Biomedical subjects

J S Osberg

Publications and source records attributed to J S Osberg.

At least 19 recordsLinked to original sources

PubMed2006

Interventions for promoting booster seat use in four to eight year olds traveling in motor vehicles.

BACKGROUND: Public health and traffic safety agencies recommend use of booster seats in motor vehicles for children aged four to eight years, and various interventions have been implemented to increase their use by individuals who transport children in motor vehicles. There is little evidence regarding the effectiveness of these interventions, hence the need to examine what works and what does not. OBJECTIVES: To assess the effectiveness of interventions intended to increase acquisition and use of booster seats in motor vehicles among four to eight year olds. SEARCH STRATEGY: We searched the Cochrane Injuries Group's Specialized Register, the Cochrane Central Register of Controlled Trials, MEDLINE (January 1966 to April 2005), EMBASE (1980 to April 2005), LILACS, Transport Research Databases (1988 to April 2005), Australian Transport Index (1976 to April 2005), additional databases and reference lists of relevant articles. We also contacted experts in the field. SELECTION CRITERIA: We included randomized and controlled before-and-after trials that investigated the effects of interventions to promote booster seat use. DATA COLLECTION AND ANALYSIS: Two authors independently assessed trial quality and extracted data. Study authors were contacted for additional information. MAIN RESULTS: Five studies involving 3,070 individuals met the criteria for inclusion in the meta-analysis. All interventions for promoting use of booster seats among 4 to 8 year olds demonstrated a positive effect (relative risk (RR) 1.43; 95% confidence intervals (CI) 1.05 to 1.96). Incentives combined with education demonstrated a beneficial effect (RR 1.32, 95% CI 1.12 to 1.55; n = 1,898). Distribution of free booster seats combined with education also had a beneficial effect (RR 2.34; 95% CI 1.50 to 3.63; n = 380) as did education-only interventions (RR 1.32; 95% CI 1.16 to 1.49; n = 563). One study which evaluated enforcement of booster seat law met the criteria for inclusion in the meta-analysis, but demonstrated no marked beneficial effect. AUTHORS' CONCLUSIONS: Available evidence suggests that interventions to increase use of booster seats among children age four to eight years are effective. Combining incentives (booster seat discount coupons or gift certificates) or distribution of free booster seats with education demonstrated marked beneficial outcomes for acquisition and use of booster seats for four to eight year olds. There is some evidence of beneficial effect of legislation on acquisition and use of booster seats but this was mainly from uncontrolled before-and-after studies, which did not meet the criteria for inclusion in the meta-analysis.

Automobiles↗

PubMed2000

Safety behavior of in-line skaters.

OBJECTIVES AND SETTING: Injuries from in-line skating have risen sharply in many cities around the world. To understand risk taking behavior and safety practices associated with urban in-line skating, 2210 outdoor skaters were observed in Boston, Massachusetts. METHODS: Estimated age, gender, use of helmets, wrist guards, elbow and kneepads were recorded. Skaters were coded as beginner, average, or advanced, and skating locations were classified as street, sidewalk, or bicycle path. RESULTS: About 60% of skaters wore wrist guards, but only 5.7% wore helmets. Males wore less protective equipment than females, and were more likely to skate on streets. Beginners and advanced skaters wore more protective gear than average skaters. Surprisingly, street skaters wore less protective gear than skaters on sidewalks or paths. CONCLUSIONS: Renewed focus on the importance of wearing helmets is needed. Given the higher injury risks for males, clinicians and public health experts need to target male skaters in prevention efforts. In addition, average and advanced skaters need to be convinced that even though they have improved, it is still important to wear protective gear.

Adolescent↗

PubMed1998

Skateboarding: more dangerous than roller skating or in-line skating.

OBJECTIVE: To describe the circumstances, severity, and outcomes of skating-related injuries among children admitted to trauma centers. DESIGN: A cross-sectional comparison of roller skaters (n = 154), in-line skaters (n = 190), and skateboarders (n = 254) aged 5 to 19 years who were hospitalized with injuries. SETTING: Seventy-nine hospitals and pediatric trauma centers participating in the National Pediatric Trauma Registry between October 1988 and April 1997. RESULTS: Three quarters (75.8%) of the study sample were male, nearly half (47.8%) were injured on roads, and more than one third (37.1%) had head injuries. Among skateboarders, 50.8% had head injuries compared with 33.7% of in-line skaters and 18.8% of roller skaters (P<.001). According to the Injury Severity Score, injuries to skateboarders were 8 times more likely to be severe or critical compared with roller skaters' injuries and more than 2 times as likely to be severe or critical compared with in-line skaters' injuries. Mean hospital length of stay was 6.0 days for skateboarders, 3.4 days for in-line skaters, and 2.4 days for roller skaters (P<.001). Skateboarders were more likely to be male and to be injured on roads than were in-line skaters or roller skaters. CONCLUSIONS: Skateboarding-related injuries are more severe and have more serious consequences than roller skating or in-line skating injuries. Research is needed to identify ergonomic and behavioral factors responsible for higher head injury risk to skateboarders, and interventions are needed to reduce the risk.

