OBJECTIVE: This study was conducted to determine whether beer consumption is associated with premature mortality across municipalities in Louisiana.
METHOD: We conducted a cross-sectional ecologic study using tax data on the sales of beer and mortality data from Louisiana. We aggregated deaths that occurred before the age of 65 to the level of the municipality and calculated age-adjusted rates of both overall premature mortality and specific causes of premature mortality that may be related to alcohol. After controlling for potential confounders including population distributions for race, income, employment and education, we examined whether beer sales were independently associated with premature mortality rates due to homicides, unintentional injuries, other acute alcohol-related causes, liver diseases, cardiovascular disease and other chronic alcohol-related causes.
FINDINGS: After controlling for race and socioeconomic status, municipalities with greater beer consumption had higher premature mortality, with the model explaining up to 24% of all premature deaths. Beer consumption was also independently associated with homicide, liver diseases and cardiovascular disease. Neither unintentional injuries nor other chronic alcohol-related causes of mortality were significantly associated with beer consumption.
COMMENTS: The population-level association between beer consumption and mortality may reflect population-level determinants of beer consumption as well as indirect health effects of alcohol consumption on persons who are not heavy drinkers.
Self-reported alcohol consumption and falls in older adults: cross-sectional and longitudinal analyses of the cardiovascular health study.
Correspondence: Kenneth Mukamal, Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA; (email: kmukamal@caregroup.harvard.edu).
OBJECTIVE: To assess the cross-sectional and longitudinal associations between alcohol consumption and risk of falls in older adults. Design: Cross-sectional and longitudinal analyses.
METHODS: Four U.S. communities. PARTICIPANTS: A total of 5,841 older adults enrolled in the Cardiovascular Health Study, an ongoing, population-based, prospective cohort study, participated.
MEASUREMENTS: Self-reported alcohol consumption at baseline, self-reported frequent falls at baseline, and the 4-year risk of falls of participants who denied frequent falls at baseline.
FINDINGS: Cross-sectional analysis indicated an apparent inverse association between alcohol consumption and risk of frequent falls (adjusted odds ratio in consumers of 14 or more drinks per week=0.41; 95% confidence interval (CI)=0.14-1.17; P for trend=.06), but longitudinal analysis indicated a similar 4-year risk of falls in abstainers and light to moderate drinkers but a 25% higher risk in consumers of 14 or more drinks per week (95% CI=3-52%; P for trend=.07). Similar results were found in analyses stratified by age, sex, race, and physical activity.
COMMENTS: Consumption of 14 or more drinks per week is associated with an increased risk of subsequent falls in older adults. Cross-sectional studies may fail to identify this risk of heavier drinking, perhaps because older adults at risk for falls decrease their alcohol use over time or because heavier drinkers at risk for falls tend not to enroll in cohort studies. However, because this study relied upon annual reporting of falls, further prospective studies should be conducted to confirm these findings.
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, Brisbane, 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.
Correspondence: Gwen Brumbaugh Keeney, University of Illinois at Chicago, UIH Rm. 404, M/C 550, 1740 W. Taylor,Chicago, IL 60612, USA; (email: gbkeeney@uic.edu).
Women and children bear the greatest burden in the midst of war and long-term disasters. Complex humanitarian emergencies are characterized by social disruption, armed conflict, population displacement, collapse of public health infrastructure, and food shortages. Humanitarian assistance for refugees and internally displaced populations requires particular attention to the common issues affecting morbidity and mortality in women and infants. Gender-based violence and reproductive health concerns are discussed within the context of populations affected by conflict and forced migration. Recommendations for midwives and women's health care providers engaging in care for women and children in complex humanitarian emergencies are discussed.
Sleep deprivation and fatigue in residency training: results of a national survey of first- and second-year residents.
- Baldwin DC Jr, Daugherty SR. Sleep 2004; 27(2): 217-223.
Correspondence: D. Baldwin, Accreditation Council for Graduate Medical Education Association, Rush Medical College, Chicago, Ill, USA; (email: dbaldwin@acgme.org).
OBJECTIVES: To examine the relationship between residents' self-reported sleep hours, work hours, and other empirical correlates.
DESIGN: Using the American Medical Association's Graduate Medical Education database, a national, random sample of PGY (postgraduate year) 1 and PGY2 residents in the 1998-1999 training year was surveyed by mail.
FINDINGS: Residents completed a 5-page survey with 44 questions requiring 144 separate responses about their residency experience. Completed surveys were received from 3,604 of 5,616 residents contacted, a 64.2% response rate. Although work hours and sleep hours were significantly correlated (r = -.39), this relationship was less robust than is generally assumed. Total average sleep hours varied across specialties but also within specialties. Just over 20% of all residents reported sleeping an average of 5 hours or less per night, with 66% averaging 6 hours or less per night. Residents averaging 5 or fewer hours of sleep per night were more likely to report serious accidents or injuries, conflict with other professional staff, use of alcohol, use of medications to stay awake, noticeable weight change, working in an "impaired condition," and having made significant medical errors.
