The purpose of this study was to evaluate the effectiveness of Safer Bars, an intervention to reduce aggression in bars. A total of 734 pre - post-intervention observations were conducted by trained observers on Friday and Saturday nights between midnight and 2 a.m. in 18 large capacity ( > 300) Toronto bars and clubs assigned randomly to receive the intervention (69% participation rate of the 26 assigned) and 12 control bars. As part of the intervention, owners/managers completed the risk assessment workbook to identify ways of reducing environmental risks, and 373 staff and owners/managers (84% participation rate) attended a 3-hour training session focused on preventing escalation of aggression, working as a team and resolving problem situations safely. The main outcome measures were rates of severe aggression (e.g. punching, kicking) and moderate physical aggression (e.g. shoving, grappling). Hierarchical linear modeling (HLM) comparing pre - post aggression for intervention versus control bars indicated a significant effect of the intervention in reducing severe and moderate aggression. This effect was moderated by turnover of managers and door/security staff with higher post-intervention aggression associated with higher turnover in the intervention bars. The findings indicate the potential for a stand-alone relatively brief intervention to reduce severe and moderate physical aggression in bars.
Emotional wellbeing and violence among social and solitary risky single occasion drinkers in adolescence.
- Kuntsche EN, Gmel G. Addiction 2004; 99(3): 331-339.
Correspondence: Emmanuel N. Kuntsche, Swiss Institute for the Prevention of Alcohol and Drug Problems (SIPA), Research Department, Lausanne, SWITZERLAND; (email: ekuntsche@sfa-ispa.ch).
OBJECTIVE: To classify adolescents according to risky single occasion drinking (RSOD) and their level of social integration, and to test whether these groups (social non-RSODs, social RSODs, solitary non-RSODs, solitary RSODs) differ in terms of emotional well-being and violence-related variables.
METHODS: K-means cluster and multiple logistic regression analyses were performed based on a cross-sectional national representative sample of 3861 8th and 9th graders in Switzerland (mean age 15.3; SD = 0.88).
FINDINGS: Although RSODs in general appear to be more violent, social RSODs tend to be more violent than solitary RSODs. Although RSODs reveal a lower life satisfaction generally and tend to have more depressive moods, solitary RSODs are even less satisfied and more depressive. In addition, the latter tend to have lower self-esteem and are more often victims of bullying.
COMMENTS: RSODs are not a homogeneous group of adolescents and preventive efforts, such as competence-enhancing and social resistance programs, should be applied in accordance with the constellation of associated problems: solitary RSODs appear to be socially inhibited, depressive and often victims of bullying, whereas social RSODs appear to be socially accepted but are prone to be violent offenders.
Engaging men as social justice allies in ending violence against women: evidence for a social norms approach.
- Fabiano PM, Perkins HW, Berkowitz A, Linkenbach J, Stark C. J Am Coll Health 2003; 52(3): 105-112.
Correspondence: Pat Fabiano, Prevention and Wellness Services, Western Washington University, Bellingham, WA 98225-9039, USA; (email: Pat.Fabiano@wwu.edu).
The field of sexual assault prevention is shifting attention to educational interventions that address the role of men in ending violence against women. Recent studies document the often-misperceived norms men hold about other men's endorsement of rape-supportive attitudes and behaviors. The authors provide further evidence supporting the design of population-based social norms interventions to prevent sexual assault. Data from this study suggest that men underestimate the importance that most men and women place on consent and willingness of most men to intervene against sexual violence. In addition, men's personal adherence to only consensual activity and their willingness to act as women's allies are strongly influenced by their perceptions of other men's and women's norms. These findings support the proposition that accurate normative data, which counters the misperception of rape-supportive environments, can be a critical part of comprehensive campus efforts to catalyze and support men's development as women's social justice allies in preventing sexual violence against women.
Exploring collaboration among urban neighborhood associations.
- Knickmeyer L, Hopkins K, Meyer M. J Community Pract 2004; 11(2): 13-25.
Correspondence: Lisa Knickmeyer, St. Michael Outreach Center, 1922 E. Lombard St., Baltimore, MD, 21231, USA; (email: lknickmeyer@stmichaeloutreach.org).
This paper examines collaboration among geographically close neighborhood associations to determine whether they share similar priorities, if they have collaborated on specific projects, and to what extent they desire collaboration to help achieve their goals. Structured interviews/ questionnaires were used to gather information about ten neighborhood associations clustered within an urban community. Results show that all ten associations are struggling to address the same community issues with a small number of active members. There is no evidence of joining forces with each other to resolve their common problems. The data illustrate that even when members of community associations recognize the value of collaboration and express interest in collaborating with others, they have difficulty translating that desire into actual collaborative projects.
Disasters affect families as a whole, and symptoms displayed by a family member may lead to secondary traumatizations for other members of the family, especially the children. This study examines the effects of parental psychopathology and family functioning on children's psychological problems six months after the earthquake in Bolu, Turkey. Forty-nine children aged between 7 and 14 and their parents were randomly chosen from among 800 families living in a survivor camp in Bolu. Both the children and parents were assessed by trained psychiatrists and psychologists using self-report measures for post-traumatic stress disorder (PTSD), depression, and anxiety symptoms six months after the earthquake. Family functioning in survivor families was also assessed using the Family Assessment Device (FAD). The results showed that the severity of PTSD in children was mainly affected by the presence of PTSD and the severity of depression in the father. State and trait anxiety scores of children were related to general family functioning. The constellation of PTSD symptomatology was different in fathers than in mothers: the most common type of symptoms was "externalizing" in fathers with PTSD. This study supports the notion that the mere presence of PTSD in parents may not be enough to explain the relational process in families experiencing trauma. Our findings with earthquake survivors suggest that when fathers become more irritable and detached because of PTSD symptoms, their symptoms may affect children more significantly.
OBJECTIVE: Minimizing driver fatigue among commercial motor-vehicle (CMV) drivers is a major safety issue in the United States. This study examines the effects of potentially fatigue-inducing factors inherent in truck driving work and company safety management in explaining: (a) drivers driving while fatigued, (b) the frequency of close calls due to fatigue, and (c) actual crashes among CMV drivers.
