Showing papers on "Poison control published in 1993"

Adolescence-limited and life-course-persistent antisocial behavior: A developmental taxonomy.

Abstract: This chapter suggests that delinquency conceals two distinct categories of individuals, each with a unique natural history and etiology: A small group engages in antisocial behavior of one sort or another at every life stage, whereas a larger group is antisocial only during adolescence. According to the theory of life-course-persistent antisocial behavior, children's neuropsychological problems interact cumulatively with their criminogenic environments across development, culminating m a pathological personality. According to the theory of adolescence-limited antisocial behavior, a contemporary maturity gap encourages teens to mimic antisocial behavior in ways that are normative and adjustive. There are marked individual differences in the stability of antisocial behavior. The chapter reviews the mysterious relationship between age and antisocial behavior. Some youths who refrain from antisocial behavior may, for some reason, not sense the maturity gap and therefore lack the hypothesized motivation for experimenting with crime.

Impact of sexual abuse on children: A review and synthesis of recent empirical studies

Abstract: A review of 45 studies clearly demonstrated that sexually abused children had more symptoms than nonabused children, with abuse accounting for 15-45% of the variance. Fears, posttraumatic stress disorder, behavior problems, sexualized behaviors, and poor self-esteem occurred most frequently among a long list of symptoms noted, but no one symptom characterized a majority of sexually abused children. Some symptoms were specific to certain ages, and approximately one third of victims had no symptoms. Penetration, the duration and frequency of the abuse, force, the relationship of the perpetrator to the child, and maternal support affected the degree of symptomatology. About two thirds of the victimized children showed recovery during the first 12-18 months. The findings suggest the absence of any specific syndrome in children who have been sexually abused and no single traumatizing process. Language: en

Timid choices and bold forecasts: a cognitive perspective on risk taking

Abstract: Decision makers have a strong tendency to consider problems as unique. They isolate the current choice from future opportunities and neglect the statistics of the past in evaluating current plans. Overly cautious attitudes to risk result from a failure to appreciate the effects of statistical aggregation in mitigating relative risk. Overly optimistic forecasts result from the adoption of an inside view of the problem, which anchors predictions on plans and scenarios. The conflicting biases are documented in psychological research. Possible implications for decision making in organizations are examined.

The role of secondary brain injury in determining outcome from severe head injury.

Abstract: As triage and resuscitation protocols evolve, it is critical to determine the major extracranial variables influencing outcome in the setting of severe head injury. We prospectively studied the outcome from severe head injury (GCS score < or = 8) in 717 cases in the Traumatic Coma Data Bank. We investigated the impact on outcome of hypotension (SBP < 90 mm Hg) and hypoxia (Pao2 < or = 60 mm Hg or apnea or cyanosis in the field) as secondary brain insults, occurring from injury through resuscitation. Hypoxia and hypotension were independently associated with significant increases in morbidity and mortality from severe head injury. Hypotension was profoundly detrimental, occurring in 34.6% of these patients and associated with a 150% increase in mortality. The increased morbidity and mortality related to severe trauma to an extracranial organ system appeared primarily attributable to associated hypotension. Improvements in trauma care delivery over the past decade have not markedly altered the adverse influence of hypotension. Hypoxia and hypotension are common and detrimental secondary brain insults. Hypotension, particularly, is a major determinant of outcome from severe head injury. Resuscitation protocols for brain injured patients should assiduously avoid hypovolemic shock on an absolute basis.

Epidemiology of trauma deaths: a reassessment

Abstract: OBJECTIVE: Recognizing the impact of the 1977 San Francisco study of trauma deaths in trauma care, our purpose was to reassess those findings in a contemporary trauma system. DESIGN: Cross-sectional. MATERIAL AND METHODS: All trauma deaths occurring in Denver City and County during 1992 were reviewed; data were obtained by cross-referencing four databases: paramedic trip reports, trauma registries, coroner autopsy reports and police reports. MEASUREMENTS AND MAIN RESULTS: There were 289 postinjury fatalities; mean age was 36.8 +/- 1.2 years and mean Injury Severity Score (ISS) was 35.7 +/- 1.2. Predominant injury mechanisms were gunshot wounds in 121 (42%), motorvehicle accidents in 75 (38%) and falls in 23 (8%) cases. Seven (2%) individuals sustained lethal burns. Ninety eight (34%) deaths occurred in the pre-hospital setting. The remaining 191 (66%) patients were transported to the hospital. Of these, 154 (81%) died in the first 48 hours (acute), 11 (6%) within three to seven days (early) and 26 (14%) after seven days (late). Central nervous system injuries were the most frequent cause of death (42%), followed by exsanguination (39%) and organ failure (7%). While acute and early deaths were mostly due to the first two causes, organ failure was the most common cause of late death (61%). CONCLUSIONS: In comparison with the previous report, we observed similar injury mechanisms, demographics and causes of death. However, in our experience, there was an improved access to the medical system, greater proportion of late deaths due to brain injury and lack of the classic trimodal distribution.

