An economic evaluation of asthma in the United States.
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Biomedical subjects
Publications and source records attributed to A B Bergman.
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Pedestrian injuries are a complex problem for which no single intervention will be completely effective. One component of a community-wide program, training of schoolchildren in street-crossing skills, is evaluated. The program targeted public school students in grades K through 4 with an eight-session training program by a single teacher, cross-age teaching, videotape feedback, and in 1990 parent-child activity workbooks. Children's street crossing was observed pretraining and posttraining and graded on four behaviors: WALKING on sidewalk/shoulder vs in the street; STOPPING at the curb; LOOKING L-R-L before crossing; KEEP LOOKING while crossing. Analysis was conducted on matched pairs in which observations pretraining were compared with those posttraining on same child. Observations were completed on 137 children in 1989 and 92 in 1990. Nearly all children walked on the side of the road; however, fewer than 50% of children STOPPED, 25% LOOKED, and fewer than 20% KEPT LOOKING before training. Training did not improve the performance on the first two behaviors in either year, significantly increased LOOKING in 1990, and increased KEEP LOOKING by twofold in 1989 and threefold in 1990. It is concluded that pedestrian skills of children can be improved but that such a program must be part of a broader effort if pedestrian injuries are to decrease.
Why does Sweden have the lowest childhood injury rate of any country in the world? The answer lies in a combination of factors including the special characteristics of Swedish society and an energetic 35-year campaign. Contributing societal characteristics are a small, relatively homogeneous, health conscious, law-abiding population that values children. Key factors in the campaign have been support of trauma surveillance systems and injury prevention research, ensuring safer environments and products through legislation and regulation, and a broad-based safety education campaign using coalitions of existing groups. Emulating the strategies used in the Swedish campaign would markedly reduce the number of US children killed, injured, and disabled from trauma.
Though bicycle head trauma is a significant cause of mortality and morbidity, much of which can be mitigated by wearing protective helmets, in 1986, few schoolchildren in the area of Seattle, Wash, were observed to wear helmets. We describe the mechanics of a multifaceted campaign undertaken to alter this situation, involving a coalition of health, bicycle, and helmet industry organizations. These were the major objectives: (1) to convince parents that riding bicycles without helmets is hazardous, (2) to lower the price of helmets to more affordable levels, and (3) to overcome the reluctance of children to wear helmets. The campaign was successful; the sales of one brand of a youth helmet in the Seattle area rose from 1500 to 22,000 over a 3-year period, and the observed helmet usage rate among school-age children increased from 5% to 16% compared with a rise of only 1% to 3% in a control community, Portland, Ore.
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Primary care pediatricians in Washington State were surveyed regarding their attitudes about iron-fortified formula. Of the 210 responding physicians who stated an opinion 70 (33%) feel that there are definite indications for non-fortified formula, and 33 (16%) routinely recommend formula without added iron. Despite evidence that adding iron to formula has helped reduce the prevalence of anemia in children and does not cause gastrointestinal symptoms, iron-fortified formula is not universally recommended by pediatricians.
Toxic Epidermal Necrolysis (TEN) is a life-threatening disorder with reported mortality rates of 25-60 percent in pediatric patients. The authors report on their experience in managing six children using a standardized treatment protocol in the intensive care unit of a regional burn center. Areas of sloughed skin were covered with porcine xenograft (pig skin) until reepithelialization was complete. There was one death in the series, and one child had ophthalmologic complications. Treatment in a multidisciplinary burn center is recommended for children with TEN.
Community programs to reduce the toll from pedestrian injuries in childhood must include parents as a key element. This study, consisting of a survey questionnaire, was undertaken to provide information concerning current parent attitudes and practices that could be used to guide prevention programs. The survey consisted of 2464 questionnaires from parents of children in grades kindergarten to four in a suburban school district. Although 94% of parents did not believe that 5- to 6-year-old children can reliably cross streets alone, one third of parents allowed kindergarten-aged children to cross residential streets alone and first-grade children to walk alone to school. The presence of speeding traffic or the lack of safe places to walk did not influence parents in limiting their children's crossings. Few (17%) parents believed that children should be taught not to cross alone; one half of parents, including 41% of parents of kindergarten-aged children believed that children should be taught to cross busy streets without traffic lights. According to results of the study, parent expectations for their children's pedestrian skills may be inappropriate and may be a fruitful target for injury-prevention programs.
Despite the effectiveness of motorcycle helmet legislation, many states have repealed these laws during the last decade. Aspects often neglected by policymakers are who pays for the care of these victims and how much of this cost is subsidized by public funds. To determine the extent of this subsidy, we studied the cost of care of 105 motorcyclists hospitalized at a major trauma center during a 12-month period. Total direct costs for these 105 patients, followed up for a mean of 20 months, were more than $2.7 million, with an average of $25,764 per patient. Only 60% of the direct costs were accounted for by the initial hospital care; 23% of costs were for rehabilitation care or readmission for treatment of acute problems. The majority (63.4%) of care was paid for by public funds, with Medicaid accounting for more than half of all charges.
Statewide data from two sources were used to compare the pedestrian-vehicle collision injury and fatality rates for urban and rural areas of Washington State from 1981 through 1983. Although the rates of pedestrian injuries are higher in urban areas, the pedestrian fatality rate in rural areas is higher for nearly all age groups, and at all posted speeds. Multiple logistic regression was carried out to measure the risk of dying once involved in a pedestrian-vehicle collision in rural areas compared to the risk for urban areas. This relative risk was seen to be elevated (RR = 2.3; 95% CI = 2.0-2.6) even after controlling for the effects of age and sex of the pedestrian, and posted speed of the vehicle. When explored further it was seen that a larger proportion of fatalities died out of the hospital and within the first hour after injury in rural areas than in urban areas. It is possible that Emergency Medical Services care is less rapidly available and that accessibility to trauma centers is more limited in rural areas.
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Data from Washington State police records of pedestrian-vehicle collisions were used to tabulate injury and fatality rates for 1981 to 1983 and to investigate event characteristics associated with the occurrence of fatalities. Case-fatality rates are seen to be relatively higher when there is decreased visibility due to fog, lack of lighting or dark color of pedestrian clothing. Fatality rates from death certificate data for the same time period were compared with the police-reported rates. For children younger than 5 years, fewer cases of pedestrian death are reported by police than by death certificate, because a large proportion of fatal injuries (27%) is not traffic related or occurs at home (46%) in the garage or driveway.
To determine whether the spectrum of serious child abuse has changed over the past decade, hospital and medical examiner records in the Seattle area were reviewed for the years 1971 to 1973 and 1981 to 1983. Although the incidence of hospitalized cases was similar in the two time periods (81 v 93), the proportion of severe injuries that occurred increased significantly (from 32% to 54%). The large number of cases in which the perpetrator was unknown makes generalization difficult. However, changes in the sex distribution for known perpetrators suggest that child abuse, especially serious and fatal cases, may be occurring more frequently at the hands of men.
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The normal computed tomographic anatomy of the larynx and surrounding structures is illustrated and discussed. An attempt is made to distinguish various types of tissues in cross-sectional display. The advantages of computed tomography over other modalities used for imaging the laryngeal region include the capacity to depict structural relationships in cross-section, to better define cartilaginous involvement by adjacent neoplasms, and to identify vascular components with contrast enhancement. The clinical application of computed tomography with respect to radiation therapy treatment planning of laryngeal tumors in an important feature of this imaging technique.