Behavioural difficulties in early childhood and risk of adolescent injury

ObjectiveTo evaluate long-term associations between early childhood hyperactivity and conduct problems (CP), measured using Strengths and Difficulties Questionnaire (SDQ) and risk of injury in early adolescence.DesignData linkage between a longitudinal birth cohort and routinely collected electronic health records.SettingConsenting Millennium Cohort Study (MCS) participants residing in Wales and Scotland.Patients3119 children who participated in the age 5 MCS interview.Main outcome measuresChildren with parent-reported SDQ scores were linked with hospital admission and Accident & Emergency (A&E) department records for injuries between ages 9 and 14 years. Negative binomial regression models adjusting for number of people in the household, lone parent, residential area, household poverty, maternal age and academic qualification, child sex, physical activity level and country of interview were fitted in the models.Results46% of children attended A&E or were admitted to hospital for injury, and 11% had high/abnormal scores for hyperactivity and CP. High/abnormal or borderline hyperactivity were not significantly associated with risk of injury, incidence rate ratio (IRR) with 95% CI of the high/abnormal and borderline were 0.92 (95% CI 0.74 to 1.14) and 1.16 (95% CI 0.88 to 1.52), respectively. Children with borderline CP had higher injury rates compared with those without CP (IRR 1.31, 95% CI 1.09 to 1.57).ConclusionsChildren with high/abnormal hyperactivity or CP scores were not at increased risk of injury; however, those with borderline CP had higher injury rates. Further research is needed to understand if those with difficulties receive treatment and support, which may reduce the likelihood of injuries.

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Prestroke physical activity could influence acute stroke severity (part of PAPSIGOT)

Neurology ◽

10.1212/wnl.0000000000006354 ◽

2018 ◽

Vol 91 (16) ◽

pp. e1461-e1467 ◽

Cited By ~ 15

Author(s):

Malin Reinholdsson ◽

Annie Palstam ◽

Katharina S. Sunnerhagen

Keyword(s):

Physical Activity ◽

Acute Stroke ◽

Odds Ratio ◽

Negative Binomial ◽

Negative Binomial Regression ◽

Activity Level ◽

Stroke Severity ◽

Cross Sectional ◽

Severe Stroke ◽

Younger Age

ObjectiveTo investigate the influence of prestroke physical activity (PA) on acute stroke severity.MethodsData from patients with first stroke were retrieved from registries with a cross-sectional design. The variables were PA, age, sex, smoking, diabetes, hypertension and statin treatment, stroke severity, myocardial infarction, new stroke during hospital stay, and duration of inpatient care at stroke unit. PA was assessed with Saltin-Grimby's 4-level Physical Activity Level Scale, and stroke severity was assessed with the National Institutes of Health Stroke Scale (NIHSS). Logistic regression was used to predict stroke severity, and negative binomial regression was used to compare the level of PA and stroke severity.ResultsThe study included 925 patients with a mean age of 73.1 years, and 45.2% were women. Patients who reported light or moderate PA levels were more likely to present a mild stroke (NIHSS score 0 to 5) compared with physically inactive patients in a model that also included younger age as a predictor (odds ratio = 2.02 for PA and odds ratio = 0.97 for age). The explanatory value was limited at 6.8%. Prestroke PA was associated with less severe stroke, and both light PA such as walking at least 4 h/wk and moderate PA 2–3 h/wk appear to be beneficial. Physical inactivity was associated with increased stroke severity.ConclusionsThis study suggests that PA and younger age could result in a less severe stroke. Both light PA such as walking at least 4 h/wk and moderate PA 2–3 h/wk appear to be beneficial.

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Visceral obesity is associated with clinical and inflammatory features of asthma: A prospective cohort study

Allergy and Asthma Proceedings ◽

10.2500/aap.2020.41.200054 ◽

2020 ◽

Vol 41 (5) ◽

pp. 348-356

Author(s):

Ke Deng ◽

Xin Zhang ◽

Ying Liu ◽

Gai Ping Cheng ◽

Hong Ping Zhang ◽

...

