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PubMed2002

An exploratory study of the relationship between road rage and crash experience in a representative sample of US drivers.

The phenomenon of road rage has been frequently discussed but infrequently examined. Using a representative sample of 1382 US adult drivers, who were interviewed in a 1998 telephone survey, exploratory analyses examined the relationship between self-reported measures of road rage, generally hazardous driving behaviors, and crash experience. Regarding specific road rage behaviors, most respondents reported having engaged in verbal expressions of annoyance; however only 2.45% reported ever having been involved in direct confrontation with another car or driver. After controlling for gender, age. driving frequency, annual miles driven and verbal expression, an angry/threatening driving subscale of road rage was significantly associated with hazardous driving behaviors that included frequency of driving over the legal blood alcohol limit, receipt of tickets in the past year. and habitually exceeding the speed limit as well as crash experience. However, the verbal/frustration expression subscale was not associated with crash experience or hazardous driving indicators, except for number of tickets, after controlling for other crash-related factors such as gender and age. Direct confrontation by deliberately hitting another car or leaving the car to argue with and/or injure another driver was rarely reported. Results suggest that angry/threatening driving is related to crash involvement; however, after controlling for exposure and angry/threatening and hazardous driving the relationship of milder expressions of frustration while driving and crash involvement was not significant.

Accidents, Traffic↗
PubMed2004

The Child Report Form of the CHIP-Child Edition: reliability and validity.

BACKGROUND: There is increasing recognition of the importance of obtaining children's reports of their health, but significant challenges must be overcome to do so in a systematic, population-based manner. OBJECTIVE: The objective of this study was to present the initial tests of the Child Report Form of the Child Health and Illness Profile-Child Edition (CHIP-CE/CRF), a self-report health status instrument for children 6 to 11 years old. METHODS: Three studies iteratively evaluated revisions of the CHIP-CE/CRF in 4 geographic locations in the United States. Children (N=1708) whose families represent the low to middle socioeconomic strata and predominant U.S. racial/ethnic groups were involved. RESULTS: The final CHIP-CE/CRF includes 5 domains: Satisfaction (with self and health), Comfort (emotional and physical symptoms and limitations), Resilience (positive activities that promote health), Risk Avoidance (risky behaviors that influence future health), and Achievement (of social expectations in school and with peers). The internal consistency and test-retest reliability of the domains are good to excellent, with a definite age gradient such that younger children's responses are less reliable although still acceptable. Validity is supported through criterion and construct validity tests and structural analyses. Standard scores (mean, 50; standard deviation, 10) were established. CONCLUSIONS: Health status can be reliably and validly assessed directly from children 6 to 11 years old on the CHIP-CE/CRF. In combination with the CHIP-AE, self-reported health status can now be obtained from youth 6 to 18 years old using a consistent conceptual framework. This can greatly improve the precision and comparability of health assessments of youth, enhancing the validity of outcome research and longitudinal studies across childhood and adolescence.

Adaptation, Psychological↗
PubMedDate not supplied

Health promotion: Control of stress and violent behavior.

Stress is an inevitable part of life in today's society. Some stress may be beneficial and can lead to improved productivity. Unless suitably managed, however, stress may contribute to physiological and psychological dysfunctions such as depression, fatigue, obesity, coronary heart disease, suicide, or violence. The impact of stress on the Nation's physical and mental health may be considerable. Tens of thousands of premature deaths annually are consequences of suicide and homicide. It is estimated that 2,000 deaths to children and up to four million injuries inflicted by abusing parents occur each year partially as a result of stress. Recent years have focused a considerable amount of public and professional interest upon the relationship between stress and physical and mental health. Scientific inquiry has demonstrated various associations between stress and health and disease and has provided evidence that stressful factors can be assessed. Much remains, however, to be elucidated about vulnerability to stress and its control. Some groups such as teenagers, the elderly, and the economically disadvantaged appear to be more vulnerable to stress, and the public in general has limited information about what can be done to reduce stress. There is a clear need to investigate the psychological, environmental, and biological interactions which link stress to health disorders.

Adolescent↗
PubMed1999

Droperidol: efficacy and side effects in psychiatric emergencies.

BACKGROUND: As admission criteria to inpatient units become more focused on patient safety and behavioral instability, primary treatment often requires use of medications that need to be quick, safe, and effective for control of agitation. This article reviews the evidence that droperidol may serve as the optimal medication for this task. DATA SOURCES: A comprehensive MEDLINE search of English-language literature was conducted using the search term droperidol concerning the use of droperidol in psychiatric emergencies. Cross-referencing of those articles was conducted to include pertinent articles in the non-psychiatric and European literature regarding safety and early development of the drug. STUDY FINDINGS: As evidenced in the animal and clinical literature, studies demonstrate the efficacy and rapidity of onset of droperidol and its relative safety compared with the most widely used antiagitation drug, haloperidol. Evidence for this use of droperidol is particularly compelling for situations in which intramuscular administration is necessary. CONCLUSION: Droperidol, while not in widespread use, may prove to be the superior typical neuroleptic for psychiatric emergencies. Increased clinical utilization and study of droperidol for this use is warranted.

