Correspondence: A.M. Hausken, Norwegian Institute of Public Health, Division of Forensic Toxicology and Drug Abuse, Oslo, NORWAY; (email: anmh@fhi.no).
An increasing number of heroin and ecstasy seizures were recorded by the Norwegian police and customs authorities in the 1990s. The number of apprehended drivers in whom heroin and ecstasy were detected also rose in the same period (Heroin, 1991: n = 17, 1999: n = 320. Ecstasy, 1995: n = 6, 1999: n = 123). Drivers who tested positive for heroin (detected in urine as the metabolite 6-monoacetyl-morphine, 6-MAM) or ecstasy (3,4-methylenedioxy-metamphetamine, MDMA, detected in blood) were characterized with regard to age distribution, drug use pattern, and earlier arrests. In 1998-1999, the police apprehended 9013 drivers on suspicion of being under the influence of drugs other than alcohol. Blood and urine samples from the drivers were sent to the Norwegian Institute of Public Health, Division of Forensic Toxicology and Drug Abuse and analyzed for the most commonly abused drugs. 6-MAM was detected in urine in 7% of the cases (n = 637), representing 542 different drivers (male: 85%, n = 463, female: 15%, n = 79) as some drivers were rearrested several times during the selection period. MDMA was detected in 2% of the cases (n = 190), representing 177 drivers (male: 90%, n = 160, female: 10%, n = 17). The median ages of drivers who tested positive for 6-MAM or MDMA were 32 and 24 years, respectively. Multi-drug use was very common in both groups (83% and 98% for the heroin and ecstasy group, respectively). Drivers in both groups were followed back to 1985 to detect earlier arrests for the same offence. Of the heroin group, 78% (n = 417) had earlier been arrested for drunken or drugged driving. Alcohol was the drug most frequently detected on first arrest. Of the ecstasy group, 47% (n = 83) had earlier been arrested, and amphetamine was most frequently found on first arrest.
Interventions for preventing injuries in problem drinkers.
- Dinh-Zarr T, Goss C, Heitman E, Roberts I, DiGuiseppi C. Cochrane Database Syst Rev 2004;(3): CD001857.
Correspondence: T. Dinh-Zarr, AAA Washington Office, 1440 New York Avenue, Suite 200, Washington DC, USA, 20005; (email: unavailable).
BACKGROUND: Alcohol consumption has been linked with injuries through motor vehicle crashes, falls, drowning, fires and burns, and violence. In the US, half of the estimated 100,000 deaths attributed to alcohol each year are due to intentional and unintentional injuries. The identification of effective interventions for the reduction of unintentional and intentional injuries due to problem drinking is, therefore, an important public health goal.
OBJECTIVE: To assess the effect of interventions for problem drinking on subsequent injury risk.
SEARCH STRATEGY: We searched 12 twelve computerized databases: MEDLINE (1966-8/96), EMBASE (1982-1/97), Cochrane Controlled Trials Register (1997, issue #1), PsycINFO (1967-1/97), CINAHL (1982-10/96), ERIC (1966-12/96), Dissertation Abstracts International (1861-11/96), IBSS (1961-1/97), ISTP (1982-1/97) and three specialized transportation databases, using terms for problem drinking combined with terms for controlled trials; bibliographies of relevant trials; and contact with authors and government agencies. The electronic and bibliographic searches were updated in May 2002.
SELECTION CRITERIA: Randomized controlled trials of interventions among participants with problem drinking, which are intended to reduce alcohol consumption or to prevent injuries or their antecedents, and which measured injury-related outcomes.
METHODS: Two authors extracted data on participants, interventions, follow-up, allocation concealment, and outcomes, and independently rated allocation concealment quality.
FINDINGS: Of 23 eligible trials identified, 22 had been completed and 17 provided results for relevant outcomes. Completed trials of problem drinkers that compared interventions for problem drinking to no intervention reported reduced motor-vehicle crashes and related injuries, falls, suicide attempts, domestic violence, assaults and child abuse, alcohol-related injuries and injury emergency visits, hospitalizations and deaths. Reductions ranged from 27% to 65%. Because few trials were sufficiently large to assess effects on injuries, individual effect estimates were generally imprecise. We did not combine the results quantitatively because the interventions, patient populations, and outcomes were so diverse. The most commonly evaluated intervention was brief counseling in the clinical setting. This was studied in seven trials, in which injury-related deaths were reduced: relative risk (RR) 0.65; 95% confidence interval (CI) 0.21 to 2.00. However, this reduction may have been due to chance. The majority of trials of brief counseling also showed beneficial effects on diverse non-fatal injury outcomes.
COMMENTS: Interventions for problem drinking appear to reduce injuries and their antecedents (e.g. falls, motor vehicle crashes, suicide attempts). Because injuries account for much of the morbidity and mortality from problem drinking, larger studies are warranted to evaluate the effect of treating problem drinking on injuries.
See item under Poisoning
See item 2 under Risk Factor Prevalence, Injury Occurrence and Costs
The aim of the study was to evaluate the outcome of a community-based prevention program against suicides among the elderly aged 65 and over in the Japanese rural town of Joboji (population 7,010), using a quasi-experimental design with two neighboring control areas. During the 10-year implementation of the program based on strategies including screening for depression, follow up with mental health care or psychiatric treatment and health education on depression, the relative risks estimated by the age-adjusted odds ratios for both males and females were reduced to almost one quarter more than a regional historical trend, with a better response to education for females than for males. A community-based management for later-life depression with mental health care supported by the psychiatric treatment can be effective against suicide among the elderly for both males and females.
