Hazardous drinkers in the accident and emergency department--Who accepts advice?
- Patton R, Crawford M, Touquet R. Emerg Med J 2004; 21(4): 491-492.
Correspondence: R. Patton, SLaM/Institute of Psychiatry, National Addiction Centre, 4 Windsor Walk, Denmark Hill, London SE5 8AF, UK; (email: r.patton@iop.kcl.ac.uk).
OBJECTIVE: To identify factors that predict acceptance of brief advice among people consuming excessive alcohol in an accident and emergency (A&E) department. METHODS: Patients presenting to an A&E department were screened using the Paddington Alcohol Test. All patients identified as hazardous drinkers were offered advice about their drinking. Data were collected on patients' age, sex, presenting condition, and alcohol consumption. Binary logistic regression was used to identify variables that predicted acceptance of the offer of advice. FINDINGS: The presenting condition, together with the total number of units consumed on a single occasion, predict the uptake of an offer of help. COMMENTS: Patients identified as hazardous drinkers who present after a fall, head injury, or other accident are less likely to accept help. Clinicians should emphasise the potential relation between alcohol consumption and health related consequences to encourage the uptake of advice for these patients.
The association of race and ethnicity with rates of drug and alcohol testing among US trauma patients.
- Kon AA, Pretzlaff RK, Marcin JP. Health Policy 2004; 69(2): 159-167.
Correspondence: Alexander A. Kon, Pediatric Critical Care Medicine and The Program in Bioethics, Department of Pediatric, University of California, Davis, 2516 Stockton Boulevard, 95817, Sacramento, CA, USA; (email: aakon@ucdavis.edu).
BACKGROUND: Racial and ethnic minority patients often receive differential medical care compared to Caucasians. The aim of this study was to evaluate the association of race and ethnicity with rates of alcohol and drug testing among adult US trauma patients.
METHODS: Data for 79,246 adults admitted to 58 institutions participating in the US National Trauma Data Bank were evaluated using multivariable, hierarchical, mixed-effects analyses to determine the odds of receiving alcohol and drug testing among different racial/ethnic groups. The primary outcome variable was whether an alcohol or drug test was performed. The secondary outcome variable was the results of those tests. Participants were stratified by injury severity using the Injury Severity Score. Additional case-mix variables included: gender, age, Glasgow Coma Scale, day and time of arrival, and payment source.
FINDINGS: Black and Hispanic males in all injury severity groups were tested for alcohol more frequently than Caucasian males (odds ratio for Black men 1.31, 95% confidence interval 1.16-1.47; and for Hispanic men 1.45, 95% confidence interval 1.19-1.77, in the moderate injury group). Hispanic males in the moderate injury group were also tested for drugs more frequently then Caucasian males (odds ratio 1.33, 95% confidence interval 1.09-1.63).
COMMENTS: Racial and ethnic minority trauma patients in the US are tested for alcohol and drugs at higher rates after adjusting for potential confounders. Because having a positive alcohol or drug test can adversely affect a patient's medical care, differential testing that is racially or ethnically biased may place minority patients at risk of receiving disparate care.
Sources of information about MDMA (ecstasy): perceived accuracy, importance, and implications for prevention among young adult users.
- Falck RS, Carlson RG, Wang J, Siegal HA. Drug Alcohol Depend 2004; 74(1): 45-54.
Correspondence: Russel S. Falck, Center for Interventions, Treatment & Addictions Research, Wright State University School of Medicine, 3640 Colonel Glenn Highway, Dayton, OH 45435, USA; (email: russel.falck@wright.edu).
The goal of this cross-sectional study was to assess the perceived accuracy and the importance of various sources of information about MDMA/ecstasy among young adult users. A respondent driven sampling plan was used to recruit a community sample of recent ecstasy users (n = 304), aged 18-30, in Ohio, who responded to structured interviews. Friends, drug abuse treatment programs, and physicians were perceived to be the most accurate sources of information about ecstasy by 45.7, 37.2, and 30.3% of the sample, respectively. Friends were considered the most important source of information about ecstasy (40.2%), followed by web sites like DanceSafe (16.2%), and MTV/VH1 television specials (6.9%). About half the sample used the Internet to obtain information about ecstasy, with younger and more educated participants significantly more likely to do so. Educated users were also significantly more likely to consider the Internet to be an important source of information. Web sites like DanceSafe were visited by four times as many users as government-sponsored web sites. Findings support the development of peer-oriented, network strategies to reach ecstasy users with prevention messages. Efforts to make prevention web sites more attractive should be considered.
- McCammon JB, Jumbelic MI, Baron RL. Public Health Rep 2004; 119(2): 112-113.
Correspondence: Jane B. McCammon, National Institute for Occupational Safety and Health Denver Field Office Director Denver, Colorado 80225 USA; (email: jbm6@cdc.gov).
In the September/October, 2003 issue of Public Health Reports, Marilyn L. Browne and collegues described environmental and personal risk factors associated with 216 watercraft-related drownings occurring between 1988 and 1994 among New York state residents. Carbon monoxide (CO) exposure was not one of the risk factors identified as meaningful for future reduction in such drownings.
As part of an ongoing investigation of boat-related CO poisonings in the United States, we have identified 503 severe CO poisonings occurring primarily between 1990 and present.2 Of these poisonings, 101 resulted in death, and 46 of these deaths were CO-related drownings. One of these drownings occurred in New York in 1996. This woman voluntarily entered the water to swim and drowned after 10 minutes in the water. Because the Medical Examiner analyzed the blood specimen for carboxyhemoglobin (COHb), which was found to be 62%, CO exposure from the boat�s operating propulsion engine was listed as contributory to her drowning.
