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Biomedical subjects

J Howland

Publications and source records attributed to J Howland.

At least 55 records · Page 3Linked to original sources
PubMed1988

Alcohol as a risk factor for drownings: a review of the literature (1950-1985).

We identified 36 English language studies (1950-1985) on alcohol and drownings. The majority of these were descriptive, reporting on the percent of drowning victims positive for alcohol upon autopsy. Most studies fell into one of three categories: Type A--complete ascertainment, duration of submergence specified; Type B--complete ascertainment, duration of submergence unspecified; Type C--partial ascertainment. Among Type A studies, percent of positives for alcohol ranged from 29% to 47%. Among Type B studies, percents ranged from 15% to 69%. Among Type C studies, percents ranged from 18% to 86%. We conclude that (1) between 25% and 50% of adult drowning victims have been exposed to alcohol and that (2) without data on the frequency of alcohol consumption among non-victims engaged in aquatic activities, the causal role of alcohol in drownings is uncertain. Suggestions for further research are offered.

Adult↗
PubMed1988

The impact of pediatric asthma education on morbidity. Assessing the evidence.

We reviewed the literature evaluating pediatric asthma education interventions to assess their impact on morbidity (school absences and health care utilization). Thirteen studies were analyzed, most of which reported favorable outcomes. Of the ten studies reporting on school absences, only seven used tests of statistical significance when reporting on postintervention reductions, and of those, only two found a significant decrease in absenteeism. Similarly, among the studies reporting on utilization, not all used tests of statistical significance when reporting on postintervention decreases in physician visits, ER visits, and hospitalization. Only four of the ten studies used adequate sample sizes to detect a 20 percent reduction in school absences, and stratification of the sample by severity of asthma suggests that some programs do reduce health care utilization among those children with more severe disease. We conclude that the effectiveness of asthma educational programs on reducing school absences and health care utilization may be small. These programs are best directed toward children with moderate or severe disease. Finally, it is important for pediatricians, children with asthma, and their families to have realistic expectations about what these programs may accomplish.

Absenteeism↗
PubMed1987

Using routine documentation of medical care to observe physician behavior.

This observational study compared the utilization of pulmonary function tests (PFTs) for outpatients at community hospitals in New Hampshire in 1975 and 1980. It was hypothesized that if preliminary care physicians were shifting toward using PFTs for early detection of chronic obstructive airway disease (COAD), an increase in the number of tests ordered, a decrease in the mean age of patients tested, and an increase in the mean lung functions (FEV1/FVC) would be observed. For hospitals providing data for 1975 and 1980, 85% showed an increase in the number of outpatient tests ordered (p = 0.002), the mean age of outpatients tested decreased at 75% of the hospitals (p = 0.019), and the mean FEV1/FVC increased at 67% of the hospitals (p = 0.014). The hypotheses thus confirmed, it is concluded that New Hampshire physicians are using PFTs for early detection of COAD.

Data Collection↗
PubMed1987

Alcohol as a risk factor for injury or death resulting from accidental falls: a review of the literature.

An examination of the English language literature published from 1950 to 1985 on the subject of alcohol consumption and falls yielded 21 studies. Those identified represented four types. Type I studies examined alcohol exposure among fall cases. The percentage of fatal falls related to alcohol exposure ranged from 21 to 77%; for nonfatal falls the range was 17-53%. Among Type II studies comparing fatal falls among alcoholics to the standard population, ratios of observed to expected deaths ranged from 2.9 to 16. Type III studies compared blood alcohol levels (BALs) of fall patients and disease patients treated medically. Those studies yielded odds ratios from 2.5 to 10. In the single Type IV study comparing BALs of fall subjects with nonfall controls relative risks were 1 (BALs, 50-100 mg/dl), 3 (BALs, 100-150 mg/dl) and 60 (BALs, greater than 160 mg/dl). We conclude that there is substantial evidence that alcohol increases risks for falls, but that more case-control studies (Type IV) are required to evaluate the exact magnitude of this risk and intervention studies are needed to assess methods to reduce the risk.

Accidental Falls↗
PubMed1987

Adjusting capitation using chronic disease risk factors: a preliminary study.

Researchers have sought ways to modify Medicare's capitation formula, the adjusted average per capita cost (AAPCC), by including measures of individual health status. The present study assesses the value of risk factors for disease as predictors of hospitalization for Framingham Heart Study participants (1,210 males and 1,496 females) 60-65 years of age. Regression models including several common physiologic measures and prior hospitalizations yielded adjusted R2s of 9.69 percent for males and 3.61 percent for females. The contributions of the risk factors and prior hospitalization were about equal and independent. These results confirm the potential utility of disease risk factors for adjusting the AAPCC.

Actuarial Analysis↗
PubMed1986

Chronic obstructive airway disease. Impact of health education.

We conducted a controlled study of the impact of an education program on the health outcomes and perceptions of patients with varying degrees of airway obstruction in two communities. In one community, patients with chronic obstructive airway disease (COAD) were identified, assessed and offered an educational program. In the other community, patients were identified, assessed and advised of the findings only. Patients at both sites were given the same pretest and, one year later, the same posttest. These tests measured physical and social function, and health outcomes (eg, respiratory symptoms, exercise tolerance, mental health), plus patients' health perceptions. Posttest results showed a significant difference between groups on a health perception measure and locus of control, but no difference on health outcomes. We conclude that education programs for COAD are unlikely to improve patients' health status unless they are part of a comprehensive medical program that includes physical reconditioning.

