'It's changed how we have these conversations': emergency department clinicians' experiences implementing firearms and other lethal suicide methods counseling for caregivers of adolescents.

Counseling parents to reduce access to firearms and other potentially lethal suicide methods is commonly known as lethal means counseling (LMC). The current study explores the experiences that emergency department-based behavioural health clinicians described having as they provided lethal means counseling to parents of adolescents at risk for suicide. Clinicians were purposively sampled from four hospital networks in Colorado after their hospitals adopted LMC protocols as part of an intervention that also included online training in LMC and provision of free medication and firearm lockboxes. Twenty-three clinicians were interviewed using semi-structured interviews. Data were analysed using a modified grounded theory-based approach. Clinicians felt more comfortable and effective in their abilities to provide LMC after the intervention. Clinicians also described how being able to offer free storage devices helped them engage in LMC. In advising parents to make guns and medications inaccessible to their at-risk child, most clinicians pointed to at least one of three research findings highlighted in the online training: (1) Suicide attempts with guns rarely afford second chances, (2) medication overdoses can kill, (3) suicidal behaviour is always unpredictable and often impulsive. All clinicians described a desire to continue LMC as currently protocolized at their hospital after the study ended.

Nickel Oxide Interstratified agr-Zirconium Phosphate, a Composite Exhibiting Ferromagnetic Behavior.

As part of an ongoing research program to synthesize novel pillared layered materials, nickel and cobalt hydroxyacetates were inserted between the layers of amine intercalates of alpha-zirconium phosphate. The structure of the resultant nickel composite, derived from x-ray powder data, was found to consist of a three-tiered layer of nickel atoms bridged by hydroxo and acetato groups. Heating to 420 degrees C converted the hydroxyacetate layers to oxide and imparted ordered magnetic domains to the composite. The phosphate layers appear to act as a template directing the growth of the inserted layers in this class of composite materials.

Disability and risk of non-fatal residential injuries among adults.

OBJECTIVE: Many unintentional injuries occur in the home, but little research has considered the specific vulnerability of people with disabilities. DESIGN: Cross-sectional study examining nationally representative data from the 2004-2006 National Health Interview Surveys. SUBJECTS: Adults aged 18 and older who reported having an unintentional, non-motor vehicle-related injury in the home (n = 2189) or outside the home (n = 2072) and those who reported no injuries (n = 81,919) 3 months before their interview. MAIN OUTCOME MEASURE: Non-fatal, unintentional, non-motor vehicle-related injuries. RESULTS: Among respondents experiencing a residential injury, 21.2% reported one type of disability, 11.2% reported two disabilities, and 9.1% reported three or more disabilities. As the number of disabilities increased, the odds of reporting a residential injury increased. Adults with three or more disabilities had three times the odds of reporting a residential injury (adjusted odds ratio = 3.2, 95% CI 2.7 to 3.9), compared with adults reporting no injury. CONCLUSION: The risk of injury in the residential environment among adults with disabilities increases with increasing numbers of disabilities. Attention to home safety issues for residents with disabilities is needed.

Sex steroids and the endothelium.

Gonadal steroids clearly influence the course of atherosclerotic cardiovascular disease in women. This observation has suggested that these hormones have beneficial effects on the physiology of the vascular wall. Increased arterial vascular caliber after estrogen treatment, decreased lipid levels in subjects receiving hormone replacement therapy, and the markedly decreased extent of atherosclerotic plaque formation in young women as compared with young men support a cardioprotective effect of ovarian steroids. Generally, it appears that the effects of 17beta-estradiol are particularly beneficial, and the mechanism of action is targeted largely to the endothelial cell. This review describes the evidence for positive effects of estrogens on endothelial cell biology and considers potential mechanisms for estrogen actions on endothelial cell signal transduction.

American Public Health Association/American Academy of Pediatrics Injury Prevention Standards.

