1
|
Bullock G, Prats-Uribe A, Thigpen C, Martin H, Loper B, Shanley E. Influence of High School Socioeconomic Status on Athlete Injuries during the COVID-19 Pandemic: An Ecological Study. Int J Sports Phys Ther 2022; 17:1383-1395. [PMID: 36518837 PMCID: PMC9718687 DOI: 10.26603/001c.39610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 08/09/2022] [Indexed: 11/12/2023] Open
Abstract
Background It is presently unclear how the cessation of high school sport has affected injury incidence at different socioeconomic levels. The COVID-19 pandemic may have disproportionately affected athletes of lower socioeconomic status, potentially increasing injury risk in this population. Purpose To 1) Describe athlete injury incidence prior to and during the 2019-2020 and 2020-2021 school years in high school athletes by socioeconomic status; 2) Investigate the association between socioeconomic status and injury incidence in high school athletes. Study Design Ecological Study. Methods High schools were matched between the 2019-2020 and 2020-2021 school years. All athletes from all sports were included. High school socioeconomic status was determined by the school district median household income. Socioeconomic strata were defined as <$30,000, $30,000-50,000, $50,001-100,000, and >$100,000. Injury incidence proportion with 95% confidence interval (95% CI) was calculated for each academic year. Mixed effects negative binomial models with robust errors were performed to assess the association between the incidence proportion ratio and high school median household income. Six states and 176 high schools were included (2019-2020: 98,487 athletes; 2020-2021: 72,521 athletes). Results Injury incidence increased in three of four socioeconomic strata during the 2020-2021 year (<$30,000: 2019-2020: 15.6 (13.1-18.1), 2020-2021: 26.3 (23.1-29.6); $30,000-50,000: 2019-2020: 7.8 (7.1-8.6), 2020-2021: 14.9 (13.8-15.9); $50,001-100,000: 2019-2020: 15.1 (14.7-15.4), 2020-2021: 21.3 (20.9-21.8); >$100,000: 2019-2020: 18.4 (18.1-18.8), 2020-2021: 17.3 (16.8-17.7)). An association was observed between injury incidence ratio and log median high school household income in 2019-2020 [1.6 (1.1-2.5)] but not 2020-2021 [1.1 (0.8-1.6)] school years. Conclusions Athletes from lower socioeconomic high schools reported increased injury incidence compared to higher socioeconomic high schools during the 2020-2021 academic school year. These results highlight the increased COVID-19 pandemic vulnerability in athletes from lower socioeconomic high schools. High school sport stakeholders should consider how abrupt sport stoppage can affect lower socioeconomic athletes. Level of Evidence 2.
Collapse
Affiliation(s)
- Garrett Bullock
- Department of Orthopaedic Surgery & Rehabilitation, Wake Forest School of Medicine; Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, University of Oxford
| | | | - Charles Thigpen
- ATI Physical Therapy; University of South Carolina Center for Effectiveness Research in Orthopedics
| | | | | | - Ellen Shanley
- ATI Physical Therapy; University of South Carolina Center for Effectiveness Research in Orthopedics
| |
Collapse
|
2
|
Lovelady NN, Zaller ND, Stewart MK, Cheney AM, Porter A, Haynes TF. Characterizing Firearm Assault Injury Among Young Black Men Using Arkansas Hospital Discharge Data. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP12609-NP12633. [PMID: 33711914 PMCID: PMC10426071 DOI: 10.1177/0886260521997947] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Using statewide hospital discharge data from 2005 to 2014, this study aimed to describe and identify predictors of firearm assault among young Black men ages 18 to 44 in Arkansas. Descriptive analyses of data were performed for patient demographics (age, marital status, residential location, etc.), injury, and health care information (hospital charges, length of stay, mortality, time, day and season of injury, etc.). Logistic regression analysis was performed to identify significant predicting factors for firearm assault among this population. Most of the sample survived firearm assault injury, were ages 18-35, were not married, resided in Central Arkansas, and were admitted to a Central Arkansas hospital during night hours on weekends. The majority had a short hospital stay, and total charges exceeded $34 million during the study observation years. Most patients had no diagnosis of a mental disorder, and a little less than half had drug use disorders. Being ages 18-25, living in the Central region of Arkansas, and being married were all significant predictors of firearm assault for this population. Death was also significantly associated with firearm assault. Our findings lay the groundwork for understanding firearm assault injury among young Black men in Arkansas. Research should be expanded to examine other important data sources for firearm assault and to further explore the context of predicting factors, in order to provide a more comprehensive understanding of firearm assault and to better inform future prevention efforts.
Collapse
Affiliation(s)
| | | | | | | | - Austin Porter
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | | |
Collapse
|
3
|
Madsen C, Gabbe BJ, Holvik K, Alver K, Grøholt EK, Lund J, Lyons J, Lyons RA, Ohm E. Injury severity and increased socioeconomic differences: A population-based cohort study. Injury 2022; 53:1904-1910. [PMID: 35365351 DOI: 10.1016/j.injury.2022.03.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 02/10/2022] [Accepted: 03/22/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Several studies have documented an inverse gradient between socioeconomic status (SES) and injury mortality, but the evidence is less consistent for injury morbidity. The aim of this study was to investigate the association between SES and injury severity for acute hospitalizations in a nationwide population-based cohort. METHODS We conducted a registry-based cohort study of all individuals aged 25-64 years residing in Norway by 1st of January 2008. This cohort was followed from 2008 through 2014 using inpatient registrations for acute hospitalizations due to all-cause injuries. We derived two measures of severity: threat-to-life using the International Classification of Disease-based Injury Severity Score (ICISS), and threat of disability using long-term disability weights from the Injury-VIBES project. Robust Poisson regression models, with adjustment for age, sex, marital status, immigrant status, municipality population size and healthcare region of residence, were used to calculate incidence rate ratios (IRRs) by SES measured as an index of education, income, and occupation. RESULTS We identified 177,663 individuals (7% of the population) hospitalized with at least one acute injury in the observation period. Two percent (n = 4,186) had injuries categorized with high threat-to-life, while one quarter (n = 43,530) had injuries with high threat of disability. The overall adjusted IRR of hospitalization among people with low compared to high SES was 1.57 (95% CI 1.55, 1.60). Comparing low to high SES, injuries with low threat-to-life were associated with an IRR of 1.56 (95% CI 1.54, 1.59), while injuries with high threat-to-life had an IRR of 2.25 (95% CI 2.03, 2.51). Comparing low to high SES, injuries with low, medium, and high threat of disability were associated with IRRs of respectively, 1.15 (95% CI 1.11, 1.19), 1.70 (95% CI 1.66, 1.73) and 1.99 (95% CI 1.92, 2.07). DISCUSSION We observed an inverse gradient between SES and injury morbidity, with the steepest gradient for the most severe injuries. This suggests a need for targeted preventive measures to reduce the magnitude and burden of severe injuries for patients with low socioeconomic status.
Collapse
Affiliation(s)
- Christian Madsen
- Department of Health and Inequality, Norwegian Institute of Public Health, Oslo, Norway.
| | - Belinda J Gabbe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Health Data Research UK, Swansea University Medical School, Singleton Park, Swansea, UK
| | - Kristin Holvik
- Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
| | - Kari Alver
- Department of Health and Inequality, Norwegian Institute of Public Health, Oslo, Norway
| | - Else Karin Grøholt
- Department of Health and Inequality, Norwegian Institute of Public Health, Oslo, Norway
| | - Johan Lund
- Department of Health and Inequality, Norwegian Institute of Public Health, Oslo, Norway
| | - Jane Lyons
- Health Data Research UK, Swansea University Medical School, Singleton Park, Swansea, UK
| | - Ronan A Lyons
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Health Data Research UK, Swansea University Medical School, Singleton Park, Swansea, UK
| | - Eyvind Ohm
- Department of Health and Inequality, Norwegian Institute of Public Health, Oslo, Norway
| |
Collapse
|
4
|
Barčot Z, Kralj R, Kurtanjek M, Petračić I, Tadić K, Žic R, Sović S. The association between improved standard of living and paediatric burns. Burns 2022; 48:683-687. [PMID: 34670716 DOI: 10.1016/j.burns.2021.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 05/07/2021] [Accepted: 05/25/2021] [Indexed: 12/15/2022]
Abstract
INTRODUCTION In the "Children's Hospital Zagreb Referral Centre for Paediatric Trauma of the Ministry of Health Republic of Croatia (MHC)" we observed a significant decline in the number of both hospitalised and ambulatory treated paediatric patients with burn injuries in the period from 2011 to 2018. Our hypothesis is that this decline could be either due to the decline of the paediatric population of Croatia or due to the economic growth and the improvement in the standard of living that Croatians have enjoyed in the past decade. MATERIALS AND METHODS In this observational study, we analysed data on the numbers of patients treated due to burn injuries from January 2011 to December 2018 in the Children's Hospital Zagreb Hospital. Indicators of standard of living and population size estimates were obtained from Eurostat and the Croatian Bureau of Statistics. Associations between the proportion of people with poor standard of living and the number of treated patients were analysed with logistic regression models. RESULTS Percentage of the population with low housing standards, percentage of Croatians with low level of education, percentage of children that live in jobless households, and percentage of children at risk of poverty and social exclusion were predictors of the rate of hospital admissions, ambulatory treated patients and total number of treatments. The slight decrease in the rate of treated patients was interrupted with notable decline in 2014 followed by the slight increase in 2015. Over following years, the rate did not change remarkably. CONCLUSION Apart from the decline of the paediatric population of Croatia, it is reasonable to assume that the improvement in the standard of housing, level of education and employment rate as well as the reduction in the risk of poverty and social exclusion in children had a notable contribution to the decline in the rate of paediatric burns in the observed period.
Collapse
Affiliation(s)
- Zoran Barčot
- Department of Paediatric Surgery, Children's Hospital Zagreb, Klaićeva 16, 10 000 Zagreb, Croatia.
| | - Rok Kralj
- Department of Paediatric Surgery, Children's Hospital Zagreb, Klaićeva 16, 10 000 Zagreb, Croatia.
| | - Mario Kurtanjek
- Department of Paediatric Surgery, Children's Hospital Zagreb, Klaićeva 16, 10 000 Zagreb, Croatia.
| | - Ivan Petračić
- Department of Paediatric Surgery, Children's Hospital Zagreb, Klaićeva 16, 10 000 Zagreb, Croatia.
| | - Karlo Tadić
- School of Medicine, University of Zagreb, Šalata 3b, Zagreb, Croatia.
| | - Rado Žic
- Department of Plastic, Reconstructive and Aesthetic Surgery, Clinical Hospital Dubrava, Avenija Gojka Šuška 6, 10 000 Zagreb, Croatia.
| | - Slavica Sović
- Department of Medical Statistics, Epidemiology and Medical Informatics, Andrija Štampar School of Public Health School of Medicine University of Zagreb, John Davidson Rockefeller 4, Zagreb, Croatia.
| |
Collapse
|
5
|
Patterns of suicide deaths in Hungary between 1995 and 2017. SSM Popul Health 2021; 16:100958. [PMID: 34815998 PMCID: PMC8592871 DOI: 10.1016/j.ssmph.2021.100958] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 09/16/2021] [Accepted: 11/04/2021] [Indexed: 11/29/2022] Open
Abstract
Hungary has had one of the highest suicide mortality rates in the world for decades. Investigating seasonality of suicide deaths is essential as its findings could be key elements in the prevention. In our study we have analyzed the seasonal effect in suicide mortality in relation to possible risk factors in Hungary during 1995–2017. Data on the numbers of suicide deaths were obtained from a published online database. Negative binomial regression was employed to investigate the effect of possible risk factors and seasonal and annual trends in suicide rates. The seasonal effect was further investigated, adding a significant risk factor from the “initial” negative binomial regression. The suicide risk was significantly (p < 0.001) higher in men than in women (incidence rate ratio: 3.48), and it increased with age and decreased with education level. Marriage was a protective factor against suicide. Annual suicide mortality declined significantly (p < 0.001 for trend) from 36.7 (95% confidence interval: 35.5–37.9) to 16.5 (15.7–17.3) per 100,000 persons per year during the study period. Significant seasonality was found in suicide rates with a peak in late June. Similar peaks were observed at each level of each risk factor. There were differences in peaks by suicide method. The peak of non-violent suicides was in early June; suicides committed by violent methods peaked half a month later. This study suggests that there was a significant seasonal effect on suicide deaths between 1995 and 2017, which remained significant even in the presence of each risk factor. To our knowledge, this has been the first study to investigate the seasonal pattern so extensively in Hungary. Our findings confirm that the environmental effects are involved in the etiology of suicide mortality. Significant seasonality was found in suicide rates with a peak in late June. Seasonal effect remained almost unchanged after adjusting sociodemographic factors. There were differences in seasonal peaks by suicide method. Environmental effects are involved in the etiology of suicide mortality.
