Biomedical subjects

G McGwin

Publications and source records attributed to G McGwin.

At least 55 records · Page 3Linked to original sources

PubMed2001

Seat belt use before and after motor vehicle trauma.

BACKGROUND: Motor vehicle crashes cause significant morbidity and mortality annually. Seat belt use has partially been associated with a decreased risk of morbidity and mortality among those involved in motor vehicle crashes. Persons injured in motor vehicle crashes and not wearing seat belts have an increased risk of admission to trauma centers for motor vehicle crash-related injury. The purpose of this study was to measure changes in seat belt use after discharge among patients admitted to a Level I trauma center for injuries sustained in motor vehicle crashes. METHODS: Patients admitted to a Level I trauma center for injuries sustained in motor vehicle crashes during 1998 were eligible for participation. A telephone interview was conducted with a random sample of 136 eligible patients regarding patterns of seat belt use before and after their collision. Demographic data and clinical characteristics were also collected. The frequency of seat belt use before and after crash involvement was compared for all patients and stratified by age, gender, race, and Injury Severity Score (ISS). RESULTS: Slightly over half (54%) of patients reported "always" wearing a seat belt before their collision compared with 85% afterward. Younger age groups, male subjects, and whites had the largest increases in the frequency of seat belt use after collision (45%, 37%, and 44% increases, respectively). With respect to injury severity, the largest increase in the frequency of seat belt use was among those with ISS of 15 to 25 (82% increase). Significant concordance between patient- and emergency medical service-reported use of seat belts was observed. Among subjects reported by emergency medical service personnel to have been restrained, nearly 90% reported belt use at the time of the telephone interview. The most frequently cited occasion for failure to use seat belts (30%) was when taking short trips. Other reported reasons were forgetting to fasten belts (29%), discomfort (10%), being in a rush (8%), riding in the back seat (4%), and that seat belts were unnecessary when riding with a good driver (3%). CONCLUSION: Involvement in a motor vehicle crash results in increased seat belt use. Prevention efforts should be directed toward those patients who report infrequent use. Patient "converts" to seat belt use after collisions may be useful in public awareness and prevention campaigns.

Accidents, Traffic↗

PubMed2001

Splenic injury in side impact motor vehicle collisions: effect of occupant restraints.

BACKGROUND: Side impact motor vehicle collisions (MVCs) are associated with higher morbidity and mortality compared with other types of MVCs. The stiffness of the lateral aspect of the vehicle and restraint use may play a role. The purpose of this study was to evaluate the role of restraint use, vehicle size, and compartment intrusion on the incidence of splenic injury in side impact MVCs. METHODS: The National Automotive Sampling System was used to identify drivers involved in side impact collisions for the years 1996 to 1998. The incidence of splenic injury in these collisions was compared according to restraint use, vehicle size, and magnitude of vehicle crush. Information on the perceived cause of splenic injuries sustained in the MVC was also obtained from National Automotive Sampling System investigator records. RESULTS: Overall, among drivers involved in side impact MVCs, restraint use was associated with a significantly reduced rate of mortality (odds ratio [OR], 0.40; p < 0.0001) and splenic injury (OR, 0.76; p < 0.0001). Restrained drivers of small vehicles (<2,500 lb), however, had a higher incidence of splenic injury in both minimal (lateral intrusion < 30 cm) (OR, 60.1; p < 0.0001) and severe (lateral intrusion > 30 cm) (OR, 4.0; p < 0.0001) magnitudes of vehicle crush on the driver's side of the vehicle. For both midsize (2,500-3,000 lb) and large (>3,000 lb) vehicles, restraint use was associated with a lower risk of splenic injury regardless of the magnitude of crush. In nearly all cases of splenic injury, the left vehicle interior was the source of injury. CONCLUSION: Overall, restraint use is associated with lower rates of splenic injury and mortality in side impacts. Despite this fact, restrained drivers of small vehicles have a higher risk of splenic injury after lateral impact MVCs when compared with unrestrained drivers. Evaluation of the combined role of restraint use, crash, and injury patterns may provide novel insight regarding vehicle safety design features.

Accidents, Traffic↗

PubMed2001

Timed instrumental activities of daily living tasks: relationship to visual function in older adults.