Injury prevention is an integral part of quality child-care programs. National standards relating to injury prevention have been published by the APHA and the AAP. The majority of these standards are preventive in nature and stress injury prevention in the development of policies and procedures and in the implementation of daily practices in child-care programs. Although it may not be possible to prevent all injuries in child-care settings, it is important for care givers, parents, and health professionals to identify potential hazards in the child-care environment. Once these hazards are identified, preventive corrective actions directed toward both environmental modifications and individual behaviors can be promoted to keep the incidence of injuries as low as possible.

Social determinants of pediatric residents' injury prevention counseling.

BACKGROUND: Social norms imparted by preceptors and the requirements necessary to pass American Board of Pediatrics' examinations are potentially important contributors to physician behavior. OBJECTIVE: To explore the relationships between perceived professional norms regarding injury prevention and the injury prevention topics discussed, and counseling strategies employed, by pediatric residents. DESIGN: A self-administered survey. SETTING: All 5 North Carolina pediatric residency programs. PARTICIPANTS: Physicians training in pediatrics or medicine-pediatrics in these programs (N = 160, 72% response rate). MAIN OUTCOME MEASURE: Correlation between perceived professional norms and self-reported content of injury prevention counseling and use of behavior change strategies. RESULTS: Although 95% of the pediatric residents reported counseling all or almost all parents with children younger than 1 year about car seat use, only 19% reported counseling this many parents about gun safety. Of the 7 behavior change strategies that residents were asked about, respondents were most likely to report "showing approval for safe behaviors" to all almost all parents (78%). Two thirds reported asking all or almost all parents about the safety of their homes. Pediatric residents' reported injury prevention counseling was correlated with their perceived professional norms regarding such counseling for most of the content areas and behavior change strategies. CONCLUSIONS: Perceived professional norms regarding injury prevention are related to pediatric residents' counseling, Preceptors should be aware that they transmit professional norms to residents. Also, the American Board of Pediatrics can increase residents' attention to injury prevention by informing them that it will be a topic included in the board examination.

Moving forward with research on the prevention of violence against workers.

OVERVIEW: This article highlights the major issues discussed at the Workplace Violence Intervention Research Workshop convened in April 2000. It includes discussion of impediments to developing research on interventions that address violence against workers, and it suggests directions for establishing a research agenda. To identify potential interventions strategies, the article provides examples to demonstrate the utility of developing interventions described in two distinct conceptual frameworks developed by William Haddon.

Parental responses to a child bicycle helmet ordinance.

Head injury associated with bicycle-related crashes is experienced disproportionately by children under age 20. Helmets are effective, but usage of helmets by children is minimal. This descriptive study, conducted in a small academic community with an ordinance requiring helmet use by children under 16, examined the views of parents and guardians about a bicycle helmet law and reports of helmet use in their families. Telephone interviews were conducted with a random sample of parents/guardians of third-, fourth-, and fifth-grade children (n = 142, 73% response rate). Sixty-five percent of those surveyed were aware of the ordinance. The vast majority (90%) agreed that bicycle helmet laws are "a good idea." Since the community helmet law was implemented, reported child helmet use increased, most notably among children who had never worn a helmet before the ordinance. Seventy percent of children who had never worn a helmet wore one most or all of the time since the ordinance. The ordinance also appears to have prompted parents to make helmet use rules for their children. Before the ordinance, families with rules reported helmet use by 79% of youths at least most of the time. This figure increased to 86% in families with rules after the ordinance was implemented. Even among the families without rules, helmet use increased from 7% before the ordinance to 60% after the law was enacted, indicating that both the ordinance and family rules are influential.

The role of surveillance and evaluation research in the reduction of violence against workers.

BACKGROUND: Violence against workers is garnering increased attention as awareness grows of the toll violent events have on workers and work environments. METHODS: In this review, we summarize information about surveillance of violent events in the workplace and summarize evaluations of intervention programs to reduce such violence. We describe surveillance programs that nationally collect data, and we compare some data. We summarize two systematic studies of workplace violence-prevention programs: The first study examined evaluations of the Crime Prevention Through Environmental Design approach to prevention, and the second examined evaluations of behavioral and administrative interventions. RESULTS: Reliable national data sets of worker homicides exist, but case identification and coding problems have yet to be solved. Although the number of workplace homicides has decreased since the mid-1990s, much less is known about the incidence of nonfatal events. The role that prevention programs have played in reducing workplace homicide remains largely unknown because so few evaluations have been conducted. CONCLUSIONS: Information about effective methods to reduce violence against workers is needed. Research that evaluates existing prevention programs, especially efforts conducted in a collaborative manner, will be invaluable to shaping effective programs in the future.

