BACKGROUND: Alcohol misuse is a risk factor in suicide and parasuicide.
OBJECTIVE: To measure the prevalence of alcohol use disorders in a cohort of psychiatric admissions using the Alcohol Use Disorders Identification Test (AUDIT), and the relationship between the AUDIT score and suicidality.
METHOD: Consecutive psychiatric admissions were interviewed with a lifestyle survey that included the AUDIT, and admission case notes were reviewed.
FINDINGS: Out of 200 subjects, 48.5% scored 8 or more (indicating hazardous or harmful alcohol use) and 22.5% scored 16 or more (indicating significant alcohol dependence) on the AUDIT. There were no significant gender differences. Alcohol misuse was strongly associated with suicidality.
COMMENTS: The AUDIT questionnaire should be incorporated into psychiatric assessments when risk of self-harm is being evaluated. Further research is warranted to examine the impact of interventions for alcohol use disorders in psychiatric settings on self-harm and suicidal ideation.
Alcohol consumption and problems among road rage victims and perpetrators.
- Mann RE, Smart RG, Stoduto G, Adlaf EM, Ialomiteanu A. J Stud Alcohol 2004; 65(2): 161-168.
Correspondence: Robert Mann, Social, Prevention and Health Policy Research Department, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, Ontario M5S 2S1, CANADA; (email: Robert_mann@camh.net).
OBJECTIVE: Road rage has generated public concern; however, data on the causes of this behavior have not been available. We examine the alcohol consumption correlates of road rage victimization and perpetration based on a population survey of adults.
METHOD: Data are based on the 2001-2002 Centre for Addiction and Mental Health Monitor, a repeated cross-sectional telephone survey of Ontario adults aged 18 and older (N = 2,610). Logistic regression analyses were performed with drinking measures (Alcohol Use Disorders Identification Test [AUDIT] consumption, dependence and problems) and demographic factors as independent variables.
FINDINGS: In the past year, 44.4% of respondents reported that someone shouted, cursed or made rude gestures at them, 6.0% were threatened with damage to their vehicle or personal injury, and 5.2% had someone attempt to or actually damage their vehicle or hurt them. Over the same period, 32% admitted shouting, etc., at someone, 1.7% threatened someone, and 1.0% attempted to or actually did damage someone's vehicle or hurt someone. Univariate analyses revealed several significant relationships between road rage and alcohol measures. Multivariate analyses revealed that the AUDIT alcohol problems measure was most consistently associated with measures of road rage victimization and perpetration, including reporting attempting or actually hurting someone or attempting or actually damaging his or her vehicle.
COMMENTS: These data indicate there is a significant relationship between alcohol problems, as measured by the AUDIT, and road victimization and perpetration. Further work must be undertaken to identify the mechanisms involved.
Correspondence: Dinesh Mohan, Transportation Research and Injury Prevention Programme, Indian Institute of Technology, Hauz Khas, New Delhi 110016, INDIA (email: dmohan@cbme.iitd.ernet.in).
Available online: ( DOWNLOAD EDITORIAL ).
(Copyright 2004, The National Medical Journal of India - All India Institute of Medical Sciences)
This three-page editorial outlines the clinical and ethical responsibilities that healthcare professionals have to assume responsibility for participating in efforts to address the problem of road traffic injuries. This document is available online via the link above.
Decreasing both workplace and school violence needs to be a priority of individuals, families, communities, and workplaces for the effort to be successful. Key factors associated with school and workplace violence such as parental influences, school staff and police involvement, peer pressure, student influences such as drug and alcohol abuse and a preoccupation with weapons, and the mass media have all been identified as possible factors associated with violence against teachers. In addition, individual student characteristics such as gender, socioeconomic status, and a history of prior violence may play a role. However, none of these factors can be identified or singled out as the reason for violence. Violence against teachers occurs as a result of a combination of these factors. Understanding how these factors interact should be a goal of every community and school. Occupational health nurses have the unique opportunity to partner with communities, school nurses, and the school system to develop effective violence prevention programs. Working in schools is an area of expansion for occupational health nurses. They have the expertise to perform worksite assessments and to identify key areas of weakness throughout the facility. Their expertise in reviewing and analyzing workplace injury data and developing cost effectiveness analysis for proposed interventions is unique. Occupational health nurses also have the skills to network with school officials and other key stakeholders to develop interventions to impact the substantial implications of violence in the schools.
Four different studies using a total sample of 711 from the same New York City student population tested a model that has emerged from previous research on disasters. The model suggests that postdisaster psychological distress is a function of exposure to the disaster, predisaster psychological distress, acute distress following the disaster, time elapsed between disaster and observation of distress, and additional traumatic experiences since the disaster. Although findings replicate those of previous cross-sectional studies regarding association of exposure and distress after the disaster, before and after studies did not detect an effect on postdisaster psychological distress of the World Trade Center attack. Great caution must be used in attributing elevated psychological distress observed postdisaster to the effects of the disaster.
Correspondence: Nikola Bradic, Department of Anesthesiology, Reanimatology and Intensive Care Medicine, University Hospital Dubrava, Zagreb, CROATIA; (email: nikola.bradic@ri.tel.hr).
BACKGROUND: This report illustrates Croatia's experience with the terrorist attack in the city of Rijeka in October 1995. Also, the intention of this report is to outline how emergency services were functioning in this sudden-onset situation.
METHODS: The medical documentation of 27 wounded citizens in the attack was analyzed and the appearance of bodily wounds, severity of wounds, and the mechanisms of injury are described. From the forensic medical report, the wounds and damages sustained by the terrorist also were analyzed. All findings were compared with similar cases from around the world.
FINDINGS: In the 27 wounded citizens, three (11%) had head injuries, and injuries of the abdomen in only two cases (7%) were found. The most common injuries sustained involved one or more extremities: 16 (59%) persons had wounds of an upper or lower extremity or a combination of multiple wounds. The main cause of death of the terrorist was explosive wounds to the chest and abdomen with destruction of multiple inner organs (primarily kidneys, liver, abdomen, and lung). Furthermore, the terrorist had a fracture of the skull base and multiple injuries to the brain.
COMMENTS: Comparing the findings with other data from the literature, the distribution in the percentages of wounded is almost the same as reported in many bomb attacks. In this case, the walls of the building protected many citizens, which is why so few were seriously injured. Forensic examination of the terrorist's body showed all of the characteristics of blast injuries.
Correspondence: Marcella Ridenour, Biokinetics Research Laboratory, Department of Kinesiology, Temple University, Philadelphia, PA 19122, USA; (email: marcella.ridenour@temple.edu).
