Biomedical subjects

D C Grossman

Publications and source records attributed to D C Grossman.

47 records · Page 3Linked to original sources

PubMed1995

Firearm injury prevention counseling by pediatricians and family physicians. Practices and beliefs.

OBJECTIVES: To ascertain and compare beliefs, attitudes, and counseling practices of primary care physicians of children and adolescents regarding firearm injury prevention counseling. DESIGN: Cross-sectional survey. SETTING: State of Washington. SUBJECTS: All active members of the state chapters of the American Academy of Pediatrics and American Academy of Family Physicians. A total of 979 pediatricians and family physicians (53%) responded to the survey after two mailings. MAIN OUTCOME MEASURES: Attitudes, beliefs, and current practices with regard to firearm safety counseling among families of child and adolescent patients. RESULTS: Only 25% of pediatricians and 12% of family physicians currently counsel more than 5% of their patients. Pediatricians were more likely than family physicians (70% vs 46%, P < .001, chi 2 test) to believe that physicians have a responsibility to counsel families about firearm safety. Pediatricians recommended removing guns from the home more frequently than family physicians (32% vs 19%, P < .001, chi 2 test), but most physicians of both specialties perceived that parents are rarely receptive to this advice. However, 97% of physicians from both specialties agreed that firearms should be stored locked separately from ammunition, and a substantial majority believed that parents would be receptive to this advice. Compared with physicians who owned guns (32%), non-owners were 15 times more likely (odds ratio, 15; 95% confidence interval, 10 to 23) to agree that families with children should not keep firearms in the home. CONCLUSIONS: Few primary care physicians who see children and adolescents currently counsel families about firearm safety, although many agree that they have such a responsibility. At least half of these physicians would potentially benefit from an intervention to improve their knowledge of and counseling skills on this topic.

Accident Prevention↗

PubMed1995

From roadside to bedside: the regionalization of trauma care in a remote rural county.

OBJECTIVE: To determine the current role of rural hospitals and prehospital agencies in the care of motor vehicle crash victims in a remote, rural county prior to the statewide regionalization of trauma care. Specifically, we determined the proportion of crashes that required a response by emergency medical services (EMSs), the timeliness of the response, the proportion of patients treated in local hospitals, and the factors that predicted referral to trauma centers. DESIGN: Population-based retrospective cohort study linking emergency medical services, emergency department, and hospital discharge data to police motor vehicle crash reports and coroner data. SETTING: Okanogan County, Washington. SUBJECTS: All motor vehicle occupants, pedestrians or pedalcyclists who were involved in a motor vehicle collision with a response by emergency medical system personnel or the county coroner. INTERVENTION: None. MAIN OUTCOME MEASURES: EMS response times, emergency department and hospital discharge disposition, Injury Severity Scores, hospital length of stay, procedures, deaths. RESULTS: Twelve percent of 669 crashes reported to the police led to the dispatch of EMS. Crashes with EMS involvement were more likely to include occupants without restraints, who were ejected from the vehicle or who had alcohol as a contributing circumstance. The median interval between crash and EMS dispatch was 5 minutes (95th percentile: 40 minutes), the median scene time was 15 minutes (95th percentile: 35 minutes), and the median interval between dispatch and emergency department arrival was 48 minutes (95th percentile: 95 minutes). Among the 210 patients treated by EMSs, 67 (32%) were admitted to local hospitals, and 19 (9%) were referred to a distant trauma center. Of these, 17 were referred directly from the emergency department, one from the scene, and one after local admission. Compared with patients who were admitted locally, referred patients had a significantly higher mean Injury Severity Score (14.4 vs. 5.1), hospital length of stay (9.1 vs. 1.8 days), and rate of operative procedures (37% vs. 9%). Of the 13 crash-related deaths during the year, nine were declared dead at the scene before EMS arrival, three were asystolic at the time of EMS arrival at the scene, and one died at a referral hospital. CONCLUSIONS: The linkage of data from police, prehospital agencies, and hospitals can reveal important information about the sequence of health care for trauma patients. The rural hospitals in this county currently play a major role in the stabilization and treatment of motor vehicle crash victims.

Accidents, Traffic↗

PubMed1994

Health status of urban American Indians and Alaska Natives. A population-based study.

