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Biomedical subjects

J H Holmes

Publications and source records attributed to J H Holmes.

At least 37 records · Page 2Linked to original sources
PubMed1996

Barriers to the use of urban medical services by rural and remote area households.

People from rural and remote areas commonly need to attend provincial and metropolitan cities for specialist care. There decisions to make such trips 'away' involve a number of non-medical considerations that include economic, emotional and social factors. This paper reports the results of two surveys that sought information about the types and importance of non-medical considerations taken into account by rural and remote Queensland householders when faced with a trip away. In addition, the problems encountered by respondents on their last trip away are reported and discussed. The data revealed that important considerations taken into account when planning the trip were predominantly related to urgency, household organisation and the costs likely to be incurred where away. A number of avoidable problems occurring at destination were also described. Generally, remote area respondents saw these impediments as more serious barriers to seeking care than did rural area respondents. When respondents were further asked to identify major problems associated with their last trip to an urban facility, problems at the destination figured more prominently, particularly problems directly related to the lack of understanding of the transport and distance needs of rural people. With one exception, these problems were reported by similar proportions of rural and remote area respondents. These are matters that merit high priority attention in any programs to enhance access to specialist medical services by people in rural and remote areas.

Emergencies↗
PubMed1996

Injuries among inner-city minority women: a population-based longitudinal study.

Active emergency department-based surveillance was conducted to determine the incidence of fatal and nonfatal injuries in an urban, female African American population from 1987 through 1990. Nearly 40% of the women studied sustained one or more injuries that required emergency care or resulted in death. By 1989, violence had surpassed falls as the leading cause of injuries, the rate increased by 55% over the study period. Injury rates were highest among young women for nearly every major cause of injury. The rate of death due to injuries was also highest among young women, for whom violence was the leading cause of death. In summary, injuries to women in this inner-city minority community were extremely common and increased significantly from 1987 to 1990. Injuries in young inner-city minority women should be considered a priority health problem in the United States.

Adult↗
PubMed1995

Occupational injuries in a poor inner-city population.

This study aims to characterize occupational injuries in a defined poor inner-city population in terms of demographic features, types, and circumstances of injuries, and medical and financial consequences. It is a case series drawn from a larger population-based injury registry in emergency departments that serve 17 poor census tracts in Philadelphia. Of 335 patients from the study area who had been treated at the emergency departments under study for occupational injuries, 107 could be contacted by telephone 2 to 3 years after their injuries. Interviews sought information on the patients, their employment, their injuries, and the consequences. Respondents were almost all African-American, approximately 50% male, and had a median age of 32. Approximately one third were employed in the health care industry, one fourth in the service sector (including conventional service firms, restaurants, and hotels), and the remainder in construction, retail and wholesale trade, education, transportation, and manufacturing. Major causes of injuries included overexertion, contact with sharp objects, and falls. Major types on injuries included sprain/strains and lacerations. Approximately half the respondents had missed more than 3 days of work, with 15% missing more than 1 month. Almost 40% of respondents reported persistent health problems after their injuries. Only about one quarter had received workers' compensation. We conclude that poor and minority workers are at risk of a wide range of occupational injuries, which may result in considerable lost work time and have serious medical and economic consequences. More, attention to the workplace risks of these relatively marginalized workers and more vigorous preventive interventions are needed.

Accidents, Occupational↗
PubMed1994

A longitudinal study of injury morbidity in an African-American population.

OBJECTIVE: To improve understanding of the patterns of injury morbidity and mortality in an urban African-American population. DESIGN: Prospective survey of emergency department records for a geographically defined population from 1987 through 1990. SETTING: Eleven hospital emergency departments in Philadelphia, Pa. PARTICIPANTS: The approximately 68,000 people living in 17 census tracts in western Philadelphia. RESULTS: A total of 46,260 injury events were identified in the survey (168.8 events per 1000 population annually). Half of the population made an emergency department visit for one or more injuries during the 4 years of study. There were 2796 hospital admissions (10.2/1000 population) and 403 deaths (1.5/1000 population) as a result of these injuries. Although in 1987 falls were the most frequent type of injury resulting in an emergency department visit, by 1989 the number of interpersonal intentional injury events exceeded the number of falls. Interpersonal intentional injuries accounted for 31.2% of hospital admissions and 42.7% of deaths. Of men 20 through 29 years old, 94.3% visited an emergency department at least once in the 4 years because of an injury, and 40.9% of men in this age group sought treatment for one or more interpersonal intentional injuries. The likelihood of future interpersonal intentional injury-related visits increased with the number of previous injuries of this type. CONCLUSIONS: Interpersonal intentional injury occurs frequently in this population. More attention needs to be paid to prevention and intervention to reduce the toll of this violence. The high prevalence of injury in certain age strata may make general, population-based efforts for injury prevention more efficient than efforts targeted to subgroups.

