Risk factors for roadway single- and multi-vehicle all-terrain vehicle crashes in Pennsylvania: 2010-2013.

BACKGROUND: All Terrain Vehicles on public roadways become major risk factors for the motorists. OBJECTIVE: To compare characteristics of crashes and injury severity related to single vehicle (SV) and multi-vehicle (MV) All-Terrain Vehicle (ATV) roadway crashes in Pennsylvania, USA. METHODS: Data on ATV crashes occurring on public roads during the years 2010-2013 was obtained from the Pennsylvania Department of Transportation (PennDOT) and analyzed. RESULTS: Almost two-thirds of the incidents were single-vehicle incidents. Single-ATV incidents have a greater risk for incapacitating injury to drivers than do multi-vehicle ATV incidents. Other factors that increase risk for incapacitating injury in SV crashes include being male, being a driver, alcohol/drug involvement, hitting a fixed object, and the incidents in non-daylight hours. For MV ATV incidents, head on and rear-end crashes and drivers who had alcohol/drug involvement were the two major incapacitating injury risk factors. CONCLUSIONS: This study has enabled us to better understand roadway ATV incidents, characteristics of SV and MV ATV crashes, and the incapacitating injury risks in both SV and MV crash incidents. Our study suggests that road safety and public health programs should focus on the users' knowledge on laws regarding ATV usage on public roadways.

Injury risks for on-road farm equipment and horse and buggy crashes in Pennsylvania: 2010-2013.

OBJECTIVE: The purpose of this study was to investigate characteristics associated with farm equipment and horse and buggy roadway crashes in relation to person, incident, and injury characteristics to identify appropriate points for injury incident prevention. METHODS: Information on crashes occurring on public roads during the years 2010-2013 was obtained from the Pennsylvania Department of Transportation (PennDOT) and analyzed. RESULTS: There were 344 farm equipment and 246 horse and buggy crashes during the 4-year study period. These crashes involved 666 and 504 vehicles and 780 and 838 people, respectively. In incidents with farm equipment, the non-farm equipment drivers had an almost 2 times greater injury risk than farm equipment operators. Horse and buggy crashes were almost 3 times more injurious to the horse and buggy drivers than the drivers of the other vehicles. CONCLUSIONS: The average crash rate for farm equipment was 198.4 crashes per 100,000 farm population and for horse and buggy the crash rate was calculated as 89.4 crashes per 100,000 Amish population per year. This study suggests that road safety and public health programs should focus not only on farm equipment operators and horse and buggy drivers but on other motorists sharing the roadway with them.

Occupational and nonoccupational farm fatalities among youth for 2000 through 2012 in Pennsylvania.

Agriculture is one of the most hazardous industries in the United States. It is crucial to analyze the previously collected farm fatality data in Pennsylvania involving youth to identify fatality sources and to delineate prevention strategies to mitigate future occurrences. The Penn State Farm and Agricultural Injury Database was updated to include the Occupational Injury and Illness Classification System (OIICS) for source and event or exposure. Occupational and nonoccupational incidents were compared based on age groups, religious sect, source of injury, and the injury event or exposure. A total of 82 fatalities to youth under 20 years were identified. Youth under 5 years old had the highest fatality rate of 87.1 fatalities per 100,000 farm household youth per year. The percentages of occupational and nonoccupational fatalities were 30.5% and 62.2%, respectively. Three primary sources accounted for 76% of the 82 farm fatalities: vehicles, machinery, and structures and surfaces. The majority of fatally injured youth (78%) were Anabaptist. The Anabaptist youth were 7 times more likely to be involved in occupational incidents than the non-Anabaptist youth. Youth <10 years of age who were not alone at the time of the fatal incident accounted for about half of the deaths, indicating the peril of adults attempting to supervise youth in the workplace. This fatal injury analysis to youth has identified common fatality injury patterns and risk factors to youth. The data can be used to identify intervention strategies for youth and underserved populations (Anabaptists) and can be used to help motivate adults and parents to adopt safety practices to prevent future injury occurrences. This paper also helps to illustrate the value of state-based monitoring of farm injury to youth using methods available to many states and territories.

Reducing care-resistant behaviors during oral hygiene in persons with dementia.

BACKGROUND: Nursing home residents with dementia are often dependent on others for mouth care, yet will react with care-resistant behavior when receiving assistance. The oral health of these elders deteriorates in the absence of daily oral hygiene, predisposing them to harmful systemic problems such as pneumonia, hyperglycemia, cardiac disease, and cerebral vascular accidents. The purpose of this study is to determine whether care-resistant behaviors can be reduced, and oral health improved, through the application of an intervention based on the neurobiological principles of threat perception and fear response. The intervention, called Managing Oral Hygiene Using Threat Reduction, combines best mouth care practices with a constellation of behavioral techniques that reduce threat perception and thereby prevent or de-escalate care-resistant behaviors. METHODS/DESIGN: Using a randomized repeated measures design, 80 elders with dementia from 5 different nursing homes will be randomized at the individual level to the experimental group, which will receive the intervention, or to the control group, which will receive standard mouth care from research team members who receive training in the proper methods for providing mouth care but no training in resistance recognition or prevention/mediation. Oral health assessments and care-resistant behavior measurements will be obtained during a 7-day observation period and a 21-day intervention period. Individual growth models using multilevel analysis will be used to estimate the efficacy of the intervention for reducing care-resistant behaviors in persons with dementia, and to estimate the overall efficacy of the intervention using oral health outcomes. Activity-based costing methods will be used to determine the cost of the proposed intervention. DISCUSSION: At the conclusion of this study, the research team anticipates having a proven intervention that prevents and reduces care-resistant within the context of mouth care. Long-term objectives include testing the effect of the intervention on systemic illnesses among persons with dementia; examining the transferability of this intervention to other activities of daily living; and disseminating threat reduction interventions to nursing home staff, which may radically change the manner in which care is provided to persons with dementia. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01363258.

