Biomedical subjects

Gordon S Smith

Publications and source records attributed to Gordon S Smith.

At least 19 recordsLinked to original sources

PubMed2006

Work-related ladder fall fractures: identification and diagnosis validation using narrative text.

OBJECTIVE: To identify ladder-related fracture injuries and determine how ladder fall fractures differ from other ladder-related injuries. METHODS: Ladder-related fracture cases were identified using narrative text and coded data from workers' compensation claims. Potential cases were identified by text searches and verified with claim records. Injury characteristics were compared using proportionate injury ratios. RESULTS: Of 9826 ladder-related injuries, 7% resulted in fracture cases. Falls caused 89% of fractures and resulted in more medical costs and disability days than other injuries. Frequent mechanisms were ladder instability (22%) and lost footing (22%). Narrative text searches identified 17% more fractures than injury codes alone. Males were more likely to sustain a fall fracture than other injuries; construction workers were most likely, and retail workers were the least likely to sustain fractures. CONCLUSIONS: Fractures are an important injury from ladder falls, resulting more serious consequences than other ladder-related injuries. Text analysis can improve the quality and utility of workers compensation data by identifying and understanding injury causes. Proportionate injury ratios are also useful for making cross-group comparisons of injury experience when denominator data are not available. Greater attention to risk factors for ladder falls is needed for targeting interventions.

Accidental Falls↗

PubMed2006

Swimming pool drownings among US residents aged 5-24 years: understanding racial/ethnic disparities.

OBJECTIVE: We examined circumstances surrounding swimming pool drownings among US residents aged 5 to 24 years to understand why Black males and other racial/ethnic groups have high drowning rates. METHODS: We obtained data about drowning deaths in the United States (1995-1998) from death certificates, medical examiner reports, and newspaper clippings collected by the US Consumer Product Safety Commission. RESULTS: During the study period, 678 US residents aged 5 to 24 years drowned in pools. Seventy-five percent were male, 47% were Black, 33% were White, and 12% were Hispanic. Drowning rates were highest among Black males, and this increased risk persisted after we controlled for income. The majority of Black victims (51%) drowned in public pools, the majority of White victims (55%) drowned in residential pools, and the majority of Hispanic victims (35%) drowned in neighborhood pools (e.g., an apartment complex pool). Foreign-born males also had an increased risk for drowning compared with American-born males. CONCLUSIONS: Targeted interventions are needed to reduce the incidence of swimming pool drownings across racial/ethnic groups, particularly adult supervision at public pools.

Adolescent↗

PubMed2006

Safety climate and self-reported injury: assessing the mediating role of employee safety control.

To further reduce injuries in the workplace, companies have begun focusing on organizational factors which may contribute to workplace safety. Safety climate is an organizational factor commonly cited as a predictor of injury occurrence. Characterized by the shared perceptions of employees, safety climate can be viewed as a snapshot of the prevailing state of safety in the organization at a discrete point in time. However, few studies have elaborated plausible mechanisms through which safety climate likely influences injury occurrence. A mediating model is proposed to link safety climate (i.e., management commitment to safety, return-to-work policies, post-injury administration, and safety training) with self-reported injury through employees' perceived control on safety. Factorial evidence substantiated that management commitment to safety, return-to-work policies, post-injury administration, and safety training are important dimensions of safety climate. In addition, the data support that safety climate is a critical factor predicting the history of a self-reported occupational injury, and that employee safety control mediates the relationship between safety climate and occupational injury. These findings highlight the importance of incorporating organizational factors and workers' characteristics in efforts to improve organizational safety performance.

Accidents, Occupational↗

PubMed2006

The relationship between safety climate and injury rates across industries: the need to adjust for injury hazards.

