Biomedical subjects

R L Berg

Publications and source records attributed to R L Berg.

At least 19 recordsLinked to original sources

PubMed2006

Evaluation of a policy to reduce youth tractor crashes on public roads.

OBJECTIVE: Evaluate the effectiveness of a United States state law, Wisconsin Act 455, in reducing highway tractor crashes involving youth operators. DESIGN: Policy outcome evaluation involving review of a retrospective case series. SETTING: Youth highway tractor crashes from Wisconsin for the years 1994-2003 that resulted in a fatality, injury, and/or property damage. SUBJECTS: One hundred and forty six tractor crash cases involving operators younger than 16 years. METHODS: Describe and model the tractor crash patterns before and after enactment of the law, and examine the relation between the contributing circumstances identified in the crash reports and the content covered in the mandated tractor certification course. RESULTS: There was neither a significant change in the number of youth tractor crashes after the law was passed, nor any reduction in the proportion of crashes where the youth operator was designated at fault. The tractor certification course did not cover the major factors contributing to youth tractor crashes on public roads. CONCLUSIONS: No significant effect of the law was detected and crash rates at the end of the study period were similar to those before Wisconsin Act 455. The authors'findings should not be construed to suggest that public policy, in general, is an ineffective strategy for the prevention of pediatric agricultural injuries. Negotiating a balance in public policy debates will be a challenge, but it is clear that future policy initiatives need to identify and implement the right policy for the right problem.

Accident Prevention↗

PubMed2005

Motivation and satisfaction among polyclinic volunteers at the 2002 Winter Olympic and Paralympic Games.

BACKGROUND: The Olympic and Paralympic Games rely heavily on volunteers to provide many essential services, including medical care of athletes. OBJECTIVE: This preliminary investigation sought to characterise the motivational influences and factors responsible for the satisfaction of Olympic and Paralympic healthcare volunteers. METHODS: The 2002 Winter Games polyclinic healthcare volunteers were asked to complete a questionnaire designed to elicit information about their motives for volunteering and the factors that contributed to their satisfaction with their volunteer experience. RESULTS: There was no significant difference in the motivation or satisfaction summary scores based on event worked. There was a strong positive correlation between motivation and satisfaction. Physician respondents had a lower mean motivation score than did non-physician volunteers. CONCLUSIONS: There were no significant motivational differences between Olympic and Paralympic volunteers, but there were several differences noted between physician and non-physician volunteers. The 2002 polyclinic volunteers appear to have been motivated by a complex process best described as "enlightened self interest," and all were generally well satisfied with their experience. These results may assist organisers of future Games in selecting appropriately motivated volunteer personnel and creating rewarding work environments for them.

Adult↗

PubMed2005

Pediatric farm injuries involving non-working children injured by a farm work hazard: five priorities for primary prevention.

OBJECTIVES: To describe pediatric farm injuries experienced by children who were not engaged in farm work, but were injured by a farm work hazard and to identify priorities for primary prevention. DESIGN: Secondary analysis of data from a novel evaluation of an injury control resource using a retrospective case series. DATA SOURCES: Fatal, hospitalized, and restricted activity farm injuries from Canada and the United States. SUBJECTS: Three hundred and seventy known non-work childhood injuries from a larger case series of 934 injury events covering the full spectrum of pediatric farm injuries. METHODS: Recurrent injury patterns were described by child demographics, external cause of injury, and associated child activities. Factors contributing to pediatric farm injury were described. New priorities for primary prevention were identified. RESULTS: The children involved were mainly resident members of farm families and 233/370 (63.0%) of the children were under the age of 7 years. Leading mechanisms of injury varied by data source but included: bystander and passenger runovers (fatalities); drowning (fatalities); machinery entanglements (hospitalizations); falls from heights (hospitalizations); and animal trauma (hospitalizations, restricted activity injuries). Common activities leading to injury included playing in the worksite (all data sources); being a bystander to or extra rider on farm machinery (all data sources); recreational horseback riding (restricted activity injuries). Five priorities for prevention programs are proposed. CONCLUSIONS: Substantial proportions of pediatric farm injuries are experienced by children who are not engaged in farm work. These injuries occur because farm children are often exposed to an occupational worksite with known hazards. Study findings could lead to more refined and focused pediatric farm injury prevention initiatives.

