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Biomedical subjects

M Schootman

Publications and source records attributed to M Schootman.

17 recordsLinked to original sources
PubMed2001

Improving survival of vulnerable infants increases neonatal intensive care unit nosocomial infection rate.

OBJECTIVE: To determine the factors associated with an increasing rate of nosocomial infections in infants with very low birth weights. METHODS: Retrospective review of clinical and nosocomial infection databases for all infants with birth weights of 1500 g or less admitted to an academic neonatal intensive care unit between January 1, 1991, and December 31, 1997 (N = 1184). Two study periods were compared: 1991-1995 and 1996-1997. RESULTS: Among the 1085 infants who survived beyond 48 hours, the proportion who developed nosocomial infections increased from 22% to 31% (P =.001) and the infection rate increased from 0.5 to 0.8 per 100 patient-days (P<.001) during the period from 1996 to 1997. In that same period, the median duration of indwelling vascular access increased from 10 to 16 days (P<.001), and the median duration of mechanical ventilation increased from 7 to 12 days (P<.001). Although the device-specific rate of bloodstream or respiratory infections did not change, the increase in infections was directly attributable to the increasing proportion of infants who required these devices. In both study periods, the peak incidence of initial infection occurred between 10 and 20 days of age. For the entire sample, proportional hazard models identified birth weight, duration of vascular access, and postnatal corticosteroid exposure as significant contributors to the risk of infection. CONCLUSIONS: The increasing number of technology-dependent infants was the primary determinant in the increase of nosocomial infections. Because these infections occur in a small proportion of infants, understanding the host factors that contribute to this vulnerability is necessary to decrease nosocomial infections in neonatal intensive care units.

Catheterization, Central Venous↗
PubMed2001

Rural-urban differences in radiation therapy for ductal carcinoma in-situ of the breast.

PURPOSE: Rural women in the United States are at a documented disadvantage with regard to breast cancer detection, diagnosis, and treatment and generally do not receive state-of-the-art therapy. The objective of the study was to determine if, and to what extent, rural women were less likely to receive radiation therapy (XRT) following breast conserving surgery (BCS) for ductal carcinoma in-situ (DCIS). METHODS: Our analyses were based on 1991-1996 data provided by the Surveillance, Epidemiology, and End Results (SEER) Program. Only women who were diagnosed with their first primary, microscopically confirmed DCIS breast cancer were included. BCS and XRT were defined according to SEER definitions. Multiple logistic regression was used in the analysis. RESULTS: During this time period, 6,988 women were treated with BCS for DCIS, 50.1% of whom received XRT. In multivariate analysis, rural women in general (OR = 0.58) and younger women (<65) in particular (OR = 0.38) were less likely to receive XRT. Local availability of XRT was not associated with receipt among younger women, while older women without this availability were less likely to receive XRT (OR = 0.48). CONCLUSIONS: Barriers to XRT following BCS for DCIS may be different between younger and older rural women relative to their urban counterparts.

Adult↗
PubMed2001

Early indicators of the effect of a breast cancer screening program for low-income women.

The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) was developed to increase screening among low-income women who are uninsured or underinsured. This study reports early indicators of the effectiveness of this breast screening program in Iowa. Using data from the Census Bureau and the Iowa Behavioral Risk Factor Surveillance System, we found that racial and ethnic minorities aged 50 to 64 more likely were screened by the NBCCEDP than were their counterparts. Data collected by the Iowa BCCEDP showed a breast cancer detection rate (7.1 per 1,000 women screened) that was at least three times higher than its historical comparison, an indication of the lead time of the screened over the nonscreened population. Predictive values positive (referral and biopsy) and stage distribution were typically higher than for the national program but lower than in other countries. In conclusion, a breast cancer screening program among low-income women can be implemented successfully, judged by early indicators of program effectiveness.

Breast Neoplasms↗
PubMed2000

Ambulatory care for traumatic brain injuries in the US, 1995-1997.

The burden of mild traumatic brain injury (TBI) is not well understood at the national level, but hospitalization rates show a decline over time. This paper describes ambulatory care for TBI patients at physician offices, hospital outpatient departments, and emergency departments (EDs) in comparison with non-TBI visits for the US during 1995-1997. An estimated 1.4 million visits for TBI were made each year for an average annual rate of 5.4/1,000 population. A decline in annual visit rate was noted during 1995-1997. Visit rates were higher for those aged 0 -14 and 75 and older. Falls (44%) and motor vehicles (28%) were the primary injury causes. Rural-urban differences were found, also in comparison with non-TBI. In 23% of visits to EDs, a CT scan was ordered or performed and in 33%, a mental status exam was conducted. Further investigations are warranted to describe ambulatory care for TBI in more detail, particularly in light of a decline in hospitalization rates.

