The effect of recall on estimation of incidence rates for injury in Ghana.

BACKGROUND: Injury is a major public health problem in many developing countries. Due to limitations of vital registry and health service data, surveys are an important tool to obtain information about injury in these countries. The value of such surveys can be limited by incomplete recall. The most appropriate recall period to use in surveys on injury in developing countries has not been well addressed. METHODS: A household survey of injury in Ghana was conducted. Estimated annual non-fatal injury incidence rates were calculated for 12 recall periods (1-12 months prior to the interview, with each successively longer period including the preceding shorter periods). RESULTS: There was a notable decline in the estimated rate from 27.6 per 100 per year for a one-month recall period to 7.6 per 100 per year for a 12-month recall period (72% decline). The extent of this decline was not influenced by age, gender, rural versus urban location, nor by type of respondent (in-person versus proxy). Rate of decline was influenced by severity of injury. Injuries resulting in <7 days of disability showed an 86% decline in estimated rates from a one-month to a 12-month recall period, whereas injuries resulting in > or =30 days of disability showed minimal decline. CONCLUSIONS: In this setting, longer recall periods significantly underestimate the injury rate compared to shorter recall periods. Shorter recall periods (1-3 months) should be used when calculating the overall non-fatal injury incidence rate. However, longer recall periods (12 months) may be safely used to obtain information on the more severe, but less frequent, injuries.     

Proposed method for estimating leprosy prevalence based on rates in children

The authors suggest that, where leprosy prevalence data for the entire population are lacking, the prevalence in schoolchildren may be a valuable index for estimating the magnitude of the problem in areas where leprosy is endemic.     

The Multimedia activity recall for children and adolescents (MARCA): development and evaluation

Background  

Self-report recall questionnaires are commonly used to measure physical activity, energy expenditure and time use in children and adolescents. However, self-report questionnaires show low to moderate validity, mainly due to inaccuracies in recalling activity in terms of duration and intensity. Aside from recall errors, inaccuracies in estimating energy expenditure from self-report questionnaires are compounded by a lack of data on the energy cost of everyday activities in children and adolescents. This article describes the development of the Multimedia Activity Recall for Children and Adolescents (MARCA), a computer-delivered use-of-time instrument designed to address both the limitations of self-report recall questionnaires in children, and the lack of energy cost data in children.     

The epidemiology of nonfatal injuries among US children and youth.

OBJECTIVES. National data are not routinely available regarding the incidence of and associated risk factors for nonfatal injuries in children and youth. The Child Health Supplement to the 1988 National Health Interview Survey provided an opportunity to determine accurate national estimates of childhood injury morbidity by demographic factors, location, external cause, nature of injury, and other factors. METHODS. The closest adult for 17,110 sampled children was asked whether the child had had an injury, accident, or poisoning during the preceding 12 months and about the cause, location, and consequences of the event. An analysis for potential underreporting from 12 months of recall provided adjustments of annual rates to those for a 1-month recall period. RESULTS. On the basis of 2772 reported injuries, the national estimated annual rate for children 0 to 17 years of age was 27 per 100 children after adjustment to 1-month recall. Boys experienced significantly higher rates than girls (risk ratio [RR] = 1.52, 95% confidence interval [CI] = 1.37, 1.68), and adolescents experienced the highest overall rate (38 per 100 children) and proportion of serious injuries. CONCLUSIONS. Approximately one fourth of US children experience a medically attended injury each year, but the risks vary considerably depending on the characteristics of subgroups and the injury cause.     

Changes in fatal and nonfatal crash rates on a toll highway.

Rates of crashes, crashes with injuries, and crashes with fatalities were lower during the 6 months of March 1-August 31, 1974, following a 5-15 mph (8-24 kph) decrease in speed limits on the Illinois Tollway, than the corresponding rates for any of the 6 preceding years, 1968-1973. During the same months of 1968-1974, rates of crashes and of crashes with injuries showed peaks without consistent trends, but rates and percentages of fatal crashes decreased. The data agree with the hypothesis that reducing speed limits on toll roads may lead to substantial reductions in rate of crashes and injuries.     