Keyword(s):

Cohort Study ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Negative Binomial ◽

Immunoglobulin E ◽

Asthma Management ◽

Visceral Obesity ◽

Negative Binomial Regression ◽

Visceral Fat Area ◽

Increased Risk

Background: Although studies have consistently linked obesity and asthma, the potential influence of visceral obesity on asthma has not been well investigated. Objective: To study the associations of visceral fat area (VFA) and clinical and inflammatory features of asthma and to further explore the effects of VFA on the future risk of asthma exacerbation. Methods: A 12-month prospective cohort study based on the Australasian Severe Asthma Network was designed to observe patients with stable asthma grouped by the median value of VFA. The clinical and inflammatory features of asthma were compared between the low VFA (VFAlow) and high VFA (VFAhigh) groups. Relationships between VFA and clinical and inflammatory features of asthma were analyzed by using correlation analysis. Univariate and multivariable negative binomial regression analyses were performed to investigate the association of VFA with exacerbations within a 12-month follow-up period. Results: The patients in the VFAhigh group were older and had a longer asthma duration. Interleukin (IL) 6 and IL-8 in sputum were higher, whereas fractional exhaled nitric oxide (FeNO) and blood eosinophils were lower in the VFAhigh group. Gender-differentiated correlations of VFA with clinical and inflammatory variables were observed in age, FeNO, immunoglobulin E, blood total white cells and neutrophils, and sputum IL-1β and IL-8. Furthermore, compared with the VFAlow group, the VFAhigh group was at significantly increased risk of moderate-to-severe exacerbations (adjusted incidence rate ratio [IRR] 1.55 [95% confidence interval {CI}, 1.06‐2.28; p = 0.025), severe exacerbations (adjusted IRR 2.25 [95% CI, 1.26‐4.04]; p = 0.007), and emergency visits (adjusted IRR 5.33 [95% CI, 1.78‐17.16]; p = 0.003). Conclusion: The level of VFA was associated with specific clinical and inflammatory characteristics of asthma. Furthermore, VFA, as an independent risk factor, was associated with an increased risk of exacerbations. It indicated that VFA would provide more potential clinical implications for asthma management.

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Evaluation of community coalition training effects on youth hospital-admitted injury incidence in Victoria, Australia: 2001–2017

Injury Prevention ◽

10.1136/injuryprev-2019-043386 ◽

2019 ◽

Vol 26 (5) ◽

pp. 463-470 ◽

Cited By ~ 1

Author(s):

Janneke Berecki-Gisolf ◽

Bosco Rowland ◽

Nicola Reavley ◽

Barbara Minuzzo ◽

John Toumbourou

Keyword(s):

Risk Factors ◽

Injury Risk ◽

Negative Binomial ◽

Hospital Admissions ◽

Intervention Strategy ◽

Age Groups ◽

Negative Binomial Regression ◽

Population Based ◽

Injury Incidence ◽

The Impact

BackgroundInjuries are one of the three leading causes of morbidity and mortality for young people internationally. Although community risk factors are modifiable causes of youth injury, there has been limited evaluation of community interventions. Communities That Care (CTC) offers a coalition training process to increase evidence-based practices that reduce youth injury risk factors.MethodUsing a non-experimental design, this study made use of population-based hospital admissions data to evaluate the impact on injuries for 15 communities that implemented CTC between 2001 and 2017 in Victoria, Australia. Negative binomial regression models evaluated trends in injury admissions (all, unintentional and transport), comparing CTC and non-CTC communities across different age groups.ResultsStatistically significant relative reductions in all hospital injury admissions in 0–4 year olds were associated with communities completing the CTC process and in 0–19 year olds when communities began their second cycle of CTC. When analysed by subgroup, a similar pattern was observed with unintentional injuries but not with transport injuries.ConclusionThe findings support CTC coalition training as an intervention strategy for preventing youth hospital injury admissions. However, future studies should consider stronger research designs, confirm findings in different community contexts, use other data sources and evaluate intervention mechanisms.

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Student-inflicted injuries to staff in schools: comparing risk between educators and non-educators

Injury Prevention ◽

10.1136/injuryprev-2017-042472 ◽

2017 ◽

Vol 25 (2) ◽

pp. 116-122 ◽

Cited By ~ 1

Author(s):

Katherine E Schofield ◽

Andrew D Ryan ◽

Craig Stroinski

Keyword(s):

