Allison Hawkes - Academia.edu (original) (raw)
Papers by Allison Hawkes
CRC Press eBooks, Oct 21, 2021
The Maine Agricultural Safety and Health Program performed a needs assessment to determine the he... more The Maine Agricultural Safety and Health Program performed a needs assessment to determine the health and safety concerns of Maine's fishing community. Information for the assessment was obtained from clinicians, focus groups of wives of fishers, and government agencies. Reports from the United States Coast Guard showed that during 1993-1994, sixty-five people were injured on commercial fishing vessels and eight people died. Decompression illness was the most frequently reported non-fatal injury (n = 15). Chronic injuries reported by clinicians included back pain, tendini
<p>a. LFS:HFS ratio = Lower Fat/less added Sugar: Higher Fat/more added Sugar.</p
American Journal of Respiratory and Critical Care Medicine, 1997
DNA fingerprinting of Mycobacterium tuberculosis is used to study the epidemiology of tuberculosi... more DNA fingerprinting of Mycobacterium tuberculosis is used to study the epidemiology of tuberculosis, but the specificity of the widely used IS6110 technique has not been validated. Isolates from Denver, Colorado from December 1988 through June 1994 were fingerprinted with the IS6110 technique. Available records were reviewed for patients whose isolates were within IS6110-defined clusters, and these isolates were fingerprinted with an independent technique (pTBN12). Of 189 isolates, 86 (46%) were in IS6110-defined clusters. Clustering was inversely related to the number of copies of IS6110, ranging from 12 of 12 (100%) to 37 of 48 (77%) and 37 of 129 (29%) for isolates having one, two to five, and more than five copies (p &amp;amp;amp;lt; 0.001). Of the 86 isolates clustered with the IS6110 technique, 35 (41%) had unique pTBN12 fingerprints. Discordant results with the two fingerprinting techniques were more common among isolates having five or fewer copies of IS6110. Epidemiologic links were identified among four of 35 (11%) patients whose isolates had discordant fingerprinting results, as compared with 40 of 51 (78%) of those whose isolates matched by both IS6110 and pTBN12. DNA fingerprinting with the IS6110 technique was not a specific marker of DNA clonality, particularly among isolates having fewer than five copies of IS6110. The use of a supplemental DNA fingerprinting technique decreased clustering and improved the correlation between the transmission links predicted by molecular techniques and epidemiologic investigation.
<p>a. This production sheet is an older version from 2012 and may not include newer U.S. De... more <p>a. This production sheet is an older version from 2012 and may not include newer U.S. Department of Agriculture requirements. [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0146875#pone.0146875.ref013" target="_blank">13</a>] b. The numbers were changed from their original values of 0 (grades K-5) and 95 (grades 6–8) for explanatory purposes (see text).</p
American Journal of Preventive Medicine, 1996
ATTENTION Although the research on which this statement was based is out of date, the position/re... more ATTENTION Although the research on which this statement was based is out of date, the position/recommendations contained in this policy were reaffirmed by the ACPM Board of Regents on 1/31/2005 until the evidence can be reevaluated. ...
Signa Vitae - A Journal In Intensive Care And Emergency Medicine, 2015
Across the nation, fire departments are adopting the 48/96 work schedule, in which firefighters w... more Across the nation, fire departments are adopting the 48/96 work schedule, in which firefighters work 48 consecutive hours with the following 96 hours off. Our study objective was to explain and quantify the impact of switching from the Kelly schedule to the 48/96 schedule by measuring changes in sleep, feelings of daytime function, as well as perceptions of professional and personal well-being for American firefighters. Sleep diaries and self-reported surveys were administered to firefighters at an urban fire department. Sleep diaries measuring the number of hours slept and feelings of refreshment were compared one month before and four months after implementation of the 48/96 schedule. The self-reported surveys measured sleepiness levels via the Epworth Sleepiness Scale. Secondary study objectives included changes in professional and personal well-being time for personal schedules, satisfaction, and health habits before and after the 48/96 schedule was implemented. The 59 firefighters included in the study reported an increase in sleep on-shift after the new schedule implementation (5.8 to 6.6 hours/night, p < 0.001). Participants also reported increased feelings of refreshment on days off (p < 0.001) and decreased daytime sleepiness (p < 0.001). We also found a general trend of improved perceptions of satisfaction, less shift interference with personal schedules and decreased feelings of burnout.