Administrative and behavioral interventions for workplace violence prevention.

BACKGROUND: Violence in the workplace accounts for 1000 fatalities and over 20,000 nonfatal events annually in the United States. The occupations with the most fatalities are taxicab drivers, employees in retail establishments, and law enforcement officers. Environmental strategies as well as behavioral and administrative measures could be employed to address violence. METHODS: This paper reports a critical review of the published literature on administrative and behavioral interventions directed at addressing workplace violence. Searching 17 different databases, we identified 137 papers that described workplace violence intervention strategies. Papers were further categorized according to whether they provided empirical data about an intervention or merely suggested intervention ideas. Suggested interventions were categorized according to applicability to types of workplace violence and organized according to the Haddon Matrix. RESULTS: Forty-one reports suggested intervention strategies but provided no empirical data; nine reported results of intervention evaluations. All intervention studies were based in the health care industry and addressed violent encounters between workers and patients. Overall, the research designs employed were weak and the results inconclusive. None used experimental designs. CONCLUSIONS: The lack of rigorous research to assess administrative and behavioral measures to address workplace violence represents a significant gap. Intervention research needs to draw on appropriate theoretical and conceptual frameworks, address the multiple contexts in which violence occurs, and employ strong evaluation research designs, including attention to process, impact, and outcome measures.

Helmet use among competitive cyclists.

The United States Cycling Federation (USCF) decision in 1986 to mandate helmet use in all sponsored races marked a major initiative in cycling safety. Confirming earlier reports about the effectiveness of helmets in preventing injuries, this study also examines the attitudes of 554 USCF members toward the policy and about helmet use in both racing and nonracing situations. Although 64% of the racers reported some hardshell helmet use in training before the policy, 80% used helmets in training after the ruling. Most cyclists favored the USCF policy, although only 19% favored requiring helmet use in all cycling situations. Attitudes about helmet policy and actual use by racers were inconsistent; large percentages of those opposing mandatory helmet use in racing (51%) and in training (76%) used helmets themselves. We suggest possibilities for incremental expansion of helmet use requirements for all riders.

State gun control advocacy tactics and resources.

CONTEXT: Enacting state laws to regulate firearm use, availability, or manufacture is one plausible strategy for preventing firearm-related injuries. Organizations that use a wide range of advocacy tactics may be successful in promoting gun control policies. OBJECTIVES: To describe tactics commonly used by groups that advocate for state gun control laws and to assess whether financial resources were associated with groups' use of these advocacy tactics. DESIGN/PARTICIPANTS: We identified 679 local and state organizations potentially active on state-level gun control issues in 1998 and mailed a 153-item questionnaire to the groups' leaders. MAIN OUTCOMES: Organizations' use of 35 gun control advocacy tactics. RESULTS: Seventy-nine percent (n=538) of groups responded to our survey, and, of those eligible, eighty-one percent (n=207) completed questionnaires. Organizations commonly used public education, media, and legislative lobbying tactics, and fewer engaged in electioneering and litigation. Except for lobbying, no associations were found between groups' use of advocacy tactics and their level of financial resources. CONCLUSIONS: Organizations advocating for state gun control laws have a varied tactical repertoire, with fewer using electioneering and litigation than other approaches. Financial resources do not appear to be the determining factor in the advocacy methods employed.

Injury-control education in six U.S. medical schools.

