Correspondence: Sami Pirkola, Department of Mental Health and Alcohol Research, National Public Health Institute, Helsinki, Finland Health and Social Services Division, STAKES National Research and Development Centre for Welfare and Health, Helsinki, FINLAND; (email: unavailable).
The association of alcohol dependence with suicidal behaviour is well established although complex. On the basis of epidemiological and clinical evidence, alcohol dependence is known to increase the risk for suicidal ideation, suicide attempts and completed suicide. However, this risk is modulated by a wide variety of factors including sociodemographic, clinical, treatment-related and life situational characteristics as well as current drinking status and the effect of inebriation. Treatment and management of patients with alcohol dependence and concomitant suicidal communication or suicide attempts is crucial, as is the recognition of these patients in emergency and other healthcare service contacts. The treatment strategies cannot be based on evidence derived from randomised clinical trials as such data do not exist. They must rather be based on current knowledge of risk factors for suicidal behaviour, efficacy of treatment for alcohol dependence or relevant co-morbid conditions and problems known to be common in treatment settings. In this article, we review the essential literature on the epidemiological and clinical research in the areas of alcohol dependence and suicidal behaviour.On the basis of current data and clinical experience, we suggest the following principles be followed in the management of alcohol-dependent individuals: (i) suicidal threats or communication by alcohol-dependent individuals in emergency and other contacts should be taken seriously; (ii) other mental disorders should be well evaluated, a consequent treatment plan initiated and follow-up arranged; (iii) appropriate and up-to-date pharmacological treatment should focus on both reducing the amount of drinking and treating symptoms of other mental disorders; (iv) psychotherapeutic efforts should be focused on emerging symptoms of both alcohol use and other mental disorders; and (v) known epidemiological and clinical risk factors, adverse life events in particular, should be recognised and taken into account.
Correspondence: Roger Mitchell, Department of Psychology, North Carolina State University, Raleigh, NC, 27695-7801, USA, (email: Roger_Mitchell@ncsu.edu).
Although community coalitions are an increasingly popular mechanism for attempting to change community-wide health, the empirical evidence has been mixed at best. Technical Assistance (TA) efforts have emerged in greater scale in hopes of improving both programming quality as well as the coalition structures supporting such programs. However, this commitment to TA interventions has outstripped our knowledge of optimal ways to deliver such assistance, and its limitations. This study takes advantage of results from a state-wide technical assistance project that generated longitudinal data on 41 health-oriented coalitions. The following questions were addressed: What are the circumstances under which coalitions will utilize available assistance? What are the effects of technical assistance on intermediate community outcomes? The results suggested that coalitions with greater initial "capacity" used more TA. Coalitions with low utilization mentioned difficulty in identifying their TA needs as the salient reason for not pursuing these resources. Over time, there were significant positive changes in coalition effectiveness as perceived by key informants, but these were not influenced by amount of TA.
The impact of the Prestige disaster on human health.
- Porta M, Casal Lareo A, Castano-Vinyals G. Gac Sanit 2004; 18 Suppl 1: 245-249.
Correspondence: M. Porta, Instituto Municipal de Investigacion Medica, Barcelona, Area de Medicina Preventiva y Salud Publica, Universidad Autonoma de Barcelona, Cerdanyola, Barcelona, SPAIN; (email: unavailable).
The worst environmental disaster of the history of Spain favoured a renewed social awareness of the intimate relationships that exist between the state of the environment and the health of human beings. However, the health of the populations most involved in the Prestige oil spill was initially not the chief concern of political authorities. The main aims of the present paper are: first, to comment succinctly on some of the most significant activities conducted by a variety of social actors during the Prestige crisis; and second, to suggest the main potential objectives and characteristics of the epidemiological studies necessary to assess with a sound rational basis the possible impact of the accident on the health of workers, volunteers and residents in the spill areas. The authors hope that in the near future it will be possible to scientifically assess the results and implications of several studies (epidemiological and of other sorts) well designed and conducted.
Advances in analytical technologies for environmental protection and public safety.
- Sadik OA, Wanekaya AK, Andreescu S. J Environ Monit 2004; 6(6): 513-522.
Correspondence: Omowunmi Sadik, Department of Chemistry, State University of New York at Binghamton, PO Box 6000, Binghamton, NY 13902, USA; (email: OSADIK@Binghamton.edu).
Due to the increased threats of chemical and biological agents of injury by terrorist organizations, a significant effort is underway to develop tools that can be used to detect and effectively combat chemical and biochemical toxins. In addition to the right mix of policies and training of medical personnel on how to recognize symptoms of biochemical warfare agents, the major success in combating terrorism still lies in the prevention, early detection and the efficient and timely response using reliable analytical technologies and powerful therapies for minimizing the effects in the event of an attack. The public and regulatory agencies expect reliable methodologies and devices for public security. Today's systems are too bulky or slow to meet the "detect-to-warn" needs for first responders such as soldiers and medical personnel. This paper presents the challenges in monitoring technologies for warfare agents and other toxins. It provides an overview of how advances in environmental analytical methodologies could be adapted to design reliable sensors for public safety and environmental surveillance. The paths to designing sensors that meet the needs of today's measurement challenges are analyzed using examples of novel sensors, autonomous cell-based toxicity monitoring, 'Lab-on-a-Chip' devices and conventional environmental analytical techniques. Finally, in order to ensure that the public and legal authorities are provided with quality data to make informed decisions, guidelines are provided for assessing data quality and quality assurance using the United States Environmental Protection Agency (US-EPA) methodologies.
Predictors for falls among hospital inpatients with impaired mobility.
- Vassallo M, Vignaraja R, Sharma JC, Briggs R, Allen SC. J R Soc Med 2004; 97(6): 266-269.
Correspondence: Michael Vassallo, Royal Bournemouth Hospital, Castle Lane East, Bournemouth BH7 7DW, UK; (email: michael.vassallo@rbch-tr.swest.nhs.uk).