During an extensive review of U.S. National Park Service records of boat-related drownings that occurred between 1994 and 2002 at Lake Powell (U.S. National Park Service Glen Canyon National Recreation Area), we determined that 11 of the 26 (42%) boat-related drownings were related to CO exposure. These drowning victims had measured COHb concentrations ranging from 26% to 59%. Nine of these victims voluntarily entered the water, one collapsed while on a platform (fell overboard), and one death was unwitnessed; thus, no information was available about his entry into the water. These drownings occurred because boat design features intended for occupancy (e.g., swim platforms, extended rear decks) and exhaust terminus configuration place people close to propulsion engine and/or on-board gasoline-powered electrical generator exhaust. Studies conducted since 2000 have shown that these engines, most of which have no emission controls, produce CO-rich clouds with concentrations greater than 60,000 parts of CO per million parts of air (690 times the short-term exposure limit recommended by the World Health Organization) measured outside the cabin area of the boat. These studies, as well other related technical and educational materials, can be found at: http://safetynet.smis.doi.gov/COhouseboats.htm.
The information from our studies leads us to ask the following questions:
Were COHb concentrations measured for any of the 99 motorboat-related drownings noted in the reported study?
What were the circumstances involved with the 50 deaths in which the victim fell overboard and the 24 deaths in which the victim voluntarily entered the water?
Are there any stored blood specimens still in existence for any of the cases cited by the authors that could be analyzed for CO testing? If so, positive results could shed light on whether poisonings had been missed as a contributing cause to the drowning.
We found it interesting that the authors based their recommendation about alcohol use on the fact that 18/73 victims for which alcohol results were available had blood alcohol concentrations greater than 100 mg/dl. Thus, the authors conclude that alcohol is a risk factor based on 18 of 216 (8%) drownings in which the victim was known to be above the limit legally recognized as "drunk." One wonders how this would compare with CO exposure as a risk factor if all 99 motorboat-related drownings (or even if just the 73 tox screens) had included a COHb analysis? If we extrapolate the Lake Powell findings (where alcohol and COHb analyses are routinely conducted on autopsy due to their history of recognition of this problem), CO could have been related to as many as 42 of the 99 New York drownings. For this reason, we recommend that COHb analyses be performed in every boat-related death whether it is a drowning, an apparent natural death on the boat itself, or accidental trauma.
The primary objective of this paper is to describe the impact of national seat belt enforcement mobilizations in terms of changes in public awareness, perceptions, and opinions as they relate to Operation ABC (Always Buckle Up). In order to monitor changes in public awareness and perceptions, a number of national telephone surveys were conducted. Survey results indicated that the following characteristics were associated with lower self-reported seat belt use rates: (a) males; (b) 18-34 age group; (c) persons with lower income; (d) persons with lower education; (e) persons living in rural areas; (f) residents of the Northeast, Midwest, and Great Lakes; (g) residents of states with secondary enforcement laws; and (h) persons less likely to read a newspaper and more likely to listen to the radio. Telephone surveys also suggested that the following groups are more likely to fail to properly secure a child under 12: (a) persons who say they have problems securing a child in seat belt; (b) farm belt residents; (c) Hispanic and Latinos; (d) persons who indicate that they always wear a seat belt but indicate they have not in the past month; (e) persons with older vehicles; (f) lower income respondents; (g) residents of the Deep South; (h) internet non-users; and (i) urban men. These findings provide support for some basic guidelines and suggestions for conducting seat belt enforcement activities.
Exercising for health: An analysis of semi-structured interviews.
Correspondence: Jochen G Bocksnick, Department of Kinesiology, The University of Lethbridge, Lethbridge, Alberta, CANADA T1K 3M4; (email: bocksnick@uleth.ca).
The objective of this study was to describe the motivation process of older adults who had completed an exercise program that was offered three times a week for 45 minutes between September and December or January and April. All respondents (N = 48, mean age = 66.4 years) volunteered to participate in an audiotaped and semi-structured interview. The questions for the interview were grounded in the theoretical concepts outlined in the Theory of Planned Behavior (Ajzen & Madden, 1986) and the Rubicon Model (Heckhausen, 1989). The interviews provided a detailed account of the respondents' motivation to participate in the structured exercise program and a detailed description of their experiences during, and perceived outcomes from, their involvement in the program. The data suggested that important for the respondents' motivation to adhere to the exercise program was making a personal commitment and experiencing desirable changes in their physical competence, which the respondents attributed to their program participation.
Correspondence: Don A. Wicks, School of Library and Information Science, Kent State University, Kent, OH, 44242-0001, USA; (email: dwicks@slis.kent.edu).
In this qualitative study the author examines the informationseeking behavior of older adults and asks whether the information sources used by participants vary with the role they are performing; whether "young" seniors just entering retirement seek information differently than the "oldest" old; and whether seniors living independently seek information differently than those who live in an institutional setting. The twenty-nine participants interviewed indicated that interpersonal sources together with internally-produced print materials were relied on for the information needed for participation in community clubs and organizations; interpersonal sources to find answers to medical and financial questions; and printed resources for hobby-related information seeking. Findings related to computer use indicated that it is important when discussing older adults to distinguish between different stages of older age.
Correspondence: Holly L. Angelique, School of Behavioral Sciences, Penn State University, Capital College, 777 W. Harrisburg Pike, Middletown, PA 17057, USA; (email: hxall@psu.edu).
This study examined the literature on children's responses to natural, technological and na-tech disasters via content analysis. Twenty two articles documenting children's responses to disasters were collected and analyzed. Children's responses were examined by (a) disaster type; (b) measurement instrument used to assess response; (c) age; and (d) administration of measures to children or their caregivers. Results indicate that it is important to ask children directly about their responses to disasters, regardless of disaster type, rather than relying on caregivers assessments. Also, witnessing scenes of destruction and/or life threatening situations elicits more stressful reactions than the type of disaster experienced. As such, the perceived threat rather than the disaster agent itself is deemed the more important factor in children's post-disaster psychopathology.
Correspondence: Igor Radun, Department of Psychology, Traffic Research Unit, University of Helsinki, Helsinki, FINLAND; (email: igor.radun@helsinki.fi).
OBJECTIVES: To analyze factors that explain the attribution of crash causes as sleep-related by accident investigators.
