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David M Bishai

Publications and source records attributed to David M Bishai.

7 recordsLinked to original sources
PubMed2006

Lawnmower injuries in the United States: 1996 to 2004.

STUDY OBJECTIVE: We update the epidemiology of lawnmower injuries, together with leading mechanisms of lawnmower injury in the United States, for the entire age range by using nationally representative data. METHODS: Data were obtained from the National Hospital Discharge Survey 1996-2003 and the National Electronic Injury Surveillance System 1996-2004. RESULTS: Individuals in the 60- to 69-year age group had the highest push mower injury incidence in 2004, whereas those in the 70 years and older age group had the highest riding mower injury incidence. Children younger than 15 years also had a substantial injury incidence. Individuals in the 15- to 19-year age group had the highest rate of hospitalizations caused by lawnmower injuries from 1996 through 2003, with 0.72 per 100,000 person-years (95% confidence interval 0.07 to 1.36). Debris from under the mower hitting a body part or entering the eye was the most common mechanism for lawnmower injury. The second most common mechanism of injury was nonspecific pain onset after the ordinary operation of the mower. Fracture of 1 or more phalanges of the foot was the most common diagnosis among lawnmower injury hospitalizations, with 34.4%, followed by traumatic amputation of the toe, with 32.4%. There is an increasing trend of lawnmower injuries in the United States during the last 9 years. CONCLUSION: Lawnmower injuries increase with age, with peaks in persons older than 59 years. Given the high incidence of projectile-related injuries, improved protective apparel and eyewear could lower the rate of injury for all age groups. The increasing trend of lawnmower injuries in the United States suggests that more must be done to prevent lawnmower injuries.

Adolescent↗
PubMed2006

Modeling the cost effectiveness of injury interventions in lower and middle income countries: opportunities and challenges.

BACKGROUND: This paper estimates the cost-effectiveness of five interventions that could counter injuries in lower and middle income countries(LMICs): better traffic enforcement, erecting speed bumps, promoting helmets for bicycles, promoting helmets for motorcycles, and storing kerosene in child proof containers. METHODS: We adopt an ingredients based approach to form models of what each intervention would cost in 6 world regions over a 10 year period discounted at both 3% and 6% from both the governmental and societal perspectives. Costs are expressed in local currency converted into US $2001. Each of these interventions has been assessed for effectiveness in a LMIC in limited region, these effectiveness estimates have been used to form models of disability adjusted life years (DALYs) averted for various regions, taking account of regional differences in the baseline burden of injury. RESULTS: The interventions modeled in this paper have cost effectiveness ratios ranging from US $5 to $ 556 per DALY averted depending on region. Depending on local acceptability thresholds many of them could be judged cost-effective relative to interventions that are already adopted. Enhanced enforcement of traffic regulations is the most cost-effective interventions with an average cost per DALY of $64 CONCLUSION: Injury counter measures appear to be cost-effective based on models. More evaluations of real interventions will help to strengthen the evidence basis.

Journal Article↗
PubMed2006

Local stakeholders' perspectives on improving the urban environment to reduce child pedestrian injury: implementing effective public health interventions at the local level.

Local-level public health interventions require action from multiple agencies, organizations and individuals, yet little is known about how best to work with stakeholders to facilitate change. We sought local stakeholders' perspectives on how best to address impediments to implementing interventions designed to reduce child pedestrian injury by improving the pedestrian environment. We conducted 20 in-person, key informant interviews with people who would be the likely advocates for environmental change to improve the pedestrian environment in one US city, Baltimore, Maryland. We discuss the importance of reframing child pedestrian injury risk as a livability issue, increasing awareness about the potential impact of environmental changes to improve public safety, and the need for a formal efficient process to facilitate communication between local government and other stakeholders. These findings provide public health professionals and advocates with useful insight into how local stakeholders view the issue and their perspectives on how best to achieve change.

Accidents, Traffic↗
PubMed2005

Can government policies help adolescents avoid risky behavior?

