Papers by Jonathan Howland
Injury epidemiology, 2017
Falls are a common and debilitating health problem for older adults. Older adults are often treat... more Falls are a common and debilitating health problem for older adults. Older adults are often treated and discharged home by emergency department (ED)-based providers with the hope they will receive falls prevention resources and referrals from their primary care provider. This descriptive study investigated falls prevention activities, including interactions with primary care providers, among community-dwelling older adults who were discharged home after presenting to an ED with a fall-related injury. We enrolled English speaking patients, aged ≥ 65 years, who presented to the ED of an urban level one trauma center with a fall or fall related injury and discharged home. During subjects' initial visits to the ED, we screened and enrolled patients, gathered patient demographics and provided them with a flyer for a Matter of Balance course. Sixty-days post enrollment, we conducted a phone follow-up interview to collect information on post-fall behaviors including information regardi...
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Drug and alcohol dependence, Jan 13, 2017
Opioid medication to treat acutely injured patients is usual care in trauma settings. A higher pr... more Opioid medication to treat acutely injured patients is usual care in trauma settings. A higher prevalence of alcohol and other substance misuse in this population compared to the general population increases the vulnerability of such patients to both misuse of their prescribed opioids, and also unintentional opioid overdose. The primary purpose of this study was to assess the prevalence of substance use and unintentional opioid overdose risk among acutely injured trauma patients, and to examine the frequency and predictors of high opioid dose at discharge. A retrospective electronic medical record (EMR) review of three-months of data from two Level 1 trauma centers. We assessed the prevalence of substance misuse, unintentional opioid overdose risk, and presence of documentation of clinical strategies to mitigate these risks, such as co-prescription of the opioid agonist naloxone. In total, 352 patient EMRs were examined. Over 40% of the patients reviewed had at least one indication ...
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The Journal of school nursing : the official publication of the National Association of School Nurses, 2017
In 2015, the Massachusetts Department of Public Health conducted focus groups with school nurses ... more In 2015, the Massachusetts Department of Public Health conducted focus groups with school nurses (SNs) and athletic trainers (ATs) from Massachusetts middle and high schools to assess implementation of legislated regulations relative to the management of students' head injuries incurred during extracurricular sports. Four tape-recorded focus groups were conducted by experienced facilitators. Lists of themes were synthesized by investigators for each focus group. Participating SNs and ATs supported the sports concussion legislation, felt that implementation had gone well, indicated that the law empowered them in managing return-to-school/play for students with concussion, and experienced support from their school administrators. Some SNs reported that they had applied relevant procedures to all students with head injuries, regardless of how or where the injury occurred. Challenges identified included protocols for away games, inconsistent concussion care by physicians, and a need...
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Alcohol Drugs and Driving, Jun 1, 1991
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Journal of neurotrauma, Jan 25, 2016
Evidence-based clinical practice guidelines can facilitate proper evaluation and management of co... more Evidence-based clinical practice guidelines can facilitate proper evaluation and management of concussions in the emergency department (ED), often the initial and primary point of contact for concussion care. There is no universally adopted set of guidelines for concussion management, and extant evidence suggests that there may be variability in concussion care practices, and limited application of clinical practice guidelines in the ED. This study surveyed EDs throughout New England to examine current practices of concussion care, and utilization of evidence-based clinical practice guidelines in the evaluation and management of concussions. A 32-item online survey was emailed to 149/168 EDs throughout New England in 2013 (Connecticut, Rhode Island, Massachusetts, Vermont, New Hampshire, Maine). Respondents included senior administrators asked to report on their EDs use of clinical practice guidelines, neuroimaging decision-making, and discharge instructions for concussion managemen...
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Independent School, 2011
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Journal of Health Behavior and Public Health, Oct 22, 2012
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Generations, 2003
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Alcohol Health and Research World, 1990
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Injury epidemiology
Falls among older adults are a common and serious public health problem. Evidence-based fall prev... more Falls among older adults are a common and serious public health problem. Evidence-based fall prevention programs delivered in community settings and targeting older adults living independently are increasingly deployed throughout the nation. These programs tend to be offered by public and private organizations that serve older adults, and recruitment usually occurs through direct marketing to the target population, rather than through referrals from healthcare providers. Matter of Balance, a program developed to reduce fear of falling and associated activity restriction in community-dwelling older adults, is currently being delivered in 38 of the 50 United States. In this study, we estimate the one-year medical care cost savings if older adults treated at Massachusetts hospitals for fall-related injuries were referred by healthcare providers to participate in Matter of Balance. Data from several sources were used for this study. We estimated annual cost savings in older adult falls ...
