TORBA, M.; GJATA, A.; BUCI, S.; BUSHI, G.; ZENELAJ, A.; KAJO, I.; KOCEKU, S.; KAGJINI, K.; SUBASHI, K.
Introduction The management of colon injuries has distinctly evolved over the last three decades. However, trauma surgeons often find themselves in a dilemma, whether to perform a diversion or to perform a primary repair. The purpose of this study is to evaluate risk factors in colon injury management and their influence on abdominal complications. Patients and methods This is a prospective study conducted at a national level I trauma center in Tirana, Albania from January 2009 to December 2012. The data with respect to demographics, physiological risk factors, intraoperative findings, and surgical procedures were collected. Colonic injury-related morbidity and mortality were analyzed. Multivariate logistic regression analysis was performed by assessing the influence of risk factors on abdominal complications. Results Of the 157 patients treated with colon injury, was performed a primary repair in 107 (68.15%) of the patients and a diversion in the remaining 50 (31.85%). The mean PATI was 18.6, while 37 (23.6%) of patients had PATI greater than 25. The complications and their frequencies according to the surgical technique used (primay repair vs diversion respectively) includes: wound infections (9.3% vs 50%), anastomotic leak (1.8% vs 8.7%), and intra-abdominal abscess (1.8% vs 6.5%). The multivariate analysis identified two independent risk factors for abdominal complications: transfusions of 4 units of blood within the first 24 hours (OR = 1.2 95% CI (1.03 –1.57) p =0.02), and diversion (OR = 9.6, 95% CI 4.4 – 21.3, p<0.001). Conclusion Blood transfusions of more than 4 units within the first 24 hours and diversion during the management of destructive colon injuries are both independent risk factors for abdominal complications. The socioeconomic impact and the need for a subsequent operation in colostomy patients are strong reasons to consider primary repair in the management of colon injuries. PMID:26017103
Nesbakken, A; Pillgram-Larsen, J; Naess, F; Gerner, T; Solheim, K; Stadaas, J O; Gjøra, O
We have reviewed the medical records of 111 patients treated for abdominal stab wounds during the period 1980-87. Our two hospitals serve a catchment area of about 450,000 people. Exploratory laparotomy was performed in 89 patients with suspected peritoneal penetration. In 16 patients the laparotomy was negative, and in 15 patients only minor injuries were noted. There were no serious complications in these 31 patients. Twenty-seven patients had thoracic wounds below the fourth intercostal space, 15 with intraabdominal injuries. The most common injuries were lacerations of the liver, the small bowel and the diaphragm. The mortality in the series was 2%. Stab wounds are infrequent in Norway, and most surgeons have limited experience of such injuries. We discuss whether to employ immediate exploratory laparotomy or selective management when the peritoneum has been penetrated. When there is no evidence of evisceration or omental protrusion, local exploration of the wound should be performed in order to confirm or exclude peritoneal penetration. Injury to the diaphragm and intraabdominal viscera should always be suspected in thoracic stab wounds below the fourth intercostal space.
Haycock, Christine E.
In sports, abdominal injuries occur most frequently in cycling, horseback riding, and skiing. Most involve children, not adults. Any athlete sustaining a severe blow to the abdomen should be examined. Guidelines are provided for recognizing and treating injuries to the abdominal muscles, kidneys, spleen, and liver. (Author/MT)
Iflazoglu, Nidal; Ureyen, Orhan; Oner, Osman Z; Tusat, Mustafa; Akcal, Mehmet A
Due to the high kinetic energy, of bullets and explosive gun particles, their paths through the abdomen (permanent cavity effect), and the blast effect (temporary cavity effect), firearm injuries (FAI) can produce damage not only in the organ they enter, but in the surrounding tissues as well. Since they change route after entering the body they may cause organ damage in locations other than those at the path of entry. For example, as a result of the crushing onto bone tissues, bullet particles or broken bone fragments may cause further damage outside of the path of travel, For these reasons it is very difficult to predict the possible complications from the size of the actual injury in patients with penetrating abdominal firearm injuries. The factors affecting the mortality and morbidity from firearm injuries have been evaluated in various studies. Insufficient blood transfusion, long duration of time until presenting to a hospital and the presence of colon injuries are common factors that cause the high complication rates and mortality. A total of 120 cases injured in the civil war at Turkey’s southern neighbouring countries were admitted to our hospital and evaluated in terms of: development of complications and factors affecting mortality; age, gender, time of presentation to the hospital, number of injured organs, the type of injuring weapon, the entrance site of the bullet, the presence of accompanying chest trauma, the amount of administered blood, the penetrating abdominal trauma index (PATI) and the injury severity score (ISS) scores were determined and evaluated retrospectively. The most significant factors for the development of complications and mortality include: accompanying clinical shock, high number of injured organs, numerous blood transfusions administered and accompanying thoracic trauma. It has also been observed that the PATI and ISS scoring systems can be used in predicting the complication and mortality rates in firearm injuries
Iflazoglu, Nidal; Ureyen, Orhan; Oner, Osman Z; Tusat, Mustafa; Akcal, Mehmet A
Due to the high kinetic energy, of bullets and explosive gun particles, their paths through the abdomen (permanent cavity effect), and the blast effect (temporary cavity effect), firearm injuries (FAI) can produce damage not only in the organ they enter, but in the surrounding tissues as well. Since they change route after entering the body they may cause organ damage in locations other than those at the path of entry. For example, as a result of the crushing onto bone tissues, bullet particles or broken bone fragments may cause further damage outside of the path of travel, For these reasons it is very difficult to predict the possible complications from the size of the actual injury in patients with penetrating abdominal firearm injuries. The factors affecting the mortality and morbidity from firearm injuries have been evaluated in various studies. Insufficient blood transfusion, long duration of time until presenting to a hospital and the presence of colon injuries are common factors that cause the high complication rates and mortality. A total of 120 cases injured in the civil war at Turkey's southern neighbouring countries were admitted to our hospital and evaluated in terms of: development of complications and factors affecting mortality; age, gender, time of presentation to the hospital, number of injured organs, the type of injuring weapon, the entrance site of the bullet, the presence of accompanying chest trauma, the amount of administered blood, the penetrating abdominal trauma index (PATI) and the injury severity score (ISS) scores were determined and evaluated retrospectively. The most significant factors for the development of complications and mortality include: accompanying clinical shock, high number of injured organs, numerous blood transfusions administered and accompanying thoracic trauma. It has also been observed that the PATI and ISS scoring systems can be used in predicting the complication and mortality rates in firearm injuries
Arbogast, Kristy B.; Ghati, Yoganand
Previous studies have demonstrated that booster seats reduce the risk of abdominal injuries by improving the fit of the seat belt on young children and encouraging better posture and compatibility with the vehicle seat. Recently, several studies have reported cases of abdominal injuries in booster seated children questioning the protective effects of these restraints. The objective of this study was to examine cases of abdominal injuries in booster seated children through parametric modeling to gain a thorough understanding of the injury causation scenarios. The Partners for Child Passenger Safety and CIREN in-depth crash investigation databases were queried to identify children in belt-positioning booster seats with abdominal injuries. The injury causation scenarios for these injuries were delineated using the CIREN Biotab method. The cases were modeled, using MADYMO with variations in key parameters, to determine the ranges of loads and loading rates for the abdomen and thorax. A parametric study was completed examining the influence of pretensioners and load limiters on the injury metrics obtained. Query of the two databases revealed three cases involving abdominal injuries to booster seated children. Children in two of the cases sustained a thoracic injury (AIS 3/AIS 4) in addition to their abdominal injuries (AIS 2) and review of these cases pointed to the role of shoulder belt loading in the injury causation. Modeling of these cases revealed chest compressions and accelerations of 30–53 mm and 41–89 g, respectively and abdominal deflection and velocity of 7.0–13.3 mm and 1.2–2.2 m/s, respectively. Parametric study suggested that coupling shoulder belt load limiting and lap belt buckle pretensioning resulted in improved chest and abdominal metrics while reducing head excursion, indicating that these technologies may provide injury reduction potential to pediatric rear seat occupants. PMID:20184845
Cripps, N P; Cooper, G J
Intestinal injury is frequent after non-penetrating abdominal trauma, particularly after modern, high-energy transfer impacts. Under these circumstances, delay in the diagnosis of perforation is a major contributor to morbidity and mortality. This study establishes patterns of intestinal injury after blunt trauma by non-penetrating projectiles and examines relationships between injury distribution and abdominal wall motion. Projectile impacts of variable momentum were produced in 31 anaesthetised pigs to cause abdominal wall motion of varying magnitude and velocity. No small bowel injury was observed at initial impact velocity of less than 40 m/s despite gross abdominal compression. At higher velocity, injury to the small bowel was frequent, irrespective of the degree of abdominal compression (P = 0.00044). Large bowel injury was observed at all impact velocities and at all degrees of abdominal compression. This study confirms the potential for intestinal injury in high velocity, low momentum impacts which do not greatly compress the abdominal cavity and demonstrates apparent differences in injury mechanisms for the small bowel and colon. Familiarity with injury mechanisms may reduce delays in the diagnosis of intestinal perforation in both military and civilian situations.
Naiem, Ahmed A.; Taqi, Kadhim M.; Al-Kendi, Badriya H.; Al-Qadhi, Hani
Hollow viscus injuries of the digestive tract are an uncommon occurrence in blunt abdominal trauma. We report a 39-year-old male who was hit by a vehicle as a pedestrian and admitted to the Sultan Qaboos University Hospital, Muscat, Oman, in 2015. He underwent an exploratory laparotomy which revealed injuries to the distal stomach, liver and descending colon. Postoperatively, the patient was febrile, tachycardic and hypotensive. Abdominal examination revealed distention and tenderness. The next day, a repeat laparotomy identified a gastric injury which had not been diagnosed during the initial laparotomy. Although the defect was repaired, the patient subsequently died as a result of multiorgan failure. Missed gastric injuries are rare and are associated with a grave prognosis, particularly for trauma patients. Delays in diagnosis, in addition to associated injuries, contribute to a high mortality rate. PMID:28003902
Ma, Richard; Zhou, Hanbing; Thompson, Matthew; Dawson, Courtney; Nguyen, Joseph; Coleman, Struan
Normal hip range of motion (ROM) is essential in running and transfer of energy from lower to upper extremities during overhead throwing. Dysfunctional hip ROM may alter lower extremity kinematics and predispose athletes to hip and groin injuries. The purpose of this study is characterize hip internal/external ROM (Arc) and its effect on the risk of hip, hamstring, and groin injuries in professional baseball players. Bilateral hip internal and external ROM was measured on all baseball players (N=201) in one professional organization (major and minor league) during spring training. Players were organized according to their respective positions. All injuries were documented prospectively for an entire MLB season (2010 to 2011). Data was analyzed according to position and injuries during the season. Total number of players (N=201) with an average age of 24±3.6 (range=17-37). Both pitchers (N=93) and catchers (N=22) had significantly decreased mean hip internal rotation and overall hip arc of motion compared to the positional players (N=86). Players with hip, groin, and hamstring injury also had decreased hip rotation arc when compared to the normal group. Overall, there is a correlation between decreased hip internal rotation and total arc of motion with hip, hamstring, and groin injuries. PMID:26793294
Introduction Abdominal organ injury in a primary blast type is always challenging for diagnosis. Air containing abdominal viscera is most vulnerable to effects of primary blast injury. In any patient exposed to a primary blast wave who presents with an acute abdomen, an abdominal organ injury is to be kept in a clinical suspicion. Aim Study various abdominal organ injuries occurring in a primary type of blast injury. Material and methods: All those who had exploratory laparotomy for abdominal organ injuries after a primary blast injury for a period of 10 years from January 1998 - January 2008 were included in this retrospective study. Results Total 154 patients had laparotomy for abdominal organ injuries with a primary blast type of injury. Small intestine was damaged in 48 patients (31.1%) followed by spleen in 22.7% cases. 54 patients (35.06%) had more than one organ injured. Liver laceration was present in 30 patients (19.48%). Multiple small gut perforations were present in 37 patients (77.08%). Negative laparotomy was found in 5 patients (3.24%) whereas 3 (1.94%) had re-exploration. Mortality was present in 6 patients (3.89%). Conclusions Primary blast injury causes varied abdominal organ injuries. Single or multiple organ damage can be there. Small intestine is commonest viscera injured. Laparotomy gives final diagnosis. PMID:20025766
Tobler, William D.; Tan, Tze-Woei; Farber, Alik
Blunt abdominal aortic injury is an uncommon traumatic finding. In the past, treatment options have traditionally consisted of open operative repair; however, the development of endovascular surgery has created new interventional possibilities. This case is presented to demonstrate the applications of endovascular abdominal aortic repair for a blunt traumatic injury. PMID:23730142
Lewandowski, Beth E.; Brooker, John E.; Weavr, Aaron S.; Myers, Jerry G., Jr.; McRae, Michael P.
The Integrated Medical Model (IMM) is a decision support tool that is useful to spaceflight mission planners and medical system designers when assessing risks and optimizing medical systems. The IMM project maintains a database of medical conditions that could occur during a spaceflight. The IMM project is in the process of assigning an incidence rate, the associated functional impairment, and a best and a worst case end state for each condition. The purpose of this work was to develop the IMM Abdominal Injury Module (AIM). The AIM calculates an incidence rate of traumatic abdominal injury per person-year of spaceflight on the International Space Station (ISS). The AIM was built so that the probability of traumatic abdominal injury during one year on ISS could be predicted. This result will be incorporated into the IMM Abdominal Injury Clinical Finding Form and used within the parent IMM model.
Ojo, Emmanuel Olorundare; Ozoilo, Kenneth N.; Sule, Augustine Z.; Ugwu, Benjamin T.; Misauno, Michael A.; Ismaila, Bashiru O.; Peter, Solomon D.; Adejumo, Adeyinka A.
Background: Abdominal injuries contribute significantly to battlefield trauma morbidity and mortality. This study sought to determine the incidence, demographics, clinical features, spectrum, severity, management, and outcome of abdominal trauma during a civilian conflict. Materials and Methods: A prospective analysis of patients treated for abdominal trauma during the Jos civil crises between December 2010 and May 2012 at the Jos University Teaching Hospital. Results: A total of 109 victims of communal conflicts with abdominal injuries were managed during the study period with 89 (81.7%) males and 20 (18.3%) females representing about 12.2% of the total 897 combat related injuries. The peak age incidence was between 21 and 40 years (range: 3–71 years). The most frequently injured intra-abdominal organs were the small intestine 69 (63.3%), colon 48 (44%), and liver 41 (37.6%). Forty-four (40.4%) patients had extra-abdominal injuries involving the chest in 17 (15.6%), musculoskeletal 12 (11%), and the head in 9 (8.3%). The most prevalent weapon injuries were gunshot 76 (69.7%), explosives 12 (11%), stab injuries 11 (10.1%), and blunt abdominal trauma 10 (9.2%). The injury severity score varied from 8 to 52 (mean: 20.8) with a fatality rate of 11 (10.1%) and morbidity rate of 29 (26.6%). Presence of irreversible shock, 3 or more injured intra-abdominal organs, severe head injuries, and delayed presentation were the main factors associated with mortality. Conclusion: Abdominal trauma is major life-threatening injuries during conflicts. Substantial mortality occurred with loss of nearly one in every 10 hospitalized victims despite aggressive emergency room resuscitation. The resources expenditure, propensity for death and expediency of timing reinforce the need for early access to the wounded in a concerted trauma care systems. PMID:26957819
Birn, Jeffrey; Jung, Melissa; Dearing, Mark
The diagnosis of blunt injury to the gallbladder may constitute a significant challenge to the diagnostician. There is often a delay in presentation with non-specific clinical symptoms. In the absence of reliable clinical symptoms, diagnostic imaging becomes an invaluable tool in the rapid identification of gallbladder injury. We present a case of isolated gallbladder injury following blunt abdominal trauma which was diagnosed by computed tomography and subsequently confirmed by cholecystectomy.
Vijay, Adarsh; Abdelrahman, Husham; El-Menyar, Ayman; Al-Thani, Hassan
The incidence of pancreatic injury following blunt abdominal trauma is rare. A timely accurate diagnosis of such injury is difficult and also the management remains controversial. Here, we reported the successful use of laparoscopy to diagnose, characterize and treat blunt pancreatic trauma in a 28-year-old male patient involved in a motor vehicle crash. An abdominal computed tomography scan showed peripancreatic fat stranding suggestive of pancreatic injury. With persistent clinical signs of peritonitis and laboratory investigations suggestive of pancreatitis, the patient underwent laparoscopic drainage of the lesser sac. The patient had an uneventful postoperative course. The management of patients with blunt pancreatic injuries should be tailored to individual situations. Our experience suggests that a timely laparoscopic management of traumatic pancreatic injury is safe approach in selected cases.
Iaselli, Francesco; Mazzei, Maria Antonietta; Firetto, Cristina; D'Elia, Domenico; Squitieri, Nevada Cioffi; Biondetti, Pietro Raimondo; Danza, Francesco Maria; Scaglione, Mariano
The bowel and the mesentery represent the third most frequently involved structures in blunt abdominal trauma after the liver and the spleen. Clinical assessment alone in patients with suspected intestinal and/or mesenteric injury from blunt abdominal trauma is associated with unacceptable diagnostic delays. Multi-detector computed tomography, thanks to its high spatial, time and contrast resolutions, allows a prompt identification and proper classification of such conditions. The radiologist, in fact, is asked not only to identify the signs of trauma but also to provide an indication of their clinical significance, suggesting the chance of conservative treatment in the cases of mild and moderate, non-complicated or self-limiting injuries and focusing on life-threatening conditions which may benefit from immediate surgical or interventional procedures. Specific and non-specific CT signs of bowel and mesenteric injuries from blunt abdominal trauma are reviewed in this paper.
Dart, C H; Braitman, H E; Larlarb, S
Renal vascular injuries are found relatively frequently after non-penetrating abdominal trauma. Penetrating renal arterial lesions occur much less frequently, involving less than 5 per cent of all penetrating arterial injuries. The association of bowel and other organ injuries makes diagnosis and treatment somewhat complex. Four cases of penetrating renal arterial injuries were seen from January 1972 to June 1976. All patients had multiple bowel lacerations. All arrived in the emergency room in hypovolemic shock. Two patients were resuscitated and successfully treated. Three patients had complete transections and 1 had major branch transection. Two patients had an associated parenchymal lesion. One patient had a through-and-through ureteropelvic injury. Preoperative arteriography was not done because of vascular instability. Renal arterial injuries were suspected by loss of psoas shadow on abdominal x-rays and by retroperitoneal hematomas. Retroperitoneal hematomas were explored to eliminate the possibility of renal injury. Both of the patients operated upon attained good renal function after surgical repairs. Postoperative renal scans and arteriograms showed initially decreased function, which returned toward normal. Repair of renal arterial lesions is possible with good functional result. Preoperative arteriography, renographic scan or excretory urography is not justified routinely because of the seriousness of commonly associated injuries.
Matthew, Dwight; Oxman, David; Djekidel, Karim; Ahmed, Ziauddin; Sherman, Michael
Abdominal compartment syndrome is an under-recognized cause of acute kidney injury in critically ill patients. We report a case of a patient with severe obstructive lung disease who, while intubated for respiratory failure, developed abdominal compartment syndrome and oliguric acute kidney injury due to air-trapping and excessive auto-positive end-expiratory pressure (auto-PEEP; also known as intrinsic PEEP). When chemical paralysis was initiated and the auto-PEEP resolved, the patient's intra-abdominal hypertension rapidly improved and kidney function recovered immediately. Abdominal compartment syndrome secondary to excessive auto-PEEP appears to be unreported in the literature; however, any process that significantly increases intrathoracic pressure conceivably could cause increased pressure to be transmitted to the abdominal compartment, resulting in organ failure. Patients undergoing mechanical ventilation, which puts them at risk of airflow obstruction and the development of intra-abdominal hypertension, should be evaluated for air-trapping and excessive auto-PEEP.
Celik, Sevim; Atar, Nurdan Yalcin; Ozturk, Nilgun; Mendes, Guler; Kuytak, Figen; Bakar, Esra; Dalgiran, Duygu; Ergin, Sumeyra
Background: Problems regarding bowel elimination are quite common in patients undergoing abdominal surgery. Objectives: To determine constipation risk before the surgery, bowel elimination during postoperative period, and the factors affecting bowel elimination. Patients and Methods: This is a cross-sectional study. It was conducted in a general surgery ward of a university hospital in Zonguldak, Turkey between January 2013 and May 2013. A total of 107 patients were included in the study, who were selected by convenience sampling. Constipation Risk Assessment Scale (CRAS), patient information form, medical and nursing records were used in the study. Results: The mean age of the patients was found to be 55.97 ± 15.74 (year). Most of the patients have undergone colon (37.4%) and stomach surgeries (21.5%). Open surgical intervention (83.2%) was performed on almost all patients (96.3%) under general anesthesia. Patients were at moderate risk for constipation with average scores of 11.71 before the surgery. A total of 77 patients (72%) did not have bowel elimination problem during postoperative period. The type of the surgery (P < 0.05), starting time for oral feeding after the surgery (P < 0.05), and mobilization (P < 0.05) were effective on postoperative bowel elimination. Conclusions: There is a risk for constipation after abdominal surgery. Postoperative practices are effective on the risk of constipation. PMID:26380107
Belgerden, S; Demirkol, K; Kayabali, M
Traffic accidents are increasingly responsible for mortality in childhood in Turkey. Between 1982 and 1984, 197 children were admitted for contused abdominal injuries to the surgical casualty ward at the School of Medicine of Istanbul University. Most of these children had been involved in traffic accidents, and peritoneal lavage was applied to all of them. The diagnosis on admission was confirmed by laparotomy in 90 per cent of all cases. 20 children died (10.1 per cent). Uncontrollable abdominal bleeding was the cause of ten deaths and massive brain lesion of another six.
Petushek, Erich J.; Ward, Paul; Cokely, Edward T.; Myer, Gregory D.
Background: Simple observational assessment of movement is a potentially low-cost method for anterior cruciate ligament (ACL) injury screening and prevention. Although many individuals utilize some form of observational assessment of movement, there are currently no substantial data on group skill differences in observational screening of ACL injury risk. Purpose/Hypothesis: The purpose of this study was to compare various groups’ abilities to visually assess ACL injury risk as well as the associated strategies and ACL knowledge levels. The hypothesis was that sports medicine professionals would perform better than coaches and exercise science academics/students and that these subgroups would all perform better than parents and other general population members. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 428 individuals, including physicians, physical therapists, athletic trainers, strength and conditioning coaches, exercise science researchers/students, athletes, parents, and members of the general public participated in the study. Participants completed the ACL Injury Risk Estimation Quiz (ACL-IQ) and answered questions related to assessment strategy and ACL knowledge. Results: Strength and conditioning coaches, athletic trainers, physical therapists, and exercise science students exhibited consistently superior ACL injury risk estimation ability (+2 SD) as compared with sport coaches, parents of athletes, and members of the general public. The performance of a substantial number of individuals in the exercise sciences/sports medicines (approximately 40%) was similar to or exceeded clinical instrument-based biomechanical assessment methods (eg, ACL nomogram). Parents, sport coaches, and the general public had lower ACL-IQ, likely due to their lower ACL knowledge and to rating the importance of knee/thigh motion lower and weight and jump height higher. Conclusion: Substantial cross-professional/group differences in visual ACL
Denis, R; Allard, M; Atlas, H; Farkouh, E
Seatbelts were incorporated as standard equipment for automobiles constructed in North America in 1964. The first seatbelt law was made mandatory in Canada as of 1 January 1971. Between January 1976 and January 1980 38 patients involved in automobile accidents while wearing passive restraints were treated at l'Hôpital du Sacré-Coeur: 32 of these 38 patients had signs and symptoms of abdominal injury. These patients wearing passive restraints had an unusually high incidence of gastrointestinal injury in comparison to previously reported patients not wearing restraints. Twenty-seven of the 32 patients had injury to the bowel or the bowel mesentery. This different spectrum of injuries is most likely related to the altered physics of rapid deceleration caused by restraint with the lap belt and shoulder harness.
Hoffman, Lance; Pierce, Daniel; Puumala, Susan
This study's objective was to identify clinical characteristics of patients with a blunt traumatic injury that increased the risk of peritoneal or pericardial fluid collections and abdominal organ injuries not identified by a bedside focused abdominal sonogram for trauma (FAST) examination. This observational study used a retrospective chart review of a cohort of patients identified through a query of the University of Nebraska Medical Center's trauma registry, a tertiary referral center for portions of Nebraska, Iowa, and Missouri. Adult patients presenting to the Emergency Department (ED) for an evaluation of blunt traumatic injury from September 1996 to December 2002 were eligible if their ED course included admission to the trauma service after completion of a bedside FAST examination (US) and a confirmatory study (Conf) such as an abdominopelvic computed tomography scan or exploratory laparotomy within 12 h of completion of the ED FAST examination. The medical records of those patients with a US+/Conf+ or US-/Conf+ examination were reviewed. Clinical characteristics were recorded on a standard data collection form. Statistically significant predictors of a US-/Conf+ examination were found using a stepwise logistic regression procedure. A query of the trauma registry for the study period revealed 1453 adult individuals with blunt abdominal trauma, with 458 patients meeting the inclusion criteria. The clinical characteristics of the 79 US+/Conf+ examinations were compared to those of the 53 US-/Conf+ examinations. The presence of a radiographically proven pelvic fracture (odds ratio 3.459; 95% confidence interval of 1.308-9.157) and a radiographically or operatively proven renal injury (odds ratio 3.667; 95% confidence interval of 1.013-13.275) were found to be significant predictors. The presence of a pelvic fracture or renal injury in adult victims of blunt abdominal trauma increases the likelihood of a US-/Conf+ examination. Patients with a negative FAST
Sen, Indrani; Samarasam, Inian; Chandran, Sudhakar; Mathew, George
Introduction Gastric emphysema or pneumatosis is a rare finding. Early endoscopy and urgent laparotomy is advised in post-trauma patients. Case Presentation A 29 year old man presented with blunt abdominal injury following a high-speed motorbike crash He complained of abdominal pain and abdomen was distended. CT abdomen revealed air in the gastric wall with disruption of gastric mucosa. He had normal white cell counts, bleeding parameters and blood gases. He was treated conservatively with nasogastric decompression, intravenous analgesics and antibiotics with which he recovered well. Conclusions Early surgical management is indicated in post-trauma patients in whom bowel infarction is suspected. In a stable patient, a negative laparotomy is a major additional stress post trauma - conservative management with close clinical observation is a suitable management alternative. PMID:24396802
Lenarczyk, Marek; Lam, Vy; Jensen, Eric; Fish, Brian L; Su, Jidong; Koprowski, Stacy; Komorowski, Richard A; Harmann, Leanne; Migrino, Raymond Q; Li, X Allen; Hopewell, John W; Moulder, John E; Baker, John E
The objective of this study was to determine whether radiation-induced injury to the heart after 10 Gy total body irradiation (TBI) is direct or indirect. Young male WAG/RijCmcr rats received a 10 Gy single dose using TBI, upper hemi-body (UHB) irradiation, lower hemi-body (LHB) irradiation, TBI with the kidneys shielded, or LHB irradiation with the intestines shielded. Age-matched, sham-irradiated rats served as controls. The lipid profile, kidney injury, heart and liver morphology and cardiac function were determined up to 120 days after irradiation. LHB, but not UHB irradiation, increased the risk factors for cardiac disease as well as the occurrence of cardiac and kidney injury in a way that was quantitatively and qualitatively similar to that observed after TBI. Shielding of the kidneys prevented the increases in risk factors for cardiac disease. Shielding of the intestines did not prevent the increases in risk factors for cardiac disease. There was no histological evidence of liver injury 120 days after irradiation. Injury to the heart from irradiation appears to be indirect, supporting the notion that injury to abdominal organs, principally the kidneys, is responsible for the increased risk factors for and the occurrence of cardiac disease after TBI and LHB irradiation. PMID:23919311
Padlipsky, Patricia S; Brindis, Seth; Young, Kelly D
The spleen is the most commonly injured abdominal organ in children who sustain blunt abdominal trauma, and pediatric splenic injury may result from minor mechanisms of injury, including sports participation. We present 2 cases of splenic injury in soccer goalies because of blunt abdominal trauma sustained during game play. Although abdominal organ injuries are uncommon in soccer, emergency medicine and primary care physicians must be aware of the possibility. A high index of suspicion and careful physical examination are key in making the diagnosis.
Kara, Eray; Içöz, Gökhan; Ersin, Sinan; Coker, Ahmet
Soccer (football) is a popular sport worldwide and can result in severe abdominal injuries. Nevertheless, the necessity of surgical intervention for abdominal organ injuries has been reported rarely. We report a case who was injured during a soccer game who underwent abdominal surgery. Distal subtotal pancreatectomy, splenectomy, cholecystectomy, and choledochotomy + T-tube drainage were performed. He was discharged on the postoperative seventh day without any complication.
Beillas, Philippe; Alonzo, François; Chevalier, Marie-Christine; Lesire, Philippe; Leopold, Franck; Trosseille, Xavier; Johannsen, Heiko
The Abdominal Pressure Twin Sensors (APTS) for Q3 and Q6 dummies are composed of soft polyurethane bladders filled with fluid and equipped with pressure sensors. Implanted within the abdominal insert of child dummies, they can be used to detect abdominal loading due to the belt during frontal collisions. In the present study - which is part of the EC funded CASPER project - two versions of APTS (V1 and V2) were evaluated in abdominal belt compression tests, torso flexion test (V1 only) and two series of sled tests with degraded restraint conditions. The results suggest that the two versions have similar responses, and that the pressure sensitivity to torso flexion is limited. The APTS ability to detect abdominal loading in sled tests was also confirmed, with peak pressures typically below 1 bar when the belt loaded only the pelvis and the thorax (appropriate restraint) and values above that level when the abdomen was loaded directly (inappropriate restraint). Then, accident reconstructions performed as part of CASPER and previous EC funded projects were reanalyzed. Selected data from 19 dummies (12 Q6 and 7 Q3) were used to plot injury risk curves. Maximum pressure, maximum pressure rate and their product were all found to be injury predictors. Maximum pressure levels for a 50% risk of AIS3+ were consistent with the levels separating appropriate and inappropriate restraint in the sled tests (e.g. 50% risk of AIS3+ at 1.09 bar for pressure filtered CFC180). Further work is needed to refine the scaling techniques between ages and confirm the risk curves.
Stensby, J Derek; Baker, Jonathan C; Fox, Michael G
The lateral abdominal wall is comprised of three muscles, each with a different function and orientation. The transversus abdominus, internal oblique, and external oblique muscles span the abdominal cavity between the iliocostalis lumborum and quadratus lumborum posteriorly and the rectus abdominis anteriorly. The lateral abdominal wall is bound superiorly by the lower ribs and costal cartilages and inferiorly by the iliac crest and inguinal ligament. The lateral abdominal wall may be acutely or chronically injured in a variety of athletic endeavors, with occasional acute injuries in the setting of high-energy trauma such as motor vehicle collisions. Injuries to the lateral abdominal wall may result in lumbar hernia formation, unique for its high incarceration rate, and also Spigelian hernias. This article will review the anatomy, the magnetic resonance (MR) imaging approach, and the features and complications of lateral abdominal wall injuries.
Shen, Xiao; Sun, Jing; Zhang, Jingzhu; Ke, Lu; Tong, Zhihui; Li, Gang; Jiang, Wei; Li, Weiqin; Li, Jieshou
The incidence of acute bleeding is reported to be 13.5% in patients with acute necrotizing pancreatitis. However, of all the bleeding events, intra-abdominal bleeding was less studied in the literature and its risk factors have not been well defined yet. The purpose of the present study was to investigate the risk factors for massive intra-abdominal bleeding among the patients with infected necrotizing pancreatitis and assessed the outcome of these patients. Both univariate and multivariate logistic regression models were applied for evaluating risk factors for intra-abdominal bleeding using 33 indices, including age, sex, etiology of acute pancreatitis (AP), APACHE II score, etc. Outcome assessments such as mortality, hospital and intensive care unit (ICU) durations, and cost were also compared between patients with or without intra-abdominal bleeding. Acute kidney injury (AKI) (odds ratio [OR]: 7.54, 95% confidence interval [CI]: 2.53-22.52, P < 0.001) and number of operation (OR: 8.84, 95% CI: 2.01-38.86, P = 0.004) were 2 predictors for massive intra-abdominal bleeding in the patients with infected necrotizing pancreatitis. In addition, AP patients with intra-abdominal bleeding also showed significantly higher mortality rate, prolonged hospital and ICU durations, more complications and invasive treatments, as well as increased cost. Our study revealed that AKI and multiple operations were 2 critical factors increasing the risk of intra-abdominal bleeding among patients with infected necrotizing pancreatitis. Additionally, massive intra-abdominal bleeding was also associated with poor prognosis.
Shen, Xiao; Sun, Jing; Zhang, Jingzhu; Ke, Lu; Tong, Zhihui; Li, Gang; Jiang, Wei; Li, Weiqin; Li, Jieshou
Abstract The incidence of acute bleeding is reported to be 13.5% in patients with acute necrotizing pancreatitis. However, of all the bleeding events, intra-abdominal bleeding was less studied in the literature and its risk factors have not been well defined yet. The purpose of the present study was to investigate the risk factors for massive intra-abdominal bleeding among the patients with infected necrotizing pancreatitis and assessed the outcome of these patients. Both univariate and multivariate logistic regression models were applied for evaluating risk factors for intra-abdominal bleeding using 33 indices, including age, sex, etiology of acute pancreatitis (AP), APACHE II score, etc. Outcome assessments such as mortality, hospital and intensive care unit (ICU) durations, and cost were also compared between patients with or without intra-abdominal bleeding. Acute kidney injury (AKI) (odds ratio [OR]: 7.54, 95% confidence interval [CI]: 2.53–22.52, P < 0.001) and number of operation (OR: 8.84, 95% CI: 2.01–38.86, P = 0.004) were 2 predictors for massive intra-abdominal bleeding in the patients with infected necrotizing pancreatitis. In addition, AP patients with intra-abdominal bleeding also showed significantly higher mortality rate, prolonged hospital and ICU durations, more complications and invasive treatments, as well as increased cost. Our study revealed that AKI and multiple operations were 2 critical factors increasing the risk of intra-abdominal bleeding among patients with infected necrotizing pancreatitis. Additionally, massive intra-abdominal bleeding was also associated with poor prognosis. PMID:26181564
Hussain, Qasim; Maleux, Geert Heye, Sam; Fourneau, Inge
Traumatic injury of the abdominal aorta is rare and potentially lethal (Yeh et al., J Vasc Surg 42(5):1007-1009, 2005; Chicos et al., Chirurgia (Bucur) 102(2):237-240, 2007) as it can result in major retroperitoneal hemorrhage, requiring an urgent open surgery. In case of concomitant bowel injury or other conditions of hostile abdomen, endovascular repair can be an alternative treatment. This case report deals with a 50-year-old man presenting at the emergency ward with three stab wounds: two in the abdomen and one in the chest. During explorative laparotomy, liver laceration and bowel perforation were repaired. One day later, abdominal CT-scan revealed an additional retroperitoneal hematoma associated with an aortic pseudoaneurysm, located anteriorly 3 cm above the aortic bifurcation. Because of the risk of graft infection, an endovascular repair of the aortic injury using a Gore excluder stent-graft was performed. Radiological and clinical follow-up revealed a gradual shrinkage of the pseudo-aneurysm and no sign of graft infection at two years' follow-up.
Abdominal wall injuries are reported to be less common than actually perceived by sports medicine practitioners. National Collegiate Athletic Association injury statistics for 2004-2005 cite a high of 0.71 abdominal muscle injuries per 1000 player-hours in wrestling competition to a low of 0.01 injuries per 1000 player-hours in autumn football practices. British professional soccer clubs reported an incidence of "torso" injuries of up to 7% of all injuries over the course of several seasons. Injury definition is most likely the explanation for this discrepancy. The abdominal wall muscles (rectus abdominis, external and internal obliques, and transverse abdominis) are injured by direct blows to the abdomen or by sudden or repetitive trunk movement, either rotation or flexion/extension. With the exception of the rare rectus sheath hematoma that does not self-tamponade, the treatment for these problems is nonoperative with symptoms guiding rehabilitation and return to play decisions.
Wildman, Rachel P; McGinn, Aileen P; Lin, Juan; Wang, Dan; Muntner, Paul; Cohen, Hillel W; Reynolds, Kristi; Fonseca, Vivian; Sowers, MaryFran R
It remains unclear whether abdominal obesity increases cardiovascular disease (CVD) risk independent of the metabolic abnormalities that often accompany it. Therefore, the objective of this study was to evaluate the independent effects of abdominal obesity vs. metabolic syndrome and diabetes on the risk for incident coronary heart disease (CHD) and stroke. The Framingham Offspring, Atherosclerosis Risk in Communities, and Cardiovascular Health studies were pooled to assess the independent effects of abdominal obesity (waist circumference >102 cm for men and >88 cm for women) vs. metabolic syndrome (excluding the waist circumference criterion) and diabetes on risk for incident CHD and stroke in 20,298 men and women aged ≥45 years. The average follow-up was 8.3 (s.d. 1.9) years. There were 1,766 CVD events. After adjustment for demographic factors, smoking, alcohol intake, number of metabolic syndrome components, and diabetes, abdominal obesity was not significantly associated with an increased risk of CVD (hazard ratio (HR) (95% confidence interval): 1.09 (0.98, 1.20)). However, after adjustment for demographics, smoking, alcohol intake, and abdominal obesity, having 1-2 metabolic syndrome components, the metabolic syndrome and diabetes were each associated with a significantly increased risk of CVD (2.12 (1.80, 2.50), 2.82 (1.92, 4.12), and 5.33 (3.37, 8.41), respectively). Although abdominal obesity is an important clinical tool for identification of individuals likely to possess metabolic abnormalities, these data suggest that the metabolic syndrome and diabetes are considerably more important prognostic indicators of CVD risk.
Toczek, Jakub; Meadows, Judith L; Sadeghi, Mehran M
Selection of patients for abdominal aortic aneurysm repair is currently based on aneurysm size, growth rate, and symptoms. Molecular imaging of biological processes associated with aneurysm growth and rupture, for example, inflammation and matrix remodeling, could improve patient risk stratification and lead to a reduction in abdominal aortic aneurysm morbidity and mortality. (18)F-fluorodeoxyglucose-positron emission tomography and ultrasmall superparamagnetic particles of iron oxide magnetic resonance imaging are 2 novel approaches to abdominal aortic aneurysm imaging evaluated in clinical trials. A variety of other tracers, including those that target inflammatory cells and proteolytic enzymes (eg, integrin αvβ3 and matrix metalloproteinases), have proven effective in preclinical models of abdominal aortic aneurysm and show great potential for clinical translation.
Kokabi, Nima; Harmouche, Elie; Xing, Minzhi; Shuaib, Waqas; Mittal, Pardeep K; Wilson, Kenneth; Johnson, Jamlik-Omari; Nicolaou, Savvas; Khosa, Faisal
Gastrointestinal hollow viscus injury after blunt chest and abdominal trauma is uncommon and complicates 0.6%-1.2% of all cases of trauma. Early recognition of such injuries significantly decreases morbidity and mortality. Since physical examination is not accurate in detecting such injuries, contrast-enhanced computed tomography has been the mainstay for diagnosis in many emergency departments. This pictorial essay aims to review the incidence, mechanisms, and signs of gastrointestinal hollow viscus injuries in the setting of blunt chest and abdominal trauma.
Tubez, François; Forthomme, Bénédicte; Croisier, Jean-Louis; Cordonnier, Caroline; Brüls, Olivier; Denoël, Vincent; Berwart, Gilles; Joris, Maurice; Grosdent, Stéphanie; Schwartz, Cédric
The serve is an important stroke in any high level tennis game. A well-mastered serve is a substantial advantage for players. However, because of its repeatability and its intensity, this stroke is potentially deleterious for upper limbs, lower limbs and trunk. The trunk is a vital link in the production and transfer of energy from the lower limbs to the upper limbs; therefore, kinematic disorder could be a potential source of risk for trunk injury in tennis. This research studies the case of a professional tennis player who has suffered from a medical tear on the left rectus abdominis muscle after tennis serve. The goal of the study is to understand whether the injury could be explained by an inappropriate technique. For this purpose, we analyzed in three dimensions the kinematic and kinetic aspects of the serve. We also performed isokinetic tests of the player's knees. We then compared the player to five other professional players as reference. We observed a possible deficit of energy transfer because of an important anterior pelvis tilt. Some compensation made by the player during the serve could be a possible higher abdominal contraction and a larger shoulder external rotation. These particularities could induce an abdominal overwork that could explain the first injury and may provoke further injuries. Key pointsIn the proximal-distal sequence, energy is transmitted from lower limbs to upper limps via trunk.The 3D analysis tool is an indispensable test for an objective evaluation of the kinematic in the tennis serve.Multiple evaluations techniques are useful for fuller comprehension of the kinematics and contribute to the awareness of the player's staff concerning pathologies and performance.
Schneider, H J; Klotsche, J; Friedrich, N; Schipf, S; Völzke, H; Silber, S; März, W; Nauck, M; Pittrow, D; Wehling, M; Sievers, C; Lehnert, H; Stalla, G K; Wittchen, H-U; Wallaschofski, H
Obesity is associated with the metabolic syndrome. However, not all obese individuals have cardiovascular risk factors (CVRF). It is not clear how many abdominally obese individuals are free of CVRF and what distinguishes them from the group of obese individuals with CVRF. In this study, we aimed to assess the associated factors and prevalence of abdominal obesity without CVRF. In our cross-sectional analysis, we included n = 4244 subjects from the Study of Health in Pomerania (SHIP), a population-based study and n = 6671 subjects from the Diabetes Cardiovascular Risk-Evaluation: Targets and Essential Data for Commitment of Treatment (DETECT) study, a representative primary care study in Germany. We defined abdominal obesity by waist-to-height ratio (WHtR) of 0.5 or greater. We assessed how many subjects with abdominal obesity had CVRF based on the definition of the metabolic syndrome. We analysed which conditions were associated with the absence of CVRF in abdominal obesity. In SHIP and DETECT, 2652 (62.5%) and 5126 (76.8%) subjects had a WHtR ≥ 0.5. Among those with a WHtR ≥ 0.5, 9.0% and 13.8% were free of CVRF and 49.9% and 52.7% had at least two CVRF in SHIP and DETECT, respectively. In both studies, after backward elimination, age, male sex, body mass index and high liver enzymes and unemployment were consistently inversely associated with the absence of CVRF. Among abdominally obese subjects, the prevalence of metabolically healthy subjects is low. Conditions consistently associated with the absence of CVRF in abdominal obesity are younger age, female sex, low BMI, and normal liver enzymes, the latter likely reflecting the absence of steatohepatitis.
Parkkari, J; Kannus, P; Natri, A; Lapinleimu, I; Palvanen, M; Heiskanen, M; Vuori, I; Järvinen, M
The purpose of this study was to get reliable insight into injury risk in various commuting and lifestyle activities, as well as recreational and competitive sports. A cohort of 3 657 persons was randomly selected from the 15- to 74-year-old Finnish population. Ninety-two percent (n = 3 363) of the subjects accepted to participate the one-year follow-up, record all their physical activities that lasted 15 min or more, and register all acute and overuse injuries that occurred during these activities. To collect the information, the study subjects were interviewed by phone by the trained personnel of the Statistics Finland three times in four-month intervals. The individual injury risk per exposure time was relatively low, ranging from 0.19 to 1.5 per 1 000 hours of participation, in commuting and lifestyle activities including walking and cycling to work, gardening, home repair, hunting and fishing, and, in sports such as golf, dancing, swimming, walking, and rowing. The risk was clearly higher in squash, orienteering, and contact and team sports, such as judo, wrestling, karate, rinkball, floorball, basketball, soccer, ice hockey, volleyball, and Finnish baseball ranging from 6.6 to 18.3 per 1 000 hours of participation. However, the highest absolute number of injuries occurred in low-risk activities, such as gardening, walking, home-repair, and cycling, because they are performed so often. In conclusion, individual injury risk per exposure hours is relatively low in commuting and lifestyle activities compared to many recreational and competitive sports. However, at a population level, these low-to-moderate intensity activities are widely practised producing a rather high absolute number of injuries, and thus, preventive efforts are needed in these activities, too.
Papadoliopoulos, Ioannis; Bourikos, Panagiotis; Chloptsios, Christos; Ilias, Georgios; Moustakis, Elias; Karanasiou, Vasilissa; Stamatiou, Kostantinos
Pancreatic laceration due to blunt trauma is relatively uncommon and it is less likely to accompany injury of a retroperitoneal organ. While renal injuries are easily detectable in both clinical and radiographic imaging examination, pancreatic injuries are difficult to diagnose clinically and in several cases remain occult. Although ultrasonography is not generally recommended for initial assessment of the trauma patient and its role is limited in the follow-up of contained intra- or perihepatic bilomas that are treated conservatively, it was demonstrated to be capable for exploration of pancreatic injuries as well. We present a case of a 23-year-old male with pancreatic injury found in ultrasonography.
Marks, Wojciech; Białko, Marek; Stasiak, Mariusz; Deja, Włodzimierz; Penkowski, Michał; Golabek-Dropiewska, Katarzyna; Lasek, Jerzy
Gunshot injuries are quite common nowadays. Increasing numbers of high-pressure injection injuries are also being observed with a good correlation with industrial progress. High-pressure devices produce pressures and velocities of fluid streams similar to those generated in firearms. However, no missile plays a part in high-pressure injection injuries. We present the unusual case of mixed missile and hydroblast injury, which has not yet been reported. Physical characteristics, typical patterns of injury and the possibility of infectious complications are shown. The importance of educating workers about safety precautions is emphasised. PMID:21686888
Ahmed, Zahoor; Nabir, Syed; Ahmed, Mohamed Nadeem; Al Hilli, Shatha; Ravikumar, Vajjala; Momin, Umais Zaid
Summary Background Blunt abdominal trauma is routinely encountered in the Emergency Department. It is one of the main causes of morbidity and mortality amongst the population below the age of 35 years worldwide. Renal artery injury secondary to blunt abdominal trauma however, is a rare occurrence. Here, we present two such cases, encountered in the emergency department sustaining polytrauma following motor vehicle accidents. Case Report We hereby report two interesting cases of renal artery injury sustained in polytrauma patients. In these two cases we revealed almost the entire spectrum of findings that one would expect in renal arterial injuries. Conclusions Traumatic renal artery occlusion is a rare occurrence with devastating consequences if missed on imaging. Emergency radiologists need to be aware of the CT findings so as to accurately identify renal artery injury. This case report stresses the need for immediate CT assessment of polytrauma patients with suspected renal injury, leading to timely diagnosis and urgent surgical or endovascular intervention. PMID:28058071
Falimirski, M E; Provost, D
Age greater than 55 is often stated to be a contraindication to nonoperative management of intraperitoneal solid organ injury, based upon failures in early experiences of nonoperative therapy. Refinements in the criteria for nonoperative management of hepatic and splenic injuries have yielded improved success rates compared with those in initial reports, raising questions as to the validity of an age-related contraindication. A retrospective chart review of patients more than 55 years of age sustaining blunt hepatic and/or splenic injury at two urban Level I trauma centers was performed. Patients were stratified into three groups in which selection criteria could not consistently be determined: those managed nonoperatively, those managed operatively, and those who died within 24 hours. The purpose of this review is to identify whether age is a determinant for nonoperative management of abdominal solid organ injury. Eighty-eight patients were identified (mean age, 68.7 +/- 9.8), 17 of whom died in the emergency department or after operative intervention. Of the remaining 71 patients, 37 were originally managed nonoperatively (mean age 69.9 +/- 9.1, mean Injury Severity Score 19.9), 24 sustained hepatic injuries (grades I-IV), 12 sustained splenic injuries (grades I-III), and one patient sustained both organ injuries. Three patients with multisystem trauma died from complications unrelated to their solid organ injury (one brain death, one septic death, and one respiratory arrest). A single patient, with a grade I liver injury, required delayed exploration (for a persistent, unexplained metabolic acidosis) and underwent a nontherapeutic celiotomy. All but one of the 37 patients were successfully treated nonoperatively, for a 97 per cent success rate. We conclude that hemodynamically stable patients more than 55 years of age sustaining intra-abdominal injury can be observed safely. Age alone should no longer be considered an exclusion criterion for nonoperative
Chapman, Brandon C.; Moore, Ernest E.; Barnett, Carlton; Stovall, Robert T.; Biffl, Walter L.; Burlew, Clay C.; Bensard, Denis D.; Jurkovich, Gregory J.; Pieracci, Fredric M.
