Religiosity is an important part of coping with grief in pregnancy after a traumatic second trimester loss.

Women (n = 15) who were pregnant after a traumatic late pregnancy loss (termination because of fetal death or serious anomalies) completed psychometric screening tests and scales, including the Perinatal Grief Scale (PGS), the Impact of Event Scale (IES), the Duke Depression Inventory (DDI), the Generalized Anxiety Disorder-7 (GAD), and the Hoge Scale for Intrinsic Religiosity (IR). Despite a mean elapsed time since the prior loss of 27 (range, 7-47) months, half (7/15, 47%) of the combined groups had high levels of grief on the PGS. Multiple positive scores on psychometric tests were frequent: Sixty percent (9/15) had high scores on the PGS Active Grief subscale or on the IES. Forty percent (6/15) had a high score on the DDI, and 17% (3/15) on the GAD. IR scores significantly and negatively correlated with scores on the Despair subscale of the PGS. The results from this pilot study suggest that high levels of grief and PTS symptoms are significant problems for pregnant women who have suffered late loss of a wanted pregnancy. Religiosity may play an important part in maternal coping during these stressful pregnancies.

Underascertainment of child abuse mortality in the United States.

CONTEXT: Mortality figures in the United States are believed to underestimate the incidence of fatal child abuse. OBJECTIVES: To describe the true incidence of fatal child abuse, determine the proportion of child abuse deaths missed by the vital records system, and provide estimates of the extent of abuse homicides in young children. DESIGN AND SETTING: Retrospective descriptive study of child abuse homicides that occurred over a 10-year period in North Carolina from 1985-1994. CASES: The Medical Examiner Information System was searched for all cases of children younger than 11 years classified with International Classification of Diseases, Ninth Revision codes E960 to E969 as the underlying cause of death and homicide as the manner of death. A total of 273 cases were identified in the search and 259 cases were reviewed after exclusion of fetal deaths and deaths of children who were not residents of North Carolina. MAIN OUTCOME MEASURE: Child abuse homicide. RESULTS: Of the 259 homicides, 220 (84.9%) were due to child abuse, 22 (8.5%) were not related to abuse, and the status of 17 (6.6%) could not be determined. The rate of child abuse homicide increased from 1.5 per 100000 person-years in 1985 to 2.8 in 1994. Of all 259 child homicides, the state vital records system underrecorded the coding of those due to battering or abuse by 58.7%. Black children were killed at 3 times the rate of white children (4.3 per 100000 vs 1.3 per 100000). Males made up 65.5% (133/203) of the known probable assailants. Biological parents accounted for 63% of the perpetrators of fatal child abuse. From 1985 through 1996, 9467 homicides among US children younger than 11 years were estimated to be due to abuse rather than the 2973 reported. The ICD-9 cause of death coding underascertained abuse homicides by an estimated 61.6%. CONCLUSIONS: Using medical examiner data, we found that significant underascertainment of child abuse homicides in vital records systems persists despite greater societal attention to abuse fatalities. Improved recording of such incidences should be a priority so that prevention strategies can be appropriately targeted and outcomes monitored, especially in light of the increasing rates.

Alcohol in aviation-related fatalities: North Carolina, 1985-1994.

BACKGROUND: Previous studies examining the role of alcohol in aviation safety have been limited to pilots and the estimated degree of alcohol involvement in fatal aviation crashes was susceptible to selection bias because alcohol testing was not conducted on a routine basis. This study examines the magnitude of and factors related to alcohol involvement in both pilot and non-pilot aviation fatalities. METHODS: We analyzed medical examiner data on all victims who died in civilian aircraft crashes in North Carolina during 1985-94, complemented by crash investigation data from the National Transportation Safety Board. RESULTS: During the 10-yr study period, the North Carolina Medical Examiner Information System recorded 337 aviation-related fatalities including 111 pilots. Alcohol testing was performed on 91% of the pilots and 72% of the non-pilot occupants. Of the victims who were tested for alcohol, 12% (7% of the pilots and 15% of non-pilot occupants) had positive blood alcohol concentrations (BACs), ranging from 0.02 to 0.14%. All four victims with BACs greater than 0.10% were pilots aged 20-29 yr who were fatally injured in nighttime general aviation crashes. In crashes of commercial flights, none of the pilots tested positive for alcohol, whereas 20% of the non-pilot occupants had positive BACs. CONCLUSIONS: Intoxicated flying, particularly among young general aviation pilots, is still a valid concern. The aviation safety implications of alcohol use by passengers of commercial flights should be further examined.

Child pedestrian and bicyclist injuries: results of community surveillance and a case-control study.

OBJECTIVES: To describe the dimensions of childhood pedestrian and bicyclist injuries in Long Beach, California, and to identify risk factors for these injuries. POPULATION: Long Beach residents aged 0-14 years who were involved in an auto versus pedestrian or bicyclist incident that resulted in a hospital visit and/or police response, between 1 September 1988 and 31 August 1990. METHODS: Cases were identified retrospectively using hospital charts, police records, and coroner's reports; demographic, clinical, and situational information were abstracted from the same. A nested case-control study was conducted to examine the street environments where children were injured, and to identify environmental risk factors at these case sites. RESULTS: 288 children comprised the sample population. Midblock dart-outs emerged as the single most common type of incident. Most incidents happened on residential streets, but the risk of injury was greatest on larger boulevards, and tended to cluster by region within the city. Adjusted odds ratios show that case sites had a larger proportion of traffic exceeding posted speed limits, and were also four times more likely to be near a convenience store, gas station, or fast food store than control sites. CONCLUSIONS: The findings of this study suggest three possible routes for the prevention of childhood pedestrian and bicyclist injuries: education, law enforcement, and environmental modification.