PloS one, 2016
A large local health department in Colorado partnered with 15 school districts to develop an appr... more A large local health department in Colorado partnered with 15 school districts to develop an approach to evaluate changes in access to healthy foods in reimbursable school lunches and a la carte offerings. School district nutrition managers were engaged at the start of this project. Health department dietitians developed criteria to classify food items as "Lower Fat and less added Sugar" (LFS) and "Higher Fat and more added Sugar" (HFS) based on the percentage of calories from fat and grams of added sugar. Lunch production sheets were obtained for two time periods, food items and the number of planned servings recorded. LFS and HFS planned servings were summed for each time period, and a LFS to HFS ratio calculated by dividing LFS planned servings by HFS planned servings. Additional analyses included calculating LFS: HFS ratios by school district, and for a la carte offerings. In 2009, the LFS: HFS ratio was 2.08, in 2011, 3.71 (P<0.0001). The method also dete...
INTRODUCTION/BACKGROUND: To increase participation in Tri-County Health Department's (TCHD) S... more INTRODUCTION/BACKGROUND: To increase participation in Tri-County Health Department's (TCHD) Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), a mixed-media advertising campaign was developed and ran from June 15-September 15, 2009. The campaign included Spanish-language radio ads, Spanish/English advertisements on the inside and outside of buses and in bus shelters located in the TCHD area. A separate phone number was established for people responding to the ads. EVALUATION DESIGN: Information collected from callers included date, residence county, WIC office referred to, and location where caller saw advertisement. The campaign's effect on attracting new clients to TCHD WIC was estimated by comparing the actual number of new clients during July December 2009 with the number that would have been expected based on data from 2008 during the same months. RESULTS: A total of 552 phone calls were received (6/15 9/15): 378 from area residents and 174 f...
INTRODUCTION/BACKGROUND Tri-County Health Department (TCHD) serves 29 jurisdictions in Colorado w... more INTRODUCTION/BACKGROUND Tri-County Health Department (TCHD) serves 29 jurisdictions in Colorado with a total population of 1.3 million. A goal of TCHD's CPPW grant is to facilitate local government land use policy change to support healthy eating and physical activity. The project described here systematically documented each jurisdiction's current healthy eating/active living (HEAL) policies and strategies. METHODS TCHD Urban Planners performed a literature review to develop an inventory of key words and phrases related to the influence of the built environment on health. Approximately 120 key words, such as wide sidewalks, tree canopy, bike lanes, were then grouped into key concepts (e.g., pedestrian friendly land use) for cataloging. The final key concepts were Comfort/Aesthetics, Connectivity, Environmental Deterrents, Healthy Eating, Parks/Recreation, Pedestrian-Friendly Land Use, Public Transportation, Traffic Safety and Walking/Biking. Staff then reviewed jurisdiction...
Public Health Nursing, 2013
To determine the risk factors associated with having a very low birth weight (VLBW) infant as a f... more To determine the risk factors associated with having a very low birth weight (VLBW) infant as a follow-up to the first phase of a Perinatal Periods of Risk approach. Retrospective cohort analysis of birth certificates. Population-based sample of 53,427 birth certificates for the city under study during the years 1999-2006. The relationship of selected maternal characteristics as predictors of VLBW using multivariate logistic regression analysis. The maternal characteristics associated with VLBW were as follows: no prenatal care (OR = 4.04), inadequate weight gain (OR = 3.97), Black, non-Hispanic race (OR = 1.50), less than 20 years old (OR = 1.42) and more than 35 years old (OR = 1.43). After analyzing age and race/ethnicity together, Black non-Hispanic women less than 20 years of age (OR = 2.70) or over 35 years of age (OR = 2.45) still had an increased odds for having a VLBW infant whereas Black non-Hispanic women between the ages of 20 and 35 did not. The findings of this study suggest educating women on the importance of preconception care, prenatal care, and adequate pregnancy weight gain to reduce the odds of having a VLBW infant.
Scandinavian Journal of Work, Environment & Health, 1997
Objectives This study was undertaken to compare the operating characteristics of the Hoar et a1 j... more Objectives This study was undertaken to compare the operating characteristics of the Hoar et a1 job-exposure matrix and the job-exposure matrix of the National Occupational Hazard Survey (NOHS) of the National Institute for Occupational Safety and Health in the United States. Both matrices were applied to occupations in the metal, paper and wood, and chemical, drug and paints industries, and the extent of agreement between the two was estimated. Methods The agents (exposure entities) selected for the comparison were colnrnon to both matrices; altogether 214 agents were included. For the comparison of occupations, the occupational codes of the Hoar et a1 matrix were converted to those of the NOHS-based matrix. For every occupational group analyzed, each of the 214 exposure entities was classified as to its "presence" or "absence", and a kappa statistic (K) was calculated. Results The K, ranged from 0.27 to-0.12. In general, most of the agreement between the 2 matrices occurred because they agreed as to the absence of exposure for the exposure entities. Variation in agreement was observed for both the individual exposure entities and for chemical families. CO~CIUS~OIIS These results indicate poor to only fair agreement between the 2 job-exposure matrices, and they underscore the importance of understanding the rules for classifying exposures when any such matrix is used. Investigators also need to be aware of the methods and limitations of the occupational coding systems.
