PubMed Health⌕ Search

Biomedical subjects

J F Kraus

Publications and source records attributed to J F Kraus.

At least 73 records · Page 4Linked to original sources
PubMed1990

Alcohol and drowning: an analysis of contributing factors and a discussion of criteria for case selection.

We test the hypothesis that there are host or environmental factors that significantly affect the likelihood of alcohol involvement in drownings. Our results are based on records of 234 drownings that meet predetermined eligibility criteria designed to exclude cases with postmortem blood alcohol concentrations (BACs) that do not reflect the BAC at the time of immersion. Cases are drawn from a total of 442 drownings occurring in Sacramento County, California, from 1974 to 1985. Overall, 41% of deaths were alcohol-associated; among these only one victim was under 15 years old. Among older persons, increasing age generally suggested a higher likelihood of alcohol involvement, and particularly of a BAC greater than 200 mg/dl. Other associated factors were male gender (OR = 2.5; 95% CI = 1.6, 3.8), activity (for land motor-vehicle occupants vs. all others, OR = 3.3; 95% CI = 2.6, 4.3), and time of year (January-June vs. July-December, OR = 2.1; 95% CI = 1.6, 2.8). A lower likelihood of alcohol involvement was seen for drownings in bathtubs (OR = .16; 95% CI = .04, .57) and swimming pools (OR = .47; 95% CI = .27, .82). Race was not a factor. Differing eligibility criteria have been used in studies of alcohol and drowning. After a critical review of the experimental literature, we propose that the following be adopted in future such studies: (i) death must occur within six hours of the onset of immersion, unless an antemortem sample is available and, unless evidence to the contrary exists, death can be assumed to have occurred within a few minutes of immersion; (ii) blood must be drawn for BAC determination within 24 hours of death.

Adolescent↗
PubMed1990

Recall bias in a case-control study of sudden infant death syndrome.

Case-control differences in the accuracy of maternal recall may create spurious associations between suspected risk factors and perinatal conditions. We examined case-control differences in the accuracy of maternal recall and evaluated the impact of maternal reporting errors on observed measures of association. We compared interview information with information recorded on medical records for the mothers of 226 cases of Sudden Infant Death Syndrome (SIDS) and the mothers of 226 living controls. We found that having a child die from SIDS increased the sensitivity of recall for less than half of the 25 study variables. However, for 18 of the 25 variables, the mothers of SIDS cases were more likely than the mothers of living controls to report events that could not be confirmed on medical records. Case-control differences in recall accuracy did not appear to create spurious associations with SIDS or to bias most associations away from the null value.

Case-Control Studies↗
PubMed1990

Sudden unexplained infant deaths among American Indians and whites in North and South Dakota.

Differences in risk factors for sudden unexplained infant death (SUID) were studied among American Indian and White infants in North and South Dakota. From 1977 to 1984, the incidence of SUID was 3.9 times higher among Indians compared with Whites. Indian SUID cases appeared to die at a slightly younger age than Whites, and the association of male gender and young maternal age with SUID was weak or absent among Indians. Low maternal education and late or no prenatal care were strongly related to SUID in both races. The Indian-White risk ratio was unaltered by adjustment for birthweight and maternal age but declined to 2.5 (95% confidence intervals = 1.9, 3.4) when adjusted for maternal education and trimester prenatal care began.

Age Factors↗
PubMed1990

Young children who drown in hot tubs, spas, and whirlpools in California: a 26-year survey.

A survey of drownings in hot tubs, spas, and whirlpools in California 1960-85 suggests a person- and site-specific profile. The identified 74 deaths occurred mostly in White children, under two years of age, in Southern California, during the late afternoons, from May through August. From 1967 to 1985, the drowning rate increased tenfold. The deaths were associated with access to the water, lack of supervision, neuromotor handicaps, and entrapment by suction. Educational and environmental control efforts are required to reduce the incidence.

Baths↗
PubMed1990

Death resulting from motor vehicle immersions: the nature of the injuries, personal and environmental contributing factors, and potential interventions.

