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Hernandez-Meier JL, Akert B, Zheng C, Guse CE, Layde PM, Hargarten S. Status of legal firearm possession and violent deaths: methods and protocol for a retrospective case-control study. Inj Prev 2019; 25:i49-i58. [PMID: 30705051 DOI: 10.1136/injuryprev-2018-042996] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 11/05/2018] [Accepted: 11/27/2018] [Indexed: 11/03/2022]
Abstract
BACKGROUND AND OBJECTIVE This project links population data to the Wisconsin Violent Death Reporting System (WVDRS) to determine the extent to which firearm possession criteria are being followed as well as the potential impact of the adoption of proposed possession criteria. DESIGN AND STUDY POPULATION Criminal justice data for WVDRS homicide suspects and victims and suicide decedents 2008-2011 and a sample of matched control group of driver's license holders (to characterise the state population) will be abstracted. METHODS Individual legal possession statuses (prohibited/not prohibited) under each current and expanded criterion will be determined. Proportions of interest will be calculated from two-way contingency tables, and tests between groups with categorical variables (eg, criterion is met or not) will be performed with Fisher's exact or binomial proportion tests. Tests between groups with continuous variables (eg, number of misdemeanours) will be performed by zero inflated negative binomial regression. Area under the receiver operating characteristic curve will be used to quantify the prediction accuracy of specific univariate or multivariate logistic model for prediction. Inverse probability weighting will be used for analyses that extend from matched controls to the general state population of license holders. DISCUSSION Linked data sets and partnerships are challenging, but necessary for comprehensive public health research. Results of this study will contribute knowledge on the proportion of prohibited suspects and suicide decedents that used firearms in violent deaths and, if applying expanded criteria would have increased prohibited persons. This study will also investigate risk and protective factors for being a victim of homicide.
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Affiliation(s)
- Jennifer L Hernandez-Meier
- Comprehensive Injury Center, School of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA .,Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Brenna Akert
- Comprehensive Injury Center, School of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Cheng Zheng
- Joseph J. Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Clare E Guse
- Department of Family and Community Medicine, School of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Peter M Layde
- Comprehensive Injury Center, School of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Stephen Hargarten
- Comprehensive Injury Center, School of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Lerner EB, Cushman JT, Drendel AL, Badawy M, Shah MN, Guse CE, Cooper A. Effect of the 2011 Revisions to the Field Triage Guidelines on Under- and Over-Triage Rates for Pediatric Trauma Patients. PREHOSP EMERG CARE 2017; 21:456-460. [PMID: 28489471 DOI: 10.1080/10903127.2017.1300717] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND In 2011, revised Field Triage Guidelines were released jointly by the Centers for Disease Control and Prevention (CDC) and the American College of Surgeons - Committee on Trauma (ACS-COT). It is unknown how the modifications will affect the number of injured children identified by EMS providers as needing transport to a trauma center. OBJECTIVE To determine the change in under- and over-triage rates when the 2011 Field Triage Guidelines are compared to the 2006 and 1999 versions. METHODS EMS providers in charge of care for injured children (<15 years) transported to pediatric trauma centers in 3 mid-sized cities were interviewed immediately after completing transport. Patients were included regardless of injury severity. The interview included patient demographics and each criterion from the Field Triage Guidelines' physiologic status, anatomic injury, and mechanism of injury steps. Included patients were followed through hospital discharge. The 1999, 2006, and 2011 Guidelines were each retrospectively applied to the collected data. Children were considered to have needed a trauma center if they had non-orthopedic surgery within 24 hours, ICU admission, or died. Data were analyzed using descriptive statistics. RESULTS EMS interviews were conducted for 5,610 children and outcome data was available for 5,594 (99.7%). Average age was 7.6 years; 5% of children were identified as needing a trauma center using the study outcome. Applying the 1999, 2006, or 2011 Guidelines to the EMS interview data the over-triage rate was 32.6%, 27.9%, and 28.0%, respectively. The under-triage rate was 26.5%, 35.1%, and 34.8%, respectively. The 2011 Guidelines resulted in an 8.2% (95% CI 0.6-15.9%) absolute increase in under-triage and a 4.6% (95% CI 2.8-6.3%) decrease in over-triage compared to 1999 Guidelines. CONCLUSION Use of the Field Triage Guidelines for children resulted in an unacceptably high rate of under-triage regardless of the version used. Use of the 2011 Guidelines increased under-triage compared to the 1999 version. Research is needed to determine how to better assist EMS providers in identifying children who need the resources of a trauma center.
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McAndrews C, Beyer K, Guse CE, Layde P. Are rural places less safe for motorists? Definitions of urban and rural to understand road safety disparities. Inj Prev 2017; 23:412-415. [PMID: 28119341 DOI: 10.1136/injuryprev-2016-042139] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 10/20/2016] [Accepted: 12/30/2016] [Indexed: 11/04/2022]
Abstract
The objectives of the study are to understand road safety within the context of regional development processes and to assess how urban-rural categories represent differences in motor vehicle occupant fatality risk. We analysed 2015 motor vehicle occupant deaths in Wisconsin from 2010 to 2014, using three definitions of urban-rural continua and negative binomial regression to adjust for population density, travel exposure and the proportion of teen residents. Rural-Urban Commuting Area codes, Beale codes and the Census definition of urban and rural places do not explain differences in urban and rural transportation fatality rates when controlling for population density. Although it is widely believed that rural places are uniquely dangerous for motorised travel, this understanding may be an artefact of inaccurate constructs. Instead, population density is a more helpful way to represent transportation hazards across different types of settlement patterns, including commuter suburbs and exurbs.
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Affiliation(s)
- Carolyn McAndrews
- Department of Urban and Regional Planning, University of Colorado Denver, Denver, Colorado, USA
| | - Kirsten Beyer
- Medical College of Wisconsin Institute for Health and Society, Milwaukee, Wisconsin, USA
| | - Clare E Guse
- Department of Family and Community Medicine, Injury Research Center, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Peter Layde
- Department of Emergency Medicine and Injury Research Center, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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McAndrews C, Beyer K, Guse CE, Layde P. How do the definitions of urban and rural matter for transportation safety? Re-interpreting transportation fatalities as an outcome of regional development processes. Accid Anal Prev 2016; 97:231-241. [PMID: 27693862 DOI: 10.1016/j.aap.2016.09.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 07/14/2016] [Accepted: 09/08/2016] [Indexed: 06/06/2023]
Abstract
Urban and rural places are integrated through economic ties and population flows. Despite their integration, most studies of road safety dichotomize urban and rural places, and studies have consistently demonstrated that rural places are more dangerous for motorists than urban places. Our study investigates whether these findings are sensitive to the definition of urban and rural. We use three different definitions of urban-rural continua to quantify and compare motor vehicle occupant fatality rates per person-trip and person-mile for the state of Wisconsin. The three urban-rural continua are defined by: (1) popular impressions of urban, suburban, and rural places using a system from regional economics; (2) population density; and (3) the intensity of commute flows to core urbanized areas. In this analysis, the three definitions captured different people and places within each continuum level, highlighting rural heterogeneity. Despite this heterogeneity, the three definitions resulted in similar fatality rate gradients, suggesting a potentially latent "rural" characteristic. We then used field observations of urban-rural transects to refine the definitions. When accounting for the presence of higher-density towns and villages in rural places, we found that low-density urban places such as suburbs and exurbs have fatality rates more similar to those in rural places. These findings support the need to understand road safety within the context of regional development processes instead of urban-rural categories.
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Affiliation(s)
- Carolyn McAndrews
- Department of Urban and Regional Planning, University of Colorado Denver 1250 14th Street, Suite 300, Denver, CO 80202, United States.
| | - Kirsten Beyer
- Medical College of Wisconsin Institute for Health and Society, Watertown Plank Road, PO Box 26509, Milwaukee, WI 53226, United States
| | - Clare E Guse
- Department of Family & Community Medicine, Medical College of Wisconsin, Watertown Plank Road, Milwaukee, WI 53226, United States; Injury Research Center, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, United States
| | - Peter Layde
- Department of Emergency Medicine, Medical College of Wisconsin, Watertown Plank Road, Milwaukee, WI 53226, United States; Injury Research Center, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, United States
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Abstract
OBJECTIVE Prior studies have identified provider and system characteristics that impede pain management in children, but no studies have investigated the effect of changing these characteristics on prehospital opioid analgesia. Our objectives were to determine: 1) the frequency of opioid analgesia and pain score documentation among prehospital pediatric patients after system wide changes to improve pain treatment, and 2) if older age, longer transport times, the presence of vascular access and pain score documentation were associated with increased prehospital administration of opioid analgesia in children. METHODS This was a retrospective cross-sectional study of pediatric patients aged 3-18 years assessed by a single EMS system between October 1, 2011 and September 30, 2013. Prior to October 2011, the EMS system had implemented 3 changes to improve pain treatment: (1) training on age appropriate pain scales, (2) protocol changes to allow opioid analgesia without contacting medical control, and (3) the introduction of intranasal fentanyl. All patients with working assessments of blunt, penetrating, lacerating, and/or burn trauma were included. We used descriptive statistics to determine the frequency of pain score documentation and opioid analgesia administration and logistic regression to determine the association of age, transport time, and the presence of intravenous access with opioid analgesia administration. RESULTS Of the 1,368 eligible children, 336 (25%) had a documented pain score. Eleven percent (130/1204) of children without documented contraindications to opioid administration received opioids. Of the children with no documented pain score and no protocol exclusions, 9% (81/929) received opioid analgesia, whereas 18% (49/275) with a documented pain score ≥4 and no protocol exclusions received opioids. Multivariate analysis revealed that vascular access (OR = 11.89; 95% CI: 7.33-19.29), longer patient transport time (OR = 1.07; 95% CI: 1.04-1.11), age (OR 0.93; 95% CI: 0.88-0.98) and pain score documentation (OR 2.23; 95% CI: 1.40-3.55) were associated with opioid analgesia. CONCLUSIONS Despite implementation of several best practice recommendations to improve prehospital pain treatment, few children have a documented pain score and even fewer receive opioid analgesia. Children with longer transport times, successful IV placement, and/or documentation of pain score(s) were more likely to receive prehospital analgesia.
