Search PubMed⌕ Search

Biomedical subjects

F P Rivara

Publications and source records attributed to F P Rivara.

At least 19 recordsLinked to original sources
PubMed2006

Ascertainment of intimate partner violence using two abuse measurement frameworks.

OBJECTIVE: To estimate prevalence of intimate partner violence (IPV) according to two abuse ascertainment tools, and agreement between the tools. METHODS: 2504 women randomly selected from a health maintenance organization were asked about IPV exposure in their most recent intimate relationship using five questions on physical and sexual abuse, and fear due to partner's threats and controlling behavior from the Behavioral Risk Factor Surveillance Survey (BRFSS) and 10 questions from the Women's Experience with Battering (WEB) scale. IPV prevalence was estimated according to the BRFSS and WEB, and the proportion of women who were WEB+/BRFSS+, WEB-/BRFSS-, WEB-/BRFSS+, and WEB+/BRFSS-. RESULTS: In their most recent relationship, 14.7% of women reported abuse of any type on the BRFSS versus 7.0% on the WEB scale. In direct comparisons of the WEB and BRFSS questions, a higher percentage of abused women reported any IPV on the five BRFSS questions (88.4%) compared to the 10 WEB questions (42.0%). However, both the BRFSS and WEB identified some women as abused that would have been missed by the other instrument. CONCLUSIONS: Intimate partner violence prevalence depends on how women are asked about abuse. Resources permitting, more than one abuse ascertainment strategy (for example, both the BRFSS and WEB questions) should be tried in order to broadly identify as many women as possible who interpret themselves as abused.

Adolescent↗
PubMed2006

Changes in traffic crash mortality rates attributed to use of alcohol, or lack of a seat belt, air bag, motorcycle helmet, or bicycle helmet, United States, 1982-2001.

OBJECTIVE: To estimate the contributions of five risk factors to changes in US traffic crash mortality: (1) alcohol use by drivers and pedestrians, (2) not wearing a seat belt, (3) lack of an air bag, (4) not wearing a motorcycle helmet, and (5) not wearing a bicycle helmet. DESIGN: Longitudinal study of deaths; attributable deaths were estimated using data from other studies. SETTING: US traffic crashes in 1982-2001. SUBJECTS: People who died in a crash. MAIN OUTCOME MEASURES: Counts of deaths attributed to each risk factor, change in rates of deaths, and counts of lives saved by changes in risk factor prevalence. RESULTS: There were 858 741 traffic deaths during the 20 year period. Estimated deaths attributed to each factor were: (1) alcohol use, 366 606; (2) not wearing a seat belt, 259 239; (3) lack of an air bag, 31 377; (4) no motorcycle helmet, 12 095; (5) no bicycle helmet, 10 552. Over the 20 years, mortality rates attributed to each risk factor declined: alcohol by 53%; not wearing a seat belt by 49%; lack of an air bag by 17%; no motorcycle helmet by 74%; no bicycle helmet by 39%. There were 153 168 lives saved by decreased drinking and driving, 129 297 by increased use of seat belts, 4305 by increased air bag prevalence, 6475 by increased use of motorcycle helmets, and 239 by increased use of bicycle helmets. CONCLUSIONS: Decreased alcohol use and increased use of seat belts were associated with substantial reductions in crash mortality from 1982 through 2001. Increased presence of air bags, motorcycle helmets, and bicycle helmets were associated with smaller reductions.

Accidents, Traffic↗
PubMed2005

Ability of parents to recall the injuries of their young children.

OBJECTIVE: To estimate the ability of parents to recall the injuries of their children. DESIGN: Comparison of parent recall with computerized medical records. SETTING: A health maintenance organization in Washington State during 2003. SUBJECTS: Parents of children younger than 6 years. MAIN OUTCOME MEASURES: The ratio of recalled injuries to injuries in computerized data. RESULTS: Telephone interviews were completed with a parent of 1672 young children who had computerized medical data for at least one injury in the last year. Counting the three most recent treated injuries, the 1672 children had 1896 separate new injuries in the year before interview and parents recalled 1150 of these: recall ratio 0.61 (95% confidence interval (CI) 0.58 to 0.63). The recall ratio decreased from 0.82 (95% CI 0.79 to 0.85) for injuries one day before interview to 0.37 (95% CI 0.32 to 0.40) at 365 days before interview. For 341 major injuries the recall ratio was 0.80 (95% CI 0.76 to 0.84), for 202 minor injuries treated in an emergency department or hospital it was 0.77 (95% CI 0.71 to 0.82), for 597 minor injuries treated in urgent care it was 0.70 (95% CI 0.65 to 0.73), and for 756 minor injuries treated in a clinic it was 0.43 (95% CI 0.39 to 0.47). CONCLUSIONS: Recall decreased with time. Recall was best for major injuries, intermediate for minor injuries treated in a hospital, emergency department, or urgent care center, and worst for minor injuries treated in a clinic.

