Sexual Violence Against Adolescents in a Brazilian State: an Analysis of Reported Cases

Background: sexual violence against adolescents is a highly prevalent problem with profound impacts throughout life, and most often perpetrators are relatives and acquaintances of the victims. In Brazil, sexual violence is a problem that must be reported in all health services and the data collected must be registered in the Information System for Reporting Diseases (SINAN - Sistema de Informação de Agravos de Notificação). This study aimed to describe the frequency of reported cases of sexual violence against adolescents and to analyze their associated factors. Method: a cross-sectional analytical study was conducted with reported data on sexual violence against adolescents in the state of Espírito Santo registered in SINAN between 2011 and 2018. Variables to characterize the victim, aggression and perpetrator were used. Bivariate analyzes were performed using Chi-Square (χ²) and Fisher’s exact tests. Multivariate analysis considered the log-binomial model and adjustment results were presented in Prevalence Ratio. All analyzes were stratified by sex. The study was approved by the Institutional Review Board of Federal University of Espirito Santo, under Opinion 2,819,597. Results: among the full-filled forms in the variables analyzed in the study, the frequency of sexual violence was 32.6% and 93% of victims were female. The occurrence of injury reporting was associated in both sexes with adolescents aged between 10 and 12 years, the place of occurrence being the home, the relationship with the victim, and the recurrence of violence. In females, the outcome was also associated with number of perpetrators, and in males, with perpetrator’s age. Conclusion: through this study, prevalence and factors associated with reporting sexual violence in Espírito Santo were observed. The importance of information systems for disseminating data and the need for measures to prevent and treat the disease among adolescents is verified. PORTUGUESE ABSTRACTIntrodução: a violência sexual contra adolescentes é um agravo de alta prevalência e de profundos impactos ao longo da vida, sendo os agressores em sua maior parte são familiares e conhecidos das vítimas. No Brasil, a violência sexual é um agravo de notificação compulsória em todos os serviços de saúde e os dados coletados devem ser registrados no Sistema de Informação de Agravos de Notificação (SINAN). O objetivo desse estudo foi descrever a frequência dos casos de violência sexual notificados contra adolescentes e analisar os seus fatores associados. Método: estudo analítico do tipo transversal realizado com os dados notificados de violência sexual contra adolescentes no Espírito Santo registrados no SINAN entre 2011 e 2018. Foram utilizadas as variáveis de caracterização da vítima, da agressão e do agressor. Foram realizadas análises bivariadas por meio do teste Qui-Quadrado (χ²) e exato de Fisher. A análise multivariada considerou o modelo log-binomial e os resultados do ajuste foram apresentados em Razão de Prevalência. Todas as análises foram estratificadas por sexo. Resultados: entre as fichas de preenchimento completo nas variáveis analisadas no estudo, a frequência de violência sexual foi 32,6%, sendo que 93% das vítimas eram do sexo feminino. A ocorrência da notificação do agravo esteve associada em ambos os sexos a adolescentes com idade entre 10 e 12 anos, ao local de ocorrência ser a residência, à variável vínculo com a vítima, e à reincidência da violência. No sexo feminino o desfecho também se manteve associado à variável quantidade de agressores e no sexo masculino à variável idade do agressor. Através desse estudo, foi observado a prevalência e os fatores associados à notificação de violência sexual em um estado do Espírito Santo.Conclusão: constata-se a importância dos sistemas de informação para a disseminação de dados e a necessidade de medidas de prevenção e tratamento do agravo entre os adolescentes.

