Motorcycle helmet use in Texas

Helmets worn by motorcyclists decrease head injuries and the likelihood of being killed in a crash by about 30 percent. From 1968 to 1977, Texas had a comprehensive motorcycle helmet use law, which was estimated to have saved 650 lives. But the law was amended in 1977 to apply only to motorcycle operators and passengers under age 18. In September 1989, a new law was passed that required helmets for all motorcycle operators and passengers. Observations of helmet use were conducted before and after the law took effect in 18 Texas cities using a survey design providing a cross-section of urban and suburban traffic across the State. The surveys indicated that helmet use increased from less than 50 percent just before the law to 90 percent immediately after, and it increased further to more than 95 percent 2 months later. These results confirm the unique effectiveness of comprehensive helmet use laws in applying the proven public health benefits of helmets to the reduction of motorcycle injuries and deaths.     

Pregnancy outcomes following hospitalization for motor vehicle crashes in Washington State from 1989 to 2001

This retrospective cohort study evaluated the risk of adverse pregnancy outcomes following motor vehicle crashes during pregnancy. The authors assessed outcomes of pregnant women hospitalized for motor vehicle crashes in Washington State from 1989 to 2001 (n = 582). They used the Injury Severity Score (ISS) to classify 84 severely injured (ISS > or =9), 309 non-severely injured (ISS 1-8), and 189 uninjured (ISS 0) pregnant women and compared them with pregnant women who had not been hospitalized for a motor vehicle crash (n = 17,274). Of pregnant women in motor vehicle crashes, 82.9% were hospitalized and discharged without delivering, and 17.1% delivered at hospitalization. Compared with women not in motor vehicle crashes, severely and non-severely injured women were at increased risk of placental abruption and cesarean delivery, and their infants were at increased risk of respiratory distress syndrome and fetal death. Uninjured women were also at increased risk of preterm labor (relative risk = 7.9, 95% confidence interval: 6.4, 9.8) and placental abruption (relative risk = 6.6, 95% confidence interval: 3.9, 11.2) compared with women not in motor vehicle crashes. Pregnant women hospitalized following motor vehicle crashes are at increased risk of adverse pregnancy outcomes, regardless of the presence or severity of injuries.     

Motorcycle helmet use and legislation: a systematic review of the literature

Although there has been a marked improvement in the safety profiles of cars and in car crash outcomes, there has been a marked worsening in outcomes of motorcycle collisions. Motorcycles account for only 2% of vehicle registrations in the United States, but motorcycle collisions account for 10% of traffic deaths. Further, motorcycle riders are 34 times more likely to die in a traffic collision than automobile drivers. Motorcycle helmet use has been suggested to be an effective way to reduce death and disability after traffic collisions, and enactment of universal helmet laws has been suggested as a means to enforce helmet use. This article presents findings from an analysis of National Highway Traffic Safety Administration data and studies in the medical literature on the impact of motorcycle helmet use and helmet legislation on the risk of death or injury in motorcycle accidents. The authors found voluminous support for motorcycle helmet use as a way to prevent severe traumatic brain injury and traffic fatalities.     

Association of helmet use with death in motorcycle crashes: a matched-pair cohort study

The association of helmet use with death in a motorcycle crash can be estimated using matched-pair cohort methods. By estimating effects among naturally matched pairs on the same motorcycle, one can account for potential confounding by motorcycle characteristics, crash characteristics, and other factors that may influence the outcome. The authors used Fatality Analysis Reporting System data, from 1980 through 1998, for motorcycles that crashed with two riders and either the driver or the passenger, or both, died. For their main analysis, the authors estimated the relative risk of death using conditional Poisson regression. The relative risk of death, accounting for the matching on motorcycle and adjusted for age, sex, and seat position, for a helmeted rider compared with an unhelmeted rider was 0.61 (95% confidence interval: 0.54, 0.70). The authors suggest that conditional Poisson regression is useful for the analysis of traffic crash data, where occupants are naturally matched in a vehicle and where crash-related confounders may be difficult or impossible to measure.     

Death and injury from motor vehicle crashes in Colombia.

