BACKGROUND: Survey research indicates that alcohol use and misuse by adolescents is prevalent worldwide and has been associated with multiple negative health, social, and economic consequences. Physical injury is one of the negative consequences of alcohol use that appears to be on the rise among adolescents.
METHODS: A retrospective review was conducted of published data currently available regarding alcohol use and injury among adolescents. Studies were reviewed if 1) the sample included adolescents between the ages of 13 and 19 years, 2) the study site was a medical setting, and 3) data were collected regarding alcohol ingestion.
FINDINGS: Data indicate that rates of adolescent alcohol use range from 5% among general emergency department (ED) admissions to nearly 50% among trauma admissions. Alcohol-positive adolescents are more likely than alcohol-negative adolescents to be injured, have a prior history of injury, require trauma service care, and have injury complications. One-third to one-half of alcohol-positive adolescents are referred for or receive intervention related to their alcohol use.
COMMENTS: Alcohol use by adolescents is associated with increases in severity of injury and cost of medical treatment. Screening of adolescent trauma unit admissions for alcohol use might be justified based on the literature. Optimal methods of screening, identification, and brief intervention for alcohol abusing adolescents within the medical setting are discussed.
New Mexico's 1998 drive-up liquor window closure. Study I: effect on alcohol-involved crashes.
OBJECTIVE: To determine the spatial relationship between drive-up liquor window locations and alcohol-related traffic crashes for 2 years before and after New Mexico banned drive-through alcohol sales.
METHODS: Current liquor licenses, crash data, roadway information and US Census data were used in this analysis. Cross-sectional and longitudinal regression analyses were applied to the entire state, and to Albuquerque only.
FINDINGS: Of all NM liquor licenses, 189 (9%) included drive-up sales, which co-occurred with on- or off-premise licenses (94%). The rate of non-pedestrian alcohol-related crashes relative to non-pedestrian total crashes showed an increasing trend prior to closure and a decreasing trend after the closure. Cross-sectional analyses in Albuquerque revealed that the percentage of alcohol-involved crashes was not related to densities of on- or off-premise outlets per kilometer of roadway, or to percentage of drive-up outlets. Statewide, the percentage of drive-up outlets was not significantly related to the percentage of alcohol-related crashes within census tracts but was associated positively with the percentage of alcohol-related crashes in surrounding census tracts. There was no statistically significant relationship between number of drive-ups and percentage of alcohol-related crashes in either longitudinal model.
COMMENTS: Despite the declining rate of alcohol-related crashes following closure of drive-up liquor windows, both in Albuquerque and statewide, regression models using spatial data do not demonstrate definitively an association between the decline and the closure of the drive-up liquor windows.
BACKGROUND: Burns and scalds are a significant cause of morbidity and mortality in children. Successful counter-measures to prevent burn and scald-related injury have been identified. However, evidence indicating the successful roll-out of these counter-measures into the wider community is lacking. Community-based interventions in the form of multi-strategy, multi-focused programmes are hypothesised to result in a reduction in population-wide injury rates. This review tests this hypothesis with regards to burn and scald injury in children.
OBJECTIVES: To assess the effectiveness of community-based interventions, defined as coordinated, multi-strategy initiatives, for reducing burns and scalds in children in children aged 0-14 years.
SEARCH STRATEGY: The search strategy was based on electronic searches, handsearches of selected journals and snowballing from reference lists of selected publications. SELECTION CRITERIA: Studies were independently screened for inclusion by two reviewers. Included studies were those that reported changes in medically attended burn and scald-related injury rates in a paediatric population (age 0 - 14 years), following the implementation of a controlled community-based intervention.
DATA COLLECTION AND ANALYSIS: Data were independently extracted by two reviewers. Meta-analysis was not appropriate, due to the heterogeneity of the included studies.
FINDINGS: Of 32 identified studies, only three met the criteria for inclusion. Only one of these three studies showed a significant decrease in paediatric burn and scald injury in the intervention community compared with the control community. The failure of the other two studies to show a positive result may have been due to limited time-frame for the intervention and/or failure to adequately implement the counter-measures in the communities.
COMMENTS: There are a very limited number of research studies allowing conclusions to be drawn about the effectiveness of community-based injury prevention programmes to prevent burns and scalds in children. There is a pressing need to evaluate high-quality community-based intervention programmes based on efficacious counter-measures to reduce burns and scalds in children.It is important that a framework for considering the problem of burns/scalds in children from a prevention perspective be articulated, and that an evidence-based suite of interventions be combined to create programme guidelines suitable for implementation in communities throughout the world.
Several surveys have reported the negative psychological impact on the general public of the terrorist attacks in the USA of September 11th, 2001. Yet the attacks also led many people to make positive changes in their relationships, values and priorities. A survey of 80 adults in Ottawa, Canada demonstrated that greater perceived threat and greater initial distress reactions significantly predicted the extent to which people reported positive changes in their lives (e.g. closer to family, refocused priorities). Initial distress and greater perceived threat also correlated positively with whether people provided help after the disaster. Follow-up data on 40 of these participants 11 months later revealed significant stability over time for the extent of positive life changes reported, and demonstrated that degree of initial distress and perceived threat continued to correlate positively with life change reports at this later point in time. The data are consistent with the argument that the perception of growth may develop out of one's personal experience of emotional pain.
Regulation of adolescent sleep: implications for behavior.
- Carskadon MA, Acebo C, Jenni OG. Ann N Y Acad Sci 2004; 1021: 276-291.
Correspondence: Mary Carskadon, E.P. Bradley Hospital Sleep Research Laboratory, Brown Medical School, 300 Duncan Drive, Providence, RI 02906 USA; (email: mary_carskadon@brown.edu).
Adolescent development is accompanied by profound changes in the timing and amounts of sleep and wakefulness. Many aspects of these changes result from altered psychosocial and life-style circumstances that accompany adolescence. The maturation of biological processes regulating sleep/wake systems, however, may be strongly related to the sleep timing and amount during adolescence-either as "compelling" or "permissive" factors. The two-process model of sleep regulation posits a fundamental sleep-wake homeostatic process (process S) working in concert with the circadian biological timing system (process C) as the primary intrinsic regulatory factors. How do these systems change during adolescence? We present data from adolescent participants examining EEG markers of sleep homeostasis to evaluate whether process S shows maturational changes permissive of altered sleep patterns across puberty. Our data indicate that certain aspects of the homeostatic system are unchanged from late childhood to young adulthood, while other features change in a manner that is permissive of later bedtimes in older adolescents. We also show alterations of the circadian timing system indicating a possible circadian substrate for later adolescent sleep timing. The circadian parameters we have assessed include phase, period, melatonin secretory pattern, light sensitivity, and phase relationships, all of which show evidence of changes during pubertal development with potential to alter sleep patterns substantially. However the changes are mediated-whether through process S, process C, or by a combination-many adolescents have too little sleep at the wrong circadian phase. This pattern is associated with increased risks for excessive sleepiness, difficulty with mood regulation, impaired academic performance, learning difficulties, school tardiness and absenteeism, and accidents and injuries.