PURPOSE: To assess knowledge, attitudes, and formal instruction related to injury control among fourth-year medical students. Injury is the leading cause of death among Americans aged 1 to 44 years. METHOD: The authors conducted a cross-sectional survey of fourth-year students at six U.S. medical schools, four of which maintain federally funded injury prevention research centers. Main outcome measures included injury-related knowledge scores, three attitude measures, and self-reported exposures to injury prevention education. RESULTS: Six hundred and thirty-five fourth-year medical students (73% of those eligible) participated. The responding students were, on average, unable to correctly answer half of the questions testing injury-related knowledge. They rated medical problems more important and more preventable than injury problems, and they felt more comfortable asking their patients about risk factors for medical problems. These findings may be explained, in part, by the students' reported minimal exposure to injury control education in medical school. The students encountered the topic more frequently on rotations in pediatrics (84%), family medicine (73%), and preventive medicine (66%) than on rotations in emergency medicine (47%), internal medicine (41%), or obstetrics and gynecology (34%). Injury control was encountered least often on rotations in psychiatry (23%) and surgery (14%). CONCLUSIONS: These findings suggest that injury control is given limited coverage in the curricula of U.S. medical schools. As a result, students have little understanding of the principles and benefits of injury control.

Teens at work: a statewide study of jobs, hazards, and injuries.

PURPOSE: Occupational injury is an ongoing and serious threat to American youth. However, little is known about the environments in which youth work or the hazards to which they are exposed. The purpose of this study was to document the patterns of work, exposures to hazardous equipment and situations, and work-related injury experiences of adolescents. METHODS: We identified a statewide targeted sample of North Carolina households with teens age 14-17 years and interviewed those who had ever worked for pay or worked on a farm. RESULTS: Five hundred sixty-two teens from 700 eligible households reported that they had worked non-farm jobs for pay. One-third were paid for work before age 14 years; two-thirds had held more than one paid job. Place of employment was most often someone's home, a retail store, or a restaurant. Common jobs were lawn care worker, cashier, and dishwasher. Common hazards to which teens were exposed included ladders or scaffolding; forklifts, tractors or riding mowers; and working around loud noises. Over half were injured at least once while working a paid job, most often from being cut or burned. CONCLUSIONS: Work among youth is common. Teens hold a variety of jobs, mostly in the retail trade and the service sector, exposing them to hazardous equipment and situations. Injuries at work are frequent and some are serious. This study supports the need to include an occupational history and work-related safety counseling in clinical encounters with adolescents.

Pediatric injury prevention counseling: an observational study of process and content.

OBJECTIVES: To describe routine injury prevention counseling; to observe how three visit components - printed prompts, parent remarks, and parent behaviors - affect such counseling; to describe the process and content of discussions about car seats as an example of routine injury prevention. METHODS: A total of 128 well-child visits of children under 7 months of age to a university pediatric clinic were videotaped (76% of eligible visits). RESULTS: Three injury topics were mentioned, on an average, per visit. Parents or caregivers rarely introduced injury topics (5%). Physicians frequently introduced those topics listed on age-specific prompting sheets (73%). Car seat counseling typically began with a physician's question (82%). Most asked simply about ownership or use (93%). Few addressed difficult issues, such as consistency of use (11%). CONCLUSIONS: Physicians bring up the injury topics that are prompted. However, most discussion is superficial. Printed prompts that address counseling process as well as content might be beneficial.

Farm work is dangerous for teens: agricultural hazards and injuries among North Carolina teens.

Children who work in agriculture suffer more than 23,000 injuries and 300 fatalities on American farms every year. Using survey data collected from a random sample of working teens (ages 14 to 17) in North Carolina, the authors analyze the farm-based hazard exposure and injury experiences of teens who work on farms. The group of farmworking teens (N = 141) is 72 percent male, has a mean age of 16.6 years, and is, on average, in the 10th grade. The data show that teens working on farms in North Carolina are exposed to significant safety hazards throughout their farmworking careers. A majority of the respondents in this group of farmworkers reported exposure to tractors, large animals, all-terrain vehicles, farm trucks, and rotary mowers, and more than one-third reported exposure to pesticides and tobacco harvesters. Common reported injuries include insect stings, cuts, burns, and falls. The researchers find that gender, age, and farmwork experiences are related to variations in types of hazards to which teens are exposed and in the types of injuries they suffer. These variables also are related to the overall complexity of the teens' farmwork experiences and the burden of injury endured by teens.

