RESUMEN
BACKGROUND: Although inequality in traumatic brain injury (TBI) by individual socioeconomic status (SES) exists, interventions to modify individual SES are difficult. However, as interventions for area-based SES can affect the individual SES, monitoring or public health intervention can be planned. We analyzed the effect of area-based SES on hospitalization for TBI and revealed yearly inequality trends to provide a basis for health intervention. METHODS: We included patients who were hospitalized due to intracranial injuries (ICIs) between 2008 and 2015 as a measure of severe TBI with data provided by the Korea National Hospital Discharge Survey. Area-based SES was synthesized using the 2010 census data. We assessed inequalities in ICI-related hospitalization rates using the relative index of inequality and the slope index of inequality for the periods 2008-2009, 2010-2011, 2012-2013, and 2014-2015. We analyzed the trends of these indices for the observation period by age and sex. RESULTS: The overall relative indices of inequality for each 2-year period were 1.82 (95% confidence interval, 1.5-2.3), 1.97 (1.6-2.5), 2.01 (1.6-2.5), and 2.01 (1.6-2.5), respectively. The overall slope indices of inequality in each period were 38.74 (23.5-54.0), 36.75 (21.7-51.8), 35.65 (20.7-50.6), and 43.11 (27.6-58.6), respectively. The relative indices of inequality showed a linear trend for men (P = 0.006), which was most evident in the ≥ 65-year age group. CONCLUSION: Inequality in hospitalization for ICIs by area-based SES tended to increase during the observation period. Practical preventive interventions and input in healthcare resources for populations with low area-based SES are likely needed.
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Disparidades en el Estado de Salud , Clase Social , Masculino , Humanos , Estudios Retrospectivos , Hospitalización , República de Corea/epidemiología , Factores SocioeconómicosRESUMEN
BACKGROUND: Teens who delay driving licensure may not be subject to graduated driver licensing restrictions that are known to reduce crash risk. We explored the association of delay in licensure with driving while impaired (DWI) and riding with an impaired driver (RWI) among emerging adults. METHODS: Data from the NEXT Generation Health Study, starting with 10th grade (2009-2010), were analyzed. The outcome variables were Wave 7 (W7) self-reported DWI and RWI as dichotomous variables. The independent variable was delay in licensure. Covariates included sex, urbanicity, race/ethnicity, family structure, parent education, family affluence, teen's highest education, minimum legal drinking age laws, and onset age of alcohol use. Descriptive analysis and logistic regressions were conducted. RESULTS: Of 2525 participants eligible for licensure, 887 reported a delay in licensure by 1-2 years (38.9%, weighted) and 1078 by > 2 years (30.3% weighted) across 7 waves. In W7, 23.5% (weighted and hereafter, 5.6% once, 17.8% ≥twice) of participants reported DWI and 32.42% (5.6% once, 25.4% ≥twice) reported RWI. Logistic regressions showed no overall significant association of delay in licensure with either W7 RWI or W7 DWI. However, in stratified analyses, among African American youth, delay in licensure was positively associated with DWI (OR = 2.41, p = 0.03) and RWI (OR = 2.72, p = 0.05). Among those with ≤ high school or lower education by W7, delayed licensure was positively associated with RWI (OR = 2.51, p < 0.01). CONCLUSIONS: While in the overall sample, delayed licensure did not appear to be associated with DWI or RWI, our findings suggest that delayed licensure may be of concern to teen risk of DWI and RWI among African Americans and among those with lower educational attainment. Furthermore, as two-thirds of youth delayed licensure, more research is needed to determine whether this is more of a positive (i.e., protective) factor by reducing their exposure to crash risk or a negative (i.e., risk) factor due to their missing important driver safety stages of graduated driver licensing.
