Search

Objective: To identify markers of maternal depressive symptoms in medical records of children aged 1-6 years., Study Design: Using a case-control methodology, mothers who were screened for depressive symptoms with the Quick Inventory of Depressive Symptomatology Self-Rated Questionnaire (QIDS-SR) at well-child visits between June 2006 and June 2008 in an inner-city pediatric clinic were grouped into cases with depressive symptoms (QIDS-SR score ≥ 11) and controls with no symptoms (QIDS-SR score ≤ 5). Potential markers for maternal depressive symptoms were collected from the children's medical record and grouped into 3 domains: (1) child health and development (eg, maternal concerns/negative attributions regarding the child's behavior); (2) child health care utilization (eg, missed appointments); and (3) maternal psychosocial factors (eg, single parent). The association between maternal depressive symptoms and each factor was determined using multiple logistic regression to calculate aORs., Results: Maternal depressive symptoms were significantly associated with reports of concerns/negative attributions about the child's behavior (aOR, 2.35; P = .01) and concerns about speech (aOR, 2.40; P = .04) and sleep (aOR, 7.75; P < .001); these were identified at the visit when the depression screening was done. Other associations included history of maternal depression (aOR, 4.94; P = .001) and a previous social work referral (aOR, 1.98; P = .01)., Conclusion: Information readily available to pediatricians was associated with maternal depressive symptoms and can serve as clinical markers to help identify at-risk mothers during well-child visits., (Copyright © 2013 Mosby, Inc. All rights reserved.)

The objective of this study was to determine how accurately teens can report miles driven. Participants were 118 drivers in Connecticut (average age 17(1/2) years; average time licensed 11 months). Half had their own vehicle; half shared family vehicles. Teens completed a telephone survey about their preceding week's driving, then completed a daily trip log for the next week and a second survey about the details of the logged week's trips and miles. Teens with their own vehicle provided odometer readings. Summing the miles for every trip was generally consistent with estimates from odometer readings. Overall mileage estimates were 20-30% lower than those from trip-by-trip listings, except for very low estimates for the first week by teens who shared vehicles. The results indicate that single overall estimates frequently understate total miles driven, but that prompted reviews of each trip can provide valid and detailed information.

Implemented January 1, 1998, Minnesota's high-BAC law mandates more severe administrative pre-conviction penalties and more severe post-conviction penalties for offenses with BACs > or = 0.20%. Most notably, the law provides for the administrative impoundment of the license plate of first-time DWI offenders with BACs > or = 0.20. During the three years after the law took effect, a large majority of first-time and repeat offenders with BACs > or = 0.20% did, in fact, receive high-BAC administrative dispositions and/or high-BAC court convictions, which carried more severe penalties. For example, in 1998 85.6% of first offenders with BACs > or = 0.20% received a high-BAC administrative disposition and/or a high-BAC court conviction; 65.0% received both high-BAC administrative and high-BAC court dispositions. The proportion of high-BAC first-time offenders who received the statutory high-BAC dispositions declined from 1998 to 1999 and 2000. Based on survival analysis, the one-year recidivism rate among first offenders arrested in 1998 with BACs > or = 0.20% was significantly lower than for offenders with BACs 0.17-0.19% (who also had relatively high BACs but were not subject to enhanced sanctions), after controlling for age and gender. There were similar, but not significant, results for first offenders arrested in 1999.

A substantial portion of the U.S. population fails to regularly use their safety belts. The explanations for the differential belt use have addressed, for example, socioeconomics, state law, attitudes, and perceived likelihood of being ticketed. The current analyses create predictive models of safety belt use. Using NHTSA's Motor Vehicle Occupant Safety Surveys (Years 1998 and 2000; N = 9577), variables related to belt use were entered into backward stepwise logistic regressions to produce two predictive models (Demographic and Attitudinal) of safety belt use (Always versus Not always). The results indicated that belt use is a complicated issue as there were several interactions between variables. The Demographic predictive model contained main effects for, law types, socioeconomics, population density, a gender-law type interaction, and a three-way interaction between age, marital status, and vehicle type. The Attitudinal model included perceived effectiveness of the belt, fatalistic attitudes, and an interaction between perceived effectiveness of the belt and perceived risk of being ticketed. These models survived a multinomial logistic regression when belt use was parsed into three categories (Always, Part-time, and Infrequent). In addition to variables that affect belt use, the results suggested that the structure of "belt use" as a psychological/behavioral construct is more complicated than once thought. Specifically, a dichotomous breakdown of belt use (Always and Not always) oversimplifies the construct because the predictor factors sometimes affect "part-time" belt users differently than "infrequent" belt users (compared to "full-time" users). Many of the factors included in the models have been previously shown to impact belt use, but the interaction effects--indicating a more complicated relationship between these variables than previously suggested--may contribute to a better understanding of safety belt use.

