Biomedical subjects

J W Collins

Publications and source records attributed to J W Collins.

At least 19 recordsLinked to original sources

PubMed2006

Optimal nutrition should improve the outcome and costs of radical cystectomy.

INTRODUCTION: Nutritional support has been demonstrated to improve recovery from radical cystectomy, but is expensive and when used inappropriately may actually increase the costs and morbidity of surgery. We sought to establish national patterns of practice with regard to feeding following cystectomy in the UK. AIMS AND METHODS: Following consultation with the specialist nutrition team, a questionnaire was designed to investigate the feeding strategy after cystectomy and dispatched by post to all UK urologists. RESULTS: The majority (60%) of respondents employed a traditional strategy of resting the bowel and feeding orally after bowel recovery. A minority used either early total parenteral nutrition (TPN; 18.5%) or enteral nutrition (6.5%), but a larger proportion (29%) felt enteral nutrition was the 'optimal' feeding regime. Only 30% used guidelines and 52% felt trials would help to establish a nutrition strategy following cystectomy. CONCLUSION: There is little evidence that TPN improves the outcome of cystectomy and it may actually increase morbidity and costs, whereas enteral nutrition may improve recovery. Despite this evidence TPN is widely used by urologists whereas enteral nutrition is used infrequently. Implementation of an evidence-based feeding regime after cystectomy is likely to reduce the morbidity and financial costs of cystectomy.

Costs and Cost Analysis↗

PubMed2004

Cost analysis of flexible ureterorenoscopy.

OBJECTIVE: To assess the costs of flexible ureterorenoscopy. MATERIALS AND METHODS: Data were collected prospectively for 100 cases using a new flexible ureteroscope (DUR8, Circon ACMI, Stamford, USA), including the indications for flexible ureterorenoscopy, use of laser probes, disposable instrumentation, and the cost and timing of ureteroscope repair. RESULTS: Of the 100 procedures 68 were for stone disease, 21 for known or suspected transitional cell carcinoma (TCC), six were diagnostic only and five were for pelvi-ureteric junction obstruction. The ureteroscope was repaired after the 29th and 88th cases. The ability of the ureteroscope to deflect was maintained throughout. At the time of purchase the ureteroscope was listed at pound 15 000 and each repair/exchange currently costs pound 4200, thus the total expenditure on the ureteroscope was pound 23 400. Total expenditure on ancillary equipment was pound 28 727, of which pound 22 927 was on disposables and pound 5800 on 10 laser probes. CONCLUSION: In this series the costs of the ancillary equipment exceeded the purchase and maintenance of the ureteroscope, and we expect this trend to continue in the long term. The advent of more durable ureteroscopes may ultimately reduce the frequency of costly repairs. The cost of disposables should be considered in planning the budget.

Carcinoma, Transitional Cell↗

PubMed2004

An evaluation of a "best practices" musculoskeletal injury prevention program in nursing homes.

OBJECTIVE: To conduct an intervention trial of a "best practices" musculoskeletal injury prevention program designed to safely lift physically dependent nursing home residents. DESIGN: A pre-post intervention trial and cost benefit analysis at six nursing homes from January 1995 through December 2000. The intervention was established in January 1998 and injury rates, injury related costs and benefits, and severity are compared for 36 months pre-intervention and 36 months post-intervention. PARTICIPANTS: A dynamic cohort of all nursing staff (n = 1728) in six nursing homes during a six year study period. INTERVENTION: "Best practices" musculoskeletal injury prevention program consisting of mechanical lifts and repositioning aids, a zero lift policy, and employee training on lift usage. MAIN OUTCOME MEASURES: Injury incidence rates, workers' compensation costs, lost work day injury rates, restricted work day rates, and resident assaults on caregivers, annually from January 1995 through December 2000. RESULTS: There was a significant reduction in resident handling injury incidence, workers' compensation costs, and lost workday injuries after the intervention. Adjusted rate ratios were 0.39 (95% confidence interval (CI) 0.29 to 0.55) for workers' compensation claims, 0.54 (95% CI 0.40 to 0.73) for Occupational Safety and Health Administration (OSHA) 200 logs, and 0.65 (95% CI 0.50 to 0.86) for first reports of employee injury. The initial investment of $158 556 for lifting equipment and worker training was recovered in less than three years based on post-intervention savings of $55 000 annually in workers' compensation costs. The rate of post-intervention assaults on caregivers during resident transfers was down 72%, 50%, and 30% based on workers' compensation, OSHA, and first reports of injury data, respectively. CONCLUSIONS: The "best practices" prevention program significantly reduced injuries for full time and part time nurses in all age groups, all lengths of experience in all study sites.