Predictors of self-efficacy and self-rated health for older male inmates.

AIMS: The aims of this study were to examine: (1) the relationships between self-efficacy for health management and (a) health-promoting behaviours, (b) health-monitoring behaviours, and (c) self-rated health status in older male prisoners; and (2) the variations in self-rated health status and self-efficacy for health management by inmate characteristics of older men in prison. BACKGROUND: The greying of the inmate population around the globe can be attributed to increases in punitive crime control practices, life expectancy; and the ageing baby boom generation. Older inmates are typically not a healthy group. Therefore, the needs of burgeoning numbers of older, sicker inmates are issues of international significance. METHODS: A descriptive, correlational, survey was conducted from late 2007 to mid-2008 with Bandura's self-efficacy model as the guiding framework. RESULTS/FINDINGS: Participants were 131 male inmates, aged 50 and older. A statistically significant positive relationship was found between self-efficacy for health management and the indexes measuring health-promoting behaviours (r=0.550; P<0.001), health-monitoring behaviours (r=0.323; P=0.001), and the single item rating for self-rated health (τ(b)=0.411; P<0.001). There was a tendency for education to be positively related to self-rated health but not self-efficacy (τ(b)=0.140; P=0.054 and τ(b)=0.105; P=0.122, respectively). Years of incarceration was not significantly related to self-rated health or self-efficacy. CONCLUSION: These research findings support Bandura's self-efficacy theoretical work and its applicability to health-related research in prisons. Nurses are front line healthcare providers in prison, who are in a key position to implement interventions that promote greater inmate self-efficacy for healthy behaviours and chronic disease management.

The relationship of stigma to the sexual risk behavior of rural men who have sex with men.

Most studies of risky sexual behaviors of men who have sex with men (MSM) have been conducted in cities. Few have documented risky sexual behavior of rural men despite increases in rural HIV. Fewer have addressed stigma and risk. This study explored the effects of stigma on sexual risk behavior among rural MSM. We hypothesized that stigma emanating from families, health care providers, and the communities of rural MSM would indirectly affect their sexual risk behavior through their mental health status, specifically self-esteem and internalized homophobia. A convenience sample of 414 rural MSM obtained through political, health service, and social organizations completed an anonymous self-administered questionnaire. Over half of the men reported high-risk sexual behavior. Sensation seeking directly affected levels of sexual risk while the effects of stigma on sexual risk behavior were mediated by mental health variables. Stigma related to respondents' low self-esteem, and low internalized homophobia increased risk behavior.

The influence of stigma on the sexual risk behavior of rural men who have sex with men.

Research investigating predictors of risky sexual behavior of rural MSM is sparse, even though the prevalence of HIV in rural areas has increased. This study explored two sets of predictors of 93 rural MSM's levels of risky sexual behavior: mental health variables and stigma emanating from men's family members, health care professionals, and people in the rural communities in which they live. Over 47% of the men were found to be at modified high to high risk. Logistic regression using a continuation logit model was used to test the relationship of the predictor variables and the four levels of risk. Findings indicate that self-esteem was predictive of the highest sexual risk behavior but not lower levels of risk. Stigma was predictive of modified high sexual risk when compared to low and no risk categories. No variables differentiated men at low risk from men at no risk.

Profiles of rural nurses' use of personal protective equipment: a cluster analysis.

This study examined the relationship between profiles of rural registered nurses' levels of compliance with the use of personal protective equipment and HIV-related attitudes. Survey data were collected from 395 practicing registered nurses in nine rural counties in New York and Pennsylvania. Cluster analysis grouped respondents according to their use of protective equipment by patient HIV status. Seven profiles were identified from the resulting 13 clusters. Profiles were named according to the characteristics of the protective equipment usage that were most evident in each profile. Usage levels included minimal users, appropriate users, anticipatory users, glove users, discriminate users, maximal users, and optimal users. Of these, three were classified as compliant, one as undercompliant, and three as overcompliant. Selective compliance (changing usage in response to patients' HIV status) was characteristic of five profiles. Knowledge that patients were HIV-positive accounted for overcompliance and selective compliance and was related to nurses' HIV attitudes. Undercompliance was related to care of patients who were HIV-negative or unknown. Rural nurses' use of personal protective equipment is not homogenous but discrete and idiosyncratic. This analysis expands current knowledge and redefines nursing practice of standard precautions.