Correspondence: Henry Wechsler, arvard School of Public Health and Social Behavior, 677 Huntington Ave, Room 704, Boston, MA 02115-6096, USA; (email: hwechsle@hsph.harvard.edu).
OBJECTIVES: This study examined whether colleges with larger enrollments of students from demographic groups with lower rates of binge drinking exert a moderating effect on students from groups with higher binge drinking rates.
METHODS: The study analyzed data from 114 colleges included in the 1993, 1997, 1999, and 2001 College Alcohol Study surveys.
FINDINGS: The binge drinking rates of White, male, and underage students were significantly lower in schools that had more minority, female, and older students. Students who do not binge drink in high school are more likely to start binge drinking at colleges with fewer minority and older students.
COMMENTS: Student-body composition and demographic diversity should be examined by colleges wishing to reduce their binge drinking problems.
Providing free smoke alarms did not reduce fire related injuries in a deprived multiethnic urban population: Commentary on publications by DiGuiseppi and by Mallonee.
Correspondence: Anne Ehrlich, School Of Nursing, McMaster University, Health Sciences Centre Room 3h46, 1280 Main Street West, Hamilton, Ontario L8S 4L8, CANADA; (email: ehrlicha@mcmaster.ca).
Rarely is a primary prevention trial of personal safety so well designed and conducted as the study by DiGuiseppi et al. Although the results were negative, the rigour of the cluster randomised design and the attention to other methodological aspects leaves little doubt as to the veracity of the principal outcome. DiGuiseppi et al replicated many of the intervention features of a study by Mallonee et al, which was conducted in an economically deprived neighbourhood in Oklahoma City, USA. Both studies distributed similar alarms to a similar proportion of the population, and both involved community members and government and voluntary agencies in the distribution process. However, DiGuiseppi et al did not find the favourable results of Mallonee et al. In fact, DiGuiseppi et al found that the intervention and control households had similar proportions of alarms installed and operational. In other words, the participants did not use the safety device as instructed.
One explanation for the differences in the findings of DiGuiseppi et al and Mallonee et al might relate to differences in the study populations. DiGuiseppi et al suggest that their participants may have had lower literacy levels and greater difficulty understanding the installation and maintenance instructions. Furthermore, factors such as mistrust of people in positions of authority and the fact that most recipients were tenants rather than homeowners may have reduced installation rates in the study by DiGuiseppi et al.
The results are important for nurses and others working in the community. The role of community assessment in tailoring interventions to local populations cannot be overemphasised. Furthermore, a community assessment process using multiple culturally appropriate methods, particularly in a multiethnic population such as in the UK study, can support the trust building phase that DiGuiseppi et al identified as a key barrier to the implementation of their intervention.
A recurrent theme in injury prevention is the preference for passive prevention strategies rather than the active ones used by DiGuiseppi et al. This study suggests a continued role for public health practitioners in advocating for policy changes such as affordable, safe housing, and passive interventions, like sprinkler systems and appropriate building code regulations.
The Johns Hopkins Children's Safety Center (CSC) is a unique health care provider and patient education resource that elevates the attention injury prevention receives in a medical setting and reduces barriers to injury prevention experienced by low-income, urban families, the Center's priority population. This article describes the CSC's development, implementation, and selected elements of its evaluation. Because evaluation has played an important role in the CSC from its inception through its implementation and sustainability, three evaluation activities are described: process evaluation to monitor activity, impact evaluation to understand its effects on parents' safety behaviors, and qualitative interviews with CSC visitors and non-visitors to enhance services. Implications of each evaluation activity are described and recommendations are made for strengthening the CSC.
Parents of fatally injured children discuss taking part in prevention campaigns: an exploratory study.
Correspondence: Deborah C. Girasek, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, Maryland 20814, USA; (email: Dgirasek@usuhs.mil).
This qualitative study explores how a small group of parents who have lost children to accidental injuries feel about taking part in prevention campaigns. Prospective participants were identified through a state medical examiner's office. Six mothers and 5 fathers of children who had died 3-5 years earlier agreed to be interviewed. All participants thought that it was appropriate to approach bereaved parents about such opportunities, after the most disabling phase of grief had subsided. Yet they raised cognitive, emotional, and practical barriers to engaging in prevention work. The appealing aspects of becoming a safety advocate included preventing emotional and physical injuries to others, as well as advancing their own recovery. It is very possible that the volunteers we spoke with held more positive views on participation than the many mothers and fathers who chose not to participate in our study. Nonetheless, their comments give us our first insights into how collaborating on prevention may feel to those for whom prevention has failed.
Crush injury and crush syndrome: a consensus statement.
- Porter K, Greaves I. Emerg Nurse 2003; 11(6): 26-30.
Correspondence: Keith Porter, Faculty of Pre-Hospital Care, Royal College of Surgeons of Edinburgh, Nicolson Street, Edinburgh EH8 9DW, UK; (email: unavailable).
