Tiffany Kendig - Academia.edu (original) (raw)

Papers by Tiffany Kendig

Journal of Clinical Oncology

e18793 Background: Women with gynecologic cancers are likely to experience acute, late, or lastin... more e18793 Background: Women with gynecologic cancers are likely to experience acute, late, or lasting functional impairments that impact ability to complete activities of daily living and quality of life. While cancer rehabilitation interventions (physical or occupational therapy, PT/OT) treat functional impairment, the use, impact, and acceptability of these services in community-based settings is unknown. We describe outpatient PT/OT services used by gynecologic cancer survivors and evaluate the impact and acceptability of these services using patient-reported outcome measures (PROM). Methods: This retrospective study included women with history of gynecologic cancer (via ICD-10 code) who: (1) received community-based outpatient cancer PT/OT services provided by a single institution in 5 geographic regions of the United States in 2019, and (2) completed a PROM at evaluation and discharge. Data was extracted from PT/OT medical charts. We calculated descriptive statistics for all avail...

Journal of Clinical Oncology, 2021

e13538 Background: The Exercise in Cancer Decision Support (EXCEEDS) algorithm is an evidence-bas... more e13538 Background: The Exercise in Cancer Decision Support (EXCEEDS) algorithm is an evidence-based, risk stratified framework. This framework allows for enhanced decision making for exercise pre-participation medical clearance and triage to cancer rehabilitation or exercise services across the cancer continuum. We conducted a Delphi study to examine utility and acceptability of the EXCEEDS algorithm for oncology stakeholders. Methods: Delphi study participants were randomized to two case studies, then made pre-participation medical clearance (yes/no) and intervention triage recommendations (cancer rehabilitation, clinically-supervised exercise, cancer-specific community-based exercise, and unsupervised exercise) in two conditions: independent (IND) and using EXCEEDS. Immediately following, participants rated algorithm acceptability in four domains using 4-point Likert scales (1- strongly disagree, to 4- strongly agree). We dichotomously coded accuracy (correct/incorrect) for each m...

MD advisor : a journal for New Jersey medical community, 2019

Journal of Cancer Survivorship, 2022

Purpose To characterize delivery features and explore effectiveness of telehealth-based cancer re... more Purpose To characterize delivery features and explore effectiveness of telehealth-based cancer rehabilitation interventions that address disability in adult cancer survivors. Methods A systematic review of electronic databases

Supportive Care in Cancer

Participation in exercise or rehabilitation services is recommended to optimize health, functioni... more Participation in exercise or rehabilitation services is recommended to optimize health, functioning, and well-being across the cancer continuum of care. However, limited knowledge of individual needs and complex decision-making are barriers to connect the right survivor to the right exercise/rehabilitation service at the right time. In this article, we define the levels of exercise/rehabilitation services, provide a conceptual model to improve understanding of individual needs, and describe the development of the Exercise in Cancer Evaluation and Decision Support (EXCEEDS) algorithm. From literature review, we synthesized defining characteristics of exercise/rehabilitation services and individual characteristics associated with safety and efficacy for each service. We developed a visual model to conceptualize the need for each level of specialized care, then organized individual characteristics into a risk-stratified algorithm. Iterative review with a multidisciplinary expert panel was conducted until consensus was reached on algorithm content and format. We identified eight defining features of the four levels of exercise/rehabilitation services and provide a conceptual model of to guide individualized navigation for each service across the continuum of care. The EXCEEDS algorithm includes a risk-stratified series of eleven dichotomous questions, organized in two sections and ten domains. The EXCEEDS algorithm is an evidence-based decision support tool that provides a common language to describe exercise/rehabilitation services, a practical model to understand individualized needs, and step-by-step decision support guidance. The EXCEEDS algorithm is designed to be used at point of care or point of need by multidisciplinary users, including survivors. Thus, implementation may improve care coordination for cancer exercise/rehabilitation services.

Journal of Clinical Oncology

287 Background: Specialized cancer rehabilitation is recommended for individuals with breast canc... more 287 Background: Specialized cancer rehabilitation is recommended for individuals with breast cancer from diagnosis throughout survivorship to mitigate the negative acute, late and lasting effects of cancer and cancer treatment on upper extremity functioning. However, evidence supporting the impact of community-based outpatient rehabilitation services is lacking, especially for older adults. Methods: Individuals with breast cancer attended cancer-specialized outpatient physical or occupational therapy provided by a single institution with multiple locations across the US in 2019, and completed the Quick DASH (Disabilities of the Arm, Shoulder and Hand). From de-identified rehabilitation records, we abstracted patient and therapy characteristics, Quick DASH scores and therapy satisfaction scores (0-10 point scale) for individuals with a history of breast cancer (identified by ICD code). We used descriptive statistics to summarize characteristics, paired samples t-tests to evaluate Qui...

