Requiring Emergency Medical Treatment Research Articles

Rates and correlates of cannabis-associated psychotic symptoms in over 230,000 people who use cannabis

Cannabis, a widely used psychoactive substance, can trigger acute cannabis-associated psychotic symptoms (CAPS) in people who use cannabis (PWUC). To assess rates and correlates of CAPS requiring emergency medical treatment, we analyzed data from an international sample of PWUC (n = 233,475). We found that 0.47% (95%CI 0.42; 0.52) PWUC reported lifetime occurrence of CAPS, defined as the occurrence of hallucinations and/or paranoia requiring emergency medical treatment following the use of cannabis. A range of factors correlated with risk of CAPS in the last year: higher rates were observed in young individuals [risk ratio (RR) 2.66, compared to older PWUC] and those residing in Denmark (RR 3.01, compared to PWUC from other countries). Furthermore, risk was elevated in those using predominantly high-potency resin (RR 2.11, compared to PWUC using herbal cannabis), those mixing cannabis with tobacco (RR 2.15, compared to PWUC not mixing with tobacco) and those with a diagnosis of psychosis (RR 14.01), bipolar (RR 4.30), anxiety (RR 2.92) and depression (RR 2.68), compared to individuals without a mental health diagnosis. Taken together, acute self-limiting psychotic symptoms in the context of cannabis use may occur in about 1 in 200 PWUC’s lifetime. Some individuals could be particularly sensitive to the adverse psychological effects of cannabis, such as young individuals or those with pre-existing mental health vulnerabilities. In light of the movements towards legalization of recreational cannabis, more research should focus on the potential harms related to cannabis use, to educate PWUC and the public about risks related to its use.

A Rare Case of Mastoiditis in an Adult Patient

Mastoiditis is more commonly seen and easily recognized in children. However, adults are more likely to present with complications requiring emergency medical treatment. One of the challenges in the management of mastoiditis is recognizing symptoms and beginning treatment with antibiotics early to prevent progression of disease and potential surgical management. This case report details an unusual case of a 41-year-old woman whose indolent symptoms went unrecognized for three weeks before presenting to the emergency department with unilateral ear pain and hearing loss. Imaging revealed coalescing mastoiditis with erosion of the medial cortex into the jugular foramen and enhancement suggestive of meningitis. This report can assist practitioners in recognizing and managing mastoiditis and its associated complications in the emergency setting.

The association between a statewide stay-at-home order and motor vehicle injury rates among population sub-groups in West Virginia

Objective Little is known about the relationship between Stay-At-Home orders issued by state governments due to the COVID-19 pandemic and their impacts on motor vehicle-related injuries. The purpose of this study was to determine whether the presence of a Stay-At-Home order was associated with lower rates of motor vehicle-related injuries requiring emergency medical treatment among population sub-groups in West Virginia (i.e., males, females, 0-17, 18-25, 26-45, 46-65, ≥66 years old). Methods A Stay-At-Home order was in effect in West Virginia from March 23-May 4, 2020. Counts of individuals who incurred motor-vehicle-related injuries that required emergency medical treatment were obtained from the Centers for Disease Control and Prevention’s National Syndromic Surveillance Program from January 1 thru September 6 of 2019 and 2020. Counts were obtained by week-year and by population sub-group in West Virginia. The presence of the Stay-At-Home order was binary coded by week. Negative binomial regression was used to assess the relationship between the presence of a Stay-At-Home and injury rates. 2019 population sub-group estimates were obtained from the United States Census Bureau and used as offsets in the models. Models were also adjusted for year and vehicle miles traveled by week-year. Results There were 23,418 motor-vehicle related injuries during the study period. The presence of the Stay-At-Home order was associated with 44% less injuries overall [Incident Rate Ratio (IRR)=0.56, 95% CI 0.48, 0.64]. Females experienced fewer injuries than males (IRR = 0.49 vs 0.63, respectively) and the number of injuries decreased with age (p-value 0.031) when comparing time periods when the Stay-At-Home was in effect compared to times when it was not. Conclusions West Virginia’s Stay-At-Home order was associated with lower motor-vehicle injury rates requiring medical treatment across all population sub-groups. Most population sub-groups likely altered their travel behaviors which resulted in lower motor-vehicle injury rates. These findings may inform future policies that impose emergency travel restrictions in populations.

