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Biomedical subjects

Brian H Rowe

Publications and source records attributed to Brian H Rowe.

78 records · Page 5Linked to original sources
PubMed2002

The effectiveness of IV beta-agonists in treating patients with acute asthma in the emergency department: a meta-analysis.

OBJECTIVES: To determine the benefit of IV beta(2)-agonists for severe acute asthma treated in the emergency department (ED). METHODS: Randomized controlled trials were identified using EMBASE, MEDLINE, and CINAHL; the Cochrane Airways Review Group database; hand searching; bibliographies; pharmaceutical companies; and author contact. Studies where IV beta(2)-agonists were compared to placebo and/or existing standards of care were considered. Where appropriate, trials were combined using odds ratios (ORs) or weighted mean differences with 95% confidence intervals (CIs). RESULTS: From 746 identified references, 55 potentially relevant articles were identified and 15 articles were included. All trials were performed outside North America and were published prior to 1997. Three main treatment strategies were reviewed: strategy 1 (three articles), IV beta(2)-agonists with inhaled beta(2)-agonists vs inhaled beta(2)-agonists; strategy 2 (six articles), IV beta(2)-agonists alone vs inhaled beta(2)-agonists; and strategy 3 (six articles), IV beta(2)-agonists vs IV methylxanthines. Compared to all treatments, IV beta(2)-agonist use did not lead to clinical or statistical significant differences in vital signs, pulmonary functions, laboratory measures, adverse effects, or clinical success. Although statistically nonsignificant, seven methodologically strong studies demonstrated that peak expiratory flows and heart rates were unchanged following beta(2)-agonist use compared to all other treatments at 60 min (8.3 L/min [95% CI, 17.6 to 34.2] and 3.65 beats/min [95% CI, 2.9 to 10.2], respectively), with an increased risk of adverse effects (OR, 1.98; 95% CI, 0.5 to 8.2). CONCLUSIONS: Evidence is lacking to support the use of IV beta(2)-agonists in ED patients with severe acute asthma. Moreover, the clinical benefit appears questionable, while the potential clinical risks are obvious. The only recommendations for IV beta-(2)agonist use should be in those patients in whom inhaled therapy is not feasible, or in the context of a controlled clinical trial comparing IV beta(2)-agonists with standard care vs standard care alone.

Acute Disease↗
PubMedDate not supplied

Bicycle helmet-wearing variation and associated factors in Ontario teenagers and adults.

BACKGROUND: The incidence of bicycle helmet use and the factors associated with helmet use in Ontario are presented in this study. The Ontario Health Survey (1996), a population-based survey of Ontario residents, was used as the data source. METHODS: As the factors associated with helmet use were found to differ between adults and teens, a separate analysis was performed for each age grouping. A logistic regression model (with Bootstrap confidence intervals--95%) was used and adjusted odds ratios (OR) are reported. RESULTS: Of the 7,693 respondents, 41.1% reported wearing their helmets on a regular basis when riding a bicycle. Helmet use was greatest among 12-14 year olds (71.7%) and lowest among those 15-18 years old (33.3%). In teenagers, drinking alcohol (OR: 2.8) and smoking (OR: 4.4) were strongly associated with helmet non-use. In the adult group, female gender (OR: 1.26), higher income (OR: 1.43), higher education (OR: 1.68), nonsmoking status (OR: 2.0) and abstinence from alcohol (1.27) were associated with helmet use. Living in a rural area was also associated with helmet use in the multi-variable analysis. CONCLUSION: This study indicates that bicycle helmet non-use is a multifaceted problem and thus any strategy for increasing helmet-wearing rates requires multi-dimensional interventions. The results of this study are discussed within the context of other studies and related to their public health implications.

Adolescent↗
PubMedDate not supplied

The spatial and temporal dimensions of child pedestrian injury in Edmonton.

OBJECTIVES: This paper describes the temporal and spatial distribution of child pedestrian injury within Edmonton, Alberta for four fiscal years (1995-96 through 1998-99), and compares this pattern to temporal and spatial data on traffic volume. METHODS: We used injury data obtained through an ongoing emergency department (ED) surveillance system involving all hospitals in Alberta's Capital Health Region. We identified peak times of injury occurrence and the location of high injury incidence as indicated by census tract of residence. Empirical Bayes estimation procedures were used to calculate stable injury incidence ratios. Cartographic and correlation analyses identified the relationship between traffic volume and injury incidence. RESULTS: Child pedestrian injury occurred most frequently during morning (0700-0900 hrs) and late afternoon (1500-1800 hrs) which corresponds with peak periods of vehicular traffic flow. The highest incidence rates occurred in or near areas of high traffic volume, notably in the central and west-central parts of Edmonton. DISCUSSION: These findings emphasize the importance of considering spatial and temporal patterns in pedestrian injury research, as well as the need to incorporate these patterns in prevention strategies. Changing the times that children attend school may reduce the convergence of pedestrian and vehicular traffic.

Accidents, Traffic↗
PubMedDate not supplied

The use of bicycle helmets in a western Canadian province without legislation.

INTRODUCTION: This study examined the use of helmets in adults, adolescents, and children in a western Canadian province that has no helmet legislation. METHODS: A prospective survey of cyclists in two urban Alberta regions was completed. Cyclist demographics, helmet wearing and helmet use were recorded. RESULTS: Helmets were observed in 2,259 (55%; 99% CI: 52-57) of 4,141 cyclists; however, only 75% (CI 71, 78) were wearing the helmet properly. Patterns of use varied according to age: 75% (CI 71, 78) of children, 29% (CI 23, 34) of adolescents, and 52% (CI 49, 55) of adults wore helmets. Percentages were higher in Calgary than Edmonton (63% vs. 45%; p < 0.0001) and females wore helmets more often (64% vs. 50%; p < 0.0001). DISCUSSION: These results identify large within- and between-region variation in the use of cycling helmets in Alberta. Injury prevention planners need to use these data to adopt interventions that are focused on age groupings, gender, and place of residence.

Adolescent↗
PubMedDate not supplied

Quantifying the iceberg effect for injury: using comprehensive community health data.

BACKGROUND: Injury is the leading cause of preventable morbidity and mortality in Canada. The "ice berg" effect in injuries was proposed to address the injury statistics that are often poorly documented. The aim of this investigation was to quantify the severity and magnitude of iceberg effect in Ontario, Canada. METHODS: Data from Vital Statistics (1999, mortality), Canadian Institute for Health Information (2001, hospitalizations), Census (2001, demographic information), National Ambulatory Care Reporting System (2001, emergency department visits), and the Canadian Community Health Survey (2000/01, other injuries) were used to construct the Ontario injury iceberg for ages 12 years and older. RESULTS: There were 79,577 fatalities in Ontario in 1999; 2,645 were attributable to injuries (crude rate: 2.3 per 10,000). Of the 913,540 hospitalizations (2001), 67,301 were caused by injuries. There were 3,520,253 emergency department (ED) visits (2001) and 959,278 were attributable to injuries. For injuries treated elsewhere, the most common treatment site was the physician's office (23.3%). The most common cause of injuries (CCHS) was falls (37.4%) and exertion/movement (20.5%). There were 1,928,000 injuries causing functional impairment (one injury to five individuals in the population). INTERPRETATION The high ratio of injury-related ED visits to deaths illustrated the high volume of injuries that present to the ED. The ratio of injuries resulting in functional impairment to the population demonstrates.that such injuries can be problematic, even if not resulting in hospitalization. Constructing the injury iceberg using valid data should assist researchers and decision-makers in priority setting.

Adolescent↗