Journal of Trauma: Injury, Infection & Critical Care, 2011
Journal of Trauma Nursing, 2010
To evaluate the child passenger safety curriculum of the Junglemobile, a traveling injury prevent... more To evaluate the child passenger safety curriculum of the Junglemobile, a traveling injury prevention program for young children. Cross-sectional evaluation with self-controls, convenience sample. School and community events in rural Colorado, Wyoming, and western Nebraska where the Junglemobile participated for the years 2000-2003. Children 11 years of age or younger attending a Junglemobile event. Children were tested on the Junglemobile child passenger safety curriculum. Children 3 to 6 years of age (Group 1) completed a pretest and a posttest. Children 7 to 11 years of age (Group 2) completed a pretest, an immediate posttest, and a 30-day posttest. Two hundred thirty-seven children in Group 1 completed the pretest, 76% completed both tests. In Group 2, 420 children took the pretest, 55% took all the 3 tests. Group 1 showed significant improvement in the ability to demonstrate the appropriate place to ride in a car, t (179) = -4.06, P &amp;lt; .001. In Group 2, 61% reported always being restrained on the pretest and 73.2% on the 30-day posttest, t(230) = -3.85, P &amp;lt; .001; 85.7% reported being restrained the last time they rode in a car or truck on the pretest; and 93.5% on the 30-day posttest t(228) = -3.38, P &amp;lt; .001. Reported booster seat use increased on 30-day posttest and was greater when parents received an educational brochure (increased approximately 5% without brochure vs 25% with brochure). Children can be taught about child passenger safety through the Junglemobile, a simple educational strategy. Parental education significantly modifies booster seat use.
Journal of Occupational & Environmental Medicine, 1998
Poisoning due to "non-automobile" gas-powered engines accounts for the largest ... more Poisoning due to "non-automobile" gas-powered engines accounts for the largest proportion of occupational carbon monoxide (CO) poisonings in Colorado workers. The present analysis was undertaken to characterize the problem and develop prevention strategies. Cases of occupational CO poisoning were identified from Colorado's population-based surveillance system for unintentional CO poisonings. For cases poisoned by "non-automobile" gas-powered engines, medical records were obtained. Results showed that almost all of the poisonings from these engines occurred indoors or in an enclosed space. Concrete saws were the most frequent source of poisoning. When compared with operators of other equipment, concrete saw operators had shorter durations of exposure to CO but generally experienced more severe symptoms and signs of poisoning. These results underscore the hazard associated with the indoor use of any gas-powered equipment; however, operators of concrete saws may receive a higher dose of CO.
Health Promotion Practice, 2007
The authors' Level I trauma center has advocated the use of ski helmets for several years and... more The authors' Level I trauma center has advocated the use of ski helmets for several years and in 1998, undertook a social-marketing campaign and a helmet loaner program to increase helmet use among skiers and snowboarders. The loaner program's effect on helmet acceptance was measured by comparing helmet acceptance in participating rental stores with acceptance in nonparticipating stores during 3 years. For the 1998-1999 season, 13.8% of renters in the participating stores accepted a helmet compared to 1.38% in the nonparticipating stores (p < .01); for 2000-2001, 33.5% to 3.93% (p < .01); and for 2001-2002, 30.3% to 4.48% (p < .01). The authors believe that efforts to increase helmet use—by increasing education and public awareness and decreasing barriers, such as through helmet loaner programs or routinely including helmets in rental packages—have significant potential to decrease the incidence and severity of brain injuries from skiing and/or snowboarding accident...
Journal of Agromedicine, 1997
The Maine Agricultural Safety and Health Program performed a needs assessment to determine the he... more The Maine Agricultural Safety and Health Program performed a needs assessment to determine the health and safety concerns of Maine&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s fishing community. Information for the assessment was obtained from clinicians, focus groups of wives of fishers, and government agencies. Reports from the United States Coast Guard showed that during 1993-1994, sixty-five people were injured on commercial fishing vessels and eight people died. Decompression illness was the most frequently reported non-fatal injury (n = 15). Chronic injuries reported by clinicians included back pain, tendinitis, carpal tunnel syndrome, dysbaric osteonecrosis. Clinicians and family members were also concerned about hand and arm infections from the bait and sun exposure. Family health issues and access to care are addressed in the report. Recommendations include, in part, increasing surveillance, reducing barriers to access, increasing clinicians&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; knowledge about the fishing industry, and fostering collaboration between agencies providing health and safety information to fishers.