Adult↗

PubMed2001

Occupational slip, trip, and fall-related injuries--can the contribution of slipperiness be isolated?

To determine if the contribution of slipperiness to occupational slip, trip and fall (STF)-related injuries could be isolated from injury surveillance systems in the USA, the UK and Sweden, six governmental systems and one industrial system were consulted. The systems varied in their capture approaches and the degree of documentation of exposure to slipping. The burden of STF-related occupational injury ranged from 20 to 40% of disabling occupational injuries in the developed countries studied. The annual direct cost of fall-related occupational injuries in the USA alone was estimated to be approximately US$6 billion. Slipperiness or slipping were found to contribute to between 40 and 50% of fall-related injuries. Slipperiness was more often a factor in same level falls than in falls to lower levels. The evaluation of the burden of slipperiness was hampered by design limitations in many of the data systems utilized. The resolution of large-scale injury registries should be improved by collecting more detailed incident sequence information to better define the full scope and contribution of slipperiness to occupational STF-related injuries. Such improvements would facilitate the allocation of prevention resources towards reduction of first-event risk factors such as slipping.

Accidental Falls↗

PubMed2001

Differing postneonatal mortality rates of Mexican-American infants with United-States-born and Mexico-born mothers in Chicago.

OBJECTIVES: This study sought to determine the relationship between maternal nativity and the postneonatal mortality rate of urban Mexican-American infants. DESIGN: This is a population-based study. METHODS: Stratified and logistic regression analyses were performed on a data set of 1992-1995 computerized birth-death records of all Mexican-American infants born to Chicago residents with appended 1990 United States Census income and 1995 Chicago Department of Public Health data. RESULTS: In Chicago, Mexican-American infants (N = 10,599) of US-born mothers had a postneonatal mortality rate of 3.2/1,000 compared to 2.1/1,000 for infants (40,813) of Mexico-born mothers; relative risk (95% confidence interval) equaled 1.5 (1.0-2.3). The adjusted odds ratio of postneonatal mortality was 1.4 (1.1-1.9) for Mexican-American infants of US-born mothers. The mortality rate due to preventable causes (sudden infant death syndrome, homicides, non-intentional injuries, and infections) for Mexican-American infants of US-born mothers was twice that of infants of Mexico-born mothers; relative risk (95% confidence interval) equaled 2.2 (1.3-3.8); this nativity differential persisted in non-impoverished communities. CONCLUSION: The postneonatal mortality rate of urban Mexican-American infants with US-born mothers exceeds that of infants with Mexico-born mothers. This nativity disparity is attributable to preventable causes.

Acculturation↗

PubMed2000

Enigma of maternal race and infant birth weight: a population-based study of US-born Black and Caribbean-born Black women.

