29 April 2002
Changing the minimum legal drinking age--its effect on a central city emergency department.
- Everitt R, Jones P. N Z Med J 2002; 115(1146): 9-11.
Correspondence: Robert Everitt, Department of Emergency Medicine, Auckland Hospital (email: Robert.Everitt@waitematadhb.govt.nz).
OBJECTIVES: To quantify the effect of a recent national law change on the presentation of ethanol intoxicated patients to a central city Emergency Department (ED).
METHODS: All records of ethanol intoxicated patients presenting to the ED for twelve months before and after the change to the minimum legal drinking age were studied. Each patient was classified as having laboratory confirmed intoxication, clinical suspicion only, or no record of intoxication. Three age groups were identified, 15-17 year olds, eighteen and nineteen year olds and over 20 year olds. Within each age group the proportion of presentations with ethanol intoxication was compared across the two time periods.
RESULTS: The number of intoxicated 18 and 19 year olds increased in the twelve months after the national law change from 66 to 107 (52 to 80 for laboratory confirmed intoxication and fourteen to 27 for clinical suspicion only). This represented an increase in the proportion of presentations in this age group with intoxication (p=0.009) from 2.9% to 4.4%, a 50% increase (RR=1.51, 95%CI 1.11-2.03). There was no evidence of an increase in the proportion intoxicated for those over nineteen years (3.4% vs 3.3%, p=0.48, RR=0.97, 95%CI=0.89-1.06) although the numbers increased slightly (963 to 992). However there was a worrying trend for an increase in the 15-17 year olds, with numbers increasing from 72 to 95 and the proportion increasing from 5.0% to 6.7% (p=0.07, RR=1.35, 95%CI=0.98-1.88).
CONCLUSION: The recent lowering of the minimum legal drinking age from 20 to eighteen years has resulted in increased presentations to the ED of intoxicated eighteen and nineteen year olds. A similar trend was seen in the 15-17 year olds.
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No reports this week
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Evaluation of a child safety program based on the WHO safe community model.
- Lindqvist K, Timpka T, Schelp L, Risto O. Inj Prev 2002; 8(1): 23-26.
Correspondence: Kent Lindqvist, Department of Health and Society, Faculty of Health Sciences, Linkoping University, S-581 85 Linkoping, SWEDEN (email: kenli@ihm.liu.se).
OBJECTIVES: To evaluate the outcome of the World Health Organization (WHO) Safe Community model with respect to child injuries.
METHODS: A population based quasiexperimental design was used. Cross sectional pre-implementation and post-implementation data were collected in intervention (Motala municipality) and control (Mjolby municipality) areas, both in Ostergotland county, Sweden.
RESULTS: The total relative risk of child injury in the intervention community decreased more (odds ratio 0.74; 95% confidence interval (CI) 0.68 to 0.81) than in a control community exposed only to national level injury prevention programs (0.93; 95% CI 0.82 to 1.05). The relative risk of moderately (abbreviated injury scale (AIS) 2) severe injury in the study area was reduced to almost a half (odds ratio 0.49; 95% Cl 0.41 to 0.57), whereas the risk of minor (AIS 1) injuries decreased only slightly (odds ratio 0.89; 95% CI 0.80 to 0.99). The risk of severe or fatal (AIS 3-6) injuries remained constant.
CONCLUSIONS: After introduction of an injury prevention program based on the WHO Safe Community model, the relative risk for child injury in the intervention community decreased significantly more than in a control community exposed only to national injury prevention programs.
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Predictors of falls in the Melbourne Visual Impairment Project.
- McCarty CA, Fu CL, Taylor HR. Aust N Z J Public Health 2002; 26: 116-124.
Correspondence: Catherine A. McCarty, Marshfield Clinic - Marshfield Center, 1000 N Oak Avenue, Marshfield, WI 54449
OBJECTIVE: To assess factors associated with falls in the past month, including visual acuity and other vision-related variables.
METHODS: A household census was used to recruit permanent residents aged 40 years and older for baseline examinations of the Melbourne Visual Impairment Project conducted from 1992-94. At the five-year follow-up examinations, returning participants were asked to recall all falls that they had ever experienced and also how many falls they had experienced in the past month. Falls history was divided into those that occurred at home and away from home. Standardised examination of visual acuity was performed.
