Youth injury data in the Canadian Hospitals Injury Reporting and Prevention Program: do they represent the Canadian experience?
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OBJECTIVE: Injuries to Canadian youth (11-15 years) identified from a population based health survey (World Health Organization-Health Behaviour in School-Aged Children Survey, or WHO-HBSC) were compared with youth injuries from a national, emergency department based surveillance system. Comparisons focused on external causes of injury, and examined whether similar rankings of injury patterns and hence priorities for intervention were identified by the different systems. SETTING: The Canadian version of the WHO-HBSC was conducted in 1998. The Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP) is the national, emergency room based, surveillance program. Two hospitals involved in CHIRPP collectively provide population based data for Kingston, Ontario. METHOD: Numbers of injuries selected for study varied by data source: WHO-HBSC (n=3673); CHIRPP (n=20,133); Kingston CHIRPP (n=1944). WHO-HBSC and Kingston CHIRPP records were coded according to four variables in the draft International Classification of External Causes of Injury. Existing CHIRPP codes were available to compare Kingston and other CHIRPP data by five variables. Males and females in the three datasets were ranked according to the external causes. Data classified by source and sex were compared using Spearman's rank correlation statistic. RESULTS: Rank orders of four variables describing external causes were remarkably similar between the WHO-HBSC and Kingston CHIRPP (p>0.78; p<0.004) for mechanism, object, location, and activity). The Kingston and other CHIRPP data were also similar (p>0.87; p<0.001) for the variables available to describe external causes of injury (including intent). CONCLUSION: The two subsets of the CHIRPP data and the WHO-HBSC data identified similar priorities for injury prevention among young people. These findings indicate that CHIRPP may be representative of general youth injury patterns in Canada. Our study provides a novel and practical model for the validation of injury surveillance programs. (+info)
Seasonal variations in incidence of fractures among elderly people.
(34/1358)
OBJECTIVE: To investigate seasonal variations in the incidence of fall related fractures among people 65 years and older. POPULATION AND METHODS: A prospective, population based cohort study was performed on people aged 65 years and older followed up from 1990 to 1997, a total of 459,904 person years. Cases were identified through a prospective registration system. RESULTS: There were 10,992 (2390 per 100,000 person years) fall related fractures. The risk was higher in the colder seasons (October through March) among people aged 65-79 years (relative risk (RR) = 1.39, 95% confidence interval (CI) 1.32 to 1.47) and in people aged 80 years and older (RR = 1.17, 95% CI 1.09 to 1.22). For arm fractures, the RR was 1.69 (95% CI 1.56 to 1.83) among people aged 65-79 years and 1.30 (95% CI 1.13 to 1.43) among those aged 80 years and older. The RR for hip fractures was 1.27 (95% CI 1.15 to 1.37) among people aged 65-79 years and 1.08 (95% CI 1.00 to 1.15) for people aged 80 years and older. Slipping on ice and snow seems to entirely explain the excessive incidence of hip and arm fractures during winter months. CONCLUSION: Season affects the incidence of all types of fractures in elderly people. Slipping on ice and snow seems to be a causal mechanism behind the seasonal effect. Preventive measures targeting this causal mechanism are likely to reduce the risk of fracture, but the size of the effect is difficult to estimate with certainty. (+info)
International comparisons of child injuries and prevention programs: recommendations for an improved prevention program in Germany.
(35/1358)
OBJECTIVES: To compare child injury mortality in Germany with that of four neighboring countries, and to examine injury prevention models in these countries with a view to improving prevention programs in Germany. METHODS: Based on official cause of death certificates, child injury mortality rates in Germany are compared with those of Austria, The Netherlands, Sweden, and Switzerland. The main structures and funding of injury prevention programs in these countries are described. RESULTS: In all five countries, mortality is highest among children aged 1-4 years for home and leisure accidents and drownings. Transport accidents are the main cause of death in the 5-14 age group. Mortality in both age groups has fallen significantly since 1980, most markedly in Sweden and The Netherlands. CONCLUSION: Drawing on the injury mortality data and experience of the comparison countries, the following recommendations are proposed to further reduce home and leisure injuries among children in Germany: (1) establish a soundly funded, central institution responsible for child injury surveillance, research, and the coordination of injury prevention activities, (2) improve product control legislation, and (3) disseminate specific safety information to target groups and the general public. (+info)
Mild hypercholesterolemia and premature heart disease: do the national criteria underestimate disease risk?
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OBJECTIVES: To determine the frequency of hospital admissions for acute coronary syndrome in young adults and to examine the risk factors that predispose to the development of premature heart disease. BACKGROUND: Significant coronary heart disease (CHD) is considered rare in the young adult. Current guidelines do not recommend treatment of mild cholesterol abnormalities for primary prevention of CHD in the young. METHODS: This is a large case series of 449 adults (< or =50 years) admitted to the hospital with acute coronary syndrome. A history of cardiovascular risk factors and lipid profile were recorded. The presence and extent of CHD were established. RESULTS: Mean patient age was 44 +/- 6 years. Documented CHD was present in 61% of hospital admissions. Multivariate analysis revealed that history of hypercholesterolemia, history of smoking and diabetes were independently associated with premature CHD. The fasting lipid profiles were only borderline to mildly abnormal. Serum total cholesterol, low-density lipoprotein (LDL) and triglyceride levels were not different in cases compared with control subjects. Nearly half (49%) of those with LDL levels of > or =160 mg/dl had only one additional risk factor or none. Despite this, a history of hypercholesterolemia had independent and incremental value on other risk factors for the likelihood of premature CHD. CONCLUSIONS: The magnitude of hospital admissions relating to premature CHD is high. In this population, the presence of borderline or mild hypercholesterolemia has significant effects on the development of premature CHD. These observations have significant implications in the development of guidelines for primary prevention of premature CHD. (+info)
Evaluating prevention programs with the Results Mapping evaluation tool: a case study of a youth substance abuse prevention program.