COMMENTS: Reduced sleep hours were significantly related to a number of work-related, learning, and personal health variables. Capping residents' work hours is unlikely to fully address the sleep deficits and resulting impairments reported by residents.
Injuries associated with homemade fireworks-- selected states, 1993-2004.
- Centers for Disease Control and Prevention (CDC). MMWR Morb Mortal Wkly Rep 2004; 53(25): 562-563.
Around the July 4 Independence Day holiday each year in the United States, injuries associated with homemade fireworks are increasingly common. During June-July 2002, approximately 5,700 persons were treated for fireworks-related injuries at U.S. emergency departments; approximately 300 (5.3%) were injured in incidents involving illegal and homemade fireworks. CDC and the Consumer Product Safety Commission (CPSC) recommend that fireworks be handled only by professionals. To describe injuries and emergency responses resulting from homemade fireworks explosions, the Agency for Toxic Substances and Disease Registry (ATSDR) researched data from its Hazardous Substances Emergency Events Surveillance (HSEES) system. This report summarizes four incidents involving homemade fireworks explosions that were identified by the surveillance system. To prevent injuries and deaths, no one should attempt to make their own fireworks.
Deindustrialisation and the long term decline in fatal occupational injuries.
- Loomis D, Richardson DB, Bena JF, Bailer AJ. Occup Environ Med 2004; 61(7): 616-621.
Correspondence: Dana Loomis, Department of Epidemiology, School of Public Health, University of North Carolina, Chapel Hill, NC 27599-7435, USA; (email: Dana.Loomis@unc.edu).
OBJECTIVE: To examine the extent to which deindustrialisation accounts for long term trends in occupational injury risk in the United States.
METHODS: Rates of fatal unintentional occupational injury were computed using data from death certificates and the population census. Trends were estimated using Poisson regression. Standardisation and regression methods were used to adjust for the potential effect of structural change in the labour market.
FINDINGS: The fatal occupational injury rate for all industries declined 45% from 1980 to 1996 (RR (rate ratio) 0.55, 95% CI 0.52 to 0.57). Adjustment for structural changes in the workforce shifted the RR to 0.62 (95% CI 0.60 to 0.65). Expanding industries enjoyed more rapid reduction in risk (-3.43% per year, 95% CI -3.62 to -3.24) than those that contracted (-2.65% per year, 95% CI -2.88 to -2.42).
COMMENTS: Deindustrialisation contributed to the decline of fatal occupational injury rates in the United States, but explained only 10-15% of the total change.
Effects of a work injury prevention program for housekeeping in the hotel industry.
- Landers M, Maguire L. Work 2004; 22(3): 239-246.
Correspondence: Merrill Landers, Department of Physical Therapy, College of Health Sciences, University of Nevada, Las Vegas, NV 89154-39029, USA; (merrill.landers@ccmail.nevada.edu).
OBJECTIVE: The aim of this retrospective study was to determine the effectiveness of a work injury prevention program in the housekeeping department of a hotel. Studies have validated the use of different injury prevention strategies to decrease the incidence of work-related injuries. Few studies, however, have reported the efficacy of an on-site work injury prevention program by a physical therapist.
STUDY DESIGN: In 1995, implementation of a work injury prevention program by a physical therapist to 50 housekeeping supervisors, 60 house persons and 340 guest room attendants at a large hotel began. This program included a detailed work risk analysis of the work environment, development of job descriptions, identification of injury-related problematic work situations, and implementation of a job specific supervisor-training program. Supervisor, house person and guest room attendant training was also conducted at the end of 1995 and the beginning of 1997.
FINDINGS: Data of injury reports in 1995, 1996, and 1997 were analyzed to determine the results of the program. There was a reduction in total injury claims, total medical expenses, total lost work time and total restricted duty time.
COMMENTS: These results demonstrate the cost effectiveness of implementing a work injury prevention program for housekeeping guest room attendants in the hotel industry.
Pedestrians dramatically overestimate their own visibility at night. This is likely to result in pedestrians unknowingly engaging in dangerous behavior. To determine the extent to which pedestrians' estimates of their own visibility are influenced by educational interventions, clothing reflectance, and headlamp beam setting, participants in 2 experiments estimated their own nighttime visibility by walking toward a stationary car to the point where they believed they were just recognizable as a pedestrian. In the first experiment 48 university students were tested and in the second experiment 9 high-school driver education students were tested. Overall, participants failed to appreciate the benefits of reflective clothing and of high-beam illumination. However, the participants in Experiment 1 who had heard a relevant lecture several weeks earlier gave estimates that were 10% shorter than did a control group. Participants in Experiment 2 heard a more focused and graphic-intensive lecture and gave estimates that were 56% shorter than did a control group. Potential applications of this research include increasing pedestrian safety by designing and implementing research-based public education campaigns aimed at reducing pedestrians' overestimates of their own nighttime visibility.