Risk Factors ◽

General Education ◽

Injury Risk ◽

Negative Binomial ◽

Negative Binomial Regression ◽

Acting Out ◽

Increased Risk ◽

Educational Assistants ◽

Reduction Methods ◽

Rate Ratios

ObjectiveStudent-inflicted injury to staff in the educational services sector is a growing concern. Studies on violence have focused on teachers as victims, but less is known about injuries to other employee groups, particularly educational assistants. Inequities may be present, as educational assistants and non-educators may not have the same wage, benefits, training and employment protections available to them as professional educators. We identified risk factors for student-related injury and their characteristics among employees in school districts.MethodsWorkers’ compensation data were used to identify incidence and severity of student-related injury. Rates were calculated using negative binomial regression; risk factors were identified using multivariate models to calculate rate ratios (RR) and 95% CIs.ResultsOver 26% of all injuries were student-related; 8% resulted in lost work time. Special and general education assistants experienced significantly increased risk of injury (RR=6.0, CI 5.05 to 7.15; RR=2.07, CI 1.40 to 3.07) as compared with educators. Risk differed by age, gender and school district type. Text analyses categorised student-related injury. It revealed injury from students acting out occurred most frequently (45.4%), whereas injuries involving play with students resulted in the highest percentage of lost-time injuries (17.7%) compared with all interaction categories.ConclusionStudent-inflicted injury to staff occurs frequently and can be severe. Special education and general assistants bear the largest burden of injury compared with educators. A variety of prevention techniques to reduce injury risk and severity, including policy or environmental modifications, may be appropriate. Equal access to risk reduction methods for all staff should be prioritised.

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Prevalence of SARS-CoV-2 infection among people experiencing homelessness in Toronto during the first wave of the COVID-19 pandemic

10.1101/2021.09.21.21263713 ◽

2021 ◽

Author(s):

Linh Luong ◽

Michaela Beder ◽

Rosane Nisenbaum ◽

Aaron Orkin ◽

Jonathan Wong ◽

...

Keyword(s):

Negative Binomial ◽

Negative Binomial Regression ◽

Infection Rates ◽

Individual Site ◽

Site Characteristics ◽

Increased Risk ◽

Binomial Regression ◽

Great Heterogeneity ◽

The Relationship ◽

Over Time

Background: People experiencing homelessness are at increased risk of SARS-CoV-2 infection. This study reports the point prevalence of SARS-CoV-2 infection during testing conducted at sites serving people experiencing homelessness in Toronto during the first wave of the COVID-19 pandemic. We also explored the association between site characteristics and prevalence rates. Methods: The study included individuals who were staying at shelters, encampments, COVID-19 physical distancing sites, and drop-in and respite sites and completed outreach-based testing for SARS-CoV-2 during the period April 17 to July 31, 2020. We examined test positivity rates over time and compared them to rates in the general population of Toronto. Negative binomial regression was used to examine the relationship between each shelter-level characteristic and SARS-CoV-2 positivity rates. We also compared the rates across 3 time periods (T1: April 17-April 25; T2: April 26-May 23; T3: May 24-June 25). Results: The overall prevalence of SARS-CoV-2 infection was 8.5% (394/4657). Site-specific rates showed great heterogeneity with infection rates ranging from 0% to 70.6%. Compared to T1, positivity rates were 0.21 times lower (95% CI: 0.06, 0.75) during T2 and 0.14 times lower (95% CI: 0.043, 0.44) during T3. Most cases were detected during outbreak testing (384/394 [97.5%]) rather than active case finding. Interpretation: During the first wave of the pandemic, rates of SARS-CoV-2 infection at sites for people experiencing homelessness in Toronto varied significantly over time. The observation of lower rates at certain sites may be attributable to overall time trends, expansion of outreach-based testing to include sites without known outbreaks and/or individual site characteristics.

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Epidemiological characteristics of COVID-19 cases in non-Italian nationals notified to the Italian surveillance system

10.1101/2020.09.22.20199398 ◽

2020 ◽

Cited By ~ 1

Author(s):

Massimo Fabiani ◽

Alberto Mateo-Urdiales ◽

Xanthi Andrianou ◽

Antonino Bella ◽

Martina Del Manso ◽

...

Keyword(s):

Surveillance System ◽

Negative Binomial ◽

Healthcare Access ◽

Delayed Diagnosis ◽

Case Fatality ◽

Negative Binomial Regression ◽

Adjusted Relative Risk ◽

Risk Of Death ◽

Increased Risk ◽

Epidemiological Characteristics

Background International literature suggests that disadvantaged groups are at higher risk of morbidity and mortality from SARS-CoV-2 infection due to poorer living/working conditions and barriers to healthcare access. Yet, to date, there is no evidence of this disproportionate impact on non-national individuals, including economic migrants, short-term travellers, and refugees. Methods We analysed data from the Italian surveillance system of all COVID-19 laboratory-confirmed cases tested positive from the beginning of the outbreak (20th of February) to the 19th of July 2020. We used multilevel negative-binomial regression models to compare the case-fatality rate and the rate of admission to hospital and intensive care unit (ICU) between Italian and non-Italian nationals. The analysis was adjusted for differences in demographic characteristics, pre-existing comorbidities, and period of diagnosis. Results We analysed 213,180 COVID-19 cases, including 15,974 (7.5%) non-Italian nationals. We found that, compared to Italian cases, non-Italian cases were diagnosed at a later date and were more likely to be hospitalised [(adjusted relative risk (ARR)=1.39, 95% confidence interval (CI): 1.33-1.44)] and admitted to ICU (ARR=1.19, 95% CI: 1.07-1.32), with differences being more pronounced in those coming from countries with lower HDI. We also observed an increased risk of death in non-Italian cases from low-HDI countries (ARR=1.32, 95% CI: 1.01-1.75). Conclusions A delayed diagnosis in non-Italian cases could explain their worse outcomes compared to Italian cases. Ensuring early access to diagnosis and treatment to non-Italians could facilitate the control of SARS-CoV-2 transmission and improve health outcomes in all people living in Italy, regardless of nationality.

