Cardiopulmonary resuscitation in nursing homes.
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Cardiopulmonary Resuscitation↗
Biomedical subjects
J A Grisso
Publications and source records attributed to J A Grisso.
Occupational injuries in a poor inner-city population.
This study aims to characterize occupational injuries in a defined poor inner-city population in terms of demographic features, types, and circumstances of injuries, and medical and financial consequences. It is a case series drawn from a larger population-based injury registry in emergency departments that serve 17 poor census tracts in Philadelphia. Of 335 patients from the study area who had been treated at the emergency departments under study for occupational injuries, 107 could be contacted by telephone 2 to 3 years after their injuries. Interviews sought information on the patients, their employment, their injuries, and the consequences. Respondents were almost all African-American, approximately 50% male, and had a median age of 32. Approximately one third were employed in the health care industry, one fourth in the service sector (including conventional service firms, restaurants, and hotels), and the remainder in construction, retail and wholesale trade, education, transportation, and manufacturing. Major causes of injuries included overexertion, contact with sharp objects, and falls. Major types on injuries included sprain/strains and lacerations. Approximately half the respondents had missed more than 3 days of work, with 15% missing more than 1 month. Almost 40% of respondents reported persistent health problems after their injuries. Only about one quarter had received workers' compensation. We conclude that poor and minority workers are at risk of a wide range of occupational injuries, which may result in considerable lost work time and have serious medical and economic consequences. More, attention to the workplace risks of these relatively marginalized workers and more vigorous preventive interventions are needed.
Accidents, Occupational↗
Risk factors for hip fracture in black women. The Northeast Hip Fracture Study Group.
BACKGROUND: Although more than 1 percent of black women 80 years of age or older have hip fractures each year, little is known about risk factors for hip fracture in these women. METHODS: We carried out a case-control study involving 144 black women admitted with a first hip fracture to 1 of 30 hospitals in New York and Philadelphia. The control were 218 black women living in the community who were matched to the case patients according to age and ZIP Code or telephone exchange and 181 hospitalized black women matched according to age and hospital. Information was obtained through personal interviews and was studied by multivariable logistic-regression analysis. RESULTS: When the case patients were compared with the control subjects from the community, the women in the lowest quintile for body-mass index had a markedly increased risk of hip fracture as compared with the women in the highest quintile (odds ratio, 13.5; 95 percent confidence interval, 4.2 to 43.3). Postmenopausal estrogen therapy for one year or more was protective for women under 75 years of age (odds ratio, 0.1; 95 percent confidence interval, < 0.1 to 0.5). Factors associated with an increased risk of hip fracture included a history of stroke (odds ratio, 3.1; 95 percent confidence interval, 1.2 to 8.1), use of aids in walking (odds ratio, 5.6; 95 percent confidence interval, 2.7 to 11.5), and consumption of seven or more alcoholic drinks per week (odds ratio, 4.6; 95 percent confidence interval, 1.5 to 14.1). The results were similar when the case patients were compared with the hospitalized control subjects. CONCLUSIONS: Among black women thinness, previous stroke, use of aids in walking, and alcohol consumption are associated with an increased risk of hip fracture. Postmenopausal estrogen therapy protects against hip fracture in women under 75 years of age.
Aged↗
A longitudinal study of injury morbidity in an African-American population.
OBJECTIVE: To improve understanding of the patterns of injury morbidity and mortality in an urban African-American population. DESIGN: Prospective survey of emergency department records for a geographically defined population from 1987 through 1990. SETTING: Eleven hospital emergency departments in Philadelphia, Pa. PARTICIPANTS: The approximately 68,000 people living in 17 census tracts in western Philadelphia. RESULTS: A total of 46,260 injury events were identified in the survey (168.8 events per 1000 population annually). Half of the population made an emergency department visit for one or more injuries during the 4 years of study. There were 2796 hospital admissions (10.2/1000 population) and 403 deaths (1.5/1000 population) as a result of these injuries. Although in 1987 falls were the most frequent type of injury resulting in an emergency department visit, by 1989 the number of interpersonal intentional injury events exceeded the number of falls. Interpersonal intentional injuries accounted for 31.2% of hospital admissions and 42.7% of deaths. Of men 20 through 29 years old, 94.3% visited an emergency department at least once in the 4 years because of an injury, and 40.9% of men in this age group sought treatment for one or more interpersonal intentional injuries. The likelihood of future interpersonal intentional injury-related visits increased with the number of previous injuries of this type. CONCLUSIONS: Interpersonal intentional injury occurs frequently in this population. More attention needs to be paid to prevention and intervention to reduce the toll of this violence. The high prevalence of injury in certain age strata may make general, population-based efforts for injury prevention more efficient than efforts targeted to subgroups.
