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PubMed2000

Motor vehicle crash characteristics and medical outcomes among older drivers in Utah, 1992-1995.

STUDY OBJECTIVE: We sought to compare the characteristics and medical outcomes of motor vehicle crashes for drivers 70 years and older with those of drivers between the ages of 30 and 39 years. METHODS: We probabilistically linked statewide motor vehicle crash and hospital discharge data between the years of 1992 and 1995 for the state of Utah. We calculated the odds of older drivers exhibiting certain motor vehicle crash characteristics compared with younger drivers. Adjusting for nighttime crash, high-speed crash, and seatbelt use, we calculated the odds of an older driver being killed or hospitalized compared with those of a younger driver. RESULTS: During the study years, there were 14,466 drivers older than 69 years and 68,706 drivers between the ages of 30 and 39 years involved in motor vehicle crashes in Utah. Older drivers were less likely to have crashes involving drug or alcohol use (odds ratio [OR] 0.1; 95% confidence interval [CI] 0.1 to 0.2) and less likely to have crashes at high speed (OR 0.6; 95% CI 0.6 to 0.7). Although older drivers were no more likely to have a crash involving a right-hand turn (OR 1.0; 95% CI 0.9 to 1.1) than younger drivers, they were over twice as likely to have a crash involving a left-hand turn (OR 2.3; 95% CI 2.2 to 2.5). Also, older drivers were more likely to be killed or hospitalized than younger drivers (OR, 3.5; P <.001). Among belted drivers, an older driver was nearly 7 times more likely to be killed or hospitalized than a younger driver (OR 6. 9; 95% CI 5.4 to 8.9). CONCLUSION: Older drivers do have distinctive motor vehicle crash patterns. Interventions must be taken to reduce the number of left-hand turn crashes involving older drivers. In addition, further research is needed to design, implement, and evaluate countermeasures that may enable older drivers to continue driving while keeping public safety in the forefront.

Accidents, Traffic↗
PubMed2000

Genetic analysis of the Utah population: a comparison of STR and VNTR loci.

Genetic data are reported for nine short tandem repeat (STR) loci (D3S1358, vWA, FGA, D8S1179, D21S11, D18S51, D5S818, D13S317, and D7S820) and six variable number of tandem repeat (VNTR) loci (D2S44, D10S28, D4S139, D1S7, D5S110, and D17S79) in samples of Utah African Americans, European Americans, and Hispanics. Little evidence of departures from Hardy-Weinberg equilibrium or gametic equilibrium was found in these populations. Because of their relatively higher mutation rates, the VNTR loci exhibited higher average heterozygosity and lower FST levels than did the STR loci. Genetic distance analysis showed congruence between the two types of systems, and a genetic distance analysis of the STR data showed that the three Utah populations are genetically similar to the same ethnic groups in other parts of the United States. In addition, this analysis showed that the African American population is the most genetically divergent, with greater similarity between the Hispanic and European American populations. This analysis demonstrates a high degree of consistency for population designations commonly used in forensic analysis.

Evolution, Molecular↗
PubMed2001

Coccidioidomycosis in workers at an archeologic site--Dinosaur National Monument, Utah, June-July 2001.

Coccidioidomycosis is a fungal infection caused by inhalation of airborne Coccidioides immitis spores that are present in the arid soil of the southwestern United States, California, and parts of Central and South America. Infection with C. immitis previously has not been diagnosed in patients outside these areas, except in travelers returning from areas where the disease is endemic. This report describes an outbreak of coccidioidomycosis in workers at an archeologic site in northeastern Utah during June-July, 2001, and represents the first identification of coccidioidomycosis in northern Utah. Health-care providers should consider coccidioidomycosis in the differential diagnosis for patients with compatible illness who reside in or recently have traveled to this area. Interventions to minimize soil disturbance and dust inhalation can reduce the risk for coccidioidomycosis.

Adolescent↗
PubMed2002

Hypothermia-related deaths--Utah, 2000, and United States, 1979-1-998.