DESIGN: Analysis of national database of fatal road accidents studied in depth. All nonprofessional nonintoxicated car drivers responsible for a fatal accident from 1991 to 2001 were included (N = 1464).
SETTING: Finland, with approximately 5.1 million inhabitants and 2.3 million motor vehicles.
MEASUREMENTS: Comprehensive database recorded by multidisciplinary investigation teams, with specific emphasis on the availability of sleep-related driver variables and sleep-related causal decisions by teams.
FINDINGS: Injury severity, age, and marital status of the responsible car driver were related to the proportion of missing data in fatigue-related variables in the database (sleeping time, time awake, lifetime mileage). While there were differences between investigation teams and their activities, a series of logistic regression models showed that the lack of relevant variables in the database did not affect the proportion of accidents attributed to falling asleep (10% of cases) or as having fatigue-related causal factors (an additional 5% of the cases). The accident type (head-on and running-off versus other) and road conditions (dry or wet versus icy or snowy pavement) predicted the investigation teams' attribution of sleep-related causes in all models.
COMMENTS: Multidisciplinary teams' attribution of sleep-related causal factors were rather stable, comprising 10% to 15% of the cases investigated, independent of the availability of specific sleep-related information.
CSHM: Web-based safety and health monitoring system for construction management.
- Cheung SO, Cheung KK, Suen HC. J Safety Res 2004; 35(2): 159-170.
Correspondence: Sai On Cheung, City University of Hong Kong, Department of Building and Construction, 83 Tat Chee Avenue, Kowloon Tong, Hong Kong, CHINA; (email: bcsoc@cityu.edu.hk).
BACKGROUND: This paper describes a web-based system for monitoring and assessing construction safety and health performance, entitled the Construction Safety and Health Monitoring (CSHM) system.
METHODS: The design and development of CSHM is an integration of internet and database systems, with the intent to create a total automated safety and health management tool. A list of safety and health performance parameters was devised for the management of safety and health in construction. A conceptual framework of the four key components of CSHM is presented: (a) Web-based Interface (templates); (b) Knowledge Base; (c) Output Data; and (d) Benchmark Group.
FINDINGS: The combined effect of these components results in a system that enables speedy performance assessment of safety and health activities on construction sites. With the CSHM's built-in functions, important management decisions can theoretically be made and corrective actions can be taken before potential hazards turn into fatal or injurious occupational accidents.
COMMENTS: As such, the CSHM system will accelerate the monitoring and assessing of performance safety and health management tasks.
Nonfatal occupational injuries from slips, trips, and falls among older workers treated in hospital emergency departments, United States 1998.
- Layne LA, Pollack KM. Am J Ind Med 2004; 46(1): 32-41.
Correspondence: Larry A. Layne, National Institute for Occupational Safety and Health, Division of Safety Research, Morgantown, West Virginia, USA; (email: lal3@cdc.gov).
BACKGROUND: Falls are a leading cause of injury among older adults. As the workforce demographics shift to an older population, the dearth of information on occupational falls among older adults must be addressed.
METHODS: A national probability sample of hospital emergency departments (EDs) (National Electronic Injury Surveillance System) was utilized to characterize falls at work.
FINDINGS: Older workers were found not to be at increased risk of a fall injury, but were more likely than younger workers to be hospitalized post-injury. Same-level falls were the most common type of incident among older workers. Falls from height were more prevalent among men than women. The narrative case descriptions for same-level falls to the floor primarily implicated floor contamination and tripping hazards.
COMMENTS: Fall prevention programs targeted to older workers must examine extrinsic sources of falls, particularly surface traction, contaminant control, and footwear.
Prevention of head injuries in children bicyclists: a proposal.
- Alleman A, Akande A, Bukacek M, Geib J, Simonson-Younger J. J Okla State Med Assoc 2004; 97(4): 160-162.
Correspondence: Anthony Alleman, Department of Radiology, University of Oklahoma Health Sciences Center, PO Box 26901, Oklahoma City, OK 73190, USA; (email: unavailable).
Bicycle-related head injury is a significant source of morbidity in children. Upon review of contemporary approaches for reducing such injuries, summarized herein, the authors conclude that a school-based promotion of proper helmet usage represents a reasonable compromise between expediency and probability of success. This proposal contains an outline for a pilot program to be implemented in an elementary school setting. It is postulated that a large-scale implementation of this program in combination with other discussed interventions will achieve the long-term goal of reducing bicycle-related pediatric head injuries.
Correspondence: Kennon Heard, The University of Colorado Health Sciences Center, Division of Emergency Medicine, Denver, CO 80262, USA; (email: Kennon.Heard@uchsc.edu).
BACKGROUND: The Glasgow Coma Scale (GCS) was developed for monitoring the mental status of head-injured patients in the intensive care unit. The purpose of this study is to determine the inter-rater reliability of the GCS for poisoning patients in the emergency department.
METHODS: This was a prospective, observational study. Two observers used a standard assessment checklist to determine the GCS of suspected poisoning patients. Inter-rater reliability was assessed with a weighted Kappa score.
FINDINGS: A total of 39 patients were enrolled. Weighted kappa for the total GCS demonstrated excellent agreement. Agreement was also good for each component of the score.
COMMENTS: The GCS is a reliable tool for the evaluation of mental status of poisoning patients in the emergency department.
BACKGROUND: Use of all-terrain vehicles (ATVs) has become a popular recreational activity for all ages, yet children suffer a markedly higher proportion of ATV-related injuries and deaths compared with the adult population. Evidence needs to be developed to direct policy to eliminate unnecessary injuries in this population.
METHODS: A review of children younger than 16 years old admitted to a tertiary pediatric trauma center with ATV-related injuries over 12.5 years was conducted. Data included demographics, mechanisms of injury, use of helmets, and outcomes.
