Kinetic and Radiographic Outcomes of Unilateral Double Pelvic Osteotomy in Six Dogs.

OBJECTIVE: The aim of this study was to assess the kinetic and radiographic outcome of unilateral double pelvic osteotomy (DPO) using a temporospatial pressure walkway, preoperative and postoperative radiographs. STUDY DESIGN: Retrospective case series of six dogs that underwent unilateral DPO for canine hip dysplasia. The untreated limb was unfit for DPO due to radiographic evidence of osteoarthritis and was therefore managed non-surgically. Preoperative and postoperative radiographs and kinetic data were compared between untreated and DPO-treated hips using a Wilcoxon signed-rank test. RESULTS: There was no significant difference in British Veterinary Association Hip Dysplasia Scheme (BVA-HD) scores between untreated and DPO-treated hips preoperatively (p-value = 0.09) and postoperatively (p-value = 0.06). The median postoperative GAIT4 Dog Lameness Score was lower in untreated hips than DPO-treated hips but was not statistically different (p-value = 0.18). CONCLUSIONS: All dogs in this case series achieved a total pressure index and GAIT4 Dog Lameness Score on the DPO-treated hip comparable to normal limbs. All untreated hips in this series had increased BVA-HD scores at follow-up, whereas all DPO-treated hips had reduced BVA-HD scores. This difference was not significant and warrants further studies. We conclude total pressure index may be preserved in hips treated with unilateral DPO, while the contralateral hip is managed non-surgically.

Do Cialdini's "Principles of Influence" Motivate Safe Practices on Farms?

On farms, power take-off (PTO) drivelines pose serious risks in terms of both fatal and non-fatal injuries. PTO shielding can prevent such injuries; however, is often underutilized by the farm population. This study aims assesses seven influence campaigns and their ability to change attitudes toward PTO shielding in order to encourage sustainable behavior change. Seven strategies based on common principles of influence (liking, social proof, authority, consistency, reciprocity, and scarcity) were implemented in seven agricultural counties in upstate New York. Pre- and post- tests focused on shielding behaviors and attitudes, as well as the presence of the influence strategies, were used to assess changes resulting from these interventions. Little change in the presence of influence strategies was noted from baseline to follow-up. Additionally, there were no significant changes in behavior or attitude toward PTO shielding in the same time period, indicating the failure of the interventions to create change. The findings of this study support the challenges identified in past efforts to increase the use of PTO shields on farms and highlight the need for more intensive, focused interventions. Future studies can use these lessons to develop more robust interventions for improved outcomes.

Cost Analysis of a PTO Driveline Shielding Program: Are Effective Programs Cost-Effective?

HIGHLIGHTS: This article describes a cost assessment of a PTO driveline shielding intervention. Considerations for effective occupational safety interventions beyond reductions in injuries or fatalities are described. The financial viability of combining various on-farm services to reduce intervention costs is discussed. ABSTRACT: PTO entanglements are a primary injury concern on U.S. farms, affecting adults and children. These events often lead to severe injury and permanent disability but can be prevented with proper use of PTO shielding. A promising strategy for increasing PTO shielding on farms has been the introduction of user-friendly shielding options by qualified safety specialists. This study looks at the cost-effectiveness of this approach. The cost-effectiveness of this PTO shielding strategy was calculated based on program-related costs, the PTO shield cost, the lifespan of PTO shields, and the number of PTO shields needed to prevent an entanglement. The cost per entanglement prevented was then calculated by dividing the total costs by the number of entanglements prevented in several cost-estimate scenarios. Costs were adjusted for inflation to 2019 dollars. Costs per entanglement prevented ranged from a low of $921,544 (assuming a 10-year PTO lifespan and using 12,487 as the number needed to treat, i.e., to prevent a PTO entanglement, referred to as the NNT) to a high of $18,583,492 (assuming a three-year PTO lifespan and 67,119 as the NNT). The cost per entanglement prevented at the median PTO lifespan of five years and median NNT of 39,802 was $6,612,244. Based on our estimates, the cost-efficacy of increasing PTO shielding using qualified safety specialists differs widely based on the shield lifespan and the number of shields needed to avoid one entanglement. However, if the cost of introducing PTO shields in on-farm visits is coupled with other on-farm services that defray these costs, then the cost-efficacy increases considerably.