Background The optimal time to initiate venous thromboembolism pharmacoprophylaxis after blunt abdominal solid organ injury is unknown. Methods Postinjury coagulation status was characterized using thromboelastography (TEG) in trauma patients with blunt abdominal solid organ injuries; TEG was divided into 12-hour intervals up to 72 hours. Results Forty-two of 304 patients (13.8%) identified underwent multiple postinjury thromboelastographic studies. Age (P = .45), gender (P = .45), and solid organ injury grade (P = .71) were similar between TEG and non-TEG patients. TEG patients had higher Injury Severity Scores compared with non-TEG patients (33.2 vs 18.3, respectively, P < .01). Among the TEG patients, the shear elastic modulus strength and maximum amplitude values began in the normal range within the first 12-hour interval after injury, increased linearly, and crossed into the hypercoagulable range at 48 hours (15.1 ± 1.9 Kd/cs and 57.6 ± 1.6 mm, respectively; P < .01, analysis of variance). Conclusions Patients sustaining blunt abdominal solid organ injuries transition to a hypercoagulable state approximately 48 hours after injury. In the absence of contraindications, pharmacoprophylaxis should be considered before this time for effective venous thromboembolism prevention. PMID:24112665
Gilani, Ramyar; Saucedo-Crespo, Hector; Scott, Bradford G; Tsai, Peter I; Wall, Metthew J; Mattox, Kenneth L
Blunt abdominal aortic injury (BAAI) is a rare and lethal injury requiring surgical management. Injury patterns can be complex and surgical strategy should accommodate specific case circumstances. Endovascular solutions appear appropriate and preferred in certain cases of BAAI, which, however, may not be applicable due to device limitations in regard to patient anatomy and limited operating room capability. However, endovascular therapy can be pursued with limited fluoroscopy capability and consumable availability providing a solution that is expeditious and effective for select cases of BAAI.
Pyogenic vertebral osteomyelitis is a rare condition usually associated with endocarditis or spinal surgery. However, it may also occur following abdominal penetrating trauma with associated gastrointestinal perforation. Diagnosis might be challenging and appropriate treatment is essential to ensure a positive outcome. In trans-abdominal trauma, 48 hours of broad-spectrum antibiotics is generally recommended for prophylaxis of secondary infections. A case report of vertebral osteomyelitis complicating trans-colonic injury to the retroperitoneum is presented and clinical management is discussed in the light of literature review. PMID:24373134
Smith, Helen C.; Vacek, Pamela; Johnson, Robert J.; Slauterbeck, James R.; Hashemi, Javad; Shultz, Sandra; Beynnon, Bruce D.
Context: Injuries to the anterior cruciate ligament (ACL) are immediately disabling and are associated with long-term consequences, such as posttraumatic osteoarthritis. It is important to have a comprehensive understanding of all possible risk factors for ACL injury to identify individuals who are at risk for future injuries and to provide an appropriate level of counseling and programs for prevention. Objective: This review, part 2 of a 2-part series, highlights what is known and still unknown regarding hormonal, genetic, cognitive function, previous injury, and extrinsic risk factors for ACL injury. Data Sources: Studies were identified from MEDLINE (1951–March 2011) using the MeSH terms anterior cruciate ligament, knee injury, and risk factors. The bibliographies of relevant articles and reviews were cross-referenced to complete the search. Study Selection: Prognostic case-control and prospective cohort study designs to evaluate risk factors for ACL injury were included in this review. Results: A total of 50 case-control and prospective cohort articles were included in parts 1 and 2. Twenty-one focused on hormonal, genetic, cognitive function, previous injury, and extrinsic risk factors. Conclusions: Several risk factors are associated with increased risk of suffering ACL injury—such as female sex, prior reconstruction of the ACL, and familial predisposition. These risk factors most likely act in combination with the anatomic factors reviewed in part 1 of this series to influence the risk of suffering ACL injury. PMID:23016083
James, Lachlan P; Kelly, Vincent G; Beckman, Emma M
Volleyball is an increasingly popular team sport. As with any competitive sport, there is an inherent risk of injury that must be recognized and collaboratively managed. This article provides a practical approach to the management of volleyball injuries within a team or organization. A brief review of the epidemiological data is presented which establishes (i) ankle sprain, (ii) shoulder overuse injury, (iii) patella tendinopathy, and (iv) anterior cruciate ligament injury as the primary injuries to address amongst these athletes. The interaction of modifiable and non-modifiable risk factors for these injuries are used to classify athletes into high-, medium- and low-risk groups. Targeted training interventions are suggested, based upon the risk level of the athlete, to minimize the occurrence of these injuries. Practical methods for integrating these activities into a training plan are also discussed.
CREMONTE, MARIANA; CHERPITEL, CHERYL J.
Injuries constitute a leading cause of morbidity and mortality in the world, with intentional injuries and those related to traffic most important, due to their social impact and high prevalence. Although alcohol consumption has been identified as a risk factor for injuries, few studies have assessed risk separately for intentional injuries and unintentional injuries caused by traffic, and by other causes. The objective of this paper was to estimate the risk of injuries after acute alcohol consumption for intentional injuries and unintentional traffic and non-traffic injuries, using, alternatively, two exposure measures: self-reported drinking prior to the event and blood alcohol concentration. A probability sample was collected of 540 patients from the emergency department of a hospital in Argentina. Logistic regressions were performed, with and without adjusting for gender, age and drinking pattern. Higher risks were found when blood alcohol concentration was used as a measure of consumption, compared to self-report. The highest risk estimates were obtained for intentional injuries, followed by unintentional traffic and, lastly, by unintentional non-traffic injuries. After controlling for confounders, risks for intentional and unintentional traffic injuries appeared similar for those above and below the legal limit. Results point to a significant involvement of alcohol in the regional context. PMID:25188654
Cremonte, Mariana; Cherpitel, Cheryl J
Injuries constitute a leading cause of morbidity and mortality in the world, with intentional injuries and those related to traffic most important, due to their social impact and high prevalence. Although alcohol consumption has been identified as a risk factor for injuries, few studies have assessed risk separately for intentional injuries and unintentional injuries caused by traffic, and by other causes. The objective of this paper was to estimate the risk of injuries after acute alcohol consumption for intentional injuries and unintentional traffic and non-traffic injuries, using, alternatively, two exposure measures: self-reported drinking prior to the event and blood alcohol concentration. A probability sample was collected of 540 patients from the emergency department of a hospital in Argentina. Logistic regressions were performed, with and without adjusting for gender, age and drinking pattern. Higher risks were found when blood alcohol concentration was used as a measure of consumption, compared to self-report. The highest risk estimates were obtained for intentional injuries, followed by unintentional traffic and, lastly, by unintentional non-traffic injuries. After controlling for confounders, risks for intentional and unintentional traffic injuries appeared similar for those above and below the legal limit. Results point to a significant involvement of alcohol in the regional context.
Jones, Benjamin P; Hunjan, Tia; Terry, Jayne
Complete congenital absence of the omentum is very rare with only one previously reported case. We present a unique case of the management of a pregnant woman with a large pelvic pseudocyst caused by complications related to congenital absence of omentum, resulting in acute kidney injury, likely secondary to acute compartment syndrome. This case highlights the importance of considering acute compartment syndrome in critically unwell pregnant women and reiterates the need to measure intra-abdominal pressure when clinically indicated. Given that pregnancy is in itself a state of intra-abdominal hypertension, obstetricians should maintain a high index of suspicion in the context of additional risk factors.
Paulus, Elena M; Croce, Martin A; Shahan, Charles P; Zarzaur, Ben L; Sharpe, John P; Dileepan, Amirtha; Boyd, Brandon S; Fabian, Timothy C
The strong association between penetrating colon injuries and intra-abdominal abscess (IAA) formation is well established and attributed to high colon bacterial counts. Since trauma patients are rarely fasting at injury, stomach and small bowel colony counts are also elevated. We hypothesized that there is a synergistic effect of increased IAA formation with concomitant stomach and/or colon injuries when compared to small bowel injuries alone. Consecutive patients at a level one trauma center with penetrating small bowel (SB), stomach (S), and/or colon (C) injuries from 1996 to 2012 were reviewed. Logistic regression determined associations with IAA, adjusting for age, gender, Injury Severity Score (ISS), admission Glasgow Coma Score, transfusions, and concurrent pancreas or liver injury. A total of 1518 patients (91% male, ISS = 15.9 ± 8.4) were identified: 496 (33%) SB, 231 (15%) S, 288 (19%) C, 40 (3%) S + SB, 69 (5%) S + C, 338 (22%) C + SB, and 56 (4%) S + C + SB. 148 (10%) patients developed IAA: 4 per cent SB, 9 per cent S, 10 per cent C, 5 per cent S + SB, 22 per cent S + C, 13 per cent C + SB, and 25 per cent S + C + SB. Multiple logistic regression demonstrated that ISS, 24 hour blood transfusions, and concomitant pancreatic or liver injuries were associated with IAA. Compared with reference SB, S or S + SB injuries were no more likely to develop IAA. However, S + C, SB + C, and S + C + SB injuries were significantly more likely to have IAA. In conclusion, combined stomach + colon, small bowel + colon, and stomach, colon, + small bowel injuries have a synergistic effect leading to increased IAA formation after penetrating injuries. Heightened clinical suspicion for IAA formation is necessary in these combined hollow viscus injury patients.
Danielian, Sh N; Abakumov, M M; Vil'k, A P; Saprin, A A; Tatarinova, E V
It was performed retrospective analysis of 463 cases of suppurative thoracic complications after injury (232) and closed thoracic trauma (231) for 20-year period. Incidence of purulent complications was 3.2% and 1.6% in case of injury and closed thoracic trauma respectively including pleural empyema in 1.5 and 1.3%, pulmonary abscess in 0.3 and 0.4%, mediastinitis in 0.35 and 0.12%, pericarditis in 1.5 and 0.26%, osteomyelitis in 0.4 and 0.18% respectively. Factors preceding suppurative complications in case of injuries and closed trauma have been considered as predictors. Multivariant regression analysis established significant risk factors of suppurative thoracic complications. Clotted hemothorax, mediastinal hemorrhage, heart injury, late appeal for medical assistance and mechanical ventilation over 5 days were identified irrespective of character of trauma. In case of thoracic injury there were damage of osteochondrous frame, hollow thoracic and abdominal organs, gunshot wound of lung, delirium and injuries severity over 20 scores according to ISS scale. Pulmonary bleeding, sternal fracture and Glasgow Coma Scale rate<12 scores were identified as risk factors in case of closed trauma.
Alcocer, Francisco; Aguilar, Jesus; Agraz, Salvador; Jordan, William D
Ligation for penetrating abdominal vein trauma may have better outcome than a vascular reconstruction in an unstable patient. However, symptoms of chronic venous insufficiency may appear over time. We describe our surgical experience with 4 patients who underwent iliac vein ligation followed by venous bypass with a modified Palma derivation between 48 and 240 hours after sustaining penetrating abdominal trauma with concomitant iliac vein injury. Patients were assessed for venous symptoms and conduit patency with continuous wave Doppler and duplex scanning. One graft occluded acutely and the remaining three remain patent with functioning valves. In order to preserve venous outflow after severe iliac vein injury, we think that venous ligation as a part of damage control surgery followed by a modified Palma operation may prevent chronic symptoms of venous outflow obstruction without compromising an already injured patient.
Jha, Nawal Kishore; Yadav, Sanjay Kumar; Sharma, Rajshekhar; Sinha, Dipendra Kumar; Kumar, Sandip; Kerketta, Marshal Daud; Sinha, Mini; Anand, Abhinav; Gandhi, Anjana; Ranjan, Satish Kumar; Yadav, Jitin
Objective: To determine the presentation, anatomical distribution, diagnostic method, management and outcome of hollow viscus injury (HVI) from blunt abdominal trauma. Methods: This was a retrospective cross-ecnal study including patients with blunt abdominal trauma leading to HVI admitted at Rajendra Institute of Medical Sciences, Ranchi, over a period of 4.5 years (January 2009 to July 2014). Data were retrieved from patients’ medical records. Total 173 patients with HVI due to blunt abdominal trauma, who underwent laparotomy at our institute, were reviewed. Data regarding clinical presentation, anatomical distribution, management and outcome were recorded and analysed. Results: Out of 173 patients 87.1% were men and 12.9% were women. Mean age of patients was 29±14.02 years. The most common site of injury was ileum (46.2%) followed by jejunum (44.5%). There were 5 gastric perforations (2.9%), 2 (1.15%) duodenal, 2 (1.15%) colonic, 2 (1.15%) sigmoidal and 2 (1.15%) rectal injuries. One caecal injury was also recorded. Road traffic accident was the most common mechanism of injury (57.2%) followed by fall from height (36.4%) and assault (6.4%). Free gas under diaphragm on erect abdomen radiography was seen in 85.5% of cases while preoperative CT Abdomen was done in 11.6% of cases. Treatment consisted of simple closure of the perforation (66.5%), resection and anastomosis (11.0%) and stoma (22.5%). Major complication was anastamotic leak which was recorded in 6.4% cases and 15.6% patients developed burst abdomen. Average hospital stay was 13±6 days. Overall mortality rate was 12.7%. Conclusion: Although early recognition of intestinal injuries from blunt abdominal trauma may be difficult in all cases, it is very important due to its tremendous life threatening potential. Age of the patient, anatomical site and time of presentation are probably main prognostic factors. PMID:27162889
The basic characteristics of war in Sarajevo are occasional shelling, sniper fire, unexpected shelling and a lack of a front line in the classic sense of the word. The extent of the wound is the key factor in deciding how the patient is to be treated. A primary contamination of this kind of wound has all the conditions to turn into a manifest infection. The abdomen wounds, because of their severity and direct threat to life, are among the most dangerous wounds altogether. They make up on average 10% of all war wounds and the mortality of these patients by today's literature is high, about 6%. The aims of this paper are to show which organs in the abdomen are wounded and what is their relationship to the wounding of the colon, and to show what is the relation between multiple and isolated wounding of the abdomen. During the years 1992 and 1993, 1106 patients with war wounds were treated at the clinic for the abdominal surgery. From that number 71 patients were treated with explorative laparotomy. The large intestine was injured in 274 patients while 221 patients had injuries of the small intestine. An injury of the liver was found in 165 cases. The gall bladder was injured in 18 cases. The stomach was injured in 324 patients. The pancreas was damaged in 72 patients. There were 94 cases of injured spleens. The kidneys were wounded in 30 cases. In 40 cases there was bleeding from the retroperitoncum. Treatment of the omentumen was carried out in 753 patients. The number of patients who did not survive is 135 of which 44 had an injury of the large intestine. A retrospective analysis data shows that the number of multiple wounds makes up over 98% of all wounds. Isolated wounds of abdominal organs are found in less than 2% of all cases. The increase mortality in our research can be explained greater energy of the projectiles which amplify the acceleration at asphalt surfaces which product the greater destructions of the tissue and the massiveness of the injuries.
Neuhof, A; Hennig, F F; Schöffl, I; Schöffl, V
The aim of this study was to quantify and rate acute sport climbing injuries. Acute sport climbing injuries occurring from 2002 to 2006 were retrospectively assessed with a standardized web based questionnaire. A total number of 1962 climbers reported 699 injuries, which is equivalent to 0.2 injuries per 1 000 h of sport participation. Most (74.4%) of the injuries were of minor severity rated NACA I or NACA II. Injury distribution between the upper (42.6%) and lower extremities (41.3%) was similar, with ligament injuries, contusions and fractures being the most common injury types. Years of climbing experience (p<0.01), difficulty level (p<0.01), climbing time per week during summer (p<0.01) and winter (p<0.01) months were correlated with the injury rate. Age (p<0.05 (p=0.034)), years of climbing experience (p<0.01) and average climbing level (p<0.01) were correlated to the injury severity rated through NACA scores. The risk of acute injuries per 1 000 h of sport participation in sport climbing was lower than in previous studies on general rock climbing and higher than in studies on indoor climbing. In order to perform inter-study comparisons of future studies on climbing injuries, the use of a systematic and standardized scoring system (UIAA score) is essential.
Smith, Helen C.; Vacek, Pamela; Johnson, Robert J.; Slauterbeck, James R.; Hashemi, Javad; Shultz, Sandra
Context: Injuries to the anterior cruciate ligament (ACL) of the knee are immediately debilitating and can cause long-term consequences, including the early onset of osteoarthritis. It is important to have a comprehensive understanding of all possible risk factors for ACL injury to identify individuals who are at risk for future injuries and to provide an appropriate level of counseling and programs for prevention. Objective: This review, part 1 of a 2-part series, highlights what is known and still unknown regarding anatomic and neuromuscular risk factors for injury to the ACL from the current peer-reviewed literature. Data Sources: Studies were identified from MEDLINE (1951–March 2011) using the MeSH terms anterior cruciate ligament, knee injury, and risk factors. The bibliographies of relevant articles and reviews were cross-referenced to complete the search. Study Selection: Prognostic studies that utilized the case-control and prospective cohort study designs to evaluate risk factors for ACL injury were included in this review. Results: A total of 50 case-control and prospective cohort articles were included in the review, and 30 of these studies focused on neuromuscular and anatomic risk factors. Conclusions: Several anatomic and neuromuscular risk factors are associated with increased risk of suffering ACL injury—such as female sex and specific measures of bony geometry of the knee joint, including decreased intercondylar femoral notch size, decreased depth of concavity of the medial tibial plateau, increased slope of the tibial plateaus, and increased anterior-posterior knee laxity. These risk factors most likely act in combination to influence the risk of ACL injury; however, multivariate risk models that consider all the aforementioned risk factors in combination have not been established to explore this interaction. PMID:23016072
Fischer, Tatjana V; Folio, Les R; Backus, Christopher E; Bunger, Rolf
Penetrating trauma is frequently encountered in forward deployed military combat hospitals. Abdominal blast injuries represent nearly 11% of combat injuries, and multiplanar computed tomography imaging is optimal for injury assessment and surgical planning. We describe a multiplanar approach to assessment of blast and ballistic injuries, which allows for more expeditious detection of missile tracts and damage caused along the path. Precise delineation of the trajectory path and localization of retained fragments enables time-saving and detailed evaluation of associated tissue and vascular injury. For consistent and reproducible documentation of fragment locations in the body, we propose a localization scheme based on Cartesian coordinates to report 3-dimensional locations of fragments and demonstrating the application in three cases of abdominal blast injury.
Drew, Michael K; Cook, Jill; Finch, Caroline F
Training loads contribute to sports injury risk but their mitigation has rarely been considered in a sports injury prevention framework. A key concept behind monitoring training loads for injury prevention is to screen for those at increased risk of injury so that workloads can be adjusted to minimise these risks. This review describes how advances in management of workload can be applied as a preventive measure. Primary prevention involves screening for preparticipation load risk factors, such as low training loads, prior to a training period or competition. Secondary prevention involves screening for workloads that are known to precede an injury developing so that modification can be undertaken to mitigate this risk. Tertiary prevention involves rehabilitation practices that include a graded return to training programme to reduce the risk of sustaining a subsequent injury. The association of training loads with injury incidence is now established. Prevention measures such as rule changes that affect the workload of an athlete are universal whereas those that address risk factors of an asymptomatic subgroup are more selective. Prevention measures, when implemented for asymptomatic individuals exhibiting possible injury risk factors, are indicated for an athlete at risk of developing a sports injury. Seven key indicated risks and associated prevention measures are proposed.
Nonpowder guns (ball-bearing [BB] guns, pellet guns, air rifles, paintball guns) continue to cause serious injuries to children and adolescents. The muzzle velocity of these guns can range from approximately 150 ft/second to 1200 ft/second (the muzzle velocities of traditional firearm pistols are 750 ft/second to 1450 ft/second). Both low- and high-velocity nonpowder guns are associated with serious injuries, and fatalities can result from high-velocity guns. A persisting problem is the lack of medical recognition of the severity of injuries that can result from these guns, including penetration of the eye, skin, internal organs, and bone. Nationally, in 2000, there were an estimated 21840 (coefficient of variation: 0.0821) injuries related to nonpowder guns, with approximately 4% resulting in hospitalization. Between 1990 and 2000, the US Consumer Product Safety Commission reported 39 nonpowder gun-related deaths, of which 32 were children younger than 15 years. The introduction of high-powered air rifles in the 1970s has been associated with approximately 4 deaths per year. The advent of war games and the use of paintball guns have resulted in a number of reports of injuries, especially to the eye. Injuries associated with nonpowder guns should receive prompt medical management similar to the management of firearm-related injuries, and nonpowder guns should never be characterized as toys.
Wang, Hao; Robinson, Richard D.; Phillips, Jessica L.; Ryon, Andrew; Simpson, Scott; Ford, Jonathan R.; Umejiego, Johnbosco; Duane, Therese M.; Putty, Bradley; Zenarosa, Nestor R.
Background Thromboelastography (TEG) has been utilized for the guidance of blood component therapy (BCT). We aimed to investigate the association between emergent TEG-guided BCT and clinical outcomes in patients with traumatic abdominal solid organ (liver and/or spleen) injuries. Methods A single center retrospective study of patients who sustained traumatic liver and/or spleen injuries receiving emergent BCT was conducted. TEG was ordered in all these patients. Patient demographics, general injury information, outcomes, BCT, and TEG parameters were analyzed and compared in patients receiving TEG-guided BCT versus those without. Results A total of 166 patients were enrolled, of whom 52% (86/166) received TEG-guided BCT. A mortality of 12% was noted among patients with TEG-guided BCT when compared with 19% of mortality in patients with non-TEG-guided BCT (P > 0.05). An average of 4 units of packed red blood cell (PRBC) was received in patients with TEG-guided BCT when compared to an average of 9 units of PRBC received in non-TEG-guided BCT patients (P < 0.01). A longer hospital length of stay (LOS, 19 ± 16 days) was found among non-TEG-guided BCT patients when compared to the TEG-guided BCT group (14 ± 12 days, P < 0.05). TEG-guided BCT showed as an independent factor associated with hospital LOS after other variables were adjusted (coefficiency: 5.44, 95% confidence interval: 0.69 - 10.18). Conclusions Traumatic abdominal solid organ injury patients receiving blood transfusions might benefit from TEG-guided BCT as indicated by less blood products needed and less hospitalization stay among the cohort.
Ramirez, M; Peek-Asa, C; Kraus, J
Objective: Approximately six million children with disabilities attend school in the United States. Cognitive and physical limitations may compromise their ability to handle environmental hazards and hence increase their risk for injury. The objective of this study was to describe the epidemiology of school related injury among children enrolled in 17 special education schools in one large, urban school district. Design: Altogether 6769 schoolchildren with disabilities were followed up from 1994–98. Injury and population data were collected from pupil accident reports and existing school records. Associations were estimated through generalized estimating equations. Results: A total of 697 injuries were reported for a rate of 4.7/100 students per year. Children with multiple disabilities had a 70% increased odds of injury compared with the developmentally disabled (odds ratio (OR) 1.7, 95% confidence interval (CI) 1.3 to 2.3). The physically disabled (OR 1.4, 95% CI 1.0 to 1.9) had a modest increased odds of injury. Cuts, bruises, and abrasions composed almost three fourths of all injuries; almost half of these injuries were to the face. Falls (34%) and insults by other students (31%) were the most common external causes. More than a fourth of injuries were sports related, and 21% occurred on the playground/athletic field. Injury patterns differed across disabilities. Conclusions: Although limited to one school district, the population studied is the largest cohort thus far of schoolchildren with disabilities. With this large study base, potentially high risk groups were identified and circumstances of injury described. This information is imperative for developing and improving school based injury prevention measures. PMID:14760022
Abdominal catastrophe is a serious clinical condition, usually being a complication arising during treatment of intraabdominal nontraumatic disorders or abdominal injuries. Most commonly, inflamation- secondary peritonitis, is concerned. Abdominal catastrophe also includes secondary signs of sepsis, abdominal compartment syndrome and enterocutaneous fistules. Most septic abdominal disorders which show signs of abdominal catastrophy, require surgical intervention and reinterventions--planned or "on demand" laparotomies. During the postoperative period, the patient requires intensive care management, including steps taken to stabilize his/hers condition, management of sepsis and metabolic and nutritional support measures, as well as adequate indication for reoperations. New technologies aimed at prevention of complications in laparostomies and to improve conditions for final laparotomy closure are used in phase procedures for surgical management of intraabdominal infections. Despite the new technologies, abdominal catastrophe has higher morbidity and lethality risk rates.
Takeoka, Atsushi; Tayama, Jun; Yamasaki, Hironori; Kobayashi, Masakazu; Ogawa, Sayaka; Saigo, Tatsuo; Kawano, Hiroaki; Abiru, Norio; Hayashida, Masaki; Maeda, Takahiro; Shirabe, Susumu
Abstract Accumulation of intra-abdominal fat is related to hypertension. Despite this, a relationship between hypertension and intra-abdominal fat in young adulthood is not clear. In this study, we verify whether intra-abdominal fat accumulation increases a hypertension risk in young adult subjects. In a cross-sectional study, intra-abdominal fat area was measured using a dual bioelectrical impedance analysis instrument in 697 university students (20.3 ± 0.7 years, 425 men). Blood pressure and anthropometric factors were measured. Lifestyle variables including smoking, drinking, physical activity, and eating behavior were assessed with questionnaire. High blood pressure risk (systolic blood pressure ≥130 mm Hg and/or diastolic blood pressure ≥85 mm Hg) with increasing intra-abdominal fat area was evaluated. Participants were divided into 5 groups according to their intra-abdominal fat area (≤24.9, 25–49.9, 50–74.9, 75–99.9, and ≥100 cm2). As compared with the values of the smallest intra-abdominal fat area group, the crude and lifestyle-adjusted odds ratios (ORs) were elevated in larger intra-abdominal fat area groups [OR 1.31, 95% confidence interval (CI) 0.66–2.80; OR 3.38, 95% CI 1.60–7.57; OR 7.71, 95% CI 2.75–22.22; OR 18.74, 95% CI 3.93–105.64, respectively). The risk increase was observed only in men. Intra-abdominal fat accumulation is related to high blood pressure in men around 20 years of age. These results indicate the importance of evaluation and reduction of intra-abdominal fat to prevent hypertension. PMID:27828861
Gameiro, Joana; Neves, Joana Briosa; Rodrigues, Natacha; Bekerman, Catarina; Melo, Maria João; Pereira, Marta; Teixeira, Catarina; Mendes, Inês; Jorge, Sofia; Rosa, Rosário; Lopes, José António
Background Acute kidney injury (AKI) is frequent during hospitalization and may contribute to adverse consequences. We aimed to evaluate long-term adverse renal function and mortality after postoperative AKI in a cohort of patients undergoing major abdominal surgery. Methods We performed a retrospective analysis of adult patients who underwent major non-vascular abdominal surgery between January 2010 and February 2011 at the Department of Surgery II of Hospital de Santa Maria–Centro Hospitalar Lisboa Norte, Portugal. Exclusion criteria were as follows: chronic kidney disease on renal replacement therapy, undergoing renal replacement therapy the week before surgery, death before discharge and loss to follow-up through January 2014. Patients were categorized according to the development of postoperative AKI in the first 48 h after surgery using the Kidney Disease: Improving Global Outcomes classification. AKI was defined by an increase in absolute serum creatinine (SCr) ≥0.3 mg/dL or by a percentage increase in SCr ≥50% and/or by a decrease in urine output to <0.5 mL/kg/h for >6 h. Adverse renal outcomes (need for long-term dialysis and/or a 25% decrease in estimated glomerular filtration rate after hospital discharge) and mortality after discharge were evaluated. Cumulative mortality was analysed with the Kaplan–Meier method and log-rank test and outcome predictive factors with the Cox regression. Significance was set at P < 0.05. Results Of 390 selected patients, 72 (18.5%) developed postoperative AKI. The median follow-up was 38 months. Adverse renal outcomes and death after hospital discharge were more frequent among AKI patients (47.2 versus 22.0%, P < 0.0001; and 47.2 versus 20.5%, P < 0.0001, respectively). The 4 year cumulative probability of death was 44.4% for AKI patients, while it was 19.8% for patients with no AKI (log-rank test, P < 0.0001). In multivariate analysis, AKI was a risk factor for adverse renal outcomes (adjusted hazard ratio 1.6, P
Polzer, Stanislav; Gasser, T Christian
A rupture risk assessment is critical to the clinical treatment of abdominal aortic aneurysm (AAA) patients. The biomechanical AAA rupture risk assessment quantitatively integrates many known AAA rupture risk factors but the variability of risk predictions due to model input uncertainties remains a challenging limitation. This study derives a probabilistic rupture risk index (PRRI). Specifically, the uncertainties in AAA wall thickness and wall strength were considered, and wall stress was predicted with a state-of-the-art deterministic biomechanical model. The discriminative power of PRRI was tested in a diameter-matched cohort of ruptured (n = 7) and intact (n = 7) AAAs and compared to alternative risk assessment methods. Computed PRRI at 1.5 mean arterial pressure was significantly (p = 0.041) higher in ruptured AAAs (20.21(s.d. 14.15%)) than in intact AAAs (3.71(s.d. 5.77)%). PRRI showed a high sensitivity and specificity (discriminative power of 0.837) to discriminate between ruptured and intact AAA cases. The underlying statistical representation of stochastic data of wall thickness, wall strength and peak wall stress had only negligible effects on PRRI computations. Uncertainties in AAA wall stress predictions, the wide range of reported wall strength and the stochastic nature of failure motivate a probabilistic rupture risk assessment. Advanced AAA biomechanical modelling paired with a probabilistic rupture index definition as known from engineering risk assessment seems to be superior to a purely deterministic approach.
Polzer, Stanislav; Gasser, T. Christian
A rupture risk assessment is critical to the clinical treatment of abdominal aortic aneurysm (AAA) patients. The biomechanical AAA rupture risk assessment quantitatively integrates many known AAA rupture risk factors but the variability of risk predictions due to model input uncertainties remains a challenging limitation. This study derives a probabilistic rupture risk index (PRRI). Specifically, the uncertainties in AAA wall thickness and wall strength were considered, and wall stress was predicted with a state-of-the-art deterministic biomechanical model. The discriminative power of PRRI was tested in a diameter-matched cohort of ruptured (n = 7) and intact (n = 7) AAAs and compared to alternative risk assessment methods. Computed PRRI at 1.5 mean arterial pressure was significantly (p = 0.041) higher in ruptured AAAs (20.21(s.d. 14.15%)) than in intact AAAs (3.71(s.d. 5.77)%). PRRI showed a high sensitivity and specificity (discriminative power of 0.837) to discriminate between ruptured and intact AAA cases. The underlying statistical representation of stochastic data of wall thickness, wall strength and peak wall stress had only negligible effects on PRRI computations. Uncertainties in AAA wall stress predictions, the wide range of reported wall strength and the stochastic nature of failure motivate a probabilistic rupture risk assessment. Advanced AAA biomechanical modelling paired with a probabilistic rupture index definition as known from engineering risk assessment seems to be superior to a purely deterministic approach. PMID:26631334
Enríquez-Vega, María Elizabeth; Solorio-Rosete, Hugo Francisco; Cossío-Zazueta, Alfonso; Bizueto-Rosas, Héctor; Cruz-Castillo, Juan Ernesto; Iturburu-Enríquez, Alessandra
Introducción: aneurisma es el incremento del diámetro de una arteria > 50 %; los más frecuentes son los aneurismas de la aorta abdominal (AAA). La ecografía abdominal es el estudio de escrutinio para su diagnóstico. La detección oportuna del AAA en población de riesgo disminuye la morbimortalidad. El objetivo fue estimar la frecuencia de AAA en pacientes mayores de 65 años.Métodos: Se realizó un estudio transversal entre junio y octubre del 2012 en pacientes de ambos sexos mayores de 65 años que cubrieron los criterios de selección. Se les practicó ultrasonidoDoppler dúplex y se midió el diámetro anteroposterior de la aorta abdominal infrarrenal, se definió como AAA a una aorta abdominal con un diámetro mayor a 3 cm. Se empleó estadística descriptiva y regresión logística para factores de riesgo.Resultados: se incluyeron 144 pacientes, edad media (72.7 ± 6.7), el 95.1 % sexo masculino. El 13 % continuaban fumando. En 127 el diámetro de la aorta fue normal. Se detectaron 10 pacientes con AAA, todos del sexo masculino, el diámetro de los aneurismas identificados variaron de 3.2 a 7.11 cm, el diámetro promedio de 3 - 4 cm (n = 5). Solo el tabaquismo activo fue un factor predictivo significativo para AAA.Conclusión: Se demostró frecuencia significativa de AAA no detectada en masculinos mayores de 65 años, el tabaquismo fue el factor de riesgo más importante.
van Weeghel, I.; Kendrick, D.; Marsh, P.
Accepted 16 April 1997 OBJECTIVE—To evaluate the relation between risk factors for childhood unintentional injury and requests for injury prevention interventions as part of the Nottingham Safe at Home project, a primary care based controlled intervention study assessing the effectiveness of a package of injury prevention interventions. SETTING—17 practices in Nottingham randomly selected from 55 practices volunteering to take part in the study. METHODS—Postal questionnaire to all parents of children aged 3 to 12 months registered with the intervention practices (n = 1124) to assess risk factors for injury and to elicit requests for three injury prevention interventions: free home safety checks, low cost safety equipment, and free first aid training. RESULTS—73% of parents responded to the questionnaire. The distribution of sociodemographic variables among responders was similar to that for the population of Nottingham. One third of parents (34%) requested one intervention, 21% requested two interventions, and 10% requested three. Receipt of means tested benefits, ethnicity, and residence in a deprived area were independently associated with requesting home safety checks. Non-owner occupation, lack of access to a car, receipt of means tested benefits, ethnicity, and unemployment were independently associated with requesting low cost safety equipment. Non-owner occupiers were less likely to request first aid training. CONCLUSIONS—Families with risk factors for childhood unintentional injury do request home safety checks and low cost safety equipment, but they are less likely to request first aid training. Other methods for providing first aid advice may be needed to reach such families. PMID:9279147
West, Christopher R.; Goosey-Tolfrey, Victoria L.; Campbell, Ian G.
We asked whether elastic binding of the abdomen influences respiratory mechanics during wheelchair propulsion in athletes with cervical spinal cord injury (SCI). Eight Paralympic wheelchair rugby players with motor-complete SCI (C5-C7) performed submaximal and maximal incremental exercise tests on a treadmill, both with and without abdominal binding. Measurements included pulmonary function, pressure-derived indices of respiratory mechanics, operating lung volumes, tidal flow-volume data, gas exchange, blood lactate, and symptoms. Residual volume and functional residual capacity were reduced with binding (77 ± 18 and 81 ± 11% of unbound, P < 0.05), vital capacity was increased (114 ± 9%, P < 0.05), whereas total lung capacity was relatively well preserved (99 ± 5%). During exercise, binding introduced a passive increase in transdiaphragmatic pressure, due primarily to an increase in gastric pressure. Active pressures during inspiration were similar across conditions. A sudden, sustained rise in operating lung volumes was evident in the unbound condition, and these volumes were shifted downward with binding. Expiratory flow limitation did not occur in any subject and there was substantial reserve to increase flow and volume in both conditions. V̇o2 was elevated with binding during the final stages of exercise (8–12%, P < 0.05), whereas blood lactate concentration was reduced (16–19%, P < 0.05). V̇o2/heart rate slopes were less steep with binding (62 ± 35 vs. 47 ± 24 ml/beat, P < 0.05). Ventilation, symptoms, and work rates were similar across conditions. The results suggest that abdominal binding shifts tidal breathing to lower lung volumes without influencing flow limitation, symptoms, or exercise tolerance. Changes in respiratory mechanics with binding may benefit O2 transport capacity by an improvement in central circulatory function. PMID:24855136
West, Christopher R; Goosey-Tolfrey, Victoria L; Campbell, Ian G; Romer, Lee M
We asked whether elastic binding of the abdomen influences respiratory mechanics during wheelchair propulsion in athletes with cervical spinal cord injury (SCI). Eight Paralympic wheelchair rugby players with motor-complete SCI (C5-C7) performed submaximal and maximal incremental exercise tests on a treadmill, both with and without abdominal binding. Measurements included pulmonary function, pressure-derived indices of respiratory mechanics, operating lung volumes, tidal flow-volume data, gas exchange, blood lactate, and symptoms. Residual volume and functional residual capacity were reduced with binding (77 ± 18 and 81 ± 11% of unbound, P < 0.05), vital capacity was increased (114 ± 9%, P < 0.05), whereas total lung capacity was relatively well preserved (99 ± 5%). During exercise, binding introduced a passive increase in transdiaphragmatic pressure, due primarily to an increase in gastric pressure. Active pressures during inspiration were similar across conditions. A sudden, sustained rise in operating lung volumes was evident in the unbound condition, and these volumes were shifted downward with binding. Expiratory flow limitation did not occur in any subject and there was substantial reserve to increase flow and volume in both conditions. V̇o2 was elevated with binding during the final stages of exercise (8-12%, P < 0.05), whereas blood lactate concentration was reduced (16-19%, P < 0.05). V̇o2/heart rate slopes were less steep with binding (62 ± 35 vs. 47 ± 24 ml/beat, P < 0.05). Ventilation, symptoms, and work rates were similar across conditions. The results suggest that abdominal binding shifts tidal breathing to lower lung volumes without influencing flow limitation, symptoms, or exercise tolerance. Changes in respiratory mechanics with binding may benefit O2 transport capacity by an improvement in central circulatory function.
Winfield, Robert D; Reese, Stacey; Bochicchio, Kelly; Mazuski, John E; Bochicchio, Grant V
Obesity is a risk factor for surgical site infection (SSI) after abdominal procedures; however, data characterizing the risk of SSI in obese patients during abdominal procedures are lacking. We hypothesized that obesity is an independent risk factor for SSI across wound classes. We analyzed American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) data for 2011. We calculated body mass index (BMI), classifying patients according to National Institute of Health (NIH) BMI groups. We excluded records in which height/weight was not recorded and patients with BMI less than 18.5. We examined patients undergoing open abdominal procedures, performing univariate and multivariate analyses to assess the relative contribution of obesity to SSI. Study criteria were met by 89,148 patients. Obese and morbidly obese patients had significantly greater SSI rates in clean and clean-contaminated cases but not contaminated or dirty/infected cases. Logistic regression confirmed obesity and morbid obesity as being independently associated with the overall SSI development, specifically in clean [Obesity odds ratio (OR) = 1.757, morbid obesity OR = 2.544, P < 0.001] and clean-contaminated (obesity OR = 1.239, morbid obesity OR = 1.287, P < 0.001) cases. Obesity is associated with increased risk of SSI overall, specifically in clean and clean-contaminated abdominal procedures; this is independent of diabetes mellitus. Novel techniques are needed to reduce SSI in this high-risk patient population.
Ogundiran, T O; Obamuyide, H A; Adesina, M A; Ademola, A F
A 25-year-old man, riding a motorcycle, rammed into a moving car at a T junction and sustained a blunt lower-right abdominal injury with the handlebar of his motorbike. He developed a swelling at the point of impact for which he presented in hospital 10 days later. Clinical assessment revealed a healthy young man with a soft, nontender reducible swelling over the lateral half of the right inguinal area. A diagnosis of acute traumatic hernia was made. Abdominal ultrasonography revealed a wide-necked defect in the anterior abdominal wall over the right inguinal area with protruding bowel loops beneath an intact skin. He was planned for herniorrhaphy but has defaulted since then.
Sullivan, Catherine A; Kahn, Steven E; Fujimoto, Wilfred Y; Hayashi, Tomoshige; Leonetti, Donna L; Boyko, Edward J
In Japanese Americans, intra-abdominal fat area measured by computed tomography is positively associated with the prevalence and incidence of hypertension. Evidence in other populations suggests that other fat areas may be protective. We sought to determine whether a change in specific fat depots predicts the development of hypertension. We prospectively followed up 286 subjects (mean age, 49.5 years; 50.4% men) from the Japanese American Community Diabetes Study for 10 years. At baseline, subjects did not have hypertension (defined as blood pressure ≥140/90 mm Hg) and were not taking blood pressure or glucose-lowering medications. Mid-thigh subcutaneous fat area, abdominal subcutaneous fat area, and intra-abdominal fat area were directly measured by computed tomography at baseline and 5 years. Logistic regression was used to estimate odds of incident hypertension over 10 years in relation to a 5-year change in fat area. The relative odds of developing hypertension for a 5-year increase in intra-abdominal fat was 1.74 (95% confidence interval, 1.28-2.37), after adjusting for age, sex, body mass index, baseline intra-abdominal fat, alcohol use, smoking status, and weekly exercise energy expenditure. This relationship remained significant when adjusted for baseline fasting insulin and 2-hour glucose levels or for diabetes mellitus and pre-diabetes mellitus classification. There were no significant associations between baseline and change in thigh or abdominal subcutaneous fat areas and incident hypertension. In conclusion, in this cohort of Japanese Americans, the risk of developing hypertension is related to the accumulation of intra-abdominal fat rather than the accrual of subcutaneous fat in either the thigh or the abdominal areas.
Warren, Ramona C; Foltin, George L
A 2-year-old girl sustained severe injury to 2 fingers from a home paper shredder. This case illustrates the risk of injury from paper shredders, which are increasingly common household items. Toddlers are at risk of finger injury and amputation. The US Consumer Product Safety Commission performed an investigation of reported injuries and the characteristics of paper shredders that might have contributed to the injuries, and we summarize their findings.
Wang, Yu; Zhao, Hong; Zhou, Zhen; Tian, Ci; Xiao, Hong-Li; Wang, Bao-En
Background: Acute abdominal pain is a common symptom of emergency patients. The severity was always evaluated based on physicians’ clinical experience. The aim of this study was to establish an early risk stratification method (ERSM) for addressing adults with acute abdominal pain, which would guide physicians to take appropriate and timely measures following the established health-care policies. Methods: In Cohort 1, the records of 490 patients with acute abdominal pain that developed within the past 72 h were enrolled in this study. Measurement data and numeration data were compared with analysis of variance and Chi-square test, respectively. Multiple regression analysis calculated odd ratio (OR) value. P and OR values showed the impacts of factors. ERSM was established by clinical experts and statistical experts according to Youden index. In Cohort 2, data from 305 patients with acute abdominal pain were enrolled to validate the accuracy of the ERSM. Then, ERSM was prospectively used in clinical practice. Results: The ERSM was established based on the scores of the patient's clinical characteristics: right lower abdominal pain + 3 × diffuse abdominal pain + 3 × cutting abdominal pain + 3 × pain frequency + 3 × pain duration + fever + 2 × vomiting + 5 × stop defecation + 3 × history of abdominal surgery + hypertension history + diabetes history + hyperlipidemia history + pulse + 2 × skin yellowing + 2 × sclera yellowing + 2 × double lung rale + 10 × unconsciousness + 2 × right lower abdominal tenderness + 5 × diffuse abdominal tenderness + 4 × peritoneal irritation + 4 × bowel sounds abnormal + 10 × suspicious diagnosis + white blood cell count + hematocrit + glucose + 2 × blood urea nitrogen + 3 × creatine + 4 × serum albumin + alanine aminotransferase + total bilirubin + 3 × conjugated bilirubin + amylase. When the score was <18, the patient did not need hospitalization. A score of ≥18 and <38 indicated that the patient should be under
Bley, T; Gahr, R H
The demands on leisuretime activities are getting more exacting. So trendy sports just like inline-skating, mountain-biking, paragliding, bungee-jumping or driving go karts become increasing popular. On the other side risks and injuries of this fun sports are not enough represented. We observed in a 16 months period 5 serious accidents with go karts. The injuries included bruise of lower leg, a contusion of the stomach with a pancreatic lesion, an instable fracture of the spinal column, a difficult fracture of the knee and upper tibia and a large sized burnwound. The mean hospitalization time was 32,5 days (17-54 days) and the average age of the patients 27,7 years (9-45 years). The lack of safety devices and the subjective inexperience make go kart driving a dangerous fun. The TUV worked out guidelines for security of indoor kart centres but they don't have any legal liability in case of injury. Therefore everyone carrying out fun sports like go kart driving should be aware of the dangers and should gather information whether the accident insurance will help out in case of injury.
Shyu, Victor Bong-Hang; Hsu, Chung En; Wen, Chih-Jen; Wun, Tze-Chein; Tang, Rui; Achilefu, Samuel; Wei, Fu-Chan; Cheng, Hui-Yun
Appropriate antithrombotic therapy is critical for successful outcomes in reconstructive microsurgical procedures involving free tissue transfer. The annexin V-6L15 (ANV-6L15) fusion protein was developed as a targeted antithrombotic reagent. Annexin V specifically binds to exposed phosphatidylserine on apoptotic or injured cells, and prevents coagulation and cell adhesion, whereas 6L15 inhibits tissue factor-VIIa pathway within the coagulation cascade. The treatment efficacy of ANV-6L15 on rat island muscle and pedicled abdominal fasciocutaneous flaps following ischemic injury and ischemia-reperfusion injury (IRI) was evaluated.
Gmachowska, Agata; Pacho, Ryszard; Anysz-Grodzicka, Agnieszka; Bakoń, Leopold; Gorycka, Maria; Jakuczun, Wawrzyniec; Patkowski, Waldemar
Summary Background Diaphragmatic injuries occur in 0.8–8% of patients with blunt trauma. The clinical diagnosis of diaphragmatic rupture is difficult and may be overshadowed by associated injuries. Diaphragmatic rupture does not resolve spontaneously and may cause life-threatening complications. The aim of this study was to present radiological findings in patients with diaphragmatic injury. Material/Methods The analysis of computed tomography examinations performed between 2007 and 2012 revealed 200 patients after blunt thoraco-abdominal trauma. Diaphragmatic rupture was diagnosed in 13 patients. Twelve of these patients had suffered traumatic injuries and underwent a surgical procedure that confirmed the rupture of the diaphragm. Most of diaphragmatic ruptures were left-sided (10) while only 2 of them were right-sided. In addition to those 12 patients there, another patient was admitted to the emergency department with left-sided abdominal and chest pain. That patient had undergone a blunt thoracoabdominal trauma 5 years earlier and complained of recurring pain. During surgery there was only partial relaxation of the diaphragm, without rupture. The most important signs of the diaphragmatic rupture in computed tomography include: segmental discontinuity of the diaphragm with herniation through the rupture, dependent viscera sign, collar sign and other signs (sinus cut-off sign, hump sign, band sign). Results In our study blunt diaphragmatic rupture occurred in 6% of cases as confirmed intraoperatively. In all patients, coronal and sagittal reformatted images showed herniation through the diaphragmatic rupture. In left-sided ruptures, herniation was accompanied by segmental discontinuity of the diaphragm and collar sign. In right-sided ruptures, predominance of hump sign and band sign was observed. Other signs were less common. Conclusions The knowledge of the CT findings suggesting diaphragmatic rupture improves the detection of injuries in thoraco-abdominal
Prasad, Priya; Mertz, Harold J; Dalmotas, Danius J; Augenstein, Jeffrey S; Diggs, Kennerly
An evaluation of the four injury risk curves proposed in the NHTSA NCAP for estimating the risk of AIS>= 3 injuries to the head, neck, chest and AIS>=2 injury to the Knee-Thigh-Hip (KTH) complex has been conducted. The predicted injury risk to the four body regions based on driver dummy responses in over 300 frontal NCAP tests were compared against those to drivers involved in real-world crashes of similar severity as represented in the NASS. The results of the study show that the predicted injury risks to the head and chest were slightly below those in NASS, and the predicted risk for the knee-thigh-hip complex was substantially below that observed in the NASS. The predicted risk for the neck by the Nij curve was greater than the observed risk in NASS by an order of magnitude due to the Nij risk curve predicting a non-zero risk when Nij = 0. An alternative and published Nte risk curve produced a risk estimate consistent with the NASS estimate of neck injury. Similarly, an alternative and published chest injury risk curve produced a risk estimate that was within the bounds of the NASS estimates. No published risk curve for femur compressive load could be found that would give risk estimates consistent with the range of the NASS estimates. Additional work on developing a femur compressive load risk curve is recommended.
Nestola, M. G. C.; Gizzi, A.; Cherubini, C.; Filippi, S.; Succi, S.
