Quantifying the association between physical activity and injury in primary school-aged children

Early temperament and physical health in school-age children: Applying a short temperament measure in a population-based cohort

Temperament has drawn considerable attention in the understanding of behavioural problems and psychopathology across developmental stages. However, less of a focus has been placed on the role of temperament in physical aspects of health. We aimed to examine the relations between early temperament traits and physical health in school-age children. This study used longitudinal data of 18,994 children (52.4% boys) born in 2005 from the Taiwan Birth Cohort Study, in which follow-up surveys were conducted via face-to-face interviews with the child's caregiver. Temperament at 5.5 years of age was assessed using a nine-item measure, and two higher-order temperament traits, surgency and regulation, were derived through confirmatory factor analysis. Physical health outcomes at age 8 included caregiver-rated general health status and medically attended injuries. Multiple logistic regression analysis was applied, with the child's birth outcome, early health status or injury history, health behaviours and family socioeconomic status as control variables. The results indicated that higher levels of surgency and regulation, as early temperament traits, significantly predicted lower odds of caregiver-rated poor health in later years. Higher level of regulation was also associated with lower odds of injury risk. Our findings suggest that assessing early temperament traits could be useful for the promotion and management of physical health in young school-age children.

Assessment of knowledge, attitude, and practice about first aid among male school teachers in Hail city

Introduction:

Children in schools are more prone to get injured during their activities. Awareness toward first aid is vital for teachers to provide solutions in case of the occurrence of accidents. Our work aimed to assess the knowledge, attitude, and practice of first aid and the associated factors among male school teachers in Hail city.

Methodology:

This is a cross-sectional study. A questionnaire-based survey was performed among teachers in primary, middle, and secondary male schools in the Hail region, Saudi Arabia. Statistical analysis was performed using STATA 12 software, Continuous variables were presented as mean, and SD and inter-group differences were compared using t-test. Categorical variables showed as numbers and percentages. P values <0.05 were considered statistically significant.

Results:

A total of 604 teachers were included in our sample; all completed an online structured questionnaire formed of 20 questions. The majority of participants were male teachers (80.96%). The teachers had a mean age of 39 ± 7.8 years old. Most of the teachers (90.9%) knew about first aids. More than one-half of teachers (58.28%) had not taken first aid training, and the majority of participants (87.9%) need to learn first aid principles. Age, sex, and marital status were significantly (P < 0.05) associated with the knowledge of first aids. Most of our samples depend on media and social media to gain information regarding first aid principles.

Conclusion:

Our study concluded that the school teachers in Hail city had good knowledge and attitude about the first aid. However, more training workshops were recommended for improving the first aid practice of teachers.

Iranian teachers' knowledge about first aid in the school environment

PURPOSE

School students are at risk of unintentional injuries. Teachers are the main caregivers and the first protectors for school students and must be able to deliver first aid. This study aimed to assess the school teachers' knowledge about first aid in Kashan, Iran.

METHODS

A cross-sectional study was undertaken on a sample of 200 teachers working in public and private primary, secondary and high schools in Kashan city, Iran. Data collection was achieved via a questionnaire consisting of items on teachers' characteristics and 20 questions on basic first-aid practices. One point was given for each correct answer. The lowest and highest possible scores were 0 and 20. Then, the sum scores 0-9, 10-16, and 17-20 were ranked as weak, moderate, and good first aid knowledge, respectively. Statistical analyses were performed using descriptive statistics, Chi-square and Fisher's exact tests, and regression analysis.

RESULTS

The mean age and working experience of teachers were respectively (41.37 ± 6.35) years and (20.07 ± 7.29) years. Among all teachers 51.0% were males and 66.3% were working in public schools. Totally, 40.3% of the teachers had passed courses on first aid and 48.5% had confronted with situations needing first-aid; 59.7% evaluated their own knowledge of first aid as moderate. The mean score of first-aid knowledge was 10.00 ± 2.58. Teachers who had received first aid training and those with previous experiences of situations requiring first-aid possessed higher scores (p < 0.001). Most teachers answered wrongly to the questions regarding first aid in a child with a fracture (93.4%) or struck by electricity (85.2%).