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Lerner EB, Drendel AL, Cushman JT, Badawy M, Shah MN, Guse CE, Cooper A. Ability of the Physiologic Criteria of the Field Triage Guidelines to Identify Children Who Need the Resources of a Trauma Center. PREHOSP EMERG CARE 2016; 21:180-184. [DOI: 10.1080/10903127.2016.1233311] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Sanders J, Guse CE. Reaching Urban Poor Hypertensive Patients: A Novel Model of Chronic Disease Care Versus a Traditional Fee-for-Service Approach. J Prim Care Community Health 2016; 8:14-19. [PMID: 27506443 DOI: 10.1177/2150131916662465] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND There is a significant disparity in hypertensive treatment rates between those with and without health insurance. If left untreated, hypertension leads to significant morbidity and mortality. The uninsured face numerous barriers to access chronic disease care. We developed the Community-based Chronic Disease Management (CCDM) clinics specifically for the uninsured with hypertension utilizing nurse-led teams, community-based locations, and evidence-based clinical protocols. All services, including laboratory and medications, are provided on-site and free of charge. METHODS In order to ascertain if the CCDM model of care was as effective as traditional models of care in achieving blood pressure goals, we compared CCDM clinics' hypertensive care outcomes with 2 traditional fee-for-service physician-led clinics. All the clinics are located near one another in poor urban neighborhoods of Milwaukee, Wisconsin. RESULTS Patients seen at the CCDM clinics and at 1 of the 2 traditional clinics showed a statistically significant improvement in reaching blood pressure goal at 6 months ( P < .001 and P < .05, respectively). Logistic regression analysis found no difference in attaining blood pressure goal at 6 months for either of the 2 fee-for-service clinics when compared with the CCDM clinics. CONCLUSION The CCDM model of care is at least as effective in controlling hypertension as more traditional fee-for-service models caring for the same population. The CCDM model of care to treat hypertension may offer another approach for engaging the urban poor in chronic disease care.
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Affiliation(s)
- Jim Sanders
- 1 Medical College of Wisconsin, Milwaukee, WI, USA
| | - Clare E Guse
- 1 Medical College of Wisconsin, Milwaukee, WI, USA
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Browne LR, Shah MI, Studnek JR, Ostermayer DG, Reynolds S, Guse CE, Brousseau DC, Lerner EB. Multicenter Evaluation of Prehospital Opioid Pain Management in Injured Children. PREHOSP EMERG CARE 2016; 20:759-767. [DOI: 10.1080/10903127.2016.1194931] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
Experiences and impact of intimate partner violence on men and women court ordered to attend abuse abatement counseling and women in a shelter were examined. Whereas court-ordered men and women appeared similar in expressed violent acts, violence frequency, and injurious outcome, court-ordered women initiated significantly fewer violent episodes than did men and were less likely to start the overall pattern of relationship violence. Court-ordered women were less likely than were shelter women to call police, try to escape, or acquiesce to their partners' violence. The two groups of women reported more fear, anger, and insult and less amusement when their partners were violent than did men. Court-ordered men were significantly more likely than were women to laugh at partner-initiated violence and exhibit dominating and controlling behaviors.
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Haley KB, Lerner EB, Guse CE, Pirrallo RG. Effect of System-Wide Interventions on the Assessment and Treatment of Pain by Emergency Medical Services Providers. PREHOSP EMERG CARE 2016; 20:752-758. [PMID: 27192662 DOI: 10.1080/10903127.2016.1182599] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND An estimated 20% of patients arriving by ambulance to the emergency department are in moderate to severe pain. However, the management of pain in the prehospital setting has been shown to be inadequate. Untreated pain may have negative physiologic and psychological consequences. The prehospital community has acknowledged this inadequacy and made treatment of pain a priority. OBJECTIVES To determine if system-wide pain management improvement efforts (i.e. education and protocol implementation) improve the assessment of pain and treatment with opioid medications in the prehospital setting and to determine if improvements are maintained over time. METHODS This was a retrospective before and after study of a countywide prehospital patient care database. The study population included all adult patients transported by EMS between February 2004 and February 2012 with a working assessment of trauma or burn. EMS patient care records were searched for documentation of pain scores and opioid administration. Four time periods were examined: 1) before interventions, 2) after pediatric specific pain management education, 3) after pain management protocol implementation, and 4) maintenance phase. Frequencies and 95% confidence intervals were calculated for all patients meeting the inclusion criteria in each time period and Chi-square was used to compare frequencies between time periods. RESULTS 15,228 adult patients transported by EMS during the study period met the inclusion criteria. Subject demographics were similar between the four time periods. Pain score documentation improved between the time periods but was not maintained over time (13% [95%CI 12-15%] to 32% [95%CI 31-34%] to 29% [95 CI 27-30%] to 19% [95%CI 18-21%]). Opioid administration also improved between the time periods and was maintained over time (7% [95%CI 6-8%] to 18% [95%CI 16-19%] to 24% [95%CI 22-25%] to 23% [95% CI 22-24%]). CONCLUSIONS In adult patients both pediatric-focused education and pain protocol implementation improved the administration of opioid pain medications. Documentation and assessment of pain scores was less affected by specific pain management improvement efforts.
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Willenbring BD, Lerner EB, Brasel K, Cushman JT, Guse CE, Shah MN, Swor R. Evaluation of a Consensus-Based Criterion Standard Definition of Trauma Center Need for Use in Field Triage Research. PREHOSP EMERG CARE 2015; 20:1-5. [PMID: 26270033 DOI: 10.3109/10903127.2015.1056896] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Research on field triage of injured patients is limited by the lack of a widely used criterion standard for defining trauma center need. Injury Severity Score (ISS) >15 has been a commonly used outcome measure in research for determining trauma center need that has never been validated. A multidisciplinary team recently published a consensus-based criterion standard definition of trauma center need, but this measure has not yet been validated. The objective was to determine if the consensus-based criterion standard can be obtained by medical record review and compare patients identified as needing a trauma center by the consensus-based criterion standard vs. ISS >15. A subanalysis of data collected during a 2-year prospective cohort study of 4,528 adult trauma patients transported by EMS to a single trauma center was conducted. These data included ICD-9-CM codes, treatment times, and other patient care data. Presence of the consensus-based criterion standard was determined for each patient. ISS was calculated based on ICD-9-CM codes assigned for billing. The consensus-based criterion standard could be applied to 4,471 (98.7%) cases. ISS could be determined for 4,506 (99.5%) cases. Based on an ISS >15, 8.9% of cases were identified as needing a trauma center. Of those, only 48.2% met the consensus-based criterion standard. Almost all patients that did not meet the consensus-based criterion standard, but had an ISS >15 were diagnosed with chest (rib fractures (100/205 cases)/pneumothorax (57/205 cases), closed head (without surgical intervention 88/205 cases), vertebral (without spinal cord injury 45/205 cases), and/or extremity injuries (39/205 cases). There were 4,053 cases with an ISS <15. 5.0% of those with an ISS <15 met the consensus-based criterion standard with the majority requiring surgery (139/203 cases) or a blood transfusion (60/203 cases). The kappa coefficient of agreement for ISS and the consensus-based criterion standard was 0.43. We determined that the consensus-based criterion standard could be identified through a medical record review. Use of the consensus-based criterion standard for field triage research will more accurately identify injured patients who need the resources of a trauma center when compared to ISS.
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Drayna PC, Browne LR, Guse CE, Brousseau DC, Lerner EB. Prehospital Pediatric Care: Opportunities for Training, Treatment, and Research. PREHOSP EMERG CARE 2015; 19:441-7. [PMID: 25658967 DOI: 10.3109/10903127.2014.995850] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Pediatric transports comprise approximately 10% of emergency medical services (EMS) requests for aid, but little is known about the clinical characteristics of pediatric EMS patients and the interventions they receive. Our objective was to describe the pediatric prehospital patient cohort in a large metropolitan EMS system. METHODS This retrospective analysis of all pediatric (age <19 years) EMS patients transported from October 2011 to September 2013 was conducted by reviewing a system-wide National EMS Information System (NEMSIS)-compliant database of all EMS patient encounters. We identified the most common primary working assessments, the frequency of abnormal initial vital signs, and the interventions provided. Vital signs included systolic blood pressure (SBP), respiratory (RR) and pulse rate, Glasgow Coma Scale (GCS), pulse oximetry (Pox), and respiratory effort. We defined abnormal vital signs using previously reported age-specific standards. We identified the working assessments most frequently associated with abnormal vital signs and the working assessments associated with the most commonly performed interventions. Data were analyzed using descriptive statistics. RESULTS There were 9,956 pediatric transports, 8.7% of the total call volume. The most common working assessments were "other" (16.1%), respiratory distress (13.7%), seizure (12.4%), and blunt trauma (12.0%). Vital signs were documented at variable rates: RR (91.1%), GCS (82.9%), SBP (71.3%), pulse (69.4%), respiratory effort (49.7%), and Pox (33.5%). Of all transported patients, 61.5% had a documented abnormal initial vital sign. Patients with an abnormal vital sign had the same most common working assessments as those with normal vital signs. Glucometry (16.9%), medication delivery (13.6%), and IV placement (11.5%) were the most common interventions and were most often provided to patients with working assessments of seizure, asthma, trauma, altered consciousness, or "other." Cardiopulmonary resuscitation (0.4%), bag mask ventilation (0.4%), and advanced airway (0.4%) occurred rarely and were most often performed for cardiac arrest and trauma. CONCLUSIONS Children made up a small part of EMS providers' clinical practice; those encountered most frequently had respiratory distress, seizures, trauma, or an undefined assessment (i.e., "other"). EMS providers frequently encounter children with physiologic evidence of acute illness, although vital sign documentation was incomplete. Prehospital providers infrequently perform pediatric interventions. Describing EMS providers' interaction with children provides the opportunity to target improvements in pediatric prehospital treatment, training, and research.