This study examined the relationship between time to reach critical end points (tolerance time [TT] and metabolic rate for three different environmental temperatures (25 degrees C, 30 degrees C, and 35 degrees C, 50% relative humidity), while wearing firefighting protective clothing (FPC) and self-contained breathing apparatus (SCBA). Thirty-seven Toronto firefighters (33 male and 4 female) were divided into four work groups defined as Heavy (H, n = 9), Moderate (M, n = 9), Light (L, n = 10), and Very Light (VL, n = 9). At 25 degrees C, 30 degrees C, and 35 degrees C, TT (min) decreased from 56 to 47 to 41 for H, 92 to 65 to 54 for M, 134 to 77 to 67 for L, and 196 to 121 to 87 for VL. Significant differences in TT were observed across all group comparisons, excluding M versus L at 30 degrees C and 35 degrees C, and H versus M at 35 degrees C. Comparing 25 degrees C to 30 degrees C, M, L, and VL had significant decreases in TT, whereas only VL had a significant decrease when 30 degrees C was compared to 35 degrees C. For 25 degrees C to 30 degrees C, the relative change in TT was significantly greater for L (37%) and VL (41%) compared with H (16%) and M (26%). For 30 degrees C to 35 degrees C, the relative change among the groups was similar and approximately 17%. During passive recovery at 35 degrees C, rectal temperature (T(re)) continued to increase 0.5 degrees C above T(re final), whereas heart rate declined significantly. These findings show the differential impact of environmental conditions at various metabolic rates on TT while wearing FPC and SCBA. Furthermore, these findings reveal passive recovery may not be sufficient to reduce T(re) below pre-recovery levels when working at higher metabolic rates in hot environments.
Blast injury research: modeling injury effects of landmines, bullets, and bombs.
Terrorist blasts and landmine injuries have become more common in the past several decades generating thousands of casualties. Preventive and prognostic measures are limited by the lack of knowledge of these complex events. Previous blast research has focused on primary blast injuries that involve the lung, despite musculoskeletal injuries being the most common. Through the use of instrumented cadavers, Hybrid III test dummies, and other surrogates, unique models of these events have been created. The investigations studied the effectiveness of antimine footwear, forces and injury mechanisms in temporary shelters subjected to blast, modeling of blast-induced glass fragmentation, and helmet deformation and injury potential under ballistic load. Despite blasts being much higher rate events than those seen in automotive blunt trauma, we were able to measure forces and create injury models. We found that antimine footwear will require additional development to be effective. Guidelines for shelter placement have been altered, and tempered glass seems to offer no protection when compared with annealed glass. Although these models are in their nascent phase, the thorough understanding of the biomechanical nature of these blast injuries will assist in developing strategies to reduce injuries and in the creation of forecasting models.
Correspondence: Samuel Charlton, Department of Psychology, University of Waikato, Private Bag 3105, Hamilton, NEW ZEALAND; (email: samiam@waikato.ac.nz).
This paper describes an experiment comparing the relative effectiveness of various types of warnings on drivers' speed selection at curves. The experiment compared three types of curve warnings across three different curve types in a driving simulator. All of the warnings worked reasonably well for severe curves (45 km/h), regardless of demands from a secondary (cell phone) task. For less demanding curves, only those warnings with a strong perceptual component (i.e., implicit cues) were effective in reducing drivers' curve speeds in the presence of the cell phone task. The design implications of these data appear straightforward; curve warnings that contain perceptual components or emphasise the physical features of the curve work best, particularly in cognitively demanding situations. The cell phone task added to driver workload and drivers became less responsive to primary task demands (i.e., speeds were elevated and reaction times were longer).
Like other areas of occupational health and safety (OHS) ergonomics is evolving and becoming more integrated into overall work management systems. As we learn more about the complex interaction between psychosocial and physical factors in the aetiology of work-related illness and injury the more we rely on managers to 'get it right' if we are to prevent these conditions. Risks to health and safety in the mining industry posed by longer shift lengths, higher work loads, less task variation and decision latitude have not really been well researched. Heavy physical workloads and stresses are still areas of concern, but are likely to be intermittent rather than constant. Recent research confirms current thinking rather than shedding new light on the subject. The contribution of slips, trips and falls and increasing age of miners to manual handling injuries is still not clear. In some cases sedentary work and the operation of machinery has completely replaced heavy physical work. The issues of machinery design for operations and maintenance and whole-body vibration exposures when operating machines and vehicles are becoming more critical. The link between prolonged sitting, poor cab design and vibration with back and neck pain is being recognized but has yet to be addressed in any systematic way by the mining industry. On the plus side some mining companies have well-developed participative approaches to problem solving and these need to be extended to areas such as ergonomics.
Multimethod strategies (i.e., questionnaires, parents' observations, injury-event recording diaries, telephone and home interviews) were used to study in-home injuries experienced by toddlers over a 3-month period. Cuts, scrapes, and puncture wounds were the most common injuries. The majority of injuries affected children's limbs, and injuries most often occurred in the morning. Boys were injured most often in rooms designated for play, and a majority of their injuries followed from misbehavior. Girls were most often injured in nonplay areas of the home, with the majority of injuries occurring during play activities. Boys experienced more frequent and severe injuries than girls, although girls reacted more than boys to their injuries. Child factors relevant to injury included: risk taking, sensation seeking, and ease of behavior management. Temperament factors did not relate to child injury. Parent factors relevant to child injury included parents' beliefs about control over their child's health, protectiveness, and beliefs about child supervision. Regression analyses revealed that both child (i.e., risk taking) and parent (i.e., protectiveness) factors were significant determinants of child injury.
Understanding Toddlers' In-Home Injuries: II. Examining Parental Strategies, and Their Efficacy, for Managing Child Injury Risk.
Multimethod strategies (i.e., questionnaires, injury-event recording diaries, and telephone and home interviews) were used to study in-home injuries experienced by toddlers over a 3-month period and to identify anticipatory prevention strategies implemented by parents, on a room-by-room basis, that effectively reduced child injury risk. Three types of prevention strategies were used by parents: environmental (e.g., hazard removal, safety devices to prevent access), parental (e.g., increased supervision, parent modification of their own behavior to decrease injury risk for their child), and child based (e.g., teaching rules or prohibitions to promote safety), with parents often using a combination of these. Use of these strategies, and their efficacy to reduce injury risk, varied on a room-by-room basis. Nonetheless, two general conclusions are supported: (1) An emphasis on child-based strategies never decreases, and often elevates, risk of injury to toddlers; and (2) parental and environmental strategies, either singularly or in combination, serve protective functions that significantly reduce children's risk of in-home injury. Although it is commonplace for parents of children between 2 and 3 years of age to transition from environmental and supervision strategies to the use of teaching and rule-based ones to manage injury risk, doing so too early clearly elevates children's risk of injury in the home.
Correspondence: J. Joy, Minerals Industry Safety and Health Centre (MISHC), University of Queensland, Queensland, AUSTRALIA; (email: j.joy@mishc.uq.edu.au).