The identification of the basic mechanisms responsible for cardiovascular diseases stands as one of the most challenging problems in modern medical research including various mechanisms which encompass a broad spectrum of space and time scales. Major implications for clinical practice and pre-emptive medicine rely on the onset and development of intraluminal thrombus in which effective clinical therapies require synthetic risk predictors/indicators capable of informing real-time decision-making protocols. In the present contribution, two novel hemodynamics synthetic indicators, based on a three-band decomposition (TBD) of the shear stress signal, are introduced. Extensive fluid-structure computer simulations of patient-specific scenarios confirm the enhanced risk-prediction capabilities of the TBD indicators. In particular, they permit a quantitative and accurate localization of the most likely thrombus deposition in realistic aortic geometries, where previous indicators would predict healthy operation. The proposed methodology is also shown to provide additional information and discrimination criteria on other factors of major clinical relevance, such as the size of the aneurysm.
Aune, Dagfinn; Norat, Teresa; Vatten, Lars J
Epidemiological studies have indicated a positive association between adiposity and gallbladder disease risk, however, the shape of the dose-response relationship and differences between overall and abdominal adiposity remains to be clarified. We conducted a systematic review and dose-response meta-analysis of cohort studies of body mass index (BMI), waist circumference and waist-to-hip ratio and risk of gallbladder disease. PubMed and Embase databases were searched up to January 9th 2015. Summary relative risks were calculated using a random effects model. Seventeen prospective studies of BMI and gallbladder disease risk with 55,670 cases among 1,921,103 participants were included. The summary relative risk (RR) for a 5 unit increment in BMI was 1.63 (95 % CI 1.49-1.78, I(2) = 98 %). There was evidence of a nonlinear association overall and among women, p(nonlinearity) < 0.0001, but not among men, p(nonlinearity) = 0.99, with a slight flattening of the curve at very high BMI levels (BMI 40-45), however, the risk of gallbladder disease increased almost twofold even within the "normal" BMI range. The summary RR for a 10 cm increase in waist circumference was 1.46 (95 % CI 1.24-1.72, I(2) = 98 %, n = 5) and for a 0.1 unit increment in waist-to-hip ratio was 1.44 (95 % CI 1.26-1.64, I(2) = 92 %, n = 4). Associations were attenuated, but still significant, when BMI and abdominal adiposity measures were mutually adjusted. Our results confirm a positive association between both general and abdominal fatness and the risk of gallbladder disease. There is an almost twofold increase in the risk even within the "normal" BMI range, suggesting that even moderate increases in BMI may increase risk.
Després, Jean-Pierre; Lemieux, Isabelle; Bergeron, Jean; Pibarot, Philippe; Mathieu, Patrick; Larose, Eric; Rodés-Cabau, Josep; Bertrand, Olivier F; Poirier, Paul
There is currently substantial confusion between the conceptual definition of the metabolic syndrome and the clinical screening parameters and cut-off values proposed by various organizations (NCEP-ATP III, IDF, WHO, etc) to identify individuals with the metabolic syndrome. Although it is clear that in vivo insulin resistance is a key abnormality associated with an atherogenic, prothrombotic, and inflammatory profile which has been named by some the "metabolic syndrome" or by others "syndrome X" or "insulin resistance syndrome", it is more and more recognized that the most prevalent form of this constellation of metabolic abnormalities linked to insulin resistance is found in patients with abdominal obesity, especially with an excess of intra-abdominal or visceral adipose tissue. We have previously proposed that visceral obesity may represent a clinical intermediate phenotype reflecting the relative inability of subcutaneous adipose tissue to act as a protective metabolic sink for the clearance and storage of the extra energy derived from dietary triglycerides, leading to ectopic fat deposition in visceral adipose depots, skeletal muscle, liver, heart, etc. Thus, visceral obesity may partly be a marker of a dysmetabolic state and partly a cause of the metabolic syndrome. Although waist circumference is a better marker of abdominal fat accumulation than the body mass index, an elevated waistline alone is not sufficient to diagnose visceral obesity and we have proposed that an elevated fasting triglyceride concentration could represent, when waist circumference is increased, a simple clinical marker of excess visceral/ectopic fat. Finally, a clinical diagnosis of visceral obesity, insulin resistance, or of the metabolic syndrome is not sufficient to assess global risk of cardiovascular disease. To achieve this goal, physicians should first pay attention to the classical risk factors while also considering the additional risk resulting from the presence of abdominal
McCoy, Thomas P.; Egan, Kathleen L.; Goldin, Shoshanna; Rhodes, Scott D.; Wolfson, Mark
Background College students who consume caffeinated alcoholic beverages (CaffAlc) are at increased injury risk. This study examines the extent to which a sensation-seeking personality accounts for the relationship between consumption of CaffAlc and negative outcomes. Methods A Web-based survey was administered to stratified random samples of 4907 college students from eight North Carolina universities in Fall 2009. Sensation seeking was assessed using the Brief Sensation-Seeking Scale (BSSS) (α=0.81). Data were analyzed using linear and logistic regression. Results 3390 students (71.2%) reported past 30-day drinking, of whom 786 (23.2%) consumed CaffAlc. CaffAlc past 30-day drinkers had higher BSSS scores (3.8 vs. 3.4; p<0.001), compared to non-CaffAlc drinkers. Consumption of CaffAlc was associated with more frequent binge drinking (p<0.001) and drunken days in a typical week (p<0.001), even after adjusting for the BSSS score. CaffAlc students were more likely to be taken advantage of sexually (adjusted odds ratio [AOR]=1.70, p=0.012), drive under the influence of alcohol (AOR=2.00, p<0.001), and ride with a driver under the influence of alcohol (AOR=1.87, p<0.001). Injury requiring medical treatment was more prevalent among CaffAlc students with higher BSSS-8 scores (interaction p=0.024), even after adjustment for drinking levels and student characteristics. Conclusions Sensation seeking does not fully account for the increase in risky drinking among college students who consume CaffAlc, nor does it moderate the relationship between CaffAlc and drinking behaviors. Sensation seeking moderates the risk of alcohol-associated injury requiring medical treatment among college students who consume CaffAlc. Those with strong sensation-seeking dispositions are at the highest risk of alcohol-associated injury requiring medical treatment. PMID:24761275
Kochhar, T; Back, D; Mann, B; Skinner, J
Background: Mixed martial arts have rapidly succeeded boxing as the world's most popular full contact sport, and the incidence of injury is recognised to be high. Objective: To assess qualitatively and quantitatively the potential risk for participants to sustain cervical spine and associated soft tissue injuries. Methods: Four commonly performed manoeuvres with possible risks to the cervical spine were analysed with respect to their kinematics, and biomechanical models were constructed. Results: Motion analysis of two manoeuvres revealed strong correlations with rear end motor vehicle impact injuries, and kinematics of the remaining two suggested a strong risk of injury. Mathematical models of the biomechanics showed that the forces involved are of the same order as those involved in whiplash injuries and of the same magnitude as compression injuries of the cervical spine. Conclusions: This study shows that there is a significant risk of whiplash injuries in this sport, and there are no safety regulations to address these concerns. PMID:15976168
Hartholt, Klaas Albert; Dekker, Jan Willem T
Blunt abdominal trauma may cause severe intra-abdominal injuries, while clinical findings could be mild or absent directly after the trauma. The absence of clinical findings could mislead physicians into underestimating the severity of the injury at the primary survey, and inevitably leads to a delay in the diagnosis. The Blunt Abdominal Trauma in Children (BATiC) score may help to identify children who are at a high risk for intra-abdominal injuries in an early stage and requires additional tests directly. A case of a 10-year-old girl with a duodenal perforation after a blunt abdominal trauma is presented. A delay in diagnosis may lead to an increased morbidity and mortality rate. A low admission threshold for children with abdominal pain after a blunt trauma is recommended.
Gulotta, C S; Finney, J W
We review risk factors commonly associated with childhood unintentional injuries and highlight adolescent mothers and their young children as a high risk group. Several intervention models of injury, including the epidemiological model, Peterson and Brown's "working model," and the socioecological model have been proposed to explain the events that lead to injuries. Discussion of these models is provided and a synthesis of the adolescent parenting model and the socioecological model of injury is suggested as way to address the complex variables that lead to an injury causing event for adolescent mothers and their young children. Finally, we suggest areas of future investigation and their implications for prevention and treatment.
... page: https://medlineplus.gov/news/fullstory_164198.html Autism Greatly Boosts Kids' Injury Risk, Especially for Drowning ... TUESDAY, March 21, 2017 (HealthDay News) -- Children with autism are at extremely high risk of drowning compared ...
Ricci, Giuseppe; Restaino, Stefano; Di Lorenzo, Giovanni; Fanfani, Francesco; Scrimin, Federica; Mangino, Francesco P
Purpose To report a case of Essure microinsert abdominal migration and literature review. Methods A 41-year-old woman was counseled to undergo Essure sterilization. The procedure was hampered by the presence of endometrial cavity adhesions, obscuring left tubal ostium. By using microscissors the adhesions were progressively lysed. Since the procedure had become very painful, the patient required general anesthesia. Once adhesion lysis was completed, the tubal ostium was well visible. Both devices were then easily introduced into the fallopian tubes. At the end of the procedure, five coils were visible on the right side and five coils on the left side, as recommended. Results The 3-month hysterosalpingogram follow-up suspected abdominal migration of the left device. Laparoscopy confirmed the device displacement in the left lower abdominal quadrant. Both fallopian tubes and the uterus appeared normal. No signs of perforation were detected. The device was embedded into the omentum, but it was easily removed. Bilateral tubal sterilization was performed by bipolar coagulation. Conclusion There are only 13 cases, including the present, of Essure abdominal migration in the literature. In most cases, abdominal displacement of the microinsert is asymptomatic and does not induce tissue damage. However, in some cases, it may cause a severe adverse event, requiring major surgery. Therefore, removal of the migrated device should be performed as soon as possible. Moreover, during presterilization counseling, the patient should also be correctly informed about the risk of this rare but relevant complication, as well as about the surgical interventions that could be required to solve it. PMID:25484591
Small, K; McNaughton, L R; Greig, M; Lohkamp, M; Lovell, R
The aim of this study was to investigate the effect of a multi-directional soccer-specific fatigue protocol on sprinting kinematics in relation to hamstring injury risk. Nine semi-professional soccer players (Mean +/- SD: Age: 21.3 +/- 2.9 year; Height 185.0 +/- 8.7 cm; Body Mass 81.6 +/- 6.7 kg) completed the SAFT(90); a multi-directional, intermittent 90 min exercise protocol representative of soccer match-play. The 10m sprint times and three-dimensional kinematic data were recorded using a high-speed motion capture system (Qualisys Track Manager) every 15 min during the SAFT(90). A significant time dependent increase was observed in sprint time during the SAFT(90) (P<0.01) with a corresponding significant decrease in stride length (P<0.01). Analysis of the kinematic sprint data revealed significantly reduced combined maximal hip flexion and knee extension angle, indicating reduced hamstring length, between pre-exercise and half-time (P<0.01) and pre-exercise and full-time (P<0.05). These findings revealed that the SAFT(90) produced time dependent impairments in sprinting performance and kinematics of technique which may result from shorter hamstring muscle length. Alterations in sprinting technique may have implications for the increased predisposition to hamstring strain injury during the latter stages of soccer match-play.
Sanchez, Erin J; Gabler, Lee F; McGhee, James S; Olszko, Ardyn V; Chancey, Valeta Carol; Crandall, Jeff; Panzer, Matthew B
Risk assessment models are developed to estimate the probability of brain injury during head impact using mechanical response variables such as head kinematics and brain tissue deformation. Existing injury risk functions have been developed using different datasets based on human volunteer and scaled animal injury responses to impact. However, many of these functions have not been independently evaluated with respect to laboratory-controlled human response data. In this study, the specificity of fourteen existing brain injury risk functions was assessed by evaluating their ability to correctly predict non-injurious response using previously conducted sled tests with well-instrumented human research volunteers. Six degree-of-freedom head kinematics data were obtained for 335 sled tests involving subjects in frontal, lateral, and oblique sled conditions up to 16 Gs peak sled acceleration. A review of the medical reports associated with each individual test indicated no clinical diagnosis of mild or moderate brain injury in any of the cases evaluated. Kinematic-based head and brain injury risk probabilities were calculated directly from the kinematic data, while strain-based risks were determined through finite element model simulation of the 335 tests. Several injury risk functions sub¬stanti¬ally over pre¬dict the likelihood of concussion and diffuse axonal injury; proposed maximum principal strain (MPS)-based injury risk functions predicted nearly 80 concussions and 14 cases of severe diffuse axonal injury out of the 335 non-injurious cases. This work is an important first step in assessing the efficacy of existing brain risk functions and highlights the need for more predictive injury assessment models.
Mohseni, Shahin; Talving, Peep; Kobayashi, Leslie; Kim, Dennis; Inaba, Kenji; Lam, Lydia; Chan, Linda S; Coimbra, Raul; Demetriades, Demetrios
The purpose of this study was to investigate the role of intra-abdominal closed-suction drainage after emergent trauma laparotomy for isolated solid organ injuries (iSOI) and to determine its association with deep surgical site infections (DSSI). All patients subjected to trauma laparotomy between January 2006 and December 2008 for an iSOI at two Level I urban trauma centers were identified. Patients with isolated hepatic, splenic, or renal injuries were included. Study variables extracted included demographics, clinical characteristics, intra-abdominal injuries, drain placement, DSSI, septic events, intensive care unit and hospital length of stay, and in-hospital mortality. Diagnosis of DSSI was based on abdominal computed tomography scan demonstrating an intra-abdominal collection combined with fever and elevated white blood cell count. For the analysis, patients were stratified based on injury severity. To identify an independent association between closed-suction drain placement and DSSI, stepwise logistic regression analysis was performed. Overall, 142 patients met the inclusion criteria with 80 per cent (n=114) having severe iSOI. In 47 per cent (n=53) of the patients with a severe injury, an intra-abdominal drain was placed. A drain was placed more often in patients with a blunt trauma with more severe injury defined by Injury Severity Score and abdominal Abbreviated Injury Scale Score and those who underwent splenectomy (P<0.05). There was a three-fold increased risk of DSSI in patients subjected to drain placement (odds ratio, 2.8; 95% confidence interval, 1.0 to 8.2; P=0.046). Subgroup analysis demonstrated those who sustained severe hepatic injury receiving a drain had a significantly increase risk of DSSI (P=0.02). There was no statistical difference in the rate of DSSI based on the presence or absence of an intra-abdominal drain after severe splenic injury (17 vs 18%, P=0.88). The use of intra-abdominal closed-suction drains after iSOI is not
Rosenson, Robert S
Several cardiometabolic factors present in obese and insulin-resistant individuals represent a continuum of increasing risk for the development of type 2 diabetes and cardiovascular disease. The importance of abdominal obesity as an independent risk factor is underscored by its association with adverse endocrine function. Recent evidence from animal and human studies has shown a role for the endocannabinoid system in maintaining energy balance and glucose and lipoprotein metabolism, with overactivity linked to aberrant glycemic and lipoprotein control, and a link to adiposity. Modulation of this system through endocannabinoid-receptor blockade has resulted in an improvement in a number of important risk factors in clinical trials, including visceral and subcutaneous abdominal adipose tissue, glucose tolerance, dyslipidemia and measures of inflammation. These findings may have significant implications for the management of patients at risk of developing cardiovascular and metabolic disease; however, the occurrence of psychiatric adverse events with rimonabant may preclude further development of centrally active endocannabinoid receptor antagonists for the treatment of cardiometabolic disorders. Future research is needed to explore the role of selective peripheral CB(1) receptor antagonists in the treatment of patients at high cardiometabolic risk.
Roudsari, Bahman S.; Utter, Garth H.; Kernic, Mary A.; Mueller, Beth A.
The incidence of twin births in the United States (US) has increased more than 65 per cent since 1980. However, the risk of injury to multiple-birth children is unknown. We sought to compare the risk of injury-related hospitalization and death between multiples and singletons. We conducted a retrospective cohort study using linked birth…
Takeoka, Atsushi; Tayama, Jun; Yamasaki, Hironori; Kobayashi, Masakazu; Ogawa, Sayaka; Saigo, Tatsuo; Kawano, Hiroaki; Abiru, Norio; Hayashida, Masaki; Maeda, Takahiro; Shirabe, Susumu
Accumulation of intra-abdominal fat is related to hypertension. Despite this, a relationship between hypertension and intra-abdominal fat in young adulthood is not clear. In this study, we verify whether intra-abdominal fat accumulation increases a hypertension risk in young adult subjects.In a cross-sectional study, intra-abdominal fat area was measured using a dual bioelectrical impedance analysis instrument in 697 university students (20.3 ± 0.7 years, 425 men). Blood pressure and anthropometric factors were measured. Lifestyle variables including smoking, drinking, physical activity, and eating behavior were assessed with questionnaire. High blood pressure risk (systolic blood pressure ≥130 mm Hg and/or diastolic blood pressure ≥85 mm Hg) with increasing intra-abdominal fat area was evaluated.Participants were divided into 5 groups according to their intra-abdominal fat area (≤24.9, 25-49.9, 50-74.9, 75-99.9, and ≥100 cm). As compared with the values of the smallest intra-abdominal fat area group, the crude and lifestyle-adjusted odds ratios (ORs) were elevated in larger intra-abdominal fat area groups [OR 1.31, 95% confidence interval (CI) 0.66-2.80; OR 3.38, 95% CI 1.60-7.57; OR 7.71, 95% CI 2.75-22.22; OR 18.74, 95% CI 3.93-105.64, respectively). The risk increase was observed only in men.Intra-abdominal fat accumulation is related to high blood pressure in men around 20 years of age. These results indicate the importance of evaluation and reduction of intra-abdominal fat to prevent hypertension.
Rutherford, Robert B
There are three choices for management of abdominal aortic aneurysms (AAA), ie, endovascular repair (EVAR), open repair (OR), and continuing surveillance (OBS). The treating physician must weigh the risk of no intervention, in terms of ultimate death from rupture, against the more immediate risk associated with either form of repair, considering in the process those risk factors that directly or indirectly relate to outcome. These risk factors include AAA size and the patient's comorbidities, age, gender, and AAA anatomy, as well as the skills and experience of the treating physicians and the health care environment in which the patient is treated. While individualization is clearly required, a generalizable platform for decision-making derived from past trials and other pertinent observational studies is also useful. This article attempts to present pertinent background information and develop it into generally applicable guidelines.
Background A one-year prospective examination of injury rates and injury risk factors was conducted in Federal Bureau of Investigation (FBI) new agent training. Methods Injury incidents were obtained from medical records and injury compensation forms. Potential injury risk factors were acquired from a lifestyle questionnaire and existing data at the FBI Academy. Results A total of 426 men and 105 women participated in the project. Thirty-five percent of men and 42% of women experienced one or more injuries during training. The injury incidence rate was 2.5 and 3.2 injuries/1,000 person-days for men and women, respectively (risk ratio (women/men) = 1.3, 95% confidence interval = 0.9-1.7). The activities most commonly associated with injuries (% of total) were defensive tactics training (58%), physical fitness training (20%), physical fitness testing (5%), and firearms training (3%). Among the men, higher injury risk was associated with older age, slower 300-meter sprint time, slower 1.5-mile run time, lower total points on the physical fitness test (PFT), lower self-rated physical activity, lower frequency of aerobic exercise, a prior upper or lower limb injury, and prior foot or knee pain that limited activity. Among the women higher injury risk was associated with slower 300-meter sprint time, slower 1.5-mile run time, lower total points on the PFT, and prior back pain that limited activity. Conclusion The results of this investigation supported those of a previous retrospective investigation emphasizing that lower fitness and self-reported pain limiting activity were associated with higher injury risk among FBI new agents. PMID:22166096
Demorest, Rebecca A; Koutures, Chris
The martial arts can provide children and adolescents with vigorous levels of physical exercise that can improve overall physical fitness. The various types of martial arts encompass noncontact basic forms and techniques that may have a lower relative risk of injury. Contact-based sparring with competitive training and bouts have a higher risk of injury. This clinical report describes important techniques and movement patterns in several types of martial arts and reviews frequently reported injuries encountered in each discipline, with focused discussions of higher risk activities. Some of these higher risk activities include blows to the head and choking or submission movements that may cause concussions or significant head injuries. The roles of rule changes, documented benefits of protective equipment, and changes in training recommendations in attempts to reduce injury are critically assessed. This information is intended to help pediatric health care providers counsel patients and families in encouraging safe participation in martial arts.
Schwender, Brian J.; Gordon, Stuart R.; Gardner, Timothy B.
Objectives Intra-abdominal fungal infections (AFI) complicating acute pancreatitis arise in the context of pancreatic necrosis. Our goal was to determine which risk factors contribute to AFI in patients with acute pancreatitis. Methods Records were reviewed from 479 non-transfer patients admitted to our medical center with acute pancreatitis from 1985–2009. Using multivariable regression models, risk factors for AFI were identified. Results Out of 479 patients admitted with acute pancreatitis, 17 patients were subsequently found to have an AFI and 3 of these patients expired. The mean length of stay for patients with an AFI was 24 days and 76% were admitted to the intensive care unit. Patients with AFI were more likely to have received prophylactic antibiotics on admission (OR 1.7, 95% C.I. 1.2–2.3), TPN within 7 days of admission (OR 1.4, 95% C.I. 1.1–1.7) or to have necrosis on CT scan within 7 days of admission (OR 1.4, 95% C.I. 1.1–1.7). Multivariable regression models identified admission antibiotic use (OR 1.6, 95% C.I. 1.4–1.8) as the strongest predictor of AFI. Conclusion Admission antibiotics are the biggest risk factor for the development of intra-abdominal fungal infections in acute pancreatitis. Prophylactic antibiotics to prevent infected necrosis should therefore be discouraged. PMID:25872170
Gerweck, Anu V.; Lin, Eleanor; Landa, Melissa G.; Torriani, Martin; Schoenfeld, David A.; Hemphill, Linda C.; Miller, Karen K.
Context: Visceral adiposity is associated with increased cardiometabolic risk and decreased GH secretion. Objective: Our objective was to determine the effects of GH administration in abdominally obese young men on body composition, including liver fat, mitochondrial function, and cardiovascular (CV) risk markers. Design and Participants: This was a 6-month, randomized, double-blind, placebo-controlled study with 62 abdominally obese men (IGF-1 below the mean, no exclusion based on GH level), 21 to 45 years of age. Main Outcome Measures: We evaluated abdominal fat depots, thigh muscle and fat (computed tomography), fat and lean mass (dual-energy x-ray absorptiometry), intramyocellular and intrahepatic lipids (proton magnetic resonance spectroscopy), mitochondrial function (dynamic phosphorous magnetic resonance spectroscopy), CV risk markers, carotid intimal-medial thickness, and endothelial function. Results: GH administration resulted in a mean IGF-1 SD score increase from −1.9 ± 0.08 to −0.2 ± 0.3 in the GH group and a decrease in visceral adipose tissue (VAT), VAT/sc adipose tissue, trunk/extremity fat, intrahepatic lipids, high-sensitivity C-reactive protein and apolipoprotein B/low-density lipoprotein vs placebo after controlling for the increase in weight observed in both groups. There were inverse associations between change in IGF-1 levels and change in VAT, VAT/sc adipose tissue, trunk fat, trunk/extremity fat, high-sensitivity C-reactive protein, and apolipoprotein B. Mitochondrial function improved in the GH group compared with placebo after controlling for change in glucose. There was no change in thigh fat, muscle mass, intramyocellular lipids, cholesterol, fibrinogen, intimal-medial thickness, or endothelial function. There was no increase in fasting glucose or hemoglobin A1c in the GH vs placebo group, although glucose during the 2-hour oral glucose tolerance test increased slightly. Conclusion: GH replacement in abdominally obese men improves
Roy, Tanja C; Songer, Thomas; Ye, Feifei; LaPorte, Ronald; Grier, Tyson; Anderson, Morgan; Chervak, Michelle
Musculoskeletal injuries (MSIs) result in the most medical encounters, lost duty days, and permanent disability. Women are at greater risk of injury than men and physical training is the leading cause of injury. The purpose of this study was to investigate the demographic, body composition, fitness, and physical training risk factors for injuries in female Soldiers serving in garrison Army units over the past 12 months. Self-report survey was collected from 625 women. The ankle was the most frequently injured body region, 13%. Running was the activity most often associated with injury, 34%. In univariate analysis lower rank, older age, history of deployment, no unit runs, weekly frequency of personal resistance training, and history of injury were all associated with injury. In multivariate analysis rank, history of injury, weekly frequency of unit runs, and weekly frequency of personal resistance training were the best combination of predictors of injury. Running once or twice a week with the unit protected against MSIs, whereas participating in personal resistance training sessions once or twice a week increased the risk of MSIs. With more emphasis on running and resistance training, the U.S. Army could reduce injuries and save billions of dollars in training and health care costs.
Gabbe, B; Finch, C; Bennell, K; Wajswelner, H
Objectives: To identify risk factors for hamstring injury at the community level of Australian football. Methods: A total of 126 community level Australian football players participated in this prospective cohort study. To provide baseline measurements, they completed a questionnaire and had a musculoskeletal screen during the 2000 preseason. All were monitored over the season. Injury surveillance and exposure data were collected for the full season. Survival analysis was used to identify independent predictors of hamstring injury. Results: A hamstring injury was the first injury of the season in 20 players (16%). After adjustment for exposure, increasing age and decreased quadriceps flexibility were identified as significant independent predictors of the time to sustaining a hamstring injury. Older age (⩾23 years) was associated with an increased risk of hamstring injury (RR 3.8; 95% confidence interval (CI) 1.1 to 14.0; p = 0.044). Players with increased quadriceps flexibility (as measured by the modified Thomas test) were less likely to sustain a hamstring injury (RR 0.3; 95% CI 0.1 to 0.8; p = 0.022). Conclusions: The findings of this study can be used in the development of hamstring injury prevention strategies and to identify Australian football players at increased risk of hamstring injury. PMID:15665208
Quebbeman, E J; Telford, G L; Hubbard, S; Wadsworth, K; Hardman, B; Goodman, H; Gottlieb, M S
The potential for transmission of deadly viral diseases to health care workers exists when contaminated blood is inoculated through injury or when blood comes in contact with nonintact skin. Operating room personnel are at particularly high risk for injury and blood contamination, but data on the specifics of which personnel are at greater risk and which practices change risk in this environment are almost nonexistent. To define these risk factors, experienced operating room nurses were employed solely to observe and record the injuries and blood contaminations that occurred during 234 operations involving 1763 personnel. Overall 118 of the operations (50%) resulted in at least one person becoming contaminated with blood. Cuts or needlestick injuries occurred in 15% of the operations. Several factors were found to significantly alter the risk of blood contamination or injury: surgical specialty, role of each person, duration of the procedure, amount of blood loss, number of needles used, and volume of irrigation fluid used. Risk calculations that use average values to include all personnel in the operating room or all operations performed substantially underestimate risk for surgeons and first assistants, who accounted for 81% of all body contamination and 65% of the injuries. The area of the body contaminated also changed with the surgical specialty. These data should help define more appropriate protection for individuals in the operating room and should allow refinements of practices and techniques to decrease injury. Images Fig. 1. PMID:1953115
Alphonse, Vanessa D; Kemper, Andrew R; Rowson, Steven; Duma, Stefan M
Eye injuries can be caused by a variety of consumer products and toys. Recently, indoor remote controlled (RC) toy helicopters have become very popular. The purpose of this study is to quantify eye injury risk associated with five commercially available RC toy helicopter blades. An experimental matrix of 25 tests was developed to test five different RC toy helicopter blades at full battery power on six postmortem human eyes. A pressure sensor inserted through the optic nerve measured intraocular pressure. Corneal abrasion was assessed post-impact using fluorescein dye. Intraocular pressure was correlated to injury risk for hyphema, lens damage, retinal damage, and globe rupture using published risk functions. All tests resulted in corneal abrasions; however, no other injuries were observed. The 25 tests produced an increase intraocular pressure between 15.2 kPa and 99.3 kPa (114.3 mmHg and 744.7 mmHg). Calculated blade velocities ranged between 16.0 m/s and 25.4 m/s. Injury risk for hyphema was a maximum of 0.2%. Injury risk for lens damage, retinal damage, and globe rupture was 0.0% for all tests. Blade design parameters such as length and mass did not affect the risk of eye injury. This is the first study to quantify the risk of eye injury from RC toy helicopter blades. While corneal abrasions were observed, more serious eye injuries were neither observed nor predicted to have occurred. Results from this study are critical for establishing safe design thresholds for RC toy helicopter blades so that more serious injuries can be prevented.
Knapik, Joseph J; Steelman, Ryan
US Army airborne operations began in World War II. Continuous improvements in parachute technology, aircraft exit procedures, and ground landing techniques have reduced the number of injuries over time from 27 per 1,000 descents to about 6 per 1,000 jumps. Studies have identified a number of factors that put parachutists at higher injury risk, including high wind speeds, night jumps, combat loads, higher temperatures, lower fitness, heavier body weight, and older age. Airborne injuries can be reduced by limiting risker training (higher wind speeds, night jumps, combat load) to the minimum necessary for tactical and operational proficiency. Wearing a parachute ankle brace (PAB) will reduce ankle injuries without increasing other injuries and should be considered by all parachutists, especially those with prior ankle problems. A high level of upper body muscular endurance and aerobic fitness is not only beneficial for general health but also associated with lower injury risk during airborne training.
Martin, Gregory J; Dunne, James R; Cho, John M; Solomkin, Joseph S
Trauma-associated injuries of the thorax and abdomen account for the majority of combat trauma-associated deaths, and infectious complications are common in those who survive the initial injury. This review focuses on the initial surgical and medical management of torso injuries intended to diminish the occurrence of infection. The evidence for recommendations is drawn from published military and civilian data in case reports, clinical trials, meta-analyses, and previously published guidelines, in the interval since publication of the 2008 guidelines. The emphasis of these recommendations is on actions that can be taken in the forward-deployed setting within hours to days of injury. This evidence-based medicine review was produced to support the Guidelines for the Prevention of Infections Associated With Combat-Related Injuries: 2011 Update contained in this supplement of Journal of Trauma.
Krause, James S.
Objectives To identify: (a) the annual incidence of subsequent injury and injury related hospitalizations among individuals with pre-existing spinal cord injury (SCI) and (b) risk and protective behaviors associated with differential risk of injury. Design Longitudinal, mailed survey. Participants were enrolled in 1997-1998, with a follow-up conducted 10 years later. Setting Data were collected from participants identified from a specialty hospital and analyzed at a medical university in the Southeastern United States. Participants There were 1386 participants during the baseline enrollment, 821 of whom also participated in the 10-year follow-up. Inclusion criteria were: (1) traumatic SCI with residual impairment A-D, (2) non-surgical onset, (3) age 18 years or older, and (4) a minimum of 12 months post-SCI. Interventions Main Outcome Measures Number of injuries severe enough to require treatment in a clinic, emergency department, or hospital in the 12 months prior to the survey, and number of injury related hospitalizations. Predictor variables included selected items from the Behavioral Risk Factor Surveillance System, the Zuckerman-Kuhlman Personality Questionnaire, and prescription medication usage. Results Over 23% of participants reported at least 1 injury within the past year, an increase from that reported 10 years earlier by the same participants (19%), and 7% reported at least 1 injury related hospitalization. Those who reported a subsequent injury during the preliminary baseline data collection were about twice as likely to report at least 1 injury 10 years later. Binge drinking, psychotropic prescription medication use, and several personality characteristics were also related to injuries and/or injury hospitalization. Conclusions Risk of injury continues to be a significant concern in the years and decades after SCI onset. Behavioral and personality factors hold the key to prevention. PMID:21044720
Ammar, AS; Mahmoud, KM
Background: Renal injury is a common cause of morbidity and mortality after elective abdominal aortic aneurysm (AAA) repair. Propofol has been reported to protect several organs from ischemia/reperfusion (I/R) induced injury. We performed a randomized clinical trial to compare propofol and sevoflurane for their effects on renal I/R injury in patients undergoing elective AAA repair. Materials and Methods: Fifty patients scheduled for elective AAA repair were randomized to receive propofol anesthesia in group I or sevoflurane anesthesia in group II. Urinary specific kidney proteins (N-acetyl-beta-glucosamidase, alpha-1-microglobulin, glutathione transferase [GST]-pi, GST-alpha) were measured within 5 min of starting anesthesia as a base line (T0), at the end of surgery (T1), 8 h after surgery (T2), 16 h after surgery (T3), and 24 h postoperatively (T4). Serum pro-inflammatory cytokines (tumor necrosis factor-α and interleukin 1-β) were measured at the same time points. In addition, serum creatinine and cystatin C were measured before starting surgery as a baseline and at days 1, 3, and 6 after surgery. Results: Postoperative urinary concentrations of all measured kidney specific proteins and serum pro-inflammatory cytokines were significantly lower in the propofol group. In addition, the serum creatinine and cystatin C were significantly lower in the propofol group compared with the sevoflurane group. Conclusion: Propofol significantly reduced renal injury after elective open AAA repair and this could have clinical implications in situations of expected renal I/R injury. PMID:27375385
Hidayat, Khemayanto; Du, Xuan; Chen, Guochong; Shi, Minhua; Shi, Bimin
Several meta-analyses of observational studies have been performed to examine the association between general obesity, as measured by body mass index (BMI), and lung cancer. These meta-analyses suggest an inverse relation between high BMI and this cancer. In contrast to general obesity, abdominal obesity appears to play a role in the development of lung cancer. However, the association between abdominal obesity (as measured by waist circumference (WC) (BMI adjusted) and waist to hip ratio (WHR)) and lung cancer is not fully understood due to sparse available evidence regarding this association. PubMed and Web of Science databases were searched for studies assessing the association between abdominal obesity and lung cancer up to October 2016. The summary relative risks (RRs) with 95% confidence intervals (CIs) were calculated with a random-effects model. Six prospective cohort studies with 5827 lung cancer cases among 831,535 participants were included in our meta-analysis. Each 10 cm increase in WC and 0.1 unit increase in WHR were associated with 10% (RR 1.10; 95% CI 1.04, 1.17; I2 = 27.7%, p-heterogeneity = 0.198) and 5% (RR 1.05; 95% CI 1.00, 1.11; I2 = 25.2%, p-heterogeneity = 0.211) greater risks of lung cancer, respectively. According to smoking status, greater WHR was only positively associated with lung cancer among former smokers (RR 1.11; 95% CI 1.00, 1.23). In contrast, greater WC was associated with increased lung cancer risk among never smokers (RR 1.11; 95% CI 1.00, 1.23), former smokers (RR 1.12; 95% CI 1.03, 1.22) and current smokers (RR 1.16; 95% CI 1.08, 1.25). The summary RRs for highest versus lowest categories of WC and WHR were 1.32 (95% CI 1.13, 1.54; I2 = 18.2%, p-heterogeneity = 0.281) and 1.10 (95% CI 1.00, 1.23; I2 = 24.2%, p-heterogeneity = 0.211), respectively. In summary, abdominal obesity may play an important role in the development of lung cancer. PMID:27983672
Koziol-McLain, J.; Brand, D.; Morgan, D.; Leff, M.; Lowenstein, S.
Background—Recently (1996–98), Colorado added 15 questions pertaining to injury related risks and behaviors to the behavioral risk factor surveillance system (BRFSS). Questions addressed bicycle helmet use, traffic crashes, exposure to violence, suicidal behavior, and gun storage. Objective—To measure the test-retest reliability of these injury related questions. Methods—Of 330 BRFSS participants, 229 (69%) were called a second time and reasked nine selected injury questions. Retests were completed 7–28 days after the original interview. Results—Test-retest agreement was very high (κ >0.80) for bicycle helmet use, domestic police visits, and gun ownership. All other injury risk questions had substantial agreement (κ >0.60). Conclusions—The injury related questions added to the Colorado BRFSS have high test-retest reliability. PMID:10875674
Zammit, Andrea R; Katz, Mindy J; Derby, Carol; Bitzer, Markus; Lipton, Richard B
The aim of this study was to assess the influence of the metabolic syndrome and its components on dysexecutive function (DF) in individuals with and without CKD. Among 588 participants aged over 70 from the Einstein Aging Study (EAS), we defined DF as performance of 2SDs below the mean on any one test or 1.5SDs below the mean on any two of the following: Block Design, Digit Symbol Coding and the Trail-making Tests A and B. We defined CKD as an eGFR below 60 mL/min/m(2). MetS was defined according to recent guidelines from the National Cholesterol Education Program. 149 participants had CKD at cross-section, 16.1% of which also showed DF. Of the 439 participants without CKD, 12.3% displayed DF. Abdominal obesity as measured by waist circumference, was an independent risk factor for dysexecutive function in CKD (OR = 14.3, 95%CI = 2.21-91.93, p = 0.005) but not in non-CKD. None of the other MetS components were associated with DF. Results suggested that abdominal obesity, recognized as an integral part of the MetS, is a strong risk factor for DF in individuals with CKD.
Tognon, Ilaria Desirée
The aim of the work has been to evaluate the risk of injuries connected to the use of machinery and work tools in the footwear industry. The analysis of the data related to injuries in the footwear industry, deduced from the registers of injuries collected in the investigated factories, shows that most accidents arise from the contact of the operator's hands with tools and machinery parts during their use. Risk factors generally include the inherent specific danger of some work tools and machines, the lack or inadequacy of safety devices, the obsolescence of the equipment, the imprudence and underestimation of risk.
Jokela, Markus; Power, Chris; Kivimaki, Mika
Background: Childhood externalizing and internalizing behaviors have been associated with injury risk in childhood and adolescence, but it is unknown whether this association continues to hold in adulthood. We examined whether externalizing and internalizing behaviors expressed in childhood predict injuries in childhood, adolescence, and…
Ward, Cynthia W.
Youth participation in sports has increased greatly over the past 20 years. Consequently, there has been a rise in the number of sports injuries. A study was conducted to determine teen's level of physical activity, knowledge about risk factors for sports injuries, use of protective equipment, and parental involvement. Two groups of teens, one of…
Borges, G; Cherpitel, C J; Mondragón, L; Poznyak, V; Peden, M; Gutierrez, I
Usual and acute alcohol consumption are important risk factors for injury. Although alcohol-dependent people are thought to be at increased risk of injury, there are few reports suggesting that their risk is greater than that of nondependent alcohol users in a given episode of alcohol use. The authors conducted a case-crossover analysis of data on 705 injury patients from a hospital emergency department in Mexico City, Mexico, collected in 2002. The majority of the sample was male (60%) and over 30 years old (51%). With use of a multiple matching approach that took into account three control time periods (the day prior to the injury, the same day in the previous week, and the same day in the previous month), the estimated relative risk of injury for patients who reported having consumed alcohol within 6 hours prior to injury (17% of the sample) was 3.97 (95% confidence interval: 2.88, 5.48). This increase in the relative risk was concentrated within the first 2 hours after drinking; there was a positive association of increasing risk with increasing number of drinks consumed. These data suggested that relative risk estimates were the same for patients with and without alcohol use disorders.
Bushman, Timothy T; Grier, Tyson L; Canham-Chervak, Michelle C; Anderson, Morgan K; North, William J; Jones, Bruce H
The Functional Movement Screen (FMS) is a tool intended to evaluate limitations or asymmetries of movement to detect individuals at risk for exercise- and sports-related injury. The purpose was to determine the association and predictive value of specific FMS tests with injury risk in physically active men. Soldiers aged 18-57 years completed the FMS (n = 2,476). Demographic and fitness data were collected by survey. Medical record data for any, overuse, and traumatic injury 6 months after the assessment were obtained. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value were calculated along with receiver operator characteristics to determine area under the curve (AUC). Risks, risk ratios, odds ratios (ORs), and 95% confidence intervals were calculated to assess injury risks. Multivariate logistic regression identified that pain on 5 of the 7 tests was associated with greater risk for any injury (OR = 1.50-3.51): deep squat, hurdle step, in-line lunge, trunk stability push-up, and rotary stability. However, FMS registered low sensitivity, PPV, and AUC for all 7 tests for the 3 injury types (2-24% sensitivity, 16-74% PPV, and 50-58% AUC). Although the presence of pain was associated with a higher risk of injury on 5 tests, a low sensitivity, PPV, and AUC were displayed. Therefore, caution is advised when implementing the FMS as a screening tool in an Army or similarly active population as it could lead to prevention and treatment resources being directed toward individuals who are not at greater risk for injury.
Tom, Sarah E.; Wickwire, Emerson M.; Park, Yujin; Albrecht, Jennifer S.
Study Objectives: The objective of this study was to test the hypothesis that use of zolpidem, eszopiclone, and zaleplon would be associated with increased risk of traumatic brain injury (TBI) and hip fracture. Methods: We conducted a case-crossover study on a 5% random sample of Medicare beneficiaries age 65 y or older hospitalized with either TBI (n = 15,031) or hip fracture (n = 37,833) during 2007–2009. Use of zolpidem, eszopiclone, or zaleplon during the 30-day period prior to injury hospitalization was compared to use during four control periods at 3, 6, 9, and 12 mo prior to injury. The primary outcome was hospitalization for TBI or hip fracture. Results: Zolpidem use during the month prior to injury was associated with increased risk of TBI (odds ratio [OR] 1.87; 95% confidence interval [CI] 1.56, 2.25); however, eszopiclone use during the same period was not associated with increased risk (OR 0.67; 95% CI 0.40, 1.13). Zolpidem use during the month prior to injury was associated with increased risk of hip fracture (OR 1.59; 95% CI 1.41, 1.79); however, eszopiclone use during the same period was not associated with increased risk (OR 1.12; 95% CI 0.83, 1.50). Analysis of zaleplon use in the month prior to injury was limited by low drug utilization but was not associated with increased risk of TBI (OR 0.85; 95% CI 0.21, 3.34) or hip fracture (OR 0.92; 95% CI 0.40, 2.13) in this study. Conclusions: For the treatment of insomnia in older adults, eszopiclone may present a safer alternative to zolpidem, in terms of fall-related injuries. Citation: Tom SE, Wickwire EM, Park Y, Albrecht JS. Nonbenzodiazepine sedative hypnotics and risk of fall-related injury. SLEEP 2016;39(5):1009–1014. PMID:26943470
Elliott, Michael R; Margulies, Susan S; Maltese, Matthew R; Arbogast, Kristy B
There has been recent dramatic increase in the use of sensors affixed to the heads or helmets of athletes to measure the biomechanics of head impacts that lead to concussion. The relationship between injury and linear or rotational head acceleration measured by such sensors can be quantified with an injury risk curve. The utility of the injury risk curve relies on the accuracy of both the clinical diagnosis and the biomechanical measure. The focus of our analysis was to demonstrate the influence of three sources of error on the shape and interpretation of concussion injury risk curves: sampling variability associated with a rare event, concussion under-reporting, and sensor measurement error. We utilized Bayesian statistical methods to generate synthetic data from previously published concussion injury risk curves developed using data from helmet-based sensors on collegiate football players and assessed the effect of the three sources of error on the risk relationship. Accounting for sampling variability adds uncertainty or width to the injury risk curve. Assuming a variety of rates of unreported concussions in the non-concussed group, we found that accounting for under-reporting lowers the rotational acceleration required for a given concussion risk. Lastly, after accounting for sensor error, we find strengthened relationships between rotational acceleration and injury risk, further lowering the magnitude of rotational acceleration needed for a given risk of concussion. As more accurate sensors are designed and more sensitive and specific clinical diagnostic tools are introduced, our analysis provides guidance for the future development of comprehensive concussion risk curves.
Use of computer keyboards requires repetitive movements that may cause "overuse injuries" among students. Education on computer literacy must include warning of these negative side effects and must instill safe operating habits among students. (10 references) (CJH)
Burkhart, Timothy A; Andrews, David M; Dunning, Cynthia E
The purpose of this study was to develop a multivariate distal radius injury risk prediction model that incorporates dynamic loading variables in multiple directions, and interpret the distal radius failure data in order to establish injury probability thresholds. Repeated impacts with increasing intensity were applied to the distal third of eight human cadaveric radius specimens (mean (SD) age=61.9 (9.7)) until injury occurred. Crack (non-propagating damage) and fracture (specimen separated into at least two fragments) injury events were recorded. Best subsets analysis was performed to find the best multivariate injury risk model. Force-only risk models were also determined for comparison. Cumulative distribution functions were developed from the parameters of a Weibull analysis and the forces and risk scores (i.e., values calculated from the injury risk models) from 10% to 90% probability were calculated. According to the adjusted R(2), variance inflation factor and p-values, the model that best predicted the crack event included medial/lateral impulse, Fz load rate, impact velocity and the natural logarithm of Fz (Adj. R(2)=0.698), while the best predictive model of the fracture event included medial/lateral impulse, impact velocity and peak Fz (Adj. R(2)=0.845). The multivariate models predicted injury risk better than both the Fz-only crack (Adj. R(2)=0.551) and fracture (Adj. R(2)=0.293) models. Risk scores of 0.5 and 0.6 corresponded to 10% failure probability for the crack and fracture events, respectively. The inclusion of medial/lateral impulse and impact velocity in both crack and fracture models, and Fz load rate in the crack model, underscores the dynamic nature of these events. This study presents a method capable of developing a set of distal radius fracture prediction models that can be used in the assessment and development of distal radius injury prevention interventions.
Liao, Mengyang; Liu, Cong-Lin; Lv, Bing-Jie; Zhang, Jin-Ying; Cheng, Longxian; Cheng, Xiang; Lindholt, Jes S.; Rasmussen, Lars M.; Shi, Guo-Ping
Background Abdominal aortic aneurysm (AAA) is characterized by inflammatory cell accumulation in AAA lesions that produce inflammatory cytokines and advance its pathogenesis. Peripheral cytokines may predict the degree or risk of AAA. Methods and Results ELISA determined plasma interleukin-6 (IL6), IL10, IL17A, IFN-γ, and C-reactive protein (CRP) from 476 AAA patients and 200 controls. AAA patients had lower IL6, IFN-γ, IL10, IL17A, and higher CRP than controls. IL10 correlated positively with IFN-γ, IL17A, or IL6, but not CRP in control or AAA populations. IL10 associated negatively with systolic blood pressure, whereas CRP associated positively with diastolic blood pressure and body mass index. CRP was an independent AAA risk factor and correlated positively with aortic diameters before and after adjustments for other risk factors. IFN-γ, IL17A, and CRP correlated positively with cross-sectional AAA area after adjustment. IL10 correlated positively with AAA growth rate before and after adjustment. AAA patients with CRP levels above the median doubled the risk of death. Conclusions Reduced IFN-γ, IL10, and IL17A in AAA patients, positive correlations of IFN-γ and IL17A with cross-sectional AAA area, IL10 with AAA growth rate, and IL10 with IFN-γ and IL17A suggest combined Th1, Th2, and Th17 immune responses in human AAAs. PMID:25856542
Shah, Selina; Weiss, David S; Burchette, Raoul J
Modern (or contemporary) dance has become increasingly popular, yet little has been reported with respect to modern dance injuries and their consequences. The purpose of this study is to define the incidence, risk factors, and management of musculoskeletal injuries in professional modern dancers. A total of 184 dancers in the United States completed an anonymous 17-page questionnaire on their injuries, including extensive details regarding the two most severe injuries that had occurred in the prior 12 months. According to their self-reports, a total of 82% of the dancers had suffered between one and seven injuries. The foot and ankle (40%) was the most common site of injury, followed by the lower back (17%) and the knee (16%). The rate of injuries was 0.59 per 1,000 hours of class and rehearsal. Injured male dancers returned to full dancing after a median of 21 days, while females returned after a median of 18 days. Most dancers missed no performances due to injury. Of the medical consultations sought by dancers for their injuries, 47% were made to physicians, 41% to physical therapists, and 34% to chiropractors. The majority of dancers adhered to the advice given them by consultants (87% of males and 78% of females for the most severe injury). While the majority of injuries were considered work-related (61% of the most severe injury and 69% of the second most severe), few were covered by Workers' Compensation insurance (12% and 5% respectively). These professional modern dancers suffer from a rate of injury similar to other groups of professional dancers. Most dancers return to a partial level of dancing several weeks before attempting full-capacity dancing.