Collapse
|
6
|
Arif AA, Adeyemi O, Laditka SB, Laditka JN, Borders T. Suicide mortality rates in farm-related occupations and the agriculture industry in the United States. Am J Ind Med 2021; 64:960-968. [PMID: 34482544 DOI: 10.1002/ajim.23287] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 08/08/2021] [Accepted: 08/16/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND Studies suggest that agricultural workers and rural residents may have an elevated suicide risk. However, suicide is relatively rare, and rural and farming populations have significantly declined, limiting their representation in national surveys. Many studies have inadequate samples for meaningful analysis. METHODS We pooled 29 years of data from the Mortality-Linked National Health Interview Survey, 1986-2014, then measured suicide mortality in groups including agriculture workers, and variation in suicide across rural and urban areas. Exposure variables indicated whether participants worked in a farm-related occupation or industry, or lived in a rural area. We used survey-weighted Poisson regression to estimate suicide mortality rates and rate ratios. RESULTS Age-adjusted suicide mortality rate per 100,000 was: 22.3 for farmers and farm managers; 21.6 for farmworkers; 28.7 in farming, forestry, and fishing; 15.3 across all other occupations; 16.1 among rural residents. Among farmworkers, age-adjusted rates were 28.3 in rural areas, 17.1 in urban areas (not significantly different). The age-adjusted suicide mortality rate ratio (RR) comparing workers in the agriculture, forestry, and fishery industries to those in all other industries was 1.34 (95% confidence interval, [CI]: 1.05-1.72) (not statistically significant after further adjustment for demographic characteristics). Age-adjusted results were consistent with a higher suicide risk for workers in forestry and fishing than in all other occupations (RR: 1.88, 95% CI: 0.79-4.46). CONCLUSION Workers in agriculture, forestry, and fishing may have an elevated suicide risk. National surveys should consider oversampling of rural residents, who have increased morbidity and mortality risks.
Collapse
Affiliation(s)
- Ahmed A. Arif
- Department of Public Health Sciences The University of North Carolina at Charlotte Charlotte North Carolina USA
| | - Oluwaseun Adeyemi
- Department of Public Health Sciences The University of North Carolina at Charlotte Charlotte North Carolina USA
| | - Sarah B. Laditka
- Department of Public Health Sciences The University of North Carolina at Charlotte Charlotte North Carolina USA
| | - James N. Laditka
- Department of Public Health Sciences The University of North Carolina at Charlotte Charlotte North Carolina USA
| | - Tyrone Borders
- College of Nursing University of Kentucky 760 Press Ave., Suite 361 Lexington Kentucky USA
| |
Collapse
|
7
|
Pulido J, Hoyos J, Martínez-Ruiz V, Sordo L, Fernández-Navarro P, Barrio G, Regidor E. Long-term impact of the 2008 economic crisis in Spain on road traffic collisions mortality by socioeconomic position. Health Place 2021; 71:102666. [PMID: 34507036 DOI: 10.1016/j.healthplace.2021.102666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 06/24/2021] [Accepted: 09/02/2021] [Indexed: 11/26/2022]
Abstract
We aimed to assess the effect of the 2008 crisis on road traffic collision (RTC) mortality in Spain, by socioeconomic position (SEP) and type of road use. This prospective, country-wide study covered all adults living in Spain and aged ≥30 years in November 2001. The long-term effect of the crisis was assessed by measuring the monthly percentage change (MPC) in RTC mortality between the pre-crisis (2002-2007) and crisis period (2008-2011). During the recession, RTC mortality fell more in people with low compared to high SEP, so MPCs difference between periods were of a higher magnitude in the low compared to high SEP groups, especially among men motorcyclists. RTC mortality trends were favorable following the 2008 crisis, particularly among low-SEP groups. In men motorcyclists, the upward trend of the pre-crisis period reversed course.
Collapse
Affiliation(s)
- J Pulido
- Department of Public Health and Maternal and Child Health, Complutense University of Madrid. Plaza Ramón y Cajal, S/n., 28040, Madrid, Spain; CIBER of Epidemiology and Public Health (CIBERESP). Monforte de Lemos, 3-5. 28029, Madrid, Spain
| | - J Hoyos
- CIBER of Epidemiology and Public Health (CIBERESP). Monforte de Lemos, 3-5. 28029, Madrid, Spain.
| | - V Martínez-Ruiz
- CIBER of Epidemiology and Public Health (CIBERESP). Monforte de Lemos, 3-5. 28029, Madrid, Spain; Department of Preventive Medicine and Public Health, University of Granada, Avda. de La Investigación 11. 18016, Granada, Spain
| | - L Sordo
- Department of Public Health and Maternal and Child Health, Complutense University of Madrid. Plaza Ramón y Cajal, S/n., 28040, Madrid, Spain; CIBER of Epidemiology and Public Health (CIBERESP). Monforte de Lemos, 3-5. 28029, Madrid, Spain
| | - P Fernández-Navarro
- CIBER of Epidemiology and Public Health (CIBERESP). Monforte de Lemos, 3-5. 28029, Madrid, Spain; Cancer and Environmental Epidemiology Unit, Department of Epidemiology of Chronic Diseases, National Center for Epidemiology, Carlos III Institute of Health, Calle Sinesio Delgado, 4. 28029, Madrid, Spain
| | - G Barrio
- CIBER of Epidemiology and Public Health (CIBERESP). Monforte de Lemos, 3-5. 28029, Madrid, Spain; National School of Public Health. Carlos III Institute of Health, Calle Sinesio Delgado, 4. 28029, Madrid, Spain
| | - E Regidor
- Department of Public Health and Maternal and Child Health, Complutense University of Madrid. Plaza Ramón y Cajal, S/n., 28040, Madrid, Spain; CIBER of Epidemiology and Public Health (CIBERESP). Monforte de Lemos, 3-5. 28029, Madrid, Spain; Health Research Institute of the Hospital Clínico San Carlos (IdISSC), Calle Del Profesor Martín Lagos. 28040, Madrid, Spain
| |
Collapse
|
8
|
Pulido J, Molist G, Vallejo F, Jiménez-Mejías E, Hoyos J, Regidor E, Barrio G. No effect of the Penalty Point System on road traffic accident mortality among men with a high socioeconomic status in Spain. ACCIDENT; ANALYSIS AND PREVENTION 2021; 156:106154. [PMID: 33933718 DOI: 10.1016/j.aap.2021.106154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 04/15/2021] [Accepted: 04/17/2021] [Indexed: 06/12/2023]
Abstract
The purpose of this study was to assess the effect of the Penalty Point System (PPS) on road traffic accident mortality by gender and socioeconomic status. We conducted a nationwide prospective study covering adult people living in Spain on November 2001. They were followed up until 30 Nov 2007 to determine vital status and cause of death. An interrupted time-series analysis was used to assess whether PPS (explanatory variable) had both immediate and long-term effect on the rates of road traffic accident mortality (RTAMs) separately by gender. Subjects were classified by socioeconomic status (low and high) using two indicators: educational attainment (up to lower secondary education; upper secondary education or more) and occupation (manual and non-manual workers). We performed several segmented Poisson regression models, controlling for trend, seasonality, 2004 road safety measures and fuel consumption as proxy for traffic exposure. Among men, we found a decrease on the RTAMs immediately after PPS in those with low educational level (16.2 %, IC95 %: 6.1 %-25.2 %) and manual workers (16.3 %, IC95 %: 2.8 %-27.8 %), and a non-significant increase among those with high education level and non-manual workers (6.2 % and 1.8 %). Among women, there were no significant differences in the immediate effect of PPS by socioeconomic status. We did not identify significant trend changes between pre-PPS and post-PPS periods in any socioeconomic group. In a context of downward trend of traffic mortality, the PPS implementation led to an immediate reduction on death rates only among men with a low socioeconomic status.
Collapse
Affiliation(s)
- J Pulido
- Department of Public Health and Maternal and Child Health, Complutense University of Madrid, Madrid, Spain; National School of Public Health, Institute of Health Carlos III, Madrid, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - G Molist
- Granollers General Hospital, Research and Innovation Area, Granollers, Barcelona, Spain
| | - F Vallejo
- National School of Public Health, Institute of Health Carlos III, Madrid, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - E Jiménez-Mejías
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain; Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain; Biosanitary Research Institute (Ibs Granada), Granada, Spain
| | - J Hoyos
- Department of Public Health and Maternal and Child Health, Complutense University of Madrid, Madrid, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain.
| | - E Regidor
- Department of Public Health and Maternal and Child Health, Complutense University of Madrid, Madrid, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain; Health Research Institute of the Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - G Barrio
- National School of Public Health, Institute of Health Carlos III, Madrid, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| |
Collapse
|
9
|
Stocker B, Weiss HK, Weingarten N, Engelhardt KE, Engoren M, Posluszny J. Challenges in Predicting Discharge Disposition for Trauma and Emergency General Surgery Patients. J Surg Res 2021; 265:278-288. [PMID: 33964638 DOI: 10.1016/j.jss.2021.03.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 03/02/2021] [Accepted: 03/10/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Changes in discharge disposition and delays in discharge negatively impact the patient and hospital system. Our objectives were1 to determine the accuracy with which trauma and emergency general surgery (TEGS) providers could predict the discharge disposition for patients and2 determine the factors associated with incorrect predictions. METHODS Discharge dispositions and barriers to discharge for 200 TEGS patients were predicted individually by members of the multidisciplinary TEGS team within 24 h of patient admission. Univariate analyses and multivariable logistic least absolute shrinkage and selection operator regressions determined the associations between patient characteristics and correct predictions. RESULTS A total of 1,498 predictions of discharge disposition were made by the multidisciplinary TEGS team for 200 TEGS patients. Providers correctly predicted 74% of discharge dispositions. Prediction accuracy was not associated with clinical experience or job title. Incorrect predictions were independently associated with older age (OR 0.98; P < 0.001), trauma admission as compared to emergency general surgery (OR 0.33; P < 0.001), higher Injury Severity Scores (OR 0.96; P < 0.001), longer lengths of stay (OR 0.90; P < 0.001), frailty (OR 0.43; P = 0.001), ICU admission (OR 0.54; P < 0.001), and higher Acute Physiology and Chronic Health Evaluation II scores (OR 0.94; P = 0.006). CONCLUSION The TEGS team can accurately predict the majority of discharge dispositions. Patients with risk factors for unpredictable dispositions should be flagged to better allocate appropriate resources and more intensively plan their discharges.
Collapse
Affiliation(s)
- Benjamin Stocker
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Hannah K Weiss
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Noah Weingarten
- Department of General Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Kathryn E Engelhardt
- Department of Surgery, Medical University of South Carolina, Charleston, South California
| | - Milo Engoren
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
| | - Joseph Posluszny
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
| |
Collapse
|
10
|
Peden AE, Franklin RC. Exploring the Impact of Remoteness and Socio-Economic Status on Child and Adolescent Injury-Related Mortality in Australia. CHILDREN (BASEL, SWITZERLAND) 2020; 8:5. [PMID: 33374211 PMCID: PMC7824025 DOI: 10.3390/children8010005] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 12/18/2020] [Accepted: 12/20/2020] [Indexed: 01/01/2023]
Abstract
Injuries are a leading cause of harm for children. This study explores the impact of determinants of health on children (0-19 years) injury-related mortality (namely remoteness and socio-economic disadvantage, calculated using the index of relative socio-economic advantage and disadvantage (IRSAD)). Cause of death data from the Australian Bureau of Statistics were sourced for children in Australia between 1 July 2007 to 30 June 2017. Fifteen injury categories (ICD-10-AM external cause codes) were used. Burden and trends by injury mechanism were explored. A total of 5153 children died; with road traffic incidents (3.39 per 100,000 population), intentional self-harm (2.46) and drowning (0.72) being the leading mechanisms. Female fatality rates in very remote areas (8.73) were nine times higher than in major cities (Relative Risk [RR] = 8.73; 95% Confidence Interval [95% CI]: 4.23-18.00). Fatality rates increased with remoteness; very remote areas recording an injury-related fatality rated six times (RR = 5.84; 95% CI: 3.76-9.12) that of major city residents. Accidental poisoning and intentional self-harm fatalities were more likely in high IRSAD areas, while road traffic fatalities were more likely in low and mid socio-economic areas (X2 = 69.1; p < 0.001). People residing in regional and remote areas and from low socio-economic backgrounds already face significant health and lifestyle challenges associated with disadvantage. It is time to invest in injury prevention interventions for these populations, as well as upstream policy strategies to minimize any further preventable loss of life.
Collapse
Affiliation(s)
- Amy E. Peden
- School of Population Health, UNSW Sydney, Kensington, NSW 2052, Australia
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD 4811, Australia;
| | - Richard C. Franklin
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD 4811, Australia;
| |
Collapse
|
11
|
Ahmed GK, Darwish AM, Khalifa H, Khashbah MA. Comparison of cognitive function, socioeconomic level, and the health-related quality of life between epileptic patients with attention deficit hyperactivity disorder and without. MIDDLE EAST CURRENT PSYCHIATRY 2020. [DOI: 10.1186/s43045-020-00054-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Abstract
Background
Epilepsy is one of the most common neurological conditions. Attention deficit hyperactivity disorder (ADHD) in children with epilepsy proves to be very common. Both epilepsy and ADHD impair quality of life. We aimed to evaluate cognitive function, socioeconomic level, and quality of life (QOL) among children with ADHD and epilepsy. A total of 100 children were divided into 5 groups (20 children/group) as (I) epilepsy, (II) ADHD with epilepsy, (III) ADHD with EEG changes, (IV) ADHD without EEG changes, and (V) control. Children aged between 6 and 11 years were recruited for this study. Early Childhood Epilepsy Severity Scale (E-Chess), Conners’ Parent Rating Scale (CPRS), Wechsler Intelligence Scale for Children-3rd edition (WISC-III), socioeconomic scale for assessment of social burden and socioeconomic classes, and PedsQL (quality of life measure) assessed.