Crush syndrome remains rare in European practice but is common in areas of civil disorder and where society has given way to civil war or natural disaster. Clinicians in the west are becoming increasingly involved in such situations and there is no reason to believe that the few instances due to conventional causes, such as an elderly person collapsing or road traffic accidents, will cease. Therefore, it is important that clinicians who deal rarely with crush syndrome have access to appropriate guidelines. This consensus report seeks to provide such advice.
A chamber-experiment investigation of the interaction between perceptions of noise and odor in humans.
Pan Z, Kjaergaard SK, Molhave L. Int Arch Occup Environ Health 2003; 76(8): 598-604.
Correspondence: Zhiwei Pan, Department of Environmental and Occupational Medicine, University of Aarhus, Vennelyst Boulevard 6, 8000, Aarhus, DENMARK; (email: pan@mil.au.dk).
OBJECTIVES: This study was designed to investigate human comfort and health effects following exposure to noise and odor and to explore the interaction between perceptions of noise and odor in humans.
MATERIALS AND METHODS: Nine healthy subjects were randomly exposed to noise, odor, and their combination, in a 3x3 Latin square design for 80 min in an exposure chamber. Continuous noise was broadcast at an average level of 75 dBA by a loudspeaker, and odor was provided by furfurylmercaptan (a coffee-aroma constituent). A standardized 28-item questionnaire, together with mood-scale ratings, nasal dimensions by acoustic rhinometry, addition tests for distraction, and skin humidity, were performed before and at the end of exposure.
FINDINGS: In the questionnaire investigation, the perceived 'sound level' was significantly affected by noise and the combined exposures, while 'odor intensity', 'air quality', and 'need more ventilation' was significantly affected by odor and the combined exposures. Perceptions of symptoms became worse with increasing exposure time, such as perceived 'sleepiness' by odor and combined exposures, 'headache' by noise, 'concentration difficulty', 'general well being' by noise, odor and combined exposures.
COMMENTS: It may be concluded that noise and odor cause discomfort in humans. Moreover, the study might indicate that additions of noise reduce (mask) the perception of discomfort from odor, and additions of odor have no or little affect on the perception of noise.
Offshore quantitative risk assessments (QRA) have historically been complex and costly. For large offshore design projects, the level of detail required for a QRA is often not available until well into the detailed design phase of the project. In these cases, the QRA may be unable to provide timely hazard understanding. As a result, the risk reduction measures identified often come too late to allow for cost effective changes to be implemented. This forces project management to make a number of difficult or costly decisions.This paper demonstrates how a scenario-based approached to fire risk assessment can be effectively applied early in a project's development. The scenario or design basis fire approach calculates the consequence of a select number of credible fire scenarios, determines the potential impact on the platform process equipment, structural members, egress routes, safety systems, and determines the effectiveness of potential options for mitigation. The early provision of hazard data allows the project team to select an optimum design that is safe and will meet corporate or regulatory risk criteria later in the project cycle.The focus of this paper is on the application of the scenario-based approach to gas jet fires. This paper draws on recent experience in the Gulf of Mexico (GOM) and other areas to outline an approach to fire hazard analysis and fire hazard management for deep-water structures. The methods presented will include discussions from the recent June 2002 International Workshop for Fire Loading and Response.
Incidence and prevention of occupational electrical accidents.
- Goffeng LO, Veiersted KB, Moian R, Remo E, Solli A, Erikssen J. Tidsskr Nor Laegeforen 2003; 123(17): 2457-2458.
Correspondence: Kaj Bo Veiersted, Statens arbeidsmiljøinstitutt, Postboks 8149 Dep 0033 Oslo, NORWAY; (email: bove@stami.no).
CONTEXT: The Norwegian Directorate for Fire and Electrical Safety receives an annual total of 50 reports of injuries caused by electricity, while the Labour Inspection Authority receives 150 reports. The underreporting is, however, considerable.
OBJECTIVES: To estimate the Incidence of occupational electrical accidents and describe the legislation regulating the reporting of injuries from electrical accidents. MATERIAL AND METHODS: 326 of 343 electricians (95 %) returned a questionnaire on electrical accidents. FINDINGS: We received reports that indicated an incidence of 7.6 serious accidents per 100 person-years, which equal more than 3000 electrical accidents annually in Norway.
COMMENTS: Underreporting complicates accident prevention. Doctors should more often report occupational accidents than what is common today.
Magnitude and risk factors of injuries in a glass bottle manufacturing plant.
Bazroy J, Roy G, Sahai A, Soudarssanane MB. J Occup Health 2003; 45(1): 53-59.