Preoperative body-related emotional distress and culture as predictors of outcomes of bariatric surgery.

PURPOSE: Findings concerning the impact of bariatric surgical intervention on both psychological variables and weight loss are often controversial and misconstrued the world over. The aim of this study was to classify bariatric surgery patients according to patterns of preoperative measures that may predict postoperative psychological and physiological outcomes and to compare these patterns between two distinct cultures. METHODS: Of 169 consecutive bariatric surgery candidates from Israel and 81 candidates from the United States, 73 and 35 patients, respectively consented to be included in a follow-up phase. Body image dissatisfaction, emotional eating behaviors, risk of suicide, depressive symptoms, anxious symptoms, and percent excess weight loss were measured. K-means clustering procedure was used to classify bariatric surgery patients according to their preoperative body-related emotional distress, which was composed of body image dissatisfaction and emotional eating. The joint effect of culture and body-related emotional distress cluster on psychological distress was tested. RESULTS: The cluster analysis revealed two preoperative body-related emotional distress patterns: high body-related emotional distress and low body-related emotional distress. Following surgery, US patients showed a higher risk of suicide and lower excess weight loss than Israeli patients within only the high body-related emotional distress cluster (a significant interaction effect). CONCLUSION: Preoperative assessment of body-related emotional distress patterns among bariatric surgery candidates may enable professionals to identify potential postoperative risks of suicide, anxiety, and decreased weight loss. The relationship between the body-related emotional distress cluster and outcome measures is culture dependent. LEVEL III: Case-control analytic study.

Effect of Smoking on Outcomes of Primary PCI in Patients With STEMI.

BACKGROUND: Smoking is a well-established risk factor for ST-segment elevation myocardial infarction (STEMI); however, once STEMI occurs, smoking has been associated with favorable short-term outcomes, an observation termed the "smoker's paradox." It has been postulated that smoking might exert protective effects that could reduce infarct size, a strong independent predictor of worse outcomes after STEMI. OBJECTIVES: The purpose of this study was to determine the relationship among smoking, infarct size, microvascular obstruction (MVO), and adverse outcomes after STEMI. METHODS: Individual patient-data were pooled from 10 randomized trials of patients with STEMI undergoing primary percutaneous coronary intervention. Infarct size was assessed at median 4 days by either cardiac magnetic resonance imaging or technetium-99m sestamibi single-photon emission computed tomography. Multivariable analysis was used to assess the relationship between smoking, infarct size, and the 1-year rates of death or heart failure (HF) hospitalization and reinfarction. RESULTS: Among 2,564 patients with STEMI, 1,093 (42.6%) were recent smokers. Smokers were 10 years younger and had fewer comorbidities. Infarct size was similar in smokers and nonsmokers (adjusted difference: 0.0%; 95% confidence interval [CI]: -3.3% to 3.3%; p = 0.99). Nor was the extent of MVO different between smokers and nonsmokers. Smokers had lower crude 1-year rates of all-cause death (1.0% vs. 2.9%; p < 0.001) and death or HF hospitalization (3.3% vs. 5.1%; p = 0.009) with similar rates of reinfarction. After adjustment for age and other risk factors, smokers had a similar 1-year risk of death (adjusted hazard ratio [adjHR]: 0.92; 95% CI: 0.46 to 1.84) and higher risks of death or HF hospitalization (adjHR: 1.49; 95% CI: 1.09 to 2.02) as well as reinfarction (adjHR: 1.97; 95% CI: 1.17 to 3.33). CONCLUSIONS: In the present large-scale individual patient-data pooled analysis, recent smoking was unrelated to infarct size or MVO, but was associated with a worse prognosis after primary PCI in STEMI. The smoker's paradox may be explained by the younger age and fewer cardiovascular risk factors in smokers compared with nonsmokers.

Assessment of the medium- to long-term radiographically confirmed outcome for juvenile dogs with hip dysplasia treated with double pelvic osteotomy.