Attitude to Health↗
PubMed1984

Locating community residents with chronic airway obstruction. A comparison of four strategies.

In the course of establishing and evaluating a patient education program, we compared 4 strategies for locating patients with chronic obstructive airway disease (COAD): (1) search of hospital discharge records (HOSP), (2) referral by physicians (MD), (3) an advertising campaign (AD), and (4) a respiratory symptom questionnaire mailed to households (QUEST). Of 1,834 persons assessed, 923 (50%) had airway obstruction; 43% of the confirmed cases (396 of 923) reported no previous diagnosis of COAD. The HOSP strategy accounted for 75 assessments (4%) and 63 confirmed cases (7%), MD produced 352 assessments (19%) and 247 cases (27%), AD generated 475 assessments (26%) and 204 cases (22%), and QUEST resulted in 932 assessments (51%) and 409 cases (44%); MD was the least expensive strategy ($17.00/case). The mailed questionnaire located the largest number of cases not previously diagnosed.

Advertising↗
PubMedDate not supplied

A pilot survey of aquatic activities and related consumption of alcohol, with implications for drowning.

The investigators considered the relationship between participation in aquatic activities and the consumption of alcohol, with their implications for the risk of drowning. In a telephone survey with random-digit dialing, interviewers asked Massachusetts residents ages 20 years and older how often they engaged in various aquatic activities, in what settings, and how often they drank alcohol in connection with participation in aquatic activities. Of 294 respondents, 79 percent of the men and 72 percent of the women reported participating in aquatic activities during August 1988, the month prior to the interview. Respondents were asked to identify their most recent aquatic activity. The mean number of days of participation in the month was 13. The most frequently reported aquatic activities were swimming (76 percent), followed by sunbathing (74 percent), power boating (25 percent), and fishing from shore (15 percent). Among those persons reporting participation in aquatic activities, 55 percent had been at the ocean on the most recent occasion, 26 percent at lakes or ponds, 17 percent at pools, and 2 percent at rivers. Among those persons reporting aquatic activities, 36 percent of the men and 11 percent of the women reported having drunk alcohol on the most recent occasion. Those who reported drinking in aquatic settings were more likely to report driving after drinking than those who did not drive. Implementation of new Federal regulations and State laws concerning drinking and boating should be accompanied by public education on the risks of drowning if aquatic activities and alcohol consumption are combined.

Adult↗
PubMedDate not supplied

Alcohol as a risk factor for injuries or death due to fires and burns: review of the literature.

The findings in 32 studies on alcohol and injuries and deaths attributed to fires and burns were analyzed in detail. The studies, all in English, were published between 1947 and 1986. Most of them were descriptive and reported on the percent of the victims who were exposed to alcohol. Eight of the nine best descriptive studies indicated that alcohol exposure was more likely among those who died in fires ignited by cigarettes than those attributable to other causes. It can be concluded that there is substantial, although not definitive, evidence that alcohol plays a role in the etiology of fire and burn injuries and deaths.

Alcohol Drinking↗
PubMedDate not supplied

Effects of legislative reform to reduce drunken driving and alcohol-related traffic fatalities.

From 1980 through 1985, considerable progress was made across the Nation in reducing drunken driving and fatal automobile crashes. More than 400 chapters of local citizen groups concerned with reducing drunken driving were formed. New media coverage, measured in number of stories, increased fiftyfold from 1980 to 1984. More than 500 legislative reforms were passed. All States now have adopted a legal drinking age of 21. Many also adopted criminal and administrative per se laws and instituted penalty increases for drunken driving. By 1985, the total number of fatal crashes declined to 39,168, a decrease of 6,116, or 16 percent, from the 1980 level of 45,284. Single-vehicle fatal crashes occurring at night, those most likely to involve alcohol, declined by 20 percent, with 3,674 fewer crashes in 1985 than in 1980. Among teenage drivers, declines in fatal crashes were steeper: Fatal crashes decreased 26 percent, and single-vehicle night fatal crashes were down 34 percent. After 1984, however, the number of new citizen groups established and the number of stories appearing in the media began to decline. In 1986, after decreasing for several years, the number of fatal crashes rose 5 percent, and single-vehicle night fatal crashes rose 7 percent, up 1,060 from 1985. Among teenage drivers, the increase in single-vehicle night fatal crashes was even higher, up 17 percent. In 1987, single-vehicle night fatal crashes declined slightly but still remained higher than in 1983, 1984, or 1985. Legal changes, while helpful in reducing drunken driving crashes, may not be sufficient to achieve optimal long-term declines.To sustain the progress of the early 1980s, we need to:* Refocus community and media attention on the drunken driving problem. * Increase police enforcement and public support for enforcement of laws against drunken driving.* Heighten educational and enforcement efforts that target risky traffic behaviors more common among drunken drivers-particularly speeding and failure to wear seatbelts.* Develop educational efforts aimed at all segments of the population to increase informal social pressure to discourage drunken driving and riding in vehicles with drivers who are drunk.Traffic accidents remain the leading cause of death among persons ages I to 34; 52 percent of the 46,050 traffic fatalities in 1986 involved ad river or pedestrian who had been drinking. Without renewed attention to the problems posed by drunken driving, we may be unable to sustain the dramatic progress of the early 1980s.

Accidents, Traffic↗