Accidents & Violence, Author Interviews, Education, Geriatrics, Nursing / 10.07.2016

MedicalResearch.com Interview with: MedicalResearch.com: What is the background for this study? What are the main findings? Response: The impetus for this article was our experience from working at FAU’s Christine E. Lynn College of Nursing’s Louis and Anne Green Memory and Wellness Center with families as we conducted assessments of older adults referred to our program by family members or law enforcement. We realized that there is a need to educate nurses that a) they can help to identify persons who may be at risk for unsafe driving before accidents occur, and b) there are resources to help families and nurses navigate this challenging topic. This awareness is especially important for persons and friend/family members who find themselves trying to cope with a known or potential diagnosis of dementia. (more…)
Accidents & Violence, Author Interviews, Pediatrics, Toxin Research / 28.06.2016

MedicalResearch.com Interview with: Thomas Swain, MPH Research Assistant, The Center for Injury Sciences, Division of Trauma, Burns and Surgical Critical Care, Department of Surgery University of Alabama at Birmingham Birmingham, AL 35294 MedicalResearch.com: What is the background for this study? What are the main findings? Response: Case reports show that the number of laundry pod detergent related cases is increasing rapidly and children are disproportionately affected by pod detergent. Pod detergent is highly concentrated and contained in a water-soluble membrane. Prior research of pod laundry detergent did not include regular, non-pod detergent; this exclusion rendered cases and severity of cases between the two incomparable. This study, comparing regular laundry detergent and pod detergent, from 2012-2014 in the United States, using national data from emergency department visits, found that children under 5 accounted for 93.8% of pod detergent related exposures and 71.8% of non-pod exposures. Importantly, 71.8% of pod exposures were diagnosed as poisoning while 72.2% of non-pod exposures were diagnosed as contact dermatitis. Those exposed to pods were 4.02 times as likely to be hospitalized, a marker for severe injury, when compared to non-pod detergent (OR: 4.02; 95% CI: 1.96-8.24). (more…)
Accidents & Violence, Author Interviews, Ophthalmology, Technology / 20.06.2016

MedicalResearch.com Interview with: Jeff C. Rabin, O.D., M.S., Ph.D., F.A.A.O., Dipl. Vision Science Professor and Assistant Dean for Graduate Studies, Research and Assessment Chief, Visual Neurophysiology Service University of the Incarnate Word Rosenberg School of Optometry San Antonio, TX MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Rabin: The use of hand-held cellphones during driving has been widely banned but the impact of hands-free communication on visual performance remained unclear. Therefore, we used a standard automobile Bluetooth device suspended above our visual display and determined that hands-free communication significantly delayed response time to detect low contrast black-white and color targets. Moreover, hands-free communication decreased sensitivity of “color-blind” subjects to detect targets corresponding to their color deficiency and all subjects showed a tendency for decreased sensitivity for detection of small, low contrast black-white targets. (more…)
Accidents & Violence, Author Interviews, Emergency Care / 15.06.2016

MedicalResearch.com Interview with: Angela Sauaia MD PhD Professor of Public Health, Medicine, and Surgery University of Colorado Denver MedicalResearch.com: What is the background for this study? What are the main findings? Authors: Americans mourn firearm related fatalities every day. Mass shootings are just the tip of the iceberg of the daily tragedy witnessed by trauma surgeons in emergency rooms. Industries strive to reduce the perils associated with motor vehicles, pedestrian and bicycles accidents, just to cite a few, through technology and education. Firearms move in the exact opposite direction. They are becoming progressively more dangerous and we have done little in terms of education to prevent accidents. The same trend is true for monitoring statistics. It is not difficult to obtain statistics on which type of car was associated with more accidents or fatalities. Conversely, trying to obtain data on which type of firearms are more likely to result in accidents or death is extremely difficult. We used the best data we could find and found that, contrary to every other injury mechanism, firearm injuries are becoming more lethal. In simple words, if you get into a car accident today, you are more likely to survive it due to improvements in trauma care and safety of vehicles than 10 years ago. On the other hand, if you get shot today, you are more likely to die than if you were shot 10 years ago, despite our excellent trauma care. (more…)
Accidents & Violence, Author Interviews, CDC, Pediatrics / 09.06.2016

MedicalResearch.com Interview with: Laura Kann, PhD Chief, School-Based Surveillance Branch Division of Adolescent and School Health National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP) Centers for Disease Control and Prevention (CDC) MedicalResearch.com: What is YRBSS? Dr. Kann: The Youth Risk Behavior Surveillance System (YRBSS) is the only surveillance system designed to measure the major health risk behaviors among our nation's high school students and to track those behaviors over time at the national, state, and local levels. Reports from this surveillance system have been released every two years since 1991. More information is available at: www.cdc.gov/yrbs. (more…)
Accidents & Violence, Author Interviews, BMJ, Mental Health Research, Pediatrics / 17.05.2016