METHODS: Data for this study are derived from a survey of CMV drivers in 116 trucking firms, with all data being driver-reported. The relative roles of fatigue-inducing factors and safety management practices in explaining variation in fatigue, close calls, and crashes are reported, along with the roles of fatigue in affecting close calls and crashes via hierarchical regression.
FINDINGS: Findings indicated that fatigue-inducing factors inherent in driving work and safety practices accounted for appreciable variation in driving fatigued (R(2) =.42) and close calls (R(2) =.35), but not crash involvement. Driving while fatigued also accounted for incremental increases in the amount of variation in close calls, after consideration of inherent factors and safety practices.
COMMENTS: Findings indicate that safety practices (e.g., establishment of a strong safety culture, dispatcher scheduling practices, company assistance with fatiguing behaviors such as loading and unloading) have considerable potential to offset fatigue-inducing factors associated with truck driving work.
OBJECTIVE: The rapid growth of teleworking has raised several social and legal issues regarding an employer's responsibility for the safety of an employee's home office. In this paper, researchers discuss the need for safety training for teleworkers and the effectiveness of a home office ergonomics training program.
METHODS: Study participants (N = 50) were randomly assigned into a treatment or control group. The treatment group completed the ergonomics training and a pre- and posttest. The control group completed the pre- and posttests without training.
FINDINGS: The study demonstrated the need for teleworker ergonomics training. More than 85% of participants had not received teleworker training before, and 44% had experienced pain or discomfort while teleworking. Participants who completed the training significantly improved their scores on knowledge, attitude, and practices subtests. In a follow-up survey, participants indicated that they had made ergonomic changes to their offices based on the training. Several participants indicated that the pain or discomfort that they had been experiencing was eliminated or reduced as a result of the training.
Informal Jobs and Non-fatal Occupational Injuries.
- Santana VS, Loomis D. Ann Occup Hyg 2004; 48(2): 147-157.
Correspondence: Vilma Santana, Program of Environmental and Workers' Health, Institute of Collective Health, Federal University of Bahia, Rua Padre Feijo 29, 4 degrees Andar, 40110-170 Salvador, Bahia, BRAZIL; (email: unavailable).
OBJECTIVES: In Brazil, workers without a formal job contract represent approximately half of the labor force but there are no official statistics on occupational injuries for them. This study estimates the annual incidence of non-fatal work-related injuries for workers with and without job contracts and examines gender differences.
METHODS: This is a community-based study carried out with a random cluster area sample of the residents of Salvador, a city with 2.7 million inhabitants, the capital of the state of Bahia, northeast Brazil. Individuals from 18 to 65 years of age who reported having a paid job comprise the study population (n = 2907). Data were obtained in individual household interviews with questionnaires applied by trained field workers.
FINDINGS: The overall estimated annual incidence rate (IR) was 5.6/100 full-time equivalent workers (FTE). The incidence of injuries differed between workers with informal (IR = 6.2/100 FTE) and formal jobs (IR = 5.1/100 FTE), and according to gender (IR = 5.8/100 FTE for female and 5.5/100 FTE for male), but these differences were not statistically significant. Statistically significant positive associations between informal jobs and non-fatal work injuries were observed among women with medium education [incident rate ratio (IRR) 2.02, 95% CI 1.00-4.00] and women with black skin (IRR 1.71, 95% CI 0.99-2.97) who perceived a job as dangerous (IRR 2.00; 95% CI 1.09-3.64) or who had no occupational training (IRR 2.08; 95% CI 1.05-4.20).
COMMENTS: This study shows that non-fatal work injuries are a common health problem among adults in urban Brazil, regardless of the type of job contract or gender, which points to a need to improve workers' health and safety programs for formal and informal hired workers.
Safety and health problems of fishermen are reviewed in this article, including work related accidents and illness and their costs, and national and international preventive interventions. The article also discusses current ILO action to address these issues.
Can social psychological models be used to promote bicycle helmet use among teenagers? A comparison of the Health Belief Model, Theory of Planned Behavior and the Locus of Control.
- Lajunen T, Rasanen M. J Safety Res 2004; 35(1): 115-123.
Correspondence: Timo Lajunen, Department of Psychology, Middle East Technical University, ODTU 06531, Ankara, TURKEY; (email: timo@metu.edu.tr).
The bicycle helmet use rate is still low among teenagers despite the cumulating evidence that bicycle helmets can prevent cyclists from serious injuries and death. The objective of this study was to investigate the usefulness of the Health Belief Model (HBM; Health Education Monographs, 2 (1974) (1), Theory of Planned Behavior (TPB; Ajzen, I. (1988). Attitudes, personality and behavior. Open University Press, Milton Keynes) and Locus of Control model (LC; Psychological Monographs, (1966) (80) in understanding the intention to use bicycle helmet use among bicycle helmet owners. Method: Data were collected at two schools in Helsinki, Finland. Students (N=965) completed a questionnaire including three social psychological models applied to helmet use. Models were compared by structural equation modeling techniques. Summary: Results showed that the TPB and LC model fitted the data well, whereas fit of the HBM model was lower than the fit of TPB and LC models. All components of TPB and external LC orientation were significantly related to the intention to use a helmet. TPB together with LC model provide a promising theoretical framework for helmet use promotion campaigns. Practical suggestions for future bicycle helmet campaigns were provided.
A local bicycle helmet 'law' in a Swedish municipality - the effects on helmet use.
Correspondence: Sixten Nolen, Swedish Road and Transport Research Institute (VTI), Linkoping, Sweden and Linkoping University, Department of Health and Society, Division of Social Medicine and Public Health Science, Linkoping, SWEDEN; (email: sixten.nolen@vti.se).