We present an epidemiologic characterization of deaths from motor vehicle immersions, based on 77 deaths in 63 motor vehicle immersions in Sacramento County, CA, during 1974-85. All persons were autopsied; all but one of the deaths were due to drowning. Average annual mortality rates per million person years were 12 for males, four for females, 30 for Hispanics, six for White non-Hispanics, Blacks and Asians. Seventy-one percent of drivers and 60 percent of passengers had a blood alcohol concentration greater than or equal to 22 mmol/L. Most cases (57 percent) had an Injury Severity Score of 1 (minor injury) or 0 (no injury). Alcohol use was associated with higher Injury Severity Scores. Road curvature of 20 degrees or greater was far more common at crash sites than at matched control sites one mile away (OR = 6.57, 95% CI = 2.93, 14.71). Guard rail placement along highly curved sections of roadway may be an effective preventive measure.

Accidents, Traffic↗
PubMed1990

Fatal and severe injury: scooter and moped crashes in California, 1985.

Fatal and severe injury crashes for scooters and mopeds in California for 1985 were compared with those for motorcycles during the same year. Scooters had more than twice the injury crash rate of mopeds but one-half the rate of motorcycles. Age of injured drivers and crash patterns for scooters, mopeds, and motorcycles varied significantly.

Accidents, Traffic↗
PubMed1990

Chronic fetal hypoxia and sudden infant death syndrome: interaction between maternal smoking and low hematocrit during pregnancy.

To investigate the hypothesis that chronic fetal hypoxia contributes to the etiology of sudden infant death syndrome (SIDS), a possible interaction between the effect of maternal cigarette smoking and low hematocrit during pregnancy on the risk of SIDS was studied using the US Collaborative Perinatal Project cohort. The 193 SIDS cases identified in the cohort were analyzed with 1930 controls randomly selected from infants who survived the first year of life. After adjustment for maternal age, infants born to mothers who smoked 10 or more cigarettes per day and who were anemic (hematocrit less than 30%) during pregnancy were at a much higher risk of SIDS than infants born to mothers who did not smoke and were not anemic (odds ratio = 4.0; 95% confidence limits, 2.1 and 7.4). Smoking 10 or more cigarettes per day vs none increased the risk of SIDS by 70% among women with hematocrit at or above 30% but increased risk threefold among women with hematocrit below 30%. After adjustment for more potential confounders in a logistic regression model, the effect of smoking on SIDS continued to increase with lower levels of hematocrit during pregnancy. Birth weight accounted for very little of these associations. Low hematocrit was not a risk factor for SIDS among nonsmokers but became an important predictor among heavy smokers. These findings are in agreement with the hypothesis that chronic fetal hypoxia may predispose to SIDS, possibly by impairing the normal development of the fetal central nervous system.

Birth Weight↗
PubMed1989

Risk factors for sudden infant death syndrome in the US Collaborative Perinatal Project.

Risk factors for sudden infant death syndrome (SIDS) were studied among infants born to the nearly 56,000 women enrolled in the US Collaborative Perinatal Project from 1959 through 1966. The 193 SIDS cases identified in the cohort were compared with 1930 controls randomly selected from infants who survived the first year of life. The previously documented excess risk associated with black race disappeared after adjusting for maternal education and family income. Maternal smoking, maternal anaemia during pregnancy, and lack of early prenatal care were all positively associated with SIDS. After adjustment for gestational age, infants with low weight and length at birth were still at increased SIDS risk, suggesting that intrauterine growth retardation may be a risk factor. Neurological abnormalities diagnosed before death were associated with SIDS, but much of the association was removed by adjusting for birthweight. The negative association of breastfeeding with SIDS was much reduced upon adjustment by maternal education and birthweight. These findings may have important implications in our understanding of the epidemiology of SIDS.

Cohort Studies↗
PubMed1989

Unintentional firearm deaths in California.