Adolescent↗

PubMed2004

Self reported injury patterns among competitive curlers in the United States: a preliminary investigation into the epidemiology of curling injuries.

OBJECTIVE: To investigate the injury patterns among competitive curlers. METHODS: Participants at two curling championship events were asked to complete injury history questionnaires. RESULTS: 76 curlers (39%) participated; 79% of these reported curling related musculoskeletal pain, most commonly involving the knee (54%), back (33%), and shoulder (20%). Sweeping and delivering the stone were most likely to provoke symptoms. Time loss injuries were estimated to occur at a rate of 2 per 1000 athlete exposures. CONCLUSIONS: Curling appears to be a relatively safe winter sport. Prospective studies are needed to confirm these preliminary findings and to further define the risk factors for curling related injuries.

Athletic Injuries↗

PubMed2004

Evaluation of the North American Guidelines for Children's Agricultural Tasks using a case series of injuries.

OBJECTIVE: To evaluate the potential for the North American Guidelines for Children's Agricultural Tasks (NAGCAT) to prevent the occurrence of pediatric farm injuries. This evaluation focuses upon farm injuries experienced when children were engaged in farm work. DESIGN: Novel outcome evaluation involving primary review of three retrospective case series. SETTING: Fatal, hospitalized, and restricted activity injuries from the United States and Canada. SUBJECTS: Nine hundred and thirty four pediatric farm injury cases. METHODS: The applicability of NAGCAT to each case was rated. For injuries where NAGCAT were applicable, recurrent injury patterns were described and the potential for NAGCAT to prevent their occurrence was assessed. RESULTS: A total of 283 (30.3%) cases involved children engaged in farm work. There was an applicable NAGCAT guideline in 64.9% of the work related cases. Leading individual guidelines applicable to the injury events were: (1) working with large animals; (2) driving a farm tractor; and (3) farm work with an all-terrain vehicle. In the judgment of the research team, 59.6% of these injuries were totally preventable if the principles espoused by NAGCAT had been applied. CONCLUSIONS: NAGCAT are a set of consensus guidelines aimed at the prevention of pediatric farm injuries. The findings suggest that NAGCAT, if applied, would be efficacious in preventing many of the most serious injuries experienced by children engaged in farm work. However, work related injuries represent only a modest portion of pediatric farm injuries. This new information assists in the refinement of NAGCAT as an injury control resource and puts its potential efficacy into context.

Accidents, Occupational↗

PubMed2004

Operational characteristics of tractors driven by children on farms in the United States and Canada.

Farm tractors are an important source of traumatic injury for children on farms. There is, however, no documentation about the age and size of tractors that children are operating and little information about the frequency with which rollover protective structures (ROPS) are used. This study described tractors that children on farms in the U.S. and Canada were operating by age, horsepower, and the presence of ROPS, according to the age and gender of the farm children involved. As a sub-analysis of data compiled during a randomized controlled trial, a descriptive analysis was completed on work exposure data collected by telephone interview. Of the 1,113 children involved in the trial, 522 (47%) were reported to perform at least one job that involved the operation of a farm tractor, and 408 (36.7%) were operating tractors of at least 20 horsepower. The majority of these children were male. There was a wide range of ages and sizes of tractors operated. However, the majority of tractors were between 20 and 70 horsepower and manufactured after 1970. Nearly one-half of the tractors were equipped with ROPS, and these tended to be newer and larger tractors. This analysis provides new data about the broad range of tractors driven by farm children in the U.S. and Canada. The findings point to a need to re-examine the reliance on a single voluntary standard to mitigate the hazard of tractor rollovers and the need for an enhanced safety policy requiring all tractors operated by children be equipped with ROPS.

Accidents, Occupational↗

PubMed2001

Assignment of work involving farm tractors to children on North American farms.

