The contribution of alcohol to serious car crash injuries.
- Connor J, Norton R, Ameratunga S, Jackson R. Epidemiology 2004; 15(3): 337-344.
Correspondence: Jennie Connor, Section of Epidemiology and Biostatistics, School of Population Health, University of Auckland, NEW ZEALAND; (email: j.connor@auckland.ac.nz).
BACKGROUND: Alcohol impairment of drivers is considered the most important contributing cause of car crash injuries. The burden of injury attributable to drinking drivers has been estimated only indirectly.
METHODS: We conducted a population-based case-control study in Auckland, New Zealand between April 1998 and July 1999. Cases were 571 car drivers involved in crashes in which at least 1 occupant was admitted to the hospital or killed. Control subjects were 588 car drivers recruited on public roads, representative of driving in the region during the study period. Participants completed a structured interview and had blood or breath alcohol measurements.
FINDINGS: Drinking alcohol before driving was strongly associated with injury crashes after controlling for known confounders. This was true for several measures of alcohol consumption: for self-report of 2 or more 12-g alcoholic drinks in the preceding 6 hours compared with none, the odds ratio (OR) was 7.9 (95% confidence interval = 3.4-18); for blood alcohol concentration 3 to 50 mg/100 mL compared with <3 mg/100 mL, the OR was 3.2 (1.1-10); and for blood alcohol concentration greater than 50 mg/100 mL compared with <3 mg/100 mL, the OR was 23 (9-56). Approximately 30% of car crash injuries in this population were attributable to alcohol, with two-thirds involving drivers with blood alcohol concentration in excess of 150 mg/100 mL. Equal proportions of alcohol-related injury crashes were attributable to drivers with blood alcohol concentrations of 3 to 50 mg/100 mL as those with levels of 51 to 150 mg/100 mL.
COMMENTS: Evidence about the proportion of crashes attributable to drivers at different blood alcohol concentrations can inform the prioritization of interventions that target different groups of drivers. These data indicate where there is the most potential for reduction of the injury burden.
Correlates and predictors of violent behavior among adolescent drinkers.
Correspondence: Monica H. Swahn, Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA; (email: mswahn@cdc.gov).
OBJECTIVE: To examine a wide range of demographic characteristics and psychosocial factors to determine the cross-sectional correlates of violence and longitudinal predictors of violent initiation among adolescent drinkers.
METHODS: We conducted secondary analyses of the 1995 (Time 1) and 1996 (Time 2) in-home surveys of the National Longitudinal Study of Adolescent Health (Add Health). This study included a nationally representative school-based sample (N=18,924) of adolescents in grades 7-12. The analyses were restricted to adolescent drinkers (n = 8885). Two logistic regression models were constructed using a backward elimination procedure to identify statistically significant cross-sectional correlates of violence and prospective predictors of violence initiation.
FINDINGS: Half (49%) of all adolescent drinkers reported violent behavior at Time 1 and 15% of those who were not violent at Time 1 reported initiating violent behavior at Time 2. A total of 14 significant cross-sectional correlates of violence were identified that included measures of alcohol use, drug use and selling, exposure to drugs, delinquency, and poor school functioning. Four variables (high-volume drinking, illicit drug use, low grade point average, and having been suspended and/or expelled from school) were significant longitudinal predictors of the initiation of violent behavior.
COMMENTS: The factors significantly associated with violence pertain mostly to alcohol use, drug use and selling, exposure to drugs, delinquency, and poor school functioning. However, most of these problems and behaviors tend to occur in closer temporal proximity to violent behavior (i.e., within a year) and do not seem to developmentally precede initiation in violent behavior.
Substance misuse and violent crime: Swedish population study.
- Grann M, Fazel S. BMJ 2004; 328(7450): 1233-1234.
Correspondence: Martin Grann, Centre for Violence Prevention, Karolinska Institute, PO Box 23000, SE-104 35 Stockholm, SWEDEN; (email: martin.grann@cvp.se).
CONTEXT: Many studies have reported strong associations between substance misuse and violent crime. But the population impact of people diagnosed with substance use disorders on such crime is not known. Calculating the population impact and the relative importance of different classes of drugs is necessary to estimate the likely public health effect of any developments in services and treatment interventions in preventing violent crime.
OBJECTIVE: To investigate the overall impact of substance misuse on violent crime, we estimated the population attributable risk using data from high quality national psychiatric and crime registers in Sweden from 1988 to 2000.
METHODS: Swedish citizens have a unique identification number that can be used to link data across health and crime registers. The hospital discharge register contains diagnoses of all individuals who are admitted to any general, psychiatric, or secure hospital for assessment or treatment. All patients are given a clinical diagnosis on discharge according to ICD-9 (until 1996) and ICD-10 (from 1997) (international classification of diseases, 9th and 10th revisions). This register is valid and reliable for psychiatric diagnoses.
The national crime register includes conviction data for people aged 15 (the age of criminal responsibility) and older. We extracted information on all individuals who had committed violent crimes�homicide, aggravated assault, common assault, robbery, threatening behaviour and harassment, arson, and any sexual offence. We included every violent crime committed by each convicted individual. Conviction data included those whose court ruling involved a mental health disposal; a non-custodial sentence, caution, or fine; a finding of legal insanity.
We identified individuals from the hospital discharge register with any principal or secondary diagnosis of alcohol misuse and alcohol induced psychoses (codes 291, 303, and F10), drug misuse and drug induced psychoses (292, 304, and F11-19) from 1 January 1988 to 31 December 2000 and linked them to the crime register. We calculated the population attributable risk (PAR; the absolute difference in the rate of violent crimes per 1000 inhabitants in the whole population and the rate in individuals that had not been patients with substance misuse), and the population attributable risk fraction (PAF; the proportion of violent crimes in the whole population that may be attributed to patients with substance misuse) with standard methods assuming Sweden's average population over age 15 during 1988-2000 was 6 724 503.
FINDINGS: During 1988-2000, 127 789 individuals (1.9% of the population) were discharged from hospital with diagnoses of substance misuse (mean age at first admission 49.1 (standard deviation 16.4) years; 28.4% female) and committed 80 215 violent crimes. The individual population attributable risk fractions for alcohol and substance misuse were 16.1% and 11.6%. The overall population attributable risk fraction for substance misuse was not calculated by adding these individuals' population attributable risk fractions, as some were admitted on repeated occasions, and a particular individual may have been diagnosed with alcohol or drug misuse on separate hospitalisations. The overall population attributable risk fraction for patients discharged with a principal diagnosis of substance misuse was 23.3%. We redid the analyses including secondary diagnoses of alcohol and drug misuse, which increased the population attributable risk fraction slightly to 24.7%.
COMMENTS: We found that 16% of all violent crimes in Sweden during 1988-2000 were committed by people who had hospital discharge diagnoses of alcohol misuse, and more than a tenth of all violent crimes were committed by patients diagnosed as having misused drugs. Treatment services aimed at alcohol and drug misusers can potentially reduce violent offending.
The approach of population attributable risk is one way of exploring the relationship between substance misuse and violent crime. It assumes a causal relationship between the two and so estimates the maximum possible impact that any intervention might have. However, the co-occurrence of substance misuse and violent crime does not necessarily imply a simple causal relationship.
Integrating mental health and substance misuse services leads to improved outcomes. This integration should be extended to the criminal justice system. The costs to the criminal justice system of drug related crime are enormous�for example, in the United Kingdom, a conservative estimate is �1bn ($1.8bn; €1.5bn) annually. Interventions to reduce the risk of violence in patients who misuse alcohol and drugs could be highly cost effective.