Rehabilitation Oncology

is the official publication of the Oncology Section, APTA. Copyright 2013 by the Oncology Section... more is the official publication of the Oncology Section, APTA. Copyright 2013 by the Oncology Section, APTA. Nonmember and institution subscriptions are available for 70peryear(4issues).Backissuesareavailableformembers(70 per year (4 issues). Back issues are available for members (70peryear(4issues).Backissuesareavailableformembers(5) and nonmembers ($20). The contents of articles appearing in this publication represent the thoughts and ideas of the authors and do not necessarily reflect the views of the Oncology Section, APTA. The editor reserves the right to edit submitted manuscripts or other material as necessary for publication. We encourage comments and opinions concerning the content of Rehabilitation Oncology through Letters to the Editor.

The oncologist, Jan 7, 2015

The purpose of this study was to investigate the prognostic importance of functional capacity in ... more The purpose of this study was to investigate the prognostic importance of functional capacity in patients undergoing allogeneic hematopoietic cell transplantation (HCT) for hematological malignancies. Using a retrospective design, 407 patients completed a 6-minute walk distance (6MWD) test to assess functional capacity before HCT; 193 (47%) completed a 6MWD test after hospital discharge. Cox proportional hazards regression was used to estimate the risk of nonrelapse mortality (NRM) and overall survival (OS) according to the 6MWD category (<400 m vs. ≥400 m) and the change in 6MWD (before HCT to discharge) with or without adjustment for Karnofsky performance status (KPS), age, and other prognostic markers. Compared with <400 m, the unadjusted hazard ratio for NRM was 0.65 (95% confidence interval, 0.44-0.96) for a 6MWD ≥400 m. A 6MWD of ≥400 m provided incremental information on the prediction of NRM with adjustment for age (p = .032) but not KPS alone (p = .062) or adjustment ...

Background. Although most states have infant restraint laws, booster seat legislation for older c... more Background. Although most states have infant restraint laws, booster seat legislation for older children has not been implemented universally despite evidence of effectiveness. We examined incidence and expenditures for motor vehicle (MV) occupant injury among 3 to 8 year olds covered vs. uncovered by booster seat legislation. Methods. Age, state of residence/hospitalization, and month of injury were used to examine injury, deaths, and expenditures due to MV occupant injury in states with vs. without legislation. Unweighted KID-HCUP 2003 (hospitalizations), WISQARS (fatalities), and census-based denominators were used to estimate outcomes and hospital expenditures by law coverage. Results. Children covered by booster seat legislation were less likely to be hospitalized for MV occupant injury than non-covered children (Odds ratio, 95% CI, 0.78, 0.69-0.88). The majority of mortality (71.7%) occurred in those below median income in both uncovered and covered children (76.4% vs. 58.4%, ...

Background. Although falls from windows result in serious pediatric trauma, prevention advocates ... more Background. Although falls from windows result in serious pediatric trauma, prevention advocates report obstacles to developing policies and regulations sufficiently strong to prevent childhood death and disability associated with this mechanism. Methods. We reviewed all available data, legal cases and news articles (1965-2005) and categorized the 40-year evolution of the New York City Department of Health and Mental Hygiene's best practices window fall program into 6 programmatic eras: 1) initiation of surveillance with failed regulation; 2) demonstration program with education and free product distribution/installation; 3) legal challenge of passed regulation; 4) regulation with obstacles and minimal enforcement; 5) regulation with intensified enforcement including criminal prosecutions; and 6) expanded responsibility/liability to owners/boards of directors of multi-family dwellings. Results. Each successive programmatic era was associated with additional improvement in annual...

The Journal of Trauma: Injury, Infection, and Critical Care, 2009

Although most states have infant restraint laws, booster seat legislation for older children has ... more Although most states have infant restraint laws, booster seat legislation for older children has not been implemented universally despite evidence of effectiveness. We examined injury and expenditures for motor vehicle traffic (MV) occupant injury among 3 year to 8 year olds covered versus uncovered by booster seat legislation. Age, state of residence/hospitalization, and month of injury were used to examine injury, deaths, and expenditures due to MV occupant injury in children covered versus uncovered by booster seat legislation. Data sources included Kids Inpatient Database 2003 and Web-based Injury Statistics Query and Reporting System. Statistical analyses used chi, Fisher&amp;amp;amp;amp;amp;amp;#39;s exact, and analysis of variance. Odds ratios were calculated with 95% confidence intervals (CI). Children covered by booster seat legislation were less likely to be hospitalized for MV occupant injury than uncovered children (odds ratio, 0.78; 95% CI, 0.69-0.88). MV occupant injury constituted a smaller proportion of total injury expenditures in children covered (4.9%) versus uncovered (6.9%) by booster seat legislation. Covered children residing in areas with zip code incomes above the median had 26% lower MV occupant/total injury (p = 0.001) compared with 13% lower MV occupant/total injury for those below the median income (p = 0.0712). The proportion of injury dollars spent for MV occupant injury was higher in self-pay children for covered (7.8%) and uncovered (8.9%) children. This study suggests that booster seat laws are associated with a lower proportion of injury expenditures for MV occupant injuries in booster seat-aged children. Observed income disparities raise questions regarding whether access to booster seats, quality of affordable seats, and proper use and/or enforcement strategies impede legislative effectiveness.