Gait and balance disturbances have been shown to predispose to falls in hospital. We aimed to investigate the patient characteristics associated with an unsafe gait and to determine what features predispose to falling in this group of hospital inpatients. In a prospective open observational study we studied 825 patients admitted for rehabilitation following acute medical illness or a surgical procedure. The patient's gait was assessed with the 'get up and go' test and classified into one of four categories-normal; abnormal but safe with or without mobility aids; unsafe; or unable. 72.6% of patients were assessed as having an unsafe gait. The factors independently associated with an unsafe gait were confusion, abnormal lower limbs, hearing defects and the use of tranquillizers. Patients with an unsafe gait who fell were more likely than the non-fallers within the group to have had falls in the past (85.3% versus 73.8%) and to be confused (66.2% versus 34.1%). Patients with both these characteristics had a 37.5% chance of falling compared with 15.4% in patients with one and 11.2% in patients with none of these characteristics. The presence of confusion and a history of falls identifies those patients who are at greatest risk of falls. Such patients might be the focus of special efforts at falls prevention.
Correspondence: Jill C. Posner, The University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, Injury Free Coalition for Kids of Philadelphia, Philadelphia, Pennsylvania, USA; (email: posner@email.chop.edu).
OBJECTIVE: To assess the effectiveness of an emergency department (ED)-based home safety intervention on caregivers' behaviors and practices related to home safety.
METHODS: We conducted a randomized, clinical trial of 96 consecutive caregivers of children who were younger than 5 years and presented to an urban pediatric ED for evaluation of an acute unintentional injury sustained in the home. After completing a structured home safety questionnaire via face-to-face interview, caregivers were randomly assigned to receive either comprehensive home safety education and free safety devices or focused, injury-specific ED discharge instructions. Participants were contacted by telephone 2 months after the initial ED visit for repeat administration of the safety questionnaire. The pretest and posttest questionnaires were scored such that the accrual of points correlated with reporting of safer practices. Scores were then normalized to a 100-point scale. The overall safety score reflected performance on the entire questionnaire, and the 8 category safety scores reflected performance in single areas of home injury prevention (fire, burn, poison, near-drowning, aspiration, cuts/piercings, falls, and safety device use). The main outcome was degree of improvement in safety practices as assessed by improvement in safety scores.
FINDINGS: The intervention group demonstrated a significantly higher average overall safety score at follow-up than the control group (73.3% +/- 8.4% vs 66.8% +/-11.1) and significant improvements in poison, cut/piercing, and burns category scores. Caregivers in the intervention group also demonstrated greater improvement in reported use of the distributed safety devices.
COMMENTS: This educational and device disbursement intervention was effective in improving the home safety practices of caregivers of young children. Moreover, the ED was used effectively to disseminate home injury prevention information.
The New Zealand child work-related fatal injury study: 1985-1998.
- Lilley R, Feyer AM, Langley J, Wren J. N Z Med J 2004; 117(1194): U891.
Correspondence: Rebecca Lilley, Department of Preventive and Social Medicine, University of Otago, Dunedin, NEW ZEALAND; (email: rebecca.lilley@stonebow.otago.ac.nz).
OBJECTIVE: To estimate the numbers and rates of work-related fatal injury for children under the age of 15 years.
METHODS: Potential cases of work-related injury deaths of persons aged <15 years of age were identified from the national electronic mortality data-files for the period 1985-1998 inclusive. The circumstances of the death in each fatality incident were reviewed directly from coronial files to determine work-relatedness.
RESULTS: A total of 87 workplace work-related fatalities were identified. The vast majority of children identified were fatally injured while a bystander to another person's work. Workplace bystander involvement was found to vary by age, with the majority of workers identified aged 10-14 years old. With a third of all fatalities, the agricultural industry was the most common industry for workplace work-related fatalities in children. In the period 1985-94, children <15 years of age were found to account for 46% of New Zealand's total workplace bystander deaths.
CONCLUSIONS: Children contribute significantly to the overall burden of work-related fatal injury in New Zealand, especially as bystanders to other people's work. The high contribution to bystander deaths by children aged <15 years suggests that hazard control in certain work settings is lacking.
Effects of a work injury prevention program for housekeeping in the hotel industry.
- Landers M, Maguire L. Work 2004; 22(3): 239-246.
Correspondence: Merrill Landers, Department of Physical Therapy, College of Health Sciences, University of Nevada, Las Vegas, NV 89154-39029, USA; (email: merrill.landers@ccmail.nevada.edu).
OBJECTIVE: The aim of this retrospective study was to determine the effectiveness of a work injury prevention program in the housekeeping department of a hotel. Studies have validated the use of different injury prevention strategies to decrease the incidence of work-related injuries. Few studies, however, have reported the efficacy of an on-site work injury prevention program by a physical therapist.
STUDY DESIGN: In 1995, implementation of a work injury prevention program by a physical therapist to 50 housekeeping supervisors, 60 house persons and 340 guest room attendants at a large hotel began. This program included a detailed work risk analysis of the work environment, development of job descriptions, identification of injury-related problematic work situations, and implementation of a job specific supervisor-training program. Supervisor, house person and guest room attendant training was also conducted at the end of 1995 and the beginning of 1997.
RESULTS: Data of injury reports in 1995, 1996, and 1997 were analyzed to determine the results of the program. There was a reduction in total injury claims, total medical expenses, total lost work time and total restricted duty time.
CONCLUSION: These results demonstrate the cost effectiveness of implementing a work injury prevention program for housekeeping guest room attendants in the hotel industry.
OBJECTIVES: To review the available literature regarding the: epidemiology of bicycle related head injuries; consequences of head injuries; rates of cycle helmet use; impact of educational campaigns and legislation on usage rates; effectiveness of cycle helmets in protecting against head and facial injuries; arguments against the compulsory use of bicycle helmets.
DATA SOURCES: A computerised Medline search was conducted using the keywords: head injury, facial injury, bicycle helmets, accidents.
DATA SELECTION: All available information was considered.
DATA SYNTHESIS: Data was collated manually.
COMMENTS: The wearing of bicycle helmets contributes significantly to the prevention of head injuries (HI) and traumatic brain injury (TBI), particularly in children and adolescents.There is evidence to support the role of cycle helmets in the prevention of injuries to the middle third of the face and some dental injuries. There is a case for the implementation of legislation accompanied by educational campaigns to increase significantly the use of cycle helmets.The dental profession could: play an active role in promoting cycle helmet use; support calls for the compulsory wearing of cycling helmets, particularly for children; press for modification of helmet design and standards to increase protection of the face.