RESULTS: Of the original cohort of 3,271, 231 (7.1%) were reported to have died, leaving 3,040 eligible. Of these, 2,594 (85%) were examined, 51 (2%) had moved interstate or overseas, 83 (3%) could not be traced, and 312 (10%) refused to participate. A history of having ever fallen at home was reported by 466 (20%) participants, and 406 (17.3%) reported having fallen away from home at least once. Five per cent of the cohort (129/2,343) had fallen in the previous month. Factors significantly related to falls at home in the past month in a multivariate logistic regression model included age (OR=1.56 for 10-year age groups) and nuclear cataract (OR=2.87).
CONCLUSIONS: Irrespective of visual acuity, cataract is major risk factor for falls at home. Interventions aimed at decreasing the incidence of falls in the community should include assessment of both visual acuity and cataract status and referral for treatment if functional impairment is evident.
Risk factors for burns in children: crowding, poverty, and poor maternal education.
- Delgado J, Ramirez-Cardich ME, Gilman RH, Lavarello R, Dahodwala N, Bazan A, Rodriguez V, Cama RI, Tovar M, Lescano A. Inj Prev 2002; 8(1):38-41.
Correspondence: Robert H. Gilman, Asociacion Benefica PRISMA, Av Carlos Gonzales #251, Lima 32, PERU (email: rgilman@prisma.org.pe).
OBJECTIVE: To characterize the presentation of burns in children and risk factors associated with their occurrence in a developing country as a basis for future prevention programs. DESIGN: Case-control study. Setting: Burn unit of the National Institute of Child Health (Instituto Nacional de Salud del Nino) in Lima, Peru.
METHODS: A questionnaire was administered to all consenting guardians of children admitted to the burns (cases) and general medicine (controls) units during a period of 14 months. Guardians of patients were questioned regarding etiology of the injury, demographic and socioeconomic data.
RESULTS: 740 cases and controls were enrolled. Altogether 77.5% of the cases burns occurred in the patient's home, with 67.8% in the kitchen; 74% were due to scalding. Most involved children younger than 5 years. Lack of water supply (odds ratio (OR) 5.2, 95% confidence interval (CI) 2.1 to 1 2.3), low income (OR 2.8, 95% CI 2.0 to 3.9), and crowding (OR 2.5, 95%CI 1.7 to 3.6) were associated with an increased risk. The presence of a living room (OR 0.6, 95% CI 0.4 to 0.8) and better maternal education (OR 0.6, 95% CI 0.5 to 0.9) were protective factors.
CONCLUSIONS: To prevent burns interventions should be directed to low socioeconomic status groups; these interventions should be designed accordingly to local risk factors.
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Factors Associated with Pilot Fatalities in Work-Related Aircraft Crashes --- Alaska, 1990--1999.
- Conway G, Moran K, Bensyl D. MMWR 2002; 51(16): 347-349.
Full report available online: ( Download Document ).
BACKGROUND: Despite its large geographic area, Alaska has only 12,200 miles of public roads, and 90% of the state's communities are not connected to a highway system. Commuter and air-taxi flights are essential for transportation of passengers and delivery of goods, services, and mail to outlying communities. Because of the substantial progress in decreasing fatalities in the fishing and logging industries, aviation crashes are the leading cause of occupational death in Alaska. During 1990--1999, aircraft crashes in Alaska caused 107 deaths among workers classified as civilian pilots. This is equivalent to 410 fatalities per 100,000 pilots each year, approximately five times the death rate for all U.S. pilots and approximately 100 times the death rate for all U.S. workers. As part of a collaborative aviation safety initiative that CDC's National Institute for Occupational Safety and Health (NIOSH) is implementing with the Federal Aviation Administration (FAA), the National Transportation Safety Board (NTSB), and the National Weather Service, CDC analyzed data from NTSB crash reports to determine factors associated with pilot fatalities in work-related aviation crashes in Alaska. This report summarizes the result of this analysis, which found that the following factors were associated with pilot fatalities: crashes involving a post-crash fire, flights in darkness or weather conditions requiring instrument use, crashes occurring away from an airport, and crashes in which the pilot was not using a shoulder restraint. Additional pilot training, improved fuel systems that are less likely to ignite in crashes, and company policies that discourage flying in poor weather conditions might help decrease pilot fatalities. More detailed analyses of crash data, collaborations with aircraft operators to improve safety, and evaluation of new technologies are needed.
