Outcomes of same-day discharge following percutaneous coronary intervention in a rural population.

BACKGROUND: Same-day discharge (SDD) following percutaneous coronary intervention (PCI) is safe, yet the nationwide rate of SDD remains low. The impact that residing in a rural area has on the safety of SDD is unknown. OBJECTIVE: To investigate the safety of SDD compared to next-day discharge (NDD) among PCI patients living in a largely rural area. METHODS: There were 3502 outpatient elective PCIs at a tertiary care center between January 1, 2011 and December 31, 2017. Data from the National Cardiovascular Data Registry CathPCI Registry® and the electronic medical records were obtained for patient demographics, procedural characteristics, and procedural outcomes. Data from the initial PCI in each 365-day period were included in the analysis for each patient. Rural-Urban Commuting Area codes 4-10 were used to define rural status. RESULTS: A total of 2099 (59.9%) PCIs met the inclusion criteria (63% rural). The overall rate of SDD increased over time (4.7% in 2011 to 39.6% in 2017) as radial access increased (14.2% in 2011 to 59.9% in 2017). In this population, a total of 329 PCIs had SDD (15.7%; median (interquartile range) age 66.0 (14.0) years, 20.1% female, 52.3% rural status). Compared to NDD, SDD patients had less hyperlipidemia, atrial fibrillation, congestive heart failure, history of coronary artery bypass graft, and more radial access. SDD was noninferior to NDD for 30-day readmission but had a decreased 1-year (adjusted odds ratio [aOR]: 0.20, 95% confidence interval [CI]: 0.05-0.81, p = 0.024) and 5-year (aOR: 0.43, 95% CI: 0.28-0.66, p < 0.001) all-cause mortality compared to NDD. Rural status did not predict outcomes. CONCLUSIONS: SDD in patients in rural areas does not have a significantly higher rate of 30-day readmission. SDD patients had lower odds of 1- and 5-year mortality when compared to NDD. Future studies prospectively evaluating the safety of SDD in this population are warranted.

Feasibility of preemptive pharmacogenetic testing in colorectal cancer patients within a community oncology setting.

INTRODUCTION: Pharmacogenetics, in hand with precision medicine in oncology, represents an opportunity to holistically tailor a patient's treatment regimen using both somatic and germline variants to improve efficacy and decrease toxicity. Colorectal cancer patients represent a population with frequent use of fluoropyrimidine and irinotecan and are an ideal opportunity for implementation of preemptive pharmacogenetics as evidence supports pharmacogenetic testing for DPYD and UGT1A1 to reduce fluoropyrimidine and irinotecan toxicities. METHODS: This was a single arm proof-of-concept study at a large community-based health system. Participants provided samples for pharmacogenetic testing via an external vendor prior to chemotherapy initiation and an oncology pharmacist was responsible for pharmacogenetic interpretation and pharmacogenetic-guided therapeutic recommendation to the treating provider. RESULTS: A total of 24 (60%) participants had a UGT1A1 variant. All participants (100%) were DPYD*1/*1. Results were available and interpreted for 29/40 (72.5%) participants prior to scheduled chemotherapy initiation (p value <0.014). Of the participants whose results were available in 5 weekdays or less (n = 23), 20 (87%) were communicated with the treating provider prior to scheduled chemotherapy administration. A total turnaround time of 5 days or less was significantly associated with PGx feasibility in a community-based oncology clinic (p = 0.03). CONCLUSIONS: In conclusion, we were able to show that implementation of preemptive pharmacogenetic testing into a community oncology clinic with results interpretation available prior to scheduled initiation of chemotherapy was feasible. As pharmacogenetic testing in oncology expands, pharmacists should be prepared to optimize supportive medication regimens as well as chemotherapy with pharmacogenetic results.

Epidemiology of traumatic brain injuries at a rural-serving Level II trauma center, 2004 - 2016.

