Showing papers on "Poison control published in 1998"

The AUDIT Alcohol consumption questions (AUDIT-C) : An effective brief screening test for problem drinking

Abstract: cording to the Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition, criteria; and (3) either. Results: Of 393 eligible patients, 243 (62%) completed AUDIT-C and interviews. For detecting heavy drinking, AUDIT-C had a higher AUROC than the full AUDIT (0.891 vs 0.881; P = .03). Although the full AUDIT performed better than AUDIT-C for detecting active alcohol abuse or dependence (0.811 vs 0.786; P<.001), the 2 questionnaires performed similarly for detecting heavy drinking and/or active abuse or dependence (0.880 vs 0.881).

Trauma and Posttraumatic Stress Disorder in the Community: The 1996 Detroit Area Survey of Trauma

Abstract: Methods: A representative sample of 2181 persons in the Detroit area aged 18 to 45 years were interviewed by telephone to assess the lifetime history of traumatic events and PTSD, according to DSM-IV. Posttraumatic stress disorder was assessed with respect to a randomly selected trauma from the list of traumas reported by each respondent, using a modified version of the Diagnostic Interview Schedule, Version IV, and the World Health Organization Composite International Diagnostic Interview. Results: The conditional risk of PTSD following exposure to trauma was 9.2%. The highest risk of PTSD was associated with assaultive violence (20.9%). The trauma most often reported as the precipitating event among persons with PTSD (31% of all PTSD cases) was sudden unexpected death of a loved one, an event experienced by 60% of the sample, and with a moderate risk of PTSD (14.3%). Women were at higher risk of PTSD than men, controlling for type of trauma. Conclusions: The risk of PTSD associated with a representative sample of traumas is less than previously estimated. Previous studies have overestimated the conditional risk of PTSD by focusing on the worst events the respondents had ever experienced. Although recent research has focused on combat, rape, and other assaultive violence as causes of PTSD, sudden unexpected death of a loved one is a far more important cause of PTSD in the community, accounting for nearly one third of PTSD cases. Arch Gen Psychiatry. 1998;55:626-632

Predicting relapse: a meta-analysis of sexual offender recidivism studies.

Abstract: reoffending than those who completed treatment. The predictors of nonsexual violent recidivism and general (any) recidivism were similar to those predictors found among nonsexual criminals (e.g., prior violent offenses, age, juvenile deliquency). Our results suggest that applied risk assessments of sexual offenders should consider separately the offender's risk for sexual and nonsexual recidivism. Assessing chronicity is crucial for clients whose sexual behaviors have brought them into conflict with the law. Many exceptional criminal justice policies, such as postsentence detention (e.g., Anderson & Masters, 1992), lifetime community supervision, and community notification, target those sexual offenders likely to reoffend. Clinicians need to judge whether the client's behaviors are truly atypical of the individual (as the client would like us to believe) or whether the client merits a virtually permanent label as a sexual offender.

Adolescent sexual behavior, drug use, and violence: increased reporting with computer survey technology

Abstract: Surveys of risk behaviors have been hobbled by their reliance on respondents to report accurately about engaging in behaviors that are highly sensitive and may be illegal. An audio computer-assisted self-interviewing (audio-CASI) technology for measuring those behaviors was tested with 1690 respondents in the 1995 National Survey of Adolescent Males. The respondents were randomly assigned to answer questions using either audio-CASI or a more traditional self-administered questionnaire. Estimates of the prevalence of male-male sex, injection drug use, and sexual contact with intravenous drug users were higher by factors of 3 or more when audio-CASI was used. Increased reporting was also found for several other risk behaviors.

Bullying as a group process: Participant roles and their relations to social status within the group

Abstract: Bullying was investigated as a group process, asocial phenomenon taking place in a school setting among 573 Finnish sixth-grade children (286 girls, 287 boys) aged 12-13 years. Different Participant Roles taken by individual children in the bullying process were examined and related to a) self-estimated behavior in bullying situations, b) social acceptance and social rejection, and c) belongingness to one of the five sociometric status groups (popular, rejected, neglected, controversial, and average). The Participant Roles assigned to the subjects were Victim, Bully, Reinforcer of the bully, Assistant of the bully, Defender of the victim, and Outsider. There were significant sex differences in the distribution of Participant Roles. Boys were more frequently in the roles of Bully, Reinforcer and Assistant, while the most frequent roles of the girls were those of Defender and Outsider. The subjects were moderately well aware of their Participant Roles, although they underestimated their participation in active bullying behavior and emphasized that they acted as Defenders and Outsiders. The sociometric status of the children was found to be connected to their Participant Roles..