Results
Children with ADHD and epilepsy had the lowest PedsQL total scores and lower scores than other groups especially in performance IQ score. The highest percentage of low socioeconomic class (25%) was observed in the group of ADHD with epilepsy and the group of epilepsy.
Conclusion
ADHD with epilepsy is associated with low performance IQ, poor socioeconomic level, and quality of life. Pediatric Quality of Life Inventory scores show significant correlation with total IQ score in the group of ADHD with epilepsy.
Collapse
|
12
|
Traumatic Falls in the Pediatric Population: Facial Fracture Patterns Observed in a Leading Cause of Childhood Injury. Ann Plast Surg 2020; 82:S195-S198. [PMID: 30730318 DOI: 10.1097/sap.0000000000001861] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE Falls are a leading cause of nonfatal injury in the pediatric population, resulting in numerous hospitalizations. Children may not have fully developed reflexive and balancing abilities, rendering them more susceptible to traumatic falls. Here the authors present their findings regarding patterns of facial fracture and concomitant injury seen in the pediatric population secondary to falls. METHODS A retrospective chart review was performed of all facial fractures as a result of falls in the pediatric population in a level 1 trauma center in an urban environment (University Hospital in Newark, NJ). Patient demographics were collected, as well as location of fractures, concomitant injuries, and surgical management strategies. RESULTS Fifty-five patients were identified as 18 years or younger and having sustained a facial fracture as the result of a fall. This cohort was compared with 418 pediatric patients with facial fractures due to nonfall etiologies. The mean age was 9.6 years (range, 0-18 years), with a male predominance of 67.3%. There were a total of 70 fractures identified on radiological imaging. The most frequently fractured bones were the orbit (n = 27), nasal bone (n = 15), and mandible (n = 11). Orbital and frontal sinus fractures each occurred more frequently due to falls compared with all other causes of injury. Patients with orbital fractures were significantly more likely to present with an additional facial fracture compared with those without (P < 0.01). The most common concomitant injuries were traumatic brain injury, skull fracture, and intracranial hemorrhage. Patients who suffered a facial fracture due to a fall were significantly more likely to sustain a concomitant skull fracture (P < 0.05) and intra-abdominal injury (P < 0.05) compared with all other etiologies. Fourteen patients required surgical intervention. One patient died. CONCLUSIONS Pediatric facial fractures are a unique entity. The general plasticity of the pediatric anatomy can predispose patients to significant injury without obvious external signs. A high level of clinical suspicion is required to avoid misdiagnosis and delay of treatment. The authors hope this study can address a preventable issue in child safety, educate caregivers, and provide insight towards fracture management that fosters functional and aesthetic recovery.
Collapse
|
13
|
Cook A, Harris R, Brown HE, Bedrick E. Geospatial characteristics of non-motor vehicle and assault-related trauma events in greater Phoenix, Arizona. Inj Epidemiol 2020; 7:34. [PMID: 32536346 PMCID: PMC7294629 DOI: 10.1186/s40621-020-00258-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 05/04/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Injury-causing events are not randomly distributed across a landscape, but how they are associated with the features and characteristics of the places where they occur in Arizona (AZ) remains understudied. Clustering of trauma events and associations with areal sociodemographic characteristics in the greater Phoenix (PHX), AZ region can promote understanding and inform efforts to ameliorate a leading cause of death and disability for Arizonans. The outcomes of interest are trauma events unrelated to motor vehicle crashes (MVC) and the subgroup of trauma events due to interpersonal assaults. METHODS A retrospective, ecological study was performed incorporating data from state and national sources for the years 2013-2017. Geographically weighted regression models explored associations between the rates of non-MVC trauma events (n/10,000 population) and the subgroup of assaultive trauma events per 1000 and areal characteristics of socioeconomic deprivation (areal deprivation index [ADI]), the density of retail alcohol outlets for offsite consumption, while controlling for race/ethnicity, population density, and the percentage urban population. RESULTS The 63,451 non-MVC traumas within a 3761 mile2 study area encompassing PHX and 22 surrounding communities, an area with nearly 60% of the state's population and 54% of the trauma events in the AZ State Trauma Registry for the years 2013-2017. Adjusting for confounders, ADI was associated with the rates of non-MVC and assaultive traumas in all census block groups studied (mean coefficients 0.05 sd. 0.001 and 0.07 sd. 0.002 for non-MVC and assaultive trauma, respectively). Alcohol retail outlet density was also associated with non-MVC and assaultive traumas in fewer block groups compared to ADI. CONCLUSION Socioeconomic deprivation and alcohol outlet density were associated with injury producing events in the greater PHX area. These features persist in the environment before and after the traumas occur. Ongoing research is warranted to identify the most influential areal predictors of traumatic injury-causing events in the greater PHX area to inform and geographically target prevention initiatives.
Collapse
Affiliation(s)
- Alan Cook
- Department of Epidemiology and Biostatistics, University of Texas Health Science Center Tyler School of Community and Rural Health, 11937 U.S. Highway 271, H252, Tyler, TX 75708 USA
| | - Robin Harris
- Department of Epidemiology and Biostatistics, University of Arizona Mel and Enid Zuckerman College of Public Health, 1295 N. Martin Ave., Drachman Hall, Tucson, AZ 85724 USA
| | - Heidi E. Brown
- Department of Epidemiology and Biostatistics, University of Arizona Mel and Enid Zuckerman College of Public Health, 1295 N. Martin Ave., Drachman Hall, Tucson, AZ 85724 USA
| | - Edward Bedrick
- Department of Epidemiology and Biostatistics, University of Arizona Mel and Enid Zuckerman College of Public Health, 1295 N. Martin Ave., Drachman Hall, Tucson, AZ 85724 USA
| |
Collapse
|
14
|
Miller JP, O' Reilly GM, Mackelprang JL, Mitra B. Trauma in adults experiencing homelessness. Injury 2020; 51:897-905. [PMID: 32147144 DOI: 10.1016/j.injury.2020.02.086] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 02/16/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Homeless individuals suffer a greater burden of health problems than the general population. This study aimed to describe the epidemiology of physical trauma among homeless patients presenting to an urban major trauma center and to ascertain any differences in the nature, injury severity and outcomes among homeless compared to domiciled patients. METHODS A retrospective matched cohort study that included adults who met inclusion criteria for The Alfred Hospital Trauma Registry between 01 July 2010 and 31 March 2017 was conducted. Primary homelessness was identified using the International Statistical Classification of Diseases, 10th Revision Coding Z59.0 and/or 'No fixed abode' address data. Homeless and domiciled patients were matched at a 1:2 ratio on age, sex, month and year of injury. The primary outcome variable was the Injury Severity Score (ISS). Secondary outcomes were hospital length of stay (LOS), mortality, emergency department (ED) disposition, hospital disposition, discharge processes and trauma registry recidivism. RESULTS Of 25,920 cases in the trauma registry, 147 (0.6%) were identified as homeless, comprising 131 unique homeless individuals who were matched with 262 domiciled patients. The median (Inter-Quartile Range) ISS among homeless patients was 5(2-10), compared to 9(4-17) for domiciled patients (p < 0.001). Homeless patients had significantly lower odds of sustaining an injury with ISS>12 (OR 0.5, 95% CI: 0.3-0.8, p = 0.001). Homeless patients were treated more often than domiciled patients for assault (32.1% vs 9.5%), intentional self-harm (10.7% vs 2.7%), and penetrating injury (16.0% vs 6.5%). Homeless patients had higher rates of psychiatry admissions (9.2% vs 0.8%), positive blood alcohol concentration (30.5% vs 13.7%), and higher odds of discharging against medical advice (DAMA)(OR 2.0, 95% CI: 1.1-3.6 p = 0.02). There were no differences in LOS (p = 0.51), mortality (p = 0.19), ED disposition (p = 0.64) or trauma registry recidivism (p = 0.09). CONCLUSION Among injured patients who presented at an urban trauma center, homelessness was associated with higher odds of assault, intentional self-harm, penetrating injury, psychiatry admissions, DAMA but lower ISS than domiciled patients. Variable definitions of homelessness and lack of standardized documentation in the medical record should be addressed to ensure these vulnerable patients are identified and linked with peripheral services.
Collapse
Affiliation(s)
| | - Gerard M O' Reilly
- Emergency & Trauma Centre, The Alfred Hospital, Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; National Trauma Research Institute, The Alfred Hospital, Melbourne, Australia
| | | | - Biswadev Mitra
- Emergency & Trauma Centre, The Alfred Hospital, Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; National Trauma Research Institute, The Alfred Hospital, Melbourne, Australia
| |
Collapse
|
15
|
Stokes MA, Hemphill S, McGillivray J, Evans-Whipp T, Satyen L, Toumbourou JW. Self-reported injury in Australian young adults: demographic and lifestyle predictors. Aust N Z J Public Health 2020; 44:106-110. [PMID: 32050296 DOI: 10.1111/1753-6405.12966] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 11/01/2019] [Accepted: 12/01/2019] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES Injury is the major cause of mortality and morbidity among adolescents and young adults. This study examined the use of injury self-reports and various causes of injury among adolescents. METHODS A cohort recruited in 2002 as a representative sample of students from the State of Victoria in south-east Australia was followed and resurveyed in young adulthood in 2010 (mean age 21.0) and 2012 (mean age 23.1) with 75% of the target sample retained (N=2,154, 55.8% female). RESULTS Prior injuries were reported by 55.5% in 2010 and 54.6% in 2012, leaving 18% with continuing disability. Reported causes of injury in 2012 were sports (55.1%) and alcohol use (9.7%). Logistic regression revealed that injury in 2012 was predicted by rural school attendance in 2002 (Adjusted Odds Ratio [OR] 1.4 CI 1.1-1.7) and in 2010 by male gender (OR 2.2, CI 1.8-2.6), reported self-harm (OR 1.6 CI 1.1-2.2), and unemployment (OR 0.7, CI 0.5-1.0). CONCLUSIONS Self-reported injury among young adults is reliably reported, and suggests the need to further examine gender, rural communities and self-harm, and indicates modifiable contributors to injury. Implications for public health: Modifiable contributors to injury prevention are revealed as work environment, sports participation and alcohol use.
Collapse
Affiliation(s)
- Mark A Stokes
- School of Psychology and Centre for Social and Early Emotional Development, Deakin University, Victoria
| | - Sheryl Hemphill
- Murdoch Children's Research Institute, Victoria.,Department of Paediatrics, The University of Melbourne, Victoria.,Centre for Adolescent Health, Murdoch Children's Research Institute, Royal Children's Hospital, Victoria.,School of Education, La Trobe University, Victoria
| | - Jane McGillivray
- School of Psychology and Centre for Social and Early Emotional Development, Deakin University, Victoria
| | - Tracy Evans-Whipp
- Department of Paediatrics, The University of Melbourne, Victoria.,Centre for Adolescent Health, Murdoch Children's Research Institute, Royal Children's Hospital, Victoria
| | - Lata Satyen
- School of Psychology and Centre for Social and Early Emotional Development, Deakin University, Victoria
| | - John W Toumbourou
- School of Psychology and Centre for Social and Early Emotional Development, Deakin University, Victoria.,Centre for Adolescent Health, Murdoch Children's Research Institute, Royal Children's Hospital, Victoria
| |
Collapse
|
16
|
Yang K, Zheng Y, Peng J, Chen J, Feng H, Yu K, Chen Y, Luo W, Yang P, Yang Y, Wu B. Incidence of Death From Unintentional Injury Among Patients With Cancer in the United States. JAMA Netw Open 2020; 3:e1921647. [PMID: 32083692 PMCID: PMC7043194 DOI: 10.1001/jamanetworkopen.2019.21647] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
IMPORTANCE Previous studies have suggested that patients with cancer may be at an increased risk of death from unintentional injury, but to our knowledge, no large studies have examined the rates of death from unintentional injury among patients with cancer. OBJECTIVE To characterize the incidence of death from unintentional injury among patients with cancer in the United States. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study included patients diagnosed with a first primary cancer between January 1, 1973, and December 31, 2015, identified from the Surveillance, Epidemiology, and End Results (SEER) program data. Comparisons with the general US population were based on mortality data collected by the National Center for Health Statistics. Analyses were performed from February 1, 2019, to August 15, 2019. MAIN OUTCOMES AND MEASURES Rates and standardized mortality ratios (SMRs) of death from unintentional injury among patients with cancer. RESULTS A total of 8 271 020 patients with cancer were included in this study (50.2% female; mean [SD] age, 63.0 [15.7] years). Among them, 40 599 deaths from unintentional injury were identified. The rates of death from unintentional injury were 81.90 per 100 000 person-years among patients with cancer and 51.21 per 100 000 person-years in the corresponding US general population. The SMR of death from unintentional injury was 1.60 (95% CI, 1.58-1.61). Higher rates of death from unintentional injury were associated with increasing age at diagnosis (≥80 years; rate ratio [RR], 2.91; 95% CI, 2.84-2.98; P < .001), male sex (RR, 1.69; 95% CI, 1.66-1.73; P < .001), American Indian or Alaskan Native population (RR, 1.48; 95% CI, 1.30-1.68; P < .001), and being unmarried (RR, 1.23; 95% CI, 1.18-1.28; P < .001). Rates of death from unintentional injury were the highest in patients with cancers of the liver (200.37 per 100 000 person-years), brain (175.04 per 100 000 person-years), larynx (148.78 per 100 000 person-years), and esophagus (144.98 per 100 000 person-years). The SMRs were the highest in the first month after cancer diagnosis. CONCLUSIONS AND RELEVANCE This study found that the incidence of death from unintentional injury among patients with cancer was significantly higher than that in the general population in the United States. The rates of death from unintentional injury varied by age, sex, race/ethnicity, marital status, cancer site, disease stage, and time since diagnosis. The findings suggest that death from unintentional injury among patients with cancer requires further attention and that initiatives to identify patients at risk and to develop targeted prevention strategies should be prioritized.