A large number of burns are sustained every year as the result of kitchen grease. A review of a 13-month period at the Joseph M. Still Burn Center in Augusta, Georgia, revealed 60 cases (9.4% of acute burn admissions). Forty-five (75%) of these patients were adults and 25% were children. There were 23 females and 37 males. Forty-two percent of the adults and 33% of the children had some percentage of third-degree injury. The average total body surface area burn in adults was 5.9% and in children 6.3%. There were no deaths in this series. Burns usually occurred as the result of scalds with grease while cooking. Spilling grease on children in the kitchen was a frequent problem. Burns due to ignition of grease was also a cause of injury. Most of the injuries were potentially preventable, and therefore the importance of burn appropriate safety programs is stressed.
Firearm ownership and storage practices, U.S. households, 1992-2002; A systematic review.
- Johnson RM, Coyne-Beasley T, Runyan CW. Am J Prev Med 2004; 27(2): 173-182.
Correspondence: Tamera Coyne-Beasley, Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA; (email: coybea@med.unc.edu).
BACKGROUND: Because the presence and improper storage of household firearms are risk factors for injury, it is important to understand the prevalence of ownership and storage practices within households to help guide intervention development. This systematic review of published articles (1992 to 2002) provides prevalence estimates of firearm ownership and storage practices in U.S. households.
METHODS: A search of bibliographic databases (MedLine, CINAHL, PsycInfo, Sociological Abstracts) was completed in January 2003.
FINDINGS: Although all were cross-sectional, the 42 articles included in this review varied in type; there were seven national and five state prevalence studies, as well as studies using clinic-based convenience samples (n =14) and samples of professionals (n =10). Published studies indicate that firearms are present in about one third of U.S. households. Handguns in particular are present in more than half of U.S. households with firearms, or about 19% of all U.S. households. The prevalence of firearms and handguns in households with young people was similar to the prevalence overall. Firearm ownership was highest in the South.
COMMENTS: Although the methodologic rigor of published articles varies substantially, the literature clearly establishes that firearms are common in U.S. households, even in the homes of medical professionals and those with children.
Unpowered scooter injuries reported to the consumer product safety commission: 1995-2001.
- Parker JF, O'shea JS, Simon HK. Am J Emerg Med 2004; 22(4): 273-275.
Correspondence: James F. Parker, Division of Pediatric Emergency Medicine, Emory University School of Medicine, Children�s Healthcare of Atlanta at Egleston, Atlanta, Georgia, USA; (email: jim_parker@oz.ped.emory.edu).
There has been a marked increase in the use of unpowered scooters over the past few years. Along with this, there has been an increase in injuries related to their use. The objective of this study was to review the unpowered scooter-related injury reports compiled by the United States Consumer Product Safety Commission (CPSC) and to describe the scope and type of injuries sustained. A consecutive case series of injuries sustained by individuals using unpowered scooters between January 1995 and June 2001 was compiled by the CPSC and was made available for review. Data collected included general demographics, date and type of injury, a brief description of the event, treatment, and outcomes. Data are reported using descriptive statistics. During the study period, 469 unique cases of unpowered scooter-related injuries were compiled by the CPSC and reviewed for the present analysis. The median age of those injured was 10 years (range, 1-70 y) with 63% male. Of those injured, 24 (5.1 %) required hospitalization. The most frequent injuries were lacerations (26%), fractures (22%), and contusions (16%). Of interest; 15 deaths were reported. A broad spectrum of injuries was reported to the CPSC related to the use of unpowered scooters. Although most injuries were relatively minor, there were 15 deaths reported. Although most injuries occurred in older children and young adolescents, the very young and adults were not immune from injuries. The risk of injury from unpowered scooters and the need for safety awareness should be stressed to all individuals including the very young and adults.
Workplace health and safety concerns in service organizations in the inner city.
- Holness DL, Somerville S, Kosny A, Gadeski J, Mastandrea JJ, Sinclair GM. J Urban Health 2004; 81(3): 489-497.
Correspondence: D. Linn Holness, Gage Occupational and Environmental Health Unit, St. Michael's Hospital, 30 Bond Street, Toronto, Ontario, CANADA; (email: holnessl@smh.toronto.on.ca).
There is little known about occupational health and safety concerns or programs in workplaces in the inner city. This work was part of a needs assessment for development of occupational health and safety programs for workplaces in the inner city. Its key objective was to identify inner-city worker concerns regarding specific hazards. The work involved two phases. The first sampled workers in an inner-city hospital and church, and the second involved both paid and volunteer workers in inner-city community outreach programs. The key concerns raised by inner-city workers were infectious disease and personal safety and violence. Occupational health and safety programs need to address infectious disease and personal safety issues in this environment. Further research is needed regarding workplace health and safety in inner-city workplaces, both regarding hazards particular to the inner city and occupational health programs for the workers, both paid and volunteer, who work there.
Quantification and risk analysis of occupational burns: Oregon workers' compensation claims, 1990 to 1997.
This study examined all accepted Oregon workers' compensation claims for occupational burn injuries during the period of 1990 to 1997 (N = 3,158). The Current Population Survey was used to derive employee population baselines for establishing rate estimates. It was estimated that the average occupational burn claim rate was 2.89 per 10,000 workers (95% confidence interval [CI] 2.76, 3.02). The majority of claimants (71.7%) were males, the largest proportion (32.6%) was aged 25 years or less, and almost half (48.7%) had less than 1 year of job tenure. The most frequent burn type cited was heat/scald burns (78.9%) followed by chemical burns (19.3%). Costs averaged over 1.6 million dollars annually. The average indemnity period was 16 days. Higher relative risks were found for evening workers (2.97, 95% CI 2.96, 2.98) and night workers (2.13, 95% CI 2.12, 2.13) compared with dayshift workers. Kitchen workers had the highest burn rate of all occupations, with 62.5 claims per 10,000 workers.
This study examined gap choices and crossing behavior in children and adults using an immersive, interactive bicycling simulator. Ten- and 12-year-olds and adults rode a bicycle mounted on a stationary trainer through a virtual environment consisting of a street with 6 intersections. Participants faced continuous cross traffic traveling at 25 mph or 35 mph and waited for gaps they judged were adequate for crossing. Children and adults chose the same size temporal gaps, but children left far less time to spare between themselves and the approaching vehicle when they crossed the intersection. Relative to adults, children delayed in getting started and took longer to reach the roadway. Discussion focuses on developmental changes in how children coordinate self movement with object movement.
BACKGROUND: National surveillance for chemical incidents is being developed in the UK. It is important to improve the quality of information collected, standardise techniques, and train personnel.
OBJECTIVE: To define the extent to which eight National Poison Information Service specialists in poison information agree on the classification of calls received as "chemical incidents" based on the national definition.
DESIGN: Blinded, inter-rater reliability measured using the kappa statistic for multiple raters.
SETTING: National Poison Information Service and Chemical Incident Response Service, Guy's and St Thomas's NHS Trust, London.
PARTICIPANTS: Eight specialists in poison information who are trained and experienced in handling poisons information calls and have been involved in extracting information for surveillance.
FINDINGS: The overall level of agreement observed was at least 69% greater than expected by chance (kappa statistic). Fire and incidents where chemicals were released within a property had a very good level of agreement with kappa statistic of 83% and 80% respectively. The lowest level of agreement was observed when no one or only one person was exposed to a chemical (33%) and when the chemical was released into the air (48%).
COMMENTS: High levels of agreement were observed. There is a need for more training and improvement in consistency of the data collected by all organisations.
