Pediatric Poisonings Associated With Ingestion of Marijuana Products.

BACKGROUND: Rapid changes in marijuana legislation have resulted in a wider array of products containing tetrahydrocannabinol (THC) to be legally manufactured and sold, such as edibles in the form of gummy candies and cookies. These products may be enticing to young children who mistake them for typical snack foods. OBJECTIVE: Our aim was to describe emergency department (ED) visits due to unintentional ingestion of cannabis products among children aged birth to 11 years old in the United States. METHODS: Using the 2019-2020 National Electronic Injury Surveillance System, U.S. ED records for poisoning events related to ingestion of THC were examined. Descriptive epidemiologic analyses were conducted to provide national estimates of the pediatric visits. RESULTS: An estimated 1245 pediatric patient visits related to unintentional marijuana poisoning occurred. Most poisonings involved edible marijuana products and most patients were admitted to the hospital. CONCLUSIONS: Cannabis edibles present a challenge with regard to prevention of poisonings among the pediatric population. Legislation or company policies pertaining to packaging and manufacturing are needed to limit the attraction of toddlers and young children, as well reliance on parents and caregivers for safe storage of the products. Continued and expanded public health education campaigns are warranted.

Erratum to "Factors that influence Puerto Rican's intention to get the COVID- 19 vaccine" [Exploratory Research in Clinical and Social Pharmacy 5C (2022) 100106].

[This corrects the article DOI: 10.1016/j.rcsop.2022.100106.].

COVID-19 Risk Perceptions and Health Behaviors in Puerto Rico.

Preventative health behaviors were encouraged for all at the beginning of the COVID-19 pandemic. However, as the pandemic continued after 2020, some people stopped implementing all measures. It is unknown if people living in Puerto Rico continued to perform preventive health behaviors throughout the pandemic. The purpose of this study was to explore if the risk perceptions of COVID-19 were associated with preventative health behaviors among Puerto Ricans during the COVID-19 pandemic. A sample from Puerto Rico (N = 285) was recruited from January to March 2021 to participate in a cross-sectional, online survey about health behaviors and risk perceptions of COVID-19. Demographics were reported, and a multivariate logistic regression explored the relationships between health behaviors (e.g., handwashing, staying at home, and not allowing visitors) and fear of COVID-19 (outcome variable) and risk of becoming infected with COVID-19 (outcome variable). Those who reported that they washed their hands more often than usual were more likely (adjusted odds ratios = 6.93) to indicate that they were afraid of COVID-19 compared with those who were not performing this behavior. Also, those who reported not leaving their home as much and who did not receive visitors into their house as much as they did before the pandemic were 2.49 and 2.89 times as likely to report being afraid of the virus, respectively, as their counterparts. Although fear may not effectively change all behaviors, it may encourage Puerto Rican adults to practice healthy behaviors that will prevent the spread of COVID-19.

Factors that influence Puerto Rican's intention to get the COVID-19 vaccine.

Despite Latino Americans having been found to be disproportionally affected by COVID-19, they report higher hesitancy to receive the COVID-19 vaccine than non-Hispanic whites. The purpose of this study was to examine factors that influence Puerto Rican's intentions to get the COVID-19 Vaccine. A sample (n = 173) of people who currently lived in Puerto Rico were recruited to complete an online, cross-sectional survey about their intention to receive the COVID-19 vaccine. Demographics and vaccine hesitancy were assessed, and logistic regressions explored relationships between variables and intention to get the COVID-19 vaccine when it became available. When controlling for covariates, 30-49-year-olds (aOR = 0.12) and those who had refused a vaccine in the past (aOR = 0.07) had lower odds of vaccine uptake than those between 18 and 29 years and who had not previously refused a vaccine, respectively. Those who had completed at least a 4-year college degree (aOR = 6.78) had greater odds of intending to get vaccinated than their counterparts. Health education campaigns about COVID-19 in Puerto Rico should be tailored to working-age adults who may mistrust information they have heard about the vaccine. Messages could be tailored to preferred communication channels to decrease vaccination hesitancy.

