Search PubMed⌕ Search

Biomedical subjects

F Rivara

Publications and source records attributed to F Rivara.

15 recordsLinked to original sources
PubMed2005

An evaluation of state firearm regulations and homicide and suicide death rates.

OBJECTIVE: To determine if any of five different state gun laws were associated with firearm mortality: (1) "shall issue" laws permitting an individual to carry a concealed weapon unless restricted by another statute; (2) a minimum age of 21 years for handgun purchase; (3) a minimum age of 21 years for private handgun possession; (4) one gun a month laws which restrict handgun purchase frequency; and (5) junk gun laws which ban the sale of certain cheaply constructed handguns. DESIGN: A cross sectional time series study of firearm mortality from 1979 to 1998. SETTING: All 50 states and the District of Columbia. SUBJECTS: All residents of the United States. MAIN OUTCOME MEASURES: Firearm homicides, all homicides, firearm suicides, and all suicides. RESULTS: When a "shall issue" law was present, the rate of firearm homicides was greater, RR 1.11 (95% confidence interval 0.99 to 1.24), than when the law was not present, as was the rate of all homicides, RR 1.08 (95% CI 0.98 to 1.17), although this was not statistically significant. No law was associated with a statistically significant decrease in the rates of firearm homicides or total homicides. No law was associated with a statistically significant change in firearm suicide rates. CONCLUSION: A "shall issue" law that eliminates most restrictions on carrying a concealed weapon may be associated with increased firearm homicide rates. No law was associated with a statistically significant reduction in firearm homicide or suicide rates.

Adolescent↗
PubMed2001

Factors influencing the patterns of injuries and outcomes in car versus car crashes compared to sport utility, van, or pick-up truck versus car crashes: Crash Injury Research Engineering Network Study.

BACKGROUND: Data using crash dummies suggest that motor vehicle crashes (MVCs) involving passenger sedans (S) vs sport utility, vans, or light trucks (SUVTs) produce more severe injuries than those involving two sedans (SvS). However, no detailed data regarding pattern of injuries or force mechanisms involved have been presented in real patients. METHODS: The relationship of injury patterns and severities with MVC reconstruction data were obtained in 412 MVC patients, drivers or front seat passengers. Crashes were examined with regard to impact direction, frontal (F) or lateral (L) crashes, vehicle mass ratio, ISS, DELTA V, seat belt use, and airbag deployment (AB). RESULTS: In 309 F-MVC, AB reduced overall ISS (24.3 to 17.9) with a reduction in the mean severity of traumatic brain injury (TBI) GCS < or = 12, from 48% to only 28%. This AB protection from TBI was preserved as DELTA V increased to > 30 mph even though non-AB protected body areas (thorax, lung, liver, and lower extremity injuries) all increased. When vehicles of incompatible size and mass (SUVT) had F-MVC with sedans the incidence of severe TBI rose as did face lacerations despite AB or belt use. In L-MVC between SUVT and sedans compared with SvS MVC, there was a cephalad shift in body injuries with increased thorax, but decreased lower extremity injuries. The incidence of TBI increased. Analysis of injury contact sites (hits) showed more hits and a wider distribution of contract sites in SUVT vs sedan MVC. These appeared due to the greater mass excess and larger mass ratio, hood height, and width in the F-SUVT vs S crashes. All of these factors plus the increased bumper height above the body frame side-door sill were injury causal factors in the L-SUVT vs S MVCs. CONCLUSION: Both F and L crashes between sedans and SUVT with a high mass ratio shift the pattern of injury cephalad with increased thorax and intrathoracic organ injuries, and more severe TBI. These data suggest that improved head and thorax side-impact buffering and design features which transmit MVC forces from the higher front end of the larger mass SUVT to the frame of the sedan may better protect sedan occupants from side-impacts.

Accidents, Traffic↗
PubMed1998

Physical assault in New Zealand: the experience of 21 year old men and women in a community sample.

AIM: To obtain epidemiological information on physical assault in a high risk group of New Zealanders. METHOD: Rates of physical assault in the preceding twelve months were ascertained by interview in a cohort of 21 year old, Dunedin-born men (n = 482) and women (n = 462). RESULTS: Forty-five percent of the men and one quarter of the women reported at least one physical assault, either completed, attempted or threatened. A small proportion of these received medical treatment. Most serious assaults were by a perpetrator who was thought to have been drinking alcohol. Most assaults on men were by strangers but partners carried out more assaults against women, especially those receiving medical treatment. One quarter of all assaults on women were by other women, compared to 15% of the assaults on men. Differences between patterns of assaults on women and on men are discussed. CONCLUSION: It is important for doctors to be aware of the widespread occurrence of interpersonal violence in New Zealand and its underreporting.