The American Journal of Surgery, 2006
Acute epidural hematomas are generally considered to require urgent operation for clot evacuation... more Acute epidural hematomas are generally considered to require urgent operation for clot evacuation and bleeding control. It has become increasingly apparent, however, that many epidural hematomas will resolve with nonoperative management. The purpose of the current study was to review our experience with nonoperative management of acute epidural hematomas. Patients admitted to our busy urban level I trauma center with an epidural hematoma were identified using our trauma registry. Patients were excluded if they suffered other significant intracranial injury mandating operative intervention. Patient records were reviewed and relevant data collected. Patients who required subsequent craniotomy were compared to those who did not in order to identify risk factors for failure of nonoperative treatment. Between January 1995 and June 2004, 84 patients were identified. The mean age was 27 +/- 1.6 years and 68 (81%) were male. Mean Glasgow Coma Scale in the emergency department was 13.7 +/- 0.3. The most common mechanism of injury was a fall. Fifty-four (64%) patients were initially managed nonoperatively and 30 (36%) were taken directly to the operating room for craniotomy. Nonoperative management was successful in 47/54 (87%) patients. Failure of initial nonoperative management was not associated with adverse outcome. There were no deaths in patients managed operatively or nonoperatively. Seventy-two (86%) patients were discharged to home with excellent neurologic outcome. Epidural hematomas can be successfully managed nonoperatively in an appropriately selected group of patients. Moreover, failure of initial nonoperative management has no adverse effect on outcome.
Spine, 2003
In 1997, the results from the Third National Acute Spinal Cord Injury Study (NASCIS 3) were publi... more In 1997, the results from the Third National Acute Spinal Cord Injury Study (NASCIS 3) were published. We undertook the present study to determine the treatment protocols for patients with spinal cord injuries in Colorado and assess whether there were any barriers to the administration of corticosteroids. Cross-sectional. In May 1999, surveys were mailed to every trauma facility medical director and emergency medical system physician advisor in the state. Physicians were asked to provide information about their facilities&amp;#39; or agencies&amp;#39; current practice(s) for administering steroids to patients with spinal cord injuries. They were also asked about their opinion on whether the data on corticosteroid treatment for spinal cord injury support its use. Ninety-eight percent (39 out of 41) of the medical directors who responded and treat patients with spinal cord injuries said that their facilities do administer steroids to those patients. Fourteen percent reported following the NASCIS 3 protocol; 75%, the NASCIS 2 protocol. About half of the medical directors were either uncertain or did not believe that the data regarding the corticosteroid treatment for spinal cord injury supported its use. The majority of physician advisors responded that they do not authorize the administration of corticosteroids to patients with spinal cord injuries in the field, primarily because of short transport times. Our study demonstrated relatively poor compliance with the NASCIS 3 protocol, but good compliance with the NASCIS 2 protocol. There was skepticism about the efficacy of corticosteroid treatment among some Colorado physicians that treat patients with spinal cord injuries acutely; however, this does not completely explain the findings.
The Journal of Trauma: Injury, Infection, and Critical Care, 2003
Current American College of Surgeons Level I trauma center verification requires the presence of ... more Current American College of Surgeons Level I trauma center verification requires the presence of a residency program in which trauma care is an integral part of the training. The rationale for this requirement remains unclear, with no scientific evidence that resident participation improves the quality of trauma care. The purpose of this study was to determine whether quality or efficiency of trauma care is influenced by general surgery residents. Our urban Level I trauma center has traditionally used 24-hour in-house postgraduate year-4 general surgery residents in conjunction with at-home trauma attending backup to provide trauma care. As of July 1, 2000, general surgery residents no longer participated in trauma patient care, leaving sole responsibility to an in-house trauma attending. Data regarding patient outcome and resource use with and without surgery resident participation were tabulated and analyzed. Continuous data were compared using Student&amp;amp;amp;amp;amp;amp;amp;#39;s t test if normally distributed and the Mann-Whitney U test if nonparametric. Categorical data were compared using chi2 analysis or Fisher&amp;amp;amp;amp;amp;amp;amp;#39;s exact test as appropriate. During the 5-month period with resident participation, 555 trauma patients were admitted. In the identical time period without residents, 516 trauma patients were admitted. During the period without housestaff, patients were older and more severely injured. Mechanism was not different during the two time periods. Mortality was not affected; however, time in the emergency department and hospital lengths of stay were significantly shorter with residents. Multiple regression confirmed these findings while controlling for age, mechanism, and Injury Severity Score. Although resident participation in trauma care at a Level I trauma center does not affect outcome, it does significantly improve the efficiency of trauma care delivery.
The Journal of Trauma: Injury, Infection, and Critical Care, 2009
Background: Optimizing human resources at trauma facilities may increase quality of care. The pur... more Background: Optimizing human resources at trauma facilities may increase quality of care. The purpose of this study was to assess whether staffing changes within a Level I trauma center improved mortality and shortened length of stay (LOS) for trauma patients.