OBJECTIVE: To describe the epidemiology of traumatic brain injury (TBI) and quantify rural and urban differences. METHODS: Patient characteristics, injury characteristics, imaging, and outcomes were extracted from the trauma registry of the level II trauma center at Essentia Health-St. Mary's Medical Center, Duluth, MN, for patients admitted for a TBI from January 1, 2004, through December 31, 2016. Estimated relative risk (RR) per year, Wald 95% confidence intervals, and p-values were calculated. RESULTS: Of the 5,079 TBI admissions during the study period, just under half (2,510, 49.4%) resided in rural areas at the time of admission. Overall, there was a 3.8% unadjusted annual increase in TBI risk rom 2004-2016, with 2.9% and 4.7% annual increases among rural and urban U.S. residents, respectively. Rural residents had significant annual increases in risk of TBI admission resulting in 30-day post-discharge emergency department readmission and 30-day post-discharge combined inpatient/emergency department readmission of 35.2% and 22.4%, respectively. CONCLUSIONS: We found that risk of rural resident TBI admission due to MVC was significantly greater than that for urban residents. Public health and medical interventions to decrease the rural/urban disparity are warranted, including public health campaigns to increase seat belt use, and supportive care post-discharge into rural communities.

Development, Implementation, and Evaluation of an Early Mobility Protocol in a Regional Level II Trauma Center.

The purpose of this project was to develop and evaluate a collaborative nursing/therapist protocol for early mobility in a medical-surgical intensive care unit (MICU) in a regional level II trauma center. Data for patients in the MICU were compared for the periods August 3, 2015-August 2, 2016, and August 3, 2014-August 2, 2015. Semistructured interviews were conducted with 10 nurses and 1 therapist. Average MICU length of stay decreased from 3.81 to 3.50 days (P = .057). Mean time in mobility chairs did not change (0.12 days vs 0.11 days, P = .389). Mean number of days to first documented level 2-5 activity decreased significantly, from 1.81 to 1.51 days (P = .036). The percentage of hospitalizations with any documented level 3 or 4 activity increased significantly (from 3.8% to 7.4% and from 61.5% to 66.7%, P = .003 and P = .031, respectively). Barriers/challenges to implementation included having enough people to assist, space, documentation, having to coax the physician to place order for upright mobility, availability of therapists for later stages of protocol, patient variability, fear of patient falls, availability of therapy chairs, staff changes, time, and patient refusal. A multidisciplinary approach to protocol development for early mobility in an intensive care unit was successfully implemented at a regional level II trauma center.

Preventing Exercise-Associated Collapse Using Online Runner Education: A Randomized, Controlled Trial.

OBJECTIVE: To determine whether online exercise-associated collapse (EAC) prevention education decreases medical tent EAC visits among first-time marathoners. DESIGN: A prospective controlled study, with age- and sex-stratified randomization, evaluated rates of medical tent diagnosed EAC among runners randomized to the intervention group and intervention participants, compared with a control group. SETTING: Grandma's Marathon Medical Tent in Duluth, MN, June 2016. PARTICIPANTS: Runners in the 2016 Grandma's Marathon who never previously ran a marathon (n = 2943), randomized into control (n = 1482) and intervention (n = 1461) groups. Intervention participants opened the EAC prevention video (n = 590). INTERVENTIONS: Online EAC education included an introductory webpage and 5-minute professional video describing EAC and prevention. MAIN OUTCOME MEASURES: Medical tent visit with EAC diagnosis. RESULTS: Intervention participants had no decreased likelihood of EAC, compared with controls [odds ratio (OR), 0.88, 95% confidence interval (CI), 0.46-1.69]. Exercise-associated collapse occurred less frequently in those with longer race times (OR, 0.58, 95% CI, 0.43-0.79). Intervention participation was associated with longer race times (OR, 1.12, 95% CI, 1.10-1.23). CONCLUSIONS: Those opening the EAC prevention video and controls had similar EAC rates. Slower running speed was associated with lower EAC rates. Video viewing was a predictor of slower running pace.

Enhancing Risk Assessment in Patients Receiving Chronic Opioid Analgesic Therapy Using Natural Language Processing.