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Conducir bajo la Influencia , Concesión de Licencias/estadística & datos numéricos , Consumo de Alcohol en Menores/estadística & datos numéricos , Adolescente , Femenino , Humanos , Masculino , Factores de TiempoRESUMEN
OBJECTIVE: Generalized epileptiform discharges (GEDs) can occur during seizures or without obvious clinical accompaniment. Motor vehicle driving risk during apparently subclinical GEDs is uncertain. Our goals were to develop a feasible, realistic test to evaluate driving safety during GEDs, and to begin evaluating electroencephalographic (EEG) features in relation to driving safety. METHODS: Subjects were aged ≥15 years with generalized epilepsy, GEDs on EEG, and no clinical seizures. Using a high-fidelity driving simulator (miniSim) with simultaneous EEG, a red oval visual stimulus was presented every 5 minutes for baseline testing, and with each GED. Participants were instructed to pull over as quickly and safely as possible with each stimulus. We analyzed driving and EEG signals during GEDs. RESULTS: Nine subjects were tested, and five experienced 88 GEDs total with mean duration 2.31 ± 1.89 (SD) seconds. Of these five subjects, three responded appropriately to all stimuli, one failed to respond to 75% of stimuli, and one stopped driving immediately during GEDs. GEDs with no response to stimuli were significantly longer than those with appropriate responses (8.47 ± 3.10 vs 1.85 ± 0.69 seconds, P < .001). Reaction times to stimuli during GEDs were significantly correlated with GED duration (r = 0.30, P = .04). In addition, EEG amplitude was greater for GEDs with no response to stimuli than GEDs with responses, both for overall root mean square voltage amplitude (66.14 µV vs 52.99 µV, P = .02) and for fractional power changes in the frequency range of waves (P < .05) and spikes (P < .001). SIGNIFICANCE: High-fidelity driving simulation is feasible for investigating driving behavior during GEDs. GEDs with longer duration and greater EEG amplitude showed more driving impairment. Future work with a large sample size may ultimately enable classification of GED EEG features to predict individual driving risk.
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Conducción de Automóvil , Convulsiones/fisiopatología , Entrenamiento Simulado/métodos , Adolescente , Adulto , Electroencefalografía , Estudios de Factibilidad , Femenino , Humanos , Masculino , Proyectos Piloto , Adulto JovenRESUMEN
Generalized spike-wave discharges (SWDs) are the hallmark of generalized epilepsy on the electroencephalogram (EEG). In clinically obvious cases, generalized SWDs produce myoclonic, atonic/tonic, or absence seizures with brief episodes of staring and behavioral unresponsiveness. However, some generalized SWDs have no obvious behavioral effects. A serious challenge arises when patients with no clinical seizures request driving privileges and licensure, yet their EEG shows generalized SWD. Specialized behavioral testing has demonstrated prolonged reaction times or missed responses during SWD, which may present a driving hazard even when patients or family members do not notice any deficits. On the other hand, some SWDs are truly asymptomatic in which case driving privileges should not be restricted. Clinicians often decide on driving privileges based on SWD duration or other EEG features. However, there are currently no empirically-validated guidelines for distinguishing generalized SWDs that are "safe" versus "unsafe" for driving. Here, we review the clinical presentation of generalized SWD and recent work investigating mechanisms of behavioral impairment during SWD with implications for driving safety. As a future approach, computational analysis of large sets of EEG data during simulated driving utilizing machine learning could lead to powerful methods to classify generalized SWD as safe vs. unsafe. This may ultimately provide more objective EEG criteria to guide decisions on driving safety in people with epilepsy.
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Conducción de Automóvil , Electroencefalografía/métodos , Epilepsia Generalizada/fisiopatología , Convulsiones/fisiopatología , Conducción de Automóvil/psicología , Epilepsia Generalizada/diagnóstico , Epilepsia Generalizada/psicología , Femenino , Humanos , Masculino , Tiempo de Reacción/fisiología , Convulsiones/diagnóstico , Convulsiones/psicologíaRESUMEN
BACKGROUND: Aim of this study is to determine if peer group risk behaviors and neighbourhood socioeconomic status (SES) would ecologically affect injury incidence according to place and gender among adolescents (aged 13-15) in South Korea. METHODS: Three variables from the Korea Youth Risk Behavior Survey (2014) were used to represent peer group risk behaviours; current alcohol consumption (cAlc), the experience of violence or bullying (VicVB), and having undergone education for injury prevention (Edu-IP). The Korea Census Data (2010) was used for neighborhood SES; the degree of urbanization, the proportion of high educational attainment, and the proportion of low residential environment. The nationwide and regional Incidence-Rates of Injury assessed by EMS (IRI-EMS) were calculated according to age and gender based on the number of injuries from EMS record (2014). A linear regression model was used to examine associations. RESULTS: The nationwide total and inside-school IRI-EMS were 623.8 and 139.3 per 100,000 population, respectively. The range of the regional IRI-EMS showed a maximum of about 4 times the difference from 345 to 1281 per 100,000 population depending on the region. The low residential environment had a significant effect on the increase of total IRI-EMS (ß = 7.5, 95% CI 0.78-14.21). In the case of boys, the IRI-EMS inside-school was increased as the percentage of VicVB was higher (ß = 17.0, 95% CI 1.09-32.91). In the case of girls, the IRI-EMS outside-school was increased in rural compared to urban location (ß = 211.3, 95% CI 19.12-403.57). CONCLUSION: The incidence rate of outside-school was higher than that of inside-school, and incidence rate of boys was higher than that of girls. Peer group risk behaviors were significant only in the injury of boys. Among the SES factors, rural area was a significant factor in girls, especially outside-school injury. Moreover, the rate of households not in an apartment was significant in all outside-school injury and outside-school injury of boys. Our study suggests that among native South Korean adolescents, neighbourhood SES and peer group risk behavior have different effects depending on the injury context such as place of occurrence or gender.