Adolescent↗
PubMed2005

Validation of parent self reported home safety practices.

OBJECTIVES: To evaluate the validity of parents' self reported home safety practices concerning smoke detectors, bike helmets, car seats, and water heater temperature. SETTING: Parents of children 12 years old and under whose child had made at least one visit to a study clinic in the years 2000-2003. METHODS: As part of a randomized controlled trial to improve patient provider communication and preventive practices, parents' responses to telephone interview were compared with observations of safety practices during a home visit. Home visits were completed within nine weeks of the telephone interview. Parents were not told that the visit was part of a validation study and home visit observers were unaware of the interview responses. The authors calculated sensitivities, specificities, positive and negative predictive values, and their corresponding confidence intervals. RESULTS: Sensitivity (0.78 to 0.98) and positive predictive values (0.75 to 1.00) were high for all items. Specificities and negative predictive values were more variable and the highest estimates (specificity 0.95 to 1.00, negative predictive value 0.95 to 0.97) were for car seat types. CONCLUSIONS: The results suggest that parent self report practice of certain injury prevention behaviors (owning a car seat, hot water temperatures) is reliable, whereas self reports on other practices (working smoke detectors, properly fitting bike helmets) may be overstated.

Accidents, Home↗
PubMed2004

Vehicle mismatch: injury patterns and severity.

Light truck vehicles (LTV) are becoming more popular on US highways. This creates greater opportunity for collisions with passenger vehicles (PV). The mismatch in weight, stiffness, and height between LTV and PV has been surmised to result in increased fatalities among PV occupants when their vehicles collide with LTV. We reviewed cases of vehicle mismatch collisions in the Seattle Crash Injury Research and Engineering Network (CIREN) database to establish patterns and source of injury. Of the first 200 Seattle CIREN cases reviewed, 32 collisions with 41 occupant cases were found to involve LTV versus PV. The cases were reviewed by type of collision and vehicle of injured occupant: side impact of PV with LTV, front impact of PV with LTV, and front impact of LTV with PV. For each type of crash, injury patterns and mechanisms were identified. For side impact to PV, head and upper thorax injuries were frequently encountered due to LTV bumper frame contact above the PV side door reinforcement. For frontal impact to PV, severe multiple extremity fractures along with some head and chest injuries were caused by intrusion of the instrument panel and steering column due to bumper frame override of the LTV. Underriding of the PV when colliding with the LTV resulted in severe lower extremity fractures of the LTV occupant due to intrusion of the toe pan into the vehicle compartment of the LTV. The injuries and the sources identified in this case series support the need for re-designing both LTV and PV to improve vehicle compatibility. Revising Federal Motor Vehicle Safety Standard 214 to reinforce the entire door, consider adding side airbags, and re-engineering LTV bumpers and/or frame heights and PV front ends are possible ways to reduce these injuries and deaths by making the vehicles more compatible.

Accidents, Traffic↗
PubMed2004

Motor vehicle crash deaths related to police pursuits in the United States.

OBJECTIVE: To determine the number and characteristics of motor vehicle crash deaths related to police pursuits in the United States. METHODS: Analysis of the Fatality Analysis Reporting System and the Crashworthiness Data System of the National Highway Traffic Safety Administration for the years 1994-2002. RESULTS: There were 2654 fatal crashes involving 3965 vehicles and 3146 fatalities during the nine year study period. Of these, 1088 were to people not in the fleeing vehicle. These crashes often occurred at high speed, in the night, on local roads. Most of the pursued drivers had prior motor vehicle related convictions. CONCLUSIONS: Many deaths related to police pursuits are to innocent victims. Given that most of the pursued drivers had prior convictions, alternative means of detaining them should be explored.

Accidents, Traffic↗
PubMed2004

Lost working days, productivity, and restraint use among occupants of motor vehicles that crashed in the United States.

