Lawn mower-related injuries to children.

Lawn mower-related injuries to children are relatively common and can result in severe injury or death. Many amputations during childhood are caused by power mowers. Pediatricians have an important role as advocates and educators to promote the prevention of these injuries.

Prevention of youth injuries.

There are four categories of causes responsible for the majority of injuries in youth 10-19 years of age: 1) motor vehicle traffic; 2) violence (intra-familial, extra-familial, self, pregnancy-related); 3) recreational; and 4) occupational. This article presents data from the National Center for Health Statistics mortality data and the National Pediatric Trauma Registry morbidity data. Nationwide, the pediatric injury death rate is highest among adolescents 15-19 years of age. Motor vehicle-related deaths account for 41% and firearm-related deaths account for 36% of injury deaths in this age group. For youths aged 10-14 years, motor vehicle-related deaths account for 38% and; firearm-related deaths account for 26% of injury deaths. For both age groups, occupant motor vehicle-related deaths account for the majority of deaths and underscore the need for seat belt use. Using theoretical principles based on the Haddon matrix and a knowledge of adolescent development, proposed interventions to decrease injuries and deaths related to motor vehicles and firearms include graduated licensing, occupant restraint, speed limits, conflict resolution, and gun control. Occupational injuries, particularly injury associated with agricultural production, account for an estimated 100,000 injuries per year. Preventive strategies include OSHA regulations imposing standards for protective devices and further study for guidelines for adolescent work in agriculture. Injuries related to recreation include drowning and sports injuries. Preventive strategies may include proper supervision and risk reduction with respect to use of alcohol/drugs. The data presented support the use of primary prevention to achieve the most effective, safe community interventions targeting adolescents.

Inappropriate use of nonculture tests for the detection of Chlamydia trachomatis in suspected victims of child sexual abuse: A continuing problem.

The introduction of nonculture tests for detection of Chlamydia trachomatis has revolutionized the management of chlamydial infections in sexually active adolescents and adults. However, these tests are insufficiently specific for use in genital and rectal sites in children; false-positive tests can be frequent. We report here 4 cases involving inappropriate use of nonculture tests in children in New York City during 1998. Two cases involved the use of enzyme immunoassays with vaginal specimens. In both cases the initial results were positive, however, cultures for C trachomatis performed later were negative. In the third case, the DNA probe test for C trachomatis was used. The fourth child was being evaluated for sexually transmitted diseases after rape. Although the pediatrician sent a rectal culture to a large commercial laboratory it was later determined that the laboratory was using an enzyme immunoassay for culture confirmation leading to a false-positive result. At the least the use of these inappropriate tests resulted in unnecessary retesting and at the worst, unnecessary hospitalization, erroneous reports of sexual abuse and possibly unjustified prosecution and incarceration. Because of the social and legal implications it is important that practitioners be aware of these recommendations and require that commercial laboratories adhere to approved C trachomatis culture methods.

American Academy of Pediatrics. Committee on Injury and Poison Prevention. Safe transportation of newborns at hospital discharge.

All hospitals should set policies that require the discharge of every newborn in a car safety seat that is appropriate for the infant's maturity and medical condition. Discharge policies for newborns should include a parent education component, regular review of educational materials, and periodic in-service education for responsible staff. Appropriate child restraint systems should become a benefit of coverage by Medicaid, managed care organizations, and other third-party insurers.

American Academy of Pediatrics. Committee on Injury and Poison Prevention. Transporting children with special health care needs.

Children with special health care needs should have access to proper resources for safe transportation. This statement reviews important considerations for transporting children with special health care needs and provides current guidelines for the protection of children with specific health care needs, including those with a tracheostomy, a spica cast, challenging behaviors, or muscle tone abnormalities as well as those transported in wheelchairs.

Epidemiology and prevention of traffic injuries to urban children and adolescents.