In the past 15 years, there has been a major safety improvement in the Australian mining industry. Part of this change can be attributed to the development and application of risk assessment methods. These systematic, team-based techniques identify, assess and control unacceptable risks to people, assets, the environment and production. The outcomes have improved mine management systems. This paper discusses the risk assessment approach applied to equipment design and mining operations, as well as the specific risk assessment methodology. The paper also discusses the reactive side of risk management, incident and accident investigation. Systematic analytical methods have also been adopted by regulatory authorities and mining companies to investigate major losses.
Corneal foreign body - an occupational hazard.
- Aziz MA, Rahman MA. Mymensingh Med J 2004; 13(2): 174-176.
Correspondence: M. Aziz, Consultant of Ophthalmology, BSMMU, Shahabag, Dhaka, BANGLADESH; (email: unavailable).
An attempt is made to describe the ocular surface injury by foreign body among the people those who are working in welding, grinding, hammering factory. Corneal foreign body which is usually iron in nature is the most common problem among the people those who are working in these factories. Clinical presentation, clinical pictures, and management are discussed. Corneal foreign body is a common cause of ocular morbidity and loss of working hour in the work place. Most of the victims do not use protective glass during work. We conclude that protective glass will useful in reduction of these accidents and alertness of both ophthalmologists and their patients are necessary.
Correspondence: Barbara Crouch, Utah Poison Control Center, 585 Komas Drive, Suite 200, Salt Lake City, UT 84108, USA; (email: barbara.crouch@hsc.utah.edu).
OBJECTIVE: Trends in child and teen nonprescription drug abuse reported to a regional poison control center over a 10-year period were examined.
METHODS: Human exposures to toxic substances reported to the Utah Poison Control Center between January 1990 and December 1999 were reviewed. Cases were selected for analysis if the exposure involved a nonprescription drug, the patient was 6-19 years old, and the reason for exposure was intentional abuse. Frequencies and cross-tabulations were calculated to identify trends in nonprescription drug abuse.
FINDINGS: There were 2214 reports of intentional drug abuse among children and teenagers 6-19 years old. Of those, 844 (38.1%) involved nonprescription drugs. The percentage of exposures Involving nonprescription products varied every year and declined over time. Exposures were slightly more common In males (51.7%). The site of exposure was a residence in 65% of cases and a school in 10% of cases. The majority of patients with exposures (68.4%) were treated In a health care facility. The most common types of nonprescription medications abused were drugs with anticholinergic properties, caffeine, dextromethorphan, and nonprescription stimulants.
COMMENTS: Reports of the Intentional abuse of nonprescription drugs by children and teenagers were common at a regional poison control center. There was significant variation in the type of nonprescription medication most commonly abused. The knowledge of these trends may assist public health policymakers, physicians, pharmacists, and child educators in their attempts to curb nonprescription drug abuse.
The Football Association medical research programme: an audit of injuries in academy youth football (soccer).
- Price RJ, Hawkins RD, Hulse MA, Hodson A. Br J Sports Med 2004; 38(4): 466-471.
Correspondence: Rob Price, The Football Association, Lilleshall Hall National Sports Centre, Lilleshall, Near Newport, Shropshire TF10 9AT, UK; (email: rob.price@thefa.com).
OBJECTIVES: To undertake a prospective epidemiological study of the injuries sustained in English youth academy football over two competitive seasons.
METHODS: Player injuries were annotated by medical staff at 38 English football club youth academies. A specific injury audit questionnaire was used together with a weekly return form that documented each club's current injury status.
FINDINGS: A total of 3805 injuries were reported over two complete seasons (June to May) with an average injury rate of 0.40 per player per season. The mean (SD) number of days absent for each injury was 21.9 (33.63), with an average of 2.31 (3.66) games missed per injury. The total amount of time absent through injury equated to about 6% of the player's development time. Players in the higher age groups (17-19 years) were more likely to receive an injury than those in the younger age groups (9-16 years). Injury incidence varied throughout the season, with training injuries peaking in January (p<0.05) and competition injuries peaking in October (p<0.05). Competition injuries accounted for 50.4% of the total, with 36% of these occurring in the last third of each half. Strains (31%) and sprains (20%) were the main injury types, predominantly affecting the lower limb, with a similar proportion of injuries affecting the thigh (19%), ankle (19%), and knee (18%). Growth related conditions, including Sever's disease and Osgood-Schlatter's disease, accounted for 5% of total injuries, peaking in the under 13 age group for Osgood-Schlatter's disease and the under 11 age group for Sever's disease. The rate of re-injury of exactly the same anatomical structure was 3%.
COMMENTS: Footballers are at high risk of injury and there is a need to investigate ways of reducing this risk. Injury incidence at academy level is approximately half that of the professional game. Academy players probably have much less exposure to injury than their full time counterparts. Areas that warrant further attention include the link between musculoskeletal development and the onset of youth related conditions such as Sever's disease and Osgood-Schlatter's disease, the significant number of non-contact injuries that occur in academy football, and the increased rates of injury during preseason training and after the mid season break. This study has highlighted the nature and severity of injuries that occur at academy level, and the third part of the audit process now needs to be undertaken: the implementation of strategies to reduce the number of injuries encountered at this level.
Shoulder injuries in golf.
- Kim DH, Millett PJ, Warner JJ, Jobe FW. Am J Sports Med 2004; 32(5): 1324-1330.
Correspondence: David Kim, Kerlan-Jobe Orthopaedic Clinic, 6801 Park Terrace Drive, Los Angeles, CA 90045, USA; (email: unavailable).
Although often perceived as a leisurely activity, golf can be a demanding sport, which can result in injury, usually from overuse and sometimes from poor technique. The shoulder is a commonly affected site, with the lead shoulder, or the left shoulder in the right-handed golfer, particularly vulnerable to injury. A thorough understanding of the biomechanics of the golf swing is helpful in diagnosing and managing these injuries. Common shoulder problems affecting golfers include subacromial impingement, acromioclavicular arthrosis, rotator cuff tear, glenohumeral instability, and glenohumeral arthrosis. Although the majority of patients with these disorders will respond to nonsurgical treatment, including rest and a structured program of physical therapy, further benefits can be obtained with subtle modifications of the golf swing. Those golfers who fail to respond to nonsurgical management can often return to competitive play with appropriate surgical treatment.
Event medicine: injury and illness during an expedition-length adventure race.