BACKGROUND: Children are at high risk for tractor-related injury. The North American Guidelines for Children's Agricultural Tasks (NAGCAT) provide recommendations for the assignment of tractor work. This analysis describes tractor-related jobs assigned to farm children and compares them to NAGCAT. METHODS: A descriptive analysis was conducted of baseline data collected by telephone interview during a randomized, controlled trial. RESULTS: The study population consisted of 1,138 children who worked on 498 North American farms. A total of 2,389 farm jobs were reported and 456 (19.1%) involved operation of farm tractors. Leading types of tractor jobs were identified. Modest, yet important, percentages of children were assigned tractor work before the minimum ages recommended by NAGCAT. CONCLUSIONS: Children on farms are involved in tractor work at a young age and some are involved in jobs that they are unlikely to have the developmental abilities to perform. NAGCAT is a new parental resource that can be applied to these work situations.

Adolescent↗

PubMed2001

Prospective study of seizures in the elderly in the Marshfield Epidemiologic Study Area (MESA).

PURPOSE: To assess the incidence, etiology, antiepileptic drug (AED) use, and quality of life in patients having their first seizure at age 50 years or older. METHODS: All patients in the Marshfield Epidemiologic Study Area (MESA) aged 50 years or older having their first seizure between July 1, 1996, and June 30, 1998, were identified through the diagnostic coding system. Patients were followed up for 12 months for recurrent seizures. Etiologies, drug treatments, magnetic resonance imaging (MRI), computed tomography (CT), or EEG results and medication adverse effects were recorded. Those patients who reached 1-year follow-up received a quality of life (QOLIE-31) survey. RESULTS: Forty-eight patients having a first seizure were identified (162 of 100,000). Twelve patients had had recurrent seizures, and 36 had a single seizure at the time of study entry. Fourteen of these 36 had had an abnormal MRI, CT, or EEG. The remaining 22 had a single seizure and normal imaging and EEG. Six of these had one or more subsequent seizures, and all six were in the group with normal tests. Etiologies included vascular, neoplasm, trauma, dementia, metabolic, and unknown. Seventy-five percent of the patients achieved seizure control with phenytoin, carbamazepine, and/or valproate. Twenty-seven percent experienced adverse side effects. None had been given second-generation AEDs as an initial treatment. Thirty-one patients received the QOLIE-31 survey; 20 did not complete the survey for various reasons. The mean QOLIE-31 scores for those completing the survey were significantly higher than those of the reference cohort. CONCLUSIONS: The incidence of first seizure in MESA is high in the elderly and increases with advancing age. As in other studies, vascular causes accounted for the largest etiology. Use of new AEDs was uncommon. There was a high incidence of untoward side effects related to the traditional AEDs. High morbidity and mortality unrelated to seizures limits follow-up analysis in the elderly. Quality-of-life analysis via QOLIE questionnaires is problematic in this population.

Adult↗

PubMed2001

Preoperative computed tomography scans for parotid tumor evaluation.

OBJECTIVE: We sought to determine whether an advantage is obtained in the routine use of computed tomography (CT) scans in preoperative assessments of parotid tumors. METHODS: A prospective study of 32 consecutive cases of patients who underwent evaluation for parotidectomies was performed. Twenty-nine received preoperative CT scans. The scans were systematically reviewed to see if they correlated with the clinical findings. Specifically, we compared clinical and CT assessments of tumor size, location, density, and malignancy. Further comparisons were performed based on postoperative tissue pathology. RESULTS: In our series of patients, routine preoperative CT scans resulted in the discovery of details not revealed on clinical examination: some masses were found to be extra-parotid rather than primary parotid tumors, some tumors deemed to be deep were superficial, tumor density was more clearly identified, and certain pathology correlates were clarified. Most importantly, there were instances of detection of additional tumors in the same lobe, and in one instance in the opposite lobe, that were not otherwise noticed. CONCLUSIONS: To reduce errors of omission in the treatment of suspected parotid tumors, it would seem appropriate to consider the inclusion of CT scans for the routine preoperative evaluation of all parotid masses.

Biopsy, Needle↗

PubMed2001

Agricultural work activities reported for children and youth on 498 North American farms.