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Guse CE, Peterson DJ, Christiansen AL, Mahoney J, Laud P, Layde PM. Translating a Fall Prevention Intervention Into Practice: A Randomized Community Trial. Am J Public Health 2015; 105:1475-81. [PMID: 25602891 DOI: 10.2105/ajph.2014.302315] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined whether community translation of an effective evidence-based fall prevention program via standard monetary support can produce a community-wide reduction in fall injuries in older adults and evaluated whether an enhanced version with added technical support and capacity building amplified the fall reduction effect. METHODS We completed a randomized controlled community trial among adults aged 65 and older in (1) 10 control communities receiving no special resources or guidance on fall prevention, (2) 5 standard support communities receiving modest funding to implement Stepping On, and (3) 5 enhanced support communities receiving funding and technical support. The primary outcome was hospital inpatient and emergency department discharges for falls, examined with Poisson regression. RESULTS Compared with control communities, standard and enhanced support communities showed significantly higher community-wide reductions (9% and 8%, respectively) in fall injuries from baseline (2007-2008) to follow-up (2010-2011). No significant difference was found between enhanced and standard support communities. CONCLUSIONS Population-based fall prevention interventions can be effective when implemented in community settings. More research is needed to identify the barriers and facilitators that influence the successful adoption and implementation of fall prevention interventions into broad community practice.
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Affiliation(s)
- Clare E Guse
- Clare E. Guse is with the Department of Family and Community Medicine, Medical College of Wisconsin, Milwaukee. Donna J. Peterson, Ann L. Christiansen, and Peter M. Layde are with the Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee. Jane Mahoney is with the Department of Medicine, Division of Geriatrics, University of Wisconsin School of Medicine and Public Health, Madison. Purushottam Laud is with the Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee. Clare E. Guse, Ann L. Christiansen, Purushottam Laud, and Peter M. Layde are also with the Injury Research Center, Medical College of Wisconsin, Milwaukee
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Brixey SN, Weaver NL, Guse CE, Zimmermann H, Williams J, Corden TE, Gorelick MH. The impact of behavioral risk assessments and tailored health information on pediatric injury. Clin Pediatr (Phila) 2014; 53:1383-9. [PMID: 25189696 DOI: 10.1177/0009922814549544] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Integrating age appropriate injury prevention messages during a well-child visit is challenging in the face of competing demands. PURPOSE To describe a 7-month pilot using technology to facilitate injury prevention risk assessment and education integration. METHODS We prospectively tracked responses to the computer-based injury prevention self-assessment tool, safety product distribution, and any subsequent contact with the local hospital system for related unintentional injuries. RESULTS A total of 2091 eligible visits by 1368 unique patients were assessed. Eight hundred forty-three unique patients completed the Safe N' Sound assessment and 7 were subsequently injured, with an injury related to a Safe N' Sound target area. CONCLUSIONS A kiosk-based tailored injury assessment tool can be successfully integrated into a busy pediatric practice. Unintentional injury outcomes can be linked to the tailored anticipatory guidance and can identify the effectiveness of this electronic integration of injury prevention messaging into well-child examinations.
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Affiliation(s)
| | | | - Clare E Guse
- Medical College of Wisconsin, Milwaukee, WI, USA
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Guse CE, Hargarten S. Limitations of travel data for rate computations. Inj Prev 2014; 21:e153. [PMID: 24562380 DOI: 10.1136/injuryprev-2014-041177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Clare E Guse
- Injury Research Center, Department of Family and Community Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Steven Hargarten
- Department of Emergency Medicine, Injury Research Center, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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McAndrews C, Beyer K, Guse CE, Layde P. Revisiting exposure: fatal and non-fatal traffic injury risk across different populations of travelers in Wisconsin, 2001-2009. Accid Anal Prev 2013; 60:103-112. [PMID: 24036316 DOI: 10.1016/j.aap.2013.08.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Revised: 07/22/2013] [Accepted: 08/10/2013] [Indexed: 06/02/2023]
Abstract
Comparing the injury risk of different travel modes requires using a travel-based measure of exposure. In this study we quantify injury risk by travel mode, age, race/ethnicity, sex, and injury severity using three different travel-based exposure measures (person-trips, person-minutes of travel, and person-miles of travel) to learn how these metrics affect the characterization of risk across populations. We used a linked database of hospital and police records to identify non-fatal injuries (2001-2009), the Fatality Analysis Reporting System for fatalities (2001-2009), and the 2001 Wisconsin Add-On to the National Household Travel Survey for exposure measures. In Wisconsin, bicyclists and pedestrians have a moderately higher injury risk compared to motor vehicle occupants (adjusting for demographic factors), but the risk is much higher when exposure is measured in distance. Although the analysis did not control for socio-economic status (a likely confounder) it showed that American Indian and Black travelers in Wisconsin face higher transportation injury risk than White travelers (adjusting for sex and travel mode), across all three measures of exposure. Working with multiple metrics to form comprehensive injury risk profiles such as this one can inform decision making about how to prioritize investments in transportation injury prevention.
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Affiliation(s)
- Carolyn McAndrews
- Department of Planning and Design, University of Colorado Denver, 1250 14(th) Street, Suite 300, Denver, CO 80209, United States.
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Lerner EB, Roberts J, Guse CE, Shah MN, Swor R, Cushman JT, Blatt A, Jurkovich GJ, Brasel K. Does EMS perceived anatomic injury predict trauma center need? PREHOSP EMERG CARE 2013; 17:312-6. [PMID: 23627418 DOI: 10.3109/10903127.2013.785620] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Our objective was to determine the predictive value of the anatomic step of the 2011 Field Triage Decision Scheme for identifying trauma center need. METHODS Emergency medical services (EMS) providers caring for injured adults transported to regional trauma centers in three midsized communities were interviewed over two years. Patients were included, regardless of injury severity, if they were at least 18 years old and were transported by EMS with a mechanism of injury that was an assault, motor vehicle or motorcycle crash, fall, or pedestrian or bicyclist struck. The interview was conducted upon emergency department (ED) arrival and collected physiologic condition and anatomic injury data. Patients who met the physiologic criteria were excluded. Trauma center need was defined as nonorthopedic surgery within 24 hours, intensive care unit admission, or death prior to hospital discharge. Data were analyzed by calculating descriptive statistics, including positive likelihood ratios (+LRs) with 95% confidence intervals (CIs). RESULTS A total of 11,892 interviews were conducted. One was excluded because of missing outcome data and 1,274 were excluded because they met the physiologic step. EMS providers identified 1,167 cases that met the anatomic criteria, of which 307 (26%) needed the resources of a trauma center (38% sensitivity, 91% specificity, +LR 4.4; CI: 3.9-4.9). Criteria with a +LR ≥5 were flail chest (9.0; CI: 4.1-19.4), paralysis (6.8; CI: 4.2-11.2), two or more long-bone fractures (6.3; CI: 4.5-8.9), and amputation (6.1; CI: 1.5-24.4). Criteria with a +LR >2 and <5 were penetrating injury (4.8; CI: 4.2-5.6) and skull fracture (4.8; CI: 3.0-7.7). Only pelvic fracture (1.9; CI: 1.3-2.9) had a +LR less than 2. CONCLUSIONS The anatomic step of the Field Triage Guidelines as determined by EMS providers is a reasonable tool for determining trauma center need. Use of EMS perceived pelvic fracture as an indicator for trauma center need should be reevaluated. Key words: wounds and injury; triage; emergency medical services; emergency medical technicians.
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Carroll CP, Cochran JA, Guse CE, Wang MC. Are We Underestimating the Burden of Traumatic Brain Injury? Surveillance of Severe Traumatic Brain Injury Using Centers for Disease Control International Classification of Disease, Ninth Revision, Clinical Modification, Traumatic Brain Injury Codes. Neurosurgery 2012; 71:1064-70; discussion 1070. [DOI: 10.1227/neu.0b013e31826f7c16] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Grundstrom AC, Guse CE, Layde PM. Risk factors for falls and fall-related injuries in adults 85 years of age and older. Arch Gerontol Geriatr 2012; 54:421-8. [PMID: 21862143 PMCID: PMC3236252 DOI: 10.1016/j.archger.2011.06.008] [Citation(s) in RCA: 117] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2011] [Revised: 06/06/2011] [Accepted: 06/07/2011] [Indexed: 11/27/2022]
Abstract
Falls are a leading cause of morbidity and mortality in older adults. No previous studies on risk factors for falls have focused on adults 85 years and older, the most rapidly growing segment of adults. We examined demographic, health, and behavioral risk factors for falls and fall-related injuries in adults 65 years and older, with a particular focus on adults 85 years and older. We analyzed self-reported information from the Behavioral Risk Factor Surveillance System (BRFSS) for 2008. Data was available for 120,923 people aged 65 or older and 12,684 people aged 85 or older. Of those aged 85 or older, 21.3% reported at least one fall in the past 3 months and 7.2% reported at least one fall related injury requiring medical care or limiting activity for a day or longer. Below average general health, male sex, perceived insufficient sleep, health problems requiring assistive devices, alcohol consumption, increasing body mass index and history of stroke were all independently associated with a greater risk of falls or fall related injuries. The greater risk of falling in those 85 years and older appeared to be due to the deterioration of overall health status with age; among those with excellent overall health status, there was no greater risk of falling in adults 85 years and older compared to those 65-84 years of age. Our results suggest that those with risk factors for falls and fall-related injuries may be appropriate targets for evidence-based fall prevention programs.
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Affiliation(s)
| | - Clare E. Guse
- Injury Research Center, Medical College of Wisconsin, Milwaukee, WI
- Department of Family and Community Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Peter M. Layde
- Injury Research Center, Medical College of Wisconsin, Milwaukee, WI
- Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI
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Layde PM, Christiansen AL, Peterson DJ, Guse CE, Maurana CA, Brandenburg T. A model to translate evidence-based interventions into community practice. Am J Public Health 2012; 102:617-24. [PMID: 22397341 DOI: 10.2105/ajph.2011.300468] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
There is a tension between 2 alternative approaches to implementing community-based interventions. The evidence-based public health movement emphasizes the scientific basis of prevention by disseminating rigorously evaluated interventions from academic and governmental agencies to local communities. Models used by local health departments to incorporate community input into their planning, such as the community health improvement process (CHIP), emphasize community leadership in identifying health problems and developing and implementing health improvement strategies. Each approach has limitations. Modifying CHIP to formally include consideration of evidence-based interventions in both the planning and evaluation phases leads to an evidence-driven community health improvement process that can serve as a useful framework for uniting the different approaches while emphasizing community ownership, priorities, and wisdom.