OBJECTIVE: To assess the medium- to long-term radiographically confirmed outcomes in juvenile dogs with hip dysplasia (HD) that did and did not undergo double pelvic osteotomy (DPO). STUDY DESIGN: Retrospective case-controlled. ANIMALS: Twenty-six dogs with HD that were candidates for DPO; 22 dogs underwent DPO (16 bilateral, six unilateral); four dogs did not. METHODS: Initial and follow-up radiographs of DPO candidates (2011-2017) that did and did not undergo surgery were reviewed, and the British Veterinary Association and Kennel Club Hip Dysplasia Scheme score (BVA-HD), osteoarthritis score (OAS) and laxity index score (LI) were determined. Baseline and follow-up BVA-HD, OAS, and change in radiographically confirmed scores were compared by using analysis of variance for correlated samples. RESULTS: There was no significant difference in BVA-HD or OAS between surgically treated and nonsurgically treated cohorts at baseline. Follow-up radiographs (median, 49 months) revealed that most (34/38) hips had a BVA-HD ≤10 after DPO, while four of eight hips from the nonsurgical cohort had BVA-HD >10. Follow-up BVA-HD and OAS were lower in hips after surgery (BVA-HD median 2.15, interquartile range [Q1-Q3] 1.3-4.1; OAS median 1.9, Q1-Q3 1.1-4.1) compared with the nonsurgically treated cohort (BVA-HD median 11.4, Q1-Q3 8.1-17.5, P < .01; OAS median 7.0, Q1-Q3 5.1-13.4, P < .01). Seven hips with an LI >1 had no radiographically confirmed progression of osteoarthritis after DPO. CONCLUSION: Double pelvic osteotomy prevented radiographically confirmed progression of osteoarthritis in the medium- to long-term. Laxity index score > 1 was not a contraindication for DPO in this study. CLINICAL SIGNIFICANCE: Double pelvic osteotomy prevents progression of radiographically confirmed features of osteoarthritis in juvenile dogs with HD.

Body Image, Emotional Eating and Psychological Distress among Bariatric Surgery Candidates in Israel and the United States.

BACKGROUND: The present study aimed to examine the relations between body image dissatisfaction (BID) and psychological distress variables among bariatric surgery candidates from two distinct cultures in Israel and in the United States. METHODS: A sample of consecutive pre-surgical bariatric candidates was recruited from a Bariatric Center in Israel (N = 114) and a Bariatric Center in the Unites States (N = 81). Body image dissatisfaction (BID-BSQ8), suicidal ideation (SBQ-R), depressive symptoms (PHQ-9), anxious symptoms (PHQ-7), and emotional eating behaviors (EES), were measured. Mediation models were assessed using path analysis. RESULTS: BID was positively correlated with suicidality, depression, and anxiety in both samples. The relations between BID depression and anxiety were mediated by emotional eating in both cultures. However, the relation between BID and suicidality that was mediated by emotional eating in the Israeli sample, was reflected in a direct link between BID and suicidality in the US sample. CONCLUSION: Our findings confirm the adverse effect of BID on psychological distress among surgery candidates in both cultures, emphasizing the intercultural similarities related to emotional eating behavior. Physicians and other health professionals are encouraged to be more attentive to this specific behavior.

Accelerometers: Assessing their potential for measuring personal flotation device use on commercial fishing vessels.

BACKGROUND: Falls overboard are the most common cause of fatalities in commercial fishing. As a result, interventions aimed at increasing and measuring the use of personal flotation devices (PFDs) are a high priority. The focus of this study was to explore the use of accelerometers as a means for objectively measuring PFD use on lobster fishing vessels. METHODS: For participating vessels, researchers attached an accelerometer to a PFD worn by a crewmember and another to the vessel's wheelhouse. GoPro videos were also employed to record crewmember activities so these could be synchronized with accelerometer outputs. Accelerometer outputs included two distinct measures, the proportional integration mode (PIM) and zero crossing mode (ZCM). Data were fitted to various equations to identify the best method for predicting PFD use. RESULTS: Seven lobster fishing vessels participated in the trial. Data indicated that accelerometers could predict PFD use with a fairly high degree of accuracy. In particular, a logistic equation incorporating PIM values from the PFD and the absolute value of the difference between the PFD PIM readings and the PIM readings from the stationary accelerometer demonstrated the highest degree of accuracy, with correct classifications for 73.3% to 77.6% of the 10-second data intervals. Accuracy was highest when crew members were moving versus stationary. The predictive value of ZCM was comparatively limited. CONCLUSIONS: PIM accelerometer readings can be used to measure PFD use with a considerably high degree of accuracy, especially for sternmen who are moving regularly and have the highest risk for falling overboard.