PURPOSE: To identify instrumental activities of daily living (IADL) tasks whose completion time is related to visual function in older adults. METHODS: Visual function (acuity, contrast sensitivity, and useful field of view) and the time to complete 17 visual tasks of everyday life were measured in a sample of 342 older adults (mean age 71 years, range 56 to 86) recruited from eye clinics. The timed IADL (TIADL) tasks included a variety of visual activities such as reading ingredients on cans of food and instructions on medicine bottles, finding a phone number in a directory, locating items on a crowded shelf and in a drawer, and using a screwdriver. RESULTS: Multiple regression analysis indicated that poorer scores for acuity, contrast sensitivity, and useful field of view were independently associated with longer times to complete visual TIADL tasks, even after adjusting for age, educational level, depression, and general health. Cognitive status also had a significant, independent association with timed task performance. CONCLUSIONS: Older adults' timed performance in everyday tasks is related to various aspects of visual function independent of the influences of other functional and health problems and advanced age. This suggests that TIADL tasks may eventually be useful as performance outcomes in intervention evaluations targeted at reversing vision impairment or minimizing its impact. To understand the relationship between vision impairment and TIADL task performance in older adults, cognitive impairment needs to be taken into account because it has a relatively strong and independent relationship with visual TIADL task performance.

Activities of Daily Living↗

PubMed2001

Hypothermia deaths in Jefferson County, Alabama.

INTRODUCTION: Some reported characteristics associated with hypothermia mortality include older age, alcohol consumption, male sex, and black race. The purpose of this paper is to present the epidemiology of hypothermia deaths in Jefferson County, Alabama. METHODS: Autopsy reports maintained by the county coroner's office were abstracted for all cases with primary or underlying causes of death listed as "hypothermia" or "exposure to cold" between January 1983 and July 1999. RESULTS: Sixty three hypothermia deaths occurred in Jefferson County during the study period. The mean age among cases was 68 years, 63.9% were male and 70% were of black race. Rates of hypothermia death were highest among black males, followed by black females, particularly blacks aged 80 years or older. Deaths occurring indoors were more common among older persons and outdoor deaths more common among younger persons. Thirty per cent of decedents tested positive for alcohol, 75% of whom were found outdoors. Nine decedents tested positive for drugs or medications. Approximately 90% of decedents were identified as having one or more chronic medical conditions. Excluding alcoholics, 52% of decedents had one or more chronic medical conditions. CONCLUSIONS: Hypothermia in Jefferson County, Alabama is a cause of death primarily affecting two distinct groups of individuals, elderly persons who develop hypothermia inside a dwelling and middle aged males who develop hypothermia out of doors and have consumed alcohol.

Adolescent↗

PubMed2001

Mobility impairments in crash-involved older drivers.

OBJECTIVE: To evaluate potential associations of impairments in physical function with motor vehicle crash involvement in older drivers. METHODS: Case participants were randomly selected residents of Mobile County, Alabama, greater or less than 65 years old who had sustained an at-fault motor vehicle crash in 1996. Similarly selected crash-free controls were frequency matched to cases on gender and age. Self-report data on demographic variables, medical conditions, medications, driving exposure, and function were collected by telephone interviewers. RESULTS: Relative to crash-free subjects, crash-involved drivers were significantly more likely to report difficulty walking one fourth mile and moving outdoors. Marginally significant associations were observed for trouble carrying a heavy object 100 yards and for the occurrence of falls in the prior year. Increasing numbers of functional limitations were directly related to the odds of crash involvement. DISCUSSION: In comparison to crash-free controls, crash-involved older drivers are more likely to report other mobility-related impairments, possibly including falls.

Accidental Falls↗

PubMed2001

Trauma-specific intensive care units can be cost effective and contribute to reduced hospital length of stay.