The municipality of Motala in Sweden introduced a local bicycle helmet 'law' on May 1, 1996. This is not a legally enacted ordinance, but instead a legislated recommendation backed up by information and education. Formally, the law applies to children (aged 6-12 years), although the intention is to increase helmet use by all cyclists. The objective of the present study was to quantitatively evaluate the impact of the Motala helmet law on observed use of helmets by children and adults. Bicycle helmet use was monitored in Motala (n = 2,458/year) and in control towns (n = 17,818/year) both before and after adoption of the helmet law (1995-1998). Chi-square tests showed that helmet wearing 1995-1998 increased in Motala among all bicyclists (from 6.1% to 10.5%) and adults biking on cycle paths (from 1.8% to 7.6%). Helmet use by school children aged 6-12 increased during the first 6 months after introduction of the law (from 65.0% to 75.7%) but then progressively decreased to the pre-law level. Considering children cycling on cycle paths and for recreation in housing areas, there was a tendency towards increased helmet use during the first post-law year, but this was followed by a reduction to a lower level in 1998 than in 1995. Logistic regression analysis taking into account data from the control towns indicated that the helmet law had a positive effect on children cycling to schools during the first 6 months, and a weak delayed but more long-term positive effect on adult cyclists on cycle paths. There were no positive effects on children in housing areas and on cycle paths. The Motala helmet law probably would have had greater and more lasting effects on helmet use by bicyclists, if certain problems had been avoided during the initiation phase. Moreover, although it did have a positive influence on both school children and adults, it is not legally binding, and hence no penalties can be imposed. Presumably, compulsory legislation would have a more substantial impact on helmet wearing than a non-mandatory helmet 'law' such as that introduced in Motala.
This report describes inquiries relating to poisoning cases which were received by the National Poison Centre of Malaysia from the years 1996 to 2000. The study utilized data from the NPC report forms. Only data relating to patient contact with a poison or chemical were included in the analysis. The poison centre received an average of 186 poisoning inquiries per year. Doctors remained the highest group of caller to the poison centre throughout the five-year period. Nearly 50% of all inquiries was regarding pesticide poisoning and this trend remained constant during the five-year period. Overall, the findings showed that poisoning inquiries relating to patient care were lower than in Japan and the United States.
Poisoning, envenomation, and trauma from marine creatures.
Correspondence: A. Perkins, Department of Family Medicine, University of South Alabama College of Medicine, Mobile, Alabama 36604, USA; (email: aperkins@jaguar1.usouthal.edu).
In the course of their clinical work or during leisure activity, family physicians occasionally may encounter patients with injuries from marine creatures. Poisoning, envenomation, and direct trauma are all possible in the marine environment. Ciguatera poisoning can result from ingestion of predatory fish that have accumulated biotoxins. Symptoms can be gastrointestinal or neurologic, or mixed. Management is mostly symptomatic. Scombroid poisoning results from ingestion of fish in which histamine-like substances have developed because of improper refrigeration. Gastrointestinal and systemic symptoms occur. Treatment is based on antihistamines. Envenomations from jellyfish in U.S. waters and the Caribbean are painful but rarely deadly. Household vinegar deactivates the nematocysts, and manual removal of tentacles is important. Treatment is symptomatic. Heat immersion may help with the pain. Stingrays cause localized damage and a typically severe envenomation. The venom is deactivated by heat. The stingray spine, including the venom gland, typically is difficult to remove from the victim, and radiographs may be necessary to localize the spine or fragment. Surgical debridement occasionally is needed. Direct trauma can result from contact with marine creatures. Hemorrhage and tissue damage occasionally are severe. Infections with organisms unique to the marine environment are possible; antibiotic choices are based on location and type of injury. Shark attacks, although rare, require immediate attention.
Knowledge, beliefs and attitudes of squash venue operators relating to use of protective eyewear.
- Eime R, Finch C, Owen N, Gifford S, Vear P. Inj Control Saf Promot 2004; 11(1): 47-53.
Correspondence: Rochelle Eime, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, AUSTRALIA; (email: Rochelle.Eime@med.monash.edu.au).
Sports venues are in a position to potentially influence the safety practices of their patrons. This study examined the knowledge, beliefs and attitudes of venue operators that could influence the use of protective eyewear by squash players. A 50% random sample of all private and public squash venues affiliated with the Victorian Squash Federation in metropolitan Melbourne was selected. Face-to-face interviews were conducted with 15 squash venue operators during August 2001. Interviews were transcribed and content and thematic analyses were performed. The content of the interviews covered five topics: (1) overall injury risk perception, (2) eye injury occurrence, (3) knowledge, behaviors, attitudes and beliefs associated with protective eyewear, (4) compulsory protective eyewear and (5) availability of protective eyewear at venues. Venue operators were mainly concerned with the severe nature of eye injuries, rather than the relatively low incidence of these injuries. Some venue operators believed that players should wear any eyewear, rather than none at all, and believed that more players should use protective eyewear. Generally, they did not believe that players with higher levels of experience and expertise needed to wear protective eyewear when playing. Only six venues had at least one type of eyewear available for players to hire or borrow or to purchase. Operators expressed a desire to be informed about correct protective eyewear. Appropriate protective eyewear is not readily available at squash venues. Better-informed venue operators may be more likely to provide suitable protective eyewear.
Secondary school athletes: a study of mouthguards.
Correspondence: Chukwudi Ochi Onyeaso, Department of Preventive Dentistry, College of Medicine/University College Hospital, University of Ibadan, NIGERIA; (email: coonyeaso@yahoo.com).
The purpose of this study was to determine the extent of mouthguard awareness and use, as well as the amount and type of oro-facial trauma associated with and without mouthguard wear in adolescent Nigerian athletes. A 13-item self-completion questionnaire was completed and returned by 1,127 secondary school athletes (completion rate of 93.9%) comprising 683 (60.6%) males and 444 (39.4%) females ranging in age from 12- to 19 years (mean age 15.18+/-2.97 SD). The athletes were randomly drawn from 23 secondary schools located in different parts of Ibadan city in Nigeria. Sixty-five-and-a-third percent of the athletes professed awareness of the need for mouthguards for sports, but only 19.6% claimed usage of the device. Thirty-four-and-a-half percent of the athletes reported having sustained one form of oro-facial injury or the other previously. The prevalence of oro-facial injuries was significantly lower while wearing a mouthguard (p<0.05), and most of the injuries occurred during contact sports. The study supports the need for the enforcement of mandatory mouthguard use in contact sports.
The intervention selection bias: an underrecognized confounder in intervention research.
- Larzelere RE, Kuhn BR, Johnson B. Psychol Bull 2004; 130(2): 289-303.