The Journal of Trauma: Injury, Infection, and Critical Care, 2007

Examination of expenditures in areas where more universal application of effective injury prevent... more Examination of expenditures in areas where more universal application of effective injury prevention approaches is indicated could identify specific mechanisms and age groups where effective intervention may impact public injury-related expenditures. The Healthcare Cost and Utilization Project 2003 (KID-HCUP) contains acute care hospitalization data for U.S. children and adolescents residing in 36 states. The study population includes 240,248 unweighted (397,943 weighted) injury-related hospital discharges for ages 0 to 19 years. Injury severity was assessed using ICDMAP-90 and International Classification of Injury Severity Scores (ICISS). SUDAAN was employed to adjust variances for stratified sampling. Expenditures were weighted to represent the U.S. population. Injury-related hospitalizations (mean 28,137+/−64,420,median28,137 +/- 64,420, median 28,137+/−64,420,median10,808) were more costly than non-injury discharges, accounting for approximately 10% of all persons hospitalized (unweighted), but more than one-fifth of expenditures. Public sources were the primary payor for 37.7% of injured persons. Incidence and cost per case variations across specific injury mechanisms heavily influenced total mechanism specific expenditures. Motor vehicle crashes were the largest expenditures for private and public payors with two thirds of expenditures in teenagers - more than 40% for drivers. Medicaid covered 45.6% ($192 million) of burn expenditures and 59.2% in 0-4 year olds. Expenditures per case (mean +/- SD, median) were: firearm ($36,196 +/- 58,052, 19,020),motorvehicledriver(19,020), motor vehicle driver (19,020),motorvehicledriver(33,731 +/- 50,583, 18,431),pedestrian(18,431), pedestrian (18,431),pedestrian(31,414 +/- 57,103, 16,552);burns(16,552); burns (16,552);burns(29,242 +/- 64,271, 10,739);falls(10,739); falls (10,739);falls(13,069 +/- 20,225, 8,610);andpoisoning(8,610); and poisoning (8,610);andpoisoning(8,290 +/- 15,462,15,462, 15,462,5,208). More universal application of proven injury prevention has the potential to decrease both the public and private health expenditure burden among several modifiable injury mechanisms.

The Journal of Trauma: Injury, Infection, and Critical Care, 2011

Gender and racial disparities in injury mortality have been well established, but less is known r... more Gender and racial disparities in injury mortality have been well established, but less is known regarding differences in fracture-related hospitalizations across the age span. Cross-sectional analysis of annual incident fracture hospital admissions used statewide acute care hospital discharge data (Statewide Program and Research Cooperative System) for non-Hispanic White (n = 138,763) and non-Hispanic Black (n = 19,588) residents of New York State between 2000 and 2002. US census data with intercensal estimates were used to ascertain the population at risk. Gender- and race-specific incident fracture was calculated in 5-year age intervals. The χ test was used to analyze categorical variables. Mechanisms of injury vary by race and gender in their relative contribution to injury-related fractures across the age span. Black males exhibited higher fracture incidence until approximately age 62, while incidence in women diverged around age 45. Total motor vehicle traffic-related fracture hospitalization is bimodal in Whites but not in Blacks. Over the life span, all groups exhibited bimodal pedestrian fractures with pedestrian fractures accounting for 8.8% and 2.5% of all fractures in Blacks and Whites, respectively. Racial disparities were present from preschool through age 70. Violence-related fractures were 10 times higher in Blacks, accounting for 18.2% of hospitalizations. Black males exhibit higher fracture incidence due to violence by age 5 and higher gun violence by age 10; both remain elevated through age 75. Despite historical studies demonstrating higher bone density in Blacks, this study found racial disparities with increased fracture risk in both Black children and adults across most nonfall-related injury mechanisms examined.

