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

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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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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Evolving epidemiology of reported cryptosporidiosis cases in the United States, 1995–2012

Epidemiology and Infection ◽

10.1017/s0950268815003131 ◽

2015 ◽

Vol 144 (8) ◽

pp. 1792-1802 ◽

Cited By ~ 11

Author(s):

J. E. PAINTER ◽

J. W. GARGANO ◽

J. S. YODER ◽

S. A. COLLIER ◽

M. C. HLAVSA

Keyword(s):

United States ◽

Risk Factors ◽

Race And Ethnicity ◽

Negative Binomial ◽

Disease Outbreaks ◽

Negative Binomial Regression ◽

The United States ◽

Case Status ◽

Estimate Rate ◽

Rate Ratios

SUMMARYCryptosporidiumis the leading aetiology of waterborne disease outbreaks in the United States. This report briefly describes the temporal and geographical distribution of US cryptosporidiosis cases and presents analyses of cryptosporidiosis case data reported in the United States for 1995–2012. The Cochran–Armitage test was used to assess changes in the proportions of cases by case status (confirmedvs.non-confirmed), sex, race, and ethnicity over the study period. Negative binomial regression models were used to estimate rate ratios (RR) and 95% confidence intervals (CI) for comparing rates across three time periods (1995–2004, 2005–2008, 2009–2012). The proportion of confirmed cases significantly decreased (P< 0·0001), and a crossover from male to female predominance in case-patients occurred (P< 0·0001). Overall, compared to 1995–2004, rates were higher in 2005–2008 (RR 2·92, 95% CI 2·08–4·09) and 2009–2012 (RR 2·66, 95% CI 1·90–3·73). However, rate changes from 2005–2008 to 2009–2012 varied by age group (Pinteraction< 0·0001): 0–14 years (RR 0·55, 95% CI 0·42–0·71), 15–44 years (RR 0·99, 95% CI 0·82–1·19), 45–64 years (RR 1·47, 95% CI 1·21–1·79) and ⩾65 years (RR 2·18, 95% CI 1·46–3·25). The evolving epidemiology of cryptosporidiosis necessitates further identification of risk factors in population subgroups. Adding systematic molecular typing ofCryptosporidiumspecimens to US national cryptosporidiosis surveillance would help further identify risk factors and markedly expand understanding of cryptosporidiosis epidemiology in the United States.

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Tuberculosis and diabetes: bidirectional association in a UK primary care data set

Journal of Epidemiology & Community Health ◽

10.1136/jech-2018-211231 ◽

2018 ◽

Vol 73 (2) ◽

pp. 142-147 ◽

Cited By ~ 6

Author(s):

Fiona Pearson ◽

Peijue Huangfu ◽

Richard McNally ◽

Mark Pearce ◽

Nigel Unwin ◽

...

Keyword(s):

Negative Binomial ◽

Smoking Status ◽

Negative Binomial Regression ◽

Health Improvement ◽

Data Set ◽

Practice Population ◽

Increased Risk ◽

Bidirectional Association ◽

Retrospective Cohort Studies ◽

Rate Ratios

BackgroundMany studies have found an increased risk of pulmonary tuberculosis (PTB) among those with diabetes mellitus (DM). However, evidence on whether the association is bidirectional remains sparse. This study investigates DM rates among those with and without prior tuberculosis (TB) disease as well as the reverse.MethodsData on a UK general practice population, between 2003 and 2009, were obtained from The Health Improvement Network database. A series of retrospective cohort studies were completed. Individuals were successively classified as ‘exposed’ or ‘unexposed’ to TB, PTB, extrapulmonary TB (EPTB) or DM. Multivariate negative binomial regression was used to calculate incidence rate ratios (IRR) among each exposure group for outcomes of interest (TB, PTB, EPTB or DM in turn) adjusting for plausible confounding variables (age, sex, region, Townsend quintile and smoking status). Potential confounding due to ethnicity was adjusted for using McNamee’s external method.ResultsDM risk was substantially raised among individuals with a history of TB disease (IRR 5.65 (95% CI 5.19 to 6.16)), PTB (IRR 5.74 (95% CI 5.08 to 6.50)) and EPTB (IRR 4.66 (95% CI 3.94 to 5.51)) compared with those without; results were attenuated after external adjustment for ethnicity (IRR 2.33 (95% CI 2.14 to 2.53)). TB risk was raised modestly among individuals with DM (IRR 1.50 (95% CI 1.27 to 1.76)) and was attenuated slightly after adjustment for ethnicity (IRR 1.26 (95% CI 1.07 to 1.48)).ConclusionDM risk was raised among those with previous TB disease; this finding has implications for follow-up and screening of patients with TB, who may be at high risk of developing DM or related complications.