Ramos, Daniel Cuevas; Mehta, Roopa; De La Luz Castro, Julieta; Limones, Rutila Castañeda; Rubí, Ernesto García; Aguilar-Salinas, Carlos A
Background: The Awareness of Abdominal Adiposity as a Cardiometabolic Risk Factor Study assesses the prevalence of cardiometabolic risk factors in adults with abdominal obesity (waist circumference ≥90 cm in men and ≥80 cm in women) and evaluates how physicians manage these patients. Methods: This is an observational cross-sectional study. Internists, cardiologists, and endocrinologists contributed patients to the study. A standardized questionnaire was completed and registered demographics, anthropometric measurements, lab results from the medical files, and any treatment utilized to manage dyslipidemia, arterial hypertension, diabetes, and cardiovascular disease. Results: A total of 1312 patients was included. The mean age was 49.3 ± 14.6 years and 834 (63.6%) were female. The primary reason for the physician consultation was treatment of obesity (47.5%), followed by management of arterial hypertension (27.7%), diabetes (18.3%), dyslipidemia (14.2%), and cardiovascular disease (7.1%). The majority of patients identified excess body weight as a health problem (81.4%). However, patients had lost a mean of 4.3 ± 3.5 kg. Only 63.4% of patients with arterial hypertension were on drug therapy. Few of them had reached target values for diastolic (24.1%) and systolic/diastolic (13.3%) pressure. Less than half of the patients with dyslipidemia were receiving lipid-lowering medication. Only 32.2% were at their target low-density lipoprotein cholesterol levels. In patients with type 2 diabetes, mean fasting plasma glucose level (8.9 ± 3.4 mmol/L) was above the threshold recommended by current guidelines. Conclusions: The study describes the medical care given to individuals with abdominal obesity during daily clinical practice by general practitioners, cardiologists, and endocrinologists in urban Mexico. Our data confirm that a large proportion of patients are undertreated. Only a small percentage of patients with obesity-related comorbidities reach treatment targets
Volans, A P
The risk factors affecting intracranial haemorrhage in warfarinised patients are described and an attempt made to calculate the risk of haemorrhage in warfarinised patients with minor head injuries. Using the data from studies of patients with spontaneous haemorrhage while taking warfarin, guidelines for treatment and given and the likely outcome predicted.
Volans, A P
The risk factors affecting intracranial haemorrhage in warfarinised patients are described and an attempt made to calculate the risk of haemorrhage in warfarinised patients with minor head injuries. Using the data from studies of patients with spontaneous haemorrhage while taking warfarin, guidelines for treatment and given and the likely outcome predicted. PMID:9639176
Djousse, Luc; Song, Yiqing; Akinkuolie, Akintunde O.; Matsumoto, Chisa; Manson, JoAnn E.; Gaziano, J. Michael; Sesso, Howard D.
Background. The associations of diabetes and obesity with the risk of abdominal aortic aneurysm (AAA) are inconclusive in previous studies. Subjects/Methods. We conducted prospective analysis in the Physicians' Health Study. Among 25,554 male physicians aged ≥ 50 years who reported no AAA at baseline, 471 reported a newly diagnosed AAA during a mean of 10.4 years' follow-up. Results. Compared with men who had baseline body mass index (BMI) < 25 kg/m2, the multivariable hazard ratio (HR [95% CI]) of newly diagnosed AAA was 1.30 [1.06–1.59] for BMI 25–<30 kg/m2 and 1.69 [1.24–2.30] for BMI ≥ 30 kg/m2. The risk of diagnosed AAA was significantly higher by 6% with each unit increase in baseline BMI. This association was consistent regardless of the other known AAA risk factors and preexisting vascular diseases. Overall, baseline history of diabetes tended to be associated with a lower risk of diagnosed AAA (HR = 0.79 [0.57–1.11]); this association appeared to vary by follow-up time (HR = 1.56 and 0.63 during ≤ and >2 years' follow-up, resp.). Conclusion. In a large cohort of middle-aged and older men, obesity was associated with a higher risk, while history of diabetes tended to associate with a lower risk of diagnosed AAA, particularly over longer follow-up. PMID:28326193
Montalvo, Alicia M; Shaefer, Hilary; Rodriguez, Belinda; Li, Tan; Epnere, Katrina; Myer, Gregory D
The objective of the study is to examine injury epidemiology and risk factors for injury in CrossFit athletes. A survey was administered to athletes at four owner-operated facilities in South Florida. Respondents reported number, location of injury, and training exposure from the preceding six months and answered questions regarding potential risk factors for injury. Fifty out of 191 athletes sustained 62 injuries during CrossFit participation in the preceding six months. The most frequently injured locations were the shoulder, knee, and lower back. Injury incidence was 2.3/1000 athlete training hours. Competitors were more likely to be injured (40% v 19%, p = 0.002) and had greater weekly athlete training hours (7.3 ± 7.0 v 4.9 ± 2.9, p < 0.001) than non-competitors. Athletes who reported injury also reported significantly higher values for the following risk factors: years of participation (2.7 ± 1.8 v 1.8 ± 1.5, p = 0.001), weekly athlete training hours (7.3 ± 3.8 v 4.9 ± 2.1, p = 0.020), weekly athlete-exposures (6.4 ± 3.8 v 4.7 ± 2.1, p = 0.003), height (1.72 ± 0.09 m v 1.68 ± 0.01 m, p = 0.011), and body mass (78.24 ± 16.86 kg v 72.91 ± 14.77 kg, p = 0.037). Injury rates during CrossFit and location of injuries were similar to those previously reported. Injury incidence was similar to related sports, including gymnastics and powerlifting. While being a competitor was related to injury, increased exposure and length of participation in CrossFit likely underlied this association. Specifically, increased exposure to training in the form of greater weekly athlete training hours and weekly participations may contribute to injury. Increased height and body mass were also related to injury which is likely reflective of increased load utilized during training. Further research is warranted to determine if biomechanical factors associated with greater height and ability to lift greater loads are modifiable factors that can be adapted to reduce the increase
Heck, Jonathan F.; Weis, Michael P.; Gartland, James M.; Weis, Craig R.
Although catastrophic head and neck injuries in football occur infrequently, their occurrence is almost always followed by litigation. The athletic trainer has to be sure he/she has adequate liability insurance to cover the costs of a defense and a possible judgment. General claims filed against athletic staffs usually deal with instruction, equipment, matching of participants, supervision, and/or postinjury care. The defenses to these claims include: statutory immunity, assumption of risk, releases or waivers, and the reckless disregard standard. The athletic trainer plays a key role in head and neck injury prevention and care, and must be aware of litigation possibilities, along with methods of risk management. We present recommendations aimed at minimizing the risk of head and neck injuries and the risk of liability. The areas covered are: preparing for head and neck lawsuits, preventing head and neck injuries, and postcatastrophic injury care. We base these recommendations on principles that the athletic trainer can easily apply to other areas, broadening the risk management concept presented. ImagesFig 1.Fig 5.Fig 6.Fig 7. PMID:16558275
Strauss, Ewa; Waliszewski, Krzysztof; Gabriel, Marcin; Zapalski, Stanisław; Pawlak, Andrzej L
Abdominal aortic aneurysm (AAA) presents itself as a progressive dilation of the abdominal aorta, leading--if untreated--to rupture. It is a common disease of the elderly, with a complex etiology. Several genetic, biochemical and environmental factors are recognized as relevant for the pathogenesis of AAA. We determined the polymorphism of the MTHFR (methylenetetrahydrofolate reductase) gene within the fourth exon (C677T) in 63 patients with AAA and compared it to that in 75 subjects of the population sample. The frequencies of the C/C, C/T and T/T genotypes were 65%, 27%, and 8% in the population sample and 33%, 60%, and 6% in the patients. This corresponds to a 4.4-fold greater risk of AAA in subjects who have the 677C/T variant of MTHFR, as compared with those who are 677C/C (p < 0.0001; 95% CI=2.11-9.34). The frequency of allele MTHFR 677T in patients (0.37) was higher than in the population sample (0.21; p < 0.007). This association between the common allele of the MTHFR gene--MTHFR 677T--and the development of AAA suggests that elevated homocysteine (Hcy) may disturb the function of the aortic wall. The disturbance may involve enhancement of elastin degradation, the process enhanced by mild hyperhomocysteinemia in minipigs. The magnitude of this effect, which refers to the AAA patients unselected for familial occurrence, indicates that the disturbance of aortic wall physiology caused by the presence of the MTHFR 677T allele is greater than the effect of the earlier described allele disequilibrium at the polymorphic alleles of the PAI1 (plasminogen activator inhibitor 1) gene seen only in familial cases of AAA.
Funk, J. R.; Duma, S. M.; Manoogian, S. J.; Rowson, S.
The objective of this study was to characterize the risk of mild traumatic brain injury (MTBI) in living humans based on a large set of head impact data taken from American football players at the collegiate level. Real-time head accelerations were recorded from helmet-mounted accelerometers designed to stay in contact with the player’s head. Over 27,000 head impacts were recorded, including four impacts resulting in MTBI. Parametric risk curves were developed by normalizing MTBI incidence data by head impact exposure data. An important finding of this research is that living humans, at least in the setting of collegiate football, sustain much more significant head impacts without apparent injury than previously thought. The following preliminary nominal injury assessment reference values associated with a 10% risk of MTBI are proposed: a peak linear head acceleration of 165 g, a HIC of 400, and a peak angular head acceleration of 9000 rad/s2. PMID:18184501
Bailey, C J; Reid, S W; Hodgson, D R; Bourke, J M; Rose, R J
A retrospective case-control study was conducted to identify and quantify risk factors for serious musculoskeletal injury sustained at 4 Australian metropolitan racetracks. During the period of study (August 1988-July 1995) there were 196 cases from flat racing, 52 cases from hurdle racing and 53 cases from steeplechases. The incidences of fatal musculoskeletal injuries per start for flat, hurdle and steeple races were 0.06, 0.63 and 1.43% respectively. Logistic regression identified harder track surfaces, horses being older than age 3 years, one racecourse (Flemington) and jumping races as significant risk factors which increased the risk of musculoskeletal breakdown. The incidence of fatal musculoskeletal injuries for flat races at the 4 study tracks was similar to that reported in the UK but less than the USA. Death rates for hurdle and steeple races in the study population were higher than in the UK. Strategies to reduce the incidence of serious musculoskeletal injuries may include avoidance of excessively hard track surfaces through closer regulation of track moisture content; implementation of more rigorous prerace lameness examinations of horses, particularly older horses; and altering the design and number of jumps in hurdle and steeple races. The quantification of risk, as we have reported here, is the first step towards addressing the causes of musculoskeletal breakdown and should help in applying a reasoned approach to intervention measures that may be effective in reducing racing injuries.
Iannuzzi, James C.; Rickles, Aaron S.; Kelly, Kristin N.; Fleming, Fergal J.; Dolan, James G.; Monson, John R. T.; Noyes, Katia
Purpose Extended duration thromboprophylaxis (EDTPPX) is the practice of prescribing antithrombotic therapy for 21 days after discharge, commonly used in surgical patients who are at high risk for venothromboembolism (VTE). While guidelines recommend EDTPPX, criteria are vague due to a paucity of data. The criteria can be further informed by cost-effectiveness thresholds. This study sought to determine the VTE incidence threshold for the cost-effectiveness EDTPPX compared to inpatient prophylaxis. Methods A decision tree was used to compare EDTPPX for 21 days after discharge to 7-days of inpatient-prophylaxis with base case assumptions based on an abdominal oncologic resection without complications in an otherwise healthy individual. Willingness to pay was set at $50,000/QALY. Sensitivity analyses were performed to assess uncertainty within the model, with particular interest in the threshold for costeffectiveness based on VTE incidence. Results EDTPPX was the dominant strategy when VTE probability exceeds 2.39%. Given a willingness to pay threshold of $50,000/QALY, EDTPPX was the preferred strategy when VTE incidence exceeded 1.22% and 0.88% when using brand name or generic medication costs respectively. Conclusions EDTPPX should be recommended whenever VTE incidence exceeds 2.39%. When post-discharge estimated VTE risk is 0.88%–2.39% patient preferences about self-injections and medication costs should be considered. PMID:24101450
injury rates, medically not ready rates, and injury risk factors, and provide recommendations based on analysis for U.S. Army Chemical Brigade...One comparison between Chemical BDE and unpublished data from an Infantry brigade shows physical therapy visits account for 36% of all injury...an Army Chemical Brigade, May 2013–June 2014 Prepared by: Morgan K. Anderson, Injury Prevention Program Tyson Grier, Injury Prevention Program
Griffin, Russell L; Davis, Gregory G; Levitan, Emily B; MacLennan, Paul A; Redden, David T; McGwin, Gerald
Research has reported that a strong risk factor for traumatic injury is having a previous injury (i.e., recidivism). To date, the only study examining the relationship between recidivism and homicide reported strong associations, but was limited by possible selection bias. The current matched case-control study utilized coroner's data from 2004 to 2008. Subjects were linked to trauma registry data to determine whether the person had a previous traumatic injury. Conditional logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (95% CIs) for the association between homicide and recidivism. Homicide risk was increased for those having a previous traumatic injury (OR 1.81, 95% CI 1.09-2.99) or a previous intentional injury (OR 2.53, 95% CI 1.24-5.17). These results suggest an association between homicide and injury recidivism, and that trauma centers may be an effective setting for screening individuals for secondary prevention efforts of homicide through violence prevention programs.
Philippart, François; Bouroche, Gaëlle; Timsit, Jean-François; Garrouste-Orgeas, Maité; Azoulay, Elie; Darmon, Michael; Adrie, Christophe; Allaouchiche, Bernard; Ara-Somohano, Claire; Ruckly, Stéphane; Dumenil, Anne-Sylvie; Souweine, Bertrand; Goldgran-Toledano, Dany; Bouadma, Lila; Misset, Benoît
Rationale Experimental studies suggest that intra-abdominal infection (IAI) induces biological alterations that may affect the risk of lung infection. Objectives To investigate the potential effect of IAI at ICU admission on the subsequent occurrence of ventilator-associated pneumonia (VAP). Methods We used data entered into the French prospective multicenter Outcomerea database in 1997–2011. Consecutive patients who had severe sepsis and/or septic shock at ICU admission and required mechanical ventilation for more than 3 days were included. Patients with acute pancreatitis were not included. Measurements and Main Results Of 2623 database patients meeting the inclusion criteria, 290 (11.1%) had IAI and 2333 (88.9%) had other infections. The IAI group had fewer patients with VAP (56 [19.3%] vs. 806 [34.5%], P<0.01) and longer time to VAP (5.0 vs.10.5 days; P<0.01). After adjustment on independent risk factors for VAP and previous antimicrobial use, IAI was associated with a decreased risk of VAP (hazard ratio, 0.62; 95% confidence interval, 0.46–0.83; P<0.0017). The pathogens responsible for VAP were not different between the groups with and without IAI (Pseudomonas aeruginosa, 345 [42.8%] and 24 [42.8%]; Enterobacteriaceae, 264 [32.8%] and 19 [34.0%]; and Staphylococcus aureus, 215 [26.7%] and 17 [30.4%], respectively). Crude ICU mortality was not different between the groups with and without IAI (81 [27.9%] and 747 [32.0%], P = 0.16). Conclusions In our observational study of mechanically ventilated ICU patients with severe sepsis and/or septic shock, VAP occurred less often and later in the group with IAIs compared to the group with infections at other sites. PMID:26339904
Saratzis, A; Thatcher, A; Bath, M F; Sidloff, D A; Bown, M J; Shakespeare, J; Sayers, R D; Imray, C
INTRODUCTION Reporting surgeons' outcomes has recently been introduced in the UK. This has the potential to result in surgeons becoming risk averse. The aim of this study was to investigate whether reporting outcomes for abdominal aortic aneurysm (AAA) surgery impacts on the number and risk profile (level of fitness) of patients offered elective treatment. METHODS Publically available National Vascular Registry data were used to compare the number of AAAs treated in those centres across the UK that reported outcomes for the periods 2008-2012, 2009-2013 and 2010-2014. Furthermore, the number and characteristics of patients referred for consideration of elective AAA repair at a single tertiary unit were analysed yearly between 2010 and 2014. Clinic, casualty and theatre event codes were searched to obtain all AAAs treated. The results of cardiopulmonary exercise testing (CPET) were assessed. RESULTS For the 85 centres that reported outcomes in all three five-year periods, the median number of AAAs treated per unit increased between the periods 2008-2012 and 2010-2014 from 192 to 214 per year (p=0.006). In the single centre cohort study, the proportion of patients offered elective AAA repair increased from 74% in 2009-2010 to 81% in 2013-2014, with a maximum of 84% in 2012-2013. The age, aneurysm size and CPET results (anaerobic threshold levels) for those eventually offered elective treatment did not differ significantly between 2010 and 2014. CONCLUSIONS The results do not support the assumption that reporting individual surgeon outcomes is associated with a risk averse strategy regarding patient selection in aneurysm surgery at present.
Goodlin, Gabrielle T.; Roos, Andrew K.; Roos, Thomas R.; Hawkins, Claire; Beache, Sydney; Baur, Stephen; Kim, Stuart K.
Recent studies have identified genetic markers associated with risk for certain sports-related injuries and performance-related conditions, with the hope that these markers could be used by individual athletes to personalize their training and diet regimens. We found that we could greatly expand the knowledge base of sports genetic information by using published data originally found in health and disease studies. For example, the results from large genome-wide association studies for low bone mineral density in elderly women can be re-purposed for low bone mineral density in young endurance athletes. In total, we found 124 single-nucleotide polymorphisms associated with: anterior cruciate ligament tear, Achilles tendon injury, low bone mineral density and stress fracture, osteoarthritis, vitamin/mineral deficiencies, and sickle cell trait. Of these single nucleotide polymorphisms, 91% have not previously been used in sports genetics. We conducted a pilot program on fourteen triathletes using this expanded knowledge base of genetic variants associated with sports injury. These athletes were genotyped and educated about how their individual genetic make-up affected their personal risk profile during an hour-long personal consultation. Overall, participants were favorable of the program, found it informative, and most acted upon their genetic results. This pilot program shows that recent genetic research provides valuable information to help reduce sports injuries and to optimize nutrition. There are many genetic studies for health and disease that can be mined to provide useful information to athletes about their individual risk for relevant injuries. PMID:25919592
Faria, D T; Shwayder, T; Krull, E A
Little research has been performed to evaluate factors that may exacerbate perineal skin injury in the adult population. But extensive research has been done and knowledge has been gained from studies with diaper dermatitis in infants. Our objectives in writing this article are to define the anatomical area affected, the terms used, and to review the available literature for diaper dermatitis in infants, elucidating the similarities and differences between diaper dermatitis in infants and perineal dermatitis in adults. The six extrinsic environmental factors that have been identified and extensively studied in diaper dermatitis are skin wetness, urine, ammonia, feces, local skin pH and microorganisms. Although the complex interactions of the six factors are still not totally defined, we do know that to prevent perineal skin injury, it is helpful to prevent excessive skin hydration, minimize the interaction of urine and feces, minimize local microorganisms, and maintain skin near its physiologic pH. In general, the six extrinsic factors can be extrapolated and applied to the care of adults. Further research in adult fecal enzymes and pH is still necessary.
Li, Kui; Fan, Xiaoxiang; Yin, Zhiyong
Background The minibus, with a nearly flat front, is widely used in China, especially in the underdeveloped regions, and results in large numbers of pedestrian injuries and deaths. The purpose of this study was to determine the injury patterns and risk for pedestrians involved in these crashes. Material/Methods We conducted an in-depth investigation of minibus/pedestrian accidents in Chongqing, China, occurring between September 2000 and April 2014. The enrolled pedestrians was classified into 3 groups: young (aged 14–44 years), middle-aged (aged 45–59 years), and elderly (aged over 60 years). Pedestrian injuries were coded according to the Abbreviated Injury Scale (AIS). Results A total of 109 pedestrians, with an average age of 55.7±16.2 years, were injured or killed – 30.3% were young, 23.9% were middle-aged, and 45.9% were elderly. Pedestrians hit by a minibus had a high proportion of head, chest, and extremity injuries – 84.4%, 50.5%, and 52.3%, respectively. In addition, impact speeds in excess of 75 km/h all ultimately resulted in fatalities. At an impact speed of 30 km/h, the risk of pedestrian fatality and AIS3+ injury are approximately 12.0% and 37.2%, respectively. At 50 km/h the risks are 65.2% and 96.9%, respectively, and at 70 km/h the risks are 96.3% and 99.9%, respectively. Conclusions A higher likelihood of chest injury was associated with being older and impact speed of over 40 km/h in minibus/pedestrian collision. Our data suggest that the injury patterns of pedestrians in minibus collisions differ from that in other vehicle/pedestrian collisions. These findings could contribute to better understanding of the injury patterns and risk of pedestrian in minibus collisions in China, which may play an important role in developing measures to improve traffic safety. PMID:25754962
Montalvo, Alicia M.; Shaefer, Hilary; Rodriguez, Belinda; Li, Tan; Epnere, Katrina; Myer, Gregory D.
The objective of the study is to examine injury epidemiology and risk factors for injury in CrossFit athletes. A survey was administered to athletes at four owner-operated facilities in South Florida. Respondents reported number, location of injury, and training exposure from the preceding six months and answered questions regarding potential risk factors for injury. Fifty out of 191 athletes sustained 62 injuries during CrossFit participation in the preceding six months. The most frequently injured locations were the shoulder, knee, and lower back. Injury incidence was 2.3/1000 athlete training hours. Competitors were more likely to be injured (40% v 19%, p = 0.002) and had greater weekly athlete training hours (7.3 ± 7.0 v 4.9 ± 2.9, p < 0.001) than non-competitors. Athletes who reported injury also reported significantly higher values for the following risk factors: years of participation (2.7 ± 1.8 v 1.8 ± 1.5, p = 0.001), weekly athlete training hours (7.3 ± 3.8 v 4.9 ± 2.1, p = 0.020), weekly athlete-exposures (6.4 ± 3.8 v 4.7 ± 2.1, p = 0.003), height (1.72 ± 0.09 m v 1.68 ± 0.01 m, p = 0.011), and body mass (78.24 ± 16.86 kg v 72.91 ± 14.77 kg, p = 0.037). Injury rates during CrossFit and location of injuries were similar to those previously reported. Injury incidence was similar to related sports, including gymnastics and powerlifting. While being a competitor was related to injury, increased exposure and length of participation in CrossFit likely underlied this association. Specifically, increased exposure to training in the form of greater weekly athlete training hours and weekly participations may contribute to injury. Increased height and body mass were also related to injury which is likely reflective of increased load utilized during training. Further research is warranted to determine if biomechanical factors associated with greater height and ability to lift greater loads are modifiable factors that can be adapted to reduce the increase
... as ulcerative colitis or Crohn's disease , pancreatitis or liver cirrhosis. cancers of the liver, kidneys, pancreas, ovaries and bladder as well as ... injuries to abdominal organs such as the spleen, liver, kidneys or other internal organs in cases of ...
Background Mechanical ventilation (MV) is considered a predisposing factor for increased intra-abdominal pressure (IAP), especially when positive end-expiratory pressure (PEEP) is applied or in the presence of auto-PEEP. So far, no prospective data exists on the effect of MV on IAP. The study aims to look on the effects of MV on IAP in a group of critically ill patients with no other risk factors for intra-abdominal hypertension (IAH). Methods An observational multicenter study was conducted on a total of 100 patients divided into two groups: 50 patients without MV and 50 patients with MV. All patients were admitted to the intensive care units of the Medical and Surgical Research Centre, the Carlos J. Finlay Hospital, the Julio Trigo University Hospital, and the Calixto García Hospital, in Havana, Cuba between July 2000 and December 2004. The IAP was measured twice daily on admission using a standard transurethral technique. IAH was considered if IAP was greater than 12 mmHg. Correlations were made between IAP and body mass index (BMI), diagnostic category, gender, age, and ventilatory parameters. Results The mean IAP in patients on MV was 6.7 ± 4.1 mmHg and significantly higher than in patients without MV (3.6 ± 2.4 mmHg, p < 0.0001). This difference was maintained regardless of gender, age, BMI, and diagnosis. The use of MV and BMI were independent predictors for IAH for the whole population, while male gender, assisted ventilation mode, and the use of PEEP were independent factors associated with IAH in patients on MV. Conclusions In this study, MV was identified as an independent predisposing factor for the development of IAH. Critically ill patients, which are on MV, present with higher IAP values on admission and should be monitored very closely, especially if PEEP is applied, even when they have no other apparent risk factors for IAH. PMID:23281625
StGeorge, Jennifer; Fletcher, Richard; Freeman, Emily; Paquette, Daniel; Dumont, Caroline
Unintentional injury is an important cause of infant and child hospitalisation and parents play a key role in reducing children's risk-taking behaviour. Studies show that maternal and paternal parenting and supervision of children differ, but there is little research showing how fathers' parenting may influence children's tendency to engage in…
The Paralympic Games are the pinnacle of sport for many athletes with a disability. A potential issue for many wheelchair athletes is how to train hard to maximise performance while also reducing the risk of injuries, particularly to the shoulder due to the accumulation of stress placed on this joint during activities of daily living, training and competition. The overall purpose of this narrative review was to use the constraints-led approach of dynamical systems theory to examine how various constraints acting upon the wheelchair-user interface may alter hand rim wheelchair performance during sporting activities, and to a lesser extent, their injury risk. As we found no studies involving Paralympic athletes that have directly utilised the dynamical systems approach to interpret their data, we have used this approach to select some potential constraints and discussed how they may alter wheelchair performance and/or injury risk. Organism constraints examined included player classifications, wheelchair setup, training and intrinsic injury risk factors. Task constraints examined the influence of velocity and types of locomotion (court sports vs racing) in wheelchair propulsion, while environmental constraints focused on forces that tend to oppose motion such as friction and surface inclination. Finally, the ecological validity of the research studies assessing wheelchair propulsion was critiqued prior to recommendations for practice and future research being given. PMID:23557065
Lee, Li-Ching; Harrington, Rebecca A.; Chang, Jen Jen; Connors, Susan L.
The objective of this study was to examine injury risk in children with autism, ADD/ADD, learning disability, psychopathology, or other medical conditions. Children aged 3-5 years who participated in the National Survey of Children's Health were included. Six study groups were analyzed in this report: autism (n=82), ADD/ADHD (n=191), learning…
Pinto, Karina Alves de Castro; Priore, Silvia Eloiza; de Carvalho, Kênia Mara Baiocchi
This study aimed to estimate the prevalence of abdominal obesity and investigate their association with parameters markers of metabolic syndrome (MS) and its risk factors in female adolescents. It is a cross-sectional study with 150 adolescents from 10 public schools in the Federal District, Brazil. The presence of abdominal obesity was considered by measuring waist circumference above the 80th percentile, according to Taylor et al. (2000). The associated factors included sociodemographic characteristics, health status of adolescents and their parents, physical activity, eating habits, blood pressure and biochemical profile. The abdominal obesity prevalence ratio (PR) was estimated by Poisson regression model, with 95% CI. Among the adolescents studied (age= 15.6 +/- 0.8 years; BMI = 21.0 +/- 3.0 kg/m2), prevalence of abdominal obesity was 20%, and this condition was not associated with sociodemographic variables, physical activity and diet. However, abdominal obesity was significantly associated with intake of less than 4 meals a day (PR = 2.27; IC95% 1.27-4.10), previous obesity (PR = 2.36; IC95% 1.31-4.01), history of parental chronic disease (PR = 3.55; IC 95% 1.63-7.75), fasting insulin = 15 uUi/mL (PR = 3.05; IC 95% 1.36-6.82) e HDL-c > 40 mg/dL (PR = 0.39; IC95% 0.23-0.67). In this population, modifiable factors, family history and determinants of MS, such as insulin and HDL-c were associated with abdominal obesity, which points to the need for effective health promotion among adolescents.
Vieira, Rita de Cássia Almeida; Paiva, Wellingson Silva; de Oliveira, Daniel Vieira; Teixeira, Manoel Jacobsen; de Andrade, Almir Ferreira; de Sousa, Regina Márcia Cardoso
Diffuse axonal injury (DAI), a type of traumatic injury, is known for its severe consequences. However, there are few studies describing the outcomes of DAI and the risk factors associated with it. This study aimed to describe the outcome for patients with a primary diagnosis of DAI 6 months after trauma and to identify sociodemographic and clinical factors associated with mortality and dependence at this time point. Seventy-eight patients with DAI were recruited from July 2013 to February 2014 in a prospective cohort study. Patient outcome was analyzed using the Extended Glasgow Outcome Scale (GOS-E) within 6 months of the traumatic injury. The mean Injury Severity Score was 35.0 (SD = 11.9), and the mean New Injury Severity Score (NISS) was 46.2 (SD = 15.9). Mild DAI was observed in 44.9% of the patients and severe DAI in 35.9%. Six months after trauma, 30.8% of the patients had died, and 45.1% had shown full recovery according to the GOS-E. In the logistic regression model, the severity variables – DAI with hypoxia, as measured by peripheral oxygen saturation, and hypotension with NISS value – had a statistically significant association with patient mortality; on the other hand, severity of DAI and length of hospital stay were the only significant predictors for dependence. Therefore, severity of DAI emerged as a risk factor for both mortality and dependence. PMID:27812349
Grantham, W. Jeffrey; Iyengar, Jaicharan J.; Byram, Ian R.; Ahmad, Christopher S.
Context: The curveball is regarded by many as a potential risk factor for injury in youth baseball pitchers. Objective: To critically evaluate the scientific evidence regarding the curveball and its impact on pitching biomechanics and the overall risk of arm injuries in baseball pitchers. Study Type: Systematic review. Level of Evidence: Level 3. Data Sources: Ovid MEDLINE from 1946 to 2012. Study Selection: Ten biomechanical studies on kinematic or electromyographic analysis of pitching a curveball were included, as well as 5 epidemiologic studies that assessed pain or injury incidence in pitchers throwing the curveball. Data Extraction: When possible, demographic, methodology, kinetics, and kinematics variables and pain/injury incidence were compiled. Results: Two biomechanical studies found greater horizontal adduction of the shoulder at ball release and less shoulder internal torque during the curveball pitching motion. Two studies demonstrated less proximal force and less torque at the elbow as the arm accelerated when throwing a curveball compared with a fastball, as well as greater supination of the forearm and less wrist extension. Electromyographic data suggested increased activity of extensor and supinator muscles for curveballs. No studies found increased force or torque about the elbow or shoulder. Three epidemiologic studies showed no significant association between pitching a curveball and upper extremity pain or injury. One retrospective epidemiologic study reported a 52% increase in shoulder pain in pitchers throwing a curveball, although this may have been due to confounders. Conclusion: Despite much debate in the baseball community about the curveball’s safety in youth pitchers, limited biomechanical and most epidemiologic data do not indicate an increased risk of injury when compared with the fastball. PMID:25553209
Papakosta, Veronica; Koumoura, Fanny; Mourouzis, Constantinos
A very popular sport worldwide, soccer generates a great number of maxillofacial injuries, mainly fractures, resulting in esthetic or functional problems. The aim of this retrospective study was to contribute to the knowledge of soccer-related maxillofacial injuries, and call attention to the risk factors that favor these injuries. A total of 108 patients, who attended hospital because of maxillofacial injuries during soccer within a period of 8 years, were included in this study. The relationship of the patients with soccer, the type, the site, the severity, the mechanism of the injuries and the applied treatment were analyzed. The injured were all males, and were principally amateurs. Around 89.8% of the patients suffered maxillofacial fractures while 10.2% presented only soft tissue injuries; 13.9% had multiple fractures; 50% of the maxillofacial fractures concerned the zygomatic complex and 38.2% the mandible where the majority occurred at the angle. The prevailing mechanism was the direct impact of players. Head to head impact outnumbered. Elbow to head impact caused contusions of the temporomandibular joint. Kick to head impact was the main cause of multiple fractures. The treatment of fractures was mainly surgical (68.2%). These findings support the fact that maxillofacial injuries sustained during soccer tend to be severe, demanding surgical treatment. The mandibular angle is in danger due to the usual existence of impacted and semi-impacted third molars. There should be a preventive intervention on the above contributors, and mainly coaches and sports physicians should be properly informed about the specificity of the maxillofacial injuries.
Esnault, Pierre; Cardinale, Mickaël; Boret, Henry; D'Aranda, Erwan; Montcriol, Ambroise; Bordes, Julien; Prunet, Bertrand; Joubert, Christophe; Dagain, Arnaud; Goutorbe, Philippe; Kaiser, Eric; Meaudre, Eric
OBJECTIVE Blunt cerebrovascular injuries (BCVIs) affect approximately 1% of patients with blunt trauma. An antithrombotic or anticoagulation therapy is recommended to prevent the occurrence or recurrence of neurovascular events. This treatment has to be carefully considered after severe traumatic brain injury (TBI), due to the risk of intracranial hemorrhage expansion. Thus, the physician in charge of the patient is confronted with a hemorrhagic and ischemic risk. The main objective of this study was to determine the incidence of BCVI after severe TBI. METHODS The authors conducted a prospective, observational, single-center study including all patients with severe TBI admitted in the trauma center. Diagnosis of BCVI was performed using a 64-channel multidetector CT. Characteristics of the patients, CT scan results, and outcomes were collected. A multivariate logistic regression model was developed to determine the risk factors of BCVI. Patients in whom BCVI was diagnosed were treated with systemic anticoagulation. RESULTS In total, 228 patients with severe TBI who were treated over a period of 7 years were included. The incidence of BCVI was 9.2%. The main risk factors were as follows: motorcycle crash (OR 8.2, 95% CI 1.9-34.8), fracture involving the carotid canal (OR 11.7, 95% CI 1.7-80.9), cervical spine injury (OR 13.5, 95% CI 3.1-59.4), thoracic trauma (OR 7.3, 95% CI 1.1-51.2), and hepatic lesion (OR 13.3, 95% CI 2.1-84.5). Among survivors, 82% of patients with BCVI received systemic anticoagulation therapy, beginning at a median of Day 1.5. The overall stroke rate was 19%. One patient had an intracranial hemorrhagic complication. CONCLUSIONS Blunt cerebrovascular injuries are frequent after severe TBI (incidence 9.2%). The main risk factors are high-velocity lesions and injuries near cervical arteries.
There is a general decline in penetrating abdominal trauma throughout the western world. As a result of that, there is a significant loss of expertise in dealing with this type of injury particularly when the patient presents to theatre with physiological instability. A significant percentage of these patients will not be operated by a trauma surgeon but, by the "occasional trauma surgeon", who is usually trained as a general surgeon. Most general surgeons have a general knowledge of operating penetrating trauma, knowledge originating from their training years and possibly enhanced by reading operative surgery textbooks. Unfortunately, the details included in most of these books are not extensive enough to provide them with enough armamentaria to tackle the difficult case. In this scenario, their operative dexterity and knowledge cannot be compared to that of their trauma surgeon colleagues, something that is taken for granted in the trauma textbooks. Techniques that are considered basic and easy by the trauma surgeons can be unfamiliar and difficult to general surgeons. Knowing the danger points and pitfalls that will be encountered in penetrating trauma to the abdomen, will help the occasional trauma surgeons to avoid intraoperative errors and improve patient care. This manuscript provides a heuristic approach from surgeons working in a high volume penetrating trauma centers in South African. Some of the statements could be considered heretic by the "accepted" trauma literature. We believe that this heuristic ("rule of thumb" approach, that originating from "try and error" experience) can help surgical trainees or less experienced in penetrating trauma surgeons to improve their surgical decision making and technique, resulting in better patient outcome. PMID:20630100
Green, M; Turner, C; Purdie, D M; McClure, R
Risk taking behaviour has been identified as an important host-related determinant of injury in young adults. The aim of this study is to clarify the relationship between the two key elements of risk taking behaviour--ie, risk assessment and risk acceptance--in participants of a high risk sporting activity. Skydivers registered with the Australian Parachute Federation were sampled at several jump meetings held at three 'drop-zones' in North Eastern Australia. A cross sectional survey of 215 skydivers ascertained each subject's risk assessment of each of nine hypothetical sky diving scenes and whether or not they would jump in the described conditions. Variables which independently predicted an individual's risk assessment were age group (p < 0.05). gender (p < 0.05) and scene details (p < 0.001). Risk assessment was found to be a statistically significant predictor of the decision to jump, with a 22% decrease in the odds of jumping with every unit increase in risk assessment (OR = 0.78: 95% CI: 0.76, 0.80). Gender was also found to be a statistically significant predictor of the decision to jump, with males being 19% more likely to jump than females, after controlling for age, experience, currency and risk assessment (OR = 1. 19: 95% CI; 1.04, 1.38). The importance of these results is that, by quantifying the relationship between two key elements of risk taking behaviour and several important host factor determinants, they facilitate more informed discussion about the possible role of risk taking behaviour in the causation of injury.
Postorino, Maurizio; Marino, Carmen; Tripepi, Giovanni; Zoccali, Carmine
Hypertriglyceridemia is the most prevalent lipid alteration in end-stage renal disease, and we studied the relationship between serum triglycerides and all-cause and cardiovascular death in these patients. Since abdominal fat modifies the effect of lipids on atherosclerosis, we analyzed the interaction between serum lipids and waist circumference (WC) as a metric of abdominal obesity. In a cohort of 537 hemodialysis patients, 182 died, 113 from cardiovascular causes, over an average follow-up of 29 months. In Cox models that included traditional and nontraditional risk factors, there were significant strong interactions between triglycerides and WC to both all-cause and cardiovascular death. A fixed (50 mg/dl) excess in triglycerides was associated with a progressive lower risk of all-cause and cardiovascular mortality in patients with threshold WC <95 cm but with a progressive increased risk in those above this threshold. A significant interaction between cholesterol and WC with all-cause and cardiovascular death emerged only in models excluding the triglycerides-WC interaction. Neither high-density lipoprotein (HDL) nor non-HDL cholesterol or their interaction terms with WC were associated with study outcomes. Thus, the predictive value of triglycerides and cholesterol for survival and atherosclerotic complications in hemodialysis patients is critically dependent on WC. Hence, intervention studies in end-stage renal disease should specifically target patients with abdominal obesity and hyperlipidemia.
Patel, Ketan M; Albino, Frank P; Nahabedian, Maurice Y; Bhanot, Parag
The purpose of this study was to analyze the performance of a porcine-derived acellular dermal matrix (Strattice Reconstructive Tissue Matrix) in patients at increased risk for perioperative complications. We reviewed medical records for patients with complex abdominal wall reconstruction (AWR) and Strattice underlay from 2007 to 2010. Intermediate-risk patients were defined as having multiple comorbidities without abdominal infection. Forty-one patients met the inclusion criteria (mean age, 60 years; mean body mass index, 35.5 kg/m(2)). Comorbidities included coronary artery disease (63.4%), diabetes mellitus (36.6%), and chronic obstructive pulmonary disease (17.1%). Fascial closure was achieved in 40 patients (97.6%). Average hospitalization was 6.4 days (range, 1-24 days). Complications included seroma (7.3%), wound dehiscence with Strattice exposure (4.9%), cellulitis (2.4%), and hematoma (2.4%). All patients achieved abdominal wall closure with no recurrent hernias or need for Strattice removal. Patients with multiple comorbidities at intermediate risk of postoperative complications can achieve successful, safe AWR with Strattice.
Mendiguchia, Jurdan; Alentorn-Geli, Eduard; Idoate, Fernando; Myer, Gregory D
Quadriceps muscle strains frequently occur in sports that require repetitive kicking and sprinting, and are common in football in its different forms around the world. This paper is a review of aetiology, mechanism of injury and the natural history of rectus femoris injury. Investigating the mechanism and risk factors for rectus femoris muscle injury aims to allow the development of a framework for future initiatives to prevent quadriceps injury in football players.
Weaver, Ashley A; Stitzel, Sarah M; Stitzel, Joel D
A predictive Lagrangian-Eulerian finite element eye model was used to analyze 2.27 and 0.45 kg trinitrotoluene equivalent blasts detonated from 24 different locations. Free air and ground level blasts were simulated directly in front of the eye and at lateral offset locations with box, average, less protective, and more protective orbital anthropometries, resulting in 96 simulations. Injury risk curves were developed for hyphema, lens dislocation, retinal damage, and globe rupture from experimental and computational data to compute risk from corneoscleral stress and intra-ocular pressure computational outputs. Corneoscleral stress, intra-ocular pressure, and injury risks increased when the blast size was larger and located nearer to the eye. Risks ranged from 20-100 % for hyphema, 1-100 % for lens dislocation, 2-100 % for retinal damage, and 0-98 % for globe rupture depending on the blast condition. Orbital geometry affected the stresses, pressures, and associated ocular injury risks of the blast conditions simulated. Orbital geometries that more fully surrounded the eye such as the more protective orbit tended to produce higher corneoscleral stresses and compression of the eye against the surrounding rigid orbit contributing to high stresses as the blast wave propagated. However, the more protective orbit tended to produce lower intra-ocular pressures in comparison with the other three orbital geometries which may indicate that the more protective orbit inhibits propagation of the blast wave and reduces ocular loading. Results of this parametric computational study of ocular blast loading are valuable to the design of eye protection equipment and the mitigation of blast-related eye injuries.
Steffen, Annika; Huerta, José-Maria; Weiderpass, Elisabete; Bueno-de-Mesquita, H B As; May, Anne M; Siersema, Peter D; Kaaks, Rudolf; Neamat-Allah, Jasmine; Pala, Valeria; Panico, Salvatore; Saieva, Calogero; Tumino, Rosario; Naccarati, Alessio; Dorronsoro, Miren; Sánchez-Cantalejo, Emilio; Ardanaz, Eva; Quirós, J Ramón; Ohlsson, Bodil; Johansson, Mattias; Wallner, Bengt; Overvad, Kim; Halkjaer, Jytte; Tjønneland, Anne; Fagherazzi, Guy; Racine, Antoine; Clavel-Chapelon, Françoise; Key, Tim J; Khaw, Kay-Tee; Wareham, Nick; Lagiou, Pagona; Bamia, Christina; Trichopoulou, Antonia; Ferrari, Pietro; Freisling, Heinz; Lu, Yunxia; Riboli, Elio; Cross, Amanda J; Gonzalez, Carlos A; Boeing, Heiner
General obesity, as reflected by BMI, is an established risk factor for esophageal adenocarcinoma (EAC), a suspected risk factor for gastric cardia adenocarcinoma (GCC) and appears unrelated to gastric non-cardia adenocarcinoma (GNCC). How abdominal obesity, as commonly measured by waist circumference (WC), relates to these cancers remains largely unexplored. Using measured anthropometric data from 391,456 individuals from the European Prospective Investigation into Cancer and Nutrition (EPIC) study and 11 years of follow-up, we comprehensively assessed the association of anthropometric measures with risk of EAC, GCC and GNCC using multivariable proportional hazards regression. One hundred twenty-four incident EAC, 193 GCC and 224 GNCC were accrued. After mutual adjustment, BMI was unrelated to EAC, while WC showed a strong positive association (highest vs. lowest quintile HR = 1.19; 95% CI, 0.63-2.22 and HR = 3.76; 1.72-8.22, respectively). Hip circumference (HC) was inversely related to EAC after controlling for WC, while WC remained positively associated (HR = 0.35; 0.18-0.68, and HR=4.10; 1.94-8.63, respectively). BMI was not associated with GCC or GNCC. WC was related to higher risks of GCC after adjustment for BMI and more strongly after adjustment for HC (highest vs. lowest quintile HR = 1.91; 1.09-3.37, and HR = 2.23; 1.28-3.90, respectively). Our study demonstrates that abdominal, rather than general, obesity is an indisputable risk factor for EAC and also provides evidence for a protective effect of gluteofemoral (subcutaneous) adipose tissue in EAC. Our study further shows that general obesity is not a risk factor for GCC and GNCC, while the role of abdominal obesity in GCC needs further investigation.
Rønning, R; Gerner, T; Engebretsen, L
Estimation of injury risk in alpine sports is difficult. We present a new method of calculating an injury index related to the distance traveled on ski or snowboard. The distance-correlated injury index equals the number of injuries per 100,000 km traveled distance. This injury index can also be correlated to the type of equipment used. The equipment-specific distance-correlated injury index is the same as the distance-correlated injury index, but it is sport-specific. We found the distance-correlated injury index for alpine skiing to be 3.9 (95% Cl = 2.8 to 5.4); for snowboarding, 13.5 (95% Cl = 8.3 to 22.0); and for telemark skiing, 3.0 (95% Cl = 1.0 to 9.4), suggesting a three- to four-times higher incidence of injuries requiring hospital treatment among snowboarders than among alpine and telemark skiers.
Kemper, G L J; van der Sluis, A; Brink, M S; Visscher, C; Frencken, W G P; Elferink-Gemser, M T
The aim of the study was to investigate whether an increased risk of injury occurrence can be determined through frequent anthropometric measurements in elite-standard youth soccer players. Over the course of one season, we followed 101 male elite-standard youth soccer players between 11 and 19 years of age. Height and body mass were monitored at monthly measurement intervals and fat percentage was assessed every 3 months by use of the sum of skinfold method. Growth in height (cm), alternations in body mass index (kg/m(2)), fat percentage and fat-free mass index (kg/m(2)) were calculated. Injuries were recorded in accordance with the recommendations of the FIFA Consensus Model for Injury Registration. Odds ratio scores and 95% confidence intervals were calculated using binary logistic regression analyses. The following anthropometric injury risk factors were identified: ≥ 0.6 centimeter growth per month (p=0.03; OR=1.63; 95% CI: 1.06-2.52), ≥ 0.3 kg/m(2) increase of body mass index value per month (p=0.03; OR=1.61; 95% CI: 1.04-2.49) and low fat percentage; i. e., < 7% for players aged 11-16 and < 5% for players over 16 years (p=0.01; OR=1.81; 95% CI: 1.18-2.76). Individual monitoring of anthropometrics provides useful information to determine increased risk of injury occurrence in elite-standard youth soccer.
Durbin, Dennis R; Kallan, Michael; Elliott, Michael; Cornejo, Rebecca A; Arbogast, Kristy B; Winston, Flaura K
The objectives of this study were to estimate the prevalence of children's exposure to passenger air bag (PAB) deployments and to determine the relative risk of both minor and more serious nonfatal injuries to restrained children exposed to PABs in frontal impact collisions. Data were collected from 1 December 1998 to 30 November 2001 from a large-scale, child-specific crash surveillance system based on insurance claims, a telephone survey, and on-site crash investigations. Vehicles qualifying for inclusion were State Farm-insured, model year 1990 or newer, and involved in a crash with at least one child occupant < or =15 years of age. Qualifying crashes were limited to those that occurred in 15 states and the District of Columbia. A stratified cluster sample was designed in order to select vehicles (the unit of sampling) for the conduction of a telephone survey with the driver. For cases in which child occupants were seriously injured or killed, in-depth crash investigations were performed. The prevalence of exposure to PABs was calculated as the number of children occupying the right front seat in a PAB deployment crash among all children occupying the right front seat in vehicles equipped with PABs. Complete interview data were obtained on 9,779 vehicles involving 15,341 children. Among PAB-exposed children, 175 (14%) suffered serious injuries versus 41 (7.5%) of those in the comparison group (OR 2.0; 95% CI, 1.1-3.7). The overall risk of any injury (both minor and serious) was 86% among children exposed to PABs, compared to 55% among the comparison group (OR 5.3; 95% CI, 2.1-13.4). Exposure to PABs increased the risk of both minor injuries, including facial and chest abrasions, and more serious injuries, particularly upper extremity fractures.
Cavalari, Rachel N S; Romanczyk, Raymond G
Unintentional injury risk research for children with an autism spectrum disorder (ASD) is currently limited. This article presents findings from a two-phase investigation of caregiver perspectives regarding unintentional injury risk in children with an ASD. Results indicate that children with an ASD exhibit elevated rates of risk-taking behaviors compared with peers, which increases the likelihood of more frequent and severe injuries. In addition, although ASD symptom severity positively correlated with risk-taking behavior and frequency of injury, children with an ASD were rarely rated as high risks for injury by caregivers. Implications are discussed in the context of pediatric health service provision.
Wong, Clare; Merkur, Harry
The anatomical position of the inferior epigastric artery (IEA) subjects it to risk of injury during abdominal procedures that are close to the artery, such as laparoscopic trocar insertion, insertion of intra-abdominal drains, Tenckhoff(®) catheter (peritoneal dialysis catheter) and paracentesis. This article aims to raise the awareness of the anatomical variations of the course of the IEA in relation to abdominal landmarks in order to define a safer zone for laparoscopic ancillary trocar placement. Methods of managing the IEA injury as well as techniques to minimise the risk of injury to the IEA are reviewed and discussed.
