Federico E. Vaca

Car safety seats for children: rear facing for best protection

This article has been retracted.

Six-month follow-up of computerized alcohol screening, brief intervention, and referral to treatment in the emergency department

The goal of this observational study was to measure change in alcohol consumption at 6 months following emergency department computerized alcohol screening brief intervention (CASI) and referral to treatment (ED-SBIRT) with integrated brief negotiated interview (BNI) and computer-generated personal alcohol reduction plans. At-risk patients received a BNI by CASI, including personalized feedback, assessment of readiness to change, reasons for cutting down, goal setting, and a printed personal alcohol reduction plan. Alcohol use was assessed by telephone interview 6 months after CASI. Factors associated with lower alcohol consumption were examined. Of the 385 participants who completed the BNI, were consented, and enrolled, 221 subjects completed the 6-month follow-up interview. Forty-seven percent of the study sample of at-risk patients were no longer drinking over the National Institute on Alcohol Abuse and Alcoholism (NIAAA)-recommended limits. Reductions were greater for patients with Alcohol Use Disorders Identification Test (AUDIT) scores of 1 to 7. Readiness to change was a good predictor of drinking below the recommended limits. The use of computerized ED-SBIRT with integrated personalized messaging and BNI holds promise as a viable screening and intervention modality for a wide range of emergency department patients.

The Relationship of Pedestrian Injuries to Socioeconomic Characteristics in a Large Southern California County

Objectives: The goal of this study is to explore the relationship between pedestrian injuries and socioeconomic characteristics. Methods: Pedestrian collisions were identified in the data of the California Statewide Integrated Traffic Records System (SWITRS), which is assembled from police crash reports by the California Highway Patrol Information Services Unit. Four thousand crashes were identified and geocoded within the census tracts in a county population of 2,846,289 over a 5-year period. Population and population characteristics for census tracts were obtained from the 2000 U.S. Census. Results: The percentage of the population living in households with low income (less than 185% of the federal poverty level) was the strongest predictor of pedestrian injuries. One fourth of census tracts had less than 8.7 percent of residents with low income and averaged 11 per 100,000 pedestrian crashes annually. One fourth of the census tracts had more than 32.2 percent of residents with low income and an average of 44 pedestrian crashes per 100,000 annually. Negative binomial regression showed that with each 1 percent increase in the percentage of residents with low income was associated with a 2.8 percent increase in pedestrian crashes. The percentage of residents age 14 years or less, adult residents who had not completed high school, residents who spoke English less than “very well” and spoke another language at home, and the population density were each associated with a higher frequency of pedestrian crashes. However, when low income was added to these 4 regression models, the relationship between low income and pedestrian crashes increased. Conclusions: Our study showed that pedestrian crashes are 4 times more frequent in poor neighborhoods and that neither age of the population, education, English language fluency, nor population density explained the effect of poverty.

Feasibility of Emergency Department Bilingual Computerized Alcohol Screening, Brief Intervention, and Referral to Treatment

The purpose of this study was to assess the feasibility of utilizing a computerized alcohol screening and intervention (CASI) kiosk in an emergency department (ED). An interactive English and Spanish audiographical computer program, developed for used on a mobile computer cart, was administered to 5103 patients. Patients who screened at risk (19%) also received a fully computer-guided brief negotiated interview (BNI) and a printed personal alcohol reduction plan. A higher percentage of younger patients, and males (31% versus 16% females), screened at risk or dependent. Patient surveys indicated CASI was easy to use and over 75% did not prefer a medical professional over the computer. The ED-based bilingual computerized alcohol screening, brief intervention, and referral to treatment required little time to administer, was acceptable to patients, identified at-risk and dependent drinkers, and was able to provide personalized feedback and brief intervention.

Alcohol Involvement among Young Female Drivers in US Fatal Crashes: Unfavourable Trends

Objective Young men have greater representation in fatal alcohol-related crashes. Recent studies of young women and risky behaviours have raised concerns about the implications this may have for alcohol-related fatal crashes. The objective of this study was to investigate the representation of young female drivers in US alcohol-involved fatal crashes (1995–2007) and to identify trends heralding future negative changes in crash profiles for young female drivers. Design Fatal crash data were obtained from the US National Highway Traffic Safety Administration Fatal Analysis Reporting System (FARS). Five age groups were analysed. The FARS multiple imputation dataset was used to estimate the proportion of drivers with blood alcohol, and variance estimates were corrected for the procedure. Linear regression was used to measure trends (1995–2007). Results 179 891 fatal crashes in all age groups occurred over the study period. The rate of involvement in fatal crashes for young drivers with positive blood alcohol concentrations (BAC) decreased for men and women aged 16 years but increased for women age 19–24 years. Young female drivers had a greater increase than young men in the proportion of alcohol-involved fatal crashes (3.1%, 95% CI 1.9 to 4.3% vs 1.2%, 95% CI 0.2 to 2.1%, p=0.02). Most of the increase occurred in drivers with BAC ≥0.15 g/dl. Drivers with higher BAC had markedly lower safety restraint use. Over time restraint use increased in all BAC groups studied. Conclusion Alcohol-involved fatal crash rates in young female drivers aged 19–24 years have increased. However, male drivers continue to surpass women in the number of alcohol-involved fatal crashes. Restraint use decreases markedly with increasing BAC.

New media use by patients who are homeless: the potential of mHealth to build connectivity.