OBJECTIVE: To use vital statistics and communicable disease reports to characterize the health status of an urban American Indian and Alaska Native (AI/AN) population and compare it with urban whites and African Americans and with AI/ANs living on or near rural reservations. DESIGN: Descriptive analysis of routinely reported data. SETTING: One metropolitan county and seven rural counties with reservation land in Washington State. SUBJECTS: All reported births, deaths, and cases of selected communicable diseases occurring in the eight counties from 1981 through 1990. MAIN OUTCOME MEASURES: Low birth weight, infant mortality, and prevalence of risk factors for poor birth outcomes; age-specific and cause-specific mortality; rates of reported hepatitis A and hepatitis B, tuberculosis, and sexually transmitted diseases. RESULTS: Urban AI/ANs had a much higher rate of low birth weight compared with urban whites and rural AI/ANs and had a higher rate of infant mortality than urban whites. During the 10 years, urban AI/AN infant mortality rates increased from 9.6 per 1000 live births to 18.6 per 1000 live births compared with no trend among the other populations. Compared with rural AI/AN mothers, urban AI/AN mothers were 50% more likely to receive late or no prenatal care during pregnancy. Relative to urban whites, urban AI/AN risk factors for poor birth outcomes (delayed prenatal care, adolescent age, and use of tobacco and alcohol) were more common and closely resembled the prevalence among the African-American population except for a higher rate of alcohol use among AI/ANs. Compared with urban whites, urban AI/AN mortality rates were higher in every age group except the elderly. Differences between urban whites and AI/ANs were largest for injury- and alcohol-related deaths. All-cause mortality was lower among urban AI/ANs compared with rural AI/ANs and urban African Americans, although injury- and alcohol-related deaths were higher for AI/ANs. All communicable diseases studied were significantly (P < .05) more common among urban AI/ANs compared with whites. Tuberculosis rates were highest in the urban AI/AN group, but rates of sexually transmitted diseases were intermediate between urban whites and African Americans. CONCLUSIONS: In this urban area, great disparities exist between the health of AI/ANs and whites across almost every health dimension we measured. No consistent pattern was found in the comparison of health indicators between urban and rural AI/ANs, though rural AI/ANs had lower rates of low birth weight and higher rates of timely prenatal care use. The poor health status of urban AI/AN people requires greater attention from federal, state, and local health authorities.

Adolescent↗

PubMed1993

Prior injury and motor vehicle crash as risk factors for youth suicide.

We conducted a case-control study to determine whether adolescents and young adults who have been in a motor vehicle crash or hospitalized for unintentional and intentional injury are at greater risk for suicide. Cases were 700 Washington State residents age 16-35 with a driver's license who died of suicide during 1987-1989. Controls were 3,494 licensed drivers matched by age, sex, and zip code. Using two different databases, we were able to determine the past incidence of in-state injury hospitalizations and motor vehicle crashes for all subjects. Overall, the incidence of suicide was tenfold higher among those with a past hospitalization for injury. Many of these admissions were for suicide attempts [odds ratio (OR) = 56, 95% confidence interval (CI) = 27-120], but the risk of suicide was also higher among those hospitalized for unintentional injuries (OR = 5.0, 95% CI = 2.2-11.5) and assaults (OR = 4.5, 95% CI = 1.1-18). The relative risk for suicide was 2.7 (95% CI = 2.0-3.5) for those with prior injury as a driver in a motor vehicle crash and 2.9 (95% CI = 2.2-3.8) for those with involvement in a single vehicle crash. Many unintentional injury hospitalizations and a proportion of motor vehicle crashes in younger adults may represent unrecognized suicide attempts.

Accidents, Traffic↗

PubMed1993

The meaning of death to adolescents in an American Indian community.

BACKGROUND: A high rate of premature death exists among young Native Americans in North America. To understand the qualitative effect of this phenomenon, we undertook this study to explore the meaning of death to adolescents in a Salish American Indian community. METHODS: Standard methods of ethnography were employed: community entry, open-ended in-depth interviews using key informant sampling, audiotape and field note transcription, review of field notes for key themes, and community feedback. Interviews were conducted with seven elders and 21 adolescents in a Pacific Northwestern American Indian community selected by key informants. Probe questions and narrative accounts primarily focused on personal experience with premature death among family and peers. RESULTS: The primary themes in the study were the subjects' personal exposure to death, alcohol and drugs. Spirit Sickness (a culturally defined illness experience), and healing. CONCLUSIONS: There are persistent beliefs in Spirit Sickness among adolescents and young adults in the Salish Indian community. Personal exposure to death is a precipitant of this potentially fatal illness experience. Clinicians working with Salish Native Americans should recognize potential beliefs in this illness experience among the youths.