CONCLUSION

Most of the teachers had insufficient knowledge on first aid. They mostly did not pass any training on first aid. Urgent action seems necessary for training teachers on first aid through in-service training programs.

A Prospective Cohort Study on Injuries Among Intensely Physically Active High School Students

BACKGROUND

The leading cause of nonfatal injuries in age group 14-19 is sports injuries. Purpose of the study was to determine the association between intense physical activity and injury and to identify the circumstances and environment in which injuries are most likely to occur.

METHODS

A prospective cohort study included 698 high school students 15-19 years old, divided into those exposed and those unexposed to intense physical activity. The international standard questionnaire about physical activity (International Physical Activity Questionnaire-IPAQ) and the metabolic equivalent task (MET) scores were used.

RESULTS

The risk of injuries was 7 times higher (relative risk [RR]: 7.041; 95% confidence interval [CI]: 6.071, 8.187) and the risk of injuries requiring treatment in health facilities was 15 times higher (RR: 14.717; 95% CI: 10.652, 20.592) in the intensely physically active adolescents. The risk of gaining sports injuries was 11 times higher in the exposed group (RR: 11.212; 95% CI: 9.013, 14.074), with a significantly higher incidence rate (Inc.) among men (82.9 per 100). Most injuries occurred in football (Inc. 4.4 per 1000 hours), volleyball (Inc. 3.9 per 1000 hours), and boxing/kickboxing (Inc. 3.7 per 1000 hours).

CONCLUSIONS

Intensely physically active high school students have a much higher risk of injury, which usually occurs during training or a match.

The Knowledge of and Attitudes Toward First Aid and Cardiopulmonary Resuscitation Among Parents

PURPOSE

To determine the level of knowledge of first aid and cardiopulmonary resuscitation (CPR) among the parents of children who attended our Pediatric Emergency Department and to identify the factors that affect this knowledge.

DESIGN AND METHODS

Descriptive, transversal study. A questionnaire was distributed anonymously among parents to collect data about their previous CPR training, knowledge and experience.

RESULTS

A total 405 valid questionnaires were returned. The mean age of the sample was 38.08 (SD 7.1) years, and 66.9% of participants were female. The mean score of correctly answered questions was 6.76 out of 19 questions. Parents with a university education received a mean score of 7.16 versus 6.24 for those with a primary education (p = 0.022). Parents with previous training received a higher mean score (8.04 vs 6.17, respectively, p < 0.01). Parents with jobs related to healthcare or education received a higher mean score compared to those who did not (8.63, p < 0.01 and 7.16, p = 0.0013, respectively). No significant differences among parents with chronically ill children (p = 0.76) or related to the number of children (ρ = -0.101) were observed. Furthermore, 77.3% of parents expressed an interest in receiving further training.

CONCLUSIONS

Knowledge of first aid among the general population is lacking. Parents with previous training in this field, those with a university-level education, and those who are healthcare providers and educational professionals received significantly higher scores.

PRACTIC IMPLICATIONS

Studies based on surveys can be useful in estimating a population's knowledge base, allowing the development of community-based training activities.

First aid facilities in the school settings: Are schools able to manage adequately?

Background and Objective:

Children spend most of their time in schools and are vulnerable to injuries and mild ailments, hence requiring first-aid care. School teacher can provide immediate first-aid care in the absence of any health professional. This study assesses first-aid facilities within school premises and assessment of teachers on first aid training.

Methods:

A cross sectional study was conducted from July-December 2017, participants were full time school teachers of both public and private sectors at both primary and secondary levels, having a minimum of one year experience. Questionnaire was filled on one to one basis by taking oral interview.

