Correspondence: Johann F. Kinzl, Department of Psychiatry, Innsbruck University Clinics, Anichstrasse 35, A-6020 Innsbruck, AUSTRIA; (email: johann.kinzl@uklibk.ac.at).
BACKGROUND: To determine the prevalence of drug consumption and the impact of workplace demands and burdens for substance use, we conducted a survey in a representative sample of Tyrolean employees. METHODS: This analysis was restricted to the 700 respondents (395 male, 305 female; age 18-60 years) in the year 2001 by telephone interview who hold a full-time or part-time job during the 6 months preceding the interview. We studied the use of antidepressants, benzodiazepines, analgetics. stimulants and phytotherapeutics. RESULTS: Of the whole sample, 5.6% employees (4.8% male, 6.6% female) stated that they take some kind of pills to cope with job demands. There was no statistically significant difference between males and females. Substance use depended to a great extent on the work atmosphere and job satisfaction. The prevalence of drug consumption increased from 3.7% (good atmosphere at work) and 3.3% (high job satisfaction) to 12.6% (bad atmosphere at work) and 42.9% (low job satisfaction ) (p = 0.019 and p = 0.001). The feeling of being a victim of bullying at work appears to be particularly destructive for the individuals' well-being. Only 4.1% of the employees who were not victims of bullying took drugs because of job problems, as compared with 20% of the bullying victims. DISCUSSION: Our results indicate that drug consumption as the consequence of workplace burdens is a frequent and serious problem with negative consequences for the life quality of the individuals and for the individuals' efficiency. Therefore, occupational medicine and employers should direct their attention to ensure the best possible work place structure and occupational conditions.
Enhanced enforcement of laws to prevent alcohol sales to underage persons--New Hampshire, 1999-2004.
- Centers for Disease Control and Prevention (CDC). MMWR 2004; 53(21):452-454.
In 1984, the National Minimum Drinking Age Act (Public Law 98-363) was passed, requiring states to raise to 21 years the minimum age to purchase and publicly possess alcohol. Although the law has contributed to substantial reductions in underage drinking and alcohol-related motor-vehicle crashes, alcohol use and binge drinking rates among youths remain high in the United States, and efforts by youths to purchase alcohol from licensed establishments frequently are successful. To reduce alcohol sales to persons aged <21 years in Concord (2000 population: 40,687), New Hampshire, the Concord Police Department (CPD) and New Hampshire Liquor Commission (NHLC) conducted a pilot program of enhanced law enforcement with quarterly compliance checks of alcohol licenses during March 2002-February 2004. This report summarizes the results of that program, which indicated that enhanced enforcement 1) resulted in a 64% reduction in retail alcohol sales to underage youths and 2) was temporally associated with declines in alcohol use and binge drinking among Concord high school students. These findings emphasize the potential effectiveness of enhanced enforcement of minimum drinking age laws to reduce consumption of alcohol by underage youths.
Community based prevention programs targeting all injuries for children.
- Spinks A, Turner C, McClure R, Nixon J. Inj Prev 2004; 10(3): 180-185.
Correspondence: Cathy Turner, Injury Research Unit, School of Population Health, Mayne Medical School, University of Queensland, Herston Rd, Herston, QLD 4006, AUSTRALIA; (email: C.Turner@sph.uq.edu.au).
OBJECTIVE: Community based models for injury prevention have become an accepted part of the overall injury control strategy. This systematic review of the scientific literature examines the evidence for their effectiveness in reducing all-cause injury in children 0-14 years of age.
METHODS: A comprehensive search of the literature was performed using the following study selection criteria: community based intervention study; children under 14 years; outcome measure was injury rates; and either a community control or an historical control was used in the design. Quality assessment and data abstraction were guided by a standardized procedure and performed independently by two authors. Data synthesis was in tabular and text form with meta-analysis not being possible due to the discrepancy in methods and measures between the studies.
FINDINGS: Thorough electronic and library search techniques yielded only nine formally evaluated community based all-cause child injury prevention programs that have reported actual injury outcomes. Of these nine studies, seven provided high level evidence where contemporary control communities were used for comparison; the remaining two used a pre and post-design or time trend analysis where historical data from the community were used as the comparison. Only three of the seven studies with contemporary control communities found significant effect of the intervention; the two studies without controls noted significant reductions in injury rates after the intervention period.
COMMENTS: There is a paucity of research from which evidence regarding the effectiveness of community based childhood injury prevention programs can be obtained and hence a clear need to increase the effort on developing this evidence base.
France has experienced two waves of major terrorist bombings since 1980. In the first wave (1985-1986), eight bombings occurred in Paris, killing 13 and injuring 281. In the second wave (1995-1996), six bombings occurred in Paris and Lyon, killing 10 and injuring 262. Based on lessons learned during these events, France has developed and improved a sophisticated national system for prehospital emergency response to conventional terrorist attacks based on its national emergency medical services (EMS) system, Service d'Aide Medicale Urgente (SAMU). According to the national plan for the emergency medical response to mass-casualty events (White Plan), the major phases of EMS response are: (1) alert; (2) search and rescue; (3) triage of victims and provision of critical care to first priority victims; (4) regulated dispatch of victims to hospitals; and (5) psychological assistance. Following the 1995 Tokyo subway sarin attack, a national plan for the emergency response to chemical and biological events (PIRATOX) was implemented. In 2002, the Ministries of Health and the Interior collaborated to produce a comprehensive national plan (BIOTOX) for the emergency response to chemical, biological, radiological, and nuclear events. Key aspects of BIOTOX are the prehospital provision of specialized advance life support for toxic injuries and the protection of responders in contaminated environments. BIOTOX was successfully used during the 2003 Severe Acute Respiratory Syndrome (SARS) outbreak in France.
The environment and its impact on health: old risks, new risks.
The objective of this article is to investigate three representative elements of environmental health from a geographical perspective taking the Autonomous Community as the unit of analysis: legionnaire's disease, chemical safety and food safety.Legionnaire's disease is a pathology with a specific epidemiological profile; males, adults, and with previous chronic pathologies and habits. The official response, with regard to recent outbreaks and the increase in the incidence of legionnaire's disease, has differed between autonomous communities due to peculiarities and different organizational cultures.Both the sinking of the ship Prestige and the accident at the oil refinery at Puertollano (Ciudad Real) have increased concern in the population about chemical substances, so familiar in our environment. However it is not only the big accidents which are relevant: it is surprising to learn that most of the registered poisonings are due to domestic cleaning goods. The pending challenge from the Public Health point of view is to elaborate the Report on Human Exposure to Environmental Chemical Agents which, undoubtedly, will help to establish differences between type and class.Finally, the number of outbreaks of food poisoning continues to be of concern; this should lead us to think about the effectiveness of food safety programmes and to focus on the home, being place where most of the outbreaks occur. The General Sanitary Inspection of Food ought to be a good tool to help improve food safety.
Structural stability and reliability of the Swedish occupational fatigue inventory among Chinese VDT workers.
- Leung AW, Chan CC, He J. Appl Ergon 2004; 35(3): 233-241.
Correspondence: C.C.H.Chetwyn C. H. Chan, Ergonomics and Human Performance Laboratory, Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, CHINA; (email: rschchan@polyu.edu.hk).
