Nancy L. Weaver

Epidemiology of Concussion in Collegiate and High School Football Players

Despite evolutionary changes in protective equipment, head injury remains common in football. We investigated concussion in football and associated epidemiologic issues such as 1) incidence of injury, 2) common signs and symptoms, and 3) patterns in making return-to-play decisions. We received 242 of 392 surveys (62%) that were sent to high school and collegiate certified athletic trainers at the beginning of three football seasons. Of the 17,549 football players represented, 888 (5.1%) sustained at least one concussion, and 131 (14.7% of the 888) sustained a second injury during the same season. The greatest incidence of concussion was found at the high school (5.6%) and collegiate division III (5.5%) levels, suggesting that there is an association between level of play and the proportion of players injured. Players who sustained one concussion in a season were three times more likely to sustain a second concussion in the same season compared with uninjured players. Contact with artificial turf appears to be associated with a more serious concussion than contact with natural grass. Only 8.9% of all injuries involved loss of consciousness, while 86% involved a headache. Overall, 30.8% of all players sustaining a concussion returned to participation on the same day of injury.

A glossary for dissemination and implementation research in health.

Dissemination and implementation (D&I) Research is increasingly Recognized as an important function of academia and is a growing priority for major health-related funders. Because D&I Research in the health field has emerged from Research traditions in diverse disciplines Ranging from agriculture to education, there are inconsistencies in the use and meaning of terms and main concepts. This glossary provides definitions for the key concepts and terms of D&I Research in health (in both public health and clinical settings). Definitions are organized under five major sections: (1) foundation concepts; (2) types of Research; (3) models, theories, and frameworks; (4) factors influencing the D&I processes; and (5) measurement/evaluation of the D&I process. The aim of this glossary is to aid in the development of more standardized and established terminology for D&I Research, facilitate the communication across different stakeholders, and ultimately contribute to higher-quality D&I Research.

Baby, Be Safe: the effect of tailored communications for pediatric injury prevention provided in a primary care setting

Injuries are a major cause of morbidity and mortality to young children. The provision of individually tailored educational materials in primary care settings may be an effective and efficient way to promote adoption of injury prevention measures by parents. A randomized controlled study compared the effectiveness of tailored and generic persuasive communications delivered in a primary care setting on the adoption of home and car safety behaviors. During routine well-child visits, a primarily African-American sample of parents of children ages 6-20 months (n=213) was randomized to receive either tailored or generic information regarding the prevention of injuries to their child. At follow-up, participants who received tailored information reported greater adoption of home and car safety behaviors than those receiving generic information. In addition, within the tailored information group, those who discussed the information with their physician showed significantly greater change than those who did not. However, this difference was not observed among those receiving generic information. Findings support the use of office-based tailored injury prevention education as a component of routine well-child care.

A Prospective Cohort Study of Injury Incidence and Risk Factors in North Carolina High School Competitive Cheerleaders

Background Cheerleaders suffer nearly half of catastrophic injuries observed in female scholastic athletes in the United States. However, incidence of noncatastrophic injury in this population has not been described. Hypothesis Coach, athlete, and injury circumstance variables may predict the injury rate among cheerleaders. Study Design Prospective cohort. Methods The authors investigated injury incidence in a sample of North Carolina female cheerleaders who competed interscholastically from 1996 to 1999. Injury, exposure, and demographic data were collected from squads that participated in the North Carolina High School Athletic Injury Study. Results Cheerleaders suffered 133 injuries during 1701 athlete seasons. More than 21% of the injuries were ankle sprains. The injury rate was 8.7; the 95% confidence interval (CI) was 6.5 to 11.7 per 10,000 athlete exposures. In a multivariate Poisson regression model, cheerleaders supervised by coaches with the most education, qualifications, and training (coach EQT) had a nearly 50% reduction in injury risk (rate ratio [RR], 0.5; 95% CI, 0.3-0.9), and cheerleaders supervised by coaches with medium coach EQT had a nearly 40% reduction in injury risk (RR = 0.6; 95% CI, 0.3-1.2) compared to cheerleaders supervised by coaches with low coach EQT.

A Population-based Study of the Association of Medical Manpower with County Trauma Death Rates in the United States

ObjectiveTo determine the association between measures of medical manpower available to treat trauma patients and county trauma death rates in the United States. The primary hypothesis was that greater availability of medical manpower to treat trauma injury would be associated with lower trauma death rates. Summary Background DataSummary Background Data viewed from the standpoint of the number of productive years of life lost, trauma has a greater effect on health care and lost productivity in the United States than any disease. Allocation of health care manpower to treat injuries seems logical, but studies have not been done to determine its efficacy. The effect of medical manpower and hospital resource allocation on the outcome of injury in the United States has not been fully explored or adequately evaluated. MethodsData on trauma deaths in the United States were obtained from the National Center for Health Statistics. Data on the number of surgeons and emergency medicine physicians were obtained from the American Hospital Association and the American Medical Association. Data on physicians who have participated in the American College of Surgeons (ACS) Advanced Trauma Life Support Course (ATLS) were obtained from the ACS. Membership information for the American Association for Surgery of Trauma (AAST) was obtained from that organization. Demographic data were obtained from the United States Census Bureau. Multivariate stepwise linear regression and cluster analysis were used to model the county trauma death rates in the United States. The Statistical Analysis System (Cary, NC) for statistical analysis was used. ResultsResults and multivariate analyses showed that a variety of medical manpower measures and demographic factors were associated with county trauma death rates in the United States. As in other studies, measures of low population density and high levels of poverty were found to be strongly associated with increased trauma death rates. After accounting for these variables, using multivariate analysis and cluster analysis, an increase in the following medical manpower measures were associated with decreased county trauma death rates: number of board - certiffed general surgeons. number of board -certified emergency medicine physicians, number of AAST membes, and number of ATLS - trained physicians ConclusionsConclusions study confirms previous work that showed a strong relation among measures of poverty, rural setting, and increased county trauma death rates. it also found that counties with more board -certified surgeons per capita and with more surgeons with an increased interest (AAST membership ) or increased training (ATLS)in trauma care have lower per capita tauma death rates. These findings are consistent with the hypothesis that physicians with increased interest and traning in trauma care decrease the devastating toll of injury in the united states.

