Injury Prevention Research Center

Chapel Hill, NC, United States

Injury Prevention Research Center

Chapel Hill, NC, United States

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Moss L.A.,Injury Prevention Research Center | Skelton J.A.,University of North Carolina at Chapel Hill
New England Journal of Medicine | Year: 2015

BACKGROUND The prevalence of severe obesity among children and young adults has increased over the past decade. Although the prevalence of cardiometabolic risk factors is relatively low among children and young adults who are overweight or obese, those with more severe forms of obesity may be at greater risk. METHODS We performed a cross-sectional analysis of data from overweight or obese children and young adults 3 to 19 years of age who were included in the National Health and Nutrition Examination Survey from 1999 through 2012 to assess the prevalence of multiple cardiometabolic risk factors according to the severity of obesity. Weight status was classified on the basis of measured height and weight. We used standard definitions of abnormal values for total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein cholesterol, triglycerides, blood pressure, glycated hemoglobin, and fasting glucose and report the prevalence of abnormal values in children and young adults according to weight status. RESULTS Among 8579 children and young adults with a body-mass index at the 85th percentile or higher (according to the Centers for Disease Control and Prevention growth charts), 46.9% were overweight, 36.4% had class I obesity, 11.9% had class II obesity, and 4.8% had class III obesity. Mean values for some, but not all, cardiometabolic variables were higher with greater severity of obesity in both male and female participants, and the values were higher in male participants than in female participants; for HDL cholesterol, the mean values were lower with greater severity of obesity. Multivariable models that controlled for age, race or ethnic group, and sex showed that the greater the severity of obesity, the higher the risks of a low HDL cholesterol level, high systolic and diastolic blood pressures, and high triglyceride and glycated hemoglobin levels. CONCLUSIONS Severe obesity in children and young adults was associated with an increased prevalence of cardiometabolic risk factors, particularly among boys and young men. © 2015 Massachusetts Medical Society. All rights reserved.


Nelson A.E.,University of North Carolina at Chapel Hill | Elstad E.,University of North Carolina at Chapel Hill | Devellis R.F.,University of North Carolina at Chapel Hill | Golightly Y.M.,University of North Carolina at Chapel Hill | And 5 more authors.
Disability and Rehabilitation | Year: 2014

Purpose: To determine associations between multiple joint symptoms and radiographic osteoarthritis (rOA) and functional outcomes. Method: Complete cross-sectional data for multi-joint symptoms and radiographs, Health Assessment Questionnaire (HAQ) scores, and gait speed were available for 1307 Johnston County Osteoarthritis Project participants (34% men, 32% African American, mean age 66 years). Factor analysis of symptom scores and radiographic grades for the lumbosacral spine, bilateral hands, knees, and hips provided composite scores. Regression models were used to determine associations between composite scores, HAQ, and gait speed, adjusting for age, body mass index, gender, and race. Results: Five rOA factors were identified: (1) IP/CMC factor (carpometacarpal [CMC] and all interphalangeal [IP] joints); (2) MCP factor (metacarpophalangeal joints 2-5); (3) Knee factor (tibiofemoral and patellofemoral joints); (4) Spine factor (L1/2 to L5/S1); and (5) Symptom factor. After adjustment, only the Symptom composite was significantly associated with HAQ and gait speed; a 1-standard deviation increase in Symptom score was associated with 9 times higher odds of having poorer function on the HAQ (odds ratio 9.32, 95% confidence interval [CI] 6.80, 12.77), and a clinically significant decline in gait speed (0.06 m/s, 95% CI -0.07, -0.05). Conclusions: A novel Symptom composite score was associated with poorer functional outcomes.Implications for RehabilitationOsteoarthritis (OA) commonly affects multiple joints and is the most common form of arthritis.Symptomatic assessments, which can be easily executed by rehabilitation practitioners, are more closely related to self-reported and performance-based functional status than are less accessible and more costly radiographs.Symptomatic assessments are likely to be more informative for understanding, treating, and potentially preventing functional limitations than radiographic assessments. © 2014 Informa UK Ltd.