Our hypothesis was that clinical outcomes are improved and cost and hospital length of stay (LOS) reduced as a result of the opening of a closed trauma intensive care unit (ICU). We conducted a cross-sectional study in a university-affiliated Level I trauma center. Our study population comprised trauma patients admitted to the ICU between June 1, 1996 and July 1, 1998 for at least 24 hours and with an Injury Severity Score (ISS) >16 (excluding those with severe brain injury). The main outcome measures were changes in LOS and number of ventilator days, prevalence of complications, changes in patient charges, and hospital costs. Two hundred four patients were included [trauma ICU (TICU) 60, surgical ICU 144]. The two groups were not statistically different in age, ISS, mechanism of injury, infection rate, and mortality; however, the TICU patients had a lower number of ventilator hours (83.1 vs 100.0; P = 0.007), lower ICU LOS (9.4 vs 12.1 days; P = 0.06), and lower total hospital LOS (15.6 vs 22.3 days; P = 0.01). Although this was not of statistical significance TICU patients had lower hospital charges ($125,383 vs $152,994; P = 0.06) and lower cost per case ($42,306 vs $47,548; P = 0.35) for a net savings of $314,520 during the first 6 months of operation of the TICU. This study suggests that improved clinical outcomes and decreases in cost and LOS are directly related to the opening of a closed trauma ICU.

Adult↗

PubMed2001

The association between body habitus, restraint use, and fatality in motor vehicle collisions.

UNLABELLED: The purpose of this study was to determine if there is an association between body habitus, restraint use, and risk of death in motor vehicle collisions (MVC). METHODS: The 1995-1999 National Automotive Sampling System Crashworthiness Data System was utilized. RESULTS: Body habitus, when described by height and weight, is associated with fatality rates in restrained drivers. Body mass index as a descriptor of body habitus was not associated with fatality rates. CONCLUSIONS: The 50th percentile male Hybrid III Crash Dummy plays a major role in vehicular cabin interior design and crash testing. For drivers with a dissimilar body habitus, the vehicle cabin/body fit changes and the safety features perform differently which may account for these observations.

Accidents, Traffic↗

PubMed2000

Increased risk of agricultural injury among African-American farm workers from Alabama and Mississippi.

Research on the epidemiology of agriculture-related injuries has largely ignored African-Americans and farm workers. This cohort study is the first to estimate injury rates and to evaluate prospectively risk factors for agriculture-related injuries and compare them among African-American and Caucasian farmers and African-American farm workers. A total of 1,246 subjects (685 Caucasian owners, 321 African-American owners, and 240 African-American workers) from Alabama and Mississippi were selected from Agricultural Statistics Services databases and other sources and were enrolled between January 1994 and June 1996. Baseline data included detailed demographic, farm and farming, and behavioral information. From January 1994 to April 1998, subjects were contacted biannually to ascertain the occurrence of an agriculture-related injury. Injury rates were 2.9 times (95% confidence interval (CI): 2.0, 4.3) higher for African-American farm workers compared with Caucasian and African-American owners. Part-time farming (relative risk (RR) = 2.0, 95% CI: 1.3, 2.5), prior agricultural injury (RR = 1.5, 95% CI: 1.0, 2.1), and farm machinery in fair/poor condition (RR = 1.8, 95% CI: 1.2, 2.7) were also independently associated with injury rates. The results demonstrate the increased frequency of agricultural injury among farm workers and identify a number of possible ways of reducing them.

Accidents, Occupational↗

PubMed2000

Relations among chronic medical conditions, medications, and automobile crashes in the elderly: a population-based case-control study.

Older drivers have elevated crash rates and are more likely to be injured or die if they have a crash. Medical conditions and medications have been hypothesized as determinants of crash involvement. This population-based case-control study sought to identify medical conditions and medications associated with risk of at-fault crashes among older drivers. A total of 901 drivers aged 65 years and older were selected in 1996 from Alabama Department of Public Safety driving records: 244 at-fault drivers involved in crashes; 182 not at-fault drivers involved in crashes; and 475 drivers not involved in crashes were enrolled. Information on demographic factors, chronic medical conditions, medications, driving habits, visual function, and cognitive status was collected. Older drivers with heart disease (odds ratio (OR) = 1.5, 95% confidence interval (CI): 1.0, 2.2) or stroke (OR = 1.9, 95% CI: 0.9, 3.9) were more likely to be involved in at-fault automobile crashes. Arthritis was also associated with an increased risk among females (OR =1.8, 95% CI: 1.1, 2.9). Use of nonsteroidal antiinflammatory drugs (OR = 1.7, 95% CI 1.0, 2.6), angiotensin converting enzyme inhibitors (OR = 1.6, 95 CI: 1.0, 2.7), and anticoagulants (OR = 2.6, 95% CI: 1.0, 73) was associated with an increased risk of at-fault involvement in crashes. Benzodiazepine use (OR = 5.2, 95% CI: 0.9, 30.0) was also associated with an increased risk. Calcium channel blockers (OR = 0.5, 95% CI: 0.2, 0.9) and vasodilators (OR = 0.3, 95% CI: 0.1, 1.0) were associated with a reduced risk of crash involvement. The identification of medical conditions and medications associated with risk of crashes is important for enhancing the safety and mobility of older drivers.

