Injury prevention in people with disabilities.
Explore the source record for details and available documents.
Accident Prevention↗
Biomedical subjects
S N Forjuoh
Publications and source records attributed to S N Forjuoh.
E-mail communications in family practice: what do patients expect?
OBJECTIVE: Many health care providers and patients are exploring the feasibility of using E-mail to address a variety of medical issues. The researchers wanted to determine the proportion of their patient population with E-mail access, determine patients' willingness to use this technology to expedite communication with health care providers, and assess their expectations of response times. STUDY DESIGN: A cross-sectional, in-person prevalence survey. POPULATION: Patients (n=950) with scheduled appointments to see a primary care provider in 6 of 18 family practice clinics in a large health care delivery system in central Texas. OUTCOMES MEASURED: The proportion of patients with E-mail access, their willingness to use it, and their expectations regarding the timeliness of responses to their E-mail queries about selected clinical services. RESULTS: Overall, 54.3% of the patients reported having E-mail access, with significant variation among the 6 clinics (33%-75%). Reported areas of strongest desire for using E-mail were to request prescription refills (90%), for non-urgent consultations (87%), and to obtain routine laboratory results or test reports (84%). Patients' expectations regarding the timeliness of responses to their E-mail queries varied by clinical service. For laboratory results, their expectations were: less than 9 hours, 21%; 9 to 24 hours, 53%; and more than 24 hours, 26%. CONCLUSIONS: Most patients attending family practice clinics in central Texas have E-mail access and indicate they would use it to request prescription refills, for non-urgent consultations, and to obtain routine laboratory results or test reports. Regardless of sex or race, patients have high expectations that these tasks can be completed within a relatively short time.
Adult↗
Child maltreatment related injuries: incidence, hospital charges, and correlates of hospitalization.
OBJECTIVE: This study was undertaken to determine the incidence, hospital charges, and correlates associated with inpatient treatment of child maltreatment related injuries. METHODS: The data were based on the 1995 Pennsylvania Hospital Discharge Data which included all Pennsylvania acute care hospitals that reported child maltreatment discharges. Per capita hospital discharge rates were computed for children discharged with child maltreatment related injuries according to selected variables. Odds ratios for child maltreatment related injury hospitalizations were also computed. RESULTS: A total of 348 maltreated injured children ages 0-19 years were discharged from Pennsylvania hospitals in 1995, representing an incidence rate of 10.8 per 100,000 persons. The total hospital charges for child maltreatment related injury discharges amounted to over $5.4 million, of which Medicaid alone paid for 45%. Compared to a random sample of non-maltreated injured children (n = 1052), maltreated injured children were found to be significantly younger, more likely to be females, and more likely to be Black. Child maltreatment related injury hospitalizations were more likely to be urgent and via physician referral or transfer from other health care facility. Maltreated injured children were three times as likely to die as other children. CONCLUSIONS: These findings indicate that injury from child maltreatment is a major cause of hospitalization of young children 5 years and younger and represents a significant cost to publicly financed health care. While hospital discharge data can be used for population-based surveillance of child maltreatment related trauma, there is need for improvement in the surveillance of these injuries.
Adolescent↗
Back-up antibiotic prescriptions for common respiratory symptoms. Patient satisfaction and fill rates.
BACKGROUND: In recent years much has been written about the overuse of antibiotics, especially for common respiratory illnesses. One approach to this issue is the use of a back-up prescription, only to be filled if a patient's condition deteriorates or fails to improve. The purpose of our study was to determine patient satisfaction, prescription fill rates, and correlates of these outcomes among patients receiving back-up antibiotic prescriptions. METHODS: In our observational study we obtained survey data from 28 physicians and 2 physician extenders in 3 family practice clinics and their patients presenting with complaints of common respiratory symptoms. We computed patient satisfaction and fill rates of back-up antibiotic prescriptions. Agreement between the perceived need of patients for antibiotics before the office visit and the subjective rating of their physicians of the clinical necessity to prescribe antibiotics for these patients was assessed using the kappa statistic. Finally, we determined correlates of satisfaction and the rate of filling back-up prescriptions. RESULTS: Of the 947 patients enrolled in the study, 46.6% received no antibiotic prescriptions, 30.2% received back-up antibiotic prescriptions, and 23.2% were given immediate-fill prescriptions for an antibiotic. Patients' self-reported satisfaction and fill rates for back-up antibiotic prescriptions were 96.1% and 50.2%, respectively. CONCLUSIONS: Our findings indicate that patients were very satisfied with a back-up antibiotic prescription. The fact that half of the patients chose not to fill these prescriptions suggests a potential health care cost savings.
