School Injuries. Epidemiology and Clinical Features of 307 Cases registered at Hospital during one School Year

Injuries at school were studied for one school year in 57 primary and three secondary schools (13733 students, aged 7–19 years) at Umea in northern Sweden. The injury rate was 22/1000 student years. There was a wide variation in injury rate between different schools. The boy/girl ratio was 1.1/1. Physical education was the dominating activity at the time of injury for the older students and play in the school yard for the younger. The majority of the students had a minor injury, but 17% had a fracture. The injured students did not seem to have more somatic, psychological or social problems than students in general. Fewer competitive sports and ball games and more adult supervision and organized activities during breaks are suggestions to reduce injuries at school. A hospital-based injury registration system is well fitted for serving as a base for analysing school injuries.     

Sports-related Injuries in Children

OBJECTIVE: To describe the demographics and types of sports-related injuries (SRIs) in children. METHODS: The authors performed a retrospective chart review of children 5-18 years of age diagnosed as having an SRI in a pediatric emergency department (ED) during a two-year period. Patients were identified by ICD-9 codes. Data collected were age, sex, sport, ED interventions, consultations, mechanism, location, and injury type. Pairwise comparisons were reported as odds ratios with 95% confidence intervals. RESULTS: Six hundred seventy-seven SRIs fit the inclusion criteria; 480 of the patients were male (71%). The mean ages of the males and females were 13.0 years (SD +/- 3.0 yr) and 12.4 years (SD +/- 2.9 yr), respectively. The six most common sports implicated were basketball (19.5%), football (17.1%), baseball/softball (14.9%), soccer (14.2%), in-line skating (Rollerblading)/skating (5.7%), and hockey (4.6%). Sprains/strains (32.0%), fractures (29.4%), contusions/abrasions (19. 3%), and lacerations (9.7%) accounted for 90% of injury types. Pairwise comparison of the four injury types in the six sports listed showed significant associations for contusions/abrasions in baseball, sprains/strains in basketball, fractures in Rollerblading/skating, and lacerations in hockey. Age variance, including all sports, of the younger group (5-11 yr) in fractures and the older group (12-18 yr) in sprains was significant. The most common injury location was wrist/hand (28%), followed by head/face (22%) and ankle/foot (18%). Each had significant sport-specific predilections. Contact with person or object was the mechanism for >50% of the SRIs. Sport-specific mechanisms followed lines drawn from the sport-specific injury types and locations. CONCLUSIONS: The pediatric age group incurs a variety of injuries in numerous sports with diverse sex, age, mechanism, location, injury type, and sport-specific differences.     

The Epidemiology and Diagnosis of Penetrating Eye Injuries

It is estimated that there are 3.1 penetrating eye injuries per 100,000 person-years in the United States. OBJECTIVES: To evaluate the epidemiology of penetrating eye injuries and to identify physical examination findings that facilitate the diagnosis and ophthalmologic referral of patients with these injuries. METHODS: This was a retrospective chart review of emergency department patients with penetrating eye injuries seen for evaluation from July 1987 to January 1999. The setting was a tertiary referral, university hospital. Three hundred eighty-four patients with 390 penetrating eye injuries were enrolled; 56% were transferred from outlying hospitals. RESULTS: Penetrating eye injuries were seen almost three times per month. Eighty percent of the injuries occurred in males, and the mean age was 29 years. Twenty-five percent of the patients had used alcohol in the period immediately preceding the injury. Final visual outcome was 28% with enucleation, "no light perception" (NLP) in 10%, light perception to 20/200 in 24%, and light perception of 20/200 or better in 38%. Poor visual outcome was associated with poor initial visual acuity, alcohol use, and delayed presentation (p = 0.036, 0.025, 0.036, respectively). Gun-related injuries caused 33% and motor vehicle crashes (MVCs) caused 21% of the worst outcomes (enucleation or NLP). In MVCs where seat belt use was reported, 71% of injured patients were unrestrained. The most common initial physical findings were hyphema (76%), abnormality of the pupil or uvea (94%), and initial visual acuity worse than 20/200 (77%). All patients had at least one of these findings. Complications occurred in 25% of cases, most commonly traumatic cataract or infection. Complications occurred more commonly in those patients transferred than in those presenting directly (p = 0.002). CONCLUSIONS: Penetrating eye injuries are relatively common, occur predominantly in young males, and often result in poor visual outcome in the affected eye. Motor vehicle crashes, alcohol use, and fire-arm use are associated with more severe injuries.     