Runyan D.K.,University of North Carolina at Chapel Hill | Runyan D.K.,Injury Prevention Research Center | Shankar V.,University of North Carolina at Chapel Hill | Shankar V.,Injury Prevention Research Center | And 12 more authors.
Pediatrics | Year: 2010

BACKGROUND: Although the history of recognition of child abuse in Europe and North America extends over 40 years, recognition and data are lacking in other parts of the world. Cultural differences in child-rearing complicate cross-cultural studies of abuse. OBJECTIVE: To ascertain rates of harsh and less-harsh parenting behavior in population-based samples. METHODS: We used parallel surveys of parental discipline of children in samples of mothers in Brazil, Chile, Egypt, India, Philippines, and the United States. Data were collected between 1998 and 2003. The instrument used was a modification of the Parent-Child Conflict Tactics Scale, along with a study-developed survey of demographic characteristics and other parent and child variables. Women (N = 14 239) from 19 communities in 6 countries were surveyed. We interviewed mothers aged 15 to 49 years (18-49 years in the United States) who had a child younger than 18 years in her home. Sample selection involved either random sampling or systematic sampling within randomly selected blocks or neighborhoods. RESULTS: Nearly all parents used nonviolent discipline and verbal or psychological punishment. Physical punishment was used in at least 55% of the families. Spanking rates (with open hand on buttocks) ranged from a low of 15% in an educated community in India to a high of 76% in a Philippine community. Similarly, there was a wide range in the rates of children who were hit with objects (9%-74% [median: 39%]) or beaten by their parents (0.1%-28.5%). Extremely harsh methods of physical punishment, such as burning or smothering, were rare in all countries. It is concerning that ≥20% of parents in 9 communities admitted shaking children younger than 2 years. CONCLUSIONS: Physical and verbal punishments of children are common in high-, middle-, and low-income communities around the world. The forms and rates of punishment vary among countries and among communities within countries. A median of 16% of children experienced harsh or potentially abusive physical discipline in the previous year. Copyright © 2010 by the American Academy of Pediatrics.


Villaveces A.,University of North Carolina at Chapel Hill | Villaveces A.,Injury Prevention Research Center | Stucky B.D.,University of North Carolina at Chapel Hill | Runyan C.W.,University of North Carolina at Chapel Hill | And 3 more authors.
Journal of Public Health Management and Practice | Year: 2010

Objectives: To develop and evaluate the characteristics of an instrument for assessing core competencies for injury and violence prevention. Methods: We developed a preliminary tool and pilot tested it with a small sample. After refining the tool, we recruited 401 participants to respond to the questions and provide information about demographic characteristics, injury activities, education, and current injury- and violence-related work. With the obtained data, we conducted a categorical confirmatory factor analysis to determine domains of knowledge for questions. We then evaluated the properties of the assessment, using item response theory. Results: Results of item evaluation using item response theory provide a 26-item Injury Prevention Assessment scale, which reliably assesses injury prevention knowledge at an entry-level ability. Conclusions: This initial assessment is useful both for individual practitioners and for institutions as a tool for determining the need for training in injury prevention concepts. Additional tools should be developed to assess higher-proficiency levels of knowledge of injury prevention. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins.


Peek-Asa C.,University of Iowa | Peek-Asa C.,Injury Prevention Research Center | Britton C.,University of Iowa | Britton C.,Injury Prevention Research Center | And 3 more authors.
Journal of Safety Research | Year: 2010

Background: Previous research has identified teenage drivers as having an increased risk for motor-vehicle crash injury compared with older drivers, and rural roads as having increased crash severity compared with urban roads. Few studies have examined incidence and characteristics of teen driver-involved crashes on rural and urban roads. Methods: All crashes involving a driver aged 10 through 18 were identified from the Iowa Department of Transportation crash data from 2002 through 2008. Rates of overall crashes and fatal or severe injury crashes were calculated for urban, suburban, rural, and remote rural areas. The distribution of driver and crash characteristics were compared between rural and urban crashes. Logistic regression was used to identify driver and crash characteristics associated with increased odds of fatal or severe injury among urban and rural crashes. Results: For younger teen drivers (age 10 through 15), overall crash rates were higher for more rural areas, although for older teen drivers (age 16 through 18) the overall crash rates were lower for rural areas. Rural teen crashes were nearly five times more likely to lead to a fatal or severe injury crash than urban teen crashes. Rural crashes were more likely to involve single vehicles, be late at night, involve a failure to yield the right-of-way and crossing the center divider. Conclusions: Intervention programs to increase safe teen driving in rural areas need to address specific risk factors associated with rural roadways. Impact on Industry: Teen crashes cause lost work time for teen workers as well as their parents. Industries such as safety, health care, and insurance have a vested interest in enhanced vehicle safety, and these efforts should address risks and injury differentials in urban and rural roadways. © 2010 National Safety Council and Elsevier Ltd.