Beckmann, Marianne; Husmann, Marc
Background Central augmentation index (cAIx) is an indicator for vascular stiffness. Obstructive and aneurysmatic vascular disease can affect pulse wave propagation and reflection, causing changes in central aortic pressures. Aim To assess and compare cAIx in patients with peripheral arterial disease (PAD) and / or abdominal aortic aneurysm (AAA). Methods cAIx was assessed by radial applanation tonometry (Sphygmocor) in a total of 184 patients at a tertiary referral centre. Patients were grouped as having PAD only, AAA only, or both AAA and PAD. Differences in cAIx measurements between the three patient groups were tested by non-parametric tests and stepwise multivariate linear regression analysis to investigate associations with obstructive or aneurysmatic patterns of vascular disease. Results In the study sample of 184 patients, 130 had PAD only, 20 had AAA only, and 34 patients had both AAA and PAD. Mean cAIx (%) was 30.5 ± 8.2 across all patients. It was significantly higher in females (35.2 ± 6.1, n = 55) than males (28.4 ± 8.2, n = 129), and significantly higher in patients over 80 years of age (34.4 ± 6.9, n = 22) than in those under 80 years (30.0 ± 8.2, n = 162). Intergroup comparison revealed a significant difference in cAIx between the three patient groups (AAA: 27.3 ± 9.5; PAD: 31.4 ± 7.8; AAA & PAD: 28.8 ± 8.5). cAIx was significantly lower in patients with AAA, higher in patients with both AAA and PAD, and highest in patients with PAD only (beta = 0.21, p = 0.006). Conclusion Non-invasive assessment of arterial stiffness in high-risk patients indicates that cAIx differs according to the pattern of vascular disease. Measurements revealed significantly higher cAIx values for patients with obstructive peripheral arterial disease than for patients with aneurysmatic disease. PMID:26452151
Ravensbergen, Henrike Rianne Joanna Cornelie; Lear, Scott Alexander; Claydon, Victoria Elizabeth
Obesity is an important identifier of cardiovascular disease (CVD) risk, but is challenging to determine accurately in individuals with spinal cord injury (SCI). Body mass index (BMI) is used worldwide as a simple indicator of obesity, but is difficult to measure in individuals with SCI. Furthermore, standard BMI cutoffs underestimate obesity in this population. Therefore, we aimed to identify the best marker of obesity in individuals with SCI, considering both practicality, and ability to detect adiposity and CVD risk. Five anthropometric measures were evaluated: BMI; waist circumference (WC); waist-to-height ratio (WHtR); waist-to-hip ratio; and neck circumference. We evaluated relationships between these measures and abdominal and total body-fat percentage, seven cardiovascular metabolic risk factors (fasting insulin, glucose, glucose tolerance, triglycerides, high-density lipoprotein, low-density lipoprotein, and total cholesterol), and the Framingham risk score. BMI, WC, and WHtR were correlated with abdominal fat percentage. WC and WHtR were correlated with five metabolic risk factors as well as the Framingham risk score. WC is a more practical measure for an SCI population. The optimal cutoff for identifying adverse CVD risk in individuals with SCI was identified as WC ≥94 cm, with 100% sensitivity and 79% specificity. We propose that WC is a simple, more sensitive alternative to BMI in this population that is easy to use in multiple settings. The cutoff provides a simple tool to predict adverse CVD risk profiles that can be used to guide risk management, as well as as a practical aid for individuals with SCI to maintain a healthy body composition.
Ravensbergen, Henrike (Rianne) Joanna Cornelie; Lear, Scott Alexander
Abstract Obesity is an important identifier of cardiovascular disease (CVD) risk, but is challenging to determine accurately in individuals with spinal cord injury (SCI). Body mass index (BMI) is used worldwide as a simple indicator of obesity, but is difficult to measure in individuals with SCI. Furthermore, standard BMI cutoffs underestimate obesity in this population. Therefore, we aimed to identify the best marker of obesity in individuals with SCI, considering both practicality, and ability to detect adiposity and CVD risk. Five anthropometric measures were evaluated: BMI; waist circumference (WC); waist-to-height ratio (WHtR); waist-to-hip ratio; and neck circumference. We evaluated relationships between these measures and abdominal and total body-fat percentage, seven cardiovascular metabolic risk factors (fasting insulin, glucose, glucose tolerance, triglycerides, high-density lipoprotein, low-density lipoprotein, and total cholesterol), and the Framingham risk score. BMI, WC, and WHtR were correlated with abdominal fat percentage. WC and WHtR were correlated with five metabolic risk factors as well as the Framingham risk score. WC is a more practical measure for an SCI population. The optimal cutoff for identifying adverse CVD risk in individuals with SCI was identified as WC ≥94 cm, with 100% sensitivity and 79% specificity. We propose that WC is a simple, more sensitive alternative to BMI in this population that is easy to use in multiple settings. The cutoff provides a simple tool to predict adverse CVD risk profiles that can be used to guide risk management, as well as as a practical aid for individuals with SCI to maintain a healthy body composition. PMID:24070685
Near-infrared spectroscopy is a noninvasive method of measuring local tissue oxygenation (StO). Abdominal StO measurements in preterm piglets are directly correlated with changes in intestinal blood flow and markedly reduced by necrotizing enterocolitis. The objectives of this study were to us...
Volpi, Piero; Bisciotti, Gian Nicola; Chamari, Karim; Cena, Emanuela; Carimati, Giulia; Bragazzi, Nicola Luigi
Summary Background The ACL lesion represents one of the most dramatic injuries in a sportsman’s career. There are many injury risk factors related to intrinsic, or non-modifiable, and extrinsic, or modifiable, factors. In literature at today current evidence suggests that ACL injury risk is multifactorial and involves biomechanical, anatomical, hormonal and neuromuscular factors. Purpose To perform a systematic review of the literature concerning the ACL injury risk factors in soccer. Conclusion The injury risk factors show a low level of evidence, further studies in the field are needed. Study design Systematic review. PMID:28217570
Edouard, P; Degache, F; Oullion, R; Plessis, J-Y; Gleizes-Cervera, S; Calmels, P
This study was conducted to analyze whether internal (IR) and external (ER) rotator shoulder muscles weakness and/or imbalance collected through a preseason assessment could be predictors of subsequent shoulder injury during a season in handball players. In preseason, 16 female elite handball players (HPG) and 14 healthy female nonathletes (CG) underwent isokinetic IR and ER strength test with use of a Con-Trex® dynamometer in a seated position with 45° shoulder abduction in scapular plane, at 60, 120 and 240°/s in concentric and at 60°/s in eccentric, for both sides. An imbalanced muscular strength profile was determined using -statistically selected cut-offs from CG values. For HPG, all newly incurred shoulder injuries were reported during the season. There were significant differences between HPG and CG only for dominant eccentric IR strength, ER/IR ratio at 240°/s and for IRecc/ERcon ratio. In HPG, IR and ER strength was higher, and ER/IR ratios lower for dominant than for nondominant side. The relative risk was 2.57 (95%CI: 1.60-3.54; P<0.05) if handball players had an imbalanced muscular strength profile. In youth female handball players IR and ER muscle strength increases on the dominant side without ER/IR imbalances; and higher injury risk was associated with imbalanced muscular strength profile.
Bailey, C J; Reid, S W; Hodgson, D R; Suann, C J; Rose, R J
Risk factors for musculoskeletal injury in racing Thoroughbreds were investigated in a case-control study conducted at racetracks administered by the Australian Jockey Club. Univariable analysis of 137 cases from the official Veterinary Surgeon's reports and an equal number of randomly selected controls from the Australian Race Results identified field size, barrier position and class of race as being significantly associated with breakdown (P < 0.05). Multiple logistic regression was then used to investigate the effect of each putative risk factor whilst controlling for all others. Horses at greater risk were older, started from a wider barrier position, ran at the same distance as their previous race and raced in the highest class of race. There was no significant difference between tracks or significant association with track condition. The incidence of fatalities in the study population was less than that reported in the UK and USA.
Segui-Gomez, Maria; Lopez-Valdes, Francisco J; Guillen-Grima, Francisco; Smyth, Ernesto; Llorca, Javier; de Irala, Jokin
Research on the risk of motor vehicle injuries and their relationship with the amount of travel has been only partially analyzed. The few individual exposure assessments are related to very specific subsets of the driving and traveling populations. This study analyzes the relationship between kilometers traveled and hospitalization due to motor vehicle injuries. Twelve thousand three hundred and sixty nine Spanish university graduates from the Seguimiento Universidad de Navarra multipurpose cohort study were evaluated. They had not been hospitalized due to motor vehicle injuries at baseline and were followed up to eight years. Biannual questionnaires allowed for self-reporting of kilometers traveled in motor vehicles, together with incidence of hospitalization. Covariates in the Cox regression models included age and gender and baseline use of safety belt while driving, driving a vehicle with driver-side airbag, driving a motorcycle, and drinking and driving. There were 49,766 participant-years with an average yearly travel of 7,828 km per person-year. Thirty-six subjects reported a first hospitalization event during this time. The adjusted hazard ratio per additional kilometer traveled was 1.00005 (95% confidence interval 1.000013 to 1.000086). Even the smallest of reductions in the amount of kilometers traveled (from an average of 3,250 km per year to 1,000) has a statistically significant protective effect on the likelihood of sustaining hospitalization due to motor vehicle injury (aHR 0.9, 95% CI 0.78 to 0.98). In light of current policies aimed to reduce motorized traffic due to environmental concerns, it may be appropriate to consider the additional health benefit related to reductions in injuries.
Backe, S; Ericson, L; Janson, S; Timpka, T
The objective was to examine injury rates and associated risk factors in a representative sample of climbers. A random sample (n=606) of the Swedish Climbing Association members was sent a postal survey, with an effective response rate of 63%. Self-reported data regarding climbing history, safety practices and retrospective accounts of injury events (recall period 1.5 years) were obtained. Descriptive statistical methods were used to calculate injury incidences, and a two-step method including zero-inflated Poisson's regression analysis of re-injuries was used to determine the combination of risk factors that best explained individual injury rates. Overall, 4.2 injuries per 1000 climbing hours were reported, overuse injuries accounting for 93% of all injuries. Inflammatory tissue damages to fingers and wrists were the most common injury types. The multivariate analysis showed that overweight and practicing bouldering generally implied an increased primary injury risk, while there was a higher re-injury risk among male climbers and a lower risk among the older climbers. The high percentage of overuse injuries implies that climbing hours and loads should be gradually and systematically increased, and climbers regularly controlled for signs and symptoms of overuse. Further study of the association between body mass index and climbing injury is warranted.
Hjelm, N; Werner, S; Renstrom, P
The aim was to investigate injury risk factors in junior tennis players. Fifty-five players, 35 boys and 20 girls, answered a questionnaire about training habits, time of exposure, previous injuries and equipment factors. A battery of clinical tests and functional performance tests were also carried out. All tennis-related injuries that occurred during a 2-year period were identified and recorded. An injury was defined as an injury if it was impossible to participate in regular tennis training or playing matches during at least one occasion, a time loss injury. Potential injury risk factors were tested in a forward stepwise logistic regression model for injury. Thirty-nine players sustained totally 100 new and recurrent injuries. Injuries to the lower extremity were the most common ones (51%) followed by the upper extremity (24%) and the trunk (24%). Injured players performed more singles per week (P<0.0001) and played more tennis hours per year (P=0.016) than the uninjured players. Playing tennis more than 6 h/week was found to be a risk factor for back pain. A previous injury regardless of location was identified as an injury risk factor, and a previous injury to the back was a risk factor for back pain.
Wang, Jing; Sukhova, Galina K.; Liu, Jian; Ozaki, Keith; Lesner, Adam; Libby, Peter; Kovanen, Petri T.; Shi, Guo-Ping
Objective Cathepsin G (CatG) is a serine protease that mediates angiotensin-I (Ang-I) to angiotensin-II (Ang-II) conversion and is highly expressed in human abdominal aortic aneurysms (AAAs). However, it remains untested whether this protease participates in the pathogenesis of AAA. Methods and Results Immunofluorescent double staining demonstrated the expression of CatG in smooth-muscle cells (SMCs), macrophages, and endothelial cells (ECs) in human AAA lesions (n=12), but not in AAA-free aortas (n=10). While inflammatory cytokines induced CatG expression, high glucose increased CatG activity in producing Ang-II and angiotensin-converting enzyme (ACE) in SMCs, which could be fully blocked by a CatG-selective inhibitor or its siRNA. To test whether CatG contributes to AAA development, we generated CatG and low-density lipoprotein receptor (LDLr) double deficient (Ldlr−/−Ctsg−/−) mice and their littermate controls (Ldlr−/−Ctsg+/+). Absence of CatG did not affect Ang-II infusion-induced AAAs. In contrast, in Ang-II-independent AAAs induced by peri-aortic CaCl2 injury (n=12 per group), CatG deficiency significantly reduced aortic diameter increase (58.33%±6.83% vs. 31.67%±5.75%, P=0.007), aortic lesion area (0.35±0.04 mm2 vs. 0.21±0.02 mm2, P=0.005), and aortic wall elastin fragmentation grade (2.75±0.18 vs. 1.58±0.17, P=0.002) along with reduced lesion collagen content grade (2.80±0.17 vs. 2.12±0.17, P=0.009) without affecting indices of lesion inflammation, angiogenesis, cell proliferation, or apoptosis. In vitro elastin degradation assays demonstrated that CaCl2-induced AAA lesions from Ldlr−/−Ctsg−/− mice contained much lower elastinolytic activity than in those from littermate control mice. Gelatin gel zymogram assay suggested that absence of CatG in CaCl2-induced AAA lesions also reduced the activity of elastinolytic matrix metalloproteinase (MMP)-2 and MMP-9. Conclusion CatG may contribute to CaCl2-induced experimental AAAs directly
Chia, Chee W.; Shardell, Michelle; Tanaka, Toshiko; Liu, David D.; Gravenstein, Kristofer S.; Simonsick, Eleanor M.
Introduction Low-calorie sweetener use for weight control has come under increasing scrutiny as obesity, especially abdominal obesity, remain entrenched despite substantial low-calorie sweetener use. We evaluated whether chronic low-calorie sweetener use is a risk factor for abdominal obesity. Participants and Methods We used 8268 anthropometric measurements and 3096 food diary records with detailed information on low-calorie sweetener consumption in all food products, from 1454 participants (741 men, 713 women) in the Baltimore Longitudinal Study of Aging collected from 1984 to 2012 with median follow-up of 10 years (range: 0–28 years). At baseline, 785 were low-calorie sweetener non-users (51.7% men) and 669 participants were low-calorie sweetener users (50.1% men). Time-varying low-calorie sweetener use was operationalized as the proportion of visits since baseline at which low-calorie sweetener use was reported. We used marginal structural models to determine the association between baseline and time-varying low-calorie sweetener use with longitudinal outcomes—body mass index, waist circumference, obesity and abdominal obesity—with outcome status assessed at the visit following low-calorie sweetener ascertainment to minimize the potential for reverse causality. All models were adjusted for year of visit, age, sex, age by sex interaction, race, current smoking status, dietary intake (caffeine, fructose, protein, carbohydrate, and fat), physical activity, diabetes status, and Dietary Approaches to Stop Hypertension score as confounders. Results With median follow-up of 10 years, low-calorie sweetener users had 0.80 kg/m2 higher body mass index (95% confidence interval [CI], 0.17–1.44), 2.6 cm larger waist circumference (95% CI, 0.71–4.39), 36.7% higher prevalence (prevalence ratio = 1.37; 95% CI, 1.10–1.69) and 53% higher incidence (hazard ratio = 1.53; 95% CI 1.10–2.12) of abdominal obesity than low-calorie sweetener non-users. Conclusions Low
Wells, Melissa; Morrongiello, Barbara A.; Kane, Alexa
Objective: Research on children's risk of injury reveals that parent and child factors are often interrelated. This study examined relations between children's risk taking, parent appraisal of this risk taking, and children's rate of injury in youth 8 and 9 years old. Methods: Responses to questionnaires and laboratory tasks were used to examine…
Murphy, D; Connolly, D; Beynnon, B
Prospective studies on risk factors for lower extremity injury are reviewed. Many intrinsic and extrinsic risk factors have been implicated; however, there is little agreement with respect to the findings. Future prospective studies are needed using sufficient sample sizes of males and females, including collection of exposure data, and using established methods for identifying and classifying injury severity to conclusively determine addtional risk factors for lower extremity injury. PMID:12547739
Amoroso, Timothy; Iverson, Katherine M
Since the Iraq and Afghanistan wars began, an unprecedented number of women have been engaging in combat operations. Likewise, the number of women using Department of Veterans Affairs (VA) services has doubled since 2001. Military service, and deployment to combat in particular, poses certain risks for traumatic brain injury (TBI)-for all service members. However, women may have additional military and nondeployment risk factors such as intimate partner violence (IPV). We briefly review the definition and classification issues related to TBI, as well as common acute and chronic health symptoms after TBI. Specific sex differences in prognosis after TBI, in particular the neurobehavioral symptoms, are also reviewed. We then focus on the emerging literature regarding TBI in women veterans including the etiologies, outcomes, and unique challenges this population faces. The article concludes with suggestions for enhanced screening by VA and non-VA providers alike, as well as directions for future research and clinical inquiry.
van 't Hof, Femke Ng; Vaucher, Julien; Holmes, Michael V; de Wilde, Arno; Baas, Annette F; Blankensteijn, Jan D; Hofman, Albert; Kiemeney, Lambertus Alm; Rivadeneira, Fernando; Uitterlinden, André G; Vermeulen, Sita H; Rinkel, Gabriël Je; de Bakker, Paul Iw; Ruigrok, Ynte M
Epidemiological studies show that type 2 diabetes (T2D) is inversely associated with intracranial aneurysms (IA) and abdominal aortic aneurysms (AAA). Although adiposity has not been considered a risk factor for IA, there have been inconsistent reports relating adiposity to AAA risk. We assessed whether these observations have a genetic, causal basis. To this end, we extracted genotypes of validated single-nucleotide polymorphisms associated with T2D (n=65), body mass index (BMI) (n=97) and waist-hip ratio adjusted for BMI (WHRadjBMI) (n=47) from genotype data collected in 717 IA cases and 1988 controls, and in 818 AAA cases and 3004 controls, all of Dutch descent. For each of these three traits, we computed genetic risk scores (GRS) for each individual in these case-control data sets by summing the number of risk alleles weighted by their published effect size, and tested whether these GRS were associated with risk of aneurysm. We divided the cohorts into GRS quartiles, and compared IA and AAA risk in the highest with the lowest GRS quartile using logistic regression. We found no evidence for association in IA or AAA risk between top and bottom quartiles for the genetic risk scores for T2D, BMI and WHRadjBMI. However, additional Mendelian randomization analyses suggested a trend to potentially causal associations between BMI and WHRadjBMI and risk of AAA. Overall, our results do not support epidemiological observations relating T2D to aneurysm risk, but may indicate a potential role of adiposity in AAA that requires further investigation.European Journal of Human Genetics advance online publication, 5 April 2017; doi:10.1038/ejhg.2017.48.
Fortenbaugh, Dave; Fleisig, Glenn S.; Andrews, James R.
Context: Baseball pitching kinematics, kinetics, ball velocity, and injuries at the shoulder and elbow are related. Evidence Acquisition: PubMed and Sport Discus were searched for original studies published between 1994 and 2008. Relevant references in these studies were retrieved. Inferential studies that tested relationships between kinematics and kinetics were included, as were studies that tested relationships between kinematics and ball velocity. Descriptive studies that simply quantified kinematics and/or kinetics were excluded. Results: Several kinematic parameters at the instant of foot contact were associated with increased upper extremity kinetics: front foot position, front foot orientation, shoulder abduction, and shoulder horizontal adduction. The timing of shoulder external rotation, pelvis rotation, and upper trunk rotation was associated with increased kinetics and decreased ball velocity. Low braking force of the lead leg and a short stride were associated with decreased ball velocity. Decreased maximum shoulder external rotation, shoulder abduction, knee extension, and trunk tilt were also associated with decreased ball velocity. As pitchers develop, kinematic values remain similar, their variability reduces, and kinetic values gradually increase. Slight kinematic variations were seen among pitch types, although the kinetics of fastballs and curveballs were relatively the same; changeup kinetics were the lowest. As pitchers fatigued, kinetic values remained constant, but increases in arm pain were reported. Conclusions: Several kinematic parameters were related to joint kinetics and ball velocity. To enhance performance and reduce injury risk, pitchers need to learn proper fastball mechanics at an early age. A changeup is recommended as a safe secondary pitch to complement the fastball; the curveball can be added after fastball and changeup mechanics are mastered. Avoiding overuse and pitching while fatigued is necessary to minimize the risk of
Yoganandan, Narayan; Banerjee, Anjishnu; Pintar, Frank A.
Injury criteria and risk curves are needed for anthropomorphic test devices (dummies) to assess injuries for improving human safety. The present state of knowledge is based on using injury outcomes and biomechanical metrics from post-mortem human subject (PMHS) and mechanical records from dummy tests. Data from these models are combined to develop dummy injury assessment risk curves (IARCs)/dummy injury assessment risk values (IARVs). This simple substitution approach involves duplicating dummy metrics for PMHS tested under similar conditions and pairing with PMHS injury outcomes. It does not directly account for the age of each specimen tested in the PMHS group. Current substitution methods for injury risk assessments use age as a covariate and dummy metrics (e.g., accelerations) are not modified so that age can be directly included in the model. The age-infusion methodology presented in this perspective article accommodates for an annual rate factor that modifies the dummy injury risk assessment responses to account for the age of the PMHS that the injury data were based on. The annual rate factor is determined using human injury risk curves. The dummy metrics are modulated based on individual PMHS age and rate factor, thus “infusing” age into the dummy data. Using PMHS injuries and accelerations from side-impact experiments, matched-pair dummy tests, and logistic regression techniques, the methodology demonstrates the process of age-infusion to derive the IARCs and IARVs. PMID:26697422
Yoganandan, Narayan; Banerjee, Anjishnu; Pintar, Frank A
Injury criteria and risk curves are needed for anthropomorphic test devices (dummies) to assess injuries for improving human safety. The present state of knowledge is based on using injury outcomes and biomechanical metrics from post-mortem human subject (PMHS) and mechanical records from dummy tests. Data from these models are combined to develop dummy injury assessment risk curves (IARCs)/dummy injury assessment risk values (IARVs). This simple substitution approach involves duplicating dummy metrics for PMHS tested under similar conditions and pairing with PMHS injury outcomes. It does not directly account for the age of each specimen tested in the PMHS group. Current substitution methods for injury risk assessments use age as a covariate and dummy metrics (e.g., accelerations) are not modified so that age can be directly included in the model. The age-infusion methodology presented in this perspective article accommodates for an annual rate factor that modifies the dummy injury risk assessment responses to account for the age of the PMHS that the injury data were based on. The annual rate factor is determined using human injury risk curves. The dummy metrics are modulated based on individual PMHS age and rate factor, thus "infusing" age into the dummy data. Using PMHS injuries and accelerations from side-impact experiments, matched-pair dummy tests, and logistic regression techniques, the methodology demonstrates the process of age-infusion to derive the IARCs and IARVs.
Li, Na; Huo, Zhi-guo; He, Nan; Xiao, Jing-jing; Wen, Quan-pei
Based on the 1951-2006 climatic observation data from 224 meteorological stations in South China (Guangdong Province, Guangxi Autonomous Region, and Fujian Province) and the historical information about the chilling injury losses of banana and litchi, the accumulated harmful chilling for the processes with minimum daily temperature < or = 5.0 degrees C and more than 3 days was used to indicate the climatic risk of chilling injury during the whole growth season, and an integrated climatic index with the background of climate change was constructed. The maps of geographical distribution of climatic risk probability for each grade chilling injury, and of integrated climatic risk zoning for banana and litchi's chilling injury were drawn, and the spatial variation of climatic risk for banana and litchi's chilling injury was commented. The results indicated that in the study area, climate warming might lead to the decrease of cold resistance of banana and litchi, which could increase the disaster risk of chilling injury. The geographical distribution of climatic risk probability for banana and litchi's chilling injury showed a zonal pattern. According to the integrated climatic risk index, the banana and litchi's chilling injury region was divided into three risk types, i.e., high risk, moderate risk, and low risk, which provided an important basis for the adjustment of agricultural production structure.
Wang, Peng; Huang, Lin; Tang, Yong; Wang, Wenhao; Chen, Keng; Ye, Jichao; Lu, Ciyong; Wu, Yanfeng; Shen, Huiyong
Background Spinal cord injuries are highly disabling and deadly injuries. Currently, few studies focus on non-traumatic spinal cord injuries, and there is little information regarding the risk factors for complete injuries. This study aims to describe the demographics and the injury characteristics for both traumatic and non-traumatic spinal cord injuries and to explore the risk factors for complete spinal cord injuries. Methods A retrospective study was performed by reviewing the medical records of 3,832 patients with spinal cord injuries who were first admitted to the sampled hospitals in Guangdong, China. The demographics and injury characteristics of the patients were described and compared between the different groups using the chi-square test. Logistic regression was conducted to analyze the risk factors for complete spinal cord injuries. Results The proportion of patients increased from 7.0% to 14.0% from 2003 to 2011. The male-to-female ratio was 3.0∶1. The major cause of spinal cord injuries was traffic accidents (21.7%). Many of the injured were workers (36.2%), peasants (22.8%), and unemployed people (13.9%); these occupations accounted for 72.9% of the total sample. A multivariate logistic regression model revealed that the OR (95% CI) for male gender compared to female gender was 1.25 (1.07–1.89), the OR (95%CI) for having a spinal fracture was 1.56 (1.35–2.60), the OR (95%CI) for having a thoracic injury was 1.23 (1.10–2.00), and the OR (95%CI) for having complications was 2.47 (1.96–3.13). Conclusion The proportion of males was higher than the proportion of females. Workers, peasants and the unemployed comprised the high-risk occupational categories. Male gender, having a spinal fracture, having a thoracic injury, and having complications were the major risk factors for a complete injury. We recommend that preventive measures should focus on high-risk populations, such as young males. PMID:24489652
Kaur, Adarshpal; Singla, Archan Lal; Kumar, Ashwani; Yadav, Manish
Blunt abdominal traumas are uncommonly encountered despite their high prevalence, and injuries to the organ like duodenum are relatively uncommon (occurring in only 3%-5% of abdominal injuries) because of its retroperitoneal location. Duodenal injury combined with gastric perforation from a single abdominal trauma impact is rarely heard. The aim of this case report is to present a rare case of blunt abdominal trauma with combined gastric and duodenal injuries. PMID:25738037
Taliaferro, Lindsay A.; Muehlenkamp, Jennifer J.
Objective: Nonsuicidal self-injury (NSSI) and suicidality among undergraduates represent important public health issues. This analysis identified risk factors that distinguished 3 groups, those who reported no history of self-harm; self-injury, but no suicide attempts (NSSI only); and self-injury and a suicide attempt (NSSI + SA) in the past year.…
Lin, Hugo You-Hsien; Chang, Kai-Ting; Chang, Yu-Han; Lu, Tzongshi; Liang, Chan-Jung; Wang, Dean-Chuan; Tsai, Jui-Hsiu; Hsu, Chung-Yao; Hung, Chi-Chih; Kuo, Mei-Chuan; Lin, Chang-Shen; Hwang, Shang-Jyh
Abstract Nonapnea sleep disorders (NASDs) and associated problems, which are highly prevalent in patients with kidney diseases, are associated with unfavorable medical sequelae. Nonetheless, whether NASDs are associated with acute kidney injury (AKI) development has not been thoroughly analyzed. We examined the association between NASD and AKI. We conducted a population-based study by using 1,000,000 representative data from the Taiwan National Health Insurance Research Database for the period from January 1, 2000, to December 31, 2010. We studied the incidence and risk of AKI in 9178 newly diagnosed NASD patients compared with 27,534 people without NASD matched according to age, sex, index year, urbanization level, region of residence, and monthly income at a 1:3 ratio. The NASD cohort had an adjusted hazard ratio (hazard ratio [HR]; 95% confidence interval [CI] = 1.15–2.63) of subsequent AKI 1.74-fold higher than that of the control cohort. Older age and type 2 diabetes mellitus were significantly associated with an increased risk of AKI (P < 0.05). Among different types of NASDs, patients with insomnia had a 120% increased risk of developing AKI (95% CI = 1.38–3.51; P = 0.001), whereas patients with other sleep disorders had a 127% increased risk of subsequent AKI (95% CI = 1.07–4.80; P = 0.033). Men with NASDs were at a high risk of AKI (P < 0.05). This nationwide population-based cohort study provides evidence that patients with NASDs are at higher risk of developing AKI than people without NASDs. PMID:26986132
Kuk, Jennifer L; Church, Timothy S; Blair, Steven N; Ross, Robert
The associations between visceral adipose tissue (VAT) and abdominal subcutaneous adipose tissue (ASAT) and metabolic risk may be influenced by measurement site. The aim of this study was to compare the strength of the associations between VAT and ASAT, as assessed by a cross-sectional image (area) or total volume, and prevalent metabolic syndrome (MetS). We also examined the association between changes in abdominal AT area and volume with concomitant changes in metabolic risk. Abdominal AT volume and areas were derived using ~35 continuous computed tomography (CT) images from T10-T11 to L5-S1 in overweight or obese postmenopausal women before (n = 67) and after (n = 39) a 6-month exercise intervention. At baseline, measurement site did not influence the inter-relationship between ASAT area and total volume, and between ASAT and MetS. Conversely, VAT areas at L1-L2 and L2-L3 were stronger correlates of VAT volume at baseline (L1-L2 (r = 0.94), L2-L3 (r = 0.95), L4-L5 (r = 0.89)) and changes therein (L1-L2 (r = 0.77), L2-L3 (r = 0.75), L4-L5 (r = 0.55)) as compared to L4-L5, but were not significantly better predictors of MetS as compared to L4-L5 or the total volume (L2-L3: odds ratio (OR) = 2.68 (1.6-4.4), L1-L2: OR = 1.88 (1.2-3.0), L4-L5: OR = 2.56 (1.6-4.1), volume: OR = 2.07 (1.1-3.8)). Changes in VAT and ASAT were not associated with changes in MetS (P > 0.10). Although measurement site has an impact on the prediction of VAT volume, this does not translate into an improved prediction for the MetS. Thus, there is not enough evidence to support changing the current research practice of assessing VAT volume or at L4-L5 for the prediction of metabolic risk.
Morrongiello, Barbara A; Walpole, Beverly; Lasenby, Jennifer
The present study examined whether school-age children show risk compensation and engage in greater risk taking when wearing safety gear compared to when not doing so when running an obstacle course containing hazards that could lead to physical injury. Because sensation seeking has been shown to influence risk taking, this child attribute was also assessed and related to risk compensation. Children 7-12 years of age were videotaped navigating the obstacle course twice, once wearing safety gear and once without safety gear, with reverse directions used to minimize possible practice effects. The time it took the child to run through the course and the number of reckless behaviors (e.g., falls, trips, bumping into things) that the child made while running the course were compared for the gear and no-gear conditions. Results indicated that children went more quickly and behaved more recklessly when wearing safety gear than when not wearing gear, providing evidence of risk compensation. Moreover, those high in sensation seeking showed greater risk compensation compared with other children. Implications for childhood injury prevention are discussed.
Stigson, Helena; Kullgren, Anders; Rosén, Erik
Knowledge of how crash severity influences injury risk in car crashes is essential in order to create a safe road transport system. Analyses of real-world crashes increase the ability to obtain such knowledge. The aim of this study was to present injury risk functions based on real-world frontal crashes where crash severity was measured with on-board crash pulse recorders. Results from 489 frontal car crashes (26 models of four car makes) with recorded acceleration-time history were analysed. Injury risk functions for restrained front seat occupants were generated for maximum AIS value of two or greater (MAIS2+) using multiple logistic regression. Analytical as well as empirical injury risk was plotted for several crash severity parameters; change of velocity, mean acceleration and peak acceleration. In addition to crash severity, the influence of occupant age and gender was investigated. A strong dependence between injury risk and crash severity was found. The risk curves reflect that small changes in crash severity may have a considerable influence on the risk of injury. Mean acceleration, followed by change of velocity, was found to be the single variable that best explained the risk of being injured (MAIS2+) in a crash. Furthermore, all three crash severity parameters were found to predict injury better than age and gender. However, age was an important factor. The very best model describing MAIS2+ injury risk included delta V supplemented by an interaction term of peak acceleration and age. PMID:23169136
Schöffl, Volker; Morrison, Audry; Schwarz, Ulrich; Schöffl, Isabelle; Küpper, Thomas
Rock and ice climbing are widely considered to be 'high-risk' sporting activities that are associated with a high incidence of severe injury and even death, compared with more mainstream sports. However, objective scientific data to support this perception are questionable. Accordingly, >400 sport-specific injury studies were analysed and compared by quantifying the injury incidence and objectively grading the injury severity (using the National Advisory Committee for Aeronautics score) per 1000 hours of sporting participation. Fatalities were also analysed. The analysis revealed that fatalities occurred in all sports, but it was not always clear whether the sport itself or pre-existing health conditions contributed or caused the deaths. Bouldering (ropeless climbing to low heights), sport climbing (mostly bolt protected lead climbing with little objective danger) and indoor climbing (climbing indoors on artificial rock structures), showed a small injury rate, minor injury severity and few fatalities. As more objective/external dangers exist for alpine and ice climbing, the injury rate, injury severity and fatality were all higher. Overall, climbing sports had a lower injury incidence and severity score than many popular sports, including basketball, sailing or soccer; indoor climbing ranked the lowest in terms of injuries of all sports assessed. Nevertheless, a fatality risk remains, especially in alpine and ice climbing. In the absence of a standard definition for a 'high-risk' sport, categorizing climbing as a high-risk sport was found to be either subjective or dependent on the definition used. In conclusion, this analysis showed that retrospective data on sport-specific injuries and fatalities are not reported in a standardized manner. To improve preventative injury measures for climbing sports, it is recommended that a standardized, robust and comprehensive sport-specific scoring model should be developed to report and fully evaluate the injury risk, severity
Mohammed, H O; Hill, T; Lowe, J
A retrospective study was carried out to identify factors which predisposed Thoroughbred horses to severe injuries, as compared to less severe injuries, while racing on New York Racing Association (NYRA) tracks during the period of January 1986 to June 1988. A severe injury was defined as an injury which led to humane destruction of the horse. A less severe injury was defined as a horse which didn't race within 6 months following a muscular, ligament, tendon, or skeletal injury on the racetrack. The data were obtained from the Horse Identification Department records kept by the Chief Examining Veterinarian of NYRA and included 55 severely injured horses and 245 less severely injured horses. Multiple logistic regression analysis was used to identify factors associated with the risk of severe injuries compared to less severe injuries in those horses. There was a significant association between track and the risk of severe injury (horses raced on Belmont and Saratoga were more likely to develop a severe injury compared to horses raced on Aqueduct Main). The track surface was also associated with the risk of severe injury (horses raced on a firm turf had a significantly lower risk of severe injury associated with the track was significantly modified by the track condition (horses raced at Belmont when it was muddy had a significantly increased risk compared to Aqueduct dirt). Horses were more likely to experience severe injury in the early part of the race (less than or equal to 6 furlongs) than the latter part of the race (greater than 6 furlongs). The risk of severe injury decreased with the age of the horse.
Zhang, Hong; Finol, Ender A.
This work describes a robust and fast semi-automatic approach for Abdominal Aortic Aneurysm (AAA) centerline detection. AAA is a vascular disease accompanied by progressive enlargement of the abdominal aorta, which leads to rupture if left untreated, an event that accounts for the 13th leading cause of death in the U.S. The lumen centerline can be used to provide the initial starting points for thrombus segmentation. Different from other methods, which are mostly based on region growing and suffer from problems of leakage and heavy computational burden, we propose a novel method based on online classification. An online version of the adaboost classifier based on steerable features is applied to AAA MRI data sets with a rectangular box enclosing the lumen in the first slice. The classifier is updated during the tracking process by using the testing result of the previous image as the new training data. Unlike traditional offline versions, the online classifier can adjust parameters automatically when a leakage occurs. With the help of integral images on the computation of haar-like features, the method can achieve nearly real time processing (about 2 seconds per image on a standard workstation). Ten ruptured and ten unruptured AAA data sets were processed and the tortuosity of the 20 centerlines was calculated. The correlation coefficient of the tortuosity was calculated to illustrate the significance of the prediction with the proposed method. The mean relative accuracy is 95.68% with a standard deviation of 0.89% when compared to a manual segmentation procedure. The correlation coefficient is 0.394.
Gianakis, Anastasia; McNett, Molly; Belle, Josie; Moran, Cristina; Grimm, Dawn
Ventilator-associated pneumonia (VAP) rates remain highest among trauma and brain injured patients; yet, no research compares VAP risk factors between the 2 groups. This retrospective, case-controlled study identified risk factors for VAP among critically ill trauma patients with and without brain injury. Data were abstracted on trauma patients with (cases) and without (controls) brain injury. Data gathered on n = 157 subjects. Trauma patients with brain injury had more emergent and field intubations. Age was strongest predictor of VAP in cases, and ventilator days predicted VAP in controls. Trauma patients with brain injury may be at higher risk for VAP.
Inness, C M; Morgan, K L
Polo, one of the world's oldest sports, is played in over 80 countries. It is unique in combining the skills of a person with the agility and performance of an animal in a contact sport. There is only one report of the frequency and type of injuries in this population. Here we report risk perception, mitigation and risk factors for injuries and falls in UK polo players. Data were collected retrospectively from a random sample of 112 UK polo players by telephone questionnaire. Injuries (commonly to a shoulder or wrist) requiring a hospital visit were sustained by 17.3% (95% confidence interval [CI] 9.1-25.5) of players. Falls (odds ratio [OR] 6.6, 95% CI 1.4-31.9) and higher self-assessed fitness levels increased the risk (OR 1.7, CI 1.2-2.4). Use of wrist supports (OR 0.2, CI 0.03-0.9) and gym exercise (OR 0.1, CI 0.02-0.9) reduced it. Falls were reported by 58% (CI 47.3-68.8) of players. Women were less at risk than men (OR 0.3, CI 0.1-0.9). Aiming for a better handicap increased the risk (OR 8.4, CI 1.2-57.0). Pre-season rider and horse training were also risk factors. Helmets are compulsory, but players reported that safety certification was not their most important criterion for helmet selection; 49.4% (CI 38.5-60.3) chose appearance. Attendance of a doctor at polo games was not considered important by 65.4% (CI 55.1-75.8) of players; attendance of paramedics and ambulances was volunteered as being of greater consequence. The findings of this study suggest that the protective effect of wrist supports needs testing, helmet manufacturers should incorporate both style and safety into their designs, and paramedics and ambulances should attend polo games.
Turner, Martin R; Goldacre, Raph; Talbot, Kevin; Goldacre, Michael J
Objective To use an unbiased method to test a previously reported association between cerebral arteriovenous malformation (AVM) embolisation and the subsequent development of amyotrophic lateral sclerosis (ALS). Methods A hospital record linkage database was used to create cohorts of individuals coded as having cerebral and peripheral vessel AVMs, stroke (separately for haemorrhagic and ischaemic), transient ischaemic attack (TIA) and subarachnoid haemorrhage (SAH). The rate ratio for subsequent ALS was compared to a reference cohort. Results An increased rate ratio for ALS was found in relation to prior AVM (2.69; p=0.005), all strokes (1.38; p<0.001), and TIA (1.47; p<0.001). Conclusions Cerebrovascular injury from a variety of causes, rather than the presence of AVM or the associated embolisation procedure per se, may be a risk factor for ALS within the context of a more complex multiple-hit model of pathogenesis. PMID:26260352
Pisani, Francesco; Spagnoli, Carlotta
Due to the increasing number of surviving preterm newborns and to the recognition of therapeutic hypothermia as the current gold standard in newborns with hypoxic-ischaemic encephalopathy, there has been a growing interest in the implementation of brain monitoring tools in newborns at high risk for neurological disorders.Among the most frequent neurological conditions and presentations in the neonatal period, neonatal seizures and neonatal status epilepticus, paroxysmal non-epileptic motor phenomena, hypoxic-ischaemic encephalopathy, white matter injury of prematurity and stroke require specific approaches to diagnosis. In this review we will describe the characteristics, aims, indications and limitations of routinely available diagnostic techniques such as conventional and amplitude-integrated EEG, evoked potentials, cranial ultrasound and brain MRI. We will conclude by briefly outlining potential future perspectives from research studies.
Schoene, Lisa M
Professional dancers have a 90% risk of injury during their career. The lower extremity is involved in approximately 75% of the injuries sustained by dancers. Proper biomechanical evaluation, risk assessment, and prevention-oriented treatment are necessary to minimize future problems and promote a full and lasting recovery when an injury is sustained. This article outlines the in-office evaluation process and discusses backstage care.
van Beijsterveldt, A M C; van de Port, I G L; Vereijken, A J; Backx, F J G
Hamstring injuries are common injuries in soccer players. In view of the high incidence and the serious consequences, identifying risk factors related to hamstring injuries is essential. The aim of this systematic review was therefore to identify risk factors for hamstring injuries in male adult soccer players. PubMed, Embase/Medline, Cumulative Index to Nursing and Allied Health Literature, and SPORTDiscus were systematically searched, and prospective studies investigating risk factors for hamstring injuries in adult male soccer players were included. The methodological quality of the included articles was assessed using a standardized set of predefined criteria. Seven of the 11 studies identified, involving a total of 1775 players and 344 hamstring injuries, met the inclusion criteria. All but one of the included studies met at least five of nine methodological criteria, causing them to be qualified as 'high quality'. The included studies used univariate as well as multivariate analyses to identify risk factors for hamstring injury. The results from the multivariate analyses suggest that previous hamstring injury is most strongly related to hamstring injury. Conflicting evidence is found for age and hamstring length or flexibility as risk factors for the occurrence of hamstring injuries.
Raman, Sudha R.; Boyce, William F.; Pickett, William
Background: Adolescents with disabilities are at risk for poor health outcomes including injury. The objective of this study was to examine if disability status modifies the association between risk behavior and injury among adolescents. Methods: The cross-sectional Health Behavior in School-Aged Children Survey was administered to a…
Morrongiello, Barbara A.; Klemencic, Nora; Corbett, Michael
Unintentional injuries are the leading cause of death for children. Prior research has implicated both child behavioral attributes and parent supervisory patterns as risk factors. The present study assessed interactions between these two risk factors and determined whether supervision moderates the relation between child attributes and injury.…
Niebuhr, Tobias; Junge, Mirko; Achmus, Stefanie
Injury risk assessment plays a pivotal role in the assessment of the effectiveness of Advanced Driver Assistance Systems (ADAS) as they specify the injury reduction potential of the system. The usual way to describe injury risks is by use of injury risk functions, i.e. specifying the probability of an injury of a given severity occurring at a specific technical accident severity (collision speed). A method for the generation of a family of risk functions for different levels of injury severity is developed. The injury severity levels are determined by use of a rescaled version of the Injury Severity Score (ISS) namely the ISSx. The injury risk curves for each collision speed is then obtained by fixing the boundary conditions and use of a case-by-case validated GIDAS subset of pedestrian-car accidents (N=852). The resultant functions are of exponential form as opposed to the frequently used logistic regression form. The exponential approach in combination with the critical speed value creates a new injury risk pattern better fitting for high speed/high energy crashes. Presented is a family of pedestrian injury risk functions for an arbitrary injury severity. Thus, the effectiveness of an ADAS can be assessed for mitigation of different injury severities using the same injury risk function and relying on the internal soundness of the risk function with regard to different injury severity levels. For the assessment of emergency braking ADAS, a Zone of Effective Endangerment Increase (ZEEI), the speed interval in which a one percent speed increase results at least in a one percent of injury risk increase, is defined. The methodology presented is kept in such general terms that a direct adaption to other accident configurations is easily done. PMID:24406954
Ramachandra, Rakshit; Kang, Yun-Seok; Bolte, John H; Hagedorn, Alena; Herriott, Rodney; Stammen, Jason A; Moorhouse, Kevin
Past studies have found that a pressure based injury risk function was the best predictor of liver injuries due to blunt impacts. In an effort to expand upon these findings, this study investigated the biomechanical responses of the abdomen of post mortem human surrogates (PMHS) to high-speed seatbelt loading and developed external response targets in conjunction with proposing an abdominal injury criterion. A total of seven unembalmed PMHS, with an average mass and stature of 71 kg and 174 cm respectively were subjected to belt loading using a seatbelt pull mechanism, with the PMHS seated upright in a freeback configuration. A pneumatic piston pulled a seatbelt into the abdomen at the level of the umbilicus with a nominal peak penetration speed of 4.0 m/s. Pressure transducers were placed in the re-pressurized abdominal vasculature, including the inferior vena cava (IVC) and abdominal aorta, to measure internal pressure variation during the event. Jejunum tear, colon hemorrhage, omentum tear, splenic fracture and transverse processes fracture were identified during post-test anatomical dissection. Peak abdominal forces ranged from 2.8 to 4.7 kN. Peak abdominal penetrations ranged from 110 to 177 mm. A force-penetration corridor was developed from the PMHS tests in an effort to benchmark ATD biofidelity. Peak aortic pressures ranged from 30 to 104 kPa and peak IVC pressures ranged from 36 to 65 kPa. Updated pressure based abdominal injury risk functions were developed for vascular Ṗmax and Pmax*Ṗmax.
... Kidney - blood and urine flow Abdominal ultrasound References Chen L. Abdominal ultrasound imaging. In: Sahani DV, Samir ... the Health on the Net Foundation (www.hon.ch). The information provided herein should not be used ...
... tap; Cirrhosis - abdominal tap; Malignant ascites - abdominal tap Images Digestive system Peritoneal sample References Garcia-Tiso G. ... urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows ...
Marques, Evelyne GSC; Júnior, Gerson A Pereira; Neto, Bruno F Muller; Freitas, Rodrigo A; Yaegashi, Lygia B; Almeida, Carlos E Fagotti; Júnior, Jayme Adriano Farina
Victims of electrical burns account for approximately 5% of admissions to major burn centers. The first case of visceral injury caused by electrical burns was described in 1927 by Simonin, who reported perforation of the small intestine. Other rare cases were reported over the following years. The colon and small intestine were the organs most frequently affected. Less frequently involved organs were the heart, esophagus, stomach, pancreas, liver, gallbladder, lung, and kidney. We highlight the potential fatal visceral injuries after the electrical trauma. This study provides a review on this topic and proposes a management flowchart that should be adopted by the multidisciplinary team to treat these patients. Conclusion: Visceral injuries are rare in electrical burns victims, but it can be severe and are associated with high rates of morbidity and mortality, sometimes requiring a more interventional approach. PMID:24624308
Wink, Jason D; Wes, Ari M; Fischer, John P; Nelson, Jonas A; Stranksy, Carrie; Kovach, Stephen J
Complex abdominal wall reconstruction (AWR) is commonly performed, but with a significant rate of surgical complications and hernia recurrence. The aim of this experiential review is to assess risk factors for hernia recurrence after complex AWR. A retrospective review of AWR patients from 2007-2012 was performed. Rates of hernia recurrence were assessed. Univariate analyses and subsequent multivariate logistic regression analysis was used to assess independent predictors of early hernia recurrence. One hundred and thirty-four consecutive cases of AWR were performed over a 5-year period. Hernia recurrence developed in 14 (10.4%) patients. Hernias derived from trauma (OR = 19.76, p = 0.011) and those who experienced postoperative wound infections (OR = 18.81, p = 0.004) were at increased risk for hernia recurrence. In conclusion, increased vigilance must be paid to patients presenting after trauma with massive loss of domain and those who experience postoperative infection, as these cohorts are at added risk for failed reconstruction.
Canchi, Tejas; Kumar, S D; Ng, E Y K; Narayanan, Sriram
Computational methods have played an important role in health care in recent years, as determining parameters that affect a certain medical condition is not possible in experimental conditions in many cases. Computational fluid dynamics (CFD) methods have been used to accurately determine the nature of blood flow in the cardiovascular and nervous systems and air flow in the respiratory system, thereby giving the surgeon a diagnostic tool to plan treatment accordingly. Machine learning or data mining (MLD) methods are currently used to develop models that learn from retrospective data to make a prediction regarding factors affecting the progression of a disease. These models have also been successful in incorporating factors such as patient history and occupation. MLD models can be used as a predictive tool to determine rupture potential in patients with abdominal aortic aneurysms (AAA) along with CFD-based prediction of parameters like wall shear stress and pressure distributions. A combination of these computer methods can be pivotal in bridging the gap between translational and outcomes research in medicine. This paper reviews the use of computational methods in the diagnosis and treatment of AAA.