The authors used 1985-1990 Illinois' vital records to determine the low birth weight components of infants delivered to US-born Black women, Caribbean-born Black women, and US-born White women. The moderately low birth weight rate (1,500-2,499 g) was 10% for infants with US-born Black mothers (n = 67,357) and 6% for infants with Caribbean-born mothers (n = 2,265) compared with 4% for infants with US-born White mothers (n = 34,124); the relative risk equaled 2.7 (95% confidence interval (CI): 2.5, 2.8) and 1.7 (95% CI: 1.4, 2.0), respectively. The very low birth weight rate (<1,500 g) was 2.6% for infants delivered to US-born Black women and 2.4% for infants to Caribbean-born women compared with 0.7% for infants to US-born White women; the relative risk equaled 3.6 (95% CI: 3.1, 4.1) and 3.3 (95% CI: 2.5, 4.4), respectively. Among the lowest risk mothers, the relative risk of moderately low birth weight for infants with US-born Black mothers and Caribbean-born mothers (compared with US-born White mothers) was 2.7 (95% CI: 2.1, 3.4) and 1.2 (95% CI: 0.4, 3.1), respectively; the relative risk of very low birth weight for infants with US-born Black mothers and Caribbean-born mothers was 6.7 (95% CI: 3.8, 12) and 4.2 (95% CI: 1.0, 18), respectively. The authors conclude that Caribbean-born women and US-born Black women have disparate moderate rates but equivalent very low birth weight rates.

Adult↗

PubMed2000

Psychophysical assessment of assistive devices for transferring patients/residents.

This article reports the psychophysical assessment of nine battery-powered lifts, a sliding board, a walking belt, and a baseline manual method for transferring nursing home patients/residents from a bed to a chair. A separate article reports the biomechanical evaluation of the same task and devices. The objectives of the psychophysical assessment were to investigate the effects of resident-transferring methods on the psychophysical stress to nursing assistants performing the transferring task, and to identify transfer methods that could reduce the psychophysical stress reported by nursing assistants. Nine nursing assistants served as test subjects. Two elderly persons participated as residents. The results indicated that the psychophysical stresses on nursing assistants were significantly lower when performing resident transfers with some of the assistive devices than when performing transfers with the baseline manual transfer method. The nursing assistants generally preferred the basket-sling lift and stand-up lift to other methods. The residents' comfort and security ratings indicated the comfort and security with most of the assistive devices were greater than or equal to the baseline manual method. Most of the comments of the nursing assistants and residents on the assistive devices were favourable.

Humans↗

PubMed2000

Low-income African-American mothers' perception of exposure to racial discrimination and infant birth weight.

We performed a hospital-based case-control study of African-American mothers to explore the relation between a mother's perception of exposure to racial discrimination during pregnancy and very low birth weight. We administered a structured questionnaire to low-income mothers of very low birth weight (<1500 gm; N = 25) and non-low birth weight (>2500 gm; N = 60) infants. The unadjusted and adjusted odds ratio of very low birth weight for maternal exposure to racial discrimination were 1.9 (0.5-6.6) and 3.2 (0.9-11.3), respectively. We conclude that maternal perception of exposure to racial discrimination during pregnancy may be associated with very low birth weight in their infants.

Black or African American↗

PubMed1999

Fatal occupational injuries associated with forklifts, United States, 1980-1994.

BACKGROUND: This paper describes deaths of American workers involving forklifts during the 15-year period from January 1, 1980 to December 31, 1994. METHODS: Death certificate data were obtained from the National Institute for Occupational Safety and Health's (NIOSH's) National Traumatic Occupational Fatality (NTOF) surveillance system. The narrative fields on the death certificate were searched for keywords indicating that a powered industrial vehicle (PIV) or forklift was involved in the death. This study examined the circumstances of the forklift-related deaths, the nature of the injury, and the decedent's age, gender, race, occupation, and industry. Average annual employment data from the Bureau of the Census were used to calculate civilian fatality rates by age, gender, industry, and occupation. RESULTS: A total of 1,021 deaths were identified. The average age of the fatally injured worker was 38 years; the 1,021 forklift-related deaths resulted in a total of 27,505 years of productive life lost. The three most common circumstances of the fatalities were forklift overturns (22%), pedestrian struck by forklifts (20%), and worker crushed by forklift (16%). The greatest proportion of the fatalities (37%) occurred to workers in Manufacturing, followed by Transportation, Communication, and Public Utilities, (TCPU), (17%), Construction (16%), Wholesale Trade (8%), and Agriculture, Forestry, and Fishing (AFF) (7%). The highest forklift-related fatality rates per ten million workers occurred among transport operatives (34.0) and laborers (32.0). CONCLUSIONS: Many of the fatalities resulting from forklift "overturns" might have been prevented if the operator had been restrained with a lap/shoulder belt. Careful consideration should be given to separating pedestrian and forklift traffic, and restricting the use of forklifts near time clocks, exits, and other areas where large numbers of pedestrians pass through an area in a short time. Additionally, systematic traffic control, including rules for pedestrian and forklift traffic, will be necessary to reduce the enormous injury and death toll associated with forklifts. Am. J. Ind. Med. 36:504-512, 1999. Published 1999 Wiley-Liss, Inc.

