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Biomedical subjects

Kimberly M Thompson

Publications and source records attributed to Kimberly M Thompson.

At least 19 recordsLinked to original sources
PubMed2006

Parental survey of beliefs and practices about bathing and water safety and their children: guidance for drowning prevention.

Drowning represents the second leading cause of unintentional injury death in children less than 19 years. In children less than 5 years, many of these deaths occur in bathtubs. The objective of this study was to describe parental beliefs and practices regarding bathing their children and general water safety to aid in improving anticipatory guidance for drowning prevention. We distributed a written survey about parental beliefs and practices concerning their children's bathing and general water safety to a convenience sample of caregivers. One hundred and thirty-six caregivers participated in the survey providing data for a total of 209 children. Overall, 85% of respondents reported using baby bathtubs, and 46% reported using bath seats when bathing their children. Some caregivers reported leaving a 6-12 months old child unsupervised in the tub, either alone or with a sibling. About half of respondents (52%) indicated that pediatricians discussed water safety and supervision with them, and 36% indicated discussing the proper use of bathing aids with their child's pediatrician. In conclusion, the survey found the majority of caregivers use bathing aids, and caregivers reported some risky behaviors of unsupervised bathing of infants, either alone or with siblings. Better water safety anticipatory guidance is needed for caregivers.

Accident Prevention↗
PubMed2006

Predicting severe head injury after light motor vehicle crashes: implications for automatic crash notification systems.

Motor vehicle crashes (MVC) are a leading public health problem. Improving notification times and the ability to predict which crashes will involve severe injuries may improve trauma system utilization. This study was undertaken to develop and validate a model to predict severe head injury following MVC using information readily incorporated into an automatic crash notification system. A cross-sectional study with derivation and validation sets was performed. The cohort was drawn from drivers of vehicles involved in MVC obtained from the National Automotive Sampling System (NASS). Independent multivariable predictors of severe head injury were identified. The model was able to stratify drivers according to their risk of severe head injury indicating its validity. The areas under the receiver-operating characteristic (ROC) curves were 0.7928 in the derivation set and 0.7940 in the validation set. We have developed a prediction model for head injury in MVC. As the development of automatic crash notification systems improves, models such as this one will be necessary to permit triage of what would be an overwhelming increase in crash notifications to pre-hospital responders.

Accidents, Traffic↗
PubMed2006

Demographic factors and their association with outcomes in pediatric submersion injury.

OBJECTIVES: To describe the epidemiology and outcomes of serious pediatric submersion injuries and to identify factors associated with an increased risk of death or chronic disability. METHODS: A retrospective database review of 1994-2000 Massachusetts death and hospital discharge data characterized demographic factors; International Classification of Diseases, Ninth Revision (ICD-9), Clinical Modification (ICD-9-CM), or ICD-10 injury codes; and outcomes for state residents 0-19 years of age identified with unintentional submersion injuries. The authors performed logistic regression analysis to correlate outcomes with risk and demographic factors. RESULTS: The database included 267 cases of serious submersion injury, defined as those requiring hospitalization or leading to death. Of these 267 patients, 125 (47%) drowned, 118 (44%) were discharged home, 13 (5%) were discharged home with intravenous therapy or with availability of a home health aide, and 11 (4%) were discharged to an intermediate care/chronic care facility. The authors observed a trend of improved outcome in successively younger age groups (p < 0.0001). The multivariable logistic regression analysis showed an increased likelihood of poor outcome for males compared with females (odds ratio [OR]: 2.52; 95% confidence interval [95% CI] = 1.31 to 4.84) and for African Americans compared with whites (OR: 3.47; 95% CI = 1.24 to 9.75), and a decreased likelihood of poor outcome for Hispanics compared with whites (OR: 0.056; 95% CI = 0.013 to 0.24). CONCLUSIONS: After serious pediatric submersion injuries, the overall outcome appears largely bimodal, with children primarily discharged home or dying. The observations that better outcomes occurred among younger age groups, females, and Hispanic children, with worse outcomes in African American children, suggest that injury prevention for submersion injuries should consider differences in age, gender, and race/ethnicity.