Correspondence: R. Larzelere, Department of Psychology, Munroe-Meyer Institute, University of Nebraska Medical Center, Omaha, NE, USA; (email: rlarzelere@unmc.edu).
Selection bias can be the most important threat to internal validity in intervention research, but is often insufficiently recognized and controlled. The bias is illustrated in research on parental interventions (punishment, homework assistance); medical interventions (hospitalization); and psychological interventions for suicide risk, sex offending, and juvenile delinquency. The intervention selection bias is most adequately controlled in randomized studies or strong quasi-experimental designs, although recent statistical innovations can enhance weaker designs. The most important points are to increase awareness of the intervention selection bias and to systematically evaluate plausible alternative explanations of data before making causal conclusions.
Methodologic issues in the use of workers' compensation databases for the study of work injuries with days away from work. I. Sensitivity of case ascertainment.
- Oleinick A, Zaidman B. Am J Ind Med 2004; 45(3): 260-274.
Correspondence: Arthur Oleinick, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA; (email: aoleinic@umich.edu).
BACKGROUND: Case ascertainment costs vary substantially between primary and secondary data sources. This review summarizes information on the sensitivity of state administrative databases in workers' compensation systems for the ascertainment of days-away-from-work (DAFW) work injuries for use in modeling studies.
METHODS: Review of the literature supplemented by data from governmental or organizational reports or produced for this report.
FINDINGS: Employers currently appear to provide workers' compensation insurance coverage for 98.9% of wage and salary workers. Wage and salary jobs account for approximately 90% of jobs in the United States. In industries such as manufacturing, the fraction of covered jobs is probably closer to 98%. In Minnesota, the number of DAFW cases ascertained by the Bureau of Labor Statistics' annual survey of occupational injuries and illnesses is approximately 92-97% concordant with the number of wage compensation claims for injuries producing DAFW over the period 1992-2000, once adjustments are made to permit direct comparisons of the numbers. The workers' compensation databases provide information for more than 95% of the total DAFW resulting from work injuries. Covariate estimates are unaffected by this less than 5% loss because effects appear dependent on time from injury.
COMMENTS: Statewide workers' compensation administrative databases can have substantial utility for epidemiologic study of work injuries with DAFW because of their size, using high sensitivity for case ascertainment as the evaluative criterion.
Correspondence: Donald William Spady, Departments of Pediatrics, Public Health Sciences, University of Alberta, Edmonton, Alberta, CANADA; (email: dspady@ualberta.ca).
OBJECTIVE: We describe the frequency and patterns of injury affecting 96,359 children between 0 and 10 years old and living in Alberta, Canada.
DESIGN: This population-based, longitudinal study involved children born in the 3 fiscal years of April 1, 1985 to March 31, 1988, recruited before age 1, and who remained in the study until at least age 5. We used the International Classification of Diseases, Ninth Revision, Clinical Modification chapter-17 diagnostic codes provided by physicians. Codes were grouped into 17 categories; injury episodes were calculated, and age- and gender-specific incidence rates for each category were calculated. The age, pattern, times of greatest risk, and the effect of gender on the type and incidence of injury were determined.
SETTING: Health care administrative data were obtained from all fee-for-service health care venues in Alberta between April 1, 1985 and March 31, 1998 providing services to children registered with the Alberta Health Care Insurance Plan and otherwise meeting entrance criteria.
FINDINGS: Nearly 84% of children received care for an injury during the study period, and in any given year approximately 21% of the population studied had at least 1 injury. Repeat injury was common (73%), and boys were more likely than girls to be injured and to have repeat injury. The most common injuries were dislocations and sprains, open wounds, and superficial injuries and contusions. Burns, poisoning, intracranial injury, and foreign bodies were the next most common, and fractures were least common. Approximately 10% of injuries were multiple-category injuries. Rates varied greatly by injury category, age, and gender. Hospitalization rates varied in a similar manner and commonly accounted for approximately 10% of all services. Males were most likely to have an injury, and aboriginal children or children who had received welfare at some time were at greatest risk.
COMMENTS: Administrative data can be used to estimate the incidence of injury in a pediatric population. Distinct patterns of injury occur at different ages. Recurrent injury is common. Almost identical proportions of injury (46%) are treated in emergency departments and physicians' offices.
Characteristics of individuals who fell while receiving home health services.
- Lewis CL, Moutoux M, Slaughter M, Bailey SP. Phys Ther 2004; 84(1): 23-32.
Correspondence: Cynthia Lewis, Department of Physical Therapy Education, Elon University, Campus Box 2085, Elon, NC 27244-2085, USA; (email: lewisc@elon.edu).
OBJECTIVE: Many patients receiving home health services are at risk for falling, but fall risk factors have not been previously investigated in this population. A retrospective record review was used to describe individuals who fell while being served by a home health agency.
SUBJECTS: The 98 individuals who fell while receiving home health services were compared with a random sample of 98 subjects served by the home health agency during the same period who did not report falling.
METHODS: Subjects were compared by age, sex, days of receiving home health services, number of falls prior to admission to the home health agency, diagnosis, medication category, home health services received, and type of health care coverage. In the group with falls, causes of falls and interventions were described.
FINDINGS: The group with falls had comorbidities of neurological and cardiovascular impairment, took more medications associated with increased risk of falling, and had almost 3 times the number of falls prior to admission than the group without falls.
COMMENTS: Home care providers should consider medical history, medication usage, and fall history as risk factors for falls in the home environment.
Psychiatric morbidity following injury.
- O'Donnell ML, Creamer M, Pattison P, Atkin C. Am J Psychiatry 2004; 161(3): 507-514.
Correspondence: O�Donnell, Australian Centre for Posttraumatic Mental Health, P.O. Box 5444, Heidelberg, Victoria 3081, AUSTRALIA; (email: mod@unimelb.edu.au).
OBJECTIVE: Accurate information regarding the psychopathological consequences of surviving traumatic injury is of great importance for effective health service design and planning. Regrettably, existing studies vary dramatically in reported prevalence rates of psychopathology within this population. The aim of this study was to identify the prevalence of psychiatric morbidity following severe injury by adopting a longitudinal design with close attention to optimizing the research methodology.