Adolescent↗

PubMed1992

Injury control in childhood.

The behavior and environment of individuals are key determinants of both unintentional and intentional injuries in childhood and adolescence. These two determinants often interact so that certain behaviors lead to different injury outcomes depending on the environmental context of the injury. For example, depression is more likely to lead to suicide in the presence of alcohol intoxication. Alcohol intoxication is much more likely to lead to the choice of a firearm in a suicide attempt. Children with poor pedestrian crossing skills are far more likely to be hit in a busy urban intersection than in a safer location. The science of injury control has attempted to learn more about both the behavioral, environmental, and agent characteristics that lead to injury. Each of these dimensions offers opportunities for injury prevention or amelioration of the outcome. Despite increasing knowledge about how certain behaviors are associated with specific types of injuries, there has been only limited success achieved by attempts to modify behavior, particularly by persuasion or education. More success has been derived by legislative mandates. The most success, particularly in the prevention of unintentional injury, has been achieved by modification of the environments and the agents that are most often associated with injury. Because intentional injuries involve extremely complex and aberrant behavior, there is a persistent concern that attempts to modify the environment (e.g., handgun control) will be overridden by those with a high level of intent, i.e., they will seek another method. Although this may be true for carefully premeditated acts, suicide attempts and assaults by youth are usually precipitated by an acute stressor that depends on the availability of a weapon at that immediate time. While we develop more sophisticated psychosocial epidemiologic models that accurately predict violent behavior, we must continue to analyze aspects of intentional injuries that offer an opportunity to reduce the injury severity after the injury has occurred. Pediatricians and other health providers of children have played three important historical roles in the field of injury control. As clinicians, we have a unique opportunity to discuss these concerns with our patients and use our influence to attempt to modify individual behavior and inform about risks. As investigators, pediatricians have been important advocates of research initiatives to use the same epidemiologic methods used to study infectious diseases and cancer and apply them to the study of injury. Finally, pediatricians have played a critical public policy role in the evolution of injury control. Pediatricians have been at the helm behind most legislative initiatives to reduce injury among all people.(ABSTRACT TRUNCATED AT 400 WORDS)

Accident Prevention↗

PubMed1992

Risk and prevention of youth suicide.

The rate of fatal suicide attempts among males rose dramatically between 1950 and 1980 and has continued to rise significantly during the 1980s among 15- to 19-year-old youth. Nonfatal suicide attempts, although far more frequent among females, appear to share similar risk factors with completed suicide. The most important preconditional risk factors for both fatal and nonfatal suicide attempts are a history of a previous attempt, major affective and conduct disorders, chronic substance abuse, and a history of personal losses, including experience of suicide attempts by peers and family members. Risk factors for the acute precipitation of an attempt include the acute disruption of an interpersonal relationship, alcohol intoxication, and access to firearms. Preventive efforts can be enhanced by pediatricians both in the office and the community. Clinical case finding of individuals thought to be at high risk will continue to identify some potential victims. Families with household firearms should be counseled regarding the risk of firearm injury and death, particularly in a home with an individual with other risk factors. Community campaigns to improve the mental health of youth and to reduce firearm ownership may hold future promise for the reduction of the unacceptable morbidity and mortality associated with adolescent suicide attempts.

Adolescent↗

PubMed1991

Risk factors for suicide attempts among Navajo adolescents.

BACKGROUND: Rates of adolescent suicide in the United States are highest among Native Americans but little is known about risk factors for suicide attempts in this population. METHODS: To identify risk factors for self-reported suicide attempts by Navajo adolescents, we analyzed the 1988 Indian Health Service Adolescent Health Survey that was administered to 7,254 students in grades 6 through 12 on the Navajo reservation. The responses of students reporting a past suicide attempt were compared to others. RESULTS: Nearly 15 percent (N = 971) reported a previous suicide attempt; over half of those admitted to more than one attempt. Controlling for age, a logistic regression model revealed the following associations with suicide attempts: a history of mental health problems (OR = 3.2); alienation from family and community (OR = 3.2); having a friend who attempted suicide (OR = 2.8); weekly consumption of hard liquor (OR = 2.7); a family history of a suicide or attempt (OR = 2.3); poor self-perception of health (OR = 2.2); a history of physical abuse (OR = 1.9); female gender (OR = 1.7); and sexual abuse (OR = 1.5). CONCLUSIONS: Efforts to prevent adolescent suicide attempts in this population should target individuals with those risk factors of the highest risk and prevalence of exposure.