Adolescent↗
PubMed2006

Content and ratings of mature-rated video games.

OBJECTIVES: To quantify the depiction of violence, blood, sexual themes, profanity, substances, and gambling in video games rated M (for "mature") and to measure agreement between the content observed and the rating information provided to consumers on the game box by the Entertainment Software Rating Board. DESIGN: We created a database of M-rated video game titles, selected a random sample, recorded at least 1 hour of game play, quantitatively assessed the content, performed statistical analyses to describe the content, and compared our observations with the Entertainment Software Rating Board content descriptors and results of our prior studies. SETTING: Harvard University, Boston, Mass. PARTICIPANTS: Authors and 1 hired game player. MAIN EXPOSURE: M-rated video games. MAIN OUTCOME MEASURES: Percentages of game play depicting violence, blood, sexual themes, gambling, alcohol, tobacco, or other drugs; use of profanity in dialogue, song lyrics, or gestures. RESULTS: Although the Entertainment Software Rating Board content descriptors for violence and blood provide a good indication of such content in the game, we identified 45 observations of content that could warrant a content descriptor in 29 games (81%) that lacked these content descriptors. M-rated video games are significantly more likely to contain blood, profanity, and substances; depict more severe injuries to human and nonhuman characters; and have a higher rate of human deaths than video games rated T (for "teen"). CONCLUSION: Parents and physicians should recognize that popular M-rated video games contain a wide range of unlabeled content and may expose children and adolescents to messages that may negatively influence their perceptions, attitudes, and behaviors.

Humans↗
PubMed2006

Risks of paralytic disease due to wild or vaccine-derived poliovirus after eradication.

After the global eradication of wild polioviruses, the risk of paralytic poliomyelitis from polioviruses will still exist and require active management. Possible reintroductions of poliovirus that can spread rapidly in unprotected populations present challenges to policymakers. For example, at least one outbreak will likely occur due to circulation of a neurovirulent vaccine-derived poliovirus after discontinuation of oral poliovirus vaccine and also could possibly result from the escape of poliovirus from a laboratory or vaccine production facility or from an intentional act. In addition, continued vaccination with oral poliovirus vaccines would result in the continued occurrence of vaccine-associated paralytic poliomyelitis. The likelihood and impacts of reintroductions in the form of poliomyelitis outbreaks depend on the policy decisions and on the size and characteristics of the vulnerable population, which change over time. A plan for managing these risks must begin with an attempt to characterize and quantify them as a function of time. This article attempts to comprehensively characterize the risks, synthesize the existing data available for modeling them, and present quantitative risk estimates that can provide a starting point for informing policy decisions.

Bioterrorism↗
PubMed2006

Retrospective cost-effectiveness analyses for polio vaccination in the United States.

The history of polio vaccination in the United States spans 50 years and includes different phases of the disease, multiple vaccines, and a sustained significant commitment of resources. We estimated cost-effectiveness ratios and assessed the net benefits of polio vaccination applicable at various points in time from the societal perspective and we discounted these back to appropriate points in time. We reconstructed vaccine price data from available sources and used these to retrospectively estimate the total costs of the U.S. historical polio vaccination strategies (all costs reported in year 2002 dollars). We estimate that the United States invested approximately US dollars 35 billion (1955 net present value, discount rate of 3%) in polio vaccines between 1955 and 2005 and will invest approximately US dollars 1.4 billion (1955 net present value, or US dollars 6.3 billion in 2006 net present value) between 2006 and 2015 assuming a policy of continued use of inactivated poliovirus vaccine (IPV) for routine vaccination. The historical and future investments translate into over 1.7 billion vaccinations that prevent approximately 1.1 million cases of paralytic polio and over 160,000 deaths (1955 net present values of approximately 480,000 cases and 73,000 deaths). Due to treatment cost savings, the investment implies net benefits of approximately US dollars 180 billion (1955 net present value), even without incorporating the intangible costs of suffering and death and of averted fear. Retrospectively, the U.S. investment in polio vaccination represents a highly valuable, cost-saving public health program. Observed changes in the cost-effectiveness ratio estimates over time suggest the need for living economic models for interventions that appropriately change with time. This article also demonstrates that estimates of cost-effectiveness ratios at any single time point may fail to adequately consider the context of the investment made to date and the importance of population and other dynamics, and shows the importance of dynamic modeling.

