Objectives
To describe victim characteristics and determinants of recurrent physical abuse of elderly.
Design
Multicenter retrospective analysis of multiple data systems to study victims of elder ...mistreatment in the greater Chicago metropolitan area.
Setting
Five teaching hospitals with Level 1 trauma centers.
Participants
Individuals aged 60 and older treated for physical and sexual abuse between 2000 and 2011.
Measurements
History of revictimization was based on hospital admission histories, Adult Protective Services records, and self‐report. Death records were also linked to participant files.
Results
Fifty‐eight individuals (52.3%) out of 111 cases suffering physical abuse had documented histories of revictimization. Based on multivariable models, individuals who were female, widowed, diagnosed with dementia, and returning to the home where the perpetrator lived or visited were substantially more likely to be revictimized. Revictimized individuals were more likely to be assaulted through unarmed force by a proximal relative, in particular a husband, boyfriend, child, or child‐in‐law. Based on hospital records, only 57% of community‐dwelling cases had their abuse reported to Adult Protective Services or the police, and only 26.6% had Adult Protective Services investigations on record.
Conclusion
Better screening that connects victims of abuse with community services, police action, and alternative residential options is important in reducing the risk of revictimization and connecting individuals with resources that can improve their safety at home, regardless of whether it is in the community or a residential facility.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Background
A more comprehensive characterization of total work‐related injury burden would ideally include all levels of medical care. Additionally, studies have suggested differential utilization of ...medical care among various socioeconomic groups, and it is unclear how this translates to work‐related injuries.
Methods
The 2004‐2016 National Health Interview Survey data were used to estimate all levels of care utilized by the individual for each injury episode. A multivariable logistic regression model based on 2004‐2014 data was developed to investigate the relationship of low income and level of medical care used by the injured worker.
Results
Around 53.1% of occupational injury were exclusively treated outside of a hospital setting and never captured by hospital/emergency department data systems, which comprises 40% (3.0 million) of total missed days of work and 44% ($452 million) of total cost of lost productivity among full‐time workers. Patients with work‐related injuries are less likely to stay overnight in hospital compared with those with nonwork‐related injuries (adjusted odds ration aOR: 0.6, 95% confidence interval CI: 0.5‐0.7), however among work‐related injuries, low‐income patients are more likely to use medical care in a hospital setting compared with patients with income higher than poverty threshold (hospitalization: aOR: 1.9, 95% CI: 1.1‐3.3; emergency room: aOR: 1.5, 95% CI: 1.1‐2.0).
Conclusions
These “minor work‐related injuries” exclusively treated outside hospital tend to be ignored when defining national injury prevention priorities, but this analysis indicates that such an approach fails to capture a large portion of injuries significant enough to result in missed days of work and cost of lost productivity.
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FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
ObjectivesThe mining industry is increasingly adopting extended workdays of 10–12 hour shifts. Studies demonstrate that long work hours are associated with psychomotor impairments caused by fatigue ...and an increased risk of injury. However, studies involving miners remain limited. This analysis aimed to identify risk factors associated with long working hour injuries and to determine if long working hour incidents were associated with being killed or incidents involving multiple injured workers.MethodsData from US Mine Safety and Health Administration Part 50 reports, 1983–2015, were used to identify long working hour injuries, which were defined as incidents occurring nine or more hours after the start of a shift.ResultsA total of 52 206 injuries (9.6%) occurred during long working hours. The proportion of long working hour injuries increased from 5.5% of all injuries in 1983 to its peak in 2015 at 13.9% (p<0.001). Risk factors associated with long working hour injuries included irregular shift starts, being newly employed, employment by a contractor, metal/non-metal operations and mines with <100 employees. In two separate adjusted models, long working hour injuries were associated with a higher odds of death (adjusted OR aOR=1.32; 95% CI 1.18 to 1.48) and single incidents resulting in two or more workers injured (aOR=1.73; 95% CI 1.58 to 1.89).ConclusionsLong working hour injuries were associated with a lack of routine, being new at the mine and specific mining activities. An international shift towards using contract labour and extended workdays indicates that injuries during long working hours will likely continue to grow as a problem in the mining industry.
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BFBNIB, CMK, NMLJ, NUK, PNG, SAZU, UL, UM, UPUK
Concerns over climate change have prompted substantial interest in temperature related injuries resulting from extreme weather conditions. Climate models predict that as global temperatures increase, ...the frequency and severity of extreme heat and cold weather events will grow which will likely increase the incidence of temperature related injury. The aim of this study was to analyze the healthcare impacts of temperature related injuries in the state of Illinois in order to serve as a model to guide future public health policy.
Outpatient and inpatient heat and cold related injuries treated in Illinois hospitals from 2011 to 2018 were analyzed. Weather data was linked to individual cases.
