Sex, military occupation and rank are associated with risk of anterior cruciate ligament injury in tactical-athletes.

INTRODUCTION: Anterior cruciate ligament (ACL) injury is common within the US military and represents a significant loss to readiness. Since recent changes to operational tempo, there has not been an analysis of ACL injury risk. The aim of this retrospective cohort study was to evaluate military occupation, sex, rank and branch of service on ACL injury risk in the US military from 2006 to 2018. METHODS: The Defense Medical Epidemiology Database was queried for the number of US tactical athletes with International Classification of Diseases diagnosis codes 717.83 (old disruption of ACL), 844.2 (sprain of knee cruciate ligament), M23.61 (other spontaneous disruption of ACL) and S83.51 (sprain of ACL of knee) on their initial encounter. Relative risk and χ2 statistics were calculated to assess sex and military occupation effects on ACL injury. A multivariable negative binomial regression model evaluated changes in ACL injury incidence with respect to sex, branch of service and rank. RESULTS: The study period displayed a significant decrease in the ACL injury rate at 0.18 cases per 1000 person-years or relative decrease of 4.08% each year (p<0.001) after averaging over the main and interactive effects of sex, rank and branch of service. The interaction effect of time with sex indicated a steeper decline in the incidence in men as compared with women. The risk of ACL injury by sex was modified by rank. The incidence among military personnel varied by occupation. CONCLUSION: Despite the decline among tactical athletes over time, rates of ACL injury remain much higher than the general US population. Sex, rank, branch of service and military occupation were found to be risk factors for ACL injury. It is critical for policy makers to understand the salient risk factors for ACL injury to guide proactive measures to prevent injury.

Prescribed footwear and orthoses are not prophylactic in preventing lower extremity injuries in military tactical athletes: a systematic review with meta-analysis.

INTRODUCTION: Military members are exposed to high cumulative physical loads that frequently lead to injury. Prescribed footwear and orthoses have been used to prevent injury. The purpose of this systematic review with meta-analysis was to assess if prescribed prophylactic footwear or foot orthoses reduced the risk of lower extremity injury in military tactical athletes. METHODS: MEDLINE, Embase, Web of Science, Cumulative Index to Nursing and Allied Health Literature, SportDiscus, and Defense Technical Information Center databases were searched for randomised controlled trials published at any time that compared foot orthoses or prescribed footwear (to include shock-absorbing insoles and socks) with a placebo intervention or a no-treatment control. Methodological quality was assessed and the number of injuries, population at risk and duration of the study epoch were extracted and relative risk (RR) calculated. An omnibus meta-analysis was performed assessing all prescribed footwear and orthoses intervention studies, with subgroup analyses conducted on studies with similar interventions (ie, basketball athletic shoes, athletic shoes (prescribed by foot type), foot orthoses, shock-absorbing insoles, socks, tropical combat boots). RESULTS: Of 1673 studies identified, 22 were included. Three of eight studies that employed orthoses demonstrated significantly reduced overuse injuries compared with no-treatment controls (RR range: 0.34-0.68); one study showed neoprene insoles significantly decreased overuse injuries (RR: 0.75). There were no other significant effects in the individual studies and no protective effects observed in the omnibus meta-analysis or in the component subanalyses. CONCLUSIONS: Prescribed footwear and orthoses do not appear to have a prophylactic effect on lower quarter musculoskeletal injuries in military members and cannot be recommended at this time.

American Academy of Pediatrics: Technical report: Alternative dispute resolution in medical malpractice.

The purpose of this technical report is to provide pediatricians with an understanding of past crises within the professional liability insurance industry, the difficulties of the tort system, and alternative strategies for resolving malpractice disputes that have been applied to medical malpractice actions. Through this report, pediatricians will gain a technical understanding of common alternative dispute resolution (ADR) strategies. The report explains the distinctions between various ADR methods in terms of process and outcome, risks and benefits, appropriateness to the nature of the dispute, and long-term ramifications. By knowing these concepts, pediatricians faced with malpractice claims will be better-equipped to participate in the decision-making with legal counsel on whether to settle, litigate, or explore ADR options.

American Academy of Pediatrics. Committee on Practice and Ambulatory Medicine and Committee on Medical Liability. Pediatric physician profiling.

Employers, insurers, and other purchasers of health care services collect data to profile the practice habits of pediatricians and other physicians. This policy statement delineates a series of recommendations that should be adopted by health care purchasers to guide the development and implementation of physician profiling systems.

Adolescent occupational injuries: Texas, 1990-1996.

BACKGROUND: A comprehensive surveillance system for occupational injuries to adolescents does not exist in Texas, as in most states. Therefore, the magnitude, severity, nature, and source of injuries to working adolescents have not been well described in Texas. METHODS: The investigators used three data sources to investigate work-related injuries and deaths in Texas: (1) Texas Workers' Compensation Commission (TWCC) claims data from 1991 through April 1996; (2) 1993 TWCC/Bureau of Labor Statistics (BLS) Annual Survey of Occupational Injuries and Illnesses; and (3) work-related fatalities identified from Texas death certificates from 1990-1995. RESULTS: There were 9,027 injuries reported to the TWCC for adolescents 14-17 years of age during slightly more than 5 years. Injuries for which indemnity payments were made (more than 7 days out of work) occurred among 21.7% of the adolescents. Based on BLS data in 1993, of 992 non-fatal injuries involving days away from work, 35% were caused by contact with objects, 27% by bodily reaction, and 24% by falls. Two-thirds of these injuries occurred while working in eating and drinking places and grocery stores. Three-quarters of the 30 deaths from 1990-1995 were accounted for equally by motor vehicle and homicide. CONCLUSIONS: In conclusion, a substantial number of adolescents are injured or killed in the workplace each year in Texas. Although improved population-based surveillance is needed, sufficient knowledge exists to begin prevention efforts now.