Do Neighborhoods Influence Child and Adolescent Development

Abstract: The effects of neighborhood characteristics on the development of children and adolescents are estimated, using two data sets, each of which contains information gathered about individual children and the families and neighborhoods in which they reside. There are reasonably powerful neighborhood effects-particularly effects of the presence of affluent neighbors-on Childhood IQ, teenage births, and school-leaving, even after the differences in the socioeconomic characteristics of families are adjusted for. The study finds that white teenagers benefit more from the presence of affluent neighbors than do black teenagers.

Prevalence of civilian trauma and posttraumatic stress disorder in a representative national sample of women

Abstract: Prevalence of crime and noncrime civilian traumatic events, lifetime posttraumatic stress disorder (PTSD), and PTSD in the past 6 months were assessed in a sample of U.S. adult women (N = 4,008). Random digit-dial telephone methods were used to identify study participants. Structured telephone interviews for assessment of specific crime or other traumatic event history and PTSD were conducted by trained female interviewers. Lifetime exposure to any type of traumatic event was 69%, whereas exposure to crimes that included sexual or aggravated assault or homicide of a close relative or friend occurred among 36%. Overall sample prevalence of PTSD was 12.3% lifetime and 4.6% within the past 6 months. The rate of PTSD was significantly higher among crime versus noncrime victims (25.8% vs. 9.4%). History of incidents that included direct threat to life or receipt of injury was a risk factor for PTSD. Findings are compared with data from other epidemiological studies. Results are discussed as they relate to PTSD etiology.

Brief interventions for alcohol problems: a review

Abstract: Relatively brief interventions have consistently been found to be effective in reducing alcohol consumption or achieving treatment referral of problem drinkers. To date, the literature includes at least a dozen randomized trials of brief referral or retention procedures, and 32 controlled studies of brief interventions targeting drinking behavior, enrolling over 6000 problem drinkers in both health care and treatment settings across 14 nations. These studies indicate that brief interventions are more effective than no counseling, and often as effective as more extensive treatment. The outcome literature is reviewed, and common motivational elements of effective brief interventions are described. There is encouraging evidence that the course of harmful alcohol use can be effectively altered by well-designed intervention strategies which are feasible within relatively brief-contact contexts such as primary health care settings and employee assistance programs. Implications for future research and practice are considered.

Abnormal behavior associated with a point mutation in the structural gene for monoamine oxidase A

Abstract: Genetic and metabolic studies have been done on a large kindred in which several males are affected by a syndrome of borderline mental retardation and abnormal behavior. The types of behavior that occurred include impulsive aggression, arson, attempted rape, and exhibitionism. Analysis of 24-hour urine samples indicated markedly disturbed monoamine metabolism. This syndrome was associated with a complete and selective deficiency of enzymatic activity of monoamine oxidase A (MAOA). In each of five affected males, a point mutation was identified in the eighth exon of the MAOA structural gene, which changes a glutamine to a termination codon. Thus, isolated complete MAOA deficiency in this family is associated with a recognizable behavioral phenotype that includes disturbed regulation of impulsive aggression.

Children's peer relations : a meta-analytic review of popular, rejected, neglected, controversial, and average sociometric status

Abstract: Two-dimensional sociometric models have had a critical role in the investigation of children's peer relations in the past decade. In a meta-analysis, fitting categorical models (Hedges, 1982), sociometric group differences on behavioral and information source typologies were assessed. The broad-band behavioral analysis showed that popular children's array of competencies makes them likely recipients of positive peer nominations, whereas high levels of aggression and withdrawal and low levels of sociability and cognitive abilities are associated with rejected peer status. A consistent profile marked by less sociability and aggression emerged for neglected status. Controversial children had higher aggressive behavior than rejected children but compensated for it with significantly better cognitive and social abilities. The moderator effects of narrow-band behavioral categories and information source were also examined.