Hypothermia is a medical emergency that is completely preventable. Hypothermia occurs when persons are exposed to ambient cold temperatures without appropriate protection for extended periods of time. The clinical definition of hypothermia is a core body temperature < or = 95 F (35 C). This report describes cases of hypothermia-related deaths in Utah during 2000 and describes unintentional hypothermia-related deaths in the United States during 1979-1998. The Utah cases illustrate risk factors and environmental conditions associated with hypothermia.

Adolescent↗
PubMedDate not supplied

Utah healthcare system watches over Olympians and spectators.

For the first time in Olympic history, a single organization was tapped to provide medical services when Intermountain Health Care (IHC), Salt Lake City, was named for the 2002 Olympic and Paralympic Games in Utah. IHC, a charitable, community owned, integrated, not-for-profit healthcare system serving patients in Utah and Idaho, spent four years developing and implementing a plan to deliver medical services to both Olympians and spectators. Nearly 350 IHC doctors, nurses, physical therapists and other professionals donated their services for the Olympics without compensation as part of their not-for-profit mission. In addition, about 1,000 IHC employees applied to be general volunteers during the games.

Advertising↗
PubMed1991

AIDS awareness among rural Utah physicians.

Studies of physicians' attitudes and knowledge of the acquired immunodeficiency syndrome (AIDS) and the clinical precautions they take against exposure to the human immunodeficiency virus (HIV) have focused on urban physicians. To determine rural physicians' knowledge and attitudes about AIDS, a questionnaire was mailed to 321 physicians practicing in rural Utah. Of the 169 physicians who completed questionnaires, 96% thought that their community or area of service had only a minor or no problem with AIDS; 89%, however, thought that their chance of seeing a patient who was HIV-positive was fair to moderate. Of the 169 respondents, 3% were not sure whether they would even treat a patient who had AIDS, 67% said they would, and 30% said they would not. Although all physicians are at risk of seeing a patient who has had exposure to HIV and other blood-borne diseases such as hepatitis B, only 55% of the respondents felt a need to take clinical precautions to prevent their exposure to the virus. Our study shows the need for all rural Utah physicians to reevaluate their risk of exposure to HIV, to increase precautionary measures for their own protection, to consider the ethical responsibility of treating AIDS patients, and to take a more active role in teaching their patients how to protect themselves from exposure to the virus.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Polymorphisms at VNTR loci suggest homogeneity of the white population of Utah.

Apparent departure from equilibrium of genetic parameters measured for multiallelic single-locus markers such as VNTR (variable number of tandem repeat) loci has been suggested as evidence of underlying heterogeneity of the tested population. Using allele frequency distributions at eight VNTR loci from the white population of Utah, we show that the observed number of alleles and the gene diversity at each locus are congruent according to expectations of the neutral mutation model. This demonstrates the genetic homogeneity of the white population of Utah with reference to the allele (total and rare) frequency distribution at eight VNTR loci. The importance of such procedures is discussed in the context of using VNTR polymorphism data for forensic and medicolegal applications. Recommendations for reporting population data for hypervariable loci are also made to aid potential users in conducting similar analyses.

Gene Frequency↗
PubMed1987

House calls in Utah.

To learn the criteria Utah physicians use in making or not making house calls and their specialty, age and frequency of calls, a random sample of half of Utah's physicians in family practice, general practice and general medicine was surveyed. Of 225 respondents, 70% reported making house calls at an average rate of 2.6 per month. More family practitioners made house calls than did internists; older physicians made more house calls than their younger counterparts. An estimated 82% of the calls were for patients aged 65 years and older. The most frequently stated reasons for making house calls were that patients were homebound and to assess the family or home situation. Reasons given for not making house calls were inefficient use of time and lack of equipment or necessary facilities.

Adult↗
PubMed1986

IAIMS and the library at the University of Utah.