Gastrointestinal decontamination in the emergency department.

Pediatric poisoning is a problem commonly encountered in the emergency department. After stabilization of airway, breathing, and circulation, one of the goals of treatment is decontamination in order to limit poison absorption and the resulting systemic toxicity. Decontamination modalities include gastric emptying (ipecac and gastric lavage), inhibiting absorption (activated charcoal), and catharsis (sorbital, magnesium citrate, and whole bowel irrigation). Each modality is discussed. Choice of modality by the practitioner must be individualized to each patient's situation.

Medical malpractice arbitration: a primer for Texas physicians.

The medical malpractice crises and ensuing tort reform efforts, including methods of alternative dispute resolution (ADR), are generally reviewed. Arbitration in the context of medical malpractice is examined from the perspective of other states' experiences. Michigan has one of the nation's oldest medical malpractice arbitration programs, but it suffers from underutilization. California's experience derives from the use of arbitration in the managed care setting. While Texas has statutory provisions for medical malpractice arbitration, in light of public policy favoring ADR, the statute could be perceived as antipublic policy, resulting in underuse. The National Practitioner Data Bank also serves to discourage physician participation. Policy options are offered to address these concerns.

Nonfatal injuries in adolescents: United States, 1988.

PURPOSE: To describe the incidence and impact of nonfatal injuries in a national sample of adolescents. METHODS: Data were obtained from the 1988 Child Health Supplement of the National Health Interview Survey (NHIS). The NHIS is a continuous multistage probability sample of the civilian noninstitutionalized population of the United States. Adolescents 10-17 years old (N = 7,470) of the total number of 17,110 children under 18 years of age in the survey were studied. Incidence rates (I) were calculated for accidents, injuries, and poisonings (AIPs) requiring medical attention in the previous 12 months and recalled by the adult household interviewee. Information on sociodemographic factors and impairment were reported. Sample weights were used to derive population estimates. RESULTS: In 1988, 4,505,000 adolescents 10-17 years old were estimated to have experienced AIPs in the previous 12 months (I = 16.1/100), resulting in 3.2 mean number days of bed rest, 4.1 mean number of days absent from school, and 20% with limited activity due to AIPs. AIPs were most frequent in older adolescents 14-17 years of age (I = 18.2/100), males (I = 20.3/100), whites (19.5/100), and Midwest U.S. residents (I = 18.1/100). The most frequent AIPs were cuts (I = 59.6/1000), sprains (I = 51.3/1,000), and broken bones (I = 43.1/1,000). AIPs most limiting to adolescents' activity were broken bones (62.6%), head injuries (58.3%), and sprains (55.7%). CONCLUSIONS: Although injury is the leading cause of death in adolescence, it also plays an important role in adolescent morbidity. Further national studies with better documentation of nonfatal injuries are needed to eliminate potential recall bias associated with an interview survey.

Immunization status of chronically ill children.

The immunization status of 103 chronically ill children attending five specialty clinics, and 52 otherwise healthy children attending an acute care clinic, was determined using a questionnaire self-administered by parents. The immunization rate in specialty clinics was 72%, compared with 85% in the acute care clinic (P = 0.118). Only the neurology clinic rate (55%) differed significantly from the control (P = 0.014). In patients age 48 months or older, there was a significant association between clinics and overall compliance (P = 0.003). Older specialty clinic patients (79%) tended to be more compliant compared to their younger counterparts (60%) (P = 0.057). No significant association was noted between immunization compliance and source of primary care services or intensity of use of services. Greater efforts are needed to identify underimmunized chronically ill children and to provide the means to bring them into compliance.

Hepatic hemangiomatosis of infancy.

A 2-month-old female infant with congestive heart failure secondary to hepatic hemangiomatosis was treated with prednisone for five weeks without clinical improvement. She then underwent acute cardiac decompensation and required assisted ventilation. The hepatic artery was ligated to decrease the blood supply to the hemangiomata. Although the engorged liver softened dramatically, she continued to require mechanical ventilation for cardiac failure. Ten days postoperatively, she underwent digitalization with significant improvement in cardiac function, and she was then weaned from the respirator. Although, at 2 1/2 years of age, her liver has remained somewhat enlarged, her cardiovascular function has been normal. Our experience indicates that hepatic hemangiomatosis can be successfully treated via hepatic artery ligation and that cardiotonic measures might sometimes be required for recovery from coexisting congestive heart failure.

Prevalence of cervical Chlamydia trachomatis and Neisseria gonorrhoeae in female adolescents.

The prevalence of cervical infection with Chlamydia trachomatis and Neisseria gonorrhoeae was examined in 125 girls receiving primary gynecologic care in a general adolescent clinic. C trachomatis was isolated in 8% of the patients using a microtiter tissue-culture method, and N gonorrhoeae was found in 12%. A significant association was found between the use of oral contraceptives and positive chlamydial cultures. Patients with Chlamydia-positive cultures were frequently asymptomatic and exhibited no positive findings on physical examination. Three of ten women with cervical chlamydial infection developed pelvic inflammatory disease. These results support the use of cervical screening for both of these pathogens in sexually active adolescents.

Neonatal sepsis and meningitis due to alpha-hemolytic Streptococcus.

We have reported a case of septicemia and meningitis due to alpha-hemolytic Streptococcus in a 5-day-old infant. The microbiologic and clinical characteristics of neonatal infection with this organism lead us to conclude that this bacterium can be pathogenic in the newborn and should not be dismissed as a contaminant.