METHODS: Consecutive admissions (N=363) to a level 1 trauma service, excluding those with moderate or severe traumatic brain injury, were assessed at three time periods: just before discharge and 3 and 12 months after their injury. Structured clinical interviews were used to assess anxiety disorders, depressive disorders, and substance use disorders.
FINDINGS: Posttraumatic stress disorder (PTSD) and major depressive disorder were the most frequent diagnoses at both 3 and 12 months, with 10% of participants meeting diagnostic criteria for each disorder at 12 months. Over 20% of the group met criteria for at least one psychiatric diagnosis 12 months after their injury. Comorbidity was common, with the most frequent being PTSD with major depressive disorder.
COMMENTS: Psychopathology following injury is a frequent and persistent occurrence. Despite the adoption of a rigorous and potentially conservative methodology, one-fifth of participants met criteria for one or more psychiatric diagnoses 12 months after their injury. These findings have major implications for injury health care providers.
One of the dimensions treated as part of a company's safety culture or climate is workers' attitudes towards risk and safety. In the present study these personal aspects are defined as workers' safety culture, which is understood as a way of acting focused on life and taking care of one's health. A questionnaire on safety culture was filled out by 200 employees of a metallurgical enterprise. Factor analysis was used to determine empirical scales of the questionnaire, whereas variance analysis was used to test hypotheses. The results confirmed the hypotheses that people who experienced accidents, dangerous situations, and -- to a lesser extent-health problems had a lower level of safety culture. Nevertheless not all of the scales determined during factor analysis turned out to be significant as far as all kinds of those undesirable situations are concerned. Proposals for future studies are formulated in the conclusion.
Summary of DG JRC/ESReDA seminar on safety investigation of accidents.
Correspondence: Christian Kirchsteiger, European Commission, DG-JRC, Institute for Energy,
Probabilistic Risk & Availability Assessment of Energy Systems, Westerduinweg 3 - 1755 LE Petten, THE NETHERLANDS; (email: christian.kirchsteiger@jrc.nl).
The European Commission and especially DG TREN and DG ENV, has been investigating for a long time how best to protect the public from major accidents originating from industrial activities, such as the operation of power plants or the various transport modes, in a way that does not compromise the competitiveness of the industry concerned. Not least due to these initiatives, there is, nowadays, broad consensus in Europe that it is essential to ensure the safety of the energy, transport and process industries in a cost-effective way and that the public has a rational perception of the risks posed by these industries to the environment and society at large.
Further, the awareness of the fact that a major accident in one industry sector gives no market advantage to a competitor if it leads to a general loss in confidence by the public in the industry has recently led to a healthy openness and exchange of information regarding safety issues amongst operators, regulators and the general public. Society is also seeking to ensure that man-made risks are clearly identified and assessed, so that necessary measures can be taken to reduce them to an acceptable level. Together with the knowledge that the consequences of major accidents are no respecters of national boundaries, all this has resulted in a number of regulatory initiatives on both national and EU levels.
For various industry sectors in the EU, such as energy and transport, there is intensive discussion on the use of uniform 'safety standards.' Somewhat similar initiatives are going on in other industry sectors, e.g. for various transport modes, or have already succeeded in drafting an EU Directive, such as for the process industry (Seveso Directive). The current proposal by DG TREN for a framework Directive defining basic obligations and general principles in the field of the safety of nuclear facilities is one example. Further, there is a recent initiative by DG ENV in the context of its civil protection work program on discussing proposals for horizontal legislation on risk mapping and introducing an obligation to inform the Commission of natural or man-made disasters exceeding a certain magnitude. Clearly, this would concern all types of natural and man-made hazards, from forest fires to floods and from transport modes to the energy sector.
The role of DG JRC in this context is to provide policy DGs, such as DG TREN and DG ENV, customer-driven scientific and technical support for the conception, development, implementation and monitoring of EU policies. As a service of the European Commission, the JRC functions as a reference centre of science and technology for the Union.
Correspondence: Angi M. Christensen, The University of Tennessee, Department of Anthropology, 250 South Stadium Hall, Knoxville, TN, USA; (email: angi@utk.edu).
Case studies of freefall injuries suggest that most falls from heights result in lower extremity, pelvic, and vertebral fractures. These injuries are largely a consequence of the fact that most falls are accidental with victims landing feet first. This study investigates whether human behavioral response affects body orientation at impact and whether the human body tends to align in a particular way as a result of physical laws. The investigation was undertaken by observing nine experimental falls of an anthropomorphic dummy from a height of 65 ft (9.8 m). In all nine falls, the dummy landed horizontally, suggesting that the human form has a tendency to align horizontally during freefall for falls greater than 50 ft (15.24 m). This has important implications for the potential use of injury patterns in the deduction of pre-fall circumstances, which are discussed here with respect to a case study of a fall victim.
The psychometric properties of the Chinese version of the Multi-Attitude Suicide Tendency Scale were examined in a sample of 415 Chinese adolescents. Confirmatory factor analyses of the present data disconfirmed the original 4-factor structure. Exploratory factor analysis was then conducted to explore the underlying structure of the data set. A revised 4-factor structure, with a number of differences in item factor loadings, was obtained for the present sample. The scale also demonstrated good internal consistency and convergent validity with the Depression Self-Rating Scale and Suicidal Behaviors Questionnaire. Distinct profiles of the scale were shown on non-suicidals, suicide ideators, and suicide attempters. Discrepant findings from previous work were discussed.
Risk factors for suicide in blacks and whites: an analysis of data from the 1993 national mortality follow-back survey.
- Castle K, Duberstein PR, Meldrum S, Conner KR, Conwell Y. Am J Psychiatry 2004; 161(3): 452-458.
Correspondence: Kathryn Castle, Department of Psychiatry, Center for the Study and Prevention of Suicide, University of Rochester Medical Center, 300 Crittenden Blvd., Rochester, NY 14642, USA; (email: kathryn_castle@urmc.rochester.edu).
OBJECTIVE: Data on risk factors for suicide in blacks in the United States are needed, given the dramatic increase in the black suicide rate from 1980 to 1997. The 1993 National Mortality Followback Survey represented an unprecedented opportunity to identify risk factors for suicide in blacks and to determine whether race differences (black versus white) in risk factors exist.