We report data on the distribution and determinants of road deaths and injuries for all victims in Colombia, with the aim of defining targets and priorities for highway death prevention in that country and other rapidly urbanizing nations. Using information from Colombia's Fund for the Prevention of Road Injury and the national death registry, we studied data on deaths and injuries from 1991 to 1995 for the nation as a whole and for the country's two largest cities, Santa Fe de Bogotá and Medellín. Deaths and injuries are rising in the nation as a whole. Of the deaths, 75% occur in urban areas, and 80% are in males. Pedestrians aged 15-34 are a peak subgroup. Thirty-four percent of deaths are attributable to speeding and/or alcohol consumption. Death tolls are highest at night and on weekends. Specific priority targets for intervention are indicated by the fact that 75% of road deaths in Colombia occur in urban areas and that 80% of all victims are males.     

Marijuana use and injury events resulting in hospitalization

PURPOSE: Information on the potential relation between marijuana use and the incidence of hospitalized injury is extremely limited. The purpose of this effort was to investigate the potential for this association. METHODS: A retrospective study was conducted in a large prepaid Northern California health care program cohort (n = 64,657) that completed baseline questionnaires about health behaviors, including marijuana use, and health status between 1979 and 1985. All injury hospitalizations through December 31, 1991, (n = 965) were identified and validated. RESULTS: Using Poisson regression modeling, increased rate-ratios and 95% confidence intervals were identified for all-cause injury hospitalizations for both men and women among current users (1.28; 1.01 to 1.61 and 1.37; 1.04 to 1.79, respectively) relative to nonusers, adjusted for age, cigarette and alcohol use, and other potential confounders. Increased rates of motor vehicle (1.96; 1.23 to 3.14), and assault (1.90, 1.16 to 3.15), injuries were identified among men who were current users; an increased rate of assault was suggestive in women (2.21; 0.92 to 5.19). CONCLUSIONS: Though the results must be viewed cautiously, they suggest that marijuana use may be independently associated with increased risk of hospitalized injury. Further study of the physiological and behavioral mechanisms is warranted [corrected].     

Work-related traumatic brain injury in Washington State, 1988 through 1990.

OBJECTIVES. Brain trauma is a major cause of disability in the United States, especially among young adults. Work-related brain trauma cases represent a subpopulation that may be amenable to intervention efforts, but largely because of unavailability of data, this group has not previously been studied. METHODS. Washington State workers'' compensation data were used to identify brain trauma cases and to describe incidence rates with respect to age, gender, and industrial classification. Cause of injury was evaluated for industrial classifications with numerous cases. RESULTS. Washington State workers experienced 301 brain traumas over a 3-year period (9.4/100,000 full-time equivalent workers per year). One third of all traumatic brain injury claims were concentrated among seven industrial classifications. Cause of injury was highly correlated with specific industrial classifications. CONCLUSIONS. This study demonstrates the usefulness of diagnosis-related group codes to identify cases of traumatic brain injury. These injuries are concentrated among a few industries, with a dominant specific cause for each industry. This suggests that intervention methods may be efficiently introduced to reduce traumatic brain injuries in the workplace.     

Sociodemographic,clinical and birth hospitalization characteristics and infant Hepatitis B vaccination in Washington State

ObjectiveHepatitis B (HepB) vaccine is recommended at birth; however, national coverage estimates fall far below target levels. Studies describing the factors associated with infant HepB vaccination are lacking. This study aimed to identify the sociodemographic, clinical and birth hospitalization factors associated with timely receipt of the first HepB vaccine dose.Study DesignThis retrospective cohort study included Washington State infants born weighing ≥2000 g who received birth hospitalization care at an urban academic medical center between January 2008–December 2013. Multivariable logistic regression was used to estimate adjusted odds ratios (AOR) and 95% confidence intervals (CI) for associations between maternal and infant characteristics and HepB vaccine receipt during the birth hospitalization.ResultsOf the 9080 study infants, 75.5% received HepB vaccine during the birth hospitalization. Infants had higher odds of being vaccinated during the birth hospitalization if they were Hispanic (AOR 2.08; CI: 1.63, 2.65), non-Hispanic black (AOR 2.34; CI: 1.93, 2.84) or Asian (AOR 2.70; CI: 2.22, 3.28) compared to non-Hispanic white. Infants with a Spanish- vs. English-speaking mother (AOR 1.97; CI: 1.46, 2.68), public vs. private insurance (AOR 2.01; CI: 1.78, 2.29), and those hospitalized ≥96 h vs. 24 to <48 h (AOR 1.67; CI: 1.34, 2.09) also had higher odds of vaccination.ConclusionsPopulations that are typically underserved (e.g., publicly insured, racial/ethnic minorities) had higher odds of receiving HepB vaccine during the birth hospitalization. These findings may aid in identifying high-risk infants who could benefit from targeted interventions to increase initial HepB vaccination.     

