Background and objective This project links population data to the Wisconsin Violent Death Reporting System (WVDRS) to determine the extent to which firearm possession criteria are being followed as well as the potential impact of the adoption of proposed possession criteria. Design and study population Criminal justice data for WVDRS homicide suspects and victims and suicide decedents 2008-2011 and a sample of matched control group of driver's license holders (to characterise the state population) will be abstracted. Methods Individual legal possession statuses (prohibited/not prohibited) under each current and expanded criterion will be determined. Proportions of interest will be calculated from two-way contingency tables, and tests between groups with categorical variables (eg, criterion is met or not) will be performed with Fisher's exact or binomial proportion tests. Tests between groups with continuous variables (eg, number of misdemeanours) will be performed by zero inflated negative binomial regression. Area under the receiver operating characteristic curve will be used to quantify the prediction accuracy of specific univariate or multivariate logistic model for prediction. Inverse probability weighting will be used for analyses that extend from matched controls to the general state population of license holders. Discussion Linked data sets and partnerships are challenging, but necessary for comprehensive public health research. Results of this study will contribute knowledge on the proportion of prohibited suspects and suicide decedents that used firearms in violent deaths and, if applying expanded criteria would have increased prohibited persons. This study will also investigate risk and protective factors for being a victim of homicide.

The objectives of the study are to understand road safety within the context of regional development processes and to assess how urban-rural categories represent differences in motor vehicle occupant fatality risk. We analysed 2015 motor vehicle occupant deaths in Wisconsin from 2010 to 2014, using three definitions of urban-rural continua and negative binomial regression to adjust for population density, travel exposure and the proportion of teen residents. Rural-Urban Commuting Area codes, Beale codes and the Census definition of urban and rural places do not explain differences in urban and rural transportation fatality rates when controlling for population density. Although it is widely believed that rural places are uniquely dangerous for motorised travel, this understanding may be an artefact of inaccurate constructs. Instead, population density is a more helpful way to represent transportation hazards across different types of settlement patterns, including commuter suburbs and exurbs.

In both developing and advanced economies, it is commonly believed that lower income and minority populations are disproportionately at risk of being injured or killed in a motor vehicle crash, especially as pedestrians. However, this risk is rarely quantified with information about exposure. We argue that a combined transportation–population health framework is one way to quantify, and therefore prioritize, equity considerations in transportation safety decision-making. We illustrate this approach with an analysis that compares age-adjusted fatal and nonfatal injury rates per 100 million person-trips by race/ethnicity and sex for motor vehicle occupants, bicyclists, and pedestrians. We found that, per trip, whites are equally safe as pedestrians and motor vehicle occupants, whereas other racial and ethnic groups for whom we have data are less safe when they walk. In addition, black/African-American female motor vehicle occupants and pedestrians have higher inpatient injury risk than female travelers of other races and ethnicities (for whom we had sufficient data). Such differences in transportation injury risk by race and ethnicity warrant deeper analysis to understand the underlying reasons, such as whether certain groups of travelers are exposed to qualitatively different hazards when they travel. We discuss frameworks for including information about injury disparities in decision-making.

Urban and rural places are integrated through economic ties and population flows. Despite their integration, most studies of road safety dichotomize urban and rural places, and studies have consistently demonstrated that rural places are more dangerous for motorists than urban places. Our study investigates whether these findings are sensitive to the definition of urban and rural. We use three different definitions of urban-rural continua to quantify and compare motor vehicle occupant fatality rates per person-trip and person-mile for the state of Wisconsin. The three urban-rural continua are defined by: (1) popular impressions of urban, suburban, and rural places using a system from regional economics; (2) population density; and (3) the intensity of commute flows to core urbanized areas. In this analysis, the three definitions captured different people and places within each continuum level, highlighting rural heterogeneity. Despite this heterogeneity, the three definitions resulted in similar fatality rate gradients, suggesting a potentially latent "rural" characteristic. We then used field observations of urban-rural transects to refine the definitions. When accounting for the presence of higher-density towns and villages in rural places, we found that low-density urban places such as suburbs and exurbs have fatality rates more similar to those in rural places. These findings support the need to understand road safety within the context of regional development processes instead of urban-rural categories.