Unnatural deaths of married women amongst the total female deaths have been an increasing trend in Indian society during the recent past years. These unnatural deaths may be suicide, homicide or even accidents. But these suicides and homicides are currently more commonly associated with the dowry disputes. In India, dowries are a continuing series of gifts endowed before and after the marriage. When dowry expectations are not met, the young bride may be killed or compelled to commit suicide, either by burning, poisoning or by some other means. Here, in the study, the main objective is to present the different epidemiological and medicolegal aspects of poisoning deaths in the married women. In a cohort of 200 married female deaths, 35 (18%) were poisoning deaths and these were analyzed from both epidemiological and medicolegal aspects. In this series, most of the women consumed organophosphorus compound and died within 10 days. The majority of the affected wives due to dowry problems were below 35 years of age. Most incidents occurred either during morning hour or during daytime.
OBJECTIVE: To determine the predictive validity of perceived risk, risk taking, estimation of ability, overefficacy, and previous injuries on actual injury among adolescents in sport; and to examine sex differences on these factors.
METHODS: A cohort of 260 (148 male, 112 female) soccer players aged 11 to 14 years participated in a 3-month prospective injury study. Preseason written measures included self-reported perceived risk, previous injuries, risk taking and estimation of ability.
FINDINGS: Low levels of perceived risk and estimation of ability were associated with a significant increase in risk of injury, with odds ratios (ORs) ranging from 3.77-7.92. Positive relationships between injury and both estimation of ability and overestimation of ability were supported. Estimation of ability was also positively related to risk taking. In this study, however, risk taking was not directly related to injury, nor were previous injuries. Girls reported higher levels of perceived risk and lower levels of risk taking than boys. However, boys and girls reported similar estimation of ability and overestimation of ability and subsequently incurred similar numbers of injuries.
COMMENTS: Perceived risk and estimation of ability represent significant psychological risk factors for injury in adolescent sports. Sex differences in perceived risk, risk taking, and previous injuries should be considered when developing environmental and behavioral injury-prevention programs.
A one season prospective cohort study of volleyball injuries.
- Verhagen EA, Van Der Beek AJ, Bouter LM, Bahr RM, Mechelen WV. Br J Sports Med 2004; 38(4): 477-481.
Correspondence: Willem van Mechelen, VU University Medical Centre, VU University Medical Centre, Department of Social Medicine and EMGO Institute, Van der Boechorstrstraat 7, NL-1081 BT Amsterdam, NETHELANDS; (email: w.vanmechelen@vumc.nl).
OBJECTIVE: To estimate the overall incidence of acute and overuse volleyball injuries, and to describe factors associated with ankle sprains.
METHODS: 486 players from the second and third Dutch national volleyball divisions participated in the study and were followed prospectively during a whole season. Three measurements were made during the season (baseline, follow up 1, and follow up 2), where all players completed a questionnaire on demographic variables (only at baseline), sports participation, use of preventive measures, and previous injuries. Volleyball exposure during training and matches was recorded for each individual player by the coach on a weekly exposure form. In case of injury the coach provided the injured player with an injury registration form, which had to be completed within one week after the onset of injury.
FINDINGS: 100 injuries were reported, resulting in an overall injury incidence of 2.6 injuries/1000 hours. The incidence of acute injuries was 2.0/1000 hours. Ankle sprains (n = 41) accounted for most of the acute injuries, and 31 (75%) of all players with an ankle sprain reported a previous ankle sprain. Twenty five overuse injuries were reported. The overall incidence of overuse injuries was 0.6/1000 hours; the back and the shoulder were the most common sites.
COMMENTS: Ankle sprain is the most common injury in volleyball, accounting for 41% of all volleyball related injuries. Previous injury seems to be an important risk factor for an ankle sprain. Injury prevention programmes should focus on ankle sprains and concentrate on players with previous ankle sprains.
Nigerian dentists' knowledge and attitudes towards mouthguard protection.
Correspondence: C. O. Onyeaso, Orthodontic Unit, Department of Preventive Dentistry, College of Medicine, University of Ibadan, NIGERIA; (email: coonyeaso@yahoo.com).
The objective of this study was to assess the knowledge and attitudes of Nigerian dentists towards mouthguard protection. A pre-tested 15-item, one-page questionnaire was distributed to 185 dentists practising in different parts of the country with government hospitals or private establishments, by 'hand-delivery' system. Filled and returned forms were 170 (response rate of 92%). The period of the survey was between April and August 2003. Dental graduates from the different dental schools in the country responded to this survey. About 49% of the respondents indicated having only classroom lectures on mouthguards during their undergraduate trainings, 11% said they had some laboratory sessions in addition while no form of education on mouthguards was received by 40%. About 82% had never recommended mouthguard protection for athletic patients, and the major reason was no formal training in the subject. Only 58.5% were familiar with the different types of mouthguards, 75.9% would not be able to supervise or fabricate mouthguards and 50.6% would prefer custom-made mouthguard for their athletic patients. About 84% felt the current training on mouthguards in Nigerian dental schools is inadequate. Over 98% agreed that mouthguard usage in contact sports should be encouraged with the involvement of the dentists. The knowledge and attitudes of the respondents towards mouthguard protection did not vary significantly across years of postqualification from dental schools as well as the professional status of the dentists (P > 0.05). Although Nigerian dentists support mouthguard protection in contact sports and want to be involved in the provision of mouthguards for athletes, their knowledge of the protective device is inadequate. There is need for attention to be given to this subject in the undergraduate curricula of our dental schools.
Accidental lodgment of an air gun pellet in the maxillary sinus of a 6-year old girl: a case report.
- Mahajan M, Shah N. Dent Traumatol 2004; 20(3): 178-180.
Air guns, although considered by many to be toys, can cause injuries ranging from trivial to very grievous. The type and severity of injuries depend on the type of air gun used, the distance at which it is fired, and the anatomic site at which the pellet hits. An interesting case involving a young girl, who was accidentally hit by an air gun pellet at a village fair, is described. The pellet penetrated the maxillary bone to be lodged in the sinus. The treatment strategy along with literature review on short- and long-term complications of air gun injuries is presented.
Are all mouthguards the same and safe to use? The influence of occlusal supporting mouthguards in decreasing bone distortion and fractures.
- Takeda T, Ishigami K, Ogawa T, Nakajima K, Shibusawa M, Shimada A, Regner CW. Dent Traumatol 2004; 20(3): 150-156.
Correspondence: Tomotaka Takeda, Department of Sports Dentistry, Tokyo Dental College, 1-2-2, Masago, Mihama-ku, Chiba-chi, Chiba-ken 261-8502, Tokyo, JAPAN; (email: takedat@attglobal.net).
The safety benefits of mouthguards have been demonstrated in many studies, with many authors and sports dentists strongly recommending the wearing of mouthguards. However, wearing a mouthguard with incorrect occlusion might cause a variety of problems. It comes as no surprise that a traumatic blow to the chin, while wearing an insufficient mouthguard lacking anterior contact, can result in severe distortions to the mandibular bone, and bone fractures. The aim of this study was to clarify how ineffective insufficient occlusal supporting mouthguards are and how dangerous they can be to use. Consequently, in this study, occlusal supportive areas were varied and accelerations of head and distortions of the mandible were measured using an artificial skull model and a pendulum impact device. As a result, the distortions of the mandible tended to increase as the supported area decreased. On the contrary, accelerations of the head decreased as the occlusion part decreased. Thus, a lot of impact energy was consumed in the distortion of the mandible; accordingly, it seemed that only a little destructive energy was transferred to the head. From this study, it would seem that wearing a mouthguard, which is insufficient in the occlusion, has the potential of causing a bone fracture of the mandible. Consequently, mouthguards should have proper occlusion.