The aim of the present study was to test the structural stability and reliability of the Swedish occupational fatigue inventory (SOFI) for use in a group of Chinese visual display terminal (VDT) workers. A qualified translator was recruited to translate the Chinese version of the SOFI (SOFI-C). The content validity was established with 12 bilingual practitioners and seven professional experts. The translated SOFI was administered to 104 sedentary workers on two occasions with an interval of 60min. Most of them were female (80.8%) and they had a mean age of 34.5 years. Fifty-one percent of them reported using a VDT for 4h or more at work. Exploratory factor analysis revealed a five-factor solution, which was comparable to the original latent factors. Cronbach's alpha for the five-factor scales was between 0.88 and 0.95. The test-retest reliability was satisfactory with intra-class correlations ranging from 0.69 to 0.83. The workers who used a VDT for 4h or more had significantly higher SOFI scores than those who used one for less than 4h ( [Formula: see text] -0.046). The results indicated that the SOFI-C was valid and reliable for measuring fatigue among Chinese sedentary workers. The satisfactory structural stability suggested that cultural influences on the construct of fatigue were not strong. Its characteristics of discrimination of the sedentary workers who had high VDT exposure suggested that the SOFI-C would be a useful instrument for prevention and intervention programs designed for work-related injuries in the workplace.
OBJECTIVE: To determine if age-related hearing loss may be related to bone health. Decreased vestibular function has been associated with hearing loss, and osteoporosis may be a cause of such demineralization. We hypothesized that hearing loss would be related to an increased risk of falling and osteoporotic fracture in 6,480 women aged 65 years or older enrolled in the Study of Osteoporotic Fractures. We further hypothesized that decreased bone mineral density would be associated with hearing loss.
METHODS: Hearing sensitivity was ascertained via screening audiometry, and was classified as normal, mild loss, or significant loss. Incident non-spine fractures and falls were ascertained every 4 months for an average 6.7 years and 3 years, respectively.
FINDINGS: The age-adjusted annual fall rate did not differ significantly by hearing category, nor did the risk of incident fracture. Adjustment for confounding factors had no effect on our results. Age- and BMI-adjusted mean calcaneal bone mineral density (g/cm(2)) was 0.380 in the normal hearing group, 0.375 in the mild loss group, and 0.371 in the significant loss group (p=0.02). There were no significant differences in total hip bone mineral density across hearing categories.
COMMENTS: Our results do not support the hypothesis that hearing loss is a risk factor for fracture or falls.
Correspondence: Lance Brown, Department of Emergency Medicine, Loma Linda University Medical Center and Children's Hospital, Loma Linda, CA, USA; (email: LBROWNMD@AOL.com).
OBJECTIVE: This study was undertaken to describe pediatric yo-yo injuries as published in the English-language medical literature and in a large national database of emergency department visits in the United States.
METHODS: Two search strategies of public data were used. All available materials from January 1993 through December 2002 including accident investigations, reported incidents, death certificates, and data from the National Electronic Injury Surveillance System involving yo-yos were requested from the United States Consumer Product Safety Commission. Data were also obtained from a search of the English-language medical literature accessing MEDLINE, a database of more than 11 million citations.
FINDINGS: Fourteen cases of injuries sustained during proper yo-yo use were identified. The injuries were sustained by children 5 to 14 years. Eleven (79%) of the subjects were boys. Most injuries involved minor blows to the face and scalp. None of these injuries were serious.
COMMENTS: When properly used, yo-yos appear to be relatively safe toys. Training in the proper use of a yo-yo to avoid being struck in the head, face, or eyes may be helpful for school-aged children. Employing a search strategy using data available from the Consumer Product Safety Commission including information provided by the National Electronic Injury Surveillance System and electronically accessing MEDLINE appear to yield useful information when questions about the safety of a consumer product arise.
An integrated comprehensive occupational surveillance system for health care workers.
- Dement JM, Pompeii LA, Ostbye T, Epling C, Lipscomb HJ, James T, Jacobs MJ, Jackson G, Thomann W. Am J Ind Med 2004; 45(6): 528-538.
Correspondence: John Dement, Division of Occupational and Environmental Medicine, Department of Community and Family Medicine, Duke University Medical Center, Durham, North Carolina 27705, USA; (email: john.dement@duke.edu).
BACKGROUND: Workers in the health care industry may be exposed to a variety of work-related stressors including infectious, chemical, and physical agents; ergonomic hazards; psychological hazards; and workplace violence. Many of these hazards lack surveillance systems to evaluate exposures and health outcomes. The development and implementation of a comprehensive surveillance system within the Duke University Health System (DUHS) that tracks occupational exposures and stressors as well as injuries and illnesses among a defined population of health care workers (HCWs) is presented.
METHODS: Human resources job and work location data were used to define the DUHS population at risk. Outcomes and exposure data from existing occupational health and safety programs, health promotion programs, and employee health insurance claims, were linked with human resources data and de-identified to create the Duke Health and Safety Surveillance System (DHSSS).
FINDINGS: The surveillance system is described and four examples are presented demonstrating how the system has successfully been used to study consequences of work-related stress, hearing conservation program evaluation, risk factors for back pain and inflammation, and exposures to blood and body fluids (BBF).
COMMENTS: Utilization of existing data, often collected for other purposes, can be successfully integrated and used for occupational health surveillance monitoring of HCWs. Use of the DHSSS for etiologic studies, benchmarking, and intervention program evaluation are discussed.
Correspondence: Bahman S Roudsari, Harborview Injury Prevention and Research Center, 325 9th Ave, Seattle, WA 98104-2499, USA; (email: roudsari@u.washington.edu).
BACKGROUND: During the last two decades changes in vehicle design and increase in the number of the light truck vehicles (LTVs) and vans have led to changes in pedestrian injury profile. Due to the dynamic nature of the pedestrian crashes biomechanical aspects of collisions can be better evaluated in field studies.
METHODS: The Pedestrian Crash Data Study, conducted from 1994 to 1998, provided a solid database upon which details and mechanism of pedestrian crashes can be investigated.
FINDINGS: From 552 recorded cases in this database, 542 patients had complete injury related information, making a meaningful study of pedestrian crash characteristics possible. Pedestrians struck by LTVs had a higher risk (29%) of severe injuries (abbreviated injury scale >/=4) compared with passenger vehicles (18%) (p = 0.02). After adjustment for pedestrian age and impact speed, LTVs were associated with 3.0 times higher risk of severe injuries (95% confidence interval (CI) 1.26 to 7.29, p = 0.013). Mortality rate for pedestrians struck by LTVs (25%) was two times higher than that for passenger vehicles (12%) (p<0.001). Risk of death for LTV crashes after adjustment for pedestrian age and impact speed was 3.4 times higher than that for passenger vehicles (95% CI 1.45 to 7.81, p = 0.005).
COMMENTS: Vehicle type strongly influences risk of severe injury and death to pedestrian. This may be due in part to the front end design of the vehicle. Hence vehicle front end design, especially for LTVs, should be considered in future motor vehicle safety standards.
Correspondence: Lee McGoodwin, Oklahoma Poison Control Center, 940 NE 13th Street, Room 3510, Nicholson Tower, Oklahoma City, Oklahoma 73104, USA; (email: Lee-McGoodwin@ouhsc.edu).
Medical professionals are recognized as a vital link in communities for education and treatment of poisoning exposures. The Oklahoma Poison Control Center (OPCC) is a resource for medical professionals as well as the public. Nationally and in Oklahoma, among all age groups, analgesics are responsible for the most fatalities. Trends in common exposures in the age 5 and younger age group and the 13 through 19 age group, an acetaminophen protocol, information about the poison center and HIPPA privacy regulations, poison prevention tips and where to obtain educational materials are outlined. National Poison Prevention Week, March 21-27, 2004, is an excellent time to educate all age groups about poison prevention techniques and what to do when there is a poisoning emergency. Board certified toxicologists, pharmacists and registered nurses are available 24 hours a day, 7 days a week by calling 1-800-222-1222.
Fatal poisoning in Jamaica: a coroner's autopsy study from the University Hospital of the West Indies.