The crude annual total hospital utilization incidence rate for heat injuries was 23.6 per 100,000 residents compared to 23.2 per 100,000 residents for cold injuries, however, the crude annual inpatient admission incidence rate was more than four-fold higher for cold injuries compared to heat injuries (10.2 vs 2.4 per 100,000). Although hypothermia made up 27.0% of all temperature related injuries, it comprised 94.0% of all deaths. In the multivariable models, we identified demographic characteristics, temperature conditions and comorbidities strongly associated with both heat and cold related in-hospital mortality.
While climate change is increasing the number of extreme heat days, it may also impact cold adaptation resulting in more serious adverse health outcomes when severe cold weather events do occur. As electronic health records become more widely available, they can prove to be a valuable resource to monitor, treat and predict temperature related injuries in the near future. Our findings regarding the substantially elevated mortality among cold related injuries, demonstrate the need to tailor public health messages to different climate zones in the United States.
•Temperature related injuries were analyzed using hospital data, 2011–2018.•Injury incidence rates were highest among African-Americans and the elderly.•Hypothermia made up 27.0% of all temperature injuries, but 94.0% of all deaths.•Cumulative hospital charges for 2011–2018 was almost one billion dollars.•Coagulopathy and liver disease were associated with increased mortality for heat injuries.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
To assess the value of hospital records in augmenting information on homelessness counts at a state level.
We used data from the Illinois Hospital Discharge Database (2011-2018) to identify ...outpatients and inpatients identified as affected by homelessness. We used probabilistic linkage methodology to estimate unique individuals rather than visits and compared them with US Department of Housing and Urban Development annual estimates of homelessness based on point-in-time counts.
Department of Housing and Urban Development point-in-time estimates indicate a substantial decline of approximately 24% in homelessness in Illinois; however, estimates of unique individuals visiting the hospital with a code for homelessness more than doubled in this same period.
Other data sources, such as hospital records, are increasingly able to identify and report information related to homelessness. Using these additional data sources may help to augment the Department of Housing and Urban Development point-in-time estimates to provide more accurate estimates of homelessness that are used to direct resources and assess policy and support services for those affected by homelessness.
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CEKLJ, DOBA, FSPLJ, IZUM, KILJ, NUK, ODKLJ, OILJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
We introduce the intraclass correlation coefficient (ICC) to the biometric community as an index of the temporal persistence, or stability, of a single biometric feature. It requires, as input, a ...feature on an interval or ratio scale, and which is reasonably normally distributed, and it can only be calculated if each subject is tested on 2 or more occasions. For a biometric system, with multiple features available for selection, the ICC can be used to measure the relative stability of each feature. We show, for 14 distinct data sets (1 synthetic, 8 eye-movement-related, 2 gait-related, and 2 face-recognition-related, and one brain-structure-related), that selecting the most stable features, based on the ICC, resulted in the best biometric performance generally. Analyses based on using only the most stable features produced superior Rank-1-Identification Rate (Rank-1-IR) performance in 12 of 14 databases (p = 0.0065, one-tailed), when compared to other sets of features, including the set of all features. For Equal Error Rate (EER), using a subset of only high-ICC features also produced superior performance in 12 of 14 databases (p = 0. 0065, one-tailed). In general, then, for our databases, prescreening potential biometric features, and choosing only highly reliable features yields better performance than choosing lower ICC features or than choosing all features combined. We also determined that, as the ICC of a group of features increases, the median of the genuine similarity score distribution increases and the spread of this distribution decreases. There was no statistically significant similar relationships for the impostor distributions. We believe that the ICC will find many uses in biometric research. In case of the eye movement-driven biometrics, the use of reliable features, as measured by ICC, allowed to us achieve the authentication performance with EER = 2.01%, which was not possible before.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Agriculture is a dangerous industry, with evidence indicating a disproportionate burden among Hispanic/Latinx workers. There is a need to expand the utilization of different data systems to improve ...the surveillance of precarious workers within agriculture. This analysis describes inclusion criteria to identify farm-related injuries and illnesses in hospital data utilizing ICD-10 codes to better assess health equity issues involving Hispanic/Latinx workers and their associated costs.
Discharge data of agriculture-related injuries and illnesses treated in Illinois hospitals and emergency departments from 2018 to 2021 were extracted using ICD-10 diagnosis and location of injury codes. Injury cause, nature, severity, and course of clinical care are stratified by ethnicity. Multivariable models were developed to assess differences in injury severity, level of care required, and cost of care.
We identified 3,745 farm-related injuries and illnesses treated in Illinois hospitals between 2018 and 2021, of which 196 involved Hispanic/Latinx individuals. Hispanic/Latinx patients were substantially younger and disproportionately covered by workers' compensation insurance or uninsured. Compared to non-Hispanic/Latinx individuals, Hispanic/Latinx patients suffered injuries from different mechanisms, particularly involving animals and cutting/piercing instruments. While non-Hispanic/Latinx individuals demonstrated more severe injuries based on the descriptive statistics, after controlling for confounding (particularly age), we did not observe ethnic disparities in injury severity or level of care required. However, the cost of care was equivalent to or higher among Hispanic/Latinx persons.
