Health Supply Utilization at a Boy Scout Summer Camp: An Evaluation for Improvement and Preparedness.

OBJECTIVE: To describe the health conditions treated by a health services center at a Boy Scout summer camp and make recommendations for appropriate resources and supplies. METHODS: We conducted a retrospective review of health center utilization at a Boy Scout camp in central Missouri during the summers of 2012 and 2013. Health logbook data were compiled and analyzed using descriptive and comparative statistics. RESULTS: During the study period 19,771 camp participants made 1586 visits to the health care center. The overall incidence rate of health center visits was 6.20 visits per 1000 camp days. Two-thirds of visits were for illness and the remainder for injury. Over 90% of patients were returned to camp, 7.3% were transferred to another health facility, and 1.6% were advised to leave camp and return home. The most common treatments were rehydration (17.8 %) and administration of analgesics (13.4%) and topical creams (12.3%). CONCLUSIONS: Summer camps need to be prepared for a wide range of conditions and injuries in youth campers, leaders, and staff members. Over 90% of presenting complaints were managed on site, and the majority of conditions were easily treatable minor injuries and illnesses. We provide recommendations for appropriate medical supplies and suggest opportunities for improvement to aid health centers in planning and treatment.

The paradox of the binomial Ixodes ricinus activity and the observed unimodal Lyme borreliosis season in Hungary.

The change of ambient temperature plays a key role in determining the run of the annual Lyme season. Our aim was to explain the apparent contradiction between the annual unimodal Lyme borreliosis incidence and the bimodal Ixodes ricinus tick activity run--both observed in Hungary--by distinguishing the temperature-dependent seasonal human and tick activity, the temperature-independent factors, and the multiplicative effect of human outdoor activity in summer holiday, using data from Hungary in the period of 1998-2012. This separation was verified by modeling the Lyme incidence based on the separated factors, and comparing the run of the observed and modeled incidence. We demonstrated the bimodality of tick season by using the originally unimodal Lyme incidence data. To model the outdoor human activity, the amount of camping guest nights was used, which showed an irregular run from mid-June to September. The human outdoor activity showed a similar exponential correlation with ambient temperature to that what the relative incidence did. It was proved that summer holiday has great influence on Lyme incidence.

Summer crowds: An analysis of USFS campground reservations during the COVID-19 pandemic.

During the COVID-19 pandemic, US public land managers faced the challenge of catering to large increases in camping demand, while maintaining social distancing guidelines. In this paper, we use multivariate linear regression to analyze weekly changes in reservations to US Forest Service (USFS) campgrounds between 2019 and 2020. The regression models estimate the impact of local COVID infection rates, public health restrictions, and spatial spillovers from proximity to National Parks (NPs), metropolitan areas and wildfire on camping demand. Our sample includes 1,688 individual USFS campgrounds from across the contiguous US. The results illustrate the dramatic increases in camping on USFS land that occurred in the summer of 2020 and demonstrate that increases in local infection rates led to significant increases in camping nights reserved in the summer. The results also illustrate that the increase in camping nights reserved at USFS campgrounds was particularly dramatic for campgrounds located near large metropolitan areas and near NPs that saw increases in overall recreational visits. These results point to the important role that public lands played during the pandemic and can help guide public land resource allocations for campground maintenance and operation.

A Single Center Review of the Dangers of Recreational Fires in the Pediatric Population.

The increasing trend of admissions due to recreational fires prompted a 5-year review. The retrospective chart review of pediatric burn injuries from campfires or bonfires treated at a single medical center's burn unit. The study included children within the ages of 0 to 15 admitted or transferred from January 2012 to December 2016 with first, second, and/or third degree burns by bonfires. These patients accrued burns due to active fires as well as postfire ember contact. Two hundred-eighty nine (289) were pediatric admissions out of which 66 (22.8%) were pediatric admissions associated with recreational fires. The mean annual admission for campfire or bonfire burns was 13 ± .98. The mean age was 4 ± 2.47 years. Gender distribution revealed 21 female and 45 male pediatric patients under the age of 15. From the available data, 8 (12%) of these burns occurred at home in the backyard and 16 (24%) at a public camp or park. Injury mechanisms were more commonly a result of direct contact with hot coals and embers (65%). Falls into open flame accounted for 23% (n = 15) of injuries, and flash flames accounted for 12% of injuries (n = 8). The presence of supervision was unknown in 56%; however, lack of supervision was a factor in 14% of our study population. By gaining a better understanding of the type of injury, mechanism of injury, and the demographic of recreational fire burn victims, policy, and awareness campaigns were instituted in an effort to reduce the incidence of recreational fire burns.