Serious pediatric toxicity resulting from exposure to small amounts of camphor-containing products has long been a problem. Twenty years ago the United States Food and Drug Administration took several actions in an attempt to ameliorate this risk. Despite these changes, camphor remains commonly available in many nonprescription vaporized or topical "cold" medications, topical musculoskeletal anesthetic "rubs" and "cold sore" preparations, though its efficacy is largely unproven. Data from the American Association of Poison Control Centers demonstrate that camphor continues to be a common source of pediatric exposures. A review of the literature reveals persistent reports of toxicity resulting from exposure to relatively small amounts. In the pediatric population, exposure to as little as 500 mg is cited as a cause of mortality. More commonly, 750 to 1000 mg are associated with the development of seizures and death. Currently available products with 10% camphor contain 500 mg in 5 mL. It is concluded that small doses are dangerous. In children less than 6 years of age, exposure to 500 mg or more requires rapid triage to the closest health care facility.
Tackling rugby injury: lessons learned from the implementation of a five-year sports injury prevention program.
- Chalmers DJ, Simpson JC, Depree R. J Sci Med Sport 2004; 7(1): 74-84.
Correspondence: David Chalmers, Injury Prevention Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, NEW ZEALAND; (email: david.chalmers@ipru.otago.ac.nz).
Rugby Union football is a very popular sport in New Zealand but of all the major sports played in that country, it has the highest reported incidence of injury. In 1995, a national rugby injury prevention program was instigated to address this problem. Known as Tackling Rugby Injury, this multifaceted program was implemented over a five-year period. The program was based on the results of a prospective cohort study of rugby injury, known as the Rugby Injury and Performance Project (RIPP), and was organised around seven themes, five relating to the prevention of injury: coaching, fitness, injury management, tackling, and foul play, and two relating to the implementation and evaluation of the program. The purpose of this paper is to describe the lessons learned from the implementation of Tackling Rugby Injury. Qualitative research methods were used to describe the process of implementation, including informant interviews, participant observation, and the scrutiny of written, visual and archival material. Among the lessons learned were the importance of basing injury prevention strategies on scientific evidence rather than popular belief, the difficulty in implementing complex interventions, the advantages of a formal agreement between partners in the implementation of a program, the central role played by coaches in promoting injury prevention strategies, and the value of describing the process of implementation as well as monitoring injury outcomes and changes in knowledge, attitudes and behaviour. It is hoped that other sports wishing to develop injury prevention programs can learn from this experience.
OBJECTIVE: To investigate the incidence and describe the nature of non-motorized scooter related injuries in children presenting to the ED.
SETTING: Pediatric ED of a metropolitan tertiary referral hospital.
METHODS: A prospective observational study of patients aged under 19 years presenting with injuries sustained while using a non-motorized scooter. Clinicians recorded the data in the patient record.
MAIN OUTCOME MEASURES: type of injury sustained; period of experience on the scooter; the use of protective gear; the presence of adult supervision; the place of accident; and the patient outcome.
FINDINGS: Sixty-two eligible patients were recruited over an 18 month period. The incidence of scooter- related injuries was 1.3% of all paediatric trauma presentations. There was a fall in scooter injury presentations over the study period; however, this was not statistically significant. The most common injury sustained using a scooter was an upper limb fracture (41.9%). Closed head injury comprised 8.1% of all scooter related injuries. The majority of patients were not wearing protective gear and were unsupervised at the time of their accident. Most patients (79%) were managed in the ED and discharged.
COMMENTS: There has been no significant change in scooter injury presentations over the two summer periods of 2000 and 2001. Children presenting to the ED with a scooter related injury tend to be primary school aged, which may have implications on scooter design, age recommendations and safety guidelines.
OBJECTIVE: The purpose of this study was to determine whether the New Injury Severity Score (NISS) is a better predictor of mortality than the Injury Severity Score (ISS) in general and in subgroups according to age, penetrating trauma, and body region injured.
METHODS: The study population consisted of 24,263 patients from three urban Level I trauma centers in the province of Quebec, Canada. Discrimination and calibration of NISS and ISS models were compared using receiver operator characteristic (ROC) curves and Hosmer-Lemeshow statistics.
FINDINGS: NISS showed better discrimination than ISS (area under the ROC curve = 0.827 vs. 0.819; p = 0.0006) and improved calibration (Hosmer-Leme-show = 62 vs. 112). The advantage of the NISS over the ISS was particularly evident among patients with head/neck injuries (area under the ROC curve = 0.819 vs. 0.784; p < 0.0001; Hosmer-Lemeshow = 59 vs. 350).
COMMENTS: The NISS is a more accurate predictor of in-hospital death than the ISS and should be chosen over the ISS for case-mix control in trauma research, especially in certain subpopulations such as head/neck-injured patients.