Impact of bleeding assessment and adjudication methodology on event rates and clinical trial outcomes: insights from the HORIZONS-AMI trial.

AIMS: Bleeding is a major safety outcome in cardiovascular trials. The present study assessed the impact of the adjudication process of bleeding events on three-year outcomes in the Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI) trial. METHODS AND RESULTS: HORIZONS-AMI enrolled 3,602 patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. An independent CEC reviewed 445 potential bleeding events identified from three sources: 339 site-reported (SR), 35 CEC-identified, and 71 database (DB)-triggered events based on programmatic identification of a decline in haemoglobin of ≥3 g/dL or in haematocrit by ≥9%; of those, 383/445 (86.1%) met the protocol definition of major bleeding. By multivariable analysis, CEC-confirmed bleeding was an independent predictor of cardiovascular death (hazard ratio [HR] 2.84, 95% confidence interval [CI]: 1.81-4.45, p<0.0001) and all-cause death (HR 2.70, 95% CI: 1.92-3.79, p<0.0001) at three years. Non-CEC-confirmed bleeding was also a predictor of cardiovascular death (HR 3.45, 95% CI: 1.47-8.11, p=0.005) and all-cause death (HR 2.41, 95% CI: 1.11-5.23, p=0.03) at three years. CONCLUSIONS: In the HORIZONS-AMI trial, adjudication of bleeding via a centralised CEC process resulted in identification of a larger number of events than were SR. All CEC-confirmed bleeding events were independently predictive of three-year cardiovascular and all-cause mortality. The association of non-CEC-confirmed bleeding with mortality merits further investigation.

ESTIMATING THE COST OF AGRICULTURAL MORBIDITY IN MAINE AND NEW HAMPSHIRE.

This article provides an estimate for the economic costs of agricultural injuries sustained in the states of Maine and New Hampshire between the years 2008 and 2010. The authors used a novel dataset of 562 agriculturally related occupational injuries, and cost estimates were generated using the CDC's Web-based Injury Statistics Query and Reporting System (WISQARS). Individual cases from the dataset that did not match the query options for WISQARS were excluded. Of the 562 agricultural injuries identified in the dataset, 361 met the WISQARS criteria. The remaining 201 cases were judged to be incompatible with the WISQARS query criteria. Significant differences (p 0.0001) were found between the median costs of eight types of injury. Amputations (median = $70,077) and fractures (median = $13,365) were found to be the most expensive types of injury. The total cost of the 361 injuries for which estimates were available was $6,342,270. Injuries that reportedly involved machinery were found to be more expensive than injuries caused by animals. This article highlights the difference in the total cost of injury between types of injuries and demonstrates that agricultural injuries were a significant economic burden for Maine and New Hampshire for the years 2008-2010. These data can be used to direct future preventive efforts. Finally, this article suggests that WISQARS is a powerful tool for estimating injury costs without requiring access to treatment or billing records.

Infarct size, left ventricular function, and prognosis in women compared to men after primary percutaneous coronary intervention in ST-segment elevation myocardial infarction: results from an individual patient-level pooled analysis of 10 randomized trials.

AIM: Studies have reported less favourable outcomes in women compared with men after primary percutaneous coronary intervention (PCI) in ST-segment elevation myocardial infarction (STEMI). Whether sex-specific differences in the magnitude or prognostic impact of infarct size or post-infarction cardiac function explain this finding is unknown. METHODS AND RESULTS: We pooled patient-level data from 10 randomized primary PCI trials in which infarct size was measured within 1 month (median 4 days) by either cardiac magnetic resonance imaging or technetium-99m sestamibi single-photon emission computed tomography. We assessed the association between sex, infarct size, and left ventricular ejection fraction (LVEF) and the composite rate of death or heart failure (HF) hospitalization within 1 year. Of 2632 patients with STEMI undergoing primary PCI, 587 (22.3%) were women. Women were older than men and had a longer delay between symptom onset and reperfusion. Infarct size did not significantly differ between women and men, and women had higher LVEF. Nonetheless, women had a higher 1-year rate of death or HF hospitalization compared to men, and while infarct size was a strong independent predictor of 1-year death or HF hospitalization (P < 0.0001), no interaction was present between sex and infarct size or LVEF on the risk of death or HF hospitalization. CONCLUSIONS: In this large-scale, individual patient-level pooled analysis of patients with STEMI undergoing primary PCI, women had a higher 1-year rate of death or HF hospitalization compared to men, a finding not explained by sex-specific differences in the magnitude or prognostic impact of infarct size or by differences in post-infarction cardiac function.

