High mortality among young crack cocaine users in Brazil: a 5-year follow-up study.
- Ribeiro M, Dunn J, Laranjeira R, Sesso R. Addiction 2004; 99(9): 1133-1135.
Correspondence: Marcelo Ribeiro, UNIAD, Departamento de Psiquiatria, Universidade Federal de Sao Paulo (UNIFESP), Sao Paulo, BRAZIL; (email: unavailable).
OBJECTIVE: Follow-up studies show that smokers, alcoholics and heroin addicts have high mortality rates, but there is little information on crack users. We have investigated the mortality rate among this population, including its risk factors and causes of death.
DESIGN: A 5-year follow-up study.
PARTICIPANTS AND SETTING: A cohort of 131 crack-dependent patients, admitted to a public detoxification unit in Sao Paulo between 1992 and 1994.
MEASUREMENTS: Data collected from a structured personal interview and from a review of patients' hospital records, confirming the deaths from records held at the Municipal Offices.
FINDINGS: Of the 124 (94.6%) patients located, 23 (18.5%) had died (a mortality ratio of 7.6). Homicide was the most common cause of death (n = 13). Observed mortality rate, adjusted for age and sex, was 24.92 per 1000, while the expected all-cause mortality rate in Sao Paulo, also adjusted for age and sex, was 3.28 per 1000, giving an excess mortality rate of 21.64 per 1000. Survival analysis showed that the probability of being alive 5 years post-treatment was 0.80 (95% CI = 0.77-0.84). Cox's proportional hazards regression showed three factors predicted mortality: history of intravenous drug use (hazard ratio 3.28, 95% CI 1.42-7.59), unemployment at index admission (hazard ratio 3.48, 95% CI 1.03-11.80) and premature discharge from index admission (hazard ratio 2.21, CI 0.94-5.18).
COMMENTS: Community-based and tailored interventions should be considered to improve those patients' social support and permanence in treatment.
The effectiveness of a community-based program for reducing the incidence of falls in the elderly: a randomized trial.
- Clemson L, Cumming RG, Kendig H, Swann M, Heard R, Taylor K. J Am Geriatr Soc 2004; 52(9): 1487-1494.
Correspondence: Lindy Clemson, School of Occupation and Leisure Sciences, Faculty of Health Sciences, University of Sydney, Sydney, AUSTRALIA; (email: l.clemson@fhs.usyd.edu.au).
OBJECTIVE: To test whether Stepping On, a multifaceted community-based program using a small-group learning environment, is effective in reducing falls in at-risk people living at home. DESIGN: A randomized trial with subjects followed for 14 months. Setting: The interventions were conducted in community venues, with a follow-up home visit.
PARTICIPANTS: Three hundred ten community residents aged 70 and older who had had a fall in the previous 12 months or were concerned about falling.
INTERVENTION: The Stepping On program aims to improve fall self-efficacy, encourage behavioral change, and reduce falls. Key aspects of the program are improving lower-limb balance and strength, improving home and community environmental and behavioral safety, encouraging regular visual screening, making adaptations to low vision, and encouraging medication review. Two-hour sessions were conducted weekly for 7 weeks, with a follow-up occupational therapy home visit.
MEASUREMENTS: The primary outcome measure was falls, ascertained using a monthly calendar mailed by each participant.
FINDINGS: The intervention group experienced a 31% reduction in falls (relative risk (RR)=0.69, 95% confidence interval (CI)=0.50-0.96; P=.025). This was a clinically meaningful result demonstrating that the Stepping On program was effective for community-residing elderly people. Secondary analysis of subgroups showed that it was particularly effective for men (n=80; RR=0.32, 95% CI=0.17-0.59).
COMMENTS: The results of this study renew attention to the idea that cognitive-behavioral learning in a small-group environment can reduce falls. Stepping On offers a successful fall-prevention option.
Predictors of help seeking among Connecticut adults after September 11, 2001.
- Adams ML, Ford JD, Dailey WF. Am J Public Health 2004; 94(9): 1596-1602.
Correspondence: Mary L. Adams, Department of Psychiatry MC1410, University of Connecticut Health Center, 263 Farmington Ave, Farmington, CT 06030, USA; (email: ford@psychiatry.uchc.edu).
OBJECTIVES: We conducted a population-based telephone survey in an attempt to determine correlates of formal and informal help seeking after September 11, 2001.
METHODS: Between October 15 and December 31, 2001, 1774 Connecticut Behavioral Risk Factor Surveillance System respondents were asked questions directly related to their experiences of September 11.
FINDINGS: Multivariate logistic regression analyses showed that receipt of formal help was predicted by sleep problems, close association with a victim, reports of increased smoking or drinking, and receipt of informal help. Age, gender, reports of 1 or more problems, and formal help seeking predicted receipt of informal help.
COMMENTS: Public health planning and bioterrorism preparedness should include programs addressing increased smoking and drinking, sleep problems, and bereavement in the wake of disasters.
Mortality in 13 French cities during the August 2003 heat wave.
- Vandentorren S, Suzan F, Medina S, Pascal M, Maulpoix A, Cohen JC, Ledrans M. Am J Public Health 2004; 94(9): 1518-1520.
Correspondence: Stephanie Vandentorren, Department of Environmental Health, Institut de Veille Sanitaire, 12 rue du Val d'Osne, 94415 Saint-Maurice cedex, FRANCE; (email: s.vandentorren@invs.sante.fr).
We observed the daily trend in mortality rates during the 2003 heat wave in 13 of France's largest cities. Mortality data were collected from July 25 to September 15 each year from 1999 through 2003. The conjunction of a maximum temperature of 35 degrees C and a minimum temperature of 20 degrees C was exceptional in 7 cities. An excess mortality rate was observed in the 13 towns, with disparities from +4% (Lille) to +142% (Paris).