The case definition used for this analysis identified agriculture-related cases and provided insights on the course of clinical care by ethnicity. This strategy would likely yield valuable information in states with larger and more diverse agricultural workforces. More targeted research to appropriately scope the issue and inform interventions is needed to understand differential exposure and reduce agricultural workplace hazards and address the financial burden resulting from farm-related injuries.
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BFBNIB, GIS, IJS, KISLJ, NUK, PNG, UL, UM, UPUK
The American Burn Association (ABA) has developed comprehensive referral criteria to determine which burn-injured patient should be transferred to burn centers. This was a retrospective analysis of ...burn injuries using Illinois inpatient and outpatient hospital data from 2010 to 2015. Multivariable logistic and linear regression models were developed to evaluate ABA burn center referral criteria adherence and to compare treatment outcomes among those treated in verified burn center (VB), nonverified burn center (NVB), and other facilities (OF). In this study, 66% of those treated in facilities without specialized burn teams met the ABA referral criteria. Patients who were older than the age of 40 years, lived farther from burn units, and were originally treated in level I trauma center without burn units were less likely to be transferred to burn centers. Those transported and treated in burn centers had overall better treatment outcomes including fewer infection complications (VB vs OF: adjusted odds ratio aOR: 0.5, 95% confidence interval CI: 0.4-0.6; NVB vs OF: aOR: 0.5, 95% CI: 0.4-0.6), fewer patients requiring additional care in skilled nursing/rehabilitation facilities (VB vs OF: aOR: 0.5, 95% CI: 0.4-0.6; NVB vs OF: aOR: 0.7, 95% CI: 0.6-0.9), shorter length of hospitalization (VB vs OF: β: -0.4, P < .001; NVB vs OF: β: -0.8, P < .001), and comparable in-hospital mortality (VB vs OF: aOR: 1.3, 95% CI: 0.97-1.7; NVB vs OF: aOR: 1.01, 95% CI: 0.7-1.5). While verified and unverified burn centers demonstrated better treatment outcomes, the data demonstrated a need to understand the barriers of adhering to ABA criteria and an improved regional burn center referral guidelines education.
OBJECTIVES:
To characterize the severity and outcome of traumatic injuries suffered by victims of elder abuse, describe the characteristics of the perpetrators, and identify risk factors associated ...with severe traumatic elder abuse.
DESIGN: Case–control study.
SETTING: Two Level I trauma units in the greater Chicago, Illinois, metropolitan area.
PARTICIPANTS: Forty‐one cases of elder abuse resulting in severe traumatic injury were identified between 1999 and 2006. Controls were randomly selected from the list of elderly patients in the trauma registry (N=123).
MEASUREMENTS: Elder abuse was defined according to the Illinois Elder Abuse and Neglect Act.
RESULTS: In this study, 85% of the perpetrators were family members or intimate partners. In the final multivariable logistic regression model, victims of severe traumatic elder abuse were more likely to be female, to have a neurological or mental disorder, and to abuse drugs or alcohol.
CONCLUSION: This is the first clinical case–control study detailing clinical outcomes and evaluating risk factors of persons suffering severe physical abuse. Of elderly trauma victims, those who are physically abused have more‐severe injuries than their nonabused counterparts. More research is needed to better evaluate risk factors of physical abuse and effective interventions.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Farmworkers are at increased risk of adverse health outcomes related to occupational heat exposure and inadequate access to water, shade, or rest breaks. Presently, there is a dearth of studies ...examining the prevalence of dehydration and related factors in U.S. farmworkers. Our objectives were to characterize hydration status during typical workdays and to identify risk factors associated with increased dehydration in migrant farmworkers employed in Florida.
Urine samples were collected and analyzed for urine specific gravity (USG) 2–3 times per person per day over five days in May 2021 and 2022. Data collection included demographic characteristics, wet-bulb-globe-temperature (WBGT), and information on working conditions (task type, duration, and crop units harvested), fluid intake, clothing worn, and heat safety behaviors. Multivariable mixed regression models were used to evaluate risk factors associated with change in USG levels (continuous) during a work shift.
A total of 111 farmworkers participated in this study providing 1020 cumulative USG measurements, of which 96.8% of end-of-shift USG samples were above 1.020 indicating potential dehydration. In multivariable models, dehydration assessed using change in USG levels significantly declined with age (β = −0.078; 95%CI: 0.150, −0.006) but showed significant increase with body mass index (β = 0.016; 95%CI: 0.003, 0.028), WGBT (β = 0.054; 95%CI:0.044, 0.064), mean shift duration, and state of primary residence. We did not find significant associations of dehydration with type of clothing worn, intake of employer-provided water, or crop units harvested during a shift in this sample of farmworkers.
Our findings underscore the need for additional research to evaluate adverse outcomes related to dehydration and to better understand recovery patterns from chronic dehydration across workweeks and harvest seasons in migrant farmworkers.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
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