Laux, Philipp; Krumm, Bertram; Diers, Martin; Flor, Herta
Professional football is a contact sport with a high risk of injury. This study was designed to examine the contribution of stress and recovery variables as assessed with the Recovery-Stress Questionnaire for Athletes (RESTQ-Sport) to the risk of injury in professional football players. In a prospective, non-experimental cohort design, 22 professional football players in the highest German football league were observed over the course of 16 months. From January 2010 until April 2011, the players completed the RESTQ-Sport a total of 222 times in monthly intervals. In addition, injury data were assessed by the medical staff of the club. Overall, 34 traumatic injuries and 10 overuse injuries occurred. Most of the injuries were located in the lower limb (79.5%), and muscle and tendon injuries (43.2%) were the most frequently occurring injury type. In a generalised linear model, the stress-related scales Fatigue (OR 1.70, P = 0.007), Disturbed Breaks (OR 1.84, P = 0.047) and Injury (OR 1.77, P < 0.001) and the recovery-related scale Sleep Quality (OR 0.53, P = 0.010) significantly predicted injuries in the month after the assessment. These results support the importance of frequent monitoring of recovery and stress parameters to lower the risk of injuries in professional football.
Téllez-Zenteno, José Francisco; Nguyen, Rita; Hernádez-Ronquillo, Lizbeth
Currently, there is intense clinical research into various aspects of the medical risks relating to epilepsy, including total and cause-specific mortality, accidents and injuries in patients with epilepsy and mortality related with seizures. Submersion injuries, motor vehicle accidents, burns, and head injuries are among the most feared epilepsy-related injuries. Published risk factors for injuries include the number of antiepileptic drugs, history of generalized seizures, and seizure frequency. In general, studies focusing on populations with more severe forms of epilepsy tend to report substantially higher risks of injuries than those involving less selected populations. On the other hand, studies based in non selected populations of people with epilepsy have not shown an increase frequency of injuries in people with epilepsy compared with the general population. Some studies have shown that patients with epilepsy are more frequently admitted to the hospital following an injury. Possible explanations include are more cautious attitude of clinicians toward injuries occurring in the setting of seizures; hospitalization required because of seizures and not to the injuries themselves; and hospitalization driven by other issues, such as comorbidities, which are highly prevalent in patients with epilepsy. This article reviews information about specific type of injuries such as fractures, burns, concussions, dislocations, etc. Finally this article review in a comprehensive way information of mortality in patients with epilepsy. Aspects of mortality discussed in this review are: epidemiology, causes of mortality, sudden death in epilepsy and prevention measures.
Laux, Philipp; Krumm, Bertram; Diers, Martin; Flor, Herta
Abstract Professional football is a contact sport with a high risk of injury. This study was designed to examine the contribution of stress and recovery variables as assessed with the Recovery-Stress Questionnaire for Athletes (RESTQ-Sport) to the risk of injury in professional football players. In a prospective, non-experimental cohort design, 22 professional football players in the highest German football league were observed over the course of 16 months. From January 2010 until April 2011, the players completed the RESTQ-Sport a total of 222 times in monthly intervals. In addition, injury data were assessed by the medical staff of the club. Overall, 34 traumatic injuries and 10 overuse injuries occurred. Most of the injuries were located in the lower limb (79.5%), and muscle and tendon injuries (43.2%) were the most frequently occurring injury type. In a generalised linear model, the stress-related scales Fatigue (OR 1.70, P = 0.007), Disturbed Breaks (OR 1.84, P = 0.047) and Injury (OR 1.77, P < 0.001) and the recovery-related scale Sleep Quality (OR 0.53, P = 0.010) significantly predicted injuries in the month after the assessment. These results support the importance of frequent monitoring of recovery and stress parameters to lower the risk of injuries in professional football. PMID:26168148
Elsner, Jonathan J; Gefen, Amit
Deep tissue injury (DTI) is a severe form of pressure ulcers that occur in subcutaneous tissue under intact skin by the prolonged compression of soft tissues overlying bony prominences. Pressure ulcers and DTI in particular are common in patients with impaired motosensory capacities, such as those with a spinal cord injury (SCI). Obesity is also common among subjects with SCI, yet there are contradicting indications regarding its potential influence as a risk factor for DTI in conditions where these patients sit in a wheelchair without changing posture for prolonged times. It has been argued that high body mass may lead to a greater risk for DTI due to increase in compressive forces from the bones on overlying deep soft tissues, whereas conversely, it has been argued that the extra body fat associated with obesity may reduce the risk by providing enhanced subcutaneous cushioning that redistributes high interface pressures. No biomechanical evaluation of this situation has been reported to date. In order to elucidate whether obesity can be considered a risk factor for DTI, we developed computational finite element (FE) models of the seated buttocks with 4 degrees of obesity, quantified by body mass index (BMI) values of 25.5, 30, 35 and 40kg/m(2). We found that peak principal strains, strain energy densities (SED) and von Mises stresses in internal soft tissues (muscle, fat) overlying the ischial tuberosities (ITs) all increased with BMI. With a rise in BMI from 25.5 to 40kg/m(2), values of these parameters increased 1.5 times on average. Moreover, the FE simulations indicated that the bodyweight load transferred through the ITs has a greater effect in increasing internal tissue strains/stresses than the counteracting effect of thickening of the adipose layer which is concurrently associated with obesity. We saw that inducing some muscle atrophy (30% reduction in muscle volume, applied to the BMI=40kg/m(2) model) which is also characteristic of chronic SCI resulted
... call your doctor. In Spanish— Dolor abdominal en niños menores de 12 años What is recurrent abdominal ... Functional abdominal pain (FAP) typically affects kids ages 4-12, and is quite common, affecting up to ...
ALBERS, JAMES T.; HUDOCK, STEPHEN D.; LOWE, BRIAN D.
Pneumatic nail guns are ubiquitous at residential construction sites across the United States. These tools are noted for the traumatic injuries that can occur from their operation. Different trigger mechanisms on these tools are associated with different levels of risk. Residential building subcontractors and workers, both native-born and immigrant, were brought together in focus groups to discuss their attitudes and beliefs regarding risk factors for nail gun injury as well as barriers to the adoption of safer technology. Participants’ comments are organized first by influences on traumatic injury occurrence or prevention and later by sociotechnical system category. Participants attributed influences on injury risk to personal and external causation factors in all sociotechnical system categories; however, participants more frequently described influences on injury prevention as related to workers’ behaviors, rather than to external factors. A discussion of these influences with respect to attribution theory and sociotechnical models of injury causation is presented. PMID:24704813
Albers, James T; Hudock, Stephen D; Lowe, Brian D
Pneumatic nail guns are ubiquitous at residential construction sites across the United States. These tools are noted for the traumatic injuries that can occur from their operation. Different trigger mechanisms on these tools are associated with different levels of risk. Residential building subcontractors and workers, both native-born and immigrant, were brought together in focus groups to discuss their attitudes and beliefs regarding risk factors for nail gun injury as well as barriers to the adoption of safer technology. Participants' comments are organized first by influences on traumatic injury occurrence or prevention and later by sociotechnical system category. Participants attributed influences on injury risk to personal and external causation factors in all sociotechnical system categories; however, participants more frequently described influences on injury prevention as related to workers' behaviors, rather than to external factors. A discussion of these influences with respect to attribution theory and sociotechnical models of injury causation is presented.
van der Worp, Maarten P.; ten Haaf, Dominique S. M.; van Cingel, Robert; de Wijer, Anton; Nijhuis-van der Sanden, Maria W. G.; Staal, J. Bart
Background The popularity of running continues to increase, which means that the incidence of running-related injuries will probably also continue to increase. Little is known about risk factors for running injuries and whether they are sex-specific. Objectives The aim of this study was to review information about risk factors and sex-specific differences for running-induced injuries in adults. Search Strategy The databases PubMed, EMBASE, CINAHL and Psych-INFO were searched for relevant articles. Selection Criteria Longitudinal cohort studies with a minimal follow-up of 1 month that investigated the association between risk factors (personal factors, running/training factors and/or health and lifestyle factors) and the occurrence of lower limb injuries in runners were included. Data Collection and Analysis Two reviewers’ independently selected relevant articles from those identified by the systematic search and assessed the risk of bias of the included studies. The strength of the evidence was determined using a best-evidence rating system. Sex differences in risk were determined by calculating the sex ratio for risk factors (the risk factor for women divided by the risk factor for men). Main Results Of 400 articles retrieved, 15 longitudinal studies were included, of which 11 were considered high-quality studies and 4 moderate-quality studies. Overall, women were at lower risk than men for sustaining running-related injuries. Strong and moderate evidence was found that a history of previous injury and of having used orthotics/inserts was associated with an increased risk of running injuries. Age, previous sports activity, running on a concrete surface, participating in a marathon, weekly running distance (30–39 miles) and wearing running shoes for 4 to 6 months were associated with a greater risk of injury in women than in men. A history of previous injuries, having a running experience of 0–2 years, restarting running, weekly running distance (20–29
... injuries among nearly 1,200 young athletes. After tracking their training schedules over the course of three ... those who didn't have an injury, the researchers found. The study authors advise young athletes to ...
Gupta, V; Wang, Y; Romero, A; Heijmen, B; Hoogeman, M; Myronenko, A; Jordan, P
Purpose: Various studies have demonstrated that online adaptive radiotherapy by real-time re-optimization of the treatment plan can improve organs-at-risk (OARs) sparing in the abdominal region. Its clinical implementation, however, requires fast and accurate auto-segmentation of OARs in CT scans acquired just before each treatment fraction. Autosegmentation is particularly challenging in the abdominal region due to the frequently observed large deformations. We present a clinical validation of a new auto-segmentation method that uses fully automated non-rigid registration for propagating abdominal OAR contours from planning to daily treatment CT scans. Methods: OARs were manually contoured by an expert panel to obtain ground truth contours for repeat CT scans (3 per patient) of 10 patients. For the non-rigid alignment, we used a new non-rigid registration method that estimates the deformation field by optimizing local normalized correlation coefficient with smoothness regularization. This field was used to propagate planning contours to repeat CTs. To quantify the performance of the auto-segmentation, we compared the propagated and ground truth contours using two widely used metrics- Dice coefficient (Dc) and Hausdorff distance (Hd). The proposed method was benchmarked against translation and rigid alignment based auto-segmentation. Results: For all organs, the auto-segmentation performed better than the baseline (translation) with an average processing time of 15 s per fraction CT. The overall improvements ranged from 2% (heart) to 32% (pancreas) in Dc, and 27% (heart) to 62% (spinal cord) in Hd. For liver, kidneys, gall bladder, stomach, spinal cord and heart, Dc above 0.85 was achieved. Duodenum and pancreas were the most challenging organs with both showing relatively larger spreads and medians of 0.79 and 2.1 mm for Dc and Hd, respectively. Conclusion: Based on the achieved accuracy and computational time we conclude that the investigated auto
NAWCADPAX/TR-2004/86 CERVICAL INJURY RISK RESULTING FROM ROTARY WING IMPACT: ASSESSMENT OF INJURY BASED UPON AVIATOR SIZE, HELMET MASS...DEPARTMENT OF THE NAVY NAVAL AIR WARFARE CENTER AIRCRAFT DIVISION PATUXENT RIVER, MARYLAND NAWCADPAX/TR-2004/86 21 October 2004 CERVICAL ... Cervical Injury Risk Resulting From Rotary Wing Impact: Assessment of Injury Based Upon Aviator Size, Helmet Mass Properties and Impact Severity 5b
Giroto, N; Hespanhol Junior, L C; Gomes, M R C; Lopes, A D
The aim of this study was to investigate the incidence and risk factors for handball injuries in Brazilian elite handball players. Overall, 339 athletes from 21 handball teams who participated in the two main Brazilian championships were followed up during a season. In total, 312 injuries were reported by 201 athletes. The injury incidence rate during training was 3.7/1000 h, and during matches was 20.3/1000 matches. Ankle (19.4%, n = 46) and knee (13.5%, n = 32) were the body regions most affected by traumatic injuries. Shoulders (44.0%, n = 33) and knee (26.7%, n = 20) were the body regions most affected by overuse injuries. Muscle injuries (27.1%, n = 68) was the traumatic injury type most reported. Tendinopathy (91.8%, n = 56) was the overuse injury type most observed. Previous injury (OR: 2.42, CI 95%: 1.51-3.89) and an additional match per week (OR: 1.31, CI 95%: 1.05-1.62) were associated with a higher risk of overuse injury. Female athletes (OR: 1.56, CI 95%: 1.08-2.25) and an additional hour of training per week (OR: 1.09, CI 95%: 1.02-1.15) were associated with a higher risk of traumatic injury. This study showed that athletes with previous injury have shown a high risk of developing an overuse injury.
Jouglar, Emmanuel; Wagner, Antoine; Delpon, Grégory; Campion, Loïc; Meingan, Philippe; Bernier, Valérie; Demoor-Goldschmidt, Charlotte; Mahé, Marc-André; Lacornerie, Thomas; Supiot, Stéphane
Objectives Late abdominal irradiation toxicity during childhood included renal damage, hepatic toxicity and secondary diabetes mellitus. We compared the potential of conformal radiotherapy (CRT), helical tomotherapy (HT) and proton beam therapy (PBT) to spare the abdominal organs at risk (pancreas, kidneys and liver- OAR) in children undergoing abdominal irradiation. Methods We selected children with abdominal tumors who received more than 10 Gy to the abdomen. Treatment plans were calculated in order to keep the dose to abdominal OAR as low as possible while maintaining the same planned target volume (PTV) coverage. Dosimetric values were compared using the Wilcoxon signed-rank test. Results The dose distribution of 20 clinical cases with a median age of 8 years (range 1–14) were calculated with different doses to the PTV: 5 medulloblastomas (36 Gy), 3 left-sided and 2 right-sided nephroblastomas (14.4 Gy to the tumor + 10.8 Gy boost to para-aortic lymphnodes), 1 left-sided and 4 right-sided or midline neuroblastomas (21 Gy) and 5 Hodgkin lymphomas (19.8 Gy to the para-aortic lymphnodes and spleen). HT significantly reduced the mean dose to the whole pancreas (WP), the pancreatic tail (PT) and to the ipsilateral kidney compared to CRT. PBT reduced the mean dose to the WP and PT compared to both CRT and HT especially in midline and right-sided tumors. PBT decreased the mean dose to the ispilateral kidney but also to the contralateral kidney and the liver compared to CRT. Low dose to normal tissue was similar or increased with HT whereas integral dose and the volume of normal tissue receiving at least 5 and 10 Gy were reduced with PBT compared to CRT and HT. Conclusion In children undergoing abdominal irradiation therapy, proton beam therapy reduces the dose to abdominal OAR while sparing normal tissue by limiting low dose irradiation. PMID:27764132
Seiler, Christian A
Patients with an abdominal catastrophe are in urgent need of early, interdisciplinary medical help. The treatment plan should be based on medical priorities and clear leadership. First priority should be given to achieve optimal oxygenation of blood and stabilization of circulation during all treatment-phases. The sicker the patient, the less invasive the (surgical) treatment should to be, which means "damage control only". This short article describes 7 important, pragmatic rules that will help to increase the survival of a patient with an abdominal catastrophe. Preexisting morbidity and risk factors must be included in the overall risk-evaluation for every therapeutic intervention. The challenge in patients with an abdominal catastrophe is to carefully balance the therapeutic stress and the existing resistance of the individual patient. The best way to avoid abdominal disaster, however, is its prevention.
Dann, K; Kristen, K H; Knoeringer, M; Boldrino, C; Nehrer, S
Since the 1998 Olympic Winter Games in Nagano, snowboarding has been established as a popular winter sport for youth and adults. The most frequently affected body region reported in many studies on snowboarding injuries are the wrists accounting for more than 50% of severe injuries, especially in beginners. Wrist braces are effective in protecting snowboarding beginners against wrist injuries. Male snowboarders up to the age of 16 and female snowboarders over the age of 25 have a higher risk of injury. Snowboarders should not use ski boots and should be careful with rented equipment. Systems providing body and limb protection and also snowboard-specific helmets can reduce the injury risk for alpine racers, freestylers, and also freeriders. Snowboard training is important to prevent injuries especially for beginners, and icy slopes should be avoided.
The rate of unintentional injuries for children in sub-Saharan Africa has reached 53.1 per 100,000, the highest for regions across all income levels. This paper reviews the relevant literature on the epidemiology of unintentional childhood injuries in the region, with an emphasis on the risk factors associated with it. Several demographic, socioeconomic, and environmental factors contributing to injuries in children have been documented for the main causes of injury. Despite the high burden, child injury prevention and control programs and policies are limited or non-existent in many countries in the region. Accurate data regarding these injuries across and within countries is incomplete. Population-based estimates and investigations into context-specific risk factors, safety attitudes, and behaviours are needed to inform the development of effective interventions.
Lawrence, David W.; Comper, Paul; Hutchison, Michael G.
Background: The risk of injury associated with American football is significant, with recent reports indicating that football has one of the highest rates of all-cause injury, including concussion, of all major sports. There are limited studies examining risk factors for injuries in the National Football League (NFL). Purpose: To identify risk factors for NFL concussions and musculoskeletal injuries. Study Design: Case-control study; Level of evidence, 3. Methods: Injury report data were collected prospectively for each week over the 2012-2013 and 2013-2014 regular seasons for all 32 teams. Poisson regression models were used to identify the relationship between predetermined variables and the risk of the 5 most frequent injuries (knee, ankle, hamstring, shoulder, and concussion). Results: A total of 480 games or 960 team games (TGs) from the 2012-2013 and 2013-2014 regular seasons were included in this study. A trend to an increasing risk of concussion and TG ankle injury with decreasing mean game-day temperature was observed. The risk of TG concussion (incidence rate ratio [IRR], 2.16; 95% CI, 1.35-3.45; P = .001) and TG ankle injury (IRR, 1.48; 95% CI, 1.10-1.98; P = .01) was significantly greater for TGs played at a mean game-day temperature of ≤9.7°C (≤49.5°F) compared with a mean game-day temperature of ≥21.0°C (≥69.8°F). The risk of TG shoulder injury was significantly increased for TGs played on grass surfaces (IRR, 1.36; 95% CI, 1.02-1.81; P = .038) compared with synthetic surfaces. The risk of TG injury was not associated with time in season, altitude, time zone change prior to game, or distance traveled to a game. Conclusion: This study evaluated extrinsic risk factors for injury in the NFL. A hazardous association was identified for risk of concussion and ankle injury with colder game-day temperature. Further research should be conducted to substantiate this relationship and its potential implication for injury prevention initiatives. PMID
Borges, Guilherme; Cherpitel, Cheryl; Mittleman, Murray
This paper reports a case-crossover analysis in a sample of 961 patients who consulted the emergency department (ED) due to an injury in Santa Clara, California, and in Pachuca, Mexico. In the analysis in which usual alcohol consumption during the last 12 months served as the control value, the estimated relative risk of injury in the hour after alcohol consumption, as compared with no alcohol consumption during that time, was 4.33 (CI, 3.55-5.27). After controlling for alcohol use in the 1-h period before injury, the relative risks for consecutive 1-h periods (2-6 h) before the injury were not significantly greater than one, indicating that the induction time was less than 1 h. The relative risk varied greatly depending on race-ethnicity and acculturation among the Hispanics in Santa Clara, with Mexicans in Pachuca showing the highest risk and the high acculturation group in Santa Clara showing the lowest risk. Violence-related injuries were associated with higher relative risk. Relative risk also varied depending on the presence of alcohol dependence and usual frequency of drunkenness: patients with alcohol dependence and patients with high frequency of usual drunkenness had lower risks than patients without alcohol dependence and with lower self-reported episodes of drunkenness in the last year. When blood alcohol content at ED admission was used instead of self-reported alcohol consumption, similar results were obtained. These findings have important public health consequences. Each episode of alcohol consumption results in an increase in the short-term risk for an injury, especially for a violence-related injury. Patients with the lowest usual involvement with alcohol are subject to a higher elevation in their risk for an injury immediately after alcohol consumption compared to patients who drink more heavily.
Bere, Tone; Kruczynski, Jacek; Veintimilla, Nadège; Hamu, Yuichiro; Bahr, Roald
Background Little is known about the rate and pattern of injuries in international volleyball competition. Objective To describe the risk and pattern of injuries among world-class players based on data from the The International Volleyball Federation (FIVB) Injury Surveillance System (ISS) (junior and senior, male and female). Methods The FIVB ISS is based on prospective registration of injuries by team medical staff during all major FIVB tournaments (World Championships, World Cup, World Grand Prix, World League, Olympic Games). This paper is based on 4-year data (September 2010 to November 2014) obtained through the FIVB ISS during 32 major FIVB events (23 senior and 9 junior). Results The incidence of time-loss injuries during match play was 3.8/1000 player hours (95% CI 3.0 to 4.5); this was greater for senior players than for junior players (relative risk: 2.04, 1.29 to 3.21), while there was no difference between males and females (1.04, 0.70 to 1.55). Across all age and sex groups, the ankle was the most commonly injured body part (25.9%), followed by the knee (15.2%), fingers/thumb (10.7%) and lower back (8.9%). Injury incidence was greater for centre players and lower for liberos than for other player functions; injury patterns also differed between player functions. Conclusions Volleyball is a very safe sport, even at the highest levels of play. Preventive measures should focus on acute ankle and finger sprains, and overuse injuries in the knee, lower back and shoulder. PMID:26194501
Kontopodis, Nikolaos; Galanakis, Nikolaos; Tsetis, Dimitrios; Ioannou, Christos V
Abdominal aortic aneurysm (AAA) continues to pose a significant cause of unexpected mortality in the developed countries with its incidence constantly rising. The indication of elective surgical repair is currently based on the maximum diameter and growth rate criteria which represent an oversimplification of the Law of Laplace stating that the stress exerted in a cylinder or sphere is proportional to its radius. These criteria fail to capture the complex pathophysiology of the aneurismal disease thus often leading to therapeutic inaccuracies (treating large AAAs with a very low actual rupture risk while observing smaller ones with a much greater risk). Aneurysmal disease is mainly a degenerative process leading to loss of structural integrity of the diseased aortic wall which cannot withhold the stresses due to systemic pressurization. Moreover aortic wall degeneration has been shown to be a localized phenomenon and rupture depends on the pointwise comparison of strength and stress rather than a global aortic wall weakening. Ex-vivo mechanical studies have related vessel wall hypoxia to loss of structural endurance and reduced wall strength. Therefore a module to capture in vivo variation of aortic wall blood supply and oxygenation would be of value for the evaluation of AAA rupture risk. Perfusion computed tomography (PCT) imaging represents a novel technique which has been already used to estimate tissue vascularity in several clinical conditions but not aneurismal disease. We hypothesize that PCT could be used as an adjunct tool during AAA diagnostics in order to evaluate aortic wall oxygenation in vivo, therefore providing a possible means to identify weak spots making the lesion amenable to rupture.
Background Process of accelerated atherosclerosis specific for uremia increases cardiovascular risk in patients with chronic kidney disease (CKD) and may be influenced by the different structure of arteries. The study assesses the influence of traditional and novel risk factors on calcification of coronary arteries (CAC) and abdominal aorta (AAC) in hemodialysis patients (HD). Methods CAC and AAC were assessed by CT in 104 prevalent adult HD and 14 apparently healthy subjects with normal kidney function (control group). Mineral metabolism parameters, plasma levels of FGF-23, MGP, osteoprotegerin, osteopontin, fetuin-A, CRP, IL-6 and TNF-α were measured. Results CAC and AAC (calcification score ≥ 1) were found in 76 (73.1%) and 83 (79.8%) HD respectively, more frequent than in the control group. In 7 HD with AAC no CAC were detected. The frequency and severity of calcifications increased with age. Both CAC and AAC were more frequently detected in diabetics (OR = 17.37 and 13.00, respectively). CAC score was significantly greater in males. CAC and AAC scores were correlated significantly with pack-years of smoking and plasma osteoprotegrin levels. However the independent contribution of plasma osteoprotegerin levels was not confirmed in multiple regression analysis. Age (OR = 1.13) and hemodialysis vintage (OR = 1.14) were the independent risk factor favoring the occurrence of CAC; while age (OR = 1.20) was the only predictor of AAC occurrence in HD. Conclusions 1. AAC precedes the occurrence of CAC in HD patients. 2. The exposition to uremic milieu and systemic chronic microinflammation has more deteriorative effect on the CAC than the AAC. PMID:23317172
Raymond, David E; Catena, Robert D; Vaughan, Teddy R
This study investigated the biomechanics of simulated sideways falls from various bed heights onto two types of protective floor mats. This article presents biomechanical injury criteria for evaluating the probability of sustaining injuries to the head, thorax, and pelvis. A side-impact dummy was raised to drop heights of 45.7 cm, 61.0 cm, and 76.2 cm and released. Two types of protective floor mats were evaluated and compared with impacts experienced on an unpadded, rigid floor. Results of the study demonstrated a high risk (> 50%) for serious head injury for falls onto an unpadded, rigid floor at 61.0-cm and 76.2-cm drop heights. Falls onto floor mats demonstrated significant reductions in injury risk to the head and pelvis for all drop heights. Thoracic injury risk was significantly reduced for all but the highest drop height.
Cantu, Robert C
This article focuses on the issues related to recurrent athletic head injuries; specifically, when cumulative exponential injury or the second impact syndrome may be anticipated. Case histories and research studies are used to illustrate the salient points. A signs-and-symptoms checklist for use in concussion evaluation and management is included. Finally, the topic of when to retire after repeated athletic head injuries is discussed and illustrated with a case study.
Long, Rachel N; Sun, Kan; Neitzel, Richard L
Occupational injury is one of many health concerns related to small-scale gold mining (ASGM), but few data exist on the subject, especially in sub-Saharan Africa. In 2011 and 2013, we examined accidents, injuries, and potential risk factors in a Ghanaian ASGM community. In 2011, 173 participants were surveyed on occupational history and health, and 22 of these were surveyed again in 2013. Injury rates were estimated at 45.5 and 38.5 injuries per 100 person-years in 2011 and in 2013, respectively; these rates far surpass those of industrialized mines in the U.S. and South Africa. Demographic and job characteristics generally were not predictive of injury risk, though there was a significant positive association with injury risk for males and smokers. Legs and knees were the most common body parts injured, and falling was the most common cause of injury. The most common type of injuries were cuts or lacerations, burns and scalds, and contusions and abrasions. Only two miners had ever received any occupational safety training, and PPE use was low. Our results suggest that injuries should be a priority area for occupational health research in ASGM.
Pain, M; Kerr, J H
The case is reported of a 40 year old male high risk sport athlete who had seriously injured himself several times and as a result was partially physically disabled and had trouble with mental tasks requiring concentration such as spelling, reading numbers, and writing. The athlete was referred to a sports psychologist. In consultations, it became clear that he was having difficulty reconciling the difference between his life as it used to be and as it would be in the future. Part of his difficulty was dealing with the frustration and anger "outbursts" which resulted from not being able to perform straightforward everyday motor skills. In spite of his injuries and disability, the patient badly wanted to continue participating in extreme sports. Reversal theory is used in the discussion to provide theoretical explanations of the motivation for his extreme risk taking behaviour.
Duerden, Emma G.; Oatley, Hannah K.; Mak-Fan, Kathleen M.; McGrath, Patricia A.; Taylor, Margot J.; Szatmari, Peter; Roberts, S. Wendy
While self-injurious behaviors (SIB) can cause significant morbidity for children with autism spectrum disorders (ASD), little is known about its associated risk factors. We assessed 7 factors that may influence self-injury in a large cohort of children with ASD: (a) atypical sensory processing; (b) impaired cognitive ability; (c) abnormal…
von Rosen, Philip; Frohm, Anna; Kottorp, Anders; Fridén, Cecilia; Heijne, Annette
Many risk factors for injury are presented in the literature, few of those are however consistent and the majority is associated with adult and not adolescent elite athletes. The aim was to identify risk factors for injury in adolescent elite athletes, by applying a biopsychosocial approach. A total of 496 adolescent elite athletes (age range 15-19), participating in 16 different sports, were monitored repeatedly over 52 weeks using a validated questionnaire about injuries, training exposure, sleep, stress, nutrition and competence-based self-esteem. Univariate and multiple cox regression analyses were used to calculate hazard ratios (HR) for risk factors for first reported injury. The main finding was that an increase in training volume, training intensity and at the same time decreasing the sleep volume resulted in a higher risk for injury compared to no change in these variables (HR 2.25, 95% CI, 1.46-3.45, p<0.01), which was the strongest risk factor identified. In addition, an increase by one score of competence-based self-esteem increased the hazard for injury with 1.02 (HR 95% CI, 1.00-1.04, p=0.01). Based on the multiple cox regression analysis, an athlete having the identified risk factors (Risk Index, competence-based self-esteem), with an average competence-based self-esteem score, had more than a threefold increased risk for injury (HR 3.35), compared to an athlete with a low competence-based self-esteem and no change in sleep or training volume.. Our findings confirm injury occurrence as a result of multiple risk factors interacting in complex ways. This article is protected by copyright. All rights reserved.
Satterthwaite, P.; Norton, R.; Larmer, P.; Robinson, E.
OBJECTIVES: To identify risk factors for injuries and other health problems occurring during or immediately after participation in a marathon. METHODS: A prospective cohort study was undertaken of participants in the 1993 Auckland Citibank marathon. Demographic data, information on running experience, training and injuries, and information on other lifestyle factors were obtained from participants before the race using an interviewer-administered questionnaire. Information on injuries and other health problems sustained during or immediately after the marathon were obtained by a self administered questionnaire. Logistic regression analyses were undertaken to identify significant risk factors for health problems. RESULTS: This study, one of only a few controlled epidemiological studies that have been undertaken of running injuries, has identified a number of risk factors for injuries and other health problems sustained in a marathon. Men were at increased risk of hamstring and calf problems, whereas women were at increased risk of hip problems. Participation in a marathon for the first time, participation in other sports, illness in the two weeks before the marathon, current use of medication, and drinking alcohol once a month or more, were associated with increased self reported risks of problems. While increased training seemed to increase the risk of front thigh and hamstring problems, it may decrease the risk of knee problems. There are significant but complex relations between age and risk of injury or health problem. CONCLUSIONS: This study has identified certain high risk subjects and risk factors for injuries and other health problems sustained in a marathon. In particular, subjects who have recently been unwell or are taking medication should weigh up carefully the pros and cons of participating. PMID:10027053
Glauser, Frédéric; Barras, Anne-Catherine; Pache, Isabelle; Monti, Matteo
Abdominal paracentesis is frequently performed in the clinical setting. Every newly developed ascites need to be investigated by abdominal paracentesis. Any clinical or biological deterioration in patients with chronic ascites also requires a new paracentesis. Therapeutically abdominal paracentesis is performed for refractory or symptomatic ascites. As other invasive procedures, it is critical to master its indications, contra-indications and complications. The aim of this article is to review the basics of abdominal paracentesis in order to help physicians to carry out this technical skill.
Labronici, Pedro José; Reder, Vitor Rodrigues; de Araujo Marins Filho, Guilherme Ferreira; Pires, Robinson Esteves Santos; Fernandes, Hélio Jorge Alvachian; Mercadante, Marcelo Tomanik
Objective To ascertain whether the number of screws or pins placed in the calcaneus might increase the risk of injury when three different techniques for treating calcaneal fractures. Method 126 radiographs of patients who suffered displaced calcaneal fractures were retrospectively analyzed. Three surgical techniques were analyzed on an interobserver basis: 31 radiographs of patients treated using plates that were not specific for the calcaneus, 48 using specific plates and 47 using an external fixator. The risk of injury to the anatomical structures in relation to each Kirschner wire or screw was determined using a graded system in accordance with the Licht classification. The total risk of injury to the anatomical structures through placement of more than one wire/screw was quantified using the additive law of probabilities for the product, for independent events. Results All of the models presented high explanatory power for the risk evaluated, since the coefficient of determination values (R2) were greater than 98.6 for all the models. Therefore, the set of variables studied explained more than 98.6% of the variations in the risks of injury to arteries, veins or nerves and can be classified as excellent models for prevention of injuries. Conclusion The risk of injury to arteries, veins or nerves is not defined by the total number of pins/screws. The region and the number of pins/screws in each region define and determine the best distribution of the risk. PMID:27069891
Giles, Kristina A.; Schermerhorn, Marc L.; O’Malley, A. James; Cotterill, Philip; Jhaveri, Ami; Pomposelli, Frank; Landon, Bruce E.
INTRODUCTION AND OBJECTIVES The impact of risk factors upon perioperative mortality might differ for patients undergoing open versus endovascular repair (EVAR) of abdominal aortic aneurysms (AAA). In order to investigate this, we developed a differential predictive model of perioperative mortality after AAA repair. METHODS A total of 45,660 propensity score matched Medicare beneficiaries undergoing elective open or endovascular AAA repair from 2001–2004 were studied. Using half the dataset we developed a multiple logistic regression model for a matched cohort of open and EVAR patients and used this to derive an easily evaluable risk prediction score. The remainder of the dataset formed a validation cohort used to confirm results. RESULTS The derivation cohort included 11,415 open and 11,415 endovascular repairs. Perioperative mortality was 5.3% and 1.8% respectively. Independent predictors of mortality (RR, 95% CI) were open repair (3.2, 2.7–3.8), age (71–75 years 1.2, 0.9–1.6; 76–80 years 1.9, 1.4–2.5; >80 years 3.1, 2.4–4.2), female sex (1.5, 1.3–1.8), dialysis (2.6, 1.5–4.6), chronic renal insufficiency (2.0, 1.6–2.6), congestive heart failure (1.7, 1.5–2.1), and vascular disease (1.3, 1.2–1.6). There were no differential predictors of mortality across the two procedures. A simple scoring system was developed from a logistic regression model fit to both endovascular and open patients (area under the ROC curve of 72.6) from which low, medium, and high risk groups were developed. The absolute predicted mortality ranged from 0.7% for an EVAR patient ≤ 70 years of age with no comorbidities to 38% for an open patient > 80 with all the comorbidities considered. Although relative risk was similar among age groups, the absolute difference was greater for older patients (with higher baseline risk). CONCLUSIONS Mortality after AAA repair is predicted by comorbidities, sex, and age and these predictors have similar effects for both methods of AAA
Somers, J. T.; Gernhardt, M.; Newby, N.
Spaceflight requires tremendous amounts of energy to achieve Earth orbit and to attain escape velocity for interplanetary missions. Although the majority of the energy is managed in such a way as to limit the accelerations on the crew, several mission phases may result in crew exposure to dynamic loads. In the automotive industry, risk of serious injury can be tolerated because the probability of a crash is remote each time a person enters a vehicle, resulting in a low total risk of injury. For spaceflight, the level of acceptable injury risk must be lower to achieve a low total risk of injury because the dynamic loads are expected on each flight. To mitigate the risk of injury due to dynamic loads, the NASA Human Research Program has developed a research plan to inform the knowledge gaps and develop relevant tools for assessing injury risk. The risk of injury due to dynamic loads can be further subdivided into extrinsic and intrinsic risk factors. Extrinsic risk factors include the vehicle dynamic profile, seat and restraint design, and spacesuit design. Human tolerance to loads varies considerably depending on the direction, amplitude, and rise-time of acceleration therefore the orientation of the body to the dynamic vector is critical to determining crew risk of injury. Although a particular vehicle dynamic profile may be safe for a particular design, the seat, restraint, and suit designs can affect the risk of injury due to localized effects. In addition, characteristics intrinsic to the crewmember may also contribute to the risk of injury, such as crewmember sex, age, anthropometry, and deconditioning due to spaceflight, and each astronaut may have a different risk profile because of these factors. The purpose of the research plan is to address any knowledge gaps in the risk factors to mitigate injury risk. Methods for assessing injury risk have been well documented in other analogous industries and include human volunteer testing, human exposure to dynamic
Sun, Zhen; Kong, Xin-Juan; Jing, Xue; Deng, Run-Jun; Tian, Zi-Bin
Background The nutritional risk screening (NRS 2002) has been applied increasingly in patients who underwent abdominal surgery for nutritional risk assessment. However, the usefulness of the NRS 2002 for predicting is controversial. This meta-analysis was to examine whether a preoperative evaluation of nutritional risk by NRS 2002 provided prediction of postoperative outcomes in patients undergoing abdominal surgery. Methods A systematic literature search for published papers was conducted using the following online databases: MEDLINE, EMBASE, the Cochrane library, EBSCO, CRD databases, Cinahl, PsycInfo and BIOSIS previews. The pooled odds ratio (OR) or weight mean difference (WMD) was calculated using a random-effect model or a fix-effect model. Results Eleven studies with a total of 3527 patients included in this study. Postoperative overall complications were more frequent in nutritional risk patients versus patients without nutritional risk (the pooled OR 3.13 [2.51, 3.90] p<0.00001). The pooled OR of mortality for the nutritional risk group and non-nutritional risk group was 3.61 [1.38, 9.47] (p = 0.009). Furthermore, the postoperative hospital stay was significant longer in the preoperative nutritional risk group than in the nutritional normal group (WMD 5.58 [4.21, 6.95] p<0.00001). Conclusions The present study has demonstrated that patients at preoperative nutritional risk have increased complication rates, high mortality and prolonged hospital stay after surgery. However, NRS 2002 needs to be validated in larger samples of patients undergoing abdominal surgery by better reference method. PMID:26172830
Bates, Nathaniel A; Hewett, Timothy E
Anterior cruciate ligament (ACL) injuries are common, catastrophic events that incur large expense and lead to degradation of the knee. As such, various motion capture techniques have been applied to identify athletes who are at increased risk for suffering ACL injuries. The objective of this clinical commentary was to synthesize information related to how motion capture analyses contribute to the identification of risk factors that may predict relative injury risk within a population. Individuals employ both active and passive mechanisms to constrain knee joint articulation during motion. There is strong evidence to indicate that athletes who consistently classify as high-risk loaders during landing suffer from combined joint stability deficits in both the active and passive knee restraints. Implementation of prophylactic neuromuscular interventions and biofeedback can effectively compensate for some of the deficiencies that result from poor control of the active knee stabilizers and reduce the incidence of ACL injuries.
Beegan, Leah; Messinger-Rapport, Barbara J
About one-third of community-dwelling adults age 65 and older fall each year, and some suffer fractures, traumatic brain injury, and even death. Therefore, it is important to identify older adults at risk and recommend helpful interventions.
... closes. (c) An electronic or solid-state circuit that performs a back-up, limiting, or other function intended to reduce the risk of fire, electric shock, or injury to persons, including entrapment...
Bliekendaal, S; Goossens, L; Stubbe, J H
Injuries can have a major impact on the physical performance and academic career of physical education teacher education (PETE) students. To investigate the injury problem, risk factors, and the impact of injuries on academic success, 252 PETE students were followed during their first semester. Risk factor analysis was conducted by means of logistic regression analysis with a differentiation for upper body, lower body, acute, overuse, and severe injuries. An incidence of 1.26 injuries/student/semester was found. Most injuries involved the lower body (61%), were new injuries (76%), occurred acutely (66%), and were sustained during curricular gymnastics (25%) or extracurricular soccer (28%). Significant risk factors for lower body acute injuries were age (OR=2.14; P=.01), previous injury (OR=2.23; P=.01), and an injury at the start of the year (OR=2.56; P=.02). For lower body overuse injuries, gender (OR=2.85; P=.02) and the interval shuttle run test score (OR=2.44; P=.04) were significant risk factors. Previous injury (OR=2.59; P=.04) and injury at the start of the year (upper body: OR=4.57; P=.02; lower body: OR=3.75; P<.01) were risk factors for severe injuries. Injury-related time loss was positively related to total academic success (r=.20; P=.02) and success in theoretical courses (r=.24; P=<.01). No association was found between time loss and academic success for sport courses.
Steffen, Kathrin; Andersen, Thor Einar; Bahr, Roald
Background Artificial turf is becoming increasingly popular, although the risk of injury on newer generations of turf is unknown. Aim To investigate the risk of injury on artificial turf compared with natural grass among young female football players. Study design Prospective cohort study. Methods 2020 players from 109 teams (mean (SD) 15.4 (0.8) years) participated in the study during the 2005 football season. Time‐loss injuries and exposure data on different types of turf were recorded over an eight‐month period. Results 421 (21%) players sustained 526 injuries, leading to an injury incidence of 3.7/1000 playing hours (95% CI 3.4 to 4.0). The incidence of acute injuries on artificial turf and grass did not differ significantly with respect to match injuries (rate ratio (RR) 1.0, 95% CI 0.8 to 1.3; p = 0.72) or training injuries (RR 1.0, 95% CI 0.6 to 1.5, p = 0.93). In matches, the incidence of serious injuries was significantly higher on artificial turf (RR 2.0, 95% CI 1.3 to 3.2; p = 0.03). Ankle sprain was the most common type of injury (34% of all acute injuries), and there was a trend towards more ankle sprains on artificial turf than on grass (RR 1.5, 95% CI 1.0 to 2.2; p = 0.06). Conclusion In the present study among young female football players, the overall risk of acute injuries was similar between artificial turf and natural grass. PMID:17550919
Uehli, Katrin; Miedinger, David; Bingisser, Roland; Dürr, Selina; Holsboer-Trachsler, Edith; Maier, Sabrina; Mehta, Amar J; Müller, Roland; Schindler, Christian; Zogg, Stefanie; Künzli, Nino; Leuppi, Jörg D
Sleep problems are a well-known risk factor for work injuries, but less is known about which vulnerable populations are most at risk. The aims of this study were to investigate the association between sleep quality and the risk of work injury and to identify factors that may modify the association. A case-control study including 180 cases and 551 controls was conducted at the University Hospital in Basel, Switzerland, from 1 December 2009 to 30 June 2011. Data on work injuries and sleep quality were collected. Adjusted odds ratios and 95% confidence intervals of the association between sleep quality and work injury were estimated in multivariable logistic regression analyses and were stratified by hypothesized effect modifiers (age, gender, job risk, shift work, sleep duration and working hours). Poor sleep quality was associated significantly with work injury of any type (P < 0.05) and with being caught in particular (P < 0.05). The association between poor sleep quality and work injury was significantly higher for workers older than 30 years (odds ratio>30 1.30 versus odds ratio≤30 0.91, P < 0.01), sleeping 7 h or less per night (odds ratio≤7 1.17 versus odds ratio>7 0.79, P < 0.05) and working 50 h or more per week (odds ratio≥50 1.79 versus odd ratio<50 1.10, P < 0.01). Work injury risk increased with increasing severity of sleep problems (P < 0.05). Prior work injury frequency increased with decreasing sleep quality (P < 0.05). Older age, short sleep duration and long working hours may enhance the risk of work injuries associated with sleep quality.
Bradshaw, Elizabeth J; Hume, Patria A
Targeted injury prevention strategies, based on biomechanical analyses, have the potential to help reduce the incidence and severity of gymnastics injuries. This review outlines the potential benefits of biomechanics research to contribute to injury prevention strategies for women's artistic gymnastics by identification of mechanisms of injury and quantification of the effects of injury risk factors. One hundred and twenty-three articles were retained for review after searching electronic databases using key words, including 'gymnastic', 'biomech*', and 'inj*', and delimiting by language and relevance to the paper aim. Impact load can be measured biomechanically by the use of instrumented equipment (e.g. beatboard), instrumentation on the gymnast (accelerometers), or by landings on force plates. We need further information on injury mechanisms and risk factors in gymnastics and practical methods of monitoring training loads. We have not yet shown, beyond a theoretical approach, how biomechanical analysis of gymnastics can help reduce injury risk through injury prevention interventions. Given the high magnitude of impact load, both acute and accumulative, coaches should monitor impact loads per training session, taking into consideration training quality and quantity such as the control of rotation and the height from which the landings are executed.
Fagher, Kristina; Forsberg, Anna; Jacobsson, Jenny; Timpka, Toomas; Dahlström, Örjan; Lexell, Jan
Our knowledge of sports-related injuries in para-sport is limited and there are no data on how Paralympic athletes themselves perceive an injury. The aim of this qualitative study was to explore Paralympic athletes' perceptions of their experiences of sports-related injuries, risk factors and preventive possibilities. Eighteen Swedish Paralympic athletes with vision impairment, intellectual impairment, spinal cord injury, cerebral palsy, myelomeningocele, dysplasia and neuromuscular disorder, representing 10 different para-sports, were interviewed. The qualitative phenomenographic method was used to interpret the data. The analysis revealed nine categories of perceptions of experiences. The athletes perceived that their impairments were involved in the cause and consequential chains associated with a sports-related injury. Other categories that denoted and described these injuries were: sport overuse, risk behaviour, functional limitations, psychological stressors, the normalised pain, health hazards, individual possibilities to prevent sports-related injuries and unequal prerequisites. This qualitative study revealed that Paralympic athletes' perceptions of their experiences of sports-related injuries are complex and multifactorial, and in several ways differ from able-bodied athletes. This needs to be considered in the sports health and safety work within the Paralympic Movement as well as in the design of future injury surveillance systems and preventive programmes.
Robinson, Mark; Siddall, Andrew; Bilzon, James; Thompson, Dylan; Greeves, Julie; Izard, Rachel; Stokes, Keith
Background Injuries sustained by military recruits during initial training impede training progression and military readiness while increasing financial costs. This study investigated training-related injuries and injury risk factors among British Army infantry recruits. Methods Recruits starting infantry training at the British Army Infantry Training Centre between September 2008 and March 2010 were eligible to take part. Information regarding lifestyle behaviours and injury history was collected using the Military Pre-training Questionnaire. Sociodemographic, anthropometric, physical fitness and injury (lower limb and lower back) data were obtained from Army databases. Univariable and multivariable Cox regression models were used to explore the association between time to first training injury and potential risk factors. Results 58% (95% CI 55% to 60%) of 1810 recruits sustained at least 1 injury during training. Overuse injuries were more common than traumatic injuries (65% and 35%, respectively). The lower leg accounted for 81% of all injuries, and non-specific soft tissue damage was the leading diagnosis (55% of all injuries). Injuries resulted in 122 (118 to 126) training days lost per 1000 person-days. Slower 2.4 km run time, low body mass, past injury and shin pain were independently associated with higher risk of any injury. Conclusions There was a high incidence of overuse injuries in British Army recruits undertaking infantry training. Recruits with lower pretraining fitness levels, low body mass and past injuries were at higher risk. Faster 2.4 km run time performance and minimal body mass standards should be considered for physical entry criteria. PMID:27900170
Jones, Gareth; Johnson, Mark I
Rock climbing is a popular sporting activity and indoor sport climbing has been accepted for inclusion in the 2020 Olympic Games. The aim of this article is to critically review research on the incidence and risk factors associated with injuries during rock climbing. A semisystematic approach in reviewing literature on incidence and prevalence was applied. Articles were identified after searches of the following electronic databases: Discover, Academic Search Complete (EBSCO), PubMed, Embase, SPORTDiscus, and ScienceDirect. Despite methodological shortcomings of the studies contained within the review, the frequency of climbing-related injuries is high and can be challenging to diagnose. The fingers are the most common site of injury with previous injury a significant risk factor for reinjury. The annular pulleys of the fingers are the most commonly injured structure and evidence suggests epiphyseal fractures in adolescent sport climbers is increasing. A diagnostic and therapeutic algorithm for climbing-related finger injuries is proposed.
Cantley, Linda F; Taiwo, Oyebode A; Galusha, Deron; Barbour, Russell; Slade, Martin D; Tessier-Sherman, Baylah; Cullen, Mark R
Objectives This study aimed to examine the effect of an ergonomic hazard control (HC) initiative, undertaken as part of a company ergonomics standard, on worker injury risk. Methods Using the company's ergonomic hazards database to identify jobs with and without ergonomic HC implementation and linking to individual job and injury histories, injury risk among person-jobs with HC implementation (the HC group) was compared to those without HC (NoHC group) using random coefficient models. Further analysis of the HC group was conducted to determine the effect of additional ergonomic hazards controlled on injury risk. Results Among 123jobs at 17 plant locations, 347 ergonomic hazards were quantitatively identified during the study period. HC were implemented for 204 quantified ergonomic hazards in 84 jobs, impacting 10 385 persons (12 967 person-jobs). No HC were implemented for quantified ergonomic hazards in the remaining 39 jobs affecting 4155 persons (5046 person-jobs). Adjusting for age, sex, plant origin, and year to control for any temporal trend in injury risk, the relative risk (RR) for musculoskeletal disorder (MSD) was 0.85 and the RR for any injury or MSD was 0.92 in the HC compared to NoHC group. Among the HC group, each ergonomic hazard controlled was associated with risk reduction for MSD and acute injury outcomes (RR 0.93). Conclusion Systematic ergonomic HC through participatory ergonomics, as part of a mandatory company ergonomics standard, is associated with MSD and injury risk reduction among workers in jobs with HC implemented. PMID:24142048
Onate, James A.; Everhart, Joshua S.; Clifton, Daniel R.; Best, Thomas M.; Borchers, James R.; Chaudhari, Ajit M.W.