OBJECTIVE: To evaluate the relationship that tiredness and sleepiness in bus drivers have to road accidents in Peru. Information from various countries indicates that driver sleepiness plays an important role in road accidents. However, there is only limited information on this subject in Peru.
METHODS: Using a supervised, pretested survey, a cross-sectional observational and comparative study was carried out with 238 bus drivers who drive on the Northern Pan American Highway of Peru. To determine the relationship between variables the chi-square test was used, along with the Pearson correlation coefficient. The level of significance was set at P < 0.05. The variables analyzed were: tiredness, sleepiness, hours of driving per day, daily hours of sleep, body mass index, snoring, sleep apnea, and either having had or almost having had an accident while driving.
FINDINGS: Of the 238 drivers, all of them were men, 45% said they had had or nearly had had an accident while driving, 55% slept less than 6 hours per day, 31% had slept less than 6 hours in the 24 hours before answering the survey, and 80% were in the habit of driving more than 5 hours without stopping. Of the drivers, 56% of them reported being tired at least some of the time while driving; of this group, 65% of them reported being tired during the early morning. Seventy-six drivers (32%) said that while they were driving their eyes had fallen shut. In terms of where they slept, 194 of the drivers (81%) said they always slept in the lower luggage compartment of the bus while another driver was driving the bus or when the bus was parked in the bus terminal. The steps that drivers took to avoid falling asleep while driving included: wetting the face with water, eating fruit, opening the window of the driver's compartment, drinking coffee, listening to music, smoking, chewing coca leaves, and drinking alcohol mixed with coca leaves. In the opinion of 55% of the drivers, the leading cause of road accidents is tiredness. Accidents and near-accidents while driving occurred mainly between midnight and 6am Having an accident or a near-accident was strongly associated with tiredness and with having the eyes drop shut while driving (P < 0.0005).
COMMENTS: Tiredness and sleepiness while driving were common among the bus drivers, with various possible causes: acute and chronic sleep deprivation, irregular schedule changes, and sleep disorders due to the drivers' working conditions. Our results support the hypothesis that fatigue and sleepiness among bus drivers are related to road accidents.
Temporal separation and self-rating of alertness as indicators of driver fatigue in commercial motor vehicle operators.
This on-road field investigation employed, for the first time, a completely automated trigger-based data collection system capable of evaluating driver performance in an extended-duration real-world commercial motor vehicle environment. The study examined the use of self-assessment of fatigue (Karolinska Sleepiness Scale) and temporal separation (minimum time to collision, minimum headway, and mean headway) as indicators of driver fatigue. Without exception, the correlation analyses for both the self-rating of alertness and temporal separation yielded models low in associative ability; neither metric was found to be a valid indicator of driver fatigue. In addition, based upon the data collected for this research, preliminary evidence suggests that driver fatigue onset within a real-world driving environment does not appear to follow the standard progression of events associated with the onset of fatigue within a simulated driving environment. Application of this research includes the development of an on-board driver performance/fatigue monitoring system that could potentially assist drivers in identifying the onset of fatigue.
Foveal task complexity and visual funneling.
- Murata A. Hum Factors 2004; 46(1): 135-141.
Correspondence: Atsuo Murata, Hiroshima City University, Department of Computer and Media Technologies, 3-4-1, Ozukahigashi, Asaminami-ku, Hiroshima 731-3194, JAPAN; (email: murata@cs.hiroshima-cu.ac.jp).
The current study was designed to examine whether increasing foveal task complexity would cause the functional field to shrink as a result of a visual funneling effect. Using 8 male participants, the study examined whether the effects of foveal task complexity on peripheral performance was most pronounced at the far periphery. The response time to an addition task using foveal vision tended to increase with the increase of the visual angle. The percentage correct, however, did not differ among 3 levels of task complexity or among 4 levels of visual angle. The miss rate in the peripheral vision task tended to increase with the increase in not only the complexity of the foveal task but also the visual angle. This is indicative of visual funneling. However, greater funneling was not necessarily observed for response time. In this study, response time was not a sensitive measure of visual funneling. Actual or potential applications of this research include safe driving and other vigilance tasks.
Comparison of two programs to teach firearm injury prevention skills to 6- and 7-year-old children.
- Gatheridge BJ, Miltenberger RG, Huneke DF, Satterlund MJ, Mattern AR, Johnson BM, Flessner CA. Pediatrics 2004; 114(3): E294-929.
Correspondence: Ray Miltenberger, Department of Psychology, North Dakota State University, Fargo, ND 58105, USA; (email: ray.miltenberger@ndsu.nodak.edu).
BACKGROUND: Each year, hundreds of children unintentionally kill or injure other children while playing with firearms in the United States. Although the numbers of these deaths and injuries are distressing, few prevention programs have been developed to prevent gun play among children.
OBJECTIVE: This study compared the efficacy of 2 programs designed to prevent gun play among young children.
DESIGN: A posttest-only, control group design with 2 treatment groups was used. Children were randomly assigned to 1 of 2 treatment groups or a control group. For all children who did not exhibit the skills after training, 1 in situ (ie, real-life situation) training session was conducted.
SETTING: Participant recruitment, training sessions, and assessments were all conducted in the children's after-school program facility.
PARTICIPANTS: Forty-five children, 6 or 7 years of age, were recruited for participation. Interventions. The efficacy of the Eddie Eagle GunSafe Program, developed by the National Rifle Association, and a behavioral skills training program that emphasized the use of instruction, modeling, rehearsal, and feedback was evaluated.
MAIN OUTCOME MEASURES: The criterion firearm safety behaviors included both motor and verbal responses, which were assessed in a naturalistic setting and then assigned a numerical value based on a scale of 0 to 3.
