Suicide acts in 8 states: incidence and case fatality rates by demographics and method.
(9/187)
OBJECTIVES: This study examined incidence rates of medically identified suicide acts (self-inflicted injuries, either fatal or nonfatal) and case fatality rates by age, sex, race, and method used. METHODS: The authors analyzed data on 10,892 suicides and 57,439 attempted suicides among hospital-admitted individuals in 8 states, along with 6219 attempted suicides among individuals released from emergency departments in 2 states. RESULTS: The 8 states experienced a mean of 11 suicides and 119 attempted suicides per 100,000 residents each year. Groups with high suicide rates were men, the elderly, and Whites; groups with high attempted suicide rates were teenagers, young adults, women, and Blacks and Whites aged 25 to 44 years. Blacks aged 15 to 44 years evidenced high attempted suicide rates undocumented in previous studies. Poisoning and firearm were the most common methods used among those attempting suicide and those completing suicide acts, respectively. The most lethal method was firearm. CONCLUSIONS: The characteristics of suicides and attempted suicides differ dramatically. Method used is important in the lethality of the act. (+info)
Complications of warfarin therapy: causes, costs, and the role of the anticoagulation clinic.
(10/187)
CONTEXT: Anticoagulation with warfarin requires careful management to avoid hemorrhage or thrombosis. The anticoagulation clinic has been suggested as a mechanism to reduce complications related to anticoagulation. OBJECTIVE: To report our experience with anticoagulation complications, the cost of subsequent care, and the role of the anticoagulation clinic. DESIGN: Sequential patients who were receiving warfarin within a period of 4 months were followed to identify warfarin-related adverse events. An independent examiner reviewed medical records to determine whether events were preventable and to identify possible causes. Hospital-based accounting data were used to determine attributable costs. PATIENTS: 306 patients who received warfarin prescriptions at a rural Vermont university-affiliated VA hospital with an established anticoagulation clinic. RESULTS: 91% (278) of patients received follow-up at the anticoagulation clinic, and the remaining 9% (28) were followed by VA physicians without involving the anticoagulation clinic. A total of 12 patients had adverse events associated with either sub- or supratherapeutic international normalized ratios, with an attributable cost of approximately $90,000; 8 of these patients were not enrolled in the anticoagulation clinic. Thus, the estimated relative risk for adverse events for patients not at the clinic, compared with those who were, was almost 20 (95% CI, 6.4 to 61.8). Review of the remaining 4 patients revealed that their problems were attributable either to missed appointments or lack of coordination between other providers and the anticoagulation clinic. CONCLUSIONS: Establishing an anticoagulation clinic is only the first step toward reducing complications related to anticoagulation. The larger challenge is ensuring that patients use the anticoagulation clinic and that providers communicate with it. Our results suggest that our institution could invest considerable resources to meet this challenge and still save money. (+info)
Favourite movie stars, their tobacco use in contemporary movies, and its association with adolescent smoking.
(11/187)
OBJECTIVE: To assess the relation between adolescents' favourite movie stars, the portrayal of tobacco use by those stars in contemporary motion pictures, and adolescent smoking. DESIGN AND SETTING: 632 students (sixth to 12th grade, ages 10-19 years) from five rural New England public schools completed a voluntary, self administered survey in October 1996. The survey assessed tobacco use, other variables associated with adolescent smoking, and favourite movie star. In addition, tobacco use by 43 selected movie stars was measured in films between 1994 and 1996. OUTCOME MEASURES: Students were categorised into an ordinal five point index (tobacco status) based on their smoking behaviour and their smoking susceptibility: non-susceptible never smokers, susceptible never smokers, non-current experimenters, current experimenters, and smokers. We determined the adjusted cumulative odds of having advanced smoking status based on the amount of on-screen tobacco use by their favourite film star. RESULTS: Of the 43 stars, 65% used tobacco at least once, and 42% portrayed smoking as an essential character trait in one or more films. Stars who smoked more than twice in a film were considered smokers. For adolescents whose favourite stars smoked in only one film, the odds of being higher on the smoking index was 0.78 (95% confidence interval (CI) 0.53 to 1.15). For adolescents whose favourite stars smoked in two films, the odds of being higher on the smoking index was 1.5 (95% CI 1.01 to 2.32). For adolescents whose favourite stars smoked in three or more films (Leonardo DiCaprio, Sharon Stone, John Travolta), the odds of being higher on the smoking index was 3.1 (95% CI 1.34 to 7.12). Among never smokers (n = 281), those who chose stars who were smokers in three or more films were much more likely to have favourable attitudes toward smoking (adjusted odds ratio 16.2, 95% CI 2.3 to 112). CONCLUSIONS: Adolescents who choose movie stars who use tobacco on-screen are significantly more likely to have an advanced smoking status and more favourable attitudes toward smoking than adolescents who choose non-smoking stars. This finding supports the proposition that the portrayal of tobacco use in contemporary motion pictures, particularly by stars who are admired by adolescents, contributes to adolescent smoking. (+info)
Smoking in correctional facilities: a survey of employees.