外国人救急患者診療に必要な通訳準備と疾病対策に関する調査(Use of interpreters and disease management for foreign patients requiring emergency medical treatment)

要旨多くの救急医療機関は準備が不十分なまま外国人患者対応をしている。そこで我々は，今後の外国人救急診療の準備に役立てることを目的として外国人診療における通訳手段や疾病対策に関する調査を実施した。2019年1月～12月に救急搬送された外国人患者を対象として年齢，性別，国籍，訪日外国人または在留外国人，使用言語，通訳方法，搬送理由，診断名，入院状況を診療記録から後ろ向きに調査した。119名の外国人患者が救急搬送され，中国人が30%で最多だった。主な使用言語は英語（35%），日本語（27%），中国語（24%）だった。英語使用時は主に医療者（48%）が通訳していたが，中国語使用時は院内通訳者（43%）かテレビ電話通訳（39%）が利用されていた。搬送理由・診断は外傷と消化器疾患が多かった。外国人救急診療は英語だけでなく中国語の準備が必要である。院内中国語通訳者の準備が難しければ，代替策としてテレビ電話通訳も利用可能である。疾病では外傷や消化器疾患が多いため，整形外科や消化器科の協力体制が必要である。

Near-fatal anaphylaxis with Kounis syndrome caused by Argas reflexus bite: a case report

BackgroundThe pigeon tick Argas reflexus is a temporary parasite of pigeons. It bites during night hours and lies briefly on its prey, as long as it takes the blood meal. When pigeons are not accessible, ticks look for other hosts, invading nearby flats and biting humans.Case presentationWe present the case of a woman aged 46 years who experienced severe anaphylaxis during the night which required emergency medical treatment, tracheal intubation and hospitalization in intensive care unit. Kounis syndrome was documented by transient ST depression and elevation of troponin. The allergological work up ruled out hypersensitivity to drugs, latex and foods containing alpha-gal, which is a cause of anaphylaxis. Basal serum tryptase was in normal range (8.63 ng/ml). When questioned about the presence of ticks, the patient brought into view various specimens of ticks that were recognized by an entomologist as Argas reflexus.ConclusionsAn in vitro diagnosis of allergy to Argas reflexus is currently not feasible because, though the major allergen Arg r 1 has been isolated, allergen extracts are not commercially available. Therefore, the diagnosis of anaphylaxis from Argas reflexus, when other causes of anaphylaxis are excluded, must rely only on history and clinical findings, as well as on the presence of pigeons and/or pigeon ticks in the immediate domestic environment.

Cerebrovascular and cardiovascular diseases caused by drugs of abuse.

Drugs such as stimulants, sedatives, sleeping pills, and narcotics are associated with drug abuse and are therefore regulated by law. Physical dependence on these drugs is sometimes difficult to control despite an awareness of the problems they cause in daily life and the harm they can cause to the body. Drug dependence is a social problem worldwide, and the physical implications are serious. Many of these drugs cause cerebrovascular and cardiovascular diseases, which often require emergency medical treatment. Differential diagnosis is essential because of the likelihood of life-threatening events, especially among young people who exhibit cerebrovascular and cardiovascular diseases without any of the typical risk factors. Drugs of abuse, especially stimulants, induce a hyperadrenergic state that evokes vasoconstriction and tachycardia, as well as subsequent ischemic and hemorrhagic stroke, acute coronary syndrome, arrhythmias, and aortic dissection. Chronic drug abuse can also cause cardiac hypertrophy and left ventricular dysfunction. As a treatment for these conditions, sedative drugs can be effective but the use of vasodilators may also be required. There are concerns that the use of both alpha- and beta-adrenergic receptor blockers may cause tachycardia and increased blood pressure. Therefore, careful differential diagnosis and selection of therapeutic agents is required.