Collapse
Affiliation(s)
- Kunyu Yang
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yongqiang Zheng
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jiangtong Peng
- Department of Cardiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jiayuan Chen
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Huayi Feng
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kaixu Yu
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ying Chen
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wenjing Luo
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Pengcheng Yang
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yun Yang
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bian Wu
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| |
Collapse
|
17
|
Sánchez González MP, Tejada Ponce Á, Escribano Sotos F. Interregional inequality and road accident rates in Spain. ACCIDENT; ANALYSIS AND PREVENTION 2020; 135:105347. [PMID: 31783333 DOI: 10.1016/j.aap.2019.105347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 09/06/2019] [Accepted: 10/21/2019] [Indexed: 06/10/2023]
Abstract
The aim of this study was to determine whether interregional inequality in Spain had the same impact on the risks of fatality and injury across the different provinces of Spain, in the period from 1999 to 2015. This allows us to map fatality and injury rates in Spanish provinces depending on their level of economic development. Provinces were divided in two large groups according to the mean weight of their per capita GDP on the national GDP from 2000 to 2015. Using fixed effects data panel models, estimations were obtained for each group of the impact of the relationships between per capita GDP, unemployment rate and other control variables on their risks of fatality and injury. The models reveal that economic conditions and education are explanatory factors with greater significance and impact on the risks of fatality and injury in provinces with higher levels of economic development. In this group, the penalty-points driving licence was found have a greater impact, although its effectiveness is now being questioned. In contrast, to reduce the risks of fatality and injury in less developed provinces, it is imperative to invest in road infrastructure, increasing the proportion of high capacity roads and investing more in road replacement and maintenance. The geographical distribution generated in this study allows us to better identify the areas with a higher risk of fatality or injury. This, in turn, confirms the need to improve the configuration of road safety policy, taking into account the different fatality or injury rates across provinces, the origins of which lie in the specific provincial conditions.
Collapse
Affiliation(s)
| | - Ángel Tejada Ponce
- Faculty of Economic and Business Sciences, University of Castilla-La Mancha, Plaza de la Universidad, 1. 02071, Albacete, Spain.
| | | |
Collapse
|
18
|
Eun SJ. Trends in mortality from road traffic injuries in South Korea, 1983-2017: Joinpoint regression and age-period-cohort analyses. ACCIDENT; ANALYSIS AND PREVENTION 2020; 134:105325. [PMID: 31706185 DOI: 10.1016/j.aap.2019.105325] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 09/19/2019] [Accepted: 10/07/2019] [Indexed: 06/10/2023]
Abstract
Although mortality trends can be influenced by different ages, periods, and cohorts, few studies have demonstrated the age-period-cohort (APC) effect on road traffic injury (RTI) mortality. Moreover, APC effects in Korea have never been documented despite the high mortality rates from RTIs. This study aimed to describe the trends in mortality from RTIs and examine APC effects on RTI mortality in Korea. Using the national death certificate and census mid-year population estimates data during 1983-2017, trends in age-standardized mortality rates from RTIs were analyzed using Joinpoint regression. Intrinsic estimator regression models were used to estimate APC effects on RTI mortality. Consistent with the trend in period effects, RTI mortality increased sharply with the economic growth in the 1980s, decelerated after the implementation of road safety policies in the early 1990s, plummeted owing to the 1997-1998 financial crisis, and gradually decreased from the early 2000s. A J-shaped age effect indicated that the relative risk of road traffic death surged in people aged ≥65 years. Educational expansion from the mid-1950s turned an increasing birth cohort effect into a continuously decreasing trend after peaking around the 1938-1943 birth cohorts. The risk of road traffic death was relatively high among the Korean Generation Y, i.e., those born in 1978-1983. RTI mortality trends in Korea have been affected by diverse socioeconomic changes through cohort and period effects. Despite the recent favorable trend, RTI mortality remains high, especially among older people. Road safety policies to address the burden of RTIs require further improvement.
Collapse
Affiliation(s)
- Sang Jun Eun
- Department of Preventive Medicine, Chungnam National University College of Medicine, 266 Munhwa-ro, Jung-gu, Daejeon, 35015, Republic of Korea.
| |
Collapse
|
19
|
Heathcote K, Wullschleger M, Gardiner B, Morgan G, Barbagello H, Sun J. The Importance of Place of Residence on Hospitalized Outcomes for Severely Injured Trauma Patients: A Trauma Registry Analysis. J Rural Health 2019; 36:381-393. [PMID: 31840316 DOI: 10.1111/jrh.12407] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE Socioecological factors are understudied in relation to trauma patients' outcomes. This study investigated the association of neighborhood socioeconomic disadvantage (SED) and remoteness of residence on acute length of hospital stay days (ALSD) and inpatient mortality. METHODS A retrospective cohort study was conducted on adults hospitalized for major trauma in a Level 1 trauma center in southeast Queensland from 2014 to 2017. Neighborhood SED and remoteness indices were linked to individual patient variables. Step-wise multivariable negative binomial regression and proportional hazards regression analyses were undertaken, adjusting for injury and patient factors. Outcomes were ALSD and inpatient mortality. FINDINGS We analyzed 1,025 patients. Statistically significant increased hazard of inpatient mortality was found for older age (HR 3.53, 95% CI: 1.77-7.11), injury severity (HR 5.27, 95% CI: 2.78-10.02), remoteness of injury location (HR 1.75, 95% CI: 1.06-2.09), and mechanisms related to intentional self-harm or assault (HR 2.72, 95% CI: 1.48-5.03,). Excess mortality risk was apparent for rural patients sustaining less severe injuries (HR 4.20, 95% CI: 1.35-13.10). Increased risk for longer ALSD was evident for older age (RR 1.35, 95% CI: 1.07-1.71), head injury (RR 1.39, 95% CI: 1.19-1.62), extremity injuries (RR 1.82, 95% CI: 1.55-2.14), and higher injury severity scores (ISS) (RR 1.51, 95%: CI: 1.29-1.76). CONCLUSIONS Severely injured rural trauma patients are more likely to be socioeconomically disadvantaged and sustain injuries predisposing them to worse hospital outcomes. Further research is needed to understand more about care pathways and factors influencing the severity, mechanism and clinical consequences of rural-based traumatic injuries.
Collapse
Affiliation(s)
| | - Martin Wullschleger
- Division of Specialty and Procedural Services, Gold Coast University Hospital and School of Medicine, Griffith University, Parkland, Gold Coast, Queensland, Australia
| | - Ben Gardiner
- Division of Specialty and Procedural Services, Gold Coast University Hospital and School of Medicine, Griffith University, Parkland, Gold Coast, Queensland, Australia
| | - Geoffrey Morgan
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Holly Barbagello
- School of Medicine, Griffith University, Gold Coast, Queensland, Australia
| | - Jing Sun
- School of Medicine, Griffith University, Gold Coast, Queensland, Australia
| |
Collapse
|
20
|
Stickley A, Waldman K, Koyanagi A, DeVylder JE, Narita Z, Sumiyoshi T, Jacob L, Oh H. Psychotic experiences and accidents, injuries, and poisonings among adults in the United States. Psychiatry Res 2019; 282:112610. [PMID: 31655406 DOI: 10.1016/j.psychres.2019.112610] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 10/10/2019] [Accepted: 10/10/2019] [Indexed: 01/25/2023]
Abstract
Psychotic experiences (PEs) have been linked to an increased risk for accidents and injuries. However, this association remains little researched in many countries. To address this research gap, the current study used cross-sectional data from the United States to examine the association between PEs and accidents, injuries, and poisoning in a general population sample. Data were analyzed from 2274 individuals who completed the psychosis screen as part of the National Comorbidity Survey Replication (NCS-R). Information was obtained on PEs (hallucinations and delusions) and the experience of past 12-month accidents, injuries, and poisoning. Logistic regression analysis was used to examine the association while adjusting for demographic variables and common mental disorders (CMDs). In a fully adjusted model past 12-month PEs were associated with almost three times higher odds for reporting accidents, injuries, and poisoning (odds ratio [OR]: 2.97, 95% confidence interval [CI]: 1.13-7.74). The results of this study indicate that PEs are associated with higher odds for accidents and injuries among adults in the United States. Research is now needed to determine the direction of this association and the factors linked to it.
Collapse
Affiliation(s)
- Andrew Stickley
- Department of Preventive Intervention for Psychiatric Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan; The Stockholm Center for Health and Social Change (SCOHOST), Södertörn University, Huddinge, Sweden.
| | - Kyle Waldman
- University of Southern California, Suzanne Dworak Peck School of Social Work, Los Angeles, CA, USA
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, Barcelona, Spain; ICREA, Pg. Lluis Companys 23, Barcelona, Spain
| | - Jordan E DeVylder
- Graduate School of Social Service, Fordham University, New York, NY, USA
| | - Zui Narita
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Tomiki Sumiyoshi
- Department of Preventive Intervention for Psychiatric Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Louis Jacob
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, Barcelona, Spain; Faculty of Medicine, University of Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux 78180, France
| | - Hans Oh
- University of Southern California, Suzanne Dworak Peck School of Social Work, Los Angeles, CA, USA
| |
Collapse
|
21
|
A "Swiss paradox" in the United States? Level of spatial aggregation changes the association between income inequality and morbidity for older Americans. Int J Health Geogr 2019; 18:28. [PMID: 31775750 PMCID: PMC6880635 DOI: 10.1186/s12942-019-0192-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 11/19/2019] [Indexed: 12/29/2022] Open
Abstract
Although a preponderance of research indicates that increased income inequality negatively impacts population health, several international studies found that a greater income inequality was associated with better population health when measured on a fine geographic level of aggregation. This finding is known as a “Swiss paradox”. To date, no studies have examined variability in the associations between income inequality and health outcomes by spatial aggregation level in the US. Therefore, this study examined associations between income inequality (Gini index, GI) and population health by geographic level using a large, nationally representative dataset of older adults. We geographically linked respondents’ county data from the 2012 Behavioral Risk Factor Surveillance System to 2012 American Community Survey data. Using generalized linear models, we estimated the association between GI decile on the state and county levels and five population health outcomes (diabetes, obesity, smoking, sedentary lifestyle and self-rated health), accounting for confounders and complex sampling. Although state-level GI was not significantly associated with obesity rates (b = − 0.245, 95% CI − 0.497, 0.008), there was a significant, negative association between county-level GI and obesity rates (b = − 0.416, 95% CI − 0.629, − 0.202). State-level GI also associated with an increased diabetes rate (b = 0.304, 95% CI 0.063, 0.546), but the association was not significant for county-level GI and diabetes rate (b = − 0.101, 95% CI − 0.305, 0.104). Associations between both county-level GI and state-level GI and current smoking status were also not significant. These findings show the associations between income inequality and health vary by spatial aggregation level and challenge the preponderance of evidence suggesting that income inequality is consistently associated with worse health. Further research is needed to understand the nuances behind these observed associations to design informed policies and programs designed to reduce socioeconomic health inequities among older adults.