Structured interviews for the Glasgow Outcome Scale and the extended Glasgow Outcome Scale: Guidelines for their use

Abstract: The Glasgow Outcome Scale (GOS) is the most widely used outcome measure after traumatic brain injury, but it is increasingly recognized to have important limitations. It is proposed that shortcomings of the GOS can be addressed by adopting a standard format for the interview used to assign outcome. A set of guidelines are outlined that are directed at the main problems encountered in applying the GOS. The guidelines cover the general principles underlying the use of the GOS and common practical problems of applying the scale. Structured interview schedules are described for both the five-point GOS and an extended eight-point GOS (GOSE). An interrater reliability study of the structured interviews for the GOS and GOSE yielded weighted kappa values of 0.89 and 0.85, respectively. It is concluded that assessment of the GOS using a standard format with a written protocol is practical and reliable.

Health promotion glossary (1998)

Abstract: The views expressed in this document by named authors are solely the responsibility of these authors. This document is not issued to the general public and all rights are reserved by the World Health Organization (WHO). The document may not be reviewed, abstracted, quoted, reproduced, translated, in part or in whole, without the prior written permission of WHO. No part of this document may be stored in a retrieval system or transmitted in any form or by any means – electronic, mechanical or other – without the prior written permission of WHO. Acknowledgements Special thanks are due to Ursel Broesskamp-Stone for her support, advice, technical contributions and perseverance, and to Desmond O'Byrne for his input and advice in the preparation of the glossary, both of the Health Education and Health Promotion Unit, WHO, Geneva; to Ilona Kickbusch for her expert opinion and guidance throughout the process of preparation and revision of the glossary, Division of Health Promotion, Education and Communication, WHO, Geneva; and to the Regional Advisors for Health Promotion/Health Education of the WHO Regional Offices for coordination of the review of the early drafts and helpful suggestions. Health 1 Health promotion 1 Health for All 2 Public health 3 Primary health care 3 Disease prevention 4 Health education 4 Advocacy for health 5 Alliance 5 Community 5 Community action for health 6 Determinants of health 6 Empowerment for health 6 Enabling 7 Epidemiology 7 Equity in health 7 Health behaviour 8 Health communication 8 Health development 8 Health expectancy 9 Health gain 9 Health goal 9 Health indicator 9 Health literacy 10 Health outcomes 10 Health policy 10 Health promoting hospitals 11 Health promoting schools 11 Health promotion evaluation 12 Health promotion outcomes 12 Health sector 12 Health status 12 Health target 13 Healthy cities 13 Healthy islands 13 Healthy public policy 13 Infrastructure for health promotion 14 Intermediate health outcomes 14 Intersectoral collaboration 14 Investment for health 15 Jakarta Declaration on Leading Health Promotion into the 21st Century 15 Life skills 15 Lifestyle (lifestyles conducive to health) 16 Living conditions 16 Mediation 16 Network 16 Ottawa Charter for Health Promotion 17 Partnership for health promotion 17 Personal skills 17 Quality of life 17 Reorienting health services 18 Risk behaviour 18 Risk factor 18 Self help 19 Settings for health 19 Social capital 19 Social networks 19 Social responsibility for health 20 Social support 20 Supportive environments for health …

Threatened egotism, narcissism, self-esteem, and direct and displaced aggression: Does self-love or self-hate lead to violence?

Abstract: It has been widely asserted that low self-esteem causes violence, but laboratory evidence is lacking, and some contrary observations have characterized aggressors as having favorable self-opinions. In 2 studies, both simple self-esteem and narcissism were measured, and then individual participants were given an opportunity to aggress against someone who had insulted them or praised them or against an innocent third person. Self-esteem proved irrelevant to aggression. The combination of narcissism and insult led to exceptionally high levels of aggression toward the source of the insult. Neither form of self-regard affected displaced aggression, which was low in general. These findings contradict the popular view that low self-esteem causes aggression and point instead toward threatened egotism as an important cause.

