Correspondence: Monica H. Swahn, Division of Violence Prevention, Mailstop K 60, National Center for Injury Prevention and Control, CDC, 4770 Buford Highway, Atlanta, GA 30341-3724, USA; (email: mswahn@cdc.gov).
This study examined the associations between specific alcohol-use measures and physical fighting, injuries received, and injuries inflicted on others while fighting. We conducted cross-sectional analyses of the National Longitudinal Study of Adolescent Health (Add Health) limiting our analyses to adolescent drinkers (n=8885) between the ages of 12 and 21 years. Results revealed that adolescent drinkers who reported problem drinking and peer drinking were more likely to engage in physical fighting, being injured, and injuring others in fights than drinkers who did not report these drinking behaviors even after controlling for drinking frequency and binge drinking. The findings highlight the need for violence prevention programs that focus on the reduction of alcohol use among adolescents.
Violence related injuries in the emergency room: alcohol, depression, and conduct problems.
- Borges G, Cherpitel CJ, Medina-Mora ME, Mondragon L. Subst Use Misuse 2004; 39(6): 911-930.
Correspondence: Guibor Borges, Instituto Nacional de Psiquiatria Ramon de la Fuente, Mexico, DF, MEXICO; (email: guibor@imp.edu.mx).
OBJECTIVE: The aim of this study was to obtain epidemiological measures of the association between alcohol consumption and emergency room (ER) attendance due to violence, compared to the general population in the city of Pachuca, Mexico, during October-November, 1996 and June-July, 1997.
METHOD: The study was a population-based case-control design. Intervention and Measurements: Data consisted of an interviewer-administered questionnaire, collected on a 24-h basis, during the entire week. Setting and Participants: Cases were 127 patients (78% male) admitted to the ER because of an injury that was the result of violence (being in a fight or being attacked by someone). A sample of residents from Pachuca (n = 920) was the comparison group.
FINDINGS: Patients reporting drinking within 6h compared to nondrinkers were more likely to suffer a violence-related injury [34.0 (17.5-66.2)] and alcohol dependent patients were more likely to be involved in a violence-related injury [7.4 (3.5-15.6)] compared to noncurrent drinkers. When both alcohol prior and alcohol dependence were considered simultaneously in multiple models among current drinkers, patients with violence-related injuries were more likely to report alcohol prior but not to be positive for alcohol dependence. Depressive symptoms, but not conduct problem behavior, were also associated with violent injury in simultaneous regressions that included alcohol variables.
COMMENTS: In the city of Pachuca, Mexico, a large relationship between drinking prior to the event and violence-related injury, regardless of alcohol dependence, was found. Depression was also related to violence, suggesting the need for more comprehensive intervention with these patients.
Community based participatory research: a promising approach for increasing epidemiology's relevance in the 21st century.
- Leung MW, Yen IH, Minkler M. Int J Epidemiol 2004; 33(3): 499-506).
Correspondence: Margaret W Leung, University of California, San Diego, School of Medicine, 9500 Gilman Dr., Mail Code 0606, MTF Building, Room 180 La Jolla, CA 92093, USA; (email: mileung@meded.ucsd.edu).
Despite the advances of modern epidemiology, the field remains limited in its ability to explain why certain outcomes occur and to generate the kind of findings that can be translated into programmes or policies to improve health. Creating community partnerships such that community representatives participate in the definition of the research problem, interpretation of the data, and application of the findings may help address these concerns. Community based participatory research (CBPR) is a framework epidemiologists can apply to their studies to gain a better understanding of the social context in which disease outcomes occur, while involving community partners in the research process, and insuring that action is part of the research process itself. The utility of CBPR principles has been particularly well demonstrated by environmental epidemiologists who have employed this approach in data gathering on exposure assessment and advancing environmental justice. This article provides examples of how popular epidemiology applies many of CBPR's key principles. At this critical juncture in its history, epidemiology may benefit from further incorporating CBPR, increasing the field's ability to study and understand complex community health problems, insure the policy and practice relevance of findings, and assist in using those findings to help promote structural changes that can improve health and prevent disease.
Correspondence: Carole Siegel, Statistics and Services Research Division, Nathan Kline Institute of Psychiatric Research, New York University Medical Center, Department of Psychiatry, Orangeburg, NY 10962, USA; (email: siegel@nki.rfmh.org).
BACKGROUND: The September 11th disaster in New York City resulted in an increase in mental health service delivery as a vast network of providers responded to the urgent needs of those impacted by the tragedy. Estimates of current capacity, potential additional capacity to deliver services and of potential shortfall within the mental health sector are needed pieces of information for planning the responses to future disasters.