Educational interventions successfully reduce pedestrians' overestimates of their own nighttime visibility.
Pedestrians dramatically overestimate their own visibility at night. This is likely to result in pedestrians unknowingly engaging in dangerous behavior. To determine the extent to which pedestrians' estimates of their own visibility are influenced by educational interventions, clothing reflectance, and headlamp beam setting, participants in 2 experiments estimated their own nighttime visibility by walking toward a stationary car to the point where they believed they were just recognizable as a pedestrian. In the first experiment 48 university students were tested and in the second experiment 9 high-school driver education students were tested. Overall, participants failed to appreciate the benefits of reflective clothing and of high-beam illumination. However, the participants in Experiment 1 who had heard a relevant lecture several weeks earlier gave estimates that were 10% shorter than did a control group. Participants in Experiment 2 heard a more focused and graphic-intensive lecture and gave estimates that were 56% shorter than did a control group. Potential applications of this research include increasing pedestrian safety by designing and implementing research-based public education campaigns aimed at reducing pedestrians' overestimates of their own nighttime visibility.
Correspondence: E. E. K. Clarke, Occupational and Environmental Health Unit, Ghana Health Service/Ministry of Health, C/O P.O. Box AN 11355, Accra-North, GHANA; (email: ochealth@ghana.com).
The need for a poison centre in Ghana has been well demonstrated over the years as evidenced by the occurrence of a variety of cases of poisoning. Important causes are accidental poisoning from mishandling of pesticides, accidental poisoning among children from kerosene and pesticide' ingestion due to unsafe storage methods in the home, use of herbal potions of unknown composition, overdoses of certain pharmaceuticals for illegal abortion, and accidental food poisonings. Bites from venomous animals particularly snakes are also common. Though preparations toward the establishment of a poison control centre started in mid 1999, it was not until early 2002 that the operations of a modest information centre commenced. Major roles the centre are currently performing include providing:an information service for health professionals on management advice in cases of poisoning; training for primary health personnel in the management of common poisonings; training for agricultural personnel in prevention and first aid management of pesticide poisoning; public awareness education and information programmes for prevention of poisoning. Some of the important challenges being faced include ensuring adequate sensitization on the need for centers particularly among health professionals, difficulties in acquiring adequate numbers of and appropriate training for staff of the centre, dedicated phone lines, literature and timely acquisition of toxicological data-bases. Others are poor networking among centers in the region and the absence of clinical and laboratory toxicology services dedicated to managing poisonings. The key lessons learned include the need for multi-sectoral involvement and support from the onset, the need to learn from experiences of established centers and the need to model requirements to suit local conditions without compromising the effectiveness of services.
Linguistic and location effects in compliance with pesticide warning labels for amateur and professional users.
- Edworthy J, Hellier E, Morley N, Grey C, Aldrich K, Lee A. Hum Factors 2004; 46(1): 11-31.
Correspondence: J Edworthy, Department of Psychology, University of Plymouth, Drake Circus, Plymouth, Devon, PL4 8AA, UK; (email: j.edworthy@plymouth.ac.uk).
Three studies explored amateur and professional users' compliance with pesticide warning labels. Professionals were classified as people working in a profession in which the use of pesticides is a necessary part of their job. Amateurs used pesticides only in their leisure time. The first study showed that the wording used affected perception of the appropriateness of hazard statements, one of the most effective variations being the use of the personal pronoun (statements beginning "You should..."). The location of warning information was also found to affect actual compliance: Compliance increased when warning information was presented in the directions for use section. A supplemental directive increased compliance only for professional users. In a final study, "best-case" and "worst-case" linguistic variations were combined with best-case and worst-case locations for safety information. Instruction statements using the personal pronoun and presented in the directions for use section resulted in the highest levels of compliance. The differences in compliance between amateur and professional users are interpreted within the framework of Rasmussen's (1986) distinction among skill-, rule-, and knowledge-based behavior. Actual or potential applications of this research include the design of warning labels and safety information.
Tackling Rugby injury: lessons learned from the implementation of a five-year sports injury prevention program.
- Chalmers DJ, Simpson JC, Depree R. J Sci Med Sport 2004; 7(1): 74-84.
Correspondence: David J. Chalmers, Injury Prevention Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, NEW ZEALAND; (email: david.chalmers@ipru.otago.ac.nz).
Rugby Union football is a very popular sport in New Zealand but of all the major sports played in that country, it has the highest reported incidence of injury. In 1995, a national rugby injury prevention program was instigated to address this problem. Known as Tackling Rugby Injury, this multifaceted program was implemented over a five-year period. The program was based on the results of a prospective cohort study of rugby injury, known as the Rugby Injury and Performance Project (RIPP), and was organised around seven themes, five relating to the prevention of injury: coaching, fitness, injury management, tackling, and foul play, and two relating to the implementation and evaluation of the program. The purpose of this paper is to describe the lessons learned from the implementation of Tackling Rugby Injury. Qualitative research methods were used to describe the process of implementation, including informant interviews, participant observation, and the scrutiny of written, visual and archival material. Among the lessons learned were the importance of basing injury prevention strategies on scientific evidence rather than popular belief, the difficulty in implementing complex interventions, the advantages of a formal agreement between partners in the implementation of a program, the central role played by coaches in promoting injury prevention strategies, and the value of describing the process of implementation as well as monitoring injury outcomes and changes in knowledge, attitudes and behaviour. It is hoped that other sports wishing to develop injury prevention programs can learn from this experience.
Epidemiology of injuries in adventure racing athletes.
- Fordham S, Garbutt G, Lopes P. Br J Sports Med 2004; 38(3): 300-303.
OBJECTIVES: To assess the demographics and training characteristics of adventure racing athletes in the United Kingdom, the prevalence and anatomical distribution of hazardous encounter, and overuse injury in this population, and the effects these injuries have on training.
METHODS: A retrospective training and injury questionnaire for the previous 18 months was distributed to 300 adventure racing athletes at two national race meetings. The definition of an injury was "any musculoskeletal problem causing a stop in training for at least one day, reduction in training mileage, taking of medicine, or seeking of medical aid."