A national program for injury prevention in children and adolescents: The injury free coalition for kids

Injury is the leading cause of death and a major source of preventable disability in children. Mechanisms of injury are rooted in a complex web of social, economic, environmental, criminal, and behavioral factors that necessitate a multifaceted, systematic injury prevention approach. This article describes the injury burden and the way physicians, community coalitions, and a private foundation teamed to impact the problem first in an urban minority community and then through a national program. Through our injury prevention work in a resource-limited neighborhood, a national model evolved that provides a systematic framework through which education and other interventions are implemented. Interventions are aimed at changing the community and home environments physically (safe play areas and elimination of community and home hazards) and socially (education and supervised extracurricular activities with mentors). This program, based on physician-community partnerships and private foundation financial support, expanded to 40 sites in 37 cities, representing all 10 US trauma regions. Each site is a local adaptation of the Injury Free Coalition model also referred to as the ABC’s of injury prevention: A, “analyze injury data through local injury surveillance”; B, “build a local coalition”; C, “communicate the problem and raise awareness that injuries are a preventable public health problem”; D, “develop interventions and injury prevention activities to create safer environments and activities for children”; and E, “evaluate the interventions with ongoing surveillance.” It is feasible to develop a comprehensive injury prevention program of national scope using a voluntary coalition of trauma centers, private foundation finaccial and technical support, and a local injury prevention model with a well-established record of reducing and sustaining lower injury rates for inner-city children and adolescents.     

Frequency, characteristics, and child and parent risk factors for nonfatal injury in rural children

PURPOSE: We sought to identify child and parent risk factors for nonfatal unintentional injury among rural children.METHODS: Design: cross-sectional health interview survey. Setting: a completely rural midwestern county not adjacent to a metropolitan area. Participants: stratified, random sample of farm, town, and nonfarm, nontown households, including parents of all children aged 0-17 years. Outcome measures: parent-reported injury episodes that occurred in the past 12 months in children that required professional care, restricted normal activities for at least four hours, or resulted in blacking out or losing awareness or memory. Potential risk factors included nine child factors and six parent factors.RESULTS: Of the 621 children in participating households, 137 or 22.1% were injured. Children on a sports team were 1.88 times (95% confidence interval: 1.07 to 3.31) more likely than other children to be injured. Track team members were more likely than non-members to have an injury (54.5% vs. 23.0%, chi square test, p = 0.001), and volleyball team members were more likely than non-members to have an injury (50.0% vs. 29.0%, chi square test, p = 0.009). Unrelated to injury status were the child's gender, rural stratum, emotional health, behavioral problems, impairment or medications. Also unrelated to child injury were the parent's marital status, alcohol dependence, binge drinking, antisocial personality, depression symptoms or fear of child abuse by spouse.CONCLUSIONS: Our findings illustrate the difficulty of discovering clues with potential to aid design of effective childhood unintentional injury prevention policies, programs, and practices. The instruments and processes in our study were of acceptable quality, therefore we failed to asses the true risk factors for childhood injury or our sample size was too small to detect associations with the factors that were included.     

Overuse injury syndromes in children and adolescents

More and more children participate in sports competitions. The main difference between children and adults is that the former still grow and develop. An immature musculoskeletal system is less able to cope with repetitive biomechanical stress. Sites of overuse injury are the sites of rapid growth: epiphysis, apophysis, and growth plates. Overuse injuries in children most commonly affect the cartilage where it meets with the tendons (nonarticular chondrosis), cartilage and bone at the joints surfaces (primary and secondary osteochondrosis), or the bone and its physis (stress fractures). The most characteristic overuse injuries in children are physeal stress fracture and osteochondrosis. The basic diagnostic and treatment principles in children greatly correspond to those in adults. The prevention of overuse injuries in children is very important. To minimise the injuries, children should be encouraged to limit the length of exercise, use high-quality equipment properly, cross train, and participate in conditioning programs to develop strength and flexibility.     

儿童青少年意外伤害预防的可控性和优先领域

儿童青少年是意外伤害的高发群体,伤害是全球范围内导致儿童死亡的主要原因.关注儿童青少年意外伤害,对提升全人群的健康水平具有十分重要的意义.作者从儿童青少年意外伤害的广泛性、严重性和可控性入手,提出中国儿童青少年意外伤害预防的优先领域,即建立监测系统,规范监测方法;加强意外伤害疾病负担研究;制定符合本地区实际的防控策略和措施;增加意外伤害防控研究和实施投入,可为开展儿童青少年意外伤害防控提供更多的研究思路和科学依据.     