FINDINGS: Both programs were effective for teaching children to verbalize the safety skills message (don't touch the gun, get away, and tell an adult). However, children who received behavioral skills training were significantly more likely to demonstrate the desired safety skills in role-playing assessments and in situ assessments than were children who received Eddie Eagle program training. In addition, in situ training was found to be effective for teaching the desired safety skills for both groups of children.
COMMENTS: Injury prevention programs using education-based learning materials are less effective for teaching children the desired safety skills, compared with programs incorporating active learning approaches (eg, modeling, rehearsal, and feedback). The efficacy of both types of injury prevention programs for teaching the desired skills could be significantly enhanced with the use of in situ training. This program, when implemented with 6- and 7-year-old children, was effective in teaching the desired safety skills.
An evaluation of a "best practices" musculoskeletal injury prevention program in nursing homes.
- Collins JW, Wolf L, Bell J, Evanoff B. Inj Prev 2004; 10(4): 206-211.
Correspondence: James W Collins, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Division of Safety Research, Morgantown, West Virginia, USA; (email: JCollins1@cdc.gov).
OBJECTIVE: To conduct an intervention trial of a "best practices" musculoskeletal injury prevention program designed to safely lift physically dependent nursing home residents.
DESIGN: A pre-post intervention trial and cost benefit analysis at six nursing homes from January 1995 through December 2000. The intervention was established in January 1998 and injury rates, injury related costs and benefits, and severity are compared for 36 months pre-intervention and 36 months post-intervention.
PARTICIPANTS: A dynamic cohort of all nursing staff (n = 1728) in six nursing homes during a six year study period.
INTERVENTION: "Best practices" musculoskeletal injury prevention program consisting of mechanical lifts and repositioning aids, a zero lift policy, and employee training on lift usage.
MAIN OUTCOME MEASURES: Injury incidence rates, workers' compensation costs, lost work day injury rates, restricted work day rates, and resident assaults on caregivers, annually from January 1995 through December 2000.
FINDINGS: There was a significant reduction in resident handling injury incidence, workers' compensation costs, and lost workday injuries after the intervention. Adjusted rate ratios were 0.39 (95% confidence interval (CI) 0.29 to 0.55) for workers' compensation claims, 0.54 (95% CI 0.40 to 0.73) for Occupational Safety and Health Administration (OSHA) 200 logs, and 0.65 (95% CI 0.50 to 0.86) for first reports of employee injury. The initial investment of $158,556 for lifting equipment and worker training was recovered in less than three years based on post-intervention savings of $55,000 annually in workers' compensation costs. The rate of post-intervention assaults on caregivers during resident transfers was down 72%, 50%, and 30% based on workers' compensation, OSHA, and first reports of injury data, respectively.
COMMENTS: The "best practices" prevention program significantly reduced injuries for full time and part time nurses in all age groups, all lengths of experience in all study sites.
Comparison of unintentional fatal occupational injuries in the Republic of Korea and the United States.
OBJECTIVES: To compare the profile of unintentional fatal occupational injuries in the Republic of Korea and the United States to help establish prevention strategies for Korea and to understand country specific differences in fatality risks in different industries.
METHODS: Occupational fatal injury data from 1998-2001 were collected from Korea's Occupational Safety and Health Agency's Survey of Causes of Occupational Injuries (identified by the Korea Labor Welfare Corporation) and from the United States Census of Fatal Occupational Injuries. Employment estimates were obtained in both countries. Industry coding and external cause of death coding were standardized. Descriptive analyses of injury rates and Poisson regression models to examine time trends were conducted.
FINDINGS: Korea exhibited a significantly higher fatal injury rate, at least two times higher than the United States, after accounting for different employment patterns. The ordering of industries with respect to risk is the same in the two countries, with mining, agriculture/forestry/fishing, and construction being the most dangerous. Fatal injury rates are decreasing in these two countries, although at a faster rate in Korea.
COMMENTS: Understanding industrial practices within different countries is critical for fully understanding country specific occupational injury statistics. However, differences in surveillance systems and employment estimation methods serve as caveats to any transnational comparison, and need to be harmonized to the fullest extent possible.
Effect of electronic ANR and conventional hearing protectors on vehicle backup alarm detection in noise.
Correspondence: John G. Casali, Grado Department of Industrial and Systems Engineering, Virginia Polytechnic Institute and State University, Blacksburg, Virginia 24061, USA; (email: jcasali@vt.edu).
An experiment was conducted wherein masked thresholds (using ascending method of limits) for a backup alarm were obtained in pink and red noise at 85 and 100 dBA for 12 participants immersed in a probability monitoring task and wearing a conventional passive hearing protection device (HPD, an earmuff or a foam earplug), an active noise reduction (ANR) headset, or no HPD at all (only in 85 dBA noise). Results revealed statistically significant between-HPD differences in red noise (from 2.3 to 3.1 dB) and in the 100-dBA noise level (from 2.6 to 4.3 dB). An additional finding, which corroborates other studies using different protocols, was that masked thresholds in 85-dBA noise were significantly lower (from 3.2 to 4.4 dB) for the occluded conditions (wearing an HPD) than for the open-ear (unoccluded) condition. This result refutes the belief among many normal-hearing workers that the use of HPDs in relatively low levels of noise compromises their ability to hear necessary workplace sounds. Actual or potential applications of this research include (a) the selection of appropriate HPDs for low-frequency-biased noise exposures wherein signal detection is important and (b) gaining insight into the appropriateness of ANR-based HPDs for certain industrial noise environments.