Adult↗
PubMed1997

The effect of payer status on utilization of hospital resources in trauma care.

OBJECTIVE: To determine the effect of payer status on outcome and resource utilization in motor vehicle-related trauma patients. DESIGN: Retrospective cohort analysis that assessed the effect of payer status on outcome and resource utilization. SETTING: The single level I trauma center in a regionalized statewide system. PATIENTS: Consecutive patients (N = 3141) who were hospitalized after a motor vehicle crash during a 3-year period. MAIN OUTCOME MEASURES: The mortality rate, disposition, total hospital length of stay (LOS), total intensive care unit LOS, and total hospital charges were examined for 2 categories of payers: "commercial insurance" (commercial, labor and industry, and contract pay) and "noncommercial insurance" (Medicaid and self-pay). RESULTS: After controlling for age, sex, race, and the Injury Severity Score, the payer status had no overall effect on the mortality rate, disposition, total hospital charges, total hospital LOS, or total intensive care unit LOS. However, there was a significantly (11.4%; P < .05) longer LOS for those patients with noncommercial insurance who required transfer to another facility for rehabilitation or long-term care. CONCLUSIONS: The utilization of hospital trauma care resources in a level I facility in a regionalized system was not associated with insurance status. Patients with noncommercial insurance who required transfer to elective long-term care facilities had a longer LOS due to delays in obtaining subsequent access. Health care policy should provide appropriate reimbursement for all aspects of regionalized trauma care systems to ensure maintenance of an egalitarian approach to care.

Accidents, Traffic↗
PubMed1996

Prehospital endotracheal intubation of children by paramedics.

STUDY OBJECTIVE: To describe the experience of an emergency medical services system with the use of liberal indications for prehospital pediatric endotracheal intubation. METHODS: We performed a retrospective review of prehospital and hospital patient records in an urban and suburban prehospital care system. The study included all children aged 15 years or younger who were intubated in the prehospital setting by King County paramedics from January 1, 1984, to December 31, 1990. RESULTS: During the 7-year study period, 654 children were intubated, of which 355 (54%) were study patients. The median age of the patients was 3 years; 60% had an injury diagnosis. On arrival of the paramedics, 60% of the patients were in sinus rhythm, 62% had a systolic blood pressure of 70 mm Hg or greater, and 56% had a respiratory rate of 10 breaths per minute or greater. The Glasgow Coma Scale score was 8 or lower in 83% of the patients. Succinylcholine was used to facilitate intubation in 47% of patients. On arrival at the emergency department, 79% of the patients were in sinus rhythm; 75% had an adequate blood pressure (70 mm Hg or greater); 86% had a PaO2 value of 100 mm Hg or greater; and 74% had a PaCO2 value of 45 mm Hg or lower. Complications of intubation, more than half of which were classified as minor, were noted in 22.6% of patients. We were unable to determine the number of failed intubation attempts. Most of the patients (58%) survived to hospital discharge. Among cardiac arrest victims, only 12% survived. CONCLUSION: In a setting where paramedics practice with close medical direction, applying liberal indications for pediatric intubation and permitting the use of succinylcholine allowed paramedics to intubate children of different ages and diagnoses.

Adolescent↗
PubMed1996

Motorcycle helmet use and injury outcome and hospitalization costs from crashes in Washington State.

OBJECTIVES: The incidence, type, severity, and costs of crash-related injuries requiring hospitalization or resulting in death were compared for helmeted and unhelmeted motorcyclists. METHODS: This was a retrospective cohort study of injured motorcyclists in Washington State in 1989. Motorcycle crash data were linked to statewide hospitalization and death data. RESULTS: The 2090 crashes included in this study resulted in 409 hospitalizations (20%) and 59 fatalities (28%). Although unhelmeted motorcyclists were only slightly more likely to be hospitalized overall, they were more severely injured, nearly three times more likely to have been head injured, and nearly four times more likely to have been severely or critically head injured than helmeted riders. Unhelmeted riders were also more likely to be readmitted to a hospital for follow-up treatment and to die from their injuries. The average hospital stay for unhelmeted motorcyclists was longer, and cost more per case; the cost of hospitalization for unhelmeted motorcyclists was 60% more overall ($3.5 vs $2.2 million). CONCLUSIONS: Helmet use is strongly associated with reduced probability and severity of injury, reduced economic impact, and a reduction in motorcyclist deaths.

Accidents, Traffic↗
PubMed1995

Admissions for injury at a rural hospital in Ghana: implications for prevention in the developing world.