CRC Press eBooks, Oct 21, 2021
The Maine Agricultural Safety and Health Program performed a needs assessment to determine the he... more The Maine Agricultural Safety and Health Program performed a needs assessment to determine the health and safety concerns of Maine's fishing community. Information for the assessment was obtained from clinicians, focus groups of wives of fishers, and government agencies. Reports from the United States Coast Guard showed that during 1993-1994, sixty-five people were injured on commercial fishing vessels and eight people died. Decompression illness was the most frequently reported non-fatal injury (n = 15). Chronic injuries reported by clinicians included back pain, tendini
<p>a. LFS:HFS ratio = Lower Fat/less added Sugar: Higher Fat/more added Sugar.</p
American Journal of Respiratory and Critical Care Medicine, 1997
DNA fingerprinting of Mycobacterium tuberculosis is used to study the epidemiology of tuberculosi... more DNA fingerprinting of Mycobacterium tuberculosis is used to study the epidemiology of tuberculosis, but the specificity of the widely used IS6110 technique has not been validated. Isolates from Denver, Colorado from December 1988 through June 1994 were fingerprinted with the IS6110 technique. Available records were reviewed for patients whose isolates were within IS6110-defined clusters, and these isolates were fingerprinted with an independent technique (pTBN12). Of 189 isolates, 86 (46%) were in IS6110-defined clusters. Clustering was inversely related to the number of copies of IS6110, ranging from 12 of 12 (100%) to 37 of 48 (77%) and 37 of 129 (29%) for isolates having one, two to five, and more than five copies (p &amp;amp;amp;lt; 0.001). Of the 86 isolates clustered with the IS6110 technique, 35 (41%) had unique pTBN12 fingerprints. Discordant results with the two fingerprinting techniques were more common among isolates having five or fewer copies of IS6110. Epidemiologic links were identified among four of 35 (11%) patients whose isolates had discordant fingerprinting results, as compared with 40 of 51 (78%) of those whose isolates matched by both IS6110 and pTBN12. DNA fingerprinting with the IS6110 technique was not a specific marker of DNA clonality, particularly among isolates having fewer than five copies of IS6110. The use of a supplemental DNA fingerprinting technique decreased clustering and improved the correlation between the transmission links predicted by molecular techniques and epidemiologic investigation.
<p>a. This production sheet is an older version from 2012 and may not include newer U.S. De... more <p>a. This production sheet is an older version from 2012 and may not include newer U.S. Department of Agriculture requirements. [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0146875#pone.0146875.ref013" target="_blank">13</a>] b. The numbers were changed from their original values of 0 (grades K-5) and 95 (grades 6–8) for explanatory purposes (see text).</p
American Journal of Preventive Medicine, 1996
ATTENTION Although the research on which this statement was based is out of date, the position/re... more ATTENTION Although the research on which this statement was based is out of date, the position/recommendations contained in this policy were reaffirmed by the ACPM Board of Regents on 1/31/2005 until the evidence can be reevaluated. ...
Signa Vitae - A Journal In Intensive Care And Emergency Medicine, 2015
Across the nation, fire departments are adopting the 48/96 work schedule, in which firefighters w... more Across the nation, fire departments are adopting the 48/96 work schedule, in which firefighters work 48 consecutive hours with the following 96 hours off. Our study objective was to explain and quantify the impact of switching from the Kelly schedule to the 48/96 schedule by measuring changes in sleep, feelings of daytime function, as well as perceptions of professional and personal well-being for American firefighters. Sleep diaries and self-reported surveys were administered to firefighters at an urban fire department. Sleep diaries measuring the number of hours slept and feelings of refreshment were compared one month before and four months after implementation of the 48/96 schedule. The self-reported surveys measured sleepiness levels via the Epworth Sleepiness Scale. Secondary study objectives included changes in professional and personal well-being time for personal schedules, satisfaction, and health habits before and after the 48/96 schedule was implemented. The 59 firefighters included in the study reported an increase in sleep on-shift after the new schedule implementation (5.8 to 6.6 hours/night, p < 0.001). Participants also reported increased feelings of refreshment on days off (p < 0.001) and decreased daytime sleepiness (p < 0.001). We also found a general trend of improved perceptions of satisfaction, less shift interference with personal schedules and decreased feelings of burnout.