A classification of backcountry campsites in Prince William Sound, Alaska, USA.

This study examined resource conditions on backcountry campsites in Prince William Sound, Alaska, USA. In order to further the understanding of campsite impacts and to improve monitoring and assessment methods, we employed a multivariate analysis procedure, suggested in one study, but heretofore untested on data from other campsite assessments. Factor analysis of ten impact indicator variables from 146 campsites produced three dimensions of campsite impact-tree and vegetation disturbance, areal disturbance and visitor behavior-related disturbance. Three types of campsites, which differed substantially in the types of impact exhibited, were then derived from a cluster analysis of the factor scores. Further analysis revealed a significant relationship between the types of substrates where campsites were located and the types of campsites derived from the analysis. This work illustrates the utility of multi-indicator monitoring approaches and the use of multivariate methods for classifying campsites, as the campsite types identified would likely require different management strategies for limiting the proliferation and expansion of impacts.

Racial Ethnic Disparities in Youth With Type 1 Diabetes Participating in Diabetes Summer Camps.

OBJECTIVE: Diabetes camps are beneficial for campers and include benefits such as increases in diabetes knowledge, glycemic control, and psychological functioning. Racial/ethnic minority youth are likely to have poorer disease management and glycemic control. We hypothesized that minority youth with type 1 diabetes have reduced participation in diabetes summer camps. RESEARCH DESIGN AND METHODS: We analyzed deidentified data from 5,256 campers with type 1 diabetes who participated in a network of 48 American Diabetes Association-affiliated summer camps in 2018, and we compared participation rates by racial/ethnic category to the most recent SEARCH for Diabetes in Youth study prevalence rates. RESULTS: Camper demographics were significantly different than in the general population of children with type 1 diabetes (P < 0.001). Minority youth were more likely to attend day camp, be first-time campers, and request financial aid, and they were less likely to be on insulin pump therapy or use continuous glucose monitors. CONCLUSIONS: Racial/ethnic minority youth with diabetes are underrepresented in diabetes camps nationwide.

Injury patterns at US and Canadian overnight summer camps: first year of the Healthy Camp study.

OBJECTIVE: To describe injury patterns at overnight summer camps in 2006, and identify risk factors for more significant injury. DESIGN: Surveillance data obtained from Healthy Camp Study from 2006 were analyzed from 71 overnight camps, representing 437,541 camper-days and 206,031 staff-days. RESULTS: Injuries were reported in 218 campers and 81 staff. 51.8% of injured campers were male versus 34.6% of staff. Among campers, 60.1% were evaluated off-site; 2.3% required hospital admission. 43.9% of injuries required >24 h activity restriction (deemed "significant injury"). Among campers, significant injury was associated with camp sessions > or =14 days (RR 1.48); among staff, with male sex (RR 1.85) and camper-to-staff ratio (RR 0.67). There were no associations with age, time of day, setting, or level of supervision. CONCLUSIONS: Significant injuries are uncommon at overnight summer camps. Rates appear similar to those in comparable activities. Targeted interventions may further reduce injury risk.

Perceived effects of setting attributes on visitor experiences in wilderness: variation with situational context and visitor characteristics.

Understanding how setting attributes influence the nature of the visitor experience is crucial to effective recreation management. Highly influential attributes are useful indicators to monitor within a planning framework, such as Limits of Acceptable Change. This study sought to identify the setting attributes perceived to have the most profound effect on the ability to have "a real wilderness experience" and to assess the degree to which attribute importance varied with situational context and visitor characteristics. To this end, exiting hikers were surveyed at moderate and very high use trailheads in Alpine Lakes Wilderness, WA (USA), and Three Sisters Wilderness, OR (USA). They were asked about the degree to which encountering varying levels of different setting attributes would add to or detract from their experience. Attributes with the largest range of effect on experience, based on evaluations of different levels, were considered most important. The most influential attributes were litter and several types of campsite interaction--people walking through camp and number of other groups camping close by. The perceived importance of setting attributes did not vary much between wilderness locations with substantially different use levels, suggesting that conclusions are robust and generalizable across wilderness areas. There also was little difference in the perceptions of day and overnight visitors. In contrast, we found substantial variation in the perceived importance of setting attributes with variation in wilderness experience, knowledge, attachment, and motivation. Our results validate the emphasis of many wilderness management plans on indicators of social interaction, such as number of encounters.

Very high and increasing incidence of type 1 diabetes mellitus in Newfoundland and Labrador, Canada.