Each year in countries like India, thousands of young women are burned to death or afflicted with fatal burns. They are victims of dowry deaths. The husband and/or in-laws have determined that the dowry, a gift given from the daughter's parents to the husband, was inadequate and therefore attempt to murder the new bride to make the husband available to remarry or to punish the bride and her family. Unfortunately, this is a domestic issue that is often ignored or minimized, and the prosecution is often inadequate. This review article illustrates various scenarios of dowry deaths, investigates different predispositions, summarizes the current legislation, and proposes solutions to this problem. One hopes that the exposure of this problem may curtail its rampant, yet well-hidden, prevalence.
The purpose of this research was to examine the effect of a multifactorial intervention to prevent falls by increasing self-efficacy to prevent falls, improving the knowledge of medication safety, and decreasing the number of environmental risks in older persons dwelling in the community. A sample of 120 cognitively intact residents of this community who were 65 years of age and older were recruited into a two-group pretest-post-test experimental design and randomly assigned to an experimental group and a comparison group (60 in each group). The intervention was delivered, and data were collected during three home visits in a 4-month period. (1) Experimental subjects improved their fall self-efficacy, environmental safety, and knowledge of medication safety significantly (p < 0.01) as compared with those in the comparison group at post-test; (2) the incidence of falls was reduced at post-test in both groups compared to pretest scores, and the falling was more serious in the comparison group at post-test compared to that in the experimental group. The results can help community health professionals to individualize their interventions to the specific needs of the elderly, thus helping to prevent falls among community-dwelling elders.
In this qualitative study the author examines the informationseeking behavior of older adults and asks whether the information sources used by participants vary with the role they are performing; whether 'young' seniors just entering retirement seek information differently than the 'oldest' old; and whether seniors living independently seek information differently than those who live in an institutional setting. The twenty-nine participants interviewed indicated that interpersonal sources together with internally-produced print materials were relied on for the information needed for participation in community clubs and organizations; interpersonal sources to find answers to medical and financial questions; and printed resources for hobby-related information seeking. Findings related to computer use indicated that it is important when discussing older adults to distinguish between different stages of older age.
Neighborhood games as a community-building strategy.
Correspondence: Bill Berkowitz , Department of Psychology, University of Massachusetts Lowell, 870 Broadway Street, Suite 1, Lowell, MA 01854, USA; (email: bill_berkowitz@uml.edu).
This paper discusses the use of neighborhood games and contests as an alternative approach to community building, and as a complement to traditional issue or interest organizing. It places these activities within the broader contexts of celebration and festivity, noting the relative lack of such events within modern American secular culture. The planning, implementation, and results of two neighborhood-wide games and contests are then described, as carried out in a representative suburban neighborhood. Though full and accurate evaluation is challenging, the community-building promise of these activities is documented. The prospects for future development and use of similar community events are then considered.
Community readiness: a promising tool for domestic violence prevention programs in the Korean community.
Correspondence: Meekyung Han, School of Social Welfare, University of California Berkeley, 120 Haviland Hall #7400, Berkeley, CA 94720-7400, USA; (email: mkhan30@uclink.berkeley.edu).
This paper explores domestic violence in the Korean community and the importance of community readiness for a promising implementation of prevention programs. Community readiness is the extent to which a community is adequately prepared to implement a domestic violence program. A prevention program should address not only the scope of domestic violence itself but also the relevant cultural aspects of the population segments being targeted for the prevention efforts. In order to make a domestic violence prevention program work, practitioners have to acknowledge that the community must have the support and commitment of its members along with resources to implement an effective prevention effort.
A terrorism movement has been active in Spain during the last 20 years, with a painful number of victims. Civil Defense is in charge of the coordination of all the structures that are implicated in a terrorist incident. There are three typical patterns of attacks: (1) individual attacks; (2) group attacks; and (3) mass attacks. The individual attacks are done with guns, usually 9 mm, fired from a short distance; victims die from serious intracranial damage. Collective attacks are done using explosives under vehicles, tramp bombs, or "bomb vehicles;" victims are of different severity with wounds, burns, and blast injuries. With mass attacks with "bomb vehicles" in buildings or crowded public places, the numbers of victims are elevated and produce brutal social consequences. Emergency Medical Services integrated in to "Civil Defense" try to minimize the damage by initializing treatment on-scene and with the rapid provision of definitive care. During the last year, post-traumatic stress disorder treatment groups have been providing care to the victims and personnel. Chemical or biological weapons have not been used, although this is a great concern to the authorities.
Chemical terrorism is a new threat to the security of mankind, which scale essentially exceeds the impact of use of the most modem firearms. At present time all over the world threats from different radical elements to use radioactive materials, potent poisonous substances and pathogenic microorganisms for terrorist purposes became more frequent. High-toxic chemical substances can fall in terrorist hands through wide range of sources. Potentially misused types of chemical compounds are discussed in this article.
Excessive daytime sleepiness (EDS) is a common but underrecognized and preventable cause of traffic accidents. It creates a problem of particular importance for professional drivers. We performed the Epworth Sleepiness Scale (ESS) and questionnaire related to their history of traffic accidents to 118 professional taxi drivers to determine the EDS and its effects on driving performance in taxi drivers. There were 58 (49.2%) subjects with loud snoring, 8 (5.9%) subjects with cardinal symptoms due to obstructive sleep apnea syndrome (OSAS) and 28 (23.7%) subjects with ESS ? 10 in the group of taxi drivers. Eighty (67.8%) drivers had been involved in a traffic accident. We found a significant relation between the number of traffic accident and EDS, witnessed apnea, cardinal symptom related to OSAS but not with snoring. The present data that sleepiness is a common symptom in taxi drivers and may be related to traffic accident.
OBJECTIVE: To determine the effects of aging on balance control during walking.
DESIGN: Two-group repeated-measures design. SETTING: Gait laboratory in Australia.
PARTICIPANTS: Convenience sample of 20 healthy older subjects (mean age, 72y) and 20 healthy young subjects (mean age, 24y).
INTERVENTIONS: Changes in locomotor performance in response to perturbations to balance were quantified for healthy older adults compared with healthy young adults for (1) straight line walking at preferred speed, (2) straight line walking at fast speed, (3) figure-of-eight walking at preferred speed, and (4) figure-of-eight walking while performing a secondary motor task.
MAIN OUTCOME MEASURES: Gait speed, stride length, cadence, and double-limb support duration, using a footswitch system.
FINDINGS: Healthy older people screened for pathology had gait patterns comparable to young adults for straight line walking at preferred speed. However, multivariate analysis of variance (MANOVA) showed a significant interaction between age and speed when balance was perturbed by requiring subjects to change from walking at preferred to fast speeds (Pillai-Bartlett trace=.259, F(4,35)=3.06, P<.029, partial eta(2)=.259). This occurred because older people did not increase their speed (F(1,38)=7.65, P<.01, partial eta(2)=.168) or stride length (F(1,38)=12.23, P<.01, partial eta(2)=.243) as much as did the young adults. MANOVAs did not show statistically significant interactions between age and turning conditions or age and dual task conditions, although older people walked more slowly and with shorter steps when turning or performing a secondary task.
