Abstract
Potential for schools-focussed long-term rehabilitation of children following complex trauma: Learning opportunities following the May 2017 Manchester Arena bombing
Rachel Isba1, David Roscoe2 and Naomi Davis2
(1)North Manchester General Hospital, Crumpsall, Manchester, United Kingdom, (2)Royal Manchester Children's Hospital, Manchester, United Kingdom
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
Background/Purpose
On 22 May 2017, an improvised explosive device was detonated at the Manchester Arena (England). The blast killed 23 people (including the bomber) and injured 250. The North West Major Trauma Network (NWMTN) dealt with 44 injured individuals, of whom, 24 children (and five adults) attended the Royal Manchester Children’s Hospital (RMCH). Fourteen children remain under the ongoing care of the NWMTN.
Children who have sustained complex trauma (CT) are typically absent from school for weeks/months during acute hospitalisation and then periodically to attend hospital-based rehabilitation. In the UK, there is the potential for health and education to work more closely together to deliver long-term rehabilitation, to improve outcomes for these children.
Methods
This work took the form of a Health Needs Assessment (HNA) - a systematic method for identifying the unmet healthcare needs of a defined population. This HNA sought to gather insights into the potential for school-focussed long-term rehabilitation of children following CT, using the cohort of children injured in the Manchester Arena bombing as a case study. The HNA involved wide stakeholder engagement as well as a review of the literature and existing practices.
Results/Outcomes
The HNA resulted in a number of recommendations, including piloting of a School Rehabilitation Facilitator (SRF) post and changes to statutory requirements in this area.
Conclusions
The learning opportunities arising from caring for children with long-term rehabilitation needs as a result of the Manchester Arena bombing have the potential to have a much wider positive impact on service development.
Administration, management, leadership Other professions or practice related to public health Program planning Systems thinking models (conceptual and theoretical models), applications related to public health
Abstract
A qualitative exploration of the caregiver perceptions for transportation injury risk and home safety among children with special healthcare needs
Ping Ma1, Marisa Abbe2 and Michelle Thomas3
(1)Texas A& M University, College Station, TX, (2)Children's Health, Dallas, TX, (3)Children's Health Complex Care Medical Services, Dallas
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
Background: Prior evidences have shown that children with special healthcare needs (CSHCNs) sustain a higher risk of injury and experience greater morbidity per injury, compared with children without disabilities. While considerable research efforts have focused on improving general children’s transportation safety, there has been little focus on children with special healthcare needs (CSHCNs) in the US. Thus, this study aims to provide a nuanced and in-depth understanding of caregiver perception, knowledge and self-efficacy surrounding transportation injury risk and home safety of their children with special healthcare needs.
Methods: a qualitative study using semi-structured interviews was conducted among the caregivers of CSHCNs ages 0-18 years. The eligible convenience sample of caregivers (n=18) were recruited at Children’s Health Complex Care Medical Home in Dallas, Texas, from June to November 2017.
Results: Themes emerged on transportation challenges and safety strategies. Specifically, the diverse safety information seeking behaviors, equipment challenges (e.g., special needs seats), and the impact of injury risk on quality of life were addressed. More transportation safety concern is linked with higher social isolation and toxic stress among caregivers. Notably, due to the medical complexity, caregivers had difficulties finding reliable resources on transportation safety for their CSHCNs, which lead to an increasing passive information seeking behaviors, e.g., exclusively rely on pediatrician’s advice.
Conclusions: caregiver perceptions on transportation safety help to facilitate the development of effective tailored injury interventions targeted at CSHCNs and their caregivers, ultimately reduce the burden of health disparities and improve quality of life within disadvantaged children and their families.
Public health or related education Public health or related research
Abstract
Registry of Orthopaedic Trauma in Children (ROTC): A Pilot Study
Rachel Seymour, PhD1, Brian Brighton, MD1, Jeffrey Cassidy, MD2, Jeffrey Martus, MD3, Brian Scannell, MD1, Susan Scherl, MD4, Mauricio Silva, MD5, Mark Sinclair, MD6, Christine Churchill, MA1, Meghan Wally, MSPH1 and Edward Hardison, BS1
(1)Carolinas Medical Center, Charlotte, NC, (2)Helen DeVos Children's Hospital, Grand Rapids, MI, (3)Vanderbilt Children's Hospital, Nashville, TN, (4)University of Nebraska Medical Center, Omaha, NE, (5)Orthopaedic Institute for Children - UCLA r, Los Angeles, CA, (6)Children's Mercy Hospital, Kansas City, MO
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
Background/Purpose:
Trauma is the most common cause of mortality and morbidity in children. The objective of the Registry of Orthopaedic Trauma in Children (ROTC) was to establish a multicenter patient registry to provide a reliable source of information regarding the incidence, management, and severity of orthopaedic injuries in children.