Driving after marijuana use among U.S. adolescents: Prevalence profiles and related behaviors.

OBJECTIVES: The interplay between marijuana legislation, perceptions of risks associated with marijuana use, and marijuana-related risk behaviors is an ever changing and complex issue. Marijuana impaired driving is of concern as legalization continues to expand in the United States. While driving after using marijuana has been shown to be prevalent among adults, little research has examined the behavior in adolescents. The aim of the present study was to examine the prevalence of driving after using marijuana among U.S. adolescents, with an examination of the relationship to age of marijuana initiation and marijuana usage patterns. METHODS: We analyzed data from the 2017 Youth Risk Behavior Survey, a nationally representative sample of high schools students in the U.S. The sample was current marijuana users, defined as past 30 day use. Driving after using marijuana was the main outcome variable, with analyses examining the association between the outcome and age of initiation and patterns of use. Prevalence ratios were obtained by modeling Poisson regression to examine factors associated with driving under the influence of marijuana. RESULTS: Nearly half of all marijuana users reported driving after use during the past 30 days, and did not differ between males and females. Prevalence of driving after using marijuana was significantly higher among heavy users (PR = 2.8; 95% CI 2.1-3.6). A higher prevalence of driving after drinking alcohol (PR = 1.7; 95% CI 1.5-1.9) was also found among those who had driven after using marijuana. CONCLUSIONS: Among adolescent marijuana users, the prevalence of driving after using marijuana was high. Enhanced surveillance, prevention, and control measures are necessary to mitigate the negative impacts of marijuana consumption and related behaviors.

Hand injuries associated with reaching into a snow blower to clear clogged snow.

INTRODUCTION: Hand injuries represent the most common and potentially serious injuries associated with the use of snow blowers. Little research has been conducted on a national scale to examine these types of injuries. Therefore, the purpose of the study was to examine hand injuries among patients treated in an emergency department (ED) related to attempting to clear snow out of a clogged snow blower. METHODS: Data were obtained from the National Electronic Injury Surveillance System for the years 2009-2017. National estimates of ED visits for hand injuries associated with the use of a snow blower were analyzed by nature of injury, age, and disposition. Trends in age adjusted rates were also obtained. RESULTS: During the 10 year period, there were 27,826 hand injuries treated in emergency departments associated with the use of snow blowers. The majority of the injuries were fractures and lacerations, with an additional 22% being amputations. The majority (95%) were among males and most occurred among middle aged adults. Overall, hand injuries associated with the use of snow blowers declined during the study period. CONCLUSIONS: Hand injuries remain the main threat of injury among snow blower operators. While trends are declining, given the seriousness of the injuries involved, further public health education campaigns and design modifications are warranted.

Emergency Department Visits for Hand and Finger Injuries Associated with the Use of Log Splitters.

The purpose of this study was to examine patients treated in an emergency department (ED) for injuries related to the use of log splitters. Data were obtained from the National Electronic Injury Surveillance System for the years 2011-2014. National estimates of ED visits for injuries associated with the use of log splitters were obtained, and descriptive epidemiological characteristics are presented. An estimated 37,000 ED visits for injuries related to the use of log splitters occurred during the study period. The majority of injuries occurred to the hand, with lacerations, fractures/avulsions, and amputations being the most common. The findings indicate that injuries from log splitters constitute a serious public health problem. Efforts to reduce injuries are discussed in accordance with the inherent challenges of detailing the circumstances surrounding these injuries.

Injury-related visits and comorbid conditions among homeless persons presenting to emergency departments.

OBJECTIVES: The authors examined the clinical characteristics of homeless patients presenting to emergency departments (EDs) in the United States, with a focus on unintentional and intentional injury events and related comorbid conditions. METHODS: The study included a nationally representative sample of patients presenting to EDs with data obtained from the 2007 through 2010 National Hospital Ambulatory Medical Care Survey (NHAMCS). Descriptive and analytical epidemiologic analyses were employed to examine injuries among homeless patients. RESULTS: Homeless persons made 603,000 visits annually to EDs, 55% of which were for injuries, with the majority related to unintentional (52%) and self-inflicted (23%) injuries. Multivariate logistic regression analyses revealed that homeless patients had a higher odds of presenting with injuries related to unintentional (odds ratio [OR]=1.4. 95% confidence interval [CI]=1.1 to 1.9), self-inflicted (OR=6.0, 95% CI=3.7 to 9.5), and assault (OR=3.0, 95% CI=1.5 to 5.9) injuries. CONCLUSIONS: A better understanding of the injuries affecting homeless populations may provide medical and public health professionals insight into more effective ways to intervene and limit further morbidity and mortality related to specific injury outcomes.