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Affiliation(s)
- Peter M Layde
- Injury Research Center, Medical College of Wisconsin, Milwaukee, 53226, USA.
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Abstract
OBJECTIVE To determine the predictive value of the mechanism-of-injury step of the American College of Surgeons Field Triage Decision Scheme for determining trauma center need. METHODS Emergency medical services (EMS) providers caring for injured adult patients transported to the regional trauma center in three midsized communities over two years were interviewed upon emergency department (ED) arrival. Included was any injured patient, regardless of injury severity. The interview collected patient physiologic condition, apparent anatomic injury, and mechanism of injury. Using the 1999 Scheme, patients who met the physiologic or anatomic steps were excluded. Patients were considered to need a trauma center if they had nonorthopedic surgery within 24 hours, had intensive care unit admission, or died prior to hospital discharge. Data were analyzed by calculating positive likelihood ratios (+LRs) and 95% confidence intervals (CIs) for each mechanism-of-injury criterion. RESULTS A total of 11,892 provider interviews were conducted. Of those, one was excluded because outcome data were not available, and 2,408 were excluded because they met the other steps of the Field Triage Decision Scheme. Of the remaining 9,483 cases, 2,363 met one of the mechanism-of-injury criteria, 204 (9%) of whom needed the resources of a trauma center. Criteria with a +LR ≥ 5 were death of another occupant in the same vehicle (6.8; CI: 2.7-16.7), fall >20 feet (5.3; CI: 2.4-11.4), and motor vehicle crash (MVC) extrication time >20 minutes (5.1; CI: 3.2-8.1). Criteria with a +LR between >2 and <5 were intrusion >12 inches (4.2; CI: 2.9-5.9), ejection (3.2; CI: 1.3-8.2), and deformity >20 inches (2.5; CI: 1.9-3.2). The criteria with a +LR ≤ 2 were MVC speed >40 mph (2.0; CI: 1.7-2.4), pedestrian/bicyclist struck at a speed >5 mph (1.2; CI:1.1-1.4), bicyclist/pedestrian thrown or run over (1.2; CI: 0.9-1.6), motorcycle crash at a speed >20 mph (1.2; CI: 1.1-1.4), rider separated from motorcycle (1.0; CI: 0.9-1.2), and MVC rollover (1.0; CI: 0.7-1.5). CONCLUSION Death of another occupant, fall distance, and extrication time were good predictors of trauma center need when a patient did not meet the anatomic or physiologic conditions. Intrusion, ejection, and vehicle deformity were moderate predictors. Key words: wounds and injury; triage; emergency medical services; emergency medical technicians; predictors; mechanism of injury; trauma center.
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Affiliation(s)
- E Brooke Lerner
- Medical College of Wisconsin, Milwaukee, Wisconsin 53226, USA.
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Abstract
OBJECTIVE To assess the impact of a booster seat law in Wisconsin on booster seat use in relation to race, ethnicity and socioeconomic status. METHODS A longitudinal study in Milwaukee County, Wisconsin, involving repeated direct observational assessments of booster seat use rates by child passengers aged 4-7 years over five time periods, before and after legislation mandating booster seat use. RESULTS Overall, booster seat use increased from 24% to 43%, whereas proper restraint use increased pre to post-legislation from 21% to 28%. Proper use increased after legislation in white, but not in black or Latino children. White individuals had a proper booster use increase from 48% to 68% over the time period of the study. Black children's proper use dropped from 18% to 7% over the study period and Latino children's proper use rates were stable at 10%. Driver-reported household income had a significant impact on overall use, but not on proper use. CONCLUSIONS Racial/ethnic minority groups and those of lower socioeconomic status have significantly lower use and proper use of booster seats. Legislation may increase the total use of booster seats but not necessarily the correct use of the restraint, particularly in racial/ethnic minorities.
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Affiliation(s)
- Suzanne N Brixey
- Department of Pediatrics and Injury Research Center, Medical College of Wisconsin, Milwaukee, Wisconsin 53233, USA.
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Abstract
OBJECTIVE To compare the accuracy of trained community observers for direct observation of child passenger restraint use to certified child passenger safety technicians who are either professional observers or community-based technicians, and to compare these three groups with a gold standard. METHODS This is a cross-sectional study of interobserver agreement and accuracy in which 75 photos of children depicted in different child passenger restraint systems were rated by 9 observers total, with 3 representing professional observers, 3 representing certified child passenger safety technicians, and 3 representing trained community observers. For each photo, observers indicated type of restraint; the appropriateness of the harness, if applicable; and overall appropriateness of the restraint. A gold standard was established by consensus agreement of 2 certified car seat technician instructors. RESULTS The sensitivity and specificity for trained community observers in identifying broad groupings of restraint types was good (78-100% sensitivity; 93-99% specificity), but they had low agreement with the gold standard for overall appropriateness of the child passenger restraints (kappa = 0.28). The community observer group was 42 percent less likely to code the photo depiction of appropriate restraint use as appropriate. CONCLUSION Community trained observers do show good sensitivity and specificity for identifying the type of restraint but have a trend toward poorer judgment when determining harness appropriateness and overall appropriateness. They may be a cost-effective option for limited restraint identification.
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Affiliation(s)
- Suzanne N Brixey
- Department of Pediatrics, Medical College of Wisconsin, and Children's Research Institute, Milwaukee, Wisconsin 53233, USA.
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Lerner EB, Shah MN, Swor RA, Cushman JT, Guse CE, Brasel K, Blatt A, Jurkovich GJ. Comparison of the 1999 and 2006 trauma triage guidelines: where do patients go? PREHOSP EMERG CARE 2010; 15:12-7. [PMID: 21054176 DOI: 10.3109/10903127.2010.519819] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND In 2006, the Centers for Disease Control and Prevention (CDC) released a revised Field Triage Decision Scheme. It is unknown how this modified scheme will affect the number of patients identified by emergency medical services (EMS) for transport to a trauma center. OBJECTIVES To determine the change in the number of patients transported by EMS who meet the 2006 scheme, compared with the 1999 scheme, and to determine how the scheme change would affect under- and overtriage rates. METHODS The EMS providers in charge of care for injured adult patients transported to a regional trauma center in three mid-sized cities were interviewed immediately after completing transport. All injured patients were included, regardless of severity. The interview included patient demographics, vital signs, apparent anatomic injury, and the mechanism of injury. Included patients were then followed through hospital discharge. The 1999 and 2006 scheme criteria were each retrospectively applied to the collected data. The numbers of patients identified by the two schemes were determined. Patients were considered to have needed a trauma center if they had nonorthopedic surgery within 24 hours, were admitted to an intensive care unit (ICU), or died. Data were analyzed using descriptive statistics including 95% confidence intervals. RESULTS EMS interviews were conducted for 11,892 patients and outcome data were unavailable for one patient. The average patient age was 48 years; 51% of the patients were men. Providers reported bringing 54% of the enrolled patients to the trauma center based on their local trauma protocol. Medical record review identified 12% of the enrolled patients as needing a trauma center. Use of the 2006 scheme would have resulted in 1,423 fewer patients (12%; 95% confidence interval [CI]:11%-13%) being identified as needing a trauma center by EMS providers (40%; 95% CI: 39%-41% versus 28%; 95% CI: 27%-29%). Of those patients, 1,344 (94%) did not actually need the resources of a trauma center, whereas 78 (6%) actually needed the resources of a trauma center and would have been undertriaged. CONCLUSION Use of the 2006 Field Triage Decision Scheme would have resulted in a significant decrease in the number of patients identified as needing the resources of a trauma center. These changes reduced overtriage while causing a small increase in the number of patients who would have been undertriaged.
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Affiliation(s)
- E Brooke Lerner
- Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
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Brixey S, Ravindran K, Guse CE. Legislating child restraint usage -Its effect on self-reported child restraint use rates in a central city. J Safety Res 2010; 41:47-52. [PMID: 20226950 DOI: 10.1016/j.jsr.2009.12.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2009] [Revised: 11/18/2009] [Accepted: 12/15/2009] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To assess the effect of the newly enacted child passenger safety law, Wisconsin Act 106, on self-report of proper restraint usage of children in Milwaukee's central city population. METHOD A prospective, non-randomized study design was used. The settings used were (a) a pediatric urban health center, and (b) two Women, Infants and Children offices in Milwaukee, Wisconsin. Participants included 11,566 surveys collected over 18 months that spanned the pre-legislation and post-legislation time periods from February 2006 through August 2008. RESULTS The study set out to assess appropriate child passenger restraint. The results showed that the changes in adjusted proper restraint usage rates for infants between the pre-law, grace period, and post-fine periods were 94%, 94%, and 94% respectively. For children 1-3years old, the adjusted proper usage rates were 65%, 63%, and 59%, respectively. And for children 4-7years old, the rates were 43%, 44% and 42%, respectively. There was a significant increase in premature booster seat use in children who should have been restrained in a rear- or forward-facing car seat (10% pre-law, 12% grace period, 20% post-fine; p<0.0005). There was no statistically significant change over time in unrestrained children (2.1%, 1.7%, 1.7%, p=0.7, respectively). CONCLUSIONS The passage of a strengthened child passenger safety law with fines did not significantly improve appropriate restraint use for 0-7year olds, and appropriate use in 1-7year olds remained suboptimal with a majority of urban children inappropriately restrained. Although the number of unrestrained children decreased, we identified an unintended consequence of the legislation - a significant increase in the rate of premature belt-positioning booster seat use among poor, urban children. IMPACT ON INDUSTRY The design of child restraint systems maximizes protection of the child. Increasing reports of misuse is a call to those who manufacture these child passenger restraints to improve advertising and marketing to the correct age group, ease of installation, and mechanisms to prevent incorrect safety strap and harness placement. To ensure accurate and consistent use on every trip, car seat manufacturers must ensure that best practice recommendations for use as well as age, weight, and height be clearly specified on each child restraint. The authors support the United States Department of Transportation's new consumer program that will assist caregivers in identifying the child seat that will fit in their vehicle. In addition, due to the increase in premature graduation of children into belt-positioning booster seats noted as a result of legislation, promoting and marketing booster seat use for children less than 40 pounds should not be accepted. Child passenger safety technicians must continue to promote best practice recommendations for child passenger restraint use and encourage other community leaders to do the same.
