SafetyLit Update: 11 November 2002

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11 November 2002

We are unable to provide photocopies of any the articles and reports abstracted below. Where possible, links have been provided to the publisher of the material and contact information for the corresponding author is listed. Many of the journals provide copies (usually for a fee) of reports online. Please consider asking your library to subscribe to the journals from which these abstracts have been gathered.

See reports under Violence

Disasters and Environmental Exposures:

The Bhopal syndrome: persistent questions about acute toxicity and management of gas victims.

Dhara VR, Gassert TH. Int J Occup Environ Health 2002; 8(4): 380-386.

Correspondence: V. Romana Dhara, Occupational Health Program, Harvard School of Public Health, Boston, Massachusetts, USA; (email: rdhara@aol.com).

A review of the health effects of the 1984 gas leak from the Union Carbide plant in Bhopal, India, shows continuing morbidity of a multisystemic nature in the exposed population. Scientific debates about the causes of the accident, the spectrum of health effects, and toxicology are presented with a view to understanding the toxic substances released in the gas cloud and their roles in the causation of health effects. Clinical dilemmas, medical management, and public health issues are also discussed. (Copyright © 2002 Hanley & Belfus)

Eye health of industrial workers in Southeastern Nigeria.

Okoye OI, Umeh RE. West Afr J Med 2002; 21(2): 132-137.

Correspondence: O.I. Okoye, Department of Ophthalmology, College of Medicine University of Nigeria, Enugu, NIGERIA.

A cross-sectional ophthalmological survey to determine the ocular health in Nigerian industries was undertaken in four randomly selected industrial establishments in Enugu State of Nigeria. The industrial establishments studied were the cement factory, coal mine, saw mill and iron/steel works where motor spare parts are fabricated. Of the 646 workers, 184 (28.5%) had a history of industrial accidents, 81 (12.5%) of which affected the eye. Eye injury was most commonly caused by metal chips, cement dust, fragments of wood, pieces of coal stone and welders' arc rays all of which could be prevented by wearing appropriate protective eye coverings. Contusion injury was the most common type of injury reported. Eye accident rate varied from factory to factory as also did the wearing of protective eye devices. overall, the percentage of workers using protective eye cover was 16.7% but there was a significant difference between the factories in this respect, protective eye wear being more often used in factories with higher eye accident rates. A total of 646 technical workers had detailed ophthalmological examination. The types and frequencies ofvisual disorders seen as well as the nature and causes of eye injuries were determined. Five hundred and twenty-eight workers (81.7%) had eye disorders. Presbyopla was responsible for 203 (31.4%) of these disorders while 169 (26.2%) were refractive errors. Of the others, pterygium and pingueculum together numbered 179 (27.7%) while cataract was found in 79 (12.2%) subjects. The results showed a high frequency of eye injuries among industrial workers and a low level of use of protective eye cover while at work. It is recommended that legislation requiring the use of protective devices in high-risk industries should be vigorously enforced to improve the eye health of Nigerian industrial workers.

Crosswalk markings and the risk of pedestrian-motor vehicle collisions in older pedestrians.

Koepsell T, McCloskey L, Wolf M, Moudon AV, Buchner D, Kraus J, Patterson M. JAMA 2002 Nov 6;288(17):2136-43.

Correspondence: Thomas D. Koepsell, Department of Epidemiology, Box 357236, University of Washington, Seattle, WA 98195, USA; (email: koepsell@u.washington.edu).

BACKGROUND: Motor vehicles struck and killed 4739 pedestrians in the United States in the year 2000. Older pedestrians are at especially high risk.

OBJECTIVE: To determine whether crosswalk markings at urban intersections influence the risk of injury to older pedestrians.

DESIGN: Case-control study in which the units of study were crossing locations.

SETTING: Six cities in Washington and California, with case accrual from February 1995 through January 1999.

PARTICIPANTS: A total of 282 case sites were street-crossing locations at an intersection where a pedestrian aged 65 years or older had been struck by a motor vehicle while crossing the street; 564 control sites were other nearby crossings that were matched to case sites based on street classification. Trained observers recorded environmental characteristics, vehicular traffic flow and speed, and pedestrian use at each site on the same day of the week and time of day as when the case event had occurred.

MAIN OUTCOME MEASURE: Risk of pedestrian-motor vehicle collision involving an older pedestrian.

RESULTS: After adjusting for pedestrian flow, vehicle flow, crossing length, and signalization, risk of a pedestrian-motor vehicle collision was 2.1-fold greater (95% confidence interval, 1.1-4.0) at sites with a marked crosswalk. Almost all of the excess risk was due to 3.6-fold (95% confidence interval, 1.7-7.9) higher risk associated with marked crosswalks at sites with no traffic signal or stop sign.

CONCLUSIONS: Crosswalk markings appear associated with increased risk of pedestrian-motor vehicle collision to older pedestrians at sites where no signal or stop sign is present to halt traffic. (Copyright © 2002 American Medical Association)
Incidence and description of stroller-related injuries to children.

Powell EC, Jovtis E, Tanz RR. Pediatrics 2002;110(5): E62-2.

Correspondence: Elizabeth C. Powell, Division of Pediatric Emergency Medicine-Box 62, Children’s Memorial Hospital, 2300 Children’s Plaza, Chicago, IL 60614, USA; (email: epowell@northwestern.edu).