2005-2012年广东省佛山市突发公共卫生事件相关信息分析及防控对策

目的 为掌握广东省佛山市突发公共卫生事件的流行病学现状及特点,分析其发生的规律,为制定预防和控制措施提供依据。 方法 应用描述性流行病学方法对佛山市2005-2012年突发公共卫生事件相关信息进行分析。 结果 2005-2012年,佛山市共报告各类突发公共卫生事件157起,发病或中毒人数3922人,死亡5例,事件以传染病事件为主,报告病种以水痘、流行性感冒等呼吸道传染病和手足口病为主,3-6月、9月和12月是报告事件数和病例数的高峰,学校和幼托机构是突发公共卫生事件发生的高发场所,占全部突发公共卫生事件数的77.07%。 结论 为有效预防突发公共卫生事件的发生,要加强学校幼托机构冬春季呼吸道传染病的防控工作,幼托机构要重点关注手足口病等接触传播的疾病,由虫媒传染病引起的突发公共卫生事件不容忽视。     

Methods Matter: Tracking Health Disparities in Alternative High Schools

Alternative high school (AHS) students are at‐risk for school dropout and engage in high levels of health‐risk behaviors that should be monitored over time. They are excluded from most public health surveillance efforts (e.g., Youth Risk Behavior Survey; YRBS), hindering our ability to monitor health disparities and allocate scarce resources to the areas of greatest need. Using active parental consent, we recruited 515 students from 14 AHSs in Texas to take a modified YRBS. We calculated three different participation rates, tracked participation by age of legal consent (≥18 and <18 years), and identified other considerations for obtaining quality data. Being required to use active consent resulted in a much lower cooperation rate among students <18 years (32%) versus those who were ≥18 years and could provide their own consent (57%). Because chronic truancy is prevalent in AHS students, cooperation rates may be more accurate than participation rates based off of enrollment or attendance. Requiring active consent and not having accurate participation rates may result in surveillance data that are of disparate quality. This threatens to mask the needs of AHS students and perpetuate disparities because we are likely missing the highest‐risk students within a high‐risk sample and cannot generalize findings.     

2004-2010年浙江省台州市学校突发公共卫生事件分析

目的 分析浙江省台州市2004-2010年学校突发公共卫生事件的流行特征,为科学地制定预防控制措施提供参考依据。 方法 应用描述流行病学分析方法对台州市86起网络直报的学校突发公共卫生事件及相关信息进行比较分析。 结果 7年间台州市共报告学校突发公共卫生事件86起,占68.8%,报告发病数3373例,死亡3例;学校突发公共卫生事件以传染病事件和食物中毒事件为主,分别占80.23%(69起)和8.14%(7起);事件分布在农村幼托、小学、中学55起(63.95%)。 结论 学校是突发公共卫生事件的高发场所,高发以小学和农村学校为主。亟需加强教育和卫生部门的协作,落实学校传染病等事件防控的各项措施。     

Epidemiology of Lower Extremity Injuries among U.S. High School Athletes

Objectives: Despite the health benefits of organized sports, high school athletes are at risk for lower extremity sports-related injuries (LESRIs). The authors documented the epidemiology of LESRIs among U.S. high school athletes.
Methods: Via two-stage sampling, 100 U.S. high schools were randomly selected. During the 2005 school year, LESRIs in nine sports were reported: boys' baseball, football, and wrestling; girls' softball and volleyball; and boys' and girls' basketball and soccer. The authors calculated rates as the ratio of LESRIs to the number of athlete exposures. National estimates were generated by assigning injuries a sample weight based on the inverse probability of the school's selection into the study.
Results: Among high school athletes in 2005, 2,298 of 4,350 injuries (52.8%) were LESRIs. This represents an estimated 807,222 LESRIs in U.S. high school athletes in nine sports (1.33/1,000 athlete exposures). Football had the highest LESRI rate for boys (2.01/1,000) and soccer the highest for girls (1.59/1,000). Leading diagnoses were sprains (50%), strains (17%), contusions (12%), and fractures (5%). The ankle (40%), knee (25%), and thigh (14%) were most frequently injured. Fractures occurred most often in the ankle (42%), lower leg (29%), or foot (18%). Girls with ligamentous knee injuries required surgery twice as often as boys (67% vs. 35%; p < 0.01). Girls had 1.5 times the proportion of season-ending LESRIs of boys (12.5% vs. 8%; p < 0.01).
Conclusions: While LESRIs occur commonly in high school athletes, team- and gender-specific patterns exist. Emergency department staff will likely encounter such injuries. To optimize prevention strategies, ongoing surveillance is needed.     

