Most studies assessing the burden of psychiatric disorders in juvenile correctional facilities have been based on small or male-only samples or have focused on a single disorder. Using electronic data routinely collected by the Texas juvenile correctional system and its contracted medical provider organization, we estimated the prevalence of selected psychiatric disorders among youths committed to Texas juvenile correctional facilities between January 1, 2004, and December 31, 2008 (N = 11,603). Ninety-eight percent were diagnosed with at least one of the disorders. Highest estimated prevalence was for conduct disorder (83.2%), followed by any substance use disorder (75.6%), any bipolar disorder (19.4%), attention-deficit/hyperactivity disorder (18.3%), and any depressive disorder (12.6%). The estimated prevalence of psychiatric disorders among these youths was exceptionally high and showed patterns by sex, race/ethnicity, and age that were both consistent and inconsistent with other juvenile justice samples.

Screening and tracking subjects and data management in clinical trials require significant investments in manpower that can be reduced through the use of web-based systems. To support a validation trial of various dietary assessment tools that required multiple clinic visits and eight repeats of online assessments, we developed an interactive web-based system to automate all levels of management of a biomarker-based clinical trial. The "Energetics System" was developed to support 1) the work of the study coordinator in recruiting, screening and tracking subject flow, 2) the need of the principal investigator to review study progress, and 3) continuous data analysis. The system was designed to automate web-based self-screening into the trial. It supported scheduling tasks and triggered tailored messaging for late and non-responders. For the investigators, it provided real time status overviews on all subjects, created electronic case reports, supported data queries and prepared analytic data files. Encryption and multi-level password protection were used to insure data privacy. The system was programmed iteratively and required six months of a web programmer's time along with active team engagement. In this study the enhancement in speed and efficiency of recruitment and quality of data collection as a result of this system outweighed the initial investment. Web-based systems have the potential to streamline the process of recruitment and day-to-day management of clinical

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There are some important points to this letter, however, particularly regarding what is referred to as the non-medicalisation of bereavement.We are ignoring our duty as professional carers if we do not concern ourselves with the imminently bereaved and are just brushing under the carpet something we find difficult to deal with by withdrawing from our responsibility to bereaved loved ones. We invite relatives, without coercion or callousness, into the resuscitation room and give information in a compassionate way. Infringement of autonomy occurs when a relative or patient is deprived of the information he or she needs for autonomous decision making. It is unacceptable medical paternalism to withhold that information in the fear that it will cause the patient or relative harm. 1 Mitchell MH, Lynch MB. Should relatives be allowed in the resuscitation room? J Accid Emerg Med 1997;14:366-9. 2 Adams S, Whitlock M, Higgs R, et al. Should relatives be allowed to watch resuscitation? BMJ 1 994;308: 1687-92. 3 Hanson C, Strawser D. Family presence during cardiopulmonary resuscitation: Foote Hospital emergency department's 9 year perspective. J Emerg Nurs 1992;18:104-6. Anterior glenohumeral dislocationEDrrOR,-I would like to make a few comments on the very informative article by A Gleeson on shoulder dislocation.' I am one of the many people who reduce shoulder dislocation without injections of drugs but I do not choose this method for physician convenience. It is possible to achieve pain free reduction of the dislocation within a few minutes of the patient's arrival in the accident and emergency (A&E) department without the use of injected drugs. It simply needs explanation, reassurance, a quiet room, use of a simple relaxation or hypnosis technique, and gentle manipulation.Relaxation reduces muscular spasm and therefore pain. Entonox given before manipulation promotes relaxation.The fact should be emphasised that most dislocations can be reduced without use offorce and that traction is not necessary. The patient should be informed of this as it helps them to relax. It may take 10 minutes of slow movement to achieve reduction but in a relaxed and confident patient this procedure can be pain free.It also means that an early attempt at reduction can be made before radiography is considered: there are no complications of slow gentle movement. If the patient is clearly in discomfort then the attempt is stopped and the traditional method used.I would like to point out that D and E in fig 2 are in the wrong order. Internal rotation is not part of the manoeuvre itself: it simply puts the arm into the position where it can be immobilised. If there is no resistance to internal rotation across the chest then reduction has been achieved. If there is resistance and pain then the dislocation persists.Can I suggest that the gold standard for shoulder dislocation is reduction: * Without undue pain * Without injections of potent drugs * As soon as possible after arrival in the A&E department * Without further damage because force is not ...

Weightlifting is a popular form of exercise for athletes and nonathletes of all ages. Previous studies suggest weightlifting has low risk for injury. However, the degree for injury may depend on a persons age and the purpose for weightlifting. The purpose of this study is to investigate the current epidemiology of weightlifting injury to determine risk by age and gender and suggest potential environmental or behavioural causes. Methods included obtaining data for the years 2000 through 2008 from the National Electronic Injury Surveillance System using product category 3265. Estimates are that approximately 650 000 injuries related to weightlifting occurred during the study years. Analysis will include the injury environment, diagnosis, intent and body location. The majority of injuries were to males and the mean age was 28. Narratives from the data will be reviewed to determine behavioural and environmental factors that precipitated the injury. Results indicate that weightlifting injuries are still a concern and are increasing. The majority of weightlifting-related injuries are minor but data provide evidence that hospitalisation and death can result from the activity. Children and older adults are high-risk groups for weightlifting injuries. In many accounts, children were bystanders or non-participants when injured. The home was the environment for the majority of injuries, especially to younger groups. Recommendations call for continued education of weightlifting participants in the home as well as in the commercial setting. Manufacturers should continue to consider the development of weightlifting equipment that reduces injury risk and increases safety.

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