Smart cars on smart roads: problems of control

Abstract: Key features of one automated intelligent vehicle/highway system (IVHS) are outlined, it is shown how core driver decisions are improved, a basic IVHS control system architecture is proposed, and a design of some control subsystems is offered. Some experimental work is summarized. A system that promises a threefold increase in capacity is outlined, and a four-layer hierarchical control architecture that decomposes this problem into more manageable units is proposed. >

Suggestibility of the child witness: A historical review and synthesis.

Abstract: The field of children's testimony is in turmoil, but a resolution to seemingly intractable debates now appears attainable. In this review, we place the current disagreement in historical context and describe psychological and legal views of child witnesses held by scholars since the turn of the 20th century. Although there has been consistent interest in children's suggestibility over the past century, the past 15 years have been the most active in terms of the number of published studies and novel theorizing about the causal mechanisms that underpin the observed findings. A synthesis of this research posits three "families" of factors--cognitive, social, and biological--that must be considered if one is to understand seemingly contradictory interpretations of the findings. We conclude that there are reliable age differences in suggestibility but that even very young children are capable of recalling much that is forensically relevant. Findings are discussed in terms of the role of expert witnesses.

A Survey of the Nature and Extent of Bullying in Junior/Middle and Secondary Schools.

Abstract: Summary As part of a survey service developed to assess bullying in schools, anonymous questionnaires were given to over 6,000 pupils in 17 junior/middle and seven secondary schools in the Sheffield LEA. The results are analysed in terms of frequencies of being bullied, and bullying others; year differences; gender differences; types of bullying; where bullying occurs; whether teachers and parents are informed; and attitudes to bullying. Rates of reported bullying are disturbingly high; they vary with year, gender and school location, partly as a result of opportunities for bullying. With the addition of data from six other schools, it was found that school size, class size and ethnic mix were not linked with bullying. Social disadvantage is linked with bullying to a small extent, and schools with high bullying rates also tend to have pupils who dislike, or are alone at, playtime. Implications for intervention against bullying are briefly discussed.

Etiology of child maltreatment: a developmental-ecological analysis.

Abstract: This article applies a developmental-ecological perspective to the question of the etiology of physical child abuse and neglect by organizing the paper around a variety of "contexts of maltreatment." The roles of parent and child characteristics and processes are considered ("developmental context"), including an examination of intergenerational transmission. The "immediate interactional context" of maltreatment, which focuses on the parenting and parent-child interactional processes associated with abuse and neglect, is analyzed. Finally, the "broader context" is discussed with 3 specific subsections dealing with the community, cultural, and evolutionary contexts of child maltreatment. Implications for intervention are considered and future research directions are outlined.

Incidence of and Risk Factors for Falls and Injurious Falls among the Community-dwelling Elderly

Abstract: To determine the frequency of and risk factors for falls and injurious falls in the noninstitutionalized elderly, the authors conducted a follow-up study of 409 community-dwelling persons aged 65 years or more in west-central Montreal, Quebec, Canada, from May 1987 to October 1988. Following an initial at-home interview, each subject was telephoned every 4 weeks for 48 weeks for collection of data on falls experienced since the last contact. Each of the 12 follow-up interviews was completed by at least 90% of the subjects eligible for interview. Data were also collected in the follow-up interviews on time-varying exposures. Twenty-nine percent of the subjects fell during follow-up; 17.6% fell once, and 11.5% fell two or more times. The incidence rate for falls was 41.4 falls per 1,000 person-months. The majority of falls resulted in no injury or in minor injury only. Potential risk factors investigated included sociodemographic variables, physical activity, alcohol consumption, acute and chronic health problems, dizziness, mobility, and medications. Multivariate analyses showed that the following factors were statistically significantly associated with an increased rate of falls: dizziness (incidence rate ratio (IRR) = 2.0), frequent physical activity (IRR = 2.0), having days on which activities were limited because of a health problem (IRR = 1.8), having trouble walking 400 m (IRR = 1.6), and having trouble bending down (IRR = 1.4). Factors which were protective included diversity of physical activities (IRR = 0.6), daily alcohol consumption (IRR = 0.5), having days spent in bed because of a health problem (IRR = 0.5), and taking heart medication (IRR = 0.6). Risk factors for injurious falls were similar.

