Kelly K. Gurka

Emotional, developmental and behavioural co‐morbidities of children with chronic health conditions

Aim:  This study estimated and compared rates of emotional, developmental and behavioural (EDB) problems among children with chronic health conditions.

Comparison of Hamstring Strain Injury Rates Between Male and Female Intercollegiate Soccer Athletes

Background: Hamstring strains are common among soccer athletes, and they have a high incidence of recurrence. Among American collegiate soccer players, men have an overall higher incidence rate of hamstring strains than women. Purpose: This research compares the hamstring strain injury rates in event and athlete characteristics between male and female college soccer athletes. Study Design: Descriptive epidemiology study. Methods: Data describing partial and complete hamstring strains were obtained from the National Collegiate Athletic Association (NCAA) Injury Surveillance System (ISS) for men’s and women’s soccer from 2004 to 2009. Incidence rate ratios (IRRs) comparing the incidence of hamstring strains between the sexes as well as during games versus practices and the preseason versus the in-season were calculated. χ2 tests were used to compare the occurrence of hamstring strains across different event and athlete characteristics. Results: Men were 64% more likely than women to sustain a hamstring strain (IRR, 1.64; 95% CI, 1.37-1.96). Men had significantly higher rates of hamstring strains than women during both games (IRR, 2.42; 95% CI, 1.82-3.23) and practices (IRR, 1.34; 95% CI, 1.06-1.68). There were no differences between men and women in injury rates during the preseason, but men were significantly more likely to sustain a hamstring strain during the in-season (IRR, 1.98; 95% CI, 1.56-2.52). Men had a significantly higher proportion of recurrent hamstring strains compared with women (men, 22%; women, 12%; P = .003). There were no significant differences in the distribution of strains in event or athlete characteristics between men and women for first-time or recurrent hamstring strains. Conclusion: In collegiate soccer, men have significantly higher rates of hamstring strains than women, and regardless of the recurrence status, the event and athlete characteristics were similar for both sexes. Identifying common characteristics may assist in the targeted development of preventive and rehabilitative programs as well as continued research on hamstring strains among collegiate soccer players.

Workplace homicides among U.S. Women: the role of intimate partner violence

PURPOSE Intimate partner violence (IPV) is an important public health issue with serious consequences for the workplace. Workplace homicides occurring to U.S. women over a 6-year period, including those perpetrated by an intimate partner, are described. METHODS Workplace homicides among U.S. women from 2003 to 2008 were categorized into type I (criminal intent), type II (customer/client), type III (co-worker), or type IV (personal relations) events using the Census of Fatal Occupational Injuries. Fatality rates were calculated and compared among workplace violence (WPV) types, occupations, and characteristics including location of homicide, type of workplace, time of day, and weapon used. RESULTS Between 2003 and 2008, 648 women were feloniously killed on the job. The leading cause of workplace homicide for U.S. women was criminal intent, such as robbing a store (n = 212; 39%), followed by homicides perpetrated by a personal relation (n = 181; 33%). The majority of these personal relations were intimate partners (n = 142; 78%). Over half of workplace homicides perpetrated by intimate partners occurred in parking lots and public buildings (n = 91; 51%). CONCLUSIONS A large percentage of homicides occurring to women at work are perpetrated by intimate partners. WPV prevention programs should incorporate strategies to prevent and respond to IPV.

Intraoperative Factors and the Risk of Respiratory Complications After Pneumonectomy

BACKGROUND The potential effect of intraoperative factors on respiratory complications after pneumonectomy is still unclear. METHODS We conducted a retrospective cohort study; charts of 129 patients who underwent elective pneumonectomy at the University of Virginia were reviewed. Logistic regression was used to estimate the effect of anesthetic factors on the odds of at least one respiratory complication. Linear regression models were fit to assess the impact of these outcomes on length of stay (LOS). RESULTS The incidence of respiratory complications in this cohort was 21%. In univariate analysis total nonblood fluids (p = 0.001), and the blood products packed red blood cells (p < 0.001), plasma (p < 0.001), and platelets (p = 0.044) were significantly associated with respiratory complications. In a multivariable logistic regression analysis, single unit transfusion of any blood product (packed red blood cells, plasma, or platelets) was identified as a major risk factor for respiratory complications after controlling for covariates (odds ratio = 1.47, 95% confidence interval 1.06 to 2.05). Respiratory failure and complications were closely related to LOS, increasing the LOS by a factor of 4.7 (95% confidence interval 3.51 to 6.18) and 3.5 (95% confidence interval 2.69 to 4.41), respectively. CONCLUSIONS Blood product transfusion affects respiratory function and is an independent risk factor for respiratory complications after pneumonectomy.