- Escoffery CT, Shirley SE. Med Sci Law 2004; 44(2): 116-120.
Correspondence: C. Escoffery, Department of Pathology, University of the West Indies, Mona, Kingston 7, JAMAICA; (email: cescoffy@cwjamaica.com).
This study reviewed cases of fatal poisoning in a coroner's autopsy series at the University Hospital of the West Indies and represented the first such study reported from Jamaica. The autopsy protocols of all coroner's autopsies performed over the 20-year period January 1980 to December 1999 were reviewed retrospectively; 22 (1.0%) cases were identified and relevant clinical and pathological data analysed. There were 13 males and nine females (M:F ratio 1.4:1) with an age range of 2 - 69 years (mean +/- SD = 27 +/- 16.1 years). The 20 - 29 year group was most commonly affected and five patients (22.7%) were children (< 18 years of age). Pesticides (herbicides/ insecticides) were implicated in nine (41%) cases: paraquat was the most common, found in six (27%) cases. Prescription drugs were the next most prevalent group with six (27%) cases, followed by anti-psychotic drugs in four (18%) cases. Cocaine and ackee were each implicated in two (9%) cases. The manner of death was suicidal in 14 (64%) cases and accidental in eight (36%) cases. Seven patients had documented psychiatric illnesses, six of whom committed suicide. Autopsy findings were largely non-specific. The relatively small number of cases was consistent with the low incidence of fatal poisoning in Jamaica.
OBJECTIVES: To examine evidence on the effectiveness of current injury prevention strategies in selected sport and recreational activities, determine the applicability of the evidence to children and youth and discuss the implications related to policy, programming and future research.
METHODS: Research questions and relevance criteria were developed a priori. Potentially relevant studies were located through electronic and hand searches. Two independent assessors assessed articles for first relevance and then quality. Relevant articles were abstracted and synthesised for activities that had three or more relevant articles.
FINDINGS: A total of 21,499 articles identified through database and manual searching yielding 117 that met inclusion criteria. The majority of the studies (93 or 89%) involved eight activities: baseball, basketball, cycling, football, ice hockey, rugby, alpine skiing and soccer. Children and youth were identified as the specific target group in 45% of the studies and another 12% included children in their sample. Studies addressed a range of intervention strategies and varied on quality of evidence.
COMMENTS: Surprisingly few well-designed and controlled studies investigating strategies to prevent injuries were found and an even smaller number evaluated strategies to reduce injury in children and youth. As governments in developed countries continue to focus on increasing physical activity among children and youth, thought must be given to the issue of risk of injury and the relative lack of evidence of effective preventive measures.
Are current playground safety standards adequate for preventing arm fractures?
- Sherker S, Ozanne-Smith J. Med J Aust 2004; 180(11): 562-565.
Correspondence: Shauna Sherker, Accident Research Centre, Building 70, Monash University, Melbourne, VIC 3800, AUSTRALIA; (email: ShaunaSherker@yahoo.com.au).
OBJECTIVES: To assess compliance with current standards of playgrounds where children have sustained a fall-related arm fracture.
METHODS: Design, setting and participants -- Between October 2000 and December 2002, a consecutive prospective series of 402 children aged under 13 years who fell from playground equipment and sustained an arm fracture was identified by emergency department staff in five Victorian hospitals. Trained field testers measured playground equipment height, surface type and depth, and surface impact attenuation factors to determine compliance with safety standards.
Main outcome measures -- Playground compliance with current Australian safety standards.
FINDINGS: Ninety-eight percent of playgrounds had a recommended type of surface material. The mean surface depth was 11.1 cm (SD, 5.0 cm) and the mean equipment height was 2.04 m (SD, 0.43 m). Although over 85% of playgrounds complied with recommended maximum equipment height and surface impact attenuation characteristics, only 4.7% complied with recommended surface depth.
COMMENTS: Playgrounds where children have sustained an arm fracture generally comply with all important safety recommendations except surface depth. Playground fall-related arm fracture requires specific countermeasures for prevention, distinct from head injury prevention guidelines.
Snowmobile trauma: 10 years' experience at Manitoba's tertiary trauma centre.
- Stewart RL, Black GB. Can J Surg 2004; 47(2): 90-94.
Correspondence: R Stewart, Section of Orthopedics, Department of Surgery, University of Manitoba, Winnipeg, Manitoba, CANADA; (email: unavailable).
BACKGROUND: According to the literature, the increased recreational use of the snowmobile has resulted in an increasing number of musculoskeletal injuries. We wished to examine whether previously described risk factors continue to be associated with snowmobile trauma and to identify previously unrecognized risks and specific patterns of injury.
METHODS: We carried out a chart review of all snowmobile-related injuries over a 10-year period at the Health Sciences Centre in Winnipeg, the only level 1 trauma centre serving the Province of Manitoba, with particular attention to the risk factors of suboptimal lighting, excessive speed and alcohol consumption.
FINDINGS: We identified 480 injuries in 294 patients, and 81 (27.6%) of these patients died. Collisions accounted for 72% of the injury mechanisms. Of the injuries sustained, 31% occurred on roads. Excessive speed was a risk factor in 54% of patients, suboptimal lighting in 86% and a blood alcohol level greater than 0.08 in 70%. Musculoskeletal injuries accounted for 57% of those recorded. There were also brachial plexus injuries (3%) and knee dislocations (2%). To our knowledge, this is the largest study detailing injury associated with recreational use of snowmobiles in Canada.
COMMENTS: Because snowmobile trauma is caused principally by human errors, it is potentially preventable. Efforts aimed at prevention must focus on the driver, who controls the common risk factors. The danger of snowmobiling while intoxicated must be emphasized. Trail-side monitoring is likely to be ineffective, as the majority of accidents do not occur on designated snowmobile trails.
Nonfatal and fatal drownings in recreational water settings--United States, 2001-2002.
- Centers for Disease Control and Prevention (CDC). MMWR 2004; 53(21): 447-452.
Drowning is the seventh leading cause of unintentional injury deaths for all ages and the second leading cause of all injury deaths in children aged 1-14 years. Many of these injuries occur in recreational water settings, including pools, spas/hot tubs, and natural water settings (e.g., lakes, rivers, or oceans). To examine the incidence and characteristics of nonfatal and fatal unintentional drownings in recreational water settings, CDC analyzed 2001-2002 data from the National Electronic Injury Surveillance System All Injury Program (NEISS-AIP) and National Vital Statistics System (NVSS) death certificate data from 2001. This report summarizes that analysis, which indicated that, during 2001-2002, an estimated 4,174 persons on average per year were treated in U.S. hospital emergency departments (EDs) for nonfatal unintentional drowning injuries in recreational water settings. Approximately 53% of persons required hospitalization or transfer for more specialized care. During 2001, a total of 3,372 persons suffered fatal unintentional drownings in recreational settings. Nonfatal and fatal injury rates were highest for children aged < or =4 years and for males of all ages. To reduce the number of drownings, environmental protections (e.g., isolation pool-fences and lifeguards) should be adopted; alcohol use should be avoided while swimming, boating, or water skiing or while supervising children; and all participants, caregivers, and supervisors should be knowledgeable regarding water-safety skills and be trained in cardiopulmonary resuscitation (CPR).
Community childhood injury surveillance: an emergency department-based model.
- Zuckerbraun NS, Powell EC, Sheehan KM, Uyeda A, Rehm KP, Barlow B. Pediatr Emerg Care 2004; 20(6): 361-366.
Correspondence: Noel Zuckerbraun, Division of Pediatric Emergency Medicine, Children's Memorial Hospital and the Department of Pediatrics, Northwestern University's Feinberg School of Medicine, Chicago, IL, USA; (email: unavailable).