OBJECTIVE: To determine the incidence of type 1 diabetes mellitus (T1DM) among children aged 0-14 yr inclusive in the Canadian province of Newfoundland and Labrador (NL). METHODS: Prospective and retrospective cohort study of the incidence of T1DM in children aged 0-14 yr from 1987 to 2005. Identified cases during this time period were ascertained from several sources and verified using the capture-recapture technique. RESULTS: Over the study period, 732 children aged 0-14 yr were diagnosed with T1DM. The incidence of T1DM in this population over the period 1987-2005 inclusive was 35.08 per 100,000 (95% confidence interval: 32.54, 37.62). The incidence over this period increased linearly at the rate of 0.78 per 100 000 per year. There was a significant difference between the incidence of 31.61 per 100,000 for boys in the 0-4-yr age-group and 19.05 per 100,000 for girls in the 0-4-yr age-group (p = 0.001). The incidence was very high throughout the entire province. CONCLUSIONS/INTERPRETATION: The province of NL has one of the highest incidences of T1DM reported worldwide. The incidence is increasing over the 19-yr study period.

Exhaled nitric oxide decreases in association with attendance at an asthma summer cAMP.

Attendance at a summer asthma camp has been associated with improved outcomes in children with asthma. We hypothesized that one mechanism involved in improved asthma outcomes is reduction in airway inflammation. To investigate this, we measured the fractional concentration of exhaled nitric oxide (FeNO), lung function (forced expiratory volume in 1 sec, FEV(1)) and asthma control (Juniper Asthma Control Questionnaire, ACQ) from children at the beginning and end of a 1-week asthma summer camp. We also obtained a symptoms-only ACQ at 1 and 6 months after the end of camp. We enrolled 10 girls, 17 boys, mean (+/- SD) age = 9.6 +/- 1.3 years. At baseline, FeNO (ppb), median (25-75 IQR) = 11.4 (7.2-21.3); ACQ = 0.86 (0.43-1.21); FEV(1) (%pred, mean +/- SD) = 87 +/- 10. At the end of camp, FeNO = 6.2 (4.4-8.4), a change of -45%, p < 0.0001; ACQ = 0.71 (0.43-1.14), a fall of 14%, p = 0.72; and mean FEV(1)% predicted remained unchanged. There were no significant changes in the follow-up symptoms-only ACQ at 1 and 6 months. We conclude that airway inflammation, as measured by FeNO, improved during 1 week of asthma camp, but there were no significant changes in lung function or asthma control. Since no child had a change in anti-inflammatory therapy during camp, these findings suggest that airway inflammation was reduced because of improved adherence to therapy and/or reduced exposure to pro-inflammatory stimuli in the home environment. The finding of reduced inflammation following attendance at an asthma summer camp should motivate the child, the parents and the clinician to focus their efforts on improving adherence to therapy and reducing exposures at home.

Blood Glucose Control and Related Factors at a Camp for Korean Children and Adolescents with Type 1 Diabetes.

Data about Asian children and adolescents with type 1 diabetes are sparse. This study's objectives were to describe blood glucose (BG) levels and related factors at a camp for Korean children and adolescents with type 1 diabetes. This descriptive study was conducted January 8-10, 2015. The participants, 24 children and adolescents, were recruited for a 3-day residential diabetes camp. Data on 24 campers were analyzed. Their mean age was 13.4 (± 1.7) years; 44.4% were boys, and mean HgbA1c was 8.5% (± 1.4%). Results revealed that BG levels were maintained safely: The mean BG level during the 3-day stay was 171.1 (± 33.3) mg/dl. Multiple regression analysis showed that insulin adjustment for hyperglycemia (standardized ß = .426; t = 2.431; p = .030) and snacks for hypoglycemia (standardized ß = -.719; t = -3.723; p = .003) at the camp were the only independent contributors to mean BG levels during the 3-day study period. No demographic or clinical factor was found to be associated with the mean BG level. This is the first study of its kind to be conducted in an Asian population, presumably because the prevalence of type 1 diabetes in Asia is low and diabetes camps are a novel concept. Further research is recommended to assess the characteristics of campers (e.g., diet, activity levels, and cultural background) and to determine how the health outcomes of children and adolescents with type 1 diabetes are affected by camp programs.

Camp nursing: rewards and challenges.

Every summer, millions of children attend summer camp, bringing with them flashlights, sleeping bags, bug spray, and a wide array of acute and chronic medical conditions. Registered nurses provide care to these children in an environment that is fun-filled, rewarding, and challenging. Familiarity with camp settings, as well as with expectations of the nurse at camp, are important because the demands are quite different from traditional nursing practice. Due to the challenges that are inherent in the camp nursing role, nurses considering this area of practice must be knowledgeable about the various camp settings, camp nurse responsibilities, practice issues for camp nursing, implications for education and research, and resources for the nurse contemplating a camp nursing position.

