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Biomedical subjects

L A Fingerhut

Publications and source records attributed to L A Fingerhut.

At least 19 recordsLinked to original sources
PubMed2002

An introduction to the Barell body region by nature of injury diagnosis matrix.

INTRODUCTION: The Barell body region by nature of injury diagnosis matrix standardizes data selection and reports, using a two dimensional array (matrix) that includes all International Classification of Diseases (ICD)-9-CM codes describing trauma. AIM: To provide a standard format for reports from trauma registries, hospital discharge data systems, emergency department data systems, or other sources of non-fatal injury data. This tool could also be used to characterize the patterns of injury using a manageable number of clinically meaningful diagnostic categories and to serve as a standard for casemix comparison across time and place. CONCEPT: The matrix displays 12 nature of injury columns and 36 body region rows placing each ICD-9-CM code in the range from 800 to 995 in a unique cell location in the matrix. Each cell includes the codes associated with a given injury. The matrix rows and columns can easily be collapsed to get broader groupings or expanded if more specific sites are required. The current matrix offers three standard levels of detail through predefined collapsing of body regions from 36 rows to nine rows to five rows. MATRIX DEVELOPMENT: This paper presents stages in the development and the major concepts and properties of the matrix, using data from the Israeli national trauma registry, and from the US National Hospital Discharge Survey. The matrix introduces new ideas such as the separation of traumatic brain injury (TBI), into three types. Injuries to the eye have been separated from other facial injuries. Other head injuries such as open wounds and burns were categorized separately. Injuries to the spinal cord and spinal column were also separated as are the abdomen and pelvis. Extremities have been divided into upper and lower with a further subdivision into more specific regions. Hip fractures were separated from other lower extremity fractures. FORTHCOMING DEVELOPMENTS: The matrix will be used for the development of standard methods for the analysis of multiple injuries and the creation of patient injury profiles. To meet the growing use of ICD-10 and to be applicable to a wider range of countries, the matrix will be translated to ICD-10 and eventually to ICD-10-CM. CONCLUSION: The Barell injury diagnosis matrix has the potential to serve as a basic tool in epidemiological and clinical analyses of injury data.

Data Collection↗
PubMed2002

Trends in BB/pellet gun injuries in children and teenagers in the United States, 1985-99.

OBJECTIVE: To characterize national trends in non-fatal BB/pellet gun related injury rates for persons aged 19 years or younger in relation to trends in non-fatal and fatal firearm related injury rates and discuss these trends in light of injury prevention and violence prevention efforts. SETTING: The National Electronic Injury Surveillance System (NEISS) includes approximately 100 hospitals with at least six beds that provide emergency services. These hospitals comprise a stratified probability sample of all US hospitals with emergency departments. The National Vital Statistics System (NVSS) is a complete census of all death certificates filed by states and is compiled annually. METHODS: National data on BB/pellet gun related injuries and injury rates were examined along with fatal and non-fatal firearm related injuries and injury rates. Non-fatal injury data for all BB/pellet gun related injury cases from 1985 through 1999, and firearm related injury cases from 1993 through 1999 were obtained from hospital emergency department records using the NEISS. Firearm related deaths from 1985 through 1999 were obtained from the NVSS. RESULTS: BB/pellet gun related injury rates increased from age 3 years to a peak at age 13 years and declined thereafter. In contrast, firearm related injury and death rates increased gradually until age 13 and then increased sharply until age 18 years. For persons aged 19 years and younger, BB/pellet gun related injury rates increased from the late 1980s until the early 1990s and then declined until 1999; these injury rates per 100 000 population were 24.0 in 1988, 32.8 in 1992, and 18.3 in 1999. This trend was similar to those for fatal and non-fatal firearm related injury rates per 100 000 which were 4.5 in 1985, 7.8 in 1993, and 4.3 in 1999 (fatal) and 38.6 in 1993 and 16.3 in 1999 (non-fatal). In 1999, an estimated 14 313 (95% confidence interval (CI) 12 025 to 16 601) cases with non-fatal BB/pellet gun injuries and an estimated 12 748 (95% CI 7881-17 615) cases with non-fatal firearm related injuries among persons aged 19 years and younger were treated in US hospital emergency departments. CONCLUSIONS: BB/pellet gun related and firearm related injury rates show similar declines since the early 1990s. These declines coincide with a growing number of prevention efforts aimed at reducing injuries to children from unsupervised access to guns and from youth violence. Evaluations at the state and local level are needed to determine true associations.

Accident Prevention↗
PubMed2000

Deaths due to injury in the military.