OBJECTIVE: To describe the incidence, circumstances, and types of stroller-related injuries among US children.

METHODS: Retrospective review of data for children 3 years old and younger from the National Electronic Injury Surveillance System of the United States Consumer Product Safety Commission for 1994-1998.

RESULTS: There were an estimated 64 373 stroller-related injuries (95% confidence interval [CI]: 49 223-79 514) to children 3 years old and younger treated in hospital emergency departments in the United States during the 5-year study period. The median age at the time of the injury was 11 months; 51% were males. The annual rate of injury among children <1 year old was 184.4 per 100 000. Seventy-six percent of injuries resulted from a fall from the stroller. A motor vehicle was involved in <1% of cases. Most injuries involved the head (44%) or face (43%). Injury diagnoses included contusions or abrasions (38%), lacerations (24%), closed head injury (22%), and extremity fractures (3%). Two percent of injured children, an estimated 992 (95% CI: 428-1556), were admitted to the hospital during the study period, an annual admission rate of 1.3 per 100 000. Seventy percent of admissions were for head trauma.

CONCLUSIONS: Injuries related to strollers are common, particularly among children in the first year of life. They often result from falls from the stroller. The data suggest that restraint use would prevent many stroller-related injuries. (Copyright © 2002 American Academy of Pediatrics)
Pelvic fractures in pregnancy: factors influencing maternal and fetal outcomes.

Leggon RE, Wood GC, Indeck MC. J Trauma 2002; 53(4):796-804.

Correspondence: Robert E Leggon, Department of Orthopaedic Surgery, Geisinger Medical Center, 100 North Academy Avenue, Danville, PA 17822, USA; (email: rleggon@geisinger.edu).

BACKGROUND The purpose of this study was to determine factors influencing maternal and fetal outcomes associated with pelvic fractures in pregnancy.

METHODS A literature review of pelvic and acetabular fractures during pregnancy was performed, providing 101 cases for analysis (1 case report was included). Factors influencing maternal and fetal mortality were evaluated.

RESULTS Pelvic and acetabular fractures during pregnancy were associated with a high maternal (9%) and a higher fetal (35%) mortality rate. Automobile-pedestrian collisions had a trend toward a higher maternal mortality rate, and vehicular collisions had a trend toward a higher fetal mortality rate, compared with falls. Injury severity influenced both maternal and fetal outcomes. Fracture classification (simple vs. complex), fracture type (acetabular vs. pelvic), the trimester of pregnancy, and the era of literature reviewed did not influence mortality rates. When considering potential causes of fetal death, direct trauma to the uterus, placenta, or fetus was not associated with a higher fetal mortality rate, compared with maternal hemorrhage. Pelvic and acetabular fracture surgery has rarely been reported in this patient population.

CONCLUSION Pelvic and acetabular fractures in pregnancy continue to be associated with a high fetal mortality rate. Mechanism of injury and injury severity appeared to influence mortality rates, whereas the fracture classification, the fracture type, the trimester of pregnancy, and the era of literature reviewed did not. (Copyright © 2002 Lippincott Williams & Wilkins)
Impact of mandatory helmet legislation on bicycle-related head injuries in children: a population-based study.

Macpherson AK, To TM, Macarthur C, Chipman ML, Wright JG, Parkin PC. Pediatrics 2002; 110(5):e60.

Correspondence: Alison K. Macpherson Division of Paediatric Medicine, Hospital for Sick Children, Toronto, Ontario, CANADA; (email: alison.macpherson@sickkids.ca).

OBJECTIVE: Childhood bicycle-related head injuries can be prevented through the use of helmets. Although helmet legislation has proved to be a successful strategy for the adoption of helmets, its effect on the rates of head injury is uncertain. In Canada, 4 provinces have such legislation. The objective of this study was to measure the impact of helmet legislation on bicycle-related head injuries in Canadian children.

METHODS: Routinely collected data from the Canadian Institute for Health Information identified all Canadian children (5-19 years) who were hospitalized for bicycling-related injuries from 1994-1998. Children were categorized as head or other injury on the basis of International Classification of Diseases, Ninth Revision, codes. Rates of head injuries and other injuries were compared over time in provinces that adopted legislation and those that did not.

RESULTS: Of the 9650 children who were hospitalized because of a bicycle-related injury, 3426 sustained injuries to the head and face and the remaining 6224 had other injuries. The bicycle-related head injury rate declined significantly (45% reduction) in provinces where legislation had been adopted compared with provinces and territories that did not adopt legislation (27% reduction).

CONCLUSION: This country-wide study compared rates of head injury in regions with and without mandatory helmet legislation. Comparing head injuries with other non-head-injured children controlled for potential differences in children's cycling habits. The strong protective association between helmet legislation and head injuries supports the adoption of helmet legislation as an effective tool in the prevention of childhood bicycle-related head injuries. (Copyright © 2002 American Academy of Pediatrics)

Carbon monoxide poisoning in Kentucky.

Scheerer A, Struttmann T. J Ky Med Assoc 2002; 100(10): 447-453.