Methods:
We established a pediatric trauma registry at 6 Level I trauma centers. Patients ages <16 with operative fractures of the upper/lower extremity, as well as pelvis and acetabular fractures were included. Registry data included patient demographic characteristics, injury information, surgical procedures, and discharge disposition. Data collected from six sites for a period of 1 year is presented.
Results/Outcomes:
2390 injuries (2258 patients) requiring operative intervention were included in 2016. 61% were males, mean age was 8.3 years, and most were 5-10 years old (45%). 6% sustained associated injuries to the head, chest, or abdomen. Upper extremity fractures were the most common (67%). The most common mechanisms of injury were falls (43%), sports (16%), monkey-bars (9%), and trampolines (7%).
Conclusions:
Many studies on management and outcomes of pediatric trauma are underpowered, single-site, and/or retrospective. By demonstrating the ability to capture significant numbers in a short time, ROTC has potential to address these concerns. These data will allow us to answer critical research questions about both rare and common injuries quickly, provide a framework for further studies, and drive advocacy efforts. Finally, mechanism of injury data can inform injury prevention efforts, such as playground safety equipment and guidelines for trampoline use.
Assessment of individual and community needs for health education Clinical medicine applied in public health Planning of health education strategies, interventions, and programs
Abstract
State policies requiring school-based teen dating violence (TDV) education show promise for reducing TDV victimization: A national cross-sectional analysis
Karisa Harland, MPH, PhD1, Priyanka Vakkalanka, ScM2 and Audrey Saftlas, PhD, MPH3
(1)University of Iowa, Carver College of Medicine, Iowa City, IA, (2)University of Iowa Carver College of Medicine, Iowa City, IA, (3)University of Iowa College of Public Health, Iowa City, IA
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
purpose: The purpose of this study was to determine if state policies establishing teen dating violence (TDV) education in schools are associated with decreased rates of TDV victimization.
methods: Physical TDV (PDV) and sexual TDV (SDV) prevalence was estimated using data from 36 states that completed the 2015 Youth Risk Behavior Surveillance System (YRBSS). Of these states, 30% (n=11) had a policy concerning school-based TDV programs in Westlaw®, a legal search engine. The adjusted odds [aOR(95%CI)] of TDV victimization by the presence of a state policy and time since policy implementation were estimated using hierarchical regression modeling, clustered on state and incorporating YRBSS weighting.
results: The 2015 prevalence of PDV and SDV was 9.8% and 10.9%, respectively. Presence of a law was not associated with PDV [aOR: 0.99(0.89-1.11)] or SDV [aOR: 0.95(0.86-1.05)]. PDV odds did not vary in states with policies in place for 1-24 months and 25-48 months relative to states with no policies; however, there was a decrease in PDV in states with policies in effect >48 months [aOR: 0.86(0.75-0.99)]. SDV odds were lower only in states with policies in place for 25-48 months compared to states without policies [aOR: 0.86(0.75-1.00)].
conclusions: TDV was not lower among states with laws governing TDV curricula for schools; however, odds of TDV decreased over time since policy implementation, suggesting policies may have the desired impact. Our future work will include examining attributes of educational policies and the longitudinal impact of introducing these policies on trends in TDV behaviors.
Advocacy for health and health education Public health or related laws, regulations, standards, or guidelines
Abstract
Study about the Influence of Life Events, Social Support on Self-Injurious Behaviors Among Adolescent from Gender Perspective
Moye Xin, Ph.D Candidate1, Xueyan Yang2 and Lijuan Liu, Student1
(1)Xi'an Jiaotong University, Xi'an, China, (2)Xi'an Jiatong University, Xi'an, China
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
Recently, the phenomenon of adolescents’ self-injurious behaviors has aroused the concern of society and academia. It is mainly subject to psychology, medicine,public health and other disciplines, but few public management disciplines from the perspective of population sociology and public health management.After doing Meta-Analysis,The following conclusions are obtained: Firstly, the incidence of self-injurious behaviors among the subjects was 25.8%, which was at a moderate level comparing with the incidence of self-injurious behaviors among ordinary adolescents.Secondly, there is no significant difference in the overall score of life events between different gender and schools. Thirdly, the overall social support for girls has a number of family support, other support were significantly better than boys.Fourthly, the overall life events have a significant positive impact on the self-injurious behaviors of male and female students, and the overall social support status has a significant negative impact on the self injurious behaviors of both gender.Based on the conclusions above, this paper puts forward some suggestions, such as strengthening public management of self-injurious behaviors of adolescents, targeting prevention and reducing the occurrence of social stereotyping attitudes to students of different gender and high schools, and strengthening educational and cultural guidance.