Incidence of cerebral concussions associated with type of mouthguard used in college football.
- Wisniewski JF, Guskiewicz K, Trope M, Sigurdsson A. Dent Traumatol 2004; 20(3): 143-149.
Correspondence: Martin Trope, Department of Endodontics, University of North Carolina School of Dentistry, Chapel Hill, NC 27599-7450, USA; (email: martin_trope@dentistry.unc.edu).
Controversy exists among sports dentists as to whether or not a 'custom made' mouthguard is more effective in reducing the incidence of cerebral concussion than the boil-and-bite 'non-custom made' mouthguard. While members on each side remain steadfast in their opinion, not a single epidemiological study has been conducted to investigate the effect of type of mouthguard worn on the incidence of cerebral concussion. The aim of this study was to determine if there was a difference between the type of mouthguard worn and the incidence of cerebral concussions among National Collegiate Athletic Association (NCAA) Division I-A football players. During the 15-week 2001 college football season, trainers entered, via an interactive web site, weekly data for each game and practice sessions for the preceding week. Eighty-seven (76%) out of a possible 114 Division I teams participated. A total of 506 297 athletic exposures were recorded; 369 brain concussions were reported. The incidence of cerebral concussions per 1000 exposures was 0.73. Utilizing a risk ratio with a 95% confidence interval, no statistical difference occurred in the incidence of cerebral concussions between football players wearing custom made versus non-custom made mouthguards (0.990,1.750). In this study, there was no advantage of wearing a custom made mouthguard over a boil-and-bite mouthguard to reduce the risk of cerebral concussion in football players.
Dental injury among Brazilian schoolchildren in the state of Sao Paulo.
To describe the distribution of dental trauma in Brazilian schoolchildren and its association with demographic, environmental and clinical factors. A random sample of 73 243 schoolchildren's oral examination records from private and public units, selected from 131 cities within the state of Sao Paulo, Brazil, was analysed. Trauma was assessed based on international methodological standards prescribed by the World Health Organization for Oral Health Surveys (1997). Proportions obtained were compared between urban and rural schools, as well as between private and public units. Oral health status indices were estimated based on the decayed, missing and filled teeth (DMFT) index - the average number of decayed, missing and filled teeth; the proportion of caries-free 5-year-old schoolchildren and anterior maxillary overjet among 12-year-old schoolchildren. The prevalence of dental trauma in anterior dentition was of 2.4, enrolling average 1.2 teeth per child. A rate of 2.4 impaired anterior teeth per thousand was obtained, upper central incisors being those that were most affected - 7.7 in every 10. Among 8- to 11-year-old children, the rates grew regularly. The proportion of dental trauma was significantly higher in boys than in girls (P < 0.01), and gender prevalence ratio was of 1.58 for boys. The results showed positive associations between dental trauma and caries-free 5-year-old schoolchildren (P = 0.003), anterior maxillary overjet > or =3 mm (P < 0.001), and private school as a socio-economic proxy indicator (P = 0.048).
Injury among the elderly: the challenge to integrate preventive activities in public and individual levels.
- Gawryszewski VP, de Mello Jorge MH, Koizumi MS. Rev Assoc Med Bras 2004; 50(1): 97-103.
Correspondence: Vilma Gawryszewski, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, USA; (email: vilmapg@saude.sp.gov.br).
BACKGROUND: In Brazil and all over the world the elderly are increasing as a result of the raise in life expectancy. This group still faces a significant risk for some diseases as well as injuries. The proposal of this study was to describe fatal and nonfatal injuries among people aged 60 years and older in Brazil.
SETTING: Brazil, the last year available was 2000.
METHODS: The data from 13,383 injury deaths and 87,177 outcomes among people aged 60 years and older were analyzed. The data sets were obtained from Federal Health Department of Brazil from Mortality System Information (from death certificates) and Hospitalization Information System (from discharges registered in public hospitals).
FINDINGS: The mortality rate is 92.1/100,000 (135.3/100,000 for male and 56.8/100,000 for female) that are higher than overall population rates, especially for women. The lead cause is transport accidents (27.5% of total injury deaths) which mortality rate is 25.3/100,000 and 48.2% are pedestrian. Homicides rate is 9.5/100,000, it is almost three times lower than for total population in Brazil. Falls rate is 14.0/100,000, it is the third place in injury deaths for men and women and suicide rate is 6.9/100,000, lower than developed countries. Opposite to mortality, falls are the major cause of nonfatal injuries hospitalization for both men and women, accounting for 48,940 discharges (56.1%). Fractures are 52.8% of all injuries, especially in falls and transport accidents.
COMMENTS: It is crucial to develop injury preventive activities in both public and individual level. Falls should receive emphasis in injury prevention efforts.
Unintentional and violent injuries among pre-school children of teenage mothers in Sweden: a national cohort study.
Correspondence: Cecilia Ekeus, Department of Public Health Sciences, IHCAR, Karolinska Institute, 171 76 Stockholm, SWEDEN; (email: cecilia_ekeus@yahoo.com).
OBJECTIVE: This study investigates the risk and mediating mechanisms of unintentional and violent injuries in pre-school children of teenage mothers.
DESIGN: Cohort study based on Swedish national registers. Cox analyses of proportional hazard were used to estimate the relative risk of hospital admission and death attributable to injuries in analyses of data from national registers.
PARTICIPANTS: The study population was a national cohort of 800 192 children born in Sweden during 1987-93 who were followed up prospectively from birth to their 7th birthday.
FINDINGS: Children of teenage mothers had higher relative risks (RRs) of hospital admissions for violent as well as unintentional injuries; age adjusted RRs of 2.7 (95% CI 1.2 to 6.1) and 1.6 (1.4 to 1.8), respectively, for children of mothers under 18 years of age and 2.5 (1.6 to 3.8) and 1.5 (1.4 to 1.6) of mothers aged 18-19 are compared with those with mothers aged at least 32 at the birth of the child. When the models were adjusted to socioeconomic variables and indicators of parental substance misuse and psychiatric illness the risk decreased slightly but remained well above that of children with older mothers. In addition, children of teenage mothers had an increased risk of death attributable to violent injuries (RR 6.7 (2.6 to 16.0), as well as to unintentional injuries (RR 3.5 (2.0 to 6.1).
COMMENTS: Maternal age is an important determinant of injuries in pre-school children in Sweden and the children of teenage mothers are at particular risk. Young parents should be given priority in injury prevention programmes.
Elderly trauma inpatients in New York state: 1994-1998.
- Hannan EL, Waller CH, Farrell LS, Rosati C. J Trauma 2004; 56(6): 1297-1304.
Correspondence: E. Hannan, Department of Health Policy, Management, and Behavior, School of Public Health, University at Albany, State University of New York, Rensselaer, New York, USA; (email: elh03@health.state.ny.us).
BACKGROUND: The aging of the population in the United States has led to an increase in geriatric trauma. This study aimed to examine the characteristics and outcomes of geriatric trauma patients in New York State.
METHODS: Four groups of elderly trauma patients (ages 40-64, 65-74, 75-84, and 85+ years) were contrasted with younger adults ages 13 to 39 years with respect to mechanism of injury, discharge disposition, hospital length of stay, comorbidities, and type of hospital in which they were treated. Also, the independent association of each group with in-hospital mortality was investigated for patients with blunt injuries using logistic regression.