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Affiliation(s)
- Suzanne Brixey
- Department of Pediatrics and Injury Research Center, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA.
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Carroll CP, Cochran JA, Price JP, Guse CE, Wang MC. The AIS-2005 Revision in Severe Traumatic Brain Injury: Mission Accomplished or Problems for Future Research? Ann Adv Automot Med 2010; 54:233-238. [PMID: 21050606 PMCID: PMC3242550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The Abbreviated Injury Scale (AIS) is commonly used to score injury severity and describe types of injuries. In 2005, the AIS-Head section was revised to capture more detailed information about head injuries and to better reflect their clinical severity, but the impact of these changes is largely unknown. The purpose of this study was to compare AIS-1998 and AIS-2005 coding of traumatic brain injuries (TBI) using medical records at a single Level I trauma center. We included patients with severe TBI (Glasgow Coma Scale 3-8) after blunt injury, excluding those who were missing medical records. Detailed descriptions of injuries were collected, then manually coded into AIS-1998 and AIS-2005 by the same Certified AIS Specialist. Compared to AIS-1998, AIS-2005 coded the same injuries with lower severity scores [p<0.01] and with decreased mean and maximum AIS-Head scores [p<0.01]. Of the types of traumatic brain injuries, most of the changes occurred among cerebellar and cerebral injuries. Traumatic hypoxic brain injury secondary to systemic dysfunction was captured by AIS-2005 but not by AIS-1998. However, AIS-2005 captured fewer loss of consciousness cases due to changes in criteria for coding concussive injury. In conclusion, changes from AIS-1998 to AIS-2005 result in significant differences in severity scores and types of injuries captured. This may complicate future TBI research by precluding direct comparison to datasets using AIS-1998. TBIs should be coded into the same AIS-version for comparison or evaluation of trends, and specify which AIS-version is used.
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Affiliation(s)
- Christopher P Carroll
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI Association for the Advancement of Automotive Medicine, Waco, TX Injury Research Center, Department of Family & Community Medicine, Medical College of Wisconsin, Milwaukee, WI Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI
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Brixey S, Guse CE, Ngui E. Free child passenger restraints for patients in an urban pediatric medical home: effects on caregiver behavior. WMJ 2009; 108:352-358. [PMID: 19886583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
CONTEXT Motor vehicle crashes are a leading cause of death in children despite the availability of effective child passenger restraints that reduce morbidity and mortality. Inappropriate restraint is more common in minority and low-income populations. Removing barriers by distributing child passenger restraint systems (CPRS) and providing education has been 1 approach to improve child safety. The objective of this study was to evaluate the efficacy of providing no-cost CPRS in combination with targeted education to improve restraint use for low-income, minority, and urban children in a medical home. DESIGN This prospective, non-randomized, community-based cohort study used a certified car seat technician to provide CPRS and training to the caregivers of 101 children when those caregivers reported not owning the appropriate type of restraint system during the index clinic visit. RESULTS In the first 3 months of follow-up, caregivers were 2.4 times more likely to report appropriate use of CPRS: relative risk 2.4 (95% confidence interval [CI] 1.7 to 3.5). Reported improvement declined slightly between months 4 and 9. CONCLUSIONS Appropriate restraint significantly improved, yet rates remained suboptimal. Multifactoral approaches are needed to understand why the set of patients studied and other at-risk populations may not use child restraints properly even when given access and information.
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Affiliation(s)
- Suzanne Brixey
- Injury Research Center, Medical College of Wisconsin, Downtown Health Center Pediatric Clinic, Milwaukee, WI 53233, USA.
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Abstract
BACKGROUND Global travel continues to increase, including among US citizens. The global burden of injuries and violence, accounting for approximately 5 million deaths worldwide in 2000, is also growing. Travelers often experience heightened risk for this biosocial disease burden. This study seeks to further describe and improve our understanding of the variable risk of travel-related injury and death. METHODS Information on US civilian citizen deaths from injury while abroad was obtained from the US Department of State Web site. This information was categorized into regional and causal groupings. The groupings were compared to each other and to injury deaths among citizens in their native countries. RESULTS From 2004 to 2006, there were 2,361 deaths of US citizens overseas due to injury. Of these US citizen injury deaths, 50.4% occurred in the Americas region. Almost 40% (37.8%) of US citizen injury deaths in the low- to middle-income Americas were due to vehicle crashes compared to about half that (18.9%) (proportional mortality ratio [PMR] = 1.72, 95% confidence interval [CI] 1.59-1.62) for low- to middle-income Americas citizen injury deaths. Similar differences between US citizen injury death abroad and the in-country distributions were also found for vehicle crashes in Europe (35.9% vs 16.5%, PMR = 2.17, 95% CI 1.78-2.64; p < 0.0005), for drowning deaths in the Americas (13.1% vs 4.6%, PMR = 2.67, 95% CI 2.29-3.11) and many island nations (63.5% vs 3.5%, PMR = 11.38, 95% CI 8.17-15.84), and for homicides in the low- to middle-income European countries (16.9% vs 10.5%, PMR = 1.52, 95% CI .90-2.57). CONCLUSIONS US citizens should be aware of regional variation of injury deaths in foreign countries, especially for motor vehicle crashes, drowning, and violence. Improved knowledge of regional variations of injury death and risk for travelers can further inform travelers and the development of evidence-based prevention programs and policies. The State Department Web site is a new data source that furthers our understanding of this challenging travel-related health issue.
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Affiliation(s)
- Daniel J Tonellato
- Injury Research Center, Medical College of Wisconsin, Milwaukee, WI 53226, USA
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Abstract
OBJECTIVES To quantify the association of driver's age with the risk of being injured, dying, and experiencing injuries of different severity when involved in a motor vehicle crash. METHODS Data from the Wisconsin Crash Outcome Data Evaluation System (CODES) from 2002 to 2004 were used to study 602,964 drivers of a car or truck who were involved in a motor vehicle crash. Odds ratios (OR) or relative risk ratios (RRR) and their 95 percent confidence intervals (CIs) were calculated for age groups, in relation to the outcomes of injury, fatality, and injury severity using logistic regression models, which controlled for sex, alcohol use, urban/rural location, seat belt use, ejection, airbag deployment, vehicle type, and highway class. RESULTS Increasing age was strongly associated the risk of dying or experiencing severe injuries for drivers involved in motor vehicle crashes with the greatest risk in drivers 85 years and older. Compared to drivers aged 25-44, drivers 85 years and older had the highest risks for moderate injury (ISS = 9-15; RRR = 5.44, 95% CI: 3.97-7.47), severe injury (ISS = 16-74; (RRR = 4.32, 95% CI: 2.73-6.84), and fatality (OR = 10.93, 95% CI: 7.76-15.38). In contrast, drivers 85 years and older had no increase in risk for minor injury (ISS = 1-8; OR = 0.94, 95% CI: 0.84-1.05). CONCLUSIONS The oldest drivers involved in motor vehicle crashes had the highest risk for severe injury and fatality. In light of the increasing number of the oldest drivers and their poor outcomes from severe trauma, substantial morbidity can be expected to occur in the oldest drivers. Evidence-based measures to reduce the risks to older drivers should continue to be developed, evaluated, and implemented.
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Affiliation(s)
- Robert B. Hanrahan
- Injury Research Center, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Peter M. Layde
- Injury Research Center, Medical College of Wisconsin, Milwaukee, WI, USA
- Department of Population Health, Medical College of Wisconsin, Milwaukee, WI, USA
- Department of Family and Community Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Shankuan Zhu
- Injury Research Center, Medical College of Wisconsin, Milwaukee, WI, USA
- Department of Family and Community Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Zhejiang University School of Medicine, Hangzhou, China
| | - Clare E. Guse
- Injury Research Center, Medical College of Wisconsin, Milwaukee, WI, USA
- Department of Family and Community Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Stephen W. Hargarten
- Injury Research Center, Medical College of Wisconsin, Milwaukee, WI, USA
- Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
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Wanta BT, Schlotthauer AE, Guse CE, Hargarten SW. The burden of suicide in Wisconsin's older adult population. WMJ 2009; 108:87-93. [PMID: 19437934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
INTRODUCTION Suicide rates in the older adult population are disproportionately high, yet most studies focus on youth suicide. This study characterized risk factors for elder suicide in Wisconsin. METHODS Wisconsin residents aged > or =65 who committed suicide from 2001-2006 were identified using the Violent Injury Reporting System (VIRS; 2001-2003) and the Wisconsin Violent Death Reporting System (WVDRS; 2004-2006). Multivariate regression was used to determine the risk of suicide and to adjust crude rates. Suicide circumstances and methods were also examined. RESULTS From 2001-2006, the rate of suicide of those > or =65 was 12.4 per 100,000 per year, lower than the national average of 14.7 per 100,000. Multivariate analysis in Caucasians found that compared to married individuals, those widowed, divorced, or never married had a 2.5- to nearly 5-fold increase in risk of suicide death. Males aged 65-74 had almost a 7-fold increased risk compared to females of that age, and the risk increased for males as they aged, compared to females 65-74 years old. Almost 40% of the cases had a medical examiner or coroner report that the victim had a diagnosed mental illness. Forty-two percent of victims had documented alcohol toxicology screening; of these, 16% were positive for alcohol at the time of death. The most common method of suicide was firearm use (66.9%). DISCUSSION Being single, male, and a male advancing in age are risk factors of suicide in the elderly. Health care workers, community advocates, and public health workers should be cognizant of these risk factors to facilitate early recognition and intervention.
