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The purpose of this study was to evaluate the mutual impact of community and individual factors on youth's perceptions of community safety, using structural equation modeling (SEM) conceptualized by syndemic theory. This study used survey data collected from a county wide sample of middle and high school students (N=25,147) in West Central Florida in 2015. The outcome variable was youth's perceptions of community safety. Predictors were latent individual and community factors constructed from 14 observed variables including gun accessibility, substance use, depressive symptoms, and multiple neighborhood disadvantage questions. Three structural equation models were conceptualized based on syndemic theory and analyzed in Mplus 8 using weighted least squares (WLS) estimation. Each model's goodness of fit was assessed. Approximately seven percent of youth reported feeling unsafe in their community. After model modifications, the final model showed a good fit of the data and adhered to the theoretical assumption. In the final SEM model, an individual latent factor was implied by individual predictors measuring gun accessibility without adult's permission (β=0.70), sadness and hopelessness (β=0.52), alcohol use (β=0.79), marijuana use (β=0.94), and illegal drug use (β=0.77). Meanwhile, a community latent factor was indicated by multiple community problems including public drinking (β=0.88), drug addiction (β=0.96), drug selling (β=0.97), lack of money (β=0.83), gang activities (β=0.90), litter and trash (β=0.79), graffiti (β=0.91), deserted houses (β=0.86), and shootings (β=0.93). A second-order syndemic factor that represented the individual and community factors showed a very strong negative association with youth's safe perception (β=-0.98). This study indicates that individual risk factors and disadvantaged community conditions interacted with each other and mutually affected youth's perceptions of community safety. To reduce these co-occurring effects and improve safe perceptions among youth, researchers and practitioners should develop and implement comprehensive strategies targeting both individual and community factors. [ABSTRACT FROM AUTHOR]

BACKGROUND: Muscular strength and endurance are important attributes for structural firefighting. Matching resistance exercises to firefighter job demands is not well-established. OBJECTIVE: This study compared the electromyographic (EMG) activity of major muscles during the Candidate Physical Ability Test (CPAT) and weight lifting exercises in firefighters. METHODS: A repeated measures study was conducted in 13 full-duty career firefighters (1 F, 12 M; age 18–44 years). Participants completed seven weight lifting exercises at a university laboratory. They separately completed the CPAT at a firefighting training grounds. During each activity, surface EMG (% maximum voluntary isometric contraction - MVIC) of major muscle groups was recorded and compared between exercises and CPAT. RESULTS: No difference in EMG activity was observed between exercises and CPAT for the deltoid, trapezius, lumbar multifidus, gluteal, and biceps femoris muscles. EMG activity was significantly greater during the CPAT for the abdominal obliques (32.3% ±27.7% vs. 12.1% ±8.3%, p < 0.001) and for the latissimus dorsi (21.8% ±25.1% vs. 11.4% ±7.7%, p < 0.001). CONCLUSIONS: Standard weight lifting and abdominal oblique exercises should be incorporated into resistance training programs for firefighters. [ABSTRACT FROM AUTHOR]

Congenital diaphragmatic hernia (CDH) is a rare birth defect with a global prevalence of 2.3 per 10,000 (range: 1.1–8.0 per 10,000). Ambient ozone has been associated with several birth defects; however, there is limited evidence for its role in the etiology of CDH. We examined the role of maternal exposure to ambient ozone as a risk factor for CDH (overall and stratified by isolated and complex) in the State of Florida. We conducted a population-based, retrospective cohort study using data from the 1998–2012 Florida Birth Defects Registry and the Environmental Protection Agency's Air Quality System. Maternal exposure was estimated by combining data to determine ozone concentrations during pregnancy for maternal census tract (at delivery) using a space-time inverse distance squared weighting method. Multilevel Poisson regression models were used to calculate the risk of CDH, overall and stratified by isolated and complex. The study population consisted of 2,649,846 singleton live births including 814 cases of CDH. The findings indicate insufficient evidence for an association between maternal exposure to ambient ozone and CDH during the etiologically relevant time window for CDH (4–12 weeks of pregnancy). Prevalence ratios and 95% confidence intervals for each increasing quartile of ozone exposure level relative to the lowest quartile were: for overall CDH: 1.12 (0.92, 1.36), 0.99 (0.81, 1.22), and 1.12 (0.94, 1.40); for isolated CDH: 1.08 (0.86, 1.36), 1.01 (0.80, 1.28), and 1.15 (0.92, 1.44); and for complex CDH: 1.22 (0.91, 1.63), 0.92 (0.67, 1.25), and 1.12 (0.83, 1.52). Our results do not support a link between maternal exposure to ambient ozone and CDH. Studies with better exposure assessment and inclusion of spontaneous and planned abortions may be needed. Gene-environment interactions and the study of maternal vitamin A status as a mediator in the pathway between ambient ozone and CDH may provide further information on the potential role of ambient ozone in the etiology of CDH. [Display omitted] • The link between ozone exposure and congenital diaphragmatic hernia was studied. • The study included 2,649,846 singleton infants born alive in 1998–2012 in Florida. • The prevalence ratio for CDH with increasing ozone exposure level was inconsistent. • The 4th exposure quartile had the highest prevalence ratio for isolated CDH. • Evidence was insufficient for association between ozone and CDH. [ABSTRACT FROM AUTHOR]