- Townes DA, Talbot TS, Wedmore IS, Billingsly R. J Emerg Med 2004; 27(2): 161-165.
Correspondence: David Townes, Division of Emergency Medicine, University of Washington School of Medicine, Seattle, Washington, USA; (email: townesd@u.washington.edu).
To describe the incidence and type of injury and illness occurring during an expedition-length adventure race and identify those resulting in withdrawal from the event, a prospective cohort study was conducted of the injuries and illness treated during the Subaru Primal Quest Expedition Adventure Race trade mark held in Colorado July 7-16, 2002. All racers, support crewmembers, and race staff were eligible to participate in the study. When a member of the study group received medical care due to an injury or illness, the encounter was recorded on a Medical Encounter Form. If an injury or illness resulted in withdrawal from the race, this was also recorded. Information from the Medical Encounter Forms was used to generate the Medical Log. There were 671 individuals eligible to participate in the study. A total of 243 medical encounters and 302 distinct injuries and illnesses were recorded. There were 179 (59%) injuries and 123 (41%) illnesses. Skin and soft tissue injuries and illness were the most frequent (48%), with blisters on the feet representing the single most common (32.8%). Second was respiratory illness (18.2%), including upper respiratory infection, bronchitis and reactive airway disease-asthma. Respiratory illness was the most common medical reason for withdrawal from the event. Injuries accounted for almost 60% of all injury and illness yet they contributed to less than 15% of the medical withdrawals from the race. Blisters accounted for almost one-third of all conditions treated. Providers of medical support for expedition-length adventure races should be prepared to treat a wide variety of injury and illness.
Into hot water head first: distribution of intentional and unintentional immersion burns.
- Daria S, Sugar NF, Feldman KW, Boos SC, Benton SA, Ornstein A. Pediatr Emerg Care 2004; 20(5): 302-310.
Correspondence: Daria Sonya, Department of Pediatrics, General Pediatric Division, University of Washington School of Medicine, Seattle, WA, USA; (email: unavailable).
BACKGROUND: Experience with several, previously unreported, intentional face-first immersion burns led us to evaluate the distribution of inflicted and unintentional immersion scald burns in a hospital series.
SETTING: (1) Authors' clinical and legal practices; (2) Burn center at regional Level 1 trauma hospital.
SUBJECTS: (1) Case series of face-first, inflicted immersion burn victims; (2) Consecutive hospitalized scald burn victims younger than 5 years old, 1/3/1996 to 3/25/2000.
METHODS: (1) Individual case reports; (2) Retrospective records review. Simple descriptive statistics, Fisher Exact test and t test.
FINDINGS: (1) Six cases of inflicted head and neck immersion injury are described. Four were tap water and 2 food/drink scalds. (2) 22/195 hospitalized victims had sustained immersion burns, 13 from tap water and 9 from other fluids. Six (46%) tap water immersions and no (0%) other immersions had inflicted injuries (P = 0.05). Two of the tap water immersions and one other source immersion included burning of the head and neck. Of these, one tap water immersion, but no other immersion, was inflicted. In no patients were head and neck injuries the sole or predominant site of scalding. In all, 9 children sustained inflicted scalds. Bilateral lower extremity tap water immersion scalds occurred in 100% (6/6) of abusive and 29% (2/7) of unintentional injuries (P = 0.02). Buttock and perineal injuries occurred in 67% (4/6) inflicted versus 29% (2/7) unintentional tap water immersion scalds (P = 0.28). Other fluids caused bilateral lower extremity immersion burns in 3/9 (33 %) unintentionally injured patients, but no abused children (NS).
COMMENTS: Craniofacial immersion injury, although seen by the authors in legal cases, is infrequent. It was present incidentally in one inflicted tap water burn in the consecutive hospital series. This series affirms the predominance of bilateral lower extremity burns in inflicted tap water immersions. Buttock/perineal immersions were more common with abuse than with unintentional injury.
Cost savings from a sustained compulsory breath testing and media campaign in New Zealand.
- Miller T, Blewden M, Zhang JF. Accid Anal Prev 2004; 36(5): 783-794.
Correspondence: Ted Miller, Pacific Institute for Research and Evaluation, 11710 Beltsville Drive, Calverton, MD 20705, USA; (email: miller@pire.org).
This paper evaluates three approaches to compulsory breath testing (CBT) where all drivers stopped are tested: (1) intensive, moderate-profile CBT (plus zero alcohol tolerance for drivers under age 20, which was implemented simultaneously, remains in effect, and unavoidably is commingled with CBT in the effectiveness estimates); (2) CBT plus an enhanced media campaign; and (3) shifting to aggressively visible booze buses, which also streamlined drunk-driver processing, plus enhanced community campaigns against drunk-driving. Approaches 1 and 2 were implemented throughout New Zealand (NZ) in 1993 and 1995. Booze buses and community programs were added for about one-third of the country in late 1996. ARIMA time series models estimated the impact on serious and fatal injury crashes between 10 p.m. and 3 a.m., a proxy for alcohol-related crashes. A benefit-cost analysis assessed return on investment. Cost savings were analyzed from four perspectives: societal, governmental, drunk-drivers', and people other than drunk-drivers (external cost). CBT plus zero tolerance reduced expected night-time crashes by 22.1% and enhanced media by 13.9%. Booze buses yielded a further 27.4% reduction where implemented. The program and associated crash reduction persisted until at least 2001 (the most recent data available). Estimated societal benefit-cost ratios were 14 for CBT, 19 for CBT plus enhanced media, and 26 for the comprehensive package. Government saved more than it spent on the program, especially with booze buses. Aggressive CBT plus zero alcohol tolerance for youth, media blitzes, and booze buses proved dramatically effective. Together, these four interventions halved late night serious and fatal injury crashes. Sustained effort seems to be critical. Better outcomes may be achieved with staged, increasingly visible and inescapable checkpoints than with an "ideal" initial program. It appears CBT is best implemented in conjunction with broader community-centered efforts to reduce drunk-driving.
- Centers for Disease Control and Prevention (CDC). MMWR Morb Mortal Wkly Rep 2004; 53(30): 675-678.