Episodic alcohol use and risk of nonfatal injury

Usual and acute alcohol consumption are important risk factors for injury. Although alcohol-dependent people are thought to be at increased risk of injury, there are few reports suggesting that their risk is greater than that of nondependent alcohol users in a given episode of alcohol use. The authors conducted a case-crossover analysis of data on 705 injury patients from a hospital emergency department in Mexico City, Mexico, collected in 2002. The majority of the sample was male (60%) and over 30 years old (51%). With use of a multiple matching approach that took into account three control time periods (the day prior to the injury, the same day in the previous week, and the same day in the previous month), the estimated relative risk of injury for patients who reported having consumed alcohol within 6 hours prior to injury (17% of the sample) was 3.97 (95% confidence interval: 2.88, 5.48). This increase in the relative risk was concentrated within the first 2 hours after drinking; there was a positive association of increasing risk with increasing number of drinks consumed. These data suggested that relative risk estimates were the same for patients with and without alcohol use disorders.     

Passive smoking in infants, children and adolescents. The effects of diet and socioeconomic factors

OBJECTIVES: Many studies have associated environmental tobacco smoke (ETS) exposure with an increased risk for various diseases in infants and children, and although superficially the evidence is compelling, on closer scrutiny socioeconomic factors, especially diet, could have a greater contributory effect. An analysis of this evidence was made. RESULTS: Studies which have correlated smoking during pregnancy with low birth weight have considered weight gain and cholesterol levels as a measure of nutrition in the mother, but not the micronutrient content of the diet to which low birth weights could be due. Several authors have attributed ETS exposure to the presence of abnormal lipid profiles in children and adolescents, without considering the diet of the latter, and the abnormal lipids have been linked to a subsequent increased risk for atherosclerosis. The evidence linking lower respiratory infections and bronchitis with passive smoking is strong, although it seems likely that the diet of the mother during pregnancy or breast feeding is equally important. Similarly, increased risks for asthma, otitis media and sudden infant death syndrome have been attributed to the effects of passive smoking, without adequate allowance for confounding by other socioeconomic factors. CONCLUSION: After consideration of the accumulated evidence, it seems improbable that the small exposure could produce all of the effects claimed.     

Measuring the population burden of fatal and nonfatal injury

The value of measuring the population burden of fatal and nonfatal injury is well established. Population health metrics are important for assessing health status and health-related quality of life after injury and for integrating mortality, disability, and quality-of-life consequences. A frequently used population health metric is the disability-adjusted life-year. This metric was launched in 1996 in the original Global Burden of Disease and Injury study and has been widely adopted by countries and health development agencies alike to identify the relative magnitude of different health problems. Apart from its obvious advantages and wide adherence, a number of challenges are encountered when the disability-adjusted life-year is applied to injuries. Validation of disability-adjusted life-year estimates for injury has been largely absent. This paper provides an overview of methods and existing knowledge regarding the population burden of injury measurement. The review of studies that measured burden of injury shows that estimates of the population burden remain uncertain because of a weak epidemiologic foundation; limited information on incidence, outcomes, and duration of disability; and a range of methodological problems, including definition and selection of incident and fatal cases, choices in selection of assessment instruments and timings of use for nonfatal injury outcomes, and the underlying concepts of valuation of disability. Recommendations are given for methodological refinements to improve the validity and comparability of future burden of injury studies.     

The effects on children and adolescents of parents' excessive drinking: an international review

The effects during childhood, adolescence, and adulthood of having a parent with a drinking problem has interested researchers in several countries. The greatest number of reports related to this subject have appeared in the U.S. literature and in the literature from countries of Eastern Europe. This review encompasses the findings of researchers in these countries as well as workers in Western Europe, Latin America, and Japan. This review does not include biological, physiological, or neurological data. The epidemiologic evidence from several countries shows significant points of agreement. Problem drinking by a parent markedly increases health risks to children and adolescents. Such risks include diminished intellectual capacity and development, increased neuroticism, and a wide range of psychological and behavioral disorders. Parents who drink excessively are also likely to have children who experience long-term adverse consequences. These include heavy and problem-causing psychoactive substance use, criminality, suicide, depression, personality disorders, and psychological and behavioral disturbances. Parents who drink heavily are also especially likely to produce children who subsequently abstain from alcohol or drink only lightly.     