OBJECTIVES: Clinical guidelines for the use of opioids in chronic noncancer pain recommend assessing risk for aberrant drug-related behaviors prior to initiating opioid therapy. Despite recent dramatic increases in prescription opioid misuse and abuse, use of screening tools by clinicians continues to be underutilized. This research evaluated natural language processing (NLP) together with other data extraction techniques for risk assessment of patients considered for opioid therapy as a means of predicting opioid abuse. DESIGN: Using a retrospective cohort of 3,668 chronic noncancer pain patients with at least one opioid agreement between January 1, 2007, and December 31, 2012, we examined the availability of electronic health record structured and unstructured data to populate the Opioid Risk Tool (ORT) and other selected outcomes. Clinician-documented opioid agreement violations in the clinical notes were determined using NLP techniques followed by manual review of the notes. RESULTS: Confirmed through manual review, the NLP algorithm had 96.1% sensitivity, 92.8% specificity, and 92.6% positive predictive value in identifying opioid agreement violation. At the time of most recent opioid agreement, automated ORT identified 42.8% of patients as at low risk, 28.2% as at moderate risk, and 29.0% as at high risk for opioid abuse. During a year following the agreement, 22.5% of patients had opioid agreement violations. Patients classified as high risk were three times more likely to violate opioid agreements compared with those with low/moderate risk. CONCLUSION: Our findings suggest that NLP techniques have potential utility to support clinicians in screening chronic noncancer pain patients considered for long-term opioid therapy.

Neuromuscular Training Availability and Efficacy in Preventing Anterior Cruciate Ligament Injury in High School Sports: A Retrospective Cohort Study.

OBJECTIVE: To document neuromuscular training (NMT) availability and its relationship to anterior cruciate ligament (ACL) injuries in 4 major high school sports by gender, sport, and rural/urban geography, with the hypothesis that increased exposure to NMT would be associated with fewer ACL injuries. DESIGN: A retrospective cohort study. SETTING: All Minnesota high schools identified in the Minnesota State High School League (MSHSL) database for fall 2014 boys' football and soccer, and girls' volleyball and soccer. PARTICIPANTS: All high school athletic directors were surveyed to report their school's fall 2014 experience; 53.5% returned the survey reporting experience with one or more of the sports. INTERVENTION: Athletic directors documented each sport's preseason and in-season exposure to NMT (plyometric exercises, proximal/core muscle strengthening, education and feedback regarding proper body mechanics, and aerobics) and licensed athletic trainers. MAIN OUTCOMES: Reported ACL injuries by sport, gender and rural/urban. RESULTS: More than two-thirds of teams incorporated facets of NMT into their sport. Among male athletes, soccer players exposed to licensed athletic trainers experienced significantly fewer ACL injuries (P < 0.005), and NMT was associated with significantly fewer ACL injuries in football (P < 0.05) and soccer (P < 0.05). Female athletes did not demonstrate similar associated improvements, with volleyball injuries associated with increased NMT (P < 0.001), and soccer injuries not associated with NMT. However, girl soccer players in rural settings reported fewer ACL injures compared with urban teams (P < 0.001). CONCLUSIONS: Most fall high school sports teams were exposed to NMT, which was associated with fewer ACL injuries for male, but not for female athletes. Improved gender- and sport-specific preventive training programs are indicated.

Alcohol Use at the Time of Traumatic Brain Injury: Screening and Brief Intervention in a Community Hospital.

The use of screening and brief interventions (SBI) has been proposed to reduce future alcohol misuse and injury in traumatic brain injury (TBI) patients. As a result a SBI protocol for TBI patients was introduced with nursing training at a community hospital. In the 2 years following the implementation of a SBI protocol and nursing training, the number of patients with positive alcohol results decreased. The number of brief interventions increased to 83 (40.1%, 95% confidence limit [CL] = 33.4, 46.8), and CAGE questionnaire screenings decreased to 88 (42.5%, 95% CL = 35.8, 49.2), with 31 (35.2%) having positive results. These results highlight the need to assess processes and training in the emergency department to ensure that SBIs occur.

Predictors of Hospital Length of Stay and Readmissions in Ischemic Stroke Patients and the Impact of Inpatient Medication Management.