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Brotzman GL, Guse CE, Fay DL, Schellhase KG, Marbella AM. Implementing an electronic medical record at a residency site: physicians' perceived effects on quality of care, documentation, and productivity. WMJ 2009; 108:99-103. [PMID: 19437936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND Electronic Medical Records (EMRs) are quickly becoming a standard component of medical practices. OBJECTIVES We longitudinally studied the impact of EMR implementation on physician perceptions of quality of care, documentation, and work hours, as well as on measured physician productivity. METHODS Physicians were surveyed at 3-month intervals regarding perceived impact of the EMR on quality of care, documentation, and productivity. Relative Value Units (RVUs) per clinic hours were used to measure productivity. Paired t-tests were used to compare the mean RVUs per clinic hour in the pre-EMR with the immediate post-EMR time period and the long-term post-EMR time period. RESULTS RVUs per hour increased significantly from the pre-EMR time period to the immediate post-EMR time period (means 1.49 and 1.82, respectively, P = 0.0007). The long-term post-EMR time period also showed a significant increase over the pre-EMR period (mean 1.79, P = 0.007). Sixty-six percent of physicians perceived that EMR implementation increased their work amount a little or much more. CONCLUSION Not only did physician production rise immediately, it stayed at the increased level for the duration of our study period. This may be due to improved documentation supporting more appropriate billing. However, physicians also perceived the EMR as taking up more of their time.
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Affiliation(s)
- Gregory L Brotzman
- Department of Family and Community Medicine, Medical College of Wisconsin, Milwaukee, USA.
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Abstract
OBJECTIVE Competency is affected by skill exposure, skill complexity, and training program quality. The purpose of this study was to reevaluate the biennial (24-month) critical care skill and experience benchmark thresholds established by the Milwaukee County Emergency Medical Services (MCEMS) system in 1997. METHODS This was a retrospective review of annual experience profiles for paramedics working during 2001-2005 using the MCEMS patient care record (PCR) database. The number of patient contacts, role as team leader/report writer, adult and pediatric endotracheal intubations, adult and pediatric intravenous (IV) access initiations, medication administration, and 12-lead electrocardiogram (ECG) acquisitions were analyzed. t-tests and descriptive statistics were performed for comparison with the 1997 study. RESULTS Over the five-year study period, 1,215 paramedic profiles gleaned from 107,524 PCRs documented a total of 297,900 patient contacts. Annual means+/-standard deviations [ranges] were as follows: patient contacts 245+/-133 [12-788]; team leader: 106+/-119 [0-739]; intubations: adult 2.57+/-2.54 [0-20], pediatric 0.1+/-0.3 [0-3]; IV starts: adult 44+/-37 [0-267], pediatric 0.34+/-0.77 [0-5]; treated cardiac arrests: adult 8+/-6 [0-34], pediatric 0.26+/-0.61 [0-4]; treated hypotensive trauma: 5+/-6 [0-42]; and ECGs acquired: 31+/-19 [0-144]. The 1997 analysis (1987-1996 data) included 1,450 paramedic profiles representing 467,559 patient contacts generated from 172,131 filed PCRs. All comparable experiences decreased significantly between the 1997 analysis and the current study, except medication administration, which increased 25%. CONCLUSION These data show a decreased opportunity and a wide variability in the frequency of successfully completed paramedic technical skills and experiences in this EMS system. Limited exposure to critically ill adult and pediatric patients reaffirms that high-risk skills are performed infrequently. A multifaceted approach should be considered for maintaining provider competency.
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Affiliation(s)
- Kristin M Vrotsos
- Department of Emergency Medcine, Injury Research Center, Medical College of Wisconsin, Milwaukee, WI 53226, USA
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Sumner SA, Layde PM, Guse CE. Firearm death rates and association with level of firearm purchase background check. Am J Prev Med 2008; 35:1-6. [PMID: 18482823 DOI: 10.1016/j.amepre.2008.03.023] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2007] [Revised: 02/01/2008] [Accepted: 03/11/2008] [Indexed: 10/22/2022]
Abstract
BACKGROUND Past ecologic analyses of firearm deaths have studied the effects of various gun-control laws; however, no study has analyzed the effects of the differences among states in the background checks required for firearm purchase. Some states utilize a federal agency to conduct the background checks; others use a state agency; still others use a local agency. The information potentially available to checking agencies at different levels of government varies; the consequence of this variation is not known. METHODS In 2007, negative binomial regression models were used to assess the association between the Department of Justice classification of agencies conducting firearm background checks for each state in 2002-2004 and firearm suicide and homicide rates for the same years from the National Center for Injury Prevention and Control while controlling for age, race, unemployment, crime, income inequality, poverty, alcohol consumption, urbanization, and divorce rate. RESULTS Performing local-level background checks was associated with a 27%-lower firearm suicide rate (incidence rate ratio [IRR]=0.73, 95% CI=0.60, 0.89) and a 22%-lower homicide rate (IRR=0.78, 95% CI=0.61, 1.01) in adults>or=21 years. CONCLUSIONS Using local-level agencies to perform firearm background checks is associated with reduced rates of firearm suicide and homicide. Methods to increase local-level agency background checks, such as authorizing local police or sheriff's departments to conduct them, or developing the capability to share local-level records with federal databases, should be evaluated as a means of reducing firearm deaths.
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Affiliation(s)
- Steven A Sumner
- Injury Research Center, Medical College of Wisconsin, Milwaukee, Wisconsin 53226-0509, USA
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Abstract
OBJECTIVE To determine use and knowledge of belt positioning booster seats by drivers transporting children from day care centers in the central city of Milwaukee, Wisconsin. METHODS A prospective, direct observational, community-based, exploratory study was undertaken in May 2005. Eighteen day care centers in urban Milwaukee that met the predetermined criteria, including > 10 children ages 4-8 enrolled, were invited to participate. Volunteer observers, including Spanish-speaking members, from community organizations were trained in proper placement by certified car seat technicians. Teams visited sites, completed a standardized survey form with drivers who agreed to participate, and observed the type and placement of restraint in which each child was placed. RESULTS Of 841 children observed, 283 were determined to be booster-seat eligible. Only 21% were in the appropriate restraint. Latino, African American, and older children were significantly less likely than white and younger children to be appropriately restrained. Appropriate restraint use was more frequent among those living in the proper ZIP codes with higher median incomes. CONCLUSIONS This is the first observational study of booster seat use in this Milwaukee population with appropriate restraint use varying widely from reported state and national data. The low rates of appropriate booster seat use, particularly by Latino and African American caregivers and those living in low-income neighborhoods, in this large metropolitan center supports the need for further study and targeted interventions.
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Affiliation(s)
- Suzanne Brixey
- Department of Pediatrics, Medical College of Wisconsin, Children's Research Institute, Milwaukee, Wisconsin, USA.
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35
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Abstract
BACKGROUND US citizens are increasingly traveling, working, and studying abroad as well as retiring abroad. The objective of this study was to describe the type and scope of injury deaths among US citizens abroad and to compare injury death proportions by region to those in the United States. METHODS A cross-sectional design using reports of US citizen deaths abroad for 1998, 2000, and 2002 on file at the US State Department was employed. The main outcome measures were the frequencies of injury deaths and proportional mortality ratios (PMRs) comparing deaths abroad to deaths in the United States. RESULTS Two thousand eleven injury deaths were reported in the 3 years, comprising 13% of all deaths. The overall age-adjusted PMR for injury fatalities abroad compared to the United States was 1.6 (95% confidence interval 1.6-1.7). The highest age-adjusted PMRs for motor vehicle crashes were found in Africa (2.7) and Southeast Asia (1.6). The proportion of drowning deaths was elevated in all regions abroad. CONCLUSIONS Injuries occur at a higher proportion abroad than in the United States. Motor vehicle crash and drowning fatalities are of particular concern. Improved data quality and surveillance of deaths would help government agencies create more evidence-based country advisories.
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Affiliation(s)
- Clare E Guse
- Injury Research Center, Department of Family and Community Medicine, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
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36
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Abstract
BACKGROUND Many factors are known to impact quality of life (QoL) after injury, but predictors of diminished QoL and the time course of recovery remain incompletely understood. This study examines predictors and correlates of QoL measured by the Short Form-36 (SF-36) one and six months postinjury. METHODS Adults with nonneurologic blunt injury were prospectively enrolled. Demographic, injury, and socioeconomic data were collected. Patients were assessed with functional and psychologic measures. In all, 196 patients had 1-month data and 123 had 6-month data available. Scores were compared at each time point and also to population norms using t-tests. Multiple regression techniques were used to identify associations between the physical and mental component scores (PCS & MCS) of the SF-36 and patient characteristics. RESULTS PCS scores improved significantly (32.8 +/- 0.9 versus 41.3 +/- 1.0, p < 0.05) whereas MCS scores (47.5 +/- 1.1 versus 47.2 +/- 1.1, p = NS) did not. Both remained significantly below population norms. Functional Independence Measure (FIM) at one month was predictive of PCS at 6 months. Posttraumatic stress disorder (PTSD) was predictive of lower MCS, and depression was associated with poor MCS. Injury Severity Score was not associated with PCS or MCS. CONCLUSIONS Overall physical and mental QoL measured by the SF-36 remains significantly below population norms 6 months after traumatic injury. It is possible to identify patients at risk for diminished QoL early during recovery by screening for functional status, PTSD, social support, and depression. Interventions to address these areas should be further studied with respect to their impact on long-term QoL.