Accidental Falls↗
Diagnostic ultrasound in pregnancy and low birthweight.
Diagnostic ultrasound has been used increasingly in obstetric practice over the past decade. To date, adverse effects of ultrasound on the fetus have not been reported, but studies have been done on small sample sizes. This study looks specifically at the association of ultrasound exposure during pregnancy and the risk of low birthweight in the offspring. A validation case-control study was also performed based on information from a sample of medical charts. With a database of more than 13,000 pregnancies, there was no indication of an adverse effect of ultrasound performed during the first two trimesters of pregnancy.
Adolescent↗
Making comparisons.
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Case-Control Studies↗
Parity, lactation and hip fracture.
The relationship between parity, lactation and the occurrence of hip fracture was investigated in a case-control study of white women. The cases were patients (n = 174) aged 45 years and over with a radiologically confirmed first hip fracture sampled from among admissions to 30 hospitals in New York and Philadelphia between September 1987 and July 1989. Controls (n = 174) were selected from general surgical and orthopedic services during the same time period and were frequency-matched to cases by age and hospital. Ever having a live birth was associated with reduced odds of hip fracture, controlling for age and hospital of recruitment (odds ratio = 0.65; 95% confidence interval = 0.41-1.04). When body mass index was also controlled, each birth was associated on average with a 9% reduction in the odds of hip fracture (odds ratio = 0.92 [0.78-1.08]), although the trend was not statistically significant. After adjusting for number of births, lactation was not associated with hip fracture (adjusted odds ratio for 12 months of lactation or less = 0.80 [0.42-1.55]; adjusted odds ratio for more than 12 months = 1.08 [0.45-2.60]).
Aged↗
An injury prevention program in an urban African-American community.
OBJECTIVES: Injury is a major US public health problem, particularly in urban minority communities. This paper evaluates the impact of the Safe Block Project, a comprehensive injury prevention trial, on home hazards and injury prevention knowledge in a poor urban African-American community. METHODS: Nine census tracts in the community were allocated to either the intervention area or the control area. The intervention, carried out by trained community outreach workers, consisted of (1) home modification for simple prevention measures, (2) home inspection accompanied by information about home hazards, and (3) education about selected injury prevention practices. Approximately 12 months after the intervention, random samples of control and intervention homes were assessed for home hazards and injury prevention knowledge. RESULTS: A significantly larger proportion of intervention homes than control homes had functioning smoke detectors, syrup of ipecac, safely stored medications, and reduced electrical and tripping hazards. No consistent differences were observed between control and intervention homes on home hazards requiring major effort to correct. CONCLUSIONS: There was a distinct difference between control and intervention homes with respect to safety knowledge and home hazards requiring minimal to moderate effort to correct. The Safe Block Project could serve as a model for future urban injury prevention efforts.
Accidents, Home↗
Hospitalized elders. Risk of confusion with hip fracture.
Although frequently underdiagnosed, more than half of all patients admitted for the treatment of hip fracture are confused at the time of hospital admission or develop confusion sometime during the course of hospitalization. This study reveals the profound vulnerability of severely confused patients with hip fracture. Severely confused patients experience higher overall rates of medical complications and are more likely to be discharged to a nursing home. In addition to being at higher risk for medical complications, severely confused patients also appear to be at greater risk for being physically restrained.
Aged↗
Economic analysis of malaria control for migrant workers in eastern Thailand.
A randomized, double-blind field trial was carried out to compare the economic impact of permethrin-treated nets with that of untreated nets as a method of malaria control. The study was conducted in 261 long-term migrant workers and 138 seasonal agricultural migrant workers in the eastern rural areas known to be highly endemic for multidrug-resistant Plasmodium falciparum infection. One hundred and twenty-six longterm migrants and 59 seasonal migrants used treated nets, while 135 and 79, respectively, used untreated nets. The impregnated-nets program was cost-saving as well as offering improved effectiveness. The net benefit of using a treated net was US$1.17 per worker from the Malaria Division's perspective and US$1.61 per worker from the worker viewpoint. The use of impregnated nets with large-scale primary health care programs likely will be the most cost-effective and cost-beneficial method for controlling malaria in eastern Thailand.
Cost-Benefit Analysis↗
A case-control study of hip fracture: evaluation of selected dietary variables and teenage physical activity.