Population-Based Study of Survival after Osteoporotic Fractures

Abstract: Vertebral fractures are the most frequent of the fractures associated with osteoporosis, yet little is known of their impact on health in the United States. To aid in this understanding, the authors examined the survival rate of 335 residents of Rochester, Minnesota, who had an initial radiologic diagnosis of vertebral fracture between 1985 and 1989. Seventy-six died during 809 person-years of follow-up. The overall survival rate was worse than expected, and diverged steadily from expected values throughout the course of the study. At 5 years after diagnosis, the estimated survival was 61% compared with an expected value of 76% (relative survival = 0.81, 95% confidence interval (CI) 0.70-0.92). The 5-year relative survival after a hip fracture in Rochester was a comparable 0.82 (95% CI 0.77-0.87), but there was a much greater excess of deaths within the first 6 months as compared with patients with vertebral fractures. The 5-year relative survival rate after a distal forearm fracture was 1.00 (95% CI 0.95-1.05). Clinically diagnosed vertebral fractures are rarely fatal, and the reduced survival seen subsequently could related to comorbid conditions. Nonetheless, the excess mortality should be accounted for in assessing the public health impact of osteoporosis.

Toward an Ecological/Transactional Model of Community Violence and Child Maltreatment: Consequences for Children’s Development

Abstract: In recent decades it has become increasingly apparent that violence affects a significant proportion of families in the United States (Bureau of Justice Statistics 1983). Violence, in fact, is becoming a defining characteristic of American society. A recent comparison of the rates of homicide among 21 developed nations indicates that the United States has the highest homicide rate in the world, and its rate is more than four times higher than the next highest rate (Fingerhut and Kleinman 1990). What is even more alarming is the high incidence of violent death and injury for children and adolescents in the United States. Acts of violence are the cause of death for over 2000 children between the ages of 0 and 19 years each year, and more than 1.5 million children and adolescents are abused by their adult caretakers each year (Christoffel 1990).

Mortality Probability Models (MPM II) based on an international cohort of intensive care unit patients

Abstract: Objective. —To revise and update models in the Mortality Probability Model (MPM II) system to estimate the probability of hospital mortality among 19124 intensive care unit (ICU) patients that can be used for quality assessment within and among ICUs. Design and Setting. —Models developed and validated on consecutive admissions to adult medical and surgical ICUs in 12 countries. Patients. —A total of 12610 patients for model development, 6514 patients for model validation. Patients younger than 18 years and burn, coronary care, and cardiac surgery patients were excluded. Outcome Measure. —Vital status at hospital discharge. Results. —The admission model, MPM0, contains 15 readily obtainable variables. In developmental and validation samples it calibrated well (goodness-of-fit tests:P=.623 andP=.327, respectively, where a highPvalue represents good fit between observed and expected values) and discriminated well (area under the receiver operating characteristic curve=0.837 and 0.824, respectively). The 24-hour model, MPM24(developed on 10357 patients still in the ICU at 24 hours), contains five of the admission variables and eight additional variables easily ascertained at 24 hours. It also calibrated well (P=.764 andP=.231 in the developmental and validation samples, respectively) and discriminated well (area under the receiver operating characteristic curve=0.844 and 0.836 in the developmental and validation samples, respectively). Conclusions. —Among severity systems for intensive care patients, the MPM0is the only model available for use at ICU admission. Both MPM0and MPM24are useful research tools and provide important clinical information when used alone or together. (JAMA. 1993;270:2478-2486)

Violent recidivism of mentally disordered offenders: The development of a statistical prediction instrument.

Abstract: Multivariate techniques were used to derive and validate an actuarial instrument for the prediction of violent postrelease offenses by mentally disordered offenders. The 618 subjects were a heterogeneous group of men who had been charged with serious offenses. Approximately half had been treated in a maximum security psychiatric institution and the rest had been briefly assessed prior to imprisonment. The actuarial instrument consisted of 12 variables and significantly predicted violent outcome in each of five subgroups. The instrument's practical application and its use in clinical appraisals of dangerousness are discussed.

