SK, Nevitt M, Cummings S, Cauley JA, Ensrud KE, Harris EL, Hochberg MC, Mangione CM. Ophthalmology 2004; 111(5): 857-862.
Correspondence: Anne L. Coleman, Jules Stein Eye Institute and the UCLA Department of Ophthalmology, UCLA School of Medicine, Los Angeles, California, USA; (email: unavailable).
OBJECTIVE: To determine the association between changes in visual acuity (VA) and frequent falls in older women. DESIGN: Prospective cohort study.
PARTICIPANTS: Two thousand two elderly community-residing women participating in the Study of Osteoporotic Fractures with measurements of VA at baseline and a follow-up examination 4 to 6 years later (mean of 5.6 years).
METHODS: Binocular VA with habitual correction was measured under standard illumination using Bailey-Lovie charts at baseline and fourth examinations. Change in VA was stratified into 5 categories: no change or VA gain, loss of 1 to 5 letters, loss of 6 to 10 letters, loss of 11 to 15 letters, and loss of >15 letters. A separate analysis considered decline in VA as the loss of >/=10 letters (>/=2 lines) on the Bailey-Lovie acuity measure between baseline and follow-up examinations.
MAIN OUTCOME MEASURES: Data on falls were obtained from postcards sent every 4 months after the follow-up examination. Frequent falling was defined as>/=2 falls during a 1-year period after the follow-up examination.
FINDINGS: Compared with women with stable or improved VA, women with declining acuity had significantly greater odds of experiencing frequent falling during the subsequent year. Odds ratios after adjustment for baseline acuity and other confounders were 2.08 (95% confidence interval [CI]: 1.39-3.12) for loss of 1 to 5 letters, 1.85 (95% CI: 1.16-2.95) for loss of 6 to 10 letters, 2.51 (95% CI: 1.39-4.52) for loss of 11 to 15 letters, and 2.08 (95% CI: 1.01-4.30) for loss of >15 letters. In the analysis of visual decline defined as a loss of >/=10 letters, heightened risk of frequent falling was evident in each of 2 subgroups defined by splitting the sample on baseline VA, with borderline significant evidence of a more pronounced effect in those women with baseline VA of 20/40 or worse (P value for interaction, 0.083).
COMMENTS: Loss of vision among elderly women increases the risk of frequent falls. Prevention or correction of visual loss may help reduce the number of future falls.
BACKGROUND: Despite generally falling mortality and suicide rates, among young men the rates of violent death from accidents and suicide continue to rise. Most research has focused upon suicide, and the potential for effective interventions, particularly in primary care, remains controversial.
OBJECTIVE: To compare health service contacts prior to suicidal and accidental deaths among young men. Design of study: Examination of inquest data, postmortem and toxicology reports, and general practitioner (GP) and hospital records.
SETTING: All sudden, unexpected, violent or unnatural deaths involving young men aged between 15 and 39 years and reported to the four coroner's offices of Merseyside and Cheshire during 1995.
METHODS: We compared data on the timing and nature of final GP contacts before death among young men with a verdict of accident or misadventure and suicide or undetermined death.
FINDINGS: Out of a total of 268 violent deaths, 130 received verdicts of accident/misadventure and 97 received verdicts of suicide/undetermined death. Information on the final contact with a GP was available for 172 deaths. Although there was a significant difference between the proportion of suicide cases (56%) and that of cases of accidental death (41%) who had seen their GP during the 3 months before death, this was not significant at 1 month (38% versus 30%, respectively). Suicide cases were more likely to have seen a mental health professional at some time (27% for suicides versus 13% for accidental deaths).
COMMENTS: These findings confirm that relatively few young men consult their GP during the period before death from suicide or accidents. Prevention strategies must extend beyond suicide risk assessment, and consider ways to encourage young men to consult GPs when they are experiencing emotional distress or problems related to mental health or substance misuse.
Suicide and attempted suicide in France: results of a general practice sentinel network, 1999-2001.
- Le Pont F, Letrilliart L, Massari V, Dorleans Y, Thomas G, Flahault A. Br J Gen Pract 2004; 54(501): 282-284.
