Pediatric emergency department visits for pedestrian injuries in relation to the enactment of Complete Streets policy

Introduction

This study aimed to evaluate the rate of pediatric emergency department (ED) visits for pedestrian injuries in relation to the enactment of the Complete Streets policy.

Methods

The National Complete Streets policies were codified by county and associated with each hospital's catchment area and date of enactment. Pedestrian injury-related ED visits were identified across 40 children's hospitals within the Pediatric Health Information System (PHIS) from 2004 to 2014. We calculated the proportion of the PHIS hospitals' catchment areas covered by any county policy. We used a generalized linear model to assess the impact of the proportion of the policy coverage on the rate of pedestrian injury-related ED visits.

Results

The proportion of the population covered by Complete Streets policies increased by 23.9%, and pedestrian injury rates at PHIS hospitals decreased by 29.8% during the study period. After controlling for years, pediatric ED visits for pedestrian injuries did not change with increases in the PHIS catchment population with enacted Complete Streets policies.

Conclusion

After accounting for time trends, Complete Streets policy enactment was not related to observed changes in ED visits for pedestrian injuries at PHIS hospitals.

Gender differences in the association of individual and contextual socioeconomic status with hypertension in 230 Latin American cities from the SALURBAL study: a multilevel analysis

BACKGROUND

Despite global interest in gender disparities and social determinants of hypertension, research in urban areas and regions with a high prevalence of hypertension, such as Latin America, is very limited. The objective of this study was to examine associations of individual- and area-level socioeconomic status with hypertension in adults living in 230 cities in eight Latin America countries.

METHODS

In this cross-sectional study, we used harmonized data from 109,184 adults (aged 18-97 years) from the SALURBAL (Salud Urbana en America Latina/Urban Health in Latin America) project. Hypertension was assessed by self-report. Individual-, sub-city- and city-level education were used as proxies of socioeconomic status. All models were stratified by gender.

RESULTS

Higher individual-level education was associated with lower odds of hypertension among women (university education or higher versus lower than primary: odds ratio [OR] = 0.67, 95% confidence interval [CI] = 0.61-0.74) but higher odds among men (OR = 1.65; 95%CI 1.47-1.86), although in men an inverse association emerged when measured blood pressure was used (OR = 0.86; 95%CI 0.76-0.97). For both genders, living in sub-city areas with higher educational achievement was associated with higher odds of hypertension (OR per standard deviation [SD] = 1.07, 95%CI = 1.02-1.12; OR = 1.11 per SD, 95%CI = 1.05-1.18, for women and men, respectively). The association of city-level education with hypertension varied across countries. In Peru, there was an inverse association (higher city level education was associated with lower odds of hypertension) in women and men, but in other countries no association was observed. In addition, the inverse association of individual-level education with hypertension became stronger (in women) or emerged (in men) as city or sub-city education increased.

CONCLUSION

The social patterning of hypertension differs by gender and by the level of analysis highlighting the importance of context- and gender-sensitive approaches and policies to reduce the prevalence of hypertension in Latin America.

Differences in Injury Characteristics and Outcomes for American Indian/Alaska Native People Hospitalized with Traumatic Injuries: an Analysis of the National Trauma Data Bank

OBJECTIVE

This study compares characteristics of American Indian/Alaska Natives (AI/AN) and non-Hispanic Whites (NHW) hospitalized for traumatic injury and examines the effect of race on hospital disposition.

METHODS

Using 2007-2014 National Trauma Data Bank data, we described differences in demographic and injury characteristics between AI/AN (n = 39,656) and NHWs (n = 3,309,484) hospitalized with traumatic injuries. Multivariable regressions, adjusted for demographic and injury characteristics, compared in-hospital mortality and the risk of discharge to different dispositions (inpatient rehabilitation/long-term care facility, skilled nursing facility, home with home health services) rather than home between AI/AN and NHW patients.

RESULTS

Compared to NHWs, a higher proportion of AI/ANs were age 19-44 (49% versus 27%) years and hospitalized with assault-related injuries (25% versus 5%). AI/ANs had lower odds of dying than NHWs during hospitalization (adjusted odds ratio (aOR) 0.72, 95% CI 0.63-0.84). However, AI/ANs also had lower odds than NHWs to discharge to locations with additional health services even after controlling for injury severity (inpatient rehabilitation/long-term care facilities aOR 0.79, 95% CI 0.67-0.93; skilled nursing facility aOR 0.70, 95% CI 0.49-0.98; home with home health services aOR 0.62, 95% CI 0.49-0.79).

CONCLUSIONS

Injury patterns and acute hospitalization outcomes were significantly different for AI/ANs compared to NHWs. Injury prevention strategies targeting AI/ANs should reflect these differential injury patterns. Outcomes such as disability and access to rehabilitation services should be included when considering the burden of injury among AI/AN communities.