OBJECTIVE: To describe the use of an emergency department (ED)-based injury surveillance model to determine the incidence and mechanisms of nonfatal injuries among children living in Cabrini Green, a poor urban community.
METHODS: Using ED records and census data, population-based injury rates were determined for a retrospective cohort of children, 0 to 14 years old, (N = 3908) with nonfatal injuries resulting in ED treatment between January 1994 and December 1998.
RESULTS: There were 1950 nonfatal injuries during the 5-year study period (annual injury incidence of 998/10,000). Age-specific rates (per 10,000 per year) were 899 among 0- to 4-year olds, 616 among 5- to 9-year olds, and 435 among 10- to 14-year olds. Sixty-three percent were male. The most common injury mechanisms were falls (339/10,000 per year), being struck by/against an object (201/10,000 per year), and being cut/pierced by an object (87/10,000 per year). Falls from a building window (2/10,000 per year) were infrequent. The incidence of housefire-related burns was 1.5/10,000 per year. Intentional injuries included alleged child abuse, 43/10,000 per year, and assaults, 30/10,000 per year. The assault rate among 10- to 14-year-old males was 100/10,000 per year. One hundred thirty-four children were admitted to the hospital (average annual rate of 69/10,000). The most frequent admission diagnoses were falls (22/10,000) among 0- to 9-year olds and assaults (13/10,000) among 10- to 14-year olds.
CONCLUSION: An ED-based injury surveillance system can provide an efficient and useful way to determine injury incidence in a defined urban community. The data suggest that rates of violence-related injuries were high, while rates of window falls and housefires were low. These data have allowed targeted injury prevention efforts in Cabrini Green, and future surveillance will allow the evaluation of injury prevention activities.
Burden of disease and injury in Aboriginal and non-Aboriginal populations in the Northern Territory, Australia.
- Zhao Y, Guthridge S, Anne Magnus A, Vos T. Med J Aust 2004; 180(10): 498-502.
Correspondence: Yuejen Zhao, Health Gains Planning, Northern Territory Department of Health and Community Services, PO Box 40596, Casuarina, NT 0811, AUSTRTALIA; (email: yuejen.zhao@nt.gov.au).
OBJECTIVE: To quantify the burden of disease and injury for the Aboriginal and non-Aboriginal populations in the Northern Territory.
METHODS: Design and setting: Analysis of Northern Territory data for 1 January 1994 to 30 December 1998 from multiple sources. Main outcome measures: Disability-adjusted life-years (DALYs), by age, sex, cause and Aboriginality.
FINDINGS: Cardiovascular disease was the leading contributor (14.9%) to the total burden of disease and injury in the NT, followed by mental disorders (14.5%) and malignant neoplasms (11.2%). There was also a substantial contribution from unintentional injury (10.4%) and intentional injury (4.9%). Overall, the NT Aboriginal population had a rate of burden of disease 2.5 times higher than the non-Aboriginal population; in the 35�54-year age group their DALY rate was 4.1 times higher. The leading causes of disease burden were cardiovascular disease for both Aboriginal men (19.1%) and women (15.7%) and mental disorders for both non-Aboriginal men (16.7%) and women (22.3%).
COMMENTS: A comprehensive assessment of fatal and non-fatal conditions is important in describing differentials in health status of the NT population. Our study provides comparative data to identify health priorities and facilitate a more equitable distribution of health funding.
The main aim of the present study was to describe children's perceptions and experiences of bullying: the way they define it, their thoughts about why children are bullied and their experiences of the way adults respond to bullying. The study group comprised 960 children in the fourth grade. The most frequent answers concerning why some children get bullied were that these children have a different appearance (43%) or that they are deviating in other ways than by appearance (31%). Two groups of bullied children seem to be of special concern; the children who do not tell adults about their situation (9% of the bullied children) and the children who do not perceive that they have received help from adults at school (24% of bullied children). The children's perceptions and experiences are discussed in relation to interventions in Swedish schools.
A population based investigation of head injuries and symptoms of concussion of children and adolescents in schools.
- Willer B, Dumas J, Hutson A, Leddy J. Inj Prev 2004; 10(3): 144-148.
Correspondence: B. Willer, Department of Psychiatry, University at Buffalo, G96 Farber Hall, 3435 Main Street, Buffalo, NY 14214, USA; (email: willer@vaxxine.com).
OBJECTIVE: To examine the incidence of head injury and symptoms of concussion among children at school and to determine the relationship of age, gender, and cause to incidence rates.
DESIGN: Incident reports involving head injury for schools in the Province of Ontario, Canada during the year 2000 were evaluated.
PARTICIPANTS: The population base for the schools represented was 1,372,979 children aged 6 to 16.
SETTING: 95% of schools in the province of Ontario, Canada participated in the injury reporting system.
MAIN OUTCOME MEASURES: A head injury was defined as any injury to the head that came to the attention of a school official. Head injuries accompanied by symptoms of concussion became a secondary outcome measure.
FINDINGS: There were 11 068 unduplicated head injury reports for the year 2000 of which 1861 qualified as producing signs or symptoms of concussion. Young children were more likely to have a head injury than older children, but slightly less likely to experience concussive symptoms. The primary cause of injury to young children was falls. Older children were more likely to receive head injuries and symptoms of concussion from sports activities.
COMMENTS: Overall rate of injury (3.98 per 100 children) was consistent with previous studies using prospective injury reporting systems. Probability of a head injury with symptoms of concussion among schoolchildren was only 1.9% for boys and <1% for girls during the course of their school years. There is ample justification for prevention efforts in schools.
- Centers for Disease Control and Prevention (CDC). MMWR 2004; 53(22):471.
Suicide is the 13th leading cause of death worldwide, the 11th in the United States (1), and the third among U.S. residents aged 10--24 years, accounting for 4,243 (11.7%) of all deaths in this age group. Suicide attempts and other acts of self harm that result in nonfatal injuries take a heavy toll on the health of younger persons. In 2002, an estimated 124,409 visits to U.S. emergency departments were made after attempted suicides or other self-harm incidents among persons aged 10--24 years. To provide insights that might lead to successful prevention programs, this week's MMWR includes reports on 1) trends in suicide by persons aged 10--19 years, 2) suicide attempts and physical fighting among high school students, 3) school-associated suicides, 4) suicide among Hispanics, and 5) suicidal behavior in China. Reducing the overall suicide rate and the number of suicide attempts reported by adolescents are among the 2010 national health objectives (objective nos. 18-1 and 18-2) (2). Integrated prevention strategies that address multiple associated factors (e.g., substance abuse prevention, family and peer support, and access to health services) are likely to be more effective in reducing suicidal behavior than programs that focus on a single risk factor (3). Additional information about suicide prevention is available at http://www.cdc.gov/ncipc/factsheets/suifacts.htm.
Methods of suicide among persons aged 10--19 Years --- United States, 1992--2001.
- Centers for Disease Control and Prevention (CDC). MMWR 2004; 53(22):471-474.
In 2001, suicide was the third leading cause of death among persons aged 10--19 years (1). The most common method of suicide in this age group was by firearm (49%), followed by suffocation (mostly hanging) (38%) and poisoning (7%) (1). During 1992--2001, although the overall suicide rate among persons aged 10--19 years declined from 6.2 to 4.6 per 100,000 population (1), methods of suicide changed substantially. To characterize trends in suicide methods among persons in this age group, CDC analyzed data for persons living in the United States during 1992--2001. This report summarizes the results of that analysis, which indicated a substantial decline in suicides by firearm and an increase in suicides by suffocation in persons aged 10--14 and 15--19 years. Beginning in 1997, among persons aged 10--14 years, suffocation surpassed firearms as the most common suicide method. The decline in firearm suicides combined with the increase in suicides by suffocation suggests that changes have occurred in suicidal behavior among youths during the preceding decade. Public health officials should develop intervention strategies that address the challenges posed by these changes, including programs that integrate monitoring systems, etiologic research, and comprehensive prevention activities.