Adult↗
PubMed2006

Risk management in a polio-free world.

Inherent in the decision to launch the Global Polio Eradication Initiative in 1988 was the expectation for many people that immunization against poliomyelitis would eventually simply stop, as had been the case with smallpox following its eradication in 1977. However, the strategies for managing the risks associated with a "polio-free" world must be continuously refined to reflect new developments, particularly in our understanding of the live polioviruses in the oral poliovirus vaccine (OPV) and in the international approach to managing potential biohazards. The most important of these developments has been the confirmation in 2000 that vaccine-derived polioviruses (VDPVs) can circulate and cause polio outbreaks, making the use of OPV after interruption of wild poliovirus transmission incompatible with a polio-free world. A comprehensive strategy has been developed to minimize the risks associated with eventual OPV cessation, centered on appropriate long-term biocontainment of poliovirus stocks (whether for vaccine production, diagnosis, or research), the controlled reintroduction of any live poliovirus vaccine (i.e., from an OPV stockpile), and appropriate use of the inactivated poliovirus vaccine (IPV). Although some aspects of this risk management strategy are still debated, there is wide agreement that no strategy would entirely eliminate the potential risks to a polio-free world. The current strategy for risk management in a polio-free world will continue to evolve with better characterization of these risks and the development of more effective approaches both to reduce those risks and to limit their consequences should they occur.

Disease Outbreaks↗
PubMed2006

Development and consideration of global policies for managing the future risks of poliovirus outbreaks: insights and lessons learned through modeling.

The success of the Global Polio Eradication Initiative promises to bring large benefits, including sustained improvements in quality of life (i.e., cases of paralytic disease and deaths avoided) and costs saved from cessation of vaccination. Obtaining and maintaining these benefits requires that policymakers manage the transition from the current massive use of oral poliovirus vaccine (OPV) to a world without OPV and free of the risks of potential future reintroductions of live polioviruses. This article describes the analytical journey that began in 2001 with a retrospective case study on polio risk management and led to development of dynamic integrated risk, economic, and decision analysis tools to inform global policies for managing the risks of polio. This analytical journey has provided several key insights and lessons learned that will be useful to future analysts involved in similar complex decision-making processes.

Centers for Disease Control and Prevention, U.S.↗
PubMed2006

The costs of future polio risk management policies.

Decisionmakers need information about the anticipated future costs of maintaining polio eradication as a function of the policy options under consideration. Given the large portfolio of options, we reviewed and synthesized the existing cost data relevant to current policies to provide context for future policies. We model the expected future costs of different strategies for continued vaccination, surveillance, and other costs that require significant potential resource commitments. We estimate the costs of different potential policy portfolios for low-, middle-, and high-income countries to demonstrate the variability in these costs. We estimate that a global transition from routine immunization with oral poliovirus vaccine (OPV) to inactivated poliovirus vaccine (IPV) would increase the costs of managing polio globally, although routine IPV use remains less costly than routine OPV use with supplemental immunization activities. The costs of surveillance and a stockpile, while small compared to routine vaccination costs, represent important expenditures to ensure adequate response to potential outbreaks. The uncertainty and sensitivity analyses highlight important uncertainty in the aggregated costs and demonstrates that the discount rate and uncertainty in price and administration cost of IPV drives the expected incremental cost of routine IPV vs. OPV immunization.

Cost-Benefit Analysis↗
PubMed2006

Evaluation of response scenarios to potential polio outbreaks using mathematical models.