Results:

Out of 209 teachers, 72.7% were from private sector. Stomachache was the most common medical incident (82.29%) requiring first-aid care in schools. First aid box was available in all schools but its contents were not satisfactory. Sick bay was not found in any school. 68.42% of teachers were not trained in first-aid management because of lack of opportunity, however 56% were willing to enroll in any first aid training and majority (91.38%) considered it essential for their professional life.

Conclusion:

First aid facilities at various schools of Karachi and availability of trained teachers who can provide first aid care is unsatisfactory.

Associations of Sedentary Behavior, Physical Activity, Cardiorespiratory Fitness, and Body Fat Content With Pain Conditions in Children: The Physical Activity and Nutrition in Children Study

We investigated the cross-sectional associations of sedentary behavior, physical activity, cardiorespiratory fitness, and body fat content with pain conditions in prepubertal children. The participants were a population sample of 439 children aged 6 to 8 years. Sedentary behavior, physical activity, and pain conditions were assessed using questionnaires, cardiorespiratory fitness using maximal cycle ergometer test, and body fat percentage using dual-energy X-ray absorptiometry. The associations of sedentary behavior, physical activity, cardiorespiratory fitness, and body fat percentage with the risk of pain conditions were analyzed using multivariate logistic regression. Children in the highest sex-specific third of sedentary behavior had 1.95 (95% confidence interval [CI], 1.20-3.17; P = .007 for trend across thirds) times higher odds of any pain than children in the lowest third. Children in the highest sex-specific third of cardiorespiratory fitness had 46% (odds ratio [OR] = .54; 95% CI, .32-.91; P = .019) lower odds of any pain and 50% (OR = .50; 95% CI, .28-.87; P = .015) lower odds of headache than children in the lowest third. Children in the highest sex-specific third of body fat percentage had 44% (OR = .56; 95% CI, .34-.93; P = .023) lower odds of any pain, 49% (OR = .51; 95% CI, .30-.86; P = .011) lower risk of multiple pain, and 48% (OR = .52; 95% CI, .31-.86; P = .010) lower odds of lower limb pain than children in the lowest third. Physical activity was not associated with pain conditions. These findings suggest that prepubertal children with high levels of sedentary behavior, low levels of cardiorespiratory fitness, and low body fat content have increased likelihood of various pain conditions. This information could be used to develop strategies to prevent chronic pain in childhood.

PERSPECTIVE

Our findings suggest that low cardiorespiratory fitness, high levels of sedentary behavior, and low body fat content are associated with increased likelihood of various pain conditions among prepubertal children. This information could be used to develop strategies to prevent chronic pain in childhood.

Injury risk during different physical activity behaviours in children: a systematic review with bias assessment

INTRODUCTION

The current focus on a physically active lifestyle in children puts children at increased physical activity-related injury risk.

OBJECTIVE

To summarise, in a systematic review, the evidence for the injury risk of several physical activity behaviours in 6- to 12-year-old children.

METHODS

An electronic search was performed in three databases (Embase, PubMed and SPORTDiscus). Inclusion criteria were: age 6-12 years; report on injuries related to overall physical activity, active commuting, unorganised leisure time physical activity, physical education and/or organised sports; incidence rates expressed as injuries per hours of physical activity; and published after January 1st 2000. Risk of bias was assessed for all studies included.

RESULTS

Eight studies were included. The risk of bias assessment resulted in two studies with a score that was higher than 75 %; risk bias of those two studies was considered low. The medically treated, injury incidence rate was reported to be between 0.15 and 0.27 injuries per 1,000 h of physical activity. The absolute number of injuries related to unorganised leisure time physical activity was higher than the absolute number of injuries reported in organised sports. The respective injury incidence rate expressed per 1,000 h exposure was, however, generally lower during unorganised leisure time than during organised sports. Reported injury incidence rates related to active commuting were comparable to those for unorganised leisure time physical activity. Conflicting injury incidence rates were reported for physical education. Subgroup analysis suggested that girls and children with low habitual levels of physical activity are at increased injury risk. A limitation of the review is that no standard bias assessment was available for this specific context.