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ABSTRACT
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Background/Purpose: Non-supine infant sleep positions increase risk for sudden unexpected infant ... more Background/Purpose: Non-supine infant sleep positions increase risk for sudden unexpected infant death (SUID). Disparities in safe sleep practices are associated with maternal income and race/ethnicity. WIC is a nutrition supplement program for low-income (185% Federal poverty line) pregnant and post-partum women and children up to age 5. Currently in Massachusetts (MA) ≈ 40% of pregnant/post-partum women are WIC clients. To inform development of a SUID intervention strategy, the MA Department of Public Health (MDPH) investigated the association between WIC status and infant safe sleep practices among post-partum MA mothers using data from the Pregnancy Risk Assessment Monitoring System (PRAMS) survey. Methods: PRAMS is an annual statewide survey of mothers of infants conducted by the MDPH in conjunction with the CDC that includes questions about infant sleep position and mothers' prenatal WIC status. We used aggregate (2007-2010) data to estimate the relative risk (RR) of infan...
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Journal of Trauma and Acute Care Surgery, 2015
Fourteen percent (43.1 million) of the population in the United States was 65 years and older in ... more Fourteen percent (43.1 million) of the population in the United States was 65 years and older in 2012. This population is projected to reach 20% (88.5 million) by 2050. Older adults accounted for 17% of all traffic fatalities and 9% of all vehicle occupant injuries in 2012. We explored the effectiveness of three interventions to help older adults assess their current driving behaviors at a Level 1 trauma center. During 2010 to 2012, 1,216 inpatients 70 years and older admitted for surgical and medical services were screened for eligibility, and 120 were enrolled. Participants completed a driving assessment and preintervention questionnaires and were subsequently randomized to one of the following interventions: (1) brief negotiated interview plus an educational kit by the American Automobile Association about older driving plus an accompanying list of Web-based resources for older adult drivers; (2) American Automobile Association document and a list of Web-based resources; (3) online referral sheet of the list of Web-based resources only. A 3-month postintervention follow-up questionnaire was administered over the telephone to measure changes in (1) driving-related knowledge, attitudes, and beliefs as well as (2) driving-related behaviors and intended behaviors. A total of 113 randomized patients were included in the analysis. The mean (SD) age was 76.8 (5.23) years; majority of patients were white (64%), followed by black African American (33%); and 51% were males and 49% were females. Multivariate analysis showed that older adults' driving knowledge, attitudes, and beliefs (p < 0.0001, R = 0.37) as well as behaviors and intentions (p < 0.0001, R = 0.27) toward driving were positively correlated, controlling for other predictors in the model. Intervention assignment did not affect changes in outcomes, although outcomes improved across experimental conditions. Our pilot study suggests that older adults are likely to make changes in their driving behavior on the basis of minimal hospital-based intervention.
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Injury Prevention, 2015
ABSTRACT Statement of purpose An average of 41 infants died each year during 2004-2010 in Massach... more ABSTRACT Statement of purpose An average of 41 infants died each year during 2004-2010 in Massachusetts due to sudden unexplained infant death (SUID). Safe sleep practices can reduce SUID risk. Approximately 40% of new mothers in Massachusetts are enrolled in the Women, Infants, and Children (WIC) program. WIC provides a platform for deploying information on safe sleep practices. The purpose of our study is to evaluate a train-the trainer program among WIC counsellors to promote safe-sleep practices among post-partum WIC enrolled mothers.