Yang J.,University of Iowa | Yang J.,Injury Prevention Research Center | Tibbetts A.S.,Injury Prevention Research Center | Covassin T.,Michigan State University | And 6 more authors.
Journal of Athletic Training | Year: 2012

Context: Although overuse injuries are gaining attention, epidemiologic studies on overuse injuries in male and female collegiate athletes are lacking. Objective: To report the epidemiology of overuse injuries sustained by collegiate athletes and to compare the rates of overuse and acute injuries. Design: Descriptive epidemiology study. Setting: A National Collegiate Athletic Association Division I university. Patients or Other Participants: A total of 1317 reported injuries sustained by 573 male and female athletes in 16 collegiate sports teams during the 2005-2008 seasons. Main Outcome Measure(s): The injury and athlete-exposure (AE) data were obtained from the Sports Injury Monitoring System. An injury was coded as either overuse or acute based on the nature of injury. Injury rate was calculated as the total number of overuse (or acute) injuries during the study period divided by the total number of AEs during the same period. Results: A total of 386 (29.3%) overuse injuries and 931 (70.7%) acute injuries were reported. The overall injury rate was 63.1 per 10000 AEs. The rate ratio (RR) of acute versus overuse injuries was 2.34 (95% confidence interval [CI] =2.05, 2.67). Football had the highest RR (RR = 8.35, 95% CI =5.38, 12.97), and women's rowing had the lowest (RR = 0.75, 95% CI = 0.51, 1.10). Men had a higher acute injury rate than women (49.8 versus 38.6 per 10000 AEs). Female athletes had a higher rate of overuse injury than male athletes (24.6 versus 13.2 per 10000 AEs). More than half of the overuse injuries (50.8%) resulted in no time loss from sport. Conclusions: Additional studies are needed to examine why female athletes are at greater risk for overuse injuries and identify the best practices for prevention and rehabilitation of overuse injuries. © by the National Athletic Trainers' Association, Inc.


Castro Y.,Northwestern University | Powell E.C.,Injury Prevention Research Center | Sheehan K.M.,Injury Prevention Research Center
Journal of Trauma - Injury, Infection and Critical Care | Year: 2010

Background: Specific information about the supervision of young children with injuries related to falls is limited. In this study, we describe the supervision and physical environment of falls resulting in medical care in the emergency department. Methods: We enrolled a convenience sample of 108 children younger than 7 years with fall injuries. Results: The average age was 3 years, and 56% were male. Seventy-six (70%) were a fall from a height including 16 that involved stairs. Among caretakers in a nongroup setting (n = 95), most (61%) were supervising more than one child. The attention to the child was holding or playing with the child (13%), observing (45%), usually constantly, or listening for the child (19%); 9% reported no supervision at the time of the fall. Thirty-two percent stated they were touching or within reach of the child. Of falls indoors (n = 56), the supervisor was in the same room as the child for more than half of cases. There was no association between the number of children supervised and fall type (height vs. same level). When compared with those with same level falls, children with falls from a height were more often supervised with listening or no supervision (vs. observation, holding, or playing with the child) χ, p = 0.004. Conclusions: Many children were supervised at the time of their fall. Most caretakers had visual contact, and up to a third were touching or within reach of the child. The strategies used in these apparently low-risk situations were insufficient to prevent the falls we report. ©2010 by Lippincott Williams & Wilkins.


De Rome L.,Injury Prevention Research Center | De Rome L.,University of Sydney | De Rome L.,University of New South Wales | Meredith L.,Injury Prevention Research Center | And 4 more authors.
Journal of Safety Research | Year: 2014

Introduction The distributions of motorcycle crash impacts and injuries were compared to the four impact risk zones and protective performance specified in the European Standard for motorcycle clothing (EN 13595). Methods Crashed motorcyclists' (n = 117) injuries and clothing damage were categorized by body area into the four risk zones. Three levels of protection were defined: protective clothing with impact protection, protective clothing only and non-protective clothing. Results The distribution of impact/injury sites corresponded to the predictions of EN 13595, with the proportion of all injuries decreasing from 43.9% in Zone 1, to 18.0%, 16.7%, and 11.5% in Zones 2 to 4, respectively. Protective clothing modified the distribution of injuries with substantially more injuries (OR = 2.69, 95% CL: 20.1-3.59) at unprotected impact sites. Practical application These findings support an appropriate framework for determining performance specifications for the manufacture of motorcycle clothing that will effectively reduce the risk of injury in crashes. © 2014 National Safety Council and Elsevier Ltd. All rights reserved.

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