Correspondence: Tim Struttmann, Kentucky Injury Prevention and Research Center, University of Kentucky, Kentucky School of Public Health, 333 Waller Avenue, Suite 202, Lexington, KY 40504-2915, USA; (email: tstruttm@uky.edu).

Fatal and nonfatal cases of carbon monoxide (CO) poisoning continue to be widespread. Hospital discharge data were used to identify cases of CO poisoning in Kentucky during 1998-1999. Additional data collection was conducted through medical record abstraction. Information was collected on 205 cases at 33 Kentucky hospitals. Over half of the CO poisoning cases occurred in residential settings. The most common types of equipment operating at the time of exposure were motor vehicles and gas heating sources. Eighteen percent of the cases required hospitalization. Almost half of the incidents occurred during December, January, and February. Incidents of CO poisoning can be reduced through education and implementation of appropriate prevention strategies. Public health professionals and health care professionals should provide education about the sources of CO and the hazards of exposure. Recommendations for prevention are provided. (Copyright C 2002 Kentucky Medical Association)

Roller Coasters, G Forces, and Brain Trauma: On the Wrong Track?

Smith DH, Meaney DF. J Neurotrauma 2002, 19(10): 1117-1120.

Correspondence: Douglas H. Smith, Department of Neurosurgery, University of Pennsylvania, 113 Hayden Hall, Philadelphia, PA 19104, USA; (email: smithdou@mail.med.upenn.edu).

There has been enormous attention in the general press on the possibility that high G force roller coasters are inducing brain injury in riders. Armed with a handful of anecdotal case reports of brain injuries, the U.S. Congress has recently proposed legislation to regulate the level of G forces of roller coasters. However, high G forces are well tolerated during many activities and, therefore, are a poor measure for the risk of brain injury. Rather, accelerations of the head that can be caused by G forces are the key to producing injury. To determine the extent of head accelerations during roller coaster rides, we acquired G force data from three popular high G roller coasters. We used the highest recorded G forces in a simple mathematical model of head rotational acceleration, with the head rigidly pivoting from the base of the skull at a radius representing typical men and women. With this model, we calculated peak head rotational accelerations in three directions. Even for a conservative worst-case scenario, we found that the highest estimated peak head accelerations induced by roller coasters were far below conventional levels that are predicted for head injuries. Accordingly, our findings do not support the contention that current roller coaster rides produce high enough forces to mechanically deform and injure the brain. (Copyright © 2002 Mary Ann Liebert Publishing)
Deer Stand-Related Trauma in West Virginia: 1994 through 1999.

Gates RL, Helmkamp JC, Wilson SL, Denning DA, Beaver BL. J Trauma 2002; 53(4):705-708.

Correspondence: Bonnie L. Beaver, Department of Surgery, Marshall University School of Medicine, 1600 Medical Center Drive, Suite 2500, Huntington, WV 25701-3655, USA; (email: bbeaver@marshall.edu).

BACKGROUND Deer hunting is a popular activity in much of the United States. In West Virginia, over 350,000 people each year actively hunt deer. Although injuries and deaths caused by shooting-related incidents have declined, hunting injuries caused by falls from deer stands have not. We present a retrospective study from January 1994 through December 1999 to determine the number of and trauma resulting from deer stand-related incidents in West Virginia.

METHODS Data have been compiled from individual hospital and state trauma registries, patient charts, and Department of Natural Resources logs.RESULTS A total of 90 individuals have been identified with injuries related to deer stand falls over the 6-year period. There were seven deaths. Most patients had multiple injuries that included extremity fracture (47%), spine fracture (36%), head injury (20%), pelvic fracture (10%), rib/clavicle fracture (11%), solid organ injury (6%), pneumothorax (3%), and other minor injuries (21%). The majority of accidents were associated with home-built as opposed to commercial stands, and most hunters were not using safety straps. Blood alcohol was elevated in only 7% of injured victims.

CONCLUSION Injuries from deer stand falls are a significant cause of morbidity and mortality in this state. This is the largest series of hunting-related deer stand injuries reported in the current literature. Other states have successfully implemented prevention programs that have resulted in a reduction of these types of injuries. Our data emphasize the need to establish and promote preventative education programs for hunters using tree stands. (Copyright © 2002 Lippincott Williams & Wilkins)
An Analysis of Head Injuries among Skiers and Snowboarders.

Levy AS, Hawkes AP, Hemminger LM, Knight S. J Trauma 2002; 53(4):695-704.

Correspondence: A. Stewart Levy, Intermountain Neurosurgery and Neuroscience, 4101 West Conejos Place, Suite 225, Denver, CO 80204, USA.

BACKGROUND: Head injury is the leading cause of death and critical injury in skiing and snowboarding accidents.METHODS Data relating to head injuries occurring on the ski slopes were collected from the trauma registry of a Level I trauma center located near a number of ski resorts.