AIMS OF THE STUDY: Using New York State data, to determine the distribution of clinical service delivery rates among programs and to examine an explanatory model of observed variation; to estimate potential additional capacity in the mental health sector; and to estimate shortfall based on this capacity and data from studies on the need and use of services post September 11th
METHODS: Empirical distributions of weekly clinical service delivery rates in programs likely to be used by persons with post disaster mental health problems were obtained from available data. Three regression models were fit to explain rate variation in terms of unmodifiable program characteristics likely to impact the rates. We argue that rates could not be easily increased if any of the models had good explanatory power, and could be increased if it did not. All models had poor fit. We then assumed that the median and 75th percentile of the clinical service delivery rates were candidates for the minimum production capability of a clinician. The service rates of those clinicians whose rates fell below these quartiles were increased to the quartile value to yield estimates of potential additional capacity. These were used along with data on clinical need to estimate shortfall. RESULTS: There is substantial variation in clinical service delivery rates within impact regions and among programs serving different age populations. The estimate of the percent increase in services overall based on the median is 12% and based on the 75th percentile is 27%. Using an estimate of need of.03 suggested by available data, and a range of services (1-10) that might be required in a six month period, shortfall estimates based on the median ranged between 22-92% and for the 75th percentile from no shortfall to 86%. A less conservative estimate of need of.05 produces median shortfall ranging between 59-96% and for the 75th percentile between 10-91%.
LIMITATIONS: While the program descriptor variables used in the explanatory model of rates were those most likely to impact rates, explanatory power of the model might have increased if other characteristics that are not modifiable had been included. In this case, the assumption that service production can be increased is called into question.
IMPLICATIONS FOR HEALTH CARE PROVISION AND USE: In the first six months post September 11th, in New York State (NYS) 250,000 persons received crisis counseling through Project Liberty. In 1999, NYS served approximately that same number in mental health clinic programs during the entire year. The estimates of this study suggest that additional funding and personnel are needed to provide mental health services in the event of a major disaster.
IMPLICATIONS FOR HEALTH POLICIES: A disaster plan is needed to coordinate the use of current and additional personnel including mental health resources from other sources and sectors.
Sleepiness and driving is a dangerous combination that causes thousands of crashes each year resulting in injury and death. In the last few years, driving simulators have been used to study the performance decrements associated with drowsiness. We correlated performances of a driving simulation task in healthy volunteers in different alertness conditions with objective (MSLT: Multiple Sleep Latency Test) and subjective (SSS: Stanford Sleepiness Scale; VAS: Visual Analogue Scale) sleepiness measurements. The subjects were tested on two days, after a normal night of sleep and after a night of complete sleep deprivation. The study consists of four sessions of MSLT, each one followed by subjective measurements of sleepiness and by a 30min driving simulation task with a monotonous driving scenario. The parameters that correlate most highly with MSLT are the standard deviation of lane position, the mean RT, crash frequency and exceeding the speed limit frequency. The monotonous driving simulation we adopted showed strong correlations with MSLT and subjective sleepiness scales in healthy subjects and is suitable to evaluate excessive daytime sleepiness in patients.
Television has become an important tool for learning and socialization in children. Although television violence has been associated with adverse effects, data on depiction of fire and burn injury are lacking. We sought to determine whether Saturday-morning television programming, viewed primarily by children, depicts fire and burn injury as safe or without consequence, thus potentially increasing the incidence of burn injury in children. This was a prospective observational study. Saturday-morning children's television programs were videotaped from 7 AM to 11 AM for eight different television networks during a 6-month period. Tapes were scored for scenes depicting fire or smoke by independent observers. Recorded items included show category, scene type, gender target, context of fire, and outcome after exposure to flame. Fire events were documented during programs and their associated commercials. A total of 108 hours of children's programs, 16 hours per network, were recorded. Scenes depicting fire or smoke were identified 1960 times, with 39% of events occurring during the program itself and 61% in commercials. Fire was depicted as either safe or without consequence in 64% of incidents. Action adventure stories accounted for 56% of flame depictions. Overall, one incident involving flame and fire was portrayed for each 3 minutes of television programming. Saturday-morning television programming frequently depicts fire as safe, empowering, or exciting. The incidence of flame use in programming varies between stations but is most prevalent in action/adventure stories. Television commercials, although brief, provide the majority of the misinformation regarding fire. Medical professional societies should alert the public to this potential hazard and recommend responsible portrayal of fire in children's television programming.
The New Zealand child work-related fatal injury study: 1985-1998.
- Lilley R, Feyer AM, Langley J, Wren J. N Z Med J 2004; 117(1194): U891.
Correspondence: Rebecca Lilley, New Zealand Environmental and Occupational Health Research Centre, Department of Preventive and Social Medicine, University of Otago, Dunedin, NEW ZEALAND; (email: rebecca.lilley@stonebow.otago.ac.nz).
OBJECTIVE: To estimate the numbers and rates of work-related fatal injury for children under the age of 15 years.
METHODS: Potential cases of work-related injury deaths of persons aged <15 years of age were identified from the national electronic mortality data-files for the period 1985-1998 inclusive. The circumstances of the death in each fatality incident were reviewed directly from coronial files to determine work-relatedness.