MedicalResearch.com Interview with: Dr Edward Tyrrell NIHR In-Practice Research Fellow Division of Primary Care University Park Nottingham  MedicalResearch.com: What is the background for this study? Dr. Tyrrell: Poisonings are among the most common causes of death amongst adolescents across the world, many of them related to self-harm. Poisonings leading to death are just the tip of the iceberg with many more resulting in invasive treatment, time off school and long term health effects. Many adolescent self-harm episodes are linked to mental health problems, which are often predictive of mental health problems in adulthood, making adolescence a key window for preventative intervention. However, up to date rates and time trends for adolescent poisonings are lacking, hindering the development of evidence-informed policy and planning of services. To quantify this problem at a national level and provide recent time trends of poisonings, we used routinely collected primary care data from 1.3 million 10-17 year olds. We assessed how intentional, unintentional and alcohol-related poisonings for adolescent males and females vary by age, how these have changed between 1992 and 2012 and whether socioeconomic inequalities exist. (more…)
Accidents & Violence, Author Interviews, Cannabis / 11.05.2016

MedicalResearch.com Interview with: Mr. Brian C. Tefft Senior Research Associate AAA Foundation for Traffic Safety MedicalResearch.com: What is the background for this study? What are the main findings? Response: In December 2012, a new law took effect in Washington state that effectively legalized the possession and use of small amounts of marijuana by adults aged 21 years and older for recreational purposes, and also created a legal limit for driving under the influence of marijuana such that having a concentration of 5.00 nanograms or greater of delta-9-tetrahydrocannabinol (THC, the main psychoactive chemical in marijuana) per milliliter of whole blood while driving in the state of Washington is per se driving under the influence. Data from population-based surveys indicate that the proportion of Washington state residents who report using marijuana increased after this law took effect; however, not much was known about the impact of this new law on traffic safety in the state. To investigate the traffic safety impact of the new law, we examined drug test results from drivers involved in motor vehicle crashes that occurred in years 2010 – 2014 in Washington and resulted in the death of at least one person within 30 days of the crash. Specifically, we looked at the proportion of all drivers involved in fatal crashes who had detectable THC in their blood at or shortly after the time of the crash, which generally suggests that the driver had used marijuana within the past few hours. Results showed that from 2010 through 2013, approximately 8-9% of drivers in fatal crashes each year were positive for THC, and that proportion was basically flat from 2010 through 2013. In 2014, the proportion basically doubled, to 17%. Our modelling suggests that an increasing trend in the proportion of drivers who were positive for THC began in late 2013, about 9-10 months after the new law took effect. (more…)
Accidents & Violence, Author Interviews, Global Health, Pediatrics / 27.04.2016

MedicalResearch.com Interview with: Prof Naeemah Abrahams South African Medical Research Council Chief  Specialist Scientist:  Gender & Health Research Unit Cape Town | Western Cape MedicalResearch.com: What is the background for this study? What are the main findings? Prof Abrahams: Violence is a common feature of the South African social landscape and the murder of children is the most severe form of violence against children.  A national child homicide study reflecting 2009 murdered was done. Information was collected from mortuaries and police detectives. We identified the demographic detail of the child, the perpetrator information (if available) and the motive of the killings. In this manuscript we look in greater detail at children under the age of 5 years as this group represent the 2nd largest group of children killed. We also have a focus on neonaticides. We estimated that 454 children under the age of 5 years were killed in South Africa in 2009. This means more than 1 young child killed per day. The study showed the first 6 days of life are the time point of highest risk for being killed among children under 5 years with more than half (53.2%) of the children killed within the 1st month of their lives and nearly two thirds of the children (74.4%)  killed as infants.  This is amongst the highest reported rates for neonaticide and infanticide. Parents, in particular mothers, were the most common perpetrator of the younger children – this is most likely due to them being responsible for the care of young children. (more…)
Accidents & Violence, Author Interviews, Pediatrics, Toxin Research / 25.04.2016

MedicalResearch.com Interview with: Dr. Gary Smith, MD PhD Director, Center for Injury Research and Policy Nationwide Children's Hospital MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Smith: Laundry detergent packets are relatively new to the U.S. market (introduced in 2012). As their popularity has increased, so have calls to poison centers for detergent packet exposures. The study analyzed calls to poison centers and compared exposures to young children from dishwasher and laundry detergent packets as well as traditional (liquid and powder) dishwasher and laundry detergents. Incidents related to laundry detergent packets saw the biggest rise - increasing 17% over the two-year study period. Poison control centers received more than 30 calls a day on average about a child who had been exposed to a laundry detergent packet, which is about one call about every 45 minutes. Claims made by others that the rate of exposures is decreasing are misleading – these claims are based on an inappropriate use of numbers. Children exposed to laundry detergent packets were significantly more likely to be admitted to a healthcare facility or have a serious medical outcome than those exposed to other types of detergent. They were also more likely to have serious clinical effects. Coma, pulmonary edema, respiratory arrest, and death were only observed among children exposed to laundry detergent packets. (more…)
Accidents & Violence, Author Interviews, Pediatrics / 18.04.2016