The formal creation of an Integrated Academic Information Management System (IAIMS) at the University of Utah began in the fall of 1983. The keystone of the IAIMS effort is the HELP hospital information system. IAIMS at the University of Utah is a broad-based program extending across the Health Sciences Center and beyond to health professionals throughout the inter-mountain area. This paper describes the background that led to IAIMS, the IAIMS planning process, and the library's participation in this effort.

Academic Medical Centers↗
PubMed1986

Two year's experience under Utah's mens rea insanity law.

The author examined the records of the seven defendants found not guilty by reason of insanity (NGI) under Utah's mens rea insanity law during the first two years of its operation. In all of the cases the attorneys, judges, and experts seemed unaware of the new law or confused about its meaning. Examination revealed that the findings of insanity were negotiated with either ignorance of or indifference to the mens rea law. Under the mens rea NGI law, the rate of insanity findings for Utah increased.

Adult↗
PubMed1978

Echinococcus granulosus in dogs and sheep in central Utah, 1971-1976.

During 1971 to 1976, a survey was conducted to determine the prevalence of Echinococcus granulosus infection among dogs and sheep in central Utah. For each year, the number of dogs positive for adult tapeworms of the total number examined and the percentage infected were: in 1971, 14 of 51 infected (27.4%); in 1972, 13 of 46 infected (28.3%); in 1973, 7 of 36 infected (19.4%); in 1974, 34 of 244 infected (13.9%); in 1975, 13 of 267 infected (4.9%); and in 1976, 14 of 195 infected (7.2%), or a 6-year total of 95 of 839 infected (av = 11.3%). For each year, the number of sheep positive with hydatid cysts of the total number examined and the percentage infected were: in 1971, 103 of 1,007 infected (10.2%); in 1972, 235 of 1,808 infected (13.0%); in 1973, 242 of 2,003 infected (12.1%); in 1974, 105 of 1,406 infected (7.5%); in 1975, 96 of 1,599 infected (6.0%); and in 1976, 96 of 1,171 infected (8.2%), or a 6-year total of 877 of 8,994 infected (av = 9.8%). These results represent a definite decline in numbers of infected animals and suggest that preventive and control measures advocated in central Utah are being implemented.

Animals↗
PubMed1995

The management of febrile infants by primary-care pediatricians in Utah: comparison with published practice guidelines.

OBJECTIVE: To determine primary-care pediatricians' management of febrile infants and compare them with published practice guidelines. DESIGN: Case scenarios were sent to 194 primary-care pediatricians in Utah, describing three febrile infants, ages 21 days, 60 days, and 20 months, corresponding to the three age groups: 0 to 28 days; 29 to 90 days, and 91 days to 36 months for which the guidelines suggest different strategies. RESULTS: Ninety-four pediatricians responded (response rate, 48%). Compliance with the guidelines was 39% for the 21 day old, 9.6% for the 60 day old, and 75% for the 20 month old. No respondent followed the guidelines for all three infants. Performance of tests to determine if an infant was low risk varied from 3%, for a stool white cell examination in a febrile 2 month old with diarrhea, to 75% for a complete blood count in a 20 month old with a temperature of 40 degrees C. Compliance did not differ between private and academic practitioners. Those in practice less than 5 years (n = 22) were more likely than those with more experience to follow the guidelines for the 21 day old but not the other two infants. CONCLUSION: Primary-care pediatricians in Utah manage febrile infants with fewer laboratory tests and less hospitalization than recent practice guidelines developed by an expert panel of academic specialists suggest.

Bacterial Infections↗
PubMed1995

The impact of family history on ovarian cancer risk. The Utah Population Database.