Background Patients experiencing homelessness represent a disproportionate share of emergency department (ED) visits due to poor access to primary care and high levels of unmet health care needs. This is in part due to the difficulty of communicating and following up with patients who are experiencing homelessness. Objective To determine the prevalence and types of “new media” use among ED patients who experience homelessness. Methods This was a cross-sectional observational study with sequential enrolling of patients from three emergency departments 24/7 for 6 weeks. In total, 5788 ED patients were enrolled, of whom 249 experienced homelessness. Analyses included descriptive statistics, and unadjusted and adjusted odds ratios. Results 70.7% (176/249) of patients experiencing homelessness own cell phones compared to 85.90% (4758/5539) of patients in stable housing (P=.001) with the former more likely to own Androids, 70% (53/76) versus 43.89% (1064/2424), and the latter more likely to have iPhones, 44.55% (1080/2424) versus 17% (13/76) (P=.001). There is no significant difference in new media use, modality, or frequency for both groups; however, there is a difference in contract plan with 50.02% (2380/4758) of stably housed patients having unlimited minutes versus 37.5% (66/176) of homeless patients. 19.78% (941/4758) of patients in stable housing have pay-as-you-go plans versus 33.0% (58/176) of homeless patients (P=.001). Patients experiencing homelessness are more likely to want health information on alcohol/substance abuse, mental health, domestic violence, pregnancy and smoking cessation. Conclusions This study is unique in its characterization of new media ownership and use among ED patients experiencing homelessness. New media is a powerful tool to connect patients experiencing homelessness to health care.

Young Female Drivers in Fatal Crashes: Recent Trends, 1995–2004

Objective. Motor vehicle crashes are the leading cause of death for 15-to 20-year-olds. In 2004, nearly 8,000 15to 20-year-old drivers were killed in crashes. Epidemiologic studies repeatedly identify overrepresentation of young males in fatal crashes. Recent studies of young females and risk-taking behaviors (drug use, violent crime, risky sexual behavior) show unfavorable trends. The objective of this study is to study the extent of contribution of young female drivers to national fatal crashes over and to uncover unfavorable trends linked to risky driving behavior. Methods. Data from the National Highway Traffic Safety Administrations Fatal Analysis Reporting System (FARS) on drivers in crashes with one or more fatalities during 1995–2004 were studied. Five age groups were used: 16, 17, 18, 19–20, and 21–24 years. Linear regression was used to measure trends over time. The regression results represent differences in proportions and changes in proportion of crashes that fell into specified categories. The FARS multiple imputation data sets was used to estimate the proportion of drivers with positive blood alcohol, and variance estimates were corrected for the imputation procedure. Results. In all, 139,000 fatal crashes involving the noted age groups occurred over 10 years. Safety restraint use: Females had more safety restraint use (by 17.8%) but a smaller increase in use over time. Drivers license validity: The percentage of valid licensure decreased over the study for young males and females both in the general population and among drivers in fatal crashes. Single-vehicle crashes: A lower proportion of female drivers (8.9% fewer) were involved in single-vehicle fatal crashes. This proportion changed little over the study period. Alcohol use: Females had a 16.7% lower proportion than males of alcohol involvement in fatal crashes. This lower proportion was seen throughout the age groups. When accounting for change over the study period, female drivers had a similar to male increase in alcohol-involved fatal crashes. Presence of peer passengers: Female drivers were less likely to have age peers as passengers. Conclusions. While young male drivers surpass young females in number of fatal crashes, there are unfavorable trends linked to crash fatalities in young females. Our results suggest a smaller increase in safety restraint use, proportional decrease in license validity, and an increase in rate of alcohol-involved fatal crashes that approaches that seen in young males. These findings have considerable implications for future traffic safety social marketing campaigns, programs, and interventions.

Latino Caregiver Experiences With Asthma Health Communication

In this article, we analyze qualitative data from a purposeful sample of limited English proficiency (LEP) asthma health caregivers. We used ethnically concordant, semistructured, in-depth Spanish-language interviews and a follow-up focus group to explore issues related to communication during pediatric asthma encounters in medical settings. Inductive coding of Spanish transcripts by a bilingual research team was performed until thematic saturation was reached. Several key findings emerged. LEP caregivers encountered significant asthma burdens related to emotional stress, observed physical changes, and communication barriers. Language-discordant communication and the use of ad hoc interpreters were common. This finding is complex, and was influenced by perceptions of interpreter availability, delays in care, feelings of mistrust toward others, and individual emotional responses. Language-concordant education and suitable action plans were valued and desired. We discuss a revealing depiction of the LEP caregiver experience with asthma health communication and recommend areas for further inquiry.

Pediatric pedestrian injuries: emergency care considerations

Pedestrian traffic injuries are a growing public health threat worldwide. The global economic burden of motor vehicle collisions and pedestrian injuries approximates

Navigating the Boundaries of Emergency Department Care: Addressing the Medical and Social Needs of Patients Who Are Homeless

500 billion. In the United States, the number of pedestrian fatalities increased from 4675 in 2004 to 4881 in 2005. In addition nearly 60,000 injuries occurred during the same year. Injury patterns vary depending on the age, sex, and socioeconomic status of the individual. Children comprise one of the most vulnerable populations in pedestrian traffic injuries. Pedestrian injury remains the second leading cause of unintentional injury-related death among children aged 5 to 14 years. The burden of injury, upon the individual, families, and society, is frequently overwhelming. From recent data, pedestrian injuries and deaths are increasing in the United States and the World, and they require particular attention by emergency care providers and policy makers.