In 2000, an estimated 6.1 million light-vehicle (e.g., passenger cars, sport utility vehicles, vans, and pickup trucks) crashes on U.S. roadways were reported to police. Of these reported crashes, 247,000 (4.0%) involved incidents in which the motor vehicle (MV) directly hit an animal on the roadway. Each year, an estimated 200 human deaths result from crashes involving animals (i.e., deaths from a direct MV animal collision or from a crash in which a driver tried to avoid an animal and ran off the roadway). To characterize nonfatal injuries from these incidents, CDC analyzed data from the National Electronic Injury Surveillance System-All Injury Program (NEISS-AIP). This report summarizes the results of that analysis, which indicated that, during 2001-2002, an estimated 26,647 MV occupants per year were involved in crashes from encounters with animals (predominantly deer) in a roadway and treated for nonfatal injuries in U.S. hospital emergency departments (EDs). Cost-effective measures targeting both drivers (e.g., speed reduction and early warnings) and animals (e.g., fencing and underpasses) are needed to reduce injuries associated with MV collisions involving animals.
Risk taking and novelty seeking in adolescence: introduction to part I.
- Kelley AE, Schochet T, Landry CF. Ann N Y Acad Sci 2004; 1021: 27-32.
Correspondence: Ann Kelley, Department of Psychiatry, University of Wisconsin-Madison Medical School, 6001 Research Park Boulevard, Madison, WI 53719, USA; (email: aekelley@wisc.edu).
Risk taking and novelty seeking are hallmarks of typical adolescent behavior. Adolescents seek new experiences and higher levels of rewarding stimulation, and often engage in risky behaviors, without considering future outcomes or consequences. These behaviors can have adaptive benefits with regard to the development of independence and survival without parental protection, but also render the adolescent more vulnerable to harm. Indeed, the risk of injury or death is higher during the adolescent period than in childhood or adulthood, and the incidence of depression, anxiety, drug use and addiction, and eating disorders increases. Brain pathways that play a key role in emotional regulation and cognitive function undergo distinct maturational changes during this transition period. It is clear that adolescents think and act differently from adults, yet relatively little is known about the precise mechanisms underlying neural, behavioral, and cognitive events during this period. Increased investigation of these dynamic alterations, particularly in prefrontal and related corticolimbic circuitry, may aid this understanding. Moreover, the investigation of mammalian animal models of adolescence-such as those examining impulsivity, reward sensitivity, and decision making-may also provide new opportunities for addressing the problem of adolescent vulnerability.
Severe traumatic brain injury in New South Wales: comparable outcomes for rural and urban residents.
- Harradine PG, Winstanley JB, Tate R, Cameron ID, Baguley IJ, Harris RD. Med J Aust 2004; 181(3): 130-134.
Correspondence: Julie B Winstanley, Rehabilitation Studies Unit, Faculty of Medicine, University of Sydney, PO Box 6, Ryde, NSW 1680, AUSTRALIA; (email: jwin6139@mail.usyd.edu.au).
OBJECTIVE: To compare differences in functional outcomes between urban and rural patients with traumatic brain injury (TBI). DESIGN: A longitudinal, prospective, multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program (BIRP) for New South Wales, with follow-up at 18 months after injury. PARTICIPANTS: 198 patients (147 urban, 51 rural) with severe TBI from the 11 participating rehabilitation units. MAIN OUTCOME MEASURES: Demographic and injury details collected prospectively using a standardised questionnaire, and measures from five validated instruments (Disability Rating Scale, Mayo-Portland Adaptability Inventory, Sydney Psychosocial Reintegration Scale, Medical Outcomes Study Short Form and the General Health Questionnaire - 28-item version) administered at follow-up to document functional, psychosocial, emotional and vocational outcomes. RESULTS: Demographic details, injury severity, lengths of stay in intensive and acute care wards were similar for both rural and urban groups. There were no significant group differences in functional outcomes, including return to work, at follow-up. CONCLUSIONS: Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents, and suggest that the integrated network of inpatient, outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live.
Correspondence: Tonja Nansel, Division of Epidemiology, Statistics, and Prevention Research, National Institute of Child Health and Human Development, Bethesda, MD, USA; (email: nanselt@mail.nih.gov).
OBJECTIVE: To determine whether the relationship between bullying and psychosocial adjustment is consistent across countries by standard measures and methods.
DESIGN: Cross-sectional self-report surveys were obtained from nationally representative samples of students in 25 countries. Involvement in bullying, as bully, victim, or both bully and victim, was assessed.
SETTING: Surveys were conducted at public and private schools throughout the participating countries.
PARTICIPANTS: Participants included all consenting students in sampled classrooms, for a total of 113 200 students at average ages of 11.5, 13.5, and 15.5 years.
MAIN OUTCOME MEASURES: Psychosocial adjustment dimensions assessed included health problems, emotional adjustment, school adjustment, relationships with classmates, alcohol use, and weapon carrying.
FINDINGS: Involvement in bullying varied dramatically across countries, ranging from 9% to 54% of youth. However, across all countries, involvement in bullying was associated with poorer psychosocial adjustment (P<.05). In all or nearly all countries, bullies, victims, and bully-victims reported greater health problems and poorer emotional and social adjustment. Victims and bully-victims consistently reported poorer relationships with classmates, whereas bullies and bully-victims reported greater alcohol use and weapon carrying.
COMMENTS: The association of bullying with poorer psychosocial adjustment is remarkably similar across countries. Bullying is a critical issue for the health of youth internationally.
Urban adolescents' exposure to community violence: the role of support, school safety, and social constraints in a school-based sample of boys and girls.
This study examined recent exposure to violence in the community and in other settings, protective factors, and current psychological functioning among 349 young adolescents from 9 urban middle schools. The majority (76%) of adolescents reported witnessing or being victimized by at least 1 violent event in the prior 6 months. Nearly half of adolescents who had talked about their experience of a violent event reported feeling constrained from sharing their thoughts or feelings because of others' reactions. After controlling for daily hassles, more exposure to violence was associated with more self-reported posttraumatic stress disorder (PTSD) and depressive symptoms. Exposure to violence was not a significant predictor of teachers' ratings of adaptive functioning or internalizing symptoms. Support from specific individuals, perceived school safety, and lower constraints for discussing violence showed protective effects in the relation between exposure to violence and specific dimensions of psychological functioning. The implications of this research for school-based interventions are discussed.
Who are the kids who self-harm? An Australian self-report school survey.