Collapse
|
22
|
Wolf AE, Garrison MM, Mills B, Chan T, Rowhani-Rahbar A. Evaluation of Injury Severity and Resource Utilization in Pediatric Firearm and Sharp Force Injuries. JAMA Netw Open 2019; 2:e1912850. [PMID: 31596492 PMCID: PMC6802232 DOI: 10.1001/jamanetworkopen.2019.12850] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 08/20/2019] [Indexed: 11/14/2022] Open
Abstract
Importance Pediatric firearm injuries are a serious and growing public health problem, constituting the second leading cause of death in children and adolescents in the United States. Firearm injuries have a high case fatality, but knowledge is limited to date regarding their injury severity and health care utilization burden compared with those of other penetrating injuries, especially among children with critical injury. Objective To describe and compare the resource utilization, injury severity, and short-term clinical outcomes associated with pediatric firearm injuries and other penetrating trauma. Design, Setting, and Participants This retrospective cohort study used data from the National Trauma Data Bank, an encounter-level registry of trauma data in the United States, from January 1, 2007, to December 31, 2016. Encounters for firearm injury (n = 25 155) or cut or pierce injury (21 270) in children 17 years or younger were analyzed. Statistical analysis was conducted from July 15, 2018, to June 5, 2019. Exposures Firearm injury compared with cut or pierce injury encounters. Main Outcomes and Measures Intensive care unit (ICU) admission, hospital and ICU length of stay (LOS), and Injury Severity Score (ISS). Results A total of 25 155 firearm injury encounters and 21 270 cut or pierce injury encounters were analyzed. Most firearm and cut or pierce injuries occurred among boys (21 573 [85.8%] and 15 864 [74.6%]) and adolescents aged 15 to 17 years (18 807 [74.8%] and 10 895 [51.2%]). A greater proportion of those with firearm injuries were African American children compared with those with cut or pierce injuries (15 019 [61.3%] vs 6397 [31.2%]). A greater proportion of those with firearm injuries compared with cut or pierce injuries were admitted to the ICU (7682 [30.5%] vs 2712 [12.8%]). Compared with cut or pierce injuries, firearm injuries were associated with a higher mean (SD) ISS (4.6 [6.8] vs 10.9 [12.7] points), longer mean (SD) hospital LOS (2.8 [4.1] vs 5.0 [8.4] days), and longer mean (SD) ICU LOS (3.1 [4.5] vs 5.1 [7.7] days). Firearm injuries accounted for 126 027 hospital days and 39 255 ICU days, whereas cut or pierce injuries accounted for 58 705 hospital days and 8353 ICU days. After adjustments for age, sex, year, and hospital, those with firearm injuries were more likely to require ICU admission (relative risk [RR], 2.3; 95% CI, 2.1-2.5; P < .001) and to have higher ISS scores (6.7 points higher for all injuries; 95% CI, 6.1-7.2) compared with those with cut or pierce injuries, even among critical injuries. Multinomial logistic regression demonstrated higher risk of prolonged hospital LOS (RR ratio, 4.11; 95% CI, 3.46-4.89; P < .001) and ICU LOS (RR ratio, 2.2; 95% CI, 1.9-2.3) for firearm injuries compared with cut or pierce injuries. Conclusions and Relevance This study found that pediatric firearm injuries were associated with greater severity and health care utilization compared with penetrating trauma from other mechanisms, suggesting that the mechanism of injury is an important consideration in penetrating sharp force trauma in children and adolescents. Public health measures, legislative efforts, and safe storage practices are among the interventions needed to reduce pediatric firearm injuries.
Collapse
Affiliation(s)
- Ashley E. Wolf
- Division of Critical Care Medicine, Seattle Children’s Hospital, University of Washington, Seattle
- School of Public Health, Department of Health Services, University of Washington, Seattle
| | | | - Brianna Mills
- Firearm Injury and Policy Research Program, Harborview Injury Prevention and Research Center, University of Washington, Seattle
| | - Titus Chan
- Division of Critical Care Medicine, Seattle Children’s Hospital, University of Washington, Seattle
| | - Ali Rowhani-Rahbar
- Firearm Injury and Policy Research Program, Harborview Injury Prevention and Research Center, University of Washington, Seattle
- School of Public Health, Department of Epidemiology, University of Washington, Seattle
| |
Collapse
|
23
|
Park Y, Kim HS. Validation of the Korean Version Interpersonal Needs Questionnaire. Suicide Life Threat Behav 2019; 49:739-758. [PMID: 29806206 DOI: 10.1111/sltb.12473] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Accepted: 01/31/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The Interpersonal Psychological Theory of Suicide posits thwarted belongingness and perceived burdensomeness as the constructs of suicidal desire. This study examined the psychometric properties of the Interpersonal Needs Questionnaire (INQ), which measures thwarted belongingness and perceived burdensomeness, in Korean university students. METHOD A series of exploratory and confirmatory factor analyses were conducted to identify the latent structure of the 15-item INQ. Then, its psychometric properties were examined through a correlation analysis and a hierarchical regression analysis. The study included 313 Korean students of which 113 were male and 200 were female. The mean age was 21.51 years. RESULTS The factor analyses supported a two-factor model. However, item 12 cross-loaded on both thwarted belongingness and perceived burdensomeness. While the correlation analysis supported convergent validity, discriminant validity was observed only through a more elaborative measure. Furthermore, the hierarchical regression analysis revealed perceived burdensomeness and the interaction between the two constructs as significant predictors of current suicide ideation. CONCLUSION The difference in the structure of the INQ may be due to cultural influences. Nevertheless, the high predictability of suicide ideation that it produces even when controlling for depression implies its clinical usefulness when assessing suicidal risk in Koreans.
Collapse
Affiliation(s)
- Yeonsoo Park
- Department of Psychology, Sogang University, Seoul, Korea
| | - Hyang Sook Kim
- Department of Psychology, Sogang University, Seoul, Korea
| |
Collapse
|
24
|
Young JT, Borschmann R, Preen DB, Spittal MJ, Brophy L, Wang EA, Heffernan E, Kinner SA. Age-specific incidence of injury-related hospital contact after release from prison: a prospective data-linkage study. Inj Prev 2019; 26:204-214. [DOI: 10.1136/injuryprev-2018-043092] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 02/25/2019] [Accepted: 03/01/2019] [Indexed: 11/03/2022]
Abstract
BackgroundIn population studies, the risk of injury declines after early adulthood. It is unclear if a similar age difference in the risk of injury exists among people released from prison.MethodsPrerelease survey data collected between 1 August 2008 and 31 July 2010, from a representative cohort of sentenced adults (≥18 years) in Queensland, Australia, were linked prospectively and retrospectively to person-level emergency department, inpatient hospital and correctional records. To ascertain predictors of injury-related hospital contact, we fit a multivariate Andersen-Gill model and tested the interactions between age group (<25 years, ≥25 years) and each variable.ResultsIn 1307 adults released from prison, there were 3804 person-years of follow-up. The crude injury rate was 385 (95% CI 364 to 407) per 1000 person-years and did not differ according to age group. Factors associated with increased injury-related hospital contact included a history of mental illness, preincarceration injury, a history of incarceration, release from a short prison sentence (<90 days), being reincarcerated during follow-up and identifying as Indigenous. The effect of mental illness, risky alcohol use, prior incarceration and intellectual disability differed across age group and predicted increased risk of injury among people aged ≥25 years compared with their counterparts without these characteristics.ConclusionsUnlike in the general population where the risk of injury declines with age, older adults released from prison are at similar risk compared with their younger peers. Adults released from prison with mental illness, a history of injury-related hospital contact and who identify as Indigenous are particularly indicated groups for injury prevention.
Collapse
|
25
|
Park Y, Kim HS. The interaction between personality and interpersonal needs in predicting suicide ideation. Psychiatry Res 2019; 272:290-295. [PMID: 30594762 DOI: 10.1016/j.psychres.2018.12.091] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 11/27/2018] [Accepted: 12/17/2018] [Indexed: 11/27/2022]
Abstract
The Interpersonal Psychological Theory of Suicide (i.e., IPTS) proposes that suicidal desire occurs when an individual simultaneously experiences thwarted belongingness (TB) and perceived burdensomeness (PB) (i.e., interpersonal needs). However, interpersonal needs have been inconsistent in predicting suicide ideation in Koreans. Therefore, we examined depressogenic personality dimensions-sociotropy and autonomy-as individual differences that may alter the effects of TB and PB on suicide ideation. We hypothesized that sociotropy will amplify the influence of TB on suicide ideation and that autonomy will regulate the degree to which PB leads to suicide ideation. This study was conducted with undergraduate students from a university located in Seoul, Korea. 313 students of whom 113 were males (36.1%) and 200 were females (63.9%) were included in the final analyses. Among the 313 participants, 42 (20.3%) endorsed suicide ideation. Significant correlations were identified between sociotropy and depression, and autonomy and depression. PB and sociotropy were valid predictors of suicide ideation even after controlling for depression. In addition, significant interactions were found between sociotropy and TB, and autonomy and PB.
Collapse
Affiliation(s)
- Yeonsoo Park
- Department of Psychology, Sogang University, Seoul, Republic of Korea
| | - Hyang Sook Kim
- Department of Psychology, Sogang University, Seoul, Republic of Korea.
| |
Collapse
|
26
|
Traumatic Brain Injury in the General Population: Incidence, Mental Health Comorbidity, and Functional Impact. J Nerv Ment Dis 2019; 207:38-42. [PMID: 30575707 DOI: 10.1097/nmd.0000000000000915] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Traumatic brain injury (TBI) is a relatively prevalent and burdensome condition with significant public health cost; however, epidemiological studies of TBI in the United States have rarely used nationally representative samples or included measures of functioning. Data were obtained from the third wave of the National Epidemiological Survey on Alcohol and Related Conditions. Of the 36,309 individuals surveyed, 193 (0.53% weighted) reported a past-year TBI. Results from weighted logistic regression modeling indicated that prior active duty military status, mood disorders, posttraumatic stress disorder, and nicotine use disorders were associated with greater odds of TBI. Annual household income greater than $20,000 was associated with lower odds of TBI. Regarding functioning, TBI was associated with greater impairment on SF-12 scales measuring mental and physical health and the organization subscale of the Executive Function Index. Results suggest that many individuals in the US population experience TBI each year and that such injuries are associated with impairment across multiple domains.
Collapse
|
27
|
Cunningham RM, Walton MA, Carter PM. The Major Causes of Death in Children and Adolescents in the United States. N Engl J Med 2018; 379:2468-2475. [PMID: 30575483 PMCID: PMC6637963 DOI: 10.1056/nejmsr1804754] [Citation(s) in RCA: 416] [Impact Index Per Article: 69.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Rebecca M Cunningham
- From the University of Michigan Injury Prevention Center (R.M.C., M.A.W., P.M.C.), the Firearm Safety among Children and Teens Consortium (R.M.C., M.A.W., P.M.C.), the Department of Emergency Medicine (R.M.C., P.M.C.), and the Addiction Center, Department of Psychiatry (M.A.W.), University of Michigan School of Medicine, and the Youth Violence Prevention Center (R.M.C., P.M.C.) and Department of Health Behavior and Health Education (R.M.C.), University of Michigan School of Public Health - both in Ann Arbor
| | - Maureen A Walton
- From the University of Michigan Injury Prevention Center (R.M.C., M.A.W., P.M.C.), the Firearm Safety among Children and Teens Consortium (R.M.C., M.A.W., P.M.C.), the Department of Emergency Medicine (R.M.C., P.M.C.), and the Addiction Center, Department of Psychiatry (M.A.W.), University of Michigan School of Medicine, and the Youth Violence Prevention Center (R.M.C., P.M.C.) and Department of Health Behavior and Health Education (R.M.C.), University of Michigan School of Public Health - both in Ann Arbor
| | - Patrick M Carter
- From the University of Michigan Injury Prevention Center (R.M.C., M.A.W., P.M.C.), the Firearm Safety among Children and Teens Consortium (R.M.C., M.A.W., P.M.C.), the Department of Emergency Medicine (R.M.C., P.M.C.), and the Addiction Center, Department of Psychiatry (M.A.W.), University of Michigan School of Medicine, and the Youth Violence Prevention Center (R.M.C., P.M.C.) and Department of Health Behavior and Health Education (R.M.C.), University of Michigan School of Public Health - both in Ann Arbor
| |
Collapse
|
28
|
Seah R, Lystad RP, Curtis K, Mitchell R. Socioeconomic variation in injury hospitalisations in Australian children ≤ 16 years: a 10-year population-based cohort study. BMC Public Health 2018; 18:1336. [PMID: 30509222 PMCID: PMC6278126 DOI: 10.1186/s12889-018-6242-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 11/21/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Childhood injury remains a significant public health problem responsible for significant morbidity and mortality. However, injury has been found to increase with socioeconomic disadvantage for some injuries. The current study examines the 10-year epidemiological profile of injury hospitalisations of children ≤16 years by socioeconomic status for different age group and select types of injury. METHOD A retrospective analysis of injury hospitalisations of children aged ≤16 years using linked hospitalisation and mortality records during 1 July 2002 to 30 June 2012 was conducted. Negative binomial regression was used to calculate incidence rate ratios (IRRs) for injury hospitalisation rates by socioeconomic disadvantage quintile. RESULTS There were 679,171 injury hospitalisations for children aged 0-16 years in Australia. Children in more disadvantaged socioeconomic quintiles were more likely to be hospitalised for an injury sustained by: assault (IRR range 1.40 to 3.64), poisoning (IRR range 1.29 to 1.36), heat and hot substances (IRR range 1.07 to 1.34), and pedestrian collisions (IRR range 1.06 to 1.54) than children in advantaged socioeconomic quintiles. CONCLUSIONS Findings support the notion that the risk of injury hospitalisation among children differs according to socioeconomic gradient and has implications for childhood injury prevention. Policy makers should consider socioeconomic differences in the design of injury prevention measures, particularly measures directed at modifying the built environment and home-based interventions.
