Biomedical subjects

Gerald McGwin

Publications and source records attributed to Gerald McGwin.

At least 55 records · Page 3Linked to original sources

PubMed2005

Systemic lupus erythematosus in three ethnic groups: XVI. Association of hydroxychloroquine use with reduced risk of damage accrual.

OBJECTIVE: To examine whether hydroxychloroquine (HCQ) usage is associated with a reduced risk of damage accrual in patients with systemic lupus erythematosus (SLE). METHODS: Patients (n = 518) meeting the American College of Rheumatology criteria for diagnosis of SLE and with </=5 years disease duration at study entry were followed up annually. Socioeconomic, demographic, clinical, and serologic manifestations as well as disease activity (by the Systemic Lupus Activity Measure [SLAM]) and damage (by the Systemic Lupus International Collaborating Clinics damage index [SDI]) were measured. Propensity scores were calculated to adjust for confounding factors affecting treatment assignment. A Cox proportional hazards model was used to compare the risk of developing new damage according to HCQ use at enrollment into the study. RESULTS: Fifty-six percent of the patients were treated with HCQ at the time of study enrollment. Patients who were not treated with HCQ on enrollment had higher SLAM and SDI scores than patients who were treated. Untreated patients were significantly more likely to have major organ involvement such as renal disease (P < 0.0001) or central nervous system disease (P < 0.0025). Results of unadjusted analysis suggested that treated patients were less likely to accrue damage (hazard ratio [HR] 0.68). With adjustment for differences in treatment assignment, HCQ usage was still associated with a reduced risk of developing new damage, with an HR of 0.68 (95% confidence interval [95% CI] 0.53-0.93) (P = 0.014). With adjustment for differences in treatment assignment, HCQ usage was still associated with a reduced risk of developing new damage (HR 0.73 [95% CI 0.52-1.00]) (P = 0.05). However, patients receiving HCQ who had no damage at study entry had a statistically significant decrease in the risk of damage accrual (HR 0.55 [95% CI 0.34-0.87]) (P = 0.0111), whereas those receiving HCQ who had damage at study entry did not (HR 1.106 [95% CI 0.70-1.74]) (P = 0.6630). CONCLUSION: These findings indicate that, after adjustment for propensity to receive HCQ, HCQ usage is independently associated with a reduced risk of damage accrual in SLE patients who had not yet accrued damage at the time of treatment initiation.

Adult↗

PubMed2005

Systemic lupus erythematosus in a multiethnic US cohort (LUMINA): XXI. Disease activity, damage accrual, and vascular events in pre- and postmenopausal women.

OBJECTIVE: To determine the differences in clinical manifestations, disease activity, damage accrual, and medication use in systemic lupus erythematosus (SLE) patients as a function of menopausal status at disease onset. METHODS: Women with SLE as per the criteria of the American College of Rheumatology, with disease duration of </=5 years and of Hispanic (Texas and Puerto Rico ancestries), African American, and Caucasian ethnicity, from LUMINA (LUpus in MInorities, NAture versus nurture), a multiethnic, longitudinal cohort, were studied. Menopause at the time of disease onset was defined as self-report of climacteric symptoms, and/or amenorrhea lasting >6 months, and/or oophorectomy, and/or increased follicle-stimulating hormone values for reproductive-age women, and/or treatment with hormone replacement therapy. Patients were divided into premenopausal and postmenopausal categories. Socioeconomic status, cumulative clinical manifestations, disease activity (at study entry or time 0, last visit, and over time), as measured by the Systemic Lupus Activity Measure, and damage accrual, as measured by the Systemic Lupus International Collaborating Clinics/American College of Rheumatology damage index (at time 0 and at last visit) were compared between the 2 groups of women. Multivariable models were then examined making adjustments for all possible known confounders. Dependent variables in the models were renal involvement, damage accrual, arterial vascular events, and venous thrombosis. RESULTS: Five hundred eighteen women from the LUMINA cohort were included; 436 (84.2%) were premenopausal and 82 (15.8%) were postmenopausal. Disease onset after menopause was more common among Caucasians. Renal involvement was more common in premenopausal women, whereas vascular arterial events were more frequent in postmenopausal women. All other disease manifestations, as well as disease activity, were comparable between both groups. The presence of damage accrual at time 0 and study end was more frequent in postmenopausal women. Age, rather than menopausal status, independently contributed to damage accrual, renal involvement, and vascular arterial events in these women. CONCLUSION: A hypoestrogenemic state secondary to menopause appears not to be protective against disease activity and damage accrual. Age rather than menopausal status is a strong independent predictor of damage accrual and of vascular events in women with lupus.