FINDINGS: The data were derived from the responses of 223 athletes. Advanced level athletes did 11 (4) sessions and 17 (8) hours of training a week (mean (SD)). An injury was reported in the previous 18 months by 73% of the respondents. The most common site of acute injury was the ankle (23%) and of chronic/overuse injury, the knee (30%), followed by the lower back, shin, and Achilles tendon (12% each). There were significant correlations (p<0.01) between the hours spent cycling per week and number of acute injuries, and between the number of days off per week and number of chronic/overuse injuries. Injuries resulted in an average of 23 days training cessation or reduction.
COMMENTS: Acute injuries were sustained mainly as a result of the nature of the terrain over which athletes train and compete. In overuse injuries lack of adequate rest days was a significant contributing factor. Only a small proportion of training time was spent developing flexibility and core stability.
OBJECTIVE: A study was undertaken on implementing medical data collection as a tool to assess the relative number and character of intentional injuries before and during an armed conflict.
METHODS: Data on hospital contacts due to intentional injury were collected retrospectively at two hospitals in West Bank, Palestine, and classified by ICD10 and the new International Classification of External Causes of Injuries (ICECI). A three-month period prior to the current Intifada, June-August 2000 and two three-month periods of the Intifada, September-December 2000 and June-August 2001 were chosen.
FINDINGS: The number of contacts increased from 23 in the period prior to the Intifada to 740 during the first and 199 during the second period of the Intifada. During the period before the Intifada the victims were men, and no one was younger than 10 years. During the Intifada 9% were women, 3% below 10 years, and 9% aged 10-14 years. Prior to the Intifada all injuries were caused by blunt force. During the Intifada 65% of the injuries were caused by firearms or explosives, 19% by beating and 6% by gaseous substances. Among children most lesions were localized to the head, including eye and brain damage, and were mostly caused by firearms.
COMMENTS: Injury registration by ICD10 combined with ICECI codes facilitates analyses of correlations between characteristics of armed conflicts and injuries. Medical data collection is an important instrument in documentation of the effects of weapons and in surveillance of violations of humanitarian law, particularly as to the worrying magnitude of young children being seriously victimized.
OBJECTIVE: Studies of trauma patients have described patterns of injuries sustained from unfortunate encounters with large animals. However, the patterns of maxillofacial injuries have yet to be reported. The goal of this investigation was to describe and report on maxillofacial injuries that are associated with interaction with horses.
METHODS: Charts were selected from the trauma registry by E-code at a level 1 trauma center in Portland, OR. A retrospective review was performed on charts collected from the previous 5 years (1998-2002). Data were collected according to patient, pattern of injuries, and mechanism of injury.
FINDINGS: The 62 patients who were identified consisted of 15 males (24%) and 47 females (76%) and ranged in age from 1 to 83 years (average age, 32 years; most frequent age, 12 years). Most of the accidents occurred in the spring months and involved a horse known to the patient. The most common mechanism was falling from the horse. However, being kicked was correlated with a more serious injury (P =.048). The most frequent injury was abrasion/contusion (24 [39%]), second were lacerations (20 [32%]), and third were fractures (18 [29%]). Fifty (81%) were not wearing helmets. Forty-six (74%) of the patients had other associated injuries.
COMMENTS: In patients with facial injuries related to horses, younger females were the most frequently involved. Facial injuries were often associated with other types of injuries. Nearly a third of the facial injuries sustained were fractures. The percentage of riders without a helmet was high. However, in our patient population, wearing a helmet does not seem to add any protection to the face, and almost all of the accidents involved a horse known to the patient. More education aimed at horse owners regarding the use of helmets, proper handling and riding skills, and supervising young riders is encouraged to prevent further injuries.
Nonfatal and Fatal Firearm-Related Injuries Among Children Aged 14 Years and Younger: United States, 1993-2000.
Correspondence: Gabriel B. Eber, Office of Statistics and Programming, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA; (email: unavailable).
OBJECTIVE: To provide national estimates of fatal and nonfatal firearm-related (FA) injuries among children </=14 years old and to examine the circumstances under which these injuries occurred.
METHODS: For nonfatal FA injuries among children, we analyzed data on emergency department (ED) visits from the National Electronic Injury Surveillance System for 1993 through 2000. National estimates of injured children who were treated in hospital EDs were examined by selected characteristics, such as age, gender, race/ethnicity of the patient, primary body part affected, intent of the injury, the relationship of the shooter to the patient, where the injury occurred, and activity at the time of injury. For fatal FA injuries among children, we analyzed mortality data from the National Vital Statistics System for 1993 through 2000. Data from both sources were used to calculate case-fatality rates.
FINDINGS: From 1993 through 2000, an estimated 22 661 (95% confidence interval [CI]: 16 668-28 654) or 4.9 per 100 000 (95% CI: 3.6-6.2) children </= 14 years old with nonfatal FA injuries were treated in US hospital EDs. Assaults accounted for 41.5% of nonfatal FA injuries, and unintentional injuries accounted for 43.1%. Approximately 4 of 5 children who sustained a nonfatal, unintentional FA injury were reportedly shot by themselves or by a friend, a relative, or another person known to them. During this period, 5542, or 1.20 per 100 000 (95% CI: 1.17, 1.23), children </=14 years old died from FA injuries; 1 of every 5 children who were wounded by a firearm gunshot died from that injury. Most FA deaths were violence related, with homicides and suicides constituting 54.7% and 21.9% of these deaths, respectively. For individuals </=14 years old, the burden of morbidity and mortality associated with FA injuries falls disproportionately on boys, blacks, and children 10 to 14 years old. Both fatal and nonfatal injury rates declined >50% during the study period.
COMMENTS: Although rates of nonfatal and fatal FA injuries declined during the period of study, FA injuries remain an important public health concern for children. Well-designed evaluation studies are needed to examine the effectiveness of potential interventions aimed at reducing FA injuries among children.
Work-related pilot fatalities in agriculture--United States, 1992-2001.
- Centers for Disease Control and Prevention (CDC). MMWR Morb Mortal Wkly Rep 2004; 53(15): 318-320.
Aircraft often are used in agriculture to apply pesticides, herbicides, or fertilizers. During 1992-2001, a total of 141 persons died in agriculture-related plane crashes. To characterize aviation fatalities in agriculture, CDC analyzed data on fatal injuries to pilots working in U.S. agriculture during 1992-2001. This report summarizes the results of that analysis, which indicated that agricultural pilots are at increased risk for fatal injury compared with pilots in all other industries. The agriculture aviation profession continues to work to reduce fatalities by recommending continual skill development and by offering training to aerial application pilots.
