Marizen Ramirez

Disability and risk of school related injury

Objective: Approximately six million children with disabilities attend school in the United States. Cognitive and physical limitations may compromise their ability to handle environmental hazards and hence increase their risk for injury. The objective of this study was to describe the epidemiology of school related injury among children enrolled in 17 special education schools in one large, urban school district. Design: Altogether 6769 schoolchildren with disabilities were followed up from 1994–98. Injury and population data were collected from pupil accident reports and existing school records. Associations were estimated through generalized estimating equations. Results: A total of 697 injuries were reported for a rate of 4.7/100 students per year. Children with multiple disabilities had a 70% increased odds of injury compared with the developmentally disabled (odds ratio (OR) 1.7, 95% confidence interval (CI) 1.3 to 2.3). The physically disabled (OR 1.4, 95% CI 1.0 to 1.9) had a modest increased odds of injury. Cuts, bruises, and abrasions composed almost three fourths of all injuries; almost half of these injuries were to the face. Falls (34%) and insults by other students (31%) were the most common external causes. More than a fourth of injuries were sports related, and 21% occurred on the playground/athletic field. Injury patterns differed across disabilities. Conclusions: Although limited to one school district, the population studied is the largest cohort thus far of schoolchildren with disabilities. With this large study base, potentially high risk groups were identified and circumstances of injury described. This information is imperative for developing and improving school based injury prevention measures.

Incidence and characteristics of school bus crashes and injuries

OBJECTIVE Studies of school bus crashes have focused on the biomechanics of catastrophic collisions, with very few examining crash incidence. METHODS Crashes in the state of Iowa were examined from January 2002 through December 2005. School bus crashes were identified through the Iowa Crash Data, a comprehensive database of all reported crashes in the State of Iowa. School bus mileage data were provided by the Iowa Department of Education. School bus crash, fatality, and injury rates were calculated and differences in crash and injury characteristics between school buses and other vehicles were examined. RESULTS The school bus crash, fatality and non-fatal injury rates were 320.7, 0.4 and 13.6 per 100 million bus miles travelled, respectively. School bus crash fatality and injury rates were 3.5 and 5.4 times lower than overall all vehicle crash fatality and injury rates, respectively. Drivers of other vehicles were more likely to have caused the crash than the bus driver (P<0.001). CONCLUSIONS School buses experience low crash rates, and the majority of crashes do not lead to injury. Buses are among the safest forms of road transportation, and efforts to educate drivers of other vehicles may help reduce crashes with buses.

Increased risk of alcohol and drug use among children from deployed military families

AIMS To examine the association between military deployment of a parent and use of alcohol and drugs among children of deployed military personnel. DESIGN Observational and cross-sectional study. SETTING Data from the USA 2010 Iowa Youth Survey, a statewide survey of 6th, 8th and 11th graders, were analyzed during 2011. PARTICIPANTS Of all 6th-, 8th- and 11th-grade students enrolled in Iowa in 2010, 69% (n = 78 240) completed the survey. MEASUREMENTS Ever drink more than a few sips of alcohol and past 30-day: binge drinking, marijuana consumption, other illegal drug use and prescription drug misuse. FINDINGS The rates of alcohol use [risk difference (RD) = 7.85, 99.91% confidence interval (CI) = 4.44-11.26], binge drinking (RD = 8.02, 99.91% CI = 4.91-11.13), marijuana use (RD = 5.30, 99.91% CI = 2.83-7.77), other illegal drug use (RD = 7.10, 99.91% CI = 4.63-9.56) and prescription drug misuse (RD = 8.58, 99.91% CI = 5.64-11.51) are greater for children of currently or recently deployed parents than for children of parents who are not in the military. The magnitude of the effects is consistent across 6th, 8th and 11th grades. Disrupted living arrangements further accentuate increased substance use, with the largest effect seen in children with a deployed parent who was not living with a parent or relative. CONCLUSIONS Children of deployed military personnel should be considered at higher risk for substance use than children of non-military citizens.

Adverse childhood experiences and trauma informed care: the future of health care

Adverse childhood experiences (ACEs) are related to short- and long-term negative physical and mental health consequences among children and adults. Studies of the last three decades on ACEs and traumatic stress have emphasized their impact and the importance of preventing and addressing trauma across all service systems utilizing universal systemic approaches. Current developments on the implementation of trauma informed care (TIC) in a variety of service systems call for the surveillance of trauma, resiliency, functional capacity, and health impact of ACEs. Despite such efforts in adult medical care, early identification of childhood trauma in children still remains a significant public health need. This article reviews childhood adversity and traumatic toxic stress, presents epidemiologic data on the prevalence of ACEs and their physical and mental health impacts, and discusses intervention modalities for prevention.