Correspondence: Joy Bazroy, Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry 60500, INDIA; (email: unavailable)
A study was conducted in a glass bottle manufacturing plant in Pondicherry, India, to assess the magnitude and identify the risk factors of work-related injuries between January and December 1998. Three hundred and seventy-seven injuries were reported among 341 permanent workers followed up for one year (incidence=1,105.5/1,000 workers/yr). A higher load of injuries was noted in the first half of the night shifts and the second half of the other three shifts. Injuries were higher in the second half of the week and during the first half of the year. Hands and wrists were the most common sites of injury (40.6%), whereas the eye, foot, ankles and other body parts had 30%, 14.6%, 10.6% and 4.2% of injuries respectively. The commonest type of injury was cuts and lacerations (50.1%); injuries to the eye (due to foreign bodies, chemicals and welding sparks) accounted for 30%, sprains 8% and burns 7.1% of the injuries. A cohort of 75 workers chosen from the 341 permanent workers were followed up for the one year for identification of risk factors. Significant risk factors were age (less than 30 yr) and experience (less than 2 yr). Technical factors responsible for injury were a hazardous worksite in 37 (38.5%) cases, inadequate protection with safety wear in 32 (33%) cases and proximity to machines in 14 (14.6%) cases. Human factors identified were non-use of protective wear in 43 (45%), overconfidence in 18 (18.7%) and timing error while working with machines in 11 (11.4%) episodes.
Correspondence: Rollin W. Nagel, Department of Family Medicine, Medical College of Ohio, 1015 Garden Lake Parkway, Toledo, OH 43614, USA; (email: rnagel@mco.edu).
CONTEXT: Prevention is understudied in trauma care. Furthermore, the effectiveness of prevention outreach programs is not well documented.
OBJECTIVES: We attempted to verify that elementary school educational programs effectively create retained knowledge.
METHODS Three hundred fifty-one students (grades 1-3) viewed a bicycle safety videotape and then listened to a structured discussion of bicycle safety rules. Coded pretests were given before and identical posttests were given immediately after the session. Tests were readministered 1 month later to evaluate retained knowledge. Two hundred fifty-one students completed all three tests.
FINDINGS: Students showed significant (p < 0.01) improvement in retained knowledge about riding with traffic, wearing a bicycle helmet, warning pedestrians when riding on sidewalks, and stopping before riding into the street.
COMMENTS: We conclude that prevention programs are effective and result in retained knowledge. Further analysis is recommended to evaluate retained knowledge at greater intervals after the original education.
A two year randomised controlled trial of headgear in Rugby Union football is being conducted in Sydney, Australia. This paper gives an overview of this study in progress and presents results related to the development and laboratory performance of the headgear. The study commenced in 2002. Participants recruited to the study are in the under 13, 15, school open (U18) and colts age groups. There are three study arms: control, IRB-approved headgear, and modified headgear. The IRB approved headgear is a popular model in rugby, the Canterbury Honeycomb model manufactured by BodyArmour in New Zealand. The dimensions of this model were altered by increasing foam density and thickness to produce the modified headgear. In impact energy attenuation tests of 15 and 20 Joules onto a flat anvil, the modified headgear demonstrated average maximum headform accelerations of 23% and 33% of the standard model, respectively. Whether or not this improvement translates into reductions in injury will be determined by a comparison of the rates and severities of head injuries across study arms. Furthermore, these dimensional changes may not be acceptable to rugby players. Player attitudes towards safety and the use of protective clothing, injury history, experience and on-field behaviour will be examined via structured pre- and end of season surveys and analysis of match video.
Injury in junior Australian Rules footballers.
- Grimmer K, Williams J. J Sci Med Sport 2003; 6(3): 328-338.
Correspondence: Karen Grimmer, Centre for Allied Health Research, University of South Australia, City East campus, Adelaide, AUSTRALIA; (email: karen.grimmer@unisa.edu.au).
This paper reports on injuries sustained by Australian Rules footballers aged seven to 17 years, who played a full season of junior South Australia National Football League (SANFL) affiliated school or club competition in 2000. 697 boys provided information on injuries sustained throughout the season. 136 players (19.5% of the total) reported 234 injuries (1.7 injuries per injured player). The leg, the head and face, and hands were the most commonly injured areas, with 43.2% of injuries related to a collision. The majority of injuries were minor, involving soft tissue contusions. The 12-14 year olds playing club competition had the highest risk of injuries, and the most common occurrence of head and hand injuries. Over 60% of injuries occurred in the last two quarters of the game, and 21% of the reported injuries occurred at training. This study identified the need to review rule modification in the young adolescent age groups playing club competition to ensure that growing bodies are not exposed to unsafe playing practices.
The neuropsychology of heading and head trauma in Association Football (soccer): a review.
Rutherford A, Stephens R, Potter D. Neuropsychol Rev 2003; 13(3): 153-179.
Correspondence: Andrew Rutherford, Department of Psychology, Keele University, Keele, Staffordshire ST5 5BG, UK; (email: a.rutherford@psy.keele.ac.uk).
Association Football (soccer) is the most popular and widespread sport in the world. A significant proportion of the injuries suffered in football are head injuries involving trauma to the brain. In normal play, head trauma frequently arises from collisions, but some researchers have claimed that it also may arise as a consequence of heading the ball. Although assessments based on biomechanical analyses are equivocal on the potential for brain injury due to football heading, a growing literature seems to support the claim that neuropsychological impairment results from general football play and football heading in particular. However, this review suggests a distinction is required between the neuropsychological effects ofconcussive and subconcussive head trauma and that all of the neuropsychological studies conducted so far suffer from methodological problems. At best, a few of these studies may be regarded as exploratory. The review concludes that presently, although there is exploratory evidence of subclinical neuropsychological impairment as a consequence of football-related concussions, there is no reliable and certainly no definitive evidence that such impairment occurs as a result of general football play or normal football heading. The neuropsychological consequences of football-related subconcussive effects await confirmatory investigation.