Correspondence: Melissa E. DeRosier, Frank Porter Graham Child Institute, University of North Carolina at Chapel Hill, Cary, NC, 27511, USA; (email: derosier@3cisd.com).
Since September 11, 2001, ethnic tensions involving persons of Middle Eastern descent have increased in the United States. This study examined the peer relationships of 748 fifth-grade students of different ethnic groups both at one month and eight months post-9-11. Results indicated that only Middle Eastern children showed a large drop in positive peer nominations and popularity over the course of the school year. Bullying of Middle Eastern and Hispanic students also showed a significant increase. Given that peer problems and bullying are detrimental to the school climate and promote violence, the need for proactive school-based programs to foster racial tolerance is discussed.
Comparing Middle School Teachers' and Students' Views on Bullying and Anti-Bullying Interventions.
Correspondence: Laura M. Crothers, Department of Counseling and Educational Psychology, Slippery Rock University, Slippery Rock, PA, 16057-1326, USA; (email: laura.crothers@sru.edu).
This study compares middle school students' and teachers' perceptions regarding the effectiveness of intervention and prevention strategies commonly used by children, teachers, and nonteaching staff to address bullying among students as identified in the research literature. Both quantitative and qualitative methods were used. The results indicate that teachers are more likely to perceive bullying intervention and prevention strategies as effective than are students, and to perceive teachers as offering assistance to student victims. Both teachers and students appear to believe that teachers need to teach students assertiveness techniques to confront perpetrators. However, both students and teachers generally did not see as helpful some of the common educational techniques utilized by most bullying prevention programs, including role-playing and literature.
Sensorial organisation favouring higher visual contribution is a risk factor of falls in an occupational setting.
- Vouriot A, Gauchard GC, Chau N, Benamghar L, Lepori ML, Mur JM, Perrin PP. Neurosci Res 2004; 48(3): 239-247.
Correspondence: Philippe P. Perrin, Faculte de Medecine, National Institute for Health and Medical Research (INSERM), U 420, Vandoeuvre-les-Nancy, FRANCE; (email: philippe.perrin@staps.uhp-nancy.fr).
The contribution of intrinsic balance control factors to fall mechanisms has received little investigation in studies on occupational accidents. The aim of this study was to assess whether postural regulation in falling workers might have specificities in terms of sensorimotor strategies and neuromuscular responses to balance perturbations. Nine multi-fall-victims (MF), 43 single-fall-victims (SF) and 52 controls (C) were compared on performance measurements of static and dynamic postural control. MF and SF had the worst postural performance both in the static and slow dynamic tests, particularly in eyes closed conditions, suggesting a high dependency on visual cues and a lower use of proprioception. Moreover, the sensorial analysis showed that MF and SF relied less on vestibular input in the development of balance strategy and had more difficulties in maintaining a correct upright stance when proprioceptive input was altered. Finally, MF showed longer latency responses to unexpected external disturbance. Overall, postural control quality increased in the order MF, SF and C. MF and SF adopted particular sensorimotor organisation, placing them at an increased risk of falling in specific sensory environments. Strategies incorporating visual information involve using the cognitive processes causing delayed and less accurate fall avoidance responses, in contrast to adaptative strategies based on proprioceptive and vestibular information.
There has been an increase in the number of Swedish psychiatric patients who self-harm, yet self-harm is seldom described in published research. The aim of this study was to describe how people who self-harm experience received care and their desired care. Nine participants, all Swedish women who had been treated for inpatient or outpatient psychiatric care, narrated their experiences of care for self-harm. Using qualitative content analysis, two themes were formulated: 'Expecting to be confirmed while being confirmed fosters hopefulness'; and, 'Expecting to be confirmed while not being confirmed stifles hopefulness'. Each of these themes emerged from five subthemes that clustered around positive and negative aspects of being seen-not being seen, being valued-being stigmatized, being connected-disconnected, being believed-doubted, and being understood-not being understood. Of significance is for nurses to view persons who self-harm as human beings and to grasp the importance of being confirmed by staff that can foster hopefulness in persons who self-harm, yet realize the possibility of the paradoxical nature of hopefulness and being confirmed.
The epidemiology of case fatality rates for suicide in the Northeast.
- Miller M, Azrael D, Hemenway D. Ann Emerg Med 2004; 43(6): 723-730.
Correspondence: Matthew Miller, Harvard School of Public Health, Boston, MA, USA; (email: mmiller@hsph.harvard.edu).
OBJECTIVE: We examine how method-specific case fatality rates for suicide differ by age and sex.
METHODS: Seven northeastern states provided mortality and hospital discharge data (1996 to 2000). Suicide acts were divided into 8 categories according to the method used. For each method, the fraction of acts resulting in death (the method-specific case fatality rate) was calculated. Only suicide acts that resulted in hospitalization or death were included.
FINDINGS: Overall, 13% of all suicide acts proved lethal (23% for males compared with 5% for females; 7% for people aged 15 to 24 years compared with 34% for individuals aged >/=65 years). Poisoning with drugs accounted for 74% of acts but only 14% of fatalities; firearms and hanging accounted for only 10% of acts but 67% of fatalities. Firearms were the most lethal means (91% resulted in death), followed by drowning (84%) and hanging (82%). For every means, method-specific case fatality rates were higher for male victims and older individuals. Age and sex were associated with overall case fatality rates primarily because of their association with the distribution of methods chosen.
COMMENTS: Our findings are based on suicide acts that result in hospitalization or death and therefore underestimate the actual incidence of suicide acts and overestimate case fatality rates. Nevertheless, we find that age and sex influence overall case fatality rates primarily through their association with methods used, rather than because of variation in method-specific case fatality rates.
Sexual abuse and suicidality: gender differences in a large community sample of adolescents.
- Martin G, Bergen HA, Richardson AS, Roeger L, Allison S. Child Abuse Negl 2004; 28(5): 491-503.
Correspondence: Graham Martin, Department of Psychiatry, The University of Queensland, Brisbane, Qld., AUSTRALIA; (email: unavailable).