This paper estimates the incidence, unit costs, and annual costs of pedestrian and pedalcycle crash injuries in the United States. It includes medical care costs, household and wage work losses, and the value of pain, suffering, and lost quality of life. The estimates are broken down by body region and severity. They rely heavily on data from the health care system. Costs of pedestrian and pedalcycle injuries in 2000 will total $40 billion over the lifetimes of the injured. Most pedalcyclist injury costs and half of pedestrian injury costs do not involve motor vehicles. Youth ages 5-14 face greater annual risks when walking or driving their own pedaled vehicles than when being driven. Children under age 5 experience higher costs than their elders when injured as pedestrians. Our results suggest European and Japanese component tests used to design pedestrian injury countermeasures for motor vehicles are too narrow. Separate lower limb testing is needed for younger children. Testing for torso/vertebral column injury of adults also seems desirable.
Educational interventions successfully reduce pedestrians' overestimates of their own nighttime visibility.
Pedestrians dramatically overestimate their own visibility at night. This is likely to result in pedestrians unknowingly engaging in dangerous behavior. To determine the extent to which pedestrians' estimates of their own visibility are influenced by educational interventions, clothing reflectance, and headlamp beam setting, participants in 2 experiments estimated their own nighttime visibility by walking toward a stationary car to the point where they believed they were just recognizable as a pedestrian. In the first experiment 48 university students were tested and in the second experiment 9 high-school driver education students were tested. Overall, participants failed to appreciate the benefits of reflective clothing and of high-beam illumination. However, the participants in Experiment 1 who had heard a relevant lecture several weeks earlier gave estimates that were 10% shorter than did a control group. Participants in Experiment 2 heard a more focused and graphic-intensive lecture and gave estimates that were 56% shorter than did a control group. Potential applications of this research include increasing pedestrian safety by designing and implementing research-based public education campaigns aimed at reducing pedestrians' overestimates of their own nighttime visibility.
There are few studies that use measurable outcomes to gauge the effect of a public educator on the mission of the poison center. Human exposures, penetrance and total call volume from 2 regional poison centers for 7y (1996-2002) were evaluated. In poison center 1 a dedicated educator was employed for the final 4y of data (1999-2002). Poison center 2 data acted as a control with no dedicated educator for the 7-y period. The 2 centers were comparable in a number of ways: similar demographic rural and urban populations; similar geographic and economic region; and served the entire state. Human exposures in poison center 1 increased 4.3 % after employment of a dedicated educator, while exposure continued to decline at center 2 (1.7%). A steep decline in penetrance in poison center 1 was reversed after employment of a dedicated educator. Human exposures and penetrance for poison center 2 continued to decline during the study years. Total calls to center 1 increased 13.8% while total calls to center 2 remained flat (0.2%). This is the first study to use measurable outcomes to evaluate the impact of a public educator on the mission of a poison center. The addition of a public educator was associated with a positive impact on human exposures and penetrance reported to a regional poison center.
Linguistic and location effects in compliance with pesticide warning labels for amateur and professional users.
- Edworthy J, Hellier E, Morley N, Grey C, Aldrich K, Lee A. Hum Factors 2004; 46(1): 11-31.
Correspondence: Judy Edworthy, Department of Psychology, University of Plymouth, Drake Circus, Plymouth, Devon, PL4 8AA, UK. (email: j.edworthy@plymouth.ac.uk)
Three studies explored amateur and professional users' compliance with pesticide warning labels. Professionals were classified as people working in a profession in which the use of pesticides is a necessary part of their job. Amateurs used pesticides only in their leisure time. The first study showed that the wording used affected perception of the appropriateness of hazard statements, one of the most effective variations being the use of the personal pronoun (statements beginning "You should..."). The location of warning information was also found to affect actual compliance: Compliance increased when warning information was presented in the directions for use section. A supplemental directive increased compliance only for professional users. In a final study, "best-case" and "worst-case" linguistic variations were combined with best-case and worst-case locations for safety information. Instruction statements using the personal pronoun and presented in the directions for use section resulted in the highest levels of compliance. The differences in compliance between amateur and professional users are interpreted within the framework of Rasmussen's (1986) distinction among skill-, rule-, and knowledge-based behavior. Actual or potential applications of this research include the design of warning labels and safety information.
Correspondence: M. Levy, Division of Neurosurgery, University of California at San Diego School of Medicine, San Diego, California, USA; (email: unavailable).
OBJECTIVE: To review the advent and evolution of the football helmet through historical, physiological, and biomechanical analysis.
METHODS: We obtained data from a thorough review of the literature.
FINDINGS: Significant correlation exists between head injuries and the advent of the football helmet in 1896, through its evolution in the early to mid-1900s, and regulatory standards for both helmet use and design and tackling rules and regulations. With the implementation of National Operating Committee on Standards for Athletic Equipment standards, fatalities decreased by 74% and serious head injuries decreased from 4.25 per 100,000 to 0.68 per 100,000. Not only is the material used important, but the protective design also proves essential in head injury prevention. Competition among leading helmet manufacturers has benefited the ultimate goal of injury prevention. However, just as significant in decreasing the incidence and severity of head injury is the implementation of newer rules and regulations in teaching, coaching, and governing tackling techniques.
COMMENTS: Helmet use in conjunction with more stringent head injury guidelines and rules has had a tremendous impact in decreasing head injury severity in football. Modifications of current testing models may further improve helmet design and hence further decrease the incidence and severity of head injury sustained while playing football.
Protective eyewear promotion : applying principles of behaviour change in the design of a squash injury prevention programme.
- Eime R, Owen N, Finch C. Sports Med 2004; 34(10): 629-638.
Correspondence: R. Eime, Sports Injury Prevention Research Unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, AUSTRALIA; (email: rochelle.eime@med.monash.edu.au).