MedicalResearch.com Interview with: Dr. Lara B. McKenzie PhD MA Principal Investigator Center for Injury Research and Policy The Research Institute Nationwide Children’s Hospital MedicalResearch.com: What is the background for this study? What are the main findings? Dr. McKenzie: Skateboarding is a popular recreational sport and participation has increased the last several decades, faster than any other sport or recreation activity between 1998 and 2007 (National Sporting Goods Association Sports Participation in 2007). With growing participation, has come an increasing rate of injuries from skateboarding. The study examined data for youth and adolescents 5-19 years of age who were treated in U.S. emergency departments (EDs) for skateboarding-related injuries from 1990-2008. It found that nationally, over the 19-year period, there was an average of 64,572 children and adolescents treated each year for skateboarding-related injuries – about 176 a day. Most patients were male (89 percent), and were injured either at home (38 percent) or in the street and/or highway (30 percent). The most commonly injured body regions were the upper (45 percent) and lower (32 percent) extremities. The most common diagnoses were fractures or dislocations (33 percent), sprains and strains (25 percent) and bruises (20 percent). Children and adolescents 11-14 years of age were hospitalized more often than younger or older children/adolescents. Lower extremity injuries increased with age, while face and head or neck injuries decreased with age. (more…)
Accidents & Violence, Author Interviews, Karolinski Institute, Social Issues / 15.04.2016

MedicalResearch.com Interview with: Zheng Chang, PhD Department of Medical Epidemiology and Biostatistics Karolinska Institutet Stockholm Medical Research: What is the background for this study? What are the main findings? Dr. Chang: More than 30 million people are released from prison worldwide every year. Despite reported decreases in violence in many countries, repeat offending remains high across many high-income and middle-income countries. Because there is considerable inconsistency and inefficiency in identifying those who are at high risk of reoffending and most in need of interventions, we developed and validated a clinical prediction rule to determine this risk in released prisoners. We did a cohort study of 47 326 prisoners released in Sweden between 2001 and 2009. We developed a 14-item model to predict violent reoffending, which includes modifiable risk factors and has been externally validated. The model showed good measures of discrimination and calibration. The study uses the methods to develop the prediction model on the basis of TRIPOD guidelines, and it is a brief, easy to use, and scalable tool. This tool has also been translated into a freely available web application (OxRec). (more…)
Accidents & Violence, Author Interviews, BMJ, Radiology, Zika / 14.04.2016

MedicalResearch.com Interview with: Maria de Fatima Vasco Aragao MD, PhD Radiologist and Neuroradiologist Professor of Radiology, Mauricio de Nassau University, Recife, Brazil Scientific Director of Multimagem Radiology Clinic, Recife - PE, Brazil President of Pernambuco Radiology Society MedicalResearch.com: What is the background for this study? Response: The new Zika virus epidemic in Brazil was recognized as starting in the first half of 2015 and the microcephaly epidemic was detected in the second half of that same year. MedicalResearch.com: What are the main findings?
  • Response:  In our study of the 23 mothers, only one did not report rash during pregnancy (rash is a sign that can happen in Zika virus infection). However, Zika virus infection can be asymptomatic in three of every four infected patients. All of the 23 babies had the same clinical and epidemiological characteristics and other congenital infection diseases had been excluded. Of these 23 babies, six were tested for IgM antibodies, specific to Zika virus and all six proved positive. So, by deduction, the other 17 babies on whom it was not possible to make the IgM test, were considered as also having presumed congenital infection related to the Zika virus, after other congenital infections being excluded.
  • All the babies showed malformations of cortical development and sulcation.  The most frequent cortical malformation were: Microcephaly with a simplified cortical gyral pattern and areas of thick cortex of polymicrogyria or pachygyria which were located predominantly in the frontal lobes.
  • Abnormalities of the corpus callósum (hypogenesis and hypoplasia) were common.
  • Decreased brain volume was a common finding. Ventriculomegaly was present in all the babies, with a predominant enlargement of the posterior portions of the lateral ventricles,
  • Delayed myelination were also common. The cisterna magna was enlarged in most of the cases, with or without cerebellar hypoplasia.
  • Some of the babies showed a symmetrical enlargement of the anterior subarachnoid space of the supratentorial compartment, associated with severe ventriculomegaly.
(more…)
Accidents & Violence, Author Interviews, CDC, Pediatrics, Sleep Disorders / 07.04.2016