OBJECTIVE: A cross-sectional study of gender specific relationships between self-reported child sexual abuse and suicidality in a community sample of adolescents.
METHODS: Students aged 14 years on average,485) from 27 schools in South Australia completed a questionnaire including items on sexual abuse and suicidality, and measures of depression (Centre for Epidemiological Studies Depression Scale), hopelessness (Beck Hopelessness Scale), and family functioning (McMaster Family Assessment Device General Functioning Subscale). Data analysis included logistic regression.
FINDINGS: In boys, self-report sexual abuse is strongly and independently associated with suicidal thoughts, plans, threats, deliberate self-injury, and suicide attempts, after controlling for current levels of depression, hopelessness, and family dysfunction. In girls, the relationship between sexual abuse and suicidality is mediated fully by depression, hopelessness, and family dysfunction. Girls who report current high distress about sexual abuse, however, have a threefold increased risk of suicidal thoughts and plans, compared to non-abused girls. Boys who report current high distress about sexual abuse have 10-fold increased risk for suicidal plans and threats, and 15-fold increased risk for suicide attempts, compared to non-abused boys. Fifty-five percent of sexually abused boys attempted suicide versus 29% girls.
COMMENTS: A history of sexual abuse should alert clinicians, professionals and carers in contact with adolescents, to greatly increased risks of suicidal behavior and attempts in boys, even in the absence of depression and hopelessness. Distress following sexual abuse, along with depression and hopelessness indicate increased risk of suicidal behavior in girls, as well as boys.
Melancholia and the probability and lethality of suicide attempts.
Correspondence: Michael F. Grunebaum, Department of Neuroscience, New York State Psychiatric Institute, 1051 Riverside Drive, Box 42, New York, NY10032, USA; (email: mfg14@columbia.edu).
We compared suicide attempts associated with melancholic v. non-melancholic major depression in 377 patients. Controlling for depression severity and other covariates, melancholia at baseline assessment was associated with more serious past suicide attempts and with the probability of suicide attempt during follow-up.
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).
This paper presents analyses of data from the Highway Safety Information System (HSIS) for the State of Illinois. Our analyses focuses on whether various changes in road network infrastructure and geometric design can be associated with changes in road fatalities and reported accidents. We also evaluate models that control for demographic changes. County-level time-series data is used and fixed effect negative binomial models are estimated. Results cannot confirm the hypothesis that changes in road infrastructure and geometric design have been beneficial for safety. Increases in the number of lanes appears to be associated with both increased traffic-related accidents and fatalities. Increased lane widths appears to be associated with increased fatalities. Increases in outside shoulder width appear to be associated with a decrease in accidents. Inclusion of demographic results does not significantly change these results but does capture much of the residual time trend in the models. Potentially mis-leading results are found when the time trend is not included. In this case a negative association between vertical curvature and both accidents and fatalities. No statistical association with changes in safety is found for median widths, inside shoulder widths, and horizontal and vertical curvature.
Changes in mortality associated with traffic accidents in Andalusia from 1975 to 2001 and forecast for 2004.
- Ruiz Ramos M, Ocana-Riola R, Hermosin Bono T. Aten Primaria 2004; 33(6): 297-302.
Correspondence: M. Ruiz Ramos, Consejeria de Salud de la Junta de Andalucia, Sevilla, SPAIN; (email: unavailable).
OBJECTIVE: To describe the evolution of mortality due to traffic accidents in Andalusia between 1975 and 2001 and to predict the mortality rates for 2004.
DESIGN: Ecological study with a population base.
SETTING: Residents in Andalusia between 1975 and 2001.
PARTICIPANTS: Deaths due to traffic accidents in Andalusia between 1975 and 2001.Main measurements and results. Mortality rates adjusted for age in men and women and in three groups: under-35s, from 35 to 64, and over 64. The evolution of rates over time was studied through trend analysis. Short-term predictions of the mortality rates were made. The adjusted rates for men fell from 21.20 per 100 000 inhabitants in 2001 to 20.21 in 2001. The rate for women fell from 4.87 to 4.60 during the same period. The evolution of mortality was similar for both sexes. COMMENTS: Traffic accident mortality evolved in an oscillating way, with an important fall in numbers starting in 1989. Mortality rates increased with age. The predictions formulated indicate that the stable trend starting in 1995 will remain the same in the coming years.
Helmets for preventing injury in motorcycle riders.
BACKGROUND: Motorcycle crash victims form a high proportion of those killed or injured in road traffic accidents. Injuries to the head, following motorcycle crashes, are a common cause of severe morbidity and mortality. It seems intuitive that helmets should protect against head injuries but it has been argued that motorcycle helmet use decreases rider vision and increases neck injuries. This review will collate the current available evidence on helmets and their impact on mortality, and head, face and neck injuries following motorcycle crashes.
OBJECTIVES: To quantify the effectiveness of wearing a motorcycle helmet in reducing mortality and head and neck injury following motorcycle crashes.
SEARCH STRATEGY: Databases including the Cochrane Injuries Group Specialised Register, Cochrane Central Register of Controlled Trials (The Cochrane Library issue 1, 2003), MEDLINE (January 1966 to February 2003), EMBASE (January 1985 to February 2003), CINAHL (January 1982 to February 2003), IRRD (International Road Research Documentation), TRANSDOC, TRIS (Transport Research Information Service), ATRI (Australian Transport Index) (1976 to Feb 2003), Science Citation Index were searched for relevant articles. Web sites of traffic and road accident research bodies including government agencies were also searched. Reference lists from topic reviews, identified studies and bibliographies were examined for relevant articles.
SELECTION CRITERIA: We considered for inclusion studies that investigated a population of motorcycle riders who had crashed, examining helmet use as an intervention and with outcomes that included one or more of the following: death, head, neck or facial injury. Studies included any that compared an intervention and control group and, therefore, included any randomised controlled trials, non-randomised controlled trials, cohort, case-control and cross-sectional studies. Ecological and case series studies were excluded.
METHODS: Two reviewers independently screened reference lists for eligible articles. Two reviewers independently assessed articles for inclusion criteria. Data were abstracted by two independent reviewers using a standard abstraction form.