FINDINGS: There was a 17.6% increase between 1994 and 1998 in the number of traumatic injuries qualifying for the New York State Trauma Registry in the 75- to 84-year-old group and a 16.4% increase in the group ages 85 years or older, despite a decrease in traumatic injuries in other age groups. The majority of these injuries among the patients 75 years of age or older resulted from low falls (from the same level). The mortality rate rose substantially with age, from 5.1% to 5.9% to 9.4% to 12.3% to 15.8%, respectively, for the groups ages 13 to 39, 40 to 64, 65 to 74, 75 to 84, and 85 or more years. Also, fewer than 20% of the patients older than 75 years died within 1 day after admission to the hospital, as compared with 44% of the patients younger than 65 years. The groups ages 40 to 64, 65 to 74, 75 to 84, and 85 years or older were all independent (increasingly) significant predictors of mortality for all three mechanisms of injury investigated. The adjusted odds ratios for mortality relative to patients who were 13 to 39 years of age were 2.67, 8.41, 17.40, and 34.98, respectively, for the groups ages 40 to 64, 65 to 74, 75 to 84, and 85 years or older.
COMMENTS: Trauma is a serious and escalating problem for the elderly, and increasing age is a significant risk factor for patient mortality.
Surveillance for certain health behaviors among selected local areas--United States, Behavioral Risk Factor Surveillance System, 2002.
- Balluz L, Ahluwalia IB, Murphy W, Mokdad A, Giles W, Harris VB. MMWR Surveill Summ 2004; 53(5): 1-100.
Correspondence: Lina Balluz, Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion, USA; (email: Lballuz@cdc.gov).
BACKGROUND: Monitoring risk behaviors for chronic diseases and participation in preventive practices are important for developing effective health education and intervention programs to prevent morbidity and mortality. Therefore, continual monitoring of these behaviors and practices at the state, city, and county levels can assist public health programs in evaluating and monitoring progress toward improving their community's health.
REPORTING PERIOD COVERED: Data collected in 2002 are presented for states, selected metropolitan, and micropolitan statistical areas (MMSA), and their counties.
DESCRIPTION OF THE SYSTEM: The Behavioral Risk Factor Surveillance System (BRFSS) is an on-going, state-based, telephone survey of the civilian, noninstitutionalized population aged >18 years. All 50 states, the District of Columbia (DC), Guam, the Virgin Islands, and the Commonwealth of Puerto Rico participated in BRFSS during 2002. Metropolitan and MMSA and their counties with >500 respondents or a minimum sample size of 19 per weighting class were included in the analyses for a total of 98 MMSA and 146 counties.
FINDINGS: Prevalence of high-risk behaviors for chronic diseases, awareness of certain medical conditions, and use of preventive health-care services varied substantially by state, county, and MMSA. Obesity ranged from 27.6% in West Virginia, 29.4% in Charleston, West Virginia, and 32.0% in Florence County, South Carolina, to 16.5% in Colorado, 12.8% in Bethesda-Frederick-Gaithersburg, Maryland, and 11.8% in Washington County, Rhode Island. No leisuretime physical activity ranged from 33.6% in Tennessee, 36.8% in Miami-Miami Beach-Kendall, Florida, and 36.8% in Miami-Dade County, Florida to 15.0% in Washington, 13.8% in Seattle-Bellevue-Everett Washington, and 11.4% in King County, Washington. Cigarette smoking ranged from 32.6% in Kentucky, 32.8% in Youngstown-Warren- Boardman, Ohio-Pennsylvania, and 31.1% in Jefferson County, Kentucky to 16.4% in California, 13.8% in Ogden- Clearfield, Utah, and 10.9% in Davis County, Utah. Binge drinking ranged from 24.9% in Wisconsin, 26.1% in Fargo, North Dakota-Minnesota, and 25.1% Cass County, North Dakota, to 7.9% in Kentucky, 8.2% in Greensboro- High Point, North Carolina, and 6.6% in Henderson County, North Carolina. At risk for heavy drinking ranged from 8.7% in Arizona, 9.5% in Lebanon, New Hampshire-Vermont, and 11.3% in Richland County, South Carolina, to 2.8% in Utah, 1.9% in Ogden-Clearfield, Utah, and 1.7% in King County, New York. Adults who were told they had diabetes ranged from 10.2% in West Virginia, 11.1% in Charleston, West Virginia, and 11.1% in Richland, South Carolina, to 3.5% in Alaska, 2.7% in Anchorage, Alaska, and 2.4% in Weber County, Utah. Percentage of adults aged>50 years who were ever screened for colorectal cancer ranged from 64.8% in Minnesota, 67.9% in Minneapolis-St. Paul-Bloomington Minnesota-Wisconsin, and 73.6% in Ramsey County, Minnesota, to 39.2% in Hawaii, 30.7% in Kahului-Wailuku, Hawaii, and 30.7% in Maui County, Hawaii. Persons aged >65 years who had received pneumococcal vaccine ranged from 72.5% in North Dakota, 74.8% in Minneapolis-St. Paul-Bloomington, Minnesota-Wisconsin, and 73.1% in Milwaukee County, Wisconsin, to 47.9% in DC, 47.5% in New York-Wayne-White Plains, New York, New Jersey, and 47.9% in DC County, DC. Older adults who had received influenza vaccine ranged from 76.6% in Minnesota, 80.0% in Minneapolis-St. Paul-Bloomington, Minnesota-Wisconsin, and 76.3% in Middlesex County, Massachusetts, to 57.0% in Florida, 55.8% in Houston-Baytown-Sugar Land, Texas, and 56.2% in Cook County, Illinois.
INTERPRETATION: BRFSS data indicate substantial variation in high-risk behaviors, participation in preventive healthcare services, and screening among U.S. adults at states and selected local areas, indicating a need for continued efforts to evaluate public health programs or policies designed to reduce morbidity and mortality.
PUBLIC HEALTH ACTIONS: Data from BRFSS are useful in developing and guiding public health programs and policies. Therefore, states, selected MMSA, and their counties can use BRFSS data as a tool to prevent premature morbidity and mortality among adult population and to assess progress toward national health objectives. The data indicate a continued need to develop and implement health promotion programs for targeting specific behaviors and practices and serve as a baseline for future surveillance at the local level in the United States.
Prevalence of traumatic injuries to the permanent incisors in candidates for orthodontic treatment.
- Bauss O, Rohling J, Schwestka-Polly R. Dent Traumatol 2004; 20(2): 61-66.
Correspondence: Oskar Bauss, Department of Orthodontics, Hannover Medical School, Hannover, GERMANY; (email: bauss.oskar@mh-hannover.de).