- De Leo D, Heller TS. Med J Aust 2004; 181(3): 140-144.
Correspondence: D. De Leo, Australian Institute for Suicide Research and Prevention, Griffith University, Messines Ridge Road, Mt Gravatt, QLD 4122, AUSTRALIA; (email: d.deleo@griffith.edu.au).
OBJECTIVE: To determine the prevalence and types of deliberate self-harm (DSH) in adolescents, and associated factors.
DESIGN: A cross-sectional questionnaire study.
PARTICIPANTS AND SETTING: 3757 of 4097 Year 10 and Year 11 students (91.7%) from 14 high schools on the Gold Coast, Queensland, during September 2002.
MAIN OUTCOME MEASURES: DSH behaviour, including descriptions of the last act, psychological symptoms, recent stressors, coping styles, help-seeking behaviour, lifestyle choices, and self-prescribing of medications.
FINDINGS: 233 students (6.2%) met the criteria for DSH in the previous 12 months, with DSH more prevalent in females than males (OR, 7.5; 95% CI, 5.1-10.9). The main methods were self-cutting (138 respondents; 59.2%) and overdosing with medication (69 respondents; 29.6%). Factors associated with DSH included similar behaviours in friends or family, coping by self-blame, and self-prescribing of medications. Most self-harmers did not seek help before or after their most recent action, with those who did primarily consulting friends.
COMMENTS: DSH is common in Australian youth, especially in females. Preventive programs should encourage young people to consult health professionals in stressful situations.
Suicide methods in the elderly in South Australia 1981-2000.
The files of the Forensic Science Centre in Adelaide, Australia were examined over a 20-year period from 1981 to 2000 for cases of suicide in individuals aged 65 years and over. A total of 445 cases were found (13.8% of all suicides) with an age range of 65-94 years (average=73.5 years). All cases had undergone full autopsies and police investigation. There were significantly more male than female victims; M:F=330:115. Hangings accounted for the highest proportion of cases (107/445; 24%) followed by gunshot wounds (96/445; 21.6%), drug toxicity (82/435; 18.9%), drowning (66/445; 14.8%), and carbon monoxide toxicity (52/445; 11.7%). A miscellaneous group accounted for 42 of 445 cases (9.2%). No significant changes occurred in either the total suicide rate or in the rates in males and females, except for drowning deaths in males, which showed a significant decrease over time. Female victims tended to avoid violent methods such as gunshot wounds in favour of drug overdose. Gunshot wound deaths were far less common than published data from other countries would indicate, with relative increases in deaths due to hanging, drug toxicity, drowning and carbon monoxide toxicity. An awareness of the considerable variability that occurs among populations in suicide methods and rates is important in determining local requirements for suicide prevention campaigns.
Challenging times: a study to detect Irish adolescents at risk of psychiatric disorders and suicidal ideation.
- Lynch F, Mills C, Daly I, Fitzpatrick C. J Adolesc 2004; 27(4): 441-451.
Correspondence: Carol Fitzpatrick, Department of Child and Family Psychiatry, Mater Misericordiae Hospital, Dublin 7, Ireland, UK; (email: cfitzpatrick@mater.ie).
Suicide rates in young Irish males have risen markedly in the past 10 years, and suicide is now the leading cause of death in young men in the 15-24-year-old age range. This is the first large-scale study in Ireland that set out to identify young people at risk of psychiatric disorders, including depressive disorders, and suicidal ideation. Seven hundred and twenty three school-going adolescents aged 12-15 years were screened using the Children's Depression Inventory and the Strengths and Difficulties Questionnaire. 19.4% were identified as being 'at risk' of having a mental health disorder. Of this 'at risk' group, 12.1% expressed possible suicidal intent and 45.7% expressed suicidal ideation. Of the 583 adolescents identified as being 'not at risk', 13% expressed suicidal ideation while none expressed suicidal intent. Being 'at risk' was not related to gender or to socio-economic status. Those living with two parents were significantly more likely to be in the 'not at risk' group. Girls attending co-educational schools were twice as likely to be in 'at risk' group compared with those attending all girls schools, while school type was not a risk factor for boys. This study shows that, as in other western countries, there are large numbers of young Irish people at risk of mental health disorders and suicidal ideation in the community, and raises the question of the importance of mental health promotion in our education system.
Association between youth-focused firearm laws and youth suicides.
Correspondence: Daniel Webster, Center for the Prevention of Youth Violence, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md 21205, USA; (email: dwebster@jhsph.edu).
CONTEXT: Firearms are used in approximately half of all youth suicides. Many state and federal laws include age-specific restrictions on the purchase, possession, or storage of firearms; however, the association between these laws and suicides among youth has not been carefully examined.
OBJECTIVE: To evaluate the association between youth-focused firearm laws and suicides among youth.
DESIGN, SETTING, AND PARTICIPANTS: Quasi-experimental design with annual state-level data on suicide rates among US youth aged 14 through 20 years, for the period 1976-2001. Negative binomial regression models were used to estimate the association between state and federal youth-focused firearm laws mandating a minimum age for the purchase or possession of handguns and state child access prevention (CAP) laws requiring safe storage of firearms on suicide rates among youth.
MAIN OUTCOME MEASURES: Association between youth-focused state and federal firearm laws and rates of firearm, nonfirearm, and total suicides among US youth aged 14 to 17 and 18 through 20 years.
RESULTS: There were 63 954 suicides among youth aged 14 through 20 years during the 1976-2001 study period, 39 655 (62%) of which were committed with firearms. Minimum purchase-age and possession-age laws were not associated with statistically significant reductions in suicide rates among youth aged 14 through 20 years. State CAP laws were associated with an 8.3% decrease (rate ratio [RR], 0.92; 95% confidence interval [CI], 0.86-0.98) in suicide rates among 14- to 17-year-olds. The annual rate of suicide in this age group in states with CAP laws was 5.97 per 100 000 population rather than the projected 6.51. This association was also statistically significant for firearm suicides (RR, 0.89; 95% CI, 0.83-0.96) but not for nonfirearm suicides (RR, 1.00; 95% CI, 0.91-1.10). CAP laws were also associated with a significant reduction in suicides among youth aged 18 through 20 years (RR, 0.89; 95% CI, 0.85-0.93); however, the association was similar for firearm suicides (RR, 0.87; 95% CI, 0.82-0.92) and nonfirearm suicides (RR, 0.91; 95% CI, 0.85-0.98).