Sleep Schedules and Daytime Functioning in Adolescents

Abstract: Sleep and waking behaviors change significantly during the adolescent years. The objective of this study was to describe the relation between adolescents' sleep/wake habits, characteristics of students (age, sex, school), and daytime functioning (mood, school performance, and behavior). A Sleep Habits Survey was administered in homeroom classes to 3,120 high school students at 4 public high schools from 3 Rhode Island school districts. Self-reported total sleep times (school and weekend nights) decreased by 40-50 min across ages 13-19, ps 120 min) reported increased daytime sleepiness, depressive mood, and sleep/wake behavior problems, ps < .05, versus those sleeping longer than 8 hr 15 min with less than 60 min weekend delay. Altogether, most of the adolescents surveyed do not get enough sleep, and their sleep loss interferes with daytime functioning.

Unintended pregnancy in the United States.

Abstract: Context Current debates on how to reduce the high U.S. abortion rate often fail to take into account the role of unintended pregnancy, an important determinant of abortion. Methods Data from the 1982, 1988 and 1995 cycles of the National Survey of Family Growth, supplemented by data from other sources, are used to estimate 1994 rates and percentages of unintended birth and pregnancy and the proportion of women who have experienced an unintended birth, an abortion or both. In addition, estimates are made of the proportion of women who will have had an abortion by age 45. Results Excluding miscarriages, 49% of the pregnancies concluding in 1994 were unintended; 54% of these ended in abortion. Forty-eight percent of women aged 15-44 in 1994 had had at least one unplanned pregnancy sometime in their lives; 28% had had one or more unplanned births, 30% had had one or more abortions and 11% had had both. At 1994 rates, women can expect to have 1.42 unintended pregnancies by the time they are 45, and at 1992 rates, 43% of women will have had an abortion. Between 1987 and 1994, the unintended pregnancy rate declined by 16%, from 54 to 45 per 1,000 women of reproductive age. The proportion of unplanned pregnancies that ended in abortion increased among women aged 20 and older, but decreased among teenagers, who are now more likely than older women to continue their unplanned pregnancies. The unintended pregnancy rate was highest among women who were aged 18-24, unmarried, low-income, black or Hispanic. Conclusion Rates of unintended pregnancy have declined, probably as a result of higher contraceptive prevalence and use of more effective methods. Efforts to achieve further decreases should focus on reducing risky behavior, promoting the use of effective contraceptive methods and improving the effectiveness with which all methods are used.

Socioeconomic factors, health behaviors, and mortality: Results from a nationally representative prospective study of US adults

Abstract: Context.— A prominent hypothesis regarding social inequalities in mortality is that the elevated risk among the socioeconomically disadvantaged is largely due to the higher prevalence of health risk behaviors among those with lower levels of education and income. Objective.— To investigate the degree to which 4 behavioral risk factors (cigarette smoking, alcohol drinking, sedentary lifestyle, and relative body weight) explain the observed association between socioeconomic characteristics and allcause mortality. Design.— Longitudinal survey study investigating the impact of education, income, and health behaviors on the risk of dying within the next 7.5 years. Participants.— A nationally representative sample of 3617 adult women and men participating in the Americans’ Changing Lives survey. Main Outcome Measure.— All-cause mortality verified through the National Death Index and death certificate reviews. Results.— Educational differences in mortality were explained in full by the strong association between education and income. Controlling for age, sex, race, urbanicity, and education, the hazard rate ratio of mortality was 3.22 (95% confidence interval [CI], 2.01-5.16) for those in the lowest-income group and 2.34 (95% CI, 1.49-3.67) for those in the middle-income group. When health risk behaviors were considered, the risk of dying was still significantly elevated for the lowestincome group (hazard rate ratio, 2.77; 95% CI, 1.74-4.42) and the middle-income group (hazard rate ratio, 2.14; 95% CI, 1.38-3.25). Conclusion.— Although reducing the prevalence of health risk behaviors in lowincome populations is an important public health goal, socioeconomic differences in mortality are due to a wider array of factors and, therefore, would persist even with improved health behaviors among the disadvantaged.