Sports Injuries to High School Athletes With Disabilities

INTRODUCTION. Physical activity in sports comes with an inherent risk for injury. For children with disabilities, their injury risk may be complicated by preexisting disability. However, very little research exists on sports injuries to young athletes with disabilities. To best manage potential injuries to children with disabilities, data on sports injury patterns are needed. The purpose of this study was to measure the frequency of and risk factors for injury to high school athletes with disabilities. METHODS. A total of 210 athletes from 8 special education high schools that are part of an interscholastic sports league participated in the study. Seven of the 8 schools were followed for 1 season each of basketball, softball, soccer, and field hockey, and 1 school enrolled only during field hockey. Data were collected from coaches on daily exposure sessions (game, practice, and conditioning, as well as length of session), athlete characteristics (disability, gender, age, seizure history, and behavioral problems), and nature of injuries resulting in any type of medical treatment. RESULTS. Thirty-eight injuries were reported among 512 special athletes for a rate of 2.0 per 1000 athlete exposures. Soccer (3.7 per 1000) had the highest rate of injury. More than half of the injuries were abrasions and contusions. Those at highest risk for injury were athletes with autism, athletes with histories of seizures, and starters. Athletes with autism had ∼5 times the injury rate of athletes with mental disabilities. Athletes with seizures had >2.5 times the rate of injury reported among those with no seizure history. CONCLUSIONS. This adapted sports program is a reasonably safe activity for children with disabilities. Nonetheless, findings have important implications for prevention. The preparticipation medical examination may be an excellent opportunity to create special guidelines, particularly for athletes with autism and seizure history.

Factors affecting hospital charges and length of stay from teenage motor vehicle crash-related hospitalizations among United States teenagers, 2002-2007

Motor vehicle crashes are the leading cause of death for all teenagers, and each year a far greater number of teens are hospitalized with non-fatal injuries. This retrospective cohort study used the National Inpatient Sample data to examine hospitalizations from the years 2002 to 2007 for 15-18-year-old teenagers who had been admitted due to a motor vehicle crash. More than 23,000 teens were hospitalized for motor vehicle-related crash injuries each year, for a total of 139,880 over the 6-year period. Total hospital charges exceeded

Accountability and assessment of emergency drill performance at schools.

1 billion almost every year, with a median hospital charge of more than

Burden of hospitalizations for bicycling injuries by motor vehicle involvement: United States, 2002 to 2009

25,000. Older teens, boys, those with fractures, internal injuries or intracranial injuries, and Medicaid/Medicare as a payer were associated with higher hospital charges and longer lengths of stay. These high charges and hospitalization periods pose a significant burden on teens, their families, and the health care system.

Implementation Evaluation of Steering Teens Safe Engaging Parents to Deliver a New Parent-Based Teen Driving Intervention to Their Teens

Many schools throughout the United States are mandated to hold drills, or operational exercises, to prepare for fires, earthquakes, violence, and other emergencies. However, drills have not been assessed for their effectiveness in improving preparedness at schools. This mixed-methods study measures the quantity and the quality of drills in an urban school district in Los Angeles. Compliance with California mandates was fair; most schools barely met requirements. Drills were not used as opportunities to improve procedures. Sites neither conducted any self-assessments nor made changes to procedures on the basis of performance. Suggestions include developing realistic simulated exercises, debriefing, and better school accountability for drills.

Evaluating racial disparity in referral source and successful completion of substance abuse treatment

BACKGROUND Bicycling and bicycling injuries have increased during the past decade in the United States, but research on the extent and outcomes of injuries has lagged behind. This study aimed to estimate the current burden of injury from bicycling injury hospitalizations by motor vehicle crash (MVC) and non-MVC in the United States. METHODS We included patients with primary or secondary diagnosis e-codes corresponding to MVC or non-MVC bicycle injury, drawn from the US Nationwide Inpatient Sample (2002–2009). Descriptive statistics, linear regression, and logistic regression were used to examine patient and hospital characteristics (length of stay, total charges, nonroutine discharges, and demographics) associated with hospitalizations for bicycling injuries by motor vehicle involvement. RESULTS On average, from 2002 to 2009, there were an annually estimated 6,877 MVC and 18,457 non-MVC bicycle injury hospitalizations nationwide. This translates to more than