Frequency of and factors associated with emergency department intracranial pressure monitor placement in severe paediatric traumatic brain injury

OBJECTIVE

To examine the frequency of and factors associated with emergency department (ED) intracranial pressure (ICP) monitor placement in severe paediatric traumatic brain injury (TBI).

METHODS

Retrospective, multicentre cohort study of children <18 years admitted to the ED with severe TBI and intubated for >48 hours from 2007 to 2011.

RESULTS

Two hundred and twenty-four children had severe TBI and 75% underwent either ED, operating room (OR) or paediatric intensive care unit (PICU) ICP monitor placement. Four out of five centres placed ICP monitors in the ED, mostly (83%) fibreoptic. Nearly 40% of the patients who received ICP monitors get it placed in the ED (29% overall). Factors associated with ED ICP monitor placement were as follows: age 13 to <18 year olds compared to infants (aRR 2.02; 95% CI 1.37, 2.98), longer ED length of stay (LOS) (aRR 1.15; 95% CI 1.08, 1.21), trauma centre designation paediatric only I/II compared to adult/paediatric I/II (aRR 1.71; 95% CI 1.48, 1.98) and higher mean paediatric TBI patient volume (aRR 1.88;95% CI 1.68, 2.11). Adjusted for centre, higher bedside ED staff was associated with longer ED LOS (aRR 2.10; 95% CI 1.06, 4.14).

CONCLUSION

ICP monitors are frequently placed in the ED at paediatric trauma centres caring for children with severe TBI. Both patient and organizational level factors are associated with ED ICP monitor placement.

Utilization of Mental Health Services After Mild Pediatric Traumatic Brain Injury

BACKGROUND

Mild traumatic brain injury injuries (mTBIs), including concussions, represent >2 million US pediatric emergency department visits annually. Post-mTBI mental health symptoms are prominent and often attributed to the mTBI. This study examined whether individuals seeking post-mTBI mental health care had previous mental health diagnoses or a new onset of such disorders, and determined if mental health care utilization differed by race/ethnicity.

METHODS

Retrospective cohort study, using the Medicaid Marketscan claims national dataset (2007-2012). Utilization of mental health services 1 year before and 1 year after mTBI was compared between children with and without mental health diagnoses before injury. Primary outcome was receipt of post-mTBI outpatient mental health care.

RESULTS

A total of 31 272 children 20 years or younger were included, 8577 (27%) with mental health diagnoses before their mTBI and 22 695 without one. After injury, children without previous mental health disorders increased mental health services utilization; however, most (86%) postinjury mental health care was received by children with previous mental health disorders. Having a mental health diagnosis pre-mTBI was the most important risk factor for receiving post-mTBI mental health care (odds ratio 7.93, 95% confidence interval 7.40-8.50). Hispanic children were less likely to receive post-mTBI mental health care.

CONCLUSIONS

mTBI was associated with increased utilization of mental health services but most of these services were received by children with previous mental health disorders. Our documentation of racial/ethnic disparities in mental health care utilization reemphasize the importance of providing individualized, culturally, and linguistically competent care to improve outcomes after mTBI for all children.

Measuring perceptions of breast cancer risk

BACKGROUND

Accurate measurement of people's risk perceptions is important for numerous bodies of research and in clinical practice, but there is no consensus about the best measure.

OBJECTIVE

This study evaluated three measures of women's breast cancer risk perception by assessing their psychometric and test characteristics.

DESIGN

A cross-sectional mailed survey to women from a primary care population asked participants to rate their chance of developing breast cancer in their lifetime on a 0% to 100% numerical scale and a verbal scale with five descriptive categories, and to compare their risk to others (seven categories). Six hundred three of 956 women returned the survey (63.1%), and we analyzed surveys from the 566 women without a self-reported personal history of breast or ovarian cancer.

RESULTS

Scores on the numeric, verbal, and comparative measures were correlated with each other (r > 0.50), worry (r > 0.51), the Gail estimate (r > 0.26), and family history (r > 0.25). The numerical scale had the strongest correlation with annual mammogram (r = 0.19), and its correlation with the Gail estimate was unassociated with participants' sociodemographics. The numerical and comparative measures had the highest sensitivity (0.89-0.90) and specificity (0.99) for identifying women with very high risk perception. The numerical and comparative scale also did well in identifying women with very low risk perception, although the numerical scale had the highest specificity (0.96), whereas the comparative scale had the highest sensitivity (0.89).

CONCLUSION

Different measures of women's perceptions about breast cancer risk have different strengths and weaknesses. Although the numerical measure did best overall, the optimal measure depends on the goals of the measure (i.e., avoidance of false positives or false negatives).