Annual data on suicides occurring in the United States during 1992--2001 (2) were obtained by using CDC's Web-based Injury Statistics Query and Reporting System (WISQARS) (1) and examined by age group (i.e., persons aged 10--14 and 15--19 years) and method (e.g., firearm, suffocation, and poisoning) for each year and the 10-year period. To analyze these data, codes were used from the International Classification of Diseases, Ninth Revision (ICD-9) and the International Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10), which was implemented in 1999. Although coding of mortality data changed in 1999, the two revisions have near 100% agreement on classification of suicides by firearm, suffocation, and poisoning (3); thus, the suicide method was defined consistently during the period analyzed.
For each method of suicide, annual suicide rates (per 100,000 population) were calculated by age group and overall. Because firearms and suffocation were the two most common methods of suicide among persons aged 10--19 years, accounting for approximately 90% of suicide deaths in this age group, trends for these two methods (Figures 1 and 2) were formally evaluated by using negative binomial rate regression to account for overdispersion in the data. Supplemental information on suicides by poisoning (the third most common method) and suicide by all other methods (e.g., jumping from a height) is provided for illustration purposes. Annual ratios of suffocation suicides to firearm suicides were examined as an additional means of assessing changes in the relative magnitude of these methods over time (Table).
Among persons aged 10--14 years, the rate of firearm suicide decreased from 0.9 per 100,000 population in 1992 to 0.4 in 2001, whereas the rate of suffocation suicide increased from 0.5 in 1992 to 0.8 in 2001. Rate regression analyses indicated that, during the study period, firearm suicide rates decreased an average of approximately 8.8% annually (p<0.0001), and suffocation suicide rates increased approximately 5.1% annually (p<0.0001). Among persons aged 15--19 years, the firearm suicide rate declined from 7.3 in 1992 to 4.1 in 2001; the suffocation suicide rate increased from 1.9 to 2.7. Rate regression analyses indicated that, during the study period, the average annual decrease in firearm suicide rates for this age group was approximately 6.8% (p<0.0001), and the average annual increase in suffocation suicide rates was approximately 3.7% (p<0.0001). Poisoning suicide rates also decreased in both age groups, at an average annual rate of 13.4% among persons aged 10--14 years (Figure 1) and 8.0% among persons aged 15--19 years (Figure 2). Because of the small number of suicides by poisoning, these decreases have had minimal impact on changes in the overall profile of suicide methods of youths.
Among persons aged 10--14 years, suffocation suicides began occurring with increasing frequency relative to firearm suicides in the early- to mid-1990s, eclipsing (i.e., ratio >1.0) firearm suicides by the late 1990s (Table). In 2001, a total of 1.8 suffocation suicides occurred for every firearm suicide among youths aged 10--14 years. Among youths aged 15--19 years, an increase in the frequency of suffocation suicides relative to firearm suicides began in the mid-1990s; however, in 2001, firearms remained the most common method of suicide in this age group, with a ratio of 0.7 suffocation suicides for every firearm suicide.
Suicide attempts and physical fighting among high school students --- United States, 2001.
- Centers for Disease Control and Prevention (CDC). MMWR 2004; 53(22):474-476.
Violence is a major cause of morbidity and mortality, particularly among youths. In the United States, homicide and suicide are the second and third leading causes of death, respectively, for persons aged 13--19 years (1). Although suicide commonly is associated with anxiety, depression, and social withdrawal, research suggests a link between violent behaviors directed at oneself (i.e., suicidal behaviors) and violent behaviors directed at others among adolescents (2--6). Certain students who engage in extreme forms of violence, such as school shootings, exhibit suicidal ideation or behavior before or during the attack (2,3). However, suicidal behavior also might be associated with involvement in less extreme forms of violent behaviors, such as physical fighting, which might be a risk factor for more severe forms of violence (3). To characterize any potential association between suicide attempts and fighting, CDC analyzed self-reported 2001 data from a nationally representative sample of high school students in the United States. The results of that analysis indicated that students who reported attempting suicide during the preceding 12 months were nearly four times more likely also to have reported fighting than those who reported not attempting suicide. Prevention programs that seek to reduce both suicidal and violent behaviors are needed. Because prevalence of this association was determined to be highest in the 9th grade, these efforts might be most effective if implemented before students reach high school.
Analyses were based on data from 11,815 (out of 13,601) nationally representative high school students in grades 9--12 who participated in the 2001 Youth Risk Behavior Survey (YRBS) and responded to questions about whether they had attempted suicide and whether they had participated in physical fighting in the preceding 12 months (7). Participation in YRBS was voluntary, anonymous, and required parental permission. Students completed a self-administered booklet consisting of 95 items and recorded responses directly on a computer-scannable answer sheet. The data were weighted to be representative of students in grades 9--12 in public and private schools in the United States.
The prevalence of reporting a suicide attempt among all students was 8.9% and the prevalence of involvement in any physical fight was 33.2%. Overall, 5.3% of the students reported both attempting suicide and participating in a fight (females, 6.0%; males, 4.5%). Logistic regression analyses were used to test whether the prevalence of fighting differed by suicide attempt status within each demographic population. Students who reported attempting suicide were more likely to have been in a physical fight than students who reported not attempting suicide (61.5% versus 30.3%). Results from the stratified models indicated an association between attempting suicide and fighting for each demographic population (Table). Higher proportions of both male and female suicide attempters (77.8% and 54.0%, respectively) reported fighting than males and females who had not attempted suicide (41.2% and 19.8%, respectively). Among those who reported attempting suicide, the proportion who reported fighting was highest among 9th graders (64.5%) and decreased with each subsequent grade.
Relationship between economic development and suicide mortality: a global cross-sectional analysis in an epidemiological transition perspective.
- Moniruzzaman S, Andersson R. Public Health 2004; 118(5): 346-348.
Correspondence: Ragnar Andersson, Department of Public Health Sciences, Division of Social Medicine, Karolinska Institutet, Stockholm, SWEDEN; (email: ragnar.andersson@kau.se).
OBJECTIVE: The aim of this study was to analyse the relationship between suicide rates and economic development within the theoretical framework of epidemiological transition.
RESULT: A weak positive correlation was found between suicide rates and GNP per capita in both sexes for all ages. Discussion. According to previous studies, there is a clear decline in deaths due to unintentional injuries with improved economic conditions. This example of a man-made disease that declines during the fourth stage is in agreement with the theory of epidemiological transition. However, our results found the opposite pattern for deaths due to intentional self-inflicted injury. Conclusion. Mortality rates due to unintentional and intentional self-inflicted injury show deviating patterns from an epidemiological transition perspective.
Correspondence: Kirsi H. Suominen, Department of Mental Health and Alcohol Research, National Public Health Institute, Mannerheimintie 166, 00300 Helsinki, FINLAND; (email: kirsi.suominen@hus.fi).
This study investigated the differences in clinical characteristics between suicide attempters referred or not referred to psychiatric consultation after a suicide attempt and factors affecting such referral to psychiatric aftercare after attempted suicide. All 1198 consecutive suicide attempters treated in hospital emergency rooms in Helsinki during a 12-month period were identified. Data were gathered on any psychiatric consultation after the attempt and on all health care contacts 1 year before and after the index attempt. We found that half of the suicide attempters who were not referred to psychiatric consultation were without any aftercare recommendation and treatment contact soon after their attempt. Factors predicting referral to psychiatric consultation were age, psychotic disorder, lack of substance use disorder and, most strongly, the hospital where the suicide attempt was treated. Although the characteristics of a patient attempting suicide do play a role in determining whether a psychiatric consultation will take place or not, the most important factor is the consultation practices of the particular hospital. This in turn influences the probability of adequate aftercare.