Correspondence: Francoise Le Pont, Inserm U444, Faculte de Medecine Saint Antoine, Paris, FRANCE; (email: unavailable).
The continuous surveillance of suicide and attempted suicide cases was added to the tasks of the French Sentinel Network of General Practitioners (GPs) in 1999. In 2001, 9700 suicides were estimated to have occurred and an estimated 61 500 attempted suicide cases were diagnosed by GPs, representing approximately 40% of cases nationwide. The majority of suicide and attempted suicide cases involved women (67%) and 43% of all cases involved patients aged 25-44 years. The fatality rate increased with age. About 80% of GPs complied with the current recommendation to refer patients who had attempted suicide to hospital.
Completed suicides among Quebec adolescents involved with juvenile justice and child welfare services.
Correspondence: Lambert Farand, Department of Health Administration, Faculty of Medicine, University of Montreal, QC, CANADA; (email: lambert.farand@umontreal.ca).
In the Province of Quebec (Canada), adolescents involved with the child welfare and juvenile justice systems committed at least one third of all completed suicides in their age group in 1995 and 1996. Their risk of suicide, standardized for age and sex, was five times that of the general adolescent population, and female juvenile delinquents had the highest relative risk of suicide (36.1). Cumulated risk factors may explain those results. Since 40% of those suicides did occur when subjects were still actively involved with the child welfare and juvenile justice systems, those agencies should revise their suicide prevention strategies.
Correspondence: Bahman Sayyar Roudsari, Sina Trauma Research Center, Sina General Hospital, Tehran University of Medical Sciences, 11365 Tehran, IRAN; (email: roudsari@u.washington.edu).
Intercountry or regional differences in patterns of injury by the road user type have significant implication for prevention policies. In order to have an estimate from the existing conditions of transport-related injuries (TRIs) and especially to evaluate sex and age distribution of traffic accident victims, we analyzed information of 8426 hospitalized trauma patients during 13 months of data gathering process. Forty-five percent of the injuries were related to car accidents and men/women ratio in these patients was 4.2/1. The highest men/women ratio was (16/1) for motorcyclists, while the lowest ratio (1/1), was for rear seat car passengers. Mean (+/-S.D.) age of the patients was 31 (+/-18), and men were nearly 2 years younger than women (33 versus 31). Sixty-seven percent of the females' and 44% of the males' injuries were related to pedestrian crashes. Motorcycle-related injuries in men and car passenger related injuries in women were the second most common type of crash (42 and 22%, respectively). The use of protective devices in our population was worrisome. In only 6% of the male motorcyclists helmet use was reported, and 3% of the male car occupants had used seatbelts at the time of the accident. The condition in the female population was much worse and no use of the protective devices was reported in this group of the patients. Crude mortality rate in men was nearly two times that of women (6.2% versus 3.8%). After adjustment for age, injury severity score (ISS) and category of the road users, men and women had similar mortality rate.
Quantifying the role of risk-taking behaviour in causation of serious road crash-related injury.
Correspondence: Cathy Turner, School of Population Health, Mayne Medical School, University of Queensland, Herston Road, Herston, Queensland 4006, Brisbane, AUSTRALIA; (email: r.mcclure@sph.uq.edu.au).
This study was designed to quantify the increased risk of road crash-related injury, which can be attributed to risk-taking behaviour. A case-control study was conducted to compare motor vehicle drivers (car and bike) who had been hospitalised for injuries following crashes with population-based controls. Cases were recruited prospectively over 12 months and controls were randomly selected from license holders (car and bike) living in the same geographical location as cases. A self-administered questionnaire was used to ascertain participants' driving behaviour, general risk-taking behaviour and selected demographic characteristics. After adjusting for demographic variables, number of years of driving and total distance driven per week, logistic regression analysis showed that a high risk acceptance was associated with an eight-fold increased risk of having a crash that resulted in serious injury (OR 7.8, 95% CI 4.2-15.8). The findings of this study support the suggestion that certain host factors increase the risk of crash-related serious injury. There would appear to be a reasonable argument for persisting with injury prevention programmes, which concentrate on host as well as environment risk factor reduction.
In Australia are people born in other countries at higher risk of road trauma than locally born people?