This study investigated the automatic safety release mechanisms on neck cords for children's cameras. The purpose of the safety release mechanism is to reduce accidental strangulation associated with children's toys that have neck cords. The horizontal pull forces that activate the automatic safety release mechanism were measured for two different styles of release mechanisms for neck cords. When these forces were compared to forces associated with child strangulation, the automatic safety mechanisms released at higher forces than the forces associated with accidental strangulation or death, which is contrary to what was intended and creates a false sense of security for parents who select a toy camera with such a device.
Correspondence: T. Nakayama, Department of Health Informatics, Kyoto University School of Public Health, Yoshida, Sakyo, Kyoto, JAPAN; (email: unavailable).
With the sustained economic recession, suicide has been increasing in Japan (more than 300,000 victims annually since 1998), particularly among middle-aged employees. Development of preventive measures is needed; however, employees have limited knowledge of the basic information about depression and suicide. One office in Saitama Prefecture, Japan, has been provided with a mental health support program. An initial questionnaire survey was conducted in December 1999. It contained demographic data and information about working styles and daily habits, including alcohol and tobacco use, quality of sleep, social support, the general well-being schedule, and knowledge/attitude toward depression and suicide. Of 225 eligible people, 216 men and women participated. Most of them had stressful schedules and demanding jobs. Their subjective well-being was generally poorer relative to the reference. The mean score of knowledge was 10.5 (SD = 2.02) for 14 items. The accuracy rates ranged from 97.6% incorrect (false) for such items as 'Most suicide victims consult psychiatrists before their deaths' to 42.1% correct (true) for 'A suicidal individual tends to be accident-prone for traffic accidents and injuries.' One-fourth of them had unfavorable attitudes toward depressive colleagues. Neither age nor gender was related to knowledge level and attitude. Variations were observed in the knowledge that employees had toward depression and suicide. A program that provides employees with appropriate information related to mental health is needed.
Summer work and injury among middle school students, aged 10-14 years.
- Zierold KM, Garman S, Anderson H. Occup Environ Med 2004; 61(6): 518-522.
Correspondence: K. Zierold, University of South Carolina, Arnold School of Public Health, Department of Environmental Health Sciences, University of South Carolina, Columbia, SC 29208, USA; (email: Zierold@gwm.sc.edu).
BACKGROUND: Little information exists on injury and factors associated with injury in working youth aged 10-14 years. Most studies do not involve children younger than 15.
METHODS: A cross-sectional anonymous survey was administered to middle school students in five school districts and one large urban school in October 2001.
FINDINGS: Of the 3189 working middle school students who responded to the survey, the majority were employed in informal job settings, such as working for someone in a home, newspaper delivery, and working on family farms or in family businesses. Overall, 18% of children reported being injured at work. Of those injured, 26% reported that their injury was severe enough to affect their activities for more than three days. Variables that were associated with injury included having a "near-miss" incident at work (AOR 6.61, 95% CI 4.92 to 8.89), having a co-worker injured (AOR 2.65, 95% CI 1.95 to 3.60), and being asked to do something dangerous (AOR 2.25, 95% CI 1.61 to 3.14).
COMMENTS: Children are working and being injured in jobs that are not covered by existing child labour laws. Injury rates in non-covered occupations are high, warranting review of current laws.
Assessing floor slipperiness in fast-food restaurants in Taiwan using objective and subjective measures.
- Chang WR, Li KW, Huang YH, Filiaggi A, Courtney TK. Appl Ergon 2004; 35(4): 401-408.
Correspondence: Wen-Ruey Chang, Liberty Mutual Research Institute for Safety, Hopkinton, MA 01748, USA; (email: wen.chang@libertymutual.com).
Slips and falls are major problems in occupational injuries in which floor slipperiness is a critical issue. Most of the studies on slipperiness assessments were conducted in laboratories. Field assessments are rarely reported in the literature. This study investigated floor slipperiness in seven kitchen areas of 10 western-style fast-food restaurants in Taiwan using both objective and subjective measurements which were conducted by friction measurements and by employees' ratings of floor slipperiness, respectively. The friction measurement results showed that the sink area had the lowest average friction in the kitchens. Employees, however, rated both the sink and back vat (chicken fry) areas as the most slippery areas. The Pearson's and Spearman's correlation coefficients between the averaged friction coefficients and subjective ratings for all 70 evaluated areas across all 10 restaurants were 0.49 and 0.45, respectively, for both. The results indicate that average friction coefficient and perception are in fair agreement, suggesting that both might be reasonably good indicators of slipperiness.
Deprived children or deprived neighbourhoods? A public health approach to the investigation of links between deprivation and injury risk with specific reference to child road safety in Devon County, UK.
BACKGROUND: Worldwide, injuries from road traffic collisions are a rapidly growing problem in terms of morbidity and mortality. The UK has amongst the worst records in Europe with regard to child pedestrian safety. A traditional view holds that resources should be directed towards training child pedestrians. In order to reduce socio-economic differentials in child pedestrian casualty rates it is suggested that these should be directed at deprived children. This paper seeks to question whether analysis of extant routinely collected data supports this view.
METHODS: Routine administrative data on road collisions has been used. A deprivation measure has been assigned to the location where a collision was reported, and the home postcode of the casualty. Aggregate data was analysed using a number of epidemiological models, concentrating on the Generalised Linear Mixed Model.
FINDINGS: This study confirms evidence suggesting a link between increasing deprivation and increasing casualty involvement of child pedestrians. However, suggestions are made that it may be necessary to control for the urban nature of an area where collisions occur. More importantly, the question is raised as to whether the casualty rate is more closely associated with deprivation measures of the ward in which the collision occurred than with the deprivation measures of the home address of the child.
COMMENTS: Conclusions have to be drawn with great caution. Limitations in the utility of the officially collected data are apparent, but the implication is that the deprivation measures of the area around the collision is a more important determinant of socio-economic differentials in casualty rates than the deprivation measures of the casualties' home location. Whilst this result must be treated with caution, if confirmed by individual level case-controlled studies this would have a strong implication for the most appropriate interventions.
Urban/rural variation in children's bicycle-related injuries.
Correspondence: Alison K. Macpherson, Department of Geography, Faculty of Arts and Science, University of Toronto, 100 St. George Street, Toronto, Ont., CANADA; (email: alison.macpherson@sickkids.ca).