The Journal of Trauma: Injury, Infection, and Critical Care, 2010

Delivery of effective primary, secondary, and tertiary injury prevention in homeless populations ... more Delivery of effective primary, secondary, and tertiary injury prevention in homeless populations is complex and could be greatly aided by an improved understanding of contributing factors. Injury and health conditions were examined for hospitalized New York City homeless persons (n = 326,073) and low socioeconomic status (SES) housed residents (n = 1,202,622) using 2000 to 2002 New York statewide hospital discharge data (Statewide Program and Research Cooperative System). Age- and gender-adjusted odds ratios with 95% confidence intervals were calculated within age groups of 0.1 years to 9 years, 10 years to 19 years, 20 years to 64 years, and ≥65 years, with low SES housed as the comparison group. Comorbid conditions, injury, and injury mechanisms varied by age, gender, race or ethnicity, and housing status. Odds of unintentional injury in homeless versus low SES housed were higher in younger children aged 0 years to 9 years (1.34, 1.27-1.42), adults (1.13, 1.09-1.18), and elderly (1.25, 1.20-1.30). Falls were increased by 30% in children, 14% in adolescents or teenagers, and 47% in the elderly. More than one-quarter (26.9%) of fall hospitalizations in homeless children younger than 5 years were due to falls from furniture with more than threefold differences observed in both 3 year and 4 year olds (p = 0.0001). Several comorbid conditions with potential to complicate injury and postinjury care were increased in homeless including nutritional deficiencies, infections, alcohol and drug use, and mental disorders. Although homelessness presents unique, highly complex social and health issues that tend to overshadow the need for and the value of injury prevention, this study highlights potentially fruitful areas for primary, secondary, and tertiary prevention.

Child: Care, Health and Development, 2007

OBJECTIVE. Mortality trends across modifiable injury mechanisms may reflect how well effective in... more OBJECTIVE. Mortality trends across modifiable injury mechanisms may reflect how well effective injury prevention efforts are penetrating high-risk populations. This study examined all-cause, unintentional, and intentional injury-related mortality in children who were aged 0 to 4 years for evidence of and to quantify racial disparities by injury mechanism. METHODS. Injury analyses used national vital statistics data from January 1, 1981, to December 31, 2003, that were available from the Centers for Disease Control and Prevention. Rate calculations and 2 test for trends (Mantel extension) used data that were collapsed into 3-year intervals to produce cell sizes with stable estimates. Percentage change for mortality rate ratios used the earliest (1981-1983) and the latest (2001-2003) study period for black, American Indian/Alaskan Native, and Asian/Pacific Islander children, with white children as the comparison group. RESULTS. All-cause injury rates declined during the study period, but current mortality ratios for all-cause injury remained higher in black and American Indian/ Alaskan Native children and lower in Asian/Pacific Islander children compared with white children. Trend analyses within racial groups demonstrate significant improvements in all groups for unintentional but not intentional injury. Black and American Indian/Alaskan Native children had higher injury risk as a result of residential fire, suffocation, poisoning, falls, motor vehicle traffic, and firearms. Disparities narrowed for residential fire, pedestrian, and poisoning and widened for motor vehicle occupant, unspecified motor vehicle, and suffocation for black and American Indian/Alaskan Native children. CONCLUSIONS. These findings identify injury areas in which disparities narrowed, improvement occurred with maintenance or widening of disparities, and little or no progress was evident. This study further suggests specific mechanisms whereby new strategies and approaches to address areas that are recalcitrant to improvement in absolute rates and/or narrowing of disparities are needed and where increased dissemination of proven efficacious injury prevention efforts to high-risk populations are indicated.

Archives of Physical Medicine and Rehabilitation, 2014

(1) To identify English-language published patient-reported upper extremity outcome measures used... more (1) To identify English-language published patient-reported upper extremity outcome measures used in breast cancer research and (2) to examine construct validity and responsiveness in patient-reported upper extremity outcome measures used in breast cancer research. PubMed, Cumulative Index to Nursing and Allied Health Literature, and ProQuest MEDLINE databases were searched up to February 5, 2013. Studies were included if a patient-reported upper extremity outcome measure was administered, the participants were diagnosed with breast cancer, and the study was published in English. A total of 865 articles were screened. Fifty-nine full text articles were assessed for eligibility. A total of 46 articles met the initial eligibility criteria for aim 1. Eleven of these articles reported means and SDs for the outcome scores and included a comparison group analysis for aim 2. Construct validity was evaluated by calculating effect sizes for known-group differences in 6 studies using the Disabilities of Arm, Shoulder and Hand (DASH), University of Pennsylvania Shoulder Score, Shoulder Disability Questionnaire-Dutch, and 10 Questions by Wingate. Responsiveness was analyzed comparing a treatment and control group by calculating the coefficient of responsiveness in 5 studies for the DASH and 10 Questions by Wingate. Eight different patient-reported upper extremity outcome measures have been reported in the peer-review literature for women with breast cancer; some that were specifically developed for breast cancer survivors (n=3) and others that were not (n=5). Based on the current evidence, we recommend administering the DASH to assess patient-reported upper extremity function in breast cancer survivors because the DASH has the most consistently large effects sizes for construct validity and responsiveness. Future large studies are needed for more definitive recommendations.