Violence by people discharged from acute psychiatric inpatient facilities and by others in the same neighborhoods.

Abstract: Background The public perception that mental disorder is strongly associated with violence drives both legal policy (eg, civil commitment) and social practice (eg, stigma) toward people with mental disorders. This study describes and characterizes the prevalence of community violence in a sample of people discharged from acute psychiatric facilities at 3 sites. At one site, a comparison group of other residents in the same neighborhoods was also assessed. Methods We enrolled 1136 male and female patients with mental disorders between the ages of 18 and 40 years in a study that monitored violence to others every 10 weeks during their first year after discharge from the hospital. Patient self-reports were augmented by reports from collateral informants and by police and hospital records. The comparison group consisted of 519 people living in the neighborhoods in which the patients resided after hospital discharge. They were interviewed once about violence in the past 10 weeks. Results There was no significant difference between the prevalence of violence by patients without symptoms of substance abuse and the prevalence of violence by others living in the same neighborhoods who were also without symptoms of substance abuse. Substance abuse symptoms significantly raised the rate of violence in both the patient and the comparison groups, and a higher portion of patients than of others in their neighborhoods reported symptoms of substance abuse. Violence in both patient and comparison groups was most frequently targeted at family members and friends, and most often took place at home. Conclusions "Discharged mental patients" do not form a homogeneous group in relation to violence in the community. The prevalence of community violence by people discharged from acute psychiatric facilities varies considerably according to diagnosis and, particularly, co-occurring substance abuse diagnosis or symptoms.

The acquisition of skilled motor performance: Fast and slow experience-driven changes in primary motor cortex

Abstract: Behavioral and neurophysiological studies suggest that skill learning can be mediated by discrete, experience-driven changes within specific neural representations subserving the performance of the trained task. We have shown that a few minutes of daily practice on a sequential finger opposition task induced large, incremental performance gains over a few weeks of training. These gains did not generalize to the contralateral hand nor to a matched sequence of identical component movements, suggesting that a lateralized representation of the learned sequence of movements evolved through practice. This interpretation was supported by functional MRI data showing that a more extensive representation of the trained sequence emerged in primary motor cortex after 3 weeks of training. The imaging data, however, also indicated important changes occurring in primary motor cortex during the initial scanning sessions, which we proposed may reflect the setting up of a task-specific motor processing routine. Here we provide behavioral and functional MRI data on experience-dependent changes induced by a limited amount of repetitions within the first imaging session. We show that this limited training experience can be sufficient to trigger performance gains that require time to become evident. We propose that skilled motor performance is acquired in several stages: “fast” learning, an initial, within-session improvement phase, followed by a period of consolidation of several hours duration, and then “slow” learning, consisting of delayed, incremental gains in performance emerging after continued practice. This time course may reflect basic mechanisms of neuronal plasticity in the adult brain that subserve the acquisition and retention of many different skills.

Testosterone and dominance in men.

Abstract: In men, high levels of endogenous testosterone (T) seem to encourage behavior intended to dominate - to enhance one's status over - other people. Sometimes dominant behavior is aggressive, its apparent intent being to inflict harm on another person, but often dominance is expressed nonaggressively. Sometimes dominant behavior takes the form of antisocial behavior, including rebellion against authority and law breaking. Measurement of T at a single point in time, presumably indicative of a man's basal T level, predicts many of these dominant or antisocial behaviors. T not only affects behavior but also responds to it. The act of competing for dominant status affects male T levels in two ways. First, T rises in the face of a challenge, as if it were an anticipatory response to impending competition. Second, after the competition, T rises in winners and declines in losers. Thus, there is a reciprocity between T and dominance behavior, each affecting the other. We contrast a reciprocal model, in which T level is variable, acting as both a cause and effect of behavior, with a basal model, in which T level is assumed to be a persistent trait that influences behavior. An unusual data set on Air Force veterans, in which data were collected four times over a decade, enables us to compare the basal and reciprocal models as explanations for the relationship between T and divorce. We discuss sociological implications of these models.