COMMENTS: Balance strategies during gait are task specific and vary according to age. In response to challenges to balance imposed by the requirement to change from preferred to fast walking, older people did not increase their speed and stride length to the same extent as did younger adults. This was possibly a strategy to maintain their stability.
OBJECTIVE: To identify determinants of mothers' home-safety practices for preventing six types of common injuries to children (burns, poisoning, drowning, cuts, strangulation/suffocation/choking, and falls).
METHODS: Home interviews were conducted with mothers of children 19-24 and 25-30 months old about home-safety practices. For each of 30 safety precautions to prevent these six types of injuries, mothers indicated whether or not they engaged in the practice, and explained why.
FINDINGS: Regression analyses revealed both common and unique determinants of mothers' home-safety practices to prevent these six types of home injuries. For burns, cuts, and falls, beliefs that child characteristics and parent characteristics elevated the child's risk of injury were the key determinants of the mother's engaging in precautionary measures. For drowning, poisoning, and suffocation/strangulation/choking, health beliefs also contributed to predict mothers' practices, including beliefs about potential injury severity and extent of effort required to implement precautionary measures.
COMMENTS: The factors that motivated mothers to engage in precautionary measures at home varied depending on the type of injury. Intervention programs to enhance maternal home-safety practices will need to target different factors depending on the type of injury to be addressed.
Using behavioral science to improve fire escape behaviors in response to a smoke alarm.
- Thompson NJ, Waterman MB, Sleet DA. J Burn Care Rehabil 2004; 25(2): 179-188.
Correspondence: Nancy J. Thompson, Division of Behavioral Science and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA; (email: nthomps@sph.emory.edu).
Although the likelihood of fire-related death in homes with smoke alarms is about one-half that in homes without alarms, alarm effectiveness is limited by behavior. Only 16% of residents of homes with alarms have developed and practiced plans for escape when the alarm sounds. We reviewed literature to identify behavioral constructs that influence smoke alarm use. We then convened experts in the behavioral aspects of smoke alarms who reviewed the constructs and determined that the appropriate areas for behavioral focus were formulating, practicing, and implementing escape plans should an alarm sound. They subsequently identified important behaviors to be addressed by burn-prevention programs and incorporated the constructs into a behavioral model for use in such programs. Finally, we organized the available literature to support this model and make programmatic recommendations. Many gaps remain in behavioral research to improve fire escape planning and practice. Future research must select the target behavior, apply behavioral theories, and distinguish between initiation and maintenance of behaviors associated with planning, practicing, and implementing home fire escape plans.
Understanding work-related injuries in children: A perspective in West Virginia using the state-managed workers' compensation system.
- Ehrlich Pf P, McClellan Wt W, Hemkamp Jc J, Islam Ss S, Ducatman Am A. J Pediatr Surg 2004; 39(5): 768-772.
Correspondence: P.F. Ehrlich, Section of Pediatric Surgery, University of Michigan, CS Mott Children's Hospital F3970, 1500 E Medical Center Dr, PO Box 0245, Ann Arbor, MI, USA; (email: unavailable).
BACKGROUND: Little data exist that defines the consequences of occupational injuries in children. Traditional assessment of work-related injury is coupled with disability payments based on salary, which give little insight into etiology and severity. The authors hypothesize that the risk and pattern of occupational injuries in young workers are different then adults.
METHODS: Claims from 1996 through 2000 were analyzed from the West Virginia Bureau of Workers Compensation. To define the significance of an injury, child and adult groups were subdivided into injuries that required surgery (ie, serious injuries). Current Procedural Terminology (CPT) codes for anesthesia and surgical procedures were cross referenced with the claims to ensure group designation. Relative risks (RR) were used to compare groups.
FINDINGS: Between 1996 and 2000, 364,063 claims were submitted, 14,093 in workers </=19 years of age. Two hundred seventy claims in children required surgery. Serious injuries in children occur more often in boys 2.2x mainly in the (16 to 24 hours) evening (48% v 23.13%; P <.05) and in July/August (26.5 v 18.4; P <.001). Falls were the main mechanism of injury. Proportionately fingers (1.70x) and hands (1.64x, 1.6 to 1.7) were injured in children. Lacerations (3.4x), fractures (1.4x), and amputations (3.75x) frequently resulted in general anesthetic procedures, and the RR of these injuries were increased versus adults. Service, manufacturing, construction, and agriculture were the main injury-related occupations in children.
COMMENTS: For any job category, injuries in children have unique features, tend to be more serious, and require a surgical intervention proportionately more frequently than adults.
An epidemiological study of the magnitude and consequences of work related violence: the Minnesota Nurses' Study.
- Gerberich SG, Church TR, McGovern PM, Hansen HE, Nachreiner NM, Geisser MS, Ryan AD, Mongin SJ, Watt GD. Occup Environ Med 2004; 61(6): 495-503.
Correspondence: S G Gerberich, Regional Injury Prevention Research Center and Center for Violence Prevention and Control, Division of Environmental and Occupational Health, School of Public Health, University of Minnesota, Mayo Mail Code 807, 420 Delaware Street SE, Minneapolis, MN 55455, USA;(email: gerbe001@umn.edu).
OBJECTIVE: To identify the magnitude of and potential risk factors for violence within a major occupational population.
METHODS: Comprehensive surveys were sent to 6300 Minnesota licensed registered (RNs) and practical (LPNs) nurses to collect data on physical and non-physical violence for the prior 12 months. Re-weighting enabled adjustment for potential biases associated with non-response, accounting for unknown eligibility.
FINDINGS: From the 78% responding, combined with non-response rate information, respective adjusted rates per 100 persons per year (95% CI) for physical and non-physical violence were 13.2 (12.2 to 14.3) and 38.8 (37.4 to 40.4); assault rates were increased, respectively, for LPNs versus RNs (16.4 and 12.0) and males versus females (19.4 and 12.9). Perpetrators of physical and non-physical events were patients/clients (97% and 67%, respectively). Consequences appeared greater for non-physical than physical violence. Multivariate modelling identified increased rates for both physical and non-physical violence for working: in a nursing home/long term care facility; in intensive care, psychiatric/behavioural or emergency departments; and with geriatric patients.
COMMENTS: Results show that non-fatal physical assault and non-physical forms of violence, and relevant consequences, are frequent among both RNs and LPNs; such violence is mostly perpetrated by patients or clients; and certain environmental factors appear to affect the risk of violence. This serves as the basis for further analytical studies that can enable the development of appropriate prevention and control efforts.
Correspondence: Per E. Garder, Department of Civil and Environmental Engineering, University of Maine, Boardman Hall, Orono, ME 04469-5711, USA; (email: garder@maine.edu).
The aim of this paper is to analyze pedestrian crashes with an emphasis on how actual travel speeds and characteristics of the locations influence crash numbers. Statewide data from Maine was analyzed. Descriptive crash and behavioral statistics are presented in the paper. Pedestrian and vehicle volumes were gathered for 122 locations in varying environments throughout Maine and crash numbers were predicted and compared to outcomes. Prediction models from Sweden and the UK were used since US models are nonexistant. It was found that high speeds and wide roads lead to more crashes and that the focus of safety improvement should be on arterials and major collectors. A strong relationship was also found between crash severity and speed.
Prevention of head injuries in children bicyclists: a proposal.
- Alleman A, Akande A, Bukacek M, Geib J, Simonson-Younger J. J Okla State Med Assoc 2004; 97(4): 160-162.