CONCLUSIONS

Children are at an inherent injury risk while participating in physical activities. Most injury prevention efforts have focussed on the sports setting, but our results suggest that many children sustain an injury during unorganised leisure time physical activities.

Back injuries in a cohort of schoolchildren aged 6-12: A 2.5-year prospective study

The aims of this prospective school cohort study were to describe the epidemiology of diagnosed back pain in childhood, classified as either nontraumatic or traumatic back injury, and to estimate the association with physical activity in different settings. Over 2.5 years, 1240 children aged 6-12 years were surveyed weekly using mobile text messages to ask about the presence or absence of back pain. Pain was clinically diagnosed and injuries were classified using the International Classification of Diseases version 10. Physical activity data were obtained from text messages and accelerometers. Of the 315 back injuries diagnosed, 186 injuries were nontraumatic and 129 were traumatic. The incidence rate ratio was 1.5 for a nontraumatic back injury compared with a traumatic injury. The overall estimated back injury incidence rate was 0.20 per 1000 physical activity units (95% confidence interval 0.18-0.23). The back injury incidence rates were higher for sports when exposure per 1000 physical activity units was taken into consideration and especially children horse-riding had a 40 times higher risk of sustaining a traumatic back injury compared to the risk during non-organized leisure time physical activity. However, the reasonably low injury incidence rates support the recommendations of children continuously being physically active.

Características das lesões desportivas e fatores associados com lesão em iniciantes de ginástica artística do sexo feminino

A ginástica artística é uma modalidade que combina arte a gestos biomecânicos e tem se destacado entre crianças e adolescentes. Sua prática pode conduzir a lesões desportivas, por isso é importante conhecer os fatores inerentes ao traumatismo para formulação de modelos preventivos. Desse modo, objetivou-se caracterizar as lesões desportivas e verificar os fatores associados com lesão em praticantes de ginástica artística de diferentes níveis de competitividade. Foram entrevistadas 46 ginastas, com média de idade de 10,1±2,0 anos do sexo feminino, classificadas em dois níveis competitivos: iniciação e treinamento. Utilizou-se o inquérito de morbidade referida adaptado com as características da modalidade para reunir dados pessoais, de treinamento e da lesão. Foram observadas 0,3 lesões por atleta e 1,4 lesões por atleta lesionado, em que ginastas da categoria de treinamento apresentaram maior frequência de lesão (83,3%; n=10) do que as de iniciação (10,5%; n=4). Para ambos os níveis, o momento treinamento e a gravidade leve foram os mais relatados. No mecanismo, o sem contato foi mais prevalente na categoria de treinamento (90%; n=9) e o contato direto foi o mais frequente na iniciação (75%; n=3). As variáveis antropométricas e de treinamento foram consideradas fatores associados com lesão para as ginastas. Conclui-se que ginastas da categoria de treinamento possuem maior frequência de lesão. As variáveis antropométricas e de treinamento foram fatores associados com lesão. As características das lesões dependem do nível de competitividade das ginastas.

Fractures in children: epidemiology and activity-specific fracture rates

BACKGROUND

Approximately one-third of pediatric fractures occur during sport or recreational activity. In this paper, we investigate the incidence and causes of pediatric fractures in our region and quantify the fracture rate per exposure time for the most common sport and recreational activities.

METHODS

We prospectively evaluated all children younger than sixteen years who presented to our institution with a new fracture within a twelve-month period. Exposure time to the most common childhood activities was measured by means of interviewing random parents from the study population. The main outcome measures were the annual fracture incidence in the population and fracture rates per 10,000 hours of exposure to various sports and recreational activities.

