PubMed Health⌕ Search

Biomedical subjects

Joseph L Wright

Publications and source records attributed to Joseph L Wright.

9 recordsLinked to original sources
PubMed2006

Assault-injured adolescents presenting to the emergency department: causes and circumstances.

OBJECTIVES: To describe the causes and circumstances of conflict leading to assault injury among urban youth seeking care in the emergency department. METHODS: The authors conducted in-person and telephone interviews with a convenience sample of 143 youth aged 12-19 years presenting to two urban emergency departments with an interpersonal assault injury. Patients were interviewed about the nature and circumstances of their injury. Descriptive analysis was performed, including stratified analysis by gender, age (12-15 vs. 16-19 years), and weapon use. RESULTS: Seventy percent of patients knew or knew of the person(s) who injured them; most were friends, classmates, or acquaintances. More than half of the injuries (56%) were related to a past disagreement. Among assaults related to a past disagreement, 33% of patients had previous arguments with their assailant, 16% had previous fights, and 14% had previous weapons threats. Twenty-nine percent had been previously threatened, and 11% had previously threatened their assailant. Twenty-eight percent of patients believed they helped to cause the injury by provoking a fight or letting down their guard. Nearly two thirds (64%) believed there were things they could change to prevent future injury, including staying away from dangerous situations and bad influences or controlling their tempers. CONCLUSIONS: Most assault injuries among adolescents involved past disagreements with people they knew. Many injured youth were mutually involved in conflict before their injury. Over time, many victims and perpetrators may be interchangeable. These data may help inform emergency department-based interventions to prevent assault injury.

Adolescent↗
PubMed2004

Children's violent television viewing: are parents monitoring?

OBJECTIVE: Violent media exposure has been associated with aggressive behavior, and it has been suggested that child health professionals counsel families on limiting exposure. Effective violence prevention counseling requires an understanding of norms regarding parental attitudes, practices, and influencing factors. Both theories of reasoned action and planned behavior emphasize that subjective norms and attitudes affect people's perceptions and intended behavior. Few data exist on violent television viewing and monitoring from a cross-section of families. By understanding the spectrum of parental attitudes, community-sensitive interventions for violence prevention can be developed. The objective of this study was to assess attitudes about and monitoring of violent television viewing from the perspective of parents. METHODS: An anonymous self-report assisted survey was administered to a convenience sample of parents/guardians who visited child health providers at 3 sites: an urban children's hospital clinic, an urban managed care clinic, and a suburban private practice. The parent questionnaire included questions on child-rearing attitudes and practices and sociodemographic information. RESULTS: A total of 1004 adults who accompanied children for health visits were recruited for the study; 922 surveys were completed (participation rate: 92%). A total of 830 (90%) respondents were parents and had complete child data. Of the 830 respondents, 677 had questions on television viewing included in the survey and were the focus of this analysis. Seventy-five percent of families reported that their youngest child watched television. Of these, 53% reported always limiting violent television viewing, although 73% believed that their children viewed television violence at least 1 time a week. Among television viewers, 81% reported usually or always limiting viewing of sexual content on television and 45% reported usually or always watching television with their youngest child. Among children who watched television, parents reported that they spent an average of 2.6 hours per day watching television. Limitation of television violence was associated with female parents and younger children. CONCLUSIONS: There was variability in attitudes and practices regarding television violence viewing and monitoring among parents. Attitudes and practices varied on the basis of the age of the child and the gender of the parent.

Attitude↗
PubMed2003

Community norms on toy guns.

OBJECTIVE: Toy gun play has been associated with aggressive behavior, and it has been suggested that child health professionals counsel families on limiting exposure. Effective violence prevention counseling requires an understanding of norms regarding parental attitudes, practices, and influencing factors. Both theories of reasoned action and planned behavior emphasize that subjective norms and attitudes affect people's perceptions and intended behavior. Few normative data exist on this issue from a cross-section of families. By establishing behavioral norms and understanding the spectrum of parental attitudes, community-sensitive and community-specific interventions for violence prevention can be developed. The objective of this study was to assess community norms on the topic of toy gun play from the perspective of parents. METHODS: An anonymous self-report assisted survey was administered to a convenience sample of parents/guardians who visited child health providers at 3 sites: an urban children's hospital clinic, an urban managed care clinic, and a suburban private practice. The parent questionnaire included questions on child rearing attitudes, practice, and sociodemographic information. RESULTS: A total of 1004 eligible participants were recruited for the study; 922 surveys were completed (participation rate 92%). The 830 (90%) respondents who were parents and had complete child data were the focus of additional analysis. Regarding toy guns, 67% of parents believed that it was never "OK for a child to play with toy guns," and 66% stated that they never let their children play with toy guns. Parents who thought that it was okay for children to play with toy guns and allowed them to play with toy guns were more likely to be male parents, have male children, and be white. CONCLUSIONS: There is variability in norms regarding toy gun play among parents, with most discouraging toy gun play. Norms varied based on gender of the child, gender of the parent, and race. Understanding norms is a first step in designing effective community-sensitive interventions.

Child Behavior↗
PubMed2003

Adolescent assault injury: risk and protective factors and locations of contact for intervention.

