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Chapel Hill, NC, United States

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. Source

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. Source

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. Source

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. Source

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

Background: Young children are at risk for injuries in the home. This study was to compare a safe house model to The Injury Prevention Program (TIPP) sheet for providing injury prevention information. Methods: Parents of children who were younger than 6 years were randomized to injury prevention education using a safe home model or an age appropriate TIPP sheet. There was a pretest before the intervention. The recall of injury prevention information was assessed by a telephone posttest 4 weeks to 6 weeks after the intervention. To obtain a sample broadly representative of community demographics, we recruited families in the dermatology clinic of a teaching hospital. Results: We collected complete information for 371 families of which 181 were in the safe home model group and 190 were in the TIPP group. There were no differences between groups in percent minority race, education, or insurance; the parents in the safe home group were slightly older (34.4 ± 6.5 vs. 32.9 ± 5.8). More than 80% in each group had education beyond high school. There was no difference between groups in pretest scores, 8.0 ± 1.3 for the safe home model group and 8.1 ± 1.1 for the TIPP group. There was no difference between groups in posttest scores, 9.0 ± 0.8 for the safe home model group and 9.1 ± 0.9 for the TIPP group. Conclusions: The safe home model and the TIPP sheets were both effective in improving safety knowledge. The use of a safe home model complements current strategies to improve injury prevention knowledge. ©2010 by Lippincott Williams & Wilkins. Source

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