Eye injuries in squash have the potential to be severe. Although these injuries can be prevented through the use of protective eyewear, few players wear such eyewear. The aim of this paper is to outline the behavioural principles guiding the design of a squash eyewear promotion initiative, the Protective Eyewear Promotion (PEP). Ecological principles of behaviour change were used to provide a comprehensive perspective on intrapersonal factors, policies and physical environmental influences of protective eyewear use. Results of baseline player surveys and venue manager interviews were used to provide relevant and specific intervention content. At baseline, protective eyewear was not found to be readily available, and players' behaviours, knowledge and attitudes did not favour its use. The main components of PEP involved informing and educating both players and squash venue operators of the risk of eye injury and of appropriate protective eyewear, as well as assisting with the availability of the eyewear and offering incentives for players to use it. A structural strength of PEP was the strong collaborative links with the researchers of different disciplines, the squash governing body, eyewear manufacturers, squash venue personnel, as well as players. Attempts were made within the project structure to make provision for the future dissemination and sustainability of more widespread eye injury prevention measures in the sport of squash.
BACKGROUND:We wanted to investigate the incidence of burns and the volume of in-hospital burn treatment in Norway.
METHODS: Data for 1999 were compiled from hospital admissions as reported to the Norwegian Patient Register. Selection was based on ICD-10 codes for burns, though caustic injuries, reconstructive procedures, and patients discharged alive with length-of-stay less than 1 day were not included.
FINDINGS: 707 admissions requiring 9444 days in hospital were identified. The incidence of burns admitted to hospital was 13.5/100 000 inhabitants/year. Additionally, 102 admissions were coded as post-burn reconstructive cases. 50 % all admissions and 40 % of all days in hospital for burns were in hospitals without a department of plastic surgery. 24 burn patients died before discharge; 50% of those who died were above 80 years of age. 29% of all stays included a code representing surgical procedures involving skin excision and grafting.
COMMENTS: The incidence of burns admitted to hospitals in 1999 was reduced by 20 % compared to a 1977 survey. The number of reconstructive procedures was low; these options should probably be offered to more patients. We suggest that early transfer to a specialised burn centre should be considered for a somewhat larger proportion of patients.
Health problems and health behaviors of preschoolers.
- Kim HS, Lee CY, Lee TW, Ham OK. Taehan Kanho Hakhoe Chi 2004; 34(1): 182-190.
Correspondence: H. Kim, College of Nursing, Nursing Policy Research Institute, Yonsei University, KOREA; (email: unavailable).
OBJECTIVE: This study was conducted to understand the health status and health behaviors of preschoolers to provide baseline data for developing health promotion programs.
METHODS: Parents of children attending day-care centers were recruited for the study. Participating day-care centers were selected using a stratified sampling method. Data was collected from June to August 2002 using a questionnaire.
FINDINGS: Among 754 preschoolers, 17.3% were overweight, while 18.2% were underweight. The most frequent infectious diseases that children have had previously were hand-foot-mouth disease (20.2%) and chicken pox (18.7%). Current health conditions that children have frequently are respiratory disease (28%) and atopic dermatitis (23.8%). Only 61% brush their teeth everyday at bedtime, 54.3% wash their hands every time after returning home, 8.8% wear bicycle helmets, 9.3% use a child car seat, and 8.1% eat fruits and vegetables five times a day. Children residing in the metropolitan area were more likely to have positive health behaviors, and children of parents with an advanced college level education were more likely to have positive health behaviors than those with only a high school level education.
COMMENTS: Based on the study results, health professionals could plan and develop health promotion programs to change unhealthy behaviors of preschoolers targeting high-risk groups.
Surveillance for fatal and nonfatal injuries--United States, 2001.
Correspondence: J. Lee Annest, Office of Statistics and Programming, National Center for Injury Prevention and Control, USA; (email: lannest@cdc.gov).
BACKGROUND: Each year in the United States, an estimated one in six residents requires medical treatment for an injury, and an estimated one in 10 residents visits a hospital emergency department (ED) for treatment of a nonfatal injury. This report summarizes national data on fatal and nonfatal injuries in the United States for 2001, by age; sex; mechanism, intent, and type of injury; and other selected characteristics.
REPORTING PERIOD COVERED: January-December 2001.
DESCRIPTION OF SYSTEM: Description of the System: Fatal injury data are derived from CDC's National Vital Statistics System (NVSS) and include information obtained from official death certificates throughout the United States. Nonfatal injury data, other than gunshot injuries, are from the National Electronic Injury Surveillance System All Injury Program (NEISS-AIP), a national stratified probability sample of 66 U.S. hospital EDs. Nonfatal firearm and BB/pellet gunshot injury data are from CDC's Firearm Injury Surveillance Study, being conducted by using the National Electronic Injury Surveillance System (NEISS), a national stratified probability sample of 100 U.S. hospital EDs.
FINDINGS: In 2001, approximately 157,078 persons in the United States (age-adjusted injury death rate: 54.9/100,000 population; 95% confidence interval [CI] = 54.6-55.2/100,000) died from an injury, and an estimated 29,721,821 persons with nonfatal injuries (age-adjusted nonfatal injury rate: 10404.3/100,000; 95% CI = 10074.9-10733.7/ 100,000) were treated in U.S. hospital EDs. The overall injury-related case-fatality rate (CFR) was 0.53%, but CFRs varied substantially by age (rates for older persons were higher than rates for younger persons); sex (rates were higher for males than females); intent (rates were higher for self-harm-related than for assault and unintentional injuries); and mechanism (rates were highest for drowning, suffocation/inhalation, and firearm-related injury). Overall, fatal and nonfatal injury rates were higher for males than females and disproportionately affected younger and older persons. For fatal injuries, 101,537 (64.6%) were unintentional, and 51,326 (32.7%) were violence-related, including homicides, legal intervention, and suicide. For nonfatal injuries, 27,551,362 (92.7%) were unintentional, and 2,155,912 (7.3%) were violence-related, including assaults, legal intervention, and self-harm. Overall, the leading cause of fatal injury was unintentional motor-vehicle-occupant injuries. The leading cause of nonfatal injury was unintentional falls; however, leading causes vary substantially by sex and age. For nonfatal injuries, the majority of injured persons were treated in hospital EDs for lacerations (25.8%), strains/sprains (20.2%), and contusions/abrasions (18.3%); the majority of injuries were to the head/neck region (29.5%) and the extremities (47.9%). Overall, 5.5% of those treated for nonfatal injuries in hospital EDs were hospitalized or transferred to another facility for specialized care.