Accidents, Occupational↗

PubMed1999

Injuries related to forklifts and other powered industrial vehicles in automobile manufacturing.

BACKGROUND: The Bureau of Labor Statistics (BLS), Census of Fatal Occupational Injuries, estimates that approximately 100 workers are fatally injured each year in forklift and other powered industrial vehicle (PIV) incidents, and an estimated 34,000 work-related injuries involving forklifts are treated in U.S. emergency rooms each year. METHODS: This paper presents a descriptive analysis of 916 incidents involving forklifts and other PIVs that occurred in 54 plants operated by a major U.S. automobile manufacturer over a 3-year period. The injury data were obtained from a company-wide occupational injury and illness surveillance system which was implemented in 1989. RESULTS: The 916 PIV-related incidents resulted in 3 fatalities and 913 nonfatal injuries. The most common incident involved pedestrians (35%) who were struck by a PIV, or the load being carried by a PIV, or a rack or bin that had been struck by a PIV. Of the 913 nonfatal injuries, 41% resulted in an employee missing work and incurred a total of 22,730 lost workdays, an average of 61 days per lost workday incident. CONCLUSIONS: Recommendations are presented to reduce the risk of injury, for example by separating PIV and pedestrian traffic, restricting the use of forklifts in an area where a large number of pedestrians travel and improving the training of all personnel who drive PIVs. Am. J. Ind. Med. 36:513-521, 1999. Published 1999 Wiley-Liss, Inc.

Absenteeism↗

PubMed1999

A case-control study of forklift and other powered industrial vehicle incidents.

BACKGROUND: This study examined risk factors associated with forklift and other powered industrial vehicle (PIV) collision injuries with an emphasis on the design of factory traffic systems, the loading and safety features of PIVs, and the characteristics of the drivers. METHODS: A case-control study examined risk factors for circumstances of injury-producing PIV incidents at eight automotive manufacturing plants between July 1992 and March 1995. A computerized safety and health surveillance system identified 171 incidents where a PIV (forklift 70%, personnel carriers 15%, other 15%) was involved in a collision incident. Site visits were conducted to collect data regarding the factory environment at the collision site, the PIVs involved in the incidents, and driver characteristics. These data were compared with information collected from a random sample of comparison worksites, PIVs, and PIV drivers who had not been involved in a PIV-related incident in the prior 3 years. RESULTS: In half of the cases (86 of 171), an employee (pedestrian) was struck by a PIV or an object being carried by the PIV. The presence of an obstruction that restricted the aisle width increased the odds of a collision incident 1.89 times (95% CI=1.22, 2.86). The presence of overhead mirrors at intersections and blind corners with limited visibility reduced the odds of a PIV collision incident by a third (OR=0.33, 95% CI=0.16, 0.68). When carrying a load, the odds of a PIV being involved in a collision was 1.58 (95% CI=1.03, 2.41) times greater than an unloaded one. CONCLUSIONS: Changes in the factory environment, vehicle safety features, and driver and pedestrian training are suggested to reduce the risk of PIV incidents. Am. J. Ind. Med. 36:522-531, 1999. Published 1999 Wiley-Liss, Inc.

Accidents, Occupational↗

PubMed1999

Biomechanical evaluation of assistive devices for transferring residents.