Problem: In the United States, teenage drivers have a higher crash risk and lower observed seat belt use than other age groups., Method: Seat belt use was examined for teenage (16-19 years) drivers who were fatally injured in traffic crashes occurring in the United States during the years 1995-2000. Vehicle, driver, and crash factors potentially related to belt use were examined. State differences in belt use rates among fatally injured teenage drivers were related to states' observed belt use rates for all ages and other state-level variables., Results: During 1995-2000, mean belt use was 36% among fatally injured teenage drivers and 23% among fatally injured teenage passengers. One of the strongest predictors of higher belt use for both drivers and passengers was whether the crash occurred in a state with a primary seat belt law. Belt use rates for 1995-2000 for fatally injured teenage drivers ranged from 20% or less in six states to more than 60% in two states. States with the highest use rates were those with strong primary belt use laws and those with high rates of observed belt use for all ages. Lower belt use among fatally injured teenage drivers was associated with increasing age; male drivers; drivers of SUVs, vans, or pickup trucks rather than cars; older vehicles; crashes occurring late at night; crashes occurring on rural roadways; single vehicle crashes; and drivers with BACs of 0.10 or higher. Teenage driver belt use declined as the number of teenage passengers increased, but increased in the presence of at least one passenger 30 years or older., Impact on Traffic Safety: It is suggested that to increase teenage belt use, states should enact strong primary belt use laws and mount highly publicized efforts to enforce these laws. Graduated driver licensing systems should incorporate strong provisions that require seat belt use by teenage drivers and passengers.

Problem: Freeway entrance and exit ramp interchanges are the sites of far more crashes per mile driven than other segments of interstate highways, but the characteristics and circumstances of ramp crashes have been the subject of relatively little recent research., Method: This study examined a sample of 1,150 crashes that occurred on heavily traveled urban interstate ramps in Northern Virginia. Based on a review of diagrams and narrative descriptions from police crash reports, the most common crash types were identified and examined for different roadway locations and ramp designs and by whether at-fault drivers were entering or exiting the freeway., Results: About half of all crashes occurred when at-fault drivers were in the process of exiting interstates, 36% occurred when drivers were entering, and 16% occurred at the midpoints of access roads or on ramps connecting two interstate freeways. Three major crash types--run-off-road, rear-end, and sideswipe/cutoff--accounted for 95% of crashes in the study. The crash type most frequently associated with exiting was run-off-road, and the types most common with entering drivers were rear-end or sideswipe/cutoff. Crashes most common on ramps--run-off-road crashes--frequently occurred when vehicles were exiting interstates at night, in bad weather, or on curved portions of ramps. Speed was often a factor. Crashes occurring on ramp margins (where ramps or access roads enter or exit) were most commonly of the sideswipe/cutoff type. These often involved at-fault passenger vehicles merging from entrance ramps into the sides of large trucks already on the freeway. The predominant crash type on access roads was rear-end crashes; congestion was a factor in these crashes. Alcohol was a reported factor in a sizeable proportion of run-off-road crashes occurring on ramps (14%) and ramp margins (30%)., Impact on Industry: Candidate countermeasures for run-off-road crashes include geometric design changes to increase ramp design speed such as increasing curve radii. Speed-related crashes may be reduced by the use of speed cameras accompanied by publicity. Rear-end crash countermeasures could include surveillance systems that quickly detect unexpected congestion, incident response programs, and variable message signs to alert drivers to traffic congestion ahead. Countermeasures for sideswipe/cutoff crashes could include extending the length of acceleration lanes.