METHOD: Multiple logistic regression analyses were used to compare cases of suicide (150 suicides in blacks and 1,279 suicides in whites) with cases of accidental deaths (737 cases in blacks and 3,458 cases in whites). Predictors of interest were 18 items tapping four domains: antisocial behavior, substance use/abuse, depressive symptoms, and psychotic symptoms.
FINDINGS: Four items distinguished suicides from accidental deaths in both black and whites: death ideation, suicidal ideation, bizarre behavior, and making violent threats. Items in two of the four domains discriminated risk for suicide in whites more strongly than in blacks: reports of community complaints and problem drinking. No variable conferred greater risk for suicide in blacks than in whites.
COMMENTS: The current study underscores the need for examination of race differences in risk factors for suicide. It is also essential to examine variables that were unavailable in the National Mortality Followback Survey data set, particularly racism, perceived discrimination, and feelings of alienation from the dominant culture.
Suicide attempts associated with externalizing psychopathology in an epidemiological sample.
- Verona E, Sachs-Ericsson N, Joiner TE Jr. Am J Psychiatry 2004; 161(3): 444-451.
Correspondence: Edelyn Verona, Department of Psychology, Kent State University, Kent, OH 44242, USA; (email: everona@kent.edu).
OBJECTIVE: Borrowing from recent dimensional models of psychopathology, the authors conducted analyses that optimized the common variance shared by internalizing (depression, anxiety) and externalizing (antisocial personality, substance dependence) disorders in statistically predicting suicidal behaviors. These relationships were analyzed in a large epidemiological sample, thus allowing for the examination of gender differences in risk for suicide attempts associated with psychopathology.
METHOD: The data were obtained from the Colorado Social Health Survey. Participants (N=4,745) were a community sample recruited by household address. Structured clinical interviews were used to obtain lifetime diagnostic and symptom count information. Symptom counts were included in a factor analysis that yielded two main dimensions of psychopathology: internalizing and externalizing. These factors were used in hierarchical logistic regression analyses to predict history of suicide attempts associated with the presence of internalizing symptoms, externalizing symptoms, and comorbid internalizing and externalizing symptoms.
FINDINGS: After the investigators controlled for the presence of internalizing symptoms and the comorbidity of internalizing and externalizing symptoms, externalizing symptoms were related to suicidal behavior in both men and women, although comorbidity was most predictive of suicide attempts among women, compared to men.
COMMENTS: Suicidal behavior among individuals with externalizing symptoms is not necessarily a result of comorbid depressive or other internalizing disorder. Thus, persons exhibiting antisocial behaviors should receive rigorous assessment for suicidal ideation and behavior.
Person factors associated with suicidal behavior among African American women and men.
- Kaslow NJ, Webb Price A, Wyckoff S, Bender Grall M, Sherry A, Young S, Scholl L, Millington Upshaw V, Rashid A, Jackson EB, Bethea K. Cultur Divers Ethnic Minor Psychol 2004; 10(1): 5-22.
Correspondence: Nadine Kaslow, Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA; (email: nkaslow@emory.edu).
This study compared person risk factors among the following groups of low-income, African American adults in an urban, public hospital: (a) suicide attempters and nonattempters, (b) male and female attempters, and (c) all 4 groups (50 female attempters, 50 female nonattempters, 50 male attempters, and 50 male nonattempters). Participants completed psychological distress, aggression, substance use, cognitive processes, religiosity/spirituality, and ethnic identity measures. Compared with nonattempters, attempters reported more psychological distress, aggression, substance use, and maladaptive coping strategies; less religiosity/spirituality; and lower levels of ethnic identity. Male attempters endorsed more substance use than female attempters. No person risk factors differentiated among the 4 groups. Assessment of person risk factors and implementation of commensurate culturally competent interventions are recommended.
Reducing suicides in New York State correctional facilities.
- Kovasznay B, Miraglia R, Beer R, Way B. Psychiatr Q 2004; 75(1): 61-70.
Correspondence: Beatrice Kovasznay, Bureau of Forensic Services, New York State Office of Mental Health, Albany, New York 12229, USA; (email: unavailable).
In an effort to identify modifiable risk factors for suicide in New York State prisons, the authors reviewed available statistical data and also examined a series of 40 psychological autopsies conducted on suicides of inmates who had received mental health services during their incarceration. Factors associated with suicide included substance abuse, history of prior suicide attempts, mental health treatment prior to incarceration, recent "bad news," recent disciplinary action, and manifestation of agitation and/or anxiety. This review led to changes in certain clinical policies and procedures, environmental modifications and hazard reduction in observation cells, and an improved process for quality assurance reviews of suicides.
Completed suicide after a suicide attempt: a 37-year follow-up study.
- Suominen K, Isometsa E, Suokas J, Haukka J, Achte K, Lonnqvist J. Am J Psychiatry 2004; 161(3): 562-563.
Correspondence: Kirsi Suominen, Department of Mental Health and Alcohol Research, National Public Health Institute, Mannerheimintie 166, FIN-00300 Helsinki, FINLAND; (email: kirsi.suominen@ktl.fi).
OBJECTIVE: Attempted suicide is the strongest known predictor of completed suicide. However, suicide risk declines over time after an attempt, and it is unclear how long the risk persists. Risk estimates are almost exclusively based on studies of less than 10 years of follow-up.
METHODS: The authors followed a cohort of 100 consecutive self-poisoned patients in Helsinki in 1963, for whom forensically classified causes of death during the following 37 years were investigated.
FINDINGS: They found that suicides continued to accumulate almost four decades after the index suicide attempt.
COMMENTS: A history of a suicide attempt by self-poisoning indicates suicide risk over the entire adult lifetime.
Not all child safety seats are created equal: the potential dangers of shield booster seats.
- Edgerton EA, Orzechowski KM, Eichelberger MR. Pediatrics 2004; 113(3 Pt 1): 153-158.
Correspondence: Elizabeth Edgerton, Department of Emergency Medicine and Trauma Services, Children's National Medical Center, Washington, DC 20010, USA; (email: eedgerto@cnmc.org).