RESULTS

A total of 1403 fractures were included. The overall annual incidence was 180.1 fractures per 10,000 children younger than sixteen years. The distal part of the radius was most often fractured (436 fractures, 31.1%). Snowboarding was associated with the highest activity-specific fracture rate, estimated to be 1.9 (95% confidence interval [CI], 1.16 to 2.60) fractures per 10,000 hours of exposure. In comparison, the fracture rate per 10,000 hours of exposure was 0.79 (CI, 0.42 to 1.09) for handball, 0.44 (CI, 0.35 to 0.52) for soccer, and 0.35 (CI, 0.23 to 0.47) for trampolining.

CONCLUSIONS

The distal part of the radius is the most common fracture site in childhood. Fracture rates differ between various physical activities. The fracture rate for snowboarding was four times higher compared with that for other common childhood sport and recreational activities in our region.

Sports injuries among adolescents: incidence, causes and consequences

AIM

The purpose of this study was to evaluate the 1-year incidence, location, type, mechanism and severity of sports injuries for adolescents in Germany.

METHODS

Data were from the 'German Health Interview and Examination Survey for Children and Adolescents', a nationwide study of n = 17 641 children and adolescents. Analyses were based on a weighted total sample size of n(w) = 7451 adolescents between 11 and 17 years of age, 51% of them boys.

RESULTS

A total of 577 adolescents (8%) reported having experienced a sports injury during the past year. Collisions and falls were reported as being the most important causes. The most frequent diagnoses were contusions, dislocations, strains and sprains (60%), followed by fractures (26%). Most injuries (88%) were treated on an outpatient basis with only 12% resulting in hospitalisation. Gender-specific analyses showed that 9% of the boys and 7% of the girls suffered from a sports injury during the past year. After adjusting for the level of physical activity, these gender differences disappeared (OR(girls) 0.94; 95% confidence intervals: 0.74-1.18). Excluding injuries incurred from falls while horse riding, there were no gender differences in the mechanism of injury. Among boys, 30% of all injuries were fractures, among girls 20% (P < 0.05). Apart from fractures, no further differences between the sexes in the range of diagnoses were identified.

CONCLUSIONS

Although these results suggest that the risk of sports injuries does not differ significantly based on adolescents' gender, the incidence rate of adolescent sports injuries within Germany is relatively high.

Health behaviours and health-care utilization in Canadian schoolchildren

Objective

Poor nutritional habits and physical inactivity are two health behaviours believed to be linked with increasing rates of overweight and obesity in children. The objective of the present study was to determine whether children who reported healthier behaviours, specifically in relation to nutrition and physical activity, also had lower health-care utilization.

Design

Population-based cross-sectional study, linking survey data from the 2003 Children's Lifestyle and School Performance Study (CLASS) with Nova Scotia administrative health data. Health-care utilization was defined as both (i) the total physician costs and (ii) the number of physician visits, for each child from 2001 to 2006. Exposures were two indices of healthy eating, the Diet Quality Index and the Healthy Eating Index, and self-reported physical activity and screen time behaviours.

Setting

Elementary schools in the Canadian province of Nova Scotia.

Subjects

Grade 5 students and their parents; of the 5200 students who participated in CLASS and completed surveys, 4380 (84 %) could be linked with information in the administrative data sets.

Results

The study found a relationship between both indices of healthy eating and a borderline significant trend towards lower health-care utilization in this population sample of children. No statistically significant relationships were seen for physical activity or screen time.

Conclusions

Both measures of diet quality produced similar results. The study suggests that healthy eating habits established in childhood may be associated with lower health-care utilization, although further research over a longer time frame is needed to demonstrate statistical significance.

Host factors and childhood injury: the influence of hyperactivity and aggression

OBJECTIVE

This study examined the association between hyperactivity, aggression, and unintentional childhood injury among a cohort of children aged 5-12 years. Participants were recruited utilizing a two-tier randomization process from primary schools in Brisbane, the capital city of Queensland, Australia. Information on hyperactivity and aggression was collected by trained interviewers using a semi structured questionnaire and episodes of injury were reported by parents using an injury event report form. Eight hundred and seventy-one children were recruited into the study of which 811 (93%) completed the full 12 months of follow-up. All subsequent analysis was limited to the children who were retained for the full study period.