FINDINGS: Fifty-three observational studies were identified of varying quality. Despite methodological differences there was a remarkable consistency in results, particularly for mortality and head injury outcomes. Motorcycle helmets appear to reduce the risk of mortality although, due to heterogeneity in study design, an overall estimate of effect was not calculated. There was some evidence that the effect of helmets on mortality is modified by speed. Motorcycle helmets were found to reduce the risk of head injury and from five well-conducted studies the risk reduction is estimated to be 72% (OR 0.28, 95%CI 0.23, 0.35). Insufficient evidence was found to estimate the effect of motorcycle helmets compared with no helmet on facial or neck injuries. However, studies of poorer quality suggest that helmets have no effect on the risk of neck injuries and are protective for facial injury. There was insufficient evidence to demonstrate whether differences in helmet type confer more or less advantage in injury reduction.
COMMENTS: Motorcycle helmets reduce the risk of mortality and head injury in motorcycle riders who crash, although the former effect may be modified by other crash factors such as speed. Further well-conducted research is required to determine the effects of helmets and different helmet types on mortality, head, neck and facial injuries. However, the findings suggest that global efforts to reduce road traffic injuries may be facilitated by increasing helmet use by motorcyclists.
Graduated driver licensing for reducing motor vehicle crashes among young drivers.
- Hartling L, Wiebe N, Russell K, Petruk J, Spinola C, Klassen T. Cochrane Database Syst Rev 2004; 2: CD003300.
Correspondence: Lisa Hartling, Department of Pediatrics, University of Alberta, Aberhart Centre One, 11402 University Avenue, Room 9424, Edmonton, Alberta, CANADA; (email: hartling@ualberta.ca).
BACKGROUND: Graduated driver licensing (GDL) has been proposed as a means of reducing crash rates among novice drivers by gradually introducing them to higher risk driving situations.
OBJECTIVES: To examine the effectiveness of GDL systems in reducing crash rates of young drivers.
SEARCH STRATEGY: Studies were identified through searches of MEDLINE, EMBASE, CINAHL, Healthstar, Web of Science, NTIS Bibliographic Database, TRIS Online, SIGLE, the World Wide Web, relevant conference proceedings, consultation with experts and authors, and reference lists. The search was not restricted by language or publication status.
SELECTION CRITERIA: Studies were included if: 1) they compared outcomes pre- and post-implementation of a GDL program within the same jurisdiction, 2) comparisons were made between jurisdictions with and without GDL, or 3) both. Studies had to report at least one objective, quantified outcome. Two reviewers independently screened searches and assessed the full text of potentially relevant studies for inclusion using a standard form.
METHODS: Data were extracted by one reviewer and checked by a second. Additional data were requested from authors. Results were not pooled due to substantial heterogeneity between studies. Percentage change was calculated for each year after the intervention, using one year prior to the intervention as the baseline rate. Results were adjusted by internal controls. Analyses were stratified by different denominators (population, licensed drivers). Results were calculated for the different crash types (overall, injury, fatal, night-time, alcohol, and those resulting in hospitalization). Results were presented for 16 year-olds alone and all teenage drivers combined.
FINDINGS: We included 13 studies evaluating 12 GDL programs that were implemented between 1979 and 1998 in the US (n=7), Canada (3), New Zealand (1), and Australia (1). Programs varied in their restrictions during the intermediate stage: e.g. night curfews (8); limitations of extra passengers (2); roadway restrictions (1). Based on the Insurance Institute for Highway Safety classification scheme, no programs were good, six were acceptable, five were marginal, and one was poor. Reductions in crash rates were seen in all jurisdictions and for all crash types. Among 16 year-old drivers, the median decrease in per population overall crash rates during the first year was 31% (range 26-41%). Per population injury crash rates were similar (median 28%, range 4-43%). Results for all teenage drivers, rates per licensed driver, and rates adjusting for internal controls were generally reduced when comparing within jurisdictions.
COMMENTS: The existing evidence shows that GDL is effective in reducing the crash rates of young drivers, although the magnitude of the effect is unclear. The conclusions are supported by consistent direction of the findings, and the temporal relationship and plausibility of the association. The reviewers have made recommendations for primary research on GDL (e.g. study methods, standardized reporting of outcomes and results, long-term follow-up). The project has also shown what is needed to carry out systematic reviews of observational studies (e.g. quality assessment instruments).
Temporal separation and self-rating of alertness as indicators of driver fatigue in commercial motor vehicle operators.
This on-road field investigation employed, for the first time, a completely automated trigger-based data collection system capable of evaluating driver performance in an extended-duration real-world commercial motor vehicle environment. The study examined the use of self-assessment of fatigue (Karolinska Sleepiness Scale) and temporal separation (minimum time to collision, minimum headway, and mean headway) as indicators of driver fatigue. Without exception, the correlation analyses for both the self-rating of alertness and temporal separation yielded models low in associative ability; neither metric was found to be a valid indicator of driver fatigue. In addition, based upon the data collected for this research, preliminary evidence suggests that driver fatigue onset within a real-world driving environment does not appear to follow the standard progression of events associated with the onset of fatigue within a simulated driving environment. Application of this research includes the development of an on-board driver performance/fatigue monitoring system that could potentially assist drivers in identifying the onset of fatigue.
Pilot ability to anticipate the consequences of flight actions as a function of expertise.
Correspondence: SM Doane, Department of Psychology, Drawer 6161, Mississippi State University, Mississippi State, MS 39762, USA; (email: sdoane@ra.msstate.edu).
The study offers insights into pilot ability to anticipate consequences of actions and how this ability changes with experience. Novice and expert pilots completed trials in which 3 screens depicted a control movement (or control movements), a cockpit flight situation, or a change in flight situation. Changes depicted in the 3rd screen of each trial were consistent, inconsistent with the mental model of the effect of the control movement or movements, or inconsistent with the application of the control movement(s) to the current flight situation. Pilots indicated whether the depicted change was inconsistent or consistent with their expectations, and accuracy of consistency judgments was greater for mental-model than for situation-model inconsistent statements. Experts are more accurate than novices, particularly for trials that involve multiple, meaningfully related control movements. Expert ability to organize information into meaningful units appears to facilitate future flight state projections, and projection failures appear to result from situation- rather than mental-model failures. Actual or potential applications of this research include analysis of flight situation awareness and flight performance errors.