The aim of this study was to evaluate the incidence, nature, and risk factors of unintentional injuries among 12-, 14-, 16- and 18-year-old Finnish adolescents. Of the 8219 respondents (response rate 75%) 5.5% reported an injury that had required medical attention during the past month. The total number of injuries was 506 and the incidence of injuries 62 per 1000 person-months. Boys had a slightly higher injury occurrence rate than girls (OR: 1.33; 95% CI: 1.13-1.59). The most common injuries were sprains (27%), fractures (26%) and wounds (16%) of the upper and lower limbs. In multivariate logistic regression analysis the strongest risk factors of injury were: having experienced violence during past month (OR: 3.6; 95% CI: 2.8-4.6), daily leisure time exercise in sports club (OR: 3.3; 95% CI: 2.3-4.6), having several somatic health complaints weekly (OR: 2.2; 95% CI: 1.7-2.9) and having chronic disease (OR: 2.0; 95% CI: 1.5-2.6). In conclusion, injuries were an important cause of morbidity among our 12-18-year-old adolescents. Adolescents' school success and their parents' education, occupation and employment status were not associated with injuries. The finding that several health and health behaviour variables are important risk factors for injuries challenges the researchers and the society to identify and treat the risk factors that can be modified to reduce the number of adolescent injuries.
Study on familial factors regarding injury-related behaviors in children.
- Guo SQ, Sun YH, Fan YP, Yu XD, Zhou ZG, Niu L, Cha RS. Zhonghua Liu Xing Bing Xue Za Zhi 2004; 25(3): 218-220.
Correspondence: Y.H. Sun, School of Public Health, Anhui Medical University, Hefei 230032, CHINA; (email: yhsun@cuhk.edu.hk).
OBJECTIVE: To probe into the effects of familial factors on injury-related behaviors in children.
METHODS: Injury-related behaviors and familial factors of 6,884 children were investigated with Family Questionnaire and Child Behavior Checklist. Multi-nominal logistic regression analysis was performed.
FINDINGS: There were 1670 (24.26%) children having serious injury-related behaviors and 3683 (53.50%) children having moderate injury-related behaviors. Factors contributing to children's injury-related behaviors would include punishment or indifference as well as the mode of parents' education; reintegral type of family; the level of parents' cognition on injuries; unfit location of medicine at home and careless attitudes of parents.
COMMENTS: There was close relationship between children's injury-related behaviors and familial factors. To avoid injury-related behaviors and to prevent injury occurrence, the importance of familial factors must be stressed.
Parental beliefs regarding developmental benefits of childhood injuries.
- Lewis T, DiLillo D, Peterson L. Am J Health Behav 2004; 28 Suppl 1: S61-68.
Correspondence: Terri Lewis, Collaborative Studies Coordinating Center, Department of Biostatistics, University of North Carolina, 203 Bank of America Plaza, CB# 8030, Chapel Hill, NC 27599-8030, USA; (email: UCCTLL@MAIL.CSCC.UNC.EDU).
OBJECTIVE: To assess parental beliefs that minor childhood injuries play a beneficial role in the development of young children.
METHODS: Mothers and fathers of 159 children, ages 15 to 40 months, completed the Injury Attitudes Questionnaire (IAQ), designed to assess parental beliefs that children "learn from" and "toughen up" as a result of experiencing minor injuries.
FINDINGS: A main effect for parent gender was found such that fathers endorsed stronger beliefs than did mothers regarding the developmental benefits of injuries.
COMMENTS: The accuracy of these beliefs as well as their relevance to parental injury-prevention behaviors is discussed.
Correspondence: Stefan Pinzkel, Department of Agricultural Biosystems and Technology, Division of Work Science, Swedish University of Agricultural Sciences, P.O. Box 88, SE-230 53, Alnarp, SWEDEN; (email: stefan.pinzke@jbt.slu.se).
The objective of this study was to reach a better understanding of accidents on Swedish roads involving slow-moving vehicles and to suggest ways of preventing such accidents. We analyzed accident data from a 5-year period (1992-1996) involving all types of farm vehicles as well as horses and horse-drawn vehicles. During each year of the period under investigation, slow-moving vehicles were involved in more than 250 traffic accidents on Swedish roads, and an average of 10 people were killed, 66 sustained serious injuries, and 192 sustained slight injuries. This was about 1.3% of all persons injured in traffic accidents in Sweden. The deaths and injuries mostly involved car drivers and passengers. Tractor drivers and unprotected road users (people walking or traveling by motorcycle, moped, or bicycle) also sustained serious injuries and deaths. Vehicles overtaking slow-moving vehicles from behind were the most common type of accident (30%), followed by turning accidents (27%), accidents at crossroads (26%), and with oncoming vehicles (17%). To strengthen the suggestions for improvement, a questionnaire was sent out to driving school teachers in Sweden. Subjects were asked about their experiences with farm vehicles on the roads and their suggestions for ways to increase traffic safety. Based on the accident data and the questionnaire responses, we developed several suggestions for reducing road accidents, including measures for making farm vehicles more visible, improvement of the training provided at driving schools, and information campaigns directed at drivers of farm vehicles and other road users. Further in-depth research is needed to analyze road accidents involving slow-moving vehicles and to test different intervention measures.