METHODS: Aircraft crash reports are compiled by NTSB and entered into a database maintained by FAA's National Aviation Safety Data Analysis Center. Crashes in which pilots in command died were compared retrospectively with those in which they survived. All variables, except age, were dichotomized. Wald Chi-squared analyses were then completed. Factors that were evaluated included age, shoulder-restraint use, weather conditions (used as a marker for poor visibility), light conditions (light or dark), aircraft type (plane or helicopter), occurrence of post-crash fire, location (on or off airport), flight experience (median: 4,350 hours, range: 78--20,000 hours), and whether the pilot was an Alaska resident (a surrogate for familiarity with geography and flight conditions in Alaska). The Statistical Analysis System (SAS) software was used to generate odds ratios.
RESULTS: The study identified 675 work-related crashes; in 567 (84%), the pilot survived, and in 108 (16%), the pilot died. The estimated likelihood of pilot death was 14 times higher when a fire occurred than when one did not, seven times higher for flights that crashed in instrument meteorological conditions than for crashes in conditions of greater visibility, and approximately two times higher for crashes that occurred away from an airport or in darkness; the estimated likelihood of a pilot dying was significantly lower when the pilot used a shoulder restraint.
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See Item 1 under Home & Consumer Product Issues
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No reports this week
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No reports this week
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Injuries in youth football: a prospective observational cohort analysis among players aged 9 to 13 years.
- Stuart MJ, Morrey MA, Smith AM, Meis JK, Ortiguera CJ. Mayo Clin Proc 2002; 77(4): 317-322.
Michael Stuart, Sports Medicine Center, Mayo Clinic, Rochester, Minn 55905, USA (email: stuart.michael@mayo.edu).
OBJECTIVE: To determine the risk of injury in youth football games.
METHODS: Nine hundred fifteen players aged 9 to 13 years on 42 teams participated, including 10 teams in each grade from grades 4 through 6 and 6 teams each in grades 7 and 8. The study was conducted in the fall of 1997. Injury incidence, prevalence, and severity were calculated for each grade level and player position. Additional analyses examined the number of injuries according to body weight.
RESULTS: A total of 55 injuries occurred in games during the entire season (overall prevalence, 5.97%). Most injuries were mild, and the most common type was contusion, which occurred in 33 players (60%). Four injuries (7%) were severe enough to prevent players from participating for the rest of the season. All 4 severe injuries were fractures involving the ankle physis. The risk of injury increased as players matured in age and grade level. Injury risk for an eighth-grade player was 4 times greater than the risk of injury to a fourth-grade player. A trend was identified for heavier players to be at increased risk, but no significant correlation was evident between body weight and injury.
CONCLUSION: Our prospective observational analysis showed that most youth football injuries are mild. Older and heavier players appear to be at higher risk.
Influence of safety gear on parental perceptions of injury risk and tolerance or children's risk taking.
- Morrongiello BA, Major K. Inj Prev 2002; 8(1): 27-31.
Barbara A. Morrongiello, University of Guelph, Psychology Department, Guelph, Ontario N1G 2W1, CANADA (email: bmorrong@uoguelph.ca).
OBJECTIVES: Risk compensation theory has been shown to relate to how individuals behave in areas such as traffic safety and consumer product safety. The present study examines whether risk compensation theory applies to parents' judgments about school age children's permissible risk taking under non-safety gear and safety gear conditions for seven common play situations. The extent of the child's experience with the activity and parental beliefs about safety gear efficacy were examined as possible moderators of extent of children's risk taking allowed by parents.
METHODS: A telephone interview was used to obtain each parent's ratings of permissible risk taking by their child (for example, speed at which child is allowed to cycle, height allowed to climb to on a climber) under safety gear and no gear conditions, and ratings of child experience and gear efficacy.