Prevalence of Headache in the Entire Population of a Small City in Brazil

Objective.— To estimate the 1-year prevalence of headache, using face-to-face interviews of the entire population of a city in Brazil.
Methods.— This was a cross-sectional, population-based study. We conducted face-to-face interviews of all individuals older than 10 years, in a town (Capela Nova) in Brazil. Prevalence of the headache was estimated using prevalence ratios, adjusted by gender, age, marital status, and level education.
Results.— The estimated 1-year prevalence of any headache was 65.4%. Headache was 1.5 times more prevalent in women and individuals aged 20 and 29, but less prevalent in the elderly and divorced. There was not association with the level of education.
Conclusions.— From a public healthcare perspective, headache should be seen as hypertension and diabetes, and actively screened and treated.     

The Quad Council Practice Competencies for Public Health Nursing

This article describes the most recent efforts by the Quad Council of Public Health Nursing organizations to review and revise the competencies for PHN practice, and highlights the implications of these competencies for practice, education, and research. The Quad Council is a coalition of four nursing organizations with a focus on public health nursing and includes the Association of Community Health Nursing Educators; the Association of Public Health Nursing (known prior to July 1, 2012 as the Association of State and Territorial Directors of Nursing); the Public Health Nursing section of the American Public Health Association; and the Council on Economics and Practice of the American Nurses' Association. The Quad Council competencies are based on the Council on Linkages competencies for public health professionals and were designed to ensure that public health nursing fits in the domain of public health science and practice.     

Disturbing TrendsThe Epidemiology of Pediatric Emergency Medical Services Use

OBJECTIVE: To compare pediatric ambulance patients transported for chief complaints of suicide, assault, alcohol, and drug intoxication (SAAD) with pediatric patients transported for all other chief complaints. METHODS: An out-of-hospital database for the primary transporting service in an urban area was analyzed for patients 0-20 years of age from 1992 to 1995. Chief complaints by age, gender, and billing status were analyzed. RESULTS: There were 17,722 transports. The SAAD group comprised 14.9% of all transports (suicide attempt 1.6%, assault 5.9%, alcohol intoxication 3.2%, and drug abuse 4.2%). The proportion of transports due to SAAD increased with age: 0-11-year-olds (4.2%); 11-16-year-olds (17.5%); and 17-20-year-olds (20.3%) (p = 0.0001). Genders were equally represented in the overall group, while males comprised 52.6% of the SAAD transports (p = 0.032). In the SAAD group, the majority of transports for assaults (55.9%) and alcohol (58.8%) involved males, while females were the majority in transports for suicide (52.3%) and drug abuse (66%) (p = 0.0001). Reimbursement sources differed, with those in the SAAD group less likely to be reimbursed by private or public (Medicaid, government) insurance (p < 0.0001) compared with the overall group. CONCLUSIONS: A substantial proportion of pediatric emergency medical services transports are for high-risk conditions. This patient population differs from the overall group by age distribution and reimbursement source.     

Public health investigation: focus group study of a regional infectious disease exercise

ABSTRACT Background: Local health departments and public health nurses are crucial in surveillance and response during public health emergencies. Simulated exercises are useful to train personnel and test emergency preparedness plans, but these exercises can be inconvenient or unrealistic. To address these drawbacks, “Public Health Investigation” (PHI), a multicounty, electronic infectious disease exercise, was created. Methods: After the 4‐week PHI exercise, 6 separate focus groups and 1 regional focus group were conducted with participating health departments to explore perceptions of whether the format was useful, how to improve future exercises, and how well exercise objectives were met. Results: Counties reported improvements in all exercise objectives, especially surge capacity and coordination between counties. Small health departments requested state assistance with risk communication. Existing protocols and procedures were reported as helpful. Suggested improvements to the exercise format included a shorter, 3‐week exercise, interviews with mock patients, pertinent scene information provided with scene questions, instruction on technology used, and clarifications to the “Rules of the Game.” Conclusions: Participants indicated that the format of the PHI exercise was successful in addressing exercise objectives. Increased regional collaboration may be the greatest strength of an exercise of this format.