PloS one, 2016
A large local health department in Colorado partnered with 15 school districts to develop an appr... more A large local health department in Colorado partnered with 15 school districts to develop an approach to evaluate changes in access to healthy foods in reimbursable school lunches and a la carte offerings. School district nutrition managers were engaged at the start of this project. Health department dietitians developed criteria to classify food items as "Lower Fat and less added Sugar" (LFS) and "Higher Fat and more added Sugar" (HFS) based on the percentage of calories from fat and grams of added sugar. Lunch production sheets were obtained for two time periods, food items and the number of planned servings recorded. LFS and HFS planned servings were summed for each time period, and a LFS to HFS ratio calculated by dividing LFS planned servings by HFS planned servings. Additional analyses included calculating LFS: HFS ratios by school district, and for a la carte offerings. In 2009, the LFS: HFS ratio was 2.08, in 2011, 3.71 (P<0.0001). The method also dete...
INTRODUCTION/BACKGROUND: To increase participation in Tri-County Health Department's (TCHD) S... more INTRODUCTION/BACKGROUND: To increase participation in Tri-County Health Department's (TCHD) Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), a mixed-media advertising campaign was developed and ran from June 15-September 15, 2009. The campaign included Spanish-language radio ads, Spanish/English advertisements on the inside and outside of buses and in bus shelters located in the TCHD area. A separate phone number was established for people responding to the ads. EVALUATION DESIGN: Information collected from callers included date, residence county, WIC office referred to, and location where caller saw advertisement. The campaign's effect on attracting new clients to TCHD WIC was estimated by comparing the actual number of new clients during July December 2009 with the number that would have been expected based on data from 2008 during the same months. RESULTS: A total of 552 phone calls were received (6/15 9/15): 378 from area residents and 174 f...
INTRODUCTION/BACKGROUND Tri-County Health Department (TCHD) serves 29 jurisdictions in Colorado w... more INTRODUCTION/BACKGROUND Tri-County Health Department (TCHD) serves 29 jurisdictions in Colorado with a total population of 1.3 million. A goal of TCHD's CPPW grant is to facilitate local government land use policy change to support healthy eating and physical activity. The project described here systematically documented each jurisdiction's current healthy eating/active living (HEAL) policies and strategies. METHODS TCHD Urban Planners performed a literature review to develop an inventory of key words and phrases related to the influence of the built environment on health. Approximately 120 key words, such as wide sidewalks, tree canopy, bike lanes, were then grouped into key concepts (e.g., pedestrian friendly land use) for cataloging. The final key concepts were Comfort/Aesthetics, Connectivity, Environmental Deterrents, Healthy Eating, Parks/Recreation, Pedestrian-Friendly Land Use, Public Transportation, Traffic Safety and Walking/Biking. Staff then reviewed jurisdiction...
Public Health Nursing, 2013
To determine the risk factors associated with having a very low birth weight (VLBW) infant as a f... more To determine the risk factors associated with having a very low birth weight (VLBW) infant as a follow-up to the first phase of a Perinatal Periods of Risk approach. Retrospective cohort analysis of birth certificates. Population-based sample of 53,427 birth certificates for the city under study during the years 1999-2006. The relationship of selected maternal characteristics as predictors of VLBW using multivariate logistic regression analysis. The maternal characteristics associated with VLBW were as follows: no prenatal care (OR = 4.04), inadequate weight gain (OR = 3.97), Black, non-Hispanic race (OR = 1.50), less than 20 years old (OR = 1.42) and more than 35 years old (OR = 1.43). After analyzing age and race/ethnicity together, Black non-Hispanic women less than 20 years of age (OR = 2.70) or over 35 years of age (OR = 2.45) still had an increased odds for having a VLBW infant whereas Black non-Hispanic women between the ages of 20 and 35 did not. The findings of this study suggest educating women on the importance of preconception care, prenatal care, and adequate pregnancy weight gain to reduce the odds of having a VLBW infant.
Scandinavian Journal of Work, Environment & Health, 1997
Objectives This study was undertaken to compare the operating characteristics of the Hoar et a1 j... more Objectives This study was undertaken to compare the operating characteristics of the Hoar et a1 job-exposure matrix and the job-exposure matrix of the National Occupational Hazard Survey (NOHS) of the National Institute for Occupational Safety and Health in the United States. Both matrices were applied to occupations in the metal, paper and wood, and chemical, drug and paints industries, and the extent of agreement between the two was estimated. Methods The agents (exposure entities) selected for the comparison were colnrnon to both matrices; altogether 214 agents were included. For the comparison of occupations, the occupational codes of the Hoar et a1 matrix were converted to those of the NOHS-based matrix. For every occupational group analyzed, each of the 214 exposure entities was classified as to its "presence" or "absence", and a kappa statistic (K) was calculated. Results The K, ranged from 0.27 to-0.12. In general, most of the agreement between the 2 matrices occurred because they agreed as to the absence of exposure for the exposure entities. Variation in agreement was observed for both the individual exposure entities and for chemical families. CO~CIUS~OIIS These results indicate poor to only fair agreement between the 2 job-exposure matrices, and they underscore the importance of understanding the rules for classifying exposures when any such matrix is used. Investigators also need to be aware of the methods and limitations of the occupational coding systems.