RESULTS: Results confirmed risk compensation operated under all seven play situations, resulting in parents reporting they would allow significantly greater risk taking by their children under safety gear than non-safety gear conditions. Children with more experience with the activities were to be allowed greater risk taking, even when not wearing safety gear. Parents who believed more strongly in the efficacy of the safety gear to prevent injuries showed greater risk compensation. No sex differences emerged in any analyses.
CONCLUSION: Results highlight the need to communicate to parents that safety gear moderates injury risk but does not necessarily guarantee the prevention of injury, particularly if children are allowed greater risk taking when wearing safety gear.
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Comparing hospital discharge records with death certificates: Can the differences be explained?
- Johansson LA, Westerling R. J Epidemiol Community Health 2002; 56(4): 301-308.
Correspondence: L A Johansson, Johan Enbergs v 48 A, 6 tr, SE-171 61 Solna, SWEDEN (email: lars.age.johansson@sos.se).
BACKGROUND: The quality of mortality statistics is important for epidemiological research. Considerable discrepancies have been reported between death certificates and corresponding hospital discharge records.
OBJECTIVES: This study examines whether differences between the death certificate's underlying cause of death and the main condition from the final hospital discharge record can be explained by differences in ICD selection procedures. The authors also discuss the implications of unexplained differences for mortality data quality.
METHODS: Using ACME, a standard software for the selection of underlying cause of death, the compatibility between the underlying cause of death and the final main condition was examined. The study also investigates whether data available in the hospital discharge record, but not reported on the death certificate, influence the selection of the underlying cause of death. Swedish death certificates for 1995 were linked to the national hospital discharge register. The resulting database comprised 69 818 people who had been hospitalised during their final year of life.
RESULTS: The underlying cause of death and the main condition differed at Basic Tabulation List level in 54% of the deaths. One third of the differences could not be explained by ICD selection procedures. Adding hospital discharge data changed the underlying cause in 11% of deaths. For some causes of death, including medical misadventures and accidental falls, the effect was substantial.
CONCLUSIONS: Most differences between underlying cause of death and final main condition can be explained by differences in ICD selection procedures. Further research is needed to investigate whether unexplained differences indicate lower data quality.
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Trends in head injury mortality among 0-14 year olds in Scotland (1986-95).
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Williamson LM, Morrison A, Stone DH. J Epidemiol Community Health 2002; 56(4): 285-288.
Correspondence: D H Stone, Paediatric Epidemiology and Community Health (PEACH) Unit, Department of Child Health, University of Glasgow, Royal Hospital for Sick Children, Yorkhill, Glasgow G3 8SJ, UK (email:
dhs1d@clinmed.gla.ac.uk).
OBJECTIVES: To examine the trends in childhood head injury mortality in Scotland between 1986 and 1995. Design: Analysis of routine mortality data from the registrar general for Scotland.
METHODS: Setting: Scotland, UK. Subjects: Children aged 0-14 years.
RESULTS: A total of 290 children in Scotland died as a result of a head injury between 1986 and 1995. While there was a significant decline in the head injury mortality rate, head injury as a proportion of all injury fatalities remained relatively stable. Boys, and children residing in relatively less affluent areas had the highest head injury mortality rates. Although both these groups experienced a significant decline over the study period, the mortality differences between children in deprivation categories 1-2 and 6-7 persisted among 0-9 year olds, and increased in the 10-14 years age group. Pedestrian accidents were the leading cause of mortality.
CONCLUSIONS: Children residing in less affluent areas seem to be at relatively greater risk of sustaining a fatal head injury than their more affluent counterparts. While the differences between the most and least affluent have decreased overall, they have widened among 10-14 year olds. The decline in head injury mortality as a result of pedestrian accidents may be partly attributable to injury prevention measures.
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No reports this week
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Development of the Student Attitudes Toward School Safety Measures (SATSSM) instrument.
- Young EM, Autry D, Lee SY, Messemer JE, Roach PS, Smit JC. J Sch Health 2002; 72(3): 107-114.
University of Georgia, Dept. of Health Promotion and Behavior, 322 Ramsey Student Center, Athens, GA 30602, USA (email: younge@mail.nih.gov).