OBJECTIVE: This study was designed to evaluate predictors of hospital length of stay (LOS) and readmissions among nonsurgical ischemic stroke patient, and the impact of inpatient medication management. METHODS: This retrospective cohort study includes adult patients (≥18 years) hospitalized with a diagnosis of nonsurgical ischemic stroke from November 2007 to March 2013. In November 2011, an inpatient medication management model was implemented in the stroke unit. At the end of the study period, patients were matched before and after implementation of the inpatient medication management model (non-PHC [pharmacist-hospitalist collaborative] and PHC, respectively) to evaluate change in outcomes. The primary outcome of the study is an evaluation of predictive factors affecting LOS and readmissions. Additionally, changes in LOS and all-cause readmission at 30, 60, and 90 days when compared between PHC and non-PHC were evaluated. FINDINGS: A total of 151 PHC patients were matched to 248 non-PHC patients. There was no difference in LOS between the PHC and non-PHC patients (mean adjusted difference -.14; P = .66). Similar finding was observed for readmissions (P > .05). Insurance type was a significant predictor of LOS, with Medicare patients having an extended LOS compared to patients with private insurance (mean difference -1.00; P = .005). Patients taking statins and patients aged less than 80 years had a lower 30-day readmission rate compared to nonstatin users and patients aged 80 years or older, respectively (P < .05). CONCLUSIONS: Insurance type and severity of illness are important predictors of LOS, whereas readmissions are mostly influenced by age and statin use.

Effects of Statins on Hospital Length of Stay and All-Cause Readmissions Among Hospitalized Patients With a Primary Diagnosis of Sepsis.

BACKGROUND: There is little information on the impact of statins on hospital length of stay (LOS) or readmission among patients with sepsis. OBJECTIVE: The objective of this study is to evaluate the association between statin use and LOS and all-cause readmissions among sepsis patients hospitalized in the medical unit. METHODS: The design was a retrospective propensity score-matched study of adult patients with a primary diagnosis of sepsis from 2007 to 2013. Information was extracted from the electronic health record. Sepsis patients were identified using ICD-9CM codes. Propensity scores estimated the probability that a patient would be on statins, and patients who were on statins were then matched with those who were not, within ±0.05. Additional greedy matching criteria were organ dysfunction (yes/no) and all patient refined diagnosis-related group (APR-DRG) medical/surgical. The primary outcome was LOS, and the secondary outcomes were all-cause readmission at 30, 60, and 90 days, adjusted for age, sex, modified Deyo-Charlson comorbidity index, APR-DRG severity of illness (SOI), and APR-DRG medical/surgical, as appropriate. RESULTS: Patients taking statins had a shorter LOS than patients not taking statins, 8.7 ± 3.7 and 10.3 ± 2.7 days, respectively (P value = 0.018). There was no significant difference (P> 0.05) in all cause readmissions between statin and nonstatin patients. Presence of comorbidities and SOI were significant factors for 60- and 90-day readmissions. CONCLUSIONS: The use of statins among patients admitted with primary sepsis in the medical unit was associated with shorter length of hospital stay. However, it did not affect frequency of readmissions.

Development and validation of a survey to assess patient-perceived medication knowledge and confidence in medication use.

BACKGROUND AND PURPOSE: The primary objective of this study is to establish the validity and reliability of a perceived medication knowledge and confidence survey instrument (Okere-Renier Survey). METHODS: Two-stage psychometric analyses were conducted to assess reliability (Cronbach's alpha > .70) of the associated knowledge scale. To evaluate the construct validity, exploratory and confirmatory factor analyses were performed. RESULTS: Exploratory factor analysis (EFA) revealed three subscale measures and confirmatory factor analysis (CFA) indicated an acceptable fit to the data (goodness-of-fit index [GFI = 0.962], adjusted goodness-of-fit index [AGFI = 0.919], root mean square residual [RMR = 0.065], root mean square error of approximation [RMSEA] = 0.073). A high internal consistency with Cronbach's a of .833 and .744 were observed in study Stages 1 and 2, respectively. CONCLUSIONS: The Okere-Renier Survey is a reliable instrument for predicting patient-perceived level of medication knowledge and confidence.