The Relationship Between Reporting Occupational Injuries, Job Control, and Safety Citizenship Sub-dimensions of Action

More than five thousand workers lost their lives in 2018 due to occupational incidents. Research suggests that increased job control and safety citizenship can help mitigate occupational incidents. This study aims to answer the following research question: Does a relationship exist between the behavior of reporting occupational injuries and both job control and safety citizenship? This exploratory cross-sectional study used an employee perception questionnaire to examine the behavior of reporting occupational injuries, employee job control, and six safety citizenship sub-dimensions of action (i.e. stewardship, civic virtue, whistleblowing, initiating safety-related change, voice, and helping) at two companies in the Midwestern region of the United States. The survey consisted of 34 items and used a 5-point Likert Scale to quantify the data gathered along with other demographic variables. An ordinal logistic regression analysis to investigate the relationship between the behavior of reporting occupational injuries, job control, and the six sub-dimensions of safety citizenship was conducted. Results indicate that job control ( X2 = 8.512, df = 1, p < 0.05) and whistleblowing (X2 = 4.836, df = 1, p < 0.05) predict the behavior of occupational injury reporting.

Removal From Activity After Sports- Related Concussion in Sex-Comparable Sports From the Michigan High School Athletic Association

Background: Research has demonstrated that female athletes are more likely to report their sports-related concussion (SRC) symptoms compared with male athletes; however, it is unknown if these reporting behaviors correspond to immediate removal from activity in sex-comparable sports. Purpose: To compare the incidence of high school student-athletes removed and not removed from activity after SRC in sex-comparable sports in Michigan. Study Design: Descriptive epidemiology study. Methods: Participants included student-athletes diagnosed with SRC participating in Michigan High School Athletic Association–sponsored athletic activities (22 sex-comparable sports) between 2016 and 2019. All SRCs were recorded in the association’s Head Injury Reporting System (HIRS) by certified athletic trainers, administrators, or coaches. Removal from activity indicated that the student-athlete was removed from play at the time of an injury event. If the student-athlete reported that his or her suspected injury event occurred earlier during activity or if symptom onset was delayed, “not removed from activity” was entered into the HIRS. Incidence proportions were calculated by dividing SRCs not removed by total SRCs in each sport. Risk ratios were calculated by dividing the incidence proportions of girls not removed by boys not removed in each sport. Results: A total of 4418 (2773 female, 1645 male) SRCs were reported, with the most occurring in female soccer players (n = 1023). Overall, 515 girls and 243 boys were not removed from activity, resulting in incidences of 0.19 (95% CI, 0.17-0.20) and 0.15 (95% CI, 0.13-0.17), respectively. Across all sports, girls were 1.26 (95% CI, 1.09-1.45) times as likely to not be removed from activity compared with boys. Of the sports with the most SRCs—soccer, basketball, baseball/softball, and lacrosse—girls had 1.37 (95% CI, 1.09-1.72), 1.15 (95% CI, 0.89-1.47), 1.19 (95% CI, 0.77-1.84), and 1.35 (95% CI, 0.94-1.95) times the risk of not being removed, respectively. Conclusion: Girls were at greater risk of not being removed from activity compared with boys in sex-comparable sports. Results from this study should be incorporated into SRC education in Michigan and potentially elsewhere to inform affiliated personnel of potential sex differences and protect female student-athletes from further harm.

Time-to-Event Analyses: Return to Unrestricted Participation After Sport-Related Concussion in a Cohort of High School Athletes

Context Understanding time loss resulting from sport-related concussion (SRC) within individual sports allows high school athletic trainers to provide accurate and evidence-based clinical information. Currently, research regarding patterns of clinical recovery outcomes in high school student-athletes across sports is lacking. Objective To describe the time to authorized unrestricted return to participation (RTP) after SRC in a large cohort of high school student-athletes in a variety of sports using a time-to-event analysis. Design Descriptive epidemiology study. Setting Aggregate injury and player exposure data from the Michigan High School Athletic Association Head Injury Reporting System. Patients or Other Participants High school student-athletes. Main Outcome Measure(s) Dates for SRC injury events and authorized unrestricted RTP were entered into the Head Injury Reporting System for each case and were used to calculate time to unrestricted RTP. Survival analysis indicated the time to authorized RTP for males and females in weekly increments across sports and academic years. Separate Kaplan-Meier analyses adjusted for SRC cases with a history of concussion also identified the proportions of student-athletes who obtained authorized medical clearance in weekly increments. Results A total of 15 821 SRCs, 10 375 (65.6%) in males and 5446 (34.4%) in females, were reported during the 2015–2016 through 2018–2019 academic years. The median time to authorized unrestricted RTP was 11 days for all patients. Approximately 30% of concussed student-athletes were not cleared for unrestricted RTP by 14 days after their SRC diagnosis, with 13% taking longer than 21 days to return to unrestricted RTP after SRC. Conclusions The results from this multisite, state-based injury surveillance system indicated that it is not abnormal for high school student-athletes to take longer than 14 days to fully recover from an SRC. This information may be useful for educating high school student-athletes and sport stakeholders, normalizing SRC recovery trajectory perceptions, and establishing realistic RTP timeline expectations.