BACKGROUND: This study examines the extent to which policies influence participation of adolescents in alcohol and tobacco consumption and in unsafe sex. METHODS: Data were obtained from the 1995 Youth Risk Behavior Surveys (YRBS) conducted by 20 different states and cities in the U.S. These data were combined with state data on cigarette taxes, vending machine laws, beer taxes, and family planning clinic availability. A model of teenage risk taking suggested that the three risk behaviors were codetermined by a common latent risk-taking propensity. We used a structural equation model (SEM) accounting for this shared latent propensity to estimate the extent of participation in terms of frequency of smoking, drinking, and the number of sex partners. RESULTS: Estimating simultaneous equations for all three risk behaviors was statistically more efficient than equation-by-equation estimates of each behavior. Estimates indicated significant deterrent effects of beer taxes, vending machine restrictions, and increased density of family planning clinics on teenage risk behavior. CONCLUSIONS: State policies, such as taxes on beer, and restrictions on location of cigarette vending machines, and placement of family planning clinics influence adolescents' behavior. Because there is interrelationship between these behaviors, systems estimators, can offer improved estimates of these effects.

Adolescent↗
PubMed2004

Telemedicine network telecolposcopy compared with computer-based telecolposcopy.

OBJECTIVES: To compare computer-based telecolposcopy with telemedicine network telecolposcopy. MATERIALS AND METHODS: An on-site expert and local clinician at two rural sites conducted colposcopic examinations on 264 women. Colposcopic images were captured and transmitted to two other experts at a remote location using a statewide telemedicine system and a computer and modem-based system. Sensitivity and specificity, agreement of examination adequacy and management, effects of delayed interpretations, and costs were compared for each system. RESULTS: A greater rate of satisfactory colposcopy results was reported by the telemedicine network (66.1%) compared with computer-based (43.6%) telecolposcopy (p < .0001). Greater rates of cervical biopsy (p = .005) and endocervical curettage (p = .03) were required by delayed telecolposcopy compared with immediate telecolposcopic services. There were no significant differences in sensitivity of detecting cervical neoplasia among the types of the telecolposcopy. Computer-based telecolposcopy cost 28 dollars less per patient than telemedicine network telecolposcopy. CONCLUSIONS: Computer-based telecolposcopy may be a reasonable, cost-effective adjunct to on-site colposcopy for evaluating women in medically underserved areas. Synchronous telecolposcopic examination minimizes histologic sampling and improves consultation.

Journal Article↗
PubMedDate not supplied

What is the least costly strategy to evaluate cervical abnormalities in rural women? Comparing telemedicine, local practitioners, and expert physicians.

OBJECTIVE: This study establishes the least costly strategy for evaluation of rural women in need of colposcopy among 3 alternatives: telemedicine, local practitioners, and referral experts. METHODS: Women in rural Georgia who needed colposcopy were examined by an expert colposcopist on site, by a local practitioner, and by a distant expert colposcopist linked by telemedicine. Independent determinations of biopsy intent were used to model the differing biopsy costs of the 3 methods. Record review determined the average total cost of telemedicine. Reports of average cost in year 2000 dollars from societal perspective include medical costs and pain and suffering due to additional biopsies and curettage, telemedicine costs, and costs of potential diagnostic delay for a 1-year time horizon. RESULTS: From the societal perspective in the baseline case, the average cost per patient evaluated was dollar 270 for patients seen by referral experts. The cost was dollar 38 less (e.g., dollar 232) for patients seen by local practitioners, and dollar 35 more (e.g., dollar 305) for patients seen by telemedicine. From the societal perspective, local practitioners were less costly than referral experts because of lower travel costs for patients, but from the medical perspective, their average cost was dollar 32 higher than referral experts because they performed more biopsies and curettage procedures than experts. Telemedicine assistance would have lowered the number of biopsies performed by local practitioners, but as of year 2000 the costs of this technology could not be justified by the savings. CONCLUSION: From the societal perspective, local practitioners performing colposcopy are the least costly way to evaluate cervical abnormalities in rural patients with substantial time and travel costs.

Colposcopy↗