Anti-Bacterial Agents↗
Epidemiology of transport-related injuries in Ghana.
To better elucidate the incidence, characteristics, and consequences of transport-related injuries in a less developed country in Africa, we undertook an epidemiologic survey in Ghana. A total of 21,105 persons were surveyed, in both an urban area (Kumasi, n = 11,663) and a rural area (Brong-Ahafo, n = 9442). In the preceding year, a total of 656 injuries were reported in the urban area and 928 injuries reported in the rural area. Transport-related mechanisms accounted for 16% of all injuries in the urban and 10% of all injuries in the rural area. The annual incidence of transport-related injuries was almost identical in the two settings, 997/100,000 persons in the urban area and 941/100,000 in the rural area. In both settings, transport-related injuries were more severe than other types of injuries in terms of mortality, length of disability, and economic consequences. In the urban area, the most common transport-related mechanisms were either to passengers involved in crashes of mini-buses or taxis (29%) or to pedestrians struck by these vehicles (21%). In the rural area, the most common transport-related mechanisms were bicycle crashes. The second most common rural mechanisms were motor vehicle crashes, which were the most severe and which involved commercial (83%) rather than private vehicles. Prevention strategies need to be different from those in developed countries and should target commercial drivers more than private road users.
Accidents, Traffic↗
From theory to practice.
Explore the source record for details and available documents.
Accident Prevention↗
Child death reviews: a gold mine for injury prevention and control.
OBJECTIVES: The purpose of this study was to demonstrate how child death review teams can be used to prevent future deaths through retrospective, multiagency case analysis and recommendations for educational programs and policy change. METHODS: A listing of all deaths to persons ages 21 years and younger in Philadelphia that occurred in 1995 was compiled by the Philadelphia Interdisciplinary Youth Fatality Review Team (PIYFRT), a multiagency, multidisciplinary, community based group created in 1993 with the mission to prevent future deaths through review, analysis, and initiation of corrective actions. Data were collected on demographic variables, as well as the circumstantial variables on injuries such as weapon type, alcohol and drug use, and contact with the criminal justice system, among others. Each case was reviewed thoroughly to determine whether or not the death was preventable. Selected injury related death cases were analyzed further by demographic and circumstantial variables. RESULTS: In 1995, 607 children ages 21 years and younger died in Philadelphia from natural causes (61.6%), unintentional injuries (16.3%), homicide (18.6%), suicide (2.3%), and undetermined causes (1.2%). More than a third (37.2%) of all deaths were considered preventable. Of the injury deaths (n=224), 95% were judged to be preventable. Preventable fire/burn injury deaths (n=29) were associated with lack of a smoke detector, nonsupervision of children, and faulty home appliances. Violent deaths were associated with substance abuse, gang involvement, chronic truancy, academic failure, and access to weapons. CONCLUSIONS: Relevant policies for these preventable or intervenable deaths are discussed such as use of non-battery powered smoke detectors.
Adolescent↗
Violence against children and adolescents. International perspectives.
Selected topics of violence against children and adolescents that occur in countries outside of the United States are discussed. Focus is given to middle-income and low-income countries and emphasis is placed on the epidemiology of this pressing public health problem, particularly on conditions that are peculiar to children and adolescents in international settings, such as female genital mutilations, wars, displacements, and land mines. The discussion of child maltreatment is presented in the context of child rearing and discipline in different cultures. Recommendations for action and violence prevention are offered in the light of vast cultural differences.
Adolescent↗
Injury control in Africa: getting governments to do more.
Despite increasing recognition of injury as a major public health problem worldwide, it has received limited attention and resources. This lack of attention is most notable in low-income countries. As part of efforts to develop coordinated injury control activities in Africa, a round table session was held at the Third International Conference on Injury Prevention and Control in Melbourne, Australia. The aims of the forum were to provide injury control researchers from Africa the opportunity to come together and reflect on issues of injury control in Africa, to deliberate on strategies of getting African governments to show more interest in injury control, and to solicit more assistance from the international donor community Participants from Ghana, Kenya, South Africa and Zimbabwe presented the magnitude of the injury burden in their respective countries, reflected on current research efforts and highlighted the preventive efforts being undertaken. The forum made many recommendations including several regarding specific actions required of African governments, individual researchers and donor agencies.