FINDINGS: Of 92 patients, 79% were male, the mean age was 12.1 years, 16% were under 10 years old, and 10% had attention deficit hyperactivity disorder (general population prevalence, 1-4%). Flipping/rolling was the most common mechanism of injury (32%) and was associated with sustaining chest and abdominal injuries (odds ratio, 3.7; 95% confidence interval, 1.1-12.9) and an increased Injury Severity Score (ISS). Only 4 of 20 patients with head/facial injuries were using helmets compared with 37 of 40 (odds ratio of head injury with helmet use, 0.02; 95% confidence interval, 0.004-0.101). Forty-five patients had more than one body system injured. The mean ISS was 7.0 (range, 1-35), and high scores were associated with sustaining head and/or truncal injuries. Fourteen percent of cases had an ISS greater than or equal to 12 and two patients died. The median length of stay was 3 days; 12% were admitted over 2 weeks.
COMMENTS: Children continue to sustain a large proportion of preventable and unnecessary injuries caused by ATVs. Although use of protective devices (i.e., helmets) diminishes the extent of injuries, children's smaller size relative to these large machines may contribute to flipping, rolling, and loss of control. Increased risk-taking by those with attention deficit hyperactivity disorder may also play a role. Efforts are needed to lobby for policies to limit the promotion and restrict the use of ATVs by children.
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).
OBJECTIVE: To assess compliance with current standards of playgrounds where children have sustained a fall-related arm fracture.
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.
BACKGROUND: Trauma centers are expected to develop injury prevention programs that address needs of the local population. A relatively simple, objective, and quantitative method is needed for prioritizing local injury prevention initiatives based on both injury frequency and severity.
STUDY DESIGN: Pediatric trauma patients (16 years or younger; n= 7,958) admitted to two Level I regional trauma centers (Johns Hopkins Children Center and Westchester Medical Center) from 1993 to 1999 were grouped by injury causal mechanism according to ICD-9 external cause codes. An Injury Prevention Priority Score (IPPS), balancing the influences of severity (based on the Injury Severity Score) and frequency, was calculated for each mechanism and mechanisms were ranked accordingly.
FINDINGS: IPPS-based rank lists differed across centers. The highest ranked mechanism of injury among children presenting to Johns Hopkins Children Center was "pedestrian struck by motor vehicle," and at Westchester Medical Center it was "motor vehicle crash." Different age groups also had specific injury prevention priorities, eg, "child abuse" was ranked second highest among infants at both centers. IPPS was found to be stable (r = 0.82 to 0.93, p < 0.05) across alternate measures of injury severity.
COMMENTS: IPPS is a relatively simple and objective tool that uses data available in trauma center registries to rank injury causes according to both frequency and severity. Differences between two centers and across age groups suggest IPPS may be useful in tailoring injury prevention programs to local population needs.
Characteristics of falls in hospitalized patients.
- Kerzman H, Chetrit A, Brin L, Toren O. J Adv Nurs 2004; 47(2): 223-229.
Correspondence: Hana Kerzman, Research Unit, Nursing Division, The Chaim Sheba Medical Center, Tel Hashomer 2621, ISRAEL; (email: hanakert@sheba.health.gov.il).
BACKGROUND: The high incidence of patient falls in a hospital setting is a major concern in any health system. Research findings have reported the risk factors for these falls as age, gender, certain medications, mental status, chronic diseases and environmental factors. Falls may lead to fear, pain, slight or severe injuries, increase the duration of hospital stay, cause patient discomfort and affect quality of life.
OBJECTIVE: The aim of this paper is to report a study of the characteristics of patient falls during hospitalization in 1998 and compare them with those in the period 1978-1981.
METHODS: A retrospective study was performed in a large, 2000-bed medical center in Israel. Reports of 711 fall incidents in 1998 were compared with 328 reports in 1978-1981. Information gathered included age, gender, department, shift, reasons, severity of injury, tests and treatment after injury.
FINDINGS: The rates of falls per 1000 admissions in psychiatric, elder care and rehabilitation departments in 1998 were statistically significantly higher than in the earlier period. Rates of 115, 91, 85, respectively, per 1000 admissions were reported in 1998 compared with 34, 9, 19, respectively, in the period 1978-1981. The percentage of reported falls in the younger age group (under 50) was higher in the later survey (1998), and a higher proportion occurred outside the patient's room. Most of the reported falls in 1998 occurred during the morning shift (P < 0.001).
COMMENTS: The increased number of falls could be an outcome of increased awareness. Nevertheless, the causes and place of falls differ for the two periods. Some of the reasons may be related to an intervention programme carried out after the first survey. The latest survey results will serve as an important basis for a further intervention programme in specific departments to ensure patient safety.
Study on the trend and disease burden of injury deaths in Chinese population, 1991 - 2000.
- Yang GH, Zhou MG, Huang ZJ, Wang LJ. Zhonghua Liu Xing Bing Xue Za Zhi 2004; 25(3): 193-198.
Correspondence: G. Yang, Institute of Basic Medicine, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100005, CHINA; (email: unavailable).
OBJECTIVE: The mortality and trend of injury in 1991 - 2000, the distribution of causes of injuries by areas as well as disease burden in Chinese population were discussed.
METHODS: Data on mortality level and causes of injuries provided by National Disease Surveillance Program in 1991 - 2000, adjusted by under-reporting rate together with years of potential life lost (YPLL) and WPYLL of injuries and proportion of YPLL and WPYLL of total death, were calculated.
FINDINGS: The mortality of injury was kept at a stable level from 1991 to 2000. The adjusted average death rates were 66.56/100 000 with 81.41/100 000 in males, 51.17/100 000 in females, and 38.68/100 000, 74.63/100 000 in urban and rural populations respectively. Death rates of injury in the east, central and west rural areas were 1:1.14:1.21 respectively. Injury was the main cause of death among children and youths. Traffic accident, suicide, drowning, poisoning and fall were main causes of injury accounting for 70 percent of all the injury mortality. Since 1990's, the death rate of traffic accident had been obviously increasing, YPLL and WPYLL in injury 2132 years/10 000 and 1587 years/10 000, respectively. The YPLL and WPYLL were 24.56% and 26.51% of total deaths.