FINDINGS: A total of 87 workplace work-related fatalities were identified. The vast majority of children identified were fatally injured while a bystander to another person's work. Workplace bystander involvement was found to vary by age, with the majority of workers identified aged 10-14 years old. With a third of all fatalities, the agricultural industry was the most common industry for workplace work-related fatalities in children. In the period 1985-94, children <15 years of age were found to account for 46% of New Zealand's total workplace bystander deaths.
COMMENTS: Children contribute significantly to the overall burden of work-related fatal injury in New Zealand, especially as bystanders to other people's work. The high contribution to bystander deaths by children aged <15 years suggests that hazard control in certain work settings is lacking.
Comparing two methods of data collection for walkway friction measurements with a portable slip meter and a force platform.
- Matz S, Grönqvist R. Safety Sci 2004; 42(6): 483-492.
Correspondence: Simon Matz, Liberty Mutual Research Institute for Safety, 71 Frankland Road, Hopkinton, MA 01748, USA; (email: simon.matz@libertymutual.com).
The objective was to investigate how two distinct data collection procedures, raw coefficient of friction (COF) data versus averaged COF data, may affect the outcome and interpretation of statistical analysis of friction tests and thus the reliability of slip resistance assessments. A prototype portable slip meter (PSM) and a force platform (FP) were used for evaluating floor friction transients over contaminated surfaces. A one-way ANOVA was performed to estimate significant differences between the PSM and the FP using raw COF data (55 measurement points) and averaged COF data (five measurement points) respectively. For comparing the FP with the portable slip meter, the best approach is to use averaged friction data. When the portable slip meter is used independently for walkway friction measurement, either the averaged or the raw data can be used to present the test results. However, the larger sample size is always the preferred choice.
Influence of weather conditions on the performance of energy absorbers and guided type fall arresters on a flexible anchorage line during fall arresting.
Correspondence: Krzysztof Baszczynski, Department of Personal Protective Equipment, Central Institute for Labour Protection, Wierzbowa 48, Lodz 90-133, POLAND; (email: krbas@ciop.lodz.pl).
Energy absorbers and guided type fall arresters on a flexible anchorage line belong to very popular group of equipment protecting against falls from a height. This equipment is used in different weather conditions (different temperature, humidity, precipitation, etc.), which influence its parameters. Fibre ropes and webbing, made from polyamide fibres, used in energy absorbers and guided type fall arresters, are sensitive to weather conditions. Laboratory tests proved that the changes in temperature, humidity, etc., especially influence dynamic elongation of this equipment and the force acting on anchor point during fall arresting. These phenomena decide directly about the fall arresting process and can influence safety of people working on a height.
Floor slipperiness measurement: friction coefficient, roughness of floors, and subjective perception under spillage conditions.
Measurement of the coefficient of friction (COF) between the shoe/sole and the floor is essential in understanding the risk of slipping accidents. In this research, the COF of five floor materials commonly used on a university campus, under five surface conditions including dry and four liquid spillage conditions, were measured. The COF measurements were conducted using a Brungraber Mark II slip tester with four footwear materials: leather, neolite, ethylene vinyl acetate, and blown rubber. The results of the COF measurements showed that floor tile, footwear material, and surface conditions were all significant factors affecting the COF. Interactions between these factors were also significant. Four surface roughness parameters (Ra, Rtm, Rpm, Rq) of the five tiles selected in the friction measurement were measured using a profilometer. The roughness of the two ceramic tiles was significantly higher than the three non-ceramic tiles. The correlation between the four roughness parameters and the measured COF was very high (r=0.932 to 0.99) under both wet and water-detergent conditions. The tile and surface conditions in the friction measurements were presented to 24 subjects and the subjective evaluation of floor slipperiness was determined. The differences of the scores from the five surface conditions were statistically significant. The difference under floor tile conditions with the same spillage condition was, however, not significant. Spearman's rank correlation coefficients between subjective score and measured COF using neolite footwear were in the range of 0.8-0.975 for the five floors under all the surface conditions. This implies that subjective scores may reasonably reflect floor slipperiness measured with the Brungraber Mark II slip tester using neolite footwear pad.
Slips and falls on ice and snow in relation to experience in winter climate and winter sport.
- Gao C, Abeysekera J. Safety Sci 2004; 42(6): 537-545.
Correspondence: Chuansi Gao, Division of Industrial Ergonomics, Department of Human Work Sciences, Luleô University of Technology, Luleå 971 87, SWEDEN; (email: chuansi.gao@arb.luth.se).