Adult↗

PubMed2005

Systemic lupus erythematosus in a multiethnic US cohort (LUMINA). XXV. Smoking, older age, disease activity, lupus anticoagulant, and glucocorticoid dose as risk factors for the occurrence of venous thrombosis in lupus patients.

OBJECTIVE: Venous thrombosis is a relatively frequent and serious complication in systemic lupus erythematosus (SLE) that has been associated with the presence of antiphospholipid antibodies (aPL). However, venous thrombotic events can also be seen in patients without aPL, and only a few patients with aPL develop venous thrombosis. This study was carried out to ascertain other factors contributing to the development of venous thrombosis in SLE. METHODS: Patients with SLE, ages > or = 16 years with < or = 5 years disease duration and of Hispanic, African American, or Caucasian ethnicity, from LUMINA (LUpus in MInorities, NAture versus nurture), a multiethnic, longitudinal study of outcome, were studied. Selected socioeconomic/demographic, clinical, laboratory, and treatment-exposure variables were compared between patients who developed and those who did not develop venous thrombotic events. Significant and clinically relevant variables were then entered into different multivariable models (Cox proportional hazards and unconditional stepwise logistic regression) to identify independent risk factors associated with the primary outcome. In another model, only patients who developed an event after enrollment (time 0) in the cohort were included. RESULTS: Of 570 LUMINA patients, 51 developed at least 1 venous thrombotic event after SLE diagnosis. In univariable analyses, smoking (P = 0.020), shorter disease duration at time 0 (P = 0.017), serum levels of total cholesterol, low-density lipoprotein, and triglycerides (all P < 0.0001), and presence of lupus anticoagulant (LAC) (P = 0.045) were associated with venous thrombotic events. Survival analyses showed a time-dependent significant association of the primary outcome with smoking (P = 0.008) and a borderline significant association with the presence of LAC (P = 0.070). Multivariable models showed an independent association with smoking, age at time 0, disease activity over time, LAC, mean dose of glucocorticoids, and shorter disease duration at time 0. CONCLUSION: Venous thrombotic events occur early in the course of SLE. Our data confirm the association between LAC and venous thrombotic events. Smoking, shorter disease duration, older age, disease activity over time, and higher mean daily glucocorticoid dose were identified as additional risk factors for the development of this vascular complication. These findings may have implications for the management of patients with SLE.

Adult↗

PubMed2005

Effects of trochanteric soft tissues and bone density on fracture of the female pelvis in experimental side impacts.

Pelvic fractures continue to be a source of morbidity and mortality for occupants in motor vehicle side impacts, especially among women. Previous studies have produced fracture tolerances for the female pelvis, yet the roles of soft tissues and bone quality remain unclear. Presently, we studied the influence of trochanteric soft tissue thickness (T) and total hip bone mineral density (BMD) on pelvic fracture of 10 female human pelves subject to lateral impact centered over the greater trochanter. Multiple impacts of increasing severity were performed and impact force, energy, impulse, compression, and viscous criteria were quantified. BMD and T were found to be additive predictors of the fracture force. For a given BMD, the force to fracture was significantly higher than that found previously using isolated pelvic bones. Impulse was found to positively correlate with T; however, maximum compression, viscous criterion, and energy to fracture were independent of BMD and T. The force tolerance at 25% probability of fracture found presently (3.16 kN) is substantially below previously reported values. The results suggest that the trochanteric soft tissue thickness and total hip BMD have a significant bearing on fracture outcome for the female pelvis in automotive side impact.

Accidents, Traffic↗

PubMed2005

Seatbelt use during pregnancy: a comparison of women in two prenatal care settings.