Previous studies have suggested that strong safety climates (shared perceptions of safe conducts at work) are associated with lower workplace-injury rates, but they rarely control for differences in industry hazards. Based on 33 companies, we assessed its association with injury rates using three rate based injury measures (claims per 100 employees, claims per 100,000 h worked, and claims per 1 million US dollars payroll), which were derived from workers' compensation injury claims. Linear regression models were used to test the predictability of safety climate on injury rates, followed by controlling for differences in hazard across industries gauged by national industry-specific injury rates. In the unadjusted model, company level safety climate were negatively and significantly associated with injury rates. However, all of the above associations were no longer apparent when controlling for the hazardousness of the specific industry. These findings may be due to over adjustment of hazard risk, or the overwhelming effects of industry specific hazards relative to safety climate effects that could not be differentiated with the statistical power in our study. Industry differences in hazard, conceptualized as one type of injury risk, however need to be considered when testing the association between safety climate and injury across different industries.

Accidents, Occupational↗

PubMed2006

How well does a national newspaper reporting system profile drowning?

In Finland, the Finnish Association for Swimming Instruction and Life Saving (SUH) and Statistics Finland (SF) both provide nationwide data on unintentional drowning. The SUH database relies on rapid reporting from a newspaper clipping service and additional local police information, whereas the SF database relies on the later release of the death certificate information, which is based on extensive medico-legal investigation. The aim of the study was to explore the main differences between the SUH and SF databases for drowning and to evaluate the capacity of the former to characterize drowning events in Finland from 1998 to 2000. Computerized files of death certificates tabulated by SF were linked with the SUH database by deterministic methods. SF and SUH databases allowed the identification of 704 and 567 unintentional drownings, respectively, giving an unintentional drowning rate of 4.5 and 3.6/100?000 per year. Of the 704 drownings described by SF, 418 (59.4%) were also found in the SUH database. The SUH database markedly underreported drowning fatalities in certain settings, such as bath, ditch and swimming pool drownings; fall- and land-traffic-related drownings; and drownings occurring in South Finland. The narrative text of SUH drownings contributed limited information to characterize the drowning events. It was concluded that the newspaper-based SUH data provide more timely data on individual drownings but are not representative of all drownings. Conversely, the SF vital statistics data are more accurate but may take up to 2 years to become available. Both SUH and SF data provide little detailed information on drowning events. A multidisciplinary national surveillance system for drowning is necessary to provide more accurate and timely drowning data, analyse risk factors and design follow-up studies for developing and monitoring prevention strategies.

Adolescent↗

PubMed2006

Declared and undeclared substance use among emergency department patients: a population-based study.

AIMS: To estimate both self-reported and corrected prevalences of substance use in a population-based study of general hospital emergency department (ED) patients and predict undeclared use. DESIGN: A state-wide cross-sectional, two-stage probability sample survey that incorporates toxicological screening. SETTING: Seven Tennessee EDs in acute care, adult, civilian, non-psychiatric hospitals. PARTICIPANTS: A total of 1502 Tennessee residents, 18 years of age and older, possessing intact cognition, able to give informed consent and not in police custody. Measurements Prevalence of self-reported current substance use by age, sex and type with correction for under-reporting based on toxicological screening. Covariates in the multivariate analysis of undeclared use were socio-demographics, ED visit circumstances, health-care coverage, prior health status and treatment history and tobacco addiction. FINDINGS: Declared current use was highest for alcohol (females 26%, males 47%), marijuana (males 11%, females 6%) and benzodiazepines (females 10%, males 7%). After correction for under-reporting, overall use for any of the eight targeted substances rose from 44% to 56% for females and 61% to 69% for males. Largest absolute changes involved opioids, benzodiazepines, marijuana, amphetamines and/or methamphetamine, with little change for alcohol. Patients aged 65 years and older manifested excess undeclared use relative to patients aged 18-24 years, as did patients not reporting tobacco addiction or receiving substance abuse treatment. CONCLUSION: Adjustment for under-reporting produced minimal change in the estimated prevalence of alcohol use. However, toxicological screening markedly increased estimates of other drug use, especially for the elderly, who may under-report medication use. Screening tests are useful tools for detecting undeclared substance use.

Adolescent↗

PubMed2005

Unmet substance abuse treatment need, health services utilization, and cost: a population-based emergency department study.