The prediction of criminal and violent recidivism among mentally disordered offenders : A meta-analysis

Abstract: A meta-analysis was conducted to examine whether the predictors of recidivism for mentally disordered offenders are different from the predictors for nondisordered offenders. Effect sizes were calculated for 35 predictors of general recidivism and 27 predictors of violent recidivism drawn from 64 unique samples. The results showed that the major predictors of recidivism were the same for mentally disordered offenders as for nondisordered offenders. Criminal history variables were the best predictors, and clinical variables showed the smallest effect sizes. The findings suggest that the risk assessment of mentally disordered offenders can be enhanced with more attention to the social psychological criminological literature and less reliance on models of psychopathology.

Where and when to pay attention: the neural systems for directing attention to spatial locations and to time intervals as revealed by both PET and fMRI.

Abstract: Although attention is distributed across time as well as space, the temporal allocation of attention has been less well researched than its spatial counterpart. A temporal analog of the covert spatial orientation task [Posner MI, Snyder CRR, Davidson BJ (1980) Attention and the detection of signals. J Exp Psychol Gen 109:160-174] was developed to compare the neural systems involved in directing attention to spatial locations versus time intervals. We asked whether there exists a general system for allocating attentional resources, independent of stimulus dimension, or whether functionally specialized brain regions are recruited for directing attention toward spatial versus temporal aspects of the environment. We measured brain activity in seven healthy volunteers by using positron emission tomography (PET) and in eight healthy volunteers by using functional magnetic resonance imaging (fMRI). The task manipulated cued attention to spatial locations (S) and temporal intervals (T) in a factorial design. Symbolic central cues oriented subjects toward S only (left or right), toward T only (300 msec or 1500 msec), toward both S and T simultaneously, or provided no information regarding S or T. Subjects also were scanned during a resting baseline condition. Behavioral data showed benefits and costs for performance during temporal attention similar to those established for spatial attention. Brain-imaging data revealed a partial overlap between neural systems involved in the performance of spatial versus temporal orientation of attention tasks. Additionally, hemispheric asymmetries revealed preferential right and left parietal activation for spatial and temporal attention, respectively. Parietal cortex was activated bilaterally by attending to both dimensions simultaneously. This is the first direct comparison of the neural correlates of attending to spatial versus temporal cues.

The American Indian Holocaust: healing historical unresolved grief.

Abstract: American Indians experienced massive losses of lives, land, and culture from European contact and colonization resulting in a long legacy of chronic trauma and unresolved grief across generations. This phenomenon, labeled historical unresolved grief, contributes to the current social pathology of high rates of suicide, homicide, domestic violence, child abuse, alcoholism and other social problems among American Indians. The present paper describes the concept of historical unresolved grief and historical trauma among American Indians, outlining the historical as well as present social and political forces which exacerbate it. The abundant literature on Jewish Holocaust survivors and their children is used to delineate the intergenerational transmission of trauma, grief, and the survivor's child complex. Interventions based on traditional American Indian ceremonies and modern western treatment modalities for grieving and healing of those losses are described.

Long-term effects of nurse home visitation on children's criminal and antisocial behavior: 15-year follow-up of a randomized controlled trial.