Objective A stated goal of the preparticipation physical evaluation (PPE) is to reduce musculoskeletal injury, yet the musculoskeletal portion of the PPE is reportedly of questionable use in assessing lower extremity injury risk in high school-aged athletes. The objectives of this study are: (1) identify clinical assessment tools demonstrated to effectively determine lower extremity injury risk in a prospective setting, and (2) critically assess the methodological quality of prospective lower extremity risk assessment studies that use these tools. Data Sources A systematic search was performed in PubMed, CINAHL, UptoDate, Google Scholar, Cochrane Reviews, and SportDiscus. Inclusion criteria were prospective injury risk assessment studies involving athletes primarily ages 13 to 19 that used screening methods that did not require highly specialized equipment. Methodological quality was evaluated with a modified physiotherapy evidence database (PEDro) scale. Main Results Nine studies were included. The mean modified PEDro score was 6.0/10 (SD, 1.5). Multidirectional balance (odds ratio [OR], 3.0; CI, 1.5–6.1; P < 0.05) and physical maturation status (P < 0.05) were predictive of overall injury risk, knee hyperextension was predictive of anterior cruciate ligament injury (OR, 5.0; CI, 1.2–18.4; P < 0.05), hip external: internal rotator strength ratio of patellofemoral pain syndrome (P = 0.02), and foot posture index of ankle sprain (r = −0.339, P = 0.008). Conclusions Minimal prospective evidence supports or refutes the use of the functional musculoskeletal exam portion of the current PPE to assess lower extremity injury risk in high school athletes. Limited evidence does support inclusion of multidirectional balance assessment and physical maturation status in a musculoskeletal exam as both are generalizable risk factors for lower extremity injury. PMID:26978166
Tolouei, Reza; Maher, Mike; Titheridge, Helena
This paper introduces a novel methodology based on disaggregate analysis of two-car crash data to estimate the partial effects of mass, through the velocity change, on absolute driver injury risk in each of the vehicles involved in the crash when absolute injury risk is defined as the probability of injury when the vehicle is involved in a two-car crash. The novel aspect of the introduced methodology is in providing a solution to the issue of lack of data on the speed of vehicles prior to the crash, which is required to calculate the velocity change, as well as a solution to the issue of lack of information on non-injury two-car crashes in national accident data. These issues have often led to focussing on relative measures of injury risk that are not independent of risk in the colliding cars. Furthermore, the introduced methodology is used to investigate whether there is any effect of vehicle size above and beyond that of mass ratio, and whether there are any effects associated with the gender and age of the drivers. The methodology was used to analyse two-car crashes to investigate the partial effects of vehicle mass and size on absolute driver injury risk. The results confirmed that in a two-car collision, vehicle mass has a protective effect on its own driver injury risk and an aggressive effect on the driver injury risk of the colliding vehicle. The results also confirmed that there is a protective effect of vehicle size above and beyond that of vehicle mass for frontal and front to side collisions.
Kilgo, Patrick D; Weaver, Ashley A; Barnard, Ryan T; Love, Timothy P; Stitzel, Joel D
The mortality risk ratio (MRR), a measure of the proportion of people who died that sustained a given injury, is reported to be among the most powerful discriminators of mortality following trauma. The primary aim was to determine whether mechanistic differences exist and are quantifiable when comparing MRR-based injury severity across two broadly defined etiologies (motor vehicle crash (MVC) versus non-MVC) for the clarification of important injury types that have some room for improvement by emergency treatment and vehicle design. All International Classification of Diseases, 9th revision (ICD-9) coded injuries in the National Trauma Data Bank (NTDB) database were stratified into MVC and non-MVC groups and the MRR for each injury was computed within each group. Injuries were classified as 11 different types for MRR comparison between etiologies. Overall, MRRs for specific injuries were 10-18% lower for MVC compared to non-MVC etiologies. MVCs however produced much higher mean MRRs for crushing injuries (0.184 versus 0.072) and internal injuries to the thorax, abdomen, and pelvis (0.200 versus 0.169). Non-MVCs produced much higher MRRs for intracranial injuries (0.199 versus 0.250). Analysis of the top 95% most frequent MVC injuries revealed higher MVC MRR values for 78% of the injuries with MRR ratios indicating an average 50% increase in a given injury's MRR when MVC was the etiology. Addressing the large differences in MRR in between etiologies for identical injuries could provide a reduction in fatalities and may be important to patient triage and vehicle safety design.
Petermann, F; Nitkowski, D
Self-injurious behavior refers to the direct destructive treatment of one's own body performed without suicidal intent. Many methods are observable, and different body parts are harmed, particularly arms and legs. The 6-month prevalence of self-injurious behavior is projected at 4% in the general population. Such behavior most often supports emotional regulation. Traumatic experiences, mental disorders, and general impulsivity facilitate its appearance.
Calling, Susanna; Palmér, Karolina; Jönsson, Lena; Sundquist, Jan; Winkleby, Marilyn; Sundquist, Kristina
Aim Preterm birth is associated with a number of physical and mental health issues. The aim of this study was to find out if there was also any association between individuals born preterm in Sweden between 1984 and 2006 and the risk of unintentional injuries during childhood, adolescence and young adulthood. Methods The study followed 2,297,134 individuals, including 5.9% born preterm, from 1985 to 2007 for unintentional injuries leading to hospitalisation or death (n=244,021). The males and females were divided into four age groups: 1–5 years, 6–12 years, 13–18 years and 19–23 years. Hazard ratios were calculated for falls, transport injuries and other injuries. Results After adjusting for a comprehensive set of covariates, some of the preterm subgroups demonstrated slightly increased risks of unintentional injuries, while others showed slightly decreased risks. However, most of the estimates were borderline or non-significant in both males and females. In addition, the absolute risk differences between individuals born preterm and full term were small. Conclusion Despite the association between preterm birth and a variety of physical and mental health consequences, this study shows that there is no consistent risk pattern between preterm birth and unintentional injuries in childhood, adolescence and young adulthood. PMID:23181809
Rupp, Jonathan D; Flannagan, Carol A C; Kuppa, Shashi M
Injury risk curves for the skeletal knee-thigh-hip (KTH) relate peak force applied to the anterior aspect of the flexed knee, the primary source of KTH injury in frontal motor-vehicle crashes, to the probability of skeletal KTH injury. Previous KTH injury risk curves have been developed from analyses of peak knee-impact force data from studies where knees of whole cadavers were impacted. However, these risk curves either neglect the effects of occupant gender, stature, and mass on KTH fracture force, or account for them using scaling factors derived from dimensional analysis without empirical support. A large amount of experimental data on the knee-impact forces associated with KTH fracture are now available, making it possible to estimate the effects of subject characteristics on skeletal KTH injury risk by statistically analyzing empirical data. Eleven studies were identified in the biomechanical literature in which the flexed knees of whole cadavers were impacted. From these, peak knee-impact force data and the associated subject characteristics were reanalyzed using survival analysis with a lognormal distribution. Results of this analysis indicate that the relationship between peak knee-impact force and the probability of KTH fracture is a function of age, total body mass, and whether the surface that loads the knee is rigid. Comparisons between injury risk curves for the midsize adult male and small adult female crash test dummies defined in previous studies and new risk curves for these sizes of occupants developed in this study suggest that previous injury risk curves generally overestimate the likelihood of KTH fracture at a given peak knee-impact force. Future work should focus on defining the relationships between impact force at the human knee and peak axial compressive forces measured by load cells in the crash test dummy KTH complex so that these new risk curves can be used with ATDs.
Ozen, Anil; Hanedan, Muhammet Onur; Songur, Çetin Murat; Boysan, Emre; Unal, Ertekin Utku; Mola, Serkan; Erkengel, Halil Ibrahim; Kubat, Emre; Iscan, Zafer; Tutun, Ufuk; Sarıtas, Ahmet; Birincioglu, Cemal Levent
Background: Surgical treatment of a ruptured abdominal aorta aneurysm (RAAA) continues to present a significant challenge to surgeons. There are some patient factors such as age and gender that cannot be changed, and comorbid conditions can be optimized but not eliminated. The purpose of this study was to identify the risk factors affecting high mortality after the surgical repair of an RAAA. Methods: Data on 121 patients who underwent surgical repair for RAAAs between January 1997 and June 2011 in our institution were collected retrospectively. All the patients had been diagnosed by computed tomography (CT) scans, and intraoperative extra-luminal blood was visualized intraoperatively. Variables studied comprised demographic data; preoperative, operative, and postoperative data; and the causes of mortality. Multivariate regression analysis was used to determine the predictors of mortality. Results: One hundred eight (89.2%) patients were male and 13 (10.7%) were female at an average age of 68.9 ± 10.5 years. Totally, 121 patients underwent surgery for RAAAs. Fifty-four patients had aortic tube grafts, 32 aortobiiliac grafts, 20 aortobifemoral grafts, 1 aortoiliac graft, and 1 aortofemoral graft for the replacement of the RAAAs. Seven patients had only surgical exploration. Operative mortality was 41.3% (50 patients). The factors associated with mortality were preoperative shock, free blood, positive inotropic agent, hematocrit value, and need for blood and plasma. In the multivariate analysis, preoperative shock and positive inotropic agents were found to be significant as the predictors of death (OR: 19.8, 95%CI: 3.2-122.8 and OR: 8.6, 95% CI: 2.9-26.3, respectively). Conclusion: This study revealed that the preoperative clinical findings affected the mortality associated with RAAAs. PMID:26697083
Aquino, Michael R; Gibson, Donald P; Bloom, David A
Paratesticular rhabdomyosarcoma is a rare but aggressive malignancy in children and adolescents. Prognosis is related to initial tumor resectability as well as staging of the disease based on tumor invasiveness, tumor bulk, nodal disease and metastases. We report the unusual presentation of paratesticular rhabdomyosarcoma with metastatic extension through the inguinal canal and encasement of the abdominal aorta. These features portend a poor prognosis given their association with a greater stage of disease and unresectable nature at presentation. Delayed surgical resection follows a regimen of chemotherapy and radiation therapy in such cases of extensive disease. Encasement of the abdominal aorta has been shown to increase presurgical risk for intraoperative vascular injury when related to other malignancies, but its role in relation to metastatic paratesticular rhabdomyosarcoma has not been investigated. Also, rhabdomyosarcoma should be considered in the differential diagnoses of tumors that demonstrate encasement of the abdominal aorta.
Fox, A S; Bonacci, J; McLean, S G; Saunders, N
Screening methods sensitive to movement strategies that increase anterior cruciate ligament (ACL) loads are likely to be effective in identifying athletes at-risk of ACL injury. Current ACL injury risk screening methods are yet to be evaluated for their ability to identify athletes' who exhibit high-risk lower limb mechanics during sport-specific maneuvers associated with ACL injury occurrences. The purpose of this study was to examine the efficacy of two ACL injury risk screening methods in identifying high-risk lower limb mechanics during a sport-specific landing task. Thirty-two female athletes were screened using the Landing Error Scoring System (LESS) and Tuck Jump Assessment. Participants' also completed a sport-specific landing task, during which three-dimensional kinematic and kinetic data were collected. One-dimensional statistical parametric mapping was used to examine the relationships between screening method scores, and the three-dimensional hip and knee joint rotation and moment data from the sport-specific landing. Higher LESS scores were associated with reduced knee flexion from 30 to 57 ms after initial contact (P = 0.003) during the sport-specific landing; however, no additional relationships were found. These findings suggest the LESS and Tuck Jump Assessment may have minimal applicability in identifying athletes' who exhibit high-risk landing postures in the sport-specific task examined.
McGwin, G; Enochs, R; Roseman, J M
Research on the epidemiology of agriculture-related injuries has largely ignored African-Americans and farm workers. This cohort study is the first to estimate injury rates and to evaluate prospectively risk factors for agriculture-related injuries and compare them among African-American and Caucasian farmers and African-American farm workers. A total of 1,246 subjects (685 Caucasian owners, 321 African-American owners, and 240 African-American workers) from Alabama and Mississippi were selected from Agricultural Statistics Services databases and other sources and were enrolled between January 1994 and June 1996. Baseline data included detailed demographic, farm and farming, and behavioral information. From January 1994 to April 1998, subjects were contacted biannually to ascertain the occurrence of an agriculture-related injury. Injury rates were 2.9 times (95% confidence interval (CI): 2.0, 4.3) higher for African-American farm workers compared with Caucasian and African-American owners. Part-time farming (relative risk (RR) = 2.0, 95% CI: 1.3, 2.5), prior agricultural injury (RR = 1.5, 95% CI: 1.0, 2.1), and farm machinery in fair/poor condition (RR = 1.8, 95% CI: 1.2, 2.7) were also independently associated with injury rates. The results demonstrate the increased frequency of agricultural injury among farm workers and identify a number of possible ways of reducing them.
Bonauto, David K.; Sheppard, Lianne; Busch-Isaksen, Tania; Calkins, Miriam; Adams, Darrin; Lieblich, Max; Fenske, Richard A.
Background Recent research suggests that heat exposure may increase the risk of traumatic injuries. Published heat-related epidemiological studies have relied upon exposure data from individual weather stations. Objective To evaluate the association between heat exposure and traumatic injuries in outdoor agricultural workers exposed to ambient heat and internal heat generated by physical activity using modeled ambient exposure data. Methods A case-crossover study using time-stratified referent selection among 12,213 outdoor agricultural workers with new Washington State Fund workers’ compensation traumatic injury claims between 2000 and 2012 was conducted. Maximum daily Humidex exposures, derived from modeled meteorological data, were assigned to latitudes and longitudes of injury locations on injury and referent dates. Conditional logistic regression was used to estimate odds ratios of injury for a priori daily maximum Humidex categories. Results The mean of within-stratum (injury day and corresponding referent days) standard deviations of daily maximum Humidex was 4.8. The traumatic injury odds ratio was 1.14 (95% confidence interval 1.06, 1.22), 1.15 (95% confidence interval 1.06, 1.25), and 1.10 (95% confidence interval 1.01, 1.20) for daily maximum Humidex of 25–29, 30–33, and ≥34, respectively, compared to < 25, adjusted for self-reported duration of employment. Stronger associations were observed during cherry harvest duties in the June and July time period, compared to all duties over the entire study period. Conclusions Agricultural workers laboring in warm conditions are at risk for heat-related traumatic injuries. Combined heat-related illness and injury prevention efforts should be considered in high-risk populations exposed to warm ambient conditions in the setting of physical exertion. PMID:27716794
Orr, Robin; Pope, Rodney; Peterson, Samantha; Hinton, Benjamin; Stierli, Michael
Tactical trainees, like those entering the police force, are required to undergo vigorous training as part of their occupational preparation. This training has the potential to cause injuries. In addition, the physical training, communal living and pressures of tactical training are known to induce immune suppression and have the potential to increase the risk of illness. The aim of this study was to investigate the relationship between leg power, as measured by a vertical jump (VJ), and rates of reported injuries and illnesses during police recruit training. Retrospective data from recruits (n = 1021) undergoing basic police recruit training at an Australian Police Force College was collected. Recruits completed a VJ assessment at the commencement of their second state of training. Formally reported illness and injuries were collected 12 weeks later, following completion of training. Correlations between VJ height and rates of reported illness and injury were low (r = −0.16 and −0.09, respectively) but significant (p < 0.005), with VJ height accounting for 2.6% and 0.8% of the variance in illness and injury rates, respectively. In terms of relative risks, recruits with the lowest recorded VJ heights were more than three times as likely as those with highest VJ heights to suffer injury and/or illness. Police recruits with lower VJ height are at a significantly greater risk of suffering an injury or illness during police basic recruit training. PMID:26907311
Orr, Robin; Pope, Rodney; Peterson, Samantha; Hinton, Benjamin; Stierli, Michael
Tactical trainees, like those entering the police force, are required to undergo vigorous training as part of their occupational preparation. This training has the potential to cause injuries. In addition, the physical training, communal living and pressures of tactical training are known to induce immune suppression and have the potential to increase the risk of illness. The aim of this study was to investigate the relationship between leg power, as measured by a vertical jump (VJ), and rates of reported injuries and illnesses during police recruit training. Retrospective data from recruits (n = 1021) undergoing basic police recruit training at an Australian Police Force College was collected. Recruits completed a VJ assessment at the commencement of their second state of training. Formally reported illness and injuries were collected 12 weeks later, following completion of training. Correlations between VJ height and rates of reported illness and injury were low (r = -0.16 and -0.09, respectively) but significant (p < 0.005), with VJ height accounting for 2.6% and 0.8% of the variance in illness and injury rates, respectively. In terms of relative risks, recruits with the lowest recorded VJ heights were more than three times as likely as those with highest VJ heights to suffer injury and/or illness. Police recruits with lower VJ height are at a significantly greater risk of suffering an injury or illness during police basic recruit training.
Grier, Tyson L; Canham-Chervak, Michelle; Bushman, Timothy T; Anderson, Morgan K; North, William J; Jones, Bruce H
Grier, TL, Canham-Chervak, M, Bushman, TT, Anderson, MK, North, WJ, and Jones, BH. Evaluating injury risk and gender performance on health- and skill-related fitness assessments. J Strength Cond Res 31(4): 971-980, 2017-The purpose of this analysis was to investigate the association of injury risk and gender performance on health- and skill-related fitness assessments. A survey was used to collect personal characteristics and Army Physical Fitness Test scores (2-mile run, push-ups, and sit-ups). Within the same day, 9 physical fitness assessments were performed. Percent body fat was estimated using height, weight, age, and sex. All fitness assessment data were categorized into tertiles of high, moderate and low performance. To investigate potential injury risk predicted by fitness assessment performance, injury risk ratios, odds ratios (ORs), and 95% confidence intervals (CIs) were calculated using medical record data. A total of 3,264 soldiers completed surveys and physical fitness assessments. Tertiles of fitness performance with men and women combined showed that on an average, 14% of women and 70% of men were in the moderate- and high-performance groups. Among men, higher injury risk was independently associated with low performance on a 2-mile run (ORslow/fast = 1.51, 95% CI 1.18-1.94) and low performance on a weighted 300-yard shuttle run (ORslow/fast = 1.36, 95% CI 1.06-1.74). For women, a higher risk of injury was associated with low performance on the 2-mile run (ORslow/fast = 2.38, 95% CI 1.04-5.74). Therefore, out of the 13 fitness assessments, the 2-mile run and weighted 300-yard shuttle run can also (in addition to measuring performance) be utilized to identify soldiers or athletes who are at a higher risk of experiencing an injury.
Shadad, Abobakr K; Sullivan, Frank J; Martin, Joseph D; Egan, Laurence J
Ionising radiation therapy is a common treatment modality for different types of cancer and its use is expected to increase with advances in screening and early detection of cancer. Radiation injury to the gastrointestinal tract is important factor working against better utility of this important therapeutic modality. Cancer survivors can suffer a wide variety of acute and chronic symptoms following radiotherapy, which significantly reduces their quality of life as well as adding an extra burden to the cost of health care. The accurate diagnosis and treatment of intestinal radiation injury often represents a clinical challenge to practicing physicians in both gastroenterology and oncology. Despite the growing recognition of the problem and some advances in understanding the cellular and molecular mechanisms of radiation injury, relatively little is known about the pathophysiology of gastrointestinal radiation injury or any possible susceptibility factors that could aggravate its severity. The aims of this review are to examine the various clinical manifestations of post-radiation gastrointestinal symptoms, to discuss possible patient and treatment factors implicated in normal gastrointestinal tissue radiosensitivity and to outline different mechanisms of intestinal tissue injury. PMID:23345941
Mitchell, R J; Bambach, M R; Foster, K; Curtis, K
Road trauma is one of the most common causes of injury for children. Yet risk factors associated with different levels of injury severity for childhood road trauma have not been examined in-depth. This study identifies crash and injury risk factors associated with the severity of non-fatal injury outcome for paediatric road trauma. A retrospective analysis was conducted of paediatric road trauma identified in linked police-reported and hospitalisation records during 1 January 2001 to 31 December 2011 in New South Wales (NSW), Australia. The linkage rate was 54%. Injury severity was calculated from diagnosis classifications in hospital records using the International Classification of Disease Injury Severity Score. Univariate and multi-variable logistic regression was conducted. There were 2412 car occupants, 1701 pedestrians and 612 pedal cyclists hospitalised where their hospital record linked to a police report. For car occupants, unauthorised vehicle drivers had twice the odds (OR: 2.21, 95%CI 1.47-3.34) and learner/provisional drivers had one and a half times higher odds (OR: 1.54, 95%CI 1.15-2.07) of a child car occupant sustaining a serious injury compared to a minor injury. For pedal cyclists and pedestrians, there were lower odds of a crash occurring during school commuting time and higher odds of a crash occurring during the weekend or on a dry road for children who sustained a serious versus a minor injury. Injury prevention initiatives, such as restraint and helmet use, that should reduce injury and/or crash severity are advocated.
Dorfman, David; George, Mary Catherine; Tamler, Ronald; Lushing, Julia; Nmashie, Alexandra; Simpson, David M
Pruritus is a risk factor for self-injury behavior (SIB) in sensory polyneuropathies. Although diabetes patients have elevated risk for pruritus, there are no reports of SIB in diabetic neuropathy. We present the case of a diabetes patient with neuropathy, whose pruritus induced SIB, resulted in partial amputation of a toe.
... 16 Commercial Practices 2 2010-01-01 2010-01-01 false Reporting of unreasonable risk of serious... Reporting of unreasonable risk of serious injury or death. (a) General provision. Every manufacturer... reporting. Such information can include reports from experts, test reports, product liability lawsuits...
Sorock, G; Lombardi, D; Hauser, R; Eisen, E; Herrick, R; Mittleman, M
Background: Workers with acute hand injuries account for over 1 000 000 emergency department visits annually in the United States. Aims: To determine potential transient risk factors for occupational acute hand injury. Methods: Subjects were recruited from 23 occupational health clinics in five northeastern states in the USA. In a telephone interview, subjects were asked to report the occurrence of seven potential risk factors within a 90-minute time period before an acute hand injury. Each case also provided control information on exposures during the month before the injury. The self-matched feature of the study design controlled for stable between-person confounders. Results: A total of 1166 subjects were interviewed (891 men, 275 women), with a mean age (SD) of 37.2 years (11.4). The median time interval between injury and interview was 1.3 days. Sixty three per cent of subjects had a laceration. The relative risk of a hand injury was increased when working with equipment, tools, or work pieces not performing as expected (11.0, 95% CI 9.4 to 12.8), or when using a different work method to do a task (10.5, 95% CI 8.7 to 12.7). Other transient factors in decreasing order of relative risk were doing an unusual task, being distracted, and being rushed. Wearing gloves reduced the relative risk by 60% (0.4, 95% CI 0.3 to 0.5). Occupational category, job experience, and safety training were found to alter several of these effects. Conclusion: The results suggest the importance of these transient, potentially modifiable factors in the aetiology of acute hand injury at work. Attempts to modify these exposures by various strategies may reduce the incidence of acute hand injury at work. PMID:15031387
Comparison of the strain field of abdominal aortic aneurysm measured by magnetic resonance imaging and stereovision: a feasibility study for prediction of the risk of rupture of aortic abdominal aneurysm.
Wang, Yufei; Joannic, David; Delassus, Patrick; Lalande, Alain; Juillion, Patrick; Fontaine, Jean-François
The prediction of the risk of rupture of abdominal aortic aneurysm (AAA) is a complex problem. Currently the criteria to predict rupture of abdominal aortic aneurysms are aneurysm diameter and growth rates. It is generally believed that study of the wall strain distribution could be helpful to find a better decision criterion for surgery of aortic aneurysms before their rupture. The wall strain distribution depends on many biological and biomechanical factors such as elastic properties of the aorta, turbulent blood flow, anatomy of the aorta, presence of thrombus or not and so on. Recently, numerical simulations to estimate rupture-potential have received many attentions. However, none of the medical imaging tools for screening and monitoring of AAAs were studied in terms of mechanical behavior and experimentally to demonstrate their capability to measure relevant variables. The aim of this study was to develop a metrological approach for deployment testing of the ability of techniques for measuring local in-vitro deformations based on comparison of stereovision and MRI. In this paper, we present the implementation approach and results of the study based on cylindrical phantoms with or without AAA representing, respectively, healthy and unhealthy artery. Through this study, an experimental device was developed for the behavior study of AAA during a cardiac cycle. The results show that the stereovision techniques used in laboratory is well suited and is qualitatively and quantitatively equivalent with MRI measurements.
Stomach pain; Pain - abdomen; Belly ache; Abdominal cramps; Bellyache; Stomachache ... Almost everyone has pain in the abdomen at some point. Most of the time, it is not serious. How bad your pain is ...
Gschossmann, J M; Holtmann, G; Netzer, P; Essig, M; Balsiger, B M; Scheurer, U
Abdominal pain can result from a variety of different intra- and extra-abdominal disorders. Given the wide variety of etiological triggers for this pain, the primary task during the first stage of the diagnostic work-up is to determine as soon as possible the underlying cause and the degree of emergency. The aim of this evaluation is to adapt the therapeutic measures which are necessary for a causal treatment to the individual situation. Contrary to somatic causes of abdominal pain, the availability of such a causal therapy for functional bowel disorders is still very limited. Given this dilemma, the therapeutic focus of abdominal pain associated with these functional syndromes has to be placed on symptom-oriented treatment.
Farmer, Charles M; Wells, Joann K; Lund, Adrian K
Automobile insurance claims were examined to determine the rates of neck injuries in rear-end crashes for vehicles with and without redesigned head restraints, redesigned seats, or both. Results indicate that the improved geometric fit of head restraints observed in many newer vehicle models are reducing the risk of whiplash injury substantially among female drivers (about 37% in the Ford Taurus and Mercury Sable), but have very little effect among male drivers. New seat designs, such as active head restraints that move upward and closer to drivers' heads during a rear impact, give added benefit, producing about a 43% reduction in whiplash injury claims (55% reduction among female drivers). Estimated effects of Volvo's Whiplash Injury Prevention System and Toyota's Whiplash Injury Lessening design were based on smaller samples and were not statistically significant.
Schmid, A; Hüring, H; Huber, G; Gösele, A; Hecker-Kube, H; Gruhn, O; Stinus, H; Birnesser, H; Keul, J
Injuries caused by cross country skiing have been poorly investigated in handicapped athletes. The dynamic sliding shape of motion makes this sport to a suitable discipline for people with a deficit of locomotion. Visual handicapped people with a guide are able to improve their motoric skills, co-ordination, orientation and body self-consciousness in the track. Since handicapped athletes are performing in international competitions the training intensity to fulfill the requirements, but also the risk of overstrain induced injuries got increased, like in other high-performance sports. Our study examined injuries and overuse syndromes of the German National Team Ski Nordic during the Paralympics in Tignes/ Albertville (1992). Lillehammer (1994) and the training period in preparation for the Paralympics in Nagano (March 1998). The incidence and kind of injuries in the competitive handicapped cross country skier was comparable with non-handicapped athletes, but the injury pattern was different.
Johnson, Sara B.; Jones, Vanya C.
In adolescence, there is a complex interaction among physical, cognitive, and psychosocial developmental processes, culminating in greater risk-taking and novelty-seeking. Concurrently, adolescents face an increasingly demanding environment, which results in heightened vulnerability to injury. In this paper, we provide an overview of developmental considerations for adolescent injury interventions based on developmental science including findings from behavioral neuroscience and psychology. We examine the role that typical developmental processes play in the way adolescents perceive and respond to risk and how this integrated body of developmental research adds to our understanding of how to do injury prevention with adolescents. We then highlight strategies to improve the translation of developmental research into adolescent injury prevention practice, calling on examples of existing interventions including graduated driver licensing. PMID:20876765
Wazana, A.; Krueger, P.; Raina, P.; Chambers, L.
PURPOSE: To identify modifiable risk factors for child pedestrian injuries. DATA SOURCES: (1) MEDLINE search from 1985 to 1995; search term used was traffic accidents; (2) review of reference lists from retrieved articles and books; (3) review of reference lists from three systematic reviews on childhood injuries and (4) consultation with 'key informants'. STUDY SELECTION: All studies that examined the risk factors for child pedestrian injuries were targeted for retrieval. Seventy potentially relevant articles were identified using article titles, and, when available, abstracts. Of the 70 retrieved articles, 44 were later assessed as being relevant. QUALITY ASSESSMENT: Articles were classified on the basis of study design as being either descriptive (hypothesis generating) (26) or analytical (hypothesis testing) (18) studies. Consensus was used for difficult to classify articles. DATA EXTRACTION: Variables judged to be risk factors for child pedestrian injuries were extracted by one author. DATA SYNTHESIS: A qualitative summary of the information extracted from relevant articles is presented in tabular form. RESULTS: Risk factors for child pedestrian injuries were classified as: (1) child, (2) social and cultural, (3) physical environment, and (4) driver. Risk factors within each classification are summarized and discussed. PMID:9493628
McLean, W; Shepherd, J P; Brann, C R; Westmoreland, D
Since bar workers often sustain cuts from unwashed bar glasses, the aims of this study were to investigate risk of injury and to examine the sero-prevalence of markers for hepatitis B amongst bar staff. Ninety-one bar staff recruited by newspaper advertisement were asked about injury experience and life-style risks associated with transmission of hepatitis B and were tested for hepatitis B surface antigen (HBsAg) and core antibody (anti-HBc). Seventy-four per cent reported lacerations from broken glassware at work: 18% had sustained such injuries in more than 10 incidents. Fifty-five per cent of respondents reported occupational skin contact with body fluids. Anti-HBc prevalence for the study group was 1.1%, suggesting that bar staff were not at increased risk from hepatitis B infection. Although 30% wore gloves for high-risk tasks, there was no evidence that glove wearing prevented glass lacerations. This level of injury experience and exposure to body fluids is unacceptable and represents a potential risk of cross-infection. Hepatitis B immunization should be considered in this group. Urgent action, including the replacement, wherever possible, of annealed with tempered bar-glassware, is necessary to protect bar workers from glass injury.
Response to Traumatic Brain Injury Promotes Risk for Alzheimer’s Disease PRINCIPAL INVESTIGATOR: Giulio Maria Pasinetti MD., PhD...TITLE AND SUBTITLE Down-Regulation of Olfactory Receptors in Response to Traumatic Brain Injury 5a. CONTRACT NUMBER Promotes Risk for Alzheimer’s...Unlimited 13. SUPPLEMENTARY NOTES 14. ABSTRACT Traumatic Brain Injury (TBI) is a risk factor for subsequent development of Alzheimer’s
McDaniel, Larry W.; Rasche, Adrienna; Gaudet, Laura; Jackson, Allen
The Anterior Cruciate Ligament (ACL) is located behind the kneecap (patella) and connects the thigh bone (femur) to the shin bone (tibia). Stabilizing the knee joint is the primary responsibility of the ACL. Injuries that affect the ACL are three to five times more common in females than males. This is a result of anatomical, biomechanical,…
Zhang, Xing Jian; Wang, Ya Li; Zhou, Song; Xue, Xiaojun; Liu, Qiang; Zhang, Wen Hua; Zheng, Jun
Objective. To investigate the role of oxidative stress, NF-κB activity, and its related cytokines in the pathogenesis of seawater immersion after open abdominal injury (SI-OAI) and whether UTI treatment can attenuate SI-OAI induced IMI. Methods. Wistar rats were randomly divided into three groups: C group, S group, and U group. The rats in C group only suffered from anesthesia and surgical operation, whereas the rats in S group and U group received caudal vein injection of normal saline without/with 50,000 U/kg body weight of UTI. The activities of TNF-α, IL-6, SOD, MDA, ROS, NF-κB, and IκB-β were monitored by ELISA, biochemical methods, EMSA, and Western blot, respectively. Results. The plasma inflammatory mediators and the contents of MDA, ROS, and NF-κB in intestine as well as the pathological scores in ileal mucosa were significantly increased in rats after SI-OAI, accompanied by a reduction in SOD activities and IκB-β levels. UTI treatment significantly attenuated intestinal histopathological changes with evidence of a decrease in all of the parameters, except for upregulation of the levels of SOD and IκB-β protein. Conclusion. UTI can attenuate SI-OAI induced IMI via inhibition of NF-κB activity, subsequently inhibiting the expression of inflammatory cytokines and by combating oxidative stress. PMID:25210512
Laible, Catherine; Sherman, Orrin H
In recent years, the number of women playing sports has increased significantly. The passage of Title IX in 1972 had a significant effect in encouraging female participation in sports. This increase in women's sports participation also led to a rise in noncontact anterior cruciate ligament (ACL) injuries. As ACL injuries in young female athletes have be- come a public health issue, much research has been done on risk factors and prevention strategies.
Currie, Leanne M; Chen, Elizabeth S
Falls and associated injuries in the inpatient environment continue to be an unsolved patient safety problem. At New York-Presbyterian Hospital (NYP), an automated fall-injury risk assessment (FIRA) instrument was developed and integrated into the desktop-based clinical information system. The following study focuses on the evaluation criteria for hardware, software, and wireless communication options to study the use of a mobile version of the instrument.
Colwell, Amy S.; Liao, Eric C.; Winograd, Jonathan M.; Austen, William G.
Background: Sensation is decreased or absent after breast reconstruction. This leaves reconstructed breasts vulnerable to injury from common household thermal sources such as heating pads and hot water bottles. We sought to categorize these injuries, provide a treatment plan, and prevent these injuries in the future. Methods: A retrospective review of patients who had sustained burns to reconstructed breasts with household devices was performed at a single institution. A PubMed search was performed to identify and summarize articles cataloguing patients who had suffered burns to breast reconstructions. Results: Five patients in our practice were affected. Fifteen articles were identified in the literature search. A total of 40 patients had sustained thermal injury to reconstructed breasts, with the majority being full thickness burns (67.5%). Patients who sustained full thickness burns to reconstructed breasts were more likely to require an operative procedure compared with patients who sustained partial thickness burns (P = 0.0076). Conclusions: Reconstructed breasts are at risk for injury from commonly used household warming devices and ambient heat from the sun. As a result, patients should be counseled about these risks accordingly, to avoid injury or loss of reconstruction. These injuries require immediate vigilant treatment. PMID:27826463
Strauss, Jillian; Miranda-Moreno, Luis F; Morency, Patrick
In recent years, the modal share of cycling has been growing in North American cities. With the increase of cycling, the need of bicycle infrastructure and road safety concerns have also raised. Bicycle flows are an essential component in safety analysis. The main objective of this work is to propose a methodology to estimate and map bicycle volumes and cyclist injury risk throughout the entire network of road segments and intersections on the island of Montreal, achieved by combining smartphone GPS traces and count data. In recent years, methods have been proposed to estimate average annual daily bicycle (AADB) volume and injury risk estimates at both the intersection and segment levels using bicycle counts. However, these works have been limited to small samples of locations for which count data is available. In this work, a methodology is proposed to combine short- and long-term bicycle counts with GPS data to estimate AADB volumes along segments and intersections in the entire network. As part of the validation process, correlation is observed between AADB values obtained from GPS data and AADB values from count data, with R-squared values of 0.7 for signalized intersections, 0.58 for non-signalized intersections and between 0.48 and 0.76 for segments with and without bicycle infrastructure. The methodology is also validated through the calibration of safety performance functions using both sources of AADB estimates, from counts and from GPS data. Using the validated AADB estimates, the factors associated with injury risk were identified using data from the entire population of intersections and segments throughout Montreal. Bayesian injury risk maps are then generated and the concentrations of expected injuries and risk at signalized intersections are identified. Signalized intersections, which are often located at the intersection of major arterials, witness 4 times more injuries and 2.5 times greater risk than non-signalized intersections. A similar
Wong, Hector R.; Cvijanovich, Natalie Z.; Anas, Nick; Allen, Geoffrey L.; Thomas, Neal J.; Bigham, Michael T.; Weiss, Scott L.; Fitzgerald, Julie; Checchia, Paul A.; Meyer, Keith; Shanley, Thomas P.; Quasney, Michael; Hall, Mark; Gedeit, Rainer; Freishtat, Robert J.; Nowak, Jeffrey; Raj, Shekhar S.; Gertz, Shira; Dawson, Emily; Howard, Kelli; Harmon, Kelli; Lahni, Patrick; Frank, Erin; Hart, Kimberly W.; Lindsell, Christopher J.
Objective The development of acute kidney injury in patients with sepsis is associated with worse outcomes. Identifying those at risk for septic acute kidney injury could help to inform clinical decision making. We derived and tested a multibiomarker-based model to estimate the risk of septic acute kidney injury in children with septic shock. Design Candidate serum protein septic acute kidney injury biomarkers were identified from previous transcriptomic studies. Model derivation involved measuring these biomarkers in serum samples from 241 subjects with septic shock obtained during the first 24 hours of admission and then using a Classification and Regression Tree approach to estimate the probability of septic acute kidney injury 3 days after the onset of septic shock, defined as at least two-fold increase from baseline serum creatinine. The model was then tested in a separate cohort of 200 subjects. Setting Multiple PICUs in the United States. Interventions None other than standard care. Measurements and Main Results The decision tree included a first-level decision node based on day 1 septic acute kidney injury status and five subsequent biomarker-based decision nodes. The area under the curve for the tree was 0.95 (CI95, 0.91–0.99), with a sensitivity of 93% and a specificity of 88%. The tree was superior to day 1 septic acute kidney injury status alone for estimating day 3 septic acute kidney injury risk. In the test cohort, the tree had an area under the curve of 0.83 (0.72–0.95), with a sensitivity of 85% and a specificity of 77% and was also superior to day 1 septic acute kidney injury status alone for estimating day 3 septic acute kidney injury risk. Conclusions We have derived and tested a model to estimate the risk of septic acute kidney injury on day 3 of septic shock using a novel panel of biomarkers. The model had very good performance in a test cohort and has test characteristics supporting clinical utility and further prospective evaluation
Hayes, John R.; Groner, Jonathan I.
OBJECTIVE: Minority populations have an increased risk for trauma, but little is known about injury rates for minority children. This study compares the causes, rates and outcomes of traumatic injuries between minority and white children in a statewide population sample. METHODS: A cohort study of 5,973 children (age <16) receiving inpatient care for treatment of acute injuries at the pediatric trauma centers in Ohio from 1999--2001. Case records were analyzed for race, injury type, injury severity, length of stay and demographic information. Supplemental data sources included the 2000 U.S. census and Ohio Vital Statistics death certificates 1996--2001. MAIN OUTCOME MEASURES: Hospital admission rate, mortality rate, length of stay, rate of admission to rehabilitation service. RESULTS: African-American children, who composed the vast majority of the minority population sample, were 7.7 more times likely to sustain a burn or gunshot wound, seven times more likely to be struck by a car, six times more likely to be intentionally injured and over twice as likely to killed by an injury than white children. However, after adjusting for injury severity, they have the same mortality, hospital length of stay and referral rate to rehabilitation as white children. CONCLUSION: Trauma has a far greater impact on minority children than on white children. Research and development of injury prevention initiatives that specifically target minority children are urgently needed. Images Figure 1 Figure 2 Figure 3 Figure 4 PMID:15779500
Murguia, M J; Vailas, A; Mandelbaum, B; Norton, J; Hodgdon, J; Goforth, H; Riedy, M
Basal plasma hydroxyproline was measured in 104 male Navy Seal candidates 1 week into their intense physical training program, which lasted 7 weeks, and correlated to the incidence of connective tissue injuries incurred later in the training program. Eleven subjects (10.6%) were diagnosed as having connective tissue injuries. Those subjects with connective tissue injuries had a significantly higher (P less than 0.05) mean plasma hydroxyproline value (4.02 micrograms/ml) than subjects without injury (3.10 micrograms/ml). The majority of graduates (75%) had plasma hydroxyproline values less than 3.3 micrograms/ml. These graduates represented the strongest and most enduring injury-free subjects. Of the subject pool who incurred connective tissue injuries, only 27% had plasma hydroxyproline values less than 3.3 micrograms/ml. The majority of the injured subjects (73%) had plasma hydroxyproline values greater than or equal to 3.3 micrograms/ml. In conclusion, there is a relationship between initial training basal plasma hydroxyproline levels and connective tissue injuries later incurred in an intense physical training program. These data suggest that elevated plasma hydroxyproline levels may represent a risk factor associated with connective tissue injuries.
Zhang, Guanjun; Cao, Libo; Hu, Jingwen; Yang, King H
The head, torso, and lower extremity are the most commonly injured body regions during vehicle-to-pedestrian crashes. A total of 312 cases were selected from the National Automotive Sampling System (NASS) Pedestrian Crash Data Study (PCDS) database to investigate factors affecting the likelihood of sustaining MAIS 3+, AIS 3+ head, AIS 3+ torso, and AIS 2+ lower extremity injuries during vehicle-to-pedestrian frontal crashes. The inclusion criteria were pedestrians: (a) aged 14 years or older, (b) with a height of 1.5 m and taller, and (c) who were injured in an upright standing position via vehicle frontal collision. The injury odds ratios (ORs) calculated from logistic regression analyses were used to evaluate the association between selected injury predictors and the odds of sustaining pedestrian head, torso, and lower extremity injuries. These predictors included a crash factor (impact speed), pedestrian factors (age, gender, height, and weight), and vehicle factors (front bumper central height, front bumper lead, ground to front/top transition point height (FTTPH), and rear hood opening distance (RHOD)). Results showed that impact speed was a statistically significant predictor for head, torso, and lower extremity injury odds, as expected. Comparison of people 65 years of age and older to young adults aged 14 to 64 showed that age was also a significant predictor for torso (p<0.001, OR=23.8) and lower extremity (p=0.020, OR=2.44) injury odds, but not for head injuries (p=0.661). Vehicles with higher FTTPH and more vertical frontal structures were aggressive to pedestrians, especially regarding injuries to the torso. A very short RHOD would be more likely to lead the pedestrian to impact the windshield and windshield frame, thus increasing the head injury risk.
Zhang, Guanjun; Cao, Libo; Hu, Jingwen; Yang, King H.
The head, torso, and lower extremity are the most commonly injured body regions during vehicle-to-pedestrian crashes. A total of 312 cases were selected from the National Automotive Sampling System (NASS) Pedestrian Crash Data Study (PCDS) database to investigate factors affecting the likelihood of sustaining MAIS 3+, AIS 3+ head, AIS 3+ torso, and AIS 2+ lower extremity injuries during vehicle-to-pedestrian frontal crashes. The inclusion criteria were pedestrians: (a) aged 14 years or older, (b) with a height of 1.5 m and taller, and (c) who were injured in an upright standing position via vehicle frontal collision. The injury odds ratios (ORs) calculated from logistic regression analyses were used to evaluate the association between selected injury predictors and the odds of sustaining pedestrian head, torso, and lower extremity injuries. These predictors included a crash factor (impact speed), pedestrian factors (age, gender, height, and weight), and vehicle factors (front bumper central height, front bumper lead, ground to front/top transition point height (FTTPH), and rear hood opening distance (RHOD)). Results showed that impact speed was a statistically significant predictor for head, torso, and lower extremity injury odds, as expected. Comparison of people 65 years of age and older to young adults aged 14 to 64 showed that age was also a significant predictor for torso (p<0.001, OR=23.8) and lower extremity (p=0.020, OR=2.44) injury odds, but not for head injuries (p=0.661). Vehicles with higher FTTPH and more vertical frontal structures were aggressive to pedestrians, especially regarding injuries to the torso. A very short RHOD would be more likely to lead the pedestrian to impact the windshield and windshield frame, thus increasing the head injury risk. PMID:19026237
Schwebel, David C.; Davis, Aaron L.; O’Neal, Elizabeth E.
Pedestrian injury is among the leading causes of pediatric death in the United States and much of the world. This paper is divided into two sections. First, we review the literature on behavioral risk factors for child injury. Cognitive and perceptual development risks are discussed. The roles of distraction, temperament and personality, and social influences from parents and peers are presented. We conclude the first section with brief reviews of environmental risks, pedestrian safety among special populations, and the role of sleep and fatigue on pediatric pedestrian safety. The second section of the review considers child pedestrian injury prevention strategies. Categorized by mode of presentation, we discuss parent instruction strategies, school-based instruction strategies (including crossing guards), and streetside training techniques. Technology-based training strategies using video, internet, and virtual reality are reviewed. We conclude the section on prevention with discussion of community-based interventions. PMID:23066380
Thelin, N; Holmberg, S; Thelin, A
Increased risk of osteoarthritis has been found among athletes active in different kinds of sports. Knee injury is an established risk factor for knee osteoarthritis. In this population-based case-control study we investigated the risk of knee osteoarthritis with respect to sports activity and previous knee injuries. A total of 825 cases with x-ray-verified femorotibial osteoarthritis were identified at six hospitals in southern Sweden. The cases were matched (age, sex and residential area) with 825 controls from the general population. Mailed questionnaire data on sports activity for more than 1 year after the age of 16, knee injuries and confounding variables (weight, height, heredity, smoking and occupation) were collected and analyzed using logistic regression models. The response frequency was 89%. Among men knee osteoarthritis was related to soccer (odds ratio (OR) 1.6, 95% confidence interval (CI) 1.1-2.2), ice hockey (OR 1.9, 95% CI 1.2-3.0) and tennis (OR 2.0, 95% CI 1.1-3.8) but not to track and field sports, cross-country skiing, and orienteering. After adjustment for confounding variables soccer and ice hockey remained significantly related to knee osteoarthritis, but after adjustment for knee injuries no significant relation remained. The sports-related increased risk for knee osteoarthritis was explained by knee injuries.
Iguchi, Junta; Watanabe, Yuya; Kimura, Misaka; Fujisawa, Yoshihiko; Hojo, Tatsuya; Yuasa, Yasuhiro; Higashi, Shinsuke; Kuzuhara, Kenji
Iguchi, J, Watanabe, Y, Kimura, M, Fujisawa, Y, Hojo, T, Yuasa, Y, Higashi, S, and Kuzuhara, K. Risk factors for injury among Japanese collegiate players of American football based on performance test results. J Strength Cond Res 30(12): 3405-3411, 2016-The purpose of this study was to identify how risk factors for injury during American football are related to players' physical strength as determined using typical performance tests. One hundred 53 Japanese collegiate players of American football were recruited for this study. Eight potential risk factors were evaluated: position (skill vs. lineman), body mass index, back squat one-repetition maximum, vertical jump height, power, height, body weight, and previous injury. Using multivariate Cox regression, we examined how these factors were associated with knee sprain, ankle sprain, and hamstring strain. We recorded 63 injuries (17 knee sprains, 23 ankle sprains, and 23 hamstring strains). Players with higher power were at significantly greater risk for knee sprains (p = 0.04), those with low power had a significantly higher incidence of ankle sprain (p = 0.01), and vertical jump height was a significant predictor of hamstring strain (p = 0.02). We identified several independent predictors of injuries associated with American football. Our findings may contribute to the development of effective screening tests and prevention exercises.
Petitjean, Audrey; Trosseille, Xavier; Praxl, Norbert; Hynd, David; Irwin, Annette
The development of the WorldSID 50th percentile male dummy was initiated in 1997 by the International Organisation for Standardisation (ISO/TC22/SC12/WG5) with the objective of developing a more biofidelic side impact dummy and supporting the adoption of a harmonised dummy into regulations. The dummy is currently under evaluation at the Working Party on Passive Safety (GRSP) in order to be included in the pole side impact global technical regulation (GTR). Injury risk curves dedicated to this dummy and built on behalf of ISO/TC22/SC12/WG6 were proposed in order to assess the occupant safety performance (Petitjean et al. 2009). At that time, there was no recommendation yet on the injury criteria and no consensus on the most accurate statistical method to be used. Since 2009, ISO/TC22/SC12/WG6 reached a consensus on the definition of guidelines to build injury risk curves, including the use of the survival analysis, the distribution assessment and quality checks. These guidelines were applied to the WorldSID 50th results published in 2009 in order to be able to provide a final set of injury risk curves recommended by ISO/TC22/SC12/WG6. The paper presents the different steps of the guidelines as well as the recommended injury risk curves dedicated to the WorldSID 50th for lateral shoulder load, thoracic rib deflection, abdomen rib deflection and pubic force.