OBJECTIVES: This study examines knowledge of proper automobile restraint use during pregnancy and attitudes toward restraint use. This manuscript, the second in a series, compares knowledge and attitudes in two populations of pregnant women, those receiving prenatal care at several county clinics and those receiving care in a private practice. METHODS: A survey requesting demographic information and frequency and knowledge of proper automobile restraint use was administered during prenatal visits. RESULTS: County clinic patients (n = 450, 70% black) were younger and less educated than private practice patients (n = 203, 75% non-Hispanic white). Fewer county patients (49%) always wore seatbelts prior to the pregnancy than private practice patients (88%). Correct use was reported by fewer county clinic patients (67%) than private practice patients (83%). Few (25-28%) in either setting reported receiving information on seatbelt use. CONCLUSIONS: Despite existing knowledge with respect to the consequences of seatbelt non-use in pregnant women, the proportion of women receiving information about correct seatbelt use during pregnancy appears to be low, regardless of care source.

Adolescent↗

PubMed2005

Symptoms of musculoskeletal disorders in ophthalmologists.

OBJECTIVE: To describe the presence of musculoskeletal disorders (MSDs) of the neck, low back, and upper extremity among ophthalmologists. DESIGN: Survey. METHODS: Mail survey using a pretested instrument to 2,529 ophthalmologists in the Northeastern United States; 697 ophthalmologists (28%) returned a completed survey. RESULTS: Self-reported prevalence of neck, upper body, or lower back symptoms in the prior month was 51.8%. Low back pain was present in 39% of respondents, followed by upper extremity symptoms (32.9%) and neck pain (32.6%). Approximately 15% of ophthalmologists were slightly to moderately limited in their work as a result of these symptoms. CONCLUSION: MSD symptoms appear to be common among ophthalmologists. With a relatively low response rate, however, it is plausible that asymptomatic subjects represent a large percentage of the nonrespondents. Additional investigation is warranted to evaluate ergonomic risk factor exposure and establish injury prevention guidelines.

Back Pain↗

PubMed2005

Glaucoma following penetrating ocular trauma: a cohort study of the United States Eye Injury Registry.

PURPOSE: To evaluate associations between baseline structural and functional ocular characteristics and the risk of developing posttraumatic glaucoma after penetrating ocular injury. DESIGN: Prospective cohort study. METHODS: Data from the United States Eye Injury Registry (USEIR) were obtained from a total of 3,627 patients who experienced penetrating ocular injury. The risk of posttraumatic glaucoma and associated structural and functional ocular risk factors was estimated. RESULTS: The risk of developing posttraumatic glaucoma was 2.67%. The development of glaucoma was independently associated with several baseline characteristics including advancing age (relative risk 1.02/yr 95% confidence interval [1.00, 1.03]), lens injury (1.56 [1.03, 2.35]), poor baseline visual acuity (2.59 [1.62, 4.14]), and inflammation (3.02 [1.52, 6.02]). CONCLUSIONS: This study provides an estimate for the risk of developing glaucoma after penetrating ocular injury in a large cohort of patients and determined several factors that are significantly associated with the development of post-traumatic glaucoma, including advancing age, lens injury, poor visual acuity, and intraocular inflammation.

Adult↗

PubMed2005

Clinical examination accurately locates capillary nonperfusion in diabetic retinopathy.

PURPOSE: To help the ophthalmologist who wishes to know the perfusion status of the retina outside the macula, we determined whether clinical examination can predict capillary nonperfusion in diabetic retinopathy (DR) as accurately as fluorescein angiography (FA). DESIGN: Prospective observational case series. METHODS SETTING: Clinical practice. STUDY POPULATION: Both eyes of 20 patients with clinically significant diabetic macular edema (CSME). OBSERVATION PROCEDURE: The location of capillary nonperfusion was recorded following 90-diopter lens slit-lamp biomicroscopy, and the same measurements made on FA. MAIN OUTCOME MEASURE: In the nasal and temporal quadrants of each eye, the clinical results were compared with the "gold standard" FA. RESULTS: Most patients (84%) had definite peripheral capillary nonperfusion. Biomicroscopy results were highly correlated with angiography, with only a few differences of clinical importance. CONCLUSIONS: Clinical examination can determine the location of capillary nonperfusion in DR with a high degree of accuracy.