COMMENTS: This report provides the first summary report of fatal and nonfatal injuries that combines death data from NVSS and nonfatal injury data from NEISS-AIP. These data indicate that mortality and morbidity associated with injuries affect all segments of the population, although the leading external causes of injuries vary substantially by age and sex of injured persons. Injury prevention efforts should include consideration of the substantial differences in fatal and nonfatal injury rates, CFRs, and the leading causes of unintentional and violence-related injuries, in regard to the sex and age of injured persons.
Correspondence: Michele L. Ybarra, Johns Hopkins Bloomberg School of Public Health, Center for Adolescent Health Promotion and Disease Prevention, Baltimore, MD, USA; (email: mybarra@jhsph.edu).
BACKGROUND: While most youth report positive experiences and activities online, little is known about experiences of Internet victimization and associated correlates of youth, specifically in regards to Internet harassment.
METHODS: The Youth Internet Safety Survey is a cross-sectional, nationally representative telephone survey of young regular Internet users in the United States. Interviews were conducted between the fall of 1999 and the spring of 2000 and examined characteristics of Internet harassment, unwanted exposure to sexual material, and sexual solicitation that had occurred on the Internet in the previous year. One thousand, five hundred and one regular Internet users between the ages of 10 and 17 years were interviewed, along with one parent or guardian. To assess the characteristics surrounding Internet harassment, four groups of youth were compared: 1) targets of aggression (having been threatened or embarrassed by someone; or feeling worried or threatened by someone's actions); 2) online aggressors (making rude or nasty comments; or harassing or embarrassing someone with whom the youth was mad at); 3) aggressor/targets (youth who report both being an aggressor as well as a target of Internet harassment); and 4) non-harassment involved youth (being neither a target nor an aggressor online).
FINDINGS: Of the 19% of young regular Internet users involved in online aggression, 3% were aggressor/targets, 4% reported being targets only, and 12% reported being online aggressors only. Youth aggressor/targets reported characteristics similar to conventional bully/victim youth, including many commonalities with aggressor-only youth, and significant psychosocial challenge.
COMMENTS: Youth aggressor/targets are intense users of the Internet who view themselves as capable web users. Beyond this, however, these youth report significant psychosocial challenge, including depressive symptomatology, problem behavior, and targeting of traditional bullying. Implications for intervention are discussed.
Farm fatalities to youth 1995-2000: A comparison by age groups.
- Goldcamp M, Hendricks KJ, Myers JR. J Safety Res 2004; 35(2): 151-157.
Correspondence: Michael Goldcamp, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Morgantown, WV, USA; (enail: ehg8@cdc.gov).
BACKGROUND: Although a myriad of research illustrates the safety issues related to farm fatalities in youth populations, very little empirical evidence exists that includes work and non-work related farm fatalities to all youths under 20 years of age at the national level.
METHODS: This research will use death certificate data for the six years from 1995 to 2000 that were collected by NIOSH from all 50 state vital statistics registries. Demographic data from the 1998 CAIS were used in rate calculations. In addition to providing annual fatality rates and descriptions of the general causes of death, this research will examine the variation between age groups.
FINDINGS: Analysis of 695 total farm-related youth fatalities shows an average annual fatality rate of 9.3 fatalities per 100,000 youths. Males account for 80% of these fatalities. The most prevalent causes of death are: machinery (25%), motor vehicle (17%), drowning (16%), suicide (8%) and homicide (6%). Of all youth fatalities occurring while at work, 45% are to youths less than 16 years of age. This same age group accounts for 71% of all non-work related fatalities.
COMMENTS: This research will provide farm families and researchers more detailed information on farm hazards that contribute to the deaths of youths. As these youths may encounter hazards while working or playing in their daily environment, identification and elimination of these hazards will increase overall safety on the farm. This research also indicates the need to include youths under 16 years of age in future comprehensive farm safety research.
Help seeking amongst child and adolescent victims of peer-aggression and bullying: The influence of school-stage, gender, victimisation, appraisal, and emotion.
BACKGROUND: An important element of many anti-bullying programmes is encouraging victims to tell someone about their predicament. Research has already reported prevalence of telling, who/when children tell and efficacy of telling. However, seeking help can be viewed as a coping behaviour, and coping processes such as appraisal and emotion may be important predictors of whether pupils ask for help.
OBJECTIVE: To examine the effects that background variables (gender, school-stage), victimisation (duration, frequency), appraisal (threat, challenge, control) and negative emotion have upon support seeking by child and adolescent victims of peer-aggression and bullying. To also examine how effective pupils perceive social support to be.
SAMPLE: Participants were 830 children (49% male) aged 9-14 years. Three hundred and seventeen pupils were in Primary 6, 307 in Secondary 2 and 206 in Secondary 3.
METHOD: A self-report bullying questionnaire was completed by the participants within their classes. Questionnaires included items relating to victimisation, appraisal, emotion, and coping strategy choice as well as demographic data.
FINDINGS: Hierarchical multiple regression analysis revealed that gender, challenge appraisals, and emotions were significant predictors of the degree to which child and adolescent victims of peer-aggression and bullying sought help (accounting for 15.8% of the variance): girls were more likely than boys to seek help, as were pupils with high challenge appraisals or those experiencing high levels of negative emotion. Also, girls were more likely than boys to view support as the best strategy for both stopping bullying and for helping them to feel better.