The Student Attitudes Toward School Safety Measures (SATSSM) instrument was developed as a new tool to assess high school students' attitudes towards school safety promotion methods. A theory-based pool of statements was scaled using Thurstone's equal appearing interval method by 186 student judges to yield a 30-item instrument. The draft version was operationalized into a 5-point, Likert scale format, using a new sample of 182 students. Exploratory factor analysis suggested three factors: mediation, surveillance, and searching methods. The SATSSM was reduced to six items for each scale with a five-item social desirability scale added, and piloted with 66 new students. Final administration of the SATSSM to 166 new students yielded scale and overall internal consistencies exceeding .80 with low interscale correlations. A simultaneously administered questionnaire measuring perceptions of school safety suggested students possessed increased awareness of school violence, but they believed improving school safety is beyond their school's control.
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Elderly suicide rates in Asian and English-speaking countries.
- Pritchard C, Baldwin DS. Acta Psychiatr Scand 2002; 105(4):271-275.
CorrespondencE: Colin Pritchard, University Department of Psychiatry, Royal South Hants Hospital, Southampton SO14 OYG, UK (email: c.pritchard@soton.ac.uk).
OBJECTIVES: Asian culture venerates elderly people. It was hypothesized that elderly suicides would be proportionately lower in Asian societies than in English-speaking countries (ESC).
METHODS: Elderly (i.e. aged 75 years or more) to general population suicide ratios were compared for six Asian societies and six ESC, based upon the latest 5-year suicide rates.
RESULTS: Males: The general population suicide rate was highest in rural China (227 per million) and third highest in Japan (217 per million), but other countries with high rates were all ESC (ranging from 224 to 198 per million). Asian countries had the six highest elderly suicide rates, 1327-1373 per million, whilst the highest ESC elderly rate was in the United States (507 per million). Asian societies had the widest range of elderly/general ratios, ranging from 6.62 to 2.6. Females: The overall suicide rates were higher in Asian countries (57-95 per million) than in ESC (40-56 per million). Asian elderly suicide rates differed (932 per million in rural China to 154 per million in Korea) but the highest ESC rate was in Australia (76 per million). The Asian countries elderly/general ratios ranged from 5.82 : 1 to 2.70 : 1, but the widest ESC ratio was 1.71 : 1, in the United Kingdom.
CONCLUSIONS: There is a need for country-specific prevention measures in elderly people, and particularly for older women in Asian countries.
Age, period and cohort effects on suicide rates in Australia, 1919-1999.
- Snowdon J, Hunt GE. Acta Psychiatr Scand 2002; 105(4):265-270.
Correspondence: John Snowdon, Rozelle Hospital, P.O. Box 1, Rozelle NSW 2039, AUSTRALIA (email: jsnowdon@mail.usyd.edu.au).
OBJECTIVES: To examine age, period and cohort effects on Australian suicide rates.
METHODS: Male suicide rates for successive 5-year periods between 1919 and 1998, and for 1999 were displayed graphically to examine interactions between age, period and cohort effects.
RESULTS: There has been a pronounced period effect on male suicide rates in all age groups over the last few decades, with lower rates in wartime and peak rates for most cohorts in the 1960s. Peak rates of all adult female 5-year age cohorts occurred in the 1960s or early 1970s.
CONCLUSIONS: Most so-called cohort effects appear to be associated with environmental changes that may not be a function of the cohort itself. While much attention has focused on the rising suicide rates in young males in Australia, local media and health authorities have given little emphasis to the high rates found in elderly males.
The Youth Self-Report (YSR) and the Depression Self-Rating Scale (DSRS) as measures of depression and suicidality among adolescents.
- Ivarsson T, Gillberg C, Arvidsson T, Broberg AG. Eur Child Adolesc Psychiatry 2002; 11(1): 31-37.
Correspondence: Tord Ivarsson, Department of Child- and Adolescent Psychiatry, Goteborg University, Sweden. (email: tord.ivarsson@vgregion.se).