METHODS

One hundred and twenty-one children were categorized as hyperactive and 48 as aggressive. Boys were nearly twice as likely as girls to be categorized as hyperactive or aggressive, although this difference was not statistically significant for aggression. Lower socioeconomic status (SES) as measured by household income was also associated with aggression while more children from middle SES households as measured by both household income and maternal education were hyperactive compared with children from either low or high SES households.

RESULTS

After adjusting for key confounding factors, children with high hyperactivity scores had an increased risk of all injuries (OR 1.98, 95% CI 1.48-2.64) and medically treated injuries (OR 1.56, 95% CI 1.01-2.43). Male gender was also a significant predictor of injury. Initiatives to prevent childhood injuries should take into account that child temperament may act as a mediating factor in the injury pathway.

CONCLUSION

Further research is necessary to determine the success of preventive efforts in higher risk children who may react to their environment in a substantially different manner compared with less hyperactive children.

Injury risk from popular childhood physical activities: results from an Australian primary school cohort

BACKGROUND

Children engage in various physical activities that pose different injury risks. However, the lack of adequate data on exposure has meant that these risks have not been quantified or compared in young children aged 5-12 years.

OBJECTIVES

To measure exposure to popular activities among Australian primary school children and to quantify the associated injury risks.

METHOD

The Childhood Injury Prevention Study prospectively followed up a cohort of randomly selected Australian primary and preschool children aged 5-12 years. Time (min) engaged in various physical activities was measured using a parent-completed 7-day diary. All injuries over 12 months were reported to the study. All data on exposure and injuries were coded using the International classification of external causes of injury. Injury rates per 1000 h of exposure were calculated for the most popular activities.

RESULTS

Complete diaries and data on injuries were available for 744 children. Over 12 months, 314 injuries relating to physical activity outside of school were reported. The highest injury risks per exposure time occurred for tackle-style football (2.18/1000 h), wheeled activities (1.72/1000 h) and tennis (1.19/1000 h). Overall, boys were injured more often than girls; however, the differences were non-significant or reversed for some activities including soccer, trampolining and team ball sports.

CONCLUSION

Although the overall injury rate was low in this prospective cohort, the safety of some popular childhood activities can be improved so that the benefits may be enjoyed with fewer negative consequences.

The properties of the International Classification of the External Cause of Injury when used as an instrument for injury prevention research

OBJECTIVE

To demonstrate properties of the International Classification of the External Cause of Injury (ICECI) as a tool for use in injury prevention research.

METHODS

The Childhood Injury Prevention Study (CHIPS) is a prospective longitudinal follow up study of a cohort of 871 children 5-12 years of age, with a nested case crossover component. The ICECI is the latest tool in the International Classification of Diseases (ICD) family and has been designed to improve the precision of coding injury events. The details of all injury events recorded in the study, as well as all measured injury related exposures, were coded using the ICECI. This paper reports a substudy on the utility and practicability of using the ICECI in the CHIPS to record exposures. Interrater reliability was quantified for a sample of injured participants using the Kappa statistic to measure concordance between codes independently coded by two research staff.

RESULTS

There were 767 diaries collected at baseline and event details from 563 injuries and exposure details from injury crossover periods. There were no event, location, or activity details which could not be coded using the ICECI. Kappa statistics for concordance between raters within each of the dimensions ranged from 0.31 to 0.93 for the injury events and 0.94 and 0.97 for activity and location in the control periods.

DISCUSSION

This study represents the first detailed account of the properties of the ICECI revealed by its use in a primary analytic epidemiological study of injury prevention. The results of this study provide considerable support for the ICECI and its further use.