COMMENTS: Results suggest that pupils are more willing to seek help when they see the situation as one in which something can be achieved. Pupils also may be seeking support to get help coping with negative emotions, and this may need to be emphasized to teachers.
Protection of human subjects in intervention research for suicidal behavior.
- Oquendo MA, Stanley B, Ellis SP, Mann JJ. Am J Psychiatry 2004; 161(9): 1558-1563.
Correspondence: Maria Oquendo, Department of Neuroscience, New York State Psychiatric Institute/Columbia University, 1051 Riverside Dr., Unit 42, New York, NY 10032, USA; (email: moquendo@neuron.cpmc.columbia.edu).
OBJECTIVE: Three domains of ethical conduct outlined in the U.S. Food and Drug Administration's 1998 Belmont Report on protection of human research subjects-respect for persons, beneficence, and justice-have posed specific dilemmas in the design of intervention studies for suicidal behavior. These issues include questions about suicidal patients' capacity to provide informed consent, the risk of some lethal outcomes, the possibility of imminent suicide risk associated with patients' right to discontinue the study treatment, and the need for a higher level of monitoring of suicidal patients. The authors examine these and other issues and discuss ways they can be addressed in research design.
METHODS: To illustrate solutions to these bioethical tensions, the authors describe the design of a randomized, controlled trial of pharmacotherapy for suicidal behavior in bipolar disorder.
FINDINGS: Using surrogate outcome measures, allowing prescription of rescue medications, integrating psychosocial interventions, and providing close clinical monitoring enable researchers to conduct research on suicidal behavior while maximizing adherence to the ethical recommendations outlined in the Belmont Report. Alternative study designs, such as add-on trials, in which the study treatment or placebo is added on to known effective treatment, may also be used in research on suicidal behavior.
COMMENTS: It is possible to design a randomized, controlled trial that minimizes the risk of morbidity and mortality for suicidal patients with bipolar disorder, but deliberation is required to address the bioethical tensions that arise.
A comparison of seasonal variation between suicide deaths and attempts in Hong Kong SAR.
Correspondence: Paul S. F. Yip, The Hong Kong Jockey Club Centre for Suicide Research and Prevention, The University of Hong Kong, Pokfulam, Hong Kong, CHINA; (email: sfpyip@hku.hk).
BACKGROUND: Seasonal variations in suicide deaths and attempted suicides have been reported for many countries. Recent research has suggested that seasonal patterns of suicide deaths have diminished considerably. The seasonality pattern between attempts and completed ones are not the same. This paper is the first one to examine seasonal variation between suicide deaths and attempts simultaneously.
METHODS: Census and Statistics Department and the Hospital Authority provided mortality and morbidity data on suicides for the period 1997-2001 in Hong Kong SAR, respectively. Seasonal patterns of suicide deaths and attempts were examined by a harmonic analysis and a non-parametric chi-square test.
FINDINGS: A significant seasonal variation was detected in suicide attempts with a markedly bi-seasonal pattern was found amongst females with a peak in May and October; only a cyclic pattern was observed for males with a peak in summer. The female attempters who used non-violent suicide methods contributed to the second peak in October. On the other hand, there was no evidence of significant differences in the seasonal distribution among the suicide deaths for males and females. Only a mild pattern was found amongst females involving in violent suicide deaths, while others can be treated as a random event and no significantly pattern was observed in our study. Overall, a significant difference in seasonal variation existed between suicide deaths and attempts (p-value<0.01).
COMMENTS: This study reinforces the findings that seasonal variation in suicide appears to be diminishing. Also, suicide attempters and completed suicides in Hong Kong seem to arise from two non-identical but overlapping groups in the community.
Correlates of attempted suicide among young injection drug users in a multi-site cohort.
- Havens JR, Strathdee SA, Fuller CM, Ikeda R, Friedman SR, Des Jarlais DC, Morse PS, Bailey S, Kerndt P, Garfein RS; Collaborative Injection Drug User Study Group. Drug Alcohol Depend 2004; 75(3): 261-269.
Correspondence: Jennifer R. Havens, Center on Drug and Alcohol Research, University of Kentucky, 915B South Limestone, Lexington, KY 40536, USA; (email: jennifer.havens@uky.edu).
The purpose of this study was to determine the prevalence and correlates of attempted suicide among young injection drug users (IDUs) from six study sites in five US cities. Two thousand two hundred and nineteen participants 15-30 years of age underwent interviewer-administered questionnaires relating to self-reported drug use, sociodemographics, suicidal ideation and attempts, and exposure to violence. The 6-month prevalence of suicidal ideation and attempts was 35.8% and 7%, respectively. Compared to those not reporting a recent (past 6 months) suicide attempt, those attempting suicide were more likely to have a lifetime history of mental health facility admission or sexual abuse. Participants receiving drug treatment at the time of the baseline interview (53.2% versus 37.1%, odds ratio, 95% confidence interval [CI]: 1.39, 2.67) were also more likely to report a recent attempt; as were those reporting a history of experiencing violence. These associations persisted after adjusting for age, sex, race/ethnicity, study site, and other significant covariates by multiple logistic regression. These data suggest that increased access to drug treatment, community mental health, and violence prevention programs may decrease suicidal behavior among young injection drug users.
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.
FINDINGS: 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).
COMMENTS: 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.
Lap and shoulder belts have been required in rear outboard positions since 1989. A recent congressional mandate encouraged the requirement of a lap and shoulder belt in the center rear seat position. This study utilized Data from the Partners for Child Passenger Safety study, a large-scale child-focused crash surveillance system, to quantify changes in seating patterns for children in vehicles that already have this feature compared to those which do not and measured the safety benefit associated with the provision of a shoulder belt in the center rear seat position. The data demonstrate that the presence of a shoulder belt in the center rear seating position influences seating practices only when there is a single child occupant in the vehicle. Belted children in the center rear of vehicles equipped with a lap shoulder belt are at an 81% reduction in risk of injury than those belted in the center rear equipped with a lap only belt. The data suggest that by requiring lap shoulder belts in the center rear, benefits would be realized to belted children, specifically the 4-8 year old group.