Children in poverty: Resilience despite risk

Abstract: Two objectives provided the focus for the Conference on Community Violence and Children's Development that was jointly sponsored by the National Institute of Mental Health and the John D. and Catherine T. MacArthur Foundation. One was to examine the evidence for deficit behaviors that characterized children reared in poverty; the second was to identify the characteristics of children who sustained their competencies despite being reared in comparable environments. These dual objectives took this form: "What can we conclude from studies of children, their families, and environments about characteristics that predispose children to maladjustment following exposure to violence, and about characteristics that protect children from such adjustment problems following, or in the midst of, violence exposure?" VioLit summary: OBJECTIVE: The intent of this article by Garmezy was to identify the differences between children who do not suffer maladjustment despite exposure to violence, and children who do suffer maladjustment as a result of exposure to violence. METHODOLOGY: The author employed a non-experimental design by reviewing literature on the effects of cumulative risk factors for children with maladjustment difficulties. The author then identified the protective factors which helped provide healthy development in children, despite their exposure to violence and other potentially maladaptive experiences. FINDINGS/DISCUSSION: One study (Rutter 1979) identified six variables, linked to the family, which created a cumulative effect that increased the likelihood of maladjustment for each factor which was present. The factors included marital discord, low socioeconomic status, an overcrowded environment or large family size, paternal criminal behavior, maternal psychiatric disorder, and foster home placement. Findings by two other researchers (Kolvin 1988, Sameroff 1982, 1984, 1989, 1990) supported the notion of cumulative effects although their categories differed slightly. All three studies noted the combination of negative sociocultural elements and negative biological elements as especially problematic in producing positive outcomes. Resiliency, the power to recover from difficult environmental or biological circumstances, appeared in one study but the children became increasingly less competent as they were tested over time (another potential example of the effects of cumulated stress, especially stress over time). Although research on the factors central to resiliency was scarce, the author did note that signs of emotional distress were not necessarily suggestive of a breakdown in resilient behavior. On the contrary, some research (Werner 1989; Werner and Smith 1982, 1992) had indicated that although adult survivors of childhood trauma demonstrated good coping with adult responsibilities, life satisfaction or happiness were not always also present. Another study (Coatsworth 1991) identified competence items for measuring success in adaptation: Academic and job performance, obedience to the law, expectations for appropriate social conduct with adults, relating well to peers, maintaining close relations with friends, and preliminary signs of developing romantic relationships. The author cautioned, however, that such competence items were rarely utilized in research on adaptive individuals and therefore the understanding of resiliency factors was minimal. Several protective factors were also identified which could lead to eventual competence, including temperament factors (reflectiveness, cognitive skills, positive responsiveness to others), families characterized as warm and cohesive, and the presence of an external support (teacher, neighbor, parents of peers) (Garmezy 1985). To confound the issue, however, Festinger (1983) tracked 277 young adult men who had been placed in foster care as young boys and determined that the overall adaptation to adult life was no different than the family-reared men she randomly selected as a control group. AUTHOR'S RECOMMENDATIONS: The author closed with the suggestion to address the scientific and political facets of understanding resilience. The scientific challenges, according to the author, required further research on biological, genetic, and social-developmental elements which effected resiliency. The political challenges included, most importantly, a serious examination of the effects of poverty on family survivorship and a resulting strategy for addressing poverty. Finally, intensive studies on shifts in individual adaptation and the correlates of this adaptation, argued the author, required additional longitudinal studies. (CSPV Abstract - Copyright © 1992-2007 by the Center for the Study and Prevention of Violence, Institute of Behavioral Science, Regents of the University of Colorado) KW - Child Witness KW - Child Development KW - Youth Development KW - Poverty KW - Socioeconomic Factors KW - At Risk Child KW - At Risk Youth KW - Exposure to Violence KW - Witnessing Violence Effects KW - Literature Review KW - Family Relations KW - Witness Adjustment KW - Child Adjustment KW - Emotional Adjustment KW - Individual Risk Factors KW - Individual Risk Factors KW - Resiliency KW - Domestic Violence Effects KW - Domestic Violence Victim KW - Child Abuse Effects KW - Child Abuse Victim KW - Child Victim KW - Victim Adjustment KW - Family Environment KW - Family Risk Factors KW - Family Protective Factors Language: en

The reality of repressed memories.