The objective of this study was to examine bicycle-related injury rates for children living in urban and rural areas. Data on all Canadian children hospitalised because of bicycling-related injuries (1994-1998) were obtained from the Canadian Institute for Health Information (CIHI). Injured children were classified as residing in urban, mixed urban, mixed rural or rural areas. Incidence rates for bicycle-related head injuries and other bicycle-related injuries were calculated. Logistic regression was used to estimate the odds of head injury, controlling for age, sex, socio-economic status (SES), collision with a motor vehicle, and the presence of provincial helmet legislation. In total, 9367 children were hospitalised for a bicycling-related injury over the 4-year-study period. Of these, 21% occurred in rural areas, 18% in mixed rural, 17% in mixed urban, while the remaining 44% occurred in urban areas. The average annual incidence rate for bicycle-related head injuries in children was 18.49 per 100,000 for children living in rural areas compared with 10.93 per 100,000 for those living in urban areas, 15.49 for children in mixed urban areas and 17.38 for children living in mixed rural areas. This variation may be explained by differences in bicycling exposure, helmet use, hospital admission criteria, or road environments across geographic areas.
Carbon monoxide poisoning while using a small cooking stove in a tent.
- Thomassen O, Brattebo G, Rostrup M. Am J Emerg Med 2004; 22(3): 204-206.
Correspondence: Oyvind Thomassen, Department of Anaesthesia and Intensive Care, Hammerfest Hospital, Hammerfest, NORWAY; (email: oyt@hammerfest-sykehus.no).
Carbon monoxide (CO) is formed wherever incomplete combustion of carbonaceous products occurs.(1) CO is the leading cause of poisoning in the United States, and common sources of CO poisoning include housefires, automobile exhaust, water heaters, kerosene space heaters, and furnaces.(2) Stoves used for cooking and heating during outdoor activities also produce significant amounts of CO. Mountain climbers have been reported to succumb to fumes generated by small cook stoves.(3) The aim of this study was to investigate if burning a cooking stove inside a tent is a potential health hazard. Seven healthy male volunteers used a cooking stove inside a small tent for 120 minutes. CO levels in the ambient tent air were measured in addition to hearth rate (HR) and pulse oximetry (SpO2). Venous blood samples were obtained every 15 minutes for measurement of carboxyhemoglobin (COHb). After 2 hours, all the subjects had significant CO levels in their blood (mean COHb = 21.5%). Mean SpO2, also fell from 98% to 95.3% (P <.05), whereas mean HR increased from 63 to 90 beats/min (P <.05). Kerosene camping stoves do produce CO when burned in a small tent. The concentration is high enough to cause significant COHb levels in venous blood after 120 minutes' stay in the tent.
New roles for poison control centres in the developing countries.
Correspondence: Amalia Laborde, Centro de Informacion y Asesoramiento Toxicologico, Department of Toxicology, Faculty of Medicine, Hospital de Clinicas, Av Italia s-n.P7, Montevideo, URUGUAY; (email: alaborde@hc.edu.uy).
The primary mission of poison control centres has always been an improvement in the poisoned patients' care and poison prevention. The need to reach this mission implies that many functions and roles must be accomplished. Many centres, even in developing countries, are multifunctional and provide a broad toxicological information service. However, the main challenges of poison centres in developing countries are still treatment information, formal training, laboratory services accessibility and availability of antidotes. At the same time poison centres from developing countries need to accomplish their public health mission through strengthening and expansion of some well-defined roles like toxico-surveillance and environmental health monitoring according to the prevailing and future toxicological problems. Poison control centres from developing countries continue to face old challenges but cannot ignore the new ones that appear in the globalised world. Poison centres have a vital role for environmental exposure surveillance systems for sentinel event detection. Poison centres offer real-time and continuous data needed for preparation and response during such events and also offer a means to report health concerns. Centres from South America were involved in some of the most important environmental health problems of the region e.g., lead contamination (children), children 'occupational' poisoning, and flour contamination with fusarium toxins. Furthermore, poison centres can be the markers of risk factors or identifiers of vulnerable population e.g., changes in drugs prescription patterns, unusual patterns of addiction, unexpected product uses, children abuse scenarios or undetected sources of environmental contamination. In an era of evidence-based medicine and research, toxico-vigilance based on the millions of cases registered by poison centres everyday acquires more and more importance. A new approach of the toxico-vigilance and preventive roles of poison information centres lies in their ability to contribute to risk assessment methodologies with their human data. The data routinely collected by poisons centres could contribute to risk assessment documentation and to define priorities for risk assessment of the harmful chemicals. Although there is some scepticism about the value of poison centres data, the shared volume of human data could validate this information. The international effort of the IPCS/INTOX program, on harmonisation of data collection and terminology for comparable recording of observational human data, has been a great advancement towards handling this problem.
The present study evaluated the association among sex, sport, and injured body region of sport injuries. The subjects were 329 men and 127 women, ranging in age from 17 to 28 years, attending classes in the departments of Physical Training and Sport of Ataturk University (Erzurum, Erzincan, and Agri in Turkey). There were no differences between men and women in percentages of injuries. The difference among various sports in the percentages of injured athletes was statistically significant. Running had the lowest percentage of injuries and basketball had the highest percentage. The most frequently injured body regions were the foot and the ankle in basketball, volleyball, soccer, and running, but in wrestling, the knee. These findings suggest that injury rates are associated with the sport rather than sex of player, and the most frequently injured body regions are the lower extremities. Therefore, the muscles of lower extremity should be strengthened to avoid injuries.
Injury prevention during physical activity in the Australian Defence Force.
- Sherrard J, Lenne M, Cassell E, Stokes M, Ozanne-Smith J. J Sci Med Sport 2004; 7(1): 106-117.
Correspondence: J. Sherrard, Accident Research Centre, Monash University, Melbourne, Victoria, AUSTRALIA; (email: unavailable).
BACKGROUND: Injuries sustained by Australian Defence Force (ADF) personnel during non-combat military training and sports activity are associated with increasing costs due to work days lost, medical treatment, compensation, and early retirement. In 2001, the ADF commissioned a systematic review of the evidence-base for reducing injuries associated with physical activity, while at the same time improving physical activity participation rates to sustain a trained, fit and deployable workforce.
METHODS: Literature from on-line library databases, relevant unclassified military reports, and material from previously published sport-specific injury countermeasure reviews were systematically and critically analysed to address the study aims.
FINDINGS: Modification of intensity, frequency and duration of basic military training activities and improved equipment is likely to reduce injury occurrence. Sports injury countermeasures used for the civilian population have merit for the ADF physical activity program. Injury countermeasures should be designed to minimise any possible deterrent effect on the motivation to participate in regular physical activity. Increasing the participation of ADF personnel in physical activity in the presence of evidence-based injury prevention strategies has the potential to increase health, fitness and deployability with minimal impact on injury frequency.