Correspondence: K. Smart, Air Accidents Investigation Branch, Department for Transport, Great Minster House, 76 Marsham Street, London SW1P 4DR, UK; (email: sduffin@aaib.gov.uk).
Within the United Kingdom the Air Accidents Investigation Branch (AAIB) has been used as a model for the other transport modes accident investigation bodies. Government Ministers considered that the AAIB's approach had established the trust of the public and the aviation industry in its ability to conduct independent and objective investigations. The paper will examine the factors that are involved in establishing this trust. They include: the investigation framework; the actual and perceived independence of the accident investigating body; the aviation industry's safety culture; the qualities of the investigators and the quality of their liaison with bereaved families those directly affected by the accidents they investigate.
Methods of multidisciplinary in-depth analyses of road traffic accidents.
A multidisciplinary Road Accident Analysis Group with the objective of conducting in-depth investigations of specific types of accidents has existed in Denmark for some years. The group has analysed head-on collisions, left-turn accidents, truck accidents and single vehicle accidents. The data collection included police reports, the group's investigation of accident sites and vehicles involved, and interviews with the involved road users and witnesses. The main accident factors in the head-on collisions and in the single vehicle accidents were excessive speed, drunk driving and driving under the influence of illegal drugs. The primary accident factors in left-turn accidents were attention errors or misjudging the amount of time available to complete the left turn. In the truck accidents insufficient searching for visual information as well as speeding were major factors. For all the accident themes the primary injury factor was failure to wear seat- belts. The multidisciplinary approach has provided a rather precise knowledge of the contributing factors leading up to the accident. The method requires a lot of resources, which is a limiting factor for the number of accidents to be analysed in this way. However, the method is suitable for analysis of common occurring or very serious types of accidents.
BACKGROUND: Domestic violence screening recommendations that guide pediatric care providers exist but screening remains low. Many providers do not understand the linkages between aversive childhood experiences and adult abuse experiences.
OBJECTIVE: To describe the childhood abuse experiences in 40 battered women.Research questions How prevalent is childhood abuse in a sample of battered women? How do these women describe their childhood abuse experiences?
METHODS: Women who had left or were currently in abusive relationships were recruited by posting advertisements in public areas. Each woman participated in a semi-structured individual interview that included open-ended questions and administration of standardized measures.
FINDINGS: Most women described abuse during their childhood, reported high depressive symptoms, and indicated a high potential risk for child abuse. Content analysis of descriptions of childhood abuse experiences yielded five themes: socialization not to tell, normalcy of events, abandonment, escape, and shame. Women reported limited assistance during their childhood and adult abuse experiences from health care providers who lacked a family focus.
COMMENTS: Mothers' experiences with childhood and adult abuse challenge their ability to develop healthy family relationships. Pediatric health care providers must routinely screen for abuse in mothers and children within a family-centered approach.
Violence and social representation in teenagers in Brazil.
Correspondence: Fundacao Oswaldo Cruz (FIOCRUZ), Departamento de Epidemiologia e Metodos Quantitativos em Saude, e Centro Latino-Americano de Estudos de Violencia e Saude Jorge Careli (CLAVES), Rio de Janeiro (RJ), BRAZIL; (email: unavailable).
OBJECTIVE: To investigate the association between the self-representation of teenagers and the severe physical, psychological, and sexual violence inflicted on them by close family relations, especially their parents, and to analyze the association between victimization in the family and victimization in other social spaces.
METHOD: An epidemiological survey was carried out in 2002 with 1 685 adolescents chosen at random from public and private schools in the municipality of Sao Goncalo, which is in the state of Rio de Janeiro, Brazil. To measure each form of violence, we used scales of tactics for dealing with conflict, of child abuse and trauma, and of psychological violence.
FINDINGS: We found that 14.6% of the students had been physically abused by the father or the mother and that 11.8% had witnessed sexual abuse of another family member or they themselves had been sexually abused. In addition, 48.0% of the students reported having been psychologically abused by a close relation. In comparison to students who had not been abused, the victims of family abuse were more often also victims of community and school violence, and they also more frequently reported having broken the law. Overall, the adolescents surveyed had a positive self-representation, but the adolescents who had been abused mentioned negative self-attributes more frequently than did the teenagers who had not been abused.
COMMENTS: The predominantly positive social representation of teenagers must be supported by health promotion initiatives. The finding of an association between indices of violence and the teenager's various spheres of action indicates that resolving this problem will require strategies that target all these spheres.
Detection of non-accidental injuries presenting at emergency departments.
- McKinney A, Lane G, Hickey F. Emerg Med J 2004; 21(5): 562-564.
Correspondence: A. McKinney, Department of Mental Health, Queens University Belfast, Whitla Medical Building, 97 Lisburn Road, Belfast BT9 7BL, UK; (email: adelemckinney@hotmail.com).
OBJECTIVES: To investigate whether cases of possible non-accidental injury as identified using five risk indicators give rise to any subjective concerns of child abuse.
METHODS: Questionnaires were completed by the triage nurse and attending doctor for every child attending the general hospitals of the North Western Health Board, with an injury, during a six month period. The questionnaires included an assessment of subjective concerns about the injury occurrence and five risk indicators of child abuse.
FINDINGS: Children presenting with an injury who had two or more positive indicators failed to raise subjective concerns in the attending emergency department staff.
COMMENTS: The introduction of a policy of identifying positive indicators from the five risk indicators of child abuse needs additional computer support within emergency departments.