Sex Differences and the Incidence of Concussions Among Collegiate Athletes.
OBJECTIVE: To compare sex differences regarding the incidence of concussions among collegiate athletes during the 1997-1998, 1998-1999, and 1999-2000 seasons. DESIGN AND SETTING: A cohort study of collegiate athletes using the National Collegiate Athletic Association (NCAA) Injury Surveillance System; certified athletic trainers recorded data during the 1997-2000 academic years.
SUBJECTS: Collegiate athletes participating in men's and women's soccer, lacrosse, basketball, softball, baseball, and gymnastics
MEASUREMENTS: Certified athletic trainers from participating NCAA institutions recorded weekly injury and athlete-exposure data from the first day of preseason practice to the final postseason game. Injury rates and incidence density ratios were computed. Incidence density ratio is an estimate of the relative risk based on injury rates per 1000 athlete-exposures.
FINDINGS: Of 14 591 reported injuries, 5.9% were classified as concussions. During the 3-year study, female athletes sustained 167 (3.6%) concussions during practices and 304 (9.5%) concussions during games, compared with male athletes, who sustained 148 (5.2%) concussions during practices and 254 (6.4%) concussions during games. Chi-square analysis revealed significant differences between male and female soccer players (chi(2)(1) = 12.99, P =.05) and basketball players (chi(2)(1) = 5.14, P =.05).
COMMENTS: Female athletes sustained a higher percentage of concussions during games than male athletes. Of all the sports, women's soccer and men's lacrosse were found to have the highest injury rate of concussions. Incidence density ratio was greatest for male and female soccer players.
Evaluation of race and ethnicity on alcohol and drug testing of adolescents admitted with trauma.
- Marcin JP, Pretzlaff RK, Whittaker HL, Kon AA. Acad Emerg Med 2003; 10(11): 1253-1259.
Robert K. Pretzlaff, Department of Pediatrics, Section of Critical Care Medicine, University of California, Davis, 2516 Stockton Boulevard, Sacramento, CA 95817, USA; (email: rkpretzlaff@ucdavis.edu).
OBJECTIVES: To describe the incidence of alcohol and drug testing in adolescents admitted for traumatic injury and to analyze these results with reference to race, ethnicity, and gender differences.
METHODS: Data were collected on adolescents (aged 12 through 17 years) from the National Trauma Data Bank. Testing statuses for alcohol and drugs were the two primary outcome variables. The results of these tests were the secondary outcome variables. Additional casemix variables included: race, ethnicity, gender, age, Glasgow Coma Scale score, Injury Severity Score, day and time of arrival, and payment source. Hierarchical, multivariable logistic regression models were used to assess the relationship of race, ethnicity, and gender with the primary and secondary outcome variables.
FINDINGS: Differences noted in the likelihood of alcohol and drug testing among the different racial, ethnic, and gender groups demonstrated an increased likelihood of Hispanic males and African American females to receive alcohol testing (odds ratio [OR]: 1.48; 95% CI = 1.06 to 2.06; and OR: 1.30; 95% CI = 1.01 to 1.67, respectively). Results of testing revealed that females of all races were less likely than males to test positive for alcohol and drugs. Drug and alcohol testing was more common during evenings, nights, and weekends, as well as in the presence of neurologic injury.
COMMENTS: Whereas small disparities in alcohol and drug testing were noted in some minority race-based groupings, systematic racial bias is not evident in adolescent trauma patients.
The connection between trauma and dissociation: a critical evaluation.
Dissociation is often considered to be a psychological defense mechanism used by victims of traumatic events (e. g., sexual abuse, physical punishment, or emotional abuse). Evidence for this view comes from studies that found a connection between self-reported traumatic childhood experiences and high levels of dissociation. However, there are some problems with this causal interpretation. The aim of this review is to summarize evidence that casts doubts on the commonly voiced view that the connection between self-reported trauma and dissociation is a simple and robust one. First, we briefly summarize studies that looked at the link between trauma and dissociation as well as studies that identified factors that may modulate this link. Second, we review studies that explored the psychological correlates of dissociation. Over the past few years, our knowledge of these correlates has increased considerably. Some of these correlates (e. g., fantasy proneness, suggestibility, and frontal lobe dysfunction) are especially relevant because they may undermine the accuracy of retrospective self-reports of trauma. Finally, we conclude that the link between trauma and dissociation is more complex than many clinicians seem to assume. In particular, the possibility that dissociation acts as an antecedent of self-reported trauma warrants serious attention.
Correspondence: Marjorie S. Hardy, Department of Psychology, Eckerd College, 4200 54th Avenue, South, Saint Petersburg, FL 33711, USA; (email: hardyms@eckerd.edu).