Injuries among Maryland jockeys during thoroughbred racing: 2015–2019

ObjectivesOur goal was to characterise jockey injuries at Maryland racetracks during thoroughbred racing activities over 4 years using medical records maintained by the sports medicine team.MethodsInjury data were prospectively gathered by sports medicine physicians who were onsite for all thoroughbred racing activities in Maryland from 12 September 2015 to 5 May 2019 to evaluate and treat any injury to the jockeys. Descriptive statistics (frequencies, rates with corresponding 95% CIs and proportions) of injury types, body parts, mechanisms, severity and location on track were calculated.ResultsOver nearly 4 years of racing and 45 000 mounts, there were 204 injuries involving 184 incidents and 131 falls during those races. The vast majority of injuries (80%) was related to soft tissue, while 4% were concussions. Most injuries involved the lower extremity (31%) or upper extremity (26%) and typically resulted from a fall from the horse. Among all incidents, 79.3% (n=146) resulted in an injury, while 76.3% (n=100) of falls resulted in an injury. We identified a significant proportion of injuries (41%) in and around the starting gate. Over a quarter of incidents resulting in injury required further medical care in hospital or other medical facility, while surgery was required in 2.5% of injuries.ConclusionAccess to a consistent group of sports medicine providers facilitated jockey injury reporting and tracking. The majority of jockey injuries is related to soft tissue and results from falls, while the starting gate area is associated with the greatest proportion of injuries.

Time-to-Event Analyses: Return to Unrestricted Participation Following Sport-Related Concussion in a Cohort of High School Athletes

Context: Understanding time-loss resulting from sport-related concussion (SRC) within individual sports allows high school athletic trainers to provide accurate and clinically evidence-based information. Currently there is a lack of research regarding patterns of clinical recovery outcomes in high school student-athletes across sports. Objective: To describe the time to authorized unrestricted RTP following SRC in a large cohort of high school student-athletes in variety of sports using a time-to-event analysis. Design: Descriptive Epidemiology Study. Setting: Aggregate injury and player exposure data from the STATE-XXX High School Athletic Association (XHSAA) Head Injury Reporting System (HIRS). Patients or Other Participants: High school student-athletes. Main Outcome Measure(s): Dates for SRC injury events and authorized unrestricted RTP were entered into the HIRS for each case, and were used to calculate time to unrestricted RTP. Survival analysis determined time to authorized RTP for males and females in weekly increments across sports and academic years. Separate Kaplan-Meier analyses adjusted for SRC cases with a history of concussion also identified the proportions of student-athletes that obtained authorized medical clearance in weekly increments. Results: There was a total of 15,821 SRC cases, 10,375 (65.6%) male and 5,446 (34.4%) female, reported during the 2015–16 through 2018–19 academic years. The median time to authorized unrestricted RTP was 11 days for all cases. Approximately, 30% of concussed student-athletes were not cleared for unrestricted RTP by 14 days following their SRC diagnosis, with 13% taking longer than 21 days to unrestricted RTP after SRC. Conclusions: The results from this multi-site, State-based injury surveillance system indicate that it is not abnormal for high school student-athletes to take longer than 14 days to fully recovery from a SRC. This information may be useful for educating high school student-athletes and sport stakeholders, normalizing SRC recovery trajectory perceptions, and establishing realistic RTP timeline expectations.

