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July 31 - August 4, 2000


  • Moody-Williams JD, Dawson D, Miller DR, Schafermeyer RW, Wright J, Athey JL. Quality and accountability: Children's emergency services in a managed care environment. Annals of Emergency Medicine. 34(6):753-760; 1999. (E.42.06 S)

    The face paced change in the health care system has sparked growing interest among purchasers, consumers, providers, health plans, and others in evaluating and improving the quality of health services. The Emergency Medical Services for Children Program's Managed Care Task Force recommended the development of a white paper to focus on issues related to quality and accountability in children's emergency medical services in a managed care environment. A literature review was conducted, and a panel reviewed and discussed relevant materials. The panelists then developed recommendations as a resource for managed care organizations, providers of care, professional associations, and federal, state, and local policy makers.

  • Moody-Williams JD, Linzer J, Stern A, Wilkinson J, Athey JL. Twenty-four-hour access to emergency care for children in managed care. Annals of Emergency Medicine. 34(6):761-767; 1999. (E.42.06 S)

    Children's medical emergencies occur around the clock. In years past, the emergency department, open 24 hours a day, was a familiar site for treating these emergencies. However, in today's health care environment, the scenario can be more confusing. As many families move from a fee-for-service system into a managed care organization (MCO), they may be unclear about what they should do in an emergency involving their child. MCOs want to provide appropriate care, and at the same time, operate within a system designed to contain costs through the establishment of effective health care delivery systems. Providers of emergency medical services, including specialists in pediatric medicine and emergency medical services responders, also must contend with a different set of problems, including administrative entanglements and concerns about reimbursement for their services. This article continues the white paper series by the Emergency Medical Services for Children Managed Care Task Force.

  • Slusarcick, A.L., McCaig, L.F. National hospital ambulatory medical care survey: 1998 outpatient department summary. Advance Data. 317; July 27, 2000. (Periodical files)

    This report describes ambulatory care visits to hospital outpatient departments in the United States. Statistics are presented on selected hospital, clinic, patient, and visit characteristics.

  • Murphy, S.L. Deaths: Final data for 1998. National Vital Statistics Reports. 48(11); July 24, 2000. (Periodical files)

    Abstract: This report present final 1998 data on U.S. deaths and death rates according to demographic and medical characteristics such as age, sex, race, Hispanic origin, marital status, educational attainment, injury at work, state of residence, and cause of death. Trends and patterns in general mortality, life expectancy, and infant and maternal mortality are also described.


  • Ramsey A, Simpson E, Rivara FP. Booster seat use and reasons for nonuse. Pediatrics. 106(2):e20; 2000. (E.52.02.06 S)

    Many children 4-9 years old are inappropriately restrained in vehicles and are at risk for injury in crashes. This study was undertaken to determine the rate of booster seat use and the reasons for nonuse. Observations were conducted at a random sample of day care centers, and drivers of unrestrained children 4-8 years old were interviewed to determine the reasons for lack of booster seat use. Shoulder belt use significantly increased with the age of the child; 28.3% of 4 year olds and 70.0% of 6-8 year olds used lap-shoulder belts. Overall, 27.7% of children in the target age group used booster seats; only 10% of children 6-8 years old used booster seats. Booster seat use decreased when there were 3 or more passengers in the vehicle. The most common reason for lack of booster seat use was that parents thought the child was large enough to use the regular lap-shoulder belt system, or problems with attempting to use the seat in the vehicle. More than half the parents who were not using booster seats at the time of the survey reported owning seats. This study indicates that parental misconceptions about size and safety of regular restraint equipment are the most common reasons that children are not appropriately restrained in vehicles. This information can be used to guide community intervention programs.

  • What to tell parents about car restraints. RN. 62(11):24hf2-24hf3; 1999. (E.52.02 S)

    Automobile crashes remain the number 1 killer of children in the U.S. This brief article advises emergency room nurses on questions to ask parents regarding car safety for their injured children. Points emphasized include use of booster seats for older children and back seat placement of all children.