An ombuds is an individual who informally helps people or groups (visitors) resolve disputes and/or interpersonal conflicts as an alternative to formal dispute resolution mechanisms within an organization. Ombuds are nearly ubiquitous in many governmental, business, and educational settings but only recently have gained visibility at medical schools. Medical schools in the United States are increasingly establishing ombuds offices as part of comprehensive conflict management systems to address concerns of faculty, staff, students, and others. As of 2015, more than 35 medical schools in the United States have active ombuds Web pages. Despite the growing number of medical schools with ombuds offices, the literature on medical school ombuds offices is scant. In this article, the authors review the first three years of experience of the ombuds office at the Medical College of Wisconsin, a freestanding medical and graduate school with a large physician practice. The article is written from the perspective of the inaugural ombuds and the president who initiated the office. The authors discuss the rationale for, costs of, potential advantages of, and initial reactions of faculty, staff, and administration to having an ombuds office in an academic medical center. Important questions relevant to medical schools that are considering an ombuds office are discussed. The authors conclude that an ombuds office can be a useful complement to traditional approaches for conflict management, regulatory compliance, and identification of systemic issues.

OBJECTIVES:We examined whether community translation of an effective evidence-based fall prevention program via standard monetary support can produce a community-wide reduction in fall injuries in older adults and evaluated whether an enhanced version with added technical support and capacity building amplified the fall reduction effect.METHODS:We completed a randomized controlled community trial among adults aged 65 and older in (1) 10 control communities receiving no special resources or guidance on fall prevention, (2) 5 standard support communities receiving modest funding to implement Stepping On, and (3) 5 enhanced support communities receiving funding and technical support. The primary outcome was hospital inpatient and emergency department discharges for falls, examined with Poisson regression.RESULTS:Compared with control communities, standard and enhanced support communities showed significantly higher community-wide reductions (9% and 8%, respectively) in fall injuries from baseline (2007-2008) to follow-up (2010-2011). No significant difference was found between enhanced and standard support communities.CONCLUSIONS:Population-based fall prevention interventions can be effective when implemented in community settings. More research is needed to identify the barriers and facilitators that influence the successful adoption and implementation of fall prevention interventions into broad community practice.

Unintentional falls increase morbidity and mortality in older adults. The consequences of falls for older adults and their families and communities support the need for evidence-based fall prevention programming that can be implemented effectively on a community-wide basis. However, translating research findings into communities is an ongoing challenge for public health. The Interactive Systems Framework for Dissemination and Implementation describes systems that can help bridge this gap between science and practice. The current study describes the process of implementing a randomized community trial to assess whether a prevention support system (i.e., enhanced support system) that builds capacity through the provision of technical assistance, best practice guides, and direct consultation can successfully bridge the gap between injury prevention and control research and the implementation of an evidence-driven, community-based fall prevention program, Stepping On. Evaluation results demonstrating the effectiveness of the Stepping On program are also presented.

We examined the association between neighborhood-level factors and intimate partner femicide (IPF) using Wisconsin Violent Death Reporting System (WVDRS) data and Wisconsin Coalition Against Domestic Violence (WCADV) reports, in concert with neighborhood-level information. After controlling for individual characteristics, neighborhood-level disadvantage was associated with a decreased likelihood of IPF status, as compared with other femicides, whereas neighborhood-level residential instability was associated with an increased likelihood of IPF status. Neighborhood plays a role in differentiating IPFs from other femicides in our study area. Our findings demonstrate the importance of multilevel strategies for understanding and reducing the burden of intimate partner violence.