Evaluation of a Pharmacist-Led COVID-19 Vaccination Program in a Hospital Setting.

PURPOSE: A pharmacist-led COVID-19 vaccination screening and administration tool was implemented at a tertiary care hospital in the Upper Midwest, allowing pharmacists to determine if an inpatient is a candidate for the COVID-19 vaccination. The purpose of this observational study was to examine the feasibility of a pharmacist-led, COVID-19 vaccination administration workflow to the inpatient population in a tertiary care hospital. METHODS: This observational study was conducted at an Upper-Midwest facility and includes a study population of adult patients admitted to the hospital between 10/1/2021 - 1/1/2022. The primary outcome of this study was the number of COVID-19 vaccinations administered. Secondary outcomes included the number of attending physician approvals, pharmacist time dedicated to the vaccination program, patient demographics, and patient acceptance of vaccination. Group differences were evaluated using odds ratios, 95% confidence intervals, Pearson's chi-square test, the Mann-Whitney U test, and multivariate logistic regression. RESULTS: There were 715 patients eligible to receive COVID-19 vaccination. Of those, 23 (3.2%) patients received a COVID-19 vaccine while inpatient. After adjusting for sex at birth, age at admission, and length of hospital stay, compared to previously unvaccinated patients, those with their second dose due were 7.3 times more likely to have been given a vaccination (95% CI 1.3-42.1, P = 0.026), while patients with their booster due were 4 times more likely to have been given a vaccination (95% CI 1.3-12.3, P = 0.014). CONCLUSIONS: Although unvaccinated patients were successfully identified, only 23 were able to be vaccinated. Additional barriers need to be addressed to make this program successful.

Impact of Pharmacist-Led Education on Proper Prophylactic Enoxaparin Dosing in Obese Patients.

Background/Purpose: Venous thromboembolism (VTE) is a common cardiovascular complication in middle-aged adults. There is a likelihood a patient may experience VTE when admitted to a hospital. Prophylactic medications such as low-dose unfractionated heparin and enoxaparin are started to prevent VTE. A pharmacist-led health system-wide Grand Rounds promoted prophylactic enoxaparin 40 mg twice daily instead of once daily in patients with a body mass index (BMI) 40 kg/m2 or greater. Methodology: This case-control study was conducted at a Essentia Health - Fargo, in the Upper Midwest. Data of acute care patients were extracted from electronic health records 2 years before and after the pharmacist-led education. Patients in the study were 18 years old or older, hospitalized with a need for prophylactic anticoagulation receiving enoxaparin, and had a BMI 40 kg/m2 or greater. Patients with a diagnosis of COVID-19 and recent bleeding were excluded. Groups were compared to determine the effect of pharmacist-led education. The outcome was the number of patients who received enoxaparin 40 mg twice daily compared to once daily. Results: In the control group, 9 out of 15 hospitalizations received enoxaparin 40 mg subcutaneous twice daily and in the case group 34 out of 70 hospitalizations received the twice daily dosing. The odds ratio of receiving enoxaparin 40 mg twice daily after the pharmacist-led education compared to before the education was OR = .99, 95% CI = .96, 1.02. Conclusions: There was no difference in enoxaparin 40 mg once daily and twice daily dosing after the pharmacist-led education.

Bridging Community Mental Health and Primary Care to Improve Medication Monitoring and Outcomes for Patients With Mental Illness Taking Second-Generation Antipsychotics-Phase 2: Quality Improvement Initiative Over 15 Months.