- Dobson A, Smith N, McFadden M, Walker M, Hollingworth S. Accid Anal Prev 2004; 36(3): 375-381.
Correspondence: Annette Dobson, School of Population Health, University of Queensland, Herston, Queensland 4006, AUSTRALIA; (email: a.dobson@sph.uq.edu.au).
This study examined whether people born in other countries had higher rates of death and hospitalization due to road crashes than people born in Australia. Data on deaths that occurred in the whole of Australia between 1994 and 1997 and hospitalizations that occurred in the state of New South Wales, Australia, between 1 July 1995 and 30 June 1997 due to road crashes were analyzed. The rates of death and hospitalization, adjusted for age and area of residence, were calculated using population data from the 1996 Australian census. The study categorized people born in other countries according to the language (English speaking, non-English speaking) and the road convention (left-hand side, right-hand side) of their country of birth. Australia has the left-hand side driving convention. The study found that drivers born in other countries had rates of death or hospitalization due to road trauma equal to or below those of Australian born drivers. In contrast, pedestrians born in other countries, especially older pedestrians had higher rates of death and hospitalization due to road crashes. Pedestrians aged 60 years or more born in non-English speaking countries where traffic travels on the right-hand side of the road had risks about twice those of Australian born pedestrians in the same age group.
Psychological correlates of the impact of road traffic accidents among South African drivers and passengers.
Correspondence: Karl Peltzer, Health Behaviour Research Unit, University of the North, Private Bag X1106, Sovenga 0727, SOUTH AFRICA; (email: peltzerk@mweb.co.za).
The aim of the study was to investigate the psychosocial consequences and coping strategies among accident victims in South Africa. Participants (138 drivers and 141 passengers) who had been involved in a road traffic accident were approached and interviewed in public places. In both groups the median age group was between 25 years and 34 years. In 34 accidents (12.2%) a family member was killed, in 68 accidents (24.4%) a non-family member was killed in the accident. In 272 accidents 197 (72.4%) persons (both drivers and passengers) were injured and 168 (61.7%) were hospitalized. Eighty-seven drivers (63%) did not perceive themselves at fault and 51 (37%) did. Following the road traffic accident both drivers and passengers showed a significant decline of their well-being. Drivers who perceived themselves to be at fault did not cope better than those not perceiving themselves at fault. Passengers related to the drivers showed more decline in their well-being than those not related. Path analysis for drivers found that holding oneself responsible had a direct, and mediated by self-blame, guilt and family distress, negative effect on personal well-being. In the passengers group, holding the driver or others responsible led, mediated by increased self-blame, feelings of guilt, and family distress, to lower psychological well-being (PWB). Findings have relevant implications for the development of coping strategies to aid victims of road traffic accidents in dealing with their trauma in this African context, which may differ to those in Western societies.
See item under Distraction and Attentional Issues
See items 4 and 5 under Risk Factors, Injury Occurrence, and Costs
BACKGROUND: Domestic abuse has a detrimental impact on the mental and physical health of a woman. The abusive partner may use physical and sexual violence and 'control' the choice of contraception.
OBJECTIVE: To examine the prevalence rates of domestic abuse. DESIGN: Data collection using anonymous questionnaire.
SETTING: A family planning clinic.
PARTICIPANTS: Two hundred and ninety-two women.
MAIN OUTCOME MEASURES: The prevalence rate of past and present history of domestic abuse and the nature of the abuse.
FINDINGS: One in three women experienced domestic abuse at some time in their life. A significant relationship existed between the age of the woman and experiencing abuse within the last year. Women in full-time employment experienced the highest rates of abuse.
COMMENTS: The anonymity of the research and the method of implementation encouraged an excellent response rate. During a woman's childbearing years, one-third of women may experience domestic abuse from their partner.
Gunshot wounds: bullet caliber is increasing, 1998-2003.
- Adibe OO, Caruso RP, Swan KG. Am Surg 2004; 70(4): 322-325.
Correspondence: O.O. Adibe, Department of Surgery, University of Connecticut Health Care System, Farmington, Connecticut, USA; (email: unavailable).