Study ObjectivesPrescription drug poisonings are an increasing cause of morbidity and mortality in the United Sates, driven in particular by opioid poisoning. Older individuals are particularly at risk of poisoning due to the use of opioids for chronic pain and polypharmacy. This study aimed to demonstrate that older adults are at increased risk of prescription drug poisoning that results in morbidity compared to other age groups.MethodsWisconsin emergency department and inpatient hospitalization records and death certificates were used to perform a retrospective cohort analysis of medication-related poisonings from 2005-2010. Incidents were categorized by sex, agent (opioid or non-opioid), and intent (unintentional or intentional). Rates of opioid and non-opioid poisoning per 100,000 person years, case hospitalizations rates (%), and case fatality rates (%), were analyzed for age groups <15, 15-17, 18-24, 25-34, 35-44, 45-54, 55-64, 65-74, 74-85, 85+.ResultsOpioid poisonings were found to have a significant 4-fold higher case fatality rate compared to non-opioid poisonings (14.0% versus 3.5% overall), and this trend held true for both men and women and within each age group. The incidence of inpatient hospitalization as a result of opioid poisoning increased consistently with increasing age (range: 26.0-78.5). Intentional poisonings with non-opioids were more likely to be treated as inpatients than unintentional non-opioid poisoning events (54.6 versus 34.6). Older adults with drug poisoning were more likely to be treated as inpatients than younger people, regardless of intentionality or agent.ConclusionPoisoning with opioid medications lead to significantly more morbidity and mortality than non-opioid medications for all age groups. Older individuals are particularly at risk of significant morbidity as a result of opioid medication poisoning as indicated by higher hospitalization rates; these hospitalizations lead to increased health care utilization for a population and increased pressure on its social support programs that are already burdened with high health care expenditures. Study ObjectivesPrescription drug poisonings are an increasing cause of morbidity and mortality in the United Sates, driven in particular by opioid poisoning. Older individuals are particularly at risk of poisoning due to the use of opioids for chronic pain and polypharmacy. This study aimed to demonstrate that older adults are at increased risk of prescription drug poisoning that results in morbidity compared to other age groups. Prescription drug poisonings are an increasing cause of morbidity and mortality in the United Sates, driven in particular by opioid poisoning. Older individuals are particularly at risk of poisoning due to the use of opioids for chronic pain and polypharmacy. This study aimed to demonstrate that older adults are at increased risk of prescription drug poisoning that results in morbidity compared to other age groups. MethodsWisconsin emergency department and inpatient hospitalization records and death certificates were used to perform a retrospective cohort analysis of medication-related poisonings from 2005-2010. Incidents were categorized by sex, agent (opioid or non-opioid), and intent (unintentional or intentional). Rates of opioid and non-opioid poisoning per 100,000 person years, case hospitalizations rates (%), and case fatality rates (%), were analyzed for age groups <15, 15-17, 18-24, 25-34, 35-44, 45-54, 55-64, 65-74, 74-85, 85+. Wisconsin emergency department and inpatient hospitalization records and death certificates were used to perform a retrospective cohort analysis of medication-related poisonings from 2005-2010. Incidents were categorized by sex, agent (opioid or non-opioid), and intent (unintentional or intentional). Rates of opioid and non-opioid poisoning per 100,000 person years, case hospitalizations rates (%), and case fatality rates (%), were analyzed for age groups <15, 15-17, 18-24, 25-34, 35-44, 45-54, 55-64, 65-74, 74-85, 85+. ResultsOpioid poisonings were found to have a significant 4-fold higher case fatality rate compared to non-opioid poisonings (14.0% versus 3.5% overall), and this trend held true for both men and women and within each age group. The incidence of inpatient hospitalization as a result of opioid poisoning increased consistently with increasing age (range: 26.0-78.5). Intentional poisonings with non-opioids were more likely to be treated as inpatients than unintentional non-opioid poisoning events (54.6 versus 34.6). Older adults with drug poisoning were more likely to be treated as inpatients than younger people, regardless of intentionality or agent. Opioid poisonings were found to have a significant 4-fold higher case fatality rate compared to non-opioid poisonings (14.0% versus 3.5% overall), and this trend held true for both men and women and within each age group. The incidence of inpatient hospitalization as a result of opioid poisoning increased consistently with increasing age (range: 26.0-78.5). Intentional poisonings with non-opioids were more likely to be treated as inpatients than unintentional non-opioid poisoning events (54.6 versus 34.6). Older adults with drug poisoning were more likely to be treated as inpatients than younger people, regardless of intentionality or agent. ConclusionPoisoning with opioid medications lead to significantly more morbidity and mortality than non-opioid medications for all age groups. Older individuals are particularly at risk of significant morbidity as a result of opioid medication poisoning as indicated by higher hospitalization rates; these hospitalizations lead to increased health care utilization for a population and increased pressure on its social support programs that are already burdened with high health care expenditures. Poisoning with opioid medications lead to significantly more morbidity and mortality than non-opioid medications for all age groups. Older individuals are particularly at risk of significant morbidity as a result of opioid medication poisoning as indicated by higher hospitalization rates; these hospitalizations lead to increased health care utilization for a population and increased pressure on its social support programs that are already burdened with high health care expenditures.