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Acoso Escolar , Servicios Médicos de Urgencia , Asunción de Riesgos , Clase Social , Medio Social , Violencia , Heridas y Lesiones/etiología , Adolescente , Conducta del Adolescente , Consumo de Bebidas Alcohólicas , Femenino , Humanos , Incidencia , Masculino , Grupo Paritario , República de Corea/epidemiología , Características de la Residencia , Factores de Riesgo , Población Rural , Instituciones Académicas , Factores Sexuales , Factores Socioeconómicos , Encuestas y Cuestionarios , Población Urbana , Heridas y Lesiones/epidemiologíaRESUMEN
Using a single source of data, such as police records, or combining data from multiple sources results in an undercount of gun-related injuries. To improve gun-related injury surveillance accuracy by using capture-recapture methods, data were culled from law enforcement, emergency departments, emergency medical services, media, and medical examiner records. The data overlap was operationalized using capture-recapture to generate estimates of uncounted gun incidents. Dependencies between data sources were controlled using log-linear modeling for accurate estimates. New Haven, Connecticut. The study population included subjects injuried/killed from a gun projectile. Incidence was measured using capture-recapture. 49 gun injuries occurred within the defined geography. No single source recorded more than 43 gun-related injuries/deaths. Log-linear modeling estimated the actual number of injuries to be 49.1 (95% CI 49-49.9). Capture-recapture may be less useful in large metropolitan areas that cross state geographical boundaries because of how government agency data are aggregated within each state. No single data source achieves complete gun-related case ascertainment. Log-linear and capture-recapture methods significantly improve gun-related injury estimates.
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Recolección de Datos/métodos , Armas de Fuego/estadística & datos numéricos , Vigilancia en Salud Pública/métodos , Heridas por Arma de Fuego/epidemiología , Adulto , Connecticut , Femenino , Humanos , Incidencia , Modelos Lineales , Masculino , Estadística como AsuntoRESUMEN
Background: The purpose of this review was to examine and chart the "scope" of strategies reported in ED-SBIRT (emergency department-based screening, brief intervention and referral to treatment) studies that employ non-face-to-face (nFtF) modalities for high-risk alcohol use (i.e., risk for alcohol-related injury, medical condition, use disorder) and to identify research gaps in the scientific literature. Methods: The scoping review population included study participants with high-risk alcohol use patterns as well as study participants targeted for primary public health prevention (e.g., adolescent ED patients). Core concepts included SBIRT components among intervention studies that incorporated some form of nFtF modality (e.g., computer-assisted brief intervention). The context encompassed ED-based studies or trauma center studies, regardless of geographic location. After screening a total of 1526 unique references, reviewers independently assessed 58 full-text articles for eligibility. Results: A total of 30 full-text articles were included. Articles covered a period of 14 years (2003-2016) and 19 journal titles. Authors reported the use of a wide range of nFtF modalities across all 3 ED-SBIRT components: "screening" (e.g., computer tablet screening), "brief intervention" (e.g., text message-based brief interventions), and "referral to treatment" (e.g., computer-generated feedback with information about alcohol treatment services). The most frequently used nFtF modality was computerized screening and/or baseline assessment. The main results were mixed with respect to showing evidence of ED-SBIRT intervention effects. Conclusions: There is an opportunity for substance use disorder researchers to explore the specific needs of several populations (e.g., ED patients with co-occurring problems such as substance use disorder and violence victimization) and on several methodological issues (e.g., ED-SBIRT theory of change). Substance use disorder researchers should take the lead on establishing guidelines for the reporting of ED-SBIRT studies-including categorization schemes for various nFtF modalities. This would facilitate both secondary research (e.g., meta-analyses) and primary research design.