Gun-safety programs frequently warn children not to touch guns with little consideration that the messages may enhance the allure of the guns. In the current study, boys rated and ranked their preference for a gun in comparison with other desirable objects. One week later, when left alone in the room with the objects, they were forbidden to touch either the gun or some other object. Observations of their behavior and reevaluation of their attitudes followed. Although the boys forbidden to touch the gun did not report an increased preference for it, all participants were significantly more likely to touch the forbidden gun than to touch other forbidden objects. Age, parent- and coach-reported simulated gun-play, and coach-reported risky behavior predicted gun-touching behavior. The results of the current study indicate that guns hold a unique allure and cast further doubt on the ability of gun admonitions to keep children safe around guns.
Parental knowledge and children's use of bicycle helmets.
Helmet use protects against head injury. Our objective was to assess whether parental knowledge of helmet safety is associated with helmet use in children, and whether a relationship exists between helmet ownership and other safety behaviors. Three hundred forty-one surveys were distributed to parents of third through fifth graders; 97% of parents believed that a helmet confers protection; 49% of parents reported that their child owns a helmet. Of the helmet owners, 27% reported that the child wears it more than 75% of the time. Seat belt usage was associated with helmet ownership (p=0.02) and frequency of wearing a helmet (p=0.04). Although parents are aware of the benefits, a barrier between helmet ownership and usage exists.
Determinism, risk and safe driving behavior in northern Alberta, Canada.
Correspondence: J. Peter Rothe, Alberta Centre for Injury Control and Research, Department of Public Health Sciences, University of Alberta, Edmonton, CANADA; (email: peter.rothe@ualberta.ca).
CONTEXT: There is evidence that Alberta's rural north is over-represented in the Canadian province's overall traffic fatality rate, even after weather, travel exposure and highway geometry are controlled for.
OBJECTIVE: The objective of this study was to identify underlying reasons and rationales that northern citizens use to accommodate risk and driving behavior.
METHODS: A total of 82 individuals participated in 13 focus groups, each with between 5 and 10 participants. Eight focus groups were conducted with general drivers and five with service professionals in five different Alberta locations. Discussions centered on a series of questions that were designed to elicit insight into general characteristics of the participants' world-view and featured two categories of questions, including dimensions of belief systems and driver characteristics and behavior.
FINDINGS: Although much of the discussions focused on freedom of choice, over half of the interviewees cited determinism as a key feature of responsibility. Three versions of determinism were emphasized as key in roadway safety: religious determinism, 'universal' determinism (fatalism), and humanistic determinism. These observations highlighted peoples' perception of the likelihood of getting into traffic situations outside one's control.
COMMENTS: In order to maximize the effectiveness of traffic safety in the north, professionals need to take an approach which addresses not only safety issues, but also issues regarding responsibility and its links with behavior.
Trauma occurring in the rural setting presents a unique set of challenges not found in more populated areas. Risk of death is distinctly increased, probably as a result of prehospital factors such as delayed recognition and inconsistency of EMS response and care. Lack of trauma trained physicians and hospital resources also contribute to a higher death rate. Development and designation of rural trauma centers can be instrumental in reversing this trend. The education in trauma care that goes hand-in-hand with designation is probably most responsible for better outcomes of trauma patients. The guiding philosophy in such a system should be one of 'minimal acceptable care' with early recognition of major trauma and expeditious transfer of these patients. This does not obviate the responsibility of rural trauma centers to deal quickly and effectively with patients in whom ongoing blood loss is an immediate threat to life and to exert a damage control approach as an initial phase of treatment.
Contributing factors to engulfments in on-farm grain storage bins: 1980 through 2001.
- Kingman DM, Deboy GR, Field WE. J Agromedicine 2003;9(1):39-63.
Correspondence: Douglas M. Kingman, Department of Agriculture, Illinois State University, Campus Box 5020, Normal, IL, 61790-5020, USA; (email: dkingma@ilstu.edu).
Since 1978 Purdue University has maintained a national database of agriculture-related engulfment cases that have occurred in loose agricultural material in both commercial and on-farm facilities. The database presently contains 502 documented cases of fatal and non-fatal engulfments from the U.S. and Canada. A review of the more recent on-farm fatal and non-fatal engulfment cases, those occurring in 1980 through 2001, was conducted in order to characterize engulfments and identify contributing factors that would be relevant to future intervention strategy development including the implementation of design standards for on-farm structures. From 1980 through 2001, 197 cases were identified that occurred in on-farm grain bins, 156 of which were fatal and 41 were non-fatal. A rate of approximately seven fatal and two non-fatal cases per year were identified from 1980 through 2001. The magnitude of the engulfment problem is continuing, based on six and seven fatal cases reported in the years 2000 and 2001, respectively. Sixteen percent of fatal and six percent of non-fatal victims were children and adolescents under the age of 16. Fifty percent of the survivors were 60 years of age or older. Engulfments were generally reported more often in the top corn-producing states and involved corn in 76% of the fatal cases when product was known. Seventy-seven percent of the fatal victims were unloading the bin at the time of engulfment in cases where activity at the time of engulfment was known. Forty-one percent of the fatality cases involved corn that was out-of-condition where the condition of the grain was known. In survival cases where information about the presence of co-workers at the time of engulfment was known, it was found that a co-worker was present at the time of engulfment in 86% of the cases. In four cases, a survivor was rescued from a bin after being completely engulfed in grain. In all four cases, a co-worker was present at the time of engulfment and out-of-condition grain was involved. Findings are being used to design new injury prevention strategies, including educational materials and recommendations for engineering controls that focus on primary causative factors.