STUDY OBJECTIVE: There is a high prevalence of unmet substance abuse treatment need among adult hospital emergency department (ED) patients. We examine the association between this unmet need and excess utilization of health services and estimate costs. METHODS: A statewide, 2-stage, probability sample survey was conducted in 7 Tennessee general hospital EDs from June 1996 to January 1997. Toxicologic screening augmented in-person interviews. Main outcome measures were ED case disposition; frequency of physician office visits, ED visits, and hospitalizations in the past 12 months; and costs of excess service utilization. Covariates in the multivariate model were substance abuse treatment need status, age, sex, main reason for ED visit, perceived previous health status, history of tobacco use, and health care coverage. Unmet substance abuse treatment need was assessed using 13 overlapping criteria that incorporated use, dependence, denial, and treatment history. Target substances included ethanol and selected illegal and prescription drugs but not nicotine. RESULTS: Compared with patients without substance abuse treatment need (n=1,073), patients with unmet need (n=415) were 81% more likely to be admitted to the hospital during their current ED visit (odds ratio [OR] 1.81; 95% confidence interval [CI] 1.27 to 2.64) and 46% more likely to have reported making at least 1 ED visit in the previous 12 months (OR 1.46; 95% CI 1.12 to 1.84). Their utilization patterns accounted for an estimated 777.2 million US dollars in extra hospital charges for Tennessee in 2000 dollars, representing an additional 1,568 US dollars per ED patient with unmet substance abuse treatment need. CONCLUSION: ED patients with unmet substance abuse treatment need generated much higher hospital and ED charges than patients without such need. Given potential savings from avoidable health care costs, the future burden of substance-associated ED visits and hospitalizations may be reduced through programs that screen and, as appropriate, provide brief interventions or treatment options to these patients.

Adolescent↗

PubMed2005

The use of sentinel injury deaths to evaluate the quality of multiple source reporting for occupational injuries.

PURPOSE: This study sought to develop an efficient method for evaluating the validity and completeness of routinely available sources of occupational injury fatality data. METHODS: Deaths due to falls from elevations, machinery, and electrocutions were selected as sentinel injuries likely to have occurred at work. Deaths from these injuries were identified from Maryland vital statistics over 7 years. The work-relatedness of these injuries and sensitivity of reporting were determined from death certificates, medical examiner reports, the National Traumatic Occupational Fatality System (NTOF), the Maryland Occupational Safety and Health Administration (MOSH), and Workers' Compensation (WC) data. RESULTS: A total of 527 deaths were identified for ages 16 and above, of which, 45% were work-related. Identification of work-related deaths varied by source: medical examiner (100%), death certificates (89%), NTOF (68%), MOSH (59%), and WC (44%). Reporting differed by age, cause of injury, year, occupation, and industry. CONCLUSIONS: Examination of work-relatedness for deaths from certain causes is an efficient means of evaluating the quality of occupational injury reporting source data. These sentinel injuries uncovered significant underreporting in sources used by national surveillance systems, resulted in improved NTOF reporting, and suggest the need to make more use of medical examiner data when available.

Accidents, Occupational↗

PubMed2005

Does occupation explain gender and other differences in work-related eye injury hospitalization rates?

OBJECTIVE: We sought to determine whether demographic differences in eye injury rates persist after adjusting for occupational exposure. METHODS: On-duty eye injury hospitalizations were linked to occupation among active-duty US Army personnel. RESULTS: Eye injury rates were higher for white soldiers, men, and for younger soldiers, even after adjusting for occupational group and specific job titles using multivariate models. CONCLUSIONS: This finding contrasts with studies of other injuries, suggesting that occupation does not fully account for variations in eye injury risk. Because protective eye-wear can prevent most serious eye injuries, we hypothesize that differences in protective eye-wear use between men and women may contribute to differences in eye injury rates, although follow-up studies are needed to confirm this. Prevention efforts should consider targeting high-risk demographic groups in addition to high-risk occupations.

Adolescent↗

PubMed2005

Injuries at work in the US adult population: contributions to the total injury burden.