Unlike urban older women, rural older women have inadequate health care and limited access to aging network services. Rural women who are part of dysfunctional family relationships are particularly disadvantaged in that they may not be able to gain access to preventive services due to isolation. Indeed, geographic and social isolation, family obligation, and caregiver stress are deemed leading contributory factors to family violence in rural settings. This study examined six forms of substantiated elder abuse, a form of family violence, among rural and urban women. Chi-square analysis and proportions were used to examine differences between 7,178 rural and 7,614 urban female victims, as were demographic characteristics of abusers. More rural women were represented in physical abuse (chi sq = 10.906; P = .001), emotional abuse (chi sq = 25.951; P < .001), and deprivation (chi sq = 3.662; P = .056) categories than urban women. Urban women were represented in the passive neglect category (chi sq = 8.186; P = .004) than rural women. Approximately 88% of rural women compared to 86% of urban women were willing to accept intervention services following abuse. Abusers were mostly non-caregivers and offspring with no legal responsibility to the victims. Since elder mistreatment permeates every segment of society, intervention programs should be distributed equitably.
Adolescent violence.
- Williams-Evans SA, Myers JS. ABNF J 2004; 15(2): 31-34.
Correspondence: S.A. Wiliams-Evans, North Carolina A&T State University School of Nursing, Greensboro, North Carolina, USA; (email: unavailable).
The purpose of this document is to provide an overview of the rising occurrences of adolescent violence in the American school systems and how various theories can be used to assist in understanding this phenomenon. The authors have become increasingly interested in this topic, after direct involvement in the summer of 2001. There were a number of students who were attending summer school as a result of consistent out-of-school suspensions for violent acts. The procedure to process through the system with these students was to suspend them, resulting in the student subsequently failing their present grade. The school was located in a community known for its high rate of violence and criminal activity. Various types of adolescent violence exist in our schools. Studies have reported that violent adolescents may come from familial environments that are full of social and interpersonal conflicts (Gray & Foshee, 1999). This paper discusses the development of a research plan to investigate the number and type of adolescent violent occurrences in a southern middle school setting.
Youth engaging in online harassment: associations with caregiver-child relationships, Internet use, and personal characteristics.
To date, research focused on "traditional" (i.e. in-person) youth bullying behaviour has documented serious psychosocial challenges for those involved. How this literature translates to youth engaging in aggressive behaviours online has yet to be examined. Using the largest US sample of youth Internet users to date, psychosocial characteristics of youth engaging in Internet harassment were examined. Results from the nationally representative survey suggested that Internet harassment is a significant public health issue, with aggressors facing multiple psychosocial challenges including poor parent-child relationships, substance use, and delinquency. Comparisons to traditional bullies were made, with similarities and differences noted.
Socioeconomic disparities in intimate partner violence against Native American women: a cross-sectional study.
- Malcoe LH, Duran BM, Montgomery JM. BMC Med 2004; 2(1): 20.
Correspondence: Lorraine Halinka Malcoe, University of New Mexico, Albuquerque, New Mexico 87131, USA; (email: lhmalcoe@salud.unm.edu).
BACKGROUND: Intimate partner violence (IPV) against women is a global public health problem, yet data on IPV against Native American women are extremely limited. We conducted a cross-sectional study of Native American women to determine prevalence of lifetime and past-year IPV and partner injury; examine IPV in relation to pregnancy; and assess demographic and socioeconomic correlates of past-year IPV.
METHODS: Participants were recruited from a tribally-operated clinic serving low-income pregnant and childbearing women in Southwest Oklahoma. A self-administered survey was completed by 312 Native American women (96% response rate) attending the clinic from June through August 1997. Lifetime and past-year IPV were measured using modified 18-item Conflict Tactics Scales. A socioeconomic index was created based on partner's education, public assistance receipt, and poverty level.
RESULTS: More than half (58.7%) of participants reported lifetime physical and/or sexual IPV; 39.1% experienced severe physical IPV; 12.2% reported partner-forced sexual activity; and 40.1% reported lifetime partner-perpetrated injuries. A total of 273 women had a spouse or boyfriend during the previous 12 months (although all participants were Native American, 59.0% of partners were non-Native). Among these women, past-year prevalence was 30.1% for physical and/or sexual IPV; 15.8% for severe physical IPV; 3.3% for forced partner-perpetrated sexual activity; and 16.4% for intimate partner injury. Reported IPV prevalence during pregnancy was 9.3%. Pregnancy was not associated with past-year IPV (odds ratio = 0.9). Past-year IPV prevalence was 42.8% among women scoring low on the socioeconomic index, compared with 10.1% among the reference group. After adjusting for age, relationship status, and household size, low socioeconomic index remained strongly associated with past-year IPV (odds ratio = 5.0; 95% confidence interval: 2.4, 10.7).
COMMENTS: Native American women in our sample experienced exceptionally high rates of lifetime and past-year IPV. Additionally, within this low-income sample, there was strong evidence of socioeconomic variability in IPV. Further research should determine prevalence of IPV against Native American women from diverse tribes and regions, and examine pathways through which socioeconomic disadvantage may increase their IPV risk.
Violence-related outcomes of the D.A.R.E. Plus project.
- Komro KA, Perry CL, Veblen-Mortenson S, Stigler MH, Bosma LM, Munson KA, Farbakhsh K. Health Educ Behav 2004; 31(3): 335-354.
Correspondence: Kelli A. Komro, Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis, USA; (email: komro@epi.umn.edu).
The objectives of this study were to examine outcomes of the Minnesota D.A.R.E. Plus Project on violence-related behaviors among middle school students and mediation analyses that test how the intervention was effective in reducing physical and verbal violence. Twenty-four schools were randomly assigned to the D.A.R.E. middle school curriculum, the D.A.R.E. Plus multicomponent intervention, or control. The study cohort completed a self-report questionnaire at baseline and two follow-ups. The results showed that boys had higher rates of violence and victimization than girls. The D.A.R.E. Plus program was more effective in preventing violence among boys than among girls. It appears that the small behavioral effect that D.A.R.E. Plus did demonstrate on physical and verbal violence among boys was entirely mediated by a decrease of norms that support violence, an increase in outcome expectancies about being violence-free, and an increase in parental consequences for fighting.