CONCLUSIONS: There is evidence that CAP laws are associated with a modest reduction in suicide rates among youth aged 14 to 17 years. As currently implemented, minimum age restrictions for the purchase and possession of firearms do not appear to reduce overall rates of suicide among youth.
See item under Risk Factor Prevalence, Injury Occurrence and Costs
From May 1999, a new system for licensing older drivers was introduced in New Zealand. It included a practical on-road driving test with expanded scope, to be completed every two years from the time the driver turns 80. The relationship between crashes and test performance needed to be studied to inform the debate regarding the testing system. The population studied was all drivers who entered this licensing system during its first three years of operation. They were defined as crash involved if they were involved in an injury crash during the two years following their first licensure under the new system. Logistic regression was used to describe the risk of crash involvement in terms of driving test performance and other driver characteristics. Each driving test failure was associated with a 33% increase in the odds of crash involvement (95% CI 14% to 55%), controlling for age, gender, minor traffic violations, and whether the older driver lived with another licensed driver or not. Minor traffic violations in the two years following the driving test were associated with twice the odds of crash involvement. These results suggest that the new on-road driving test does identify older driver behaviors or limitations that are related to crash liability. It is anticipated that the results presented here will provide essential information for discussing older driver licensing systems, whose impact will grow in importance as the population of drivers ages.
Tracking traffic citations through court adjudications to posting to public driver records.
Research has shown that one of the best predictors of a driver's future crash risk is the number of prior moving traffic violations (e.g., speeding). Public driver records are used by government and nongovernment users to assess drivers' future crash risks. However, the adequacy of such records may be compromised by deficient recordkeeping systems and by court-based diversion programs (e.g., probation before judgment, traffic school election) that allow drivers presumed guilty to avoid convictions in court and posting of the violations to their driver records. Using a case study approach in four jurisdictions in three states, citations issued for traffic violations were tracked through court adjudication to placement on driver records. Individual court case records and driver history records were reviewed. The percentages of citations issued that appeared on driver records were 58-87% for moving violations, 30-94% for driving while impaired (DWI), and 67-95% for occupant restraint violations. Diversion programs were a significant factor in two states, where 21% and 35% of moving violation citations resulted in diversions. Almost all court convictions in each jurisdiction were recorded on driver records, but few citations resulting in diversions were recorded. Thus, diversion programs in some jurisdictions substantially reduce the utility of public driver records as reliable indicators of prior traffic violations and future crash risks. Recordkeeping inefficiencies and errors were less important factors in this study.
Prediction of accidents at full green and green arrow traffic lights in Switzerland with the aid of configuration-specific features.
- Hubacher M, Allenbach R. Accid Anal Prev 2004; 36(5): 739-747.
Correspondence: Markus Hubacher, Swiss Council for Accident Prevention bfu, CP, CH-3001 Bern, SWITZERLAND; (email: m.hubacher@bfu.ch).
In this study it was endeavored to predict full green and green arrow accidents at traffic lights, using configuration-specific features. This was done using the statistical method known as Poisson regression. A total of 45 sets of traffic lights (criteria: in an urban area, with four approach roads) with 178 approach roads were investigated (the data from two approach roads was unable to be used). Configuration-specific features were surveyed on all approach roads (characteristics of traffic lanes, road signs, traffic lights, etc.), traffic monitored and accidents (full green and green arrow) recorded over a period of 5 consecutive years. It was demonstrated that only between 23 and 34% of variance could be explained with the models predicting both types of accidents. In green arrow accidents, the approach road topography was found to be the major contributory factor to an accident: if the approach road slopes downwards, the risk of a green arrow accident is approximately five and a half times greater (relative risk, than on a level or upward sloping approach road. With full green accidents, obstructed vision plays the major role: where vision can be obstructed by vehicles turning off, the accident risk is eight times greater than where no comparable obstructed vision is possible. From the study it emerges that technical features of traffic lights are not able to control a driver's actions in such a way as to eradicate error. Other factors, in particular the personal characteristics of the driver (age, sex, etc.) and accident circumstances (lighting, road conditions, etc.), are likely to make an important contribution to explaining how an accident occurs.
Warning signs as countermeasures to camel-vehicle collisions in Saudi Arabia.
Correspondence: Ali S. Al-Ghamdi, Civil Engineering Department, College of Engineering, King Saud University, P.O. Box 800, Riyadh 11421, SAUDI ARABIA; (email: asghamdi@ksu.edu.sa).
The camel-vehicle collision (CVC) problem has been increasing in Saudi Arabia and countermeasures are urgently needed to alleviate the heavy losses from such accidents. A research project was funded by the Saudi Arabian government to investigate the problem and to develop techniques to deal with it. Among the different techniques investigated were camel-crossing warning signs. In this study, seven camel-crossing warning signs were tested to determine if they would reduce the number of CVCs on rural roads. The measure of effectiveness utilized was the mean speed reduction of motorists passing such signs. In this paper, the experiments of warning sign testing are detailed, and the evaluation of the signs, based on the results of the testing experiments, is presented. Although most of the signs brought about significant reductions in mean speed, indicating statistical effectiveness, the speed reductions were not relatively large; they ranged from around 3 to about 7 km/h. Furthermore, statistical analysis was used to rank the signs according to their effectiveness. A triangular warning sign with a black camel silhouette and diamond reflective material (220 cm x 220 cm x 220 cm) is recommended in this study. This sign is similar to the standard warning sign used in Saudi Arabia except that it is twice the standard size and uses diamond reflective material.
Buses as Fire Hazards: A Swedish Problem Only? Suggestions for Fire-Prevention Measures.
- Huss FR, Erlandsson U, Sjoberg F. J Burn Care Rehabil 2004; 25(4): 377-380.
Correspondence: Fredrick Huss, Department of Plastic, Hand, and Burn Surgery and daggerDepartment of Anesthesiology and Intensive Care, University Hospital of Linkoping; and double daggerSwedish Rescue Services Agency, Karlstad, SWEDEN; (email: unavailable).