Acute Disease↗
PubMed1993

Condom use with primary partners among injecting drug users in Bangkok, Thailand and New York City, United States.

OBJECTIVE: To determine factors associated with likelihood or failure to use condoms with primary sexual partners among injecting drug users (IDU) in two cities. DESIGN AND METHODS: Interviews were conducted with 601 IDU in Bangkok in 1989 and with 957 IDU in New York City in 1990-1991. Subjects were recruited from drug-use treatment programs and a research storefront. Informed consent was obtained and a World Health Organization standardized questionnaire about AIDS risk behaviors administered by a trained interviewer. RESULTS: A substantial minority (37%) of IDU in Bangkok and a majority (55%) of IDU in New York City reported penetrative intercourse (vaginal, anal or oral) with a primary partner in the 6 months before the interview. Of those reporting penetrative intercourse with a primary partner, only 12% in Bangkok and 20% in New York reported that they always used condoms. Parallel bivariate and multiple logistic regression analyses were conducted to distinguish between subjects who reported always using condoms and subjects who reported unsafe sexual activity with primary partners. The same two factor--knowing that one is HIV-seropositive and talking about AIDS with sexual partners--were most strongly associated with always using condoms with primary partners in both cities. CONCLUSIONS: Programs to prevent sexual transmission of HIV among IDU should provide voluntary and confidential/anonymous HIV counseling and testing, and should facilitate discussions of AIDS and sexual transmission of HIV between IDU and their sexual partners. That the same two factors were associated with always using condoms with primary partners among IDU in these two cities suggests that these factors may also be important in other groups at high risk for HIV.

Adult↗
PubMed1980

Alternative to mental hospital treatment. III. Social cost.

Much concern has been expressed over the possible burden placed on family and community members by programs that emphasize community treatment of severely disturbed patients. In this study, the social costs of an experimental in-community program were compared with those of a traditional approach using short-term hospitalization plus aftercare. Six objective and one subjective measures of the burden placed on the family members of patients in both groups were obtained. Community burden was assessed through police records of frequency of patient arrests, number of suicidal gestures that required medical attention, and frequency of emergency room use. All measures showed that the total in-community program resulted in no more burden on the family or community than the traditional approach. The large amount of support provided to patients, families, and community members in the experimental approach is emphasized in explaining these results.

Adult↗
PubMed1980

Structure: the neglected ingredient of community treatment.

Eighty patients in a locked, skilled-nursing facility that serves only psychiatric patients were studied. Of these, 78 were diagnosed as psychotic, 48 had overt major psychopathologic characteristics, and 33 had been physically assaultive within the past 12 months. A third had diagnoses both of psychosis and severe drug and/or alcohol problems. Fifty-eight were unmanageable in previous placements in open settlings. Four of five were resistant to taking psychotropic medications. Six were judged dangerous to themselves. Such patients are extremely difficult to manage in community settings where the need for structure is often overlooked; therefore, this facility, serves as an alternative to the state hospital. Structure is provided not only by security features but also by an intensive treatment and rehabilitation program. This type of facility is contrasted with the state hospital.

Adolescent↗
PubMed1982

Decision to seek commitment. Psychiatric decision making in a legal context.

In seeking to commit patients, psychiatrists have often been accused of pursuing ends other than those prescribed by the law, but empiric data have been lacking on those factors that influence commitment decisions. In this study 34 clinicians, most of whom were psychiatrists, responded to 65 requests by voluntary patients for discharge from the hospital. The legal criteria governing commitment were found to be significantly related to the decision. Those nonlegal criteria that seemed most consistently to play a significant role in the decision seemed closely related to one of the legal criteria. The clinicians' affective responses to their patients and the patients' personality traits did not play a significant role in the decision. These findings suggest that this group of clinicians was acting in substantial accordance with the dangerousness requirements of the commitment law.

Attitude of Health Personnel↗
PubMed1982

Stone-Roth model of civil commitment and the California dangerousness standard: operational comparison.

Professional opposition to making "dangerousness" the primary criterion for involuntary civil commitment has galvanized in support of the proposed "new medical model." The Stone-Roth criteria for commitment were applied to patients being committed under California's version of the dangerousness standard. Results showed that 86% of the patients committed under the California statute were viewed by the examining psychiatrists as committable under the Stone-Roth procedures as well.

Adult↗
PubMed1983

Differences among clinicians in the decision to admit.