Journal of Clinical Oncology

e18793 Background: Women with gynecologic cancers are likely to experience acute, late, or lastin... more e18793 Background: Women with gynecologic cancers are likely to experience acute, late, or lasting functional impairments that impact ability to complete activities of daily living and quality of life. While cancer rehabilitation interventions (physical or occupational therapy, PT/OT) treat functional impairment, the use, impact, and acceptability of these services in community-based settings is unknown. We describe outpatient PT/OT services used by gynecologic cancer survivors and evaluate the impact and acceptability of these services using patient-reported outcome measures (PROM). Methods: This retrospective study included women with history of gynecologic cancer (via ICD-10 code) who: (1) received community-based outpatient cancer PT/OT services provided by a single institution in 5 geographic regions of the United States in 2019, and (2) completed a PROM at evaluation and discharge. Data was extracted from PT/OT medical charts. We calculated descriptive statistics for all avail...

Journal of Clinical Oncology, 2021

e13538 Background: The Exercise in Cancer Decision Support (EXCEEDS) algorithm is an evidence-bas... more e13538 Background: The Exercise in Cancer Decision Support (EXCEEDS) algorithm is an evidence-based, risk stratified framework. This framework allows for enhanced decision making for exercise pre-participation medical clearance and triage to cancer rehabilitation or exercise services across the cancer continuum. We conducted a Delphi study to examine utility and acceptability of the EXCEEDS algorithm for oncology stakeholders. Methods: Delphi study participants were randomized to two case studies, then made pre-participation medical clearance (yes/no) and intervention triage recommendations (cancer rehabilitation, clinically-supervised exercise, cancer-specific community-based exercise, and unsupervised exercise) in two conditions: independent (IND) and using EXCEEDS. Immediately following, participants rated algorithm acceptability in four domains using 4-point Likert scales (1- strongly disagree, to 4- strongly agree). We dichotomously coded accuracy (correct/incorrect) for each m...

MD advisor : a journal for New Jersey medical community, 2019

Journal of Cancer Survivorship, 2022

Purpose To characterize delivery features and explore effectiveness of telehealth-based cancer re... more Purpose To characterize delivery features and explore effectiveness of telehealth-based cancer rehabilitation interventions that address disability in adult cancer survivors. Methods A systematic review of electronic databases

Supportive Care in Cancer

Participation in exercise or rehabilitation services is recommended to optimize health, functioni... more Participation in exercise or rehabilitation services is recommended to optimize health, functioning, and well-being across the cancer continuum of care. However, limited knowledge of individual needs and complex decision-making are barriers to connect the right survivor to the right exercise/rehabilitation service at the right time. In this article, we define the levels of exercise/rehabilitation services, provide a conceptual model to improve understanding of individual needs, and describe the development of the Exercise in Cancer Evaluation and Decision Support (EXCEEDS) algorithm. From literature review, we synthesized defining characteristics of exercise/rehabilitation services and individual characteristics associated with safety and efficacy for each service. We developed a visual model to conceptualize the need for each level of specialized care, then organized individual characteristics into a risk-stratified algorithm. Iterative review with a multidisciplinary expert panel was conducted until consensus was reached on algorithm content and format. We identified eight defining features of the four levels of exercise/rehabilitation services and provide a conceptual model of to guide individualized navigation for each service across the continuum of care. The EXCEEDS algorithm includes a risk-stratified series of eleven dichotomous questions, organized in two sections and ten domains. The EXCEEDS algorithm is an evidence-based decision support tool that provides a common language to describe exercise/rehabilitation services, a practical model to understand individualized needs, and step-by-step decision support guidance. The EXCEEDS algorithm is designed to be used at point of care or point of need by multidisciplinary users, including survivors. Thus, implementation may improve care coordination for cancer exercise/rehabilitation services.

Journal of Clinical Oncology

287 Background: Specialized cancer rehabilitation is recommended for individuals with breast canc... more 287 Background: Specialized cancer rehabilitation is recommended for individuals with breast cancer from diagnosis throughout survivorship to mitigate the negative acute, late and lasting effects of cancer and cancer treatment on upper extremity functioning. However, evidence supporting the impact of community-based outpatient rehabilitation services is lacking, especially for older adults. Methods: Individuals with breast cancer attended cancer-specialized outpatient physical or occupational therapy provided by a single institution with multiple locations across the US in 2019, and completed the Quick DASH (Disabilities of the Arm, Shoulder and Hand). From de-identified rehabilitation records, we abstracted patient and therapy characteristics, Quick DASH scores and therapy satisfaction scores (0-10 point scale) for individuals with a history of breast cancer (identified by ICD code). We used descriptive statistics to summarize characteristics, paired samples t-tests to evaluate Qui...

