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Paediatric Scuba-related Morbidity at US Emergency Departments
Abstracts / Annals of Epidemiology 27 (2017) 504e540
Every additional infection reduced the odds of ALL by 4% (OR¼0.96, 95%CI: 0.94, 0.98) in studies with self-reported data; whereas every additional infection increased the odds of ALL by 11% (OR¼1.11, 95%CI: 1.07, 1.15) in studies with administrative/medical records data. Conclusions: There was no overall effect between infections and childhood ALL, however, qualitative difference between subgroup effects indicate a potential infectious etiology for ALL that may depend on how infections were ascertained. Future research will need to address the challenges in measuring infectious exposures, and to reduce the knowledge gaps identified.
P125. Paediatric Scuba-related Morbidity at US Emergency Departments P. Buzzacott, J. Chimiak, M. Nochetto, P.J. Denoble. Divers Alert Network, Durham, North Carolina, USA Background: Scuba diving is a popular recreational pursuit enjoyed by millions of U.S. divers. The burden of scuba injury among children is unknown. This study investigated scuba-related Emergency Department (ED) presentations by children in the US. Methods: The National Electronic Surveillance System (NEISS) was searched for scuba diving injuries 1998-2015. Identified data met U.S. Consumer Product Safety Commission (CPSC) criteria for reliability, I.E. coefficient of variation <0.3, >20 actual cases and >1,200 estimated (weighted) cases nationally. Confidence intervals were estimated by Monte Carlo resampling with replacement. Results: In the US there were an estimated 13.5 million ED presentations annually (95% CI 13.1, 13.8 million), with 1,401 (95% CI 646, 2,156) for scuba-related injuries (0.01%), 76 of those (95% CI 0, 212) per year (0.0005%) in paediatric patients. Over the study period a weighted estimate total of 1362 children presented with scuba-related injuries (95% CI 0, 2,924). Where recorded, almost all occurred at places of recreation, not the home. Of the 37 actual cases, 24 (65%) were male, 13 (35%) female, median age was 14 (range 2-17) and the most common injuries were barotrauma (most commonly to the ears but also to the eyes and lungs), lacerations, or musculoskeletal strains. The majority (33/37, 89%) were treated and released, or examined and released without treatment. The remaining four were admitted to hospital or held for observation. Conclusions: ED presentations for scuba-related injuries among children are extremely rare. In the US only one out of every 10,000 ED presentations is due to a scubaerelated injury, and only one of every 200,000 ED presentations are for scuba-related injuries in children. The most common paediatric scuba-related injuries seen at the ED were typical of those also seen in adults. The majority of children presenting at the ED with scuba-related injuries were treated and released.
P126. The Prevalence, Epidemiologic, and Survival of Infants with Congenital Diaphragmatic Hernia in Florida: 1998 e 2012 Rema Ramakrishnan,a Jason Salemi,b Amy Stuart,c Henian Chen,a Kathleen O’Rourke,a Russell Kirbyd. a Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa, b Department of Family and Community Medicine, Baylor College of Medicine, Houston, c Department of Environmental Occupational Health, College of Public Health, University of South Florida, Tampa, d Department of Community and Family Health, College of Public Health, University of South Florida, Tampa Purpose: To identify the live-birth prevalence, trends, correlates, and neonatal and oneeyear survival of congenital diaphragmatic hernia (CDH) in Florida using 1998 e 2012 Florida Birth Defects Registry data. Methods: Using a retrospective cohort study design we examined 1,025 cases of CDH in Florida over 15 years. We used Poisson and joinpoint regression models to compute prevalence rates and ratios and trends, respectively, and Kaplan-Meier survival curves and Cox proportional hazards regression to estimate neonatal and oneeyear survival; overall, isolated, and complex CDH. Results: The birth prevalence of CDH was 3.18 per 10,000 live births with a 5.1% increase from 1998 e 2007 among complex cases only. The highest prevalence rate was for infants with birth weight<1,500 grams and gestational age<37 weeks (15.70 per 10,000 live births). Strongest predictor was history of chronic hypertension for overall (Prevalence ratio [PR]¼1.99, 95 % CI: 1.10-3.62) and isolated (PR¼ 2.40, 95 % CI: 1.28-4.49) cases; however, birth weight<1,500 grams and gestational age<37 weeks was the strongest correlate for overall