Long-term effects of a system of care on children and adolescents

This study evaluates an exemplary system of care designed to provide comprehensive mental health services to children and adolescents. It was believed that the system would lead to more improvement in the functioning and symptoms of clients compared to those receiving care as usual. The project employed a randomized experimental five-wave longitudinal design with 350 families. While access to care, type of care, and the amount of care were better in the system of care, there were no differences in clinical outcomes compared to care received outside the system. In addition, children who did not receive any services, regardless of experimental condition, improved at the same rate as treated children. Similar to the Fort Bragg results, the effects of systems of care are primarily limited to system-level outcomes but do not appear to affect individual outcomes such as functioning and symptomatology.     

对儿童青少年肥胖伴高血压综合干预效果的研究

目的 研究对儿童青少年超重、肥胖伴有高血压患者进行综合干预的效果,为儿童青少年高血压的防治提供干预指导.方法 选取门诊7～18岁超重或肥胖伴高血压儿童青少年64例(男33,女31)为研究对象.从心理、饮食、运动、行为等多方面,对其进行系统管理与综合干预.采用自身前后对照法,在干预前及干预后6个月对血压、血脂、体质指数(BMI)等指标进行比较,探讨系统管理与综合干预对超重、肥胖儿童青少年伴高血压患者的效果.结果 所有研究对象均未服用降压药,经系统管理与综合干预后,其平均收缩压、舒张压和BMI较干预前的(135.8±16.8) mm Hg、(87.5±7.5)mm Hg、(28.7±5.3) kg/m2下降至(112.7±13.4) mm Hg、(71.2±9.1) mm Hg、(26.3±5.1) kg/m2,差异均有统计学意义(t值分别为12.259、14.3、7.2,P＜0.01).血压转归康复率和有效率分别达45.8％和40.7％.除高密度脂蛋白胆固醇(HDL-C)外,血脂各指标较干预前均有明显下降.结论 心理、饮食、运动、行为等方面的综合护理干预,对控制儿童青少年肥胖伴高血压的效果显著,可减少未来对患者心血管系统的负担.     

Dose-response effects of exercise on behavioral health in children and adolescents

PurposeAerobic exercise may positively affect behavior in children but little research has been conducted among those with behavioral health disorders (BHD). This study is a secondary exploration of data originally collected from an RCT that tested effects of a cybercycling intervention on behavior in children with BHD. We examine dose-response relationships between duration and intensity of cybercycling and minutes of disciplinary time spent out of class (TOC) and self-regulation scores (SRS); additionally we examine potential effect modification by Attention-Deficit/Hyperactivity Disorder (ADHD) diagnosis.MethodsWe extracted data from study days on which participants (N = 103, 83.5% male, age 11.8 ± 2.3) cybercycled during physical education classes. Minutes of riding and average heart rate for each session were collected via the bicycles. The Conners Abbreviated Teacher Rating Scale (SRS) and minutes of TOC were recorded daily. Ride duration and average heart rate were treated as continuous predictors of outcomes using mixed-effects linear regression.ResultsFor every 10 min of riding, children had an associated decline of 10.7 min of TOC (p < 0.001) and 1.2 points improvement in self-regulation score (p = 0.001). For each increase of 10 beats per minute average heart rate children had an associated decline of 1.3 min (p = 0.05) and 0.21 points (p < 0.05). Children with ADHD experienced 12.9 min less time out of class (p < 0.05) for each 10 additional minutes of riding.ConclusionDuration in particular had significant, linear relationships with improved behavioral outcomes among children with a variety of BHD; children with ADHD may experience the greatest benefits.     

Trends of hospitalization rates from asthma in children and adolescents in Poland

Hospitalization rates from asthma in children and adolescents below 19 years of age showed a consistent rising trend over the last two decades and in the period 1984-1996 the rates were doubled in both genders. Among boys the rates were 1.6 times higher than in girls. On average the rates increased annually by 12.2% in boys and by 10.6% in girls. The fastest increase has been noted in the youngest children in the age 0-4 years (20.3% in boys and 18.9% in girls). In the older age groups (5-9 and 10-14 years) the annual increase was in the range of 10.5-14.1%. The slowest increase was observed in children in the oldest age group (3.7%) and in the latter age group there was no differences in hospitalization rates between both genders. We found the highest rates in the southeastern and northern part of the country and this was not compatible with the hygienic hypothesis of asthma and allergic diseases.