This study assessed the relative contributions of visual and proprioceptive/motor information during self-motion in a virtual environment using a speed discrimination task. Subjects wore a head-mounted display and rode a stationary bicycle along a straight path in an empty, seemingly infinite hallway with random surface texture. For each trial, subjects were required to pedal the bicycle along two paths at two different speeds (a standard speed and a comparison speed) and subsequently report whether the second speed travelled was faster than the first. The standard speed remained the same while the comparison speed was varied between trials according to the method of constant stimuli. When visual and proprioceptive/motor cues were provided separately or in combination, the speed discrimination thresholds were comparable, suggesting that either cue alone is sufficient. When the relation between visual and proprioceptive information was made inconsistent by varying optic flow gain, the resulting psychometric functions shifted along the horizontal axis (pedalling speed). The degree of separation between these functions indicated that both optic flow and proprioceptive cues contributed to speed estimation, with proprioceptive cues being dominant. These results suggest an important role for proprioceptive information in speed estimation during self-motion.
Comparison of balance in older people with and without visual impairment.
Lee HK, Scudds RJ. Age Ageing 2003; 32(6): 643-649.
Correspondence: Harry K. M. Lee, Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hung Hom, Kowloon, HONG KONG; (email: harrykmlee@hotmail.com).
OBJECTIVE: A cross-sectional study was used to compare the balance ability of older people with and without visual impairment.
SETTING: Tung Wah Group of Hospitals Jockey Club Rehabilitation Complex and the Pok Oi Hospital Jockey Club care and attention homes for aged individuals. SUBJECTS: A total of 66 subjects, 65 years of age and older were divided into three groups based on their degree of visual impairment.
METHODS: The directional Es chart was used to test the subjects ' visual acuity. Functional balance ability was measured using the Berg balance scale. Demographic characteristics and baseline variables such as lower extremity range of motion, muscle strength, and joint pain was assessed and compared between the groups.
FINDINGS: 66 older adults (43 women, 23 men) aged 69-94 years of age participated in the study. The one-way ANOVA showed that the mean Berg balance scores were significantly different (F(2,63) = 19.19, P < 0.001). Post hoc tests showed that the group with no visual impairment had higher mean balance scores than the group with mild visual impairment (P = 0.04) and those with moderate visual impairment (P < 0.001). The balance scores for the group with mild visual impairment were also shown to be significantly difference from those of the group with moderate visual impairment (P = 0.003). Control of factors related to balance, such as range of motion, pain and strength, did not affect the analysis of variance analyses.
COMMENTS: Balance was shown to be more impaired with greater visual impairment, which could result in falls and resultant injury. The findings suggest that early intervention to improve visual acuity in older people may be important.
Perceived causes of suicide attempts were examined in 180 ethnic South Asian women living in the London area. The 3 factors endorsed most frequently and strongly as causes of suicide attempts in South Asian women were violence by the husband, being trapped in an unhappy family situation, and depression.
Toward understanding youth suicide in an Australian rural community.
Correspondence: Lisa Bourke, School of Rural Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, P.O. Box 6500 VIC 3632, Shepparton, AUSTRALIA; (email: bourke@unimelb.edu.au).
Australia has one of the highest rates of youth suicide in the western world, especially among rural men. This paper discusses the social construction of this issue in Australia and explores the issue through interviews with 30 young people and 12 key informants from a rural town in NSW. Findings suggest that young people struggle to deal with conflict in social relationships, that community discourses shape young people's understandings and that suicide is talked about in reference to depression. Implications for youth suicide prevention in Australian rural communities are discussed.
A stubborn behaviour: the failure of antidepressants to reduce suicide rates.
Over the past decades the rate of completed suicide has remained quite stable, that of suicide attempts even seems to have increased (to the extent it has been studied in defined regions). These are puzzling observations, since depression is the major suicide precursor and since antidepressants over the years have been increasingly used in the treatment of depression. These observations have not attracted sufficient attention, possibly because they do not accord with consensus opinions about depression treatment in psychiatry today. In this paper a number of possible explanations are discussed.
Motor vehicle crash fatalities among Hispanics in rural North Carolina.
- March JA, Evans MA, Ward B, Brewer KL. Acad Emerg Med 2003; 10(11): 1249-1252.
Juan A. March, East Carolina University, School of Medicine, Division of Emergency Medical Services, Physicians Quadrangle, Building M, Greenville, NC 27858, USA; (email: marchj@mail.ecu.edu).