COMMENTS: The disease burden of injury was heavy and the death of injury caused more social and economic losses owing to premature death. The increasing death rate of traffic accident called for more attention. Different effective control strategies should be formulated based on different death causes of injury and different target populations.
Survey on injury in four rural communities in China.
- Yang GH, Ma JM, Wang LJ. Zhonghua Liu Xing Bing Xue Za Zhi 2004; 25(3): 204-208.
Correspondence: G. Yang, Institute of Basic Medicine Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100005, CHINA; (email: unavailable).
OBJECTIVE: To understand the incidence and prevalence by causes of injury, and the proportion of different causes of deaths, as well as occurrence of disability due to injuries.
METHODS: 200,000 families were randomly sampled in 4 rural communities. Questionnaire on occurrence, disability, death of injury and related risk factors for all family members living at home from Feb. 12, 2002 to Aug. 12, 2002 were studied.
FINDINGS: The incidence rate and prevalence rate in the observed population were 65.1/1000 and 69.2/1000, respectively. In every 100 cases of injury there were one death and 6 disabled. Fall, animal bites, striking or crushing, cutting and piercing, road accidents, fire and poisoning were the common causes in injury. Animal bites was the leading cause while drawing appeared the highest in children aged 0 - 14. Rate of road accident was the highest in adults aged 15 - 34, while falls causing higher proportion of disability in population aged over 60.
COMMENTS: Based on the report of National Disease Surveillance Points System, there were 592,000 death cases of injury in Chinese rural areas every year, meaning 59.2 million cases of injury and 3,490,000 disabled cases every year. Since injury causes serious social and economic loss with different orders of incidence and mortality, it is necessary to develop different preventive strategies on different target populations and different causes accordingly.
OBJECTIVE: To examine the relationship between behavioural problems and school performance following traumatic brain injury (TBI).
METHODS: Subjects: 67 school-age children with TBI (35 mild, 13 moderate, 19 severe) and 14 uninjured matched controls. Parents and children were interviewed at a mean of 2 years post-TBI. Teachers reported on academic performance and educational needs. Children were assessed using the Vineland Adaptive Behaviour Scales (VABS) and the Weschler Intelligence Scale for Children (WISC-III).
FINDINGS: Two-thirds of children with TBI exhibited significant behavioural problems, significantly more than controls (p = 0.02). Children with behavioural problems had a mean IQ aproximately 15 points lower than those without (p = 0.001, 95% CI: 7-26.7). At school, 76%(19) of children with behavioural problems also had difficulties with schoolwork. Behavioural problems were associated with social deprivation and parental marital status (p < or = 0.01).
COMMENTS: Children with TBI are at risk of developing behavioural problems which may affect school performance. Children with TBI should be screened to identify significant behavioural problems before they return to school.
Trends and monthly variations in the historical record of suicide in Japan from 1976 to 1994.
- Yamasaki A, Morgenthaler S, Kaneko Y, Shirakawa T. Psychol Rep 2004; 94(2): 607-612.
Correspondence: A. Yamasaki, Department of Health Promotion and Human Behavior, Graduate School of Public Health, Kyoto University, Yoshida-konoe, Kyoto 606-8501, JAPAN; (email: unavailable).
Monthly suicide rates in Japan were analyzed for the period from 1976 to 1994 to clarify trends and recurring effects. The data were separated by sex, and the least-squares method was used. The major findings were (1) a significant positive correlation between unemployment rate and suicide rate for both sexes, (2) the suicide rate was highest in April for both sexes, and (3) an upsurge in male suicide mortality was noted from 1983 to 1990. These findings may well be associated with socioeconomic factors as well as neurobehavioral variables.
Death by suicide in Grampian 1991-1999: comparison with a previous study.
- Nicoll KS, McGee MA, Callender JS. Scott Med J 2004; 49(2): 44-47.
OBJECTIVES: To review the changes in suicide and undetermined death rates in Grampian between 1991-1999 and to make comparisons with a previous study on the same population.
DESIGN: All suicide and undetermined deaths in Grampian recorded by the General Register Office for Scotland were included and linked with the psychiatric case records from Grampian Health Board.
FINDINGS: The high suicide and undetermined death rates in Grampian are accounted for by the excess of deaths in males. In males there has been a change in the method used to commit suicide with hanging now being the commonest method used. Firearm deaths have reduced dramatically since legislation was introduced in 1997 (RR = 021,95% CI [0.05,0.91). For those with previous psychiatric contact, a greater proportion were drug users than in 1974-1990 (OR = 3.75,95%CI [2.7, 5.2]). A higher percentage of suicides have a history of more than one previous attempt at suicide than in 1974-990. In Grampian there is a lower percentage of inpatient suicide than the rest of Scotland.
COMMENTS: There have been changes in suicide trends in Grampian and these are similar to elsewhere in Scotland Strategies to address this are discussed.
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 Moniruzzaman, Department of Public Health Sciences, Division of Social Medicine, Karolinska Institutet, Stockholm, SWEDEN; (email: ragnar.moniruzzaman@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.
FINDINGS: A weak positive correlation was found between suicide rates and GNP per capita in both sexes for all ages.
COMMENTS: 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. Mortality rates due to unintentional and intentional self-inflicted injury show deviating patterns from an epidemiological transition perspective.
Correspondence: Joshua Shemer, Israeli Center for Technology Assessment in Health Care, Gertner Institute for Epidemiology and Health Policy Research, Tel Hashomer, ISRAEL; (email: shemerj@post.tau.ac.il).