  • Robitaille Y, Legault J, Abbey H, Pless B. Evaluation of an infant car seat program in a low-income community. American Journal of Diseases of Children. 144:74-78; 1990. (E.52.02.06 S)

    This study was designed to assess the influence of an infant car seat loan program on car seat utilization in a low-income community. An adjacent community, with no car seat program, was used as a control. Greater use of infant seats was observed in the intervention community (41%) than in the control community (27%) for infants younger than 6 months old. The rate of observed utilization of infants between 7-18 months of age increased to 50% on average, but no significant differences were noted between the two communities. These findings suggest that a community based loan program can produce short-term increases in car seat use rates for infants, even in a low-income community. A strategy is needed, however, to maintain these improvements.


  • Laforest S, Robitaille Y, Dorval D, Lesage D, Pless B. Severity of fall injuries on sand or grass in playgrounds. Journal of Epidemiology and Community Health. 54(6):475-477; 2000. (E.60.08 S)

    Laboratory studies have recommended sand, pearock, synthetic materials, or wood chips as protective layers beneath playground equipment, but questions remain about grass. This study compared the protection offered by grass and sand in public and residential playgrounds. During the summers of 1991 and 1995 children aged 1-14 who attended the emergency department of Montreal's two children's hospitals for a fall related injury involving playground equipment were identified. Information was later gathered by telephone interviews with the parents. Nearly 27% of injuries were sustained on grass, mostly in residential settings. Among these, 75% were fractures or head injuries, compared with 61% on sand. Correspondingly, residential playgrounds were associated with a greater proportion of fractures and head injuries (75%) and of Abbreviated Injury Scale (AIS) 2-3 injuries (64%). The adjusted risk of fractures and head injuries and of AIS 2-3 injuries was 1.7 times greater on grass than on sand.


  • Ludwig J, Cook PJ. Homicide and suicide rates associated with implementation of the Brady Handgun Violence Prevention Act. Journal of the American Medical Association. 284(5):585-591; 2000. (E.96.04 S)

    In February 1994, the Brady Handgun Violence Prevention Act established a nationwide requirement that licensed firearms dealers observe a waiting period and initiate a background check for handgun sales. This study evaluated the effects of this act on rates of homicide and suicide. The 32 "treatment" states directly affected by the Brady Act were compared with the 18 "control" states and the District of Columbia, which had equivalent legislation already in place. Changes in the rates of homicide and suicide for treatment and control states were not significantly different, except for firearm suicides among persons aged 55 and older. This reduction in suicides for persons 55 and older was much stronger in states that had instituted both waiting periods and background checks than in states that only changed background check requirements. However, the pattern of implementation of the Brady Act does not permit a reliable analysis of a potential effect of reductions in the flow of guns from treatment state gun dealers into secondary markets. (Also included in this folder are an editorial, "Tracing the Brady Act's connection with homicide and suicide trends" by Richard Rosenfeld, and a research letter, "Relationship between illegal use of handguns and handgun sales volume" by Garen J. Wintemute.)

  • Coker AL, Oldendick R, Derrick C, Lumpkin J. Intimate partner violence among men and women - South Carolina, 1998. Morbidity and Mortality Weekly Report. 49(30):691-694; 2000. (E.82.02 S)

    To estimate the lifetime incidence of intimate partner violence (IPV) by type of violence (e.g., physical, sexual, and perceived emotional abuse) and to explore demographic correlates of reporting IPV among men and women, the South Carolina Department of Health and Environmental Control and the University of South Carolina conducted a population based random digit dialed telephone survey of adults in the state. This report summarizes the results of the survey, which indicated that approximately 25% of women and 13% of men have experienced some type of IPV during their lifetime. Although women were significantly more likely to report physical and sexual IPV, men were as likely as women to report emotional abuse without concurrent physical or sexual IPV.


  • Surface Transportation Policy Project Progress. 10(3); June-July 2000. Washington, DC: Surface Transportation Policy Project. Cover Story: Another batch of books for the beach!

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