Accidental Falls↗

PubMed1998

Bicycle safety behavior in Paris and Boston.

Concerns about bicycle-related deaths and injuries have led to extensive injury prevention efforts in the United States, yet these concerns are not universal. For instance, in France attitudes toward bicycle safety are quite different. To understand more about variation in urban bicycle safety behavior, we observed passing bicyclists in Paris and Boston. In addition to helmet use, we looked at use of lights at night. Among 5,808 passing bicyclists, there were large differences in helmet and light use: only 2.2% of Paris bicyclists wore helmets compared to 31.5% in Boston. In contrast, 46.8% of nighttime Paris bicyclists had working head or tail lights compared to only 14.8% in Boston. These large and seemingly contradictory percentages are the result of different laws and public health priorities, types of bicycle riding, and perceived risks. Suggestions for further research and practical ways to improve U.S. bicycle safety behavior are discussed.

Accidents, Traffic↗

PubMed1997

Impact of childhood brain injury on work and family finances.

Parents of children who suffer brain injuries are often surprised by the extent to which work and family finances are disrupted. In this paper, work and financial problems are described, predictors are identified, and ways to minimize problems are discussed. Eighty-two children treated at two Massachusetts trauma centres were given an extensive battery of medical, functional, and psychosocial tests during hospitalization. At 1 and 6 months post-discharge they were retested and their parents were surveyed about work and financial difficulties. Trouble maintaining regular work schedules and injury-related financial problems were common. At highest risk for work and financial problems were families of children with severe injuries who had four to nine impairments, along with children hospitalized > 2 weeks who were not discharged to home. Surprisingly, families with HMO coverage reported significantly fewer financial problems, and this relationship was not due to differences in socioeconomic status or injury severity. Health-care providers need to pay more attention to the potential impact of injury on work and family finances. Providers can help at-risk families muster child-care services, deal effectively with employers and insurance companies, and plan for the future.

Adaptation, Psychological↗

PubMed1997

Differences in follow-up visits between African American and white Medicaid children hospitalized with asthma.

Asthma-related hospitalizations and mortality have risen at alarming rates in the past two decades, taking a disproportionate toll on African American children. Adverse asthma outcomes have been attributed to inadequacies in primary care, raising concerns about the quality of primary care delivered to African American children. To assess differences in care between African American and white children, the authors identified 500 children enrolled in Massachusetts Medicaid and hospitalized for asthma, and reviewed their medical claims data for the six-month period after hospitalization. It was found that African American children had significantly fewer primary care visits than their white counterparts, even after adjusting for potential confounding variables. In contrast, emergency service utilization did not differ by race. The authors conclude that racial disparity exists in primary care access among children with asthma. Interventions should be designed to target poor African American children who suffer disproportionately from this life-threatening yet treatable disease.

Adolescent↗

PubMed1996

Pediatric trauma: impact on work and family finances.

OBJECTIVES: National data now exist on incidence, prevalence, and cost of injury. However, the personal impact of injury on work and family finances has not been thoroughly studied. We examine the extent and nature of work and financial problems after pediatric trauma and identify predictors. Clinicians are alerted so they can better counsel parents about potential postinjury work and financial difficulties. METHODS: Staff collected comprehensive data on the acute care and short-term rehabilitation of 182 Massachusetts children with injuries. Consenting parents were surveyed and their children were given a battery of medical, functional, and psychosocial tests. Information on work and financial impact at 1 and 6 months postinjury was available from 120 parents. RESULTS: Given these children's generally mild injuries, the impact on work and family finances was remarkable. For many families work and financial problems were short-lived; however, for others serious problems remained at 6 months postdischarge. Families whose children were severely injured were at highest risk for work and financial problems. Middle-class parents and parents on public assistance or in our other insurance category reported more work and financial problems than those in health maintenance organizations. Long acute hospital stay and four or more impairments at discharge were also strong predictors. CONCLUSION: Childhood injury can lead to serious work and financial problems for families. Given the central role of the family in pediatric rehabilitation, clinicians and policymakers involved in acute trauma care and rehabilitation should pay greater attention to the financial repercussions of injury.

Child↗

PubMed1994

Changes in positions of authority held by US physicians: a fresh look at existing data.

Some experts contend that physicians have lost positions of authority in the past 40 years. Others argue the opposite, yet neither side bases its arguments on empirical data. This study examined longitudinal variables measuring authority positions held by physicians. Data on the relative position of physicians in medical schools show that medical doctors held 65.6% of the sampled positions in 1970 vs 72.8% in 1990. Yet, in the wider society and within the nonmedical school portion of the health sector, other data indicate that physicians occupy a smaller proportion of authority positions.