A cross-national study of violence-related behaviors in adolescents.
- Smith-Khuri E, Iachan R, Scheidt PC, Overpeck MD, Gabhainn SN, Pickett W, Harel Y. Arch Pediatr Adolesc Med 2004; 158(6): 592-594.
Correspondence: Eleanor Smith-Khuri, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892, USA; (email: unavailable).
BACKGROUND: Violent behavior among adolescents is a significant problem worldwide, and a cross-national comparison of adolescent violent behaviors can provide information about the development and pattern of physical violence in young adolescents.
OBJECTIVES: To determine and compare frequencies of adolescent violence-related behaviors in 5 countries and to examine associations between violence-related behaviors and potential explanatory characteristics.
METHODS: Cross-sectional, school-based nationally representative survey at ages 11.5, 13.5, and 15.5 years in 5 countries (Ireland, Israel, Portugal, Sweden, and the United States).
MAIN OUTCOME MEASURES: Frequency of physical fighting, bullying, weapon carrying, and fighting injuries in relation to other risk behaviors and characteristics in home and school settings.
FINDINGS: Fighting frequency among US youth was similar to that of all 5 countries (nonfighters: US, 60.2%; mean frequency of 5 countries, 60.2%), as were the frequencies of weapon carrying (noncarriers: US, 89.6%; mean frequency of 5 countries, 89.6%) and fighting injury (noninjured: US, 84.5%; mean frequency of 5 countries, 84.6%). Bullying frequency varied widely cross-nationally (nonbullies: from 57.0% for Israel to 85.2% for Sweden). Fighting was most highly associated with smoking, drinking, feeling irritable or bad tempered, and having been bullied.
COMMENTS: Adolescents in 5 countries behaved similarly in their expression of violence-related behaviors. Occasional fighting and bullying were common, whereas frequent fighting, frequent bullying, any weapon carrying, or any fighting injury were infrequent behaviors. These findings were consistent across countries, with little cross-national variation except for bullying rates. Traditional risk-taking behaviors (smoking and drinking) and being bullied were highly associated with the expression of violence-related behavior.
Bullying in college by students and teachers.
- Chapell M, Casey D, De la Cruz C, Ferrell J, Forman J, Lipkin R, Newsham M, Sterling M, Whittaker S. Adolescence 2004; 39(153): 53-64.
Correspondence: Mark Chapell, Department of Psychology, Rowan University, 201 Mullica Hill Road, Glassboro, New Jersey 08028, USA; (email: chapell@rowan.edu).
This study explored bullying in college by students and teachers. The reports of a sample of 1,025 undergraduates indicated that 24.7% had seen students bully other students occasionally and 2.8% very frequently, 5% had been bullied by students occasionally and 1.1% very frequently, 12.8% had seen teachers bully students occasionally and 1.9% very frequently, 4.2% had been bullied by teachers occasionally and .5% very frequently, while 3.2% had bullied other students occasionally and 1.9% very frequently. Male students bullied significantly more than females. Student bullying was predicted by having seen other students bully, and by having been bullied by both students and teachers.
The prevention of suicide is a top priority in mental health. The determination of high risk suicidal groups is not sufficient. The expressing suicidal ideas is not a protective factor, but in contrary a risk factor to take into account, or even to search and to quantify: 80% of the subjects who attempt to commit suicide or commit suicide express such ideas Months before. Several evaluation instruments try to help the practicians or the research workers in this reasoning. The suicidal risk assessment scale RSD can be cited in particular. It is composed of eleven sections. The 0 level corresponds to the absence of particular ideas of death or suicide. Levels 1 and 2, the presence of ideas of death. Levels 3-4-5, the pre-sence of suicidal ideas. The difference compared to the majority of the other scales consecrated to the same subject, the passif desire of death, occupies a place totally particular in the RSD (level 6). From the level 7, the risk of acting out seems to become more important. It stops being a simple idea of suicide, but becomes a real will of dying, firstly retained by something or someone (level 7), the fear of causing suffering to dear ones or a religious belief., then determinated (level 8). Finally, the patient has elaborated a concrete plan (level 9) or he has already started the preparation of acting out (level 10). It is just necessary to evaluate and to note the hightest level of the scale. The inclusion of the suicidal risk assessment scale RSD and of the Suicidal Ideation Scale by Beck in an international multicentrist, phase IV, double-blind study, according to two parallel groups, with a fixed dose of fluoxetine or fluvoxamine for six weeks, allowed to search correlations which could exist between the two scales. The ana-lysis before the beginning of the treatment was done on 108 outpatients depressive, male and female, aged 18 or over. It finds a satisfactory concurrent validity between the suicidal risk assessment scale RSD and the Suicidal Ideation Scale by Beck (r=0.69; p<0.0001) as well as between the RSD and the item "suicide" of the Depression scale by Hamilton (r=0.60; p<0.0001). On the other hand, it is less satisfactory between the suicidal risk assessment scale RSD and the Hamilton Depression scale overall score (r=0.35; p=0.0002). During the evolution under the treatment, the suicidal risk assessment scale RSD shows an improvement si-gnificantly faster than the Hamilton Depression scale or the Beck's Suicidal Ideation Scale (p<0.0001). This statement of fact arouses some questions about the suicidal risk of which the evolution in the case of a treated depressive episode could be quicker than first thought. All the more so as this difference is affected by the type of the treatment (p=0.015). Moreover, a score of 7 and more on the suicidal risk assessment scale RSD seems to represent a risk level judged particularly significant by the experimenters. In effect, the existence of such a suicidal risk was a criteria of exclusion and no patient with a level superior to 6 on suicidal risk assessment scale RSD was included. In conclusion, the utilisation of the suicidal risk assessment scale RSD could be interesting in the prevention of suicide.