The dental records made on presentation of 1367 consecutive patients (731 females and 636 males) for orthodontic treatment at a private orthodontic practice between 1998 and 2002 were examined for data relating to trauma to the permanent incisors. The results showed that 10.3% of these patients had suffered from dental trauma before the onset of orthodontic treatment. The highest prevalence of dental trauma was determined in the 11-15 years age group, corresponding to the dental developmental stage of the late mixed dentition. The most frequently affected teeth were the maxillary central incisors (79.6%), and the most common types of trauma were fracture of enamel-dentin without pulpal involvement (42.7%) and fracture of enamel (33.8%). Compared to patients with normal overjet and adequate lip coverage, the frequency of dental trauma was significantly higher in patients with increased overjet and adequate lip coverage (P = 0.028) or with increased overjet and inadequate lip coverage (P = 0.003). The results of the present study indicate that a significant percentage of candidates for orthodontic treatment, and especially those with increased overjet and inadequate lip coverage, suffer trauma to their permanent incisors before the onset of orthodontic treatment. It might also be concluded that preventive orthodontic treatment of such patients should be initiated and completed before the age of 11, i.e. in the early to middle mixed dentition.
Collaboration between nurses and agricultural teachers to prevent adolescent agricultural injuries: the agricultural disability awareness and risk education model.
Nearly 2 million children live or work on America's farms and ranches. Despite the increasing mechanization of production agriculture in the United States, children still constitute a considerable portion of the work force on farms and ranches. When adjusted for actual work exposure time, adolescent injury rates on agricultural establishments surpass those of adults (Castillo, D. N., Landen, D. D., & Layne, L. A. (1994). American Journal of Public Health, 84, 646-649). This project, headed by two public health nurses, developed and tested an agricultural safety curriculum [Agricultural Disability Awareness and Risk Education (AgDARE)] for use in high school agriculture classes. Students who participated in AgDARE scored significantly higher in farm safety attitude and intent to change work behavior than the control group. School and public health nurses, working together with agriculture teachers, may make an effective team in reducing injuries among teen agricultural workers.
This study examined the relation between witnessing violence and drug use initiation among 6th graders attending middle schools in 5 rural counties and investigated the extent to which family support and parental monitoring moderated this relation. Data were obtained from 1,282 adolescents at 2 time points during the 6th grade. Witnessing violence predicted subsequent initiation of cigarette, beer and wine, liquor, and advanced alcohol use. Adolescents who reported high levels of family support and parental monitoring were less likely to initiate use across all drug categories except beer and wine. High levels of parental monitoring and family support were effective in buffering the relation between witnessing violence and initiation of cigarette and advanced alcohol use at low levels of witnessing violence. With increasing levels of witnessing violence, however, the protective effects of monitoring and support were substantially diminished. These findings have important implications for research and intervention efforts.
A study was undertaken of the rates and methods of female suicide observed at the Forensic Science Centre in South Australia over a 15 year period from 1986 to 2000. A total of 609 cases of female suicide were found (age range=13-88 yrs; mean=44 yrs), with 249 drug overdoses, 114 hangings, 100 deaths due to carbon monoxide (CO) toxicity, 40 drownings, 35 firearm deaths and 71 miscellaneous deaths (including deaths due to self-immolation, jumping from heights and incised wounds). The most common age range was 26-50 yrs in all categories except for drowning where victims tended to be older. While overall suicide rates in females remained unchanged, with no changes in the rates at different ages, significant increases in hanging and CO deaths occurred over all age groups, with significant falls in drug overdose deaths in the 10-25 year age group, and significant overall falls in suicides due to gunshot wounds. No changes were observed in female suicides due to drowning. This study has demonstrated, therefore, that although no changes in overall suicide rates for females occurred, there have been alterations in the types of methods being used. Although drug related deaths remained the largest category, hanging deaths, which were once uncommon in females, have increased markedly.
Attempted Suicide among Injecting and Noninjecting Cocaine Users in Sydney, Australia.
Correspondence: Shane Darke, National Drug and Alcohol Research Centre, University of New South Wales, NSW, 2052, AUSTRALIA; (email: s.darke@unsw.edu.au).
A sample of 183 current cocaine users, 120 primary injecting cocaine users (ICUs), and 63 primary noninjecting cocaine users (NICUs) were administered a structured interview to ascertain attempted suicide histories, methods used, and factors associated with suicide attempts. All respondents were volunteers and current cocaine users recruited through a wide range of sources. The mean age of participants was 30.1 years, and 65% were male. The ICUs were older (32.3 vs. 26.7 years, respectively), more likely to be male (72% vs. 54%, respectively), to be unemployed (84% vs. 23%, respectively) and to have a prison history (53% vs. 1%, respectively) compared to NICUs. Of the sample, 31% had attempted suicide, 18% had done so on more than one occasion, and 8% had made an attempt in the preceding 12 months. Overall, 28% of the sample had been treated by a medical practitioner after an attempt. ICUs (38%) were significantly more likely than NICUs (10%) to have attempted suicide and to have done so on more than one occasion (23% vs. 3%, respectively). The most common method used among both groups was self-poisoning (ICUs 28%, NICUs 8%), primarily by drug overdose. Violent methods had been used by 22% of ICUs and 3% of NICUs. Multivariate analyses revealed that injecting, female gender, and more extensive polydrug use were independent predictors of a suicide attempt. The prevalence of suicide in this study indicates that it represents a major clinical issue among ICUs and to a lesser extent among noninjectors of the drug. Those treating cocaine users for drug dependence need to be aware of the salience of suicide as a problem, among injectors in particular.
Epidemiology of attempted suicide with drugs.
- Schwarz UI, Ruder S, Krappweis J, Israel M, Kirch W. Dtsch Med Wochenschr 2004; 129(31-32): 1669-1673.
Correspondence: U. Schwarz, BMBF Forschungsverbund Public Health Sachsen, GERMANY; (email: unavailable)
BACKGROUND AND OBJECTIVE: Little representative data of the epidemiology of attempted suicide exists in Germany. In this study the frequency of parasuicidal drug intoxication, the distribution of age and gender, as well as the kind and origin of used drugs were evaluated. Furthermore the knowledge about used drugs and possible adverse effects of a previously given medication were analysed.
METHODS: Over a period of 2 years (January 1998-December 1999) 155 patients (41males, 114 females, average age 40.5 years) with drug intoxication by attempted suicide were recruited at the University Hospital of Dresden, Germany, for further retrospective analysis.
FINDINGS: 74 % of these patients were women. Sedatives and hypnotics were most frequently used for parasuicide (44 %), followed by analgesics (18 %) and antidepressants (12 %). Benzodiazepines and benzodiazepine-agonists were the most commonly used drugs (32 %). Moreover, 80 % of all drugs used had been prescribed by physicians. Approximately half of the patients were well-informed about drugs taken. In 43 (47 %) of 92 patients with long-term medication an adverse effect was considered as a possible cause of the attempted suicide.
COMMENTS: Our data underline the importance of attempted suicide in view of the frequency of their use, the need of hospitalization, the required intensive care and possible relapses. Because the majority of drugs used were prescribed by physicians, before giving any medication to their possible suicidal use should be considered.
Factors associated with higher levels of injury severity in occupants of motor vehicles that were severely damaged in traffic crashes in Kentucky, 2000-2001.
- Singleton M, Qin H, Luan J. Traffic Inj Prev 2004; 5(2): 144-150.
Correspondence: Michael Singleton, Kentucky Injury Prevention and Research Center, Lexington, Kentucky 40504, USA; (email: msingle@email.uky.edu).
OBJECTIVES: The majority of motor vehicle occupants who were killed or hospitalized in crashes in Kentucky in 2000-2001 occupied vehicles that were severely damaged in the crash. Even so, overall only a small percentage of all severely damaged vehicle occupants were killed or hospitalized. The purpose was to identify occupant, vehicle, crash, and roadway/environmental factors that were associated with increased risk of severe injury in crashes where the occupant's vehicle was severely damaged.