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Consumo de Bebidas Alcohólicas/prevención & control , Consejo/métodos , Servicio de Urgencia en Hospital , Tamizaje Masivo/métodos , Prevención Primaria/métodos , Derivación y Consulta , Telemedicina/métodos , HumanosRESUMEN
We offer a perspective on the literature discussing the importance of driving for youth, the complexities of learning to drive, and the risks of driving which lead to motor vehicle crashes (MVCs). Specifically, we discuss important underlying reasons why some adolescents and young adults may be more susceptible to engaging in driving behaviors which result in fatal MVCs; the leading cause of death among 15 to 20 y/o. Some of the factors known to lead to crash fatalities span the domains of cognitive development, distraction, alcohol/drug use, psychosocial development and peer influence, and young driver inexperience. While advancements in driver training, traffic safety legislation, vehicle safety engineering, and emergency/trauma care have helped reduce the prevalence of crashes, we suggest that natural brain maturation which occurs during adolescence and young adulthood may hold unique susceptibilities for young driver crashes. As such, we discuss the importance in using a multidisciplinary research approach, and specifically neuroscience methods, to develop a more compressive understanding of crash risk factors among young drivers. By using a multidisciplinary approach when studying young drivers, we can advance the injury and prevention science as well as inform relevant policies, innovative technologies, comprehensive training and intervention programs which will develop safer young drivers sooner.
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Accidentes de Tránsito , Conducción de Automóvil , Vehículos a Motor , Adolescente , Humanos , Neurociencias , Adulto JovenRESUMEN
BACKGROUND: The rising agitated patient population presenting to the emergency department (ED) has caused increasing safety threats for health care workers and patients. Development of evidence-based strategies has been limited by the lack of a structured framework to examine agitated patient care in the ED. In this study, a systems approach from the patient safety literature was used to derive a comprehensive theoretical framework for addressing ED patient agitation. METHODS: A mixed-methods approach was used with ED staff members at an academic site and a community site of a regional health care network. Participants consisted of resident and attending physicians, physician assistants/nurse practitioners, nurses, technicians, and security officers. After a simulated agitated patient encounter to prime participants, uniprofessional and interprofessional focus groups were conducted, followed by a structured thematic analysis using a grounded theory approach. Quantitative data consisted of surveys of violence exposure and attitudes toward patient aggression and management. RESULTS: Data saturation was reached with 57 participants. Violence exposure was higher for technicians, nurses, and officers. Conflicting priorities and management challenges occurred due to four main interconnected elements: perceived complex patient motivations; a patient care paradox between professional duty and personal safety; discordant interprofessional dynamics mitigated by respect and trust; and logistical challenges impeding care delivery and long-term outcomes. CONCLUSION: Using a systems approach, five interconnected levels of ED agitated patient care delivery were identified: patient, staff, team, ED microsystem, and health care macrosystem. These care dimensions were synthesized to form a novel patient safety-based framework that can help guide future research, practice, and policy.
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Servicio de Urgencia en Hospital/organización & administración , Personal de Hospital , Mejoramiento de la Calidad/organización & administración , Administración de la Seguridad/organización & administración , Análisis de Sistemas , Agresión , Actitud del Personal de Salud , Servicio de Urgencia en Hospital/normas , Ambiente , Humanos , Grupo de Atención al Paciente/organización & administración , Seguridad del Paciente , Simulación de Paciente , Rol Profesional/psicología , Desarrollo de Programa , Evaluación de Programas y Proyectos de Salud , Mejoramiento de la Calidad/normas , Administración de la Seguridad/normas , Violencia Laboral/prevención & controlRESUMEN
OBJECTIVES: To evaluate limited English proficiency (LEP) Latino caregiver asthma knowledge after exposure to an educational video designed for this target group. METHODS: A cross-sectional, interventional study was performed. We aimed to evaluate the post-test impact on asthma knowledge from baseline after exposure to a patient-centered, evidence-based, and professionally produced Spanish asthma educational video. Participants included LEP Latino caregivers of children 2-12 years old with persistent asthma. Enrollment was performed during ED encounters or scheduled through a local community organization. Asthma knowledge was measured with a validated Spanish parental asthma knowledge questionnaire. Differences in mean scores were calculated with a paired t-test. RESULTS: Twenty caregivers were enrolled. Participants included mothers (100%) from Puerto Rico (75%), with a high-school diploma or higher (85%), with no written asthma action plan (65%), whose child's asthma diagnosis was present for at least 3 years (80%). Mean baseline asthma knowledge scores improved 8 points from 58.4 to 66.4 after watching the educational video (95% CI 5.3-10.7; t(19) = 6.21, p < 0.01). Knowledge improvements were similar across the ED and community groups. Knowledge gains were observed in the areas of ED utilization, medication usage, and activity limitations. CONCLUSIONS: The developed educational video improved caregiver asthma knowledge for a Latino population facing communication barriers to quality asthma care. Dissemination of this educational resource to LEP caregivers has the potential to improve pediatric asthma care in the United States.