Blood Flow Velocity↗

PubMed2005

Visual outcome and risk factors for light perception and no light perception vision after vitrectomy for diabetic retinopathy.

PURPOSE: To assess the visual outcome following vitrectomy for diabetic retinopathy compared with previous studies; to evaluate risk factors for light perception (LP) and no light perception (NLP) vision after diabetic vitrectomy. DESIGN: Retrospective medical record review. METHODS: The charts of 100 consecutive patients who underwent vitrectomy for proliferative diabetic retinopathy between November 1, 1997, and November 30, 1998, were reviewed. Surgical technique included standard pars plana vitrectomy with combination of delamination and segmentation of gliotic tractional membranes using bimanual techniques. All patients had post-operative follow-up of at least 12 months. Several factors were analyzed for their effect on poor visual outcome (LP and NLP) using Fisher's exact test. RESULTS: Post-vitrectomy, 73% of diabetic patients had stable or improved vision; 16% had worsened but functional vision, defined as worse but still >or= 20/400; 4% had worsened but ambulatory vision, defined as worse but still count fingers (CF) or hand motion (HM); and 7% had poor visual outcome, LP or NLP. Resultant visual acuity was >or=20/40 in 38% of patients, 20/50 to 20/100 in 34%, 20/120 to CF in 18%, HM in 3%, LP in 4%, and NLP in 3%. Risk factors for eyes with LP and NLP vision included pre-operative iris neovascularization (INV), P = .05, post-operative INV, P = .02, post-operative macular ischemia, P = .0001, and post-operative vitreous hemorrhage (VH), P = .02. CONCLUSIONS: Pre-operative and post-operative INV, post-operative macular ischemia, and post-operative VH appear to be risk factors for LP and NLP vision following diabetic vitrectomy, whereas overall improvements in surgical technique and visual outcome continue to be reported.

Adult↗

PubMed2005

Reconstruction of the posterolateral corner of the knee.

PURPOSE: To describe a technique for reconstruction of the posterolateral corner (PLC) of the knee and report the results of a prospective series of patients. TYPE OF STUDY: Case series. METHODS: Twenty-two patients with PLC injuries underwent reconstruction; 15 patients had multiligamentous knee injuries and 7 had isolated PLC injuries. We used the modified 2-tailed technique that reconstructs the popliteofibular ligament and fibulocollateral ligament. The technique includes use of an allograft tendon placed through transtibial and transfibular bone tunnels and around a screw on the lateral femoral condyle. All patients have been followed-up prospectively with clinical examinations, Lysholm knee scores, KT-2000 ligament arthrometer examinations, and evaluation of work and recreational functional status. RESULTS: There were 15 male and 7 female patients (mean age, 32 years; range, 17 to 55 years). Follow-up was a minimum of 24 months (mean, 29.5 months; range, 24 to 38 months). Mean range of motion is extension of 0.2 degrees (range, 0 degrees to 5 degrees) and flexion of 133.4 degrees (80 degrees to 144 degrees). The range of motion for the multiligamentous knees was 0.3 degrees to 129 degrees compared with 0 degrees to 143 degrees for knees with isolated corner injuries. Mean Lysholm knee scores were 90 for the entire group with a score of 92 for the multiligamentous knees and 88 for the isolated corners. Stability was clinically graded on a scale of 0 to 3 for both varus stress and external rotation, with a score of 2 or 3 indicating a failed PLC reconstruction. The mean score for varus stress was 0.2 for the whole group, with 0.3 in the multiligamentous knee and 0.1 for the isolated injuries. Similarly, the mean score for external rotation was 0.4, with a 0.5 for multiligamentous knee and 0.3 for isolated PLC injuries. There were 2 failures in the multiligamentous knee injury group (13%), compared with no failures in the isolated PLC group. The failure rate for the whole study was 9%. CONCLUSIONS: Reconstruction of the PLC using an allograft reconstruction of the popliteus, popliteofibular, and fibulocollateral ligaments yielded a stable reconstruction with excellent functional results. Predictably, range of motion and incidence of failure were both better for patients with isolated PLC injuries than for those with multiligamentous knees. Both groups, however, showed excellent overall functional results. LEVEL OF EVIDENCE: Level IV, case series.