Objective: To evaluate the effectiveness of a quality improvement (QI) initiative to improve family medicine residents' metabolic monitoring of second-generation antipsychotics (SGAs) for patients comanaged across nonintegrated community mental health and family medicine clinics.Methods: Patients were aged ≥ 18 years seen by family medicine residents and prescribed at least 1 SGA (N = 175). Preparative and scheduled QI interventions were nonblinded and included collaboration across organizations, education, and monthly interprofessional care conferences. The QI outcome included evaluation of pre-post metabolic monitoring laboratory data over the 15-month study period. A subset of patients (n = 26) was reviewed at least once at monthly interprofessional care conferences. Patients were stratified by diagnosis of diabetes (n = 45) and no diabetes (n = 130) at baseline. Analyses of the QI intervention outcomes were framed by the time period of monthly care conferences (January 31, 2019-April 30, 2020) and compared to baseline (the historical time period) (October 31, 2017-January 29, 2019).Results: Improved adherence in glycated hemoglobin (HbA1c) (P = .042) and lipid (P < .001) monitoring per guidelines from baseline to follow-up was seen in the total patient population (N = 175). Patients without diabetes (n = 130) had significant improvement (P = .001) in HbA1c monitoring from baseline to follow-up. The subgroup of patient cases that were discussed at a care conference showed no significant improvement in HbA1c or lipid monitoring.Conclusion: Preparative and scheduled QI interventions provided family medicine residents powerful reminders of the SGA monitoring guidelines that improved the metabolic monitoring behaviors for all patients on SGAs.Prim Care Companion CNS Disord. 2023;25(3)22m03432. Author affiliations are listed at the end of this article.

Mathematical Analysis of Melanocyte Patterns on Danio rerio.

The study of zebrafish skin pattern development could lead to a better understanding of how these patterns are generated and how they evolved. To compare and contrast wild-type (WT) striped and leopardt1 mutant spotted patterns, photographs were taken of the developing fish. Initial observations led to the hypothesis that the black melanocyte spots in leopardt1 mutants were not randomly distributed, but rather were located in "dashed" stripes. To test this, melanocyte-spot-sized transparent grids were overlaid onto photographs and the location of melanocyte clusters was recorded. The grid maps were used to identify whether a black, melanocyte positive, grid area was present adjacent to each melanocyte cluster in each cardinal and intercardinal direction. In addition, Python-based computer programs were used to analyze the photographs at the pixel level. When analyzed using analysis of variance and logistic regression models, the striped and spotted patterns expressed more similarities than expected. In the leopardt1 zebrafish, the spots were organized into dashed stripes that had similar locations to the WT stripes. This research suggests that spotted and striped patterns are related. Further, the leopardt1 spots were farther apart along the dorsal-ventral axis than in the anterior-posterior direction, suggesting that different mechanisms control spacing along these two axes.

Parents' safety beliefs and childhood agricultural injury.

BACKGROUND: This study examined potential associations between parental safety beliefs and children's chore assignments or risk of agricultural injury. METHODS: Analyses were based on nested case-control data collected by the 1999 and 2001 Regional Rural Injury Study-II (RRIS-II) surveillance efforts. Cases (n = 425, reporting injuries) and controls (n = 1,886, no injuries; selected using incidence density sampling) were persons younger than 20 years of age from Midwestern agricultural households. A causal model served as the basis for multivariate data analysis. RESULTS: Decreased risks of injury (odds ratio [OR] and 95% confidence intervals [CI]) were observed for working-aged children with "moderate," compared to "very strict" parental monitoring (0.60; 0.40-0.90), and with parents believing in the importance of physical (0.80; 0.60-0.95) and cognitive readiness (0.70, 0.50-0.90, all children; 0.30, 0.20-0.50, females) when assigning new tasks. Parents' safety beliefs were not associated with chore assignments. CONCLUSIONS: Parents' safety beliefs were associated with reduced risk of childhood agricultural injury; the association was not mediated by chore assignments.

Massage in the management of agitation in nursing home residents with cognitive impairment.

This was a prospective study designed to examine the potential of massage to reduce agitation in cognitively impaired nursing home residents. Subjects were identified as susceptible to agitation by nursing home staff or by Minimum Data Set (MDS) report. Data was collected during baseline (3 days), intervention (6 days), and at follow-up. Five aspects of agitation were assessed: Wandering, Verbally Agitated/Abusive, Physically Agitated/Abusive, Socially Inappropriate/Disruptive, and Resists Care. At each observation, agitation was scored 5 times during the 1-hour window of observation. Subjects' agitation was lower during the massage intervention than at baseline (2.05 vs. 1.22, P < .001), and remained lower at follow-up. Of the 5 agitated behaviors examined in this study, massage was associated with significant improvement for 4: Wandering (0.38 vs. 0.16, P < .001), Verbally Agitated/Abusive (0.59 vs. 0.49, P = .002), Physically Agitated/Abusive (0.82 vs. 0.40, P < .001), and Resists Care (0.10 vs. 0.09, P = .022). When analysis was restricted to residents with significant levels of agitation at baseline, the observed effects of massage on agitation increased. Massage is an accessible, easily learned intervention that is effective in controlling some types of agitation in elders with cognitive impairment. Massage should be studied further as a nonpharmacological intervention in such patients.