The failure to detect suicide risk is one of the most prevalent and preventable clinical errors in behavioral health. A managed behavioral health care organization (MBHO) implemented patient self-report assessment as a means of identifying clinical risk. An analysis of the first full year of patient self-report data compared with data collected from clinicians observed that more than 50% of practitioners underdetected the presence of suicidal ideation. Discordance between patient self-report and practitioner report was noted, suggesting that suicide risk might not be sufficiently addressed in clinical practice. The MBHO addressed the underdetection from 2000 to 2002. The result was a reduction in the rate of underdetection for clinicians using the early warning system and adopting process changes implemented during the course of the study.
Medical helicopter accidents in the United States: a 10-year review.
- Bledsoe BE, Smith MG. J Trauma 2004; 56(6): 1325-1329.
Correspondence: Bryan Bledsoe, Division of Emergency Medicine, University of North Texas Health Sciences Center Fort Worth, Texas, USA; (email: bbledsoe@earthlink.net).
OBJECTIVE: There has been a significant proliferation of medical helicopters and medical helicopter operations in the United States over the last decade. The purpose of this study was to determine whether the proliferation of medical helicopter operations in the United States was associated with a subsequent increase in the number of accidents
METHODS: We used univariate descriptive analysis of all pertinent medical accident files obtained from United States aviation databases for a 10-year period (1993-2002).
FINDINGS: There were 84 medical helicopter accidents involving 260 persons (passengers, patients, crew, and pilots) during the 10-year study period. Of these, there were 72 fatalities and 64 injuries. The incidence of fatalities was 0.86 fatalities per accident. The incidence of nonfatal injuries was 0.76 per accident. Fifty-two percent of all reported accidents occurred during the last 3 years of the study period (2000-2002).
COMMENTS: There was a steady and marked increase in the number of medical helicopter accidents in the United States during the 10-year period (1993-2002). These findings are worrisome in light of recent research that has indicated use of medical helicopters may be excessive and nonbeneficial for most patients.
Louisiana motorcycle fatalities linked to statewide helmet law repeal.
- Ho EL, Haydel MJ. J La State Med Soc 2004; 156(3): 151-152, 154-115, 157.
Correspondence: E. Ho, Louisiana State University Emergency Medicine Residency Program, New Orleans, USA; (email: unavailable).
BACKGROUND: On August 15, 1999, Louisiana's mandatory motorcycle helmet law was repealed. Our primary objective was to determine if the repeal resulted in an increase in motorcyclist morbidity and mortality.
METHODS: We retrospectively evaluated the frequency of helmet use and morbidity and mortality before and after the repeal of the law. Fatality statistics for Louisiana were obtained through the National Highway Safety Traffic Association between 1994 and 2002. Injury statistics were totaled for motorcyclists admitted to Medical Center of Louisiana New Orleans during the same period of time.
FINDINGS: Statewide, helmet use decreased 21.2% (p < 0.001, chi-square) after repeal of the helmet law, while locally, helmet use decreased 34.7% (p < 0.001). Fatalities significantly increased after the repeal, both statewide (3.0%-3.9%, p < 0.05) and locally (3.8%-5.8%, p < 0.0001).
COMMENTS: Motorcycle helmet use decreased significantly and motorcyclist fatality rates increased significantly after repeal of the Louisiana mandatory helmet law.
Analysis of fatal injuries to motorcyclists by helmet type.
- Hitosugi M, Shigeta A, Takatsu A, Yokoyama T, Tokudome S. Am J Forensic Med Pathol 2004; 25(2): 125-128.
Correspondence: Masahito Hitosugi, Department of Legal Medicine, Dokkyo University School of Medicine, Tochigi, JAPAN; (email: hitosugi@dokkyomed.ac.jp).