OBJECTIVES: We estimated the contribution of nonfatal work-related injuries on the injury burden among working-age adults (aged 18-64 years) in the United States. METHODS: We used the 1997-1999 National Health Interview Survey (NHIS) to estimate injury rates and proportions of work-related vs non-work-related injuries. RESULTS: An estimated 19.4 million medically treated injuries occurred annually to working-age adults (11.7 episodes per 100 persons; 95% confidence interval [CI]=11.3, 12.1); 29%, or 5.5 million (4.5 per 100 persons; 95% CI=4.2, 4.7), occurred at work and varied by gender, age, and race/ethnicity. Among employed persons, 38% of injuries occurred at work, and among employed men aged 55-64 years, 49% of injuries occurred at work. CONCLUSIONS: Injuries at work comprise a substantial part of the injury burden, accounting for nearly half of all injuries in some age groups. The NHIS provides an important source of population-based data with which to determine the work relatedness of injuries. Study estimates of days away from work after injury were 1.8 times higher than the Bureau of Labor Statistics (BLS) workplace-based estimates and 1.4 times as high as BLS estimates for private industry. The prominence of occupational injuries among injuries to working-age adults reinforces the need to examine workplace conditions in efforts to reduce the societal impact of injuries.

Adult↗

PubMed2004

Unintentional drowning in Finland 1970-2000: a population-based study.

BACKGROUND: While standard data on drowning reported by the World Health Organization (WHO) fails to provide a reliable picture of the burden of drowning in Finland, they suggest that the rates are much higher than those of other industrialized countries. AIM: To determine the true burden of drowning in Finland and factors related to its high rates. DESIGN: Descriptive, retrospective, population-based analysis of all deaths by drowning, among residents of all ages. SETTING: Finland, 1970-2000. MATERIAL AND METHODS: Mortality and population data furnished by Statistics Finland (SF) were used to determine age- and sex-specific drowning mortality rates using both nature- and cause-of-injury codes. Individual-level data from the death certificates were analysed and cross-linked to a nationwide postmortem toxicology database. RESULTS: From 1970 to 2000, 9279 unintentional drownings occurred (mean: 299.3/year SD 84.3, rate 6.1/100 000/year; M:F ratio = 8.6:1), accounting for 11.7% of all unintentional injury deaths. Drowning rates overall have decreased from 9.9/100 000/year in 1970-1972, to 4.5 in 1998-2000 (-2.7%/year; 95% CL: -3.0; -2.5). The most frequent activities related to drowning included boating (29.8%), falling (26.1%), swimming (25.0%), and activities on ice (12.4%). In non-boating-related drownings, 74.5% of males and 67.4% of females tested had a blood alcohol concentration (BAC) >/=50 mg/dl, while in boating-related drownings, the respective values were 78.1% and 71.4%. CONCLUSIONS: WHO statistics underestimate the true burden of drowning in Finland by up to 40-50%. Drowning rates and alcohol involvement in drowning are much higher than in other comparable developed countries. Broad-based countermeasures to reduce alcohol use in water activities are needed as part of any strategy to reduce drowning rates.

Adolescent↗

PubMed2004

Computerized coding of injury narrative data from the National Health Interview Survey.

OBJECTIVE: To investigate the accuracy of a computerized method for classifying injury narratives into external-cause-of-injury and poisoning (E-code) categories. METHODS: This study used injury narratives and corresponding E-codes assigned by experts from the 1997 and 1998 US National Health Interview Survey (NHIS). A Fuzzy Bayesian model was used to assign injury descriptions to 13 E-code categories. Sensitivity, specificity and positive predictive value were measured by comparing the computer generated codes with E-code categories assigned by experts. RESULTS: The computer program correctly classified 4695 (82.7%) of the 5677 injury narratives when multiple words were included as keywords in the model. The use of multiple-word predictors compared with using single words alone improved both the sensitivity and specificity of the computer generated codes. The program is capable of identifying and filtering out cases that would benefit most from manual coding. For example, the program could be used to code the narrative if the maximum probability of a category given the keywords in the narrative was at least 0.9. If the maximum probability was lower than 0.9 (which will be the case for approximately 33% of the narratives) the case would be filtered out for manual review. CONCLUSIONS: A computer program based on Fuzzy Bayes logic is capable of accurately categorizing cause-of-injury codes from injury narratives. The capacity to filter out certain cases for manual coding improves the utility of this process.