Hospital inpatient costs resulting from road crashes in Western Australia

Abstract: The purpose of this study was to estimate the inpatient costs of road crashes in Western Australia, and to investigate factors relating to casualties and their injuries that affect the hospital costs resulting from road crashes. All road crash casualties who were injured severely enough to be hospitalised in Western Australia in 1988 were included. A casemix classification system was used to classify patients into diagnostic related groups. Hospital costs were assigned to individual patients on the basis of their diagnostic related group and length of hospital stay. The annual cost of hospital treatment for road crash casualties was estimated as $13.9 million, and 33 per cent of this was incurred by those with lower extremity injuries and 27 per cent by those with head injuries. Hospital costs per casualty ranged from an average of $1388 for those sustaining minor (Abbreviated Injury Scale severity score of 1 or 2) spinal injuries to $16 580 and $33 424, respectively, for those sustaining severe (Abbreviated Injury Scale severity score of 4 or 5) head and spinal injuries. A multivariate analysis of variance revealed the following factors as having a significant independent effect on the hospital inpatient costs of road crash casualties: type of hospital (teaching or nonteaching), body region of injury, injury severity level and road user group. There were also significant interaction effects between different factors. Since hospital inpatient costs vary considerably across factors, using average cost data in the specific economic evaluation of road safety interventions for groups of road users is inappropriate.     

Local health departments in Washington State use APEX to assess capacity.

THE ASSESSMENT PROTOCOL for EXCELLENCE in PUBLIC HEALTH process was carried out in the state of Washington to assess local health department capacity and to identify their self-perceived strengths and weaknesses. Staff from 24 of the 32 local health departments in Washington completed organizational capacity assessments. Fifty percent or more of the health departments identified the following eight indicators as strengths: legal authority, public policy and implementation, budget development, financial reporting and administration, audit, financial documentation, organization and structure of program management, and policy board procedures. Seven indicators were identified as weaknesses by 50% or more of the respondents: legal counsel, mission and role, data collection and analysis, planning and development, evaluation and assurance of community health assessment, community health assessment and planning, and community health policy. The results of the assessment highlight the traditional organizational and service delivery strengths of the local health departments and point out weaknesses in their ability to assess community health and to develop communitywide health policy.     

Collaborative assessment: exploring parental injury prevention strategies through bicycle helmet use.

While multiple studies have investigated bicycle helmet use, qualitative studies investigating parental strategies to promote their children's safety are rare. Thirty-four parents were interviewed to explore their injury prevention strategies. Findings suggest that the developmental stage of the child, the child's gender, and rural versus urban residence are all related to strategies parents use and their success in promoting bicycle safety. Peer pressure was the major deterrent, and negative "parent pressure" was also identified as problematic. Themes emerged that may support future injury prevention efforts with children, parents, and their communities and provide agencies information not previously captured quantitatively.     

Motorcycle headlight-use laws and fatal motorcycle crashes in the US, 1975-83.

Fatal motorcycle crashes in the United States from 1975 to 1983 were analyzed. In the 14 states that had motorcycle headlight-use laws during the study period, about 600 daytime crashes of the type included in the study were prevented by these laws. This reduction corresponds to a 13 per cent reduction in fatal daytime crashes and to an average reduction of about five fatal crashes per year for each of the 14 states. About 30 states did not have motorcycle daytime headlight laws in effect during the study period. If all of these states had such laws, in an average year, approximately 140 additional fatal motorcycle crashes would have been prevented.     

Prevalence of substance use and delinquent behavior in adolescents from Victoria, Australia and Washington State, United States.

This article compares prevalence estimates of substance use and delinquent behavior in Washington State, United States and Victoria, Australia, two states chosen for their different policy environments around problem behavior. Few comparisons of international differences on rates of multiple problem behavior exist, and most are based on methods that are not matched, raising the question of whether findings are based on methodological differences rather than actual rate differences. The International Youth Development Study used standardized methods to recruit and administer an adaptation of the Communities That Care Youth Survey to representative state samples of fifth-, seventh-, and ninth-grade students in each state. Rates of delinquent behavior were generally comparable. However, striking differences in substance use were noted, with Victoria students reporting higher rates of alcohol use, alcohol misuse, smoking, and inhalant use, whereas Washington State students reported higher rates of marijuana use. Implications for conducting international comparisons are discussed.     