In Sweden, approximately 6% of all human transportation is made via buses. The Swedish Board of Accident Investigation and the Swedish Rescue Services Agency have pointed out repeatedly that buses are potential fire and burn hazards, not only when involved in collisions but also in other circumstances. The number of fire incidents is increasing, especially in newer buses. In conjunction with the Swedish Rescue Services Agency, we examined some of the recent bus fires in Sweden. We did not find any casualties, but the results of our study suggest that casualties as a result of bus fires are imminent unless preventive measures are taken. We also studied experiences from previous bus fires and suggest preventive measures.
See item 1 under Alcohol and Other Drugs
See item 2 under Risk Factor Prevalence, Injury Occurrence and Costs
This study was designed to investigate the detection rate of domestic violence by resident physicians in a community-based, primary care training program. Baseline information on detection rates was gathered from residents in the prestudy phase and was compared with data from the 6-month investigation phase of the study, during which a self-administered pencil-and-paper questionnaire on domestic violence was provided to patients and residents. The nursing staff screened new female patients and established patients returning for annual physical examinations. Patients older than 18 years were asked to complete a four-question survey. The examining resident physicians then reviewed the questionnaire answers with patients. During the 6-month prestudy phase, only 7 of 136 patients (5.1%) were determined to be in current (2.9%) or past (2.2%) abusive relationships. Of the 52 patients who completed the investigation phase of the study, 25 (48.1%) reported a lifetime history of abuse, with 9.6% of patients reporting current abuse and 38.5% reporting past abuse. There was a statistical difference regarding history of abuse and lifetime incidence of abuse between the control and study groups. The authors found that routine screening with a few questions could significantly increase detection of domestic violence and enable victims to begin to address their problems. This study has implications for continuing medical education programs as well as residency training programs.
Violence Exposure and Adjustment in Inner-City Youth: Child and Caregiver Emotion Regulation Skill, Caregiver-Child Relationship Quality, and Neighborhood Cohesion as Protective Factor.
- Kliewer W, Cunningham JN, Diehl R, Parrish KA, Walker JM, Atiyeh C, Neace B, Duncan L, Taylor K, Mejia R. J Clin Child Adolesc Psychol 2004; 33(3): 477-487.
Correspondence: Wendy Kliewer, Department of Psychology, Virginia Commonwealth University, USA; (email: wkliewer@vcu.edu).
This short-term, longitudinal interview study used an ecological framework to explore protective factors within the child, the caregiver, the caregiver-child relationship, and the community that might moderate relations between community violence exposure and subsequent internalizing and externalizing adjustment problems and the different patterns of protection they might confer. Participants included 101 pairs of African American female caregivers and one of their children (56% male, M = 11.15 yrs, SD = 1.28) living in high-violence areas of a mid-sized southeastern city. Child emotion regulation skill, felt acceptance from caregiver, observed quality of caregiver-child interaction, and caregiver regulation of emotion each were protective, but the pattern of protection differed across level of the child's ecology and form of adjustment. Implications for prevention are discussed.
The interrelatedness of multiple forms of childhood abuse, neglect, and household dysfunction.
- Dong M, Anda RF, Felitti VJ, Dube SR, Williamson DF, Thompson TJ, Loo CM, Giles WH. Child Abuse Negl 2004; 28(7): 771-784.
Correspondence: Maxia Dong, Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway, N.E., MS K-67, Atlanta, GA 30341-3717, USA; (email: mfd7@cdc.gov).
OBJECTIVE: Childhood abuse and other adverse childhood experiences (ACEs) have historically been studied individually, and relatively little is known about the co-occurrence of these events. The purpose of this study is to examine the degree to which ACEs co-occur as well as the nature of their co-occurrence.
METHODS: We used data from 8,629 adult members of a health plan who completed a survey about 10 ACEs which included: childhood abuse (emotional, physical, and sexual), neglect (emotional and physical), witnessing domestic violence, parental marital discord, and living with substance abusing, mentally ill, or criminal household members. The bivariate relationship between each of these 10 ACEs was assessed, and multivariate linear regression models were used to describe the interrelatedness of ACEs after adjusting for demographic factors.
FINDINGS: Two-thirds of participants reported at least one ACE; 81%-98% of respondents who had experienced one ACE reported at least one additional ACE (median: 87%). The presence of one ACE significantly increased the prevalence of having additional ACEs, elevating the adjusted odds by 2 to 17.7 times (median: 2.8). The observed number of respondents with high ACE scores was notably higher than the expected number under the assumption of independence of ACEs (p <.0001), confirming the statistical interrelatedness of ACEs.
COMMENTS: The study provides strong evidence that ACEs are interrelated rather than occurring independently. Therefore, collecting information about exposure to other ACEs is advisable for studies that focus on the consequences of a specific ACE. Assessment of multiple ACEs allows for the potential assessment of a graded relationship between these childhood exposures and health and social outcomes.
Prevalence and Patterns of Gender-based Violence and Revictimization among Women Attending Antenatal Clinics in Soweto, South Africa.
- Dunkle KL, Jewkes RK, Brown HC, Yoshihama M, Gray GE, McIntyre JA, Harlow SD. Am J Epidemiol 2004; 160(3): 230-239.
Correspondence: Kristin Dunkle, Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA; (email: kdunkle@umich.edu).
Gender-based violence is a key health risk for women globally and in South Africa. The authors analyzed data from 1,395 interviews with women attending antenatal clinics in Soweto, South Africa, between November 2001 and April 2002 to estimate the prevalence of physical/sexual partner violence (55.5%), adult sexual assault by nonpartners (7.9%), child sexual assault (8.0%), and forced first intercourse (7.3%). Age at first experience of each type of violence was modeled by the Kaplan-Meier method, and Cox hazard models with time-varying covariates were used to explore whether child sexual assault and forced first intercourse were associated with risk of violent revictimization in adulthood. Child sexual assault was associated with increased risk of physical and/or sexual partner violence (risk ratio = 2.43, 95% confidence interval: 1.93, 3.06) and with adult sexual assault by a nonpartner (risk ratio = 2.33, 95% confidence interval: 1.40, 3.89). Forced first intercourse was associated with increased risk of physical and/or sexual partner violence (risk ratio = 2.64, 95% confidence interval: 2.07, 3.38) and nonsignificantly with adult sexual assault by a nonpartner (risk ratio = 2.14, 95% confidence interval: 0.92, 4.98). This study confirms the need for increased attention by the public health community to primary and secondary prevention of gender-based violence, with a specific need to reduce risk among South African adolescents.