COMMENTS: Recommendations arising from the review include injury intervention trials in basic military training and sports. These and other interventions should be supported by refinement to ADF injury surveillance systems. Research should focus on interventions with the greatest gain for fitness, deployability, and cost effectiveness.
Community level Australian Football: a profile of injuries.
- Braham R, Finch CF, McIntosh A, McCrory P. J Sci Med Sport 2004; 7(1): 96-105.
Correspondence: Rebecca Braham, Trauma and Sports Injury Prevention Research Unit, Monash University, Victoria, AUSTRALIA;(email: rebecca.braham@med.monash.edu.au).
Identification of injuries and their risk factors is required in order to develop risk controls within the context of sports injury prevention. The Australian Football Injury Prevention Project (AFIPP) was a randomised controlled trial (RCT) examining the effects of protective equipment on injury rates in Australian Rules Football. The aim of this paper is to describe the general injury profile of community level Australian Football players over one season, as recorded during this RCT. Players were recruited from the largest community football league in Victoria, Australia, during the 2001 playing season. A total of 301 players participated (64% response rate) and all injuries occurring during training and games were recorded. The overall injury incidence rate was 12.1/1000 player hours. Bruises/soft tissue injuries made up more than a quarter of all injuries (28%) and the leg (lower leg, ankle, thigh/hamstring and knee) was the most commonly injured body region. Most injuries occurred at the beginning of the season (April-May, 53% of injuries), during competition (77%) and through body contact (49.9%). Midfielders (OR = 3.39, 95% CI: 1.13, 10.14) and players aged at least 25 years (OR = 2.15, 95% CI: 1.06, 4.34) were significantly more likely to experience an injury than other playing positions and younger players. Although the injury rate in this study was lower than that in previous studies, the results are consistent with the finding that injuries tend to occur earlier in the season and more commonly during competition. Injury prevention efforts should be particularly targeted at midfielders and older players.
Correspondence: Kelli A. Komro MPH, PhD, Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis, MN 55454-1015 USA; (email: komro001@umn.edu).
The purpose of this paper is to outline the evaluation plan for the Minnesota D.A.R.E. Plus Project, a drug and violence prevention program for young adolescents, and to present the results of psychometric analyses on the measures that will be used in the assessment of the intervention program. The survey instrument was tested using different samples for each stage of its development. The main scale development sample included seventh grade students in urban, suburban and rural schools. The results indicate that the scales constructed are reliable and valid measures of young adolescents' drug use and violent behaviors, as well as intrapersonal, social, and environmental factors related to those behaviors.
Incidence and patterns of childhood burn injuries in the Western Cape, South Africa.
- Van Niekerk A, Rode H, Laflamme L. Burns 2004; 30(4): 341-347.
Correspondence: A. Van Niekerk, Pediatric Surgery, Red Cross Children's Hospital, University of Cape Town, Rondebosch 7701, SOUTH AFRICA; (email: ashley.vanniekerk@mrc.ac.za).
The current study describes the epidemiology and patterns of moderate to severe childhood burn injuries in the Western Cape province in South Africa. Burn injuries sustained by children aged 12 years and younger and registered over January 1999 to December 2000 at the Red Cross Children's Hospital in the Western Cape are analysed ( [Formula: see text] ). Differences in risk distribution between different segments of the population are measured and typical injury patterns are identified. The results show that burn injury incidence is particularly high for toddlers (15.8/10000 child-years/c-y) and infants (14.6/10000 c-y) for boys (7.0/10000 c-y), and for African children (11.4/10000 c-y). Burn injury incidence is highest in winter (1.7/10000 c-y) but only significantly greater than the rate in summer (1.3/10000 c-y). Further, four burn injury patterns are identified, and labeled 'infant scalding', 'toddler scalding', 'injuries among older children with an over-representation of flame-related burns' and 'other causes of burns sustained to the head and neck region'. In sum, the risk of burn injury is higher in younger children. Differences between genders were more pronounced among younger and older age groups. Differences between population groups are more important in magnitude than in nature. The patterns identified can stimulate further research and development into the household product and environmental contributors to childhood burn injury.
Accidents will happen? Unintentional childhood injuries and the effects of child care regulations.
Correspondence: Janet Currie, Department of Economics, UCLA and NBER, 405 Hilgard Avenur, Los Angeles, CA 90095-1477, USA; (email: currie@simba.sscnet.ucla.edu).
Accidents are the leading cause of death and injury among children in the United States, far surpassing diseases as a health threat. We examine the effects of child care regulation on rates of accidental injury using both micro data from the National Longitudinal Survey of Youth, and Vital Statistics mortality records. Estimates from both data sources suggest that requiring day care center directors to have more education reduces the incidence of unintentional injuries. An auxiliary analysis of the choice of child care mode confirms that these regulations are binding and that higher educational requirements tend to crowd some children out of care, as do regulations requiring frequent inspections of child care facilities and lower pupil-teacher ratios. Thus, regulation creates winners and losers: Some children benefit from safer environments, while those who are squeezed out of the regulated sector are placed at higher risk of injury.
The Canadian Adverse Events Study: the incidence of adverse events among hospital patients in Canada.
- Baker GR, Norton PG, Flintoft V, Blais R, Brown A, Cox J, Etchells E, Ghali WA, Hebert P, Majumdar SR, O'Beirne M, Palacios-Derflingher L, Reid RJ, Sheps S, Tamblyn R. CMAJ 2004; 170(11): 1678-1686.
Correspondence: G. Ross Baker, Department of Health Policy, Management and Evaluation (Baker, Flintoft, Brown) and of Medicine (Etchells, Hebert), University of Toronto, Toronto, CANADA; (email: ross.baker@utoronto.ca).
BACKGROUND: Research into adverse events (AEs) has highlighted the need to improve patient safety. AEs are unintended injuries or complications resulting in death, disability or prolonged hospital stay that arise from health care management. We estimated the incidence of AEs among patients in Canadian acute care hospitals.
METHODS: We randomly selected 1 teaching, 1 large community and 2 small community hospitals in each of 5 provinces (British Columbia, Alberta, Ontario, Quebec and Nova Scotia) and reviewed a random sample of charts for nonpsychiatric, nonobstetric adult patients in each hospital for the fiscal year 2000. Trained reviewers screened all eligible charts, and physicians reviewed the positively screened charts to identify AEs and determine their preventability.