INTRODUCTION: More military personnel die of injuries each year than any other cause. This paper provides a basic epidemiologic description of injury deaths in the military. METHODS: Using fatality data from the Department of Defense Directorate of Information and Operations Reports and population data from the Defense Manpower Data Center, death rates of men and women in the military services for unintentional injury, suicide, homicide, and illness were calculated for the 1980-1992 period. RESULTS: From 1980 to 1992, injuries (unintentional injuries, suicides, and homicides combined) accounted for 81% of all nonhostile deaths among active duty personnel in the Armed Services. The overall death rate due to unintentional injuries was 62.3 per 100,000 person-years. The suicide rate was 12.5, the homicide rate 5.0, and the death rate due to illness 18.4. From 1980 to 1992 mortality from unintentional injuries declined about 4% per year. The rates for suicide and homicide were stable. Men in the services die from unintentional injuries at about 2.5 times the rate of women and from suicides at about twice the rate of women. Women in the military, however, have a slightly higher homicide rate than men. CONCLUSION: Injuries (unintentional injuries, suicides, and homicides) are the leading cause of death among active duty members of the U.S. Armed Forces, accounting for about four out of five deaths. The downward trend for fatal unintentional injuries indicates the success that can be achieved when attention is focused on preventing injuries. Further reduction in injury mortality would be facilitated if collection and coding of data were standardized across the military services.

Adult↗
PubMed1998

International comparative analysis of injury mortality. Findings from the ICE on injury statistics. International Collaborative Effort on Injury Statistics.

OBJECTIVE: This report investigates international differences in injury mortality rates among 11 of the countries participating in the International Collaborative Effort on Injury Statistics. METHODS: The cause, intent, and age-specific injury mortality rates are calculated and presented from Australia, Canada, Denmark, England & Wales, France, Israel, New Zealand, The Netherlands, Norway, Scotland, and the United States. Data are presented by cause (or mechanism) and intent (or manner of death) according to the matrix framework for presenting injury mortality statistics published in August 1997. The benefits of this matrix approach to investigating injury mortality are explained with numerous examples. RESULTS: Injury death rates are higher in France and Denmark and lower in England & Wales, Israel, and The Netherlands than elsewhere. New Zealand, the United States, and Norway had similar average annual injury death rates of 56-57 per 100,000 population. As an example of the benefit of presenting data in the matrix framework, the total poisoning death rate in Denmark for all categories of intent (13 per 100,000) is about twice the rate in the United States. Unintentional poisoning death rates, however, are similar in the United States and Denmark (about 4 per 100,000) and are higher than elsewhere. However, the suicide poisoning death rate in Denmark is 3 times the rate in the United States. CONCLUSION: Using these results, the ICE on Injury will be investigating death registration practices in each of the countries to better understand international variation in injury mortality due to reporting or registration procedures.

Accidents↗
PubMed1998

Homicide rates among US teenagers and young adults: differences by mechanism, level of urbanization, race, and sex, 1987 through 1995.

CONTEXT: Homicide rates for persons 15 through 24 years old began to decline between 1993 and 1994, but recent trends in homicide rates by mechanism of homicide and urbanization group have not been described. OBJECTIVE: To examine homicide trends from 1987 through 1995 for persons 15 through 24 years old by urbanization level. DESIGN: Homicide rates by urbanization level were analyzed using the Compressed Mortality File, a county-level mortality and population database maintained by the National Center for Health Statistics, Centers for Disease Control and Prevention, and the rural-urban continuum codes developed by the Economic Research Service, US Department of Agriculture. SETTING: United States, 1987 through 1995, according to 5 urbanization strata: core, counties with the primary central city of a metropolitan statistical area (MSA) of 1 million or more; fringe, remaining counties within an MSA of 1 million or more; medium, counties within an MSA of 250000 to 999999; small, counties in an MSA of less than 250000; and nonmetropolitan, counties not in an MSA. SUBJECTS: All persons 15 through 24 years old by race whose cause of death was homicide (International Classification of Diseases, Ninth Revision codes E960-E969). MAIN OUTCOME MEASURES: Firearm and nonfirearm homicide rates and average annual percentage changes by 5 urbanization levels, race, and sex. RESULTS: From 1987 through 1991, the average annual firearm homicide rates among persons 15 through 24 years old among all 5 urbanization strata increased between 10.7% in small counties and 19.8% in fringe counties. From 1991 through 1993, the rates increased between 3.3% in core counties and 11.7% in small counties. From 1993 through 1995, the rates declined between 4.4% in fringe counties and 15.3% in medium counties. By 1995, firearm homicide rates among persons 15 through 24 years old ranged from 6.5 and 7.3 per 100000 in the nonmetropolitan and small counties, respectively, to 9.6 and 13.3 per 100000 in the fringe and medium strata, respectively, to 33.5 per 100000 in the core stratum. During 1987 through 1990, nonfirearm homicide rates either were stable or increased, and from 1990 through 1995, nonfirearm homicide rates declined in all 5 strata, on average 3.7% to 8.0% per year, with rates in 1995 ranging from 2.1 to 4.7 per 100000 across the strata. CONCLUSIONS: After increasing since 1987, firearm and nonfirearm homicide rates began declining between 1993 and 1995 among persons 15 through 24 years old. These declines are taking place across all urbanization strata and among white and black males and females.