Correspondence: A. Alleman, Department of Radiology, University of Oklahoma Health Sciences Center, PO Box 26901, Oklahoma City, OK 73190, USA; (email: unavailable).
Bicycle-related head injury is a significant source of morbidity in children. Upon review of contemporary approaches for reducing such injuries, summarized herein, the authors conclude that a school-based promotion of proper helmet usage represents a reasonable compromise between expediency and probability of success. This proposal contains an outline for a pilot program to be implemented in an elementary school setting. It is postulated that a large-scale implementation of this program in combination with other discussed interventions will achieve the long-term goal of reducing bicycle-related pediatric head injuries.
Correspondence: Alan Woolf, Children's Hospital, Harvard Medical School, 1295 Boylston Street, Suite 100, Boston, MA 02115, USA; (email: alan.woolf@tch.harvard.edu).
Poisonings and toxic exposures worldwide account for tremendous suffering and unnecessary deaths. Poison control centers are well positioned to provide specialized services to both the public and health professionals alike so as to ease this public health burden. Future challenges for poison control centers include: the mobilization of adequate financial and infrastructural resources to initiate, stabilize and/or expand their services, provision of training for the next cadre of toxicologists; pursuit of needed research in toxicology; and the collection, analysis, and harmonization of data pertaining to their population.
Poison control services in China.
- Wu YQ, Sun CY. Toxicology 2004; 198(1-3): 279-284.
Correspondence: Yi-Qun Wu, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Beijing 100050, PR CHINA; (email: wuyq@public3.btu.net.cn).
The following aspects are discussed: the public health problems of acute poisoning in China in recent years; the characteristics of acute poisoning; the negative effects of poison cases on the society and economy. The four stages of development of a poison control system in China are: (1) clinical hospital as the only facility used for detoxification; (2) institutes and hospitals of occupational medicine got involved in the program; (3) the traditional model of poison control changed to the modern National Poison Control Center (NPCC), and its network got established and it began to play a key role; (4) establishment of a multi-disciplinary network for dealing with emergencies in which chemical poison control is an important component. Introduction of the operations of the NPCC: the functions of the center are a 24h hotline service, clinical consultants service, poison identification and diagnosis, laboratory analysis, education for public, training for physicians, coordination of anti-dotes, and the development of a network of poison control centers for dealing with chemical emergencies. The work practice and achievement of NPCC and its network in the field of poison control during the last 3 years is discussed. Lessons from SARS infection: to extend the network, to strengthen multi-disciplinary cooperation, enhance communication between centers, to pay attention to capacity building, to improve reporting systems, and to share resources.
Serious injuries resulting in paralysis or death have been shown to occur to hunters who have sustained falls from tree stands. A total of sixteen spinal cord injuries or deaths among Oklahoma hunters falling from tree stands were reported between 1987 and 1999. The mean height of the falls was 16.4 feet. Three (18.8%) of the cases were related to substance use. None of the patients were using a safety restraint. Nearly 90% of the injuries resulted in paraplegia/paresis; two (12.5%) of the injuries resulted in death. Forty-four percent of the spinal injuries occurred at the thoraco-lumbor junction (T12 or L1). Burst fractures were the most common fracture pattern. Hospitalizations averaged 19.6 days (range 3 to 73 days) and eight (50%) were discharged to inpatient rehabilitation facilities. Falls from tree stands can result in serious injuries or death. Hunter education and the use of safety harnesses for prevention of injuries related to tree stands are paramount.
The mosaic of equestrian-related injuries in Greece.
- Petridou E, Kedikoglou S, Belechri M, Ntouvelis E, Dessypris N, Trichopoulos D. J Trauma 2004; 56(3): 643-647.
Correspondence: Eleni Petridou, Department of Hygiene and Epidemiology, Athens University Medical School, 75 Mikras Asias, Goudi, Athens 115-27, GREECE; (email: epetrid@med.uoa.gr).
BACKGROUND: This study aims to estimate the burden and describe the profile of equestrian injuries in Greece, where horses, donkeys, and mules are still used in agriculture and where horse riding is a popular leisure activity.
METHODS: Prospectively collected information on 140,823 injuries reported in the national Emergency Department Injury Surveillance System was examined and 244 equestrian-related injuries that occurred during farming, equestrian sports, or horse racing were analyzed.
FINDINGS: The estimated countrywide injury incidence for farming and equestrian sports combined was 21 per 100,000 person-years, but it was 160 times higher for horse-racing personnel. Men had higher rates of racing injuries and women had higher rates of equestrian sport injuries. Fractures accounted for 39.0% of injuries in horse racing and 30.5% in farming; head injuries accounted for approximately 50% of injuries among farmers. Farming injuries were more serious, with 25% requiring hospitalization. Analysis through the Barell matrix pointed to the role of spurs in the causation of ankle fractures and dislocations and the likely contribution of helmets in preventing traumatic brain injuries.
COMMENTS: Equestrian-related injuries are a serious but underappreciated health problem and merit targeted prevention efforts for each category affected.
A Prospective study of kitesurfing injuries.
- Nickel C, Zernial O, Musahl V, Hansen U, Zantop T, Petersen W. Am J Sports Med 2004; 32(4): 921-927.
Correspondence: Wolf Petersen, Department of Trauma, Hand, and Reconstructive Surgery, University Hospital Muenster, Muenster, GERMANY; (email: Wolf.Petersen@ukmuenster.de).
BACKGROUND: To date, the pattern and rate of kitesurfing injuries are largely unclear.
HYPOTHESIS: The pattern and rate of kitesurfing injuries are comparable to that of contact sports such as football and soccer.
STUDY DESIGN: Prospective study.
METHODS: The study was conducted over a 6-month period of 1 season and included 235 kitesurfers.
FINDINGS: The number of self-reported injuries was 124, for an overall self-reported injury rate of 7 per 1000 hours of practice. One fatal accident (polytrauma) and 11 severe injuries occurred during the study period (2 knee ligament injuries and 9 fractures at various sites). The most commonly injured sites were the foot and ankle (28%), skull (14%), chest (13%), and knee (13%). Fifty-six percent of the injuries were attributed to the inability to detach the kite from the harness in a situation involving loss of control over the kite. There was a tendency for athletes using a quick-release system to sustain fewer injuries than athletes without such a release system.
COMMENTS: Kitesurfing can be considered a high-risk sport. Clinical Relevance: The use of a quick-release system that enables the surfers to detach the kite in case of an accident might aid in the prevention of injuries.
An understanding of the complex nature of addiction and the multidisciplinary, multi-modal approaches to treatment are essential in searching for science-based literature and other resources. The process of evidence-based decision making is described, including the use of the Cochrane Database to locate systematic reviews, primarily for medical therapies. Pointers for comprehensive searching for evidence-based literature supporting addiction treatments are provided. Practice guidelines are described, along with key sources and samples for both medical and behavioral therapies. Limitations to preparing evidence-based guidelines are discussed, the main one being the lack of standard conditions among treatment trials. Finally, the concept of best practices is described and the types of documents relating to the process, many of which are limited to grey literature, are discussed.
Improving the TRISS methodology by restructuring age categories and adding comorbidities.
- Bergeron E, Rossignol M, Osler T, Clas D, Lavoie A. J Trauma 2004; 56(4):760-767.
Correspondence: Eric Bergeron, Charles-LeMoyne Hospital, Dept. of Traumatology, 3120 Blvd. Taschereau, Greenfield Park (Quebec) CANADA J4V 2H1; (email: eric.bergeron@traumaquebec.org).