Despite considerable efforts by researchers and clinicians to elucidate the nature of the decision to admit patients for psychiatric treatment, they disagree about the criteria for hospitalization and have made little progress understanding the decision-making process. This study further investigated factors influencing the decision to admit by incorporating two unusual (for this area) features: (1) use of a multivariate analysis and (2) examination of individual differences among clinicians. The results showed both strong similarities and differences in the criteria used by individual clinicians. For each caretaker, a relatively small list of criteria was developed. Taken together, these criteria correctly classified 90% of the patients (96% of nonhospitalized and 60% of hospitalized patients) in a large, urban, general-hospital emergency room.

Bipolar Disorder↗
PubMed1984

A study of mandatory review of civil commitment.

The California Civil Commitment Statute provides for prolonged (14-day) involuntary hospitalization of the mentally ill on the basis of grave disability (GD), danger to self, and danger to others. Recently the procedure has been modified to provide mandatory review of all 14-day certificates for GD. Comparison of 47 patients certified before the law change with 58 subjects certified after the change found that correlations between certification category and criterion measures were significant but low. Although the change was directed toward GD, no significant improvement was seen in the specificity of application of the GD category after the legal change. Because of these limited effects, the value of time-consuming mandatory judicial review is questionable. The attempt may have been doomed from the start because of unquantifiable commitment criteria. Before additional judicial burdens are imposed on the psychiatrist, careful assessment of the rationale for such procedures should be made.

Adult↗
PubMed1984

Clinical judgments in the decision to commit. Psychiatric discretion and the law.

Judicial decisions and statutory reforms point to a return to psychiatric discretion when clinical needs and patients' rights must be balanced. In seeking to commit patients, psychiatrists have been accused of contravening the legal rights of their patients by applying criteria other than those prescribed by law. This study examined the factors involved in the psychiatrists' decisions to seek commitment or to release 90 voluntarily hospitalized patients; we found psychiatrists' decisions to be appropriately correlated to legal criteria and legally relevant clinical and psychosocial factors. Interpersonal variables did not play a material role in the decision. Independent assessment of the patients' clinical status were consistent with clinicians' judgments of dangerousness. These findings indicate that this group of psychiatrists, faced with the decision to seek commitment, based their judgments on clinically relevant data rather than interpersonal factors and conformed to the dangerousness requirements of the commitment law.

Attitude of Health Personnel↗
PubMed1988

Civil commitment in the psychiatric emergency room. II. Mental disorder indicators and three dangerousness criteria.

Proponents of return to a "need for treatment" standard for civil commitment contend that the current dangerousness standard forces psychiatrists to neglect severely ill patients in favor of those who are less ill but dangerous to others. Among 198 psychiatric emergency patients in five facilities, those rated as most dangerous on Three Ratings of Involuntary Admissibility, a reliable index of indicators employed by clinicians in evaluating danger to self, danger to others, and grave disability, were also most severely ill on diagnostic and symptomatic assessments of mental disorder. Clinicians' Global Ratings of patient dangerousness on the three criteria were similarly related to severity of diagnosis and symptoms. Perceived dangerousness was associated with major mental disorder and severity of most symptom types, especially impulsivity. Danger to self was the criterion related to the fewest indicators of mental disorder.

Adolescent↗
PubMed1988

Civil commitment in the psychiatric emergency room. III. Disposition as a function of mental disorder and dangerousness indicators.

In 251 evaluations observed in five California public psychiatric emergency rooms, patients who were retained, whether new to the system or having histories of hospitalization, rated higher on measures of danger to self, danger to others, and grave disability than patients who were released. They were also more severely symptomatic and more often given major diagnoses. The combination of dangerousness and mental disorder predicted disposition for 93% of new patients and 88% of recidivist patients. Impulsivity was the most influential aspect of mental disorder.

Adult↗
PubMed1988

Limitations on psychiatrists' discretionary civil commitment authority by the Stone and dangerousness criteria.

The dangerousness-oriented commitment criteria of Massachusetts were compared with the paternalistic Stone model of commitment in an emergency setting. In a sample of 1062 patients, the Stone criteria were more restrictive than the dangerousness-oriented criteria; 91 patients were committable by the Stone model compared with 218 under the present statute. A second comparison of only those patients who refused treatment yielded similar findings--52 patients were committable according to the Stone criteria compared with 80 under the Massachusetts statute. The greater restrictiveness of the Stone criteria in each comparison was in large part the result of the requirement that the treatment decisions of the patient be incompetent; in the broader sample, the criterion of major patient distress had a comparable impact. A comparison of patients committable under both standards with those patients currently committable who would be excluded under the Stone standard revealed significant differences. The dually committable patients were more likely to be psychotic, to meet statutory criteria for grave disability, and to be diagnosed as manic. The implications of the findings are discussed.

Adult↗