Adolescent↗
PubMed2000

Use of the capture-recapture method to estimate severe traumatic brain injury rates.

OBJECTIVE: This study assessed the applicability of using three different data sources (hospital discharge data, Traumatic Brain Injury Registry data, and death certificates) to identify high-risk groups for traumatic brain injuries (TBI). Reporting biases were also addressed. METHODS: Linkage of the data sources and log-linear modelling in conjunction with the capture-recapture method was used to estimate the number of missing TBI. Biased reporting to each data source was assessed by using the total number of estimated TBI by age and sex. RESULTS: An estimated 2% of TBI that occurred in Iowa were not reported to any of the data sources. Overall, women 85 years old and older were more likely to be missed by the combined data sources. Males and those of advanced age were less likely to be reported to the Registry. By using the capture-recapture method, falls among the elderly were found to be a significant public health problem in Iowa. CONCLUSION: Despite biased reporting to the three data sources, the capture-recapture method can be used to identify high-risk groups for TBI in Iowa.

Accidental Falls↗
PubMed2000

Description of Missouri children who suffer burn injuries.

OBJECTIVE: This study uses Missouri's inpatient and outpatient E code data system to describe the demographic characteristics of Missouri children who suffered burn injuries during 1994 and 1995. METHODS: Retrospective review of Missouri E code data. RESULTS: Altogether 8,404 children aged 0-14 years were treated for burn injuries in Missouri hospitals during 1994 and 1995. The rate of burn injury in Missouri children was 339 per 100,000/year. African-American boys 0-4 years living in urban counties were at increased risk. In addition, African-American girls ages 0-4 years living in counties with a high poverty rate had raised burn injury rates. Burns from hot objects and scalds from hot liquids caused more than half of the burns. CONCLUSIONS: Hospital based E coding has proven an invaluable tool for the study of burns and will, no doubt, prove equally useful for other injuries.

Burns↗
PubMed1999

Breast and cervical carcinoma: the correlation of activity limitations and rurality with screening, disease incidence, and mortality.

BACKGROUND: Although screening for breast and cervical carcinoma has been widely accepted as beneficial, specific segments of the population are not receiving these services as frequently as recommended. The objective of this study was to describe differences in breast and cervical screening prevalence among those with activity limitations and those residing in rural areas. Disparities in the incidence rates of in situ breast carcinoma and cervical carcinoma, as well as mortality among rural and urban women, are also described. METHODS: Data from the Iowa Behavioral Risk Factor Surveillance System (BRFSS) and Iowa's Surveillance, Epidemiology, and End Results (SEER) were used to determine the prevalence of screening and adverse outcomes among rural populations. To describe the rural nature of counties, the authors used the number of residents per square mile for each county and classified the results into five groups. Mulitple logistic regression was used to determine the prevalence of screening among those with activity limitations and rural residents. RESULTS: Using the BRFSS, those with activity limitations and those residing in rural Iowa were less likely screened for breast or cervical carcinoma. This translated into a lower in situ breast carcinoma incidence rate and a higher invasive cervical carcinoma incidence rate among rural women relative to their urban counterparts. No differences were found for mortality from these cancers. CONCLUSIONS: Lower screening prevalence among rural residents translated into adverse health outcomes. Interventions for increasing the frequency of screening are described.

Activities of Daily Living↗
PubMed1999

Functional status following traumatic brain injuries: population-based rural-urban differences.

Many studies have described functional outcomes following traumatic brain injury (TBI), but few have attempted to contrast differences in functional status and receipt of services of persons residing in rural and urban counties. Persons hospitalized with TBI completed a self-administered survey 1-1.5 years after their injury. Survivors of TBI in rural areas were more likely to be functionally dependent and reported a lower health status than their urban counterparts. Additionally, those who did not receive any TBI-related services but perceived an additional service need were more likely to be functionally dependent than those who received services and did not perceive any additional need. Perceived service needs of those functionally dependent are described. Further investigations into this rural-urban difference are warranted to maximize functional status following TBI for all individuals.

Activities of Daily Living↗
PubMed1996

Method to electronically collect emergency department data.