Collapse
Affiliation(s)
- Rebecca Seah
- Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, 2109, Australia
| | - Reidar P Lystad
- Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, 2109, Australia
| | - Kate Curtis
- Sydney Medical School, University of Sydney, Sydney, Australia
| | - Rebecca Mitchell
- Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, 2109, Australia.
| |
Collapse
|
29
|
Cheng CJ, Nelson JF. Physiological basis for sex-specific differences in longevity. CURRENT OPINION IN PHYSIOLOGY 2018. [DOI: 10.1016/j.cophys.2018.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
|
30
|
Ullah S, Ali N, Khan A, Ali S, Nazish HR. The Epidemiological Characteristics of Epilepsy in the Province of Khyber Pakhtunkhwa, Pakistan. Front Neurol 2018; 9:845. [PMID: 30459698 PMCID: PMC6232227 DOI: 10.3389/fneur.2018.00845] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Accepted: 09/20/2018] [Indexed: 02/05/2023] Open
Abstract
Previous studies have shown that Khyber Pakhtunkhwa, Pakistan has a high incidence of epilepsy and a high proportion of low socioeconomic background and high treatment gap. Considering the changes over the past 20 years little is known about the current epidemiological characteristics of epilepsy in Khyber Pakhtunkhwa, Pakistan. The current study was focused to find the impact of various contributing factors on the clinical response to anti-epileptic drugs in the KP population, Pakistan. A total of 315 participants aged 19.1 ± 8.6 years were examined. Mean age of the patients was 18 ± 8.1 year. Epilepsy was high in male patients (64.39%) and urban areas (60.1%). Mostly, 88.6% of patients were belonging to low socioeconomic status background. 42.4% patients have positive family history for epilepsy and 42.8% patients had consanguineous marriages. Middle SES class patients (OR, 2.22 [CI, 0.54-9.1]) were slightly associated with controlled response to CBZ and VPA therapy. Absence seizure (OR, 1.16 [CI, 0.59-2.3]), and Complex partial seizure (OR, 1.29 [CI, 0.58-6.3]) showed good response to CBZ therapy while, Myoclonic seizure (OR, 2.23 [CI, 0.05-8.8]) was responsive to VPA therapy. However, non-compliance (R 2 0.82, P < 0.0001) and nature of seizures (R 2 0.83, P < 0.0001) were associated with the high risk for poor response to both CBZ and VPA therapy. Epilepsy was high in male patients and in urban areas. Most patients were belonging to low socioeconomic status. Non-compliance, low socioeconomic and nature of seizures strongly predict poor clinical response of anti-epileptic drugs therapy.
Collapse
Affiliation(s)
- Shakir Ullah
- Pharmacology/Institute of Basic Medical Sciences, Khyber Medical University, Peshawar, Pakistan
- Center for Neuroscience, Shantou University Medical College, Shantou, China
| | - Niaz Ali
- Pharmacology/Institute of Basic Medical Sciences, Khyber Medical University, Peshawar, Pakistan
| | - Adnan Khan
- Neurology Departments, Lady Reading Hospital Peshawar, Peshawar, Pakistan
| | - Saad Ali
- Neurology Departments, Lady Reading Hospital Peshawar, Peshawar, Pakistan
| | - Haleema Rehana Nazish
- Pharmacology/Institute of Basic Medical Sciences, Khyber Medical University, Peshawar, Pakistan
| |
Collapse
|
31
|
Shendell DG, Noomnual S, Plascak J, Apostolico AA. Injuries among young workers in career-technical-vocational education and associations with per pupil spending. BMC Public Health 2018; 18:1190. [PMID: 30342506 PMCID: PMC6196011 DOI: 10.1186/s12889-018-6099-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 10/05/2018] [Indexed: 11/20/2022] Open
Abstract
Background New Jersey Department of Education (NJDOE) requires by law for accidents/incidents (injury) involving career-technical-vocational education (CTE) students and staff to be reported within five business days to the NJ Safe Schools Program (NJSS) using an online surveillance system. NJ public schools and charter schools (CS) through school districts (SD) or county offices report school data annually to NJDOE, including per pupil spending (PPS). In this study, we examined potential associations of PPS with several variables on injury in NJ: injury cause, injury location on the body, injury type, injury severity, use of PPE, and location of treatment for injury. Methods PPS data for December 1998–June 2015 from CTE SDs (one per NJ county, n = 21), four CS SD and eight county special services districts were analyzed. T-test examined potential differences in PPS regarding injury severity and use of personal protective equipment (PPE). Stepwise logistic regression assessed potential associations between PPS and various injury surveillance variables. Results There were more CTE injuries reported among SD with lower PPS than among SD with higher PPS. Relatively less severe injuries, e.g., bruise/bumps and cuts/lacerations, more often occurred at schools and SD with higher PPS. Conversely, relatively more severe injuries, e.g., fractures, more often occurred at schools and SD with lower PPS. Conclusion Future research should further investigate disparities regarding younger worker injuries reported within school-based career-technical-vocational education programs by PPS and other factors like sex or gender, severity, safety training provided and work experience at time of injury.
Collapse
Affiliation(s)
- Derek G Shendell
- Environmental and Occupational Health And New Jersey Safe Schools Program (NJ SS) Rutgers School of Public Health, 683 Hoes Lane West, 3rd Floor SPH Building, Piscataway, NJ, 08854-8020, USA.
| | | | - Jesse Plascak
- Department of Epidemiology, Rutgers School of Public Health, Piscataway, USA
| | - Alexsandra A Apostolico
- University of Illinois-Chicago, Chicago, USA.,School of Public Health, The University of North Carolina, Chapel Hill, USA
| |
Collapse
|
32
|
Loberg JA, Hayward RD, Fessler M, Edhayan E. Associations of race, mechanism of injury, and neighborhood poverty with in-hospital mortality from trauma: A population-based study in the Detroit metropolitan area. Medicine (Baltimore) 2018; 97:e12606. [PMID: 30278575 PMCID: PMC6181609 DOI: 10.1097/md.0000000000012606] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Health disparities based on race and socioeconomic status are a serious problem in the US health care system, but disparities in outcomes related to traumatic injury have received relatively little attention in the research literature.This study uses data from the State Inpatient Database for Michigan including all trauma-related hospital admissions in the period from 2006 to 2014 in the Detroit metropolitan area (N = 407,553) to examine the relationship between race (White N = 232,109; African American N = 86,356, Hispanic N = 2709, Other N = 10,623), socioeconomic background, and in-hospital trauma mortality.Compared with other groups, there was a higher risk of mortality after trauma among African Americans (odds ratio [OR] = 1.20, P < .001), people living in high-poverty neighborhoods (OR = 1.01, P < .001), and those enrolled in public health insurance programs (OR = 1.53, P < .001). African American patients were more likely to have had traumatic injuries caused by certain mechanisms with higher risk of death (P < .001). After controlling for mechanism alone in multiple logistic regression, African American race remained a significant predictor of mortality risk (OR = 1.12, P < .001). After additionally controlling for the socioeconomic factors of insurance status and neighborhood poverty levels, there were no longer any significant differences between racial groups in terms of mortality (OR = 0.99, P = .746).These results suggest that in this population the racial inequalities in mortality outcomes were fully mediated by differences between groups in the pattern of injuries suffered and differences in risk based on socioeconomic factors.
Collapse
|
33
|
Schmidt S, Sparks PJ. Disparities in injury morbidity among young adults in the USA: individual and contextual determinants. J Epidemiol Community Health 2018; 72:458-464. [PMID: 29439190 PMCID: PMC6152816 DOI: 10.1136/jech-2017-210259] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 01/26/2018] [Accepted: 01/29/2018] [Indexed: 11/03/2022]
Abstract
BACKGROUND Injuries have been recognised as important public health concerns, particularly among adolescents and young adults. Few studies have examined injuries using a multilevel perspective that addresses individual socioeconomic status (SES) and health behaviours and local socioeconomic conditions in early adolescence. We offer a conceptual framework incorporating these various components. METHODS We test our conceptual framework using population data from the National Longitudinal Study of Adolescent Health Wave 4 when respondents were young adults and linked them to contextual level data from when they were middle-schoolers. We use logistic and multilevel regression models to examine self-reported injury risk in young adults by sex (n=14 356). RESULTS Logistic regression models showed that men were more likely to experience serious injuries than women (OR 1.75, P<0.0001), but SES and health behaviours operated differently by sex. In stratified models, men with lower education had consistently higher injury risk, while only women with some college had increased injury risk (OR 1.40, P=0.0089) than college graduates. Low household income (OR 1.54, P=0.0011) and unemployment (OR 1.50, P=0.0008) increased female injury risk, but was non-significant for men. Alcohol consumption increased injury risk for both sexes, while only female smokers had elevated injury risk (OR 1.38, P=0.0154). In multilevel models, significant county-level variation was only observed for women. Women living in disadvantaged neighbourhoods during adolescence had increased injury risk (OR 1.001, P<0.0001). CONCLUSIONS These findings highlight the importance of investigating mechanisms that link early-life contextual conditions to early adult SES and health behaviours and their linkage to injury risk, particularly for women.
Collapse
Affiliation(s)
- Susanne Schmidt
- Department of Epidemiology and Biostatistics, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - P Johnelle Sparks
- Department of Demography, University of Texas at San Antonio, San Antonio, Texas, USA
| |
Collapse
|
34
|
Cancelliere C, Coronado VG, Taylor CA, Xu L. Epidemiology of Isolated Versus Nonisolated Mild Traumatic Brain Injury Treated in Emergency Departments in the United States, 2006-2012: Sociodemographic Characteristics. J Head Trauma Rehabil 2018; 32:E37-E46. [PMID: 28489698 PMCID: PMC5554936 DOI: 10.1097/htr.0000000000000260] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To describe the frequencies and rates of mild traumatic brain injury (mTBI) emergency department (ED) visits, analyze the trend across the years, and compare sociodemographic characteristics of visits by mTBI type (ie, mTBI as the only injury, or present along with other injuries). DESIGN Population-based descriptive study using data from the Nationwide Emergency Department Sample (2006-2012). METHODS Joinpoint regression was used to calculate the average annual percent changes of mTBI incidence rates. Characteristics between isolated and nonisolated visits were compared, and the odds ratios were reported. RESULTS The rate per 100 000 population of mTBI ED visits in the United States increased significantly from 569.4 (in 2006) to 807.9 (in 2012). The highest rates were observed in 0- to 4-year-olds, followed by male 15- to 24-year-olds and females 65 years and older; the lowest rates were among 45- to 64-year-olds. The majority (70%) of all visits were nonisolated and occurred more frequently in residents of metropolitan areas. Falls were the leading external cause. Most visits were privately insured or covered by Medicare/Medicaid, and the injury occurred on weekdays in predominantly metropolitan hospitals in the South region. CONCLUSIONS The burden of mTBI in US EDs is high. Most mTBI ED visits present with other injuries. Awareness of sociodemographic factors associated with nonisolated mTBI may help improve diagnosis in US EDs. This information has implications for resource planning and mTBI screening in EDs.
Collapse
Affiliation(s)
- Carol Cancelliere
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada (Dr Cancelliere); and National Center for Injury Prevention and Control (Drs Taylor and Xu), Centers for Disease Control and Prevention, Atlanta, Georgia (Dr Coronado)
| | | | | | | |
Collapse
|
35
|
Macaluso M, Summerville LA, Tabangin ME, Daraiseh NM. Enhancing the detection of injuries and near-misses among patient care staff in a large pediatric hospital. Scand J Work Environ Health 2018; 44:377-384. [PMID: 29777614 DOI: 10.5271/sjweh.3739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objectives Compared to other industries, healthcare has one of the highest rates of non-fatal occupational injury/illness. Evidence indicates these rates are underestimated, highlighting the need for improved injury surveillance. This study aims to demonstrate the feasibility of integrating active data collection in a passive injury surveillance system to improve detection of injuries in a healthcare establishment. Methods Using digital voice recorders (DVR), pediatric healthcare providers prospectively recorded events throughout their shift for two weeks. This sample-based active injury surveillance was then integrated into an institutional surveillance system (ISS) centered on passive data collection initiated by employee reports. Results Injuries reported using DVR during two-week intervals from February 2014 to July 2015 were 40.7 times more frequent than what would be expected on the basis of the usual ISS reports. Psychological injuries (eg, stress, conflict) and near-misses were captured at a rate of 16.1 per 1000 days [95% confidence interval (CI) 14.1-18.3] and 35.6 per 1000 days (95% CI 32.7-38.8), respectively. Finally, 68% (95% CI 65-72%) of participants preferred using DVR either as an alternative or complement to the existing ISS. Conclusions This study showed that it is feasible to improve injury surveillance in a healthcare establishment by integrating active data collection based on voice recording within a passive injury surveillance system. Enhanced surveillance provides richer information that can guide the development of effective injury prevention strategies.