OBJECTIVES: To describe the incidence of severe traffic injuries before and after implementation of a comprehensive, hospital-initiated injury prevention program aimed at the prevention of traffic injuries to school-aged children in an urban community. MATERIALS AND METHODS: Hospital discharge and death certificate data on severe pediatric injuries (ie, injuries resulting in hospital admission and/or death to persons age <17 years) in northern Manhattan over a 13-year period (1983-1995) were linked to census counts to compute incidence. Rate ratios with 95% CIs, both unadjusted and adjusted for annual trends, were calculated to test for a change in injury incidence after implementation of the Harlem Hospital Injury Prevention Program. This program was initiated in the fall of 1988 and continued throughout the study period. It included 1) school and community based traffic safety education implemented in classroom settings in a simulated traffic environment, Safety City, and via theatrical performances in community settings; 2) construction of new playgrounds as well as improvement of existing playgrounds and parks to provide expanded off-street play areas for children; 3) bicycle safety clinics and helmet distribution; and 4) a range of supervised recreational and artistic activities for children in the community. PRIMARY RESULTS: Traffic injuries were a leading cause of severe childhood injury in this population, accounting for nearly 16% of the injuries, second only to falls (24%). During the preintervention period (1983-1988), severe traffic injuries occurred at a rate of 147.2/100 000 children <17 years per year. Slightly <2% of these injuries were fatal. Pedestrian injuries accounted for two thirds of all severe traffic injuries in the population. Among school-aged children, average annual rates (per 100 000) of severe injuries before the intervention were 127.2 for pedestrian, 37.4 for bicyclist, and 25.5 for motor vehicle occupant injuries. Peak incidence of pedestrian and bicyclist injuries occurred during the summer months and afternoon hours, whereas motor vehicle occupant injuries showed little seasonal variation and were more common during evening and night-time hours. Age-specific rates showed peak incidence of pedestrian injuries among 6- to 10-year-old children, of bicyclist injuries among 9- to 15-year-old children, and of motor vehicle occupant injuries among adolescents between the ages of 12 and 16 years. The peak age for all traffic injuries combined was 15 years, an age at which nearly 3 of every 1000 children each year in this population sustained a severe traffic injury. Among children hospitalized for traffic injuries during the preintervention period, 6.3% sustained major head trauma (including concussion with loss of consciousness for >/=1 hour, cerebral laceration and/or cerebral hemorrhage), and 36.9% sustained minor head trauma (skull fracture and/or concussion with no loss of consciousness >/=1 hour and no major head injury). The percentage of injured children with major and minor head trauma was higher among those injured in traffic than among those injured by all other means (43.2% vs 14.2%, respectively; chi2 = 336; degrees of freedom = 1). The percentages of children sustaining head trauma were 45.4% of those who were injured as pedestrians, 40.2% of those who were injured as bicyclists, and 38.9% of those who were injured as motor vehicle occupants. During the intervention period, the average incidence of traffic injuries among school aged children declined by 36% relative to the preintervention period (rate ratio:.64; 95% CI:.58,.72). After adjusting for annual trends in incidence, pedestrian injuries declined during the intervention period among school aged children by 45% (adjusted rate ratio:.55; 95% CI:.38,.79). No comparable reduction occurred in nontargeted injuries among school-aged children (adjusted rate ratio:.89; 95% CI:.72, 1.09) or in traffic injuries among younger children who

The hospital record of the injured child and the need for external cause-of-injury codes. American Academy of Pediatrics. Committee on Injury and Poison Prevention, 1998-1999.

Proper record-keeping of emergency department visits and hospitalizations of injured children is vital for appropriate patient management. Determination and documentation of the circumstances surrounding the injury event are essential. This information not only is the basis for preventive counseling, but also provides clues about how similar injuries in other youth can be avoided. The hospital records have an important secondary purpose; namely, if sufficient information about the cause and mechanism of injury is documented, it can be subsequently coded, electronically compiled, and retrieved later to provide an epidemiologic profile of the injury, the first step in prevention at the population level. To be of greatest use, hospital records should indicate the "who, what, when, where, why, and how" of the injury occurrence and whether protective equipment (eg, a seat belt) was used. The pediatrician has two important roles in this area: to document fully the injury event and to advocate the use of standardized external cause-of-injury codes, which allow such data to be compiled and analyzed.

Predictors of reported condom use in central Harlem youth as conceptualized by the health belief model.