Rehabilitation Oncology

is the official publication of the Oncology Section, APTA. Copyright 2013 by the Oncology Section... more is the official publication of the Oncology Section, APTA. Copyright 2013 by the Oncology Section, APTA. Nonmember and institution subscriptions are available for 70peryear(4issues).Backissuesareavailableformembers(70 per year (4 issues). Back issues are available for members (70peryear(4issues).Backissuesareavailableformembers(5) and nonmembers ($20). The contents of articles appearing in this publication represent the thoughts and ideas of the authors and do not necessarily reflect the views of the Oncology Section, APTA. The editor reserves the right to edit submitted manuscripts or other material as necessary for publication. We encourage comments and opinions concerning the content of Rehabilitation Oncology through Letters to the Editor.

The oncologist, Jan 7, 2015

The purpose of this study was to investigate the prognostic importance of functional capacity in ... more The purpose of this study was to investigate the prognostic importance of functional capacity in patients undergoing allogeneic hematopoietic cell transplantation (HCT) for hematological malignancies. Using a retrospective design, 407 patients completed a 6-minute walk distance (6MWD) test to assess functional capacity before HCT; 193 (47%) completed a 6MWD test after hospital discharge. Cox proportional hazards regression was used to estimate the risk of nonrelapse mortality (NRM) and overall survival (OS) according to the 6MWD category (<400 m vs. ≥400 m) and the change in 6MWD (before HCT to discharge) with or without adjustment for Karnofsky performance status (KPS), age, and other prognostic markers. Compared with <400 m, the unadjusted hazard ratio for NRM was 0.65 (95% confidence interval, 0.44-0.96) for a 6MWD ≥400 m. A 6MWD of ≥400 m provided incremental information on the prediction of NRM with adjustment for age (p = .032) but not KPS alone (p = .062) or adjustment ...

Background. Although most states have infant restraint laws, booster seat legislation for older c... more Background. Although most states have infant restraint laws, booster seat legislation for older children has not been implemented universally despite evidence of effectiveness. We examined incidence and expenditures for motor vehicle (MV) occupant injury among 3 to 8 year olds covered vs. uncovered by booster seat legislation. Methods. Age, state of residence/hospitalization, and month of injury were used to examine injury, deaths, and expenditures due to MV occupant injury in states with vs. without legislation. Unweighted KID-HCUP 2003 (hospitalizations), WISQARS (fatalities), and census-based denominators were used to estimate outcomes and hospital expenditures by law coverage. Results. Children covered by booster seat legislation were less likely to be hospitalized for MV occupant injury than non-covered children (Odds ratio, 95% CI, 0.78, 0.69-0.88). The majority of mortality (71.7%) occurred in those below median income in both uncovered and covered children (76.4% vs. 58.4%, ...

Background. Although falls from windows result in serious pediatric trauma, prevention advocates ... more Background. Although falls from windows result in serious pediatric trauma, prevention advocates report obstacles to developing policies and regulations sufficiently strong to prevent childhood death and disability associated with this mechanism. Methods. We reviewed all available data, legal cases and news articles (1965-2005) and categorized the 40-year evolution of the New York City Department of Health and Mental Hygiene's best practices window fall program into 6 programmatic eras: 1) initiation of surveillance with failed regulation; 2) demonstration program with education and free product distribution/installation; 3) legal challenge of passed regulation; 4) regulation with obstacles and minimal enforcement; 5) regulation with intensified enforcement including criminal prosecutions; and 6) expanded responsibility/liability to owners/boards of directors of multi-family dwellings. Results. Each successive programmatic era was associated with additional improvement in annual...

The Journal of Trauma: Injury, Infection, and Critical Care, 2009

Although most states have infant restraint laws, booster seat legislation for older children has ... more Although most states have infant restraint laws, booster seat legislation for older children has not been implemented universally despite evidence of effectiveness. We examined injury and expenditures for motor vehicle traffic (MV) occupant injury among 3 year to 8 year olds covered versus uncovered by booster seat legislation. Age, state of residence/hospitalization, and month of injury were used to examine injury, deaths, and expenditures due to MV occupant injury in children covered versus uncovered by booster seat legislation. Data sources included Kids Inpatient Database 2003 and Web-based Injury Statistics Query and Reporting System. Statistical analyses used chi, Fisher&amp;amp;amp;amp;amp;amp;#39;s exact, and analysis of variance. Odds ratios were calculated with 95% confidence intervals (CI). Children covered by booster seat legislation were less likely to be hospitalized for MV occupant injury than uncovered children (odds ratio, 0.78; 95% CI, 0.69-0.88). MV occupant injury constituted a smaller proportion of total injury expenditures in children covered (4.9%) versus uncovered (6.9%) by booster seat legislation. Covered children residing in areas with zip code incomes above the median had 26% lower MV occupant/total injury (p = 0.001) compared with 13% lower MV occupant/total injury for those below the median income (p = 0.0712). The proportion of injury dollars spent for MV occupant injury was higher in self-pay children for covered (7.8%) and uncovered (8.9%) children. This study suggests that booster seat laws are associated with a lower proportion of injury expenditures for MV occupant injuries in booster seat-aged children. Observed income disparities raise questions regarding whether access to booster seats, quality of affordable seats, and proper use and/or enforcement strategies impede legislative effectiveness.