Two hundred and thirty-seven adolescents from a junior high school in a small community outside Goteborg, Sweden, completed the Youth Self Report (YSR) and the Depression Self Rating Scale (DSRS). Self-reported suicidality and biographical data were also recorded. The school doctor and nurse assessed the adolescents' somatic, psychological and behavioural problems using school health-records. The convergent validity of the YSR total problems scale and syndrome scales were tested against the DSRS. Discriminant validity was assessed by the two measures' ability to predict suicidality and school health problems. The Internalising (r = 0.65**) and Anxious/Depressed (r= 0.61**) syndrome scales of the YSR had the highest correlations with the DSRS. However, all YSR syndrome scales were significantly, though more modestly, correlated with the DSRS. Using stepwise logistic regression analysis, four YSR sub-scales [Social Withdrawal, Anxious/Depressed, Attention problems and Delinquency] predicted mild-severe self-reported depression (DSRS scores 12 and above). The YSR syndrome scales Anxious/Depressed and Delinquency predicted suicide ideation whereas the Self-destructive/Identity problem and Social Withdrawal (low scores) scales predicted Suicide attempts. The YSR Anxious/Depressed sub-scale and the DSRS total score seem to measure a similar dimension. However, the Anxious/Depressed and Selfdestructive/Identity problem scales were superior in predicting suicidality.
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Autonomic responses of young passengers contingent to the speed and driving mode of a vehicle.
- Min BC, Chung SC, Park SJ, Kim CJ, Sim M-K, Sakamoto K. Int J Indust Ergonomics 2002; 29(4): 187-198.
Correspondence: Byung Chan Min, Ergonomics Laboratory, Korea Research Institute of Standards and Science, P.O. Box 102, Yusong, Taejon 305-600, South Korea (email: bcmin@kriss.re.kr).
The purpose of the research was to measure the sensibility of young passengers through autonomic responses and subjective assessment under different speeds and driving modes of a vehicle. The study is composed of two categories: (1) measurement of the human sensibility at five speeds of a vehicle (i.e., 0, 30, 60, 90, and 120 km/h), and (2) three modes of driving conditions (i.e., rest, constant speed (60 km/h), sudden start, sudden stop). The physiological measurements used are autonomic responses of heart rate, galvanic skin response, and skin temperature, and the psychological measurement is the subjective assessment. Comparing the results of the pre-test with the post-test under various speed conditions, it was found that subjects feel tension under the high speed driving condition (120 km/h). The result of physiological signals also showed that as the speed of a car increased, the sympathetic nervous system of passengers became more highly activated. Comparing the rest and constant speed conditions with the sudden-start-sudden-stop condition, the subjects reported that they felt tension, and the responses of their autonomic nervous system also show that for the sudden-start-sudden-stop condition, the sympathetic nervous system was highly activated. The present study showed that depending on the speed of a vehicle and the driving mode, the human sensibilities change. It also showed that human sensibilities can be measured in an objective and systematical way as well as in the conventional and subjective way. If the relationship between human feelings or emotions and physiological and psychological parameters of a passenger or driver were clarified better, car designs could be developed based on the characteristics of human senses or feelings.
An analysis of 'looked but failed to see' accidents involving parked police vehicles.
- Langham M, Hole G, Edwards J, O'Neil C. Ergonomics 2002; 45(3):167-185.
Correspondence: Martin Langham, School of Cognitive and Computing Sciences, University of Sussex, Falmer, Brighton BN1 9QH, UK (email: martinl@cogs.susx.ac.uk).
Drivers who collide with a vehicle that is parked on the hard shoulder of a motorway or dual-carriageway sometimes claim not to have seen it before the collision. Previous research into vehicle conspicuity has taken such 'looked but failed to see' claims at face value, and concentrated on attempting to remedy the problem by making vehicles more conspicuous in sensory terms. However, the present study describes investigations into accidents of this kind which have involved stationary police cars, vehicles which are objectively highly conspicuous. Two laboratory studies showed that experienced drivers viewing a film of dual-carriageway driving were slower to respond to a parked police car as a 'hazard' if it was parked directly in the direction of travel than if it was parked at an angle; this effect was more pronounced when the driver's attention was distracted with a secondary reasoning task. Taken together with the accident reports, these results suggest that 'looked but failed to see' accidents may arise not because the parked vehicle is difficult to see, but for more cognitive reasons, such as vigilance failure, or possession by the driver of a 'false hypothesis' about the road conditions ahead. An emergency vehicle parked in the direction of travel, with only its blue lights flashing, may encourage drivers to believe that the vehicle is moving rather than stationary. Parking at an angle in the road, and avoiding the use of blue lights alone while parked, are two steps that drivers of parked emergency vehicles should consider taking in order to alert approaching drivers to the fact that a stationary vehicle is ahead.