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Affiliation(s)
- James M Kiely
- Department of Surgery, Division of Trauma/Critical Care, Medical College of Wisconsin, Milwaukee, Wisconsin 53226, USA
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37
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Abstract
PURPOSE We wanted to estimate excess risk of in-hospital mortality associated with medical injuries identified using an injury surveillance system, after controlling for risk of death resulting from comorbidities. METHODS The Wisconsin Medical Injuries Prevention Program (WMIPP) screening criteria were used to identify medical injuries, defined as "any untoward harm associated with a therapeutic or diagnostic healthcare intervention," among discharge diagnoses for all 562,317 patients discharged from 134 acute care hospitals in Wisconsin in 2002. We then derived estimates for crude and adjusted relative risk of in-hospital mortality associated with the presence of a medical injury diagnosis. Logistic regression adjusted for baseline risk of mortality using a comorbidity index, age, sex, Diagnosis Related Groups, hospital characteristics, and clustering within hospital. RESULTS There were 77,666 discharges that met WMIPP criteria for at least 1 medical injury (13.8%). Crude risk ratios for death ranged from 1.27 to 2.4 for those with medical injuries within 1 of 4 categories: drugs/biologics; devices, implants, and grafts; procedures; and radiation. After adjustment, estimates of excess mortality decreased, and significance persisted only for injuries related to procedures (39%; 95% confidence interval [CI], 28%-52%) and devices, implants, and grafts (16%; 95% CI, 3%-30%). CONCLUSIONS Estimates of excess mortality that do not account for baseline mortality risk may be exaggerated. Findings have implications for the care family physicians provide in the hospital and for the advice they give their patients who are concerned about the risks of hospitalization.
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Affiliation(s)
- Linda N Meurer
- Department of Family and Community Medicine, Medical College of Wisconsin, Milwaukee, Wisc 53226, USA.
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Abstract
OBJECTIVE In single-institution studies, age is a risk factor for mortality after rib fracture. Sample size has limited the assessment of other risk factors. We used a national database to analyze suspected risk factors contributing to pneumonia and mortality in patients sustaining rib fractures. DESIGN : Database analysis. PATIENTS All patients with rib fractures discharged from hospitals submitting information to the Nationwide Inpatient Sample database. INTERVENTIONS The 1999 Nationwide Inpatient Sample was queried for all patients with rib fracture. Age, gender, number of rib fractures, Injury Severity Score, comorbidities, pneumonia, and mortality were abstracted from the database. Comorbidities were scored according to Elixhauser. Multivariate analysis identified independent risk factors for mortality and pneumonia. MEASUREMENTS AND MAIN RESULTS We identified 23,426 patients; 17,308 patients had a primary diagnosis of trauma and were included in the analysis. Mean age was 56. Mean Injury Severity Score was 13.1. The number of comorbidities ranged from 0 to 9. Overall mortality was 4%. Six percent of patients had pneumonia. In a multivariate model, age and Injury Severity Score were significantly associated with both mortality and pneumonia. Comorbidity score was associated with pneumonia and mortality only in patients with isolated thoracic trauma. Pneumonia was associated with mortality only in patients with isolated thoracic trauma. CONCLUSIONS In a model controlling for multiple known risk factors, age and Injury Severity Score were the only important predictors of mortality in patients with rib fractures and multiple-system injury. Pneumonia was significantly associated with mortality only in patients with isolated thoracic trauma.
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Affiliation(s)
- Karen J Brasel
- Department of Surgery, Injury Research Center, Medical College of Wisconsin, USA
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39
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Abstract
OBJECTIVE To examine multiple risk factors for medical injury using administrative data. DESIGN This cross-sectional study used logistic regression models to examine associations among patient characteristics such as age, sex, and insurance payer status and hospital characteristics such as ownership, teaching status and trauma level, and comorbidities and presence of a medical injury diagnosis. Data were from the Bureau of Health Information: Wisconsin hospital in-patient discharge records and hospital characteristics for the year 2001. SETTING All Wisconsin non-federal, acute-care hospitals. PARTICIPANTS A total of 556 899 patients discharged from 132 Wisconsin hospitals, excluding newborns, participated. INTERVENTION None. Main outcome measure. Medical injury, defined as untoward harm to a patient as a result of a medical intervention, was determined using discharge diagnosis criteria. RESULTS Medical injuries were found in 13.3% of 556 899 hospital discharge records. Covariates associated with increased risk of a recorded medical injury code included age 45-84 years, female sex, comorbidities, non-profit religious order ownership, proportion of cardiac intensive care in-patient days to total in-patient days, percent of board-certified medical staff, and community trauma center or regional trauma resource. CONCLUSION This article describes an innovative analysis of risk factors for medical injury that controlled for numerous potential confounding factors, including hospital coding characteristics. The associations we found, such as increased risk of medical injury in women, can be used to generate hypotheses for further testing through other methods and suggest intervention points for patient safety efforts.
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Affiliation(s)
- Clare E Guse
- Medical College of Wisconsin, Family & Community Medicine, Milwaukee, WI 53226, USA.
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40
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Abstract
BACKGROUND Inpatient medical injuries among children are common and result in a longer stay in hospital and increased hospital charges. However, previous studies have used screening criteria that focus on inpatient occurrences only rather than on injuries that also occur in ambulatory or community settings leading to hospital admission. OBJECTIVE To describe the incidence and outcomes of medical injuries among children hospitalized in Wisconsin using the Wisconsin Medical Injury Prevention Program (WMIPP) screening criteria. METHODS Cross sectional analysis of discharge records of 318,785 children from 134 hospitals in Wisconsin between 2000 and 2002. RESULTS The WMIPP criteria identified 3.4% of discharges as having one or more medical injuries: 1.5% due to medications, 1.3% to procedures, and 0.9% to devices, implants and grafts. After adjusting for the All Patient Refined-Diagnosis Related Groups disease category, illness severity, mortality risk, and clustering within hospitals, the mean length of stay (LOS) was a half day (12%) longer for patients with medical injuries than for those without injuries. The similarly adjusted mean total hospital charges were 1614 dollars (26%) higher for the group with medical injuries. Excess LOS and charges were greatest for injuries due to genitourinary devices/implants, vascular devices, and infections/inflammation after procedures. CONCLUSIONS This study reinforces previous national findings up to 2000 using Wisconsin data to the end of 2002. The results suggest that hospitals and pediatricians should focus clinical improvement on medications, procedures, and devices frequently associated with medical injuries and use medical injury surveillance to track medical injury rates in children.
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Affiliation(s)
- J R Meurer
- Department of Pediatrics and Children's Research Institute, Medical College of Wisconsin in Milwaukee, WI 53233, USA.
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41
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Abstract
OBJECTIVES We examined the role of body mass index (BMI) and other factors in driver deaths within 30 days after motor vehicle crashes. METHODS We collected data for 22 107 drivers aged 16 years and older who were involved in motor vehicle crashes from the Crashworthiness Data System of the National Automotive Sampling System (1997-2001). We used logistic regression and adjusted for confounding factors to analyze associations between BMI and driver fatality and the associations between BMI and gender, age, seatbelt use, type of collision, airbag deployment, and change in velocity during a crash. RESULTS The fatality rate was 0.87% (95% confidence interval [CI]=0.50, 1.24) among men and 0.43% (95% CI=0.31, 0.56) among women involved as drivers in motor vehicle crashes. Risk for death increased significantly at both ends of the BMI continuum among men but not among women (P<.05). The association between BMI and male fatality increased significantly with a change in velocity and was modified by the type of collision, but it did not differ by age, seatbelt use, or airbag deployment. CONCLUSIONS The increased risk for death due to motor vehicle crashes among obese men may have important implications for traffic safety and motor vehicle design.
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Affiliation(s)
- Shankuan Zhu
- Injury Research Center and Dept of Family and Community Medicine, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI 53226, USA.
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Abstract
BACKGROUND The SF-36 is a commonly used general measure of health-related quality of life (QoL). The SF-12 is a related tool with less response burden, but its performance in a general trauma population is unknown. HYPOTHESIS The SF-12 would provide similar QoL information to the SF-36 in blunt trauma patients. METHODS Adults with nonneurological blunt injury were prospectively enrolled. Demographic, injury, and socioeconomic data were collected. Patients were assessed with functional and psychologic questionnaires 1 and 6 months after injury. Physical (PCS) and mental (MCS) component scores of the SF-36 and SF-12 were compared using Pearson's correlation coefficient. Linear regression identified factors associated with the SF-12 and SF-36 PCS and MCS. Responsiveness to change was assessed using the standardized response mean. RESULTS Correlation of the PCS was 0.924 and MCS was 0.925 (both P < 0.001). QoL remained below population norms at 6 months. PCS was moderately responsive to change and was equivalent using either the SF-12 or the SF-36. MCS was not responsive to change using either tool. At both time points, at least 25% of patients with normal SF-12 PCS or MCS had SF-36 subscale scores significantly below the normal population. CONCLUSIONS The SF-12 can be used to assess QoL in trauma patients. The lack of responsiveness to change of the MCS suggests other methods may be necessary to fully evaluate mental QoL. Summary scores may not be sufficient to fully assess QoL in this population. Combining the SF-12 with measures to assess psychosocial variables should be further investigated.
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Affiliation(s)
- James M Kiely
- Department of Surgery, Division of Trauma/Critical Care, Medical College of Wisconsin, Milwaukee, WI 53226, USA
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Fohr SA, Layde PM, Guse CE. Graduated driver licensing in Wisconsin: does it create safer drivers? WMJ 2005; 104:31-6. [PMID: 16294597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
OBJECTIVES The purpose of this study was to measure the effectiveness of Wisconsin's graduated driver licensing law and determine whether a reduction in crash rates was due to reduced exposure, safer driving, or both. METHODS General population crash rates for 16 and 17 year olds were computed for years before and after graduated drivers licensing. The induced exposure method was used to measure exposure and compute the odds ratio of at-fault crash involvement. RESULTS For 16 year olds, general crash rates declined 13.8% while injury crash rates declined 15.6%. For 17 year olds, crash rates declined 6.2% for all crashes and 5.8% for injury crashes. There was no statistically significant change in the odds ratio of at-fault crash involvement for 16- or 17-year-old drivers, relative to the reference group. After graduated drivers licensing, 16-year-old drivers were more likely to have at least 1 adult present and less likely to carry 2 or more teen passengers. There was no statistically significant effect on driving habits by time for 16 year olds. CONCLUSIONS Graduated driver licensing in Wisconsin has resulted in a drop in the general population crash rates for 16 and 17 year olds. This decrease is the result of reduced exposure to the risk of collision rather than safer driving by teens.