This is the first of two articles to report a biomechanical evaluation and psychophysical assessment of nine battery-powered lifts, a sliding board, a walking belt, and a baseline manual method for transferring nursing home residents from a bed to a chair. The objectives of the biomechanical evaluation were: (1) to investigate the effects of transfer method and resident weight on the biomechanical stress to nursing assistants performing the transferring task, and (2) to identify resident-transferring methods that could reduce the biomechanical stress to the nursing assistants. Nine nursing assistants served as test subjects; two elderly persons participated as residents. A four-camera motion analysis system, two force platforms, and a three-dimensional biomechanical model were used to measure biomechanical load. The results indicate that transfer method and resident weight affect a nursing assistant's low-back loading. The basket-sling and overhead lift devices significantly reduced the nursing assistants' back-compressive forces during the preparation phase of a resident transfer. In addition, the use of basket-sling, overhead, and stand-up lifts removed about two-thirds of the exposure to low-back stress (lifting activities per transfer) as compared to the baseline manual method. Thus, the use of these devices reduces biomechanical stress, and thereby will decrease the occurrence of resident-handling-related low-back injuries. Furthermore, lifting device maneuvering forces were found to be significantly different and a number of design/use problems were identified with various assistive devices. The second article will detail the psychophysical assessment of the same resident-transferring methods.

Biomechanical Phenomena↗

PubMed1999

Vismiaphenones D-G, new prenylated benzophenones from Vismia cayennensis.

Following anti-HIV bioassay-guided fractionation, four new prenylated benzophenones, vismiaphenones D-G (7-10), were isolated from extracts of leaves of Vismia cayennensis. The structures were elucidated by spectral analyses. Only vismiaphenone D (7) exhibited HIV-inhibitory activity in the NCI primary screen.

Anti-HIV Agents↗

PubMed1998

Differential effect of ecologic risk factors on the low birthweight components of African-American, Mexican-American, and non-Latino white infants in Chicago.

This study explored the relationship between ecologic risk factors and infant birthweight. A stratified analysis was performed on all African-American, Mexican-American, and white infants born in Chicago in 1990. One half of African-American mothers (n = 26,799) resided in communities with multiple ecologic risk factors, yet their very low birthweight rates were unaffected by the number of these factors. By contrast, only 5% of Mexican-American mothers (n = 9913) and 5% of white mothers (n = 13,596) lived in communities with multiple ecologic risk factors. Their very low birthweights were twice that of infants born to mothers who resided in communities with no ecologic risk factors. These results indicate that ecologic risk factors affect the very low birthweight rates of Mexican Americans and whites but not African Americans.

Black or African American↗

PubMed1998

African-American mothers' perception of their residential environment, stressful life events, and very low birthweight.

We performed a hospital-based case-control study of African-American mothers to explore the relation between a mother's perception of her own residential environment and very low birthweight. We administered a structured questionnaire to mothers of very-low-birthweight (<1,500 gm; N = 28) and critically ill non-low-birthweight (>2,500 gm; N = 52) infants. The groups had similar sociodemographic characteristics. The vast majority of participants were unmarried and had no private medical insurance. The odds ratios of very low birthweight fluctuated between 1.7 and 3.2 for African-American mothers who rated their neighborhoods (in terms of police protection, protection of property, personal safety, friendliness, delivery of municipal services, cleanliness, quietness, and schools) unfavorably. Additionally, the odds ratio of very low birthweight for mothers exposed to three or more stressful life events during pregnancy was 3.1 (95% confidence interval = 1.2-8.2). We conclude that African-American mothers' perception of their residential environment and frequency of stressful life events are associated with very low birthweight in their infants.

Adolescent↗

PubMed1998

Relation of traditional risk factors to intrauterine growth retardation among United States-born and foreign-born Mexican Americans in Chicago.