Data Collection↗

PubMed1994

Social supports as a determinant of community-based care utilization among rehabilitation patients.

OBJECTIVE: We determine the extent to which noninstitutionalized long-term care patients receive assistance from family members and friends, and evaluate the effect of this assistance on use of outpatient rehabilitative and personal care services. DATA SOURCES AND STUDY SETTING: Over 12 months, primary data were collected from 289 patients in noninstitutional settings after inpatient rehabilitation at three Boston-area rehabilitation hospitals. Data on patients' acute and rehabilitative stays were obtained from medical record reviews. Patients provided primary data on sociodemographics, living arrangements, social supports, functional status, health behaviors, life events, and use of outpatient services during the study period. The latter was verified and service charge data obtained from the care providers. STUDY DESIGN: The study was longitudinal and observational. Patient-provided information was obtained at one, six, and twelve months postdischarge. ANALYTIC METHODS: Multivariate Tobit regression was used to evaluate the effect of social supports on patients' use of rehabilitative and personal care services, controlling for sociodemographics and functional status. Service use was measured as charges incurred during the 12-month study period. PRINCIPAL FINDINGS: Results confirm the primary role of family and friends in providing daily personal care and identify the availability of that support as a key determinant of expenditures on community-based personal care services. Social supports do not predict outpatient rehabilitative service use. CONCLUSIONS: Differing eligibility criteria seem appropriate for outpatient rehabilitative and personal care services. The current emphasis on functional status in determining rehabilitative service eligibility appears appropriate; but we find that considering patients' social supports would be both meaningful and appropriate in determining personal care service eligibility. This approach would avert the expense of making personal care services universally available, while facilitating assistance for patients whose functional and social status put them at increased risk of institutional placement.

Activities of Daily Living↗

PubMed1992

Morbidity among pediatric motor vehicle crash victims: the effectiveness of seat belts.

It is well established that seat belts reduce mortality and morbidity among children. Data are presented for 413 children injured severely enough in motor vehicle crashes to require hospitalization. Of the unrestrained children, 4.5% died, compared with 2.4% of the belted children. Unrestrained children had a higher proportion of injuries in four of five anatomical regions, were more severely injured, stayed longer in the hospital, and were 15% more likely than belted children to be discharged with impairments.

Abdominal Injuries↗

PubMed1991

Children with traumatic head injury: morbidity and postacute treatment.

The purpose of this paper was to describe pediatric head trauma and the factors that affect the extent, characteristics, and postacute service needs of functional limitations resulting from head trauma. Data are presented on 4,870 children who survived head injuries and who were enrolled in the National Pediatric Trauma Registry during 1985 to 1988. The sample excluded 349 children who died and 151 children who had impairments before injury. More than 50% of the surviving children sustained extracranial injury in addition to head injury, and this occurrence was related to age and mechanism of injury. Although 78% of the children were discharged from acute care without obvious impairments, 787 had one to three impairments, and 286 had four or more impairments. Discharge to rehabilitation or extended care facilities depended on the number and type of resulting impairments.

Activities of Daily Living↗

PubMed1990

Utilization of inpatient rehabilitation services among traumatically injured children discharged from pediatric trauma centers.

This paper investigates factors that predict whether or not children treated at pediatric trauma centers are discharged to inpatient rehabilitation. Variables pertaining to functional impairments, injury severity and institutional factors explained over 45% of the variance in discharge disposition. It appears that a good deal of rationality pervades the decision as to whether patients are discharged to home or to rehabilitation. The extent of functional impairments and the severity of injury are closely related to these discharge decisions, as one would expect in a well-functioning discharge planning system. However, there are indications that discharge decisions are also affected by factors that ideally should be external to the decision process. Chief among these is whether or not the trauma center has an onsite rehabilitation unit. Patients treated at trauma centers that have onsite rehabilitation units are significantly more likely to be discharged to rehabilitation than patients treated at trauma centers without onsite rehabilitation.

Adolescent↗

PubMed1990

Characteristics of cost outliers who did not benefit from stroke rehabilitation.

The purpose of this paper is twofold: 1) to identify stroke patients who generated substantial charges during inpatient rehabilitation, but did not seem to benefit from that experience and 2) to identify factors that can predict which patients will fall into this group using only variables known at admission to rehabilitation. High cost stroke patients during inpatient medical rehabilitation are examined to determine how they differ from low cost patients and to identify a subset who did not appear to benefit from rehabilitation. This paper is based on longitudinal charge data involving 73 former stroke rehabilitation patients discharged from three Boston area rehabilitation facilities in 1984. Medical charges are presented on initial acute and rehabilitation inpatient stays and on care received in the 12 months after discharge. Among these 73 stroke patients, charges for inpatient medical rehabilitation amounted to nearly 1.8 million dollars, excluding physician fees and out-of-pocket expenses. Of this total, 57.6% was accured by only 33% of the patients. Fourteen patients, who were both rehabilitation cost outliers and apparent rehabilitation "failures," were identified. Rehabilitation charges for these 14 amounted to $673,232 or 37.5% of the total rehabilitation charges for all 73 patients.