Accidents, Traffic↗

PubMed2000

The impact of agricultural injury on farm owners and workers in Alabama and Mississippi.

BACKGROUND: Few studies have assessed the consequences of agricultural injury and none have done so comparing Caucasian and African-American farm owners and workers. METHODS: 1244 farmers were enrolled and prospectively observed between 1994-1996 for farming-related injuries. Injured farmers provided information on the consequences of injuries. RESULTS: One-hundred and thirty-one subjects reported a total of 140 injuries. The majority of injuries were classified as minor or moderate and required medical attention. African-American farm workers tended to have more severe injuries. Nearly all injured subjects experienced acute residual effects (e.g., pain when moving), while persistent effects occurred in about half of the injured subjects, the latter being more common among African-American workers. Lost work was a frequent nonmedical effect of the injury. African-American workers tended to be more likely to lose work and/or be hurt financially. CONCLUSIONS: The impact of agricultural injury is nontrivial, particularly for African-American farm workers. The provision of better medical care facilities for African-American farm workers may be a positive approach for reducing the impact of agricultural injuries in this population.

Absenteeism↗

PubMed2000

Visual risk factors for driving difficulty among older drivers.

This study sought to evaluate associations between visual function and self-reported difficulty with driving tasks. Drivers (N = 384) between the ages of 55 and 85 were selected from ophthalmology practices and optometry clinics; three out of four of the sample had cataracts and the remaining were cataract-free. Information on driving exposure and difficulty was obtained via self-report. Visual functional status of all participants was measured with respect to acuity, contrast sensitivity, disability glare and useful field of view. Cognitive impairment was evaluated using the Mattis Organic Mental Syndrome Screening Examination. The results show a pattern of difficulty in high-risk driving situations among those with decreased visual acuity and contrast sensitivity, even after adjustments for age, gender, weekly mileage, and cognitive impairment.

Age Factors↗

PubMed2000

Exploratory study of incident vehicle crashes among older drivers.

BACKGROUND: As the number of older adult drivers increases, distinguishing safe from unsafe older adult drivers will become an increasing public health concern. We report on the medical and functional factors associated with vehicle crashes in a cohort of Alabama drivers, 55 years old and older. METHODS: This prospective study involved 174 older adults, on whom demographic, medical, functional, and physical performance data were collected in 1991. Subjects were then followed through 1996 for incident vehicle crashes. RESULTS: Sixty-one subjects experienced between one and four police-reported vehicle crashes during the study period. Following adjustment for age, race, days driven per week, and gender, Cox proportional-hazards models showed the following variables to be associated with crash involvement: reported difficulty with yardwork or light housework (relative risk [RR] = 2.1; 95% confidence interval [CI] 1.1, 4.0; p = .02), or opening ajar (RR = 3. 1; 95% CI 1.4, 6.7; p = .004); at least one crash before 1991 (RR = 2.1; 95% CI 1.2, 3.7; p = .008); using hypnotic medication (RR = 2.9; 95% CI 1.3, 6.6; p = .01); self-reported stroke or transient ischemic attack (RR = 2.7; 95% CI 1.1, 6.6; p = .03); scoring within the depressed range on the Geriatric Depression Scale (RR = 2.5; 95% CI 1.1, 6.0; p = .03), and failing the useful field-of-view test (RR = 1.9; 95% CI 1.0, 3.5; p = .05). CONCLUSIONS: Variables related to function, medication use, affect, neurological disease, and visuocognitive skills were associated with vehicle crash involvement in this cohort. Our findings suggest that multifactorial assessments are warranted to identify at-risk older drivers.

Accidents, Traffic↗

PubMed2000

The April 8, 1998 tornado: assessment of the trauma system response and the resulting injuries.