METHODS: This study probabilistically linked Kentucky's statewide motor vehicle crash and inpatient hospital discharge data files for 2000 and 2001, and selected cases representing occupants of vehicles that were reported by police as having either "severe" or "very severe" damage. For occupants who were identified through data linkage as having been hospitalized, the Injury Severity Score (ISS) was calculated using ICDMAP-90 software, and the scores were stratified into the following categories: critical (>24), severe (15-24), moderate (9-14), and mild (<9). We then created an outcome variable, injury severity level, with five levels: killed; hospitalized with at least moderate injuries (ISS = critical, severe, or moderate); hospitalized with mild injuries (ISS = mild); injured according to the police report but not hospitalized; and no apparent injury according to the police report. We performed a stepwise, ordinal logistic regression of injury severity, using independent variables identified from the existing crash literature.
FINDINGS: Occupant risk factors for higher levels of injury severity selected by the regression were age (risk increased with age, other factors being equal), female gender, restraint non-use, ejection from the vehicle, and driver impairment (by alcohol and/or drugs). Crash risk factors included head-on collision, collision with a fixed object, vehicle rollover, and vehicle fire. Roadway/environmental factors were federal- or state-maintained roadway and posted speed limit 89 kph (55 mph) or greater.
COMMENTS: Many of the identified risk factors are explicitly or implicitly mentioned in the strategic plans of key organizations involved in highway safety and injury prevention in Kentucky. Our analysis provides additional evidence of their importance, and confirms that their mitigation will reduce injury severity in crashes involving severe vehicle damage. Additionally, older occupants and female occupants showed increased risks of serious injury, but to our knowledge these factors are not currently addressed in any state plans. An opportunity exists to clarify the nature of these risks through further studies, which might lead to the identification of countermeasures specific to these populations.
Predictive models of safety belt use: a regression analysis of MVOSS data.
A substantial portion of the U.S. population fails to regularly use their safety belts. The explanations for the differential belt use have addressed, for example, socioeconomics, state law, attitudes, and perceived likelihood of being ticketed. The current analyses create predictive models of safety belt use. Using NHTSA's Motor Vehicle Occupant Safety Surveys (Years 1998 and 2000; N = 9577), variables related to belt use were entered into backward stepwise logistic regressions to produce two predictive models (Demographic and Attitudinal) of safety belt use (Always versus Not always). The results indicated that belt use is a complicated issue as there were several interactions between variables. The Demographic predictive model contained main effects for, law types, socioeconomics, population density, a gender-law type interaction, and a three-way interaction between age, marital status, and vehicle type. The Attitudinal model included perceived effectiveness of the belt, fatalistic attitudes, and an interaction between perceived effectiveness of the belt and perceived risk of being ticketed. These models survived a multinomial logistic regression when belt use was parsed into three categories (Always, Part-time, and Infrequent). In addition to variables that affect belt use, the results suggested that the structure of "belt use" as a psychological/behavioral construct is more complicated than once thought. Specifically, a dichotomous breakdown of belt use (Always and Not always) oversimplifies the construct because the predictor factors sometimes affect "part-time" belt users differently than "infrequent" belt users (compared to "full-time" users). Many of the factors included in the models have been previously shown to impact belt use, but the interaction effects--indicating a more complicated relationship between these variables than previously suggested--may contribute to a better understanding of safety belt use.
The effectiveness of home-study driver education compared to classroom instruction: the impact on student knowledge and attitudes.
OBJECTIVE: Home-study driver education programs exist in several states, but none have been scientifically evaluated to determine if such courses are as effective as classroom courses for teaching driver education.
METHODS: Over 1,300 students were randomly assigned to classroom instruction, or CD ROM, workbook, or Internet/workbook home-study courses and compared on proctored exit examination knowledge and attitude scores, and written knowledge test outcomes.
FINDINGS: Few differences were found on exit examination knowledge and attitude scores, but they tended to favor the CD and Internet/workbook home-study courses over the classroom or workbook courses. Differences favoring the classroom on written knowledge test outcomes likely reflect a bias in classroom courses toward teaching test-specific material.
COMMENTS: The findings present no compelling evidence that home-study courses are less effective than classroom courses for teaching driver education. The findings could result in more widespread use of home-study courses. Also, the use of low-cost home-study courses as the first course of a two-stage driver education and training system could make integrating such programs with graduated driver licensing more feasible and acceptable to the public.
Road traffic injury--a global public health scourge: a review for World Health Day 2004 (April 7).
Correspondence: Joan Ozanne Smith, Monash University Accident Research Centre, Clayton, Victoria, AUSTRALIA; (email: joan.ozanne-smith@general.monash.edu.au).
OBJECTIVE: Globally in 2000, 1.2 million deaths resulted from road traffic injury (RTI) and about 10 times this number were injured. Because of the size of the problem, its expected growth and its preventability, World Health Day 2004 (April 7) was devoted to RTI. This review highlights attention to RTI by the ANZJPH and investigates relevance to the developing world, where 90% of all RTI deaths now occur.
METHOD: All articles published by the ANZJPH over the five-year period 1999-2004, which met the World Health Organization definition of RTI, were reviewed.
FINDINGS: The eight studies selected and reviewed focused particularly on young drivers, alcohol use and Indigenous Australians, using a range of research and evaluation methods. Risk factors identified including widespread risky driving behaviour by young males and alcohol involvement. Intervention successes included legislative change regarding utility passengers, current vehicle inspection certificate and effects associated with the lead-up to New Zealand's 1992 Transport Act.
COMMENTS: The dramatic and continued reduction in Australia's road toll following peak rates in the 1960s has relied on scientific research, such as that reviewed here, for its effective evidence base. This review indicates that RTI is established on the public health agenda in Australia--a key aim of WHO's five-year strategy, for emulation by developing regions and nations.
IMPLICATIONS: High-income countries such as Australia and New Zealand have the knowledge, expertise and also the responsibility to assist regional low- and middle-income countries to counter the growing scourge of RTI that accompanies rapid motorisation.
Motorcycle helmet use and related risk behaviors among adolescents and young adults in Northern Thailand.
- Pitaktong U, Manopaiboon C, Kilmarx PH, Jeeyapant S, Jenkins R, Tappero J, Uthaivoravit W, van Griensven F. Southeast Asian J Trop Med Public Health 2004; 35(1): 232-241.
Correspondence: U. Pitaktong, The Thailand Ministry of Public Health-US Centers for Disease Control and Prevention Collaboration, Nonthaburi, THAILAND; (email: unavailable).
The objective of this study was to assess the prevalence of not wearing a helmet (unprotected) while riding a motorcycle and associated risk behaviors among adolescents and young adults in Northern Thailand. Participants were 1725 students, aged 15-21 years, from 3 vocational schools in Chiang Rai Province; 51.8% were male. Participants completed a classroom-based computer-assisted self-interview (ACASI). Of men 72.7% and of women 64.4% reported unprotected motorcycle riding 3 times or more in the past week. Logistic regression analysis showed the variables independently associated with unprotected riding to be history of ever riding after having had 3 or more alcoholic drinks (odds ratio (OR) = 2.21, 95% confidence interval (CI) = 1.76-2.21), attending technical school (OR = 2.09, 95% Cl = 1.55-2.83), living with the family (OR = 1.38, 95% CI = 1.10-1.73), and having ever had a traffic accident (OR = 1.20, 95% CI = 1.12-1.29). Being of hill tribe ethnicity (vs Thai lowlander) was associated with protected riding (OR = 0.42, 95% CI = 0.20-0.90). Adolescents and young adults in Chiang Rai are at high risk for riding a motorcycle without a helmet buckled on the head. Public education in combination with enforcement of compulsory helmet use while riding a motorcycle is recommended.