BACKGROUND: Violence is a large contributor to morbidity and mortality among adolescents. Most studies assessing markers for violent injury are cross-sectional. To guide intervention, we conducted a case-control study to explore factors associated with assault injury and locations to reach at-risk adolescents. OBJECTIVE: 1) To assess risk and protective factors for adolescent assault injury compared with 2 control groups of youth with unintentional injuries and noninjury complaints presenting to the emergency department and 2) to assess locations of contact with assault-injured youth for prevention programs. METHODS: Face-to-face and phone interviews were conducted with systematic samples of youth aged 12 to 19 years presenting to the emergency department with assault injury, unintentional injury, and noninjury complaints. Youth with intentional injuries were matched to youth in the 2 control groups on age +/-1 year, gender, race, and residency. RESULTS: One hundred forty-seven 147 assault-injured youth completed interviews. One hundred thirty-three assault-injured youth were matched to 133 unintentionally injured and 133 noninjured youth presenting to the emergency department. Compared with the 2 control groups, assault-injured youth were more likely to have had more fights in the past year (odds ratio [OR]: 3.91; 95% confidence interval [CI]: 2.02, 7.58; OR: 4.00; 95% CI: 2.23, 7.18) and fights requiring medical treatment (OR: 35.49; 95% CI: 8.71, 144.68; OR: 80.00; 95% CI: 11.13, 574.80). Eighty percent of assault-injured youth had been in 1 or more fights in the last 12 months compared with 55% and 46% in unintentional and noninjured controls, respectively. Assault-injured youth were more likely to have had previous weapon injuries (OR: 9.50; 95% CI: 3.39, 26.6; OR: 8.50; 95% CI: 3.02, 23.95) and have seen someone shot (OR: 2.00; 95% CI 1.12, 3.58; OR: 2.00; 95% CI: 1.12, 3.58). Eighty-six percent of assault-injured youth had a regular health care provider with 82% reporting a visit within the last year. There were no differences between cases and controls with regard to physician contact, extracurricular activity involvement, school or church attendance, police contact, weapon access or weapon-carrying, or witnessing nonweapon-related violence. CONCLUSIONS: Fighting was common among all groups. Assault-injured youth were more likely to have had previous weapon injuries and were high-risk for future injury. Past fights, past fight injuries, and seeing someone else shot were markers associated with assault injury. Health providers do have access to at-risk teens for clinical risk assessment and intervention.

Accidents↗
PubMed2002

Injury surveillance in the ED: design, implementation, and analysis.

Comprehensive, population-based surveillance for nonfatal injuries requires uniform methods for data collection from multiple hospitals. To show issues related to design and implementation of multihospital, emergency department (ED), injury surveillance, a city-wide system in the United States is discussed. From October 1, 1995 to September 30, 1996 all injury-related ED visits among District of Columbia residents <3 years of age were ascertained at the 10 hospitals where city children routinely sought care. Information was abstracted from 2,938 injury-related, ED visits (132.7 visits/1,000 person-years). Based on this experience, suggestions to facilitate design of multihospital, injury surveillance in other locations are offered. Importantly, injury-related visits were reliably ascertained from ED logs, and for most variables, a systematic sample of injury-related visits was representative of the total injured population. However, there is a need for more complete documentation of circumstances surrounding injuries and for standardization of data elements on ED logs and treatment records.

Child, Preschool↗
PubMed2002

Pediatric trauma systems.

The origins of trauma systems in the United States date to the 1960s when physicians returning from wars abroad realized that lessons learned from managing military casualties could be applied to civilian traumatic injury. Over the next several decades, trauma centers and then trauma systems began to be developed in an attempt to improve prehospital and acute care for these patients. Although studies of trauma system effectiveness are fraught with methodologic difficulties, several types of studies (panel reviews of preventable deaths, registry studies, and population-based studies), suggest that there may be improvements in mortality when trauma systems are established. Further study needs to focus on other outcomes than mortality, such as return to function after rehabilitation. Pediatric trauma systems have by necessity developed within the "adult" systems in place. The history of pediatric system development and studies assessing outcomes are also discussed. Continued system development, assessment, and educational efforts about how childhood injuries are different are essential to combat this leading killer of children.

Adolescent↗
PubMedDate not supplied

Children with special health care needs: a template for prehospital protocol development.

There are 12 million children in the United States with special health care needs. Improvements in medical technology, managed care, and changing social views about the institutionalization of children have all contributed to an increasing number of children with special health care needs (CSHCN) residing primarily in their home communities. Because of the dynamic and fragile nature of the medical conditions typically borne by CSHCN, the need for emergency care is not uncommon and prehospital providers are increasingly likely to encounter this population. Few states have initiated emergency medical services (EMS) protocols addressing field assessment, management, and stabilization of CSHCN and existing model protocols have not yet incorporated a distinct CSHCN component. With the support of grant funding from the federal Emergency Medical Services for Children (EMSC) program, a project was undertaken by investigators in the Center for Prehospital Pediatrics at Children's National Medical Center to develop prehospital protocols for CSHCN. This report details the protocol development process, discusses suggestions for their use, and presents the detailed protocols. The protocols are intended to serve as a resource template for the development and/or revision of jurisdiction-specific, customized practice guidelines.

Child↗