PURPOSE: To examine the relationship of reported condom use to specific sociodemographics, psychosocial variables, and perceptions of and motivations for condom use as conceptualized by the Health Belief Model. METHODS: This study performed a cross-sectional survey of 557 adolescents enrolled in a hospital-based pregnancy prevention program in an urban community hospital (Harlem Hospital). Multiple logistic regression analysis examined the combined relationship of the significant psychosocial variables to consistent condom use. RESULTS: Males were less likely than females to report teen-parent conflict and depression and more likely to report support for birth control, participation in community activities, and favorable attitudes toward delaying parenthood. Consistent with the Health Belief Model adjusting for age, the strongest predictors of consistent condom use were partner preference for condoms, perceived benefit of avoidance of pregnancy, male gender, and support for birth control (usually by a parent). CONCLUSIONS: The data on this urban, predominantly African-American sample of adolescents suggest the importance of the influences on specific motivations to use protection--that is, the wish to avoid pregnancy, human immunodeficiency virus/acquired immunodeficiency syndrome, and sexually transmitted diseases, although the mechanisms are still unclear. In addition, gender and the modifying effects of parental and partner support of the use of protection strongly influence the reported use of condoms by adolescents. These factors (in addition to psychosocial factors such as depression) may be important in planning interventions to increase condom use by sexually active teens.

PIP: The relationship of condom use to the sociodemographic, psychosocial, and cognitive factors included in the Health Belief Model was investigated in a cross-sectional study of 557 primarily low-income, African-American youth 12-19 years of age (mean age, 15.9 years) enrolled in a pregnancy prevention program at Harlem Hospital, New York City, during 1991-93. 74% reported ever having sex, 51% in the preceding 3 months. At last intercourse, 47% used no protection, 43% reported condom use, and 10% used another method. Males were more than 4 times as likely to report condom use than females. Males had more assets, more positive attitudes toward delaying parenthood, less teen-parent conflict, less depression, and more social support for birth control than females. Consistent with the Health Belief Model, the strongest predictors of consistent condom use (after adjustment for age) were partner preference for condoms, perceived benefit of avoidance of pregnancy, male gender, and social (mostly parental) support for birth control. These factors should be considered in the planning of interventions to increase condom use among sexually active teenagers.

Epidemiology and prevention of severe assault and gun injuries to children in an urban community.

OBJECTIVES: To describe the epidemiology of severe assault and gun injuries to children in an urban population and consider the impact of a comprehensive injury prevention program. MATERIALS AND METHODS: Pediatric injury deaths and hospital admissions for Northern Manhattan (1983-1992) were linked to census counts to compute incidence. Poisson regression was used to compare trends in incidence of assault and gun injuries before and during a community-wide pediatric injury prevention program in Central Harlem. MAIN RESULTS: The incidence of severe nonfatal assault injury was 60.94/100,000/year, 10 times the fatality rate. The incidence of all gun injuries was 31.13. In adolescence, guns were the leading cause of both fatal and severe nonfatal assault injury, and were the most lethal method of assault (case-fatality = 18.5% for gun vs. 1.2% for all non-gun assault injury). Rates of assault and gun injuries declined by nearly 50% in the intervention community, while they increased in a neighboring community. CONCLUSIONS: Comprehensive interventions may be effective in curbing the incidence of severe assault injuries to urban youth. Further controlled evaluations are needed to confirm the effectiveness of programs such as this and to better understand the prevention of violent injuries.

Children who are shot: a 30-year experience.

Three data sets describe the pattern of gunshot injuries to children from 1960 to 1993: The Harlem Hospital pediatric trauma registry (HHPTR), the northern Manhattan injury surveillance system (NMISS) a population-based study, and the National Pediatric Trauma Registry (NPTR). A small case-control study compares the characteristics of injured children with a control group. Before 1970 gunshot injuries to Harlem children were rare. In 1971 an initial rise in pediatric gunshot admissions occurred, and by 1988 pediatric gunshot injuries at Harlem Hospital had peaked at 33. Population-based data through NMISS showed that the gunshot rate for Central Harlem children 10 to 16 years of age rose from 64.6 per 100,000 in 1986 to 267.6 per 100,000 in 1987, a 400% increase. The case fatality for children admitted to Harlem Hospital (1960 to 1993) was 3%, usually because of brain injury, but the majority of deaths occurred before hospitalization. During the same period, felony drug arrests in Harlem increased by 163%. The neighboring South Bronx experienced the same increase in gunshot wound admissions and felony arrests from 1986 to 1993. The NPTR showed a similar injury pattern for other communities in the United States. In a case-control analysis. Harlem adolescents who had sustained gunshot wounds were more likely to have dropped out of school, to have lived in a household without a biological parent, to have experienced parental death, and to have known of a relative or friend who had been shot than community adolescents treated for other medical or surgical problems.(ABSTRACT TRUNCATED AT 250 WORDS)