FINDINGS: At least 1 screening criterion was identified in 1527 (40.8%) of 3745 charts. The physician reviewers identified AEs in 255 of the charts. After adjustment for the sampling strategy, the AE rate was 7.5 per 100 hospital admissions (95% confidence interval [CI] 5.7- 9.3). Among the patients with AEs, events judged to be preventable occurred in 36.9% (95% CI 32.0%-41.8%) and death in 20.8% (95% CI 7.8%-33.8%). Physician reviewers estimated that 1521 additional hospital days were associated with AEs. Although men and women experienced equal rates of AEs, patients who had AEs were significantly older than those who did not (mean age [and standard deviation] 64.9 [16.7] v. 62.0 [18.4] years; p = 0.016).
COMMENTS: The overall incidence rate of AEs of 7.5% in our study suggests that, of the almost 2.5 million annual hospital admissions in Canada similar to the type studied, about 185, 000 are associated with an AE and close to 70 000 of these are potentially preventable.
Correspondence: Katherine E. Gregory, William F. Connell School of Nursing, Boston College, Chestnut Hill, MA, USA; (email: katherine.gregory.2@bc.edu).
Use of bibliotherapy to address childhood teasing and bullying is an innovative approach school nurses should consider as they work to promote a healthy school environment. Children's books serve as a unique conduit of exchange between parents, teachers, and children. Bibliotherapy, using books to help people solve problems, involves three stages: identification, catharsis, and insight. These stages lend themselves well to coping with the sensitivities related to teasing and bullying. Salient research findings pertinent to teasing and bullying have made their way into the children's literature and have been well received by children and their families over the course of the Child Adolescent Teasing in Schools (CATS) book review project and web site development. After exposure to a fictional story about teasing and bullying, children have shared their own nonfictional account of this often devastating experience and have come to develop successful coping strategies for dealing with the teasing and bullying that takes place in schools nationwide.
Principals' perceptions and practices of school bullying prevention activities.
The purpose of this study was to examine principals' perceptions and practices regarding bullying prevention. A survey instrument was developed to assess principals' stages of change and perceived barriers regarding selected bullying prevention activities as well as the effectiveness of bullying prevention activities. Of a national random sample of 700 principals to which the survey was mailed, 55% responded. None of the school-based bullying prevention activities were being done by more than one in five schools even though principals perceived there to be no barriers regarding these activities. Characteristics that affected the offering of these activities included number of perceived barriers to implementing the activity, whether the principal had received violence/bullying prevention training, perceptions regarding the extent of bullying, and the number of bullying problems reported to them. The findings suggest that preprofessional training and continuing education are needed to educate principals regarding this area.
The prevalence of balance symptoms (vertigo, dizziness, and dysequilibrium) was investigated in an epidemiological study of elderly people, the longitudinal and cross-sectional gerontological and geriatric population study from Goteborg, Sweden (H70). Three different age cohorts were studied, one at age 70, one at age 75 and one at ages 79, 82, 85, 88 and 90 years. Altogether 2011 participants answered the questionnaire at 3197 occasions. The overall prevalence of balance problems at age 70 was 36% (women) and 29% (men). Balance symptoms were more common among women than men, and increased with increasing age. At ages 88-90 years the corresponding values were 51-45%. The most common symptom was poor balance/general unsteadiness (11-41%). Rotatory symptoms occurred in 2-17%. Other types of symptoms were less common. Precipitating factors were rising from supine to sitting position in 17-40%. Balance symptoms in a side position were uncommon, but occurred more often when tilting the head backwards (up to 14%). Signs that possibly could indicate neurological involvement were uncommon. Falls in conjuncture to dizziness, vertigo and similar symptoms occurred in 7-15%, in about equal proportions indoors as outdoors.
Effect of electronic ANR and conventional hearing protectors on vehicle backup alarm detection in noise.
Correspondence: John G. Casali, Grado Department of Industrial and Systems Engineering, Virginia Polytechnic Institute and State University, Blacksburg, Virginia 24061, USA; (email: jcasali@vt.edu).
An experiment was conducted wherein masked thresholds (using ascending method of limits) for a backup alarm were obtained in pink and red noise at 85 and 100 dBA for 12 participants immersed in a probability monitoring task and wearing a conventional passive hearing protection device (HPD, an earmuff or a foam earplug), an active noise reduction (ANR) headset, or no HPD at all (only in 85 dBA noise). Results revealed statistically significant between-HPD differences in red noise (from 2.3 to 3.1 dB) and in the 100-dBA noise level (from 2.6 to 4.3 dB). An additional finding, which corroborates other studies using different protocols, was that masked thresholds in 85-dBA noise were significantly lower (from 3.2 to 4.4 dB) for the occluded conditions (wearing an HPD) than for the open-ear (unoccluded) condition. This result refutes the belief among many normal-hearing workers that the use of HPDs in relatively low levels of noise compromises their ability to hear necessary workplace sounds. Actual or potential applications of this research include (a) the selection of appropriate HPDs for low-frequency-biased noise exposures wherein signal detection is important and (b) gaining insight into the appropriateness of ANR-based HPDs for certain industrial noise environments.
Correspondence: Atsuo Murata, Hiroshima City University, Department of Computer and Media Technologies, 3-4-1, Ozukahigashi, Asaminami-ku, Hiroshima 731-3194, JAPAN; (email: murata@cs.hiroshima-cu.ac.jp).
The current study was designed to examine whether increasing foveal task complexity would cause the functional field to shrink as a result of a visual funneling effect. Using 8 male participants, the study examined whether the effects of foveal task complexity on peripheral performance was most pronounced at the far periphery. The response time to an addition task using foveal vision tended to increase with the increase of the visual angle. The percentage correct, however, did not differ among 3 levels of task complexity or among 4 levels of visual angle. The miss rate in the peripheral vision task tended to increase with the increase in not only the complexity of the foveal task but also the visual angle. This is indicative of visual funneling. However, greater funneling was not necessarily observed for response time. In this study, response time was not a sensitive measure of visual funneling. Actual or potential applications of this research include safe driving and other vigilance tasks.
Correspondence: Linda Chaudron, Center for the Study and Prevention of Suicide, Department of Psychiatry, University of Rochester School of Medicine, USA; (email: linda_chaudron@urmc.rochester.edu).
Despite increasing attention to suicide as a preventable outcome associated with mood disorders, little attention has been given to the risk factors for suicide among women. In this paper, we: 1) review the current literature regarding risk factors for suicide among women; 2) address the theories regarding risk and protective factors for women; 3) integrate the findings into a practical assessment of women's risk of suicide in clinical settings; and 4) consider avenues for future research.