Suicide with a butcher's bolt.
- Viola L, Costantinides F, Di Nunno C, Battista GM, Di Nunno N. J Forensic Sci 2004; 49(3): 595-597.
Correspondence: Luigi Viola, Section of Forensic Medicine, Department of Internal Medicine and Public Medicine, University of Bari, Bari, ITALY.
The captive bolt pistol is an atypical firearm exclusively produced and used for butchery of breeding animals, but in some rare cases, it has been used as a lethal weapon for committing suicide by butchers, breeders and other people who have access to such weapons during their professional activities. This study describes the suicide committed by a butcher in the province of Udine (N. Italy) in 2001 who shot himself with his own captive bolt pistol that produced in the right temporal region a circular wound and a bone lesion of the temporal squama with a groove involving the frontal lobe; he died five days later of the fatal consequences of the meningo-encephalic lesions. The medico-legal issues implicated in this case, seen in the light of the data reported in the international literature, illustrate the difficulties faced when diagnosing these types of lesions, bearing in mind their rarity and peculiar nature, and introduce elements of differential diagnosis regarding lesions produced by similar weapons that lead to ascertainment of the event as accidental, suicidal, or homicidal.
Driving and riding avoidance following motor vehicle crashes in a non-clinical sample: psychometric properties of a new measure.
- Stewart AE, St Peter CC. Behav Res Ther 2004; 42(8): 859-879.
Correspondence: Alan Stewart, Department of Counseling and Human Development, The University of Georgia, 402 Aderhold Hall, Athens, GA 30602, USA; (email: astewart@coe.uga.edu).
Three studies were conducted to assess the reliability and validity of a measure that we developed using a non-clinical sample of university undergraduates, the Driving and Riding Avoidance Scale (DRAS). Study 1 indicated that the scale was internally consistent ( [Formula: see text] ) and that a four-factor model (general avoidance, avoidance of traffic and busy roads, avoidance of weather or darkness, and riding avoidance) provided the best fit to the data in a sample of 386 crash survivors. This study also revealed that survivors who received medical treatment for their crash-related injuries reported significantly greater avoidance than people who were uninjured or injured and not medically treated. Study 2 revealed that the DRAS possessed acceptable test-retest reliability ( [Formula: see text] ) over a 4-week interval in a sample of 67 crash survivors. Using a sample of 118 survivors, study 3 examined the instrument's convergent and divergent validity through correlations with the Accident Fear Questionnaire (AFQ), the Mobility Inventory (MI), the Fear Survey Schedule-II (FSS-II), and the Fear Questionnaire (FQ). The strongest relationships were observed between the DRAS and the AFQ and with a driving subscale created from the MI items. The DRAS exhibited significantly weaker relationships with the FQ subscales that assessed other kinds of phobic avoidance.
A focused educational intervention can promote the proper application of seat belts during pregnancy.
- McGwin G Jr, Willey P, Ware A, Kohler C, Kirby T, Rue LW 3rd. J Trauma 2004; 56(5): 1016-1021.
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, USA; (email: gerald.mcgwin@ccc.uab.edu).
BACKGROUND: The failure to properly use automobile restraints during pregnancy is a significant contributor to both maternal and fetal injury and death. Misconceptions as to the effects of restraint use on the fetus and a lack of instruction as to proper restraint positioning contribute to this problem.
METHODS: Focus groups were used to develop an intervention consisting of educational material for prenatal care clinic patients and staff pertaining to seat belt use during pregnancy. The intervention was administered over a 2-month period. Two groups of women, one preintervention and one postintervention, were surveyed to determine demographics, pregnancy status, and current restraint use characteristics.
FINDINGS: Preintervention and postintervention surveys were administered to 450 and 285 women, respectively. The proportion of women reporting correct placement of seat belts increased from 70.8% to 83.0% (p < 0.001) after the intervention. Knowledge of seat belt effectiveness also increased significantly (p < 0.001) after the intervention. Only 25.2% of women in the preintervention group reported receiving information from clinic staff on restraint use compared with 76.8% of the postintervention group (p < 0.001).
COMMENTS: Lack of knowledge regarding restraint use during pregnancy contributes to a lack of consistent and proper use of restraints. Educational tools that improve both knowledge and behavior have the potential to increase automotive safety during pregnancy.
Deaths due to road traffic crashes in Hyderabad city in India: need for strengthening surveillance.
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).
BACKGROUND: 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.
Ocular injuries secondary to motor vehicle accidents.
OBJECTIVE: Ocular trauma is one of the main causes of visual reduction or loss, particularly in the younger population.
METHODS: In this prospective study the authors included 67 consecutive patients with ocular trauma secondary to motor vehicle accidents who were hospitalized in the Athens University Eye Clinic from September 1993 to December 1996. The mean follow-up time was 31 months, the mean age was 31.7 years, and the ratio between men and women was 2.7:1.
FINDINGS: Thirty-two of the accidents (47.76%) took place in populated areas. Among the 67 injured persons, 58 (86.56%) were car passengers, 8 (11.95%) were on motorcycles, and 1 (1.49%) was a pedestrian. Only 3 (5.2%) of the 58 persons injured inside automobiles used safety belts and none of the motorcyclists used crash helmets during the accidents. Fifty-three (79.1%) ocular traumas were penetrating in nature, with glass fragments being the main cause in 36 of them (67.9%). Among the 53 injured persons experiencing penetrating ocular trauma, 49 had a follow-up time of more than 6 months. Twenty of them (40.8%) underwent one surgical procedure, 22 (44.9%) were submitted to two surgical procedures, and the remaining 7 persons (14.3%) needed three or more operations. Eighteen (36.7%) of the 49 patients with penetrating ocular trauma and with 6 months follow-up had a final visual acuity of less than 1/20, 21 (42.9%) had a visual acuity of more than 5/10, and 3 (6.1%) underwent enucleation. Among the 67 patients, 61 had a follow-up time of more than 6 months, regardless of their history of penetrating ocular trauma. Eighteen of them (29.5%) had a final visual acuity of less than 1/20, 8 (13.1%) had a visual acuity between 2/10 and 4/10, and 22 (52.5%) had a visual acuity of more than 5/10.
COMMENTS: Because motor vehicle accidents can cause severe ocular trauma, it would be helpful for drivers to be more careful and aware of motor vehicle regulations. There seems to be a great need of enforcement of seatbelt laws in Greece.
Factors associated with rear seating of children in motor vehicles: a study in two low-income, predominantly Hispanic communities.
Correspondence: David Hemenway, Injury Control Research Center, Harvard School of Public Health, 677 Huntington Avenue, 3rd Floor, Boston, MA 02115, USA; (email: hemenway@hsph.harvard.edu).
