Biomedical subjects
I B Pless
Publications and source records attributed to I B Pless.
The effectiveness of a home visit to prevent childhood injury.
OBJECTIVE: To examine the effectiveness of a home visit program to improve home safety and decrease the frequency of injury in children. We examined the effects of the program on 1) parental injury awareness and knowledge; 2) the extent that families used home safety measures; 3) the rate of injury; and 4) the cost effectiveness of the intervention. DESIGN: A randomized, controlled trial. SETTING: A multicenter trial conducted at 5 hospitals in 4 Canadian urban centers. PARTICIPANTS: Children <8 years old, initially enrolled in an injury case-control study, were eligible to participate. Intervention. Subsequent to a home inspection conducted to determine baseline hazard rates for both groups, participants in the intervention group received a single home visit that included the provision of an information package, discount coupons, and specific instruction regarding home safety measures. MAIN RESULTS: The median age was 2 years, with males comprising ~60% of participants. The experimental groups were comparable at outset in terms of case-control status, age, gender, and socioeconomic status. Parental injury awareness and knowledge was high; 73% correctly identified injury as the leading cause of death in children, and an intervention effect was not demonstrated. The adjusted odds ratios (ORs) for the home inspection items indicated that significant safety modifications only occurred in the number of homes having hot water not exceeding 54 degrees C (OR: 1.31, 95% confidence interval [CI]: 1.14, 1.50) or the presence of a smoke detector (OR: 1.45, 95% CI: 0.94, 2.22). However, the intervention group reported home safety modifications of 62% at 4 months and significantly less injury visits to the doctor compared with the nonintervention group (rate ratio: 0.75; 95% CI: 0.58, 0.96). The total costs of care for injuries were significantly lower in the intervention group compared with the nonintervention group with a cost of $372 per injury prevented. CONCLUSIONS: An intervention using a single home visit to improve the extent to which families use safety measures was found to be insufficient to influence the long-term adoption of home safety measures, but was effective to decrease the overall occurrence of injuries. Future programs should target a few, well-focused, evidence-based areas including the evaluation of high-risk groups and the effect of repeated visits on outcome.
Preventing spinal cord injuries: is this the best we can do?
Explore the source record for details and available documents.
Venting spleen: helmet legislation.
Explore the source record for details and available documents.
Alcohol: the ubiquitous risk factor.
Explore the source record for details and available documents.
Killing speed--enlightening the cost of injury debate.
Explore the source record for details and available documents.
Evaluation of the quality of an injury surveillance system.
The sensitivity, positive predictive value, and representativeness of the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP) were assessed. Sensitivity was estimated at four centers in June through August 1992, by matching independently identified injuries with those in the CHIRPP database. The positive predictive value was determined by reviewing all "injuries" in the database (at Montreal Children's Hospital) that could not be matched. Representativeness was assessed by comparing missed with captured injuries (at Montreal Children's Hospital) on demographic, social, and clinical factors. Sensitivity ranged from 30% to 91%, and the positive predictive value was 99.9% (i.e., the frequency of false-positive capture was negligible). The representativeness study compared 277 missed injuries with 2,746 captured injuries. The groups were similar on age, sex, socioeconomic status, delay before presentation, month, and day of presentation. Injuries resulting in admissions, poisonings, and those presenting overnight were, however, more likely to be missed. The adjusted odds ratio of being missed by CHIRPP for admitted injuries (compared with those treated and released) was 13.07 (95% confidence interval 7.82-21.82); for poisonings (compared with all other injuries), it was 9.91 (95% confidence interval 5.39-18.20); and for injuries presenting overnight (compared with those presenting during the day or evening), it was 4.11 (95% confidence interval 3.11-5.44). These injuries were probably missed because of inadequate education of participants in the system. The authors conclude that CHIRPP data are of relatively high quality and may be used, with caution, for research and public health policy.
An editor's dilemma--avoiding conflict of interest.
Explore the source record for details and available documents.
CHIRPP: Canada's principal injury surveillance program. Canadian Hospitals Injury Reporting and Prevention Program.
Explore the source record for details and available documents.
Sensitivity and representativeness of a childhood injury surveillance system.
OBJECTIVE: To determine the sensitivity and representativeness of the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP). SETTING: The study was conducted in the Ottawa-Carleton region of Ontario, Canada (June through August, 1992). METHODS: Surveillance system sensitivity was estimated by dividing the number of injured children attending the Children's Hospital of Eastern Ontario (the only CHIRPP center in Ottawa-Carleton) by the total number of emergency department attended childhood injuries in the region. CHIRPP representativeness was assessed by comparing the injuries missed by the system with those captured on social, demographic, and clinical factors. RESULTS: Sensitivity was 65% (1552/2386). Missed and captured injuries were similar on sex, day, time of presentation, injury intent, and delay before presentation. Children older than 14 years, however, were more likely to be missed by the system; adjusted odds ratio 3.52 (95% confidence interval (CI) 2.87 to 4.32). Conversely, children admitted to hospital were less likely to be missed; adjusted odds ratio 0.43 (95% CI 0.23 to 0.80). CONCLUSION: Given the systematic errors in capture, CHIRPP data should be used cautiously in studies of etiology.
A double standard? Disease v injury.
Explore the source record for details and available documents.
FoWoCo, Rijstafel, and FiWoCo.
Explore the source record for details and available documents.
Product safety: getting tough or being nice?
Explore the source record for details and available documents.
Children's exposure to traffic and pedestrian injuries.
OBJECTIVES: The purpose of this study was to estimate children's exposure to traffic (number of streets crossed) and to determine the role of exposure in pedestrian injury. METHODS: Questionnaires were distributed to a random sample of 4080 first- and fourth-grade children in 43 Montreal schools. RESULTS: When analyzed by police district, injury and exposure rates were positively correlated (r2 = 0.53). Crossings were similar by sex but increased with age and were inversely related to socioeconomic status. CONCLUSIONS: These results suggest that although children's exposure to traffic could be reduced by transporting them to school, a more reasonable prevention strategy involves environmental changes.
Reliability and validity of proxy respondent information about childhood injury: an assessment of a Canadian surveillance system.
The reliability and validity of proxy respondent information in the Canadian Hospitals Injury Reporting and Prevention Program surveillance system was assessed. A standardized form was used to collect data on injury date, location, context (activity at the time), breakdown factor (what went wrong), mechanism, product involvement, safety precaution use, and motor vehicle involvement. The test-retest method determined reliability, with the kappa coefficient quantifying agreement between respondent information provided in the emergency department and later during a telephone interview. Of 421 eligible respondents, 325 (77%) completed the telephone interview, with a median time to interview of 33 hours (range 24-70 hours). Agreement was high for all items; kappa coefficients ranged from 0.79 (substantial agreement) to 1.00 (perfect agreement). Reliability was not significantly modified by respondent view of the injury event, age of the child, language of the form, or level of respondent education. Validity was determined by measuring the agreement between respondent information and that provided by an independent witness. Witness information was considered to represent the truth. Of the 140 injury events selected, 92 (66%) had the form completed by both the original respondent and an independent witness. Kappa coefficients were greater than 0.65 for all but one item (safety precaution use), and the positive predictive value of respondent information for item categories whose prevalence was > or = 0.25 ranged from 0.82 to 0.95. The authors conclude that proxy respondent data on childhood injury are both reliable and valid.