If we want more evidence-based practice, we need more practice-based evidence.*

If we want more evidence-based practice, we need more practice-based evidence.*

 


Chapter 13
- Archives of Headlines
Community Injury Control

 

Dade Schools Get `A' For Safety Of Gay Kids From The Miami Herald: September 10, 1998. Dade County Public Schools is one of only eight school systems in the nation to earn an A for protecting gay and lesbian students in a report card released today by a group dedicated to ending anti-gay bias in schools. Schools here received high marks for a board policy that forbids discrimination against gay and lesbian students and teachers. They also were applauded for providing awareness training for teachers, as well as counseling and clubs for gay and lesbian students.

Teen Drinking & Driving Declines    Traffic fatalities caused by drunken driving dropped to a record low in 1997, but still accounted for more than one third (38.6%) of automobile deaths, according to new statistics from the U.S. Department of Transportation. Drunken driving deaths among teens aged 15 to 20 dropped five percent in 1997 from the previous year.
    The 1997 figures represent a decline from 1996, when deaths from drunken driving accounted for 40.9% of all traffic deaths. The new figures show an even more dramatic decline from 1982, when more than one half (57.3%) of all traffic deaths were caused by drunken driving.
    The Clinton Administration hailed the decline as evidence that "zero tolerance" laws for young drivers work. All 50 states have implemented these laws, which permit suspension of drivers' licenses for people under 21 found to be driving after drinking, regardless of their blood-alcohol level.  To support the trend toward lowered death rates from drunken driving, Clinton has encouraged states to lower their drunken-driving threshold to a 0.08 of 1 percent blood-alcohol concentration. To date, 15 states have done so.

Hazards associated with blind and curtain cords
(Health Canada, 5 October 1998)-  A recent tragedy in Ontario has underscored the need for parents and caregivers to protect children from strangulation hazards associated with blind and curtain cords. Health Canada recommends keeping cords out of the reach of young children by cutting or tying-up the cords or by installing safety devices which are available at hardware stores or places that  sell curtains and blinds.

MISSION POSSIBLE TRAFFIC SAFETY INITIATIVE DRIVES TO SAVE LIVES EDMONTON, Sept. 25 /CNW/ - On the heels of recently released statistics showing an increase in traffic fatalities and injuries in Alberta, Mission Possible today announced plans to launch its next communications campaign aimed at reducing the number of deaths, injuries and associated costs from traffic collisions. The campaign begins September 28, and asks drivers to think about their own driving habits and actions. Mission Possible and its partners are using a proven four step social marketing model for attitude and behavior change: create awareness for the magnitude of the problem; motivate road users to assess their own behavior, attitudes and abilities as they relate to road safety; encourage road users to take ownership of the problem; and develop sustained change in driving attitude and behavior. The communications program, which is funded by the Alberta Automobile Insurance Coalition, will use a combination of advertising and public relations tactics to deliver the campaigns messages. The primary element in the campaign is a highly emotional 30 second television commercial depicting an inattentive driver and the devastating results of his actions. Other traffic safety messages will be delivered through different media.
    Communication is just one component of the five year safety campaign. Mission Possible uses an integrated approach to road safety that combines several activities: public education and awareness, safety engineering; and enforcement. These activities, collectively working together, can make a real impact on reducing the toll on Alberta's roads. Mission Possible is a five year traffic safety initiative to lower the total number of deaths, injuries and societal costs resulting from traffic collisions. The province's traffic safety community and other community partners are working together to raise awareness of the problem and to effect change.

ICRC urges all states to ratify landmines pact
. GENEVA (Reuters, Sept. 17, 1998) - The International Committee of the Red Cross Thursday welcomed the entry into force next March of an international treaty banning anti-personnel landmines (APLs), and urged all states to ratify the pact. The Swiss-based organization, which has relief operations in 80 countries, said that organizing and financing mine-clearance programs would be a huge global challenge for years to come. Burkina Faso on Wednesday became the 40th country to ratify the Ottawa Convention, meaning it takes effect in six months. The pact bans development, production, planting, stockpiling and transfer of APLs, which are blamed for killing or maiming about 25,000 people a year, mainly civilians.