Pica

Pica is an extremely troublesome behaviors and causes a particularly high burdens for family caregivers. It can lead to dangerous medical consequences, such as malnutrition and intoxication, which sometimes require emergency medical treatment. Its neural basis and underlying mechanisms, however, have not been clarified. We addressed these issues by investigating patients with acquired brain injury who presented with pica. We found that semantic memory deficits were most often associated with pica rather than frontal release signs or changes in eating behaviors. Individuals with pica displayed lesion in the posterior part of the middle temporal gyrus, although spread across a wide area. Taken together, our findings suggest that semantic memory deficits, because of temporal lobe damage might be associated with pica. Moreover, Alzheimer's disease and semantic dementia are the two main degenerative disease etiologies that cause pica. Our findings may also be applied to degenerative disorders as temporal lobe involvement and semantic memory deficits are common. The most common items ingested in pica are daily necessities that are easy to swallow or drink; as such, these items should be avoided in patients with pica.

Risk of Energy Drink Consumption to Adolescent Health.

Energy drinks are beverages marketed to quickly increase alertness and performance of the consumer that typically contain relatively high quantities of caffeine, simple carbohydrates, and a mixture of additional ingredients. The carbohydrate sources, usually glucose and sucrose, found in the beverages supply the substrates needed for physiological energy, while the high caffeine content supplies the perceived energy through enhancing feelings of alertness during fatigued states. Although mean youth caffeine consumption as a whole has decreased over the past 2 decades, adolescent energy drink consumption has significantly increased in the past 10 years. High energy drink consumption of youth is concerning due to the range of reported adverse reactions attributed to excessive caffeine consumption, ranging from mild sleep disturbances to death. Reactions are severe enough to require reporting to the National Poison Data System and may even require emergency medical treatment. Studies have also shown that adolescents who consume energy drinks are likely to also use tobacco, alcohol, and illicit drugs. There is substantial evidence to suggest that the risk energy drinks pose to health are incredibly hazardous and should not be consumed by children and adolescents.

Temporal changes in frequency of severe hypoglycemia treated by emergency medical services in types 1 and 2 diabetes: a population-based data-linkage cohort study

BackgroundAlmost 20 years ago, the frequencies of severe hypoglycemia requiring emergency medical treatment were reported in people with types 1 and 2 diabetes in the Tayside region of Scotland. With subsequent improvements in the treatment of diabetes, concurrent with changes in the provision of emergency medical care, a decline in the frequency of severe hypoglycemia could be anticipated. The present population-based data-linkage cohort study aimed to ascertain whether a temporal change has occurred in the incidence rates of hypoglycemia requiring emergency medical services in people with types 1 and 2 diabetes.MethodsThe study population comprised all people with diabetes in Tayside, Scotland over the period 1 January 2011 to 31 December 2012. Patients’ data from different healthcare sources were linked anonymously to measure the incidence rates of hypoglycemia requiring emergency medical services that include treatment by ambulance staff and in hospital emergency departments, and necessitated hospital admission. These were compared with data recorded in 1997–1998 in the same region.ResultsIn January 2011 to December 2012, 2029 people in Tayside had type 1 diabetes and 21,734 had type 2 diabetes, compared to 977 and 7678, respectively, in June 1997 to May 1998. In people with type 2 diabetes, the proportion treated with sulfonylureas had declined from 36.8 to 22.4% (p < 0.001), while insulin-treatment had increased from 11.7 to 18.7% (p < 0.001). The incidence rate of hypoglycemia requiring emergency medical treatment had significantly fallen from 0.115 (95% CI: 0.094–0.136) to 0.082 (0.073–0.092) events per person per year in type 1 diabetes (p < 0.001), and from 0.118 (0.095–0.141) to 0.037 (0.003–0.041) in insulin-treated type 2 diabetes (p = 0.008). However, the absolute annual number of hypoglycemia events requiring emergency treatment was 1.4-fold higher.ConclusionsAlthough from 1998 to 2012 the incidences of hypoglycemia requiring emergency medical services appeared to have declined by a third in type 1 diabetes and by two thirds in insulin-treated type 2 diabetes, because the prevalence of diabetes was higher (2.7 fold), the number of severe hypoglycemia events requiring emergency medical treatment was greater.