Injury prevention in an urban setting: challenges and successes.

The Harlem Hospital Injury Prevention Program (HHIPP) was established in 1988 with the goal of reducing injuries to children in central Harlem by providing safe play areas, supervised activities, and injury prevention education. To achieve this goal, a broad-based coalition was formed with state and local governmental agencies interested in injury prevention and with community groups, schools, parents, and hospital staff. An evaluation of the program in terms of both process and outcome formed a critical element of this effort. Since 1988 the HHIPP, as the lead agency for the Healthy Neighborhoods/Safe Kids Coalition, developed or participated in two types of programs: injury-prevention education programs and programs that provide safe activities and/or environments for children. The educational programs included Window Guards campaign; Safety City Program; Kids, Injuries and Street Smarts Program (KISS); Burn Prevention Curriculum and Smoke Detector Distribution; Harlem Alternative to Violence Program; Adolescent Outreach Program; and Critical Incident Stress Management Teams. The safe activities and environmental programs included the Bicycle Safety Program/Urban Youth Bike Corps; Playground Injury Prevention Program; the Greening of Harlem Program; the Harlem Horizon Art Studio; Harlem Hospital Dance Clinic; Unity through Murals project; baseball at the Harlem Little League; winter baseball clinic; and the soccer league. Each program was conceived using injury data, coupled with parental concern and activism, which acted as catalysts to create a community coalition to respond to a specific problem. Data systems developed over time, which monitored the prevalence and incidence of childhood injuries in northern Manhattan, including central Harlem, became essential not only to identify specific types of childhood injuries in this community but also to evaluate these programs for the prevention of injuries in children.

Autism and developmental abnormalities in children with perinatal cocaine exposure.

Cocaine in all forms is the number one illicit drug of choice among pregnant women. Records of 70 children with cocaine exposure in utero who were referred for developmental evaluation at a large inner-city hospital were reviewed in an effort to determine whether a specific pattern of abnormalities could be discerned. Patients received physical examinations, neurological screenings, and behavioral and developmental assessments based on the Gesell Developmental Inventory, and the Denver Developmental Screening Test. Documentation of specified drug use was obtained by history. Mean age (SEM) at referral was 19.2 (1.7) months. All mothers used cocaine in one of its forms, although polydrug use was common. Growth parameters were low (median = 15th percentile). Significant neurodevelopmental abnormalities were observed, including language delay in 94% of the children and an extremely high frequency of autism (11.4%). The high rate of autistic disorders not known to occur in children exposed to alcohol or opiates alone suggests specific cocaine effects.

Blood lead, calcium status, and behavior in preschool children.

To determine if calcium status is associated with blood lead levels and behavior, 64 black urban children aged 18 to 47 months were studied. Twenty-seven controls (blood lead levels, less than 1.45 mumol/L) were compared with 37 cases (blood lead levels, greater than or equal to 1.45 mumol/L) with respect to four calcium measures (calcium intake, serum calcium level, 1,25-dihydroxyvitamin D level, and bone densitometric findings) and three behavioral scores. Levels of 25-hydroxyvitamin D provided a measure of vitamin D sufficiency. As expected, blood lead level was associated with pica scores. However, none of the calcium measures differed between cases and controls. Controlling for four confounders (season, pica score, maternal education, and sex), yielded no significant differences between the two groups in the mean values of 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D level. There was no interaction between blood lead level and the four covariates. No relationship could be demonstrated between calcium status and the pica scores.