MedicalResearch.com Interview with: Anne G. Wheaton, Ph.D. Epidemiologist Centers for Disease Control and Prevention National Center for Chronic Disease Prevention and Health Promotion Division of Population Health Epidemiology and Surveillance Branch Atlanta, GA  30341-3717  MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Wheaton: Unintentional injury, mostly from motor vehicle crashes, is the leading cause of death for adolescents. Adolescents who do not get enough sleep are at an increased risk for motor vehicle crashes and other unintentional injury, such as sports injuries and occupational injuries. We evaluated the association between self-reported sleep duration on an average school night and several injury-related risk behaviors (infrequent bicycle helmet use, infrequent seatbelt use, riding with a driver who had been drinking, drinking and driving, and texting while driving) among more than 50 thousand US high school students. The likelihood of each of five injury-related risk behaviors (infrequent bicycle helmet use, infrequent seatbelt use, riding with a driver who had been drinking, drinking and driving, and texting while driving) was significantly higher for students sleeping ≤7 hours on an average school night compared with 9 hours. Infrequent seatbelt use, riding with a drinking driver, and drinking and driving were also more likely for students sleeping ≥10 hours compared to 9 hours on an average school night. Although short and long sleep may simply be associated with other adolescent risk behaviors, insufficient sleep may cause individuals to take more risks and disregard the possibility of negative consequences. However, the study was cross-sectional, meaning the students were asked questions at one time point, so it is not possible to determine if there is a cause and effect association between sleep and these risk behaviors. Insufficient sleep may contribute to injury risk directly by slowing reaction time, impairing ability to pay attention, or causing a driver to fall asleep, but these results provide evidence that some of the increased risk associated with insufficient sleep might be due to engaging in injury-related risk behaviors. (more…)
Accidents & Violence, Author Interviews, Brigham & Women's - Harvard, Obstructive Sleep Apnea / 21.03.2016

MedicalResearch.com Interview with: Stefanos N. Kales, MD, MPH, FACP, FACOEM  Associate Professor, Harvard Medical School & Harvard TH Chan School of Public Health Director, Occupational Medicine Residency Division Chief OEM, Cambridge Health Alliance MedicalResearch: What is the background for this study? Dr. Kales: Up to 20% of all large truck crashes are due to drowsy or fatigued driving, which would account for almost 9,000 fatalities and up to 220,000 serious injuries. OSA is the most common medical cause of excessive daytime sleepiness or fatigue, and has been linked with negative impacts on attention, working memory, vigilance, and executive functioning. Past studies primarily of passenger car drivers have linked untreated OSA with a several-fold increased risk of motor vehicle accidents. They have also shown that effective treatment with CPAP reduces this risk close to that of unaffected drivers. Although commercial truck drivers undergo a biennial examination to determine their medical fitness to safely operate a vehicle, there are currently no mandatory standards for OSA screening or diagnosis, in part because there have been no large-scale studies evaluating the crash risk of commercial drivers diagnosed with OSA. Our study examined the results of the first large-scale employer program to screen, diagnose, and monitor OSA treatment adherence in the U.S. trucking industry  (more…)
Accidents & Violence, Author Interviews, JAMA, Pediatrics / 08.03.2016

MedicalResearch.com Interview with: Alison Culyba, MD MPH Adolescent Medicine Advanced Research Fellow Craig-Dalsimer Division of Adolescent Medicine Children’s Hospital of Philadelphia PhD Candidate, Epidemiology Department of Epidemiology and Biostatistics Perelman School of Medicine at the University of Pennsylvania  MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Culyba: Youth violence is a major public health problem. Homicide is the second leading cause of death among all adolescents in the U.S., and the number one cause of death among African American adolescents. Prom prior research, we know that where you live and where you spend time has a major impact on health, and that making changes to environments, such as greening vacant lots and remediating abandoned buildings, can significantly reduce crime. However, much less is known about the relationship between adolescent’s immediate surroundings and the risk of homicide. The goal of this study was to examine associations between neighborhood environmental features, such as streets, buildings, and natural surroundings and adolescent homicide. We conducted a population-based case control study of 143 adolescents, ages 13 to 20, who were victims of homicides in Philadelphia and 155 matched controls in the same range, who were outdoors in Philadelphia at the same time that the homicides occurred. To assess features in the immediate environments of homicide victims and control individuals, trained field staff stood on the street corner of each homicide and control location and took a series of photographs that we stitched together into 360-degree high resolution panoramas, which we assessed for environmental features. After accounting for many individual and neighborhood contextual factors, we found that the odds of homicide was significantly lower in locations with street lighting, pedestrian infrastructure, public transportation, parks, and maintained vacant lots. (more…)
Accidents & Violence, Author Interviews, BMJ, Brain Injury, CDC, Pediatrics / 29.02.2016

MedicalResearch.com Interview with: Dr. Joanne Klevens, MD, PhD, MPH Division of Violence Prevention US Centers for Disease Control and Prevention Atlanta, Georgia Medical Research: What is the background for this study? What are the main findings? Dr. Klevens: Pediatric abusive head trauma is a leading cause of fatal child maltreatment among young children and current prevention efforts have not been proven to be consistently effective. In this study, compared to seven states with no paid family leave policies, California’s policy showed significant decreases of hospital admissions for abusive head trauma in young children. This impact was observed despite low uptake of policy benefits by Californians, particularly among populations at highest risk of abusive head trauma. (more…)
Accidents & Violence, Author Interviews, JAMA / 29.02.2016