Analysis of burns caused by pre-filled gas canisters used for lamps or portable camping stoves.

The use of pre-filled valveless gas canisters for lamps or camping stoves has caused a number of serious burn incidents. We performed a retrospective analysis of all of the patients who were victims of such incidents admitted to the Marseille Burn Centre between January 1990 and March 2004. There were a total of 21 patients burned in such conditions. Adult males made up the majority of the victims of this sort. Lesions were often extensive (60% of the patients were burned over more than 10% of their body surface) and systematically deep. In order of frequency, burn locations were: the lower limbs, the upper limbs, the hands and the face. The incidents principally occurred during replacement of the canister near an open flame. The marketing of a canister with a valve in order to avoid gas leaks did not cause the old canisters to be taken off the market. On the contrary, European Safety Standard EN417, updated in October 2003, validated the use of these valveless canisters. The severity of the lesions caused and the existence of safe equivalent products requires the passage of a law that forbids valveless canisters.

Injury and illness epidemiology at a summer sport-camp program, 2008 through 2011.

CONTEXT: University-sponsored summer sport camps often employ athletic trainers; however, there is a dearth of epidemiologic studies describing the injury and illness experience of sport-camp participants to guide clinicians. OBJECTIVE: To describe the injury and illness experience of youth participants at a university-sponsored summer sport-camp program during a 4-year period. DESIGN: Descriptive epidemiology study. SETTING: A National Collegiate Athletic Association Division I university that sponsored 76 to 81 camps for 28 sports each summer. PATIENTS OR OTHER PARTICIPANTS: A total of 44, 499 camp participants enrolled during the 4 years. Male and female participants ranged in age from 10 to 17 years and in athletic skill from novice to elite. MAIN OUTCOME MEASURE(S): Data from handwritten injury and illness log books, maintained by sports health care personnel, were accessed retrospectively, entered into an electronic spreadsheet, and coded. Data were applied to the National Athletic Injury/Illness Reporting System. Participant-personnel contacts, defined as any instance when a participant sought health care services from personnel, were calculated per 100 participants. Injury and illness rates were calculated per 10 ,000 exposures, measured in participant-days. The distribution of injury and illness conditions and affected body regions were calculated. RESULTS: There were 11 ,735 contacts, for an overall rate of 26 per 100 participants, and 4949 injuries and illnesses, for a rate of 1 per 10, 000 participant-days. Participants at single-sex camps were less likely to sustain injuries and illnesses than participants at coeducational camps (rate ratio [RR] = 0.49; 95% confidence interval = 0.45, 0. 35; P < .001, and RR = 0.47; 95% confidence interval = 0.43, 0.51; P < .001, respectively). The lower extremity was injured most frequently (27.9%). Most injury and illness conditions were dermatologic (37.1%). CONCLUSIONS: The contact and injury and illness differences observed among sports and between sexes demonstrated potential differences in the sports health care needs of camp participants. These data can be used to make evidence-based clinical decisions, such as determining injury-prevention strategies and sports health care staffing needs.

Aseptic meningitis outbreak associated with echovirus 9 among recreational vehicle campers--Connecticut, 2003.

Aseptic meningitis is an inflammation of the tissues covering the brain and spinal cord and caused by a virus, most frequently an enterovirus. In August 2003, the Connecticut Department of Public Health (CDPH) received a report of three viral meningitis cases among recreational vehicle (RV) campers staying at a campground in northeastern Connecticut. CDPH, assisted by CDC, conducted an investigation, which 1) identified a total of 12 cases of aseptic meningitis and 24 cases of enterovirus-like illness among 201 campers interviewed, 2) demonstrated how transmission of enterovirus from persons with mild illness contributed to the aseptic meningitis outbreak, and 3) determined that crowded conditions inside RVs and in the campground swimming pool likely facilitated spread of enterovirus. Pool operators should check chlorine and pH levels frequently, particularly during peak pool occupancy; adults should take precautions against passing enterovirus to children, who are at greater risk for severe illness.

High prevalence of bedbugs Cimex hemipterus and Cimex lectularis in camps for internally displaced persons in Freetown, Sierra Leone: a pilot humanitarian investigation.