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The harmful effects of alcohol and other drug abuse are widespread. Our health care, social service, education and legal systems are strained under the impact of substance abuse, not to mention the economic costs associated with substance abuse. Consequently, effective strategies which prevent substance abuse must be identified and replicated. Yet, user-friendly and cost-effective evaluation tools for community-based substance abuse prevention programs are rare. A recently developed tool that has promise to overcome some of the barriers which exist when evaluating prevention programs is 'Results Mapping'. Results Mapping documents and aims to quantify the contributions of a program to future outcomes of its target population with the intention of making data meaningful at the program and funding agency level. This case study was conducted to assess the feasibility of implementing the Results Mapping evaluation tool for community-based prevention programs. The study assessed qualitatively how well Results Mapping worked for one community-based substance abuse prevention program, as well as how much time and funding it took to implement this new tool. Results suggested that Results Mapping may be a valuable documentation, planning and learning tool, but funding agencies should be cautious about using Results Mapping scores to determine funding allocations. (+info)
Breast self examination for early detection of breast cancer.
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Breast cancer is the commonest form of cancer in women in Western countries and second most common in women of developing countries like India. In the absence of an exact aetiological agent for breast cancer, the most appropriate way of controlling it is by early detection and treatment. Of the various methods of screening for breast cancer, mammography is the method of choice but its use is limited due to high cost and unavailability. Considering this, breast self examination (BSE) is an ideal method which can be done by every woman at her leisure time with little training. Medical and paramedical professionals can act as trend setters in promoting BSE for control of breast cancer in the community. (+info)
Use of preventive health behaviors by lesbian, bisexual, and heterosexual women: questionnaire survey.
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OBJECTIVES: To determine whether lesbians and bisexual women are less likely than heterosexual women to use preventive health measures. DESIGN: Written, anonymous, self-administered questionnaire. SETTING: 33 physicians' offices and community clinics mainly in urban areas of 13 states. PARTICIPANTS: 524 lesbians, 143 bisexual women, and 637 heterosexual women. RESULTS: Bisexual women were less likely than heterosexual women to have had appropriate cholesterol screening (odds ratio 0.29, 95% confidence interval 0.11 to 0.73) or appropriate mammography (0.33, 0.13 to 0.84). Human immunodeficiency virus testing was more common in lesbians (2.38, 1. 51 to 3.74) and bisexual women (1.99, 1.17 to 3.38) than in heterosexual women. Illicit drug use was higher in lesbians (2.04, 1. 14 to 3.70) and bisexual women (1.96, 1.07 to 3.57) than in heterosexual women. Lesbians were more likely than heterosexual women to practice safer sex (2.60, 1.23 to 5.49) and less likely to have ever been infected with human papillomavirus (0.48, 0.25 to 0. 89). CONCLUSION: There were important differences in the preventive health measures taken by lesbians and bisexual women and those taken by heterosexual women. All patients should receive standard health tests, such as cholesterol screening and mammography, regardless of their sexual orientation. Lesbians and bisexual women who report illicit drug use should receive counseling, as appropriate. (+info)
Cost-effectiveness of strategies for primary prevention of nonsteroidal anti-inflammatory drug-induced peptic ulcer disease.
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OBJECTIVE: Nonsteroidal anti-inflammatory drugs (NSAIDs) increase the risk of peptic ulcer disease by 5- to 7-fold in the first 3 months of treatment. This study examined the relative cost-effectiveness of different strategies for the primary prevention of NSAID-induced ulcers in patients that are starting NSAID treatment. MEASUREMENTS AND MAIN RESULTS: A decision analysis model was developed to compare the cost-effectiveness of 6 prophylactic strategies relative to no prophylaxis for patients 65 years of age starting a 3-month course of NSAIDs: (1) testing for Helicobacter pylori infection and treating those with positive tests; (2) empiric treatment of all patients for Helicobacter pylori; (3) conventional-dose histamine2 receptor antagonists; (4) high-dose histamine2 receptor antagonists; (5) misoprostol; and (6) omeprazole. Costs were estimated from 1997 Medicare reimbursement schedules and the Drug Topics Red Book. Empiric treatment of Helicobacter pylori with bismuth, metronidazole, and tetracycline was cost-saving in the baseline analysis. Selective treatment of Helicobacter pylori, misoprostol, omeprazole, and conventional-dose or high-dose histamine2 receptor antagonists cost $23,800, $46,100, $34,400, and $15,600 or $21,500 per year of life saved, respectively, relative to prophylaxis. The results were sensitive to the probability of an ulcer, the probability and mortality of ulcer complications, and the cost of, efficacy of, and compliance with prophylaxis. The cost-effectiveness estimates did not change substantially when costs associated with antibiotic resistance of Helicobacter pylori were incorporated. CONCLUSIONS: Several strategies for primary prevention of NSAID-induced ulcers in patients starting NSAIDs were estimated to have acceptable cost-effectiveness relative to prophylaxis. Empirically treating all patients for Helicobacter pylori with bismuth, metronidazole, and tetracycline was projected to be cost-saving in older patients. (+info)