Abstract: Context.— A program of home visitation by nurses has been shown to affect the rates of maternal welfare dependence, criminality, problems due to use of substances, and child abuse and neglect. However, the long-term effects of this program on children’s antisocial behavior have not been examined. Objective.— To examine the long-term effects of a program of prenatal and early childhood home visitation by nurses on children’s antisocial behavior. Design.— Fifteen-year follow-up of a randomized trial. Interviews were conducted with the adolescents and their biological mothers or custodial parents. Setting.— Semirural community in New York. Participants.— Between April 1978 and September 1980, 500 consecutive pregnant women with no previous live births were recruited, and 400 were enrolled. A total of 315 adolescent offspring participated in a follow-up study when they were 15 years old; 280 (89%) were born to white mothers, 195 (62%) to unmarried mothers, 151 (48%) to mothers younger than 19 years, and 186 (59%) to mothers from households of low socioeconomic status at the time of registration during pregnancy. Intervention.— Families in the groups that received home visits had an average of 9 (range, 0-16) home visits during pregnancy and 23 (range, 0-59) home visits from birth through the child’s second birthday. The control groups received standard prenatal and well-child care in a clinic. Main Outcome Measures.— Children’s self-reports of running away, arrests, convictions, being sentenced to youth corrections, initiation of sexual intercourse, number of sex partners, and use of illegal substances; school records of suspensions; teachers’ reports of children’s disruptive behavior in school; and parents’ reports of the children’s arrests and behavioral problems related to the children’s use of alcohol and other drugs. Results.— Adolescents born to women who received nurse visits during pregnancy and postnatally and who were unmarried and from households of low socioeconomic status (risk factors for antisocial behavior), in contrast with those in the comparison groups, reported fewer instances (incidence) of running away (0.24 vs 0.60; P = .003), fewer arrests (0.20 vs 0.45; P = .03), fewer convictions and violations of probation (0.09 vs 0.47; P,.001), fewer lifetime sex partners (0.92 vs 2.48; P = .003), fewer cigarettes smoked per day (1.50 vs 2.50; P = .10), and fewer days having consumed alcohol in the last 6 months (1.09 vs 2.49; P = .03). Parents of nurse-visited children reported that their children had fewer behavioral problems related to use of alcohol and other drugs (0.15 vs 0.34; P = .08). There were no program effects on other behavioral problems. Conclusions.— This program of prenatal and early childhood home visitation by nurses can reduce reported serious antisocial behavior and emergent use of substances on the part of adolescents born into high-risk families. JAMA. 1998;280:1238-1244 JUVENILE CRIME is a significant problem in the United States. In 1996, law enforcement agencies made 2.9 million arrests of juveniles (children ,18 years). Moreover, 19% of all arrests and 19% of all violent crime arrests were accounted for by juveniles. Although the number of juvenile Violent Crime Index arrests (ie, for murder, forcible rape, robbery, and aggravated assault) declined in both 1995 and 1996, the rate in 1996 was still 60% higher than the 1987 level. 1

Psychological predictors of chronic posttraumatic stress disorder after motor vehicle accidents.

Abstract: A prospective longitudinal study assessed 967 consecutive patients who attended an emergency clinic shortly after a motor vehicle accident, again at 3 months, and at 1 year. The prevalence of posttraumatic stress disorder (PTSD) was 23.1% at 3 months and 16.5% at 1 year. Chronic PTSD was related to some objective measures of trauma severity, perceived threat, and dissociation during the accident, to female gender, to previous emotional problems, and to litigation. Maintaining psychological factors, that is, negative interpretation of intrusions, rumination, thought suppression, and anger cognitions, enhanced the accuracy of the prediction. Negative interpretation of intrusions, persistent medical problems, and rumination at 3 months were the most important predictors of PTSD symptoms at 1 year. Rumination, anger cognitions, injury severity, and prior emotional problems identified cases of delayed onset.

Prospective Study of Posttraumatic Stress Disorder and Depression Following Trauma

Abstract: OBJECTIVE: The purpose of this study was to prospectively evaluate the onset, overlap, and course of posttraumatic stress disorder (PTSD) and major depression following traumatic events. METHOD: The occurrence of PTSD and major depression and the intensity of related symptoms were assessed in 211 trauma survivors recruited from a general hospital's emergency room. Psychometrics and structured clinical interview (the Structured Clinical Interview for DSM-III-R and the Clinician-Administered PTSD Scale) were administered 1 week, 1 month, and 4 months after the traumatic event. Heart rate was assessed upon arrival at the emergency room for subjects with minor physical injury. Twenty-three subjects with PTSD and 35 matched comparison subjects were followed for 1 year. RESULTS: Major depression and PTSD occurred early on after trauma; patients with these diagnoses had similar recovery rates: 63 survivors (29.9%) met criteria for PTSD at 1 month, and 37 (17.5%) had PTSD at 4 months. Forty subjects (19.0%) met c...

Self-mutilation in clinical and general population samples: prevalence, correlates, and functions.