Children are at high risk for agricultural injury, yet there is little documentation about the range of farm work that children perform or the ages at which children experience these work exposures. The purpose of this study was to identify the scope of agricultural jobs performed by farm children and to describe variations in work involvement within demographic subgroups. A descriptive analysis was conducted of baseline data collected by telephone interview during a multi-site randomized controlled trial. The study population consisted of 1,138 children from 498 North American farms. A total of 2,389 jobs were reported for the 1,138 children. The leading categories of work were animal care, crop management, and tractor with implement operation. Regional differences were observed, consistent with variations in commodities. Substantial proportions of children were assigned to farm work even in the youngest age group of 7-9 years. Males were differentially assigned to tractor with implement operations, while females were more often assigned to animal care. This study provides one of the first systematic accounts of farm work performed by North American children. This analysis of work exposures provides information from which known prevention priorities can be reinforced and new opportunities for prevention identified.

Accidents, Occupational↗

PubMed1996

Does patient-controlled analgesia achieve better control of pain and fewer adverse effects than intramuscular analgesia? A prospective randomized trial.

OBJECTIVE: To compare three analgesic regimens in patients undergoing colon resection: patient-controlled morphine sulfate analgesia (PCA), intramuscular (IM) morphine, and IM ketorolac tromethamine. DESIGN: Prospective randomized case series. SETTING: Rural, private teaching hospital. PATIENTS: All patients (307) scheduled to undergo a major colon resection between January 1, 1992, and December 31, 1993, were eligible to participate. Of these, 10 (3%) were missed in the screening process, 132 (43%) declined participation, 73 (24%) were excluded, and 92 (30%) were enrolled and randomly assigned to a treatment group. INTERVENTIONS: Ninety-two patients were enrolled in the study. Two patients never received the medication to which they were assigned, owing to administrative error; their data was not analyzed. Of the remaining patients, 31 were randomized to the PCA morphine group, 31 were randomized to the IM morphine group, and 28 were randomized to the IM ketorolac group. The randomly assigned drug was first administered in the post-anesthesia care unit. On arrival on the postoperative ward, the patient was asked to rate his or her pain using both a numerical rating scale and a visual analog scale at 30 minutes; 1, 2, 3, 4, and 6 hours after arrival on the ward; and every 4 hours throughout the first 5 postoperative days. The Mini-Mental State Examination (MMSE) was administered the day before surgery and then daily for the first 5 postoperative days. The first day the patient passed flatus after surgery was also recorded. MAIN OUTCOME MEASURES: The end points analyzed were adverse effects, duration of postoperative ileus, degree of pain control, length of hospitalization, and development of postoperative confusion as measured on serial MMSEs. RESULTS: Only two patients, both in the PCA group, reported adverse effects; neither required a change in analgesia group. Significantly more patients assigned to IM ketorolac broke protocol and required alternative analgesia than did patients in the morphine groups (32% ketorolac vs 16% IM morphine and 0% PCA). The ketorolac group had a significantly shorter duration of ileus than either morphine group (P<.0l). The ketorolac group also had significantly lower pain scores (P<.04) and less postoperative confusion than the morphine groups (P<.03), although these results are limited by missing values. The ketorolac group had a significantly shorter length of stay than either morphine group (P<.01), while there was no significant difference between the morphine groups (P=.75). CONCLUSIONS: While it appears that ketorolac provides a better postoperative course than either IM or PCA morphine in terms of pain control, postoperative confusion, length of stay, and duration of ileus, 18% of our patients assigned to ketorolac required additional analgesia, and there was a strong patient preference for PCA. Most patients should probably be managed with PCA narcotics, but the addition of ketorolac might reduce narcotic dose and resultant adverse effects. Those patients particularly prone to adverse effects should receive primarily ketorolac.

Analgesia, Patient-Controlled↗

PubMed1996

Prevalence of hypertension in 1,795 subjects with chronic renal disease: the modification of diet in renal disease study baseline cohort. Modification of Diet in Renal Disease Study Group.