Accidents, Home↗
Correlates of injury to women with partners enrolled in batterer treatment programs.
OBJECTIVES: This study examined correlates of injury in a cohort of women who were partners of men enrolled in batterer treatment programs. METHODS: Cross-sectional data of 670 pairs of battered women and their partners were analyzed. Prevalence rates of women's self-reports of injury due to their partners' abusive behavior were computed and compared by couples' demographic and behavioral characteristics. RESULTS: Men's use of severe tactics of abuse was the characteristic most significantly associated with injury (odds ratio = 15.47; 95% confidence interval = 9.02, 26.55). CONCLUSIONS: Our findings underscore the need to obtain information on the specific tactics used by couples to settle their disputes during universal screening by practitioners.
Adult↗
Getting together for injury control.
The proceedings of a round table session on injury control in Africa, held as part of the Third International Conference on Injury Prevention and Control, are outlined in the present article. The prospects for collaborative efforts in this field seem reasonable, but increased support from governments and the international donor community is essential if the immense burden of injury is to be significantly diminished.
Accident Prevention↗
A population-based study of fatal and nonfatal firearm-related injuries.
OBJECTIVE: To determine population-based firearm-related morbidity and mortality for Allegheny County, PA (population = 1.3 million), for the year 1994. METHODS: Fatalities were identified from a review of death certificates. To identify nonfatal cases, an active surveillance was conducted at all 24 acute care EDs in the county. The ED surveillance used 2 existing sources of case identification from each hospital to minimize undercount. RESULTS: Firearms were the leading cause of injury death to county residents, accounting for 155 deaths. The crude mortality rate from firearms was 11.7/100,000. Black males aged 15-19 years were most at risk for a firearm fatality (293/100,000). There were 514 nonfatal firearm injuries, producing a case fatality rate of 23%. The highest age-specific rate for nonfatal firearm-related injuries treated in the county EDs was observed for black males aged 15-19 years (2,245/100,000), which is 58 times higher than the firearm-related injury rate for the entire county population (38.7/100,000). CONCLUSION: Firearm-related injury and death are a significant public health problem in Allegheny County. Although the crude mortality rate from firearms in the county is lower than the reported national rate, the observed rate for nonfatal injuries in the black youth of this community is the highest firearm injury incidence rate ever reported. Local surveillance of firearm-related injuries, including nonfatal events, is needed to more accurately demonstrate the magnitude of this problem.
Adolescent↗
Victimization from physical violence in Pennsylvania: prevalence and health care use.
OBJECTIVES: To determine the prevalence of interpersonal physical violence (IPV) among Pennsylvania adults, to identify the personal characteristics of the victims, and to determine their health care use for resulting injuries. METHODS: Population-based data describing physical violence were obtained through a statewide telephone survey of 3,620 Pennsylvania adults selected from households by random-digit dialing in 1994. The prevalence and 95% confidence interval (95% CI) of victimization from IPV along with ED or other medical care facility use for IPV-related injuries were computed by several personal characteristics. Logistic regression was used to compare victims of IPV and their levels of health care use. RESULTS: The prevalence of reported victimization from IPV was 5.6% (95% CI = 4.9, 6.3). Significantly more victimization was reported by males, persons aged 18-29 years, those employed, and unmarried persons. The proportion of victims who reported to have gone to an ED or other medical care facility for IPV-related injury treatment was 12.9%. Significantly more persons with annual household incomes < $20,000 reported health care use for injuries resulting from IPV than did those with incomes of > or = $20,000 (OR = 3.98; 95% CI = 1.27, 12.48). Health care use for injuries was not found to be related to gender, age, race, employment, or marital status. CONCLUSIONS: This population-based study of health care use for IPV-related injuries found that victims of physical violence in Pennsylvania were not only young and unmarried men, but also employed. Health care use for resulting injuries was greater among persons with lower incomes.
Adolescent↗
Estimation of age specific incidence rates of childhood burns from a prevalence survey of burn scars.