CONTEXT: The Trauma and Injury Severity Score (TRISS) methodology was developed to predict the probability of survival after trauma. Despite many criticisms, this methodology remains in common use.
OBJECTIVE:The purpose of this study was to show that improving the stratification for age and adding an adjustment for comorbidity significantly increases the predictive accuracy of the TRISS model.
METHODS: The trauma registry and the hospital administrative database of a regional trauma center were used to identify all blunt trauma patients older than 14 years of age admitted with International Classification of Diseases, Ninth Revision codes 800 to 959 from April 1993 to March 2001. Each individual medical record was then reviewed to ascertain the Revised Trauma Score, the Injury Severity Score, the age of the patients, and the presence of eight comorbidities. The outcome variable was the status at discharge: alive or dead. The study population was divided into two subsamples of equal size using a random sampling method. Logistic regression was used to develop models on the first subsample; a second sub-sample was used for cross-validation of the models. The original TRISS and three TRISS-derived models were created using different categorizations of Revised Trauma Score, Injury Severity Score, and age. A new model labeled TRISSCOM was created that included an additional term for the presence of comorbidity.
FINDINGS: There were 5,672 blunt trauma patients, 2,836 in each group. For original TRISS, the Hosmer-Lemeshow statistic (HL) was 179.1 and the area under the receiver operating characteristic (AUROC) curve was 0.873. Sensitivity and specificity were 99.0% and 27.8%, respectively. For the best modified TRISS model, the HL statistic was 20.35, the AUROC curve was 0.902, the sensitivity was 99.0%, and the specificity was 27.8%. For TRISSCOM, the HL statistic was 14.95 and the AUROC curve was 0.918. Sensitivity and specificity were 99.0% and 29.7%, respectively. The difference between the two models almost reached statistical significance (p = 0.086). When TRISSCOM was applied to the cross-validation group, the HL statistic was 10.48 and the AUROC curve was 0.914. The sensitivity was 98.6% and the specificity was 34.9%.
COMMENTS: TRISSCOM can predict survival more accurately than models that do not include comorbidity. A better categorization of age and the inclusion of co-morbid conditions in the logistic model significantly improves the predictive performance of TRISS.
Mortality trends from burn injuries in Chile: 1954-1999.
- Danilla Enei S, Pasten Rojas J, Fasce Pineda G, Diaz Tapia V, Iruretagoyena Bruce M. Burns 2004; 30(4): 348-356.
Correspondence: S. Danilla Enei, Clinical Epidemiology Center (INCLEN), Hospital J. J. Aguirre, Universidad de Chile, Santiago, CHILE; (email: drstefandanilla@yahoo.com).
OBJECTIVE: To study mortality trends due to burns in Chile.
METHODS: Correlation, and descriptive study. Death reports from the Annals of Demography from 1954 to 1999, were analyzed and standardized rates of mortality by etiology, age and sex were calculated using regression models (Prais-Winsten) for each of them. Spearman's Rho test was used to show correlations (STATA 7.0((R))).
FINDINGS: Linear reduction in burns rate (7.03-0.53) was found mainly because of a reduction in the pediatric group (15.3-2.4). The rate in the elder group showed a significant increase (4.28-11.03). The mortality rate due to chemical burns remained stable (1.4/1,000,000) and electrical burns showed an important increase since the 1990s (0.4-5.0/1,000,000).
COMMENTS: The decrease of the mortality rates due to burns, is mainly due to a large decrease in the pediatric group rates. Rates remained relatively stable for adults and increased in elders. The findings set a challenge to improve prevention campaigns and professional assessment and management in adults and elders.
Childhood unintentional injuries: factors predicting injury risk among preschoolers.
- Dal Santo JA, Goodman RM, Glik D, Jackson K. J Pediatr Psychol 2004; 29(4): 273-283.
Correspondence: Janet Abboud Dal Santo, Injury Prevention Research Center, University of North Carolina at Chapel Hill, CB #7505, Chapel Hill, North Carolina, 27599-7505, USA; (email: Dalsanto@nc.rr.com).
OBJECTIVE: To examine the relationships between maternal perceptions of risk, stress, social support, safety-proofing behaviors, supervision practices and unintentional injuries to children under 5 years old.
METHODS: Household interviews were conducted with 159 mothers who had a preschool-age child. The secondary data were part of a population-based study that collected self-report data and home observational data. Diaries were used for collecting prospective injury data.
FINDINGS: White children whose mothers were unemployed and whose homes needed repair were reported to be at higher injury risk than other children. Predicting a higher injury risk were children's behavioral characteristics as well as their being older than 2.5 years. Maternal social support, stress, and coping variables were not related to injury risk. Maternal perceptions of risk variables interacted with maternal safety behavior variables when predicting injury risk.
COMMENTS: Childhood injuries are predicted by a set of interrelated sociodemographic, cognitive, behavioral, and child-related factors.
- Grunbaum JA, Kann L, Kinchen S, Ross J, Hawkins J, Lowry R, Harris WA, McManus T, Chyen D, Collins J. MMWR Surveill Summ 2004; 53(2): 1-96.
Correspondence: Jo Anne Grunbaum, Division of Adolescent and School Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, USA; (email: joanne.grunbaum@cdc.hhs.gov).
BACKGROUND: Priority health-risk behaviors, which contribute to the leading causes of morbidity and mortality among youth and adults, often are established during youth, extend into adulthood, are interrelated, and are preventable.
REPORTING PERIOD: This report covers data collected during February-December 2003.
DESCRIPTION OF SYSTEM: The Youth Risk Behavior Surveillance System (YRBSS) monitors six categories of priority health-risk behaviors among youth and young adults--behaviors that contribute to unintentional injuries and violence; tobacco use; alcohol and other drug use; sexual behaviors that contribute to unintended pregnancy and sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV) infection; unhealthy dietary behaviors; and physical inactivity--plus overweight. YRBSS includes a national school-based survey conducted by CDC as well as state and local school-based surveys conducted by education and health agencies. This report summarizes results from the national survey, 32 state surveys, and 18 local surveys conducted among students in grades 9-12 during February-December 2003.
FINDINGS AND COMMENTS: In the United States, 70.8% of all deaths among persons aged 10-24 years result from only four causes: motor-vehicle crashes, other unintentional injuries, homicide, and suicide. Results from the 2003 national Youth Risk Behavior Survey demonstrated that, during the 30 days preceding the survey, numerous high school students engage in behaviors that increase their likelihood of death from these four causes: 30.2% had ridden with a driver who had been drinking alcohol; 17.1% had carried a weapon; 44.9% had drunk alcohol; and 22.4% had used marijuana. In addition, during the 12 months preceding the survey, 33.0% of high school students had been in a physical fight, and 8.5% had attempted suicide. Substantial morbidity and social problems among young persons also result from unintended pregnancies and STDs, including HIV infection. In 2003, 46.7% of high school students had ever had sexual intercourse; 37% of sexually active students had not used a condom at last sexual intercourse; and 3.2% had ever injected an illegal drug. Among adults aged > or =25 years, 62.9% of all deaths results from two causes: cardiovascular diseases and cancer. Results from the 2003 national Youth Risk Behavior Survey demonstrate that the majority of risk behaviors associated with these two causes of death are initiated during adolescence. In 2003, a total of 21.9% of high school students had smoked cigarettes during the 30 days preceding the survey; 78% had not eaten > or =5 servings/day of fruits and vegetables during the 7 days preceding the survey; 33.4% had participated in an insufficient amount of physical activity; and 13.5% were overweight.