MedicalResearch.com Interview with: Anna-Karin Numé MD, PhD student Copenhagen University Gentofte Hospital Department of Cardiology Cardiovascular Research Hellerup Denmark  Medical Research: What is the background for this study? Dr. Numé: While it is obvious that a loss of consciousness while driving a car is very dangerous, what is not known is whether individuals who have had an episode of fainting (syncope) have a significantly higher risk of having car crashes in the future. Because about one third of patients with syncope are likely to have a recurrence, physicians face a difficult judgment about whether patients with syncope are fit to drive. Medical Research: What are the main findings? Dr. Numé: In this nationwide study of patients with syncope, having a history of syncope were associated with a 2-fold-higher risk of later motor vehicle crashes requiring medical attention at an emergency department or hospital compared with the general population – a risk that remained elevated throughout a follow-up of 5 years. This risk was small in absolute terms, yet raises important questions about policies towards driving. (more…)
Accidents & Violence, Author Interviews, JAMA / 11.02.2016

MedicalResearch.com Interview with: Dr. Andrew Fenelon PhD NIH Postdoctoral Fellow Brown University Medical Research: What is the background for this study? What are the main findings? Dr. Fenelon: The life expectancy of the US population is about 2 years less than that of other high-income nations, which is an important problem in public health. Although much previous work looks at differences in death rates among older adults, some recent work has shown that deaths at younger ages (below age 50) account for a significant fraction of the life expectancy gap. Our study examines the contribution of major injuries, Motor Vehicle Crashes, Firearm-related deaths, and drug poisonings, which often occur at younger ages and account for many years of lost life. Our findings indicate that US men and women experience significantly higher death rates from these three causes of injury death than each of the 12 comparison high-income countries. Overall, these three causes of death explained 48% of the 2.2 year life expectancy gap between the United States and other high-income countries among men, with firearm injuries alone explaining 21%. Among women, these causes explained 19%. (more…)
Accidents & Violence, Alcohol, Author Interviews, CMAJ / 10.02.2016

MedicalResearch.com Interview with: [wysija_form id="5"]Dr. Russ Callaghan, PhD Associate Professor Northern Medical Program University of Northern British Columbia Prince George, British Columbia  Medical Research: What is the background for this study? Dr. Callaghan: In Canada, the minimum legal drinking age (MLDA) is 18 years in Alberta, Manitoba and Québec, and 19 in the rest of the country. Given that public-health organizations not only have recommended increasing the MLDA to 19 years, but also have identified 21 years as ideal, the current study tested whether drivers slightly older than the MLDA had significant and abrupt increases in alcohol-impaired driving (AID) crimes, compared with their counterparts just younger than the MLDA. Data on the effectiveness of Canadian drinking-age laws is lacking, and the current study provides important information for the current national and international MLDA debates. (more…)
Accidents & Violence, Author Interviews / 03.02.2016

MedicalResearch.com Interview with: Erin Grinshteyn, PhD Assistant Professor University of Nevada-Reno School of Community Health Science Medical Research: What is the background for this study? What are the main findings? Dr. Grinshteyn: Gun deaths are a serious public health issue in the United States. This paper compared the US to 22 other high-income nations, and found that Americans are ten times more likely to be killed by a gun than their counterparts in the developed world. Gun homicide rates are 25 times higher in the U.S. and, while the overall suicide rate is on par with other high-income nations, the U.S. gun suicide rate is eight times higher. Ninety percent of women, 91% of all children aged 0 to 14 years, and 92% of youth aged 15 to 24 years who were killed by firearms were in the United States. (more…)
Abuse and Neglect, Accidents & Violence, Author Interviews, JAMA, Mental Health Research / 29.01.2016

MedicalResearch.com Interview with: Tracie O. Afifi, PhD Associate Professor of Epidemiology CIHR New Investigator (2013-2018) Departments of Community Health Sciences and Psychiatry College of Medicine, Faculty of Health Sciences University of Manitoba  Medical Research: What is the background for this study? Dr. Afifi: Recent studies in the US have examined predictors and correlates of suicide among solider, but none of these studies have investigated the potential role that child abuse exposure may play in suicide-related outcomes. In addition no representative military and civilian comparisons from any country have examined possible differences in the prevalence of child abuse exposure and the potential differences in the relationships between child abuse exposure and suicide-related outcomes in these populations. This study uses nationally representative military and civilian samples from Canada. Medical Research: What are the main findings? Dr. Afifi: Child abuse was more prevalent among Regular Forces personnel (47.7%) and Reserve Forces personnel (49.4%) compared to the Canadian general population (33.1%). Child abuse exposure was associated with an increased likelihood of suicidal thoughts, plans, and attempts in military and civilian populations, with associations weaker for many outcomes in military personnel relative to civilians. Deployment-related trauma was associated with past-year suicidal thoughts and suicide plans. However, relative to deployment-related trauma, child abuse exposure had a more robust association with suicide-related outcomes. (more…)
Accidents & Violence, Author Interviews, JAMA, Surgical Research, UCSF / 22.01.2016