Suicide in Canada's immigrant population.
- Malenfant EC. Health Rep 2004; 15(2): 9-17.
Correspondence: Eric Caron-Malenfant, Demography Division at Statistics Canada, Ottawa, Ontario, K1A 0T6, CANADA; (email: Eric.Caron-Malenfant@statcan.ca).
OBJECTIVES: This article compares suicide in the immigrant and Canadian-born populations.
DATA SOURCES: The suicide data are from the Canadian Vital Statistics Data Base and the World Health Statistics Annual of the World Health Organization. The socio-demographic information used to determine denominators for suicide rates in Canada comes from the Census of Population.
METHODS: Age-standardized suicide rates by sex and place of residence were calculated for the immigrant and Canadian-born populations, as were age- and sex-specific suicide rates. Three-year average rates, centred on census years 1991 and 1996, were used. A weighted data set based on 8 of the top 10 countries of birth for immigrants to Canada was created for international comparisons. Differences between rates were tested for statistical significance.
FINDINGS: Suicide rates for the immigrant population were about half those for the Canadian-born. Among immigrants, suicide rates increase with age; among the Canadian-born, suicide is a "younger" phenomenon. Although male suicide rates exceeded female rates in both populations, the difference was less pronounced among immigrants. The pattern of suicide among immigrants was more like that in their countries of origin than that of the Canadian-born population. Immigrants living in Toronto, Montreal and Vancouver had lower suicide rates than immigrants in other parts of Canada.
Building a case for understanding the lived experiences of males who attempt suicide in Alberta, Canada.
Building a case for understanding the lived experiences of males who attempt suicide in Alberta, CanadaSuicide is a serious public health concern in Alberta, with, on average, over 400 Albertans taking their own lives annually. The case for concern is even more pronounced when one considers that for younger Albertans (those aged less than 45 years), suicide is the second leading cause of death. While trends in rates of suicide fluctuate over time, it is important to note that suicide rates for males have been at least three times higher than the corresponding rates for females since the 1950s. Furthermore, these differences have increased so that, by the 1990s the rate for male suicide was four times higher than that of females. In addition, rates are increasing at a faster pace in younger cohorts. Despite the existence of numerous positivistically orientated studies, and the introduction of a range of strategies to help prevent suicide, significant reductions in suicide rates have not been achieved. Similarly, while there is a substantial literature on the issue of suicide in Canada, there remain many gaps in our knowledge. Our understanding of the experiences and the meanings attributed to these experiences that motivate contemporary Albertan males to attempt suicide is far from complete. In order to design interventions to help reduce the suicide rate, whether these are interventions at the preprimary, primary or secondary level of care, it is necessary to gain a more detailed and comprehensive understanding of this highly complex behaviour. Consequently, there is an urgent need to better understand the particular life experiences and the meanings that individuals attach to these experiences. Accordingly, this paper makes the case for the use of hermeneutic, phenomenological investigations, as a means to further elucidate the lived experiences of suicidal Alberta males.
Screening for suicide risk in adults: a summary of the evidence for the U.S. Preventive Services Task Force.
- Gaynes BN, West SL, Ford CA, Frame P, Klein J, Lohr KN. Ann Intern Med 2004; 140(10): 822-835.
Correspondence: Bradley N. Gaynes, University of North Carolina at Chapel Hill, Chapel Hill 27599, USA; (email: bradley_gaynes@med.unc.edu).
BACKGROUND: Suicide is the 11th leading cause of death and the seventh leading cause of years of potential life lost in the United States. Although suicide is of great public health significance, its clinical management is complicated.
OBJECTIVE: The authors systematically reviewed the literature to determine whether screening for suicide risk in primary care settings decreases morbidity, mortality, or both.
DATA SOURCES: MEDLINE (1966 to 17 October 2002), PsycINFO, Cochrane databases, hand-searched bibliographies, and experts.
STUDY SELECTION: For screening, only English-language studies performed in primary care settings were examined. For treatment, randomized, controlled trials and cohort studies were included if they were performed in any setting where suicide completions, suicide attempts, or suicidal ideation were reported.
DATA EXTRACTION: A primary reviewer abstracted data on key variables of study sample, design, and outcomes; a second reviewer checked information accuracy against the original articles.
DATA SYNTHESIS: No study directly addressed whether screening for suicide in primary care reduces morbidity and mortality. The remainder of the review focused on the questions of reliable screening tests for suicide risk and the effectiveness of interventions to decrease depression, suicidal ideation, and suicide attempts or completion. One screening study provided limited evidence for the accuracy of suicide screening in a primary care setting. Intervention studies provided fair and mixed evidence that treating those at risk for suicide reduces the number of suicide attempts or completions. The evidence suggests mild to moderate improvement for interventions addressing intermediate outcomes such as suicidal ideation, decreased depressive severity, decreased hopelessness, or improved level of function.
CONCLUSION: Because of the complexity of studying the risk for suicide and the paucity of well-designed research studies, only limited evidence guides the primary care clinician's assessment and management of suicide risk.
Correspondence: Rakhi Dandona, Centre for Public Health Research, Administrative Staff College of India, Bella Vista, Raj Bhavan Road, Hyderabad 500082, INDIA; (email: rakhi@asci.org.in).
(Copyright 2004, The National Medical Journal of India - All India Institute of Medical Sciences)
CONTEXT: Road traffic crashes are an important cause of death and disability in India. Reliable and accurate data are necessary to plan strategies to reduce death and disability due to road traffic crashes. We assessed the utility of the available data on deaths due to road traffic crashes for road crash surveillance for a major metropolitan city of southern India.
METHODS: We analysed the Department of Police database on deaths due to road traffic crashes for 2002 in Hyderabad, southern India and collected data from a leading newspaper for the same information using a standardized format.
FINDINGS: A total of 3039 cases of road traffic crashes were recorded in the police database for 2002, including 400 cases (13.2%) in which 411 people were killed. In the same year, 316 cases of road traffic crashes resulting in 353 deaths were reported in the newspaper. The majority of those who died due to these crashes were males. Seventy per cent of those killed were between 16 and 49 years of age. Pedestrians and riders of two-wheelers were the most vulnerable. Collision with a vehicle caused 86.4% of all crashes and 60% of the victims died before reaching a hospital. The available data were not comprehensive enough to provide a thorough basis for planning intervention strategies to reduce fatalities due to road crashes.