BACKGROUND: On April 8, 1998, an F5 tornado touched down in two counties of Alabama producing a wide path of destruction. The presence of a regional trauma system in this area presents an opportunity to evaluate the effectiveness of the system in responding to the victims of this natural disaster. METHODS: Emergency room logs and the regional trauma system database were searched for all patients treated for injuries sustained from the tornado, and medical records were reviewed for demographic information, mode of transportation to hospital, injuries, treatment, and outcome. Fatalities were identified by means of the coroner's office. RESULTS: A total of 224 patients were evaluated at nine area hospitals, of whom 63 (28%) required admission. There were 32 deaths: 30 persons were dead at the scene, and 2 patients subsequently died at Level I trauma centers. Among patients with nonfatal injuries, 39% were managed at Level I facilities, 46% at Level III facilities, and 15% at nontrauma facilities. Forty patients (55%) seen at Level I facilities required admission compared with 15 patients (17%) at Level III facilities and 8 patients (29%) at nontrauma facilities; Level I facilities also had the highest Injury Severity Score. Of patients requiring admission, 83% were transported by emergency medical services; these patients also had the highest Injury Severity Score. CONCLUSION: The regional trauma system facilitated appropriate and efficient triage to system hospitals, routing the most severely injured patients to the Level I centers without overwhelming them with the more numerous, less severely injured patients.

Adult↗

PubMed2000

Long-term survival in the elderly after trauma.

BACKGROUND: In the elderly, trauma has been associated with increased, long-term, all-cause mortality. Functional limitations secondary to injury may be responsible for the reduced survival rate. The objective of this study was to test this hypothesis using data from the Longitudinal Study of Aging (LSOA). METHODS: The LSOA is an extension of the 1984 National Health Interview Survey, which focused on 7,527 persons who were 70 years and older in 1984. Using data from the LSOA, a cohort of elderly patients hospitalized for injury in 1985 (N = 102) was identified from Medicare hospital discharge data. An uninjured cohort (N = 408) was also identified using the LSOA and matched by age (within 1 year) and sex. Deaths in both cohorts were identified using the National Death Index. Hazard ratios (HRs) for mortality within 6 years subsequent to injury, adjusted for demographic, health status, and functional characteristics, were calculated. RESULTS: The injured cohort had a significantly reduced rate of survival compared with the uninjured cohort (HR = 1.5; 95% confidence interval [CI] 1.1-2.2), and this relationship persisted after adjusting for demographic and health characteristics (HR = 1.4; 95% CI 1.0-2.0). After additional adjustment for measures of functional decline, the association diminished (HR = 1.2; 95% CI 0.8-1.7). Functional decline remained a strong, independent factor for the risk of mortality. CONCLUSION: Trauma in the elderly has both an acute and long-term influence on mortality; the latter seems to be mediated through a decline in function resulting from the injury. This study suggests that strategies to return the elderly patient to preinjury functional status are of paramount importance. Future research should explore the impact of these interventions on long-term survival.

Activities of Daily Living↗

PubMed2000

Reduction of vancomycin-resistant enterococcal infections by limitation of broad-spectrum cephalosporin use in a trauma and burn intensive care unit.

Both vancomycin and third-generation cephalosporin use are believed to contribute to a rise in vancomycin-resistant enterococci (VRE) infections. In 1998, the largest number of VRE infections in our hospital occurred in the trauma/burn intensive care unit (TBICU), accounting for nearly 20% of hospital infections. In an attempt to control the VRE infection rate, antibiotic protocols for prophylaxis, empiric, and definitive therapy were initiated during the final quarter of 1998 to minimize cephalosporin use by the introduction of piperacillin/tazobactam. Therefore, we undertook a study of the VRE infection rate for the TBICU in relation to vancomycin, piperacillin/tazobactam, piperacillin, third-generation cephalosporin, and total cephalosporin use before and after efforts to limit cephalosporins. These data were compared to those in the medical and surgical intensive care units. During 1998, seven VRE infections occurred in the TBICU. Following initiation of antibiotic protocols, one case of VRE infection occurred in the subsequent month and no cases in the 17 months since. The decrease in the VRE infection rate corresponded with a significant increase in the use of piperacillin/tazobactam and a reduction in third-generation and total cephalosporin use. In contrast, cephalosporin use in the medical and surgical intensive care units remains significantly higher than in the TBICU, and neither unit has had a reduction in their VRE infection rates.