Adolescent↗

PubMed2005

Differences in optic disc topography between black and white normal subjects.

PURPOSE: To determine if differences in optic disc topography exist between blacks and whites independent of racial differences in the area of the scleral canal. DESIGN: Cross-sectional observational study. PARTICIPANTS: A cohort of 146 eyes from black subjects and 97 eyes from white subjects without detectable ocular disease. METHODS: Reliable bilateral images were obtained using a retinal topographer. Mean values for all topographic parameters were compared both unadjusted and adjusted for differences in optic disc area and/or reference plane height. Comparisons of group differences for parameters and linear discriminant functions were adjusted for interocular dependence and multiple comparisons. RESULTS: Blacks had a significantly greater optic disc area (mean disc area in right eye: black subjects, 2.14 mm(2); white subjects, 1.96 mm(2) [P = 0.02]; mean disc area in left eye: black subjects, 2.18 mm(2); white subjects, 2.02 mm(2) [P = 0.04]). Most racial differences in optic disc parameters were not significant after adjustment for differences in optic disc area and reference plane height. However, eyes of black subjects demonstrated a deeper maximum cup depth than those of whites (P = 0.004), independent of differences in disc area and reference plane height. The values of linear discriminant functions did not differ significantly between racial groups, and the Moorfield classification correctly identified a similar proportion of subjects as normal in each racial group. CONCLUSIONS: Most of the normal variation in optic disc topography between blacks and whites seen with a retinal topographer is due to either differences in disc area or differences in reference plane height. However, small residual differences remain in cup depth independent of these parameters. These racial differences in optic disc structure should be considered in the statistical judgment of disease status based on these parameters. The Moorfield classification, which takes disc area into account, performed with similar specificity in each racial group.

Adult↗

PubMed2005

The use of cholesterol-lowering medications and age-related macular degeneration.

PURPOSE: To evaluate the association between cholesterol-lowering medications and age-related macular degeneration (AMD). DESIGN: Case-control study. PARTICIPANTS: The Atherosclerosis Risk in Communities study is a prospective, population-based, cohort study conducted in 4 communities across the United States. A total of 15792 individuals aged 45 to 65 years were enrolled between 1987 and 1989; fundus photographs were added to the study protocol at the 6-year follow-up (1993-1995). Cases were subjects who were identified as having AMD after applying a standard definition to their fundus photographs; controls did not have AMD. METHODS: The use of cholesterol-lowering medications at any time during the study was determined and compared between cases and controls, adjusting for the potentially confounding effect of demographic, behavioral, and medical characteristics. MAIN OUTCOME MEASURES: Presence of AMD and the use of cholesterol-lowering medications. RESULTS: A total of 871 AMD cases and 11,717 controls were identified. Of the AMD cases, 11% made use of cholesterol-lowering medications, as compared with 12.3% of controls (odds ratio [OR], 0.89; 95% confidence interval [CI], 0.71-1.11). Adjusting for the confounding influence of age, gender, and race revealed a statistically significant relationship between AMD and use of cholesterol-lowering medications (OR, 0.79; 95% CI, 0.63-0.99). CONCLUSIONS: The results of this study add to the growing body of evidence that cholesterol-lowering medications may reduce the risk of developing AMD. Additional research is needed to document the mechanism responsible for this association. A clinical trial of the impact of statins on AMD deserves consideration.

Aged↗

PubMed2005

A hemoglobin-based oxygen carrier, bovine polymerized hemoglobin (HBOC-201) versus hetastarch (HEX) in a moderate severity hemorrhagic shock swine model with delayed evacuation.