Administration, management, leadership Public health administration or related administration Social and behavioral sciences
Abstract
Effect of Parent-Child Communication on Responses to Electronic Aggression among Parent-Child Dyads
Ashley Hernandez, MSPH1, Yoon-Sung Nam, MPH1, Marizen Ramirez, PhD1, Rachel Young, MPH, PhD2 and Melissa Tully, PhD2
(1)University of Minnesota, Minneapolis, MN, (2)University of Iowa, Iowa City, IA
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
Efforts to prevent and respond to electronic aggression require parental guidance. This study investigates associations between parent-child communication and how parents and children say they would respond to electronic aggression. Parent-child dyads (n=365) completed a questionnaire including items for child-reported communication warmth and difficulty, and parent- and child-reported responses to hypothetical victim and bystander scenarios (e.g. “Ignore it”, “Tell an adult”, etc.). Scenarios were answered on a five-point Likert scale with the highest score as the preferred response (i.e. “Definitely would do”). Summed scores for communication warmth and difficulty were created using principal component analysis. Gaussian generalized linear models using robust variance were used to assess the associations between communication warmth and difficulty and child-reported victim and bystander scenario scores, stratified by parent’s score. Final models adjusted for parent and child sex and age. In both scenarios, children were more likely to ignore electronic aggression as communication difficulty with their parents increased (victim: β=-0.054; 95%CI=-0.080, -0.028; bystander: β=-0.067; 95%CI=-0.089, -0.044), whereas children were more likely to respond to electronic aggression as communication warmth with their parents increased (victim: β=0.108; 95%CI=0.237, 0.504; bystander: β=0.111; 95%CI=0.071, 0.150). In the victim scenario, even among parents who would ignore electronic aggression, communication warmth was associated with preferred response strategies (i.e., not ignoring cyberbullying) (β=0.081; 95%CI=0.015, 0.149). Our findings suggest that child-perceived communication warmth and difficulty may have an impact on children’s responses to electronic aggression. This may inform future intervention studies aimed at reducing electronic aggression and its effects.
Public health or related research Social and behavioral sciences
Abstract
Sports injuries and concussions among 5-11 year old children in Hillsborough County, Florida playing in local recreational leagues: Year 2
Karen Liller, PhD1, Barbara Morris, DHSc2, Yingwei Yang, MS3, Omonigho M. Bubu, MD, MPH3, Brad Perich4 and Jessica Fillion, BS4
(1)University of South Florida, Tampa, FL, (2)Florida Hospital-Wesley Chapel, Tampa, FL, (3)University of South Florida, College of Public Health, Tampa, FL, (4)University of South Florida College of Public Health, Tampa, FL
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
Background/Purpose: The purpose of this research is to report the latest 2017-2018 (Year 2) research findings of sports injuries and concussions of children, ages 5-11, who play in local recreational sports leagues in Hillsborough County, Florida.
Methods: Children’s injury data (using exposure rates of per 1000) were collected for baseball/softball, soccer, and football along with baseline and follow-up concussion data. The data were collected by a certified athletic trainer (ATC) using Reporting Information Online (RIO) and analyzed with SAS Version 9.4. Neurocognitive data were collected with ImPACT® Pediatric computerized test (test version).
Results/Outcomes: Latest results for 2017-2018 show that we have observed over 1,300 athletes and conducted 135 baseline and 4 post-concussion neurocognitive tests this year. A total of 6 concussions have been reported. One concussion happened to a female athlete in softball, two to males in recreational soccer, one to a female in competitive soccer and two in recreational soccer. The leading concussion injury rate in practice occurred in girls’ softball (.59/1000) and the leading concussion rate in competition occurred in girls’ soccer (1.86/1000). Leading injury activities were chasing a loose ball and general play and injury mechanisms included contact with another player or ball. General return to play time for these athletes is approximately 1.5 to 2 weeks.
Conclusions: The second year results of this research show the importance of collecting injury data on our youngest athletes. Concussions have dominated the injuries thus far this season emphasizing the important role for their further study and prevention.
Epidemiology Public health or related education Public health or related research Social and behavioral sciences
Abstract
New Jersey (NJ) Adolescent Concussions Surveillance to Inform Education and Prevention: Impact of Weather Conditions and Field Type on Football Injuries from Preseason/ Fall 2015-2017
Lauren Gonzalez, BS1, Daniel Uhiara, BS, MPH (c)1 and Derek Shendell, D. Env, MPH2
(1)Rutgers School of Public Health, Piscataway, NJ, (2)Rutgers, The State University of New Jersey, Piscataway, NJ
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
Background: Despite increased awareness of short and long term consequences of concussions, epidemiologic surveillance efforts to date have been scarce for child and adolescent populations. No peer-reviewed published studies to date simultaneously assessed concussions, field type and weather parameters.
Objectives: Field type and weather conditions for days concussions were sustained in interscholastic football games and practices were reviewed. Data were analyzed for summer preseason and fall football seasons of three (2015-2018) school years.