Adult↗

PubMed1990

Ventilator dependency: decision-making, daily functioning and quality of life for patients with Duchenne muscular dystrophy.

Ventilator assistance is offered to patients with Duchenne muscular dystrophy as an option to extend life. This paper discusses the effect of respiratory difficulties and the subsequent quality of life for 17 patients and 14 family members living in the community. Areas covered included decision-making, health, education, vocational and recreational status, community resources and life satisfaction. Activity levels before and after ventilator use were assessed. Despite restrictions in daily life both before and after ventilator use, quality of life was fairly good. Restrictions in daily life were caused by a combination of progression of the disease and the ventilator, and family members were more burdened by the ventilator than were patients. It is concluded that patients and their families should make the decision about accepting or rejecting assisted ventilation.

Activities of Daily Living↗

PubMed1990

Return to work after stroke: development of a predictive model.

Seventy-nine stroke patients who underwent a vocationally oriented, comprehensive, inpatient stroke rehabilitation program were followed up to evaluate their return to work. At follow-up, 49% had returned to work a mean of 3.1 months after rehabilitation discharge. Factors associated with success and with failure of vocational rehabilitation were then identified, and a predictive model was developed. There were positive associations between return to work and Barthel Index on admission (p = 0.0002) and discharge (p = 0.0015). Negative associations were found between return to work and aphasia (p = 0.0009), rehabilitation length of stay (p less than 0.0001), and prior alcohol consumption (p = 0.03). A step-wise multiple regression model explained 42% of the variance in return to work. Those most likely to return to work were not aphasic; they had shorter rehabilitation lengths of stay and higher Barthel Index scores on discharge; and they were lighter consumers of alcoholic beverages before their strokes. In conclusion, a set of factors predictive of return to work in younger stroke patients was identified, including, most notably, a strong negative association with aphasia and an intriguing negative association with prior alcohol consumption.

Adult↗

PubMed1989

Kappa coefficient calculation using multiple ratings per subject: a special communication.

The purpose of this special communication is to describe the application of the Kappa coefficient for the estimation of interobserver agreement. Kappa is a preferred statistic for the estimation of the accuracy of nominal and ordinal data in clinical research by physical therapists. A brief introduction to the properties of the Kappa coefficient is given, and a special case of Kappa for multiple ratings per subject is explained. A FORTRAN program, written specifically for the multiple-ratings situation, is described.

Electronic Data Processing↗

PubMed1988

Electrodiagnosis of diabetic peripheral polyneuropathy. A multivariate analytic approach.

Traditional univariate comparisons of nerve conduction data against standard norms may produce conflicting estimates of the presence or absence of a diabetic neuropathy, depending upon the data obtained and the specific nerves sampled. Alternatively, a multivariate analytic approach, using discriminant functions, provides a useful single measure of the degree of neuropathy determined as a weighted combination of the available data. The weights are derived from the linear discriminant function, which maximizes statistical separation of diabetic and nondiabetic subject groups. In this study, 12 electrophysiologic attributes are used to generate a single discriminant function that clearly separates diabetic from nondiabetic subjects and is interpretable as a neuropathic index. Each individual's index of diabetic neuropathy (I) can be quantified as follows: (Formula: see text) where Ai is the original electrophysiologic attribute (i = 12), ai is the coefficient for each attribute that defines the discriminant function and C is a constant specific for that function. For the first time, the degree of diabetic neuropathy can thus be quantified for purposes of comparison and correlation with other quantifiable clinical/somatic measures of diabetes. The index allows for a higher percentage of type II diabetic patients to be classified as neuropathic than previously described and enables determination of degree of neuropathy is affected individuals by an interpolative method.

Analysis of Variance↗

PubMed1988

Long-term utilization and charges among post-rehabilitation stroke patients.

This paper presents longitudinal charge data on 89 former stroke rehabilitation patients discharged from three Boston area rehabilitation facilities. Medical charges are presented on initial acute and rehabilitation inpatient stays and on care received in the 12 months after discharge. In the sample of 89 stroke patients, charges exceeded four million dollars excluding physician fees and out-of-pocket expenses. Of this total, 23% was for acute hospital care preceding rehabilitation (mean = 18 days), 52% for inpatient rehabilitation (mean = 55 days), 13% for rehospitalizations in the 12 months after discharge from rehabilitation (mean = 22 days) and 12% for a variety of outpatient services.

Adult↗