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Marbella AM, Yang H, Guse CE, Meurer JR, Layde PM. Adolescent hospital discharges associated with self-poisonings in Wisconsin, 2000-2002. WMJ 2005; 104:59-64. [PMID: 16294602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
OBJECTIVE This study investigates the Wisconsin adolescent self-poisoning problem, using state discharge data on medication-related self-inflicted injuries, focusing on medications used and risk factors. METHODS Wisconsin inpatient discharge files for 3 years (January 1, 2000-December 31, 2002) were evaluated. Medication-related injuries were analyzed for intentionality, medications used, discharge status, and risk factors such as mental illness, eating disorders, and alcohol abuse or dependence. RESULTS There were nearly 3000 medication-related injury hospitalizations--1150 of them self-poisoning hospitalizations--among Wisconsin 12-17 year olds during 2000-2002. Females 12-17 years had twice as many medication-related injuries as males. Sixty percent of medication-related injuries occurred in patients with a mental disorder diagnosis. Non-narcotic analgesics were most commonly used and had one of the highest rates of intentionality (65%). A large proportion of intentional/suicidal medication-related injuries were discharged to another facility (35%), compared to 14% among all medical injuries. Males with medication-related injuries were twice (95% CI: 1.60, 2.75) as likely and females 1.4 (95% CI: 1.2, 1.6) times as likely to have intentional/suicidal injuries if they also abused or depended on alcohol. CONCLUSIONS Given that a nonfatal suicide attempt is the strongest predictor of eventual suicide, the hundreds of self-poisoning discharges per year in Wisconsin 12-17 year olds is a serious public health concern. Both the medical community and public health community should heed the warnings of these nonfatal suicide attempts and implement educational programs addressing this issue.
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Affiliation(s)
- Anne M Marbella
- Injury Research Center, Medical College of Wisconsin, Department of Family and Community Medicine, Milwaukee 53226, USA.
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45
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Abstract
OBJECTIVE To describe the incidence and patterns of sports and recreation related injuries resulting in inpatient hospitalization in Wisconsin. Although much sports and recreation related injury research has focused on the emergency department setting, little is known about the scope or characteristics of more severe sports injuries resulting in hospitalization. SETTING The Wisconsin Bureau of Health Information (BHI) maintains hospital inpatient discharge data through a statewide mandatory reporting system. The database contains demographic and health information on all patients hospitalized in acute care non-federal hospitals in Wisconsin. METHODS The authors developed a classification scheme based on the International Classification of Diseases External cause of injury code (E code) to identify hospitalizations for sports and recreation related injuries from the BHI data files (2000). Due to the uncertainty within E codes in specifying sports and recreation related injuries, the authors used Bayesian analysis to model the incidence of these types of injuries. RESULTS There were 1714 (95% credible interval 1499 to 2022) sports and recreation-related injury hospitalizations in Wisconsin in 2000 (32.0 per 100,000 population). The most common mechanisms of injury were being struck by/against an object in sports (6.4 per 100,000 population) and pedal cycle riding (6.2 per 100,000). Ten to 19 year olds had the highest rate of sports and recreation related injury hospitalization (65.3 per 100,000 population), and males overall had a rate four times higher than females. CONCLUSIONS Over 1700 sports and recreation related injuries occurred in Wisconsin in 2000 that were treated during an inpatient hospitalization. Sports and recreation activities result in a substantial number of serious, as well as minor injuries. Prevention efforts aimed at reducing injuries while continuing to promote participation in physical activity for all ages are critical.
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Affiliation(s)
- R L Dempsey
- Injury Research Center, Department of Family and Community Medicine, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
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Phelan MB, Hamberger LK, Guse CE, Edwards S, Walczak S, Zosel A. Domestic violence among male and female patients seeking emergency medical services. Violence Vict 2005; 20:187-206. [PMID: 16075666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Gender differences among a cohort of injured patients seeking emergency medical services were examined with respect to their experiences as perpetrators and/or victims of domestic violence. Contextual issues, including violence initiation, emotional and behavioral responses to partner-initiated violence, and injury frequency and severity were analyzed. Women reported male partner-initiated violence more frequently than men reported female partner-initiated violence. Behavioral responses to partner initiated violence varied. Women were more likely to report using force back and to involve law enforcement. Women were more likely to be injured in a domestic assault over their lifetime, within the last year, and at the time of recruitment. Comparison of injury severity revealed that women reported higher rates of injuries than men in all possible severity categories. Women also reported experiencing more fear than men during partner-initiated violence, as well as being subjected to larger numbers of dominating and controlling behaviors, and greater intimidation secondary to their partner's size. Understanding contextual differences in partner violence for women and men has significant implications for policy development, identification, treatment, and referral of patients identified as living in violent relationships.
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Affiliation(s)
- Mary Beth Phelan
- Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI 53266, USA.
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Abstract
OBJECTIVE To identify the prevalence of upper extremity pain symptoms in fly-casting instructors and examine the association between pain and casting style and equipment. METHODS We used a cross-sectional survey of a randomly selected group of 577 fly-casting instructor mailing-list members and recorded equipment; casting styles; pain symptoms; and Disability of the Arm, Shoulder, and Hand inventory. We used univariate statistical tests to examine the associations between pain and casters' equipment and styles. RESULTS In 292 usable surveys, pain was reported in the shoulder (50%), elbow (39%), and wrist (36%) of those surveyed and was characterized as moderate-to-severe by 25% of all respondents. Overhead casting was associated with less frequent wrist and elbow pain than was sidearm or elliptical casting. Respondents who used multiple casting styles had significantly less elbow pain than did single-style casters (7% vs 38% overhead, P = .04: 45% sidearm, P = .02; 71% elliptical, P = .003). Pain was significantly more frequent in those who cast with a haul (75% vs 33%, P = .04), used shooting heads (79% vs 66%, P = .04), or added weight to sinking flies (78% vs 60%, P = .01). Moderate-to-severe pain was more frequent in fishers of heavy saltwater fish. CONCLUSIONS Upper extremity pain was frequent, but not often severe, in this group of fly-casting instructors. Increased weight on the line and "haul" technique appeared to increase pain symptoms. Modifications in casting style and equipment may help in avoiding or reducing pain.
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Affiliation(s)
- Timothy J McCue
- Curry Health Center, The University of Montana, Missoula, MT 59812, USA.
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Guse CE, Marbella AM, Layde PM, Christiansen A, Remington P. Clean indoor air policies in Wisconsin workplaces. WMJ 2004; 103:27-31. [PMID: 15481867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
OBJECTIVE To describe the nature and extent of workplace environmental tobacco smoke exposures in Wisconsin. METHODS Descriptive data and confidence intervals from the Current Population Survey tobacco supplements of 1995-1996 and 1998-1999 are presented. RESULTS The percent of indoor workers working under a smoke-free policy increased slightly, from 62% in 1995-1996 to 65% in 1998-1999. Respondents with a college degree were more likely to work under a smoke-free policy than those with a high school education or less. Among respondents with a work policy in 1998-1999, a complete ban on smoking reduced any workplace exposure in the past 2 weeks (4%) compared to a partial ban (26%) or an unrestricted policy (30%). CONCLUSION Wisconsin has seen a small increase in workplace policies that ban smoking in the workplace. These policies are more likely to protect workers of higher socioeconomic status and may increase health disparities in tobacco-related diseases in the future.
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Affiliation(s)
- Clare E Guse
- Department of Family and Community Medicine, Medical College of Wisconsin, USA
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Guse CE, Porinsky R. Risk factors associated with hospitalization for unintentional falls: Wisconsin hospital discharge data for patients aged 65 and over. WMJ 2003; 102:37-42. [PMID: 12967020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
OBJECTIVE To identify risk factors associated with hospitalizations for falls in Wisconsin in patients aged 65 and older. METHODS This study was a cross-sectional study of year 2000 hospital inpatient discharge records for patients aged 65 and older who did not have a diagnosis-related group code indicating rehabilitation, obtained from the Wisconsin Bureau of Health Information. The database includes all discharges from all non-federal Wisconsin hospitals. RESULTS Of 223,085 discharged older adults, 6.9% had an unintentional fall diagnosis. Independent predictors of an unintentional fall diagnosis were age, sex, time of year of discharge, region of residence, alcohol-related problems, dementia, Parkinson's disease, mechanical and motor problems, altered consciousness, convulsions/epilepsy, anemia, and glaucoma. CONCLUSIONS Alcohol-related problems and mechanical and motor problems significantly increased the risk of a fall diagnosis in hospitalized patients aged 65 and over.
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Affiliation(s)
- Clare E Guse
- Department of Family and Community Medicine and Injury Research Center, Medical College of Wisconsin, Milwaukee, Wis 53226, USA.
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Abstract
BACKGROUND Residency clinics with high no-show rates experience negative ramifications in patient health care, continuity, clinic productivity, and learning experiences for residents. This study tested patient education in the form of an exit interview to reduce no-show rates. METHODS All eligible new patients at St. Mary's Family Practice Center between 1 February 1996 and 30 April 1997 were offered study enrollment. Patients with initial appointments during 5 of 9 clinic sessions were offered an exit interview with visit debriefing, written patient information where appropriate, and review of clinic policies. Missed patients or those with initial appointments during the remaining 4 sessions formed the control group. Interviewers were social work, medical, and nursing students. Insurance and subsequent appointment data were obtained from billing records. Median household income of ZIP codes in which patients resided was obtained from the 1990 Federal Census data. Data were analyzed using chi(2) tests, Wilcoxon rank-sum tests, and logistic regression. RESULTS One hundred forty-six patients were enrolled into the intervention and 297 into the control group. Simple logistic regression showed a significant reduction in the risk of no-shows in the intervention group (odds ratio = 0.71, P =.04). CONCLUSIONS The exit interview improved attendance at subsequent visits.
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Affiliation(s)
- Clare E Guse
- Department of Family and Community Medicine, Medical College of Wisconsin, Milwaukee 53226, USA
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