The Impact of a Prenatal Education Video on Rates of Breastfeeding Initiation and Exclusivity during the Newborn Hospital Stay in a Low-income Population

Background: Guidelines recommend prenatal education to improve breastfeeding rates; however, effective educational interventions targeted at low-income, minority populations are needed as they remain less likely to breastfeed. Objective: To determine whether a low-cost prenatal education video improves hospital rates of breastfeeding initiation and exclusivity in a low-income population. Methods: A total of 522 low-income women were randomized during a prenatal care visit occurring in the third trimester to view an educational video on either breastfeeding or prenatal nutrition and exercise. Using multivariable analyses, breastfeeding initiation rates and exclusivity during the hospital stay were compared. Results: Exposure to the intervention did not affect breastfeeding initiation rates or duration during the hospital stay. The lack of an effect on breastfeeding initiation persisted even after controlling for partner, parent, or other living at home and infant complications (adjusted odds ratio [OR] = 1.05, 95% CI, 0.70-1.56). In addition, breastfeeding exclusivity rates during the hospital stay did not differ between the groups (P = .87). Conclusion: This study suggests that an educational breastfeeding video alone is ineffective in improving the hospital breastfeeding practices of low-income women. Increasing breastfeeding rates in this at-risk population likely requires a multipronged effort begun early in pregnancy or preconception.

Days to Return to Participation After a Hamstrings Strain Among American Collegiate Soccer Players

CONTEXT Among US collegiate soccer players, the incidence rate and the event characteristics of hamstrings strains differ between sexes, but comparisons in the return-to-participation (RTP) time have not been reported. OBJECTIVE To compare the RTP time between male and female collegiate soccer players and analyze the influence of event characteristics on the RTP time for each sex. DESIGN Descriptive epidemiology study. SETTING Data were collected from collegiate teams that voluntarily participated in the National Collegiate Athletic Association Injury Surveillance System. PATIENTS OR OTHER PARTICIPANTS Collegiate soccer athletes who sustained 507 hamstrings strains (306 men, 201 women) during the 2004 through 2009 fall seasons. MAIN OUTCOME MEASURE(S) Nonparametric statistics were used to evaluate RTP time differences between sexes and among categories of each event characteristic (ie, time of season, practice or competition, player position). Negative binomial regression was used to model the RTP time for each sex. All analyses were performed separately for first-time and recurrent strains. RESULTS We found no differences in the RTP time between sexes for first-time (median: men = 7.0 days, women = 6.0 days; P = .07) or recurrent (median: men = 11 days, women = 5.5 days; P = .06) hamstrings strains. For male players with first-time strains, RTP time was increased when the strain occurred during competition or the in-season/postseason and varied depending on the division of play. Among female players with first-time strains, we found no differences in RTP time within characteristics. For male players with recurrent hamstrings strains, the RTP time was longer when the injury occurred during the in-season/postseason. Among female players with recurrent strains, RTP time was longer for forwards than for midfielders or defenders. CONCLUSIONS Although we found no differences in the RTP time after hamstrings strains in male and female collegiate soccer players, each sex had unique event characteristics that influenced RTP time.

Appalachian versus non-Appalachian U.S. traffic fatalities, 2008–2010

PURPOSE Although myriad health disparities exist in Appalachia, limited research has examined traffic fatalities in the region. This study compared traffic fatality rates in Appalachia and the non-Appalachian United States. METHODS Fatality Analysis Reporting System and Census data from 2008 through 2010 were used to calculate traffic fatality rates. Poisson models were used to estimate unadjusted (rate ratio [RR]) and adjusted rate ratios, controlling for age, gender, and county-specific population density levels. RESULTS The Appalachian traffic fatality rate was 45% (95% confidence interval [CI], 1.42-1.47) higher than the non-Appalachian rate. Although only 29% of fatalities occur in rural counties in non-Appalachia versus 48% in Appalachia, rates in rural counties were similar (RR, 0.97; 95% CI, 0.95-1.00). However, the rate for urban, Appalachian counties was 42% (95% CI, 1.38-1.45) higher than among urban, non-Appalachian counties. Appalachian rates were higher for passenger vehicle drivers, motorcyclists, and all terrain vehicle riders, regardless of rurality, as well as for passenger vehicle passengers overall and for urban counties. Conversely, Appalachia experienced lower rates among pedestrians and bicyclists, regardless of rurality. CONCLUSIONS Disparities in traffic fatality rates exist in Appalachia. Although elevated rates are partially explained by the proportion of residents living in rural settings, overall rates in urban Appalachia were consistently higher than in urban non-Appalachia.