The objective of this paper was to investigate whether living experience in winter climate and winter sport helps to prevent slips and falls on ice and snow. A questionnaire survey was conducted among foreigners at Luleô University of Technology of Sweden, where winter season lasts for six months in a year. Seventy respondents replied. The results of ordinal regression showed that the slip frequency according to a 5-point rating scale decreased as the living experience in cold environments increased (B=-0.0113, p=0.019). A logistic regression was applied to model the probability of fall events occurrence based on the experience of living in cold climate. The results showed that the fall events reduced as living experience increased (B=-0.030, p=0.001). Chi-square test showed that fall events in those who took part in winter sport were significantly less than in those who did not participate in winter sport (chi sq=10.745, p=0.001). The findings imply that experience of living in cold environments and training in gait balance on ice and snow can have positive effects in preventing slips and falls for inexperienced workers and pedestrians. This study also revealed that the majority of fall events happened on hard ice covered with snow while wearing ordinary winter footwear, indicating the need to improve slip resistance.
Lead poisoning associated with ayurvedic medications--five states, 2000-2003.
- Centers for Disease Control and Prevention (CDC). MMWR Morb Mortal Wkly Rep 2004; 53(26): 582-584.
Although approximately 95% of lead poisoning among U.S. adults results from occupational exposure, lead poisoning also can occur from use of traditional or folk remedies. Ayurveda is a traditional form of medicine practiced in India and other South Asian countries. Ayurvedic medications can contain herbs, minerals, metals, or animal products and are made in standardized and nonstandardized formulations. During 2000-2003, a total of 12 cases of lead poisoning among adults in five states associated with ayurvedic medications or remedies were reported to CDC. This report summarizes these 12 cases. Culturally appropriate educational efforts are needed to inform persons in populations using traditional or folk medications of the potential health risks posed by these remedies.
Correspondence: Bert Jacobson, School of Applied Health and Educational Psychology, Oklahoma State University, Stillwater, OK 74078, USA; (email: bhj52ok@state.edu).
STUDY DESIGN: Mail survey of cheerleading-related training and injuries.
OBJECTIVE: To collect and describe injury frequency, distribution, and associated factors related to the activity of cheerleading.
BACKGROUND: Estimates indicate that more than 1 million participants are involved in cheerleading at various levels; however, little information exists relative to injuries and training. Unlike most other sports, cheerleader injuries are not tracked in a central database.
METHODS: High school cheerleaders (mean age, 16.3 years) in 3 midwest states completed questionnaires mailed to their respective high schools. Of the surveys mailed to 104 schools, 425 (32.2%) were returned and sufficiently completed for analysis.
FINDINGS: Participants reported an average of 4.1 years of experience and 61.9% of the respondents had sustained 1 or more career injury. During the previous year, 41.3% had sustained 1 or more injuries (mean +/- SD, 1.7 +/- 1.9), resulting in an average of 3.4 reported missed practice or performance days. Of all injuries, the ankle (24.4%), back (16.1%), and wrist or hand (15.6%) were the most frequent sites of injury.
COMMENTS: The rates of injury in cheerleading are comparable to rates of other sports. To accurately provide safety guidelines for all levels of cheerleading, a nationwide injury tracking system is necessary.
Spinal injuries in rugby union, 1970-2003: lessons and responsibilities.
There was an increase in the frequency of rugby union spinal injuries worldwide during the 1970s and early 1980s. The United Kingdom and Australia have since had some success in reducing this increase in spinal injuries. These changes were the result of actions by rugby union authorities in response to recommendations by medical advisors; legal action by injured players has also played a part. The frequency of spinal injuries has not decreased in New Zealand (up to 2000) and South Africa (up to 1997). Rugby union authorities' responsibilities should include establishing and maintaining national and international spinal injury registers to forge closer working relationships with medical researchers. Such registers would provide up-to-date information for enhancing and developing preventive measures. There has been no specific publicly available record of the incidence of rugby union spinal injuries in Australia since 1996, so it is uncertain whether the safety measures introduced so far have had a lasting impact.
Method for validating a multi-component safety system.
- Lan A, Arteau J, Sirard C. Safety Sci 2004; 42(6): 493-517.
Correspondence: André Lan, Safety-Engineering Program, IRSST, Quebec Occupational Health and Safety Research Institute, 505 Boul. de Maisonneuve Ouest, Montréal, Que., CANADA H3A 3C2; (email: lan.andre@irsst.qc.ca).
This paper presents a method for validating safety systems with several components. A fall arrest system for billposters is one example. It includes a Canadian Standards Association certified harness, shock absorber and self-retracting lanyard, a hand-made hook, a horizontal lifeline and noncertified anchorage. Since no regulations exist for verifying a multi-component assembly made up of certified and hand-made components, we present a method for verifying a multi-component system. The verification applies the limit states design method. By applying the concepts of this method to fall arrest systems, resistance and performance requirements can be differentiated. Dynamic strength tests maximize the impact forces in the assembly in order to determine the strength of the assembly; these tests are performed using a rigid compact mass attached to a wire rope lanyard. They therefore verify the ultimate limit states. Dynamic performance tests are carried out by reproducing the actual conditions of use as closely as possible, only the person is replaced by a rigid torso. They verify the serviceability limit states. Only the total fall distance is verified. This distinction between dynamic strength and performance tests enables to identify the proper dynamic drop tests that must be performed in certifying components or an assembly.