A Comparison of Interventional Approaches for Increasing Power Take-off Shielding on New York Farms.

OBJECTIVE: Power take-off (PTO) driveline entanglements are a primary source of injury on US farms. As with many farm injury concerns, hazard control technology is widely available for mitigating the risk of these entanglements. Despite the availability of hazard control technology, PTO shields are damaged or missing on approximately 57% of PTO driveline implements in New York. Given the catastrophic nature of entanglements and the ready access to safety technology, a better understanding of what motivates farmers to install or replace PTO shields is warranted. METHODS: To examine this question, agricultural health and safety researchers in New York State conducted an initial comparison of PTO shield sales on farms receiving one of three different interventional approaches. These included PTO shield audits, a social marketing campaign, and on-farm safety services. PTO shield purchases were tracked from January 2011 through June 2016 on farms receiving these interventions and on other farms that were not exposed to interventional strategies. RESULTS: Results indicate that a significantly higher number of PTO shields were purchased on farms that requested and received on-farm safety services versus farms that were exposed to PTO shield audits, the social marketing campaign, or the control group. PTO shield sales were slightly elevated on farms receiving driveline audits, as compared with control farms (although these differences were not significant). CONCLUSIONS: No marked differences in sales were noted between control farms and farms exposed to the social marketing campaign. Only one of the three interventional strategies (on-farm safety services) approached the number of PTO shield sales necessary to prevent an entanglement.

Methodological concerns related to response bias in migrant and seasonal farmworkers.

BACKGROUND: The original objective was to measure the impact of kneepads on musculoskeletal pain in migrant and seasonal farmworkers (MSFWs). Secondary analyses were conducted to quantify the extent to which response bias may have skewed the study's results. METHODS: Surveys were used to collect data on baseline pain and post-intervention pain, the amount of time participants spent wearing kneepads, and their overall ratings of the intervention. RESULTS: Participants did not experience significantly less pain with kneepads, and wore them for considerably less than the prescribed amount of time. However, subjects rated them very favorably. Given the strong suspicion of response bias, no firm conclusions could be drawn regarding the intervention. CONCLUSIONS: Unique survey methodologies must be used with MSFWs, who tend to have low research literacy and are particularly susceptible to response bias. Objective study outcomes are particularly favorable in this population in order to minimize dependence on self-reported measures. Am. J. Ind. Med. 59:1112-1119, 2016. © 2016 Wiley Periodicals, Inc.

Relationship Between Infarct Size and Outcomes Following Primary PCI: Patient-Level Analysis From 10 Randomized Trials.

BACKGROUND: Prompt reperfusion in patients with ST-segment elevation myocardial infarction (STEMI) reduces infarct size and improves survival. However, the intuitive link between infarct size and prognosis has not been convincingly demonstrated in the contemporary era. OBJECTIVES: This study sought to determine the strength of the relationship between infarct size assessed early after primary percutaneous coronary intervention (PCI) in STEMI and subsequent all-cause mortality, reinfarction, and hospitalization for heart failure. METHODS: We performed a pooled patient-level analysis from 10 randomized primary PCI trials (total 2,632 patients) in which infarct size was assessed within 1 month after randomization by either cardiac magnetic resonance (CMR) imaging or technetium-99m sestamibi single-photon emission computed tomography (SPECT), with clinical follow-up for ≥ 6 months. RESULTS: Infarct size was assessed by CMR in 1,889 patients (71.8%) and by SPECT in 743 patients (28.2%). Median (25th, 75th percentile) time to infarct size measurement was 4 days (3, 10 days) after STEMI. Median infarct size (% left ventricular myocardial mass) was 17.9% (8.0%, 29.8%), and median duration of clinical follow-up was 352 days (185, 371 days). The Kaplan-Meier estimated 1-year rates of all-cause mortality, reinfarction, and HF hospitalization were 2.2%, 2.5%, and 2.6%, respectively. A strong graded response was present between infarct size (per 5% increase) and subsequent mortality (Cox-adjusted hazard ratio: 1.19 [95% confidence interval: 1.18 to 1.20]; p < 0.0001) and hospitalization for heart failure (adjusted hazard ratio: 1.20 [95% confidence interval: 1.19 to 1.21]; p < 0.0001), independent of age, sex, diabetes, hypertension, hyperlipidemia, current smoking, left anterior descending versus non-left anterior descending infarct vessel, symptom-to-first device time, and baseline TIMI (Thrombolysis In Myocardial Infarction) flow 0/1 versus 2/3. Infarct size was not significantly related to subsequent reinfarction. CONCLUSIONS: Infarct size, measured by CMR or technetium-99m sestamibi SPECT within 1 month after primary PCI, is strongly associated with all-cause mortality and hospitalization for HF within 1 year. Infarct size may, therefore, be useful as an endpoint in clinical trials and as an important prognostic measure when caring for patients with STEMI.