Accidental Falls↗
PubMed1994

Intake of trichostrongylid larvae by goats and sheep grazing together.

Cashmere goats and Merino sheep were grazed together at 7.5 animals per ha on annual rye grass and clover pasture in southern Victoria, a winter rainfall area. Intake of parasitic larvae was measured in oesophageal extrusa samples collected from 2 animals of each species, 4 times in one week, on 7 occasions between mid-March (autumn) and mid-June (winter). Pasture contamination with larvae was measured at the same times. The number of larvae per kg of green grass was lower than on green clover; the most heavily contaminated portion of the pasture was the mat of dead herbage on the ground. The diet selected by goats contained more green grass and dead herbage and less clover that that of sheep (P < 0.01). Goats ingested 643 infective trichostrongylid larvae per kg dry matter intake (DMI) versus 274 per kg DMI for sheep in autumn, increasing to 1892 versus 1143 in early winter. The heavier trichostrongylid burdens of goats compared with sheep, when grazed together, are due in part to greater rates of infection consequent on different grazing patterns as well as greater susceptibility to infection.

Animal Feed↗
PubMed1993

Pressure sores in a Christian Science sanatorium.

We reviewed the Dallas County Medical Examiner's Office records of all individuals who had died in a local Christian Science Sanatorium during a 5 1/2-year period. Of 116 such patients, only 13 (11%) had pressure sores (decubitus ulcers). In 10 of these patients, the sores were described as small, superficial, and/or healing, while the other three patients had more serious ulcers. In contrast, for patients dying in nursing homes or hospitals, the incidence of pressure sores may be as high as 54-57%. It is our opinion that the difference in incidence is due to the personal and conscientious nursing care provided by Christian Science institutions.

Aged↗
PubMed1993

Effect of high-protein feed supplements on concentrations of growth hormone (GH), insulin-like growth factor-I (IGF-I) and IGF-binding protein-3 in plasma and on the amounts of GH and messenger RNA for GH in the pituitary glands of adult rams.

Three groups of mature rams were maintained on diets of hay, hay + 2% lupin or hay + 2% cowpea for 11 weeks. Serial blood samples were taken at 15-min intervals for 12 h for the determination of GH and IGF-I content by radioimmunoassay and for IGF-binding protein-3 (IGFBP-3) levels by Western blotting. The rams were killed after 77 days of supplementary feeding and their pituitary glands analysed for content of GH and GH mRNA. Mean plasma GH and baseline GH levels were significantly (P < 0.01) decreased in the rams fed lupin and cowpea compared with controls fed hay and GH pulse amplitude was significantly (P < 0.001) decreased in the group fed the cowpea diet. The frequency of GH pulses was not significantly altered by either treatment. Plasma concentrations of IGF-I were elevated in rams fed lupin (P < 0.001) or cowpea (P < 0.05). IGFBP-3 levels were not significantly (P > 0.05) altered by either treatment. There were no significant differences in pituitary content of GH mRNA but pituitary content of GH was increased in rams fed lupin (P < 0.05) and cowpea (P = 0.07). In conclusion, a high-protein diet decreases plasma GH levels and increases IGF-I without changing plasma IGFBP-3 levels in rams. Thus ongoing synthesis of GH, as indicated by the mRNA levels, may cause a build up of GH stores in the pituitary gland.

Animal Nutritional Physiological Phenomena↗
PubMed1993

An injury prevention program in an urban African-American community.

OBJECTIVES: Injury is a major US public health problem, particularly in urban minority communities. This paper evaluates the impact of the Safe Block Project, a comprehensive injury prevention trial, on home hazards and injury prevention knowledge in a poor urban African-American community. METHODS: Nine census tracts in the community were allocated to either the intervention area or the control area. The intervention, carried out by trained community outreach workers, consisted of (1) home modification for simple prevention measures, (2) home inspection accompanied by information about home hazards, and (3) education about selected injury prevention practices. Approximately 12 months after the intervention, random samples of control and intervention homes were assessed for home hazards and injury prevention knowledge. RESULTS: A significantly larger proportion of intervention homes than control homes had functioning smoke detectors, syrup of ipecac, safely stored medications, and reduced electrical and tripping hazards. No consistent differences were observed between control and intervention homes on home hazards requiring major effort to correct. CONCLUSIONS: There was a distinct difference between control and intervention homes with respect to safety knowledge and home hazards requiring minimal to moderate effort to correct. The Safe Block Project could serve as a model for future urban injury prevention efforts.