Recent diet, teenage physical activity and teenage calcium consumption were examined as risk factors for hip fracture in a case-control study. Cases were 161 white women admitted to one of 30 participating hospitals with a first hip fracture. Controls included 168 white women from general and orthopedic surgical services frequency-matched to cases by age group and hospital. Information on exposure to possible risk factors was obtained by in-person interview. No association was found between recent intake of calcium, phosphorus, protein, vitamin C or caffeine and hip fracture. Also, teenage calcium intake and milk drinking were not related to hip fracture risk. Recreational activities in adolescence and early adulthood appeared to afford protection against hip fracture. The highest quartile of recreational activity (greater than or equal to 4 times/week) was associated with an odds ratio of 0.24 (95% confidence interval 0.08-0.75) relative to the lowest quartile (less than 1 time/week).
Adolescent↗
The impact of falls in an inner-city elderly African-American population.
OBJECTIVE: To describe the impact of falls in an elderly African-American urban community and to identify predictors of poor recovery from falls. DESIGN: Prospective cohort study. SETTING: Emergency departments of 11 hospitals in western Philadelphia. SUBJECTS: Interviews were conducted with 197 African-American persons 65 years and older residing in West Philadelphia who were treated at an emergency department because of a fall. Second interviews were conducted a median of 7 months after the fall with a sample of 70 patients who had not recovered at the time of the first interview. MAIN OUTCOME MEASURES: Information abstracted from emergency department medical records and information on recovery obtained from two subsequent interviews. RESULTS: A median of 8 weeks after the fall occurred, 43% of persons reported continued pain or restriction in their usual activities as a result of the fall. Predictors of poor recovery included the presence of grandchildren in the household, hearing impairment, severity of the injury, and injury to the lower extremities. Having someone present at the time of the fall was associated with a lower risk of poor recovery. Forty-one percent of the 70 persons interviewed a second time reported continued pain or restriction in usual activities a median of 7 months after the fall occurred. However, only 7% and 39% had received the services of a home health aide or physical therapist, respectively, and only 14% reported that a physician or other health professional had been particularly helpful since the fall had occurred. CONCLUSIONS: A large proportion of elderly African-American persons treated at emergency departments for falls experience continued pain and restriction of activities after the fall. Many individuals have not recovered 7 months or longer after the fall and few persons report that a physician or other health professional has been particularly helpful since the fall occurred. We suggest that follow-up programs be developed for elderly persons in minority communities who come to emergency departments after a fall.
Accidental Falls↗
A population-based study of injuries in inner-city women.
Although injuries are the number one cause of death for women under age 45 years in the United States, very little is known about nonfatal injuries to women, particularly those from urban, black communities. The Philadelphia Injury Prevention Program is a surveillance system of fatal and nonfatal injuries in a poor, urban, black community in western Philadelphia, Pennsylvania. Nearly 10% of the estimated population of 31,032 women aged 15 years and older suffered an injury resulting in an emergency room visit or death during the 1-year study period from March 1, 1987 through February 29, 1988. The major causes of injury were falls (25.1 per 1,000 women), violence (20.8 per 1,000 women), and motor vehicle incidents (16.8 per 1,000 women). Violence was the leading cause of injury for women aged 15-44 years and the most common cause of injuries among women with two or more injuries during the 1-year period. Injury rates were highest for women aged 25-34 years (157.1 per 1,000 women); nearly 16% of the population in this age group suffered an injury resulting in an emergency room visit or death during the 1-year study period. Rates declined with advancing age for each injury type except for falls; which were most common in young women aged 25-34 years (28.4 per 1,000 women) and in the aged 65 years and older (29.0 per 1,000 women). We conclude that in his population, injuries to young women appear to be a major public health problem. More work is needed to understand the nature of injuries occurring to young women in urban communities.
Accidental Falls↗
Risk factors for falls as a cause of hip fracture in women. The Northeast Hip Fracture Study Group.
