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Volume 104, Issue 1 (January 2005)


 
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Editorials

Thomas C. Meyer, MD Medical Editor, Wisconsin Medical Society
Injury prevention: Part 1
(full text PDF)

Michael C. Reineck, MD
Falls—the great silent killer
(full text PDF)

As physicians, we are well aware of the toll heart disease, smoking, and cancer have on our patients. But there’s another less visible killer we need to recognize. It’s falling, especially among our older citizens. As an orthopaedic surgeon, even I was surprised to learn that Wisconsin has one of the highest mortality rates from falls in the whole country! That’s why I chose to highlight this issue as my presidential theme.

Timothy E. Corden, MD; Ann L. Christiansen, MPH; Stephen W. Hargarten, MD, MPH
Injury: A disease that affects all of society
(full text PDF)

The economics of health care is a significant challenge for all of society. On an individual level, nothing is more valued than good health. Yet how much can a society spend on health care, and where does the funding come from? Disease prevention offers the hope of reducing the cost of health care by leading to a healthier society, with decreased need for expensive disease therapy. This issue of the Wisconsin Medical Journal focuses on the “disease” of injury and presents evidence-based information on how injury is affecting the lives of people in Wisconsin and the nation, while offering approaches of how to decrease the burden of injury through prevention measures. Many still view “injuries” as “accidents,” things that “just happen,” or random “bad luck,” but injury, like other disease entities, is preventable and open to scientific methods of study.

Commentaries

Bridget Clementi
Making Wisconsin kids SAFE KIDS
(full text PDF)

The unintentional injury-related death rate among children ages 14 and under nationwide declined more than 40 percent from 1987 to 2001. But the bad news is that unintentional injury remains the leading cause of death for this age group. More children die from what people call “accidents” (motor vehicle crashes, fires, drowning, and other injuries) than from any other cause.

Randall L. Glysch, MS; Linda J. Hale, RN, BSN; Carrie Nie, MPH; Stephen W. Hargarten, MD, MPH; Murray L. Katcher, MD, PhD
Wisconsin’s Violent Death Reporting System: Monitoring and responding to Wisconsin’s violent deaths
(full text PDF)

In 2003, the Centers for Disease Control and Prevention (CDC) awarded the Wisconsin Department of Health and Family Services, Injury Prevention Program, a grant to participate in a multistate project called the National Violent Death Reporting System (NVDRS). The purpose of the Wisconsin Violent Death Reporting System (WVDRS) is to link violent death records (death certificates, police reports, medical examiner and coroner reports, crime laboratories, and perhaps child fatality review teams) from the same event, promote more timely information retrieval, describe in detail circumstances that may have contributed to the violent death, and identify and characterize perpetrators and their relationships to victims. This article describes the development of WVDRS and its importance in understanding and preventing violent injury and death in Wisconsin.

Sarah Pierce, BS
Public Health: A fellowship in government and community service
(full text PDF)

Original Research

Jane E. Mahoney, MD; Randall L. Glysch, MS; Sheila M. Guilfoyle, BA; Linda J. Hale, RN, BSN; Murray L. Katcher, MD, PhD
Trends, Risk Factors, and Prevention of Falls in Older Adults in Wisconsin
(full text PDF)

Wisconsin’s death rate due to falls among adults 65 years and older is more than twice the national average. The hospitalization rate due to falls-related injuries in Wisconsin increased slightly from 1995 to 2002, with an injury rate of 2159 per 100,000 in 1995, and 2263 per 100,000 in 2002. Emergency department (ED) utilization and hospitalization rates for falls-related injury are higher for women than for men in Wisconsin. In 2002, the total statewide charges for hospitalizations and ED visits for falls-related injuries were more than $96 million. Two thirds of those admitted to the hospital for a falls-related injury were discharged to a nursing home or rehabilitation facility. Multifactorial intervention strategies have been shown to decrease the rate of falls in randomized, controlled trials. The purpose of this paper is to describe trends in falls-related injury fatalities, hospitalizations, and ED visits in Wisconsin. Also included are cost data related to falls, identification of risk factors, and descriptions of the possible role of physicians and other health care professionals in interdisciplinary, multi-focal programs to prevent falls-related injuries in high-risk older adults.

Sheila M. Guilfoyle, BA; Linda J. Hale, RN, BSN
Community-Based Fall Prevention Programs for Older Adults in Wisconsin
(full text PDF)

Falls prevention and intervention programs are important strategies to reduce the considerable morbidity and mortality from falls in older adults in Wisconsin. This article attempts to dispel the common misperception that falls are a normal part of the aging process, to provide examples of prevention programs in Wisconsin targeted specifically to community-dwelling older adults, and to provide prevention messages for older adults and the health care and social or human services professionals that serve them.