Developing Surveillance Methodology for Agricultural and Logging Injury in New Hampshire Using Electronic Administrative Data Sets.

OBJECTIVE: Agriculture and logging rank among industries with the highest rates of occupational fatality and injury. Establishing a nonfatal injury surveillance system is a top priority in the National Occupational Research Agenda. Sources of data such as patient care reports (PCRs) and hospitalization data have recently transitioned to electronic databases. METHODS: Using narrative and location codes from PCRs, along with International Classification of Diseases, 9th Revision, external cause of injury codes (E-codes) in hospital data, researchers are designing a surveillance system to track farm and logging injury. RESULTS: A total of 357 true agricultural or logging cases were identified. CONCLUSIONS: These data indicate that it is possible to identify agricultural and logging injury events in PCR and hospital data. Multiple data sources increase catchment; nevertheless, limitations in methods of identification of agricultural and logging injury contribute to the likely undercount of injury events.

Estimation of agricultural and logging injury incidence in Maine using electronic administrative data sets.

Agriculture and forestry rank among industries with the highest rates of occupational fatality and injury. Establishing a nonfatal injury surveillance system is a top priority in the National Occupational Research Agenda. Recently, new sources of data such as Pre-Hospital Care Reports (PCRs) and hospitalization data have transitioned to electronic databases. Using narrative free text and location codes from Maine PCRs, along with International Classification of Diseases (ICD)-9 External Cause of Injury Codes (E-codes) in Maine hospital data, researchers are designing a surveillance system to track farm and forestry injury that utilizes electronic match-merging of the two data sources. For 2008, PCR records produced a total of 104 true agricultural cases. Of these, 66 (63%) were identified from the keyword/visual inspection process alone, 25 (24%) were identified by the farm checkbox only, and the remaining 13 (13%) by both methods. For the 150 unique injury events found in hospitalization data, 146 had the initial episode of care documented in only one of the three hospital files. The emergency department (ED) file had the largest number of these (123/146 = 84.2%), followed by the outpatient file (12/146 = 8.2%) and the inpatient file (11/146 = 7.5%). Of the 250 unique agricultural injuries identified (100 PCR only + 146 hospital only + 4 from both), 66 (26%) would not have been identified without free text review of PCR narrative. The false-positive rate (97.14%) keyword searches underscores that without visual inspection, it is not an effective strategy. Both sources of data (PCR and hospital data) need to be used in a continued surveillance system.

Do the Guidelines for Adolescent Preventive Services (GAPS) facilitate mental health diagnosis?

OBJECTIVE: To determine if the Guidelines for Adolescent Preventive Services (GAPS) increases detection or shortens time to diagnosis of mental health (MH) disorders, particularly adolescent depression. METHODS: Starting in May 1999, GAPS questionnaires were routinely administered at adolescent annual visits at 1 primary care clinic in a rural health network. Using an administrative database, we enumerated all MH diagnostic codes for outpatient visits of adolescents aged 13 to 15 years. Population based rates were derived using school enrollment data. Using time series, the rates of MH diagnoses were compared pre- and post-GAPS. Using survival analysis, the time to any MH diagnosis subsequent to index annual visits was also compared pre- and post-GAPS. Because the GAPS questionnaire includes questions for depressed mood, anhedonia, and suicidality, ICD-9-CM codes for depression and mood disorder were also analyzed separately. RESULTS: Time series analysis included 8112 adolescents. The rate of MH diagnosis did not change pre- and post-GAPS (P = .13). Time to any MH diagnosis was similar pre-GAPS (9.0 months) and post-GAPS (7.0 months, log rank P = .30). Time to any first diagnosis of depression or mood disorder was similar post-GAPS (12.2 months) versus pre-GAPS (11.0 months, log rank P = .34). CONCLUSIONS: Use of the GAPS was not associated with change in the rate of or time to MH diagnosis. Our results challenge the prevalent expectation that requiring mental health screening will reduce unmet need for MH treatment. Validated MH screening tools, primary care provider training, and access to MH services may also be needed but further study is required.