Injuries related to snow blowers in the United States: 2002 through 2008.

OBJECTIVES: The objective was to examine injuries related to the use of a snow blower among patients treated in an emergency department (ED). METHODS: Data were obtained from the National Electronic Injury Surveillance System (NEISS) for the years 2002-2008. National estimates of ED visits for injuries associated with the use of a snow blower were obtained, and descriptive epidemiologic characteristics assessed. RESULTS: From 2002 through 2008, there were an estimated 32,307 ED visits for injuries related to the use of a snow blower in the United States. Older adults had a higher proportion of ED visits for such injuries than younger age groups. The majority of injuries involved injuries to the hand, with 42% of cases diagnosed with fractures and 20% resulting in amputations. CONCLUSIONS: Findings indicate that injuries from snow blowers remain a public health problem. Efforts to reduce injury incidence are discussed in accordance with inherent challenges of prevention of injuries associated with these products.

Is patient activation associated with future health outcomes and healthcare utilization among patients with diabetes?

We examined the relationship between the patient activation measure (PAM) and future diabetes-related health outcomes through retrospective analysis of secondary data using multivariate logistic regression. PAM scores from a 2004 survey on 1180 randomly sampled adults with diabetes and health information from a 2006 diabetes registry were the data sources used. The PAM was predictive for hemoglobin A1c (HgA1c) testing (P < .008), low-density lipoprotein cholesterol (LDL-C) testing (P < .005), HgA1c control (P < .01), and all-cause discharges (P < .03), but not for lipid-lowering drug use, LDL-C control, or acute myocardial infarction discharges. These results suggest that PAM scores can be used to identify patients at risk for poorer health outcomes.

Injuries associated with the use of riding mowers in the United States, 2002-2007.

CONTEXT: To examine injuries among patients treated in an emergency department (ED) related to the use of a riding lawn mower. DESIGN AND SETTING: Data were obtained from the National Electronic Injury Surveillance System for the years 2002-2007. National estimates of ED visits for injuries associated with the use of a riding lawn mower were analyzed. Narrative text entries were categorized to provide a detailed record of the circumstances precipitating the injury. Average annual rates were calculated and logistic regression analyses were employed to determine risk estimates for patient disposition and demographic characteristics related to ED visits for injuries associated with riding mowers. RESULTS: From 2002 through 2007, there were an estimated 66,341 ED visits for injuries related to the use of riding lawnmowers in the U.S., with an average annual rate of 6.0 ED visits per 100,000 males, and 1.6 ED visits per 100,000 females. Older adults had higher rates of ED visits for injuries (7.2/100,000) than younger age groups. The most common injuries involved contusions (24%); sprains/strains (22%) and fractures (17%). The majority of patients (90%) were treated and released the same day. Results of logistic regression analyses revealed that older adults were more likely to be hospitalized when compared to younger age groups; and incidents involving rollovers [OR=5.45 (95% CI=3.22-9.23)] and being run over [6.01 (95% CI 3.23-11.17)] were more likely to result in hospitalization when compared to all other circumstances of injury. CONCLUSIONS: Riding mowers present injury patterns and circumstances that are different than those reported for push mowers. Circumstances related to injuries and age groups affected were varied, making prevention of riding mower injuries challenging. APPLICATION/IMPACT: Findings support the need to increase awareness and/or change the design of riding mowers with respect to risk of rollover injuries.

Case report: injuries associated with interactive game consoles: preliminary data.