Youth Agricultural Work-Related Injuries Treated in Emergency Departments -- United States, October 1995-September 1997. Morbidity  and Mortality Weekly Report, September 11, 1998/Vol. 47/No. 35.  See
http://www.cdc.gov/mmwr/preview/mmwrhtml/00054662.htm

Study says walking most dangerous way to travel: August 5, 1998 (Reuters). Walking is more dangerous per mile traveled than any other form of transportation, said a group that advocates making public areas more friendly for pedestrians. The Surface Transportation Policy Project said the approximately 5,000 pedestrians killed in 1996 out of 42,000 traffic deaths were often not even seen as legitimate road users. "Instead of blaming pedestrians for being hit by cars, planners and engineers must design communities and roads that are safe for walking," the group said in its "Mean Streets" report.

Formula for longer life and slower aging - diet
Strict dieting slows down the aging process by putting the reproductive process on hold, a finding that could eventually allow scientists to alter life spans, researchers said Thursday. The study on fruit flies, published in the journal Science, also showed that a restricted diet can allow reproduction to continue into very late stages of life. "It may lead us into other areas where you can manipulate the rate of aging," said James Carey, an insect demographer at the University of California at Davis, who led the study.

Tall tots make playground bullies, study finds. August 15, 1998. Children who are taller than their peers, especially if they are fearless and aggressive, may grow up to be playground bullies, researchers reported at the University of Southern California. They said bigger children may grow  up to learn that might makes right and warned parents to guard against such attitudes. "Three-year-olds, male or female, who average just half an inch taller than their peers tend to be more aggressive than normal when they reach age 11," said Adrian Raine of the University of Southern California, who led the study. The same seems to apply to small children who are more fearless and who seek stimulation more than normal, Raine, a neuroscientist, said.

Recent facts on violence and injury in U.S.

Domestic abuse strikes 1 in 3 women   
Yet only 5 in 100 battered women detected by ER staff            
MSNBC  Aug. 4, 1998 -More than one of three women treated in community hospital emergency departments have been domestically abused during their lifetimes, according to a new study that finds many such incidents go unreported.            
In an anonymous survey of 3,455 adult women, 36.9 percent said they have experienced emotional or physical abuse during their lifetime by an intimate partner; 14.4 percent said they have experienced physical or sexual abuse in the past year; and 2.2 percent said they came to the hospital as a result of injuries they suffered from abuse from an intimate partner.
Several factors raised a woman's risk of physical or sexual injury from abuse within the past year:
Age between 18 and 39;
Having a monthly income of less than $1,000;
Having children younger than 18 years old living in the home;
Ending a relationship within the past year.
"Findings from this study support evidence from previous studies that a significant number of women are seen in emergency departments who have experienced domestic abuse, both during the past year and at any point in their lifetime, and that the problem is not limited to large, urban or tertiary care hospitals," the researchers wrote.
"They also illustrate that although community hospitals are encountering significant numbers of abused women, they are not identifying or documenting the abuse."
Past research has shown that only 5 percent of battered women are detected by emergency department staff, according to the new report.
Noting that hospital emergency departments are often the only contacts that many abused women have with health care professionals, the researchers called for emergency room protocols that initiate appropriate screening and treatment for domestic abuse, as well as referral of victims to programs to prevent further abuse.
The study, led by Stephen R. Dearwater, of the Allegheny University of the Health Sciences in Pittsburgh, appears in this week's issue of Journal of the American Medical Association.
The survey was administered to all consenting women over 18 who came into 11 community hospital emergency departments in California and Pennsylvania for varying health problems. The questions inquired about physical, sexual and emotional abuse from 1995 to 1997.
Reported rates of domestic abuse were higher in California than in Pennsylvania, the survey showed.
Noting that hospital emergency departments are often the only contacts that many abused women have with health care professionals, the researchers called for emergency room protocols that initiate appropriate screening and treatment for domestic abuse, as well as referral of victims to programs to prevent further abuse.
The study, led by Stephen R. Dearwater, of the Allegheny University of the Health Sciences in Pittsburgh, appears in this week's issue of Journal of the American Medical Association.
The survey was administered to all consenting women over 18 who came into 11 community hospital emergency departments in California and Pennsylvania for varying health problems. The questions inquired about physical, sexual and emotional abuse from 1995 to 1997.
Reported rates of domestic abuse were higher in California than in Pennsylvania, the survey showed.

Noting that hospital emergency departments are often the only contacts that many abused women have with health care professionals, the researchers called for emergency room protocols that initiate appropriate screening and treatment for domestic abuse, as well as referral of victims to programs to prevent further abuse.
The study, led by Stephen R. Dearwater, of the Allegheny University of the Health Sciences in Pittsburgh, appears in this week's issue of Journal of the American Medical Association.
The survey was administered to all consenting women over 18 who came into 11 community hospital emergency departments in California and Pennsylvania for varying health problems. The questions inquired about physical, sexual and emotional abuse from 1995 to 1997.
Reported rates of domestic abuse were higher in California than in Pennsylvania, the survey showed.