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(PR¼ 7.27, 95 % CI: 5.30-9.98) and isolated (PR¼ 6.21, 95 % CI: 4.29-9.00) cases. One-year, 24-hour, and neonatal mortality rates were 28.7%, 22.1%, and 70.1%, respectively, with better survival for isolated cases. Birth weight<1,500 grams and gestational age<37 weeks was the predominant predictor of mortality among overall cases, neonatal (Hazard ratio[HR]¼10.11, 95 % CI: 5.94-17.22) and oneeyear (HR¼ 8.26, 95 % CI: 5.12-13.33); among isolated cases, neonatal (HR¼10.92, 95 % CI: 5.56-21. 44) and one-year (HR¼7.95, 95% CI: 4.36-14.49); and among complex cases, neonatal mortality (HR¼5.94, 95 % CI: 2.21-15.95). Other race/ethnicity (HR¼6.64, 95% CI: 1.72-25.59) had the highest one-year mortality among complex CDH. Conclusion: Prevalence of CDH in Florida continues to remain constant; however, the trends, correlates, and predictors of neonatal and oneeyear survival can differ between CDH subtypes.
P127. Heterosexual Identity Moderates the Association between Bullying and Suicide Planning among Adolescents with Same-Sex Sexual Partners Rodman Turpin,a Bradley Boekeloo,b Typhanye Dyera. a University of Maryland, Department of Epidemiology and Biostatistics, College Park, MD, USA, b University of Maryland, Department of Behavioral and Community Health, College Park, MD, USA Purpose: Adolescents claiming heterosexual identity and having same-sex sexual partners may be presenting a developmental stage of uncertain or exploratory sexual identity formation, or protecting themselves from bullying. As these adolescents are not claiming a sexual orientation that completely aligns with their sexual behavior, they may be particularly vulnerable to bullying with homophobic connotation. In extreme cases, stress from being bullied may contribute to suicidality. This study seeks to examine how heterosexual identity impacts the association between bullying at school and suicide planning among adolescents with same-sex sexual partners. Methods: Data from the 2015 Youth Risk Behavior Surveillance System was analyzed using multivariate logistic regression. The original sample included 987 observations, and was 74% female and 26% male, and racially diverse. A quarter (25%) of the sample identified as heterosexual, 44% identified as bisexual, 18% identified as gay or lesbian, and 13% were unsure of their sexual identity. Results: Bullying was significantly associated with higher odds of suicide planning (OR¼3.05, p<0.001). Heterosexual identity moderated the association between bullying and suicide planning (Interaction OR¼3.96, p¼.0071). This moderating effect remained after adjusting for race and sex (Interaction aOR ¼ 3.812, p¼.0156). Among adolescents with same-sex sexual partners, those with heterosexual identity had elevated odds of suicide planning when bullied compared to adolescents identifying as non-heterosexual. Conclusions: The population of adolescents with same-sex sexual partners who identify as heterosexual is not often studied in the literature, so additional research is needed to fully understand why such youth identify as heterosexual when having same-sex partners, and the specific factors that increase bullying and suicide planning among these adolescents. Anti-homophobia messaging and school intervention programs may be needed that specifically target these youth. Further research into the bullying of heterosexual-identifying adolescents with same-sex partners may inform development of effective suicide prevention programs for this population.
P128. Associations between Birthweight, Mono-isobutyl Phthalate Concentrations, Behaviors, Non-chemical Stressors and OverweightandObesityinYoungU.S.Adolescents Symielle Gaston,a Nicolle Tulveb. a ORISE Post-Doctoral Participant, U.S. EPA, Office of Research and Development, National Exposure Research Laboratory, Research Triangle Park, NC, b U.S. EPA, Office of Research and Development, National Exposure Research Laboratory, Research Triangle Park, NC Purpose: Research suggests associations between high birthweight, mono-isobutyl phthalate (MiBP) concentrations, and obesity in U.S.
