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Splinters & Fragments
  1. A Guard
  1. Join Together, Boston, Massachusetts, USA

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    Examining the age at which people begin drinking alcohol has resulted in some interesting relationships: younger onset has been associated with a greater likelihood to report drunk driving and alcohol related crash involvement, as well as other unintentional injuries after drinking. Now an analysis of the same dataset reveals that drinkers who started young are more likely to engage in physical fights, especially after drinking, and this association carries over into adulthood. (Hingson R, Heeren T, Zakocs R. Age of drinking onset and involvement in physical fights after drinking.

    and Hingson R, Heeren T, Levenson S, et al. Age of drinking onset, driving after drinking, and involvement in alcohol related motor-vehicle crashes.

    )

    Many people report feeling depressed during the dark days of winter. But suicide rates increase in spring—one reason why National Suicide Prevention Week is held in May in the US and Canada, and in August in Australia. A brief international study finds a positive correlation between the presence of sunshine and risk of suicide. The authors suggest further research, particularly in sunshine regulated hormones such as melatonin. (Petridou E, Papadopoulos FC, Frangakis CD, et al. A role of sunshine in the triggering of suicide.

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    Another widespread concern about suicide is its “contagion”, spread by media reports and other publicity. This study presents a historical perspective, describing how 19th century medical literature also warned of news reports triggering suicide attempts. As early as 1837, a Quaker physician wrote a psychological autopsy that blamed one suicide on newspaper accounts of an earlier death. Although current guidelines continue to recommend careful reporting of suicides, easy access to the internet and other media make these restrictions more difficult to implement than ever. (Leonard Jr EC. Confidential death to prevent suicidal contagion: an accepted, but never implemented, nineteenth-century idea.

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    Does Hollywood portray real life? Of course not, but it can and does affect viewers' perceptions of social norms. A brief report describes seat belt use in 211 top grossing movies and compares it with actual trends in US belt usage. Although real usage steadily increased after 1984, movie images of seat belt use lag far behind. Mental health advocates and brain injury activists have conducted campaigns to chastise film and television studios for inappropriate portrayals. Is a similar campaign needed by traffic safety practitioners? (Jacobsen HA, Kreuter MW, Luke D, et al. Seat belt use in top-grossing movies vs actual US rates, 1978–1998.

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    Amusement parks are building faster and higher rides in their efforts to attract and thrill their customers. But several well publicized deaths—mostly on rollercoasters—underscore the dangers that accompany the thrills. An analysis of medical literature reports and Consumer Product Safety Commission data describes injuries and deaths at fixed-ride amusement parks. The authors also discuss the physics of rollercoasters and advise physicians to ask about thrill rides, particularly with patients who have neurologic symptoms. (Braksiek RJ, Roberts DJ. Amusement park injuries and deaths.

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    I am pleased to summarize a report from the Mideast. A retrospective review of 28 cases of near drowning in warm water identified a lack of cardiopulmonary resuscitation training in the children's families and many swimming pools without safety features. This study, in Saudi Arabia, echoes the common themes of a real need for four sided fencing, for good enforcement of safety regulations, and for better training of adults. (Al-Mofadda SM, Nassar A, Al-Turki A, et al. Pediatric near drowning: the experience of King Khalid University Hospital.

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    By the time this issue of the journal is in readers' hands, the David and Lucile Packard Foundation will have released their special edition of Future of Children on children, youth, and gun violence. The publication, which is free, is organized into four sections: dimensions of the youth gun violence problem; effects of firearm injury and death; approaches to intervention; and public perspectives. See http://www.futureofchildren.org/ or request a copy by fax: +1 650 941 2273.

    Two recent articles focus on passenger safety: in many nations, seat belt use is required only for occupants in the front seats of motor vehicles. Researchers in Japan found that front seat occupants had almost five times the risk of severe injury or death when the passengers in the rear were not belted. They recommend, not surprisingly, that all occupants be mandated to wear seat belts for their own safety, and for that of their fellow riders. (Ichikawa M, Nakahara S, Wakai S. Mortality of front-seat occupants attributable to unbelted rear-seat passengers in car crashes.

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    Researchers at Children's Hospital of Philadelphia examined injuries to children in compact extended-cab pickup trucks. In these trucks, the side facing “jump seats” are exempt from occupant protection standards and have only lap belts available. The data showed that children in these seats were at nearly five times the risk of injury than if they rode in the rear seats of other vehicles. (Winston FK, Kallan MJ, Elliott MR, et al. Risk of injury to child passengers in compact extended-cab pickup trucks.

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    Why do people with alcohol and drug dependence continue to sustain high rates of injury even after going through “detox”? Researchers who interviewed clients of a detox center found that those who had alcohol dependence had higher rates of injury—including falls, motor vehicles, assaults, and other causes—than those who had been treated for drug addiction. The authors hypothesize that sustained nerve damage to the extremities might account for some of the differences, or that risk taking behavior might be a factor. In any case, the study points out that drug and alcohol detoxification programs offer one more venue for injury prevention education and promotion. (Rees VW, Horton NJ, Hingson RW, et al. Injury among detoxification patients: alcohol users' greater risk.

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    Have you read—or published—an interesting article recently? Please send the citation, and copy if possible, to the editor of Splinters & Fragments: Anara Guard, 44 King Street, Auburndale MA 02466, USA (fax 1 617 437 9394; email guardwilliams{at}rcn.comoraguard{at}bu.edu).

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