STUDY OBJECTIVE: To describe the development and completeness of an electronic injury-surveillance system, the Rural Injury Surveillance System (RISS). METHODS: The emergency departments of nine rural Iowa hospitals submitted information on all patients treated from May 1993 through June 1994. RESULTS: The EDs submitted information on 23,594 patients with 32,445 different injury, disease, or follow-up visits. On the basis of comparison with the handwritten ED logbook, 90% of visits were also available in the RISS. Of the visits recorded in the RISS, 99% were also recorded in the logbook. The proportion of missing diagnostic codes decreased from a high of 22.6% in May 1993 to 8.1% in June 1994. The proportion of missing external cause codes was about 25% at the end of the study period. The proportion of missing industry and occupational codes was less than 5% at the end of the study period. CONCLUSION: Our findings show that complete, computerized, ED-based injury surveillance in rural EDs is possible and should be developed further.

Data Collection↗
PubMed1996

Utilization of cancer early detection services among farm and rural nonfarm adults in Iowa.

An increase in the proportion of advanced malignancies among rural residents has been noted and may be due to a combination of factors, including availability of screening services, demographic characteristics, and access to health care facilities. A cross-sectional study was conducted in 33 nonmetropolitan Iowa counties among randomly selected middle-aged farm and rural nonfarm adults to compare utilization of cancer early detection services. A total of 1,126 adults in 600 farm households and 1,092 adults in 589 rural nonfarm households provided information through a 155-item in-home interview. Differences in income, age, and health insurance coverage (including preventive services) between the farm and nonfarm study populations were found. Although farm men were less likely to have had a checkup during the past year than men in the nonfarm population, no difference was found for women. Overall, differences in screening behaviors were small. Larger differences between both populations were observed for use of mammograms, prostate examinations among men age 50 and older, use of sigmoidoscopy among women age 50 and older, and skin cancer examinations among both sexes. When controlling for demographic characteristics and insurance coverage, members of the farm and rural nonfarm population were equally likely to use multiple screenings according to ACS guidelines. Because of the increased risk of breast cancer, interventions aimed at increasing utilization of mammography among women age 50 and older should be implemented. Although the farm population was more likely to use skin examinations, prevalence should be increased substantially to counteract the continuing rise in skin cancer.

Adult↗
PubMed1994

Study designs and potential biases in sports injury research. The case-control study.

Several different epidemiological study designs can be used for aetiological investigations of potential risk factors for the occurrence of sports injuries. The case-control study is an example of a retrospective design in which the investigator starts with the classification of injury status (case or control) and obtains information regarding prior exposure to risk factors. Several decisions need to be made when designing case-control studies. Firstly, the source of the study participants needs to be considered. Cases and controls need to be identified from the same source, i.e. same sport or clinic. Secondly, the same eligibility criteria need to be applied to potential cases and controls. Thirdly, when an injury occurred must be established. The fourth issue concerns the status of cases (incident or prevalent cases). Finally, the number and size of the control groups needs to be determined. Strengths of the case-control study design are the high level of information obtained, the relatively low cost and its usefulness for studying rare sports injuries. The higher susceptibility to bias is one of the limitations of case-control studies. Bias in a case-control study can lead to over or underestimation of the true association between an alleged risk factor and the occurrence of sports injuries. Three types of bias have been distinguished: (i) selection bias; (ii) information bias; and (iii) confounding. Furthermore, the applicability of this type of design is limited to risk factors that remain relatively stable after the occurrence of an injury. The effect of changeable risk factors, such as quadriceps strength and range of motion, is difficult to assess since in many cases data at the time of injury are unavailable.

Athletic Injuries↗
PubMed1994

Epidemiology of back injury in university hospital nurses from review of workers' compensation records and a case-control survey.

Reviewing Workers' Compensation records for back injury from a large university hospital for a 2-year period, we found a yearly incidence of lost work time back injury among nurses of 2.0% per year, exceeded only by physical plant staff, who had a rate of 3.5%. Nurses' aides had an injury rate 3.3-fold higher than registered nurses and licensed practical nurses and higher than any other occupational group. We compared 100 cases of nurses with back injury in the previous 2 years with 197 noninjured control subjects using a mailed 40-item questionnaire. Multivariate logistic modelling showed that prior nonback injury and performing combined lifting activities were statistically significant risk factors for back injury, and being overweight approached significance, after adjusting for the effects of age, gender, and each of the evaluated risk factors.