RESULTS: From 1982 to 1998, 350 skiers and snowboarders with head injuries were admitted to our Level I trauma center. Most of the injuries were mild, with Glasgow Coma Scale (GCS) scores of 13 to 15 in 81% and simple concussion in 69%. However, 14% of patients had severe brain injuries, with GCS scores of 3 to 8, and the overall mortality rate was 4%. Collision with a tree or other stationary object (skier-tree) was the mechanism of injury in 47% of patients; simple falls in 37%; collision with another skier (skier-skier) in 13%; and major falls in 3%. Skier-tree collision and major falls resulted in a higher percentage of severe injuries, with GCS scores of 3 to 8 in 24% and 20%, respectively, and mean Injury Severity Scores of 14 and 17, respectively. Mortality from skier-tree collision was 7.2%, compared with 1.6% in simple falls and no deaths from skier-skier collision or major falls. The risk of sustaining a head injury was 2.23 times greater for male subjects compared with female subjects, 2.81 times higher for skiers/boarders </= 35 years of age compared with those > 35 years, and 3.04 times higher for snowboarders compared with skiers.

CONCLUSIONS: Skier-tree collision was the most common mechanism for head injuries in patients admitted to our Level I trauma center, and resulted in the most severe injuries and the highest mortality rate. Because most traumatic brain injuries treated at our facility resulted from a direct impact mechanism, we believe that the use of helmets can reduce the incidence and severity of head injuries occurring on the ski slopes. (Copyright © 2002 Lippincott Williams & Wilkins)

Self-reported injury rates in New Zealand.

Coggan C, Hooper R, Adams B. N Z Med J 2002; 115(1161): U167.

Injury Prevention Research Centre, University of Auckland, Auckland, NEW ZEALAND; (email: c.coggan@auckland.ac.nz).

OBJECTIVES: The study aimed to obtain baseline information on the incidence and nature of self-reported injuries in New Zealand.

METHODS: A cross-sectional survey was conducted of approximately 400 randomly-selected households from each of 13 Territorial Local Authorities across New Zealand, giving a total sample size of 5282. Respondents were asked if anyone in their household had been treated by a medical doctor in the previous twelve months for any injuries and, if so, details of the injury event were recorded.

RESULTS: Forty one per cent of households reported that someone in the household had sustained an injury. The most common types of injuries were falls (33%), sports-related injuries (28%) and injuries caused by lifting an object (16%). Only eight per cent of the injuries required overnight hospitalisation.

CONCLUSION: The findings from this study indicate that the total burden of injury in New Zealand is much larger than estimated by routinely-collected injury hospitalisation data. (Copyright © 2002 New Zealand Medical Association)
Infant-furniture-related injuries among preschool children in New Zealand, 1987-1996.

Morrison L, Chalmers D, Parry M, Wright C. J Paediatr Child Health 2002; 38(6): 587-592.

Correspondence: Luke Morrison, Injury Prevention Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, NEW ZEALAND; (email: unavailable).

OBJECTIVE: To describe the epidemiology of infant-furniture-related fatalities and hospitalizations in New Zealand, for children aged 0-4 years.

METHODS: Infant-furniture-related deaths and hospitalizations were selected from the New Zealand Health Information Service databases for the 10-year period 1987-1996. Intentional injuries were excluded.

RESULTS: Forty-three fatalities were identified. Twenty-two fatalities (51%) occurred in cots, while 13 (30%) occurred in beds. Other products involved were prams, push chairs, high chairs, car seats, portable cots and walkers. A total of 1679 infants were hospitalized through infant-furniture-related injuries. Increasing trends in hospitalizations for baby walkers, beds and bunks were observed.

CONCLUSIONS: On average, four infants die each year from injuries related to infant furniture, and hospitalizations from injuries associated with infant furniture use are increasing. Mandatory standards are one measure to reduce these numbers, but education is also necessary. (Copyright © 2002 Blackwell Synergy)
Descriptive Epidemiology of Head Injury in Romagna and Trentino. comparison between two geographically different italian regions.

Servadei F, Verlicchi A, Soldano F, Zanotti B, Piffer S. Neuroepidemiology 2002; 21(6): 297-304.

Correspondence: Franco Servadei, Divisione di Neurotraumatologia, Ospedale Bufalini, I-47023 Cesena, ITALY; (email: fservade@ausl-cesena.emr.it).

We studied the occurrence of head injury in two different Italian regions: Romagna and Trentino. Both geographical areas attract large numbers of seasonal tourists. The study was carried out over 1 year (January 1, 1998 to December 31, 1998), prospectively in Romagna and retrospectively in Trentino because of their different head injury management protocols. The study was based on all admissions to hospital extracted by medical staff from the case records, and all cases were identified by the ICD-9 codes (ranges: 800.0-800.3, 801.0-801.3, 803.0-803.3, 850, 851.0-851.1, 852.0-852.1, 853.0-853.1, 854.0-854.1). The annual incidence of hospitalization for head injury was 314/100,000, 297 for Romagna and 332 for Trentino. The causes of head trauma and the type of injuries were similar to those reported in the international literature, and so were the characteristics of the population at risk. Romagna recorded a higher incidence of head injury among the elderly, probably due to the widespread use of bicycles without safety helmets. In Romagna, where neurosurgery departments exist, hospital mortality was low (8/100,000/year). Based on similar international literature findings, different prevention measures are suggested to reduce the occurrence and severity of head injury. Copyright 2002 S. Karger AG, Basel)

Risk factors for falls during treatment of late-life depression.

Joo JH, Lenze EJ, Mulsant BH, Begley AE, Weber EM, Stack JA, Mazumdar S, Reynolds CF 3rd, Pollock BG. J Clin Psychiatry 2002; 63(10): 936-941.