Accidents, Home↗
PubMed1991

A population-based study of injuries in inner-city women.

Although injuries are the number one cause of death for women under age 45 years in the United States, very little is known about nonfatal injuries to women, particularly those from urban, black communities. The Philadelphia Injury Prevention Program is a surveillance system of fatal and nonfatal injuries in a poor, urban, black community in western Philadelphia, Pennsylvania. Nearly 10% of the estimated population of 31,032 women aged 15 years and older suffered an injury resulting in an emergency room visit or death during the 1-year study period from March 1, 1987 through February 29, 1988. The major causes of injury were falls (25.1 per 1,000 women), violence (20.8 per 1,000 women), and motor vehicle incidents (16.8 per 1,000 women). Violence was the leading cause of injury for women aged 15-44 years and the most common cause of injuries among women with two or more injuries during the 1-year period. Injury rates were highest for women aged 25-34 years (157.1 per 1,000 women); nearly 16% of the population in this age group suffered an injury resulting in an emergency room visit or death during the 1-year study period. Rates declined with advancing age for each injury type except for falls; which were most common in young women aged 25-34 years (28.4 per 1,000 women) and in the aged 65 years and older (29.0 per 1,000 women). We conclude that in his population, injuries to young women appear to be a major public health problem. More work is needed to understand the nature of injuries occurring to young women in urban communities.

Accidental Falls↗
PubMed1991

A survey of the health of homeless children in Philadelphia shelters.

We conducted a random-sample survey of homeless children and their mothers residing in Philadelphia (Pa) shelters. One hundred forty-six families were included in the final sample, resulting in an 80% response rate. The aims of the survey were to characterize the child's current and past health status, to determine access to and use of medical services, and to determine the serum erythrocyte protoporphyrin levels and tuberculin skin test status of the children. In addition, psychological tests were administered to both child and parent to assess developmental level and psychological problems. Finally, detailed questions were asked concerning the reasons for the homeless condition. The important reasons for homelessness cited in the survey included physical abuse, substance abuse, disagreements with landlords, and poor living conditions. The children's health problems included a high incidence of reported accidents and injuries, burns, and lead toxicity; the parents suffered from depression, physical abuse, and substance abuse. School-aged children tended to have low scores on tests of expressive vocabulary and word decoding, and preschoolers seemed to be below age expectations in receptive vocabulary and visual motor skills. The findings of this study suggest that homeless children tend to score poorly on developmental and psychological tests and tend to sustain serious burns and accidents. Policy implications of the survey include suggestions for health screening, rehabilitation, and education.

Accidents↗
PubMed1991

Interpersonal violence-related injuries in an African-American community in Philadelphia.

Violence has been recognized as a significant health problem. This study describes fatal and nonfatal interpersonal violence-related injury events over 1 year in an indigent African-American community in Philadelphia. Information on injuries was collected from emergency rooms, the Office of the Medical Examiner, and death certificate files. For persons aged 15 through 49 years, violence-related injury rates surpassed any other injury type. The overall violence-related injury rate was 28.7 per thousand population. Interpersonal violence-related injuries were important for the 0- to 4-year age group (9.19 injuries per 1000 population), and continued as a major cause of morbidity through age 59 (12.08 injuries per 1000 population). For more than half of the events, information from the emergency room chart was sufficient only to categorize the incident as a "fight" or that it was intentional; no further classification was possible.

Adolescent↗
PubMed1990

Factors associated with smoking in low-income pregnant women: relationship to birth weight, stressful life events, social support, health behaviors and mental distress.