Research suggests that between 960,000 to 4 million individuals are victims of intimate partner violence (IPV) each year and of these about 85 percent are women. In a recent survey conducted by the Commonwealth Fund, it was estimated that approximately one-third of American women will become a victim of IPV at some point in their life. The literature reports 36 percent to 95 percent of battered women suffer injuries to the face, neck or head. Women who have been abused by a partner report significantly lower self assessments of health, increased disabilities and increased chronic health conditions than non-abused women. When direct costs to the health care system are combined with indirect costs to society, total health care costs of IPV can escalate into the billions. Intimate partner violence erodes the health of patients, consumes healthcare dollars, compromises the health and safety of children and communities, and represents a liability exposure for the healthcare clinician who turns their head. Healthcare providers, especially dental professionals, must gain experience in the diagnosis and management of IPV so that identification occurs earlier and intervention follows established protocols.
Physical aggression during early childhood: trajectories and predictors.
- Tremblay RE, Nagin DS, Seguin JR, Zoccolillo M, Zelazo PD, Boivin M, Perusse D, Japel C. Pediatrics 2004; 114(1): e43-50.
Correspondence: Research Unit on Children's Psychosocial Maladjustment, University of Montreal, Montreal, Quebec, CANADA; (email: grip@umontreal.ca).
OBJECTIVES: Physical aggression in children is a major public health problem. Not only is childhood physical aggression a precursor of the physical and mental health problems that will be visited on victims, but also aggressive children themselves are at higher risk of alcohol and drug abuse, accidents, violent crimes, depression, suicide attempts, spouse abuse, and neglectful and abusive parenting. Furthermore, violence commonly results in serious injuries to the perpetrators themselves. Although it is unusual for young children to harm seriously the targets of their physical aggression, studies of physical aggression during infancy indicate that by 17 months of age, the large majority of children are physically aggressive toward siblings, peers, and adults. This study aimed, first, to identify the trajectories of physical aggression during early childhood and, second, to identify antecedents of high levels of physical aggression early in life. Such antecedents could help to understand better the developmental origins of violence later in life and to identify targets for preventive interventions.
METHODS: A random population sample of 572 families with a 5-month-old newborn was recruited. Assessments of physical aggression frequency were obtained from mothers at 17, 30, and 42 months after birth. Using a semiparametric, mixture model, distinct clusters of physical aggression trajectories were identified. Multivariate logit regression analysis was then used to identify which family and child characteristics, before 5 months of age, predict individuals on a high-level physical aggression trajectory from 17 to 42 months after birth.
FINDINGS: Three trajectories of physical aggression were identified. The first was composed of children who displayed little or no physical aggression. These individuals were estimated to account for approximately 28% of the sample. The largest group, estimated at approximately 58% of the sample, followed a rising trajectory of modest aggression. Finally, a group, estimated to comprise approximately 14% of the sample, followed a rising trajectory of high physical aggression. Best predictors before or at birth of the high physical aggression trajectory group, controlling for the levels of the other risk factors, were having young siblings (odds ratio [OR]: 4.00; confidence interval [CI]: 2.2-7.4), mothers with high levels of antisocial behavior before the end of high school (OR: 3.1; CI: 1.1-8.6), mothers who started having children early (OR: 3.1; CI: 1.4-6.8), families with low income (OR: 2.6; CI: 1.3-5.2), and mothers who smoked during pregnancy (OR: 2.2; CI: 1.1-4.1). Best predictors at 5 months of age were mothers' coercive parenting behavior (OR: 2.3; CI: 1.1-4.7) and family dysfunction (OR: 2.2; CI: 1.2-4.1). The OR for a high-aggression trajectory was 10.9 for children whose mother reported both high levels of antisocial behavior and early childbearing.
COMMENTS: Most children have initiated the use of physical aggression during infancy, and most will learn to use alternatives in the following years before they enter primary school. Humans seem to learn to regulate the use of physical aggression during the preschool years. Those who do not, seem to be at highest risk of serious violent behavior during adolescence and adulthood. Results from the present study indicate that children who are at highest risk of not learning to regulate physical aggression in early childhood have mothers with a history of antisocial behavior during their school years, mothers who start childbearing early and who smoke during pregnancy, and parents who have low income and have serious problems living together. All of these variables are relatively easy to measure during pregnancy. Preventive interventions should target families with high-risk profiles on these variables. Experiments with such programs have shown long-term impacts on child abuse and child antisocial behavior. However, these impacts were not observed in families with physical violence. The problem may be that the prevention programs that ion programs that were provided did not specifically target the parents' control over their physical aggression and their skills in teaching their infant not to be physically aggressive. Most intervention programs to prevent youth physical aggression have targeted school-age children. If children normally learn not to be physically aggressive during the preschool years, then one would expect that interventions that target infants who are at high risk of chronic physical aggression would have more of an impact than interventions 5 to 10 years later, when physical aggression has become a way of life.
Children's Exposure to Community Violence: Implications for Understanding Risk and Resilience.
The 5 articles included in this special section are reviewed in this article. The studies encompassed were all focused on pre- or early adolescents, and samples were generally from inner-city areas, with 1 involving rural youth. Considered collectively, the results point to 3 major conclusions: Many children in America are regularly exposed to violence in communities; such exposure carries risk for psychopathology; and parents and other adults can provide valuable support but are limited in how much they can offset the effects of ongoing violence exposure. Intervention implications are, foremost, that community violence itself must be reduced and, second, that positive relationships with significant adults should be fostered to the degree possible among children living in high-risk, violence-prone communities.
Identifying three types of violent offenders and predicting violent recidivism while on probation: a classification tree analysis.
- Stalans LJ, Yarnold PR, Seng M, Olson DE, Repp M. Law Hum Behav 2004; 28(3): 253-271.
Correspondence: Loretta J. Stalans, Loyola University Chicago, Department of Criminal Justice, Chicago, Illinois 60646, USA; (email: lstalan@luc.edu).
This study employs classification tree analysis (CTA) to address whether 3 groups of violent offenders have similar or different risk factors for violent recidivism while on probation. A sample of 1344 violent offenders on probation was classified as generalized aggressors (N = 302), family only aggressors (N = 321), or nonfamily only aggressors (N = 717). The strongest predictor of violent recidivism while on probation was whether the offender was a generalized aggressor or not, with generalized aggressors more likely to be arrested for new violent crimes. Prior arrests for violent crimes predicted violent recidivism of generalized aggressors, but did not significantly predict violent recidivism of family only and nonfamily only aggressors. For generalized aggressors and family only batterers, treatment noncompliance was an important risk predictor of violent recidivism. CTA compared to logistic regression classified a higher percentage of cases into low-risk and high-risk groups, provided higher improvement in classification accuracy of violent recidivists beyond chance performance, and provided a better balance of false positives and false negatives. The implications for the risk assessment and domestic violence literature are discussed.
See item 2 under Risk Factor Prevalence, Injury Occurence and Costs