We conducted a two-part study of unintentional firearm deaths in California. First, we analyzed death certificate data for the 688 unintentional firearm deaths of California residents occurring during 1977-1983. Mortality rates were 7.5 for males, 0.9 for females, 4.8 for whites, and 5.3 for blacks, all per million persons per year. Males ages 15-24 had the highest rate (17 per million persons per year). We then investigated the 131 childhood deaths in greater detail, using coroners' or medical examiners' reports. Most of these shootings occurred at a residence. Handguns were involved more frequently than predicted by their reported availability in homes in the region. Almost two thirds of child deaths resulted from head wounds, reinforcing the importance of primary prevention. At least 40% of child deaths in this study appeared in part to be attributable to defects in firearm performance or current firearm design practices, suggesting that improvements should be sought and mandated.

Accidents, Home↗
PubMed1989

Blood alcohol tests, prevalence of involvement, and outcomes following brain injury.

We collected data on all residents of San Diego County, California who were hospitalized for or died from a brain injury in 1981. The objectives were to assess the frequency of blood alcohol concentration (BAC) testing and the associations of BAC prevalence with the external cause of the brain injury and case outcome. We found that high BAC levels were most frequent among brain-injured subjects between the ages of 25 and 44 and among those subjects involved in motor vehicle crashes and assaults. Contrary to expectations, injury severity and hospital mortality were inversely related to BAC level, controlling for other predictors. We believe that these inverse associations might be due to differential rates of BAC testing by severity. Among brain-injured survivors with more severe injuries, however, we found that BAC level was positively associated with the prevalence of physician-diagnosed neurological impairment at discharge and with the length of hospitalization.

Accidents↗
PubMed1988

The epidemiology of mild, uncomplicated brain injury.

Mild brain injury accounts for a substantial proportion of all persons admitted to a hospital for brain trauma, yet the amount of information on the epidemiology of this problem is quite sparse. Data on mild brain injuries for San Diego County residents injured in 1981 were analyzed for incidence, external cause, prehospital factors, diagnoses, alcohol use, and in-hospital treatment costs. More than 80% of all San Diego County residents hospitalized for an acute brain injury had a mild uncomplicated brain injury: a rate of 130.8 per 100,000 per year. Three quarters of these had an ER Glasgow Coma Scale of 15. Rates are twice as high for males compared to females, with peak occurrence for males at ages 15-19 years. More than 40% of mild brain injuries are caused by motor-vehicle-related events. The most common diagnosis was concussion (80%) or other intracranial injury (14%). Median length of hospital stay was 2-3 days and depended on brain injury diagnosis or Glasgow Coma Scale. Although less than 30% of those aged 15 years and older were blood tested for alcohol, two thirds of those tested had a level of 100 mg% or higher. In-hospital treatment costs for concussion or other mild intracranial injury for San Diego County residents exceeded six million dollars in 1981.

Adolescent↗
PubMed1988

Survival after brain injury. Cause of death, length of survival, and prognostic variables in a cohort of brain-injured people.

Injuries are the leading cause of death in the United States for those between 1 and 44 years of age and brain injuries are a major component of trauma. This report examines survival in a cohort of San Diego County, California, residents who incurred a brain injury in 1981. Cumulative risk of death over time, using the Cox Proportional Hazards Model, and predictors of death (determined by logistic regression) are used to evaluate survival. The results showed that about half of all brain-injured people who died, died in less than 2 h. Severe overall body damage and severe brain injury are the greatest causes of prehospital death. Even if they survived to the hospital, most people who die have brain injury as their underlying cause of death. Age as well as nature and severity of brain injury are the important predictors of in-hospital death. People who are discharged alive from the hospital have survival comparable to that of the population they came from. However, more die from trauma-related causes than would be expected.

Adolescent↗
PubMed1988

The choice of weapons in firearm suicides.

We report on the firearms used in 235 suicides in Sacramento County, California, during 1983-85. Handguns were used in 69 per cent of firearm suicides--65 per cent for males, 88 per cent for females--and in all such deaths among women ages 35 and older. We tested the hypothesis that the choice of firearms by persons committing suicide at home would passively reflect the reported prevalence of firearms by type in households in the region. Handguns were used more frequently (rate ratio 2.00; 95% CI = 1.68, 2.39), and rifles and shotguns less frequently than expected.

Adolescent↗