Every additional infection reduced the odds of ALL by 4% (OR¼0.96, 95%CI: 0.94, 0.98) in studies with self-reported data; whereas every additional infection increased the odds of ALL by 11% (OR¼1.11, 95%CI: 1.07, 1.15) in studies with administrative/medical records data. Conclusions: There was no overall effect between infections and childhood ALL, however, qualitative difference between subgroup effects indicate a potential infectious etiology for ALL that may depend on how infections were ascertained. Future research will need to address the challenges in measuring infectious exposures, and to reduce the knowledge gaps identified.
P125. Paediatric Scuba-related Morbidity at US Emergency Departments P. Buzzacott, J. Chimiak, M. Nochetto, P.J. Denoble. Divers Alert Network, Durham, North Carolina, USA Background: Scuba diving is a popular recreational pursuit enjoyed by millions of U.S. divers. The burden of scuba injury among children is unknown. This study investigated scuba-related Emergency Department (ED) presentations by children in the US. Methods: The National Electronic Surveillance System (NEISS) was searched for scuba diving injuries 1998-2015. Identified data met U.S. Consumer Product Safety Commission (CPSC) criteria for reliability, I.E. coefficient of variation <0.3, >20 actual cases and >1,200 estimated (weighted) cases nationally. Confidence intervals were estimated by Monte Carlo resampling with replacement. Results: In the US there were an estimated 13.5 million ED presentations annually (95% CI 13.1, 13.8 million), with 1,401 (95% CI 646, 2,156) for scuba-related injuries (0.01%), 76 of those (95% CI 0, 212) per year (0.0005%) in paediatric patients. Over the study period a weighted estimate total of 1362 children presented with scuba-related injuries (95% CI 0, 2,924). Where recorded, almost all occurred at places of recreation, not the home. Of the 37 actual cases, 24 (65%) were male, 13 (35%) female, median age was 14 (range 2-17) and the most common injuries were barotrauma (most commonly to the ears but also to the eyes and lungs), lacerations, or musculoskeletal strains. The majority (33/37, 89%) were treated and released, or examined and released without treatment. The remaining four were admitted to hospital or held for observation. Conclusions: ED presentations for scuba-related injuries among children are extremely rare. In the US only one out of every 10,000 ED presentations is due to a scubaerelated injury, and only one of every 200,000 ED presentations are for scuba-related injuries in children. The most common paediatric scuba-related injuries seen at the ED were typical of those also seen in adults. The majority of children presenting at the ED with scuba-related injuries were treated and released.
P126. The Prevalence, Epidemiologic, and Survival of Infants with Congenital Diaphragmatic Hernia in Florida: 1998 e 2012 Rema Ramakrishnan,a Jason Salemi,b Amy Stuart,c Henian Chen,a Kathleen O’Rourke,a Russell Kirbyd. a Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa, b Department of Family and Community Medicine, Baylor College of Medicine, Houston, c Department of Environmental Occupational Health, College of Public Health, University of South Florida, Tampa, d Department of Community and Family Health, College of Public Health, University of South Florida, Tampa Purpose: To identify the live-birth prevalence, trends, correlates, and neonatal and oneeyear survival of congenital diaphragmatic hernia (CDH) in Florida using 1998 e 2012 Florida Birth Defects Registry data. Methods: Using a retrospective cohort study design we examined 1,025 cases of CDH in Florida over 15 years. We used Poisson and joinpoint regression models to compute prevalence rates and ratios and trends, respectively, and Kaplan-Meier survival curves and Cox proportional hazards regression to estimate neonatal and oneeyear survival; overall, isolated, and complex CDH. Results: The birth prevalence of CDH was 3.18 per 10,000 live births with a 5.1% increase from 1998 e 2007 among complex cases only. The highest prevalence rate was for infants with birth weight<1,500 grams and gestational age<37 weeks (15.70 per 10,000 live births). Strongest predictor was history of chronic hypertension for overall (Prevalence ratio [PR]¼1.99, 95 % CI: 1.10-3.62) and isolated (PR¼ 2.40, 95 % CI: 1.28-4.49) cases; however, birth weight<1,500 grams and gestational age<37 weeks was the strongest correlate for overall