Methods: An online form facilitated reporting of sports-related concussions, by volunteers employed by schools, among public secondary school student-athletes. Thirteen secondary schools represented twelve school districts in eight counties across northern, central, and southern NJ from 2015-2018. Data on field type and outdoor environmental variables like air temperature, relative humidity, rainfall, and average wind speed on date of injury were collected via surveillance form, athletic schedules, and historical records. Concussion survey, weather, and field type data were entered into Microsoft Excel for review and analyses.
Selected Results: Thirty-eight football concussions were reported fall 2015, thirty-three fall 2016, and thirty-four fall 2017. Football ranked first in frequency of concussions among season and year from 2015-2018 comprising at least 45% of reported concussions in fall seasons. In 2015, 65% of football concussions that occurred under conditions of high humidity (>60%) were on turf, 80% in 2016, and 83% in 2017.
Conclusion: If NJ findings are replicated, these results and future research on student-athletes can relate up to adult student-athletes at college/university levels and then adult semi-pro and professional levels.
Environmental health sciences Epidemiology Public health or related education Public health or related laws, regulations, standards, or guidelines Public health or related research
Abstract
Emergency Department Utilization and Follow-Up Care for Concussions among Medicaid-insured Children Before and After Ohio Concussion Law
Anirudh Tarimala, BS1, Bhavna Singichetti, MPH2, Lihong Huang, PhD3, Honggang Yi, Ph.D.4, Michael Tiso, MD5, Rachel Doerschuk, MPH2 and Jingzhen Yang, PhD, MPH6
(1)Nationwide Children's Hospital; The Ohio State University, Columbus, OH, (2)Nationwide Children's Hospital, Columbus, OH, (3)Nationwide Children's Hosptial, Columbus, OH, (4)Nanjing Medical University, Nanjing, China, (5)The Ohio State University, Lewis Center, OH, (6)Nationwide Children's Hospital/Ohio State University, Columbus, OH
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
purpose: To evaluate emergency department (ED) utilization and follow-up care for concussions among Medicaid-insured children, before and after the Ohio concussion law.
methods: We analyzed healthcare claims (April 1, 2008 to December 31, 2016) for Medicaid-insured children (ages 0-18) with a concussion who presented to the ED for their initial encounter. Pre- and post- law periods were based on the Ohio concussion law effective date (April 26, 2013). Logistic regressions were used to determine the effects of law on number of medical encounters per injury, adjusted for sex, age group, and geographic distribution.
results: A total of 12,525 concussions, comprised of 47,962 claims, were included, with the majority being male (63.9%), ages 10-18 years (70.1%), from urban areas (65.2%). 51.2% of the injuries included at least one follow-up visit following the initial ED encounter. The rate of initial ED encounters for concussions increased from 2008 to 2014 (3.08 to 5.25 per 10,000), followed by a decrease to 4.53 per 10,000 in 2016. A shift in follow-up care was observed from radiology and ambulance services in pre-law to primary care providers in post-law. The number of medical encounters per injury was significantly increased during the post-law period (OR=1.72, 95%CI=1.60, 1.85).
conclusion: The Ohio concussion law had a palpable impact on the healthcare utilization for concussions among Medicaid-insured children. Future studies evaluating the impact of the law should analyze the utilization patterns among children with various insurance/payment types.
Epidemiology Public health or related laws, regulations, standards, or guidelines
Abstract
Informing return to play concussion strategies in public schools through federal and state level case precedent
Shelby Lautner, Ph.D.1 and John O. Spengler, J.D., Ph.D.2
(1)Texas A&M University, College Station, TX, (2)Texas A&M University-School of Public Health, College Station, TX
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
Background: In recent years, there have been great strides in public health to help prevent concussions in youth sport programs, but current practice may be inadequate to ensure a child returns safely to sport post-concussion. The purpose of this study was to analyze case law to better understand key issues in return to play concussion protocol among youth participating in sports in public schools.
Methods: To collect cases that were used to form the recommendations, search terms entered into Westlaw and Nexis Uni included “return to play”, “youth sport”, and “concussion”. After the search was completed, the cases were then narrowed by relevancy and cross-referenced for duplicates. Nine federal cases and 12 state level cases remained. The cases were sorted into categories to determine commonalities between the supporting facts and claims for each case.
Results: From an analysis of federal and state case law of negligence claims against coaches and school districts for negligence in the area of concussion safety, several key fact patterns giving rise to these negligence claims emerged. These included facts where athletes were not removed from play upon impact, concussion training was not followed by the coaches, and athletes returning to play too soon.
Conclusions: Based on the findings, return to play could be improved though education and training for both athletes and coaches. The cases indicate that while coaches have received training, they are not always following concussion management and prevention protocols both pre and post-concussion, and when returning athletes to their sport.
Public health or related laws, regulations, standards, or guidelines