Is violence a disease? Situating violence prevention in public health policy and practice.

The paper provides a review of some of the thoughts, ideas, and opinions that pervade the public health literature concerning how to classify or conceptualise violence. It is argued that violence transcends classic distinctions between communicable and non-communicable diseases, distinguishes itself from the discipline of injury control, and is influenced by wider, social determinants. Through a discussion of these varied perspectives it is concluded that a fourth revolution in public health is needed - a 'change in scope' revolution - that recognizes the influence of social justice, economics, and globalization in the aetiology of premature death and ill health, into which violence fits. However, rather than be shackled by debates of definition or classification, it is important that public health acknowledges the role it can play in preventing violence through policy and practice, and takes unified action.

Exploring the relationship between ADHD symptoms and prison breaches of discipline amongst youths in four Scottish prisons.

OBJECTIVE: To explore the relationship between attention deficit hyperactivity disorder (ADHD) symptoms (inattention, hyperactivity and impulsivity) and violent and non-violent prison breaches of discipline in incarcerated male youths aged 18-21 years. STUDY DESIGN: A case-control study of 169 male youth offenders incarcerated in Scottish prisons and classified as 'symptomatic' or 'non-symptomatic' of inattentive and hyperactive/impulsive ADHD symptoms. METHODS: ADHD symptoms were measured using the Conners' Adult ADHD Rating Scales-Self Report: Long Version, and prison breaches of discipline were gathered from the Scottish Prison Service's Prisoner Records System. RESULTS: Youths who were symptomatic of Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) ADHD total symptoms had a significantly higher number of prison breaches of discipline than those who were non-symptomatic. Youths who were symptomatic of DSM-IV hyperactive/impulsive symptoms had a significantly higher number of violent and non-violent prison breaches of discipline than those who were non-symptomatic. However, no such significant difference was found between youths who were symptomatic and non-symptomatic of DSM-IV inattentive symptoms. CONCLUSIONS: Young male offenders who are symptomatic of ADHD have a higher number of prison breaches of discipline. In particular, symptoms of hyperactivity/impulsivity are associated with breaches of both a violent and non-violent nature. Implications of such symptoms on rehabilitation and recidivism are discussed.

Lay CPR trainees: retraining, confidence and willingness to attempt resuscitation 4 years after training.

Two independent samples of 800 lay CPR trainees from an original cohort of 7584 were surveyed postally 4 years after training. Only 2% of respondents had used CPR, but 92 had used other aspects of their life support training. Those who had retrained were more confident than those who had not and 89% of those who had not retrained were willing to do so. More than 80% expressed willingness to perform full CPR on casualties who were unknown to them, but this fell to 40% where facial blood was present and 48% where the victim was a gay man.

Targeted mailing of information to improve uptake of measles, mumps, and rubella vaccine: a randomised controlled trial.

Uptake of the measles, mumps, and rubella vaccine in the United Kingdom has declined to levels that will allow outbreaks of these preventable diseases to occur. A leaflet sent with a personalized reminder did not increase vaccine uptake in children who had not been immunised at 21 months of age.

Evaluating CPR performance in basic life support: the VIDRAP protocol.

This paper presents the second part of the validated Cardiff test for one rescuer basic life support skills, based on observation of video recording combined with the Recording Resusci Anne printout (VIDRAP). The authors believe that this is a robust evaluation tool which is capable of assessing the potential value to a casualty of a simulated resuscitation. The adoption of a widely accepted test methodology would facilitate comparison of research in different centres, which is not possible at present.

Assessing with CARE: an innovative method of testing the approach and casualty assessment components of basic life support, using video recording.

The resuscitation community is now moving towards a set of basic life support guidelines but different countries and training centres have their own individual methods of instruction. It would be advantageous if a universal testing method were available to facilitate intercentre comparison. This could lead to an international course which had been rigorously assessed and evaluated. Taking this as a starting point, the Cardiff Assessment of Response and Evaluation (CARE) was developed. CARE is an innovative assessment technique using video recording for testing the preliminary steps of life support as outlined by the European Resuscitation Council. The assessment was validated by testing 67 members of the public who had been trained in cardiopulmonary resuscitation, 27 shortly after instruction and 40 between 6 and 18 months after instruction. All subjects were tested without prior warning and video recorded for independent scoring by two researchers and a paramedic training officer. Scores were compared using the k correlation which showed a high level of agreement between observers. Video recording and marking using the CARE schedule and guidelines is a reliable method for assessing the preliminary steps in life support.