The Modification of Diet in Renal Disease Study was a multicenter trial of the effect of protein restriction and strict blood pressure control on the progression rate of chronic renal failure of multiple causes. At the first baseline visit, 1,795 screened patients with renal disease had blood pressure measured, antihypertensive medications recorded, glomerular filtration rate (GFR) determined by 125I-iothalamate clearance, a nutritional assessment, and a 24-hour urine collection to determine sodium and potassium levels. A total of 1,494 patients in this cohort were classified as hypertensive (83%) and the remainder (301 patients) as nonhypertensive. Ninety-one percent of the hypertensive subjects were on treatment, 54% being controlled to a blood pressure of < or = 140/90 mm Hg. To better understand the factors that contribute to the development of hypertension in chronic renal disease, some determinants of the prevalence of hypertension in this cohort were investigated. Compared with normotensive subjects, hypertensive patients were older (51.2 +/- 12.7 years v 46.6 +/- 13.1 years [mean +/- SD]), had a higher body mass index (BMI; 27.5 +/- 4.7 kg/m2 v 25.4 +/- 4.2 kg/m2), and had a lower GFR (37.8 +/- 19.6 mL/min/1.73 m2 v 50.1 +/- 25 mL/min/1.73 m2). All these differences were significant (P < 0.01). The prevalence of hypertension was significantly higher for men than for women (86% v 80%; P = 0.001), and for blacks than for whites (93% v 81%; P < 0.001). The prevalence of hypertension was higher in subjects with glomerular disease than in those with tubulointerstitial disease (85% v 62.6%; P < 0.001). The prevalence of hypertension varied inversely with GFR (from 66% at a GFR of 83 mL/min/1.73 m2 to 95% at a GFR of 12 mL/min/1.73 m2). The prevalence of hypertension varied directly with BMI (from 70% with a BMI at the 10th percentile to 94% with a BMI at the 97th percentile). This relationship was independent of GFR. Multiple logistic regression analysis showed five predictors in decreasing order of significance as determined by chi-square values: GFR, 83.2; BMI, 36.7; black race, 19.9; increasing age, 14.5 (all P < 0.001); and male gender, 5.1 (P = 0.024). Salt intake was not a determinant of blood pressure status. These results confirm previous reports indicating that hypertension in renal disease is determined by the level of renal function. For the first time, three factors known to predict blood pressure levels in populations with normal renal function were also shown to be determinants of blood pressure in renal disease: BMI, black race, and age. In addition, the data suggest that hypertension is inadequately treated in more than half of patients with chronic renal disease in the United States.

Adolescent↗

PubMed1995

The value of routine urine dipstick screening for protein at each prenatal visit.

OBJECTIVE: Our purpose was to determine whether dipstick urinalysis for protein, when performed as a routine screening test at each prenatal visit, predicts subsequent gestational outcome. STUDY DESIGN: All 3217 low-risk obstetric patients had dipstick urinalysis for protein at each prenatal visit. When there were any objective findings of a possible hypertensive disorder, the urine protein test for that visit was considered an indicated diagnostic test. Otherwise it was considered a routine screening test. Subjects were grouped according to whether those urine tests considered routine screening tests were positive for protein. The groups were then compared with regard to relevant pregnancy outcomes. RESULTS: There were no significant differences in the measured pregnancy outcomes between the groups. CONCLUSIONS: In low-risk women with no objective signs of a possible hypertensive disorder, routine dipstick proteinuria screening at each prenatal visit did not provide any clinically important information regarding pregnancy outcome.

Adult↗

PubMed1995

The value of urine screening for glucose at each prenatal visit.

OBJECTIVE: To determine whether chemical (dipstick) urinalysis for glucose at each prenatal visit predicts gestational outcomes such as gestational diabetes, abruptio placentae, preterm delivery, fetal heart rate abnormality, cesarean delivery for dystocia, fetal macrosomia, and shoulder dystocia. METHODS: We retrospectively evaluated each of the 3217 women who were delivered at St. Joseph's Hospital between July 1, 1990, and September 1, 1993, and who had received all prenatal care at Marshfield Clinic. Study subjects had complete urinalyses at the first prenatal visit, blood glucose diabetes screening at 24-28 weeks, and dipstick urinalysis for glucose at each prenatal visit. Women were excluded because of preexisting diabetes, multiple gestation, glucosuria at the first prenatal visit, or failure to complete the recommended blood screening at 24-28 weeks. The remaining 2965 women were grouped according to whether their dipstick urine tests were positive for glucose. Then the two groups were compared with regard to relevant pregnancy outcomes. RESULTS: Women with glucosuria in the first two trimesters had a significantly higher incidence of gestational diabetes (12.8 versus 2.9%, P = .003). For women without evidence of gestational diabetes, there were no clinically important differences in the measured pregnancy outcomes between the two groups. CONCLUSION: Routine dipstick urinalysis for glucose can identify gravidas at increased risk for gestational diabetes, possibly allowing certain women with gestational diabetes to be diagnosed earlier than 24-28 weeks. However, most glucosuria testing is performed after a patient has completed routine blood screening for gestational diabetes. This third-trimester testing is not predictive of any clinically important pregnancy outcome.