BACKGROUND: Although even in the elderly most falls are not associated with fractures, over 90 percent of hip fractures are the result of a fall. Few studies have assessed whether the risk factors for falls are also important risk factors for hip fracture. METHODS: To examine the importance of risk factors for falls in the epidemiology of hip fracture, we performed a case-control study of 174 women (median age, 80 years) admitted with a first hip fracture to 1 of 30 hospitals in New York and Philadelphia. Controls, matched to the case patients according to age and hospital, were selected from general surgical and orthopedic surgical hospital services. Information was obtained by direct interview. RESULTS: As measured by the odds ratio, increased risks for hip fracture were associated with lower-limb dysfunction (odds ratio = 1.7; 95 percent confidence interval, 1.1 to 2.8), visual impairment (odds ratio = 5.1; 95 percent confidence interval, 1.9 to 13.9), previous stroke (odds ratio = 2.0; 95 percent confidence interval, 1.0 to 4.0), Parkinson's disease (odds ratio = 9.4; 95 percent confidence interval, 1.2 to 76.1), and use of long-acting barbiturates (odds ratio = 5.2; 95 percent confidence interval, 0.6 to 45.0). Of the controls, 44 (25 percent) had had a recent fall. The case patients were more likely than these controls to have fallen from a standing height or higher (odds ratio = 2.4; 95 percent confidence interval, 1.0 to 5.7). Of those with hip fracture the younger patients (less than 75 years old) were more likely than the older ones (greater than or equal to 75 years old) to have fallen on a hard surface (odds ratio = 1.9; 95 percent confidence interval, 1.04 to 3.7). CONCLUSIONS: A number of factors that have been identified as risk factors for falls are also associated with hip fracture, including lower-limb dysfunction, neurologic conditions, barbiturate use, and visual impairment. Given the prevalence of these problems among the elderly, who are at highest risk, programs to prevent hip fracture should include measures to prevent falls in addition to measures to slow bone loss.
Accidental Falls↗
Parental leave policies for faculty in U.S. medical schools.
OBJECTIVE: To assess medical school policies for maternity and other parental leaves as well as related opportunities for part-time employment, flexibility in tenure systems, and the availability of child care centers. DESIGN: Cross-sectional survey of all 127 U.S. medical schools based on telephone interviews and review of faculty handbooks. MEASUREMENTS AND MAIN RESULTS: Ninety-three percent of medical schools responded. Twenty-two percent of medical schools have no written guidelines for maternity leave, 45% categorize maternity leave as a form of sick or disability leave, and only 34% have developed specific policies. Most schools (61%) require that maternity leave be taken from allotted sick days or from vacation days (or from both) for women to obtain salary support. The time available from sick and vacation leave averages 6.8 weeks. Although 72% of schools make allowances in the tenure probationary period for extended leaves of absence, few have developed specific provisions for childbearing or childrearing. Finally, 18% of medical schools have child care facilities. CONCLUSIONS: Considerable work is needed to develop adequate support for faculty members who are parents. Recommendations include developing specific parental leave policies and flexible tenure systems and providing adequate child care facilities.
Absenteeism↗
Risk factors for hip fractures in men: a preliminary study.
Although hip fracture rates are higher in women than in men, for older men the lifetime risk of fractures of the femur is substantial. Very little is known about risk factors for hip fracture in men. A preliminary case control study was conducted comparing the medical charts of men with first hip fractures with two sets of age-matched controls. The major risk factors for hip fracture that emerged were preadmission ambulatory problems, confusion, heavy alcohol use, and low body mass. Although this study is limited to a medical chart review in a veteran population, these results confirm some of the known associations for hip fracture in women. Further studies in men are recommended.
Adult↗
Extended longitudinal study of uterine activity among low-risk women.
Eighty-nine black women without major medical risks for preterm labor participated in this longitudinal, prospective study for the evaluation of usual prelabor uterine activity and for the assessment of how gestational age, time of day, maternal weight, age, and parity affected contraction frequency. Participants wore an ambulatory tocodynamometer for 72 consecutive hours at three points in gestation during the second and early third trimesters while engaged in usual home and work activity. Data obtained from the 81 women with uncomplicated term pregnancies demonstrated a significant increase in contraction frequency with advancing gestational age between 22 and 33 weeks. After 26 weeks, significantly more uterine activity occurred at night. Perhaps because of detection difficulties, contraction frequency was inversely related to maternal weight in women weighing greater than 112% ideal weight. Maternal age and parity did not affect contraction frequency. Contraction characteristics of eight women experiencing preterm labor or medically indicated preterm delivery are described.
Adolescent↗
Interpersonal violence-related injuries in an African-American community in Philadelphia.
Violence has been recognized as a significant health problem. This study describes fatal and nonfatal interpersonal violence-related injury events over 1 year in an indigent African-American community in Philadelphia. Information on injuries was collected from emergency rooms, the Office of the Medical Examiner, and death certificate files. For persons aged 15 through 49 years, violence-related injury rates surpassed any other injury type. The overall violence-related injury rate was 28.7 per thousand population. Interpersonal violence-related injuries were important for the 0- to 4-year age group (9.19 injuries per 1000 population), and continued as a major cause of morbidity through age 59 (12.08 injuries per 1000 population). For more than half of the events, information from the emergency room chart was sufficient only to categorize the incident as a "fight" or that it was intentional; no further classification was possible.
Adolescent↗