Ultrasonically enhanced vancomycin activity against Staphylococcus epidermidis biofilms in vivo.

Infection of implanted medical devices by Gram-positive organisms such as Staphylococcus ssp. is a serious concern in the biomaterial community. In this research the application of low frequency ultrasound to enhance the activity of vancomycin against implanted Staphylococcus epidermidis biofilms was examined. Polyethylene disks covered with a biofilm of S. epidermidis were implanted subcutaneously in rabbits on both sides of their spine. The rabbits received systemic vancomycin for the duration of the experiment. Following 24 h of recovery, one disk was insonated for 24 or 48 h while the other was a control. Disks were removed and viable bacteria counted. At 24 h of insonation, there was no difference in viable counts between control and insonated biofilms, while at 48 h of insonation there were statistically fewer viable bacteria in the insonated biofilm. The S. epidermidis biofilms responded favorably to combinations of ultrasound and vancomycin, but longer treatment times are required for this Gram-positive organism than was observed previously for a Gram-negative species.

Variations in the relative speeds of orofacial structures with stuttering severity.

Stuttering can be characterized in part as a disorder in the coordination of different muscle systems. In light of basic aspects of orofacial physiology and development, the speeds of the lips and tongue relative to the jaw may be an important dimension for evaluating motor coordination among persons who stutter (PWS). To test this idea, an electromagnetic system was used to obtain measures of lip, tongue, and jaw speed in 38 adults (29 PWS and 9 normally fluent speakers, NFS) as they repeated a simple speech utterance at a normal rate. Using categorical ratings of stuttering severity, ratios of tongue speed to jaw speed were significantly greater in PWS rated as severe, compared to NFS and other PWS. Significant increases in lower lip-to-jaw and tongue-to-jaw speed ratios with stuttering severity were also reflected in correlation analyses relating speed ratios to a continuous measure of stuttering severity. These trends in speed ratio were related to increases in lower lip and tongue speed and decreases in jaw speed with stuttering severity. Sources of the speed differences are discussed in relation to underlying muscle activity, motor compensation processes in adults, and the development of orofacial motor control in children who stutter.

Accidental policy: an analysis of the problem of unintended injuries of childhood.

The problem of childhood injury is examined from an ecological, public health perspective, and a range of preventive and ameliorative strategies is considered. Three policy evaluation criteria--efficiency, freedom of choice, and equity--are discussed. A framework is proposed, and examples given, to assist professionals concerned with mental health and with child health and development in critically analyzing policy options.

Partner homicide-suicide involving female homicide victims: a population-based study in North Carolina, 1988-1992.

Homicide-suicide is a form of fatal violence in which an individual commits homicide and subsequently kills him- or herself. One hundred and sixteen homicide-suicide events involving 119 female homicide victims in North Carolina from 1988-1992 were identified through state medical examiner files. Case files were reviewed retrospectively to identify event characteristics, precursors, and typologies. In 86% of cases the perpetrator was the current or former partner of the victim. During the study period, 24% of men who killed their female partners in North Carolina subsequently committed suicide and another 3% attempted suicide but survived. Victim separation from the perpetrator was the most prevalent precursor (41%), followed by a history of domestic violence (29%). In nearly half of the cases with a history of domestic violence, the victim had previously sought protection from the perpetrator in the form of an arrest warrant, restraining order, or intervention by a law enforcement officer. Children of the victim (and/or perpetrator) witnessed the homicide-suicide, were in the immediate vicinity, found their parents' bodies, or were killed, in 43% of cases. The prevalence of separation and domestic violence suggests several potential points of intervention, including stronger domestic violence legislation. Future research should place priority on assessing the impact of partner homicide-suicides on the families in which they occur. Such studies are essential for the informed development of preventive and therapeutic interventions for the families of both the victims and perpetrators of these fatal events. In addition, research focused on assisting men in coping with issues of control and separation is needed.