Adolescent↗
PubMed1998

Injury visits to hospital emergency departments: United States, 1992-95.

OBJECTIVES: This report describes ambulatory care visits for injuries to hospital emergency departments in the United States. Statistics are presented on selected patient, hospital, and visit characteristics. METHODS: The data presented in this report were collected in the National Hospital Ambulatory Medical Care Survey (NHAMCS) over a period of 4 years from 1992 through 1995. The NHAMCS is a national probability survey of visits to hospital emergency and outpatient departments of non-Federal, short-stay, and general hospitals in the United States. Sample data were combined across years and weighted to produce annual estimates. RESULTS: From 1992 through 1995, an estimated 147 million visits for injuries were made to hospital emergency departments in the United States, an average of 36.8 million visits per year with an annual utilization rate of 14.3 visits per 100 persons. Persons 15-24 years had a higher rate of injury-related emergency department visits compared with other age groups. The injury visit rate was higher in the Midwest than in the South or West. Injury visits represented 37.8 percent of all visits to hospital emergency departments but 53.5 percent of all visits for children between 5 and 14 years and 48.5 percent of all visits for persons 15-24 years. Open wounds accounted for the largest proportion of injuries (22.0 percent). The leading external causes of injuries included falls, being struck by or striking against a person or object, and motor vehicle traffic injuries. For all ages, 6.3 percent of the injury visits had a disposition of admission for inpatient care, while almost one-quarter of injury visits by persons 65 years and over resulted in hospitalization. ED visits caused by poisonings or firearm injuries were more likely to result in hospitalization compared with other causes.

Accidental Falls↗
PubMed1992

Firearm homicide among black teenage males in metropolitan counties. Comparison of death rates in two periods, 1983 through 1985 and 1987 through 1989.

OBJECTIVE: To identify US counties (1) that had either significantly high or significantly low firearm homicide rates among black males 15 through 19 years of age in 1983 through 1985 and in 1987 through 1989, and/or (2) that experienced a significant increase in the firearm homicide rate between 1983 through 1985 and 1987 through 1989. DESIGN: Using the Compressed Mortality File, a county-level mortality and population database maintained by the National Center for Health Statistics, Centers for Disease Control, Hyattsville, Md, county-level firearm homicide rates are analyzed. SETTING: Eighty counties with a population of at least 10,000 black males 15 through 19 years of age in 1987 through 1989. SUBJECTS: Black males 15 through 19 years of age whose underlying cause of death was classified as firearm homicide (E965.0 through E965.4, or E970) in the ICD-9 (International Statistical Classification of Diseases, Injuries, and Causes of Death, Ninth Revision). MAIN OUTCOME MEASURE: County-specific firearm homicide rate. RESULTS: In 1983 through 1985 and in 1987 through 1989, seven and 13 counties, respectively, were identified that had significantly high firearm homicide rates. Firearm homicide rates were significantly high in both time periods in the following counties: Los Angeles, California; Wayne, Michigan; Kings, New York; St Louis City, Missouri; and Baltimore City, Maryland. Firearm homicide rates increased significantly between 1983 through 1985 and 1987 through 1989 in 34 of the 80 counties. Twenty counties had significantly low rates in both time periods. Several counties with low rates in 1983 through 1985 experienced significant increases and by 1987 through 1989 were among those with high rates. CONCLUSIONS: Surveillance of firearm homicide rates at the county levels in counties with high and with low rates is a necessary first step in the development of successful violence prevention programs. Those counties where rates are high and increasing are the counties that are in greatest need for intervention strategies. Knowledge of the incidence of nonfatal firearm injuries is also needed.

Adolescent↗
PubMed1992

Firearm and nonfirearm homicide among persons 15 through 19 years of age. Differences by level of urbanization, United States, 1979 through 1989.