MedicalResearch.com Interview with: Dr. Rachael Callcut M.D., M.S.P.H Assistant Professor of Surgery Division of General Surgery UCSF Medical Research: What is the background for this study? What are the main findings? Dr. Callcut: San Francisco General Hospital (SFGH) responded on July 6, 2013 to one of the larger multiple casualty events in the history of our institution.  Asiana Airlines flight 214 crashed on approach to San Francisco International Airport with 307 people on board.  192 patients were injured and SFGH received the highest total of number of patients of area hospitals. The majority of data that is available on disaster response focuses on initial scene triage or initial hospital resources required to respond to these types of major events.  Our paper focuses on some additional considerations for optimizing disaster response not typically included in literature on these events including nursing resources, blood bank needs, and radiology studies. As an example, over 370 hours of nursing overtime were needed just in the first 18 hours following the disaster to care for patients.  This type of information in traditionally not been included in disaster planning, but clearly was a critical element of providing optimum care to our patients. (more…)
Accidents & Violence, Author Interviews, Autism, JAMA / 12.01.2016

MedicalResearch.com Interview with: Diana Schendel, Professor MSO Department of Public Health Institute of Epidemiology and Social Medicine and Department of Economics and Business                             National Centre for Register-based Research Aarhus University Denmark Medical Research: What is the background for this study? What are the main findings? Dr. Schende: Elevated mortality has been reported in persons with autism spectrum disorder (ASD), especially with comorbid epilepsy and intellectual disability. The effect of comorbidity on the risk for mortality in ASD, however, has not been rigorously examined in large, population-based studies. Our study aim was to investigate ASD mortality patterns overall and to assess the specific effects of comorbid mental, behavioral, and neurologic disorders on ASD mortality into young adulthood. Our study comprised a nation-wide Danish cohort of 1.9 million children of whom 20,492 were diagnosed with ASD. We observed 68 deaths in persons with ASD; 83% of the persons with ASD who died had comorbid mental/behavioral or neurologic disorders. The risk for mortality was two-fold higher in persons with autism spectrum disorder overall. An elevated risk for mortality was also seen in persons who had ASD only, or had both ASD and other neurologic or mental/behavioral disorders, compared to persons without these other morbidities and no ASD. However, the co-occurrence of ASD in persons with neurologic, or with mental/behavioral disorders, added no additional mortality risk compared to persons with these disorders and no autism spectrum disorder. These results suggest that the mechanisms underlying mortality risk in ASD in part may be shared with these other disorders, although what might be the specific shared mechanisms cannot be determined with these data. (more…)
Abuse and Neglect, Accidents & Violence, Author Interviews, Sexual Health / 27.12.2015

MedicalResearch.com Interview with: Anna Austin, MPH PhD Student UNC Gillings School of Global Public Health MedicalResearch: What is the background for this study? What are the main findings? Response: Several studies have examined experiences of childhood abuse among individuals who identify as lesbian, gay, or bisexual (LGB), but there has been relatively little research exploring experiences of other types of childhood trauma, like witnessing domestic violence between parents or growing up with a parent who is an alcoholic, among LGB individuals. We know from the study on adverse childhood experiences (ACEs) conducted by Kaiser Permanente and the Centers for Disease Control and Prevention that the greater number of childhood traumas and adversities an individual experiences, the greater the risk for poor health later in life. There have also been a number of studies that have demonstrated health disparities by sexual orientation, with LGB adults typically having worse health than heterosexual adults. We were interested in the role that multiple types of adverse childhood experiences play in the development of poor adult health outcomes among LGB individuals. In this study, we captured 8 categories of ACEs. We captured 3 categories of childhood abuse (sexual, physical, and emotional abuse) and 5 categories of household dysfunction (adult mental illness, substance abuse, and domestic violence in the household; incarceration of a household member; and parental divorce or separation). LGB adults were more likely to report each of these 8 categories of ACEs than heterosexuals, with the largest differences found for sexual abuse, adult mental illness in the household, and incarceration of a household member. LGB adults were also more likely to report having experienced multiple ACEs. Forty-two percent of LGB adults compared to 24 percent of heterosexual adults reported having experienced between 3 to 8 ACEs. We also found that LGB adults were more likely to report poor adult health like smoking, HIV risk behaviors, 14 or more days of poor physical or mental health in the past 30 days, asthma, depression, and disability than heterosexuals. However, after we accounted for the number of ACEs each individual reported, LGB adults were no longer more likely to report smoking, binge drinking, and 14 or more days of poor physical health in the past 30 days. (more…)
Accidents & Violence, Author Interviews, CDC, Exercise - Fitness, Orthopedics, Pediatrics / 11.12.2015