Intimate partner violence-related hospitalizations in Appalachia and the non-Appalachian United States

The highly rural region of Appalachia faces considerable socioeconomic disadvantage and health disparities that are recognized risk factors for intimate partner violence (IPV). The objective of this study was to estimate the rate of IPV-related hospitalizations in Appalachia and the non-Appalachian United States for 2007–2011 and compare hospitalizations in each region by clinical and sociodemographic factors. Data on IPV-related hospitalizations were extracted from the State Inpatient Databases, which are part of the Healthcare Cost and Utilization Project. Hospitalization day, year, in-hospital mortality, length of stay, average and total hospital charges, sex, age, payer, urban-rural location, income, diagnoses and procedures were compared between Appalachian and non-Appalachian counties. Poisson regression models were constructed to test differences in the rate of IPV-related hospitalizations between both regions. From 2007–2011, there were 7,385 hospitalizations related to IPV, with one-third (2,645) occurring in Appalachia. After adjusting for age and rurality, Appalachian counties had a 22% higher hospitalization rate than non-Appalachian counties (ARR = 1.22, 95% CI: 1.14–1.31). Appalachian residents may be at increased risk for IPV and associated conditions. Exploring disparities in healthcare utilization and costs associated with IPV in Appalachia is critical for the development of programs to effectively target the needs of this population.

Comparison of Thigh Muscle Strain Occurrence and Injury Patterns between Male and Female High School Soccer-Athletes

CONTEXT Thigh muscle strains are among the most common injuries in high school soccer for both males and females. Similar results have been reported among college soccer players, specifically for hamstring strains. In college soccer, males have a higher injury rate than women, although they share common injury characteristics. Currently, no studies exist comparing the injury rate or injury characteristics of thigh muscle strains between sexes playing high school soccer. OBJECTIVE To compare thigh muscle strain injury rates and injury event characteristics among sexes participating in high school soccer. DESIGN Descriptive epidemiology study. SETTING A total of 100 nationally representative high schools that participated in the High School Sports-Related Injury Surveillance System, Reporting Information Online. PARTICIPANTS High school soccer athletes who had a thigh muscle strain. MAIN OUTCOME MEASURES Injury rates of thigh muscle strains were calculated between sexes. The occurrence of the following variables during a thigh muscle injury was compared between sexes: grade level, age, level of play, event type, time of practice, time of competition, basic injury mechanism, soccer activity, player position, field location, practice type, and time of season. RESULTS Males had a lower injury rate of thigh muscle strains during competition than females (rate ratio = 0.66; 95% confidence interval, 0.47-0.93). No differences between sexes existed in the distribution of first-time or recurrent event characteristics. When combining sexes, recurrent strains (93%) occurred more frequently on the offensive side of the field than first-time strains (59%), P < .001. The majority of strains occurred among the varsity players (71%), during running activities (60%) and practices (58%). CONCLUSIONS Males were less likely to sustain a thigh muscle strain during competitions, but no other differences existed between sexes. The events surrounding all thigh muscle strains may be described with some common properties. Consideration of these characteristics may assist in the development of preventive and rehabilitative programs as well as direct future research on thigh muscle strains among high school soccer players.

Non-robbery-related occupational homicides in the retail industry, 2003-2008.

BACKGROUND The purpose of this study was to examine non-robbery-related occupational homicides in the retail industry from 2003 to 2008. METHODS Data were abstracted from the Census of Fatal Occupational Injuries. Motive (robbery- or non-robbery-related) and workplace violence (WPV) typology (Type I-IV) were assigned using narrative text fields. Non-robbery-related homicide rates were calculated and compared among WPV types, demographic characteristics, and occupation. RESULTS Twenty-eight percent of homicides that occurred in the retail industry were non-robbery-related. The leading event associated with non-robbery-related homicides was Type II (perpetrated by customers) (34%), followed by Type IV (perpetrated by personal relationship) (31%). The majority of homicides were due to arguments (50%). Security guards and workers in drinking establishments had the highest homicide rates per 100,000 workers (14.3 and 6.0, respectively). CONCLUSIONS Non-robbery-related homicides comprised a meaningful proportion of workplace homicides in the retail industry. Research is needed to develop strategies to prevent non-robbery-related homicides specifically.