Journal of Trauma: Injury, Infection & Critical Care, 2011
Journal of Trauma Nursing, 2010
To evaluate the child passenger safety curriculum of the Junglemobile, a traveling injury prevent... more To evaluate the child passenger safety curriculum of the Junglemobile, a traveling injury prevention program for young children. Cross-sectional evaluation with self-controls, convenience sample. School and community events in rural Colorado, Wyoming, and western Nebraska where the Junglemobile participated for the years 2000-2003. Children 11 years of age or younger attending a Junglemobile event. Children were tested on the Junglemobile child passenger safety curriculum. Children 3 to 6 years of age (Group 1) completed a pretest and a posttest. Children 7 to 11 years of age (Group 2) completed a pretest, an immediate posttest, and a 30-day posttest. Two hundred thirty-seven children in Group 1 completed the pretest, 76% completed both tests. In Group 2, 420 children took the pretest, 55% took all the 3 tests. Group 1 showed significant improvement in the ability to demonstrate the appropriate place to ride in a car, t (179) = -4.06, P &amp;lt; .001. In Group 2, 61% reported always being restrained on the pretest and 73.2% on the 30-day posttest, t(230) = -3.85, P &amp;lt; .001; 85.7% reported being restrained the last time they rode in a car or truck on the pretest; and 93.5% on the 30-day posttest t(228) = -3.38, P &amp;lt; .001. Reported booster seat use increased on 30-day posttest and was greater when parents received an educational brochure (increased approximately 5% without brochure vs 25% with brochure). Children can be taught about child passenger safety through the Junglemobile, a simple educational strategy. Parental education significantly modifies booster seat use.
Journal of Occupational & Environmental Medicine, 1998
Poisoning due to "non-automobile" gas-powered engines accounts for the largest ... more Poisoning due to "non-automobile" gas-powered engines accounts for the largest proportion of occupational carbon monoxide (CO) poisonings in Colorado workers. The present analysis was undertaken to characterize the problem and develop prevention strategies. Cases of occupational CO poisoning were identified from Colorado's population-based surveillance system for unintentional CO poisonings. For cases poisoned by "non-automobile" gas-powered engines, medical records were obtained. Results showed that almost all of the poisonings from these engines occurred indoors or in an enclosed space. Concrete saws were the most frequent source of poisoning. When compared with operators of other equipment, concrete saw operators had shorter durations of exposure to CO but generally experienced more severe symptoms and signs of poisoning. These results underscore the hazard associated with the indoor use of any gas-powered equipment; however, operators of concrete saws may receive a higher dose of CO.
Health Promotion Practice, 2007
The authors' Level I trauma center has advocated the use of ski helmets for several years and... more The authors' Level I trauma center has advocated the use of ski helmets for several years and in 1998, undertook a social-marketing campaign and a helmet loaner program to increase helmet use among skiers and snowboarders. The loaner program's effect on helmet acceptance was measured by comparing helmet acceptance in participating rental stores with acceptance in nonparticipating stores during 3 years. For the 1998-1999 season, 13.8% of renters in the participating stores accepted a helmet compared to 1.38% in the nonparticipating stores (p < .01); for 2000-2001, 33.5% to 3.93% (p < .01); and for 2001-2002, 30.3% to 4.48% (p < .01). The authors believe that efforts to increase helmet use—by increasing education and public awareness and decreasing barriers, such as through helmet loaner programs or routinely including helmets in rental packages—have significant potential to decrease the incidence and severity of brain injuries from skiing and/or snowboarding accident...
Journal of Agromedicine, 1997
The Maine Agricultural Safety and Health Program performed a needs assessment to determine the he... more The Maine Agricultural Safety and Health Program performed a needs assessment to determine the health and safety concerns of Maine&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s fishing community. Information for the assessment was obtained from clinicians, focus groups of wives of fishers, and government agencies. Reports from the United States Coast Guard showed that during 1993-1994, sixty-five people were injured on commercial fishing vessels and eight people died. Decompression illness was the most frequently reported non-fatal injury (n = 15). Chronic injuries reported by clinicians included back pain, tendinitis, carpal tunnel syndrome, dysbaric osteonecrosis. Clinicians and family members were also concerned about hand and arm infections from the bait and sun exposure. Family health issues and access to care are addressed in the report. Recommendations include, in part, increasing surveillance, reducing barriers to access, increasing clinicians&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; knowledge about the fishing industry, and fostering collaboration between agencies providing health and safety information to fishers.