Appropriate response to polio outbreaks represents an important prerequisite for achieving and maintaining global polio eradication. We use an existing dynamic disease transmission model to evaluate the impact of different aspects of immunization campaigns in response to polio outbreaks occurring in previously polio-free areas. This analysis yields several important insights about response strategies. We find that delay in response represents a crucial risk factor for occurrence of large outbreaks and we characterize the tradeoffs associated with delaying the initial response to achieve better population coverage. We also demonstrate that controlling most potential outbreaks will likely require at least three immunization rounds, although the impact of the optimal interval between rounds varies. Finally, long after oral poliovirus vaccine cessation the choice of target age groups during a response represents an important consideration.

Disease Outbreaks↗
PubMed2006

Global surveillance and the value of information: the case of the global polio laboratory network.

Effective control and eradication of diseases requires reliable information from surveillance activities, including laboratories, which typically incur real financial costs. This article presents data from a survey we conducted to estimate the costs of the Global Polio Laboratory Network (GPLN), which currently supports aggressive global surveillance for acute flaccid paralysis (AFP) to detect circulating polioviruses. The Global Polio Eradication Initiative (GPEI) of the World Health Organization (WHO) provides resources for some of the laboratory network costs, but the total cost of the network remains relatively poorly characterized given the limited documentation of national contributions. We surveyed network laboratories to quantify AFP surveillance support costs and provide data for cost estimates of potential posteradication surveillance policies related to the laboratories. We estimate that the GPLN currently requires millions (US dollars 2002) in total support annually, and that half of the support for national and regional reference laboratories comes from external donors through the WHO or bilateral agreements and half from within nations that host those laboratories. The article also presents the framework for considering the value of information from this global surveillance network and suggests that the expected value of surveillance information from the GPLN currently exceeds its costs. We also provided important insights about how the value of information may change after successful eradication of wild polioviruses.

Global Health↗
PubMed2005

Body weight and water ingestion estimates for women in two communities in the Philippines: the importance of collecting site-specific data.

In this paper, we report data on exposure factors relevant to assessing health risks of contaminant exposures to women of childbearing age (age 15-49) in two communities in the Philippines. We collected exposure factor data through an interview survey of 182 women conducted between January and May 2002 and we present distributions of self-reported body weight and water ingestion rates. A simple comparison of our results to those from large studies of US women suggests that these small subpopulations may both weigh less and consume more water than might be expected based on the extensive national US data, and it suggests that exposure analysts focused on a particular geographic area should consider the value of obtaining site-specific data to characterize exposure and risk. The lack of a comparable large study of water ingestion rates and body weights of Filipino women makes it difficult to determine whether the communities studied are typical of the population of the Philippines or represent unique subgroups. We suggest that Philippine health authorities consider the possibility of including questions about water ingestion rates in future national health or nutrition surveys.

Adolescent↗
PubMed2005

Quantifying the federal minimal risk standard: implications for pediatric research without a prospect of direct benefit.

United States federal regulations allow institutional review boards (IRBs) to approve pediatric research that does not offer participants a "prospect of direct" benefit only when the risks are minimal or a "minor" increase over minimal. The federal regulations define minimal risks based on the risks "ordinarily encountered in daily life or during routine physical or psychological examinations or tests." In the absence of empirical data, IRB members may assume they are familiar with the risks of daily life and with the risks of routine examinations and tests and rely on their own intuitive judgment to make these assessments. Yet intuitive judgment of risk is subject to systematic errors, highlighting the need for empirical data to guide IRB review and approval of pediatric research. Current data reveal that car trips pose the highest risk of mortality ordinarily encountered by healthy children. On average, these risks are approximately 0.06 per million for children aged 14 years and younger, and approximately 0.4 per million for children aged 15 through 19 years. Riskier, but still ordinary, car trips pose an approximately 0.6 per million chance of death for children aged 14 years and younger and an approximately 4 per million chance of death for children aged 15 through 19 years. Participation in sports represents the upper end of the range of morbidity risks for healthy children. For every million instances of playing basketball, approximately 1900 individuals will sustain injuries, including 180 broken bones and 58 permanent disabilities. These findings suggest IRBs are implementing the federal minimal risk standard too cautiously in many cases. These data also raise the question of whether the federal minimal risk standard may sometimes fail to provide sufficient protection for children, prompting the need to consider alternative standards.