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Asma/fisiopatología , Barreras de Comunicación , Educación en Salud/métodos , Conocimientos, Actitudes y Práctica en Salud , Madres/psicología , Adulto , Antiasmáticos/uso terapéutico , Asma/tratamiento farmacológico , Niño , Preescolar , Estudios Transversales , Servicio de Urgencia en Hospital/estadística & datos numéricos , Femenino , Hispánicos o Latinos , Humanos , Internet , Lenguaje , Masculino , Persona de Mediana Edad , Puerto Rico/etnología , Factores SocioeconómicosRESUMEN
OBJECTIVE: To assess limited English proficiency (LEP) asthma caregiver quality of life (QoL), skills retention and healthcare utilization after an asthma education fair (AEF). METHODS: A language concordant AEF was conducted at a Latino community center. LEP caregivers of children 1-12 years old and an established asthma diagnosis participated in three skill stations: (a) medication recognition and administration, (b) peak flow use (if child ≥ 5 years) and (c) action plan dissemination. Spacers, peak flow meters and individualized action plans were distributed. A validated, pediatric asthma caregiver quality of life questionnaire (PACQLQ-Spanish version) was administered. Baseline data was compared to follow-up interview data at three and six months after the AEF. Mean PACQLQ scores were analyzed with Wilcoxon signed-rank test and nominal paired data with McNemar's test. RESULTS: We analyzed data from 18 caregivers able to speak English well (22%), not well (28%) or not at all (50%). After three months, improved caregiver QoL was experienced (51 vs. 72, p<0.01). No differences were observed in medication recognition, spacer and peak flow use or peak flow interpretation. After six months, mean school days missed due to asthma decreased (4.1 vs. 0.4, p<0.01). Mean clinic visits, emergency department visits and hospitalizations remained unchanged. CONCLUSIONS: Implementation of a community-based AEF with action plan administration can be beneficial for LEP caregivers and their children. QoL improvements to emotional wellbeing and activity limitations were observed, and lower rates of school absenteeism were reported. Caregiver ability to accurately identify medications was not enhanced.
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Asma , Cuidadores/estadística & datos numéricos , Educación en Salud , Hispánicos o Latinos , Absentismo , Adolescente , Corticoesteroides/uso terapéutico , Agonistas Adrenérgicos beta/uso terapéutico , Adulto , Instituciones de Atención Ambulatoria/estadística & datos numéricos , Antiasmáticos/uso terapéutico , Asma/tratamiento farmacológico , Asma/etnología , Cuidadores/psicología , Niño , Preescolar , Investigación Participativa Basada en la Comunidad , Servicio de Urgencia en Hospital/estadística & datos numéricos , Conocimientos, Actitudes y Práctica en Salud , Hospitalización/estadística & datos numéricos , Humanos , Lactante , Lenguaje , Inhaladores de Dosis Medida , Persona de Mediana Edad , Calidad de Vida , Características de la Residencia , Adulto JovenRESUMEN
In this article, we analyze qualitative data from a purposeful sample of limited English proficiency (LEP) asthma health caregivers. We used ethnically concordant, semistructured, in-depth Spanish-language interviews and a follow-up focus group to explore issues related to communication during pediatric asthma encounters in medical settings. Inductive coding of Spanish transcripts by a bilingual research team was performed until thematic saturation was reached. Several key findings emerged. LEP caregivers encountered significant asthma burdens related to emotional stress, observed physical changes, and communication barriers. Language-discordant communication and the use of ad hoc interpreters were common. This finding is complex, and was influenced by perceptions of interpreter availability, delays in care, feelings of mistrust toward others, and individual emotional responses. Language-concordant education and suitable action plans were valued and desired. We discuss a revealing depiction of the LEP caregiver experience with asthma health communication and recommend areas for further inquiry.