(12/187)
OBJECTIVE: To assess level of endorsement and expected consequences of worksite smoking restriction policies among correctional employees. DESIGN: Mailed survey to Vermont state correctional employees. MAIN OUTCOME MEASURES: Support for various policy alternatives for both staff and inmate smoking; expected consequences of restrictive smoking policies and smoking behaviour. PARTICIPANTS: 321 of 640 (50%) state correctional employees responded. RESULTS: Employees were somewhat receptive to smoking restrictions for inmates, but less supportive of staff smoking restrictions. A complete ban on inmate smoking both indoors and outdoors was supported by 56% and 49% of never and ex-smokers, respectively, but only 15% of current smokers (p < 0.01). A similar ban on employee smoking was supported by 38% of never and ex-smokers, but only 3% of current smokers (p < 0.01). Overall, employees were most supportive (52%) of a policy for themselves that banned indoor smoking and restricted it to certain areas outdoors. Current smokers were more likely to expect negative consequences as a result of further restrictions than were never or ex-smokers. CONCLUSIONS: Although our findings are limited by a low response rate, most employees support an indoor ban, but not a total ban on smoking. Employees generally favoured a policy that was slightly more restrictive than the current policy, but were less supportive of tighter smoking restrictions for themselves. However, a more restrictive smoking policy is likely to result in some degree of resistance among current smoking employees, who may require specific attention to address their opposition. (+info)
In 1993, an outbreak of an unexplained pulmonary illness occurred in the southwestern United States. This outbreak led to the first description of hantavirus pulmonary syndrome (HPS), a rodentborne hantaviral infection. Hantaviruses have been found in rodents in rural areas throughout the United States, but most infection has occurred in the southwest. This report describes the first HPS case in Vermont and underscores the importance of preventing exposure to peridomestic rodents and recognizing the signs and symptoms of HPS. (+info)
Evaluation of a child sexual abuse prevention program--Vermont, 1995-1997.
(14/187)
Public health social marketing campaigns have targeted adults to prevent drinking and driving, smoking, and human immunodeficiency virus transmission; however, adults have not been targeted for prevention of child sexual abuse. In Vermont, STOP IT NOW! addresses child sexual abuse systematically as a public health issue by using social marketing and public education to emphasize the responsibility of adults for prevention. As one component of STOP IT NOW!, Vermont sex offender treatment providers and state attorneys' offices were surveyed in September 1997 to assess self-reported abuse by adults and adolescents. This report summarizes the results of the survey, which indicate that some adults who abuse will turn themselves in voluntarily for treatment despite mandated reporting to the legal system, and some parents will intervene to seek help for their children who have sexual behavior problems even without a victim's report. Continued studies are needed to evaluate this approach to preventing child sexual abuse. (+info)
Effect of seeing tobacco use in films on trying smoking among adolescents: cross sectional study.
(15/187)
OBJECTIVE: To test the hypothesis that greater exposure to smoking in films is associated with trying smoking among adolescents. DESIGN: Cross sectional survey of 4919 schoolchildren aged 9-15 years, and assessment of occurrence of smoking in 601 films. SETTING: Randomly selected middle schools in Vermont and New Hampshire, USA. MAIN OUTCOME MEASURE: Number of schoolchildren who had ever tried smoking a cigarette. RESULTS: The films contained a median of 5 (interquartile range 1-12) occurrences of smoking. The typical adolescent had seen 17 of 50 films listed. Exposure to smoking in films varied widely: median 91 (49-152) occurrences. The prevalence of ever trying smoking increased with higher categories of exposure: 4.9% among students who saw 0-50 occurrences of smoking, 13.7% for 51-100 occurrences, 22.1% for 101-150, and 31.3% for >150. The association remained significant after adjustment for age; sex; school performance; school; parents' education; smoking by friend, sibling, or parent; and receptivity to tobacco promotions. The adjusted odds ratios of ever trying smoking for students in the higher categories of exposure, compared with students exposed to 0-50 occurrences of smoking in films, were 1.7 (95% confidence interval 1.2 to 2.4), 2.4 (1.7 to 3.4), and 2.7 (2.0 to 3.8). These odds ratios were not substantially affected by adjustment for parenting style or for personality traits of the adolescent. CONCLUSION: In this sample of adolescents there was a strong, direct, and independent association between seeing tobacco use in films and trying cigarettes, a finding that supports the hypothesis that smoking in films has a role in the initiation of smoking in adolescents. (+info)
Outbreak of Powassan encephalitis--Maine and Vermont, 1999-2001.
(16/187)
Powassan (POW) virus, a North American tickborne flavivirus related to the Eastern Hemisphere's tickborne encephalitis viruses, was first isolated from a patient with encephalitis in 1958. During 1958-1998, 27 human POW encephalitis cases were reported from Canada and the northeastern United States. During September 1999-July 2001, four Maine and Vermont residents with encephalitis were found to be infected with POW virus. These persons were tested for other arbovirus infections found in the northeast after testing for West Nile virus (WNV) infection was negative. This report describes these four cases, summarizes the results of ecologic investigations, and discusses a potential association between ticks that infest medium-sized mammals and the risk for human exposure to POW virus. The findings underscore the need for personal protective measures to prevent tick bites and continued encephalitis surveillance. (+info)