Jeffrey W. Britton, MD, FAAP
Kids Can’t Fly: Preventing Fall Injuries in Children
(full text PDF)

Falls are the leading cause of unintentional injury in children. Pediatric fall injuries can be grouped into roughly 4 categories: (1) falls while walking or running, (2) falls from heights, (3) falls while participating in recreational activities, and (4) falls during competitive sports activities. Because injury statistics collected by the US Consumer Product Safety Commission are product-related, there is little data on falls from walking or running. Falling down stairs is the most common height-related fall injury, followed by playground-related falls. Bicycle-related injury leads the third category in frequency. Over 30% of parents report that their child has been injured while playing a team sport; although not all sports-related injuries are caused by falling, most result in a fall. Strategies for preventing fall injuries are based on finding risk factors that can be modified; these modifications can be pre-event, event-specific, or post-event. Office-based injury prevention counseling plays an important role in preventing pediatric fall injury.

Lisa A. Uherick, MD; Marlene D. Melzer-Lange, MD; Sarah E. Pierce, BS
Give Wisconsin Children a Boost
(full text PDF)

In the United States, more children die from motor vehicle crashes than any other cause. Research has demonstrated that children ages 4-8 have a significantly reduced risk of injury if they are restrained in booster seats rather than adult seatbelts. Despite current recommendations, few children in this age group are properly restrained. Health care providers can help increase booster seat use by educating parents, participating in community campaigns, and advocating for mandatory booster seat laws.

Timothy E. Corden, MD
Analysis of Booster Seat and Seat Belt Use: How Many Wisconsin Childhood Deaths and Hospitalizations Could Have Been Prevented in 1998–2002?
(full text PDF)

Background: Motor vehicle collisions (MVC) remain the leading cause of childhood death and injury in Wisconsin and throughout the nation. The objective of this study is to estimate the potential benefits of increased use of belt-positioning booster (BPB) seats for children ages 4-7, and increased seat belt use for children ages 8-18.5 years. The outcomes measured were the reduction in MVC-associated childhood deaths and hospitalizations as a result of increased use of BPB seats or seat belts.

Method: Childhood MVC-associated deaths and hospitalizations from 1998 to 2002 were obtained from the Wisconsin Interactive Statistics on Health (WISH) data query system. Three separate age groups were analyzed: children ages 4-7, 8-15, and 16-18.5 years. Ages for the groups were designed to match current “best practice” recommendations for the use of BPB seats, published age-range specific baseline restraint use data, and age specific mortality/injury relative risk (RR) values as closely as possible for a pediatric population. Population attributable risk (PAR) was calculated to predict preventable deaths and injuries (hospitalizations) over the years studied.

Results: From 1998 to 2002, MVCs accounted for 440 childhood deaths and 2639 injuries requiring hospital admission. Using the calculated PAR population statistic for each age group studied, the predicted reduction in childhood MVC deaths and hospitalizations were calculated for various increases in restraint use above current baseline compliance. At the 100% use level, the model predicted 16 fewer deaths and 84 fewer hospitalizations for children 4-7 years old (BPB seat use); 45 fewer deaths and 206 fewer hospitalizations for children 8-15 years old (seat belt use); and 119 fewer deaths and 669 fewer hospitalizations for children 16-18.5 years old (seat belt use). The total potentially avoided deaths and hospitalizations across all age groups studied was 180 childhood deaths and 959 hospitalizations during this 5-year study period.

Conclusion: Communities should devote resources to public education programs directed at increasing the use of belt-positioning booster seats for children 4-7 years old and seat belts for older children. Evidence-based child passenger safety laws should be improved and enforced in Wisconsin in an effort to support families in their attempts to safeguard their children. With a multi-component child passenger restraint safety campaign, unnecessary MVC-associated childhood deaths and injuries can be avoided in the future.

Sarah E. Pierce, BS; Marlon P. Mundt, MS; Nan M. Peterson, RN, MS; Murray L. Katcher, MD, PhD
Improving Awareness and Use of Booster Seats in Head Start Families
(full text PDF)

Objectives: To determine the knowledge level of Head Start providers, parents, and students about booster seats and to directly observe booster seat use before and after a combined educational program and booster seat giveaway. Methods: Before and after a short educational session and child safety seat giveaway, Head Start providers and parents received a brief questionnaire on booster seats and the state child restraint law. Direct parking-lot observation of booster seat use was performed before and after the giveaway. Results: Forty-three students were enrolled in the study, with 33 receiving booster seats and 5 receiving forward-facing car seats, dependent on the weight and age of the child. Before the study, 15 (35%) of the children had weight/age appropriate child safety seats; after the giveaway, this number increased to 42 (98%; P<0.001). The proportion of children observed using booster seats before the giveaway was 6%, which increased to 34% after the giveaway (P<0.001). Conclusions: This study indicates that a booster seat giveaway can be successful in increasing the number of children who use booster seats; however, the majority (66%) of participating children still rode inappropriately restrained after the giveaway. Steps beyond providing booster seats, such as combining this intervention with ongoing parent and community education efforts, as well as legislation and enforcement, are needed to bring booster seat use to a high level. The information from this study may be helpful in designing future programs intended to increase booster seat use, as well as emphasizing the need for booster seat legislation. Gwen McIntosh, MD, MPH
Wisconsin’s Experience with the Graduated Driver Licensing Law
(full text PDF)