In JAMA - August 5, 1998 http://jama.ama-assn.org/issues/v280n5/toc.html
 

Theme Issue on Violence/Human Rights
Homicide Rates Decline Among Teens, Young Adults

In a national study of homicide rates among persons aged 15 to 24 years, Dr Fingerhut and colleagues found that, after rates of firearm-related homicides and non-firearm-related homicides increased steadily during the late 1980s, both firearm-related and non-firearm-related homicides decreased between 1993 and 1995, with declines occurring across all urban strata, among whites and blacks, and among males and females.
http://jama.ama-assn.org/issues/v280n5/toc.html
 

Elder Mistreatment and Survival
Elder abuse and neglect are common, but whether abuse and neglect increase an elder's risk of death is not known. Dr Lachs and colleagues found that elderly patients with verified allegations of abuse, neglect, or self-neglect were much less likely to survive than those who had not had allegations of mistreatment or self-neglect. http://jama.ama-assn.org/issues/v280n5/toc.html   
 

Partner Abuse Among Women in Community Hospitals
The prevalence of domestic violence among women presenting to community hospital emergency departments (EDs) is not known. Dr Dearwater and colleagues surveyed 3455 women in 11 EDs and found 2.2% reported acute trauma from abuse from an intimate partner, 14.4% reported physical or sexual abuse within the past year, and 36.9% reported lifetime emotional or physical abuse. http://jama.ama-assn.org/issues/v280n5/toc.html
 

Mental Health of Refugees Who Have Been Tortured
Little research on refugee mental health has been conducted in developing nations, where most refugees are. Dr Shrestha and colleagues assessed Bhutanese refugees in United Nations refugee camps in Nepal and found that refugees who had experienced torture were much more likely to have symptoms of posttraumatic stress disorder, depression, and anxiety.  http://jama.ama-assn.org/issues/v280n5/toc.html
 

Physicians Must Advocate Against Nuclear War
Physicians have actively called for prevention of nuclear war since the 1960s and should assume a new role in the 21st century, according to Drs Forrow and Sidel. In an editorial, Drs Lown, Chazov, and Foege, and Drs Saeed-Ul-Majeed and R. Jayachandra Reddy, the presidents of the Pakistan and Indian Medical Associations, respectively, appeal to the Prime Ministers of India and Pakistan to pledge no first use of nuclear weapons, stating, "Now, the essential conclusion is that total elimination of these genocidal weapons is the sole guarantee that they will never be used."  http://jama.ama-assn.org/issues/v280n5/toc.html
 

Medical News & Perspectives
While a new CDC survey shows firearm-related deaths and injuries declining, the number of violent incidents in schools continues to increase-and psychiatrists ponder this frightening US trend.  http://jama.ama-assn.org/issues/v280n5/toc.html
 

Controversies
Do the possible benefits of owning a gun outweigh the potential risks?
http://jama.ama-assn.org/issues/v280n5/toc.html
 

The JAMA Patient Page  For your patients: Information on domestic violence.
http://jama.ama-assn.org/issues/v280n5/toc.html


Deaths Resulting from Residential Fires and the Prevalence of Smoke Alarms -- United States, 1991-1995. Morbidity and Mortality Weekly Report, October 1, 1998/Vol. 47/No. 38.