The Journal of Trauma: Injury, Infection, and Critical Care, 2007

Examination of expenditures in areas where more universal application of effective injury prevent... more Examination of expenditures in areas where more universal application of effective injury prevention approaches is indicated could identify specific mechanisms and age groups where effective intervention may impact public injury-related expenditures. The Healthcare Cost and Utilization Project 2003 (KID-HCUP) contains acute care hospitalization data for U.S. children and adolescents residing in 36 states. The study population includes 240,248 unweighted (397,943 weighted) injury-related hospital discharges for ages 0 to 19 years. Injury severity was assessed using ICDMAP-90 and International Classification of Injury Severity Scores (ICISS). SUDAAN was employed to adjust variances for stratified sampling. Expenditures were weighted to represent the U.S. population. Injury-related hospitalizations (mean 28,137+/−64,420,median28,137 +/- 64,420, median 28,137+/−64,420,median10,808) were more costly than non-injury discharges, accounting for approximately 10% of all persons hospitalized (unweighted), but more than one-fifth of expenditures. Public sources were the primary payor for 37.7% of injured persons. Incidence and cost per case variations across specific injury mechanisms heavily influenced total mechanism specific expenditures. Motor vehicle crashes were the largest expenditures for private and public payors with two thirds of expenditures in teenagers - more than 40% for drivers. Medicaid covered 45.6% ($192 million) of burn expenditures and 59.2% in 0-4 year olds. Expenditures per case (mean +/- SD, median) were: firearm ($36,196 +/- 58,052, 19,020),motorvehicledriver(19,020), motor vehicle driver (19,020),motorvehicledriver(33,731 +/- 50,583, 18,431),pedestrian(18,431), pedestrian (18,431),pedestrian(31,414 +/- 57,103, 16,552);burns(16,552); burns (16,552);burns(29,242 +/- 64,271, 10,739);falls(10,739); falls (10,739);falls(13,069 +/- 20,225, 8,610);andpoisoning(8,610); and poisoning (8,610);andpoisoning(8,290 +/- 15,462,15,462, 15,462,5,208). More universal application of proven injury prevention has the potential to decrease both the public and private health expenditure burden among several modifiable injury mechanisms.

The Journal of Trauma: Injury, Infection, and Critical Care, 2011

Gender and racial disparities in injury mortality have been well established, but less is known r... more Gender and racial disparities in injury mortality have been well established, but less is known regarding differences in fracture-related hospitalizations across the age span. Cross-sectional analysis of annual incident fracture hospital admissions used statewide acute care hospital discharge data (Statewide Program and Research Cooperative System) for non-Hispanic White (n = 138,763) and non-Hispanic Black (n = 19,588) residents of New York State between 2000 and 2002. US census data with intercensal estimates were used to ascertain the population at risk. Gender- and race-specific incident fracture was calculated in 5-year age intervals. The χ test was used to analyze categorical variables. Mechanisms of injury vary by race and gender in their relative contribution to injury-related fractures across the age span. Black males exhibited higher fracture incidence until approximately age 62, while incidence in women diverged around age 45. Total motor vehicle traffic-related fracture hospitalization is bimodal in Whites but not in Blacks. Over the life span, all groups exhibited bimodal pedestrian fractures with pedestrian fractures accounting for 8.8% and 2.5% of all fractures in Blacks and Whites, respectively. Racial disparities were present from preschool through age 70. Violence-related fractures were 10 times higher in Blacks, accounting for 18.2% of hospitalizations. Black males exhibit higher fracture incidence due to violence by age 5 and higher gun violence by age 10; both remain elevated through age 75. Despite historical studies demonstrating higher bone density in Blacks, this study found racial disparities with increased fracture risk in both Black children and adults across most nonfall-related injury mechanisms examined.