OBJECTIVE: To estimate the relative risks and population attributable risks of ovarian cancer associated with family histories of cancer at several sites. METHODS: A matched case-control analytic study (662 cases, 2647 controls), employing the Utah Population Database, a genealogy of approximately 1 million individuals linked to cancer incidence data from the Utah Cancer Registry. Family history was assessed using kinship order and a kinship-weighted familial standardized incidence ratio statistic. RESULTS: Family histories of ovarian, uterine, breast, and pancreatic cancer were significantly associated with increased risk of ovarian cancer. The relative risk of ovarian cancer was 4.31 (95% confidence interval [CI], 2.35 to 7.90) for women with a first-degree relative with ovarian cancer, 2.12 (95% CI, 1.19 to 3.78) for women with an affected second-degree relative, and 1.48 (95% CI, 0.98 to 2.24) for women with an affected third-degree relative. The odds ratio (OR) was 2.06 (95% CI, 1.44 to 2.93) for those with the highest familial standardized incidence ratio. No age differences were observed between cases with and without a family history of ovarian cancer. There was substantial heterogeneity of family history effects by cell type. Increased parity was not protective among women with a strong family history of cancer at the sites studied (OR, 1.11; 95% CI, 0.38 to 3.26), although it was protective among women without a family history of these cancers (OR, 0.29; 95% CI, 0.11 to 0.62). CONCLUSIONS: The risk of ovarian cancer was substantially increased among women with family histories of ovarian, uterine, pancreatic, and, to a lesser degree, breast cancer. Among women with family histories of any of these cancers, the risk of ovarian cancer is not diminished by high parity.

Adult↗
PubMed1994

Leading causes of death, by age and sex--Utah, 1988-1992.

Mortality statistics are frequently used to measure the health status of a population (1) and to assess the importance of public health problems. However, for most diseases, crude and age-adjusted death rates are primarily influenced by deaths among the elderly. Although years of potential life lost (YPLL) is one approach that has been used to identify causes of premature death (2), the results of YPLL analysis are subject to certain limitations (3). As an alternative approach to identifying causes of premature death, the Utah Department of Health (UDOH) analyzed age- and sex-specific death rates among Utah residents during 1988-1992. This report summarizes the results of that analysis and compares findings with national data.

Adolescent↗
PubMed1993

Assessment of Aedes sierrensis as a vector of canine heartworm in Utah using a new technique for determining the infectivity rate.

Both Aedes sierrensis and Dirofilaria immitis have recently become established in Utah. We evaluated the vector potential of this Aedes sierrensis strain using a new technique for detecting Dirofilaria immitis in individual mosquitoes. Survival of Aedes sierrensis females after bloodfeeding did not differ from that of Ae. triseriatus but infective Ae. sierrensis produced significantly more L3 nematodes. This observation and epidemiological data support the hypothesis that Ae. sierrensis is the vector of canine heartworm in Utah. Infectivity was determined by counting infective-stage parasites that migrated into the medium after individual mosquitoes were decapitated or crushed in the wells of tissue culture plates. Complete recovery of infective-stage nematodes was attained in 60-74% of the mosquitoes and 77-93% of all L3 were collected with this technique. There were few false negatives. High recovery rates (mean = 89%) were also obtained for mosquitoes treated en masse.

Aedes↗
PubMed1995

Poisonous snakebite in Utah.

A retrospective study was done of poisonous snakebite in Utah to determine the current epidemiology and scope of treatment, reviewing emergency department logs and other sources statewide for a 69-month period. Of 61 cases of poisonous snakebite identified, 13 occurred in snake hobbyists or venom laboratory personnel and were considered nonaccidental, and 48 were inflicted by native noncaptive snakes. These bites were considered accidental, and all were presumed to be from rattlesnakes. Nearly three fourths of the victims were male, ranging in age from 2 to 56 years (mean, 22 years). Most accidental bites occurred in areas of high human populations, during the summer months, in the afternoon or evening hours, and during recreational activities. Of the 48 bites, 11 (23%) were provoked. Two thirds of bites were on the upper extremities, and a third were on the lower extremities. More than half of the victims had no first-aid treatment recorded. Of those who did receive first aid, many were subjected to possibly harmful treatments, including tourniquets and ice application. The median time to a hospital was 68 minutes, with a range of 15 to 440 minutes. Swelling and discoloration were the most common signs and pain and paresthesia the most common symptoms. Half the bites resulted in minimal or no envenomation, 17 (35%) produced moderate envenomation, and 6 (12%) severe envenomation. Most patients with moderate or severe envenomation received antivenin, but the dosages given were usually less than recommended dosages. Five patients received surgical treatment based on clinical findings. One child died in a snake-handling incident. Long-term morbidity was unknown due to lack of follow-up. The Utah Poison Control Center was poorly utilized as a reporting and informational resource.