Traffic accidents are the most prevalent cause of death in developed countries between the ages of 1-33 years. In spite of a low motorization level in Israel, the rate of injury per 100,000 residents in Israel (2.8) was higher than in the US (1.8), NZ (1.7), Canada (1.7), Japan (1.3) and most European countries. The worst injuries were among pedestrians; particularly children aged 1-9 years and elderly (70+ years). In the past decade there have been significant advances in trauma care in Israel. Major strides included the foundation of trauma centers in hospitals, the establishment of the National Council for Trauma and the National Center for Trauma and Emergency Medicine Research at the Gertner Institute that coordinates the national trauma registry. One of the primary aims of the registry was to provide data to support decision-makers in setting national policy for accident prevention. The Israeli Police Department provides data on traffic accident victims to the Israeli Central Bureau of Statistics (CBS) which publishes the national figures. In their article in this edition of the journal, Dr Peleg and Dr. Aharonson-Daniel present a grave concern regarding the fact that details of over 50% of hospitalized traffic accident victims were not reported to the CBS by the police, including data on the severely injured casualties. Traffic accidents are a major cause of loss of life and disability, creating a heavy economic burden on the state and the health care system. Hence, the authors recommend establishing a national database which will combine data from medical and other sources and present the complete comprehensive picture of traffic accident injuries. Such a database will improve the decision-making process, providing more focused data to enhance the preparation and dissemination of appropriate injury prevention policies.
Multivariate head injury threshold measures for various sized children seated behind vehicle seats in rear impacts.
- Saczalski K, Sances A Jr, Kumaresan S, Pozzi M, Saczalski T, Burton JL, Lewis P Jr. Biomed Sci Instrum 2004; 40: 381-386.
Correspondence: K. Saczalski, Environmental Research & Safety Technologists, Inc., Newport Beach, CA, USA; (email: unavailable).
Government recommendations to place children into the rear areas of motor vehicles to avoid airbag induced injuries have been complicated by the fact that most adult occupied front seats will collapse into the rear area during rear-impacts, and thus pose another potentially serious injury hazard to rear-seated children. Many variables affect whether or not a front seat occupant will collapse into the rear child, and whether that interaction could be injurious to the child. For instance, the severity of rear impact, coupled with front and rear occupant sizes (mass and stature), and the level of front seat strength, all interrelate to influence whether or not a rear seated child is likely to be impacted and possibly injured. The most common types of child injuries in these instances are head and chest injuries. In this study, a "high-low" experimental method was employed with a multi-level "factorial analysis" technique to study "multivariate" biomechanics of child head injury potential determined from rear-seated 3 and 6 year-old child surrogates in different types of vehicle bodies mounted to a sled system. The sled-buck systems were towed rearward into crushable barriers that matched the crash pulses of the vehicle types being tested. Various sizes of adult surrogates (i.e. 50 kg up to 110 kg), seated in both the "typical" low strength "single recliner" collapsing type front seat (i.e. 3.2 kN) and a much stronger "belt-integrated" seat design (i.e. up to 14.5 kN), were tested in the two different "sled body-buck" set-ups at various impact levels (i.e. 22.5 to 50 kph). One set-up used a popular minivan vehicle body with "built-in booster" seats for the 3 year-old. The other used a 4-door family sedan vehicle body with the 6 year-old in a standard rear bench seat. The parameters of the tests enabled the experimental data to be combined into polynomial "head injury" functions of the independent variables so the "likelihood" of rear child head-injury potential could be "mapped" over ranges of the key parameters. Accident cases were compared with predictions to verify the methodology.
Effectiveness of primary enforcement safety belt laws and enhanced enforcement of safety belt laws: A summary of the Guide to Community Preventive Services systematic reviews.
- Shults RA, Nichols JL, Dinh-Zarr TB, Sleet DA, Elder RW. J Safety Res 2004; 35(2): 189-196.
Correspondence: Ruth A. Shults, Division of Unintentional Injury Prevention, Centers for Disease Control and Prevention, 4770 Buford Highway, Mailstop K-63, Atlanta, GA 30341, USA; (email: rshults@cdc.gov).
BACKGROUND: The use of safety belts is the single most effective means of reducing fatal and nonfatal injuries in motor-vehicle crashes. This paper summarizes the systematic reviews of two interventions to increase safety belt use: primary enforcement safety belt laws and enhanced enforcement of safety belt laws. The reviews were previously published in the American Journal of Preventive Medicine.
METHODS: We conducted the systematic reviews using the methodology developed for the Guide to Community Preventive Services.
FINDINGS: These reviews provide strong evidence that primary laws are more effective than secondary laws in increasing safety belt use and decreasing fatalities and that enhanced enforcement is effective in increasing safety belt use. Increases in belt use are generally highest in states with low baseline rates of belt use.
COMMENTS: Primary safety belt laws and enhanced enforcement programs tend to result in greater increases in usage rates for target groups with lower baseline rates. Concerns regarding public opposition to these interventions may impede their implementation in some jurisdictions. However, surveys indicate that a substantial majority of the public supports implementation of both primary laws and enhanced enforcement programs. Based on the strong evidence for effectiveness of primary safety belt laws and enhanced enforcement programs, the Task Force on Community Preventive Services recommended that all states enact primary safety belt laws and that communities implement enhanced enforcement programs.
Traffic ticket fixing and driving behaviours in a large French working population.
OBJECTIVE: The use of connections who have the authority to cancel penalties related to traffic violations seems to be very frequent in France. This study aimed at describing risk taking driving behaviours associated in France with using connections to have traffic tickets cancelled (ticket fixing).
DESIGN: Retrospective study on driving behaviour and road safety conducted between March and December 2001 within a cohort of French employees.
SETTING: France.
PARTICIPANTS: Employees of the French national utility company who have been followed up since 1989. The sample comprises 10 594 men aged 53-63 years and 3258 women aged 48-63 in 2001.
FINDINGS: One third of the men and one fifth of the women reported that they had had a ticket fixed at some time. Those who reported having tickets fixed were more likely than the others to report high driving speeds (adjusted odds ratios (aOR) were 1.24, 1.52, and 1.66 in built up areas, on rural roads, and on motorways respectively), to report driving while under the influence (aOR = 1.39), and to report risky use of cellular phone while driving (aOR = 1.83). In addition, participants who reported having tickets fixed were more likely to have had at least one serious road traffic accident in the past 11 years (aOR = 1.21).
