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Lenora M Olson

Publications and source records attributed to Lenora M Olson.

9 recordsLinked to original sources
PubMed2006

American Indians and suicide: a neglected area of research.

Suicide is a major public health problem for American Indians in the United States. Published studies indicate that American Indians experience the highest rate of suicide of all ethnic groups in the United States. This article synthesizes the epidemiology and risk factors associated with suicide among American Indians, barriers to research, prevention, mental-health services, and recommendations for research and practice. The authors' recommendations arise from the current literature as well as interviews with practitioners and academics in the field of suicide prevention. The authors present significant substantive and methodological issues that inform research on suicide in American Indian communities, as well as existing contemporary interventions. Overall, socioeconomic characteristics, substance abuse, barriers to mental health services and acculturation play a role in the occurrence of suicide in American Indian communities. These findings suggest suicide is an important public health problem that needs to be addressed for American Indians.

Health Services Accessibility↗
PubMed2005

Graduated driver licensing in Utah: is it effective?

STUDY OBJECTIVE: We seek to examine the effectiveness of the graduated driver licensing system in Utah by determining whether crash rates of 16-year-old drivers decreased after graduated driver licensing implementation. METHODS: We studied 16-year-old-driver crashes using statewide motor vehicle crash data probabilistically linked to emergency department (ED), hospital inpatient, and driver licensure data for 1996 to 2001. Outcomes examined included overall crash rates, nighttime crashes, crash severity indicators (eg, noninjury crash, injury crash, ED crash, inpatient crash, fatal crash), seat belt usage, licensure status, and citations. Rate ratios (RR), chi 2 tests, and interventional time series analyses were used to assess changes before and after graduated driver licensing implementation. RESULTS: There were 27,304 16-year-old-driver crashes during the study period. The overall crash rate per 1,000 licensed 16-year-old drivers decreased by 5% (RR 0.95; 95% confidence interval [CI] 0.92 to 0.97), and a time-series analysis showed a reduction of 0.8 (SD 0.39) crashes per month per 1,000 licensed drivers after graduated driver licensing implementation (1996 to 1999 versus 1999 to 2001). The nighttime crash rate did not change (RR 0.91; 95% CI 0.78 to 1.04), and there was no association between crash severity and graduated driver licensing implementation ( P =.096). Reported seat belt usage increased by 6.3%, and few graduated driver licensing citations were issued by law enforcement. CONCLUSION: The results suggest that graduated driver licensing may have contributed to a reduction in young driver crashes, but the effects were minimal compared with those shown in many other graduated driver licensing evaluations.

Accidents, Traffic↗
PubMed2005

Underestimating injury mortality using statewide databases.

BACKGROUND: This study examines the potential for misclassifying injury-related deaths reported in Vital Statistics and assesses the rate of postdischarge death among injured patients released from hospital, emergency department (ED), and emergency medical services (EMS) care. METHODS: Statewide death certificate, inpatient, ED, and EMS databases for 1996 through 1997 were probabilistically linked and information in each database compared. RESULTS: One thousand two hundred ninety-four injured inpatients or ED patients were matched with a death certificate record that listed an injury (56.3%) or illness (43.7%) as the primary cause of death. Injured decedents with an illness-coded cause of death were older (p < 0.001), with causes of death indicative of chronic medical conditions. Few deaths occurred within 30 days of inpatient discharge (6%); however, 38% and 9% of deaths in ED and EMS databases occurred after discharge from health care, respectively. Many deaths among EMS and ED patients occur in subsequent phases of care. CONCLUSION: Estimates of injury mortality substantially increase when using multiple independent databases.

Adult↗
PubMed2004

Trends of behavioral risk factors in motor vehicle crashes in Utah, 1992-1997.

OBJECTIVE: Measure changes in the prevalence of behavioral factors including police-reported fatigue and alcohol intoxication, as well as self-reported seatbelt use, and assess their effect on hospitalization or death after a motor vehicle crash. METHODS: Probabilistic linkage was used to match drivers in motor vehicle crashes with hospital discharge records for the years 1992-1997. Frequencies of specific behavioral factors were evaluated using the Cochran-Armitage test for trend. Odds ratios and corresponding 95% confidence intervals were calculated using generalized estimating equations (GEEs) with crash and driver characteristics as independent variables and hospitalization or death as the dependent variable. RESULTS: The analysis database consisted of 450,286 crash driver records, which linked to 4219 (0.9%) hospitalizations or deaths. There was an increasing trend for self-reported seatbelt use among crash-involved drivers from 80.5% in 1992 to 89.3% in 1997 (P<0.001). Police-reported alcohol intoxication among crash-involved drivers showed a decreasing trend from 2.4% in 1992 to 1.5% in 1997 (P<0.001). There was no trend for police-reported fatigue-related crashes. Odds ratios of hospitalization or death for seatbelt use, alcohol involvement, and fatigue were significant and did not fluctuate considerably between 1992 and 1997. Seatbelt use offered a protective effect from hospitalization or death, while alcohol intoxication and fatigue contributed to increased likelihood of hospitalization or death. CONCLUSIONS: These results suggest that while some improvement has been made in decreasing seatbelt non-use and driver alcohol intoxication among crash-involved drivers, no improvement has been made in reducing fatigue-related crashes.

Accidents, Traffic↗
PubMed2004

Repeat patients to the emergency department in a statewide database.