Chores at Times of Fatal or Serious Injuries Associated with Tractor Overturns with and without Rollover Protection

This study describes chores when farmers were either fatally or seriously injured and required emergency medical treatment as a result of overturns of tractors with or without rollover protective structures (ROPS). Data from the 2002 Kentucky Farm Tractor Overturn Survey were used for this study. The data were collected by a telephone survey of a population-based random sample of 6063 (7.98%) of Kentucky’s 76,017 farm operators as listed in the Kentucky Agricultural Statistics Service database. Of farm operators interviewed, 551 (9.1%) reported 603 overturns and 5512 (90.9%) reported no overturns in the history of their farm, covering a period from 1925 to February 2002. Only the latest overturn was considered to improve recall accuracy. In addition, since the 1925 to 1959 time period had only 49 (8.1%) of the overturns reported, (14 farmers did not provide the year of most recent overturn); only data from the 1960 to 2002 period (approximately 41 years) were used. After making these adjustments, incidents evaluated included 25 cases (one fatal and four serious nonfatal injuries) that involved ROPS-equipped tractor overturns and 88 cases (24 fatal and 64 serious nonfatal injuries) that involved non-ROPS tractor overturns. Chores at highest risk for tractor overturns were identified for which educational and ROPS retrofit interventions could be emphasized. The highest frequency of overturn-related fatalities and nonfatal injuries were associated with hay harvesting, rotary mowing, and on-farm travel chores. These three chores represented 68.2% of fatal events and 50.0% of permanent and 56.6% of temporary disability overturn incidents. Tragically, in countries such as India and China with emerging mechanization, a large majority of tractors are produced without ROPS that can be expected to result in the same overturn-related epidemic of deaths experienced in highly mechanized countries, despite evidence of the protection provided by ROPS.

May doctors refuse to treat rape survivors in order to avoid having to give evidence in court?

It has been reported recently that private doctors often refuse to treat rape survivors because they do not want to give evidence in court. Private doctors and hospitals must treat patients in emergency situations, but may otherwise refuse to treat patients provided such refusal is not unconstitutional. Rape survivors require emergency medical treatment and should not be refused treatment by private doctors and hospitals because practitioners do not wish to give evidence in court. Such refusal is unconstitutional. Sexual assault evidence kits may be used by both private doctors and hospitals. Given the high rate of sexual violence in South Africa it is recommended that both private and state doctors should have stocks of sexual assault kits, and the National Police Commissioner’s national instruction for providing assistance to survivors of sexual offences. District surgeons ‘on call’ must treat rape survivors as requiring emergency medical treatment. They may not defer seeing them until the next day as this violates their constitutional right to dignity and exposes them to secondary victimisation.

Dabigatran: ‘One-dose-fits-all’ approach raises risks

Dabigatran: ‘One-dose-fits-all’ approach raises risks

Low-dose ketamine improves pain relief in patients receiving intravenous opioids for acute pain in the emergency department: results of a randomized, double-blind, clinical trial.