In 1995, residential fires accounted for an estimated 3600 deaths and approximately 18,600 injuries (1,2). In addition, property damage and other direct costs have been estimated to exceed more than $4 billion annually (3). To determine residential fire-related death rates, CDC analyzed death certificate data from 1991 to 1995 from U.S. vital statistics mortality tapes. Data from CDC's Behavioral Risk Factor Surveillance System (BRFSS) was used to determine the prevalence of smoke alarms in U.S. households. This report presents the findings of these analyses, which indicate a seasonal variation in fire-related deaths and a high prevalence of smoke alarms in residences in the United States. Deaths from residential fires were classified using International Classification of Diseases, Ninth Revision, external cause of injury codes E890-E899 and the place of occurrence noted as residence on the death certificate. The 1995 BRFSS survey is the only comprehensive survey from which state-specific prevalence rates for smoke alarms can be generated. The BRFSS is an ongoing, state-based, random-digit-dialed telephone survey of the U.S.  population aged greater than or equal to 18 years. Estimates of the prevalence of smoke alarms were weighted based on the number of telephone numbers per household and the age, sex, and race distribution in each state.
From 1991 to 1995, the U.S. residential fire-related death rate declined from 1.3 per 100,000 population to 1.1. During this time period, residential fire-related death rates were greatest
during December-February and lowest during June-August. The averaged annualized death rates for 1991-1995 showed that children aged less than 5 years and adults aged greater than or equal to 65 years had higher rates than those in other age groups. In 1995, 93.6% of households in the United States reported having at least one smoke alarm. The prevalence of smoke alarms ranged from 78.9% in Hawaii (95% confidence interval [CI]=76.7%-81.2%) to 98.7% in Maryland (95% CI=98.3%-99.1%).
Reported by: Div of Unintentional Injury Prevention, National Center for Injury Prevention and Control, CDC.
Editorial Note: During 1991-1995, deaths from residential fires declined, meeting the national health objective for 2000 of 1.2 per 100,000 persons (objective 9.6) (4). The findings in this report
suggest that residential fire-related deaths were greatest during December-February, reflecting the seasonal use of heating devices (e.g., portable space heaters and wood-burning stoves). The leading causes of residential fires are due to cooking and heating devices improperly placed and/or left unattended (5). Because 81% of fire-related deaths occur in the home, strategies that emphasize residential fire prevention probably will result in the largest reduction in fire-related deaths. To reduce the risk for death or injury resulting from fires, a smoke alarm should be installed outside each sleeping area and on every habitable level of a home (6). Homes with smoke alarms have almost half as many fire-related deaths compared with homes without smoke alarms (7,8). Children aged less than 5 years and adults aged greater than or equal to 65 years have two to six times higher fire-related death rates compared with the national average for all ages (2). Both young children and older adults who may have physical limitations can benefit from the early warnings provided by smoke alarms.
The findings in this report also indicate that the prevalence of smoke alarms across the United States is high. This is, in part, due to various programs, such as distribution and installation
programs, conducted by state and local health departments and fire service personnel and programs that provide smoke alarms to parents of newborns (9). However, these data do not necessarily reflect the proportion of homes equipped with functional smoke alarms. The effectiveness of smoke alarms is dependent on appropriately installing and maintaining the device (1), and approximately 50% of smoke alarms are no longer functional 12 months after installation.
It is necessary to continue with programs to install smoke alarms in homes to achieve 100% coverage and to implement public health programs that focus on their maintenance. This analysis has at least one important limitation. Low-income households less likely to have telephones are probably less likely to have smoke alarms. Because the BRFSS excludes households without telephones, the prevalence of smoke alarms may be overestimated.
Effective public health strategies to reduce residential fire-related injuries and deaths should include 1) smoke alarm installation, 2) monthly testing of smoke alarms, 3) reduction of residential fire hazards, 4) the design and practice of fire escape plans, 5) fire-safety education, and 6) the implementation of smoke alarm ordinances. The adoption of these strategies should lead to continued declines in residential fire-related deaths.

References
1. Mallonee S, Istre GR, Rosenberg M, et al. Surveillance and prevention of residential-fire injuries. N Engl J Med 1996;335:27-31.
2. National Center for Health Statistics. National summary of injury mortality data, 1995. Hyattsville, Maryland: US Department of Health and Human Services, CDC, National Center for Health
Statistics, 1997.
3. Karter MJ Jr. Fire loss in the United States during 1995. Quincy, Massachusetts: National Fire Protection Association, Fire Analysis and Research Division, 1996.
4. Public Health Service. Healthy people 2000: national health promotion and disease prevention objectives--full report, with commentary. Washington, DC: US Department of Health and Human
Services, Public Health Service, 1990; DHHS publication no. (PHS)91-50212.
5. Hall JR. The U.S. fire problem and overview report: leading causes and other patterns and trends. Quincy, Massachusetts:  National Fire Protection Association, Fire Analysis and Research
Division, 1998.
6. US Department of Commerce. Smoke alarm training, 1977. Washington, DC: National Fire Prevention and Control Administration, Public Education Office, 1977.
7. Ahrens M. U.S. experience with smoke detectors and other fire detectors. Quincy, Massachusetts: National Fire Protection Association, Fire Analysis and Research Division, 1997.
8. Marshall S, Runyan CW, Bangdiwala SI, Linzer MA, Sacks JJ, Butts JD. Fatal residential fires: who dies and who survives. JAMA 1998;279:1633-7.
9. CDC. Efforts to increase smoke detector use in U.S. households: an inventory of programs. Atlanta, Georgia: US Department of Health and Human Services, CDC, National Center for Injury Prevention and Control, 1996.


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