OBJECTIVES: Deaths from motor vehicle crashes (MVCs) have decreased significantly over the past three decades. Unfortunately, few data have been collected regarding death rates for MVCs in minority populations. The purpose of this study was to compare the death rate of whites versus Hispanics for MVCs in a rural environment.
METHODS: This study examined one rural county in North Carolina from January 1, 1999, to December 31, 1999. A retrospective cohort study was performed using the North Carolina State Highway Patrol computerized database of MVCs. Data regarding the total number of MVCs, fatalities, alcohol-related deaths, seatbelt usage, and cause of the collision were analyzed for both whites and Hispanics. Census information regarding population in this region also was obtained from the U.S. Bureau of Census. Data were analyzed using a chi-square test, with an alpha value of 0.05 used to establish statistical significance.
FINDINDS: During the study period, whites were involved in 2,689 MVCs, compared with 158 MVCs for Hispanics. Whites were involved in ten fatal MVCs, compared with seven fatal MVCs involving Hispanics. The percent of fatal MVCs for whites was 0.3%, or 10 deaths per 2,689 MVCs. In contrast, the percent of fatal MVCs for Hispanics was 4.4%, or 7 deaths per 158 MVCs; odds ratio (OR) = 12.4, 95% CI = 4.7 to 33.1. The 2000 Census Report for Pitt County noted a white population of 81,613 and a Hispanic population of 4,216. Based on these population data, the death rate for MVCs per 100,000 population was 12.3 for whites versus 166.0 for Hispanics, OR = 13.6, 95% CI = 5.2 to 35.6. Although the cause for this disparity was not determined, previous studies suggest that alcohol and decreased seatbelt usage are contributing factors.
COMMENTS: In this study, the death rates among Hispanics for rural MVCs were significantly higher than for whites. The causes of this disparity are not clear but are important to define. Only by understanding this disparity can we begin to develop appropriate interventions that may prevent these deaths.
Traumatic brain injury and automotive design: making motor vehicles safer.
CONTEXT: Traumatic brain injury (TBI) remains a major public health problem in the United States. Identifying and modifying vehicle designs associated with TBI will have a significant impact on the frequency and severity of TBI in motor vehicle crashes (MVCs).
OBJECTIVES: Our objective was to identify interior vehicle contact points associated with severe TBI (head Abbreviated Injury Scale score > 3) among drivers and determine the extent to which modifications of these contact points impact the likelihood of severe TBI.
METHODS: We analyzed drivers in MVCs from the 1993 to 2001 National Automotive Sampling System database. The odds of severe TBI with respect to various vehicle contact points were estimated using multivariate logistic regression. Using computer simulation software, the magnitude of driver head deceleration was modeled while manipulating vehicle design features. The potential impact of this design modification on the frequency and hospital charges of TBI cases was estimated.
FINDINGS: There were 18,313 drivers involved who were victims of TBI, equating to a national sample size of 3,275,472 cases. The most frequent contact point associated with severe TBI was the roof rail (odds ratio, 2.0; 95% confidence interval, 1.2-3.3). Increasing roof rail padding thickness to 5.0 cm reduced the peak acceleration from 700 g to 218 g, which would potentially reduce the attributable number of severe TBI cases per year from 2,730 to 210, thereby reducing annual acute care charges from $136.5 million to $10.5 million.
COMMENTS: Contact with the roof rail significantly increases the likelihood of TBI in MVCs. Minor increases in padding at these points may reduce the frequency of severe TBI, which would have a substantial effect on health care costs.
Aggression and violence are concerns that engage us across society as moral and cultural issues. They are also critical issues for mental health research-both for survivors and for understanding how such behaviors occur. Interpersonal violence often explodes in deliberate acts of physical force leaving survivors behind with a diminished sense of control that is often shadowed by persistent fear and anxiety. The treatment of the victims is a clear and immediate concern; from their perspectives the medical consequences require effective attention whether they suffered as a result of acts of nature, mental disease, ideology, or combinations of these. At the same time preventing violent behavior from happening in the first place is a compelling challenge for public health research.
What can animal aggression research tell us about human aggression?
Correspondence: D. Caroline Blanchard, Pacific Biomedical Research Center and Department of Genetics and Molecular Biology, John A. Burns School of Medicine, University of Hawaii, 96822, Honolulu, HI, USA, (email: blanchar@hawaii.edu).
Research on endocrinological correlates of aggression in laboratory animals is implicitly motivated by an expectation that the results of such studies may be applicable to human aggression as well. Research with a focus on the stimulus antecedents of aggression, its response characteristics, and its outcomes suggests a number of detailed correspondences between offensive aggression in laboratory rodents and human angry aggression. These include resource (including status and territory) competition as motives that are particularly elicited by conspecific challenge situations and, when the aggression is successful, outcomes of reduction of challenge and enhancement of resource control and status. Although the response characteristics of human aggression have been dramatically altered by human verbal, technological, and social advancements, there is some evidence for targeting of blows, similar to a well-established pattern for offensive aggression in many nonhuman mammals. Finally, for people as well as for nonhuman mammals, fear of defeat or punishment is a major factor inhibiting the expression of offensive aggression. While defensive aggression has been very little researched in people, it may represent a different phenomenon than angry aggression, again providing a parallel to the offense-defense distinction of laboratory rodent studies.