OBJECTIVES: This paper describes two methods of estimating the age specific incidence rates of childhood burns from a prevalence survey of burn scars. METHODS: A prevalence survey of burn scars was carried out in 1992 on 15,742 Ghanaian children aged 5 years or less. Nine hundred and fifty five (6.1%) of these children had scars from burn, and for 630 (66%) of these children, additional information about the burn incident, including the child's age at the time of the burn, was obtained from the mother two to three months later. Thirty four per cent of mothers of children with burn scars were not interviewed due to absence, relocation, or inaccessibility. Age specific incidence rates of burns were estimated for eight age groups using two methods. In method I, the number of incident cases of burns for each age group were estimated from the burn scars by subtracting the estimated contribution of scars from burns that had occurred at earlier ages. In method II, the estimate was based on the mother's recall of the age of the child at the time of the burn. RESULTS: Slightly different results were obtained with the two methods, and problems were noted with both methods. CONCLUSION: We recommend the use of these methods for estimating age specific incidence rates from retrospective population surveys for health conditions which result in long term residual markers.
Age Distribution↗
Burn repetitions in Ghanaian children: prevalence, epidemiological characteristics and socioenvironmental factors.
This paper reports the prevalence, epidemiological characteristics and socioenvironmental-factors for burn repetitions in Ghanaian children newborn to 5 years old using a population-based survey. Mothers of children identified in a survey with burn scars were interviewed to obtain information on each child's demographics and the burn event, among others. Burn repeaters were compared with non-repeaters (children burned just once). Of 630 children identified with burns, 20 (3.2 per cent) had been burned twice. This statistic is significantly lower than expected from the known burn prevalence of 6.1 per cent in the region (P < 0.01). Burn repeaters included nine (45 per cent) children aged 24-35 months, 11 (55 per cent) males, and 9 (45 per cent) rural residents. The mean time interval between repeat burns was 9.6 months. While different mechanisms caused the two burns in 14 children, six were burned by the same mechanism. None of the demographic and socioenvironmental variables examined was significantly associated with burn repetition. It is concluded that since burn repetitions are low and share similar epidemiological characteristics with first-time burns, prevention efforts need not address repeat burns separately from burns in general.
Age Distribution↗
Injury surveillance: a statewide survey of emergency department data collection practices.
STUDY OBJECTIVE: To assess current emergency department data collection practices in Pennsylvania and determine whether existing data sources can be used as part of a statewide injury surveillance system. METHODS: Separate survey questionnaires requesting information on current ED patient data collection practices and attitudes were mailed to all directors of medical records, billing, and EDs in Pennsylvania (N = 212). RESULTS: Of the medical records department respondents, 92% indicated that ED registration data are retained in a computerized information system; 94% of respondents from billing departments reported that their ED patient registration system is integrated with an ED billing system. A total of 36% of EDs surveyed use a computerized ED patient logbook, and another 27% plan to begin a computerized log within 2 years. Dictation and transcription services that permit electronic retrieval of text are being used by 26% of EDs for patient medical records. CONCLUSION: Many elements for building a statewide ED injury surveillance system are in place in Pennsylvania, but they are as yet incomplete. Future studies should examine the feasibility of integrating existing ED data systems into statewide injury surveillance systems.
Data Collection↗
A review of successful transport and home injury interventions to guide developing countries.
Injury is recognized as an increasing public health problem in developing countries. Extensive research on injury control has been conducted in the U.S. and other industrialized countries in the past several decades, but research is still in its infancy in developing countries. In this paper, successful interventions for transport and home injuries are reviewed in the context of the developing country setting. The aim is to evaluate injury interventions developed in the industrialized countries and identify those likely to be usable in developing countries. The evaluation criteria used include the efficacy of the interventions, as well as their affordability, feasibility and sustainability. The review demonstrates that while several interventions are available in the field of injury prevention for developing countries to import, caution should be taken in doing this. The use of automobile safety seat belts, bicyclist and motorcyclist helmets, speed limits, laws banning the sale of alcohol at lorry parks, pedestrian crossing signs, adequate roadway lighting, separation of pedestrians from vehicles, conspicuity-enhancement measures, simple safety equipment, and poison prevention packaging should be seriously considered by developing countries to reduce the morbidity and mortality from transport and home injuries. Since injury prevention may often require a blend of several interventions due to the multifactorial nature of the causes of injury, interventions that appear to be most effective are those with multidimensional strategies including education, legislation and environmental modification. This review should serve as a useful guide to injury control efforts in developing countries which must grapple with limited resources and low levels of education.
Accidents, Home↗