Accurately assessing elderly fall deaths using hospital discharge and vital statistics data

Historically, fatal injury monitoring and surveillance have relied on mortality data derived from death certificates (DC). However, problems associated with utilizing DC have been well documented. Recently, access to and utilization of hospital discharge data (HDD) have offered a new and important secondary source of data regarding in-hospital deaths. However, studies have shown that discrepancies between the HDD and the corresponding DC often exist. This discrepancy was especially evident when comparing HDD to the vital statistics data (VSD) for deaths by falls among those aged 65 and over in 19 states.This was a retrospective forensic review of elderly (age 65 and over) fall-associated fatalities (E880-E888) identified from HDD and VSD in Allegheny County, Pennsylvania, between 1997 and 1998. Seventy-seven cases were identified, with the original manner of death listed as natural (34), suicide (1), and accidental (42) on the DC. Following a forensic review of the cases, the manner of the death on the DC should have been changed from natural to accidental in 28% (n = 12) of the cases, representing an undercount in the VSD. Undercounts were due to a failure of clinicians to account for the significance of a fall event that contributed to subsequent pathology and death. In addition, in that 22% (n = 17) of the HDD fall-associated deaths, the fall did not contribute directly or sequentially to the underlying cause of death, thereby representing an overcount in the HDD.Based on these findings we recommend (1) elderly fall surveillance systems should only count HDD E-coded falls that demonstrate a serious traumatic injury which directly or subsequently results in death, (2) all in-hospital fall-associated deaths should be reported to and reviewed by coroner/Medical Examiner offices for determination of the cause and manner of death, and (3) physicians should be better educated in properly completing death certificates.     

Duverger's Hypothesis, the Run-Off Rule, and Electoral Competition

I analyze a model of electoral competition with entry underthe run-off rule. I consider both two- and multiple-party systems.The principal result is that two-party systems may prove stableunder the run-off rule: I show that a continuum of equilibriaexists in which only two parties enter and subsequent entryis deterred. This finding conflicts with the accepted wisdomon the run-off rule encapsulated by Duverger's Hypothesis. Theresults of the model are then reconciled with Duverger's Hypothesisand a more precise formulation is proposed.     

Alcohol abuse prevention among high-risk youth: computer-based intervention

SUMMARYThis study examined the feasibility of a CD-ROM intervention to prevent alcohol abuse among high-risk youths. Youths from 41 community-based agencies in greater New York City participated in a randomized trial of a skills-based interactive CD-ROM. Outcome data were collected on 489 early adolescents in these agencies before and after a randomized subset of youths interacted with a 10-session alcohol abuse prevention program on CD-ROM. Compared to control participants, youths in the intervention arm had a positive increase in perceived harm of alcohol use and increased assertiveness skills. At posttest, drinking rates for control and intervention participants were equal and unchanged from pretest. These findings suggest that CD-ROM technology offers a new and promising medium for engaging high-risk youth in an alcohol abuse prevention program. Study implications and future applications of the present approach are discussed.     

The effectiveness of interactive journaling in reducing recidivism among substance-dependent jail inmates

The present study sought to evaluate the influence of interactive journaling on criminal recidivism and identify significant predictors of recidivism among a sample of 183 male inmates incarcerated in a local jail facility randomly assigned to either an interactive journaling condition or a control group. All participants met DSM-IV-TR criteria for substance dependence, had their current offense indicate substance involvement, and had a minimum of one previous arrest in the prior 12 months. The recidivism rate (51%), in terms of subsequent bookings within a 12-month period, for the journaling group was significantly lower than the recidivism rate (66%) for the control group, χ(2)(1, 183) = 4.13, p < .05. The three most significant independent predictors of subsequent bookings were severity of posttraumatic stress disorder, group assignment (journaling vs. placebo), and employment status. Interactive journaling appears to show promise as a brief treatment intervention strategy for substance dependence in local jail settings and may have the potential for reducing recidivism.