ACTIONS TAKEN: YRBSS data are being used to measure progress toward achieving 15 national health objectives for 2010 and three of the 10 leading health indicators. In addition, education and health officials at national, state, and local levels are using these YRBSS data to improve policies and programs to reduce priority health-risk behaviors among youth.
Correspondence: Eric Aakko, Health Hazard Evaluation Section, Bureau of Environmental Health, Wisconsin Department of Health and Family Services, USA; (email: eaakko@state.mt.us).
Risk communication is about building trust while deploying an interactive and ongoing communication process in which audience members are active participants. This interactive participation may not solve a public health crisis, but it will help reduce unwarranted fear, anxiety and distrust. Consequently, if a government agency fails to understand how to effectively communicate about health risks, their trustworthiness and credibility may suffer, and a crisis event may go from bad to worse.
Correspondence: Gary A. Smith, Center for Injury Research and Policy, Columbus Children's Research Institute, Children's Hospital, Columbus, Ohio and Department of Pediatrics, The Ohio State University College of Medicine and Public Health, Columbus, Ohio, USA; (email: gsmith@chi.osu.edu).
Ninety-six children were admitted during a 9-year period to a pediatric level 1 trauma center for treatment of farm-related injuries. The age range was from 6 weeks to 17 years (median, 7.5 years; mean, 7.6 years; standard deviation, 4.4). Thirty-nine patients (40.6%) had an animal-related injury, including 36 children (37.5%) who had an injury associated with a horse. Amish children had an increased risk of horse-related injury when compared with non-Amish children (p=0.04; RR=2.09, 95% CI: 1.18<RR<3.70). Thirty-seven patients (38.5%) had farm machinery-related injuries, including 14 children (14.6%) with an injury associated with a tractor. Falls from buildings or haylofts accounted for injuries to 12 patients (12.5%). Head trauma accounted for 35 cases (36.4%), with skull fractures in 23 cases (24.0%). Animal-related injuries were significantly associated with head/maxillofacial trauma (p = 0.001; RR = 2.15, 95% CI: 1.35 <RR<3.41). Five children (5.2%) died, and one child with a severe brain injury was discharged to a long-term rehabilitation facility. Animals, especially horses, accounted for a large percentage of farm-related injuries in this population. Clin Pediatr. 2004;43:335-342
Correspondence: Rosario Ortega, Departamento de Educacion, Universidad de Cordoba, Av. San Alberto Magno, s/n. Campus Menendez Pidal, 14004 Cordoba, SPAIN; (email: ortegaruiz@uco.es).
The ways in which children appraise and cope with school bullying are likely to influence the long-term outcomes experienced. To examine this possibility, 219 Spanish undergraduate students (73 male, 146 female) aged between 18 and 40, completed an adapted version of the Retrospective Bullying Questionnaire (RBQ; Schafer et al., 2004) and a distress scale (Rivers, 1999). Results indicated that neither coping strategies reported by victims of bullying nor the match between control appraisal and coping strategy influenced levels of distress experienced as adults. Control, threat and challenge appraisals did, however, influence long-term distress. Explanations for these effects are discussed, and include the possibility that appraisals may directly influence levels of distress and the quality of emotions experienced by victims during the actual bullying episode. Active strategies were perceived by students to be effective in dealing with bullying, whereas those centered on avoiding the conflict, or which involved aggression, were considered ineffective.
Innovative treatment for children with serious emotional disturbance: preliminary outcomes for a school-based intensive mental health program.
This article describes the development, implementation, and preliminary evaluation of a school-based Intensive Mental Health Program (IMHP) for 50 children (42 boys, 8 girls) with severe, early-onset, serious emotional disturbances (SED). Eighty-four percent of the children showed clinically significant improvement in overall functioning as measured by the Child and Adolescent Functional Assessment Scale (CAFAS). Child functioning at home and school, behavior toward others, regulation of moods and emotions, self-harm, and problems in thinking improved significantly. Results provide initial support for the IMHP as a promising approach to serving the needs of children with SED.
See item 2 under Risk Factor Prevalence, Injury Occurrence and Costs
In response to the growing suicide rate among adolescents and young adults, researchers have noted the importance of peer responses to suicidal disclosures in this population. The most adaptive response is to inform a responsible adult about the suicidal peer, but existing data indicate that most adolescents and young adults choose to talk to the peer on their own. The present study examined whether young adults' own history of suicidal ideation, gender, social history with suicide, and ambiguity of the disclosure would predict their response to a hypothetical suicidal peer. The data revealed significant effects of ambiguity and participants' suicidal ideation on the confidants' response strategy. The confidants' experience with others' attempted or completed suicides increased their likelihood of saving they would tell an authority, whereas their own history of ideation or attempts reduced the likelihood of that response. These effects were most pronounced when the hypothetical peer's suicidal intent was not completely clear, which may often be the case in disclosures by suicidal adolescents. Youth and young adults should be encouraged to inform adults about suicidal peers, particularly those who have been suicidal themselves previously, and who may resist that strategy. It is postulated that these particular peers may be more easily convinced to respond in this manner if they could be involved in the intervention with their suicidal peer.
Further suicidal behavior among medically serious suicide attempters.
Correspondence: A. Beautrais, Canterbury Suicide Project, Christchurch (New Zealand) School of Medicine & Health Sciences, NEW ZEALAND; (email: suicide@chmeds.ac.nz).
Analysis of rates of further suicidal behavior among individuals making medically serious suicide attempts may help to predict suicide and suicide attempt from baseline characteristics of the individual and the index suicide attempt. Data are drawn from a 5-year study of 302 individuals making medically serious suicide attempts with information collected by personal interview at baseline, 6, 18, 30, and 60 months after the index attempt. Within 5 years, 6.7% died by suicide; 37% made at least one nonfatal suicide attempt. Although baseline characteristics permitted a modest prediction of suicide attempt, only a very limited prediction of suicide was possible. Almost half of those who made serious suicide attempts made a further fatal or nonfatal attempt within 5 years. These findings imply the need for enhanced follow-up, treatment, and surveillance of all patients making serious suicide attempts.
Self-harm: understanding the causes and treatment options.
Deliberate self-harm rates in the UK are the highest in Europe, and at present, this problem is poorly understood, as there has been little research available to shed light on why such a considerable number of young people are compelled to hurt themselves. The Mental Health Foundation and The Camelot Foundation recently launched a UK-wide inquiry into self-harm among 11-25-year-olds, which aims to produce a practical and thoughtful approach to the prevention and treatment of self-harm in young people, inform future education and training, and provide strategies for service providers.
Screening for suicide risk: recommendation and rationale.
- U.S. Preventive Services Task Force. Ann Intern Med 2004; 140(10): 820-821.
Correspondence: U.S. Preventive Services Task Force, Agency for Healthcare Research and Quality, Rockville, Maryland, USA; (email: ahrqpubs@ahrq.gov).
This statement summarizes the current U.S. Preventive Services Task Force (USPSTF) recommendations on screening for suicide risk and the supporting scientific evidence and updates the 1996 recommendations on this topic. The complete information on which this statement is based, including evidence tables and references, is available in the accompanying article in this issue and in the systematic evidence review on this topic, which is available through the USPSTF Web site (www.preventiveservices.ahrq.gov) and through the National Guideline Clearinghouse (www.guideline.gov). The complete recommendation statement and the summary of the evidence are also available from the Agency for Healthcare Research and Quality Publications Clearinghouse (telephone, 800-358-9295; e-mail, ahrqpubs@ahrq.gov).