OBJECTIVE: To evaluate the efficacy of HBOC-201 for resuscitation of hemorrhagic shock in a swine model incorporating soft tissue injury and delayed evacuation. METHODS: A muscle crush injury and 40% estimated blood volume controlled hemorrhage was completed in 24 Yucatan mini-pigs. Pigs were untreated or resuscitated with HBOC-201 or 6% hetastarch (HEX) at 20 min. Invasive hemodynamics and clinical variables were monitored for 4 h (pre-hospital phase) and subsequent fluid infusions were administered for severe hypotension or tachycardia. Animals were recovered from anesthesia and monitored non-invasively to 72 h (hospital phase). RESULTS: 100% (8/8) of HBOC-201-, 88% (7/8) of HEX-, and 63% (5/8) of non-resuscitated pigs, survived to 72 h (p=0.27). Mean arterial pressure, mean pulmonary arterial pressure and systemic vascular resistance index were higher in HBOC-201 pigs. By 90 min, cardiac index was restored to baseline in the HBOC-201 group and was 1.4-fold greater than baseline in the HEX group. HBOC-201 pigs had lower fluid requirements than HEX pigs (18.8+/-1.8 and 29.9+/-1.1 ml/kg, p<0.001) in the pre-hospital phase and required fewer blood transfusions (1.3+/-1.3 and 9.4+/-0.6 ml/kg, respectively, p<0.001) in the hospital phase. Urine output and blood creatinine were comparable in HBOC-201 and HEX pigs. Tissue oxygenation levels were highest in the HBOC-201 group. CONCLUSIONS: As HBOC-201 restored hemodynamics and tissue oxygenation and decreased fluid requirements, in comparison with HEX, HBOC-201 was at least as efficacious and possibly a superior resuscitative fluid in a military-relevant delayed evacuation hemorrhagic shock swine model.

Animals↗

PubMed2005

Motor vehicle mismatch-related spinal injury.

BACKGROUND/OBJECTIVE: Motor vehicle collision (MVC)-related spinal cord injury (SCI) is the most prevalent etiology of SCI. Few studies have defined SCI risk factors. Vehicle mismatch occurs in 2-vehicle MVCs in which there are significant differences in vehicle weight, stiffness, and height. This study examined SCI risk and vehicle mismatch. METHODS: A matched case-control study using the 1995 to 2003 National Automotive Sampling System (NASS). Study subjects were identified from 2-vehicle MVCs. Cases were occupants who had suffered a cervical, thoracic, or lumbar SCI. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. RESULTS: There were 101,682 cases of SCI matched to 805,091 controls. Occupants of passenger vehicles involved in MVCs with a light truck or van (LTV) were at increased risk for SCI (OR = 1.87, 95% CI = 1.07-3.24) and this risk was greatest for thoracic SCI (OR = 5.09, 95% CI = 2.33-11.13). In addition, occupants of LTVs involved in MVCs with passenger vehicles were at significant increased risk for cervical (OR = 1.39) and lumbar (OR = 2.65) SCI; and occupants of LTVs involved in MVCs with other LTVs were at increased risk of any SCI (OR = 2.02, 95% CI = 1.52-2.69). For these subjects, significant increased risks were seen for all spine regions: cervical (OR = 1.41), thoracic (OR = 2.86), and lumbar (OR = 2.38). CONCLUSIONS: The results of this study suggest that occupants of passenger vehicles are at increased SCI risk when involved in 2-vehicle MVCs with LTVs; and that occupants of LTVs are at increased SCI risk, regardless.

Adult↗

PubMed2005

Unusual job activities as a risk factor for occupational injuries.

BACKGROUND: Based upon our clinical observation, many job-related injuries occur as a consequence of workers performing a task or engaging in an activity for which they have not been trained. METHODS: A case-crossover study was used to evaluate unusual job tasks, unusual tools and unusual work locations as triggers for occupational injuries. Data on work activities on the day of the injury and 7 days prior to injury were collected via in-person interview. RESULTS: All the 33 subjects enrolled were male, 23 were white and 10 were black, with a mean age of 34.9 years. The most common mechanisms of injury were falls and burns. The most common injuries were fractures and closed head injuries. Unusual job tasks [odds ratio (OR) 27.0, 95% confidence interval (CI) 3.1-235.3] and unusual tools (OR 13.3, 95% CI 1.4-125.4) were associated with the injury. CONCLUSIONS: Workers should be extra cautious and they should be provided with training for new tasks and new tools.

Accidents, Occupational↗

PubMed2005

The association between restraint system and upper extremity injury after motor vehicle collisions.