COMMENTS: Indulgence and the use of connections are common practices in France. These results suggest that it is to confer a feeling of impunity that jeopardises efforts to combat unsafe driving. Abolition of these traditions is essential to ensure the credibility of preventive and repressive measures.
Recent estimates of safety belt use.
- Glassbrenner D, Carra JS, Nichols J. J Safety Res 2004; 35(2): 237-244.
Correspondence: Donna Glassbrenner, Mathematical Analysis Division, National Center for Statistics and Analysis, NHTSA NPO-101, 400 7th Street, SW, Washington, DC 20590, USA; (email: donna.glassbrenner@nhtsa.dot.gov).
The National Occupant Protection Use Survey (NOPUS) has shown that safety belt use in the United States has increased steadily over the past decade. Increases have been consistent since 2000, when the National Highway Traffic Safety Administration, in partnership with the Air Bag & Seat Belt Safety Campaign, increased its encouragement of states to implement highly visible enforcement programs. In 2003, significant increases were found in the South; in secondary law states; in all types of vehicles; during both weekdays and weekends; and during both rush-hours and non-rush-hours. In spite of these increases, use remains significantly lower in secondary law states; pickup trucks; the Northeast; and the Midwest. The differences between primary and secondary law states and between pickups and other passenger vehicles have been consistent from year to year. A controlled intersection study, which is part of the NOPUS, has shown that safety belt use has increased for both sexes, for nearly all age groups, and for all races for which data are available. Finally, the NOPUS suggests that children are 3-4 times as likely to be unrestrained when riding with an unbuckled driver as when driving with a buckled driver.
Air-gun injuries: initial evaluation and resultant morbidity.
- Keller JE, Hindman JW, Kidd JN, Jackson RJ, Smith SD, Wagner CW. Am Surg 2004; 70(6): 484-490.
Correspondence: J. Keller, University of Arkansas Medical Sciences, Department of Surgery, Arkansas Chlildren's Hospital, Division of Pediatric Surgery, Little Rock, Arkansas, USA; (email:unavailable).
Severity of injuries from air-powered weapons can be underappreciated. Transformation of these weapons into toys makes them available to children. Our experience reveals the underestimated injury severity and emphasizes need for prompt trauma evaluation. Retrospective chart review of children sustaining air-gun injuries and evaluated at a single, pediatric hospital from 1991 to 2002 was performed. Medical record numbers were retrieved from a trauma data base. Data included age, weapon type, firing distance, injury site, radiographic studies, operative intervention, length of stay, and long-term disability. Ocular injuries were excluded secondary to known severity. All other injuries and treatments are described. Thirty-four children, average age 10 years +/- 3.3 years, sustained 35 injuries from 1991 through 2002. Twenty-one children required admission, 19 children required surgery, and 5 children experienced long-term disability. Average time to definitive care was 3 hours 12 minutes. Sites of injury included head, neck, chest, abdomen, and extremities. Average hospital stay was 4.3 days. In the pediatric population, air-gun injuries can be underestimated. Lack of collateral tissue damage makes wounds appear innocuous to unsuspecting medical personnel resulting in delayed care. During initial evaluation, injuries from air guns deserve the same respect as those caused by conventional firearms.
A study of homicidal deaths in Delhi.
- Gupta A, Rani M, Mittal AK, Dikshit PC. Med Sci Law 2004; 44(2): 127-132.
Correspondence: Avneesh Gupta, Department of Forensic Medicine, Maulana Azad Medical College, New Delhi 110002, INDIA; (email: avneeshgupta@hotmail.com).
A meticulous post-mortem review was undertaken in the department of forensic medicine at the Maulana Azad Medical College (MAMC) to find out trends in homicides during the period 1992-1996. Standard procedures for autopsies and a review of the inquest papers were carried out. Out of 3,886 medico-legal autopsies performed in the department during the said period, only 232 cases (5.9%) were homicidal deaths. The commonest age group of the victims was 21-30 years (38%). Males were victimized three times more often than females. The incidence of crime was slightly more at night than in the daytime, though evenly distributed during the winter and summer seasons. In our series, sharp weapon injuries were the most common type (34.9%) followed by blunt force injuries (15.9%). Defence wounds were present in 35 cases (15%). Violent rage/quarrel was the motive in 61 cases (29%).
Intimate partner violence: social and health determinants and responses.
- Ruiz-Perez I, Blanco-Prieto P, Vives-Cases C. Gac Sanit 2004; 18 Suppl 2: 4-12.
Correspondence: I. Ruiz-Perez, Coordinadora de Investigacion, Escuela Andaluza de Salud Publica, Granada, Espana, Red de Investigacion de Salud y Genero, Madrid, SPAIN; (email: unavailable).
The present study aims to review the problem of intimate partner violence, as well as its causes and consequences. It will also specifically analyze the role of health professionals. In opposition to the classical epidemiological view of risk factors, Heise proposes an ecological framework to study violence against women. This framework analyzes the interplay among the personal, situational and sociocultural factors that combine to cause abuse. Regarding the frequency of intimate partner violence in Spain, in January 2003 there were 2.519 formal complaints and 69 women died between January and November 2003. No geographical patterns in mortality or the incidence of formal complaints of intimate partner violence or among the provinces with the highest incidence of formal complains and those with highest mortality were observed. The only national survey published in Spain was performed by the Women's Institute in 1999, which reported a prevalence of domestic violence of 9.2%. A frequency of 22.8% was found in a primary health care center in Granada. Health services can play a key role in helping victims of domestic violence, since most women contact the health services at some time in their lives. Professionals in administrative or managerial positions can contribute to raising awareness of this health problem, which is one of the main causes of poor health and disability. Evidently, beyond consciousness-raising and early detection campaigns, public health strategies should be designed to prevent this serious health problem the causes of which can be changed.
Domestic Violence and Stalking Among Older Adults An Assessment of Risk Markers.