Low-dose ketamine has been used perioperatively for pain control and may be a useful adjunct to intravenous (IV) opioids in the control of acute pain in the emergency department (ED). The aim of this study was to determine the effectiveness of low-dose ketamine as an adjunct to morphine versus standard care with morphine alone for the treatment of acute moderate to severe pain among ED patients. A double-blind, randomized, placebo-controlled trial with three study groups was conducted at a large, urban academic ED over a 10-month period. Eligible patients were 18 to 65 years old with acute moderate to severe pain (score of at least 5 out of 10 on the numerical pain rating scale [NRS] and pain duration < 7 days) who were deemed by their treating physician to require IV opioids. The three study groups were: 1) morphine and normal saline placebo (standard care group), 2) morphine and 0.15 mg/kg ketamine (group 1), or 3) morphine and 0.3 mg/kg ketamine (group 2). Participants were assessed at 30, 60, and 120 minutes after study medication administration and received rescue analgesia as needed to target a 50% reduction in pain. The primary outcome measure of pain relief, or pain intensity reduction, was derived using the NRS and calculated as the summed pain-intensity (SPID) difference over 2 hours. The amount and timing of rescue opioid analgesia was evaluated as a secondary outcome. The occurrence of adverse events was also measured. Sixty patients were enrolled (n = 20 in each group). There were no differences between study groups with respect to age, sex, race/ethnicity, preenrollment analgesia, or baseline NRS. Over the 2-hour poststudy medication administration period, the SPIDs were higher (greater pain relief) for the ketamine study groups than the control group (standard care 4.0, interquartile range [IQR] = 1.8 to 6.5; group 1 7.0, IQR = 4.3 to 10.8; and group 2 7.8, IQR = 4.8 to 12.8; p < 0.02). The SPIDs for the ketamine groups were similar (p < 0.46). When compared to standard care, group 2 sustained the reduction in pain intensity up to 2 hours, whereas group 1 was similar to standard care by 2 hours. Similar numbers of patients received rescue analgesia: standard care group, seven of 20, 35%; group 1, four of 20, 20%; and group 2, four of 20, 20% (p = 0.48). Among those receiving rescue analgesia, those in the standard care group received analgesia sooner than either low-dose ketamine group, on average. More participants in the low-dose ketamine groups reported dysphoria and dizziness. Low-dose ketamine is a viable analgesic adjunct to morphine for the treatment of moderate to severe acute pain. Dosing of 0.3 mg/kg is possibly more effective than 0.15 mg/kg, but may be associated with minor adverse events. Future studies should evaluate additional outcomes, optimum dosing, and use in specific populations.

Clinical, hematologic, and electrolyte changes with 0.9% sodium chloride or acetated fluids in endurance horses

To describe the clinical and laboratory changes associated with the use of IV0.9% sodium chloride and a commercially available acetated fluid (CAF) to treat endurance horses requiring emergency medical treatment. Randomized, controlled clinical trial from 2007 to 2010. Emergency treatment centers of the Western States 100-mile (220 km) endurance ride. Twelve horses requiring emergency medical treatment in the form of IVfluids completed the study. Horses were assigned to either the 0.9% sodium chloride group (6 horses) or CAF group (6 horses) and received a total of 20 L of fluid. Clinical, hematologic, and electrolyte data were collected prior to and during fluid therapy. As compared to results prior to fluid therapy, horses treated with 0.9% sodium chloride had a decrease in heart rate (P<0.01), PCV (P<0.001), total plasma protein (TPP) (P<0.001), and the sodium-chloride difference (P<0.05). These horses also had an increase in plasma chloride (P<0.01) and sodium (P<0.01) concentrations. Horses treated with CAF showed a decrease in PCV (P<0.01) and TPP (P<0.001). These findings should aid in the design a larger clinical trial to provide further clarification on the effects of type of fluid therapy on clinical and biochemical parameters in endurance horses. The use of 0.9% sodium chloride may not be ideal for the emergency management of endurance horses as it was associated with an increase in plasma chloride concentration.