539
(PR¼ 7.27, 95 % CI: 5.30-9.98) and isolated (PR¼ 6.21, 95 % CI: 4.29-9.00) cases. One-year, 24-hour, and neonatal mortality rates were 28.7%, 22.1%, and 70.1%, respectively, with better survival for isolated cases. Birth weight<1,500 grams and gestational age<37 weeks was the predominant predictor of mortality among overall cases, neonatal (Hazard ratio[HR]¼10.11, 95 % CI: 5.94-17.22) and oneeyear (HR¼ 8.26, 95 % CI: 5.12-13.33); among isolated cases, neonatal (HR¼10.92, 95 % CI: 5.56-21. 44) and one-year (HR¼7.95, 95% CI: 4.36-14.49); and among complex cases, neonatal mortality (HR¼5.94, 95 % CI: 2.21-15.95). Other race/ethnicity (HR¼6.64, 95% CI: 1.72-25.59) had the highest one-year mortality among complex CDH. Conclusion: Prevalence of CDH in Florida continues to remain constant; however, the trends, correlates, and predictors of neonatal and oneeyear survival can differ between CDH subtypes.
P127. Heterosexual Identity Moderates the Association between Bullying and Suicide Planning among Adolescents with Same-Sex Sexual Partners Rodman Turpin,a Bradley Boekeloo,b Typhanye Dyera. a University of Maryland, Department of Epidemiology and Biostatistics, College Park, MD, USA, b University of Maryland, Department of Behavioral and Community Health, College Park, MD, USA Purpose: Adolescents claiming heterosexual identity and having same-sex sexual partners may be presenting a developmental stage of uncertain or exploratory sexual identity formation, or protecting themselves from bullying. As these adolescents are not claiming a sexual orientation that completely aligns with their sexual behavior, they may be particularly vulnerable to bullying with homophobic connotation. In extreme cases, stress from being bullied may contribute to suicidality. This study seeks to examine how heterosexual identity impacts the association between bullying at school and suicide planning among adolescents with same-sex sexual partners. Methods: Data from the 2015 Youth Risk Behavior Surveillance System was analyzed using multivariate logistic regression. The original sample included 987 observations, and was 74% female and 26% male, and racially diverse. A quarter (25%) of the sample identified as heterosexual, 44% identified as bisexual, 18% identified as gay or lesbian, and 13% were unsure of their sexual identity. Results: Bullying was significantly associated with higher odds of suicide planning (OR¼3.05, p<0.001). Heterosexual identity moderated the association between bullying and suicide planning (Interaction OR¼3.96, p¼.0071). This moderating effect remained after adjusting for race and sex (Interaction aOR ¼ 3.812, p¼.0156). Among adolescents with same-sex sexual partners, those with heterosexual identity had elevated odds of suicide planning when bullied compared to adolescents identifying as non-heterosexual. Conclusions: The population of adolescents with same-sex sexual partners who identify as heterosexual is not often studied in the literature, so additional research is needed to fully understand why such youth identify as heterosexual when having same-sex partners, and the specific factors that increase bullying and suicide planning among these adolescents. Anti-homophobia messaging and school intervention programs may be needed that specifically target these youth. Further research into the bullying of heterosexual-identifying adolescents with same-sex partners may inform development of effective suicide prevention programs for this population.
P128. Associations between Birthweight, Mono-isobutyl Phthalate Concentrations, Behaviors, Non-chemical Stressors and OverweightandObesityinYoungU.S.Adolescents Symielle Gaston,a Nicolle Tulveb. a ORISE Post-Doctoral Participant, U.S. EPA, Office of Research and Development, National Exposure Research Laboratory, Research Triangle Park, NC, b U.S. EPA, Office of Research and Development, National Exposure Research Laboratory, Research Triangle Park, NC Purpose: Research suggests associations between high birthweight, mono-isobutyl phthalate (MiBP) concentrations, and obesity in U.S.