Effectiveness of the BBC's 999 training roadshows on cardiopulmonary resuscitation: video performance of cohort of unforewarned participants at home six months afterwards.

OBJECTIVE: To examine the competence of a cohort trained in cardiopulmonary resuscitation by the BBC's 999 training roadshows. DESIGN: Descriptive cohort study applying an innovative testing procedure to a nationwide systematic sample. The test sample received an unsolicited home visit and without warning were required to perform cardiopulmonary resuscitation on a manikin while being videoed. The videos were then analysed for effectiveness and safety using the new test. SETTING: Nine cities and surrounding areas in the United Kingdom. SUBJECTS: 280 people aged between 11 and 72. RESULTS: Thirty three (12%) trainees were able to perform effective cardiopulmonary resuscitation, but of these 14 (5%) performed one or more elements in a way that was deemed to be potentially injurious. Thus only 19 (7%) trainees were able at six months to provide safe cardiopulmonary resuscitation. In addition, large numbers of subjects failed to shout for help, effectively assess the status of the patient, or alert an ambulance. Significantly better performances were recorded by those under 45 years old (31 (14%) v 2 (4%) gave effective performances respectively, P < 0.05), those who had attended a subsequent cardiopulmonary resuscitation course (8 (40%) v 25 (10%) gave effective performances respectively, P < 0.0001), and those confident in their initial ability (26 (20%) v 7 (6%) gave effective performances respectively, P < 0.005). Females were significantly less likely than males to perform procedures in a harmful way (117 (62%) v 10 (12%) performed safely respectively, P < 0.005). CONCLUSION: Television is an effective means of generating large training cohorts. Volunteers will cooperate with unsolicited testing in their home, such testing being a realistic simulation of the stress and lack of forewarning that would surround a real event. Under such conditions the performance of cardiopulmonary resuscitation was disappointing. However, retraining greatly improves performance.

Respiratory arrest outside hospital.

Of 954 attempted resuscitations outside hospital performed by ambulance personnel, 48 patients (5%) had primary respiratory arrest. Comparing this group with those manifesting cardiorespiratory arrest, patients with primary respiratory arrest were significantly more likely to be female (25 of 48 vs 269 of 906-P < 0.005), were more likely to have a non-cardiac cause (67% vs. 22%-P < 0.00001) and more likely to have witnessed arrest. Of all arrests witnessed by ambulance crew, 35% were respiratory arrests. Basic and advanced life-support was delivered sooner. Outcome was significantly better, with 19 patients (40%) being discharged compared to only 49 patients (5.1%) discharged in cases of cardiorespiratory arrest (p < 0.00001). Considering that many respiratory arrests were witnessed by ambulance crew, the type of crew (EMT or paramedic) made no difference to outcome. Our findings suggest that patients manifesting respiratory arrest outside hospital are a heterogeneous group who have a relatively good prognosis regardless of the type of ambulance crew that attends.

The need for wider dissemination of CPR skills: are schools the answer?

The value of instructing members of the public in CPR is now widely recognised, but community training schemes which rely largely on volunteers may fail to reach their targets. CPR training for lay people is often a once only activity and it has been shown that, without revision, skills deteriorate rapidly. By teaching CPR in secondary schools all social classes and ethnic groups could be reached, and retention of skills improved by regular revision. Health education has shown that it may be beneficial to use older pupils as instruction assistants.

Comparison of in vivo and in vitro responses to histamine in human airways.

The study was designed to compare in vivo responses to histamine in 14 patients prior to thoracotomy with in vitro responses to histamine of both parenchymal and bronchial tissue. Although a wide range of responsiveness occurred in vivo, as measured by the histamine inhalation test, the variation in the in vitro dose-response curves was negligible. There was no correlation between the dose of histamine that resulted in a 20% reduction in forced expiratory volume in one second and the concentration of histamine producing 50% of the maximal response in vitro. These findings raise the possibility that airway hyperresponsiveness may not result from an intrinsic abnormality of airway smooth muscle.