In 1999, Caruso reported data from the level 1 trauma center in Newark, New Jersey, documenting "...an ominous trend toward the use of larger caliber firearms in accidents, homicides and suicides." Those data were derived from measurements of bullets removed from our trauma patients and submitted to the Surgical Pathology laboratory from 1981 through 1997. We further document this trend with measurements of similar source bullets from 1998 through 2002. During the same time, we recorded mortality among gunshot wound victims treated at our trauma center. Bullets submitted to surgical pathology during the years 1998 through 2002 were measured with a millimeter rule to determine caliber or transverse diameter. A total of 367 bullets were studied in this 5-year period. Bullets deformed beyond measurability (approximately 22%) and shotgun pellets (< 5%) were excluded from our study. Bullet calibers were expressed in terms of mean plus or minus standard error (x +/- SE). Mortality figures were derived from analysis of medical records concerning the outcomes all victims of gunshot wounds (E 922, E 965) treated at our hospital during the years studied and expressed as percentages. Linear regression of mean bullet caliber over time was performed, and analysis of variance was used to assess statistical significance of apparent differences in mortality. Bullet caliber continued to increase from 8.47 +/- 0.22 to 9.16 +/- 0.15 mm during the 5-year observation period. Linear regression reveals R = 0.9649, P < 0.01. Mortality ranged from 4.7 per cent to 10.7 per cent but the differences were not significant (P > 0.20). These data support a continued trend toward the use of larger caliber firearms in accidents, homicides, and suicides. Mortality does not change during this time and presumably because of improvements in treatment, from resuscitation to definitive surgery and its convalescence.
Physical aggression, forced sex, and stalking victimization by a dating partner: an analysis of the National Violence Against Women Survey.
This study used the National Violence Against Women Survey (NVAWS) of women and men to estimate noncohabitating dating violence prevalence by type (physical, forced sex, and stalking), associations between dating violence and other types of interpersonal violence across the lifespan, and association of dating violence with longer-term mental health including substance abuse. Among respondents aged 18 to 65, 8.3% of 6,790 women and 2.4% of 7,122 men experienced physical aggression, forced sex, or stalking victimization by a dating partner. Few (20.6% of women and 9.7% of men) reported more than one type of dating violence. Childhood physical aggression by a parent or guardian was strongly associated with subsequent dating violence risk for men and women. Dating violence (physical aggression specifically) was associated with current depressive symptoms, current therapeutic drug use (antidepressants, tranquilizers, or pain medications), and current recreation drug use for women. Implications for parents, survivors, health care, and service providers are discussed.
An analysis of the self-control and criminal versatility of gang and dating violence offenders.
How versatile are gang and dating violence offenders? Current gang research highlights the versatility of gang members, yet the versatility of intimate violence offenders is often unexamined. Gottfredson and Hirschi, A General Theory of Crime (1990), support the idea of versatile rather than specialized offenders and suggests that low self-control is associated with a host of criminal and noncriminal risk-taking activities. Using data from a self-report sample of 1139 youths in grades 9 through 11, we investigated both the versatility of gang and dating violence offenders and theoretical variables associated with each. We find disproportionate offending by dating and gang violence offenders in a variety of crimes, as well as considerable overlap in the independent variables associated with both types of violence. Low levels of self-control and exposure to general and crime-specific criminal opportunities are significantly associated with engaging in dating and gang violence.
Adolescents and firearms: a California statewide survey.
OBJECTIVE: We assessed the prevalence and correlates of adolescents� reports regarding firearms in their homes, of their own, of close friends, and of same-aged peers.
METHODS: Random-digit-dialed interviews were conducted with 5801 adolescents as part of the California Health Interview Survey.
FINDINGS: One fifth (19.6%) of California adolescents reported having a firearm in their homes; few (3.0%) reported having their own gun. Characteristics associated with having one�s own gun and with perceptions regarding others� guns generally were consistent with characteristics associated with having a firearm in the home. The 2 exceptions were related to socioeconomic status and to ethnicity.
COMMENTS: The source from which adolescents obtain guns, especially adolescents from less wealthy households, merits further investigation. Further research is needed to ascertain the accuracy of Black and Latino adolescents� perceptions regarding handguns among their peers.