Correspondence: Dragana Puzovic, Institute of Forensic Medicine and Clinic of Maxillofacial Surgery, Faculty of Stomatology, University of Belgrade, and Institute of Otorynolaryngology and Maxillofacial Surgery, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, SERBIA; (email: unavailable).
The aim of this research was to evaluate maxillofacial weapon-related injuries from the epidemiological, clinical, and forensic points of view. Analysis of medical records of 183 patients treated for weapon-related injuries in Belgrade maxillofacial surgery clinics in the period 1988 through 2002 has been carried out. Most treated patients were male, 21 to 50 years of age, and injured during the war in the territory of the former Yugoslavia. Injuries involving the mandible were the most frequent (40%); firearm (85%) and perforating (70%) wounds occurred more frequently than explosive (25%) and penetrating (30%) wounds; in certain cases, medical records were incomplete and thus useless for forensic court expertise and evidence. A rapid increase in maxillofacial weapon-related injuries was recorded in the period from 1991 to 1995 as a result of war injuries; high-velocity projectiles caused most of the injuries. It is necessary to keep adequate medical records for successful forensic and court expertise and evidence.
Epidemiology of adult eye injuries in Split-Dalmatian county.
- Karaman K, Gverovic-Antunica A, Rogosic V, Lakos-Krzelj V, Rozga A, Radocaj-Perko S. Croat Med J 2004; 45(3): 304-309.
Correspondence: Ksenija Karaman, Department of Ophtalmology, Split University Hospital, Spinciceva 1, 21000 Split, CROATIA; (email: ksenija.karaman@kbsplit.hr).
OBJECTIVE: To determine the incidence of eye injuries, population groups at risk, circumstances and activities at the time of accident, causes, mechanism, type and severity of injury, therapeutic procedures, final outcome, and the incidence of blindness in patients over 18 years of age.
METHODS: We retrospectively analyzed data on 383 patients with eye injuries (397 eyes) hospitalized at Split University Hospital, Department of Ophthalmology, between January 1998 and December 2002. Standardized international classification of ocular trauma (Birmingham Eye Trauma Terminology) and eye injury score were used for eye injury categorization.
FINDINGS: The incidence of ocular injuries requiring hospitalization in Split-Dalmatian County was 23.9 per 100,000 population and the incidence of monocular blindness caused by injuries was 4.1 per 100,000 population. The male to female ratio was 5.4 to 1. Forty-one percent of injuries occurred at home, 27.7% at work, 13.8% in agriculture, 7.0% during assault or scuffle, 5.2% in traffic, 3.7% during sports activities, and 1.6% at school. Among 397 injuries, 86.4% were mechanical and 13.6% chemical. Out of 343 mechanical injuries, 67.3% were closed globe and 32.7% were open globe injuries. The most frequent objects causing mechanical injuries were tree branch or wood (15.9%) causing 26.3% of ruptures and 21.4% of contusions; pieces of metal or stone (13.9%) causing 80.8% of intraocular foreign body lacerations; and nails, wire, or scissors (8.8%) causing 26.7% of lamellar and 23.9% of penetrating lacerations. Closed globe injuries were less severe and had better final visual outcome than open globe injuries. Final visual acuity was 0.4 or better in 91.4% of mild vs 13.9% of severe injuries. Injuries resulted in monocular blindness (visual acuity<0.1) in 71 (17.9%) patients: 35.2% were due to penetrating lacerations, 23.9% to ruptures, 21.1% to contusions, 16.9% to intraocular foreign body lacerations, and 1.4% due to burns as well as lamellar lacerations.
COMMENTS: There was a high incidence of ocular trauma and consequent blindness in Split-Dalmatian County. For the prevention of serious eye injuries, health education and safety strategies should be applied both at home and place of work, where blinding injuries most often occur.
Bullying: who does what, when and where? Involvement of children, teachers and parents in bullying behavior.
- Fekkes M, Pijpers FI, Verloove-Vanhorick SP. Health Educ Res 2004; Epub ahead of print.
Correspondence: M. Fekkes, TNO (Netherlands Organization of Applied Scientific Research) Prevention.ealth, PO Box 2215, 2301 CE Leiden, THE NETHERLANDS; (email: unavailable).
Bullying victimization is associated with several health issues. Prevention of bullying is therefore an important goal for health and education professionals. In the present study, 2766 children from 32 Dutch elementary schools participated by completing a questionnaire on bullying behavior, and the involvement of teachers, parents and classmates in bullying incidents. The results of this study show that bullying is still prevalent in Dutch schools. More than 16% of the children aged 9-11 years reported being bullied on a regular basis and 5.5% reported regular active bullying during the current school term. Almost half of the bullied children did not tell their teacher that they were being bullied. When teachers knew about the bullying, they often tried to stop it, but in many cases the bullying stayed the same or even got worse. With regard to active bullying, neither the majority of the teachers nor parents talked to the bullies about their behavior. Our results stress the importance of regular communication between children, parents, teachers and health care professionals with regard to bullying incidents. In addition, teachers need to learn effective ways to deal with bullying incidents. Schools need to adopt a whole-school approach with their anti-bullying interventions.