Feasibility of Injury Reporting Via Text Messaging in Club Sport Settings: A Prospective Cohort Study

A novel technique of short message service (SMS), or text message, has examined injuries in elite handball and female football and community Australian football with a response rate of over 75%. The purpose of this study was to determine if text message is a feasible method of prospectively collecting injury density data in club sports teams in the United States. Participants received a weekly text message with four questions asking about pain and participation in the past week. If the participant indicated pain in the past week, a follow-up phone interview was conducted to determine the nature of the pain/injury. The overall text message response rate was 89.8%; there were 281 responses out of 313 participant contacts over the 12-week study period. Semi-structured follow-up phone interviews were completed for 37 of the 55 reports of pain that were indicated through text message response, resulting in further injury information for 65.5% of injuries. Incidence density of reporting pain over the 12-week study was 0.88 (95% CI: 0.68–1.15) per 1,000 min of activity. In this sample, text message response rates were similar to previous studies; however, we did lose nine (25.7%) participants to follow-up.

Injuries in the time of COVID-19

Introduction Research has shown that during the 2003 SARS pandemic, emergency department (ED) visits among the pediatric population decreased. We set out to investigate if this was also true for injury-related ED visits during the COVID-19 pandemic. Methods Using data from the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP), we looked at 28 years of injury-related ED visits at the Montreal Children’s Hospital, a provincially designated Pediatric Trauma Centre. We compared data from a two-month period during the COVID-19 lockdown (16 March to 15 May) to the same period in previous years (1993–2019) to determine whether the 2020 decrease in ED visit numbers was unprecedented (i.e. a similar decrease had never occurred) for different age groups, nature of injuries, mechanisms and severity. Results The 2020 decrease was unprecedented across all age groups between 1993 and 2019. When compared with the 2015 to 2019 average, the decrease was smallest in children aged 2 to 5 years (a 35% decrease), and greatest in the group aged 12 to 17 years (83%). Motor vehicle collisions and sports-related injuries practically vanished during the COVID-19 lockdown. Surprisingly, more children aged 6 to 17 years presented with less urgent injuries during the COVID-19 lockdown than in previous years. Conclusion As was the case with SARS in 2003, COVID-19 acted as a deterrent for pediatric ED visits. The lockdown in particular had a profound impact on injury-related visits. The de-confinement period will be monitored to determine the impact in both the short and the long term.

A-139 Knowledge of Concussion is Determined by Concussion Education but not Prior Concussion or Participation in Contact Sport

Objective In order to prevent concussion and promote help-seeking behaviour, this study sought to establish baseline concussion knowledge scores in the general population and to better understand the factors that influence variations in these scores. Data Selection Participants were (N = 223) individuals over the age of 18 years (M = 35.21, SD = 14.31) recruited from the general population via an online questionnaire. Designed to measure knowledge of concussion, the questionnaire contained demographics, grouping variables (previous concussion education, n = 74; history of concussion, n = 72; and participation in contact sport, n = 36), and 37-items from the Concussion Knowledge Index (CKI) of the Rosenbaum Concussion Knowledge and Attitudes Survey (RoCKAS). Results Concussion knowledge was higher than expected with 79.12% of participants responding correctly to CKI items. Group comparisons found individuals with prior concussion education to be significantly higher than individuals without U = 4382.50, z = −2.526, p = .01 (two-tailed), the effect was small r = .21. There was no difference in knowledge scores for gender, participants with a history of concussion or those who participate in contact sport. Conclusion When compared to similar studies sampling contact sports players, concussion knowledge was higher than expected. High-risk groups within the study (history of concussion and contact sport) were similarly informed than the general population. Further research is needed to understand whether higher knowledge translates to increased injury reporting and safer behaviour.