COMMENTS: Despite the gaps in reporting of fatalities in road traffic crashes in these data sources, they provide insights into the magnitude and nature of deaths resulting from such crashes in Hyderabad. The available data have limitations and there is a need for strengthening the road traffic crash surveillance system to have reliable, accurate and adequate data on road traffic crashes and the resulting fatalities and injuries. These could then form the basis for planning effective intervention strategies to improve road safety.
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 "genetics" of driving behavior: parents' driving style predicts their children's driving style.
- Bianchi A, Summala H. Accid Anal Prev 2004; 36(4): 655-659.
Correspondence: Heikki Summala, Department of Psychology, Traffic Research Unit, P.O. Box 9, University of Helsinki, Helsinki 00014, FINLAND; (email: heikki.summala@helsinki.fi).
It can be hypothesized that children inherit their parents' driving habits both through genetic disposition and model learning. A few studies have shown indeed that parents' and their children's traffic convictions and accidents correlate which, however, may be due to life style and other exposure factors. This study aimed at investigating the relationships between parents' and their children's self-reported driving behavior. The subjects were 174 parent-child pairs who independently completed a questionnaire. Driving behavior-driving style-was evaluated by means of Manchester driver behavior questionnaire (DBQ), while data about driving exposure, life style, accidents, and traffic tickets were also collected. A series of regression models indicated that parents' self-reported driving behavior explains their children's respective self-reported behavior, even when exposure and demographic and life-style factors are controlled.
Estimating the safety performance of urban road transportation networks.
Transportation planning models are typically used to estimate future traffic patterns, peak period traffic, travel time, and various environmental or other related traffic flow characteristics. Unfortunately, traffic safety is seldom, if ever, explicitly considered proactively during the transportation planning process. This omission is attributed to various factors, including the lack of available tools needed to estimate the number of crashes during this process. To help fill this void, the research on which this paper is based aimed, as a primary objective, to develop a tool that would allow the estimation of crashes on digital or coded urban transportation networks during the planning process. The secondary objective of the research was to describe how the predictive models should be applied on these networks and explain the important issues and limitations surrounding their application. To accomplish these objectives, safety performance functions specifically created for this work were applied to two sample digital networks created with the help of EMME/2, a software package widely used in transportation planning. The results showed that it is possible to predict crashes on digital transportation networks, but confirmed the reality that the accuracy of the predictions is directly related to the precision of the traffic flow estimates. The crash predictions are also sensitive to how the digital network is coded, and it is shown how appropriate adjustments can be made.
A spatial and temporal analysis of safety-belt usage and safety-belt laws.
Correspondence: Robert B. Noland, Department of Civil and Environmental Engineering, Centre for Transport Studies, Imperial College of Science, Technology and Medicine, London SW7 2BU, UK; (email: r.noland@ic.ac.uk).
Safety-belt usage has increased significantly in the US since the introduction of mandatory safety-belt usage laws in the 1980s. This paper analyzes the impact of these laws on increasing safety-belt usage while controlling for other state-specific variables. A fixed effects cross-sectional time-series analyses shows the relative significance of various state-level attributes in explaining safety-belt usage, including whether or not primary or secondary safety-belt laws have been passed. To further explore these relationships we employ spatial analyses techniques and find spatial autocorrelation in the data. Spatial correlation also exhibits a clear east-west direction. When the analyses is further corrected for temporal autocorrelation we find that the spatial autocorrelation is greatly diminished and that many variables lose their statistical significance, though safety-belt laws are still statistically significant. Results suggest that for this data, it is critical to control for temporal autocorrelation while spatial autocorrelation is less important. We also find that our spatial analyses does provide interesting information on similarities between various regions on the effectiveness of safety-belt laws.
Does increased confidence among novice drivers imply a decrease in safety?; The effects of skid training on slippery road accidents.
- Katila A, Keskinen E, Hatakka M, Laapotti S. Accid Anal Prev 2004; 36(4): 543-550.
Correspondence: Ari Katila, Department of Psychology, University of Turku, Turku, FIN 20014, FINLAND; (email: ari.katila@utu.fi).
Finnish driver training was renewed in 1990 with the inclusion of a compulsory skid training course in the curriculum. The study evaluated the renewal's effect on accidents in slippery road conditions. A questionnaire was sent by mail to 41,000 novice drivers who were randomly selected from the official register of driving licences. It included questions on driving exposure and the accidents the drivers had been involved in during 6-18 months following licensing. The rate of return was 74.7%. Half of the drivers had received their licence in 1989 and had, therefore, not received any skid training. The other half had received their licence in 1990 after the introduction of the skid training course. The results showed no effects of the renewal on slippery road accidents for either male or female drivers. Another questionnaire was sent to 1300 old and new curriculum drivers immediately after licensing and a second time 1/2-1 year later, both with questions about skills, worries and perceived risks regarding driving in slippery conditions. The new curriculum drivers showed higher confidence in their skills and they were less afraid to drive in slippery conditions than the old curriculum drivers. This increase in confidence as a result of skid training is discussed. It is argued that high confidence in one's personal skills does not necessarily imply negative safety. The crucial factor is how these skills are used, and for what purpose.
Injunctive social norms of adults regarding teen dating violence.
- Taylor CA, Sorenson SB. J Adolesc Health 2004; 34(6): 468-479.
Correspondence: Catherine A. Taylor, Department of Community Health Sciences, UCLA School of Public Health, Los Angeles, California, USA; (email: cat28@cornell.edu).
OBJECTIVE: To assess applied injunctive social norms of adults regarding teen dating violence (TDV) and compare them with those regarding adult domestic violence (ADV).
METHODS: A total of 3679 California adults from six ethnic groups (roughly equal numbers of African-American, Hispanic, Korean-American, Vietnamese-American, other Asian-American, and white respondents) participated in a 27-minute interview. An experimental vignette design was used to test for associations among contextual (i.e., victim, assailant, and situational) characteristics of TDV and ADV, respondent demographic characteristics, and injunctive social norms (i.e., whether adults thought the behavior was wrong, illegal, or should be illegal, police should be called, or a restraining order issued). Data were analyzed using multivariate logistic regression, controlling for vignette variables (i.e., contextual characteristics) and respondent characteristics. Interactions were examined to test for differences in responses to TDV and ADV.
FINDINGS: Nearly all adults report that most forms of TDV are wrong (97%) and should be illegal (81%), and a majority support interventions for TDV such as calling police and issuing a restraining order. TDV involving sexual assault, physical assault, or weapons received the greatest levels of support for societal intervention. Differences in respondent judgments regarding TDV and ADV were evident when the victim had been raped. Respondent characteristics generally were not associated with responses.