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Asma/etnología , Cuidadores/psicología , Barreras de Comunicación , Comunicación en Salud , Hispánicos o Latinos , Adulto , Antiasmáticos/uso terapéutico , Asma/psicología , Asma/terapia , Preescolar , Investigación Participativa Basada en la Comunidad , Ambiente , Femenino , Humanos , Lactante , Entrevistas como Asunto , Lenguaje , Masculino , Persona de Mediana Edad , Educación del Paciente como Asunto , Relaciones Médico-Paciente , Investigación Cualitativa , Contaminación por Humo de Tabaco/prevención & control , TraducciónRESUMEN
The opioid overdose epidemic is a major threat to the public's health, resulting in the development and implementation of a variety of strategies to reduce fatal overdose. Many strategies are focused on primary prevention and increased access to effective treatment, although the past decade has seen an exponential increase in harm reduction initiatives. To maximize identification of opportunities for intervention, initiatives focusing on prevention, access to effective treatment, and harm reduction are examined independently, although considerable overlap exists. Particular attention is given to harm reduction approaches, as increased public and political will have facilitated widespread implementation of several initiatives, including increased distribution of naloxone and policy changes designed to increase bystander assistance during a witnessed overdose.
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Sobredosis de Droga/mortalidad , Sobredosis de Droga/prevención & control , Reducción del Daño , Naloxona/uso terapéutico , Trastornos Relacionados con Opioides/mortalidad , Trastornos Relacionados con Opioides/prevención & control , Medicina Basada en la Evidencia , Humanos , Incidencia , Antagonistas de Narcóticos/uso terapéutico , Factores de Riesgo , Resultado del TratamientoRESUMEN
OBJECTIVE: The goal of this study was to compare rates of asthma action plan use by limited English proficiency (LEP) caregivers to English proficient (EP) caregivers. METHODS: A cross-sectional bilingual survey was distributed at an urban, academic, pediatric emergency department (PED). Surveys were completed by adult caregivers of children with asthma who sought PED care for asthma related chief complaints. LEP was defined as caregiver ability to speak English less than "very well". Data were analyzed using Fisher's exact test and odds ratios (OR). RESULTS: One hundred seven surveys were completed and analyzed. Fifty-one surveys (48%) were completed by LEP caregivers and 56 (52%) by EP caregivers. A 25% difference (p = .01) in action plan use rates between LEP caregivers (39%) and EP caregivers (64%) was observed. EP alone was associated with action plan use (OR 2.8 [95% CI 1.3-6.1]). Variables not associated with plan use included mother acting as caregiver (OR 2.1 [95% CI 0.7-7.0]), age of child >7 years (OR 1.0 [95% CI 0.5-2.4]), caregiver education ≥ associate degree (OR 1.4 [95% CI 0.6-3.0]), private insurance (OR 0.7 [95% CI 0.3-1.8]), White race (OR 0.7 [95% CI 0.2-2.2]), Latino ethnicity (OR 0.5 [95% CI 0.2-1.3]) and a federally qualified health center (OR 0.8 [95% CI 0.3-2.0]). The main caregiver reasons for plan use were feeling that a plan works/gets results, helps with symptom management and appreciation towards physician attentiveness when a plan is prescribed. The main caregiver reasons for non plan use were they were not informed/given an action plan or perceived the child's asthma as mild/well controlled. CONCLUSION: Compared with EP caregivers, those with LEP experience disparate rates of asthma action plan use.