Adolescent↗

PubMedDate not supplied

Asthma prevalence among American Indian and Alaska Native children.

OBJECTIVES: Although asthma is the most common chronic childhood illness in the United States, little is known about its prevalence among American Indian and Alaska Native (AI/AN) children. The authors used the latest available household survey data to estimate the prevalence of asthma in this population. METHODS: The authors analyzed data for children ages 1 through 17 years from the 1987 Survey of American Indians and Alaska Natives (SAIAN) and the 1987 National Medical Expenditure Survey (NMES). At least one member of each AI/AN household included in the SAIAN was eligible for services through the Indian Health Service. RESULTS: The weighted prevalence of parent-reported asthma was 7.06% among 2288 AI/AN children ages 1-17 (95% CI 5.08, 9.04), compared with a US estimate of 8.40% for children ages 1-17 based on the 1987 NMES (95% CI 7.65, 9.15). The AI/AN sample was too small to yield stable estimates for a comparison between AI/AN children and all US children when the data were stratified according to household income and metropolitan vs non-metropolitan residence. The unadjusted asthma prevalence rates were similar for AI/AN children and for children in the NMES sample. CONCLUSIONS: In 1987, the prevalence of parent-reported asthma was similar for AI/AN children in the SAIAN sample and for children in the NMES sample. More recent data are needed to better understand the current prevalence of asthma among AI/AN children.

Adolescent↗

PubMedDate not supplied

The history of injury control and the epidemiology of child and adolescent injuries.

Unintentional injuries claim the lives of more children each year than any other cause of death. A substantial proportion of child hospitalizations and emergency department visits also are attributable to unintentional injuries. The conceptualization of unintentional injuries as a public health problem that is preventable has gained credibility over the past few decades, as effective solutions to reduce the burden of injuries--such as child safety seats, bicycle helmets, and smoke detectors--have been identified. Successful implementation of these strategies requires a clear understanding of the circumstances surrounding injuries and the risk and protective factors that influence the likelihood that a child will be injured. Although adequate data on these factors is available for some causes of injury, such as motor vehicle crashes, it is almost nonexistent for others, such as unintentional firearm injuries. Overall, unintentional injury rates are highest among adolescents ages 15 to 19, males, children from impoverished families, and minorities. Also, some injuries occur more often in rural areas. Although these demographic risk factors cannot be modified, environmental and behavioral risks, such as unsafe roads, alcohol intoxication, unfenced swimming pools, and the absence of a smoke detector in the home, can be modified successfully with appropriate strategies. Motor vehicle occupant, drowning, and pedestrian injuries were the most common unintentional injuries causing death among children ages 0 to 19 in 1996. Together, these mechanisms accounted for more than half of all unintentional injury deaths among children and adolescents, although rates varied considerably by age. Child injury death rates across most age categories and mechanisms of injury have declined during the past 20 years, yet the reasons for these declines are poorly understood. Additional research about risk and protective factors, and efforts to implement successful injury prevention strategies among populations at highest risk for injuries, are necessary to further reduce the toll on children's lives.

Accident Prevention↗

PubMedDate not supplied

Trauma among American Indians in an urban county.

OBJECTIVE: To describe severe injury among American Indians in a large metropolitan county given that most previous studies of the high Indian injury morbidity and mortality rates have been conducted primarily in rural areas. METHODS: A retrospective analysis of a hospital trauma registry was conducted for the years 1986-92 at the Harborview Medical Center, the only Level I trauma center in King County, Washington, metropolitan county with the seventh largest number of urban American Indians in the United States. RESULTS: Of 14,851 King County residents included in the registry, 593 (4%) were classified as American Indian. With King County whites as the reference, the age-standardized incidence ratio for inclusion of American Indians in the registry was 4.4 (95% confidence interval 4.1, 4.8). The standardized incidence ratios and proportional incidence ratios showed significant differences in mechanism and whether it was intentional or unintentional among Indians compared with whites. Hospitalizations for stab wounds, bites, and other blunt trauma were all significantly more frequent among Indians. Trauma admissions among Indians were disproportionately associated with assaults. A high proportion (72.3%) of American Indians tested had blood alcohol levels exceeding 0.1%. CONCLUSION: Urban American Indians experience high rates of trauma, differing from those among whites. Efforts to reduce injury in urban areas should include collaboration with representative urban American Indian organizations.

Adolescent↗