Flight paramedic scope of practice: current level and breadth

This studys objective was to determine the current level and breadth of flight paramedic scope of practice. A six-item survey of lead flight paramedics in 158 air medical programs addressed five issues: 1) Certifications required above state certification; 2) Procedures included in scope of practice; 3) Medications flight paramedics are allowed to administer; 4) Requirements needed to expand scope of practice; and 5) Views on establishing a National Flight Paramedic Certification to alter their scope of practice. Eighty programs out of the 90 respondents (89%) stated that they utilize flight paramedics. Of these 80 programs that use flight paramedics, 76 programs (95%) require certification in ACLS, 65 (81%) in PALS, and 50 (63%) in BCLS. Paramedics are allowed to perform cricothyroidotomy in 68 programs (85%), pericardiocentesis in 24 (30%), and tube thoracostomy in 23 (29%). Medications approved for administration include streptokinase in 37 programs (46 %), r-TPA in 48 (60%), and succinylcholine in 50 (63%). In 61 programs (76%), the scope of practice is determined solely by the air medical director. Eighteen respondents (23%) believe that the development of a National Flight Paramedic Certification Program would alter their scope of practice. In conclusion, flight paramedic scope of practice varies enormously. Since most medical directors have the authority to alter flight paramedic scope of practice and few programs believe that a National Flight Paramedic Certification would alter their practice, medical directors should work directly with flight paramedics to expand their scope of practice.

Advancing Organizational Health Literacy in Health Care Organizations Serving High-Needs Populations: A Case Study

Health care organizations, well positioned to address health literacy, are beginning to shift their systems and policies to support health literacy efforts. Organizations can identify barriers, emphasize and leverage their strengths, and initiate activities that promote health literacy–related practices. The current project employed an open-ended approach to conduct a needs assessment of rural federally qualified health center clinics. Using customized assessment tools, the collaborators were then able to determine priorities for changing organizational structures and policies in order to support continued health literacy efforts. Six domains of organizational health literacy were measured with three methods: environmental assessments, patient interviews, and key informant interviews with staff and providers. Subsequent strategic planning was conducted by collaborators from the academic and clinic teams and resulted in a focused, context-appropriate action plan. The needs assessment revealed several gaps in organizational health literacy practices, such as low awareness of health literacy within the organization and variation in perceived values of protocols, interstaff communication, and patient communication. Facilitators included high employee morale and patient satisfaction. The resulting targeted action plan considered the organizations culture as revealed in the interviews, informing a collaborative process well suited to improving organizational structures and systems to support health literacy best practices. The customized needs assessment contributed to an ongoing collaborative process to implement organizational changes that aided in addressing health literacy needs.

Preventing sports injuries: opportunities for intervention in youth athletics.

Participation in youth sports has steadily grown over the past 30 years and continues to rise. During the 1998-1999 school year over 360,000 collegiate athletes and almost 6.5 million high school athletes participated in sports. This expansion has been accompanied by an increased awareness of the injury problem associated with participation in youth sports. Estimates are that one-third of high school athletes will sustain an injury during a sports season serious enough to result in time lost from participation. While there may always be some risk associated with sports participation, health professionals can actively encourage injury prevention. In this paper, we describe the benefits of sport participation, the injury problem associated with sports, injury prevention frameworks, and conclude by discussing the changing role of the team physician in youth sports.

The economy as a factor in motor vehicle fatalities, suicides, and homicides

The effect of the economy as reflected by employment and unemployment rates on motor vehicle fatalities, suicides, and homicides is examined using several national databases. First, regression models are fit to these fatality data-overall as well as for a variety of age-race-gender subgroups. Then time series models-autoregressive integrated moving average (ARIMA) and structural time series analysis-were fit to the data, both with and without the economic indicators, to examine the relative ability of the models to forecast subsequent fatalities. No evidence was found using any of the modeling techniques that knowledge of yearly values of rates of employment, unemployment, and nonlabor force leads to improved forecasts of the level of motor vehicle fatalities, suicides, or homicides in the total U.S. population or within various subpopulations of interest.

Differential strength of association of child injury prevention attitudes and beliefs on practices: a case for audience segmentation

Objective: Many injuries to children cannot be prevented without some degree of active behavior on the part of parents. A better understanding of social and cognitive determinants of parents’ injury prevention behavior and the identification of potential subgroups for targeted message delivery could advance the effectiveness of educational and behavioral interventions. This study assessed the degree to which parents’ injury prevention behavior is associated with theoretical determinants and examined whether this relation differs by age or birth order of child. Design: Cross sectional observational study. Setting: Three Midwestern pediatric clinics. Subjects: 594 parents of children ages 0–4 attending routine well child visits. Measures: Injury prevention attitudes, beliefs, and practices. Results: Overall, only modest relations were observed between injury beliefs and attitudes and injury prevention behaviors. However, these relations differed substantially by child age and birth order, with stronger associations observed for parents of older first born children. Outcome expectations and social norms were more strongly related to injury prevention behavior among parents of preschool children than among parents of infants and toddlers, while attitudes were more predictive for parents of first born children than parents of later born children. Conclusions: These findings highlight the complexity of relations between theorized determinants and behavior, and suggest the potential utility of using audience segmentation strategies in behavioral interventions addressing injury prevention.