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610 Self-Reported Sleep and Circadian Characteristics Predict Future Substance Use: A Longitudinal Analysis from the NCANDA Study

SLEEP ◽

10.1093/sleep/zsab072.608 ◽

2021 ◽

Vol 44 (Supplement_2) ◽

pp. A240-A240

Author(s):

Brant Hasler ◽

Jessica Graves ◽

Meredith Wallace ◽

Stephanie Claudatos ◽

Fiona Baker ◽

...

Keyword(s):

Risk Factors ◽

Substance Use ◽

Sleep Duration ◽

Daytime Sleepiness ◽

Parental Education ◽

Negative Binomial ◽

Longitudinal Design ◽

Random Effect ◽

Cannabis Use ◽

Increased Risk

Abstract Introduction Growing evidence indicates that sleep characteristics predict later substance use and related problems during adolescence and young adulthood. However, most prior studies have assessed a limited range of sleep characteristics, studied only a narrow age span, and included relatively few follow-up assessments. Here, we used multiple years of data from the National Consortium on Alcohol and Neurodevelopment in Adolescence (NCANDA) study, which spans the adolescent period with an accelerated longitudinal design, to examine whether multiple sleep characteristics in any year predict substance use the following year. Methods The sample included 831 participants (423 females; age 12–21 years at baseline) from NCANDA. Sleep variables included the previous year’s circadian preference, sleep quality, daytime sleepiness, timing of midsleep (weekday and weekend), and sleep duration (weekday and weekend). Each sleep variable’s association with the subsequent year’s substance use (cannabis use or alcohol binge severity) across years 1–5 was tested separately using generalized linear mixed models (zero-inflated Negative Binomial for cannabis; ordinal for binge severity) with age, sex, race, visit, parental education, previous year’s substance use (yes/no) as covariates and subject as a random effect. Results With regard to cannabis use, greater eveningness and shorter weekday sleep duration predicted an increased risk for additional days of cannabis use the following year, while greater eveningness and later weekend midsleep predicted a greater likelihood of any cannabis use the following year. With regard to alcohol binge severity, greater eveningness, greater daytime sleepiness, and shorter sleep duration (weekday and weekend) all predicted an increased risk for more severe alcohol bingeing the following year. Post-hoc stratified analyses indicated that some of these associations may differ between high school-age and college-age participants. Conclusion Our findings extend prior work, indicating that eveningness and later sleep timing, as well as shorter sleep duration, especially on weekdays, are risk factors for future cannabis use and alcohol misuse. These results underscore a need for greater attention to sleep characteristics as potential risk factors for substance use in adolescents and young adults and may inform future areas of intervention. Support (if any) Grants from NIH: R01AA025626 (Hasler) and U01AA021690 (Clark) and UO1 AA021696 (Baker & Colrain)

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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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Factors associated with COVID-19 infections and mortality in Africa: a cross-sectional study using publicly available data

BMJ Open ◽

10.1136/bmjopen-2020-042750 ◽

2020 ◽

Vol 10 (11) ◽

pp. e042750

Author(s):

Charles Okeahalam ◽

Victor Williams ◽

Kennedy Otwombe

Keyword(s):