Correspondence: Jin H. Joo, Intervention Research Center for Late-Life Mood Disorders, Department of Psychiatry, University of Pittsburgh School of Medicine, PA, USA; (email: jhj3@pitt.edu).

BACKGROUND: Prior studies have found that antidepressant medications are associated with an increased risk of falling in elderly persons. However, little is known about the prevention of falls during treatment for depression in elderly persons. This study evaluated the time course and potential risk factors for falls in a treatment protocol for late-life depression to identify specific at-risk periods and risk factors for falls in this population.

METHOD: One hundred four subjects aged 69 years and over were treated in a protocolized manner using paroxetine and interpersonal psychotherapy. Those who did not respond received augmentation therapy with bupropion, nortriptyline, or lithium. Subjects were assessed at baseline and weekly during treatment; demographic and clinical characteristics of those who experienced a fall during treatment were compared with those who did not fall. Cox proportional hazards models were used to define risk factors for falls in univariate and multivariate models.

RESULTS: During a mean of 21 weeks of treatment, 40 subjects (38%) fell. About half (53%) of the subjects fell during the first 6 weeks of treatment. In the multivariate model, memory impairment and orthostatic changes in blood pressure during treatment were risk factors for falling. Additionally, augmentation with bupropion appeared to be a risk factor for falls in univariate analysis, but this result is preliminary due to the small number of subjects who took bupropion.

CONCLUSION: Increased monitoring for falls is warranted during the acute treatment of late-life depression. When treating such patients, clinicians should be especially watchful of those with memory impairments or those who develop orthostatic blood pressure changes; orthostatic blood pressure should be measured throughout acute treatment. Additionally, augmenting paroxetine with bupropion may also increase the risk of falls, and this medication combination should be used with caution in elderly patients. (Copyright © 2002 Physicians Postgraduate Press)
Community-based exercise program reduces risk factors for falls in 65- to 75-year-old women with osteoporosis: randomized controlled trial.

Carter ND, Khan KM, McKay HA, Petit MA, Waterman C, Heinonen A, Janssen PA, Donaldson MG, Mallinson A, Riddell L, Kruse K, Prior JC, Flicker L. CMAJ 2002; 167(9): 997-1004.

Correspondence: Karim Khan, UBC Bone Health Research Group, University of British Columbia, Room 175, James Mather Building, 5804 Fairview Ave., Vancouver BC V6T 1Z3, CANADA; (email: kkhan@interchange.ubc.ca).

BACKGROUND: Exercise programs improve balance, strength and agility in elderly people and thus may prevent falls. However, specific exercise programs that might be widely used in the community and that might be "prescribed" by physicians, especially for patients with osteoporosis, have not been evaluated. We conducted a randomized controlled trial of such a program designed specifically for women with osteoporosis.

METHODS: We identified women 65 to 75 years of age in whom osteoporosis had been diagnosed by dual-energy X-ray absorptiometry in our hospital between 1996 and 2000 and who were not engaged in regular weekly programs of moderate or hard exercise. Women who agreed to participate were randomly assigned to participate in a twice-weekly exercise class or to not participate in the class. We measured baseline data and, 20 weeks later, changes in static balance (by dynamic posturography), dynamic balance (by a timed figure-eight run) and knee extension strength (by dynamometry).

RESULTS: Of 93 women who began the trial, 80 completed it. Before adjustment for covariates, the intervention group tended to have greater, although nonsignificant, improvements in static balance (mean difference 4.8%, 95% confidence interval [CI] -1.3% to 11.0%), dynamic balance (mean difference 3.3%, 95% CI -1.7% to 8.4%) and knee extension strength (mean difference 7.8%, 95% CI -5.4% to 21.0%). Mean crude changes in the static balance score were -0.85 (95% CI -2.91 to 1.21) for the control group and 1.40 (95% CI -0.66 to 3.46) for the intervention group. Mean crude changes in figure-eight velocity (dynamic balance) were 0.08 (95% CI 0.02 to 0.14) m/s for the control group and 0.14 (95% CI 0.08 to 0.20) m/s for the intervention group. For knee extension strength, mean changes were -0.58 (95% CI -3.02 to 1.81) kg/m for the control group and 1.03 (95% CI -1.31 to 3.34) kg/m for the intervention group. After adjustment for age, physical activity and years of estrogen use, the improvement in dynamic balance was 4.9% greater for the intervention group than for the control group (p = 0.044). After adjustment for physical activity, cognitive status and number of fractures ever, the improvement in knee extension strength was 12.8% greater for the intervention group than for the control group (p = 0.047). The intervention group also had a 6.3% greater improvement in static balance after adjustment for rheumatoid arthritis and osteoarthritis, but this difference was not significant (p = 0.06).

DISCUSSION: Relative to controls, participants in the exercise program experienced improvements in dynamic balance and strength, both important determinants of risk for falls, particularly in older women with osteoporosis. (Copyright © 2002 Canadian Medical Association Journal)

No reports this week

Longitudinal study of the number and choice of leisure time physical activities from mid to late adolescence: implications for school curricula and community recreation programs.

Aaron DJ, Storti KL, Robertson RJ, Kriska AM, LaPorte RE. Arch Pediatr Adolesc Med 2002; 156(11): 1075-1080.