This study examined child seating patterns in two predominantly low-income, Hispanic communities in Massachusetts. The purpose was to determine the factors associated with child rear seating in the community as a whole and for a subset of Hispanic motorists. Five hundred and five vehicles carrying child passengers and no adult other than the driver were observed in parking lots of fast food restaurants and grocery stores. Four hundred and thirty-two vehicle drivers agreed to be interviewed. A child was defined as a passenger younger than age 12 as determined by appearance and height (head below the vehicle headrest when seated). Variables under study included driver gender, age, ethnicity, and educational attainment; driver shoulder belt use; driver perception of passenger-side airbag presence; and the number and ages of children in the car. Overall, 51% of vehicles were observed with all children seated in the rear. In a bivariate analysis, child rear seating was strongly associated with female drivers, younger drivers, driver shoulder belt use, perceived presence of a passenger-side airbag, all children in the vehicle <==6 years old, and fewer than three children in the vehicle. Non-Hispanic ethnicity was weakly associated with child rear seating. In the multivariate analysis, only the association between child rear seating and all children in the vehicle <==6 years old remained strong (RR 2.4, 95% CI 1.7-3.3). Factors associated with rear seating were similar between Hispanic and non-Hispanic motorists. Controlling for other factors, the presence of a passenger-side airbag appeared to be more strongly associated with rear seating among non-Hispanics compared to Hispanics (RR 1.5 versus 1.1). Fewer Hispanic motorists drove vehicles with all children in the rear compared with the non-Hispanic motorists (48% versus 56%); this difference appears to be associated with the finding that fewer Hispanic drivers wore their seat belt. For both Hispanic and non-Hispanic motorists, efforts to increase child rear seating should focus on older children, male drivers, and on increasing general motor vehicle safety behavior (e.g. seat belt use). Messages should be culturally appropriate and should emphasize driver seat belt use in conjunction with rear seating and the importance of rear seating regardless of the presence of a passenger-side airbag.
In this article, we express concerns regarding the availability of airguns, the injuries that they cause and their abuse as weapons of assault. We wish to stimulate debate on this topic and report a 5-year retrospective analysis of all airgun injuries to the head and neck, presenting to Alder Hey Children's Hospital, Liverpool, from June 1998 to June 2003. We identified 16 patients who suffered such injuries with ages ranging from 5 to 15 years. The majority of cases were violent assaults, which is not in accordance with previous published reports. All of these occurred in public places outside the home. Most incidents occurred through the spring and summer period. Six patients required overnight stay in hospital. Nine patients required operative procedures to remove the airgun pellets. Two patients had serious eye injuries resulting in loss of vision. Two patients had penetrating neck injuries requiring exploration of the wound. The remaining group had either skin-penetrating injuries with lodgement of fragments in subcutaneous tissues or non-skin penetrating injuries. This study highlights serious injuries arising from the abuse of airguns as weapons of assault. Airguns are readily available to people without license. Recent legislation has increased the minimum age at which airguns can be carried in a public place, but we believe that stricter legislation is required to produce a reduction in the number of airgun-related injuries.
Unsupervised firearm handling by California adolescents.
- Miller M, Hemenway D. Inj Prev 2004; 10(3): 163-168.
Correspondence: Matthew Miller, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 01115, USA; mmiller@hsph.harvard.edu).
OBJECTIVE: Relatively little is known about the behavior of adolescents around firearms. The present investigation was undertaken to estimate the proportion of community-residing adolescents who report that they have ever handled a gun without adult knowledge or supervision.
METHODS: A random digit dial interview was conducted with 5801 California adolescents as part of the California Health Interview Survey. Respondents were asked whether they have ever held a gun and whether they have ever done so without adult knowledge or supervision. Study design and population weights were applied to these data. In addition, adolescents' reports about the most recent unsupervised handling incident were coded to ascertain what they were doing with the gun as well as with whom and where the incident occurred.
FINDINGS: One third (33%) of California adolescents report that they have handled a firearm; 5% report that they have done so without adult knowledge or supervision. Half (49%) of all unsupervised handling involved shooting and only 11% occurred in the respondent's home. Several demographic variables (being male, African American, living in a rural area) and risk behaviors (smoking, drinking, being the victim of a gun related threat), as well as having a gun in the home and parents not knowing the adolescent's whereabouts in the afternoon were each associated with unsupervised gun handling.
COMMENTS: Unsupervised gun handling is associated with other health risk behaviors. Unsupervised gun handling typically involves shooting the gun and usually occurs with friends, away from the home.
Factors associated with state variations in homicide, suicide, and unintentional firearm deaths.
- Price JH, Thompson AJ, Dake JA. J Community Health 2004; 29(4): 271-283.
Corresponsence: James Price, Mississippi State University, Department of HPERS, Mississippi State, MS, USA; (email: jprice@utnet.utoledo.edu).
This study examined the relationship of 16 variables with homicide, suicide, and unintentional firearm deaths. This cross-sectional analysis, using adjusted partial correlation coefficients, found that state-level firearm homicide rates significantly varied by the prevalence of firearms and by percent of the population which was African American. Whereas, state-level variations in firearm suicide mortality significantly varied by firearm prevalence, per capita alcohol consumption, percent of the population which was African American, and level of urbanization. None of the variables were significantly (p < or = .05) related to state-level variations in unintentional firearm mortality. Furthermore, state gun laws had only a limited effect on firearm-related homicide deaths. Although the current study cannot determine causation, firearm mortality in its various forms is most commonly related to the prevalence of firearms and the percent of the population that is African American.
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 30341-3724, USA.
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OBJECTIVE: To provide national estimates of fatal and nonfatal firearm-related (FA) injuries among children < or =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. RESULTS: 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 < or = 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 < or =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 < or =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. CONCLUSIONS: 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.
Are medical societies developing a standard for gun injury prevention?
- Longjohn MM, Christoffel KK. Inj Prev 2004; 10(3): 169-173.
Correspondence: Katherine Kaufer Christoffel, 2300 Children's Plaza #157, Chicago, IL 60614, USA; (email: kkauferchristoffel@northwestern.edu).
CONTEXT: Following heightened gun violence in the 1990s, many medical societies in the United States adopted policies on the topic. OBJECTIVE: Identify points of firearm violence policy agreement among large medical organizations. DESIGN: Fourteen national medical societies-clinical focus, demonstrated interest in gun injury prevention, >2000 members-were selected for policy review in 2002. Policies were categorized on areas covered and items within these. Consensus areas were addressed by >/=7/14 societies.Consensus items were included by >/=7/14 societies, shared items by 5-6. RESULTS: There were five consensus areas: access prevention, gun commerce, research, public education, and clinical counseling. There were four consensus items: restricting gun access by enforcing existing laws, restricting access to all guns at the point of sale, restricting access to handguns at the point of sale, and creating a national database on gun injury and death. Shared items promote violence prevention, clinical education on risks of guns in the home, treating guns as consumer products, restricting gun access to children, bans on automatic weapons, and promoting trigger locks. CONCLUSIONS: Large medical societies in the United States agree on key approaches for reducing gun injury mortality and morbidity. Future research will be needed to track the evolution of this emerging standard for physician action, which now includes the consensus areas and items. It promises to be, in effect, a medical standard of care for gun injury prevention. The United States experience may be useful to others working on gun injury prevention.
Homicidal and dyadic falls from a height: rarities in Singapore.
- Lau G. Med Sci Law 2004; 44(2): 93-106.
Correspondence: Gilbert Lau, Centre for Forensic Medicine, Health Sciences Authority, 11 Outram Road, SINGAPORE; (email: gilbert_lau@hsa.gov.sg).
A review of homicidal falls from a height, over a ten-year-period (1991-2000), demonstrated the rarity of such deaths in Singapore, despite the high frequency of fatal falls from a height that prevails in the city-state. During that time, there were four cases (involving five individuals) of pure homicide and nine episodes (involving 19 individuals) of dyadic death involving vertical deceleration from a considerable height in the approximate range of 17-31 m (6-11 floors) and 17-50 m (6-18 floors), respectively. The index cases were gleaned from a total of 533 homicides and 3,963 fatal falls from a height. Hence, the corresponding ten-year prevalence rates of homicidal falls were 0.9% in terms of all homicidal deaths and 0.1% in relation to all fatal falls, and 3.6% and 0.5% for dyadic falls, respectively. The majority of victims were children, with almost equal numbers of males and females, aged between two months and six years for pure homicides and between 20 months and 13 years for homicide-suicides. Over a third (9/24) of these subjects attained the maximum Injury Severity Score (ISS) of 75. With respect to the dyadic deaths, the majority of the perpetrators (6/9) were females, comprising four mothers and two live-in maids. It would appear that strained or broken relationships, probable or actual mental illness, or a combination of both factors, had largely predisposed them to these tragic events which may, potentially, carry diplomatic implications when foreign nationals are involved.