BACKGROUND: In 2001, 6.3 million passengers were involved in motor vehicle crashes. This study aimed to determine the number of work days lost as a result of motor vehicle crashes and factors that influenced people's return to work. METHODS: This was a retrospective, population based cohort study of occupants in motor vehicles involved in crashes from the 1993-2001 Crashworthiness Data System produced by the National Highway Traffic Safety Administration. The sample population of people aged 18-65 years included two groups: occupants who survived and were working before the crash and occupants who were injured fatally and were estimated to have been working before the crash. Multivariate linear regression was used to analyze the impact of restraint use and injury type on return to work. RESULTS: Overall, 30.1% of occupants of vehicles that crashed missed one or more days of work. A crash resulted in a mean 28.0 (95% confidence interval 15.8 to 40.1) days lost from work, including losses associated with fatalities. The 2.1 million working occupants of vehicles that crashed in 2001 lost a total of 60 million days of work, resulting in annual productivity losses of over $7.5 billion (2964 to 12 075). Unrestrained vehicle occupants accounted for $5.6 billion in lost productivity. CONCLUSIONS: Motor vehicle crashes result in large and potentially preventable productive losses that are mostly attributable to fatal injuries.

Accidents, Traffic↗
PubMed2003

Correlation of head injury to vehicle contact points using crash injury research and engineering network data.

Head injury is the most common cause of morbidity and mortality in motor vehicle crashes. Efforts to improve vehicle design, which minimize forces exerted to the occupant's head, may lead to a reduction in the frequency and severity of head injury. We therefore set out to identify mechanisms producing severe head injury in motor vehicle crashes (MVC) derived from the crash injury research and engineering network (CIREN) database. CIREN combines crash site analysis, vehicle damage assessment, and occupant kinematics in relation to the occupant's injuries. From the Seattle CIREN database of 101 cases, compiled from 1997 to 1998, we selected those crashes in which the occupant sustained severe head injury (abbreviated injury score, AIS>or=4) for analysis. We examined crash mechanism, energy transfer, point of head contact, vehicle intrusion and resulting injuries. There were 15 cases with severe head injury. These were primarily due to side impacts (n=10) in comparison to front impacts (n=5). The average net change in velocity (delta velocity, DV) was 15 mile/h (range 4-29 mile/h). In cases where the primary point of head contact could be elucidated the B-pillar predominated (4 cases, 33.3%) followed by the striking external object (2 cases, 16.7%), A- (1 case, 8.3%) and C- (1 case, 8.3%) pillars, roof side rail (1 case, 8.3%), windshield header (1 case, 8.3%), windowsill (1 case, 8.3%) and airbag (1 case, 8.3%). In this series the predominant mechanism of head injury was lateral impacts, especially those in which the victims' heads struck the B-pillar. The need for improved head protection from lateral impacts is indicated.

Accidents, Traffic↗
PubMed2003

Injuries and death of children in rollover motor vehicle crashes in the United States.

CONTEXT: There is an increased awareness of the problem of rollover crashes, but few data on children involved in rollover crashes in the United States. OBJECTIVE: To determine: (1) the rates of rollover crashes involving children and the incidence of fatal injury; (2) the characteristics of crashes involving children; (3) the risk factors for children being in a rollover compared with a non-rollover crash; and (4) whether the risk of death is greater for children involved in crashes in sport utility vehicles (SUVs) or passenger cars. DESIGN: Retrospective cohort study. DATA: 1993 through 1998 crashes involving children younger than 16 years included in the Crashworthiness Data System or reported to the Fatality Analysis Reporting System. RESULTS: During the study period, 100.4 children per 100 000 person-years were involved in a rollover crash, accounting for 10% of all children involved in crashes. The incidence of fatal injuries in rollover crashes was 3.4 per 100 000 person-years. Sixty percent of children involved in rollovers were riding in SUVs. Among vehicles carrying children and involved in a crash, the adjusted relative risk of the crash being a rollover was 11.1 (95% confidence interval (CI) 9.3 to 13.3) for SUVs compared with passenger cars. The adjusted relative risk of death was 1.8 (95% CI 1.1 to 2.8) in a rollover crash and the relative risk of injury was 2.1 (95% CI 1.1 to 3.8) compared with non-rollover crashes. However, the relative risk of death for children in SUVs which crashed was 0.4 (95% CI 0.1 to 2.5) compared with passenger cars which crashed. CONCLUSIONS: Crashes involving children in SUVs were more likely to be rollover crashes than those involving passenger cars, and rollover crashes were associated with an increased risk of death and injury. However, the overall risk of death for children in a crash was not higher for children who crashed in an SUV compared to children who crashed in a passenger vehicle. Whether children are safer overall in SUVs compared with other cars cannot be answered with the data used.

Accidents, Traffic↗
PubMed2003

A community-based telephone survey of work and injuries in teenage agricultural workers.