OBJECTIVE: To examine trends (1979 through 1989) and current status in firearm and nonfirearm homicide rates by level of urbanization among persons 15 through 19 years of age. DESIGN: The Compressed Mortality File, a county-level mortality and population database maintained by the National Center for Health Statistics, Centers for Disease Control, Hyattsville, Md, and the 1980 Human Resource Profile County Codes are used to analyze age-, sex-, and race-specific firearm and nonfirearm homicide rates by urbanization level. SETTING: United States, 1979 through 1989. SUBJECTS: Black and white males and females 15 through 19 years of age whose underlying cause of death was either firearm homicide (E965.0 through E965.4 or E970) or nonfirearm homicide (E960 through E964, E965.5 through E969, or E971 through E978) in the ICD-9 (International Statistical Classification of Diseases, Injuries, and Causes of Death, Ninth Revision). MAIN OUTCOME MEASURES: Urbanization level-specific firearm and nonfirearm homicide rates. RESULTS: The 1989 firearm homicide rate in metropolitan counties was nearly five times the rate in nonmetropolitan counties (13.7 vs 2.9 deaths per 100,000 population). Firearm homicide rates were highest in core metropolitan counties, 27.7 per 100,000 population; rates were higher for black males than for any other race-sex group in each of five county urbanization strata for 1979 through 1989. Nonfirearm homicide rates are considerably lower, with smaller urban differentials; the rate in metropolitan counties was 1.4 times the rate in nonmetropolitan counties (2.6 vs 1.8 per 100,000 population). From 1979 through 1984, firearm homicide rates declined in each of the county strata. From 1984 through 1987, firearm homicide rates increased, and from 1987 through 1989 they increased rapidly, from 23% to 35% per year in the four metropolitan strata. From 1979 through 1989, nonfirearm homicide rates declined or remained stable. CONCLUSIONS: Large urbanization differentials in firearm homicide and smaller differentials in nonfirearm homicide are identified. Firearm homicide rates are highest and increasing the fastest among black teenage males in the core, fringe, and medium metropolitan strata.

Adolescent↗
PubMed1991

Differences in infant mortality by race, nativity status, and other maternal characteristics.

The objective of this study was to examine the effects of nativity status (native vs foreign born) and other maternal characteristics (age, parity, education, and marital status) on infant, neonatal, and postneonatal mortality among white and black mothers. The design of this nonrandomized cohort study was based on birth and death certificates. The setting involved live births among US residents (excluding California, Texas, and Washington) in 1983 and 1984. The participants included white mothers with 4.4 million births and black mothers with 926,000 births in single deliveries. There were no interventions. With regard to measurements (the main results), after adjusting for other risk factors, neonatal mortality risk was 22% lower among the black foreign-born mothers than among the black native-born mothers, while among white infants, there was no risk difference by nativity. Relative risks were more similar for postneonatal mortality, ie, 24% lower among black foreign-born mothers and 20% lower among white foreign-born mothers. Combining the several categories of risk factors into three broad maternal risk groups, there was a near-doubling of black and near-tripling of white infant mortality rates between the low and high levels of maternal risk. We concluded that if the infant mortality rate in the low-risk groups could be achieved by the moderate- and high-risk groups, there would be a 30% reduction in infant deaths within each race. Since the black infant mortality rate is twice the white infant mortality rate and black foreign-born mothers have much lower rates than black native-born mothers, it is likely that further improvement is possible among black infants.

Educational Status↗
PubMed1990

International and interstate comparisons of homicide among young males.

The homicide rate for males 15 through 24 years of age in the United States was compared with the rates in 21 other developed countries. The US homicide rate, 21.9 per 100,000, was more than four times higher than the next highest rate in Scotland (5.0). Most countries had rates that were between 1 and 3 per 100,000. The lowest rates were in Japan and Austria, each with rates below 0.6 per 100,000 males 15 through 24 years of age. Three quarters of the homicides in the United States resulted from the use of firearms contrasted with less than a quarter of all homicides in the comparison countries. The US homicide rate for black males 15 through 24 years of age (85.6) was more than seven times the rate for white males (11.2). In 1987 there were only four states that had homicide rates among white males that were as low as the rates among males in the comparison countries. The lowest state rate among young black males was still seven times the highest rate abroad. There are about 4000 homicides per year among young males in the United States. If the US homicide rate could be reduced to that in the country with the next highest rate, more than 3000 lives would be saved.

Adolescent↗
PubMed1990

Smoking before, during, and after pregnancy.

We report the first national data on smoking before, during, and after pregnancy. Estimates are based on the 1986 Linked Telephone Survey that reinterviewed 1,550 White women 20-44 years of age who were respondents to the 1985 National Health Interview Survey. An estimated 39 percent of White women who had smoked before pregnancy quit smoking while pregnant (27 percent when they found out they were pregnant and 12 percent later during pregnancy). Women with less than 12 years of education were five times as likely to smoke and one-fourth as likely to quit as those with 16 or more years of education. Women who smoked more than one pack of cigarettes per day before pregnancy were one-fifth as likely to quit as those smoking less. Of the women who quit, 70 percent resumed smoking within one year of delivery. Of those who relapsed, 67 percent resumed smoking within three months of delivery and 93 percent within six months. There is little evidence of educational differentials in relapse rates. The fact that relapse remains high suggests that while health of the fetus is a strong influence on women's smoking habits, women may be less aware of the effect of passive smoke on the infant.

Adult↗