Collapse
Affiliation(s)
- Maurizio Macaluso
- Research in Patient Services; Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave. Cincinnati, OH 45229, USA. MLC 7014.
| | | | | | | |
Collapse
|
36
|
Coughlin K, Hayward RD, Fessler M, Edhayan E. Changes in trauma admission rates and mechanisms during recession and recovery: evidence from the Detroit metropolitan area. Int J Public Health 2018; 63:847-854. [PMID: 29546441 DOI: 10.1007/s00038-018-1087-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 02/15/2018] [Accepted: 03/05/2018] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES Although individual socioeconomic status has been linked with risk of traumatic injury, there has been relatively little research into the question of how economic changes may impact trauma admission rates in neighborhoods with different socioeconomic backgrounds. METHODS This study pairs ZIP code-level data on trauma admissions with county-level data on unemployment to assess differences in the type of changes experienced in more and less affluent neighborhoods of the Detroit metropolitan area between 2006 and 2014. RESULTS Conditional linear growth curve modeling results indicate that trauma admission rates decreased during the "great recession" of 2008-2010 in neighborhoods with the highest unemployment levels, but increased during the same period of time in neighborhoods with lower unemployment. Consequently, citywide disparities in trauma incidence decreased during the recession and widened again as the economy began to improve. CONCLUSION Trauma risks and demand for trauma care may shift geographically in relation to broader economic changes. Health care policy and planning should consider these dynamics when anticipating changing demands and needs for efforts at prevention.
Collapse
Affiliation(s)
- Kimberly Coughlin
- Department of Surgery, St. John Hospital and Medical Center, 22101 Moross Rd, Professional Building 1, Suite 212, Detroit, MI, 48236, USA.
| | - R David Hayward
- Department of Surgery, St. John Hospital and Medical Center, 22101 Moross Rd, Professional Building 1, Suite 212, Detroit, MI, 48236, USA
| | - Mary Fessler
- Department of Surgery, St. John Hospital and Medical Center, 22101 Moross Rd, Professional Building 1, Suite 212, Detroit, MI, 48236, USA
| | - Elango Edhayan
- Department of Surgery, St. John Hospital and Medical Center, 22101 Moross Rd, Professional Building 1, Suite 212, Detroit, MI, 48236, USA
| |
Collapse
|
37
|
Bonander C, Jernbro C. Does gender moderate the association between intellectual ability and accidental injuries? Evidence from the 1953 Stockholm Birth Cohort study. ACCIDENT; ANALYSIS AND PREVENTION 2017; 106:109-114. [PMID: 28600987 DOI: 10.1016/j.aap.2017.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Revised: 05/16/2017] [Accepted: 06/01/2017] [Indexed: 06/07/2023]
Abstract
In this paper, we test for gender differences in the effects of intellectual ability on accidental injury risks using longitudinal data from the 1953 Stockholm Birth Cohort study (n=14,294). Intellectual ability was measured using IQ tests issued during a school survey at age ∼13, and outcome and covariate data was collected via record linkage to population and health registers, following the cohort from childhood to 55 years of age. We used ICD codes to identify accidental injuries resulting in hospital admissions and deaths, and shared frailty models to quantify the effects of IQ, while allowing for within-individual dependencies and recurrent events. The models included tests for the moderating effects of gender, as well as childhood family variables (parental socioeconomic status), and cohort member mediators (highest achieved education, socioeconomic status and income at the time of the event). The results indicate an inverse association between childhood IQ and subsequent accidental injury events, where 1 SD decrease in IQ implies a 17.8% increase in injury risk. We also found evidence that gender moderates this relationship, where the effect size was twice as large for men than for women (21.8% vs 9.3% per 1 SD decrease). Adult socioeconomic status can explain roughly half of the observed association. Potential explanations for these results are discussed.
Collapse
Affiliation(s)
- Carl Bonander
- Centre for Public Safety, Karlstad University, Sweden; Department of Environmental and Life Sciences, Karlstad University, Sweden.
| | - Carolina Jernbro
- Centre for Public Safety, Karlstad University, Sweden; Department Health Sciences, Karlstad University, Sweden
| |
Collapse
|
38
|
Socioeconomic Status and Non-Fatal Adult Injuries in Selected Atlanta (Georgia USA) Hospitals. Prehosp Disaster Med 2017; 32:403-413. [PMID: 28359343 DOI: 10.1017/s1049023x17000255] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Injury mortality data for adults in the United States and other countries consistently show higher mortality for those with lower socioeconomic status (SES). Data are sparse regarding the role of SES among adult, non-fatal US injuries. The current study estimated non-fatal injury risk by household income using hospital emergency department (ED) visits. METHODS A total of 1,308,892 ED visits at 10 Atlanta (Georgia USA) hospitals from 2001-2004 (347,866 injuries) were studied. The SES was based on US census-block group income, with subjects assigned to census blocks based on reported residence. Logistic regression was used to determine risk by SES for injuries versus all other ED visits, adjusting for demographics, hospital, and weather. Supplemental analyses using hospital data from 2010-2013, without data on SES, were conducted to determine whether earlier patterns by race, age, and gender persisted. RESULTS Risk for many injury categories increased with higher income. Odds ratio by quartiles of increasing income (lowest quartile as referent, 95% confidence interval [CI] given for upper most quartile) were 1.00, 1.23, 1.34, 1.40 (95% CI 1.36-1.45) for motor vehicle accidents; 1.00, 1.03, 1.11, 1.24 (95% CI 1.20-1.29) for being struck by objects; 1.00. 0.99, 1.04, 1.12 (95% CI 1.00-1.25) for suicide; and 1.00, 1.03, 1.05, 1.12 (95% CI 1.09-1.15) for falls. In contrast, decreased injury risk with increased household income was seen for assaults (1.00, 0.83, 0.73, 0.67 [95% CI 0.63-0.72], by increasing quartiles). These trends by income did not differ markedly by race and gender. Whites generally had less risk of injuries, with the exception of assaults and motor vehicle accidents. Males had higher risk of injury than females, with the exception of falls and suicide attempts. Patterns of risk for race, age, and gender were consistent between 2001-2004 and 2010-2013. CONCLUSION For most non-fatal injuries, those with higher income had more risk of ED visits, although the opposite was true for assault. Hulland E , Chowdhury R , Sarnat S , Chang HH , Steenland K . Socioeconomic status and non-fatal adult injuries in selected Atlanta (Georgia USA) hospitals. Prehosp Disaster Med. 2017;32(4):403-413.
Collapse
|
39
|
L Wilson M, Tenovuo O, Mattila VM, Gissler M, Celedonia KL, Impinen A, Saarijärvi S. Pediatric TBI in Finland: An examination of hospital discharges (1998-2012). Eur J Paediatr Neurol 2017; 21:374-381. [PMID: 27840023 DOI: 10.1016/j.ejpn.2016.10.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 10/01/2016] [Accepted: 10/20/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Traumatic brain injury constitutes a persistent health problem among pediatric populations worldwide and is often referred to as a silent epidemic. There remains a paucity of scientific exploration with regard to understanding the ecological risk profiles of well-defined populations. In Finland, the healthcare system covers all hospitals, provides uniform access to care and has a universal surveillance system that allows for epidemiological examination of a wide variety of health issues. The present study aims to clarify the incidence, type and geographical presentation of pediatric TBI in Finland. METHODS We utilized the National Hospital Discharge Register (NHDR) to prospectively identify all new cases of TBI among persons aged 18 years or younger between 1998 and 2012. Incidence rates were computed as average annual rates per 100,000 person years (py). RESULTS During the study period 1998-2012, 21,457 children and adolescents were hospitalized for TBI. The cumulative incidence rate for the entire period was 99/100,000. Males were approximatively 1.5 times more likely to have sustained a TBI and had consistently higher rates during each year under study. Concussions were the most common form of TBI (92.9/100,000 person years), with diffuse brain injuries being the second most common (8.7/100,000 py). Diagnostic trends differed markedly with southern Finland experiencing the lowest rates of TBI when adjusted for population size. CONCLUSIONS TBI are serious and potentially disabling conditions. The elevated levels of pediatric TBI in Finland warrant increased attention.
Collapse
Affiliation(s)
- Michael L Wilson
- Turku University Hospital, Department of Adolescent Psychiatry, University of Turku, Kaivokatu 18 A, 4th Floor, 20520 Turku, Finland; Centre for Injury Prevention and Community Safety, PeerCorps Trust Fund, 352/64 Makunganya Street, Co-Architecture Building, 4th Floor, P.O. Box 22499, Dar es Salaam, Tanzania.
| | - Olli Tenovuo
- Division of Clinical Neurosciences, Department of Rehabilitation and Brain Trauma, Turku University Hospital, Turku University, Turku, Finland
| | - Ville M Mattila
- Department of Orthopaedics, Tampere University Hospital Tampere, Finland; Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Orthopedics and Biotechnology, Karolinska Institutet, Stockholm, Sweden
| | - Mika Gissler
- THL National Institute for Health and Welfare, P.O. Box 30, 00271 Helsinki, Finland; Karolinska: Department of Neurobiology, Care Sciences and Society (NVS), SE-171 77 Stockholm, Sweden
| | - Karen L Celedonia
- Centre for Injury Prevention and Community Safety, PeerCorps Trust Fund, 352/64 Makunganya Street, Co-Architecture Building, 4th Floor, P.O. Box 22499, Dar es Salaam, Tanzania
| | - Antti Impinen
- THL National Institute for Health and Welfare, P.O. Box 30, 00271 Helsinki, Finland
| | - Simo Saarijärvi
- Turku University Hospital, Department of Adolescent Psychiatry, University of Turku, Kaivokatu 18 A, 4th Floor, 20520 Turku, Finland
| |
Collapse
|
40
|
Gavine A, MacGillivray S, Williams DJ. Universal community-based social development interventions for preventing community violence by young people 12 to 18 years of age. Hippokratia 2017. [DOI: 10.1002/14651858.cd011258.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Anna Gavine
- University of Dundee; evidence Synthesis Training and Research Group (eSTAR), School of Nursing and Health Sciences, Dundee Centre for Health and Related Research; 11 Airlie Place Dundee UK DD1 4HJ
| | - Stephen MacGillivray
- University of Dundee; evidence Synthesis Training and Research Group (eSTAR), School of Nursing and Health Science, Dundee Centre for Health and Related Research; Airlie Place Dundee Tayside UK DD1 4HN
| | - Damien J Williams
- University of St Andrews; School of Medicine; Medical and Biological Sciences Building, North Haugh St Andrews Fife UK KY16 9TF
| |
Collapse
|
41
|
|
42
|
Tamosiunas A, Reklaitiene R, Radisauskas R, Jureniene K. Prognosis of risk factors and trends in mortality from external causes among middle-aged men in Lithuania. Scand J Public Health 2016; 33:190-6. [PMID: 16040459 DOI: 10.1080/14034940510005707] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Aims: The aims of this study were to investigate the risk of death and time trends from external causes, and to evaluate the significance of the effects of age, period and birth cohort on suicide mortality among middle-aged men during the period 1971—2000 in Lithuania. Methods: Random samples of men aged 45—59 years from the Kaunas Rotterdam Intervention Study (conducted in 1972—74) and Study of Multifactorial Prevention of CHD (conducted in 1977—80) were examined (n=6,480). The participants of the two surveys were observed until 1 January 2001. Over this time 2,841 men had died, 230 of these from external causes. The Cox proportional hazards model was used to evaluate the risk of death from external causes. Trends in mortality from external causes and average annual changes were based on logarithmic regression analysis. For assessment of the effects of age, period, and birth cohort the Poisson regression model was applied. Results: The risk of mortality from external causes among men was positively related to smoking habits and arterial hypertension and negatively related to education level and total serum cholesterol concentration but there was no association with consumption of alcohol. The risk of suicide mortality was associated with family status and occupation only. Trends in mortality from all external causes showed no significant changes during the period 1971—2000. After adjusting for age and cohort effects, the period effect was statistically significant. Conclusion: Prognosis of risk factors for mortality from external causes and period effect on suicide mortality rates will form important parts of future research agendas.
Collapse
Affiliation(s)
- Abdonas Tamosiunas
- Institute of Cardiology, Kaunas University of Medicine, Kaunas, Lithuania.
| | | | | | | |
Collapse
|
43
|
Mekkodathil A, El-Menyar A, Al-Thani H. Occupational injuries in workers from different ethnicities. Int J Crit Illn Inj Sci 2016; 6:25-32. [PMID: 27051619 PMCID: PMC4795358 DOI: 10.4103/2229-5151.177365] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Occupational injuries remain an important unresolved issue in many of the developing and developed countries. We aimed to outline the causes, characteristics, measures and impact of occupational injuries among different ethnicities. MATERIALS AND METHODS We reviewed the literatures using PUBMED, MEDLINE, Google Scholar and EMBASE search engine using words: "Occupational injuries" and "workplace" between 1984 and 2014. RESULTS Incidence of fatal occupational injuries decreased over time in many countries. However, it increased in the migrant, foreign born and ethnic minority workers in certain high risk industries. Disproportionate representations of those groups in different industries resulted in wide range of fatality rates. CONCLUSIONS Overrepresentation of migrant workers, foreign born and ethnic minorities in high risk and unskilled occupations warrants effective safety training programs and enforcement of laws to assure safe workplaces. The burden of occupational injuries at the individual and community levels urges the development and implementation of effective preventive programs.