Follow-up study of a school-based scalds prevention programme.
- Moore J, Morath K, Harre N. Health Educ Res 2004; 19(4): 430-439.
Correspondence: J. Moore, Department of Psychology, University of Auckland, Private Bag 92019, Auckland, NEW ZEALAND; (email: unavailable).
This paper describes the follow-up evaluation of a school-based scalds prevention programme designed to teach children about scalds hazards and encourage safe family practices. It involved two classroom sessions and a homework exercise that targeted five safety practices. The programme was taught to 28 classes in 14 schools in Waitakere City, New Zealand by Public Health Nurses (PHNs). Children (n = 116) aged 10-11 years from three of the schools in ethnically diverse, low/middle-income areas were assessed for their knowledge of scalds hazards 1 year after the programme. They recalled a mean of 7.46 out of 10 hazards, which was almost equivalent to children in an earlier evaluation who recalled 7.62 hazards immediately after the teaching. Altogether, 65-79% of children reported that each of the four safety items provided were at least temporarily used as intended, with 29-55% reporting that they were still in use 1 year later. Interviews with children's parents (n = 18) indicated that the majority of their hot water practices were not optimally safe prior to the programme and that many had adopted the suggested practices. While the PHNs were positive about the programme, they suggested teachers could deliver it as part of the school curriculum.
OBJECTIVE: To study the specificity of hospitalized adolescent suicide attempters.
METHOD: Among a national sample of students (n = 11,718, mean age = 16.6 years) studied in 1999, 9.2% (n = 1078) made at least one suicide attempt during their life (SA); 21.9% (n = 234) of them were hospitalized (HSA). We identified the risk factors (family, school, behavioral and psychological) of SA and HSA by comparing (by gender) a) suicide attempters to non-suicide attempters and b) hospitalized suicide attempters to non-hospitalized suicide attempters.
FINDINGS: Both for girls and boys, the risk factors for SA varied. However, certain risk factors, particularly depressive mood, low self-esteem and poor parent-child relationships, were not associated with hospitalization. Hospitalized suicide attempters had more personal and social problems. But there is an important difference according to gender: in boys, hospitalization is related to physical fighting (OR = 2.2) and offences (OR = 3.4), in girls to running away (OR = 1.7), consumption of illegal drugs other than cannabis (OR = 2.0), having a living standard outside average (OR = 2.0) and going to a private school (OR = 1.7).
COMMENTS: Suicide attempters with problem behavior are more at risk of being hospitalized than others. However, the difference between hospitalized and non-hospitalized subjects was smaller than expected.
Gender influence in suicidal behaviour of Polish adolescents.
- Gmitrowicz A, Szymczak W, Kropiwnicki P, Rabe-Jablonska J. Eur Child Adolesc Psychiatry 2003 Oct;12(5):205-213.
Correspondence: Agnieszka Gmitrowicz, II Department of Psychiatry, Medical University of Lodz, ul. Czechoslowacka 8/10, 92-216 Lodz, POLAND; (email: agnes@csk.am.lodz.pl).
OBJECTIVE: The aim of the study was to assess the prevalence and possible suicide attempts and ideation predictors in the school population of girls and boys in the city of Lodz. METHOD: A self-administered anonymous questionnaire was distributed to a representative (random) sample of 1663 students, aged 14-21. Boys and girls reporting no suicidal behaviour (NSB) constitute the control groups; the characteristics of these groups were compared to those of the groups with suicidal behaviour (SB), with focus on the associations between different variables and gender, separately for suicidal ideation (SI) and suicide attempts (SA). RESULTS: About 37% of girls and 25% of boys reported suicidal ideation and about 11% and 5%, respectively, suicide attempts. Boys were more likely to make multiple suicide attempts. The relation between SB and the history of psychiatric treatment was the same for both sexes. Boys with SB were significantly more often fascinated with death, and girls were significantly more often exposed to difficult family situations.
Effect of loss control service on reported injury incidence.
- Nave ME, Veltri A. J Safety Res 2004; 35(1): 39-46.
Correspondence: Michael Nave, Department of Kinesiology and Health Science, California State University, 6000 J Street, Sacramento, CA 95819 6073, USA; (email: menave@csus.edu).
BACKGROUND: A retrospective analysis evaluated the effectiveness of an insurance carrier's flexible loss control service strategy in reducing workers' compensation policyholders' reported injury and illness claims.