Correspondence: Deborah J. Aaron, Department of Health and Physical Education, School of Education, University of Pittsburgh, 155 Trees Hall, Pittsburgh, PA 15261, USA; (email: debaaron@pitt.edu).

BACKGROUND: Physical activity (PA) declines during adolescence. There has been little research describing this decline or examining participation and nonparticipation in specific activities.

OBJECTIVE: To describe the pattern of change in the number of physical activities, the time spent on specific activities, and the stability of participation and nonparticipation in specific activities during adolescence.

DESIGN AND SETTING: A population-based 4-year longitudinal study of adolescents recruited from a single suburban school district near Pittsburgh, Pa.

PARTICIPANTS: A total of 782 adolescents, aged 12 to 15 years at baseline. MAIN OUTCOME MEASURES: Physical activity was measured annually via questionnaire. Outcome measures include hours per week of PA, number of reported activities, and participation (yes or no) in specific activities.

RESULTS: Physical activity declined during the 4 years by 26%. The decline in PA was primarily due to a decrease in the number of reported activities. Adolescents who continued to report an activity during the 4 years of the study maintained or increased the time spent on that specific activity. Female adolescents were more likely to report individual activities, while male adolescents were more likely to report team activities. The probability of maintaining participation in a specific activity during the 4 years was low to moderate, 0.02 to 0.47 for female adolescents and 0.04 to 0.71 for male adolescents. The probability of not participating in a specific activity during the 4 years was extremely high and consistent for male and female adolescents, 0.70 to 1.00.

CONCLUSIONS: The decline in PA during adolescence is primarily due to a decrease in the number of activities in which the adolescent is participating, and there is only a moderate probability that an adolescent will continue to participate in an activity during the 4-year period from junior to senior high. Future efforts should be directed at identifying factors associated with initiating and maintaining participation in specific activities. (Copyright © 2002 American Medical Association)

A longitudinal view of triggers and thresholds of suicidal behavior in depression.

Pezawas L, Stamenkovic M, Jagsch R, Ackerl S, Putz C, Stelzer B, Moffat RR, Schindler S, Aschauer H, Kasper S. J Clin Psychiatry 2002 Oct;63(10):866-873.

Correspondence: Lukas Pezawas, Department of General Psychiatry, University of Vienna, AUSTRIA; (email: pezawas@nariya.nimh.nih.gov).

BACKGROUND: Recurrent brief depressive disorder (RBD) and major depressive disorder (MDD) share the same diagnostic picture of full-blown depression and are both associated with increased suicide attempt rates. However, longitudinal diagnostic shifts from RBD to MDD or vice versa, called "combined depression" (CD), have demonstrated a substantially higher risk of suicide attempts in epidemiologic and clinical studies. Following the stress-diathesis model of suicidal behavior, we compared possible triggers and thresholds for suicidal behavior among patients with RBD, MDD, and CD. RBD and MDD diagnoses were based on DSM-IV criteria. Furthermore, the goal of this study was to determine if impulsivity as an underlying factor could explain high suicide attempt rates in CD.

METHODS: A structured clinical interview evaluating comorbid Axis I and II disorders and RBD and a battery of instruments assessing suicidal behavior were administered to 101 patients with RBD (N = 27), MDD (N = 33), or CD (N = 41).

RESULTS: Patients with CD showed significantly higher (p < .05) scores on measures of suicidal behavior in comparison with RBD and MDD patients. Together with comorbid substance abuse and marital status, CD was among the highest-ranking risk factors for suicide attempts. Impulsivity was identified as a major underlying factor, predicting 80.7% of suicide attempts.

CONCLUSION: CD seems to be an important clinical risk factor for the prediction of suicide attempts, similar to risk factors such as substance use disorders and borderline personality disorder. All of these factors share the same diathesis for increased impulsivity and suicidal ideation, which could explain comorbidity and suicidal behavior. The coexistence of a greater propensity for suicidal ideation and impulsivity in RBD might also explain why such patients are more prone to attempt suicide, even if they do not, in the case of RBD, meet the duration criteria for MDD.
A follow-up study of adolescent attempted suicide in Israel.

Farbstein I, Dycian A, Gothelf D, King RA, Cohen DJ, Kron S, Apter A. J Am Acad Child Adolesc Psychiatry 2002; 41(11): 1342-1349.

Correspondence: Alan Apter, Department of Psychiatry, Schneider Children’s Medical Center of Israel, 14 Kaplan Street, Petah Tikva, 49100, ISRAEL; (email: apter@post.tau.ac.il).

OBJECTIVES: (1) To compare the outcome of adolescent subjects who have made a suicide attempt with the outcome of matched controls, using their psychological and psychometric screening tests for military service at age 16.5 years. Their subsequent performance during military service between ages 18 and 21 was also evaluated. (2) To compare the prognosis of those attempters who received intensive psychiatric inpatient evaluation in a general hospital with the prognosis of those who received emergency room treatment only.

METHODS: The computerized military records of 216 adolescents, who had been treated between 1987 and 1988 for attempted suicide in a general hospital emergency room, prior to their induction into the army, were evaluated. They were rated on the following tests: cognitive/educational performance and psychosocial adaptation, psychiatric and psychological health diagnoses, and performance during their military service between 1989 and 1992.