MedicalResearch.com Interview with: Zachary Y. Kerr, PhD, MPH Sports Injury Epidemiologist Director, NCAA Injury Surveillance Program Datalys Center for Sports Injury Research and Prevention Indianapolis, IN 46202  Medical Research: What is the background for this study? What are the main findings? Dr. Kerr: The NCAA Injury Surveillance Program has been ongoing since 1982, but the Datalys Center for Sports Injury Research and Prevention began management in 2009.  We provide the NCAA sports and medical committees with evidence-based data they can use to make rule and policy decisions aimed at student-athlete health and safety.  However, among the research community, there lacks current injury incidence data across the collegiate student-athlete population. The main findings of this study is that the rate of injury was higher in competitions than in practices.  However, the total number of injuries estimated in practices exceeds that of competition, which suggests that interventions should be aimed at reducing injury incidence in both practices and competitions. (more…)
Accidents & Violence, Author Interviews / 06.12.2015

MedicalResearch.com Interview with: Professor Ajai Singh Department of Orthopaedic Surgery King George's Medical University India  Medical Research: What is the background for this study? Prof. Singh: Road traffic accidents (RTAs), in the current scenario, have taken the form of an epidemic. Developing countries are presently showing an increasing trend with respect to the number of vehicles and population. Personality characteristics are becoming a significant contributor in RTAs, owing to rising stress levels and varying circumstances. In developing countries, most of the RTAs occur in urban regions and pedestrians, passengers, and motorcyclists collectively constitute around 90% of deaths. We, therefore, conducted this study in order to evaluate the patterns of various personality characteristics in patients suffering from nonfatal orthopedic injuries as a result of Road traffic accidents and attending a tertiary care center, with special focus on motorcyclists. Medical Research: What are the main findings? Prof. Singh: Most of the accidental injuries are faced by motorized two wheeler drivers of younger age. This is probably due to the fact that we are a developing nation with a huge population having motorized two wheeler vehicles as a major means of private transport. Also, these motorized two wheelers have a low safety profile that makes their riders more prone to accident. Amongst all the motorcyclists encountering road traffic accidents, impulsive personality trait is found in 85.19% and histrionic trait was found in 82.72% of cases. (more…)
Abuse and Neglect, Accidents & Violence, Author Interviews, Pediatrics / 25.11.2015

Dr. Ffion C Davies Consultant in Emergency Medicine & Paediatric Lead University Hospitals of Leicester NHS Trust Leicester Royal Infirmary Leicester UKMedicalResearch.com Interview with: Dr. Ffion C Davies Consultant in Emergency Medicine & Paediatric Lead University Hospitals of Leicester NHS Trust Leicester Royal Infirmary Leicester UK Medical Research: What is the background for this study? Dr. Davies: This study is from the Trauma Audit Research Network data, which is a major trauma database receiving data from nearly all hospitals in England and Wales. A 2012 TARN report on major trauma in children showed a peak of injuries resulting from child abuse in the younger age group. In this study we analysed the database in more detail, in order to profile this peak of injuries from non-accidental injury (NAI). Medical Research: What are the main findings? Dr. Davies: The main findings are that severe injury and death resulting from non-accidental injury occurs nearly always in the under 5 year old age group, and 75% of cases are under 1 year old. This contrasts with reports in the media, whereby high profile deaths in children from non-accidental injury are often older children. This probably reflects reporting bias, because those children experienced a prolonged period of abuse, despite involvement of health and social services. Our study shows that very small infants are the most likely to die, or to sustain severe head injuries. (more…)
Accidents & Violence, Author Interviews, Pediatrics / 24.11.2015

MedicalResearch.com Interview with: N.J. Scheers, PhD Former manager of CPSC's Infant Suffocation Project BDS Data Analytics, Alexandria, VA Medical Research: What is the background for this study? What are the main findings? Dr. Scheers: There are no federal regulations for crib bumpers. The American Academy of Pediatrics, the Canadian Pediatric Society, the National Institutes of Health, and others have long recommended against crib bumper use. Crib bumper manufacturers have a long-standing voluntary safety standard aimed at making crib bumpers safe. Neither of these approaches has worked to prevent deaths from bumpers.  Medical Research: What are the main findings? Dr. Scheers: Using data from the Consumer Product Safety Commission (CPSC), the research identified 48 deaths from crib bumpers from 1985-2012. Reports of the deaths increased significantly and were three times higher from 2006 through 2012 than in previous years. In most of the deaths, the crib bumpers were the only source of suffocation, rebutting beliefs that other items in the cribs (comforters, pillows, blankets) caused the deaths. In other deaths, wedging occurred between the bumper and other objects such as pillows and infant recliners. All of these deaths would have been preventable if crib bumpers had not been in the cribs. The study linked more deaths to crib bumpers than the 48 indicated in the CPSC data. A review of data from the National Center for the Review and Prevention of Child Deaths reveals reports of 32 bumper-related deaths from 37 states from 2008-2011. That puts the number of fatalities tied to crib bumpers at 77 and suggests the actual number is much higher. The study identified 146 injuries from 1990-2012. Eleven were “near-misses” in which the babies were rescued before they died. These were near-suffocations, chokings, strangulations, and falls from infants using bumpers to climb out of the cribs. There were reports of poor bumper design, such as a lack of bottom bumper ties, or construction problems, such as bumper ties and decoration that detached. Parents often buy bumpers to prevent slat entrapments or to prevent infants bumping their heads in the cribs. This is the first study to show that these events occurred even with a bumper present. (more…)
Accidents & Violence, Author Interviews, Mental Health Research, PLoS / 17.11.2015