OBJECTIVES: To assess the effects of a loss control service strategy on workers' compensation claim frequency rates, on medical-only claim rates, on severity-claim rates, and on claim cost among a group of California employers.
METHODS: Eighty-two small- and medium-sized companies with workers' compensation policies expiring in 1999 were randomly selected from a population of policyholders assigned to loss control consultants for two or more years. Claim performance data were obtained for each company's first expired in-force policy year and its 1999 expired policy year. The retrospective design was combined with a control component based on a randomly selected comparison group of 45 companies whose first policy year with the insurer expired in 1999 and who received safety services from the loss control staff.
FINDINGS: The flexible loss control consultation service strategy was associated with lower average claim rates and costs. Companies assigned to a loss control consultant for two or more years (the "outcome group") had an average claim rate of 1.24 per $10,000 premium, compared with a rate of 1.62 in the "initial group" and a rate of 1.60 in the "comparison group." The average severity-claim rate of the outcome group was 0.32, compared with the initial-year and comparison-group means of 0.48 and 0.46, respectively. The average medical-only claim rate was 0.92, compared with the initial- and comparison-group means of 1.14 and 1.14. The outcome group's average loss ratio was over 10% lower than that of the initial and comparison groups. Statistical analysis indicated that differences among the groups' claim rates and severity-claim rates were [F=(2,206) 4.938, P=0.008] and [F=(2,206) 8.208, P<0.001], respectively.
COMMENTS: A loss control service strategy that provides service flexibility and develops partnership between employer and consultant can help reduce the frequency and severity of workers' compensation claims. Barriers to consultation service flexibility, both internal and external, should be identified and removed to enhance service efficacy.
Graduated driver licensing research in 2003 and beyond.
- Hedlund J, Compton R. J Safety Res 2004; 35(1): 5-11.
Correspondence: James Hedlund, Highway Safety North, 110 Homestead Road, Ithaca, NY 14850-6216, USA; (email: jhedlund@sprynet.com).
This paper updates the comprehensive summary of graduated driver licensing (GDL) published in the January 2003 special issue of the Journal of Safety Research. It summarizes recent research not included in the special issue as well as research in progress or planned research. The most active research areas are risk factors for beginning teen drivers and evaluations of GDL programs. Results in each area strengthen the case for GDL. Additional research is producing valuable information about specific GDL implementation issues and the roles of parents and driver education in helping teenagers learn to drive safely.
Children in side-impact motor vehicle crashes: seating positions and injury mechanisms.
- Howard A, Rothman L, McKeag AM, Pazmino-Canizares J, Monk B, Comeau JL, Mills D, Blazeski S, Hale I, German A. J Trauma 2004; 56(6): 1276-1285.
Correspondence: Andrew Howard, Hospital for Sick Children, Toronto, CANADA; (email: andrew.howard@sickkids.ca).
BACKGROUND: This study aimed to describe the injury mechanisms of children involved in side-impact car crashes, particularly as these relate to seating position, and to estimate the danger of the near-side seating position.
METHODS: A prospective two-center study of children involved in severe car crashes in Canada was conducted as well as a retrospective cohort study of children involved in crashes reported in the Fatality Analysis Reporting System (FARS) and the National Automotive Sampling System: Crashworthiness Data System (NASS CDS).
FINGINGS: Children sitting at the side the car was struck (near-side position) sustained severe head, trunk, and limb injuries. Many of these injuries were attributable to direct intrusion, but some occurred without direct damage to the occupant compartment. Center-seat and far-side occupants had severe injuries only when unrestrained. Injury severity scores were higher for children seated on the near side, and this was statistically significant (p = 0.024) The analysis of Fatality Analysis Reporting System data showed that the risk of fatality was higher for children seated in the near-side position than for those in the center-seat position. The fatality risk ratio was 2.53 (95% confidence interval [CI], 2.08-3.07) for restrained children and 1.84 (95% CI, 1.57-2.17) for unrestrained children. Analysis of the NASS-CDS data showed that for restrained children, severe injury (ISS >=16) was more common among those on the near side (7 per 1,000 children) than among those in the center seat (2 per 1,000) or on the far-side seat (1 per 1,000) (p < 0.001).
COMMENTS: Severe injuries to near-side occupants occurred in both the presence and absence of compartment intrusion. A typical pattern of head, chest, and extremity injury similar to that seen among child pedestrians was observed among near-side child occupants in side-impact crashes. The center seat was statistically safer than the near-side seat, particularly for restrained child occupants. Scene information may be useful to trauma teams for the prediction of injury type and location. Avoiding intrusion and preventing the occupant from striking the vehicle wall are both important to side-impact protection for children. Improvement of the vehicle safety cage may protect against intrusion injuries. Seating two child occupants in inboard seating positions may provide additional protection against intrusion injuries, and also may protect against nonintrusion injuries.
Acculturation, ethnic identity, and dating violence among Latino ninth-grade students.