Activities of Daily Living↗
PubMed2005

A dynamic model of poliomyelitis outbreaks: learning from the past to help inform the future.

Policy-makers now face important questions regarding the tradeoffs among different strategies for managing poliomyelitis risks after they succeed with polio eradication. To estimate the potential consequences of reintroductions of polioviruses and the resulting outbreaks, the authors developed a dynamic disease transmission model that can simulate many aspects of outbreaks for different posteradication conditions. In this paper, the authors identify the issues related to prospective modeling of future outbreaks using such a model, including the reality that accurate prediction of conditions and associated model inputs prior to future outbreaks remains challenging. The authors explored the model's behavior in the context of three recent outbreaks resulting from importation of poliovirus into previously polio-free countries and found that the model reproduced reported data on the incidence of cases. The authors expect that this model can provide important insights into the dynamics of future potential poliomyelitis outbreaks and in this way serve as a useful tool for risk assessment.

Adolescent↗
PubMed2005

Addicted media: substances on screen.

The depiction of alcohol and drug traffic/usage in films has caused concern since the advent of motion pictures and continues to raise concern with the introduction of new media. This article provides a comprehensive review of much of the existing peer-reviewed published literature about the depiction of substances in the media by focusing on the information obtained in content analyses. This article demonstrates the widespread and overwhelming presence of substances in the media viewed by youth and highlights reviews that discuss the potential impacts of these depictions.

Adolescent↗
PubMed2005

Interdisciplinary vision: the first 25 years of the Society for Risk Analysis (SRA), 1980-2005.

In early 1979 Robert B. Cumming recognized the growing need for risk researchers and practitioners to publish their work in a dedicated professional journal. This led to the formation of an organization to support such a journal, with the Certificate of Incorporation for the Society for Risk Analysis (SRA) made official on August 28, 1980. The first issue of Risk Analysis: An International Journal appeared in March 1981. This article reviews the history of the SRA's first 25 years. It reviews the SRA's formation and growth, provides analyses of its major products (the journal, newsletter, conferences, and meetings), and discusses its impact. This article relies on published literature and a history of the SRA's first 20 years written by two of the authors. This history covers the SRA's many successes, which demonstrate the strength and vitality of the organization and provide optimism for its future. These successes include this journal, which published over 2,150 papers between March 1981 and this December 2005 issue. The successes also include its stable membership of approximately 2,000 members from 43 countries, well-attended annual meetings, and increasing support for true international growth as demonstrated by international risk forums like the World Congress on Risk held in Brussels in June 2003. Similarly, the history also covers the SRA's challenges and difficulties, with the recognition that these provide both an important context about the organization and the opportunity to learn from past experiences. These include the challenges associated with spin-off organizations that decreased the SRA membership in some disciplinary areas, notably in engineering and exposure assessment. This history also includes quantitative analyses of the contents of the first 25 years of Risk Analysis: An International Journal. The results show significant growth in the number of articles published each year, starting with approximately 30 articles published in the first few years to over 120 articles per year now. They also show a relatively even distribution of articles in the life, physical, and social sciences, which demonstrate the sustained commitment of the SRA and the journal to support interdisciplinary risk-related research. The SRA organizational structure currently includes two sections (SRA-Europe and SRA-Japan), 22 Chapters, and nine Specialty Groups, and the structure remains somewhat in flux. We present this history in five sections that cover major themes: (1) SRA formation, (2) membership and organization, (3) publications, (4) meetings, and (5) thematic issues. Like any organization of its size, the SRA boasts a long and diverse history, and no article can possibly capture it all. We hope that in documenting the first 25 years, we strengthen the SRA by providing some perspective on its roots and a rigorous quantitative analysis of some of its products.

Journal Article↗