To clarify the characteristics of injuries of motorcyclists dying in accidents in relation to helmet type, we retrospectively analyzed forensic autopsies of 36 helmeted motorcycle riders. The presence of major injuries and injury severity were evaluated with the injury severity score and the 1990 revision of the Abbreviated Injury Scale. Persons with open-face helmets (19 cases) were significantly more likely to have sustained severe head and neck injuries, especially brain contusions, than were persons with full-face helmets (17 cases). Furthermore, major injuries of the chest or abdomen, rib fractures, lung injuries, and liver injuries were each present in more than one quarter of all cases (26.3% to 70.6%), but their prevalences did not differ significantly between riders with different types of helmet. Because many types of head and neck injuries cannot be prevented and fatal chest and abdominal injuries occur despite the use of full-face helmets, more effective helmets and devices for protecting the chest and abdomen are needed to decrease deaths from motorcycle accidents.
Documenting the sustainability of a mature Click It or Ticket program: The North Carolina experience.
North Carolina was the first United States jurisdiction to implement a statewide program (called Click It or Ticket) coupling concentrated enforcement with massive publicity to increase seat belt use. After a successful pilot program in three very different North Carolina communities, the statewide program was launched in October 1993, and has been most active and productive as well as imitated by many other states over the past decade. This paper explores the combination of ingredients that have been employed and sustained over that period of time. These include: (a) a basic coalition of critical public-private agencies (central to the planning, execution, and publicity of the many Click It or Ticket programs); (b) critical top-down commitments (starting with the governor); (c) pervasive and innovative media events/press releases/ PSAs/ web site information; (d) vigorous and well-publicized law enforcement; (e) feedback on results with solid, updated data; (f) related statewide and local programs/activities; and last but not least (g) continuous funding.
The role of enforcement programs in increasing seat belt use.
- Williams AF, Wells JK. J Safety Res 2004; 35(2):175-180.
Correspondence: Allan F. Williams, Insurance Institute for Highway Safety, 1005 North Glebe Road, Arlington, VA 22201, USA; (email: research@iihs.org).
Seat belt laws by themselves led to increased belt use in the United States and Canada, but initial effects were limited. Canadian provincial officials launched highly publicized enforcement campaigns in the early 1980s that resulted in substantially increased belt use. Canadian-style enforcement programs subsequently were adopted in the United States, and the use of such programs has grown in recent years. Lessons from these efforts include the importance of police leadership, focused publicity about enforcement, and sustained rather than single-shot efforts. What is needed in the United States to achieve a national belt use rate of 90% or greater is widespread, methodical, and sustained application of enforcement programs augmented by creative publicity. Enhanced penalties-in particular drivers license points-likely will be needed to reach hard-core nonusers.
Methods to reduce traffic crashes involving deer: what works and what does not.
More than 1.5 million traffic crashes involving deer, producing at least $1.1 billion in vehicle damage and about 150 fatalities, are estimated to occur annually in the United States. Deer-related crashes are increasing as both deer populations and vehicular travel increase. Many methods have been used in attempts to reduce deer crashes, often with little scientific foundation and limited evaluation. This article summarizes the methods and reviews the evidence of their effectiveness and the situations in which each may be useful. The only widely accepted method with solid evidence of effectiveness is well-designed and maintained fencing, combined with underpasses or overpasses as appropriate. Herd reduction is controversial but can be effective. Deer whistles appear useless. Roadside reflectors appear to have little long-term effect, although additional well-designed evaluations are needed before firm conclusions can be drawn. Both temporary passive signs and active signs appear promising in specific situations, but considerable research is required to evaluate long-term driver response and to improve and test deer detection technology for active signs. Other methods using advanced technology require substantial additional research and evaluation.
Randomized trial of a statewide home visiting program to prevent child abuse: impact in reducing parental risk factors.
- Duggan A, Fuddy L, Burrell L, Higman SM, McFarlane E, Windham A, Sia C. Child Abuse Negl 2004; 28(6): 625-645.
Correspondence: Anne Duggan, Johns Hopkins University School of Medicine, 1620 McElderry Street, Baltimore, MD 21205-1903, USA; (email: aduggan@jhmi.edu).
OBJECTIVE: To assess the impact of a home visiting program in reducing malleable parental risk factors for child abuse in families of newborns identified, through population-based screening, as at-risk of child abuse.
METHODS: This randomized trial focused on Healthy Start Program (HSP) sites operated by three community-based organizations on Oahu, HI, USA. From 11/94 to 12/95, 643 families were enrolled and randomly assigned to intervention and control groups. Mothers in both groups were interviewed annually for 3 years (88% follow-up each year) to measure mental health, substance use, and partner violence. HSP records were reviewed to measure home visiting services provided. Home visitors were surveyed annually to measure their perceived competence.