The Journal of Trauma: Injury, Infection, and Critical Care, 2010

Delivery of effective primary, secondary, and tertiary injury prevention in homeless populations ... more Delivery of effective primary, secondary, and tertiary injury prevention in homeless populations is complex and could be greatly aided by an improved understanding of contributing factors. Injury and health conditions were examined for hospitalized New York City homeless persons (n = 326,073) and low socioeconomic status (SES) housed residents (n = 1,202,622) using 2000 to 2002 New York statewide hospital discharge data (Statewide Program and Research Cooperative System). Age- and gender-adjusted odds ratios with 95% confidence intervals were calculated within age groups of 0.1 years to 9 years, 10 years to 19 years, 20 years to 64 years, and ≥65 years, with low SES housed as the comparison group. Comorbid conditions, injury, and injury mechanisms varied by age, gender, race or ethnicity, and housing status. Odds of unintentional injury in homeless versus low SES housed were higher in younger children aged 0 years to 9 years (1.34, 1.27-1.42), adults (1.13, 1.09-1.18), and elderly (1.25, 1.20-1.30). Falls were increased by 30% in children, 14% in adolescents or teenagers, and 47% in the elderly. More than one-quarter (26.9%) of fall hospitalizations in homeless children younger than 5 years were due to falls from furniture with more than threefold differences observed in both 3 year and 4 year olds (p = 0.0001). Several comorbid conditions with potential to complicate injury and postinjury care were increased in homeless including nutritional deficiencies, infections, alcohol and drug use, and mental disorders. Although homelessness presents unique, highly complex social and health issues that tend to overshadow the need for and the value of injury prevention, this study highlights potentially fruitful areas for primary, secondary, and tertiary prevention.

Child: Care, Health and Development, 2007

OBJECTIVE. Mortality trends across modifiable injury mechanisms may reflect how well effective in... more OBJECTIVE. Mortality trends across modifiable injury mechanisms may reflect how well effective injury prevention efforts are penetrating high-risk populations. This study examined all-cause, unintentional, and intentional injury-related mortality in children who were aged 0 to 4 years for evidence of and to quantify racial disparities by injury mechanism. METHODS. Injury analyses used national vital statistics data from January 1, 1981, to December 31, 2003, that were available from the Centers for Disease Control and Prevention. Rate calculations and 2 test for trends (Mantel extension) used data that were collapsed into 3-year intervals to produce cell sizes with stable estimates. Percentage change for mortality rate ratios used the earliest (1981-1983) and the latest (2001-2003) study period for black, American Indian/Alaskan Native, and Asian/Pacific Islander children, with white children as the comparison group. RESULTS. All-cause injury rates declined during the study period, but current mortality ratios for all-cause injury remained higher in black and American Indian/ Alaskan Native children and lower in Asian/Pacific Islander children compared with white children. Trend analyses within racial groups demonstrate significant improvements in all groups for unintentional but not intentional injury. Black and American Indian/Alaskan Native children had higher injury risk as a result of residential fire, suffocation, poisoning, falls, motor vehicle traffic, and firearms. Disparities narrowed for residential fire, pedestrian, and poisoning and widened for motor vehicle occupant, unspecified motor vehicle, and suffocation for black and American Indian/Alaskan Native children. CONCLUSIONS. These findings identify injury areas in which disparities narrowed, improvement occurred with maintenance or widening of disparities, and little or no progress was evident. This study further suggests specific mechanisms whereby new strategies and approaches to address areas that are recalcitrant to improvement in absolute rates and/or narrowing of disparities are needed and where increased dissemination of proven efficacious injury prevention efforts to high-risk populations are indicated.

Archives of Physical Medicine and Rehabilitation, 2014

(1) To identify English-language published patient-reported upper extremity outcome measures used... more (1) To identify English-language published patient-reported upper extremity outcome measures used in breast cancer research and (2) to examine construct validity and responsiveness in patient-reported upper extremity outcome measures used in breast cancer research. PubMed, Cumulative Index to Nursing and Allied Health Literature, and ProQuest MEDLINE databases were searched up to February 5, 2013. Studies were included if a patient-reported upper extremity outcome measure was administered, the participants were diagnosed with breast cancer, and the study was published in English. A total of 865 articles were screened. Fifty-nine full text articles were assessed for eligibility. A total of 46 articles met the initial eligibility criteria for aim 1. Eleven of these articles reported means and SDs for the outcome scores and included a comparison group analysis for aim 2. Construct validity was evaluated by calculating effect sizes for known-group differences in 6 studies using the Disabilities of Arm, Shoulder and Hand (DASH), University of Pennsylvania Shoulder Score, Shoulder Disability Questionnaire-Dutch, and 10 Questions by Wingate. Responsiveness was analyzed comparing a treatment and control group by calculating the coefficient of responsiveness in 5 studies for the DASH and 10 Questions by Wingate. Eight different patient-reported upper extremity outcome measures have been reported in the peer-review literature for women with breast cancer; some that were specifically developed for breast cancer survivors (n=3) and others that were not (n=5). Based on the current evidence, we recommend administering the DASH to assess patient-reported upper extremity function in breast cancer survivors because the DASH has the most consistently large effects sizes for construct validity and responsiveness. Future large studies are needed for more definitive recommendations.