Animal-related injuries: a population-based study of a five-state region in the upper Midwest: Regional Rural Injury Study II.

PROBLEM: While agricultural injury has been identified among the major causes of occupational injury mortality and morbidity, data have been limited pertinent to the magnitude, consequences, and potential risk factors for animal-related injuries -- a major source of morbidity among agricultural operations. METHODS: Demographics, exposure, and injury data were collected for 1999 and 2001 among agricultural households in a five-state region. Causal models facilitated survey design, data analyses, and interpretation of results; directed acyclic graphs guided multivariate modeling. RESULTS: From 7,420 households (84% response of eligible), a total of 5,045 injury events were reported; 1,016 (20.1%) were animal-related. Multivariate analyses revealed increased risks for those <20 years; residents of all states compared to Minnesota; all age groups compared to 0-4 years; >0 hours worked; and prior agricultural injury history. For those 20+ years, increased risks were identified for: South Dakota residents; males; >0 hours worked; and prior agricultural injury history. For those cases <20 and 20+ years of age, 58% and 46%, respectively, resulted in lost work time on their agricultural operations (31% and 50%, one week or more). CONCLUSIONS: Animal-related injury has a major impact on the agricultural industry. Results serve as a basis for interventions and further research. IMPACT ON INDUSTRY: The impact of animal-related injuries on the agricultural industry appears significant; among age groups <20 and 20+, 85% and 82%, respectively, had some resulting restriction. For all events combined, 29% and 30%, respectively, involved restriction from one week to 3+ months; 12% and 15% involved restriction for one month or more. Among those <20 and 20+ years of age, 58% and 46%, respectively, lost work time on their own agricultural operation as a result of injuries associated with their own operation; 22% and 15% lost one week or more. Moreover, of the non-agriculture-related injuries, 31% and 50% resulted in lost work time on their own operation; 15% and 28%, respectively, lost one week or more. Restrictions such as these can affect the productivity of the operation, resulting in financial impacts, especially on small operations that have few people to manage the required tasks.

The association between parents' past agricultural injuries and their children's risk of injury: analyses from the Regional Rural Injury Study-II.

OBJECTIVE: To examine associations between parents' and children's agricultural injuries in a cohort of farming and ranching households. DESIGN: Analyses from a population-based, nested case-control study. SETTING: The 1999 Regional Rural Injury Study-II, involving a cohort of 3765 agricultural households. Demographic, injury, and exposure data were collected for household members for 1 year. PARTICIPANTS: A total of 203 injured children (cases) and 755 randomly selected control children were identified for the study. MAIN EXPOSURE: Children's risk of injury was estimated in reference to individual and combined parental injury experience. Two periods were evaluated, separately and in combination. MAIN OUTCOME MEASURES: Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated by using logistic regression; directed acyclic graphs guided selection of potential confounders. RESULTS: When controlling for potential confounders, children whose fathers were injured before the study year had twice the risk of injury of those whose fathers were not injured (OR, 2.1; 95% CI, 1.5-3.0). Children had increased risk of injury if their mothers were injured before the study (OR, 2.5; 95% CI, 1.7-3.8) or during the study (OR, 2.0; 95% CI, 0.9-4.2). Children whose parents both reported agricultural injuries before the study had a 4-fold increase in injury risk over those with neither parent injured (OR, 4.2; 95% CI, 2.6-6.9). CONCLUSIONS: Positive associations between parents' and children's injuries were observed, with a potential additive effect if both parents were injured. These results indicate a need for further research into the social and/or physical environments driving these associations so that appropriate interventions for pediatric injury can be determined.