RESULTS: Although the female attempters had slightly more problems in the military than the controls, their overall prognosis was surprisingly good. The male suicide attempters did very poorly in their subsequent military service. There was no long-term advantage in having had a psychiatric evaluation performed in a hospital over a brief emergency room evaluation. Most differences between attempters and controls were in service performance, rather than in cognitive and psychometric tests.

CONCLUSIONS: There may be marked differences between the sexes in the significance of attempted suicide and in the indications for intervention. The policy of mandatory general hospitalization for suicide attempters may need reevaluation. (Copyright © 2002
Cultural correlates of youth suicide.

Eckersley R, Dear K. Soc Sci Med 2002; 55(11): 1891-1904.

Correspondence: Richard Eckersley, National Centre for Epidemiology and Population Health, Australian National University, ACT 0200, Canberra, AUSTRALIA; (email: richard.eckersley@anu.edu.au).

Youth suicide has risen in most developed nations over the past 50 years, especially among males, but the increase remains to be explained. Statistical analyses were used to examine associations between youth suicide rates in 11-21 mainly Western, developed nations and 32 socio-economic and cultural variables. The central hypothesis was that suicide rates would be correlated with various cultural measures of social attachment and integration, especially individualism. Socio-economic variables were included in the analysis to demonstrate the relative strength of the cultural associations. The study found a strong positive correlation between male youth suicide rates and subjective measures of health, optimism, and several indices of individualism, including personal freedom and control. Correlations between female youth suicide and individualism were smaller, attaining significance in only one instance. Male youth suicide and individualism were negatively correlated with older people's sense of parental duty. Correlations between suicide and other possibly relevant cultural variables-tolerance of suicide, belief in God and national pride-were not significant. The analysis of socio-economic variables yielded only one significant, but doubtful, correlation. The findings can be interpreted as supporting two very different hypotheses: that youth suicide represents "an island of misery in an ocean of happiness" or "the tip of an iceberg of suffering". In favouring the latter interpretation, and consistent with Durkheim's theories on suicide, it is argued that increased youth suicide reflects a failure of Western societies to provide appropriate sites or sources of social identity and attachment, and, conversely, a tendency to promote unrealistic or inappropriate expectations of individual freedom and autonomy. (Copyright © 2002 Elsevier Science)

Spectators prohibited at illegal speed contests or exhibitions of speed.

San Diego, California: City Ordinance.

The text of the ordanance is available on-line HERE.

Street racing can lead to the death or serious injury of racers, bystanders, adn other road users. This law makes it a misdemeanor for spectators to be knowingly present at all illegal speed contests or street races. Violators would be subject to arrest, punishable by up to six months in jail and a $1,000 fine. Three other California jurisdictions -- City of Los Angeles, County of Los Angeles, and the City of Ontario -- also have similar ordinances.
Distractions and the risk of car crash injury: the effect of drivers' age.

Lam LT. J Safety Res 2002; 33(3): 411-419.

Correspondence: Lawrence Lam, Royal Alexandra Hospital for Children, Locked Bag 4001, Westmead, Sydney, NSW 2145, AUSTRALIA; (email: lawrencl@chw.edu.au).

BACKGROUND: Motor-vehicle accidents are one of the major causes of injury in most motorized countries. Driver distractions have been suggested as a contributor to traffic accidents. Moreover, age of the driver seems to have a role in the relationship between distractions and car crashes. But very few studies have investigated the effect of driver's age on this relationship.

OBJECTIVES: This exploratory study investigated the association between distractions, both inside and outside the vehicle, and the increased risk of car crash injury among drivers across different ages.

METHOD: This study used a case series design to analyze data routinely collected by the NSW police in Australia. A special focus of this study was on how drivers' age affects the risk of car crash injury, which was determined by using a well-documented risk estimation methodology.

RESULTS: The results obtained indicated that drivers of all ages, on the whole, are more susceptible to distractions inside the vehicle than distractions coming from outside. Age was shown to affect the relationship between in-vehicle distraction and the risk of car crash injury. A separate analysis was also conducted on hand-held phone usage while driving with results supplementing previous findings reported in the literature.(Copyright © 2002 Elsevier Science)

Domestic violence: an education programme for hospital staff.

Wallace A. J Fam Health Care 2002; 12(3): 65-67.

Correspondence: A. Wallace, Kingston Hospital NHS Trust, Galsworthy Rd, Kingston upon Thames, Surrey KT2 7QB, UK.

An assistant director of nursing in an acute hospital describes how she identified a need for staff education about domestic violence and set up an awareness programme. Nominated nurses from the clinical areas most affected--Accident & Emergency, maternity, gynaecology and paediatrics--attended and disseminated information to colleagues. The content of the course is described. Evaluation showed that participants' knowledge base increased by an estimated 25%. Junior medical staff now receive one hour's education in domestic violence during their A&E rotation. Links were forged with community agencies specialising in domestic violence, resulting in a more effective referral system. (Copyright © 2002 Chichester PMH Publications)
Measuring the Quality of Hospital-based Domestic Violence Programs.

Coben JH. Acad Emerg Med 2002; 9(11): 1176-1183.