- Sanderson M, Coker AL, Roberts RE, Tortolero SR, Reininger BM. Prev Med 2004; 39(2): 373-383.
Correspondence: Maureen Sanderson, University of Texas-Houston School of Public Health at Brownsville, Brownsville, TX 78520, USA; (email: msanderson@utb.edu).
BACKGROUND: Studies of dating violence among Latino men and women have found that victims who are less acculturated have lower rates of dating violence. None of these studies have focused on adolescents. We assessed acculturation, ethnic identity, and dating violence victimization among Latino ninth-grade students.
METHODS: Students from 13 high schools representing 24% of ninth-grade students in the Texas Lower Rio Grande Valley during 2000-2001 completed questionnaires. This analysis is restricted to students age 14 years or older who self-identified as Hispanic or Latino (n = 4,525). Logistic regression was performed to estimate the risk of dating violence associated with measures of acculturation and ethnic identity.
FINDINGS: Latino female adolescents were more likely to report dating violence victimization in the past 12 months (8.7%) than were males (6.4%). Parental birthplace outside of the United States was significantly associated with a reduced likelihood of dating violence victimization among females. Reporting a great deal of ethnic discrimination was strongly associated with increased dating violence victimization among females.
COMMENTS: These findings suggest that greater acculturation may be associated with greater prevalence of dating violence victimization among females. Understanding those aspects of Latino culture that may impact risk of dating violence could have important public health implications.
Characterization of interpersonal violence events involving young adolescent girls vs events involving young adolescent boys.
Correspondence: Cynthia Mollen, Department of Pediatrics, Division of Emergency Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA; (email: mollenc@e-mail.chop.edu).
BACKGROUND: Multiple studies have demonstrated that girls are engaging in interpersonal violence. However, little is known about the potentially unique aspects of violent events involving girls.
OBJECTIVES: To describe characteristics of interpersonal violence events in preadolescents and young adolescents and to determine if events involving any girl are different than those involving only boys.
DESIGN: A cross-sectional survey of 8- to 14-year-old patients who were being evaluated at an urban children's hospital emergency department for injuries caused by interpersonal violence was conducted between September 2000 and August 2001. The survey asked the patient to describe details about event circumstances, opponents, weapon use, and injury severity.
FINDINGS: We enrolled 190 patients into the study; 58 (31%) were girls. Seventy-four events (39%) had a girl involved, 156 (82%) occurred on a weekday, 127 (67%) were classified as fights, 140 (74%) were with a known opponent, and 93 (49%) occurred at school. Events involving girls were more likely than events involving all boys to occur at home (relative risk [RR], 1.6; 95% confidence interval [CI], 1.0-2.5). Both boys and girls reported "being disrespected" and "teasing" as popular reasons for a fight. Events involving girls were more commonly related to a "recurrence of a previous fight" (RR, 6.4; 95% CI, 1.9-21.5), were more likely to end because of adult intervention (RR, 1.7; 95% CI, 1.1-2.6), and have a family member try to physically break up the fight (RR, 3.7; 95% CI, 1.5-9.1).
COMMENTS: Violent events involving preadolescent and early adolescent girls are more likely to be in response to a previous event and to involve the home environment and family member intervention. Health care professionals should screen violently injured girls for safety concerns and retaliation plans and consider engaging the family in efforts to prevent future events.
Childhood sexual abuse: a gender perspective on context and consequences.
Literature on gender and child sexual abuse (CSA) has highlighted patterns of similarity and difference among survivors and the need for further research. This study relied on gender analysis of 128 women and 69 men, obtained through an examination of childhood hospital records, to further examine gender differences in mental health outcomes among abuse survivors and correlates of mental health outcomes including professional help seeking, family environment, and other trauma exposure. Overall, men and women were similar in the context and consequences of CSA. The role of the characteristics of CSA and contextual variables in explaining variance in mental health for 106 male victims and nonvictims was also examined. Among male participants, number of incidents of sexual abuse, injury at the hands of a caregiver, and exposure to other traumas significantly explained higher levels of an array of mental health symptoms. Implications for future research are discussed.
Because dentists routinely assess a patient's head, neck and mouth, they have a unique and excellent opportunity to recognize whether or not a patient is being abused. This article seeks to enlist the collaboration of the dental community in the effort to prevent domestic/intimate partner violence and provide more information about the signs and symptoms of domestic violence injuries, including strangulation, which is often overlooked by medical and dental professionals. Strangulation has only been identified in recent years as one of the most lethal forms of domestic violence. Unconsciousness may occur within seconds and death within minutes. It is known that victims may have no visible injuries whatsoever yet because of underlying brain damage by a lack of oxygen from being strangled, victims may have many serious internal injuries or die days or several weeks later. Strangulation is often indicative of a high level of domestic violence in a relationship. Attempted strangulation may cause physiological changes evident in the course of a dental examination. For these reasons, dentists should be vigilant in looking for its symptoms.