OBJECTIVE: Children are safest when traveling in a child safety seat appropriate for their age and size. Previous research indicates that children are often transitioned to shield booster seats (SBSs) before reaching the 40-lb weight limit for their forward-facing child safety seat (FFCSS). These children could have otherwise been restrained in a FFCSS as is currently recommended by the American Academy of Pediatrics and the National Highway Traffic Safety Administration. The objective of this study was to compare the injury patterns among children who were restrained in SBSs and FFCSSs. Children in FFCSSs were chosen as a comparison group because SBS are predominantly used to restrain children who are <40 lb and could have been restrained in an FFCSS, and SBSs are no longer certified for use in children who are >40 lb.
METHODS: This is a cohort study involving restrained crash victims who were admitted to a level 1 pediatric trauma center between 1991 and 2003. Patients were older than 1 year, weighed between 20 and 40 lb, and were restrained in an SBS (N = 16) or an FFCSS (N = 30). Injury Severity Score, Abbreviated Injury Scale, Glasgow coma score, intensive care admission, length of stay, and acute care charges served as outcomes of interest.
FINDINGS: No significant differences regarding crash and occupant characteristics were found (mean Delta V, crash type, passenger compartment intrusion, driver restraint use). Odds of severe injury were greater for children in SBSs compared with children in FFCSSs as measured by Injury Severity Score >15 (odds ratio [OR]: 8.3; 95% confidence interval [CI]: 2.1-33.6), intensive care admission (OR: 5.5; 95% CI: 1.5-20.5), length of stay >2 days (OR: 6.3; 95% CI: 1.6-24.6), and Abbreviated Injury Scale > or = 3 (OR: 4.4; 95% CI: 1.2-16.1). Furthermore, SBS cases had greater odds of head (OR: 4.5; 95% CI: 1.2-17.3), chest (OR: 29.0; 95% CI: 3.1-267.3), and abdominal/pelvic injury (25% vs 0%).
COMMENTS: This study provides information about the increased risk of injury associated with shield boosters when compared with FFCSSs. The challenge for pediatricians is not only to promote the use of child restraints but also to ensure that parents use the most appropriate restraint for their child's age and weight.
Children at risk in traffic: improvement potentials in the Swedish context.
- Hasselberg M, Laflamme L. Acta Paediatr 2004; 93(1): 113-119.
Correspondence: Marie Hasselberg, Department of Public Health Sciences, Division of Social Medicine, Karolinska Institutet, Stockholm, SWEDEN; (email: marie.hasselberg@smd.sll.se).
OBJECTIVE: To investigate the social risk distribution and improvement potentials for road traffic injuries among Swedish children by considering three categories of road users.
METHODS: A population-based cohort study of children aged 1-14 y was carried out. Subjects were taken from the Swedish Population and Housing Census of 1990 (n = 1406405), and followed-up in the National Hospital Discharge Register for the years 1991-1999 focusing on injuries incurred as pedestrians, bicyclists or car passengers (n = 16084). Household socio-economic position was measured using social class, education and disposable income. Relative risks were calculated using Poisson regression for each measure of socio-economic position and by combining them, adjusting for sex, age of child and age of mother at delivery. Population-attributable risks were compiled for each category of road user and each measure of socio-economic position.
FINDINGS: Children of farmers and the self-employed are at greater risk for injuries as car passengers (RR 2.40, CI 1.79-3.20 and RR 1.44, CI 1.16-1.79, respectively), but not for pedestrian- and bicycle-related injuries. Children of unskilled workers are at greater risk for pedestrian injuries (RR 1.39, CI 1.15-1.67). Controlling for education and disposable income did not affect the relative risks to the same extent according to the social class and category of road user. The highest population-attributable risks were related to family disposable income and were indicated for pedestrians and car passengers (19-20%).
COMMENTS: By taking children's limited ability to deal with different types of traffic situations into consideration, considerable improvements in children's risk levels have been observed. Now there is a need to add equity in the road traffic safety equation.
Effects of safety belt laws on safety belt use by American high school seniors, 1986-2000.
Correspondence: Patrick M. O'Malley, Senior Research Scientist, Institute for Social Research, University of Michigan, Ann Arbor MI, USA; (email: pomalley@umich.edu).
OBJECTIVE: This manuscript evaluates the effects of enactment of state laws that required safety belt use in various U.S. states between 1986 and 2000.
METHOD: Safety belt use was assessed using nationally representative cross-sectional samples of high school seniors; evaluation of the effects of laws used data from over 2,000 high school seniors before and about 3,300 after the laws took effect in 20 states.
FINDINGS: Belt use was found to increase significantly between 1986 and 2000, and the laws contributed significantly to that increase. Increases were similar for students differing by gender, race/ethnicity, parent education, grades, truancy, evenings out per week, miles driven per week, and an index of illicit drug use. COMMENTS: The data show that although the laws have increased belt use, use is not universal and continued efforts are needed. This study shows that many teenagers fail to use belts when there is a secondary use law; an implication is that primary laws would be more efficacious in increasing use among this vulnerable population.
Graduated driver licensing research in 2003 and beyond.
- Hedlund J, Compton R. J Safety Res 2004; 35(1): 5-11.
Correspondence: James Hedlund, Highway Safety North, 110 Homestead Road, Ithaca, NY 14850-6216, USA; (email: jhedlund@sprynet.com).
This paper updates the comprehensive summary of graduated driver licensing (GDL) published in the January 2003 special issue of the Journal of Safety Research. It summarizes recent research not included in the special issue as well as research in progress or planned research. The most active research areas are risk factors for beginning teen drivers and evaluations of GDL programs. Results in each area strengthen the case for GDL. Additional research is producing valuable information about specific GDL implementation issues and the roles of parents and driver education in helping teenagers learn to drive safely.
Application of a model of collision between cars to the analysis of compatibility and its sensitivity to the variation of certain design parameters.
Frontal collisions between vehicles are one of the most severe accidents that usually occur in our roads, and the incompatibility between masses, stiffness and geometries of vehicles has a great influence in the consequences of the collision. It is necessary to go forward in the reduction of the aggressiveness of vehicles to each other without reducing self-protection. In order to research about compatibility, simplified mathematical models of
collision will be very useful. In this paper, it is described the development of a frontal collision model especially conceived to reproduce the factors that may influence the compatibility. The model was adjusted to represent the behavior of several vehicle types representative of the car-park, and was validated through real accidents data and vehicle-to-vehicle crash tests. Finally, the usefulness of the model for compatibility study is shown by an application example, an analysis of the sensitivity to the variation of certain design parameters.