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Asma/terapia , Cuidadores/estadística & datos numéricos , Servicio de Urgencia en Hospital/estadística & datos numéricos , Lenguaje , Adolescente , Niño , Preescolar , Barreras de Comunicación , Recolección de Datos , Femenino , Humanos , Lactante , MasculinoRESUMEN
PURPOSE: Driving after drinking is a preventable threat to public health. We examined the prospective association of adolescent-reported parental monitoring knowledge (PMK) with recurrent driving after drinking in emerging adulthood. METHODS: We analyzed six annual rounds (1-4, 6, 11) of the National Longitudinal Survey of Youth 1997 with a sample of 5,261 participants. PMK variables were created to recategorize parental monitoring measures by age of the youth. Recurrent driving after drinking was measured in 2002 and 2007 and dichotomized. Unadjusted and adjusted binary logistic regressions analyzed the association of PMK at ages 14, 15, 16, and 17 with recurrent drinking after driving in 2002 (ages 18-23) and 2007 (ages 22-28). Adjusted models included age, sex, race, household income, and education. RESULTS: Mother's PMK from ages 14 to 17 was inversely associated with recurrent driving after drinking in 2002 (adjusted odds ratios [AORs]: 0.89 [p = .003, age 14], 0.93 [marginal p = .062, age 15], 0.88 [p = .0003, age 16], 0.88 [p = .0003, age 17]). By 2007, the only significant association between mother's PMK and recurrent driving after drinking was for age 16 (AOR: 0.95, p = .017). For father's PMK, significant inverse associations were only found for ages 16 and 17 with 2002 recurrent driving after drinking (AORs: 0.93, p = .025 and .88, p = .0005) and age 15 (AOR: 0.95, p = .021) with 2007 recurrent driving after drinking. DISCUSSION: Adolescent perceived PMK appears to offer protection against recurrent driving after drinking in emerging adulthood. This protective effect appears to wane as youth reach their mid-twenties.
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Conducir bajo la Influencia , Humanos , Adolescente , Femenino , Masculino , Estudios Longitudinales , Adulto Joven , Conducir bajo la Influencia/prevención & control , Conducir bajo la Influencia/estadística & datos numéricos , Responsabilidad Parental/psicología , Adulto , Estudios Prospectivos , Conducción de Automóvil , Relaciones Padres-Hijo , Conducta del Adolescente/psicología , Consumo de Bebidas Alcohólicas , Consumo de Alcohol en Menores/prevención & control , Consumo de Alcohol en Menores/estadística & datos numéricosRESUMEN
In 2021, there were 11.7 million licensed young drivers in the U.S. This is 1.5 million fewer young drivers compared to 2007. The phenomenon of delay in driving licensure among teens has notable implications for opportunities positioning them for life success when transitioning into emerging adulthood and in later life.
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Conducción de Automóvil , Concesión de Licencias , Humanos , Conducción de Automóvil/legislación & jurisprudencia , Adolescente , Concesión de Licencias/legislación & jurisprudencia , Estados Unidos , Bienestar Social , Adulto JovenRESUMEN
Alcohol-impaired driving is a formidable public health problem in the United States, claiming the lives of 37 individuals daily in alcohol-related crashes. Alcohol-impaired driving is affected by a multitude of interconnected factors, coupled with long delays between stakeholders' actions and their impacts, which not only complicate policy-making but also increase the likelihood of unintended consequences. We developed a system dynamics simulation model of drinking and driving behaviors among adolescents and young adults. This was achieved through group model building sessions with a team of multidisciplinary subject matter experts, and a focused literature review. The model was calibrated with data series from multiple sources and replicated the historical trends for male and female individuals aged 15 to 24 from 1982 to 2020. We simulated the model under different scenarios to examine the impact of a wide range of interventions on alcohol-related crash fatalities. We found that interventions vary in terms of their effectiveness in reducing alcohol-related crash fatalities. In addition, although some interventions reduce alcohol-related crash fatalities, some may increase the number of drinkers who drive after drinking. Based on insights from simulation experiments, we combined three interventions and found that the combined strategy may reduce alcohol-related crash fatalities significantly without increasing the number of alcohol-impaired drivers on US roads. Nevertheless, related fatalities plateau over time despite the combined interventions, underscoring the need for new interventions for a sustained decline in alcohol-related crash deaths beyond a few decades. Finally, through model calibration we estimated time delays between actions and their consequences in the system which provide insights for policymakers and activists when designing strategies to reduce alcohol-related crash fatalities.