Abstract: Self-mutilation, examined in samples of the general population, clinical groups, and self-identified self-mutilators, was reported by 4% of the general and 21% of the clinical sample, and was equally prevalent among males and females. Results suggest that such behavior is used to decrease dissociation, emotional distress, and posttraumatic symptoms. Childhood sexual abuse was associated with self-mutilation in both clinical and nonclinical samples.

A Population-Based Study of Seizures after Traumatic Brain Injuries

Abstract: Background The risk of seizures is increased after traumatic brain injury, but the extent and duration of the increase in risk are unknown. The purpose of this study was to identify the characteristics of brain injuries that are associated with the development of seizures. Methods We identified 4541 children and adults with traumatic brain injury (characterized by loss of consciousness, post-traumatic amnesia, or skull fracture) in Olmsted County, Minnesota, during the period from 1935 through 1984. Injuries were classified as mild (loss of consciousness or amnesia lasting less than 30 minutes), moderate (loss of consciousness for 30 minutes to 24 hours or a skull fracture), or severe (loss of consciousness or amnesia for more than 24 hours, subdural hematoma, or brain contusion). We compared the incidence of new unprovoked seizures in this cohort with population rates, using standardized incidence ratios and Cox proportional-hazards analysis. Results The overall standardized incidence ratio was 3.1 (95 p...

Criminal Deterrence Research at the Outset of the Twenty-First Century

Abstract: Evidence for a substantial deterrent effect is much firmer than it was two decades ago. However, large gaps in knowledge on the links between policy actions and behavior make it difficult to assess the effectiveness of policy options for deterring crime. There are four major impediments. First, analyses must estimate not only short-term consequences but also calibrate long-term effects. Some policies that are effective in preventing crime in the short term may be ineffective or even criminogenic in the long run because they may erode the foundation of the deterrent effect-fear of stigmatization. Second, knowledge about the relationship of sanction risk perceptions to policy is virtually nonexistent; such knowledge would be invaluable in designing effective crime-deterrent policies. Third, estimates of deterrent effects based on data from multiple governmental units measure a policy's average effectiveness across unit. It is important to understand better the sources of variation in response across place a...

Screening and brief intervention for high-risk college student drinkers: results from a 2-year follow-up assessment.

Abstract: This randomized controlled trial evaluated the efficacy of a brief intervention designed to reduce the harmful consequences of heavy drinking among high-risk college students. Students screened for risk while in their senior year of high school (188 women and 160 men) were randomly assigned to receive an individualized motivational brief intervention in their freshman year of college or to a no-treatment control condition. A normative group selected from the entire screening pool provided a natural history comparison. Follow-up assessments over a 2-year period showed significant reductions in both drinking rates and harmful consequences, favoring students receiving the intervention. Although high-risk students continued to experience more alcohol problems than the natural history comparison group over the 2-year period, most showed a decline in problems over time, suggesting a developmental maturational effect.

Visual Processing Impairment and Risk of Motor Vehicle Crash Among Older Adults

Abstract: CONTEXT: Motor vehicle crash risk in older drivers has been associated with visual acuity loss, but only weakly so, suggesting other factors contribute. The useful field of view is a measure that reflects decline in visual sensory function, slowed visual processing speed, and impaired visual attention skills. OBJECTIVE: To identify whether measures of visual processing ability, including the useful field of view test, are associated with crash involvement by older drivers. DESIGN: Prospective cohort study with 3 years of follow-up, 1990-1993. SETTING: Ophthalmology clinic assessment of community-based sample. PATIENTS: A total of 294 drivers aged 55 to 87 years at enrollment. MAIN OUTCOME MEASURE: Motor vehicle crash occurrence. RESULTS: Older drivers with a 40% or greater impairment in the useful field of view were 2.2 times (95% confidence interval, 1.2-4.1) more likely to incur a crash during 3 years of follow-up, after adjusting for age, sex, race, chronic medical conditions, mental status, and days driven per week. This association was primarily mediated by difficulty in dividing attention under brief target durations. CONCLUSION: Reduction in the useful field of view increases crash risk in older drivers. Given the relatively high prevalence of visual processing impairment among the elderly, visual dysfunction and eye disease deserve further examination as causes of motor vehicle crashes and injury.