OBJECTIVES: Strategies for injury prevention have been extensively studied in developed nations but not in the developing world. This study sought to determine which mechanisms of injury were common in a rural developing area and which were important contributors to mortality and disability. METHODS: All 614 patients admitted for injuries to a rural African hospital between 1987 and 1991 were analyzed retrospectively for mechanism of injury and outcome, as assessed by mortality and long-term functional status. RESULTS: The leading mechanisms of injury were transport related (29%) and burns (16%). Burns accounted for 61% of injuries in children under 5 years. Mortality was 7.3% in the series, with 24% of deaths owing to transport injuries. Disability developed in 103 (22%) of the 462 survivors available for assessment, with most disability resulting from transport injuries (26% of all disabilities), burns (13%), and agricultural injuries (14%). CONCLUSIONS: Among injured patients who presented for treatment in this rural developing area, the largest burden of mortality and disability was from burns and transport-related injuries. Population-based studies are needed to substantiate whether these should be priorities for injury prevention efforts.

Adolescent↗
PubMed1995

Baby walker associated scalding injuries seen at University Hospital Kuala Lumpur.

Baby walker associated injuries are occurring in Malaysia. Most are not noticed as paediatricians are more concerned with the treatment of the injury and forget the preventive measures required to overcome this problem. We believe that baby walkers should be banned in Malaysia as the risks of injury far outweighs any benefits. We present 4 cases of baby walker associated scalding injuries.

Burns↗
PubMed1993

Gun laws.

Explore the source record for details and available documents.

Firearms↗
PubMed1992

Association of smoking and alcohol drinking with residential fire injuries.

To investigate whether tobacco, alcohol, and their combined use are important risk factors for fire injuries, the authors analyzed data from a population-based case-control study in King County, Washington, between 1986 and 1987. Cases (n = 116) were households with at least one fatal or nonfatal unintentional residential fire injury reported to the Washington State Fire Incident Reporting System from 1984 through 1985. Controls were selected by random digit dialing (n = 256). After adjustment for household size, number of male household members, total household income, and education of the head of the household, the odds ratio for fire injury in households whose members collectively smoked 1-9 cigarettes per day was 1.5 (95% confidence interval (CI) 0.6-4.2) relative to households with no smokers; for 10-19 cigarettes per day, the odds ratio was 6.6 (95% CI 2.5-17.5), and for 20 or more cigarettes per day, it was 3.6 (95% CI 1.9-7.2). Although households with alcohol drinkers who consumed five or more drinks per occasion were found to be at increased risk in the crude analysis, multivariate analysis suggested that this was partly because drinkers tended to live in households with higher smoking levels. Thus, even though households with alcohol drinkers who consume five or more drinks per occasion may be at increased risk of residential fire injury, smoking appears to be the more important underlying risk factor.

Accidents, Home↗
PubMed1989

Principles in injury control: lessons to be learned from child safety seats.

The effort to increase the use of child safety seats (CSS) over the last decade has been an outstanding success in the field of childhood injury control. This article describes that effort and discusses lessons which can be learned and applied to other injury control problems. These include choosing a specific important problem and addressing it with a particular solution, developing a critical mass of community awareness through broad-based grass roots support, legislation, efforts of primary care physicians, and eventual institutionalization of the program.

Child↗
PubMed1987

Contact burns of the hand.

Contact burns of the hand in children present difficult management questions. Because visual inspection of the acute wound often fails to distinguish major burns requiring inpatient treatment from minor burns amenable to outpatient therapy, we sought to identify characteristics of patients that would aid in decision making at the time the burn patient is seen. During the 5-year period, 1980 to 1984, 32 children less than 14 years of age were admitted to our medical center with contact burns of the hand. Patients were divided into two groups: those with major burns requiring greater than or equal to seven days of hospitalization (n = 16) and those with minor burns requiring less than seven days of hospitalization (n = 16). Compared with patients in the minor burn group, patients in the major burn group were hospitalized longer (16.9 v 2.8 days), were more likely to require surgical excision and grafting (63% v 0%), and had more extensive follow-up (5.3 v 2.5 visits). There were no significant differences between the two groups with regard to percentage of area burned, age, sex, primary admission v referral, and cause of burn. These data support the recommendation that all such burns be managed initially on an inpatient basis.

Burns↗
PubMed1987

Poor prediction of positive computed tomographic scans by clinical criteria in symptomatic pediatric head trauma.

A retrospective study of 98 children who received CT scanning for head trauma was conducted to determine whether clinical signs would accurately identify patients needing CT scans. The clinical findings of Glasgow Coma Scale score of 12 or less, altered consciousness on admission, and focal abnormalities on neurologic examination were each significantly associated with abnormal findings on CT scans (P less than .01). However, 31% of the 51 patients with Glasgow Coma Scale scores greater than 12 had abnormal CT scan findings. No clinical findings, alone or in combination, accurately identified all patients with abnormal findings on CT scans.

Brain Injuries↗