Sleepy driving: Accidents and injury.
- Powell NB, Schechtman KB, Riley RW, Li K, Guilleminault C. Otolaryngol Head Neck Surg 2002; 126(3):217-27.
Correspondence: Nelson B. Powell, Stanford Sleep Disorders and Research Center, 750 Welch Rd, Suite 317, Palo Alto, CA 94304 USA (email: npowell@ix.netcom.com).
OBJECTIVE: The study goals were to evaluate the associated risks of driving and to assess predictors of accidents and injury due to sleepiness.
METHODS: Study Design: A cross-sectional Internet-linked survey was designed to elicit data on driving habits, sleepiness, accidents, and injuries during the preceding 3 years. Statistical analysis included logistic models with covariate-adjusted P values of <0.01 (odds ratios and 95% confidence intervals or limits). Independent accident predictors were sought.
RESULTS: Responses from 10,870 drivers were evaluated. The mean +/- SD age was 36.9 +/- 13 years; 61% were women and 85% were white. The Epworth Sleepiness Scale overall baseline score was 7.4 +/- 4.2 (for drivers with no accidents) and ranged to 12.7 +/- 7.2 (for drivers with >/= 4 accidents) (P = < 0.0001). Twenty-three percent of all respondents experienced >/= 1 accident. Among respondents who reported >/= 4 accidents, a strong association existed for the most recent accident to include injury (P < 0.0001). Sleep disorders were reported by 22.5% of all respondents, with a significantly higher prevalence (35%, P = 0.002) for drivers who had been involved in >/= 3 accidents.
CONCLUSION: Factors of sleepiness were strongly associated with a greater risk of automobile accidents. Predictors were identified that may contribute to accidents and injury when associated with sleepiness and driving.
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Violence against women: global scope and magnitude.
- Watts C, Zimmerman C. Lancet 2002; 359(9313):1232-1237.
Correspondence: Charlotte Watts, Health Policy Unit, Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK (email: charlotte.watts@lshtm.ac.uk).
An increasing amount of research is beginning to offer a global overview of the extent of violence against women. In this paper we discuss the magnitude of some of the most common and most severe forms of violence against women: intimate partner violence; sexual abuse by non-intimate partners; trafficking, forced prostitution, exploitation of labour, and debt bondage of women and girls; physical and sexual violence against prostitutes; sex selective abortion, female infanticide, and the deliberate neglect of girls; and rape in war. There are many potential perpetrators, including spouses and partners, parents, other family members, neighbours, and men in positions of power or influence. Most forms of violence are not unique incidents but are ongoing, and can even continue for decades. Because of the sensitivity of the subject, violence is almost universally under-reported. Nevertheless, the prevalence of such violence suggests that globally, millions of women are experiencing violence or living with its consequences.
Variations in age-specific homicide death rates: a cohort explanation for charges in the age distribution of homicide deaths.
- O'Brien RM, Stockard J. Soc Sci Res 2002; 31(1):124-150.
Correspondence: Robert O'Brien, Department of Sociology, University of Oregon, USA (email: bobrien@oregon.uoregon.edu).
An age-period-cohort characteristic model previously used to explain age-period-specific rates of homicide arrests for those 15 to 49 from 1960 to 1995 is applied to measures of age-period-specific homicide deaths. The extension of this model to the examination of homicide victimization is significant because we are able to test the utility of the model across a longer time span (1930 to 1995) and a wider range of ages (10 to 79) and disaggregated by sex and race (Whites and non-Whites). Although the results indicate that past and recent shifts in age-period-specific rates of homicide deaths are associated with specific characteristics of cohorts, there are some important differences across race and sex groupings in the effects of these characteristics. The effects of the cohort variables examined in our model are independent of age and period, often substantively large, and last throughout the life course. The results are consistent with Durkheimian explanations of lethal violence, hypotheses from victimization theory, and basic tenets of cohort theory.
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