Prevalence and determinants of male partner violence against Mexican women: a population-based study.
- Rivera-Rivera L, Lazcano-Ponce E, Salmeron-Castro J, Salazar-Martinez E, Castro R, Hernandez-Avila M. Salud Publica Mex 2004; 46(2): 113-122.
Correspondence: L. Rivera, Centro de Investigacion en Salud Poblacional, Instituto Nacional de Salud Publica, Cuernavaca, Morelos, MEXICO; (email: lrivera@correo.insp.mx).
OBJECTIVE: To determine the prevalence of and risk factors for violence against women, inflicted by their male partners, in a representative sample of women residing in the metropolitan area of Cuernavaca Morelos, Mexico.
METHODS: A population-based study was conducted from June to September 1998, among 1,535 women aged 15 to 49 years. Principal components analysis was used to determine the domains of violence that served as the dependent variable. Polynomial logistic regression models were used to estimate odds ratios (OR), with 95% confidence intervals (CI).
FINDINGS: Prevalence of low-moderate level violence was 35.8%, while prevalence of severe violence was 9.5%. The lifetime prevalence of reported rape was 5.9%. The main factors associated with violence were socio-economic status (OR=0.57; 95% CI=0.34-0.95); education level, both of the women studied (test for trend p=0.01) and of the male partner (test for trend p=0.002); number of years living with partner (OR=2.63; 95% CI=1.55-4.45), alcohol use (OR=2.56; 95% CI=2.02-3.25), illegal drug use by partner (OR=6.17; 95% CI=2.37-16.03); violence during childhood (OR=3.40; 95% CI=2.23-5.18), and a history of rape (OR=5.89; 95% CI=2.78-12.5).
COMMENTS: Study findings confirm that violence against women is a prevalent phenomenon in Mexico. Awareness-raising campaigns about male partner violence should bring this important issue to the front of public discussion. Such efforts will help assure that future generations do not experience partner violence to the extent that contemporary Mexican women do.
Blast injury research: Modeling injury effects of landmines, bullets, and bombs.
Correspondence: Roman Hayda, Institute of Surgical Research, 3851 Roger Brooke Dr.,
Fort Sam Houston, TX 78234-6200, USA; (email: roman.hayda@cen.amedd.army.mil).
Terrorist blasts and landmine injuries have become more common in the past several decades generating thousands of casualties. Preventive and prognostic measures are limited by the lack of knowledge of these complex events. Previous blast research has focused on primary blast injuries that involve the lung, despite musculoskeletal injuries being the most common. Through the use of instrumented cadavers, Hybrid III test dummies, and other surrogates, unique models of these events have been created. The investigations studied the effectiveness of antimine footwear, forces and injury mechanisms in temporary shelters subjected to blast, modeling of blast-induced glass fragmentation, and helmet deformation and injury potential under ballistic load. Despite blasts being much higher rate events than those seen in automotive blunt trauma, we were able to measure forces and create injury models. We found that antimine footwear will require additional development to be effective. Guidelines for shelter placement have been altered, and tempered glass seems to offer no protection when compared with annealed glass. Although these models are in their nascent phase, the thorough understanding of the biomechanical nature of these blast injuries will assist in developing strategies to reduce injuries and in the creation of forecasting models.
Investigations on landmine detection by neutron-based techniques.
Correspondence: Guyla J. Csikai, Institute of Nuclear Research of the Hungarian Academy of Sciences (ATOMKI), P.O.B. 51, Debrecen H-4001, HUNGARY; (email: csikai@delfin.klte.hu).
Principles and techniques of some neutron-based methods used to identify the antipersonnel landmines (APMs) are discussed. New results have been achieved in the field of neutron reflection, transmission, scattering and reaction techniques. Some conclusions are as follows: The neutron hand-held detector is suitable for the observation of anomaly caused by a DLM2-like sample in different soils with a scanning speed of 1m(2)/1.5min; the reflection cross section of thermal neutrons rendered the determination of equivalent thickness of different soil components possible; a simple method was developed for the determination of the thermal neutron flux perturbation factor needed for multi-elemental analysis of bulky samples; unfolded spectra of elastically backscattered neutrons using broad-spectrum sources render the identification of APMs possible; the knowledge of leakage spectra of different source neutrons is indispensable for the determination of the differential and integrated reaction rates and through it the dimension of the interrogated volume; the precise determination of the C/O atom fraction requires the investigations on the angular distribution of the 6.13MeV gamma-ray emitted in the (16)O(n,n'gamma) reaction. These results, in addition to the identification of landmines, render the improvement of the non-intrusive neutron methods possible.
Risk behaviors and resiliency within physically abused adolescents.
Correspondence: Daniel F. Perkins, Family and Youth Policy for Resiliency, Department of Agricultural and Extension Education, The Pennsylvania State University, 323 Agricultural Administration Building, University Park, PA 16802, USA; (email: dfp102@psu.edu).
Objective: This study examines the relationship between physical abuse and several risk behaviors, and thriving behaviors, and the relationship between potential protective factors and engagement in risk and thriving behaviors among victims of physical abuse. Three categories of potential protective factors were examined: (1) individual characteristics, (2) family processes, and (3) extra-familial factors. We expected that high levels of protective factors would reduce engagement in risk behaviors (i.e., alcohol use, tobacco use, drug use, sexual activity, antisocial behavior, attempted suicide, and purging) among abused adolescents. Results: Across all the risk behaviors, abused adolescents reported a higher frequency of engagement than non-abused adolescents. Several protective factors were identified for the seven risk behaviors. Peer group characteristics was a significant predictor in all seven of the logistic regressions, followed by positive school climate (six models), religiosity (five models), other adult support (five models), family support (four models), view of the future (two models), and involvement in extra-curricular activities (two models). The variance accounted for by the models ranged from 2% (risk behavior of purging) to 26% (risk behavior of alcohol use and antisocial behavior). Conclusions: The findings indicate that, with the exception of sexual activity, the majority of abused adolescents were not engaging in risk behaviors; however, significantly more abused adolescents were engaging in risk behaviors than their non-abused counterparts. In addition, that protective factors were found to exist at various levels of the adolescents' ecology has strong implications for practice.
Violence and suffering in television news: toward a broader conception of harmful television content for children.
- Van Der Molen JH. Pediatrics 2004; 113(6): 1771-1775.
Correspondence: Juliette H. Walma van der Molen, Department of Communication, University of Amsterdam, Amsterdam, THE NETHERLANDS; (email: j.h.walmavandermolen@uva.nl).
Traditionally, the public and professional debate about the inappropriateness of media violence for children focuses mainly on the negative effects of violence in entertainment programming. However, since the terrorist attacks on September 11 1th and the recent coverage of the war in Iraq, the suitability of real-life news violence for children may be doubted more than ever. To draw attention to the potential harmful effects of violence presented in news programs, it is argued in the present article that health care professionals should advocate a broader conception of media violence than thus far has been used. On the basis of recent research, potential effects of violent news content, such as fear, aggression, and desensitization, are discussed and recommendations are provided on how to abate these outcomes.
