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Item Circumstances and consequences of falls among people with chronic stroke(2013) Schmid, Arlene A.; Yaggi, H. Klar; Burrus, Nicholas; McClain, Vincent; Austin, Charles; Ferguson, Jared; Fragoso, Carlos; Sico, Jason J.; Miech, Edward J.; Matthias, Marianne S.; Williams, Linda S.; Bravata, Dawn M.Falls are common after stroke; however, circumstances and consequences are relatively unknown. Our objectives were to identify the differences between fallers and non-fallers among people with chronic stroke, identify the circumstances of fall events, and examine the consequences of the falls. This is a secondary data analysis; all participants included sustained a stroke. Variables included demographics, stroke characteristics, and comorbidities. Falls were collected via self-report, and circumstances and consequences were derived from participant description of the event and categorized as appropriate. Among 160 participants, 53 (33%) reported a fall during the 1 yr period. Circumstances of falls were categorized as intrinsic or extrinsic. Location and circumstance of the fall were included: 70% occurred at home and 40% were associated with impaired physical or mental state (e.g., inattention to tying shoes). Additionally, 21% of falls were associated with activities of daily living and mobility and 34% with slips or trips. The majority who fell sustained an injury (72%). Injuries ranged from bruising to fractures, and 55% of those with an injury sought medical care (32% to emergency department). Poststroke falls are associated with an alarming rate of injury and healthcare utilization. Targeting mental and physical states may be key to fall prevention.Item Comprehensive Coach Education Reduces Head Impact Exposure in American Youth Football(2015-10) Kerr, Zachary Y.; Yeargin, Susan W.; Valovich McLeod, Tamara C.; Mensch, James; Hayden, Ross; Dompier, Thomas P.BACKGROUND: Despite little evidence that defines a threshold of head impact exposure or that participation in youth sports leads to long-term cognitive impairments, it is prudent to identify methods of reducing the frequency of head impacts. PURPOSE: To compare the mean number of head impacts between youth football players in practice and games between leagues that implemented the Heads Up Football (HUF) educational program and those that did not (NHUF). STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: During the 2014 season, head impact exposure was measured using xPatch accelerometers from 70 youth football players aged 8 to 15 years from 5 leagues. Data were collected during both games and practices. The NHUF group comprised 32 players from 8 teams within 3 leagues. The HUF group comprised 38 players from 7 teams within 2 leagues. Independent-sample t tests evaluated differences in head impact exposure across groups (ie, HUF and NHUF). RESULTS: Players (mean ± SD: age, 11.7 ± 1.4 years; height, 152.2 ± 10.5 cm; weight, 51.6 ± 9.6 kg) experienced a total of 7478 impacts over 10g, of which 4250 (56.8%) and 3228 (43.2%) occurred in practices and games, respectively. The majority of impacts occurred within the NHUF group (62.0%), followed by the HUF group (38.0%). With a 10g impact threshold, the mean number of impacts during practice per individual event was lower in the HUF group (mean ± SD, 5.6 ± 2.9) than in the NHUF group (mean ± SD, 8.9 ± 3.1; difference, 3.4; 95% CI, 2.9-3.9). This difference was attenuated when the threshold was changed to 20g but remained significant (difference, 1.0; 95% CI, 0.7-1.3). At both the 10g and 20g impact thresholds, no differences were found in games. CONCLUSION: Players who participated in HUF leagues accumulated fewer head impacts per practice at both the 10g and 20g thresholds. Youth football leagues should consider the HUF educational program, while exploring additional interventions, to help reduce the number of head impacts in players.Item Daily Situational Brief, June 22, 2011(MESH Coalition, 6/22/2011) MESH CoalitionItem Elaborating the Correlates of Firearm Injury Severity: Combining Criminological and Public Health Concerns(2014-11) Grommon, Eric; Rydberg, JasonThis research addresses recent calls to incorporate multidisciplinary approaches in the study of firearm violence by utilizing an elaborated criminal events perspective to explore the correlates of firearm injury severity. A unique dataset of nonfatal firearm injury data are derived from official police reports, allowing the use of a medically validated measure of injury trauma in place of more typical injury indicators. The relative and collaborative contributions of criminological and public health indicators for explaining variation in levels of injury severity are assessed. Multinomial logit models suggest that critical injuries are more likely among older victims, victims who knew their assailants, and victims who refused to cooperate with police. Additionally, the likelihood of critical victim injuries decreased as the time to report an incident to the police increased. The strongest correlates were measures of incident circumstances and the number of gunshot wounds a victim received. In all, these results reveal that a combination of measures from both fields is needed to provide a deeper understanding of injury severity outcomes.Item Injuries associated with bunk beds that occur in jail(Elsevier, 2018-01) Loder, Randall T.; Young, Jocelyn Cole; Orthopaedic Surgery, School of MedicineBackground There are many studies of bunk bed injuries, but none specifically addressing those occurring in jails. It was the purpose of this study to investigate the magnitude and patterns of bunk bed injuries occurring in correctional institutions. Methods The National Electronic Injury Surveillance System (NEISS) data for the 10 year period 2006 through 2015 due to bunk beds was accessed. Injuries involving bunk beds were identified and the mechanism of injury determined. Statistical analyses were performed with SUDAAN 10™ software. A p < 0.05 was considered statistically significant. Results There were an estimated 639,505 ED visits for bunk bed associated injuries; 51,204 occurred in jail. All jail cases occurred in the age groups ≥10 years (177,165); 29% of these 177,165 sustained the injury in jail. Those who sustained a bunk bed injury in jail compared to those who did not were older, more commonly male, seen in smaller hospitals, more likely admitted, and more frequently associated with a seizure. For those injuries occurring in jail, the most common injury in the trunk and lower extremity was a strain/sprain; the upper extremity a contusion/abrasion; and the head/neck a laceration or traumatic brain injury. A fall off the bunk bed accounted for 71.8% of the injuries, had the highest hospital admission rate (7.4%), accounted for all of the spine injuries, 96% of the head injuries, and had the highest proportion of fractures (14.4%). Inmates having a seizure before the injury sustained fewer fractures, more lacerations, and more head/neck injuries. Conclusions Injuries in jail account for 29% of all bunk bed injuries resulting in an ED visit in the USA in those age groups ≥10 years. A fall from the bed occurred in 72% and a seizure disorder was 4.5 times more common in jail inmates compared to non inmates. Possible prevention strategies include railings/ladders to reduce the incidence of falls, changes in flooring surfaces, and seizure education and placing inmates with seizure and/or alcohol related disorders on the bottom bunk. This will require a multidisciplinary approach involving the disciplines of medicine, material engineering, and criminal justice.