OBJECTIVES: To determine the relation of traditional sociodemographic characteristics to the small-for-gestational age rates of urban Mexican Americans. DESIGN: A cross-sectional study. METHODS: We performed a stratified analysis of 1982-1983 Illinois vital records and 1980 U.S. Census income data. The authors analyzed the 1982-1983 Illinois vital records and 1980 U.S. Census income data to determine whether maternal sociodemographic characteristics are associated with the small-for-gestational age (weight-for-gestational-length < 10th percentile) rates among Mexican Americans in Chicago. RESULTS: The small-for-gestational age rate was 2.1% for infants with U.S.-born mothers (N = 2,253) compared to 1.4% for infants with foreign-born mothers (N = 8,746); relative risk 1.5 (95% confidence interval 1.1-2.1). For the U.S.-born cohort, maternal education, marital status, parity, prenatal care, and community income were associated with small-for-gestational age rates. In contrast, with the exception of marital status, these commonly cited risk factors were not associated with the small-for-gestational age rates of infants with Mexican-born mothers. The U.S.-born:Mexico-born small-for-gestational age rate ratio fluctuated around 2 among mothers with a high-risk (maternal age < 20 years, < 12 years education, unmarried marital status) demographic profile. CONCLUSIONS: We conclude that traditional sociodemographic risk factors have different reproductive outcome consequences for U.S.-born and foreign-born Mexican-American mothers.

Adolescent↗

PubMed1997

Relation of parental birth weights to infant birth weight among African Americans and whites in Illinois: a transgenerational study.

The authors used a transgenerational data set of Illinois vital records to ascertain the relation between parental birth weights and infant birth weight. The infant generation consisted of all African Americans and whites born in Illinois during 1989-1991. The parent generation included the mothers and fathers who were also born in Illinois between 1956 and 1975. In the infant cohort, the rate of low birth weight (LBW) (<2,500 g) was 11.7% for African Americans (n = 15,287) versus 5.0% for whites (n = 117,708) (relative risk (RR) = 2.3, 95% confidence interval (CI) 2.2-2.5). For African Americans, the LBW rate was 17.9% among those born to LBW mothers (n = 1,943) compared with 10.8% among those born to non-LBW mothers (n = 13,344) (RR = 1.8, 95% CI 1.6-1.9). For whites, the LBW rate was 8.5% among those born to LBW mothers (n = 2,174) compared with 4.8% among those born to non-LBW mothers (n = 115,534) (RR = 1.7, 95% CI 1.6-2.0). A weaker association was observed between paternal birth weight and infant birth weight. The authors conclude that parental birth weights are important risk factors for LBW in both African Americans and whites.

Adult↗

PubMed1997

Differing birth weight among infants of U.S.-born blacks, African-born blacks, and U.S.-born whites.

BACKGROUND: In the United States, the birth weights of infants of black women are lower than those of infants of white women. The extent to which the lower birth weights among blacks are related to social or genetic factors is unclear. METHODS: We used vital records for 1980 through 1995 from Illinois to determine the distribution of birth weights among infants born to three groups of women -- U.S.-born blacks, African-born blacks, and U.S.-born whites. RESULTS: The mean birth weight of 44,046 infants of U.S.-born white women was 3446 g, that of 3135 infants of African-born black women was 3333 g, and that of 43,322 infants of U.S.-born black women was 3089 g. The incidence of low birth weight (weight less than 2500 g) was 13.2 percent among infants of U.S.-born black women and 7.1 percent among infants of African-born black women, as compared with 4.3 percent among infants of U.S.-born white women (relative risks, 3.1 and 1.6, respectively). Among the women at lowest risk (those 20 to 39 years old, with 12 years of education for themselves and their spouses, early prenatal care, gravida 2 or 3, and no previous fetal loss), the rate of low birth weight in infants of African-born black women (3.6 percent) was closer to the rate in infants of U.S.-born white women (2.4 percent), and the rate in infants of U.S.-born black women remained high (7.5 percent). CONCLUSIONS: The birth-weight patterns of infants of African-born black women and U.S.-born white women are more closely related to one another than to the birth weights of infants of U.S.-born black women.

Africa↗