Risk Factors ◽

Negative Binomial ◽

Negative Binomial Regression ◽

Cross Sectional Study ◽

Sub Saharan Africa ◽

Sectional Study ◽

African Countries ◽

Cross Sectional ◽

Life Expectancy At Birth ◽

Services Delivery

IntroductionThe current COVID-19 pandemic is a global threat. This elicits questions on the level of preparedness and capacity of health systems to respond to emergencies relative to other parts of the world.MethodsThis cross-sectional study uses publicly available core health data for 53 African countries to determine risk factors for cumulative COVID-19 deaths and cases per million in all countries in the continent. Descriptive statistics were determined for the indicators, and a negative binomial regression was used for modelling the risk factors.ResultsIn sub-Saharan Africa, an increase in the number of nursing and midwifery personnel decreased the risk of COVID-19 deaths (p=0.0178), while a unit increase in universal healthcare (UHC) index of service coverage and prevalence of insufficient physical activity among adults increased the risk of COVID-19 deaths (p=0.0432 and p=0.0127). An increase in the proportion of infants initiating breast feeding reduced the number of cases per million (p<0.0001), while an increase in higher healthy life expectancy at birth increased the number of cases per million (p=0.0340).ConclusionDespite its limited resources, Africa’s preparedness and response to the COVID-19 pandemic can be improved by identifying and addressing specific gaps in the funding of health services delivery. These gaps impact negatively on service delivery in Africa, which requires more nursing personnel and increased UHC coverage to mitigate the effects of COVID-19.

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Behavioural difficulties in early childhood and risk of adolescent injury

Archives of Disease in Childhood ◽

10.1136/archdischild-2019-317271 ◽

2019 ◽

Vol 105 (3) ◽

pp. 282-287

Author(s):

Amrita Bandyopadhyay ◽

Karen Tingay ◽

Ashley Akbari ◽

Lucy Griffiths ◽

Helen Bedford ◽

...

Keyword(s):

Early Childhood ◽

Negative Binomial ◽

Negative Binomial Regression ◽

Activity Level ◽

Injury Incidence ◽

Injury Rates ◽

Risk Of Injury ◽

Academic Qualification ◽

Increased Risk ◽

Receive Treatment

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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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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Assessing Differential Impacts of COVID-19 on Black Communities

10.1101/2020.05.04.20090274 ◽

2020 ◽

Cited By ~ 3

Author(s):

Gregorio A. Millett ◽

Austin T. Jones ◽

David Benkeser ◽

Stefan Baral ◽

Laina Mercer ◽

...

Keyword(s):

Black People ◽

Negative Binomial ◽

Negative Binomial Regression ◽

Black Communities ◽

Negative Binomial Regression Model ◽

County Level ◽

Structural Racism ◽

Black Residents ◽

Us Counties ◽

Rate Ratios

AbstractPurposeGiven incomplete data reporting by race, we used data on COVID-19 cases and deaths in US counties to describe racial disparities in COVID-19 disease and death and associated determinants.MethodsUsing publicly available data (accessed April 13, 2020), predictors of COVID-19 cases and deaths were compared between disproportionately (≥13%) black and all other (<13% black) counties. Rate ratios were calculated and population attributable fractions (PAF) were estimated using COVID-19 cases and deaths via zero-inflated negative binomial regression model. National maps with county-level data and an interactive scatterplot of COVID-19 cases were generated.ResultsNearly ninety-seven percent of disproportionately black counties (656/677) reported a case and 49% (330/677) reported a death versus 81% (1987/2,465) and 28% (684/ 2465), respectively, for all other counties. Counties with higher proportions of black people have higher prevalence of comorbidities and greater air pollution. Counties with higher proportions of black residents had more COVID-19 diagnoses (RR 1.24, 95% CI 1.17-1.33) and deaths (RR 1.18, 95% CI 1.00-1.40), after adjusting for county-level characteristics such as age, poverty, comorbidities, and epidemic duration. COVID-19 deaths were higher in disproportionally black rural and small metro counties. The PAF of COVID-19 diagnosis due to lack of health insurance was 3.3% for counties with <13% black residents and 4.2% for counties with ≥13% black residents.ConclusionsNearly twenty-two percent of US counties are disproportionately black and they accounted for 52% of COVID-19 diagnoses and 58% of COVID-19 deaths nationally. County-level comparisons can both inform COVID-19 responses and identify epidemic hot spots. Social conditions, structural racism, and other factors elevate risk for COVID-19 diagnoses and deaths in black communities.

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