The American Journal of Surgery, 2006
Acute epidural hematomas are generally considered to require urgent operation for clot evacuation... more Acute epidural hematomas are generally considered to require urgent operation for clot evacuation and bleeding control. It has become increasingly apparent, however, that many epidural hematomas will resolve with nonoperative management. The purpose of the current study was to review our experience with nonoperative management of acute epidural hematomas. Patients admitted to our busy urban level I trauma center with an epidural hematoma were identified using our trauma registry. Patients were excluded if they suffered other significant intracranial injury mandating operative intervention. Patient records were reviewed and relevant data collected. Patients who required subsequent craniotomy were compared to those who did not in order to identify risk factors for failure of nonoperative treatment. Between January 1995 and June 2004, 84 patients were identified. The mean age was 27 +/- 1.6 years and 68 (81%) were male. Mean Glasgow Coma Scale in the emergency department was 13.7 +/- 0.3. The most common mechanism of injury was a fall. Fifty-four (64%) patients were initially managed nonoperatively and 30 (36%) were taken directly to the operating room for craniotomy. Nonoperative management was successful in 47/54 (87%) patients. Failure of initial nonoperative management was not associated with adverse outcome. There were no deaths in patients managed operatively or nonoperatively. Seventy-two (86%) patients were discharged to home with excellent neurologic outcome. Epidural hematomas can be successfully managed nonoperatively in an appropriately selected group of patients. Moreover, failure of initial nonoperative management has no adverse effect on outcome.
Spine, 2003
In 1997, the results from the Third National Acute Spinal Cord Injury Study (NASCIS 3) were publi... more In 1997, the results from the Third National Acute Spinal Cord Injury Study (NASCIS 3) were published. We undertook the present study to determine the treatment protocols for patients with spinal cord injuries in Colorado and assess whether there were any barriers to the administration of corticosteroids. Cross-sectional. In May 1999, surveys were mailed to every trauma facility medical director and emergency medical system physician advisor in the state. Physicians were asked to provide information about their facilities&amp;#39; or agencies&amp;#39; current practice(s) for administering steroids to patients with spinal cord injuries. They were also asked about their opinion on whether the data on corticosteroid treatment for spinal cord injury support its use. Ninety-eight percent (39 out of 41) of the medical directors who responded and treat patients with spinal cord injuries said that their facilities do administer steroids to those patients. Fourteen percent reported following the NASCIS 3 protocol; 75%, the NASCIS 2 protocol. About half of the medical directors were either uncertain or did not believe that the data regarding the corticosteroid treatment for spinal cord injury supported its use. The majority of physician advisors responded that they do not authorize the administration of corticosteroids to patients with spinal cord injuries in the field, primarily because of short transport times. Our study demonstrated relatively poor compliance with the NASCIS 3 protocol, but good compliance with the NASCIS 2 protocol. There was skepticism about the efficacy of corticosteroid treatment among some Colorado physicians that treat patients with spinal cord injuries acutely; however, this does not completely explain the findings.
The Journal of Trauma: Injury, Infection, and Critical Care, 2003
Current American College of Surgeons Level I trauma center verification requires the presence of ... more Current American College of Surgeons Level I trauma center verification requires the presence of a residency program in which trauma care is an integral part of the training. The rationale for this requirement remains unclear, with no scientific evidence that resident participation improves the quality of trauma care. The purpose of this study was to determine whether quality or efficiency of trauma care is influenced by general surgery residents. Our urban Level I trauma center has traditionally used 24-hour in-house postgraduate year-4 general surgery residents in conjunction with at-home trauma attending backup to provide trauma care. As of July 1, 2000, general surgery residents no longer participated in trauma patient care, leaving sole responsibility to an in-house trauma attending. Data regarding patient outcome and resource use with and without surgery resident participation were tabulated and analyzed. Continuous data were compared using Student&amp;amp;amp;amp;amp;amp;amp;#39;s t test if normally distributed and the Mann-Whitney U test if nonparametric. Categorical data were compared using chi2 analysis or Fisher&amp;amp;amp;amp;amp;amp;amp;#39;s exact test as appropriate. During the 5-month period with resident participation, 555 trauma patients were admitted. In the identical time period without residents, 516 trauma patients were admitted. During the period without housestaff, patients were older and more severely injured. Mechanism was not different during the two time periods. Mortality was not affected; however, time in the emergency department and hospital lengths of stay were significantly shorter with residents. Multiple regression confirmed these findings while controlling for age, mechanism, and Injury Severity Score. Although resident participation in trauma care at a Level I trauma center does not affect outcome, it does significantly improve the efficiency of trauma care delivery.
The Journal of Trauma: Injury, Infection, and Critical Care, 2009
Background: Optimizing human resources at trauma facilities may increase quality of care. The pur... more Background: Optimizing human resources at trauma facilities may increase quality of care. The purpose of this study was to assess whether staffing changes within a Level I trauma center improved mortality and shortened length of stay (LOS) for trauma patients.