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Outdoor transmission of COVID-19: Analysis of windspeed

10.1101/2021.02.05.21251179 ◽

2021 ◽

Author(s):

Sean A. P. Clouston ◽

Olga Morozova ◽

Jaymie R. Meliker

Keyword(s):

Population Size ◽

Negative Binomial ◽

Negative Binomial Regression ◽

Daily Temperature ◽

Susceptible Population ◽

Initial Wave ◽

Outdoor Transmission ◽

Increased Risk ◽

Binomial Regression ◽

Very High

AbstractBackgroundTo examine whether outdoor exposures may contribute to the COVID-19 epidemic, we hypothesized that slower outdoor windspeed is associated with increased risk of transmission when individuals socialize outside.MethodsDaily COVID-19 incidence reported between 3/16/2020-12/31/2020 was the outcome. Average windspeed and maximal daily temperature were derived from the National Oceanic and Atmospheric Administration. Negative binomial regression was used to model incidence, adjusting for susceptible population size.ResultsCases were very high in the initial wave but diminished quickly once lockdown procedures were enacted. Unadjusted and multivariable-adjusted analyses revealed that warmer days with windspeed <5.5 MPH had increased COVID-19 incidence (aIRR=1.50, 95% C.I.=[1.25-1.81], P<0.001) as compared to days with average windspeed ≥5.5 MPH.ConclusionThis study suggests that outdoor transmission of COVID-19 may occur by noting that the risk of transmission of COVID-19 in the summer was highest on days when wind was reduced.

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Socioeconomic status during youth and risk of car crash during adulthood. Findings from the DRIVE cohort study

Journal of Epidemiology & Community Health ◽

10.1136/jech-2020-214083 ◽

2021 ◽

pp. jech-2020-214083

Author(s):

Holger Mőller ◽

Kris Rogers ◽

Patricia Cullen ◽

Teresa Senserrick ◽

Soufiane Boufous ◽

...

Keyword(s):

Socioeconomic Status ◽

Low Socioeconomic Status ◽

Negative Binomial ◽

Negative Binomial Regression ◽

Road Transport ◽

Crash Risk ◽

Young Drivers ◽

Car Crash ◽

Increased Risk ◽

Single Vehicle

BackgroundYoung drivers of low socioeconomic status (SES) have a disproportionally high risk of crashing compared with their more affluent counterparts. Little is known if this risk persists into adulthood and if it differs between men and women.MethodsWe used data from a 2003/2004 Australian survey of young drivers (n=20 806), which included measures of drivers’ demographics and established crash risk factors. These data were linked to police-reported crash, hospital and death data up to 2016. We used negative binomial regression models to estimate the association between participants’ SES, with car crash.ResultsAfter adjusting for confounding, drivers of lowest SES had 1.30 (95% CI 1.20 to 1.42), 1.90 (95% CI 1.25 to 2.88), 3.09 (95% CI 2.41 to 3.95) and 2.28 (95% CI 1.85 to 2.82) times higher rate of crash, crash-related hospitalisation, crash in country areas and crash on streets with a speed limit of 80 km/hour or above compared with drivers of highest SES, respectively. For single-vehicle crashes, women in the lowest SES groups had 2.88 (95% CI 1.83 to 4.54) times higher rate of crash compared with those in the highest SES group, but no differences were observed for men from different SES groups.ConclusionYoung drivers who lived in areas of low SES at the time of the survey had a sustained increased risk of crash over the following 13 years compared with drivers from the most affluent areas. Our findings suggest that in addition to traditional measures, road transport injury prevention needs to consider the wider social determinants of health.

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The Effect of Thursday Night Games on In-Game Injury Rates in the National Football League

The American Journal of Sports Medicine ◽

10.1177/0363546520919989 ◽

2020 ◽

Vol 48 (8) ◽

pp. 1999-2003

Author(s):

Jose R. Perez ◽

Jonathan Burke ◽

Abdul K. Zalikha ◽

Dhanur Damodar ◽

Joseph S. Geller ◽

...