A statistical analysis of the threat posed by unrestrained rear seat car passengers to restrained drivers and front seat passengers was published in 2002. This was based on Japanese accident data from 1995 to 1999, and the conclusions have been checked using corresponding accident data from Great Britain. The law in respect of the use of seat belts and other restraint systems was less strict in Japan than in Great Britain between 1995 and 1999, so an earlier period had to be studied. The results suggest that the risk of death to a front seat car occupant is increased by about three-quarters by the presence of an unrestrained rear seat passenger behind them, a much smaller increase than was claimed by the Japanese researchers.
Typical patterns in road-traffic accidents during driver training; An explorative Swedish national study.
Correspondence: Hans-Yngve Berg, Division of Social Medicine, Department of Public Health Sciences, Karolinska Institutet, SE 171 76 Stockholm, SWEDEN; (email: hans-yngve.berg@vv.se).
A new law came into force in Sweden on 1 September 1993, which makes instructor-assisted driving practice possible at the age of 16 years instead of the previous 17 years and 6 months. When the age limit was reduced, the possibility that this would lead to more road-traffic accidents (RTA) during driving practice was discussed. The aim of this study was to highlight typical road-traffic accident patterns and to discuss their potential for improved training and targeted prevention. A total of 11 variables (41 categories) descriptive of the 1081 RTA involving novice drivers and police registered during the period 1994-1999 were analysed simultaneously using in turn, two multivariate analysis techniques: the Factorial Analysis of Correspondence (FAC) and the Hierarchical Ascendant Classification (HAC). Four accident classes were identified and quantified, of which the first two were more typical of rural areas: (1) accidents in rural areas on straight stretches and related to speed limit 70km/h; (2) accidents in rural areas on straight stretches and high-speed related; (3) accidents in built-up areas, low-speed related and of the type rear-end; and (4) accidents in built-up areas, at road junctions and low-speed related). Together, these classes point to a variety of opportunities to develop ways of working with targeted prevention. Instead of adopting a general attempt to counteract the relationship between individual variables and accidents, it is possible instead to focus on a whole context and its relationship with its typical accidents and any resulting injuries. This, in its turn, allows greater specificity in the build up of the Swedish licence and training regulations and its corresponding course curriculum.
Has the difference in accident patterns between male and female drivers changed between 1984 and 2000?
The motorcar accident pattern of culpable young (18-25 years old) and middle-aged (35-55 years old) male and female drivers was studied in Finland. The aim was to see whether the difference in accident patterns between males and females has remained constant or whether it has changed over a 16-year period. Two different sets of traffic accident data were used. The first set of data covered all motorcar accidents for which damages were paid between 1987 and 2000, a total of 140802 accidents. The second set of data covered all fatal motor vehicle accidents in Finland during the time period between 1984 and 2000, a total of 2401 accidents. The results are analysed and discussed in the framework of a four-level hierarchical model of driving behaviour [Keskinen, E., 1996. Why do young drivers have more accidents? In: Junge, F., Fahrerinnen (Eds.), Young Drivers (in German and in English). Berichte der Bundesanstalt fur Strabetaenwesen, Mensch und Sicherheit, Heft M 52, Bergisch Gladbach, Germany; Hatakka, M., Keskinen, E., Gregersen, N.P., Glad, A., Hernetkoski, K., 2002. From control of the vehicle to personal self-control; broadening the perspectives to driver education. Transportation Res. Part F 5 (3), 201-215]. Female drivers had proportionally more accidents that were connected to vehicle manoeuvring and control of traffic situations, e.g. reversing and loss-of-control accidents in a sober state and when not speeding. Male drivers, and especially young male drivers, had proportionally more accidents connected to higher levels of driving behaviour like motives for driving and attitudes. Factors that characterised these accidents were speeding and alcohol consumption. Male drivers also had previous traffic offences more often than female drivers. The study concludes that the difference in accident patterns between male and female drivers has remained constant, i.e. the accident pattern of female drivers was as dissimilar to the accident pattern of male drivers in the year 2000 as in the middle of the 1980s.
Testing and injury potential analysis of rollovers with narrow object impacts.
- Meyer SE, Forrest S, Herbst B, Hayden J, Orton T, Sances A Jr, Kumaresan S. Biomed Sci Instrum 2004; 40: 395-400.
Correspondence: S.E. Meyer, University of California, Santa Barbara, California, USA; (email: unavailable).
Recent statistics highlight the significant risk of serious and fatal injuries to occupants involved in rollover collisions due to excessive roof crush. The government has reported that in 2002. Sports Utility Vehicle rollover related fatalities increased by 14% to more than 2400 annually. 61% of all SUV fatalities included rollovers. Rollover crashes rely primarily upon the roof structures to maintain occupant survival space. Frequently these crashes occur off the travel lanes of the roadway and, therefore, can include impacts with various types of narrow objects such as light poles, utility poles and/or trees. A test device and methodology is presented which facilitates dynamic, repeatable rollover impact evaluation of complete vehicle roof structures with such narrow objects. These tests allow for the incorporation of Anthropomorphic Test Dummies (ATDs) which can be instrumented to measure accelerations, forces and moments to evaluate injury potential. High-speed video permits for detailed analysis of occupant kinematics and evaluation of injury causation. Criteria such as restraint performance, injury potential, survival space and the effect of roof crush associated with various types of design alternatives, countermeasures and impact circumstances can also be evaluated. In addition to presentation of the methodology, two representative vehicle crash tests are also reported. Results indicated that the reinforced roof structure significantly reduced the roof deformation compared to the production roof structure.
Knowledge, beliefs, and practices concerning seat belt use during pregnancy.
- McGwin G Jr, Russell SR, Rux RL, Leath CA, Valent F, Rue LW. J Trauma 2004; 56(3): 670-675.
Correspondence: Gerald McGwin, Section of Trauma, Burns, and Surgical Critical Care, Division of General Surgery, Department of Surgery, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama 35294, USA; (email: gerald.mcgwin@ccc.uab.edu).
OBJECTIVE: This study seeks to evaluate the comprehension of and attitudes toward proper restraint use among women attending prenatal care clinics.
METHODS: Four-hundred and fifty women were asked to complete a survey during prenatal care visits at county health department clinics; the response rate was 92.0%. Women were asked to provide demographic information and report their frequency and knowledge of proper automobile restraint use.
FINDINGS: Nearly all subjects (95.4%) either maintained or increased their pre-pregnancy frequency of restraint use. Three-hundred (72.5%) subjects demonstrated that they wore their restraints in the correct location, with women who wore restraints more frequently being more likely to report correct placement. Two-hundred and forty-nine (60.1%) of women reported that restraints would protect their baby if they were involved in a collision, while 48 (11.6%) thought the restraints would cause injury to their baby, and 153 (37.0%) were unsure. Women who reported that restraints would protect them and their baby if involved in a collision were significantly more likely to report always wearing restraints compared with those who were unsure or had negative perceptions of restraints (84.4% vs. 64.6%; p < 0.0001). The most commonly reported reasons for lack of restraint use were lack of comfort (52.8%) and forgetfulness (42.5%). Only 36.9% percent of women reported receiving information regarding restraint use during their current pregnancy.