Electronic merger of large health care data sets: cautionary notes from a study of agricultural morbidity in New York State.

Agriculture ranks among industries with the highest rates of occupational injury and fatality. Administrative medical data sets have long been thought to have potential for occupational injury surveillance. This research explores the feasibility of establishing an agricultural injury surveillance system in New York State that combines data from existing electronic sources. Prehospital Care Report (PCR) data containing the nature of the accident, type of injury, time and date, and patient disposition were received. Researchers also obtained both hospital inpatient and emergency department (ED) records for 2007 through 2009 from the Statewide Planning and Research Cooperative System (SPARCS). For SPARCS data, a computer algorithm identified all potential cases of agricultural injury using International Classification of Diseases (ICD)-9 codes. An attempt was then made to match PCR and SPARCS data using accident date, gender, age, and admitting hospital. Of the PCR records that were matched to SPARCS, 46.8% were found on subsequent inspection to not actually relate to the same incident. Total PCR counts for 2007 and 2008 showed considerable fluctuation, at 2,512,828 and 2,948,841, respectively. A total of 1275, 1336, and 1393 farm injuries were identified in the SPARCS records for 2007, 2008, and 2009, respectively. This study demonstrates that accurate matching of PCR and SPARCS records requires the use of unique personal identifiers. Further, annual fluctuations in PCR counts preclude their current use in a surveillance system. An electronic data set consisting of SPARCS data could be used for surveillance, but would benefit from the addition of PCR data as these become more consistent.

Associations among social capital, parenting for active lifestyles, and youth physical activity in rural families living in upstate New York.

While emerging research supports a positive relationship between social capital and youth physical activity (PA), few studies have examined possible mechanisms explaining this relationship and no studies have focused on rural youth. In this study, we examined parents' support of children's PA as an intermediary factor linking social capital and youth PA in a largely rural cross sectional sample of American children aged 6- to 19-years and their parents/guardians (N=767 families) living in upstate New York. Parents completed a self-administered survey assessing demographic factors, perceived social capital, support for children's PA, and children's PA including time spent outdoors and days per week of sufficient PA. Structural equation modeling was used to test the hypothesis that higher social capital is linked with higher parental support for PA and, in turn, higher PA in children. Analyses were conducted separately for younger (6-12 years) and older (13-19 years) children and controlled for demographic factors (child age, household education, participation in a food assistance program) and perceived neighborhood safety. Anticipated relationships among social capital, parents' activity-related support, and children's PA were identified for older, but not younger children. Findings suggest that parent support for children's PA is one possible mechanism linking social capital and youth PA and the parents of adolescents may rely more heavily on cues from their social environment to shape their approaches to supporting their children's PA than parents of younger children.

Self-rated health does not predict 10-year weight change among middle-aged adults in a longitudinal population study.

BACKGROUND: There is a worldwide obesity epidemic, but lack of a simple method, applicable for research or clinical use, to identify individuals at high risk of weight gain. Therefore, the relationship of self-rated health and 10-year percent weight change was evaluated to determine if self-rated health would predict weight change. METHODS: From 1990 to 2008, adults aged 30, 40, 50 and 60 years were invited to health surveys that included self-rated health and measured weight and height. ANOVA was used to evaluate the relationship of 10-year percent weight change and self-rated health. RESULTS: The study population consisted of 29,207 participants (46.5% men). There was no relationship between baseline self-rated health and 10-year percent weight change for middle-aged men or women. CONCLUSIONS: Self-rated health is not able to predict weight change over a 10-year period in this age group.