Accidents, Occupational↗
PubMed1993

A case-control study of risk factors for industrial low back injury. The utility of preplacement screening in defining high-risk groups.

Using a cohort of 8183 postal workers, this study assesses the efficacy of preplacement medical examinations in defining the risk of occupational low back injuries. From this cohort, 154 subjects with occupational low back injuries between 1983 and 1988 and 942 control subjects who did not have low back injuries were identified. A multivariate logistic regression shows that a history of prior disability, odds ratio 2.90 (95% confidence interval 1.88-4.48), and a heavy lifting job, odds ratio 1.91 (1.32-276) are associated with occupational low back injuries. However, a history of previous back injury on screening examination is not associated with subsequent occupational injury. The association between a history of disability and occupational low back injury has not been previously noted and warrants further research.

Adult↗
PubMed1993

Safety behavior among Iowa junior high and high school students.

The goal of this study was to determine demographic factors associated with reported safety behavior by studying 2250 Iowa junior high and high school students via a self-administered questionnaire. Students attending rural schools used front seat belts and helmets less frequently than urban students. Seat belt and helmet use and swim safety decreased dramatically with age. Occurrences of driving or riding while drunk or high increased with age. Boys were less likely than girls to wear back seat belts and moped helmets and to check water depth before diving. Possession of a driver's license was not independently associated with any of the safety behaviors.

Adolescent↗
PubMedDate not supplied

A multivariate risk analysis of selected playing surfaces in the National Football League: 1980 to 1989. An epidemiologic study of knee injuries.

This study focuses on the injury rates for natural grass and AstroTurf surfaces and the risk factors of game position and type of play. We examined the game-related knee sprains, medial collateral ligament sprains, and anterior cruciate ligament sprains that occurred in the National Football League during the 1980 to 1989 seasons. The findings are controlled for categories of severity (number of games missed due to injury), position, and situation (rushing or passing) at the time of injury. The analysis of the data incorporates epidemiologic techniques associated with incidence density ratios. The data show that there is a statistically significant difference between the higher AstroTurf injury rates for knee sprains. When knee sprains are separated into medial collateral ligament sprains and anterior cruciate ligament sprains, only the anterior cruciate ligament sprains show a statistically significant higher injury rate for AstroTurf. When simultaneous control variables are considered, significantly more knee sprains occurred to backs on rushing plays and linemen on passing plays. When controlling the data for severity, only the Category II injuries (three or more games missed) sustained by linemen on passing plays had statistically significant higher injury rates for the AstroTurf. For medial collateral ligament sprains, only the Category II injuries for linemen on passing plays remain statistically significant. The data for the ACL sprains show statistically significant differences between the injury rate on natural grass and the injury rate on Astro Turf under conditions of special teams play.

Adult↗
PubMedDate not supplied

Factors associated with adequacy of diagnostic workup after abnormal breast cancer screening results.

BACKGROUND: Women with certain characteristics, such as those residing in rural areas, are less likely screened for breast cancer. To enhance detection of early breast cancer, it is imperative that all women who have abnormal screening results receive appropriate diagnostic procedures. This study reports differences in receipt of diagnostic services following abnormal screening results. METHODS: Screening and diagnostic data were collected as part of a breast and cervical cancer early detection program aimed at reaching women of lower socioeconomic status. Women with completed diagnostic information after having abnormal screening results were included. We based adequacy of diagnostic services on guidelines from the Society for Surgical Oncology, The Commission on Cancer of the American College of Surgeons, and the Centers for Disease Control and Prevention. Several factors were assessed for their association with adequacy of diagnostic follow-up: income, age, race, education, health insurance status, rural-urban residence, reported breast lump, family history of breast cancer, and clinical beast examination or mammogram results. RESULTS: Overall, 14.1% of the 351 abnormal findings were considered inadequately followed up based on the algorithm used. Eighty percent involved an abnormal finding on a clinical breast examination regardless of the mammogram results. Rural women, those with abnormal clinical breast examination findings but normal or equivocal findings on mammograms, and those who self-discovered a mass were less likely to receive adequate follow-up than were their counterparts in multivariate analysis. Rural women were less likely to receive a biopsy or fine-needle aspiration, although it was indicated. One facility accounted for most of the inadequate follow-up screenings among urban women. CONCLUSIONS: Women who have specific demographic and clinical characteristics were less likely to have received adequate diagnostic services. Breast cancers could have been missed initially as a result of inappropriate follow-up. Further investigation of the clinical scenarios using chart reviews is warranted.

Algorithms↗