Since low-income women are at increased risk of having low birth weight infants, factors associated with birth weight among such groups have special relevance. Cigarette-smoking has emerged as an important predictor of low birth weight due to intrauterine growth retardation and pre-term delivery. After confirming the relation of smoking with birth weight, we examined the association of smoking with sociodemographic factors, attitudes towards pregnancy, health behaviors, stressful life events, social support, and symptoms of mental distress in a cohort of 458 Central Harlem women. We found that social support, stress and mental health were associated with smoking behavior but not directly with birth weight. These findings suggest that programs designed to modify health behaviors such as smoking during pregnancy must also take into account such characteristics of the women and their environments which may make behavioral change difficult. Moreover, programs aimed at fostering better health behaviors to improve pregnancy outcome may have to extend beyond the current pregnancy, as indicated by an association between prior adverse pregnancy outcome and smoking in the current pregnancy.

Adult↗
PubMed1990

Injuries in an elderly inner-city population.

Even though injuries are a leading cause of morbidity and mortality among the elderly in the United States, no comprehensive population-based study of nonfatal and fatal injuries has been carried out in an elderly minority inner-city population. To study injuries in this population, we developed an active surveillance system as part of a large injury prevention program in a poor urban black community. We report 577 cases of nonfatal and fatal injuries in a community of 12,139 persons 65 years of age and older that resulted in emergency room treatment or death between March 1, 1987, and February 29, 1988. Nearly 5% of the elderly population was treated at an emergency room for, or died as a result of, an injury during the study period; the overall injury rate was 48 injuries per 1,000 persons. Injury rates for older women exceeded those for older men and increased with advancing age in both sexes. Fall injuries accounted for 312 (54%) of all injuries and 75% of all hospitalizations for injury. Motor vehicle incidents and violence were the second and third most common injuries, accounting for 13% and 7% of injuries, respectively. Given the predominance of falls relative to other injuries, prevention of falls should receive major emphasis in injury prevention efforts in inner-city minority populations.

Accidental Falls↗
PubMed1989

Outreach as case finding: its effect on enrollment in prenatal care.

One mechanism proposed for encouraging use of prenatal services in low-income communities involves the employment of community residents to encourage and support individuals in the use of available medical care. This study examines the effect of such workers on the start of prenatal care among a cohort of women receiving prenatal services at clinics affiliated with Harlem Hospital. Of the 599 women enrolling for prenatal care during the intake period for the study, only 52 had had an outreach contact before the start of prenatal care despite extensive field activity. No difference in the week of gestation at the start of prenatal care was noted between those with and without outreach contacts. Controlling for factors associated both with trimester of initiation of prenatal care in this population and with outreach contact did not account for this lack of difference. This type of outreach, known as case-finding, proved to be very labor intensive. Other less costly techniques for encouraging use of services in mobile, urban populations should be sought.

Adolescent↗
PubMed1989

Factors associated with maternal rating of infant health in central Harlem.

Maternal perceptions of infant health are strongly associated with the use of health services and may influence the child's future health and development. The extent to which such perceptions reflect infant health problems or a response to environmental stress in the mother's life is unclear. Because this issue may be especially important in disadvantaged groups for which both high levels of infant morbidity and environmental stress are common, we have explored the correlates of maternal perceptions of infant health among 367 mothers of 12-month-olds in central Harlem. Lower ratings of infant health were associated with such indicators of morbidity as problems in the neonatal period, hospitalization, and one or more episodes of illness. They were also associated with lower family income and the mother's rating of her own health in the bivariate analyses, but not in multivariate analyses. Neither maternal mental health, social support, nor environmental stress appeared to influence maternal rating of child health. These findings indicate that a mother's ratings of her infant's health relate specifically to the child's morbidity, independent of her own health and environmental stress. Moreover, within disadvantaged communities, infants of the poorest mothers may experience greater levels of morbidity.

Child Welfare↗
PubMed1987

The planning of pregnancy among low-income women in central Harlem.

A planned pregnancy is considered desirable, in part because of the potential of a better pregnancy outcome. Since the improvement of pregnancy outcome is of particular relevance in low-income populations, we have compared the characteristics of women with planned and unplanned pregnancies in central Harlem with regard to those factors that might affect pregnancy planning such as sociodemographic factors, attitudes toward child-rearing, environmental stress, social support, and maternal mental health. Of the 416 women in the study, a minority (27%) reported their pregnancy as being planned. They differed from the remainder in being more likely to be married and/or living with a boyfriend or husband and to have been born outside New York City. The two groups did not differ in any other risk factor or in outcome in terms of birth weight and gestational age. The results provide little support for the lack of planning of pregnancy as an indicator of risk in a low-income population and suggest that improvement of perinatal outcome must involve more broadly based interventions that are not confined to the periconceptional period.

Educational Status↗