Keyword(s):

National Football League ◽

Negative Binomial ◽

Epidemiologic Study ◽

Rest Period ◽

Future Research ◽

Injury Incidence ◽

Injury Rates ◽

Rest Periods ◽

Significant Difference ◽

Team Game

Background: Although claims of increased injury rates with Thursday night National Football League (NFL) games exist, a paucity of data exist substantiating these claims. Purpose: To evaluate the effect of rest between games on in-game injury rates as it pertains to overall injury incidence, location, and player position. Study Design: Descriptive epidemiologic study. Methods: Data were obtained from official NFL game books for regular season games from all 32 teams for the 2013-2016 seasons. All in-game injuries recorded in official game books were included. Rest periods between games were classified as short (4 days), regular (6-8 days), or long (≥10 days). Overall observed injury rates per team-game were analyzed in relation to different rest periods using negative binomial regression. For results with significant overall findings, pairwise comparisons were tested using the Wald chi-square test. Exploratory secondary analyses were performed in a similar fashion to assess differences in injury rates for the different rest periods when stratified by anatomic location and player position. Results: A total of 2846 injuries were identified throughout the 4 seasons. There was an overall significant difference in injuries per team-game between short, regular, and long rest ( P = .01). With short rest, an observed mean of 1.26 injuries per game (95% CI, 1.06-1.49) was significantly different from the 1.53 observed injuries per game with regular rest (95% CI, 1.46-1.60; P = .03), but not compared with the 1.34 observed injuries per game with long rest ( P = .56). For player position, only the tight end, linebacker, and fullback group demonstrated significant differences between the injury rates for different rest categories. Quarterback was the only position with more injuries during games played on Thursday compared with both regular and long rest. This specific analysis was underpowered and the difference was not significant ( P = .08). No differences were found regarding injury rates in correlation with differences in rest periods with different injury locations. Conclusion: A short rest period between games is not associated with increased rates of observed injuries reported in NFL game books; rather, our data suggest there are significantly fewer injuries for Thursday night games compared with games played on regular rest. Future research correlating rest and quarterback injury rates is warranted.

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Effect of environmental conditions on injury rates at a Colorado ski resort

Injury Prevention ◽

10.1136/injuryprev-2019-043275 ◽

2019 ◽

Vol 26 (4) ◽

pp. 324-329

Author(s):

Lauren A Pierpoint ◽

Zachary Y Kerr ◽

Gary Grunwald ◽

Morteza Khodaee ◽

Tessa Crume ◽

...

Keyword(s):

Environmental Conditions ◽

Negative Binomial ◽

Injury Rate ◽

Negative Binomial Regression ◽

Injury Rates ◽

Ski Resort ◽

Average Temperature ◽

Binomial Regression ◽

Rate Ratios ◽

Packed Powder

ObjectiveTo determine the effect of daily environmental conditions on skiing and snowboarding-related injury rates.MethodsInjury information was collected from a mountainside clinic at a large Colorado ski resort for the 2012/2013 through 2016/2017 seasons. Daily environmental conditions including snowfall, snow base depth, temperature, open terrain and participant visits were obtained from historical resort records. Snowpack and visibility information were obtained for the 2013/2014 through 2014/2015 seasons and included in a subanalysis. Negative binomial regression was used to estimate injury rate ratios (IRRs) and 95% CIs.ResultsThe overall injury rate among skiers and snowboarders was 1.37 per 1000 participant visits during 2012/2013 through 2016/2017. After adjustment for other environmental covariates, injury rates were 22% higher (IRR=1.22, 95% CI 1.14 to 1.29) on days with <2.5 compared with ≥2.5 cm of snowfall, and 14% higher on days with average temperature in the highest quartile (≥−3.1°C) compared with the lowest (<−10.6°C; IRR=1.14, 95% CI 1.03 to 1.26). Rates decreased by 8% for every 25 cm increase in snow base depth (IRR=0.92, 95% CI 0.88 to 0.95). In a subanalysis of the 2013/2014 and 2014/2015 seasons including the same covariates plus snowpack and visibility, only snowpack remained significantly associated with injury rates. Rates were 71% higher on hardpack compared with powder days (IRR=1.71, 95% CI 1.18 to 2.49) and 36% higher on packed powder compared with powder days (IRR 1.36, 95% CI 1.12 to 1.64).ConclusionsEnvironmental conditions, particularly snowfall and snowpack, have a significant impact on injury rates. Injury prevention efforts should consider environmental factors to decrease injury rates in skiers and snowboarders.

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