OBJECTIVES: To describe the epidemiology of repeat users of the emergency department (ED) using a statewide database. METHODS: Probabilistic linkage was used to convert three years of statewide ED visit data into a longitudinal, patient-based data set. Patients were classified as single, repeat (at least two visits within three years), or serial (four or more visits within a 365-day period) users of the ED. Serial patients were further stratified by the number of EDs attended. Descriptive statistics were used to assess differences between patient types. RESULTS: There were 1,370,607 separate visits associated with 780,074 patients from 1996 to 1998. While repeat and serial patients represented 33% of the patients, they accounted for 62% of the ED visits during the study period. Repeat and serial patients were younger and had smaller median ED charges per visit than single-use patients. Serial patients attending five or more EDs were more likely to be coded as self-pay than other serial patients. Diagnosis codes relating to sprains, back problems, and headaches were prevalent among serial patients who visited five or more EDs. Approximately 30% of serial patients during the first year remained serial patients in the second year. CONCLUSIONS: Due to the high turnover in serial patients, control groups in future studies are necessary to evaluate interventions aimed at decreasing serial ED use. The likelihood of serial ED users to use multiple EDs indicates that those studying serial ED use should collect data from multiple EDs.

Adolescent↗
PubMed2003

Effect of motor vehicle crashes on adverse fetal outcomes.

OBJECTIVE: To assess the effect of maternal involvement in motor vehicle crashes on the likelihood of adverse pregnancy outcomes and to estimate the effect of seatbelt use in reducing the occurrence of those outcomes. METHODS: Statewide motor vehicle crash, birth, and fetal death records from 1992 to 1999 were probabilistically linked. Logistic regression was used to compare the likelihood of adverse birth and fetal outcomes including low birth weight, prematurity, placental abruption, fetal distress, excessive bleeding, fetal death, and other complications among pregnant women in crashes and those not in crashes. RESULTS: Of 322,704 single live resident births, 8938 mothers (2.8%) experienced a crash during pregnancy. Pregnant women using seatbelts were not significantly more at risk for adverse fetal outcomes than pregnant women not in crashes. However, pregnant women who did not wear seatbelts during a crash were 1.3 times more likely to have a low birth weight infant than pregnant women not in a crash (95% confidence interval [CI] 1.0, 1.6) and twice as likely to experience excessive maternal bleeding than belted pregnant women in a crash (95% CI 1.0, 4.2). Forty-five of 2645 fetal deaths were linked to a motor vehicle crash, with unbelted pregnant women 2.8 times more likely to experience a fetal death than belted pregnant women in crashes (95% CI 1.4, 5.6). CONCLUSION: Pregnant women should be counseled to wear seatbelts throughout pregnancy and reduce crash risk.

Accidents, Traffic↗
PubMed2003

Against all advice: an analysis of out-of-hospital refusals of care.

STUDY OBJECTIVE: We examine the characteristics of patients involved in out-of-hospital emergency medical services (EMS) incidents that result in refusal of care and determine the rates of subsequent EMS, emergency department (ED), and inpatient care, as well as death within 7 days. METHODS: Utah statewide EMS data identifying refusals of care were probabilistically linked to Utah statewide ED, inpatient, and death certificate data within 7 days of the initial EMS refusals for 1996 to 1998. Refusals were defined as incidents in which field treatment or transport was refused and did not include incidents in which EMS providers deemed care or transport unnecessary. RESULTS: Of 277244 EMS incidents, 14109 (5.1%) resulted in refusals of care. For all age groups, motor vehicle crash dispatches resulted in the highest rate of refusal of care, ranging from 8.0% to 11.7%. Slightly more than 3% of patients involved in a refusal of care incident had a subsequent EMS dispatch within a week. One fifth of the patients involved in EMS refusals of care had a subsequent ED visit. Less than 2% of the EMS refusal patients were hospitalized; hospitalization was highest among children younger than 3 years and adults older than 64 years. Twenty-five adults died within a week of refusing EMS care, of whom 19 (76.0%) were older than 64 years. CONCLUSION: Refusal of care incidents are a small segment of all EMS incidents. They arise from a variety of situations, and the risk for missed intervention may be minimal.

Accidents, Traffic↗
PubMed2003

Classroom injuries in Utah public schools.

OBJECTIVES: School injuries are a serious public health problem, yet classroom injuries have received little attention. The purpose of this study was to describe the epidemiology of classroom injuries in Utah public schools. METHODS: Utah statewide school injury data on kindergarten through 12th grade students for 1996 through 1998 were used. The data were generated from a standardized Student Injury Report (SIR) form completed by school personnel for injuries that (1) caused loss of at least one half of a day of school or (2) warranted medical attention and treatment. Injuries occurring in laboratories, shop, and physical education classes were excluded. To determine the medical outcome and charges associated with classroom injuries, the authors probabilistically linked the SIR database to Utah statewide emergency department (ED) records and Utah statewide hospital inpatients discharge records for 1996 through 1998. RESULTS: During the period 1996 through 1998, there were 1,366 classroom injuries. Nearly two thirds of the injuries occurred to male students. More than half the classroom injuries were related to equipment use. Weapon use was rare. Twenty percent of students injured in the classroom obtained treatment in an ED, where 71% of these injuries were determined to involve the head, neck, and upper extremity. Two incidents, one involving carbon monoxide and the other tear gas, accounted for 11% of the ED admissions. CONCLUSIONS: Classroom injuries are not sufficiently frequent, severe, or costly to justify special studies focused solely on acute injuries in standard classrooms. This does not negate the need for continued surveillance of classroom injuries along with other school injuries.

Adolescent↗