Children in motor vehicle collisions: analysis of injury by restraint use and seat location

This study was a retrospective chart review of hospital records and autopsy reports of 499 children nine years old or younger involved in motor vehicle collisions from 1994 to 1998. The objective was to evaluate the frequency and severity of injuries as a function of age, restraint use, and seat position. We found that 33% of the children were unrestrained and 20% were improperly restrained. Unrestrained children had the highest mean Maximum Abbreviated Injury Scores (MAIS) and Injury Severity Scores (ISS), accounted for 70% of the fatalities, and had the highest incidence of head injuries. Although most of the head injuries were superficial, 80% of the fatalities were the result of a head injury. Improperly restrained children had the highest frequency of abdominal injuries. Regardless of restraint use, the back seat was associated with fewer head injuries and lower mean MAIS and ISS scores compared to the front seat. Also, properly restrained children in the front seat had lower mean MAIS and ISS scores than unrestrained children in the back seat, suggesting that restraint use is more beneficial than seat position.     

The policy adoption-implementation spiral

The “Policy Adoption-Implementation Spiral” is an exploration of the policy-making process that begins at the national level and proceeds through the labyrinth of administrative interpretations, court decisions, and judicial decrees before it is finally implemented at the state level. This analysis is based on the premise that policy adoption and policy implementation are not two separate steps in the policy-making process. The adoption/implementation process may be more clearly thought of as a continually narrowing spiral with each inward band of the spiral representing a further specification, refine- ment, clarification, or interpretation of a piece of public policy.

Equal Employment Opportunity policy is the content area used in this analysis. A case study is used which follows EEO policy from the National level down to its implementation in the area of employment opportunities for state jobs in the State of Alabama.     

Two dimensions of democracy and the economy

Does democracy influence economic policymaking and outcomes? Our study investigates the implications of Dahl's two dimensions of democracy (‘polyarchy’): contestation/competition and inclusion/participation. We hypothesize that increases in democratic competition inspire policy incrementalism, thus lowering growth volatility and generating fewer deep crises. Meanwhile, increases in substantive democratic inclusion – genuine political voice, or democratic participation in the presence of a minimum of contestation – should increase the political weight of relatively poor voters, who have a differentially strong aversion to deep growth crises. A statistical analysis of 149 countries for 1961–98 finds greater democracy associated with fewer years of sharply negative growth (‘crisis’), with both democratic contestation and substantive inclusion contributing to this outcome. Our conclusions question the wisdom of designing economic policy institutions that are intentionally insulated from the democratic process.     

Barriers to the operation of mental health legislation in Australian emergency departments: a qualitative analysis

This study aimed to describe the perceived barriers faced by emergency clinicians in utilising mental health legislation in Australian hospital emergency departments. A semi-structured interview methodology was used to assess what barriers emergency department doctors and nurses perceive in the operation of mental health legislation. Key findings from the interview data were drawn in accordance with the most commonly represented themes. A total of 36 interviews were conducted with 20 members of the Australasian College for Emergency Medicine and 16 members of the College for Emergency Nursing Australasia representing the various Australian jurisdictions. Most concerning to clinicians were the effects of access block and overcrowding on the appropriate use of mental health legislation, and the substandard medical care that mental health patients received as a result of long periods in the emergency department. Many respondents were concerned about the lack of applicability of mental health legislation to the emergency department environment, variation in legislation between States and Territories causing problems for clinicians working interstate, and a lack of knowledge and training in mental health legislation. Many felt that clarification of legislative issues around duty of care and intoxicated or violent patients was required. The authors conclude that access block has detrimental effects on emergency mental health care as it does in other areas of emergency medicine. Consideration should be given to uniform national mental health legislation to better serve the needs of people with mental health emergencies.