OBJECTIVE:To determine the association of neck dissection and radiation treatment for head and neck cancer (HNC) with subsequent shoulder range of motion (ROM) and quality of life (QOL) in 5-year survivors.DESIGN:A cross-sectional convenience sample.SETTING:Otolaryngology clinics at tertiary care hospital and Veterans Affairs medical center.PATIENTS:Five-year, disease-free survivors of HNC.METHODS:Demographic and cancer treatment information was collected, including type of neck dissection (none, spinal accessory "nerve sparing," and "nerve sacrificing") and radiation. QOL questionnaires were administered, and shoulder ROM was measured.MAIN OUTCOME MEASUREMENTS:University of Washington Quality of Life (UWQOL), Functional Assessment of Cancer Therapy (FACT) Head and Neck, and Performance Status Scale for Head and Neck. Shoulder ROM measurements included abduction, adduction, flexion, extension, internal and external rotation.RESULTS:One hundred and five survivors completed QOL surveys; 85 survivors underwent additional shoulder ROM evaluations. The nerve sacrifice group exhibited significantly poorer scores for UWQOL measures of disfigurement, level of activity, recreation and/or entertainment, speech and shoulder disability, and willingness to eat in public, FACT functional well-being, and FACT Head and Neck (P < .05). Shoulder ROM for flexion and abduction was poorest in the nerve sacrifice group (P < .05). Radiation was associated with significantly worse UWQOL swallowing (P < .05), but no other differences were found for QOL or ROM measurements. Decreased QOL scores were associated with decreased shoulder flexion and abduction (P < .05). Survivors with decreased shoulder abduction had significantly (P < .05) worse scores in disfigurement, recreation and/or entertainment, employment, shoulder disability, and FACT emotional well-being.CONCLUSIONS:Sparing the spinal accessory nerve during neck dissection is associated with significantly less long-term shoulder disability in 5-year survivors of HNC. QOL measures demonstrated the highest level of function in the no dissection group, an intermediate level of functioning with nerve sparing, and poorest function when the nerve is sacrificed. Decreased shoulder flexion and abduction is associated with reduced QOL in long-term survivors of HNC.

Renewable energy production may offer advantages to human health by way of less pollution and fewer climate-change associated ill-health effects. Limited data suggests that renewable energy will also offer benefits to workers in the form of reduced occupational injury, illness and deaths. However, studies of worker safety and health in the industry are limited. The Mountain and Plains Education and Research Center (MAP ERC) Energy Summit held in April 2011 explored issues concerning worker health and safety in the renewable energy industry. The limited information on hazards of working in the renewable energy industry emphasizes the need for further research. Two basic approaches to guiding both prevention and future research should include: (1) applying lessons learned from other fields of occupational safety and health, particularly the extractive energy industry; and (2) utilizing knowledge of occupational hazards of specific materials and processes used in the renewable energy industry.

PURPOSE:A growing body of work examines the association between neighborhood environment and intimate partner violence (IPV). As in the larger literature examining the influence of place context on health, rural settings are understudied and urban and rural residential environments are rarely compared. In addition, despite increased attention to the linkages between neighborhood environment and IPV, few studies have examined the influence of neighborhood context on intimate partner femicide (IPF). In this paper, we examine the role for neighborhood-level factors in differentiating urban and rural IPFs in Wisconsin, USA.METHODS:We use a combination of Wisconsin Violent Death Reporting System (WVDRS) data and Wisconsin Coalition Against Domestic Violence (WCADV) reports from 2004 to 2008, in concert with neighborhood-level information from the US Census Bureau and US Department of Agriculture, to compare urban and rural IPFs.FINDINGS:Rates of IPF vary based on degree of rurality, and bivariate analyses show differences between urban and rural victims in race/ethnicity, marital status, country of birth, and neighborhood characteristics. After controlling for individual characteristics, the nature of the residential neighborhood environment significantly differentiates urban and rural IPFs.CONCLUSIONS:Our findings suggest a different role for neighborhood context in affecting intimate violence risk in rural settings, and that different measures may be needed to capture the qualities of rural environments that affect intimate violence risk. Our findings reinforce the argument that multilevel strategies are required to understand and reduce the burden of intimate violence, and that interventions may need to be crafted for specific geographical contexts.