Collapse
Affiliation(s)
- Ahammed Mekkodathil
- Department of Surgery, Clinical Research, Trauma Section, Hamad General Hospital, Doha, Qatar
| | - Ayman El-Menyar
- Department of Surgery, Clinical Research, Trauma Section, Hamad General Hospital, Doha, Qatar; Department of Clinical Medicine, Weill Cornell Medical College, Doha, Qatar
| | | |
Collapse
|
44
|
Beghi E. Addressing the burden of epilepsy: Many unmet needs. Pharmacol Res 2016; 107:79-84. [PMID: 26952026 DOI: 10.1016/j.phrs.2016.03.003] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 03/02/2016] [Accepted: 03/02/2016] [Indexed: 11/19/2022]
Abstract
Epilepsy is a heterogeneous clinical condition characterized by recurrent unprovoked seizures, their causes and complications. The incidence, prevalence and mortality of epilepsy vary with age, place and time contributing to a variable extent to the burden of the disease. Diagnostic misclassification may have strong impact on personal and societal reflections of the disease in light of its clinical manifestations and the need for chronic treatment. Epilepsy accounts for a significant proportion of the world's disease burden ranking fourth after tension-type headache, migraine and Alzheimer disease. Among neurological diseases, it accounts for the highest disability-adjusted life year rates both in men and in women. Although epilepsy is self-remitting in up to 50% of cases, variable long-term prognostic patterns can be identified based on the response to the available treatments. Epilepsy carries an overall increased risk of premature mortality with variable estimates across countries. Premature mortality predominates in patients aged less than 50 years, with epilepsies due to structural/metabolic conditions, with generalized tonic-clonic seizures, and seizures not remitting under treatment. Among deaths directly attributable to epilepsy or seizures, included are sudden unexpected death in epilepsy (SUDEP), status epilepticus, accidents, drowning, unintentional injuries, and suicide. Somatic and psychiatric disorders prevail in patients with epilepsy than in people without epilepsy. Asthma, migraine and cerebral tumors tend to occur more frequently in younger adults while cardiovascular disorders, stroke, dementia and meningioma predominate in the elderly. As being a fairly common clinical condition affecting all ages and requiring long-term (sometimes lifelong) treatment, epilepsy carries high health care costs for the society. Direct costs peak in the first year after diagnosis and then vary according to the severity of the disease, the response to treatment, and the presence of comorbidity. Although in several countries the costs of epilepsy are met by the national health systems, out-of-pocket costs may be a relevant fraction of the overall costs, especially in countries where the public management of health care is suboptimal or non-existent. Epilepsy strongly affects patients' independence, psychological health and emotional adjustment. Epilepsy impairs all aspects of health-related quality of life. Awareness and attitudes of the public about epilepsy may significantly affect the burden of the disease. All these factors add to the burden of the disease. However, many of the factors implicated in the onset of epilepsy, its course and treatment can be favorably addressed with appropriate strategic plans. More research is needed to investigate and manage the medical and psychosocial implications of epilepsy.
Collapse
Affiliation(s)
- Ettore Beghi
- Laboratory of Neurological Disorders, IRCCSIstituto di Ricerche Farmacologiche Mario Negri, Via Giuseppe La Masa, 19, 20156 Milan, Italy.
| |
Collapse
|
45
|
Apostolico AA, Shendell DG. Injury surveillance and associations with socioeconomic status indicators among youth/young workers in New Jersey secondary schools. Environ Health 2016; 15:22. [PMID: 26883909 PMCID: PMC4754864 DOI: 10.1186/s12940-016-0118-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 02/08/2016] [Indexed: 06/05/2023]
Abstract
BACKGROUND Injuries involving career-technical-vocational education (CTE) are reported to the New Jersey Safe Schools Program online reporting system, the only U.S. State law-based surveillance data for young workers (ages twenty-one and younger), a susceptible, vulnerable adolescent sub-population. METHODS We examined potential associations between socioeconomic status (SES) indicators and high school student injuries reported between 12/1998-12/2013, excluding injuries acquired by staff members. Associations between DFG score-a proxy for school/district SES-and variables relating to reported injuries, including severity, injury type, injury cause, body parts injured, injury treatment setting and demographics were examined with chi square test (X(2)) for independence and logistic regression. To assess potential associations between SES and personal protective equipment (PPE), data were stratified by 2003-2008 and 2008-2013, given mandated payment by employers of PPE for employees. RESULTS Statistically significant associations were found between SES and injury cause [X(2) = (7, 14.74), p = 0.04] and SES and injury treatment setting [X(2) = (1, 4.76), p = 0.03]. Adjusted odds ratio suggested students from low SES schools were at a higher odds of being treated at a hospital emergency department (ED) than students from high SES schools (95 % CI 1.3-4.3, p < 0.01). CONCLUSIONS These findings indicated low SES schools/districts have increased odds of being treated at ED, after controlling for injury severity. Future research should focus on implications such associations have on health care access and insurance for young workers and their families. With small sample sizes representing lower DFG scoring (SES) schools/districts, additional efforts should be enacted to increase injury reporting in these schools/districts.
Collapse
Affiliation(s)
- Alexsandra A Apostolico
- Rutgers School of Public Health (SPH), Center for School and Community-Based Research and Education (CSCBRE), 335 George Street - Suite 2200, New Brunswick, NJ, 08903, USA.
- New Jersey Safe Schools Program, 683 Hoes Lane West, 3rd Floor, Piscataway, NJ, 08854, USA.
| | - Derek G Shendell
- Rutgers School of Public Health (SPH), Center for School and Community-Based Research and Education (CSCBRE), 335 George Street - Suite 2200, New Brunswick, NJ, 08903, USA.
- New Jersey Safe Schools Program, 683 Hoes Lane West, 3rd Floor, Piscataway, NJ, 08854, USA.
- Rutgers SPH, Department of Environmental and Occupational Health, 683 Hoes Lane West, 3rd Floor SPH Building, Piscataway, NJ, 08854, USA.
- Rutgers University, Environmental and Occupational Health Sciences Institute-Exposure Measurement and Assessment Division, 170 Frelinghuysen Road, Piscataway, NJ, 08854, USA.
| |
Collapse
|
46
|
Chen GS, Liao KH, Bien MY, Peng GS, Wang JY. Increased Risk of Post-Trauma Stroke after Traumatic Brain Injury-Induced Acute Respiratory Distress Syndrome. J Neurotrauma 2016; 33:1263-9. [PMID: 26426583 DOI: 10.1089/neu.2015.4063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
This study determines whether acute respiratory distress syndrome (ARDS) is an independent risk factor for an increased risk of post-traumatic brain injury (TBI) stroke during 3-month, 1-year, and 5-year follow-ups, respectively, after adjusting for other covariates. Clinical data for the analysis were from the National Health Insurance Database 2000, which covered a total of 2121 TBI patients and 101 patients with a diagnosis of TBI complicated with ARDS (TBI-ARDS) hospitalized between January 1, 2001 and December 31, 2005. Each patient was tracked for 5 years to record stroke occurrences after discharge from the hospital. The prognostic value of TBI-ARDS was evaluated using a multivariate Cox proportional hazard model. The main outcome found that stroke occurred in nearly 40% of patients with TBI-ARDS, and the hazard ratio for post-TBI stroke increased fourfold during the 5-year follow-up period after adjusting for other covariates. The increased risk of hemorrhagic stroke in the ARDS group was considerably higher than in the TBI-only cohort. This is the first study to report that post-traumatic ARDS yielded an approximate fourfold increased risk of stroke in TBI-only patients. We suggest intensive and appropriate medical management and intensive follow-up of TBI-ARDS patients during the beginning of the hospital discharge.
Collapse
Affiliation(s)
- Gunng-Shinng Chen
- 1 Graduate Institute of Medical Sciences, College of Medicine, Taipei Medical University , Taipei, Taiwan .,6 Orthodontic and Pedodontic Division, Tri-Service General Hospital (TSGH), National Defense Medical Center (NDMC), Neihu District, Taipei, Taiwan
| | - Kuo-Hsing Liao
- 2 Department of Neurosurgery, Wan Fang Hospital, Taipei Medical University , Taipei, Taiwan
| | - Mauo-Ying Bien
- 3 School of Respiratory Therapy, College of Medicine, Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Medical University Hospital and Wan Fang Hospital, Taipei Medical University , Taipei, Taiwan
| | - Giia-Sheun Peng
- 4 Department of Neurology, Tri-Service General Hospital (TSGH), National Defense Medical Center (NDMC), Neihu District, Taipei, Taiwan
| | - Jia-Yi Wang
- 1 Graduate Institute of Medical Sciences, College of Medicine, Taipei Medical University , Taipei, Taiwan .,5 Department of Physiology, School of Medicine, College of Medicine, Taipei Medical University , Taipei, Taiwan
| |
Collapse
|
47
|
Associations between marital and educational status and risk of completed suicide in Hungary. J Affect Disord 2016; 190:777-783. [PMID: 26625089 DOI: 10.1016/j.jad.2015.11.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 10/13/2015] [Accepted: 11/09/2015] [Indexed: 02/08/2023]
Abstract
BACKGROUND Suicide rates in Hungary are notoriously high. According to the literature, marital and educational status are associated with suicidal behaviour and these associations are somewhat influenced by gender. Since in Hungary these associations have not yet been investigated by means of large-scale multivariate epidemiological studies we aimed to investigate these in the current paper. METHOD Census data on marital and educational status, age and gender from 1980, 1990, 2001 and 2011 were used for the general population. Corresponding data from the same years for suicide victims derived from the Hungarian Demographic Register. Suicide victims younger than 20 years were excluded. Negative binomial regression analyses were used to reveal the effects of the above variables on suicide. All statistical procedures were conducted using Stata 12 software (StataCorp. 2011). RESULTS Female gender, young age, higher educational attainment and marriage were significantly associated with decreased risks of suicide. Intriguingly, effects of educational and marital status on suicide were stronger in males. LIMITATIONS Data on the length of the periods between changes in marital status and suicides were unavailable. Our four categories are not suitable to cover the whole gamut of marital statuses in a modern society (e.g. we did not have a specific category for people living in cohabitation). Ecological study design. CONCLUSION We found that in Hungary between 1980 and 2011 the effects of some frequently investigated societal factors (e.g. educational and marital status) on suicide risk were very similar to those found in the majority of other countries. The effects of studied determinants of suicide have not changed dramatically over the past three decades in Hungary.
Collapse
|
48
|
Measures of Maternal Socioeconomic Status in Yemen and Association with Maternal and Child Health Outcomes. Matern Child Health J 2015; 20:386-97. [DOI: 10.1007/s10995-015-1837-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
49
|
Bell N, Arrington A, Adams SA. Census-based socioeconomic indicators for monitoring injury causes in the USA: a review. Inj Prev 2015; 21:278-84. [PMID: 25678685 PMCID: PMC4518757 DOI: 10.1136/injuryprev-2014-041444] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Revised: 11/21/2014] [Accepted: 12/06/2014] [Indexed: 01/07/2023]
Abstract
BACKGROUND Unlike the UK or New Zealand, there is no standard set of census variables in the USA for characterising socioeconomic (SES, socioeconomic status) inequalities in health outcomes, including injury. We systematically reviewed existing US studies to identify conceptual and methodological strengths and limitations of current approaches to determine those most suitable for research and surveillance. METHODS We searched seven electronic databases to identify census variables proposed in the peer-reviewed literature to monitor injury risk. Inclusion criteria were that numerator data were derived from hospital, trauma or vital statistics registries and that exposure variables included census SES constructs. RESULTS From 33 eligible studies, we identified 70 different census constructs for monitoring injury risk. Of these, fewer than half were replicated by other studies or against other causes, making the majority of studies non-comparable. When evaluated for a statistically significant relationship with a cause of injury, 74% of all constructs were predictive of injury risk when assessed in pairwise comparisons, whereas 98% of all constructs were significant when aggregated into composite indices. Fewer than 30% of studies selected SES constructs based on known associations with injury risk. CONCLUSIONS There is heterogeneity in the conceptual and methodological approaches for using census data for monitoring injury risk as well as in the recommendations as to how these constructs can be used for injury prevention. We recommend four priority areas for research to facilitate a more unified approach towards use of the census for monitoring socioeconomic inequalities in injury risk.
Collapse
Affiliation(s)
- Nathaniel Bell
- College of Nursing, University of South Carolina, Columbia, South Carolina, USA
| | - Amanda Arrington
- Department of Surgery, Marshall University, Huntington, West Virginia, USA
| | - Swann Arp Adams
- College of Nursing, University of South Carolina, Columbia, South Carolina, USA
| |
Collapse
|
50
|
Daw J. Explaining the Persistence of Health Disparities: Social Stratification and the Efficiency-Equity Trade-off in the Kidney Transplantation System. AJS; AMERICAN JOURNAL OF SOCIOLOGY 2015; 120:1595-1640. [PMID: 26478940 DOI: 10.1086/681961] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Why do health disparities persist when their previous mechanisms are eliminated? Fundamental-cause theorists argue that social position primarily improves health through two metamechanisms: better access to health information and technology. I argue that the general, cumulative, and embodied consequences of social stratification can produce another metamechanism: an efficiency-equity trade-off. A case in point is kidney transplantation, where the mechanisms previously thought to link race to outcomes--ability to pay and certain factors in the kidney allocation system--have been greatly reduced, yet large disparities persist. I show that these current disparities are rooted in factors that directly influence posttransplant success, placing efficiency and racial/ethnic equity at cross-purposes.
Collapse
|