In order to estimate the one-year cumulative incidence of work-related injuries in teenage agricultural workers and to characterize the patterns and types of agricultural work performed by teenagers, we performed a community-based random-digit dialing telephone survey. We used a sampling frame of farm and non-farm households to access information on teenage agricultural workers. An agricultural community in eastern Washington State was selected due to the high number of teenage youth and its agricultural economy. Teenage agricultural workers who worked for an agricultural business owned by one of their family members were more likely to work a greater number of seasons, work fewer hours per week, perform tasks involving driving, animal care, and mechanic work, and were less likely to be seasonal workers or work in the harvest than teenagers who did not work for a family member. A similar pattern of work differences was seen when comparing non-Hispanic to Hispanic agricultural workers. Teenagers working for a family member in agriculture had a higher injury rate than teenagers working for an agricultural business not owned by a family member. The injury rate among Hispanic teenage agricultural workers was also higher than that of non-Hispanics.

Accidents, Occupational↗
PubMed2002

Dynamic cerebral autoregulation in healthy adolescents.

BACKGROUND: : There is little information on the limits of cerebral autoregulation and the autoregulatory capacity in children. The aim of this study was to compare dynamic cerebral autoregulation between healthy adolescents and adults. METHODS: : Seventeen healthy volunteers 12-17 years (n = 8) and 25-45 years (n = 9) were enrolled in this study. Bilateral mean middle cerebral artery flow velocities (Vmca; (cm/s)) were measured using transcranial Doppler ultrasonography (TCD). Mean arterial blood pressure (MAP) and end-tidal carbon dioxide were measured continuously during dynamic cerebral autoregulation studies. Blood pressure cuffs were placed around both thighs and inflated to 30 mmHg above the systolic blood pressure for 3 min and then rapidly deflated, resulting in transient systemic hypotension. The change of Vmca to change in MAP constitutes the autoregulatory response, and the speed of this response was quantified using computer model parameter estimation. The dynamic autoregulatory index (ARI) was averaged between the two sides. RESULTS: : Adolescents had significantly lower ARI (3.9 +/- 2.1 vs. 5.3 +/- 0.8; P=0.05), and higher Vmca (75.2 +/- 15.2 vs. 57.6 +/- 15.0; P<0.001) than adults. CONCLUSION: : The autoregulatory index is physiologically lower in normal adolescents 12-17 years of age than in adults.

Adolescent↗
PubMed2002

Research on injury prevention: topics for systematic review.

BACKGROUND: Duplication should be avoided in research and only effective intervention programs should be implemented. OBJECTIVE: To arrive at a consensus among injury control investigators and practitioners on the most important research questions for systematic review in the area of injury prevention. DESIGN: Delphi survey. METHODS: A total of 34 injury prevention experts were asked to submit questions for systematic review. These were then collated; experts then ranked these on importance and availability of research. RESULTS: Twenty one experts generated 79 questions. The prevention areas with the most number of questions generated were fires and burns, motor vehicle, and violence (other than intimate partner), and the least were other interventions (which included Safe Communities), and risk compensation. These were ranked by mean score. There was good agreement between the mean score and the proportion of experts rating questions as important or very important. Nine of the top 24 questions were rated as having some to a substantial amount of research available, and 15 as having little research available. CONCLUSIONS: The Delphi technique provided a useful means to develop consensus on injury prevention research needs and questions for systematic review.

Humans↗
PubMed2002

Mobilizing for pedestrian safety: an experiment in community action.

In contrast to the steady reduction in mortality and morbidity from collisions involving motor vehicle occupants, relatively little progress has been made in controlling motor vehicle/pedestrian collisions. Engineering modifications are the most effective means of reducing such collisions, but mainly because of their cost, and public apathy about pedestrian safety, are too rarely employed. A modest experiment in community action was undertaken by attempting to induce the authorities of 10 small cities to apply for state funds to create a single model pedestrian refuge in their respective communities. Our hope was that this model would later lead to more widespread improvements. The key elements of the campaign were organizing local pedestrian safety task forces, compiling local pedestrian injury statistics, and publicizing the stories of pedestrian injury victims. At the conclusion of the planning process, all 10 target communities submitted grant applications and all 10 received full grant funding. Five projects were completed as planned, two are under construction, and the plans for three were abandoned. Pedestrian safety is not an issue that captures public attention. To make progress, goals must be modest, and a dedicated constituency must be developed. "Victim advocacy" is a vital part of this process. Progress in injury control requires concerted community action.

Accident Prevention↗