The use of motion-sensing video game software has provided users with the ability to mimic movements in many sports such as baseball, tennis, and boxing. Epidemiology on injuries and overuse of motion-sensing video game systems is minimal because the systems have only been available for 2 years. This case series report presents preliminary data on injuries related to the game systems from the first full year of use. Methods included the use of secondary data from the National Electronic Injury Surveillance System for 2007. The query found 21 cases of injury related to the use of the "Wii" video game system (Nintendo of America Inc., Redmond, WA). Results indicated that females were more prone to injuries, and the mean age was 16 years. Most injuries were soft tissue in nature and located in the shoulders, hands and fingers, and the face and neck region. Our discussion includes prevention strategies for reducing injury risk when playing motion-sensing video games.

Comparison of bone mineral density measurements at different sites: applications for primary care providers.

Bone densitometry is an effective screening tool for osteoporosis; however, problems may exist when patients present with high variability between readings at different sites. The purpose of this study was to compare bone mineral density measures of the femur, spine and whole body using dual-energy x-ray absorptiometry. While correlations between anatomic regions were high, substantial variability existed for participants which presents the potential for misdiagnosis and confusion. Densitometry screening using both spine and femur is recommended; information regarding readings that are variable are provided. Applications for bone mineral density screening and counseling are presented for primary care physicians.

Epidemiology of exercise equipment-related injuries to young children.

OBJECTIVES: The objective of this study was to describe and identify the type, cause, and epidemiology of injuries related to exercise equipment to children younger than 5 years reported to US emergency rooms. METHODS: A retrospective review of data for children 4 years old and younger from the National Electronic Injury Surveillance System of the US Consumer Product Safety Commission for the years 1994 to 2001 was conducted. A total of 1679 children were identified obtaining treatment at a participating emergency room. RESULTS: There were an estimated 46,440 exercise equipment-related injuries (95% confidence interval, 38,081-55,079 injuries) to children 4 years old and younger treated in hospital emergency departments in the United States during the 8-year study period. The annual rate of injury among children was 28.32 per 100,000. Most injuries involved the head, foot, and hand regions. Injury diagnosis included lacerations (49%), soft tissue injuries (29%), and fractures and dislocations (9%). Most hospital admissions were for amputations (36%), fractures (34%), and lacerations (20%). CONCLUSIONS: Injuries can result from children's exposure to exercise equipment in the home. Parental awareness of the dangers of home-based exercise equipment and the potential hazards of exercise equipment-related injuries on the limbs and head region is recommended.

Non-equipment exercise-related injuries among US women 65 and older: emergency department visits from 1994-2001.

The objective of this study was to estimate the relative frequency, types of injury, types of exercise, and mechanism of non-equipment exercise-related injury among women 65 and older. Methods included a descriptive analysis of emergency department (ED) visits to hospitals participating in the National Electronic Injury Surveillance System (NEISS). Researchers identified 851 exercise-related injuries to women 65 and older. Estimates are that 37729 older women were treated in emergency departments for injuries related to non-equipment type exercise activity from 1994-2001. Although there are many benefits to exercise, injuries due to overuse and existing physical conditions such as osteoporosis are a concern for active older women. Promotion of safe exercise activities and programs for older women are recommended.

Evaluating the impact of child safety seat check-up events on parental knowledge.

Riding unrestrained is the greatest risk factor for death and injury among children in motor vehicles. Restraining a child can reduce the risk of death for that child by up to 71%. However, despite increased awareness, child safety seat usage rates are still disturbingly low. The purpose of this study was to evaluate the impact that child safety seat check-up events have on parental knowledge on child safety seats and installation. The subjects for this study were 101 parents/caregivers who attended child safety seat check-up events in northwest Arkansas from May 2000 through June 2001. A 20-item survey was conducted via the telephone. Results showed that the check-up events in northwest Arkansas have had an impact on self-efficacy. The participants of the events were primarily Caucasian and females in the 30-34 age group. Nine of 10 subjects scored in the high knowledge category. Conclusions are that check-up events do have an impact on parental knowledge and are accepted by the target group. Additionally, participants believed that car seats are of great importance and do protect their children in the event of a crash.