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A new method for assessing the costs of gun injuries to a health system examines data on paid amounts, comprehensive medical expenses, and expenses over time. The authors extracted claims using injury diagnosis codes from billing forms and medical charts. The study demonstrates that a claims database can be used to accurately measure health care costs associated with gun injuries. The study is the first to include gun-related injuries treated in ambulatory care settings and to track actual payments over time.

Objective: To determine the rate, type, and severity of injuries incurred and penalties assessed during the qualifying fair-play (points for playing without excessive penalties) and championship "regular" rules (winner advances) portions of a 1994 Junior Gold ice hockey tournament., Design: A prospective evaluation of injuries by certified athletic trainers at the tournament site., Setting: A community-organized, 3-day, 31-game tournament in Minnesota., Participants: Two hundred seventy-three male players, younger than 20 years and in high school., Measurements/main Results: Injuries were recorded by an on-site certified athletic trainer, and the penalties were tallied from the score sheets. The injury rates for the total number of injuries were 26.4 injuries per 1000 athlete exposures and 273.8 injuries per 1000 player hours. When only notable injuries (concussion, facial laceration, or moderate level of severity and above) were considered, the injury rates were 10 per 1000 athlete exposures and 103.9 per 1000 player hours. The ratio of notable fair-play to notable regular-rules injuries was 1:4.8. The number of penalties assessed per game averaged 7.1 penalties during fair-play rules and 13 penalties during the regular-rules competition. Penalties related to rough play and injury occurred four times more frequently during games with regular rules than those with fair-play rules., Conclusions: The fair-play concept can reduce injury rates, penalty rates, and severity of penalties and should be considered for ice hockey at all levels of play. The fair-play concept could be applied to other contact sports to reduce injury rates and rules infractions.

Home care (rather than hospital care) for a diverse group of medically fragile children has expanded in the last decade without an adequate understanding of its impact on families. In this report, the psychological distress of parents was measured using family data and a standardized psychological distress instrument. Of 57 families studied, 59% of the mothers and 67% of the fathers reported significant levels of distress symptoms. Regressions analysis suggest that factors associated with increased family responsibility contribute to parents' distress. The type and amount of professional support also affect parental distress.

Objective: To determine the rate, type, and severity of injuries to child hockey players as well as assessing coaches', parents', and players' attitudes and knowledge of hockey., Design: A prospective observation of a population's injuries using injury-reporting forms and surveys., Setting: A community-organized hockey program in Minnesota., Participants: One hundred fifty boys, aged 9 through 15 years, who played ice hockey during the 1990-1991 winter season., Measurements and Main Results: Injuries were reported by multiple observers, including coaches, managers, and trained independent observers at the time an injury occurred; coaches, parents, and players were surveyed regarding hockey injuries, knowledge, and attitudes. One in three players experienced an injury during the season. The most common injuries were contusions. Six of 100 players experienced injuries severe enough to require cessation of physical activities for 8 to 25 days or longer. Weight differences of 53 kg and height differences of 55 cm were reported between Bantam-aged players (13 through 15 years), and body contact, including legal checks, accounted for 86% of injuries during games. Illegal checks and violations were associated with 66% of injuries during games, yet only four penalties (14%) were assessed. In addition, one in three games in which an injury resulted was described as hostile and 15% of the injuries were considered intentional., Conclusions: Eliminating violence and body checking for prepubertal boys while emphasizing rule enforcement and good sportsmanship are recommended.

This paper considers the financial burden of parents caring for severely disabled children. A model to predict parents' out-of-pocket expenses and caregiving time demands is described. Discriminant analysis correctly classified high and low group membership for out-of-pocket expenses and caregiving time at 72 percent and 77 percent, respectively. Expected rates were 50 percent. Time spent caregiving was the best predictor for out-of-pocket expenses, and out-of-pocket expenses was the best predictor of caregiving time. A need-based approach for the distribution of resources that recognizes and adjusts for caregiving time and out-of-pocket costs is recommended.

The self-concept of 105 children (8 to 11 years) and adolescents (12 to 18 years) with cleft lip and/or palate (CLP) was studied using the Piers-Harris Children's Self-Concept Scale and selected demographic and medical variables. Results indicated that most (98%) of children had average or above average self-concept scores. Further analysis, however, demonstrated an interaction between age and gender: adolescent girls experienced a more negative self-concept in comparison to younger girls and adolescent boys experienced a more positive self-concept in comparison to younger boys. In addition, popularity cluster scores for all children were below the mean for the normed population. Because children with CLP have additional difficulties (i.e., facial disfigurement, speech and language deficits, multiple surgeries), professionals should intercede to prevent or interrupt negative psychosocial outcomes, particularly for adolescent girls.

Home care programs for severely disabled, usually technology-dependent, children got a boost in 1981 when the Federal Government gave States permission to use Medicaid to fund home care under the Medicaid model home- and community-based waiver (2176). The model waiver program was unique because it eliminated the bias toward hospitalization by waiving parental income and assets when determining eligibility for children cared for at home and by allowing Medicaid to cover needed home care services. In 1985 Minnesota received Federal approval for the model waiver, and the results are detailed in this report. Although the waiver could provide funding for up to 50 children, after 2 years only 24 children had received approval. Stringent and complex eligibility criteria acted as barriers to accessing the model waiver. In addition, the interaction between the waiver and the State's health care system contributed to inconsistencies in eligibility. This interaction demonstrates the difficulty of administering publicly funded programs in the current health care environment. Recommendations are made for adjusting criteria for eligibility in the waiver program. Unresolved problems facing technology-dependent children on home care programs are discussed.