Abstract: Repression is one of the most haunting concepts in psychology. Something shocking happens, and the mind pushes it into some inaccessible corner of the unconscious. Later, the memory may emerge into consciousness. Repression is one of the foundation stones on which the structure of psychoanalysis rests. Recently there has been a rise in reported memories of childhood sexual abuse that were allegedly repressed for many years. With recent changes in legislation, people with recently unearthed memories are suing alleged perpetrators for events that happened 20, 30, even 40 or more years earlier. These new developments give rise to a number of questions: (a) How common is it for memories of child abuse to be repressed? (b) How are jurors and judges likely to react to these repressed memory claims? (c) When the memories surface, what are they like? and (d) How authentic are the memories?

The Nimh Community Violence Project: I. Children as Victims of and Witnesses to Violence

Abstract: The 1980s witnessed an extraordinary increase in community violence in most major cities across the United States. In 1990 the homicide rate in Boston increased by 45% over the previous year; in Denver, by 29%; in Chicago, Dallas, and New Orleans, by more than 20%; in Los Angeles, by 16%; in New York, by 11%. In Washington, DC, which has the highest per capita homicide rate in the country, the 1990 murder rate set an all time record in the District's history (Escobar 1991). Across the country, 1 out of 5 teenage and young adult deaths was gun related in 1988 - the first year in which firearm death rates for both Black and White teenagers exceeded the total for all natural causes of death combined. Also in 1988, the firearm homicide rate for young Black males increased by 35%, and Black male teens were 11 times more likely than their White counterparts to be killed by guns (Christofel 1990).

Mortality and morbidity after hip fractures.

Abstract: OBJECTIVE--To study the mortality and morbidity associated with proximal femoral fractures with reference to fracture type (intracapsular and extracapsular). DESIGN--Consecutive prospective study with 12 month follow ups. SETTING--Two British trauma receiving centres. PATIENTS--1000 consecutive acute proximal femoral fractures (fractured necks of femur) in 972 patients. RESULTS--Significantly higher mortality at one year was seen in patients with extracapsular fractures (188/490; 38%) than in those with intracapsular fractures (147/510; 29%; p < 0.01). Greater morbidity was experienced during the study period by patients with extracapsular fractures, who were less mobile and less independent at the time of their injury. CONCLUSIONS--The rise in average age of presentation with proximal femoral fracture is associated with a persistently high mortality (33%) and morbidity, greater in patients with an extracapsular fracture. Comparison with other studies, principally from outside Britain, is difficult, but despite advancing standards of care the mortality and morbidity of femoral neck fractures remains high, placing an ever increasing burden on the health service.

Visual attention problems as a predictor of vehicle crashes in older drivers.

Abstract: PURPOSE. To identify visual factors that are significantly associated with increased vehicle crashes in older drivers. METHODS. Several aspects of vision and visual information processing were assessed in 294 drivers aged 55 to 90 years. The sample was stratified with respect to age and crash frequency during the 5-year period before the test date. Variables assessed included eye health status, visual sensory function, the size of the useful field of view, and cognitive status. Crash data were obtained from state records. RESULTS. The size of the useful field of view, a test of visual attention, had high sensitivity (89%) and specificity (81%) in predicting which older drivers had a history of crash problems. This level of predictability is unprecedented in research on crash risk in older drivers. Older adults with substantial shrinkage in the useful field of view were six times more likely to have incurred one or more crashes in the previous 5-year period. Eye health status, visual sensory function, cognitive status, and chronological age were significantly correlated with crashes, but were relatively poor at discriminating between crash-involved versus crash-free drivers. CONCLUSIONS. This study suggests that policies that restrict driving privileges based solely on age or on common stereotypes of age-related declines in vision and cognition are scientifically unfounded. With the identification of a visual attention measure highly predictive of crash problems in the elderly, this study points to a way in which the suitability of licensure in the older adult population could be based on objective, performance-based criteria. Keywords: Driver distraction;

Psychiatric risk factors for adolescent suicide: A case-control study.

Abstract: Objective The objective of this study was to determine the psychiatric risk factors for adolescent suicide. Method Sixty-seven adolescent suicide victims were compared with 67 demographically matched community controls. Psychiatric disorder was assessed in suicide victims using a psychological autopsy protocol and in controls using similar semistructured psychiatric interviews. Risk factors were quantified by use of the odds ratio (OR), that is, the relative frequency of the occurrence of a given condition in the suicides compared with the controls. Results The most significant psychiatric risk factors associated with adolescent suicide were major depression (OR = 27.0), bipolar mixed state (OR = 9.0), substance abuse (OR = 8.5), and conduct disorder (OR = 6.0). Substance abuse was a more significant risk factor when comorbid with affective illness than when alone (OR = 17.0 versus 3.3). The majority of depressed suicide victims had a primary affective disorder (82%). A significant minority (31%) of depressed suicide victims had been depressed less than 3 months. Previous suicide attempts, suicidal ideation, and homicidal ideation also were associated with adolescent suicide. Conclusions The development of effective treatments for youth who fit the above-noted risk profiles should be given high priority. J. Am. Acad. Child Adolesc. Psychiatry , 1993, 32, 3:521–529.