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Injury Prevention, 2015
ABSTRACT The Massachusetts (MA) Department of Public Health engaged the Injury Prevention Centre ... more ABSTRACT The Massachusetts (MA) Department of Public Health engaged the Injury Prevention Centre at Boston Medical Centre to develop a state-wide baseline (2012) inventory of evidence-based (EB) community falls prevention programs for MA older adults living independently. A survey of organisations serving older adults was deployed in two parts: Part 1 determined if a program had been offered in 2012; the salience of falls prevention for the organisation; and, intention to offer future falls prevention programming. If a falls prevention program had been offered in 2012, the Director designated a Coordinator to provide details. This designation triggered Part 2 which collected Information on the specific programs. For the last program offered, data were collected on number of participants, the training and occupations of program facilitators and program funding. This served as a cross-sectional sample of all programs. Response rates: 55% and 86% for Part 1 and Part 2, respectively. 32% of respondents reported falls prevention programming; 68% indicated intention to offer future programs. Mean falls prevention salience score: 3.68, on a 1-5 scale. 12% offered ≥ 1 EB program. 107 EB programs served 1137 MA older adults. 90.6% were A Matter of Balance and 7.6% were EB Tai Chi. 37% were offered by Area Agencies on Ageing; 46% by Councils on Ageing. 95% of programs had trained facilitators. 42% were facilitated by healthcare professionals. 44% of programs were internally funded. 81% of the programs charged no fees. Infrastructure for deployment of EB falls prevention programs is developing in MA, despite the absence of institutionalised funding, legislative mandates, widespread referrals from healthcare providers, or health insurance reimbursement. Methods developed for this study could be adapted by other states wishing to describe community-based falls prevention programming. © 2015, Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
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Pediatrics, 1991
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Journal of studies on alcohol, 2006
The effects of an evening of heavy drinking on next-day occupational performance are mixed across... more The effects of an evening of heavy drinking on next-day occupational performance are mixed across studies and have not been investigated for ship-handling performance. Furthermore, it is not known whether the residual effects of alcohol on next-day performance are due to its effects on sleep. Merchant marine cadets (N=61) who had been trained on a diesel power plant simulator and who drank heavily at least episodically were given placebo beer one evening and were randomized on a second evening to placebo or real beer that resulted in a mean breath alcohol concentration (BrAC) of .115 g%. After an 8-hour sleep period, a meal, and a return to < or = .02 g% BrAC, cadets were assessed with self-report measures and the power plant simulator. No effects of beverage condition were seen on actual performance, although cadets who consumed alcohol rated their performance as impaired compared with the placebo conditions. Alcohol consumption also increased the Acute Hangover Scale score, imp...
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Journal of studies on alcohol. Supplement, 2002
This article reviews comprehensive community interventions that sought to reduce (1) cardiovascul... more This article reviews comprehensive community interventions that sought to reduce (1) cardiovascular disease risks; (2) smoking; (3) alcohol use disorders, alcohol-related injury and illicit drug use; or (4) sexual risk taking that could lead to HIV infection, sexually transmitted disease and pregnancy. Comprehensive community programs typically involve multiple city government agencies as well as private citizens and organizations and use multiple intervention strategies such as school-based and public education programs, media advocacy, community organizing, environmental policy changes and heightened enforcement of existing policies. This review focused on English-language papers published over the past several decades. Some programs in each of the four problem areas achieved their behavioral and health goals. The most consistent benefits were found in programs targeting behaviors with immediate health consequences such as alcohol misuse or sexual risk taking. Results were less co...
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Health care financing review, 1987
Researchers have sought ways to modify Medicare's capitation formula, the adjusted average pe... more Researchers have sought ways to modify Medicare's capitation formula, the adjusted average per capita cost (AAPCC), by including measures of individual health status. The present study assesses the value of risk factors for disease as predictors of hospitalization for Framingham Heart Study participants (1,210 males and 1,496 females) 60-65 years of age. Regression models including several common physiologic measures and prior hospitalizations yielded adjusted R2s of 9.69 percent for males and 3.61 percent for females. The contributions of the risk factors and prior hospitalization were about equal and independent. These results confirm the potential utility of disease risk factors for adjusting the AAPCC.
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Health care financing review, 1992
This study evaluates the use of risk factors for chronic disease as health status adjusters for M... more This study evaluates the use of risk factors for chronic disease as health status adjusters for Medicare's capitation formula, the average adjusted per capita costs (AAPCC). Risk factor data for the surviving members of the Framingham Study cohort who were examined in 1982-83 were merged with 100 percent Medicare payment data for 1984 and 1985, matching on Social Security number and sex. Seven different AAPCC models were estimated to assess the independent contributions of risk factors and measures of prior utilization and disability in increasing the explanatory power of AAPCC. The findings suggest that inclusion of risk factors for chronic disease as health status adjusters can improve substantially the predictive accuracy of AAPCC.
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Papers by Jonathan Howland