Evidence of Methamphetamine Exposure in Children Removed From Clandestine Methamphetamine Laboratories

To determine whether asymptomatic children removed from clandestine methamphetamine laboratories have evidence of exposure to methamphetamine. Retrospective chart review of children removed from law enforcement-certified clandestine methamphetamine laboratories in the Tulsa area of Oklahoma and Sacramento County, California. Exposure was determined by positive urine toxicology for methamphetamine. One hundred four children were evaluated after removal from clandestine methamphetamine laboratories. Forty-eight children (46%) tested positive for methamphetamine. Timed urine results were known for 68 of 104, with no child testing positive after 6.5 hours from being removed from the laboratory. No child required emergency medical treatment at the time urine samples were obtained. Almost half of the children in this sample had evidence of exposure to methamphetamine soon after removal from methamphetamine manufacturing environments. Further research is indicated to determine the health effects of subclinical methamphetamine exposure.

Clinical and biochemical abnormalities in endurance horses eliminated from competition for medical complications and requiring emergency medical treatment: 30 cases (2005–2006)

To describe the clinical and clinicopathologic abnormalities in endurance horses eliminated from competition and requiring emergency medical treatment. Retrospective study over a 2-year period (2005-2006). Ten horses that successfully completed the ride in 2006 were included for comparison. Temporary equine emergency field hospital. All horses (n=30) that were removed from endurance competition and treated for a metabolic abnormality were studied. Horses were treated with IV fluids and analgesics. Monitoring included lab work (PCV, total protein, and electrolytes) and serial physical examinations. Statistical analysis included descriptive statistics and parametric and nonparametric comparisons (ANOVA, Friedman's test, and Kruskal-Wallis) where appropriate. The clinical diagnoses identified included colic, esophageal obstruction, poor cardiovascular recovery, myopathy, and synchronous diaphragmatic flutter. As a group, these sick horses had lower plasma chloride and potassium and higher total plasma protein concentrations as compared with 10 healthy horses that successfully completed the ride (P<0.05, <0.01, and <0.05 for chloride, potassium, and total protein, respectively). Horses with colic had a lower PCV as compared with horses with poor recovery and those with synchronous diaphragmatic flutter (P<0.05). All horses, including colics, were treated medically and discharged to owners. Based on the results of this study, the prognosis for horses requiring emergency veterinary treatment after being removed from endurance competition (for metabolic reasons) appears to be good if horses are withdrawn from competition under the same criteria outlined in this study. Biochemical abnormalities tend to be mild and do not necessarily aid in delineating sick horses from successfully completing horses. None of the horses with gastrointestinal disease required abdominal surgery.

Comment on: Nathan DM, Buse JB, Davidson MB et al (2006) Management of hyperglycaemia in type 2 diabetes: a consensus algorithm for the initiation and adjustment of therapy. A consensus statement from the American Diabetes Association and the European Association for the Study of Diabetes. Diabetologia 49:1711–1721