Forms and Records Control↗

PubMed2004

Alcohol involvement in burn, submersion, spinal cord, and brain injuries.

BACKGROUND: Alcohol is involved in many injuries, but estimates of this involvement vary considerably. Most information pertains to deaths although most injuries are nonfatal. MATERIAL/METHODS: The portion of fatal and nonfatal injuries involving alcohol was determined from a comprehensive Oklahoma surveillance system that tracks persons killed or hospitalized due to burns, submersions, spinal cord injuries (SCIs), and traumatic brain injuries (TBIs). Logistic regression was used to determine factors that explain the percentage of alcohol involvement in fatal versus nonfatal cases. RESULTS: The victim was alcohol involved in 17% of fire burns, 4% of scald burns, 24% of submersions, 34% of SCIs, and 41% of TBIs where involvement was known. Large differences existed in total alcohol involvement between age and gender groups and between fatal and nonfatal cases of fire burns (31% vs.11%) and submersions (33% vs. 6%). Large differences also existed in victim alcohol involvement between fatal and nonfatal cases of intentional SCIs (0% vs. 48%) and TBIs (38% vs. 70%). Those who imbibed during the day were not at excess risk of scald injury, but they were twice as likely to suffer a serious fire burn, 3 times as likely to suffer a spinal cord injury, 3.5 times as likely to suffer a submersion injury, and 2 to 4 times as likely to suffer a TBI. These excess risks persisted for all age groups between 15 and 64, with the excess risk especially high for underage drinkers aged 15 to 20. In contrast, people aged 65 and older did not appear to be at excess risk on days that they imbibed. CONCLUSIONS: A large percentage of fatal and nonfatal injuries as classified by diagnosis group involve alcohol. People who had been drinking were substantially more likely to suffer serious nonfatal and fatal injuries other than scald burns.

Adolescent↗

PubMed2003

The effect of cigarette smoking on musculoskeletal-related disability.

BACKGROUND: This study describes cigarette smoking's effect on development of physical disability following initial musculoskeletal-related hospitalization. METHODS: We followed 15,140 US Army personnel hospitalized for common musculoskeletal disorders between 1989-1996 for up to 8 years (1997) to assess risk for long-term physical disability. RESULTS: Trends between increased smoking level and long-term disability were identified for persons with knee injuries, rotator cuff injuries, and intervertebral disc displacement. In proportional hazards models, disability was significantly associated with heavy smoking among all subjects (relative hazard (RH) = 1.21). Both heavy smokers (RH = 1.49) and light to moderate smokers (RH = 1.44) were at greater risk for disability following meniscal injuries. Excess fraction due to smoking among subjects with meniscal injuries who currently smoke was 38%. CONCLUSIONS: Findings suggest an association between smoking and development of disability following meniscal injury. Given the high excess fraction of disability associated with smoking, other studies are needed to confirm this association.

Adult↗

PubMed2003

Evidence for an early onset of endogenous alcohol production in bodies recovered from the water: implications for studying alcohol and drowning.

Endogenous alcohol production can increase the blood alcohol concentration (BAC) of drowning victims following submersion and confound epidemiological studies of the role of alcohol. This study seeks to determine how soon after a drowning death a victim's BAC is influenced by post-mortem alcohol production. The drop in mean lung weight that occurs over time in the water was hypothesized to serve as a proxy for the time course of decomposition, and thus provide an empirical measure to determine how soon after death to first suspect endogenous alcohol. The autopsy lung weights of 562 previously healthy males who drowned were compared across six submersion time groups (0-11.9, 12-23.9, 24-47.9, 48-95.9, 96-167.9 and >or=168 h) and two times of year (winter and non-winter). The hypothesis that a drop in lung weight is sensitive to the time course of decomposition was supported by (1). a statistically significant drop in mean lung weight that occurred 12-23.9 h post-submersion in the non-winter months, but not until 96-167.9 h in the colder winter months; and (2). a significant drop in lung weight was not observed in the group of cases with zero BAC. With a parallel finding that an increase in the proportion of cases with a positive BAC first occurred at the 12-23.9 h submersion group during the warmer non-winter months, we concluded that production of alcohol can occur in bodies recovered from the water as early as 12 h after death. Because excluding drownings with submersion durations greater than 12 h would exclude almost half of our cases from epidemiological studies of alcohol and drowning, additional evidence from the forensic literature was used to develop an adjustment procedure to account for endogenous alcohol production for submersion times of up to 1 week.