Seismicity Remotely Triggered by the Magnitude 7.3 Landers, California, Earthquake

Abstract: The magnitude 7.3 Landers earthquake of 28 June 1992 triggered a remarkably sudden and widespread increase in earthquake activity across much of the western United States. The triggered earthquakes, which occurred at distances up to 1250 kilometers (17 source dimensions) from the Landers mainshock, were confined to areas of persistent seismicity and strike-slip to normal faulting. Many of the triggered areas also are sites of geothermal and recent volcanic activity. Static stress changes calculated for elastic models of the earthquake appear to be too small to have caused the triggering. The most promising explanations involve nonlinear interactions between large dynamic strains accompanying seismic waves from the mainshock and crustal fluids (perhaps including crustal magma).

Snoring, sleep disturbance, and behaviour in 4-5 year olds.

Abstract: Parents of 996 children aged 4-5 years identified consecutively from the Oxford health visitor register were asked to complete a questionnaire about breathing disorders during sleep. A total of 782 (78.5%) was returned. Ninety five (12.1%) children were reported to snore on most nights. Habitual snoring was significantly associated with daytime sleepiness, restless sleep, and hyperactivity. The questionnaire responses were used to select two subgroups, one at high risk of a sleep and breathing disorder and a control group. These children (132 in total) were monitored at home with overnight video recording and oximetry, and had formal behavioural assessment using the Conners scale. Seven (7/66) children from the high risk group and none from the control group had obvious sleep disturbance consequent on snoring and upper airway obstruction. Thus our estimate of the prevalence of sleep and breathing disorders in this age group is 7/996 or 0.7%. The high risk group had significantly higher nocturnal movement, oxygen saturation dip rates, and overnight pulse rates than the controls. Maternal but not paternal smoking was associated with the high risk group. Parents and teachers thought those in the high risk group were more hyperactive and inattentive than the controls, but only their parents thought them more aggressive. Significant sleep and breathing disorders occur in about 0.7% of 4-5 year olds. Children whose parents report snoring and sleep disturbance have objective evidence of sleep disruption and show more behaviour problems than controls.

Naturalistic follow-up of a behavioral treatment for chronically parasuicidal borderline patients.

Abstract: Background: A randomized clinical trial was conducted to evaluate whether the superior performance of dialectical behavior therapy (DBT), a psychosocial treatment for borderline personality disorder, compared with treatment-as-usual in the community, is maintained during a 1-year posttreatment follow-up. Methods: We analyzed 39 women who met criteria for borderline personality disorder, defined by Gunderson's Diagnostic Interview for Borderline Personality Disorder and DSM-III-R criteria, and who had a history of parasuicidal behavior. Subjects were randomly assigned either to 1 year of DBT, a cognitive behavioral therapy that combines individual psychotherapy with group behavioral skills training, or to treatment-as-usual, which may or may not have included individual psychotherapy. Efficacy was measured on parasuicidal behavior (Parasuicide History Interview), psychiatric inpatient days (Treatment History Interview), anger (State-Trait Anger Scale), global functioning (Global Assessment Scale), and social adjustment (Social Adjustment Scale—Interview and Social Adjustment Scale—Self-Report). Subjects were assessed at 6 and 12 months into the follow-up year. Results: Comparison of the two conditions revealed that throughout the follow-up year, DBT subjects had significantly higher Global Assessment Scale scores. During the initial 6 months of the follow-up, DBT subjects had significantly less parasuicidal behavior, less anger, and better self-reported social adjustment. During the final 6 months, DBT subjects had significantly fewer psychiatric inpatient days and better interviewer-rated social adjustment. Conclusion: In general, the superiority of DBT over treatmentas-usual, found in previous studies at the completion of 1 year of treatment, was retained during a 1-year follow-up.