To the Editor: The consensus statement from the American Diabetes Association and the European Association for the Study of Diabetes, published in both Diabetologia [1] and Diabetes Care [2], included the following statement concerning the incidence of hypoglycaemia in insulintreated type 2 diabetes: ‘In clinical trials aimed at normoglycaemia and achieving a mean HbA1c of ∼7%, severe hypoglycaemic episodes (defined as requiring help from another person to treat) occurred at a rate of between 1 and 3 per 100 patient-years ....’ This is not a balanced description of the published literature. The authors cited five publications to support the statement quoted [3–7]. However, two of these do not include event rates for severe hypoglycaemia as defined in the statement [5, 6] and one was a review with no original data [7]. Notably, the latter review cited studies reporting event rates for severe hypoglycaemia in insulin-treated type 2 diabetic patients of 28 and 35 per 100 patient-years [7], which are well in excess of ‘between 1 and 3 per 100 patient-years’ [1, 2]. Thus, only two [3, 4] of the five publications cited, involving 127 patients with insulin-treated type 2 diabetes, support the authors’ statement (Table 1). The authors did not cite original publications reporting severe hypoglycaemia event rates of 10 [8], 28 [9], 35 [10], 44 [11] and 73 [12] per 100 patient-years, involving 907 patients with insulin-treated type 2 diabetes (Table 1). (Admittedly, one [11] was published at about the same time as the consensus statement.) These five reports included a prospective study of a population-based random sample of patients with insulin-treated type 2 diabetes that found a severe hypoglycaemia event rate of 35 per 100 patient-years [10]. These severe hypoglycaemia event rates, ranging from 10–73 per 100 patient-years, in insulin-treated type 2 diabetes [8–12] approach those in type 1 diabetes, which range from 62–170 per 100 patient-years [10, 12–14] (Table 1). Furthermore, the authors did not cite additional population-based data in which the event rates for severe hypoglycaemia requiring emergency medical treatment in insulin-treated type 2 diabetes ranged from 40–100% [15, 16] of those in type 1 diabetes. The barrier of hypoglycaemia precludes maintenance of euglycaemia over a lifetime of diabetes and thus full realisation of the now well-established vascular benefits of glycaemic control [17]. In contrast to type 1 diabetes, hypoglycaemia is relatively infrequent early in the course of type 2 diabetes when glucose counter-regulatory defences against falling plasma glucose concentrations are intact [17, 18]. However, as discussed here and summarised in Table 1, there is a body of evidence—including prospective, population-based data—indicating that hypoglycaemia becomes progressively more frequent, approaching the incidence rate seen in type 1 diabetes, as patients approach the insulin-deficient end of the spectrum of type 2 diabetes, where physiological and behavioural defences against falling glucose levels become compromised [17, 18]. I quite agree with the authors of the consensus statement that insulin is the most effective of diabetes medications in Diabetologia (2007) 50:222–224 DOI 10.1007/s00125-006-0448-4

Concerns and Coping of African-American Mothers After Youth Assault Requiring Emergency Medical Treatment

To explore maternal experience following youth assault occurring in the community. A semistructured interview was used to elicit concerns and coping strategies among 35 African-American mothers whose children received emergency department (ED) treatment for assault-related injuries. Mothers also completed measures of violence exposure, trauma symptoms, social support, and youth functioning. The most common concerns involved family safety, maternal mental health, and youth externalizing behavior. Faith and social support were the most common coping strategies. High levels of distress were found, which were directly related to maternal violence exposure, relationships that required mothers to nurture others, and youth functioning. Distress was inversely related to relationships that provided guidance from others. Distress is common among low-income African-American mothers of youth assault victims. To bolster youth recovery and to reduce the risk of future injury, ED staff should be knowledgeable regarding culturally sensitive resources to address maternal distress.

Playground Safety: Using Research to Guide Community Policy

Each year over 200,000 children in the United States require emergency medical treatment for playground-related injuries, costing an estimated $1.2 billion. Thus, the issue of playground safety is a topic of concern for many health care professionals. However, without a reasonable understanding of the scope and magnitude of the problem, any attempts to develop an injury prevention program will be limited. Therefore, this article reviews the data-based playground research so that suggestions can be made concerning the development of a comprehensive playground injury prevention program.

Head Injury and Battered Women: An Initial Inquiry

Approximately 2 to 3 million women are battered by their intimate partners each year. Severe injuries requiring emergency medical treatment of battered women have been noted, yet the prevalence of head injuries and the negative consequences emanating from such injuries have been noticeably absent from the literature. The descriptive study discussed in this article examined the case records of residents in a domestic violence shelter over a three-month period and found a 35 percent prevalence rate of battered women who had experienced head injury during a battering incident with their intimate partner. This study calls attention to the long-range difficulties that head-injured battered women may experience as a result of cognitive, emotional, and behavioral difficulties resulting from domestic violence and how social workers can intervene with this population.