Adolescent↗

PubMed2003

Assessing substance abuse treatment need: a statewide hospital emergency department study.

STUDY OBJECTIVE: Health care providers in hospital emergency departments rarely take substance abuse histories or assess associated treatment need. This study compares documentation of psychoactive drug-related diagnoses for adult ED patients in medical records with treatment need assessed through self-report, toxicologic screening, and Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV), criteria. METHODS: A statewide, 2-stage, probability sample survey was conducted in 7 Tennessee general hospital EDs from June 1996 to January 1997. Main outcome measures were the prevalence of diagnosed substance abuse problems, positive bioassay results, denied use, and treatment need. Sensitivity and multivariate analyses were conducted by using varied case definitions of treatment need. RESULTS: Thirty-one percent (95% confidence interval [CI] 27.3% to 34.7%) of screened ED patients (n=1,330) had positive test results for substance use. Their prevalence of denial of use in the 30 days before the survey ranged from 10% for alcohol (95% CI 5.7% to 14.3%) to 100% for phencyclidine. One percent of all ED patients (n=1,502) had a recorded diagnosis of substance abuse. By contrast, as many as 27% (95% CI 23.3% to 31.8%) were assessed as needing substance abuse treatment on the basis of a comprehensive case definition that accounted for denial and positive test results. A sensitivity analysis using other case definitions is also presented. For example, 4% (95% CI 2.8% to 5.3%) of patients met the very strict definition of DSM-IV current drug dependence only. Under the comprehensive case definition, TennCare patients (adjusted odds ratio [OR] 1.63; 95% CI 1.30 to 2.05) and Medicare patients (adjusted OR 2.50; 95% CI 1.34 to 4.65) showed excess treatment need relative to the privately insured. Excess need was also exhibited by patients reporting 1 or more prior ED visits in the past year (adjusted OR 1.62; 95% CI 1.13 to 2.31) and by patients taking 2 or more hours to reach the ED after the onset of injury or illness (adjusted OR 1.54; 95% CI 1.16 to 2.04). Treatment need was inversely associated with age. Irrespective of case definition, less than 10% of ED patients who needed substance abuse treatment were receiving such treatment. CONCLUSION: EDs can be important venues for detecting persons in need of substance abuse treatment.

Adolescent↗

PubMed2003

Swimming lessons, swimming ability, and the risk of drowning.

Drowning is a leading cause of injury related death in many countries. Strategies to prevent these deaths depend upon characteristics of the victim and the specific circumstances surrounding the event. One preventive strategy that may be beneficial for persons of all ages and under nearly all circumstances is increased swimming ability, through some form of swimming instruction. However, a clear protective relationship between increased swimming ability and the risk of drowning has never been demonstrated. Studies focused on children, suggest that swimming ability may confer some protection, although the data are far from conclusive. This paper (1) reviews the current evidence regarding the relationship between swimming ability, swimming lessons and the risk of drowning, (2) reviews the past and present recommendations for swimming instruction and (3) outlines future research needs.

Adolescent↗

PubMed2003

Undetermined drowning.

Drowning is one of the leading causes of death when the manner of death remains undetermined. In the present study, we examined the epidemiological and medico-legal profile of 276 undetermined deaths (M:F=3.4:1; mean age 41.9+/-16.0 SD) among 1,707 consecutive bodies found in water and autopsied at the Department of Forensic Medicine, University of Helsinki, from 1976 to 2000. We also describe the differences between the police investigator's initial opinion and the forensic pathologist's death certification, and the different approaches among forensic pathologists when determining the cause of death. There was considerable variation among individual pathologists in the percentage of deaths considered undetermined but these differences were not significantly related to their level of training. Medico-legal training should focus on a standardised diagnostic approach to borderline cases, in which essential factors in determining the manner of death are often ambiguous.

Accidents↗