In 2000, Wisconsin enacted the Graduated Driver Licensing (GDL) Law in an effort to reduce the number of teen deaths and injuries due to motor vehicle crashes. The GDL program targets high-risk teen driving behaviors by mandating more hours of supervised driving, limiting nighttime driving, restricting vehicle passengers, requiring seatbelt use, and mandating absolute sobriety for all teen drivers. In the first 3 years of graduated driver licensing, Wisconsin saw a 15% decrease in the number of motor vehicle collisions involving 16-year-old drivers. While this decline is encouraging, it lags behind the effectiveness documented by other states with GDL laws. The current study evaluates informational or attitudinal barriers that may prevent the effective implementation of Wisconsin’s GDL law. Knowledge and attitude surveys were administered to 15-17 year olds and their parents. Parents (n=26) and teens (n=26) were knowledgeable about the 30 hours of supervised driving during the learner’s permit phase and extremely knowledgeable about the 9-month nighttime and passenger restrictions of the probationary phase. While 76% of parents supported GDL, 70% of teens disapproved of the law. The reasons for disapproval varied, parents often cited inconvenience and restrictiveness. Teens most often cited passenger restrictions as the reason for disapproval. Overall, negative attitudes, more than lack of knowledge, may weaken compliance with Wisconsin’s GDL law and, in turn, limit the reduction of teen crashes.

Marlene D. Melzer-Lange, MD; Rebecca W. Cohen, MS, BFA, WMTR; Paul M. Grossberg, MD; Camilla K. B. Matthews, MD; Wendi Heuermann, MPA; Katherine J. Kocs, MSW; Linda J. Hale, RN, BSN; Claude Gilmore, MSSW, MHSA
Bullying Prevention: Wisconsin Takes a Stand
(full text PDF)

Bullying in our schools and neighborhoods is a significant problem for our youth. Over the past decade, professionals in Wisconsin from education, medicine, psychology, public health, and social work have worked to prevent bullying among our youth as part of a larger violence prevention effort. In this paper, we will provide an update on many of these efforts, including an overview of victimization and mental health implications; the impact of gender roles; and discussion of several bullying prevention initiatives, including a new prevention program in Southeastern Wisconsin, a school-based program being implemented across Wisconsin, and an update on the state health plan’s bully prevention components. Finally, this article provides a number of resources for professionals and families to learn more about prevention of bullying in Wisconsin and the United States, and strategies for future bullying prevention.

Thomas Shiffler, MD; Stephen W. Hargarten, MD, MPH; Richard L. Withers, JD
The Burden of Suicide and Homicide of Wisconsin’s Children and Youth
(full text PDF)

Objective: To describe the epidemiology of violent deaths (suicides and homicides) of children and youth in Wisconsin. Methods: Linked data from death certificates, coroners or medical examiners, Uniform Crime Reports, police case reports and crime laboratories were analyzed using SPSS 11.5. Analyses from 2000 to 2002 describe suicides and homicides of children and youth under age 25. Rates are per 100,000 population per year. Results: A total of 585 persons under age 25 in Wisconsin died from suicide or homicide during 2000-2002. Suicides outnumbered homicides 323 (55%) to 262 (45%). Firearms were involved in 59% (n=344) of cases. Fatality rates increased with advancing age, ranging from 2.0 in 0-13 year olds to 26.9 in youth age 21-24. There were over twice as many violent deaths compared to cancer and infectious disease deaths combined (n=253). Conclusion: Suicides and homicides are a significant burden on the children and youth of Wisconsin. An investment in reducing this burden requires comprehensive data and informed programs and policies. We recommend that physicians and public health community leaders collaborate with the criminal justice community and policy makers to develop, implement, and evaluate prevention programs and policies.

Your Practice

Jay A. Gold, MD, JD, MPH
The surgical care improvement project
(full text PDF)

MetaStar, along with other Medicare Quality Improvement Organizations nationwide, soon will be working in Wisconsin to implement the Surgical Care Improvement Project (SCIP), a partnership whose goal is to reduce the incidence of surgical complications by 25% by 2010.

Your Profession

Michael J. Dunn, MD, Dean and Executive Vice President, Medical College of Wisconsin
Medical College faculty provide national leadership in injury control and prevention
(full text PDF)

Injury prevention is best achieved through a better understanding of how and why injuries occur. Not long ago, injuries were viewed as accidents or random acts of circumstance, outside the scope of human intervention. Early injury research changed that flawed, fatalistic view, exposing injury as a disease influenced by risk factors like any other threat to human health.

Your Society

L. H. Prince, MD, Palmyra, Wis, Wisconsin Medical Journal, 1904;(3)4:254-257
Osteosarcoma of the Humerus with removal of the arm, clavicle and scapula; death from sarcoma of lung nine months later
(full text PDF)

A. W., a young man of nineteen years, of Palmyra, Wis., was referred to me by Dr. Keithley, April 9, 1903, for operation. I saw the case with Dr. Keithley a few weeks prior to this, at which time sarcoma was diagnosed and operation advised and rejected…

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