OBJECTIVE To evaluate the feasibility, reliability, validity, and responsiveness of the Pediatric Quality of Life Inventory 4.0 Generic Core Scales (PedsQL) in the first 2 weeks after pediatric emergency department care of minor injury. DESIGN Prospective cohort study. SETTING Pediatric hospital emergency department. PARTICIPANTS Children and adolescents with minor injury (n = 334). MAIN OUTCOME MEASURES Child- and parent-reported clinical outcomes and PedsQL scale scores. RESULTS The PedsQL had good to excellent internal consistency reliability (α range, 0.73-0.93). For each day that the clinical symptoms persisted, there were consistent decreases in mean health-related quality of life (HRQOL) scores (validity testing). There were significantly greater negative changes in mean HRQOL scores for fractures vs soft-tissue injuries and for lower vs upper extremity injuries. Clinical outcomes categorized as poor had large negative changes in HRQOL not seen in good outcome groups. Distribution-based indicators of change supported good responsiveness (effect sizes for the physical summary score, 0.01-2.44; group differences at follow-up exceeded estimates of the minimal importance difference). CONCLUSIONS The PedsQL is feasible, reliable, and demonstrates good construct and discriminant validity and responsiveness in measuring short-term outcome after minor injury care in the pediatric emergency department. Assessing short-term outcome from the patient perspective with HRQOL measures may greatly enhance our ability to evaluate the effectiveness of emergency department care.

Objective: Falls are a leading cause of injury death. Stepping On is a fall prevention program developed in Australia and shown to reduce falls by up to 31%. The original program was implemented in a community setting, by an occupational therapist, and included a home visit. The purpose of this study was to examine aspects of the translation and implementation of Stepping On in three community settings in Wisconsin.Methods: The investigative team identified four research questions to understand the spread and use of the program, as well as to determine whether critical components of the program could be modified to maximize use in community practice. The team evaluated program uptake, participant reach, program feasibility, program acceptability, and program fidelity by varying the implementation setting and components of Stepping On. Implementation setting included type of host organization, rural versus urban location, health versus non-health background of leaders, and whether a phone call could replace the home visit. A mixed methodology of surveys and interviews completed by site managers, leaders, guest experts, participants, and content expert observations for program fidelity during classes was used.Results: The study identified implementation challenges that varied by setting, including securing a physical therapist for the class and needing more time to recruit participants. There were no implementation differences between rural and urban locations. Potential differences emerged in program fidelity between health and non-health professional leaders, although fidelity was high overall with both. Home visits identified more home hazards than did phone calls and were perceived as of greater benefit to participants, but at 1 year no differences were apparent in uptake of strategies discussed in home versus phone visits.Conclusion: Adaptations to the program to increase implementation include using a leader who is a non-health professional, and omitting the home visit. Our research demonstrated that a non-health professional leader can conduct Stepping On with adequate fidelity, however non-health professional leaders may benefit from increased training in certain aspects of Stepping On. A phone call may be substituted for the home visit, although short-term benefits are greater with the home visit.