OBJECTIVES: This study was designed to investigate the relationship between upper extremity (UE) injuries and occupant restraint systems among front seat occupants who were involved in frontal motor vehicle collisions (MVCs). DESIGN: Case-control. SETTING: The 1995 through 2002 National Automotive Sampling System (NASS) Crashworthiness Data System (CDS). PARTICIPANTS: Subjects were identified from the NASS-CDS. All cases sustained an UE injury with a > or = 2 Abbreviated Injury Scale Score. OUTCOMES: Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated comparing risk of UE in 3 mutually exclusive restraint system groups (seatbelt-only, airbag-only, seatbelt-airbag-combined) to the unrestrained group. Data analysis was adjusted for significant occupant, vehicle, and collision characteristics. RESULTS: Seatbelt-only occupants had a reduced UE injury risk (OR, 0.41; 95% CI, 0.22-0.76). Near null associations were found for airbag-only (OR, 1.1; 95% CI, 0.68-1.76) and seatbelt-airbag-combined (OR, 0.97; 95% CI, 0.56-1.69). CONCLUSION: The results of this study suggest that UE injuries may become more common as a result of MVCs as the proportion of airbags in motor vehicles increases.

Abbreviated Injury Scale↗

PubMed2005

Glaucoma after ocular contusion: a cohort study of the United States Eye Injury Registry.

PURPOSE: This cohort study was designed to evaluate risk factors for the development of posttraumatic glaucoma after ocular contusion. METHODS: Data from the United States Eye Injury Registry (USEIR) were obtained from a total of 6021 patients who experienced blunt ocular contusion. Logistic regression was used to evaluate the association between these baseline structural and functional ocular characteristics and posttraumatic glaucoma. Odds ratios with 95% confidence intervals were obtained. RESULTS: The 6-month incidence of developing posttraumatic glaucoma was 3.39%. The development of glaucoma was independently associated with: advancing age (OR = 1.02; 95% CI = 1.02, 1.03), visual acuity worse than 20/200 (OR = 1.92; 95% CI = 1.19, 3.10), iris injury (OR = 1.60; 95% CI = 1.05, 2.44), lens injury (OR = 1.86; 95% CI = 1.11, 3.11), hyphema (OR = 2.23; 95% CI = 1.40, 3.54), or angle recession (OR = 1.71; 95% CI = 1.00, 2.90). CONCLUSION: This study provides an estimate for the risk of developing glaucoma after ocular contusion in a large cohort of patients and has determined several independently predictive factors that were significantly associated with the development of posttraumatic glaucoma including poor initial visual acuity, advancing age, lens injury, angle recession, and hyphema.

Adult↗

PubMed2005

On-road driving with moderate visual field loss.

PURPOSE: We examined the relationship between visual field extent and driving performance in an open, on-road environment using a detailed scoring method that assessed the quality of specific skills for a range of maneuvers. The purpose was to determine which maneuvers and skills should be included in future, larger scale investigations of the effect of peripheral field loss on driving performance. METHODS: Twenty-eight current drivers (67 +/- 14 years) with restricted peripheral visual fields participated. Binocular visual field extent was quantified using Goldmann perimetry (V4e target). The useful field of view (UFOV) and Pelli-Robson letter contrast sensitivity tests were administered. Driving performance was assessed along a 14-mile route on roads in the city of Birmingham, Alabama. The course included a representative variety of general driving maneuvers, as well as maneuvers expected to be difficult for people with restricted fields. RESULTS: Drivers with more restricted horizontal and vertical binocular field extents showed significantly (p < or = 0.05) poorer skills in speed matching when changing lanes, in maintaining lane position and keeping to the path of the curve when driving around curves, and received significantly (p < or = 0.05) poorer ratings for anticipatory skills. Deficits in UFOV performance and poorer contrast sensitivity scores were significantly (p < or = 0.05) correlated with overall driving performance as well as specific maneuver/skill combinations. CONCLUSIONS: In a small sample of drivers, mild to moderate peripheral visual field restrictions were adversely associated with specific driving skills involved in maneuvers for which a wide field of vision is likely to be important (however most were regarded as safe drivers). Further studies using similar assessment methods with drivers with more restricted fields are necessary to determine the minimum field extent for safe driving.

Aged↗