Background: Drowning is a leading cause of preventable mortality and morbidity in children. Its high fatality rate and frequent severe sequelae (e.g. brain damage and permanent loss of functioning) place a premium on preventive efforts., Methods: A retrospective analysis of patients ≤21 years of age admitted between 2010 and 2017 to a pediatric trauma center was conducted to identify factors associated with drowning admissions, fatal drowning, and severe outcome (ventilator use, ICU admission, or death). Outcomes were modeled and estimated by use of logistic regression and Poisson regression., Results: Drowning accounted for 153/4931 (3.1%) trauma admissions between 2010 and 2017. The risk of death (13.1% vs. 1.5%, p < .01), and severe outcome (24.8% vs. 7.8%, p < .01) was significantly higher for drownings vs. other causes. All 20 drowning deaths occurred among children left unattended. In Poisson regression analysis, weekends, summer breaks, and hotter days were independently associated with a higher probability of drowning admissions. Additionally, in analyses excluding indicators of severity, the odds of severe outcome were higher for children age ≤ 2 years [adjusted odds ratio (AOR) = 3.88 95% CI (1.58, 9.53)], and injury downtime of >5 min or unknown length [AOR = 6.66 95% CI (2.74-16.15)]. Immediate intervention after the discovery was associated with ~70% lower odds of a severe outcome., Conclusions: Drowning admissions were both more severe and more often fatal compared to other pediatric injury causes of admission. Enhanced and targeted educational messages for parents of young children, focused on prevention behaviors on high-risk days and immediate bystander intervention, may reduce the occurrence and severity of these tragic accidents., Table of Contents Summary: A retrospective multi-year cohort study to identify modifiable factors associated with drowning admissions, severe complications, and death from a large trauma registry database., What's Known on This Subject: Drowning is a leading cause of unintentional injury that results in severe morbidity and a high rate of mortality. Children are disproportionately affected by drowning and have a higher risk of long term sequelae and death., What This Study Adds: This study identified high-risk populations and periods for drowning, the importance of supervision, and the effectiveness of immediate intervention in reducing unfavorable outcomes after drowning. It also highlights a need for heightened local intervention for drowning prevention., Competing Interests: Declaration of competing interest The authors have no conflicts of interest relevant to this article to disclose., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: Congenital diaphragmatic hernia (CDH) is a rare musculoskeletal birth defect with a prevalence of 2.61 per 10,000 in the United States. There is limited evidence for ambient air pollutants in the etiology of CDH in humans., Objectives: We investigated the role of maternal exposure to ambient cadmium as a risk factor for CDH (overall and stratified by isolated and non-isolated subtypes) in Florida and whether maternal smoking during pregnancy was an effect modifier of this association., Methods: We conducted a population-based, retrospective cohort study using data from the 1999-2012 Florida Birth Defects Registry linked to the National Air Toxic Assessment database. Analyses included chi-square tests; multilevel Poisson regression models to calculate measures of association between cadmium and CDH; and stratified analyses to examine effect modification by maternal smoking status., Results: The study population consisted of 2,591,395 live births including 840 CDH cases. We did not find evidence for an association between maternal exposure to ambient cadmium concentration and CDH. We observed a 24% increased risk of CDH among isolated cases in the highest quartile of cadmium exposure (95% confidence interval [CI]: 1.00, 1.55). Although we were limited by small sample size for CDH cases, we found that among mothers who smoked during pregnancy, exposure to the highest quartile of cadmium was associated with more than two times higher risk for CDH among overall (95%CI: 1.04, 4.39) and isolated (95%CI: 1.07, 5.57) cases., Conclusions: Additional research is needed to elucidate the mechanism by which maternal ambient cadmium exposure may increase the risk of CDH in offspring, and the extent to which maternal smoking during pregnancy modifies this association., (© 2019 Wiley Periodicals, Inc.)

Objective: To identify the live-birth prevalence, trends, correlates, and neonatal and 1-year survival rates of congenital diaphragmatic hernia., Methods: Using a population-based, retrospective cohort study design, we examined 1,025 cases of congenital diaphragmatic hernia from the 1998-2012 Florida Birth Defects Registry. We used Poisson and joinpoint regression models to compute prevalence ratios and temporal trends, respectively. Kaplan-Meier survival curves and Cox proportional hazards regression were used to describe neonatal and 1-year survival and estimate hazard ratios representing the predictors of infant survival., Results: The birth prevalence of congenital diaphragmatic hernia was 3.19 per 10,000 live births (95% confidence interval [CI]: 3.00-3.39); there was a 4.2% yearly increase among multiple cases only. Among all cases, maternal education less than high school (prevalence ratio: 1.25, 95% CI: 1.02-1.53), high school/associate degree/GED (prevalence ratio: 1.15, 95% CI: 1.01-1.32), multiple birth (prevalence ratio: 1.38, 95% CI: 1.05-1.81), and male sex (prevalence ratio: 1.18, 95% CI: 1.05-1.32) were associated with increased risk for congenital diaphragmatic hernia. The 24-hr, neonatal, and 1-year survival rates were 93.6%, 79.8%, and 71.2%, respectively. The highest hazard ratio of 17.87 (95% CI: 1.49-213.82) was observed for neonatal mortality among cases associated with chromosomal anomalies and born <37 weeks at < 1,500 g. Among isolated cases, multiple birth (hazard ratio: 0.41, 95% CI: 0.20-0.86) was associated with decreased 1-year mortality., Conclusion: Low maternal education and multiple birth may be linked to congenital diaphragmatic hernia. The trends in prevalence, epidemiologic correlates, and predictors of early survival can differ between congenital diaphragmatic hernia subtypes-isolated, multiple, and chromosomal.© 2018 Wiley Periodicals, Inc. © 2018 Wiley Periodicals, Inc., (© 2018 Wiley Periodicals, Inc.)