OBJECTIVES:The objective was to estimate the fatal and nonfatal injury risk associated with inappropriate or no use of child restraint systems (CRS) for children younger than 13 years of age involved in motor vehicle crashes (MVC) in the United States.METHODS:This was a cross-sectional study of children aged 0 to 12 years involved in MVCs based on a nationally representative probability sample from 1996 to 2005 in the United States. A total of 7,633 children were included in the analysis, weighted to represent 3,798,830 children. Logistic regression models were used to examine the association between restraint use and fatal or nonfatal injury.RESULTS:In all age groups, failure to use a restraint increased the risk of fatal injury (odds ratio [OR] ranged from 9.81 to 23.79, all p < 0.05). In children aged 1 to 3 years, inappropriate use of a restraint was associated with fatal injury (OR = 6.28, 95% confidence interval [CI] = 2.40 to 16.48). Restrained children aged 4 to 7 years in rear seats with seat belts only (OR = 0.33, 95% CI = 0.11 to 0.94) and infants in front seats using child safety seats (OR = 0.26, 95% CI = 0.07 to 0.99) were associated with decreased nonfatal but not fatal injury compared to children with the recommended use of CRS in the two age groups.CONCLUSIONS:Failure to use child restraints was associated with increased fatal injury. Our findings raise questions regarding current recommendations for specific CRS use in infants and children 4 to 7 years old. Further research is needed to identify the most effective CRS and seating location for children of each age.

Falls are a leading cause of morbidity and mortality in older adults. No previous studies on risk factors for falls have focused on adults 85 years and older, the most rapidly growing segment of adults. We examined demographic, health, and behavioral risk factors for falls and fall-related injuries in adults 65 years and older, with a particular focus on adults 85 years and older. We analyzed self-reported information from the Behavioral Risk Factor Surveillance System (BRFSS) for 2008. Data was available for 120,923 people aged 65 or older and 12,684 people aged 85 or older. Of those aged 85 or older, 21.3% reported at least one fall in the past 3 months and 7.2% reported at least one fall related injury requiring medical care or limiting activity for a day or longer. Below average general health, male sex, perceived insufficient sleep, health problems requiring assistive devices, alcohol consumption, increasing body mass index and history of stroke were all independently associated with a greater risk of falls or fall related injuries. The greater risk of falling in those 85 years and older appeared to be due to the deterioration of overall health status with age; among those with excellent overall health status, there was no greater risk of falling in adults 85 years and older compared to those 65-84 years of age. Our results suggest that those with risk factors for falls and fall-related injuries may be appropriate targets for evidence-based fall prevention programs. (C) 2011 Elsevier Ireland Ltd. All rights reserved.

Because good information on deaths caused by a fall would be important for prevention policies, we analyzed the influence of coding differences on variability in state-level fall death rates in the elderly. We examined state differences in the number of cause of death codes on death certificates, death certifiers, completeness of E-coding, and indicators of specificity of coding. We found that state-specific fall mortality rates ranged from 13.9 to 140.4 in people aged 65 years and above. States employing a coroner to investigate injury deaths had 14 per cent fewer recorded fall deaths than those where a medical examiner conducted the investigations. Each unit increase in the median number of cause of death codes was associated with a 10 per cent increase in the number of falls. For each 1 per cent increase in the use of unspecified codes for the underlying cause of death, the number of falls dropped by 2 per cent. Current fall mortality data do not appear to identify all instances of falls. Variability in unintentional fall-related death rates among states may be partly explained by death certification coding practices. Standardization of coding and training for documentation of fall events and death certificate reporting could help uncover the actual fall mortality burden in the elderly.

In Guatemala, as in many places throughout the world, millions of indigenous people cook over non-ventilated indoor open fires. Indoor air pollution and accidental burns are well-known problems attributed to such fires. Efforts have been made to improve health outcomes by placing more efficient vented stoves in homes to decrease such exposure. The purpose of this study is to see if there are any measurable improvements in health outcomes after placement of such stoves within a community. Specifically, this study is designed to evaluate the health effects of placement of the ONIL stove, a rocket-style stove that has been shown to decrease household carbon monoxide (CO) levels and wood-fuel use. The ONIL stove was installed in more than 90% of the homes in Santa Avelina, Quiche, Guatemala between 2002 and 2006. The number of clinic visits per year for acute upper- and lower-respiratory illnesses in this village was compared for the years 2002 and 2006. Clinic visits for upper- and lower-respiratory illnesses combined decreased by 26%, and for acute lower respiratory solely, by 45% between 2002 and 2006. This study suggests that the placement of an improved vented stove may be associated with a corresponding decrease in acute respiratory illnesses.