Neurosteroids, GABA(A) receptors, and escalated aggressive behavior.
- Miczek KA, Fish EW, De Bold JF. Horm Behav 2003; 44(3): 242-257.
Correspondence: Klaus A. Miczek, Department of Psychology, Tufts University, 530 Boston Avenue (Bacon Hall), Medford, MA 02155, USA; (email: klaus.miczek@tufts.edu).
Aggressive behavior can serve important adaptive functions in social species. However, if it exceeds the species-typical pattern, it may become maladaptive. Very high or escalated levels of aggressive behavior can be induced in laboratory rodents by pharmacological (alcohol-heightened aggression), environmental (social instigation), or behavioral (frustration-induced aggression) means. These various forms of escalated aggressive behavior may be useful in further elucidating the neurochemical control over aggression and violence. One neurochemical system most consistently linked with escalated aggression is the GABAergic system, in conjunction with other amines and peptides. Although direct stimulation of GABA receptors generally suppresses aggression, a number of studies have found that positive allosteric modulators of GABA(A) receptors can cause increases in aggressive behavior. For example, alcohol, benzodiazepines, and many neurosteroids are all positive modulators of the GABA(A) receptor and all can cause increased levels of aggressive behavior. These effects are dose-dependent and higher doses of these compounds generally shift from heightening aggressive behavior to being sedative and anti-aggressive. In addition, these modulators interact with each other and can have additive effects on the GABA(A) receptor and on behavior, including aggression. The GABA(A) receptor is a heteropentameric protein that can be constituted from various subunits. It has been shown that subunit composition can affect sensitivity of the receptor to some modulators and that subunit composition differentially affects the sedative vs anxiolytic actions of benzodiazepines. Initial studies targeting alpha subunits of the GABA(A) receptor point to their significant role in the aggression-heightening effects of alcohol, benzodiazepines, and neurosteroids.
Correspondence: Dorothy Shaw, Division of Maternal Fetal Medicine, BC Women's Hospital and Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, CANADA; (email: dshaw@cw.bc.ca).
Domestic violence has been recognized as a public health concern worldwide with serious social and health consequences, including adverse pregnancy outcome. Although health-care professionals are becoming better informed about domestic violence, and women accept being questioned in this regard, studies have shown that fewer than 10% of physicians ask women routinely about domestic violence, even during pregnancy. Further, based on traditional criteria for screening, reviews have not supported screening programs for domestic violence. This purist approach to screening is inconsistent with what we know about domestic violence and provides a rationale for health-care professionals who are personally uncomfortable with routinely asking women about domestic violence to avoid such an approach. Biomedical models are inadequate to measure the "success" of screening for complex psychosocial health issues. Recent studies suggest that merely asking about violence and providing validation and support reduces violent incidents. The term "screening" in this context may be a misnomer better replaced by "routine enquiry." Published systematic reviews and guidelines about domestic or relationship violence acknowledge the seriousness of the problem from a health perspective and the justification to include routine enquiry about domestic violence as part of health care, even when concluding that the evidence is lacking to justify screening programs as traditionally defined. Continued education and support for health professionals is essential in ensuring that women are not unknowingly left at greater risk due to a non-systematic approach.
Intimate partner violence and depression among Whites, Blacks, and Hispanics.
Caetano R, Cunradi C. Ann Epidemiol 2003; 13(10): 661-665.
Correspondence: Raul Caetano, M.D., Ph.D., Dallas Regional Campus, University of Texas School of Public Health, 5323 Harry Hines Boulevard, Room v8.112, Dallas, TX 75390-9128, USA; (email: raul.caetano@UTSouthwestern.edu).
OBJECTIVE: To examine the relationship between intimate partner violence and depression.
METHODS: A household probability sample of Whites (n=616), Blacks (n=377), and Hispanics (n=592) age 18 or older was interviewed in 1995. The response rate was 85%. Logistic analysis is used to identify predictors of depression.
FINDINGS: Among men, Black (OR=.29; 95% CI, 0.13-.65) and Hispanic (OR=0.4; 95% CI, 0.2-0.8) ethnicity were protective against depression. Factors of risk for men included victimization by female to male partner violence (OR=4.04; 95% CI, 1.15-14.11), unemployment (OR=7.65; 95% CI, 1.59-16.39), and living in a high-unemployment neighborhood (OR=4.6; 95% CI, 1.86-11.37). Among women, the predictors are perpetration of moderate (OR=4.08; 95% CI, 1.33-12.47) or severe (OR=6.57; 95% CI, 1.76-24.52) female to male partner violence, and impulsivity (OR=1.82; 95% CI, 3.87-20.71).
COMMENTS: Knowledge from surveys using general population samples is important for developing prevention interventions in the community. Because predictors of depression in these samples are both individual and contextual at neighborhood level, prevention interventions to be effective must address not only individual factors of risk but also structural conditions in the environment where individuals live.