Diabetes, Gestational↗

PubMed1995

Determinants of serum lipid and lipoprotein concentrations in children.

We evaluated determinants of serum lipid and lipoprotein concentrations in 3,106 schoolchildren who participated in a community survey. We administered a brief questionnaire and measured height, weight, and fasting serum lipid concentrations. Family history of hypercholesterolemia and body mass index were strong determinants of lipid and lipoprotein levels. Results for specific foods were not always what would have been expected based on their contents of saturated fatty acids and cholesterol. Our findings point to the need for more detailed studies of the effects of specific foods, especially cheeses, milk, and whole grain bread, on the entire lipoprotein profile of children.

Adolescent↗

PubMed1994

Patterns of fasting plasma amino acid levels in chronic renal insufficiency: results from the feasibility phase of the Modification of Diet in Renal Disease Study.

Fasting plasma amino acid levels were measured in 78 patients with chronic renal insufficiency (glomerular filtration rate [GFR], 8.0 to 56.0 mL/min), who had been enrolled in phase II of the Modification of Diet in Renal Disease study, prior to their beginning the experimental portion of the protocol. Alterations in many plasma amino acid levels were observed in the patients with the mildest degrees of renal insufficiency, and the number and severity of abnormalities tended to be greater in the patients with more severe renal failure. In patients with GFRs greater than 24.5 mL/min, 15 to 24.5 mL/min, and less than 15 mL/min, statistically significant abnormalities were observed in the concentrations or ratios of 9, 14, and 18 amino acids, respectively. The following correlations of amino acid levels or ratios with GFR were observed (all P < 0.001): citrulline, r = -0.41; citrulline to arginine ratio, r = -0.42; glycine to serine ratio, r = -0.37; N-tau methylhistidine, r = -0.65; and cystine, r = -0.37. Other weaker correlations observed were valine, r = 0.26 (P < 0.025); valine to glycine ratio, r = 0.32 (P = 0.004); and sum of isoleucine, leucine, and valine, r = 0.21 (P = 0.061). N-tau methylhistidine and the essential to nonessential amino acid ratio became altered with declining GFR in a nonlinear fashion. Thus, many of the characteristic alterations in the plasma amino acid profile that are observed in chronic end-stage renal disease are already present in mild renal insufficiency. Progressive loss of renal function generally results in increasing abnormalities; these changes in plasma amino acid concentrations with reduction in GFR were usually linear.

Adult↗

PubMed1991

Cancer prevention and screening in light of health promotion and prevention of disability for the second 50 years. A report from the Institute of Medicine of the National Academy of Science.

Increased attention is needed to the prevention of disability resulting from cancer in promoting the health of aged persons. This will require enhanced concern from the medical profession, the general adoption of a taxonomy of disability, and more efficient use of health-care resources. Little is known in quantitative terms of the relative effectiveness (for example, as measured by Quality Life Years) and costs of health-care interventions that reduce disability resulting from cancer. Considerable research will be needed on outcome benefits to make possible rational allocation decisions.

Aged↗

PubMed1991

Cancer control and the older person. Prevention and detection in older persons.

Older persons are appropriate targets for a range of prevention and early detection interventions, however, greater emphasis should be given to structuring the delivery of prevention and detection services to the special needs of this population. This may require research and program development to reach older persons in the most effective and cost-effective manner. The American Cancer Society and other program efforts must accommodate the heterogeneity and special needs of segments of the older population. Racial and cultural minorities, impoverished persons, the cognitively impaired, and the physically impaired are four groups requiring special attention. Early detection guidelines specific to older persons should be developed.

Aged↗