Adolescent↗
PubMedDate not supplied

Utah's parent, teacher, and physician sealant awareness surveys.

PURPOSE: The Year 2000 Oral Health Objective 13.8 reads, "Increase to at least 50% the proportion of children who have received protective sealants on the occlusal surfaces of permanent molar teeth." In order to develop the next phase of Utah's continuing sealant promotion program directed towards meeting this objective, the Dental Health Bureau surveyed parents, teachers, and physicians in 1992. METHODS: Parents of 3,355 first- and sixth-grade students in a stratified random sample of 25 Utah urban and rural schools were surveyed to determine sealant awareness and placement. In 20 elementary urban and rural schools, 471 teachers were surveyed to determine their source of dental health knowledge and their dental unit subject matter. Five hundred ninety-six physicians were surveyed to determine their knowledge of sealants. The results of the parent and teacher surveys were analyzed using chi-square to determine statistically significant differences between urban and rural respondents. The physician results are reported in percentages. RESULTS: The parental response rate was 32%, teacher response rate was 37%, and physician response rate was 44%. Between 73% and 81% of the parents knew about sealants and 40% to 47% have had sealants placed on a child's teeth. The most frequently mentioned source of knowledge about sealants was the dentist or dental hygienist. Fewer rural than urban parents had heard about dental sealants and had insurance that covered sealants. Of the teachers who taught dental health, most taught brushing/flossing, sugar avoidance, and annual dental visits. Only a few taught about sealants. Most of the teachers received their information from a Dental Health Bureau newsletter or from their dentist or dental hygienist. When questioned about their knowledge of sealants, 68% of the physicians indicated they were unfamiliar with them. Eighty-four percent requested professional information and 65% requested patient information. CONCLUSIONS: The dental hygienist as a preventive healthcare professional is a frequent source of sealant information. Parents, physicians, and teachers need up-to-date oral health information. Dental hygienists can be instrumental in achieving the Year 2000 Oral Health Objective on dental sealants by promoting awareness in the public sector and by placing dental sealants.

Chi-Square Distribution↗
PubMedDate not supplied

Managed care preapproval and its effect on the cost of Utah worker compensation claims.

OBJECTIVE: To determine the effect of preauthorization of chiropractic services costs in non-surgical back injury cases in a managed care environment. The program was implemented in the chiropractic provider group by the Worker Compensation Fund of Utah. The results were compared with those of similar injury claims in a separate provider group in which there was no preauthorization program. DESIGN: The study was a retrospective review of approximately 5000 claims from 1986 and 5000 claims from 1989 of injured workers in the Utah Worker Compensation Fund. We extracted approximately 1000 nonsurgical back-related injury claims from each year. MAIN OUTCOME MEASURE: Cost comparisons between medical and chiropractic provider groups in the management of nonsurgical compensable back pain in both 1986 and 1989. RESULTS: Treatment costs in cases managed by chiropractic physicians increased 12% between 1986 and 1989. Treatment cost in cases managed by medical physicians increased 71% in the same time period. Compensation (wage replacement) costs increased 21% for the chiropractic group and 114% for the medical group. CONCLUSION: Retrospective analysis of worker compensation databases continue to struggle with issues related to measurement of severity, appropriate condition identification, adequate inclusion of all related costs and unbiased case selection. Treatment costs appeared to be controlled under the auspices of a preapproval program required of the chiropractic physician whereas medical costs escalated in the absence of price controls.

Back Injuries↗