Burn Units↗

PubMed2000

Systemic lupus erythematosus in three ethnic groups. VI: Factors associated with fatigue within 5 years of criteria diagnosis. LUMINA Study Group. LUpus in MInority populations: NAture vs Nurture.

OBJECTIVE: To determine the frequency, degree and associated features of fatigue among Hispanic (H), African American (AA) and Caucasian (C) patients with recent onset (< or = 5 yr) systemic lupus erythematosus (SLE) at their baseline evaluation. METHODS: H (n = 69), AA (n = 83) and C (n = 71) patients from the LUMINA (LUpus in MInority populations: NAture vs Nurture) cohort were studied. Fatigue [Fatigue Severity Scale (FSS)] was defined as present if FSS score > or = 3.0. Variables from functional, clinical, sociodemographic, health behaviors, behavioral and psychological and immunogenetics domains were ascertained at study entry. Associations were examined using regression models. RESULTS: Eighty-six percent (85.7%) of patients reported having fatigue (82.6% H; 85.5% AA; 88.7% C); median FSS score, 5.3. Factors from the psychological and clinical domains were primarily associated with FSS; immunogenetic (HLA Class II phenotypes) features were not. Increased fatigue was strongly associated with decreasing function, both physical and mental. Variables associated with significantly greater degree of fatigue at baseline in the multivariable stepwise model in order of decreasing additional partial R2 explained included: abnormal illness-related behaviors, older age, higher self-reported pain, greater degree of helplessness, greater disease activity, Caucasian race, and lacking health insurance (model R2 = 37%). CONCLUSIONS: Fatigue is one of the most prevalent clinical manifestations of SLE across all ethnic groups. The perception of fatigue severity in SLE may be multifactorial in origin, including psychosocial factors and disease activity. If these prove causal, knowledge of their contribution may suggest therapeutic and/or behavioral interventions, which could ameliorate this pervasive and often incapacitating symptom of SLE.

Black or African American↗

PubMed2000

Temperature-related deaths in Alabama.

BACKGROUND: Mortality rates for hyperthermia and hypothermia are higher in Alabama than nationally, and Alabama has twice as many hypothermia deaths as hyperthermia deaths. These causes of death have not been studied in the southeastern United States. We describe the epidemiology of heat- and cold-related deaths in Alabama. METHODS: We examined state mortality data for the years 1987 through 1998 and calculated mortality rates by age, race, and sex. RESULTS: Approximately half the hyperthermia-related deaths were among whites, and approximately two thirds were among males. Of the hypothermia-related deaths, 61.5% were among blacks, and approximately three fourths were among males. The highest rates of hyperthermia- and hypothermia-related death were among black males. Mortality rates increased with age for both causes of death. CONCLUSIONS: In Alabama, the elderly and black males are most likely to die of hyperthermia or hypothermia. Public health interventions must be directed toward these groups.

Adolescent↗

PubMed1999

History of agricultural injury among farmers in Alabama and Mississippi: prevalence, characteristics, and associated factors.

BACKGROUND: There have been no studies of the prevalence, characteristics, and factors associated with the history of prior farm injury among active farmers. No studies have had adequate numbers of black farmers to evaluate farm owner/farm worker and black/white similarities and differences. METHODS: Our sample is based upon surveys administered to 1,310 active male farmers in nine rural counties in Alabama (5) and Mississippi (4). The farmers are white owner/operators (53.6%), black owner/operators (26.6%), and black workers (19.8%). RESULTS: Overall, 23.4% of the farmers had a prior injury. Prior injury was more frequent among white owner/operators (29.1%), compared with black workers (18.9%), and black owner/operators (15.2%). In multiple logistic regression analyses, post-high school education and tiredness when farming were independently associated with prior injury in black owner/operators. In white owner/operators, age > or = 60 years, post-high school education, full-time farming, tractor use, more pieces of machinery, hurry when farming, and alcohol consumption were associated with prior injury. In black workers, only being very careful was associated with prior injury. CONCLUSIONS: The results suggest that prevention efforts focusing on alcohol consumption, fatigue, and hurry when farming might reduce injuries; however, only a follow-up study of this sample can determine whether these associations reflect causal factors, recall, or selection bias.

Adult↗