Asunto(s)
Accidentes de Tránsito , Consumo de Bebidas Alcohólicas , Conducción de Automóvil , Humanos , Adolescente , Estados Unidos/epidemiología , Masculino , Femenino , Adulto Joven , Accidentes de Tránsito/estadística & datos numéricos , Accidentes de Tránsito/prevención & control , Consumo de Bebidas Alcohólicas/epidemiología , Consumo de Bebidas Alcohólicas/psicología , Conducción de Automóvil/psicología , Conducción de Automóvil/estadística & datos numéricos , Conducir bajo la Influencia/estadística & datos numéricos , Conducir bajo la Influencia/prevención & control , Modelos TeóricosRESUMEN
INTRODUCTION: Prior work has found incongruencies in injury information reported by crash and hospital records. However, no work has focused on child passengers. The objective of this study was to compare crash scene and hospital-reported injury information for crash-involved child passengers. This study also explored injury location and severity by child age and restraint type. METHODS: Utilizing linked New Jersey data from 2017 through 2019, the authors identified crash-involved child passengers <13 years old and their injuries in crash and hospital reports. Then, they characterized the congruency of injury frequency, severity, and location, as well as the frequency of injuries by child age and restraint type. Analyses were conducted from December 2023 through February 2024. RESULTS: Of 84,060 crash-involved child passengers, crash reports documented 7,858 (9%) children with at least "possible" injuries, while 2,577 (3%) had at least one injury in hospital events. Crash report and hospital data were incongruent for both body region of injury and injury severity. The proportion of children injured increased as children's ages increased and as restraint type progressed. CONCLUSIONS: Crash reports overestimated the number of injured child passengers and misrepresented injury severity and locations. Child restraint systems mitigated a child's injury risk. Importantly, injury information documented on crash reports currently informs the allocation of traffic safety resources. These results highlight the importance of improving these reports' accuracy and underscore calls to link administrative datasets for public health efforts.
RESUMEN
OBJECTIVES: We sought to understand interpersonal and systems-level factors relevant to delivering health care to emergency department (ED) patients who are homeless. METHODS: We conducted semistructured interviews with emergency medicine residents from 2 residency programs, 1 in New York City and 1 in a medium-sized northeastern city, from February to September 2012. A team of researchers reviewed transcripts independently and coded text segments using a grounded theory approach. They reconciled differences in code interpretations and generated themes inductively. Data collection and analysis occurred iteratively, and interviews continued until theoretical saturation was achieved. RESULTS: From 23 interviews, 3 key themes emerged: (1) use of pattern recognition in identifying and treating patients who are homeless, (2) variations from standard ED care for patients who are homeless, and (3) tensions in navigating the boundaries of ED social care. CONCLUSIONS: Our study revealed practical and philosophical tensions in providing social care to patients in the ED who are homeless. Screening for homelessness in the ED and admission practices for patients who are homeless are important areas for future research and intervention with implications for health care costs and patient outcomes.
Asunto(s)
Actitud del Personal de Salud , Servicio de Urgencia en Hospital/organización & administración , Personas con Mala Vivienda , Internado y Residencia , Comunicación , Femenino , Humanos , Entrevistas como Asunto , Masculino , Trastornos Mentales/epidemiología , Ciudad de Nueva York , Gravedad del Paciente , Admisión del Paciente , Servicio Social/organización & administraciónRESUMEN
BACKGROUND: Patients experiencing homelessness represent a disproportionate share of emergency department (ED) visits due to poor access to primary care and high levels of unmet health care needs. This is in part due to the difficulty of communicating and following up with patients who are experiencing homelessness. OBJECTIVE: To determine the prevalence and types of "new media" use among ED patients who experience homelessness. METHODS: This was a cross-sectional observational study with sequential enrolling of patients from three emergency departments 24/7 for 6 weeks. In total, 5788 ED patients were enrolled, of whom 249 experienced homelessness. Analyses included descriptive statistics, and unadjusted and adjusted odds ratios. RESULTS: 70.7% (176/249) of patients experiencing homelessness own cell phones compared to 85.90% (4758/5539) of patients in stable housing (P=.001) with the former more likely to own Androids, 70% (53/76) versus 43.89% (1064/2424), and the latter more likely to have iPhones, 44.55% (1080/2424) versus 17% (13/76) (P=.001). There is no significant difference in new media use, modality, or frequency for both groups; however, there is a difference in contract plan with 50.02% (2380/4758) of stably housed patients having unlimited minutes versus 37.5% (66/176) of homeless patients. 19.78% (941/4758) of patients in stable housing have pay-as-you-go plans versus 33.0% (58/176) of homeless patients (P=.001). Patients experiencing homelessness are more likely to want health information on alcohol/substance abuse, mental health, domestic violence, pregnancy and smoking cessation. CONCLUSIONS: This study is unique in its characterization of new media ownership and use among ED patients experiencing homelessness. New media is a powerful tool to connect patients experiencing homelessness to health care.