Correspondence: Iris Wagman Borowsky, Division of General Pediatrics and Adolescent Health, University of Minnesota, Minneapolis, Minnesota, USA; (email: borow004@umn.edu)
OBJECTIVE: Nonfatal fight-related injuries among youths result in lost capacity and high costs of medical care and rehabilitation and constitute a major public health problem. This study identifies factors that predict the occurrence of a fight-related injury that requires medical attention among boys and girls.
METHODS: We analyzed data from 14 787 adolescents who completing 2 interviews, approximately 1 year apart, in the National Longitudinal Study of Adolescent Health, a nationally representative, school-based sample of youths. We identified time 1 factors at the community, family, and individual levels that predicted any self-reported fight-related injury that required medical treatment at time 2.
FINDINGS: Factors that predict future injury among both boys and girls in multivariate models were violence-related factors: witnessing or being a victim of violence (odds ratio [OR]: 3.69; 95% confidence interval [CI]: 1.81-7.49 for boys; OR: 5.13; 95% CI: 1.25-21.09 for girls), history of a violence-related injury (OR: 2.30; 95% CI: 1.60-3.29 for boys; OR: 3.18; 95% CI: 1.87-5.41 for girls), and physical fighting (OR: 2.02; 95% CI: 1.44-2.84 for boys; OR: 5.15; 95% CI: 3.18-8.34 for girls). Among boys, illicit drug use was also an independent predictor of future injury (OR: 1.72; 95% CI: 1.24-2.37), whereas excellent perceived general health (OR: 0.48; 95% CI: 0.25-0.93) and a high grade point average (OR: 0.52; 95% CI: 0.29-0.95) were significant protective factors against fight-related injury. Girls who reported a high level of depressive symptoms were much more likely to report fight-related injury than nondepressed girls (OR: 8.98; 95% CI: 2.43-33.25).
COMMENTS: Factors related to violence, substance use, school achievement, and physical and mental health predicted a future fight-related injury that required medical treatment. The results could assist health and social service providers, educators, and others in identifying youths who are at high risk for fight-related injury and may benefit from appropriate intervention.
Gender differences in violent behaviors: relationship to clinical symptoms and psychosocial factors.
- Krakowski M, Czobor P. Am J Psychiatry 2004; 161(3): 459-465.
Correspondence: Menahem Krakowski, Nathan Kline Institute for Psychiatric Research, 140 Old Orangeburg Road, Orangeburg, New York 10962, USA; (email: krakow@nki.rfmh.org).
OBJECTIVE: Men are more violent than women in the general population, but this has not been found to be the case among psychiatric inpatients. The reason for this exception is poorly understood. The present study investigated gender differences in violent behaviors among patients with major psychiatric disorders. It examined various clinical symptoms and psychosocial factors to determine their differential impact on violence in men and women.
METHOD: Physical assaults and verbal assaults committed by psychiatric inpatients were recorded prospectively. Patients whose violent incident occurred during their first 2 months of hospitalization were eligible for the study. Patient history of community violence was also obtained. Psychiatric symptoms and ward behaviors were assessed upon entry into the study and after 4 weeks.
FINDINGS: A similar percentage of women and men had an incident of physical assault in the hospital. Among the patients entered into the study, the women had a much higher level of verbal assaults throughout the evaluation period and a higher level of early physical assaults (i.e., within the first 10 days of the 4-week study period). Positive psychotic symptoms were more likely to result in assaults in women than in men. Physical assaults in the community, on the other hand, were more common in men and were associated with substance abuse, property crime, and a history of school truancy.
COMMENTS: There are gender differences in the patterns of violent behavior among patients with major psychiatric disorders. Furthermore, psychiatric symptoms and psychosocial risk factors have a different impact on this behavior in men and women. This has important implications for the prediction and differential treatment of violent behavior.
Urban youth disruptive behavioral difficulties: exploring association with parenting and gender.
- Schiff M, McKay MM. Fam Process 2003; 42(4): 517-529.
Correspondence: M. Schiff, Hebrew University of Jerusalem, School of Social Work, Jerusalem, ISRAEL; (email: msschiff@mscc.huji.ac.il).
The current study will examine behavioral difficulties among a sample of African American urban youth who were exposed to violence. Possible gender differences in disruptive behavioral difficulties, as well as possible associations between parental practices, family relationships, and youth disruptive behavioral difficulties are examined. A secondary data analysis from baseline data for 125 African American urban mothers and their children collected as part of a large-scale, urban, family-based, HIV prevention research study was analyzed. Findings reveal that externalizing behavioral problems in youth are associated with exposure to violence. Girls displayed significantly higher levels of externalizing behavioral difficulties than boys. Mothers' parenting practices and family relationships were associated with youths' externalizing behavior problems. Implications for interventions to reduce youths' exposure to violence and to develop gender sensitive interventions for youth and supportive interventions for their parents are discussed.
It's in our hands: Stop violence against women.
- Amnesty International. London: Amnesty International Publications, 2004.
From birth to death, in times of peace as well as war, women face discrimination and violence at the hands of the state, the community and the family. Female infanticide deprives countless women of life itself. Every year, millions of women are raped by partners, relatives, friends and strangers, by employers and colleagues, security officials and soldiers.
Women, children and men suffer from violence inflicted in the home, but the overwhelming majority of victims are women and girls. During armed conflicts, violence against women is often used as a weapon of war, in order to dehumanize the women themselves, or to persecute the community to which they belong.
Violence against women is not confined to any particular political or economic system, but is prevalent in every society in the world. It cuts across boundaries of wealth, race and culture. The power structures within society that perpetuate violence against women are deep-rooted and intransigent. The experience or threat of violence inhibits women everywhere from fully exercising and enjoying their human rights.
This report describes the patterns of violence against women in different parts of the world, provides data and statistics that describe the magnitude of the problem, discusses why the existing data systems may underestimate the problem, and provides suggestions for ways to overcome this problem.