MedicalResearch.com Interview with: Simone Ullrich, PhD Senior Lecturer in Forensic Mental Health Violence Prevention Research Unit Queen Mary University of London Medical Research: What is the background for this study? What are the main findings? Dr. Ullrich: There are currently thought to be more than three hundred risk assessment instruments used by professionals such as psychiatrists, psychologists, and probation officers to assess the risks of violence and sexual offending among psychiatric patients, prisoners, and the general population. In some mental health services the hospital does not get paid unless staff have carried out a risk assessment on their patients. Producing risk assessment instruments has become an ‘industry’ and new instruments are being produced annually, on every form of violence and criminal activity. The Queen Mary research group believe that none of these instruments have any advantage over those produced before. Furthermore, their best predictions for future violence get 30% wrong. Professor Coid and colleagues believe that no further progress can be made because researchers have been too obsessed with predicting the future of whether a patient will be violent rather than looking for the causes of why they become violent. All previous studies have used special statistical techniques which are designed to measure predictive accuracy. The Queen Mary research group say there is nothing wrong with being accurate or measuring accuracy, but there is no point in trying to develop new instruments which can never improve on getting it right more than 70% of the time. It may be helpful to know that your patient has a high or low risk of being violent if you release them from hospital, but this is not going to tell you what you should do to stop them being violent. Furthermore, if the risk assessment says that their risk is high then it is likely that you will not release them. The problem is that professionals will always play safe and, although there is a good chance (around 30%) that they are totally wrong, the patient will not be released. This is probably one of the most important reasons why patients are staying longer and longer in secure mental health services. These instruments achieve little more than making healthcare professionals risk averse. The National Institute for Health Research (NIHR) funded a study where 409 male and female patients who were discharged from medium secure services in England and Wales were followed up after release into the community. They received assessments with two ‘state of the art’ assessment instruments, the HCR-20 which aims to guide clinicians in their assessment of violence, and the SAPROF, another instrument aimed to guide clinicians on which factors protect patients from becoming violent. Both instruments were developed on the basis of predictive statistics. Measures were taken with these instruments prior to release into the community, then after 6 and 12 months following discharge. Information on violence was gathered via individual case notes and a search of the police national computer. By 6 months following discharge, 54 (14%) had committed a violent act, between 6 and 12 months 43 (13%) had been violent. The authors used two methods to investigate the associations between these risk/ protective factors and violence. They first tested the standard approach of risk assessment for the factors that occurred in the past 6 months which were then used to statistically predict violence in the following 6 months (predictive model). They then used a second approach which looked at the co-occurrence of the risk/ protective factors and violence within the same 6 month time window (causal model). Using the traditional approach and looking at accuracy, the predictive model produced statistical coefficients of low size, suggesting that the risk and protective factors were poor in identifying who would be violent and who would not. Because many associations between the factors and violence were weak, few appeared useful in identifying those which should be targeted to manage future violence. Surprisingly, symptoms of major mental disorder did not show an association with violence, even though most of the patients in the study suffered from major mental disorder. It might have been expected that some patients would relapse, with more symptoms, leading to violence. When the researchers used a causal approach aiming to confirm which risk and protective factors resulted in violence, the findings were very different. Symptoms of major mental disorder, the patients’ living condition, and whether they were taking medication were highly important factors. Secondly, the effects of risk and protective factors on violence were much bigger using the causal approach. For example, the effects of violent thoughts and ruminations, being in an unstable life situation, were about 3 times stronger using the causal model. The effects of being under stress and unable to cope were more than 4 times stronger than using the traditional predictive approach. They concluded that the causal approach was much better in identifying the key factors that need to be considered in the assessment and management of violence. (more…)
Accidents & Violence, Duke, Ophthalmology / 17.11.2015

MedicalResearch.com Interview with: Christina R. Prescott, M.D., Ph.D Assistant Professor of Ophthalmology Johns Hopkins Wilmer Eye Institute Medical Research: What is the background for this study? What are the main findings? Dr. Prescott: I wanted to look at the most common causes of severe ocular injuries, with the hope of helping to focus injury prevention strategies. From 2002 to 2011, the mean hospital charge for inpatient hospitalizations due to eye injuries increased from $12,430 to $20,116, when controlling for inflation.  This increase paralleled the increase of mean hospital charges for all inpatient stays during the same time period, even when controlling for length of stay, which actually decreased slightly.  Costs were highest at large hospitals and for older patients.  Race, insurance, and gender were less strongly correlated to cost. (more…)