COMMENTS: Findings suggest that there is general public support for prevention and intervention strategies aimed at reducing and responding to TDV, and may inform efforts to alter social norms and expectations regarding TDV.
Comparison between the abuse assessment screen and the revised conflict tactics scales for measuring physical violence during pregnancy.
Correspondence: M. E. Reichenheim, Departamento de Epidemiologia, Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rua São Francisco Xavier, 524, 7 andar, 20559-900-Rio de Janeiro-RJ, BRAZIL; (email: michael@ims.uerj.br).
OBJECTIVE: Because of the promise of its ability to quickly identify cases of violence against women during pregnancy, the abuse assessment screen (AAS) should be the focus of numerous psychometric evaluations. This paper assesses its measurement accuracy compared with the revised conflict tactics scales (CTS2) used as standard.
DESIGN: Cross sectional study. Besides several ancillary questions, the AAS consists of three anchor questions about violence against pregnant women. These are inclusive, respectively covering lifetime, preceding 12 months, and pregnancy periods. These questions are the main focus of this article. The CTS2 physical aggression scale consists of 12 items divided into minor and severe subscales. A positive event is defined as having at least one positive item in the respective subscale. The 12 item score is also used.
SETTING AND PARTICIPANTS: The instruments were applied to 748 women, 24 to 72 hours after delivery in three major public sector maternity wards of Rio de Janeiro from March to September 2000. Main results: According to the CTS2, prevalences of minor and severe physical violence perpetrated against a pregnant woman are 18.4% (95% CI 15.7 to 21.4) and 7.6% (95% CI 5.8 to 9.8), respectively. Taking these subscales as standards, sensitivities are 31.9% (95% CI 24.9 to 40.3) and 61.4% (95% CI 47.6 to 74.0), respectively. Specificities are above 97%.
COMMENTS: These findings are somewhat worrying because the number of victims who are not identified and offered assistance is considerable. On a practical note, it would be sensible not to use the AAS as a stand alone screening tool until more evidence is gathered.
Domestic violence in Puerto Rican gay male couples: perceived prevalence, intergenerational violence, addictive behaviors, and conflict resolution skills.
Domestic violence (DV) is a pattern of behaviors in the context of an intimate relationship, which can be manifested in emotional, physical, or sexual abuse. DV currently represents a social and a public health issue. This study is an effort to foster a better understanding of DV among same-sex couples. In it, the authors included the participation of 199 Puerto Rican gay males to identify prevalence of DV, violence in their family of origin, participants' addictive behaviors and exposure to violence at childhood, and their conflict resolution skills. Participants were relatively young, highly educated Puerto Rican gay men who reported a high level of domestic violence in their relationships. This violence was identified as emotional violence by 48% of the participants. This sample reported high levels of violence among their families of origin and low conflict resolution skills.
Defense Mechanisms and Self-Reported Violence Toward Partners and Strangers.
- No authors listed. J Pers Assess 2004; 82(3): 317-320.
We examined the relationship between defense mechanisms and self-reported violence toward partners and toward strangers in a sample of college student men. Fifty men completed the Thematic Apperception Test (TAT; Murray, 1943) and the Conflict Tactics Scale (CTS; Straus, 1979), a self-report measure of strategies (including violence) for resolving conflicts with partners and strangers. The TAT responses were coded for defense mechanisms with the Defense Mechanisms Manual (Cramer, 1991b). The relative use of identification was negatively correlated (r = -.49, p <.001), and the relative use of projection was positively correlated (r =.49, p <.001) with the most extreme CTS report of violence toward partners. The relative use of identification was negatively correlated with the most extreme CTS report of violence toward strangers (r = -.34, p <.05). The relative use of denial was positively correlated with the most extreme CTS report of violence toward strangers (r =.32, p <.05).
The life cycle of crime guns: A description based on guns recovered from young people in California.
- Wintemute GJ, Romero MP, Wright MA, Grassel KM. Ann Emerg Med 2004; 43(6): 733-742.
Correspondence: Garen J. Wintemute, Violence Prevention Research Program, University of California-Davis, Sacramento, CA, USA; (email: gjwintemute@ucdavis.edu).
OBJECTIVE: We describe the life cycle of crime guns recovered from young people-the movement of those guns from manufacture to criminal use-and identify associations between the characteristics of those guns and their possessors, purchasers, sellers, and places of origin.
METHODS: This is a cross-sectional study of data from gun ownership tracing records compiled by the Bureau of Alcohol, Tobacco, Firearms and Explosives for 2,121 crime guns recovered in California from persons younger than 25 years and traced in 1999. Purchaser and seller data for handguns were updated when possible by linking to California handgun sales records.
FINDINGS: The 2,121 traced guns were recovered from 1,717 young people. Guns recovered from persons aged 21 to 24 years were most frequently also purchased by persons aged 21 to 24 years; those recovered from persons younger than 18 years were most often purchased by persons aged 45 years or older. Small-caliber handguns made up 41.0% of handguns recovered from persons younger than 18 years but 25.2% of handguns recovered from persons aged 21 to 24 years. The median time from sale to recovery (commonly called time to crime) for all guns was 6.4 years (interquartile range 2.7 to 12.4 years). A time to crime of less than 3 years, suggesting deliberate gun trafficking, was observed for 17.3% of guns recovered from persons younger than 18 years but 34.6% of guns recovered from persons aged 21 to 24 years. Ten retailers who sold 10 or more traced guns accounted for 13.1% of all guns traced to a retailer. Handguns whose purchaser and possessor were the same person were more likely than others to be large-caliber semiautomatic pistols (29.3% and 11.7%, respectively); their median time to crime was 0.2 years (69 days).
COMMENTS: Analysis of crime-gun ownership traces reveals patterns that may help refine gun violence prevention efforts and render them more effective.
Teaching safety skills to children to prevent gun play.
Research has shown that children often engage in gun play when they find a firearm and that this behavior is often involved in unintentional firearm injuries. Previous research has shown existing programs to be ineffective for teaching children safety skills to reduce gun play. This study examined the effectiveness of a behavioral skills training (BST) program supplemented with in situ training for teaching children safety skills to use when they find a gun (i.e., don't touch, leave the area, tell an adult). Eight 4- to 5-year-old children were trained and assessed in a naturalistic setting and in a generalized setting in a multiple baseline across subjects design. Results showed that 3 of the children performed the skills after receiving BST, whereas 5 of the children required supplemental in situ training. All children in the study learned to perform the skills when assessed in a naturalistic setting and when assessed in a generalization setting. Performance was maintained at 2- to 8-week follow-up assessments.