Correspondence: Jeffrey H. Coben, Center for Violence and Injury Control, Allegheny-Singer Research Institute, Pittsburgh, PA, USA.

OBJECTIVE: To obtain consensus among a panel of experts on performance measures useful for evaluating the quality of hospital-based domestic violence (DV) programs.

METHODS: The Delphi process of consensus development was used with a panel of 18 experts including DV researchers, program planners, and advocates. Three rounds were conducted over a period of six months, with each round involving the completion of a written questionnaire. Panelists were instructed to concentrate on structure and process measures of DV program performance. Health outcome measures were not considered. During each round, panelists rated (scale of 1-5) their level of agreement with each measure, in terms of the measure's usefulness for evaluating hospital-based DV programs. Data were entered into SPSS on a personal computer and frequency distributions, measures of central tendency, and variance were computed for each measure. Consensus development was defined as a reduction in the item-specific variance from one round to the next.

RESULTS: A total of 37 performance measures were agreed upon. These measures fell within nine different domains of DV program activities, including: Policies and Procedures, Hospital Physical Environment, Hospital Cultural Environment, Training of Providers, Screening and Safety Assessment, Documentation, Intervention Services, Evaluation Activities, and Collaboration.

CONCLUSIONS: A number of measures have been identified as useful for evaluating hospital-based DV programs. Use of these measures should assist researchers, program planners, and administrators in assessing the quality of hospital-based DV programs.
Prevalence and associations of partner abuse in women attending general practice: a cross-sectional survey.

Hegarty KL, Bush R. Aust N Z J Public Health 2002 Oct;26(5):437-442.

Correspondence: K.L. Hegarty, Department of General Practice, University of Melbourne, Victoria, Carlton, AUSTRALIA; (email: k.hegarty@unimelb.edu.au)

OBJECTIVE: To determine the prevalence and socio-demographic associations of physical, emotional and sexual abuse by a partner or ex-partner for women attending Australian general practices. METHOD: In 1996, women attending 20 randomly chosen Brisbane inner south region general practices were screened for a history of partner abuse using a self-report questionnaire. Multivariate analyses were conducted on the data, using presence of abuse or not adjusting for cluster effect to obtain prevalence rate ratios for socio-demographic background data and history of violence in the family of origin. RESULTS: Thirty-seven per cent (CI 31.0-42.4) of the survey participants (n = 1,836, response rate 78.5%) admitted to having ever experienced abuse in an adult intimate relationship. One in four women (23.3%) had ever experienced physical abuse, one in three (33.9%) emotional abuse and one in 10 (10.6%) sexual abuse. Abused women were 64.1 (Cl 44.4-94.1) times more likely to have ever been afraid of any partner than non-abused women. Of women in current relationships (n = 1,344), 8.0% self-reported physical or emotional or sexual abuse in the past 12 months and 1.5% all three types of abuse. Associations of abuse included being younger (< 60 years), separated or divorced, having a history of child abuse or domestic violence between their parents. CONCLUSION: Partner abuse is very common in women attending general practices and clinicians need to be alert to possible indications of partner abuse (age, marital status, past history of abuse).
Recording of community violence by medical and police services.

Sutherland I, Sivarajasingam V, Shepherd JP. Inj Prev 2002; 8(3): 246-247.

Correspondence: Ian Sutherland, Violence Research Group, Department of Oral Surgery, Medicine and Pathology, University of Wales College of Medicine, Cardiff, UK; (email: southerlandi3@cardiff.ac.uk).

OBJECTIVES: To determine the extent to which community violence that results in injury treated in emergency departments appears in official police records and to identify age/gender groups at particular risk of under-recording by the police.

METHODS: Non-confidential data for patients with assault related injury treated in the emergency departments of two hospitals in one South Wales city (Swansea) during a six month period were compared with data relating to all recorded crimes in the category "Violence against the person" in the police area where the hospitals were located.

RESULTS: Over the six month period a total of 1513 assaults were recorded by Swansea emergency departments and the police (1019, 67.3% injured males and 494, 32.7% injured females). The majority of these assaults (993, 65.6%) were recorded exclusively by emergency departments; 357 (23.6%) were recorded only by the police and 163 (10.8%) were recorded by both emergency departments and the police. Equal proportions of males (67.3%) and females (67.5%) injured in assaults were recorded by both emergency departments and the police, but men were more likely to have their assault recorded exclusively in emergency departments (odds ratio (OR) 2.1, 95% confidence interval (CI) 1.7 to 2.7) while women were more likely to have their assault recorded exclusively by the police (OR 2.5, 95% CI 2.0 to 3.2). There were no significant relationships between exclusive emergency department recording and increasing age (OR 1.0, 95% CI 0.9 to 1.2), exclusive police recording and increasing age (OR 1.1, 95% CI 1.0 to 1.2), or between age and dual recording (OR 0.9, 95% CI 0.8 to 1.0).

CONCLUSIONS: Most assaults leading to emergency department treatment, particularly in which males were injured, were not recorded by the police. Assaults on the youngest group (0-10, particularly boys) were those least likely to be recorded by police and females over age 45, the most likely. Emergency department derived assault data provide unique perspectives of community violence and police detection.

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Rev. 08-Nov-2002 at 17:47 hours.