Correspondence: Jana L. Jasinski, Department of Sociology and Anthropology, University of Central Florida, Orlando, FL, 32816-1360, USA; (email: jjasinsk@pegasus.cc.ucf.edu).
There is limited empirical evidence regarding the extent to which older adults are physically abused by their spouse or partner, and the risk factors associated with such abuse. Much of what does exist focuses on either caregiver abuse or abuse occurring in institutional settings. Moreover, there is virtually no information on stalking victimization among older adults. The current study used the National Violence Against Women Survey to examine physical abuse and stalking victimization among a sample of adults ages 55 and older (N = 3,622). Similar to research conducted with younger samples, women age 55 and older were significantly more likely than men to be both stalked and physically assaulted. Significant racial differences also emerged with respect to intimate partner physical violence, but not stalking. Specifically, African-American and Hispanic respondents were more likely to be victims of intimate partner violence compared to White respondents. Income, however, was not significantly associated with either stalking or physical assault victimization.
This study investigates abuse and neglect concerns from the nursing home resident's perspective in the state of Connecticut through a retrospective case record review. Complaints tracked from July 1998 through July 2000, using the Connecticut Ombudsman Reporting System, totaled 3,443 and were combined with related data from all of the state's nursing homes (N = 261). Within the total number of complaints, analysis centered on the subcategories of abuse, gross neglect, exploitation (n = 269), and care (n = 791). Findings show that 69% of Connecticut's nursing homes had accounts of care complaints and 47% had one or more accounts of abuse. Identifying abuse and care concerns in Connecticut's nursing homes may lead to the exposition of additional patterns related to abuse and care in other institutional settings and merits further exploration of staffing characteristics in relation to abuse.
Firearm homicide and firearm suicide: opposite but equal.
- Branas CC, Richmond TS, Schwab CW. Public Health Rep 2004; 119(2): 114-124.
Correspondence: Charles Branas, Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Firearm Injury Center at Penn, University of Pennsylvania, Philadelphia, PA, USA; (email: cbranas@cceb.med.upenn.edu).
OBJECTIVE: Homicide and suicide are intentional acts of violence that disproportionately involve firearms. Much more effort has been devoted to the ecological study of homicide; methods that have been developed to better understand and subsequently prevent homicide may be applicable to suicide. The purpose of the present study was to compare the occurrence of firearm homicide and firearm suicide using routine activity theory as a framework for analysis.
METHODS: Detailed mortality data pertaining to decedents, their neighborhoods, and use of firearms were collected from 1994 to 1998 for the counties containing and surrounding three small to medium-sized U.S. cities. Data from a total of 468 neighborhoods that collectively experienced 1,025 intentional deaths from firearms (396 firearm homicides and 629 firearm suicides) were analyzed.
FINDINGS: Firearm homicide was consistently associated with out-of-home, nighttime activity in neighborhoods where many people were likely to be coming and going. In an opposite-but-equal fashion, firearm suicide was consistently associated with in-home, daytime activity in out-of-the-way neighborhoods.
COMMENTS: Firearm homicide and firearm suicide were found to be consistently associated with markers of routine activity in all three cities, albeit in an opposite-but-equal manner. Because firearm suicides very often occur as lonely events in lonely neighborhoods, they may go under-noticed relative to firearm homicides. More awareness and additional public health studies of firearm suicide, in tandem with firearm homicide, should be pursued to better identify individuals and neighborhoods that are at greatest risk of experiencing each event.
Substance abuse and behavioral correlates of sexual assault among South African adolescents.
- King G, Flisher AJ, Noubary F, Reece R, Marais A, Lombard C. Child Abuse Negl 2004; 28(6): 685-698.
Correspondence: Gary King, Department of Biobehavioral Health, 315 HHDE, Penn State University, University Park, PA 16802, USA; (email: gxk14@psu.edu).
OBJECTIVE: The aim of this article is twofold: first, to examine the prevalence of being the victim of actual and attempted rape among a large representative sample of Cape Town high school students; and second, to identify the correlates of sexual assault for both boys and girls, including alcohol, tobacco and other drug use, behavioral problems, and suicidality.
METHODS: Data for this study were derived from the 1997 South African Community Epidemiology Network on Drug Use (SACENDU) school survey. A stratified sampling procedure was used to select students in Grades 8 and 11 at non-private high schools in Cape Town. A total of 2,946 students completed a survey consisting of socio-demographic questions and items about substance abuse, sexual activity, and other adolescent health risk behaviors. A subsample of 939 was randomly selected to complete items about sexual violence.
FINDINGS: The results revealed that 8.4% of respondents were victims of attempted rape, while 5.8% were victims of actual rape. Ordinal logistic regression showed that girls were 3.9 times more likely than boys to have been victims of sexual abuse. Family structure was also significantly related to rape as persons who lived with a single parent (OR = 1.74, CI = 1.00-3.04) and those who resided with one biological parent and one step parent (OR = 2.59, CI = 1.34-5.01) were more likely to have been have been victims of sexual abuse than those living with both biological parents. Alcohol use (OR = 2.0, CI = 1.10-3.62), anti-social behavior (stolen property, caused physical damage to property, bullied others, or been in physical fights) (OR = 1.44, CI = 1.12-1.86), suicidal dialogue (OR = 2.48, CI = 1.19-5.19), and suicidal attempts (OR = 3.2, CI = 1.65-6.30) were also significant predictors of sexual abuse victimization. Racially classified social groups (RCSG), age, drug use, and cigarette smoking were not significant predictors of sexual abuse victimization, while socioeconomic status was found to be marginally significant.
COMMENTS: This study reinforces the importance of multiple factors including alcohol use, anti-social behavior, suicidal thoughts and actions, and family structure with respect to sexual assault of adolescents in South Africa. Establishing and strengthening intervention programs, school based child protective protocols, professional education of teachers and school personnel, community prevention programs, and initiatives could help prevent adolescent sexual violence and reduce the sequelae associated with this problem.