The prevalence of bedbugs Cimex hemipera and C. lectularis was investigated in camps for the internally displaced persons (IDPs) in Freetown, Sierra Leone. Two hundred and thirty eight rooms were searched during the day and at night, and 233 (98%) of those rooms in 30 booths were infested with different life cycle stages of bedbugs. There hundred and ninety-eight (68%) of the bedbugs were adults, 145 (24.8%) were nymphs of various instars, and 41 (7%) were clusters of eggs. Significantly (P > 0.05) more bedbugs were recovered during the night inspections 64.6% as compared to 35.4% during the day inspections. In addition, more adult bedbugs were recovered at night than during the day, a manifestation of their peak feeding period. Of the total of 570 adults and nymphs collected and identified, 320 (56.1%) and 250 (43.9%) were Cimex lectularis and Cimex hemipterus respectively. Clinical examination of 221 individuals living in the booths during 3 consecutive weeks of examinations and treatment for conditions suggestive of bedbug infestation (bites and skin reactions as well as treatments for other health and medical conditions) showed that 196 (86%) had wheals as a direct result of bedbug bites. The data of this pilot humanitarian investigation shows a high prevalence of bedbug infestation in these displacement camps. It is recommended that some control measures be instituted, like residual insecticide application along with integrating control methods within the primary health care system, because bedbugs are a source of great irritation and sleepless nights that could lead to stress.

[Streptococcal respiratory infection in large organized children's collectives and experience in optimizing its prevention]. / Respiratornaia streptokokkovaia infektsiia v krupnykh organizovannykh detskikh kollektivakh i opyt optimizatsii ee profilaktiki.

Epidemiological analysis of the manifestations of respiratory streptococcal infection in the all-year-round pioneer camp "Ocean" over 1984-1990 and in similar large organized groups of children revealed some common regularities manifested as consecutively repeating morbidity rises in acute respiratory diseases, tonsillitis, scarlet fever over a year (rotations 1-3 and 9). Time course of the disease incidence over each rotation (month) had a specific pattern as well. Trials of our newly developed system of prevention and treatment with tomicid showed its high effectiveness, which manifested by a drop in the morbidity level and changes in the structure and dynamics of respiratory streptococcal infection.

Injury causation in the great outdoors: A systems analysis of led outdoor activity injury incidents.

Despite calls for a systems approach to assessing and preventing injurious incidents within the led outdoor activity domain, applications of systems analysis frameworks to the analysis of incident data have been sparse. This article presents an analysis of 1014 led outdoor activity injury and near miss incidents whereby a systems-based risk management framework was used to classify the contributing factors involved across six levels of the led outdoor activity 'system'. The analysis identified causal factors across all levels of the led outdoor activity system, demonstrating the framework's utility for accident analysis efforts in the led outdoor activity injury domain. In addition, issues associated with the current data collection framework that potentially limited the identification of contributing factors outside of the individuals, equipment, and environment involved were identified. In closing, the requirement for new and improved data systems to be underpinned by the systems philosophy and new models of led outdoor activity accident causation is discussed.

Epidemiology and severity of paediatric burn injuries occurring during camping and caravanning holidays.

BACKGROUND: Due to its unique location, the South West England Paediatric Burns Service based in Bristol admits an interesting cohort of holiday-makers, who have sustained their burns whilst on camping and caravanning holidays. AIM: We aimed to establish whether burns sustained during camping and caravanning holidays are more severe and require more extensive intervention compared to burns sustained in other situations. METHODS: We undertook a retrospective, observational study of admissions to the South West Paediatric Burns Service between June, and August from 2003 to 2005. Our primary outcome was to assess the severity of the burns as defined by percentage total body surface area of partial and full thickness burns. We used secondary outcomes of indirect indicators of burn severity: length of hospital stay, number of general anaesthetics, and need for surgical debridement, artificial skin dressing and/or skin grafting. Analysis of the data was undertaken using Mann-Whitney test, Fisher's exact test, and Chi-squared test. RESULTS: 151 patients were included in the study, 30 (20%) of which were campers. Our results show that burns sustained during camping and caravanning holidays are significantly more likely to be of larger surface area than burns sustained in other environments. Campers' burns also required more frequent surgical intervention (in 87% versus 66%) and had longer inpatient admissions (5.3 days versus 3.8 days). CONCLUSIONS: Our results have implications for clinicians and campsite owners. Access to free flowing water is often not immediately available on campsites and time taken to reach the nearest Emergency Department is often prolonged with a further delay before reaching the tertiary centre. The general public needs to be aware of the risks of burn during camping and caravanning holidays. Campsite owners should consider improving first aid facilities and clinicians need to be aware of the need for early referral and timely transfer to tertiary facilities.