COMMENTS: Many gravid women lack information regarding proper seat belt use and their role in injury prevention. Consequently, the frequency of seat belt use and its correct placement are negatively impacted. Health care workers should take an active role in educating pregnant gravid women about proper restraint use.
The influence of side airbags on the risk of head and thoracic injury after motor vehicle collisions.
- McGwin G Jr, Metzger J, Rue LW 3rd. J Trauma 2004; 56(3):512-516.
Correspondence: Gerald McGwin, Section of Trauma, Burns, and Surgical Critical Care, Division of General Surgery, Department of Surgery, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama 35294, USA; (email: gerald.mcgwin@ccc.uab.edu).
BACKGROUND: Side airbags (SABs) were developed as an energy-absorbing barrier to protect specific occupant body regions in near side impact motor vehicle collisions.
METHODS: The National Automotive Sampling System Crashworthiness Data System was used to evaluate drivers and front-seated passengers in 1998 or newer vehicles involved in near side impact collisions. Risk ratios were calculated comparing the risk of head and thoracic injury among occupants in vehicles with and without SABs adjusting for occupant, vehicle, and collision characteristics.
FINDINGS: Occupants in vehicles equipped with head protection SABs had a 75% lower risk of head injury (p = 0.008) after near side collisions. With respect to thoracic injury, SABs that provide thoracic protection are associated with a 68% reduction (p = 0.01) in thoracic injury risk.
COMMENTS: As SAB-equipped vehicles become an increasingly larger segment of the on-road vehicle fleet, the impact of head and thoracic injury after near side impact collision is likely to be reduced.
Effect of restraint systems on maxillofacial injury in frontal motor vehicle collisions.
Correspondence: Gerald McGwin, Section of Trauma, Burns, and Surgical Critical Care, Division of General Surgery, Department of Surgery, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama 35294, USA; (email: gerald.mcgwin@ccc.uab.edu).
CONTEXT: Motor vehicle collisions (MVCs) are the leading cause of maxillofacial fractures. Additionally, maxillofacial injuries are the most common injury related to air bag deployment.
OBJECTIVE: We sought to characterize the occupant restraint system (seat belt and air bag) and collision characteristics associated with MVC-related maxillofacial injuries.
MATERIALS AND METHODS: The 1991-2000 National (United States) Automotive Sampling System Crashworthiness Data System (CDS) data files were used. The CDS is a national probability sample of passenger vehicles involved in police-reported tow-away MVCs. Analysis was limited to front seat occupants involved in frontal collisions of delta-V (estimated change in velocity) of greater than 15 km/hr. The risk of facial injury was calculated according to occupants' restraint use (unrestrained, seat belt only, air bag only, and seat belt and air bag combined) and compared using risk ratios (RRs) and associated 95% confidence intervals (CIs).
FINDINGS: Occupants restrained with a seat belt only (RR, 0.48; 95% CI, 0.40 to 0.57) or a seat belt and an air bag (RR, 0.83; 95% CI, 0.73 to 0.94) had a significantly reduced risk of any facial injury compared with completely unrestrained occupants. There was no association for those restrained with an air bag only (RR, 1.19; 95% CI, 0.82 to 1.73). A similar pattern of results was observed for moderate to severe facial injuries and for facial fractures.
COMMENTS: Seat belt use significantly reduces the risk of facial injury in frontal MVCs. Air bag use was not associated with the risk of facial injury.
More and more researchers, evaluators, and policy makers are recognizing that in order to best understand the factors precipitating, supporting, and prohibiting intimate violence against women, we must often gather information directly from battered women themselves. Such data collection, however, is not without its risks to the women involved in such studies. It is important that researchers and evaluators consider ethical issues, especially but not limited to those related to safety and confidentiality, before attempting to gather information either directly from battered women or through their records or files. This article provides a number of practical strategies and protocols that have been used successfully when gathering sensitive information from and about women with abusive partners.
Gender and physical violence.
- Steen K, Hunskaar S. Soc Sci Med 2004; 59(3): 567-571.
This study examines incidents of physical violence in relation to the sex of both assault victim and attacker. A survey of all assault victims attending an urban accident and emergency department (AED) in Norway during a 2-year period was carried out. All the assault victims were interviewed using a structured questionnaire administered by the attending physician as part of the initial consultation at the AED. During this interview, information about the victims, the attackers and the assaults was collected from the victims. Information on the sex, age, alcohol state of victims, and any referral to hospitals and specialists, was collected from the victim's medical notes at the AED. The severity of the victim's injuries was rated retrospectively using Abbreviated Injury Scale (AIS) and Shepherd's Injury Severity Scale for rating of injuries of assault. A total of 1234 men (74%) were attacked by other men, 354 women (21%) were attacked by men, 33 men (2%) by women, and 59 women (4%) by other women. The characteristics of the assaults carried out amongst female victim-female attacker and male victim-male attacker groups had many similarities. The same was found for the female victim-male attacker and male victim-female attacker groups. We conclude that changes in the traditional behaviour associated with women and men in relation to physical violence may be taking place.
Gun availability and use of guns for suicide, homicide, and murder in Canada.
Correspondence: Division of Health, Leisure, and Exercise Science, The University of West Florida, 11000 University Parkway, Pensacola, FL 32514-5750, USA; (email: fbridges@uwf.edu).
A reliability check of Lester's (2000b) 1970-1995 time series that examined associations between the availability of firearms and their use for homicide and suicide in Canada. For the period 1974 to 1999, the relative availability of firearms as measured by the rate of accidental death from firearms and the average of the percentages of suicides + homicides using firearms was positively associated with the rate of homicide by firearms but not negatively associated with the rate of homicide by all other methods, and positively associated with the rate of suicide by firearms and negatively associated with the rate of suicide by all other methods. Correlations for the homicide versus murder rates, homicide rate using guns versus murder rate using guns, and homicide rate by all other methods versus murder rate by all other methods were very similar. There was a decrease over time of total suicide and homicide rates and firearm suicide and homicide rates, and with a slight indication of substitution of other methods for suicide.
Gender inequality, violence against women, and fear: a cross-national test of the feminist theory of violence against women.
This article presents a cross-national test of the feminist theory of violence against women. Combining data from the International Crime Victims Survey (ICVS) with United Nations statistics, the findings support the theory. Specifically, the results indicate that the educational and occupational status of women in a country is related to the prevalence of sexual violence against women. In countries where the status of women is low, prevalence of sexual violence against women tends to be higher. In turn, sexual violence is related to higher levels of fear among women relative to men. In comparison, in countries where the status of women is high, sexual violence against women is lower. The findings of this study add confirmation to the argument that we need to look beyond individual level variables to understand and develop strategies for reducing violence against and fear among women.
Locating the texts and status of international human rights protection agreements.
Correspondence: Edward Grosek, Government Publications Librarian, Founders Memorial Library, Northern Illinois University, DeKalb, IL, 60115, USA; (email: egrosek@niu.edu).
Most people know what human rights are and why they must be defended. How human rights are protected-with treaty instruments-is a common social science and political science topic of analysis. This paper explains human rights treaties and identifies the problem that reference librarians sometimes have in furnishing information on human rights violations in foreign countries: determining the specific treaties that those countries signed and locating the texts of those treaties. More specifically, this paper gives the names, dates, and source citations for nineteen consequential human rights treaties and ends with a bibliography of sixteen paper and Internet compilations for the texts of those and other rights protection agreements.