Mammography quality assurance in Washington State.

Poor mammography quality control results in the loss of important diagnostic information. Several organizations and agencies recommend or require that mammography quality assurance procedures include the periodic evaluation of equipment. The objective of this study was to assess compliance with published guidelines pertaining to the monitoring of mammography equipment. One hundred eighty-four Washington state mammography facilities were surveyed by mail during late 1989 and early 1990. The response rate was 71%. A large proportion of facilities was not complying with published guidelines concerning the frequency of evaluation of processor parameters and phantom image quality. Results suggest that many facilities were not in compliance with American College of Radiology recommendations concerning annual system evaluation by a physicist. The results of this study reinforce the importance of establishing minimum quality assurance standards and indicate a need for more mammography quality assurance technologist training.     

Behavioral risk factors and use of preventive services among veterans in Washington State

BACKGROUND: Little is known about the special preventive health needs of U.S. veterans and the 3.6 million users of VA health care. METHODS: The Washington State version of the 1999 Behavioral Risk Factor Survey included three new questions about veteran status and use of VA health care. Data on this population-based sample of 3,608 adults were used to compare sociodemographic, health, and behavioral characteristics between veterans and nonveterans and between VA users and nonusers. RESULTS: Veterans were nearly 13 years older than nonveterans. VA users were socioeconomically worse off and had poorer health status than nonusers. Current smoking among males was more common among veterans than among nonveterans (24% vs 18%). This difference persisted after controlling for age, race, education, and income and held across all age groups. Use of several screening tests varied little in relation to veteran or VA user status. CONCLUSIONS: The BRFSS has become a rich source of data on veteran health. Veterans and VA users have distinct sociodemographic profiles that must be considered when comparing health-related characteristics. Cigarette smoking is especially prevalent among veterans--an excess unexplained by sociodemographic differences.     

脑卒中患者住院费用及预后影响因素研究

目的:揭示以医保类型和职业为代表的社会背景因素对脑卒中患者住院费用差异的影响,以及这种差异对患者预后的影响。方法:对2011—2014年分布在不同省份的5家三甲医院共计18 879例脑卒中住院患者的住院费用和院内死亡情况进行描述性分析,并通过多元线性回归和logistic回归分别分析住院费用和预后的影响因素。结果:在控制了患者人口社会学特征、住院过程和临床特征的前提下,公费医疗患者的费用比自费患者高19.7%(P0.001),退休人群和公务员、企事业单位人员的住院费用分别比农民高4.2%(P0.001)、2.9%(P=0.049);公费医疗患者院内死亡的风险是自费患者的4.901倍(95%CI 1.652~14.537),退休人群院内死亡风险比农民高2.145倍(95%CI 1.287~3.573)。结论:由于社会背景因素的影响,部分患者花费了更多的住院费用,但并不是花费的住院费用越多,脑卒中的预后就越好。     

Bicycle helmet laws and educational campaigns: an evaluation of strategies to increase children's helmet use.

OBJECTIVES. The passage of a mandatory bicycle helmet law for children in Howard County, Maryland, provided an opportunity to compare legislation and education as strategies to increase helmet use. METHODS. In 1991, a survey was mailed to fourth-, seventh-, and ninth-grade students attending a stratified sample of public schools in Howard County and in two similar suburban/rural counties without helmet laws. RESULTS. Of 7217 students surveyed, 3494 responded (48.4%). Self-reported helmet use in Howard County rose from 11% to 37% after the law and accompanying educational campaign went into effect. Helmet use changed from 8% to 13% in Montgomery County, where educational efforts were undertaken, and from 7% to 11% in Baltimore County, where helmet promotion activities were minimal. Predictors of helmet use included having friends who wore helmets, believing helmet laws are good, being in fourth grade, living in Howard County, and using seatbelts regularly. CONCLUSIONS. Legislation combined with education appears to increase bicycle helmet use substantially more than does education alone. The Howard County law may be considered a successful model of a strategy to increase children's helmet use.