FINDINGS: Malleable parental risks for child abuse were common at baseline. There was no significant overall program effect on any risk or on at-risk mothers' desire for and use of community services to address risks. There was a significant reduction in one measure of poor mental health at one agency and a significant reduction in maternal problem alcohol use and repeated incidents of physical partner violence for families receiving >/=75% of visits called for in the model. Home visitors often failed to recognize parental risks and seldom linked families with community resources. HSP training programs were under-developed in preparing staff to address risks and to link families with community resources.
COMMENTS: Overall, the home visiting program did not reduce major risk factors for child abuse that made families eligible for service. Research is needed to develop and test strategies to improve home visiting effectiveness in reducing parental risks for child abuse.
Impact of Police and Legislative Initiatives on Urban Gunshot Wound Admissions.
- Weichenthal LA, Roberts AL. J Trauma 2004; 56(6): 1206-1210.
Correspondence: Lori Weichenthal, Department of Emergency Medicine, UCSF Fresno, University Medical Center, Fresno, California, USA; (email: weichent@ucsfresno.edu).
BACKGROUND: This study aimed to assess the effects of local and state anti-crime initiatives on the number of gunshot wound admissions to a level 1 trauma center.
METHODS: A retrospective time series analysis of gunshot wound admissions from July 1, 1990 to July 30, 1999 was performed at a level 1 trauma center. The gunshot wound admissions were divided into four subgroups: assault, suicide, accident, and police-involved gunshot wounds. The effects of the following three initiatives were studied: (1) the Three Strikes law; (2) a local police initiative, the Violent Crime Suppression Unit; and (3) the Use a Gun and You're Done law. The periods that corresponded with each intervention were defined, and the rates of gunshot wound-related admissions for all causes after each intervention were compared.
FINDINGS: During the study, 1,499 patients were admitted with gunshot wounds. These admissions involved 1,220 assaults, 196 suicide attempts, 52 accidents, and 31 police-involved cases. Over the defined periods, an average of 13.7 gunshot wound admissions (range, 7.9-15.5) occurred, most of which were assaults (mean, 10.8; range, 5.5-13). There were no differences across the periods for gunshot wound admissions among three of the subgroups: suicide, accidental, and police-related gunshot wounds. However, the assault subgroup showed a significant decrease across all the periods and a statistically significant decrease after enactment of the Use a Gun and You're Done law (p < 0.005). When control was used for an increasing number of police officers, however, the association was no longer statistically significant.
COMMENTS: Gunshot wound admissions attributable to assault at a level 1 trauma center decreased during a period when several local and state initiatives focused on decreasing violent crime were enacted. The causes likely were multifunctional, and included increasing the number of police officers as well as the enactment of new laws.
Characterizing perceived police violence: implications for public health.
- Cooper H, Moore L, Gruskin S, Krieger N. Am J Public Health 2004; 94(7): 1109-1118.
Correspondence: Hanna Cooper, National Development and Research Institutes, Inc, 71 W 23rd St, 8th Floor, New York, NY 10010, USA; (email: cooper@ndri.org).
Despite growing recognition of violence's health consequences and the World Health Organization's recent classification of police officers' excessive use of force as a form of violence, public health investigators have produced scant research characterizing police-perpetrated abuse.Using qualitative data from a study of a police drug crackdown in 2000 in 1 New York City police precinct, we explored 40 injection drug using and 25 non-drug using precinct residents' perceptions of and experiences with police-perpetrated abuse. Participants, particularly injection drug users and non-drug using men, reported police physical, psychological, and sexual violence and neglect; they often associated this abuse with crackdown-related tactics and perceived officer prejudice.We recommend that public health research address the prevalence, nature, and public health implications of police violence.
The poor reputation of the NHS in dealing with domestic violence is not helped by a lack of evidence on effective approaches to it. Screening programmes modestly increase disclosure of abuse but few studies measure outcome. Healthcare professionals should be alert to the possibility of domestic violence if the path to homelessness is to be avoided.
Predicting the intentions of women in domestic violence shelters to return to partners: does forgiveness play a role?
- Gordon KC, Burton S, Porter L. J Fam Psychol 2004; 18(2): 331-338.
Correspondence: Kristina Coop Gordon, Department of Psychology, University of Tennessee-Knoxville, Knoxville, TN, USA; (email: kgordon1@utk.edu).
Recent findings indicate that college women's forgiveness of hypothetical dating violence was predictive of their hypothetical decisions to stay in the relationship. This study was designed to evaluate the role of forgiveness in women's intentions to return to their partners from a domestic violence shelter. A sample of 121 women residing in both urban and rural domestic violence shelters filled out a series of questionnaires evaluating demographic information, severity of violence, attributions for violence, psychological constraints (or investment), and forgiveness of the partner. Forgiveness was found to predict intention to return to partner over and above the other variables studied. These findings suggest that the degree to which women are willing to "move on" from the abuse and to let go of their anger toward their partners may play a significant role in their intention to remain in a relationship with their partners.