Lewis, C. J.; Li, P.; Stewart, L.; Weintrob, A. C.; Carson, M. L.; Murray, C. K.; Tribble, D. R.; Ross, J. D.
Background Tranexamic acid (TXA) has been shown to reduce mortality from severe hemorrhage. Although recent data suggest that TXA has anti-inflammatory properties, few analyses have investigated the impact of TXA on infectious complications in trauma patients. We examined the association between TXA administration and infection risk among injured military personnel. Methods Patients administered TXA were matched by injury severity score to patients who did not receive TXA. Conditional logistic regression was used to examine risk factors associated with infections within 30 days. A Cox proportional analysis evaluated risk factors in a time-to-first infection model. Results A total of 335 TXA recipients were matched to 626 patients not administered TXA. A greater proportion of TXA recipients had an infection compared to the comparative group (P <0.001). The univariate analysis estimated an unadjusted odds ratio (OR) of 2.5 (95 per cent confidence interval [CI]: 1.8–3.4) for the association of TXA with infection risk; however, upon multivariable analysis, TXA administration was not significant (OR: 1.3; CI: 0.8–1.9). Blast injuries, intensive care unit (ICU) admission, and receipt of ≥10 units of blood within 24 hours post-injury were independently associated with infection risk. The Cox proportional model confirmed association with ICU admission and blood transfusions. Moreover, traumatic amputations were also significantly associated with a reduced time-to-first infection. Conclusion In life-threatening military injuries matched for injury severity, TXA recipients did not have a higher risk for infections nor was time to developed infections shorter than in non-recipients. Extent of blood loss, blast injuries, extremity amputations, and intensive care stay were associated with infections. PMID:26791625
Mohammed, H O; Hill, T; Lowe, J
A case-control study was conducted on Thoroughbred horses to identify factors associated with the risk of breakdown on racetracks. A total of 310 cases (breakdowns) were identified from the Horse Identification Department records kept by the chief examining veterinarian of New York Racing Association. For each case, two control horses were selected randomly from the Daily Racing Form Inc. records. Multiple logistic regression analysis was used to identify and quantify the risk of factors associated with breakdown, while simultaneously controlling for the effect of other putative factors. Factors associated with risk of breakdown were: track (horses raced on Saratoga racetrack were at a lesser risk of breakdown), track composition/condition (turf tracks had a lower risk compared to dirt), number of seasons in race, racing in a later race, number of starts per year, the total number of starts, season (summer had a higher risk than winter or spring) and age of the horse.
Mutto, Milton; Lawoko, Stephen; Ovuga, Emilio; Svanstrom, Leif
Childhood injuries remain understudied in Uganda. The objective of this study was to determine the extent, nature and determinants of school-related childhood injury risk in north-western Uganda. A cohort of 1000 grade fives from 13 elementary schools was followed-up for one term. Survival and multi-level modelling techniques compared the risk rates across gender, schools and locations. Childhood injuries are common in north-western Uganda. Most of them occur during travel, breaks, practical classes and gardening, while walking, playing, learning and digging. Most injuries result from collisions with objects, sports and falls. Two-thirds of children receive first aid and hospital care. Times to injury were 72.1 and 192.9 person days (p = 0.0000). Gender differences in time to event were significant (p = 0.0091). Girls had better survival rates: cumulative prevalence of childhood injury was 36.1%; with significant gender differences (p = 0.007). Injury rate was 12.3/1000 person days, with a hazard ratio of 1.4. Compared to girls, boys had a 37% higher injury rate (p = 0.004). Rates varied among schools. Associated factors include sex and school. Rural-urban location and school differences do influence childhood injury risk. Childhood injuries are common: the risk is high, gender- and school-specific. Determinants include gender and school. Location and school contexts influence injury risk.
Saunders, Natasha R.; Lee, Hannah; Macpherson, Alison; Guan, Jun; Guttmann, Astrid
BACKGROUND: Firearm injuries contribute to substantial morbidity and mortality. The immigrant paradox suggests that, despite being more socially disadvantaged, immigrants are less likely than nonimmigrants to have poor outcomes. We tested the association of immigrant characteristics with firearm injuries among children and youth. METHODS: We conducted a population-based cohort study involving residents of Ontario aged 24 years and younger from 2008–2012 using health and administrative databases. We estimated rate ratios of unintentional and assault-related firearm injuries by immigrant status using Poisson regression models with Generalized Estimating Equations. RESULTS: We included 15 866 954 nonimmigrant and 4 551 291 immigrant person-years in our analysis. Nonimmigrant males had 1032 unintentional (12.4 per 100 000, 95% confidence interval [CI] 11.7–13.2) and 304 assault-related (3.6 per 100 000, 95% CI 3.2–4.0) firearm injuries. Immigrant males had 148 unintentional (7.2 per 100 000, 95% CI 6.1–8.5) and 113 assault-related (5.5 per 100 000, 95% CI 4.5–6.6) firearm injuries. Compared with nonimmigrants, immigrants had a lower rate of unintentional firearm injury (adjusted rate ratio 0.5, 95% CI 0.4–0.6) but a similar rate of assault-related firearm injury. Among immigrants, refugees had a 43% higher risk of assault-related firearm injury compared with nonrefugees (adjusted rate ratio 1.4, 95% CI 1.0–2.0). Immigrants from Central America and Africa accounted for 68% of immigrants with assault-related firearm injuries. INTERPRETATION: Compared with nonimmigrants, immigrant children and youth had a lower risk of unintentional firearm injury, although the risk of assault-related firearm injury was higher among refugees and immigrants from Central America and Africa. The results suggest that prevention strategies for firearm safety should target nonimmigrant youth as well as these newly identified high-risk immigrant populations. PMID:28385861
Background The participation of children and adolescents in sports has become increasingly frequent, including soccer. This growing involvement gives rise to concerns regarding the risk of sports injuries. Therefore, the aim of the present study was to describe the musculoskeletal injuries in young soccer players. Methods 301 male soccer players with a mean age 14.67 ± 2.08 years were randomly recruited. The Referred Condition Inquiry was used to collect information on the mechanism of injury and anatomic site affected as well as personal data on the participants. The variables were analyzed based on the degree of association using Goodman’s test for contrasts between multinomial populations, with the p < 0.05. Results Among the 301 athletes, 24.25% reported at least one injury. With regard to height, taller individuals reported more injuries than shorter individuals (62.5% and 37.5%, respectively; p < 0.05). Injuries were more frequent among players with a training duration greater than five years (69.65%) in comparison to those who trained for a shorter duration (30.35%) (p < 0.05). The lower limbs, especially the ankle/foot and knee, were the most affected anatomic sites. Impact was the most common mechanism of injury. Conclusion The young practitioners of soccer analyzed had low rates of injury. The main causal mechanism was the impact. A taller height and longer exposure to training were the main risk factors for injury among young soccer players. PMID:23602027
De Waele, Jan J
Abdominal infections are an important challenge for the intensive care physician. In an era of increasing antimicrobial resistance, selecting the appropriate regimen is important and, with new drugs coming to the market, correct use is important more than ever before and abdominal infections are an excellent target for antimicrobial stewardship programs. Biomarkers may be helpful, but their exact role in managing abdominal infections remains incompletely understood. Source control also remains an ongoing conundrum, and evidence is increasing that its importance supersedes the impact of antibiotic therapy. New strategies such as open abdomen management may offer added benefit in severely ill patients, but more data are needed to identify its exact role. The role of fungi and the need for antifungal coverage, on the other hand, have been investigated extensively in recent years, but at this point, it remains unclear who requires empirical as well as directed therapy.
Ziraba, Abdhalah Kasiira; Kyobutungi, Catherine; Zulu, Eliya Msiyaphazi
Injuries contribute significantly to the rising morbidity and mortality attributable to non-communicable diseases in the developing world. Unfortunately, active injury surveillance is lacking in many developing countries, including Kenya. This study aims to describe and identify causes of and risk factors for fatal injuries in two slums in Nairobi city using a demographic surveillance system framework. The causes of death are determined using verbal autopsies. We used a nested case-control study design with all deaths from injuries between 2003 and 2005 as cases. Two controls were randomly selected from the non-injury deaths over the same period and individually matched to each case on age and sex. We used conditional logistic regression modeling to identity individual- and community-level factors associated with fatal injuries. Intentional injuries accounted for about 51% and unintentional injuries accounted for 49% of all injuries. Homicides accounted for 91% of intentional injuries and 47% of all injury-related deaths. Firearms (23%) and road traffic crashes (22%) were the leading single causes of deaths due to injuries. About 15% of injuries were due to substance intoxication, particularly alcohol, which in this community comes from illicit brews and is at times contaminated with methanol. Results suggest that in the pervasively unsafe and insecure environment that characterizes the urban slums, ethnicity, residence, and area level factors contribute significantly to the risk of injury-related mortality.
Shaikh, Nissar; Rhaman, M. A.; Raza, Ali; Shabana, Adel; Malstrom, Mahommad Faisal; Al-Sulaiti, Ghanem
Background: High spinal cord injury (HSCI) is one of the devastating traumatic injuries. 80% of these patients are young male, and 93% will have major neurological disabilities. There is a paucity of literature about prolonged bradycardia in HSCI patients. The aim of this study was to know the prevalence, risk factors, precipitating factors for prolonged bradycardia in the HSCI patients. Materials and Methods: All patients who were admitted to the Intensive Care Unit (ICU) of a tertiary hospital, with spinal cord injury above level of dorsal (D4) were enrolled in this study prospectively. Patient's demographic data, mechanism, level and type of spinal injury, associated injuries, injury severity score (ISS), spinal shock, vasopressors used, time of occurrence of bradycardia, treatment for bradycardia, precipitating as well as risk factors and outcome were recorded. Results: During the study period, a total of 138 patients were admitted to the ICU with HSCI. Majority of patients were male. The most frequently associated injury in these patients was skeletal fractures (38.4%). Most common complication was pneumonia 56 (41%). Forty-five (33%) of the total patients had prolonged bradycardia; 87% of these patients had pneumonia when bradycardia occurred. 53.4% had cardiac asystole. 29 (21%) patients had bradycardia at the time of endotracheal suctioning, whereas 27 (20%) patients developed bradycardia at the time of positioning. Majority of the patients were managed conservatively. Those HSCI patients who developed prolonged bradycardia, their ISS score was statistically higher, ICU and hospital stay was significantly higher compared with those HSCI patient who did not have prolonged bradycardia. Multivariate analysis revealed that hypotension on admission; pneumonia, and tracheostomy were risk factors for the development of prolonged bradycardia in HSCI patients. Conclusion: Prolonged bradycardia was associated with significantly higher incidence of asystole
Objective To investigate the risks of mild traumatic brain injury and neck injury associated with head banging, a popular dance form accompanying heavy metal music. Design Observational studies, focus group, and biomechanical analysis. Participants Head bangers. Main outcome measures Head Injury Criterion and Neck Injury Criterion were derived for head banging styles and both popular heavy metal songs and easy listening music controls. Results An average head banging song has a tempo of about 146 beats per minute, which is predicted to cause mild head injury when the range of motion is greater than 75°. At higher tempos and greater ranges of motion there is a risk of neck injury. Conclusion To minimise the risk of head and neck injury, head bangers should decrease their range of head and neck motion, head bang to slower tempo songs by replacing heavy metal with adult oriented rock, only head bang to every second beat, or use personal protective equipment. PMID:19091761
Engstrom, K; Diderichsen, F; Laflamme, L
Study objective: To measure socioeconomic differences in injuries among different age groups of children and adolescents. Subjects: Children under 20 living in Sweden between 1990 and 1994 (about 2.6 million). Method: A cross sectional study based on record linkage between 15 Swedish national registers. Children were divided into four age groups and allocated to four household socioeconomic status groups. Absolute and relative risks were compiled using children of high/intermediate level salaried employees as the comparison group. Four diagnostic groups were considered: fall, traffic, interpersonal violence, and self inflicted injuries. Results: Injury incidences were relatively low and socioeconomic differences negligible in the 0–4 year olds. Thereafter, significant socioeconomic differences were observed in all diagnostic groups except falls. The highest absolute differences were in traffic injuries, especially among 15–19 year olds, and in self inflicted injuries among 15–19 year old girls. Relative differences were highest in both categories of intentional injuries for the age group 10–14. Social circumstances in the household other than family socioeconomic status affected the social pattern of intentional but not that of unintentional injuries. Conclusions: Socioeconomic differences in injury risks are not necessarily constant over age. Inequalities are particularly high in absolute terms among adolescents 15–19 years old for traffic injuries and in relative terms among 10–14 year olds for intentional injuries. PMID:12120833
Morrongiello, Barbara A.; Zdzieborski, Daniel; Normand, Jackie
This study compared reactions of mothers and fathers to the risk taking behavior of sons and daughters. Mother-father pairs (N = 52) imagined their 2-year-old boy or girl behaving in risky ways in common home situations that could, and did, result in injury. Emotional and parenting reactions to the behaviors were assessed before and after injury.…
Bojicic, Katherine M.; Beaulieu, Mélanie L.; Imaizumi Krieger, Daniel Y.; Ashton-Miller, James A.; Wojtys, Edward M.
Background: While body mass index (BMI), a modifiable parameter, and knee morphology, a nonmodifiable parameter, have been identified as risk factors for anterior cruciate ligament (ACL) rupture, the interaction between them remains unknown. An understanding of this interaction is important because greater compressive axial force (perhaps due to greater BMI) applied to a knee that is already at an increased risk because of its geometry, such as a steep lateral posterior tibial slope, could further increase the probability of ACL injury. Purpose: To quantify the relationship between BMI and select knee morphological parameters as potential risk factors for ACL injury. Study Design: Case-control study; Level of evidence, 3. Methods: Sagittal knee magnetic resonance imaging (MRI) files from 76 ACL-injured and 42 uninjured subjects were gathered from the University of Michigan Health System’s archive. The posterior tibial slope (PTS), middle cartilage slope (MCS), posterior meniscus height (PMH), and posterior meniscus bone angle (MBA) in the lateral compartment were measured using MRI. BMI was calculated from demographic data. The association between the knee structural factors, BMI, and ACL injury risk was explored using univariate and multivariate logistic regression. Results: PTS (P = .043) and MCS (P = .037) significantly predicted ACL injury risk. As PTS and MCS increased by 1°, odds of sustaining an ACL injury increased by 12% and 13%, respectively. The multivariate logistic regression analysis, which included PTS, BMI centered around the mean (cBMI), and their interaction, showed that this interaction predicted the odds of ACL rupture (P = .050; odds ratio, 1.03). For every 1-unit increase in BMI from the average that is combined with a 1° increase in PTS, the odds of an ACL tear increased by 15%. Conclusion: An increase in BMI was associated with increased risk of ACL tear in the presence of increased lateral posterior tibial slope. Larger values of PTS or
Kemler, E; Vriend, I; Paulis, W D; Schoots, W; van Middelkoop, M; Koes, B
Physical activity and sports participation are promoted to counteract the increased prevalence of overweight and obesity in children and young adults. Both high body mass index and physical activity level have been associated with an increased risk of sports injuries. The objective is to determine the relationship between sports injuries and overweight in sports participants (4-24 years), taking physical activity into account. Data were obtained from the 2006-2011 "Injuries and Physical Activity in the Netherlands" survey. Analyses were based on a representative sample of 3846 sports participants (4-24 years). Univariate and multiple logistic regression analyses were applied to investigate the association between sports injury and weight status. Of all the sports participants, 14.7% were overweight. Compared with normal-weight sports participants, the odds of sustaining a sports injury was 0.73 [confidence interval (CI): 0.53-1.00, P = 0.050] for overweight sports participants; the odds for underweight sports participants was 0.80 (CI: 0.56-1.15, P = 0.226). There is some evidence that overweight sports participants (4-24 years) do not have an increased injury risk compared with normal-weight sports participants, even when the level of physical activity is taken into account. Additional research is recommended regarding overweight people who start to participate in a physically active lifestyle.
Furth, Peter G; Morency, Patrick; Miranda-Moreno, Luis F; Willett, Walter C; Dennerlein, Jack T
Most individuals prefer bicycling separated from motor traffic. However, cycle tracks (physically separated bicycle-exclusive paths along roads, as found in The Netherlands) are discouraged in the USA by engineering guidance that suggests that facilities such as cycle tracks are more dangerous than the street. The objective of this study conducted in Montreal (with a longstanding network of cycle tracks) was to compare bicyclist injury rates on cycle tracks versus in the street. For six cycle tracks and comparable reference streets, vehicle/bicycle crashes and health record injury counts were obtained and use counts conducted. The relative risk (RR) of injury on cycle tracks, compared with reference streets, was determined. Overall, 2.5 times as many cyclists rode on cycle tracks compared with reference streets and there were 8.5 injuries and 10.5 crashes per million bicycle-kilometres. The RR of injury on cycle tracks was 0.72 (95% CI 0.60 to 0.85) compared with bicycling in reference streets. These data suggest that the injury risk of bicycling on cycle tracks is less than bicycling in streets. The construction of cycle tracks should not be discouraged. PMID:21307080
Daley, W Randolph; Brown, Sheryll; Archer, Pam; Kruger, Elizabeth; Jordan, Fred; Batts, Dahna; Mallonee, Sue
On May 3, 1999, powerful tornadoes, including a category F5 tornado, swept through Oklahoma. The authors examined all tornado-related deaths, hospital admissions, and emergency department visits to identify important risk factors. Data on deaths and injuries directly related to the tornadoes and information obtained from a survey of residents in the damage path of the F5 tornado were used in a case-control analysis. The direct force of the tornadoes caused 40 deaths, 133 hospital admissions, and 265 emergency department outpatient visits. The risk of death from the F5 tornado was greater for persons who were in mobile homes (odds ratio (OR) = 35.3, 95% confidence interval (CI): 7.8, 175.6) or outdoors (OR = 141.2, 95% CI: 15.9, 6,379.8) when the tornado struck than for those in permanently anchored houses. Risk of severe injury was also greater for persons in mobile homes (OR = 11.8, 95% CI: 3.4, 51.7) or outdoors (OR = 34.3, 95% CI: 4.4, 1,526.2). However, the risk of death (OR = 0.0, 95% CI: 0.0, 9.9), severe injury (OR = 0.0, 95% CI: 0.0, 2.0), or minor injury (OR = 0.8, 95% CI: 0.1, 3.1) was not greater among persons in motor vehicles than among those in houses. The risk of death (OR = 0.6, 95% CI: 0.1, 1.7), severe injury (OR = 0.2, 95% CI: 0.1, 0.6), or minor injury (OR = 0.3, 95% CI: 0.2, 0.7) was lower among those fleeing their homes in motor vehicles than among those remaining. Recommendations involving the relative safety of motor vehicles during a tornado should be evaluated using experience from recent tornado events.
Herbert, Rob D; Gabriel, Michael
Objective To determine the effects of stretching before and after exercising on muscle soreness after exercise, risk of injury, and athletic performance. Method Systematic review. Data sources Randomised or quasi-randomised studies identified by searching Medline, Embase, CINAHL, SPORTDiscus, and PEDro, and by recursive checking of bibliographies. Main outcome measures Muscle soreness, incidence of injury, athletic performance. Results Five studies, all of moderate quality, reported sufficient data on the effects of stretching on muscle soreness to be included in the analysis. Outcomes seemed homogeneous. Stretching produced small and statistically non-significant reductions in muscle soreness. The pooled estimate of reduction in muscle soreness 24 hours after exercising was only 0.9 mm on a 100 mm scale (95% confidence interval −2.6 mm to 4.4 mm). Data from two studies on army recruits in military training show that muscle stretching before exercising does not produce useful reductions in injury risk (pooled hazard ratio 0.95, 0.78 to 1.16). Conclusions Stretching before or after exercising does not confer protection from muscle soreness. Stretching before exercising does not seem to confer a practically useful reduction in the risk of injury, but the generality of this finding needs testing. Insufficient research has been done with which to determine the effects of stretching on sporting performance. What is already known on this topicReviews of the effects of stretching before exercising have drawn conflicting conclusionsThe literature on effects of stretching before and after exercising on muscle soreness and risk of injury has not been systematically reviewedWhat this study addsStretching before and after exercising does not confer protection from muscle soreness and stretching before exercise does not seem to confer a practically useful reduction in the risk of injury PMID:12202327
Phifer, T J; Gerlock, A J; Vekovius, W A; Rich, N M; McDonald, J C
Only a small subset of patients with combined superficial femoral artery and vein injuries results in amputation. The importance of the venous component as a risk factor for amputation is uncertain. Ligation vs. reconstruction of venous injuries is controversial. For clarification of these issues, we analyzed retrospectively multiple risk factors for amputation in combined superficial femoral artery and vein injuries in a civilian population. There were 25 patients treated in a 20-year period. Sixteen injuries were caused by small caliber missiles, six by shotgun blasts, and three by knife wounds. Three patients (12%) ultimately underwent amputation. The major risk factor for amputation was method of vascular reconstruction. All three amputations underwent ligation of the superficial femoral vein with arterial reconstruction by placement of a reversed interposition saphenous vein graft (p = 0.0009). None of the remaining 22 patients with salvaged limbs underwent reconstruction by this combination of techniques. Consequently, the authors emphasize the importance of venous reconstruction, particularly in combined injuries with major arterial involvement requiring interposed grafts. PMID:6696539
Buzeman, D G; Viano, D C; Lövsund, P
Front occupant exposure, MAIS2+ and MAIS3+ injury risk, and maximum-injured body regions were studied in frontal offset impacts. The effect of overlap amount was evaluated in three data subsets from 9,902 accident-involved Volvo cars with at least SEK35,000 (= US$5,000) damage. The subsets were selected by a MAIS2+ or MAIS3+ injured co-occupant or by an equivalent barrier speed (EBS) > 20 mph, and consisted of 661 or 249 cases and 654 cases, respectively. Age and gender effects were minimized. Collisions with 1/3 to 2/3 overlap were most frequent, but the most injurious crash type was influenced by the data sorting technique. The EBS criterion seemed to select crashes of more comparable severity and this dataset may be most appropriate to evaluate overlap effects. With EBS > 20 mph, the highest injury risk occurred in 1/3 overlap crashes, at 62% for MAIS2+ and 44% for MAIS3+ injury. This was two to three times higher than the corresponding risk in full frontal crashes. Head and chest were the most severely injured body regions, but lower-extremity injuries became more important as overlap decreased.
Sabri, Bushra; Renner, Lynette M; Stockman, Jamila K; Mittal, Mona; Decker, Michele R
Relying on an ecological framework, we examined risk factors for severe physical intimate partner violence (IPV) and related injuries among a nationally representative sample of women (N = 67,226) in India. Data for this cross-sectional study were derived from the 2005-2006 India National Family Health Survey, a nationally representative household-based health surveillance system. Logistic regression analyses were used to generate the study findings. We found that factors related to severe physical IPV and injuries included low or no education, low socioeconomic status, rural residence, greater number of children, and separated or divorced marital status. Husbands' problem drinking, jealousy, suspicion, control, and emotionally and sexually abusive behaviors were also related to an increased likelihood of women experiencing severe IPV and injuries. Other factors included women's exposure to domestic violence in childhood, perpetration of IPV, and adherence to social norms that accept husbands' violence. Practitioners may use these findings to identify women at high risk of being victimized by severe IPV or injuries for prevention and intervention strategies. Policies and programs that focus on empowering abused women and holding perpetrators accountable may protect women at risk for severe IPV or injuries that may result in death.
Jordan, Gillian; Nowrouzi-Kia, Behnam; Gohar, Basem; Nowrouzi, Behdin
Time-loss injuries are still a major occurrence in Canada, injuring thousands of Canadian workers each year. With obesity rates on the rise across the country, as well as around the world, it is important that the possible effects of obesity in the workplace be fully understood, especially those effects linked to lost-time injuries. The aim of this paper was to evaluate predictors of workplace lost-time injuries and how they may be related to obesity or high body mass index by examining factors associated with lost-time injuries in the health care sector, a well-studied industry with the highest number of reported time loss injuries in Canada. A literature review focusing on lost-time injuries in Registered Nurses (RNs) was conducted using the keywords and terms: lost time injury, workers' compensation, occupational injury, workplace injury, injury, injuries, work, workplace, occupational, nurse, registered nurse, RN, health care, predictors, risk factors, risk, risks, cause, causes, obese, obesity, and body mass index. Data on predictors or factors associated with lost-time injuries in RNs were gathered and organized using Loisel's Work Disability Prevention Management Model and extrapolated upon using existing literature surrounding obesity in the Canadian workplace. PMID:25830063
Oukara, Amar; Nsiampa, Nestor; Robbe, Cyril; Papy, Alexandre
Kinetic energy non-lethal projectiles are used to impart sufficient effect onto a person in order to deter uncivil or hazardous behavior with a low probability of permanent injury. Since their first use, real cases indicate that the injuries inflicted by such projectiles may be irreversible and sometimes lead to death, especially for the head impacts. Given the high velocities and the low masses involved in such impacts, the assessment approaches proposed in automotive crash tests and sports may not be appropriate. Therefore, there is a need of a specific approach to assess the lethality of these projectiles. In this framework, some recent research data referred in this article as “force wall approach” suggest the use of three lesional thresholds (unconsciousness, meningeal damages and bone damages) that depend on the intracranial pressure. Three corresponding critical impact forces are determined for a reference projectile. Based on the principle that equal rigid wall maximal impact forces will produce equal damage on the head, these limits can be determined for any other projectile. In order to validate the consistence of this innovative method, it is necessary to compare the results with other existing assessment methods. This paper proposes a comparison between the “force wall approach” and two different head models. The first one is a numerical model (Strasbourg University Finite Element Head Model-SUFEHM) from Strasbourg University; the second one is a mechanical surrogate (Ballistics Load Sensing Headform-BLSH) from Biokinetics. PMID:25400712
Oukara, Amar; Nsiampa, Nestor; Robbe, Cyril; Papy, Alexandre
Kinetic energy non-lethal projectiles are used to impart sufficient effect onto a person in order to deter uncivil or hazardous behavior with a low probability of permanent injury. Since their first use, real cases indicate that the injuries inflicted by such projectiles may be irreversible and sometimes lead to death, especially for the head impacts. Given the high velocities and the low masses involved in such impacts, the assessment approaches proposed in automotive crash tests and sports may not be appropriate. Therefore, there is a need of a specific approach to assess the lethality of these projectiles. In this framework, some recent research data referred in this article as "force wall approach" suggest the use of three lesional thresholds (unconsciousness, meningeal damages and bone damages) that depend on the intracranial pressure. Three corresponding critical impact forces are determined for a reference projectile. Based on the principle that equal rigid wall maximal impact forces will produce equal damage on the head, these limits can be determined for any other projectile. In order to validate the consistence of this innovative method, it is necessary to compare the results with other existing assessment methods. This paper proposes a comparison between the "force wall approach" and two different head models. The first one is a numerical model (Strasbourg University Finite Element Head Model-SUFEHM) from Strasbourg University; the second one is a mechanical surrogate (Ballistics Load Sensing Headform-BLSH) from Biokinetics.
... Adhesions 1 Ward BC, Panitch A. Abdominal adhesions: current and novel therapies. Journal of Surgical Research. 2011;165(1):91–111. Seek Help for ... and how to participate, visit the NIH Clinical Research Trials and You website ... Foundation for Functional Gastrointestinal Disorders 700 West Virginia ...
Award Number: W81XWH-12-1-0582 TITLE: Down-Regulation of Olfactory Receptors in Response to Traumatic Brain Injury Promotes Risk for Alzheimer’s...Annual 3. DATES COVERED 25 Sep 2013 - 24 Sep 2014 4. TITLE AND SUBTITLE Down-Regulation of Olfactory Receptors in Response to Traumatic Brain Injury...SUPPLEMENTARY NOTES 14. ABSTRACT Traumatic Brain Injury (TBI) is a risk factor for subsequent development of Alzheimer’s disease (AD). Abnormal tau
de Looze, Margaretha; Pickett, William; Raaijmakers, Quinten; Kuntsche, Emmanuel; Hublet, Anne; Nic Gabhainn, Saoirse; Bjarnason, Thoroddur; Molcho, Michal; Vollebergh, Wilma; ter Bogt, Tom
Injury is a leading cause of mortality and morbidity among adolescents in developed countries. Jessor and Jessor's Problem Behavior Theory suggests an association between risk behaviors (e.g., smoking, drunkenness, cannabis use, and sexual intercourse) and adolescent injury. The present study examined whether early engagement in risk behaviors…
... by children; risks of death or injury. 1145.17 Section 1145.17 Commercial Practices CONSUMER PRODUCT... UNDER THE CONSUMER PRODUCT SAFETY ACT § 1145.17 Multi-purpose lighters that can be operated by children; risks of death or injury. (a) The Commission finds that it is in the public interest to regulate...
... by children; risks of death or injury. 1145.17 Section 1145.17 Commercial Practices CONSUMER PRODUCT... UNDER THE CONSUMER PRODUCT SAFETY ACT § 1145.17 Multi-purpose lighters that can be operated by children; risks of death or injury. (a) The Commission finds that it is in the public interest to regulate...
... by children; risks of death or injury. 1145.17 Section 1145.17 Commercial Practices CONSUMER PRODUCT... UNDER THE CONSUMER PRODUCT SAFETY ACT § 1145.17 Multi-purpose lighters that can be operated by children; risks of death or injury. (a) The Commission finds that it is in the public interest to regulate...
Hill, Lee; Collins, Malcolm; Posthumus, Michael
Swimming is one of the most popular recreational and competitive sporting activities. In the 2013/2014 swimming season, 9630 men and 12,333 women were registered with the National Collegiate Athletics Association in the USA. The repetitive nature of the swimming stroke and demanding training programs of its athletes raises a number of concerns regarding incidence and severity of injuries that a swimmer might experience during a competitive season. A number of risk factors have previously been identified but the level of evidence from individual studies, as well as the level of certainty that these factors predispose a swimmer to pain and injury, to our knowledge has yet to be critically evaluated in a systematic review. Therefore, the primary objective of this review is to conduct a systematic review to critically assess the published evidence for risk factors that may predispose a swimmer to shoulder pain and injury. Three electronic databases, ScienceDirect, PubMed and SpringerLink, were searched using keywords "(Injury OR pain) AND (Swim*)" and "(Shoulder) AND (Swim*)". Based on the inclusion and exclusion criteria, 2731 unique titles were identified and were analyzed to a final 29 articles. Only articles with a level of evidence of I, II and III were included according to robust study design and data analysis. The level of certainty for each risk factor was determined. No studies were determined to have a high level of certainty, clinical joint laxity and instability, internal/external rotation, previous history of pain and injury and competitive level were determined to have a moderate level of certainty. All other risk factors were evaluated as having a low level of certainty. Although several risk factors were identified from the reviewed studies, prospective cohort studies, larger sample sizes, consistent and robust measures of risk should be employed in future research.
Hall, H I; Haugh, G S; Price-Green, P A; Dhara, V R; Kaye, W E
This study was undertaken to determine risk factors associated with hazardous substance releases (at fixed facilities or during transport) that have public health consequences. Data from nine states with surveillance systems for such releases and their consequences were analyzed. Risk factors were determined for releases resulting in (1) injuries or (2) evacuations. Both outcomes were more likely to occur as a result of facility releases (odds ratio [OR] = 1.89, 95% confidence interval [CI] = 1.44, 2.47, for injuries; OR = 3.29, 95% CI = 2.28, 4.74, for evacuations). Releases of ammonia, chlorine, and acids resulted in injuries and evacuations more frequently than releases of other substances. PMID:8659662
Bini, Rodrigo; Hume, Patria A; Croft, James L
Incorrect bicycle configuration may predispose athletes to injury and reduce their cycling performance. There is disagreement within scientific and coaching communities regarding optimal configuration of bicycles for athletes. This review summarizes literature on methods for determining bicycle saddle height and the effects of bicycle saddle height on measures of cycling performance and lower limb injury risk. Peer-reviewed journals, books, theses and conference proceedings published since 1960 were searched using MEDLINE, Scopus, ISI Web of Knowledge, EBSCO and Google Scholar databases, resulting in 62 references being reviewed. Keywords searched included 'body positioning', 'saddle', 'posture, 'cycling' and 'injury'. The review revealed that methods for determining optimal saddle height are varied and not well established, and have been based on relationships between saddle height and lower limb length (Hamley and Thomas, trochanteric length, length from ischial tuberosity to floor, LeMond, heel methods) or a reference range of knee joint flexion. There is limited information on the effects of saddle height on lower limb injury risk (lower limb kinematics, knee joint forces and moments and muscle mechanics), but more information on the effects of saddle height on cycling performance (performance time, energy expenditure/oxygen uptake, power output, pedal force application). Increasing saddle height can cause increased shortening of the vastii muscle group, but no change in hamstring length. Length and velocity of contraction in the soleus seems to be more affected by saddle height than that in the gastrocnemius. The majority of evidence suggested that a 5% change in saddle height affected knee joint kinematics by 35% and moments by 16%. Patellofemoral compressive force seems to be inversely related to saddle height but the effects on tibiofemoral forces are uncertain. Changes of less than 4% in trochanteric length do not seem to affect injury risk or performance
Harris, M. Anne; Reynolds, Conor C. O.; Winters, Meghan; Babul, Shelina; Chipman, Mary; Cusimano, Michael D.; Brubacher, Jeff R.; Hunte, Garth; Friedman, Steven M.; Monro, Melody; Shen, Hui; Vernich, Lee; Cripton, Peter A.
Objectives. We compared cycling injury risks of 14 route types and other route infrastructure features. Methods. We recruited 690 city residents injured while cycling in Toronto or Vancouver, Canada. A case-crossover design compared route infrastructure at each injury site to that of a randomly selected control site from the same trip. Results. Of 14 route types, cycle tracks had the lowest risk (adjusted odds ratio [OR] = 0.11; 95% confidence interval [CI] = 0.02, 0.54), about one ninth the risk of the reference: major streets with parked cars and no bike infrastructure. Risks on major streets were lower without parked cars (adjusted OR = 0.63; 95% CI = 0.41, 0.96) and with bike lanes (adjusted OR = 0.54; 95% CI = 0.29, 1.01). Local streets also had lower risks (adjusted OR = 0.51; 95% CI = 0.31, 0.84). Other infrastructure characteristics were associated with increased risks: streetcar or train tracks (adjusted OR = 3.0; 95% CI = 1.8, 5.1), downhill grades (adjusted OR = 2.3; 95% CI = 1.7, 3.1), and construction (adjusted OR = 1.9; 95% CI = 1.3, 2.9). Conclusions. The lower risks on quiet streets and with bike-specific infrastructure along busy streets support the route-design approach used in many northern European countries. Transportation infrastructure with lower bicycling injury risks merits public health support to reduce injuries and promote cycling. PMID:23078480
Bjorklun, Eugene C.
Examines the defenses of contributory negligence and assumption of risk for protection from liability for school athletic injuries. Advises school personnel to adhere to court decisions that define what schools owe their athletic team participants: (1) instruction; (2) supervision; (3) equipment; (4) medical treatment; and (5) selection and…
Betz, Marian E.; Barber, Catherine; Miller, Matthew
The association between home firearms and the likelihood and nature of suicidal thoughts and plans was examined using the Second Injury Control and Risk Survey, a 2001-2003 representative telephone survey of U.S. households. Of 9,483 respondents, 7.4% reported past-year suicidal thoughts, 21.3% with a plan. Similar proportions of those with and…
Adrian, Molly; Zeman, Janice; Erdley, Cynthia; Lisa, Ludmila; Sim, Leslie
The purpose of this study was to examine a model of factors that place psychiatrically hospitalized girls at risk for non-suicidal self-injury (NSSI). The role of familial and peer interpersonal difficulties, as well as emotional dysregulation, were examined in relationship to NSSI behaviors. Participants were 99 adolescent girls (83.2% Caucasian;…
James, C. Roger; Dufek, Janet S.; Bates, Barry T.
The purpose of this study was to examine changes in landing performance during fatigue that could result in increased stress fracture injury risk. Five participants performed nonfatigued and fatigued drop landings (0.60 m), while ground reaction force (GRF), electromyographic (EMG) activity, and kinematics were recorded. Fatigue was defined as a…
Ido, Ayumi; Nakayama, Yuki; Ishii, Kojiro; Iemitsu, Motoyuki; Sato, Koji; Fujimoto, Masahiro; Kurihara, Toshiyuki; Hamaoka, Takafumi; Satoh-Asahara, Noriko; Sanada, Kiyoshi
Sarcopenia has never been diagnosed based on site-specific muscle loss, and little is known about the relationship between site-specific muscle loss and metabolic syndrome (MetS) risk factors. To this end, this cross-sectional study aimed to investigate the relationship between site-specific muscle size and MetS risk factors. Subjects were 38 obese men and women aged 40–82 years. Total body fat and lean body mass were assessed by whole-body dual-energy X-ray absorptiometry (DXA) scan. Muscle thickness (MTH) was measured using B-mode ultrasound scanning in six body regions. Subjects were classified into general obesity (GO) and sarcopenic obesity (SO) groups using the threshold values of one standard deviation below the sex-specific means of either MTH or skeletal muscle index (SMI) measured by DXA. MetS risk score was acquired by standardizing and summing the following continuously distributed variables: visceral fat area, mean blood pressure, HbA1c, and serum triglyceride / high density lipoprotein cholesterol, to obtain the Z-score. Multiple regression analysis revealed that the MetS risk score was independently associated with abdominal MTH in all subjects, but not with MTH in other muscle regions, including the thigh. Although HbA1c and the number of MetS risk factors in the SO group were significantly higher than those in the GO group, there were no significant differences between GO and SO groups as defined by SMI. Ultrasound-derived abdominal MTH would allow a better assessment of sarcopenia in obese patients and can be used as an alternative to the conventionally-used SMI measured by DXA. PMID:26700167
McAndrews, Carolyn; Beyer, Kirsten; Guse, Clare E; Layde, Peter
Comparing the injury risk of different travel modes requires using a travel-based measure of exposure. In this study we quantify injury risk by travel mode, age, race/ethnicity, sex, and injury severity using three different travel-based exposure measures (person-trips, person-minutes of travel, and person-miles of travel) to learn how these metrics affect the characterization of risk across populations. We used a linked database of hospital and police records to identify non-fatal injuries (2001-2009), the Fatality Analysis Reporting System for fatalities (2001-2009), and the 2001 Wisconsin Add-On to the National Household Travel Survey for exposure measures. In Wisconsin, bicyclists and pedestrians have a moderately higher injury risk compared to motor vehicle occupants (adjusting for demographic factors), but the risk is much higher when exposure is measured in distance. Although the analysis did not control for socio-economic status (a likely confounder) it showed that American Indian and Black travelers in Wisconsin face higher transportation injury risk than White travelers (adjusting for sex and travel mode), across all three measures of exposure. Working with multiple metrics to form comprehensive injury risk profiles such as this one can inform decision making about how to prioritize investments in transportation injury prevention.
Stevens, Gretchen; Dias, Rodrigo H; Thomas, Kevin J. A; Rivera, Juan A; Carvalho, Natalie; Barquera, Simón; Hill, Kenneth; Ezzati, Majid
Background Rates of diseases and injuries and the effects of their risk factors can have substantial subnational heterogeneity, especially in middle-income countries like Mexico. Subnational analysis of the burden of diseases, injuries, and risk factors can improve characterization of the epidemiological transition and identify policy priorities. Methods and Findings We estimated deaths and loss of healthy life years (measured in disability-adjusted life years [DALYs]) in 2004 from a comprehensive list of diseases and injuries, and 16 major risk factors, by sex and age for Mexico and its states. Data sources included the vital statistics, national censuses, health examination surveys, and published epidemiological studies. Mortality statistics were adjusted for underreporting, misreporting of age at death, and for misclassification and incomparability of cause-of-death assignment. Nationally, noncommunicable diseases caused 75% of total deaths and 68% of total DALYs, with another 14% of deaths and 18% of DALYs caused by undernutrition and communicable, maternal, and perinatal diseases. The leading causes of death were ischemic heart disease, diabetes mellitus, cerebrovascular disease, liver cirrhosis, and road traffic injuries. High body mass index, high blood glucose, and alcohol use were the leading risk factors for disease burden, causing 5.1%, 5.0%, and 7.3% of total burden of disease, respectively. Mexico City had the lowest mortality rates (4.2 per 1,000) and the Southern region the highest (5.0 per 1,000); under-five mortality in the Southern region was nearly twice that of Mexico City. In the Southern region undernutrition and communicable, maternal, and perinatal diseases caused 23% of DALYs; in Chiapas, they caused 29% of DALYs. At the same time, the absolute rates of noncommunicable disease and injury burdens were highest in the Southern region (105 DALYs per 1,000 population versus 97 nationally for noncommunicable diseases; 22 versus 19 for injuries
Thomas, Nancy I; Brown, Norman D; Hodges, Linda C; Gandy, Jay; Lawson, Louanne; Lord, Janet E; Williams, David K
In this retrospective case-control study, researchers examined risk factors for four types of work-related injury (WRI) in hospital employees. Data were collected from employee health charts and computer databases (N = 2050) and analyzed using logistic regression. Study results showed that strain injuries were related to increased age, increased body mass index (BMI), and maintenance, custodial, and direct-caregiver employment types. Repetitive motion injuries were related to increased BMI and clerical and custodial employment types. Exposure/reaction injuries were related to increased age, increased BMI, and maintenance, custodial, and direct-caregiver employment types. Contact/assault injuries were related to increased age, increased BMI, and maintenance, custodial, and direct-caregiver employment types. All injury types were most often related to female gender and full-time employment status. Reformulating policies to improve screening, prevention, and education for those at risk for certain injury types may limit WRI occurrences and costs.
Després, Jean-Pierre; Lemieux, Isabelle
Metabolic syndrome is associated with abdominal obesity, blood lipid disorders, inflammation, insulin resistance or full-blown diabetes, and increased risk of developing cardiovascular disease. Proposed criteria for identifying patients with metabolic syndrome have contributed greatly to preventive medicine, but the value of metabolic syndrome as a scientific concept remains controversial. The presence of metabolic syndrome alone cannot predict global cardiovascular disease risk. But abdominal obesity - the most prevalent manifestation of metabolic syndrome - is a marker of 'dysfunctional adipose tissue', and is of central importance in clinical diagnosis. Better risk assessment algorithms are needed to quantify diabetes and cardiovascular disease risk on a global scale.
Glickman, Michael S.; Schluger, Neil
Inhaled environmental pollutants, most prominently from cigarettes, confer an increased risk of tuberculosis. A recent study published in Cell by Berg, Levitte, et al., (2016) using the zebrafish model of Mycobacterium marinum infection provides new insights into the role of macrophage lysosomal engorgement in compromising host defense against mycobacteria. PMID:27078065
Tromp, Gerard; Kuivaniemi, Helena; Gretarsdottir, Solveig; Baas, Annette F.; Giusti, Betti; Strauss, Ewa; van‘t Hof, Femke N.G.; Webb, Thomas R.; Erdman, Robert; Ritchie, Marylyn D.; Elmore, James R.; Verma, Anurag; Pendergrass, Sarah; Kullo, Iftikhar J.; Ye, Zi; Peissig, Peggy L.; Gottesman, Omri; Verma, Shefali S.; Malinowski, Jennifer; Rasmussen-Torvik, Laura J.; Borthwick, Kenneth M.; Smelser, Diane T.; Crosslin, David R.; de Andrade, Mariza; Ryer, Evan J.; McCarty, Catherine A.; Böttinger, Erwin P.; Pacheco, Jennifer A.; Crawford, Dana C.; Carrell, David S.; Gerhard, Glenn S.; Franklin, David P.; Carey, David J.; Phillips, Victoria L.; Williams, Michael J.A.; Wei, Wenhua; Blair, Ross; Hill, Andrew A.; Vasudevan, Thodor M.; Lewis, David R.; Thomson, Ian A.; Krysa, Jo; Hill, Geraldine B.; Roake, Justin; Merriman, Tony R.; Oszkinis, Grzegorz; Galora, Silvia; Saracini, Claudia; Abbate, Rosanna; Pulli, Raffaele; Pratesi, Carlo; Saratzis, Athanasios; Verissimo, Ana R.; Bumpstead, Suzannah; Badger, Stephen A.; Clough, Rachel E.; Cockerill, Gillian; Hafez, Hany; Scott, D. Julian A.; Futers, T. Simon; Romaine, Simon P.R.; Bridge, Katherine; Griffin, Kathryn J.; Bailey, Marc A.; Smith, Alberto; Thompson, Matthew M.; van Bockxmeer, Frank M.; Matthiasson, Stefan E.; Thorleifsson, Gudmar; Thorsteinsdottir, Unnur; Blankensteijn, Jan D.; Teijink, Joep A.W.; Wijmenga, Cisca; de Graaf, Jacqueline; Kiemeney, Lambertus A.; Lindholt, Jes S.; Hughes, Anne; Bradley, Declan T.; Stirrups, Kathleen; Golledge, Jonathan; Norman, Paul E.; Powell, Janet T.; Humphries, Steve E.; Hamby, Stephen E.; Goodall, Alison H.; Nelson, Christopher P.; Sakalihasan, Natzi; Courtois, Audrey; Ferrell, Robert E.; Eriksson, Per; Folkersen, Lasse; Franco-Cereceda, Anders; Eicher, John D.; Johnson, Andrew D.; Betsholtz, Christer; Ruusalepp, Arno; Franzén, Oscar; Schadt, Eric E.; Björkegren, Johan L.M.; Lipovich, Leonard; Drolet, Anne M.; Verhoeven, Eric L.; Zeebregts, Clark J.; Geelkerken, Robert H.; van Sambeek, Marc R.; van Sterkenburg, Steven M.; de Vries, Jean-Paul; Stefansson, Kari; Thompson, John R.; de Bakker, Paul I.W.; Deloukas, Panos; Sayers, Robert D.; Harrison, Seamus C.; van Rij, Andre M.; Samani, Nilesh J.
Rationale: Abdominal aortic aneurysm (AAA) is a complex disease with both genetic and environmental risk factors. Together, 6 previously identified risk loci only explain a small proportion of the heritability of AAA. Objective: To identify additional AAA risk loci using data from all available genome-wide association studies. Methods and Results: Through a meta-analysis of 6 genome-wide association study data sets and a validation study totaling 10 204 cases and 107 766 controls, we identified 4 new AAA risk loci: 1q32.3 (SMYD2), 13q12.11 (LINC00540), 20q13.12 (near PCIF1/MMP9/ZNF335), and 21q22.2 (ERG). In various database searches, we observed no new associations between the lead AAA single nucleotide polymorphisms and coronary artery disease, blood pressure, lipids, or diabetes mellitus. Network analyses identified ERG, IL6R, and LDLR as modifiers of MMP9, with a direct interaction between ERG and MMP9. Conclusions: The 4 new risk loci for AAA seem to be specific for AAA compared with other cardiovascular diseases and related traits suggesting that traditional cardiovascular risk factor management may only have limited value in preventing the progression of aneurysmal disease. PMID:27899403
Gardner, L I; Landsittel, D P; Nelson, N A
Risk factors for work-associated strain or sprain back injuries were investigated in a cohort of 31,076 material handlers from 260 retail merchandise stores in the United States. The workers studied were those with significant material-handling responsibilities--daily lifting and movement of merchandise. Workers in jobs with the greatest physical work requirements had an injury rate of 3.64 per 100 person-years versus 1.82 in workers with lesser work requirements. The unadjusted injury rate for males was 3.67 per 100 person-years compared with 2.34 per 100 person-years for females, but the excess for males was confounded by higher physical work requirements for men in the stocker/receiver job category. The injury rate ratio for short versus long duration of employment was 3.53 (95% confidence interval: 2.90, 4.30); for medium versus long duration of employment, it was 1.38 (95% confidence interval: 1.18, 1.62). The elevated rate ratios were maintained when the data were stratified by subsets with different rates of turnover. The results suggest that workers with the greatest physical work requirements and those with the shortest duration of employment are at the highest risk of back injuries. However, selection forces causing worker turnover within this cohort of active workers are not well characterized and have the potential to bias the measures for time-related factors such as duration of employment.
Boufous, Soufiane; de Rome, Liz; Senserrick, Teresa; Ivers, Rebecca
This study examines the impact of cyclist, road and crash characteristics on the injury severity of cyclists involved in traffic crashes reported to the police in Victoria, Australia between 2004 and 2008. Logistic regression analysis was carried out to identify predictors of severe injury (serious injury and fatality) in cyclist crashes reported to the police. There were 6432 cyclist crashes reported to the police in Victoria between 2004 and 2008 with 2181 (33.9%) resulting in severe injury of the cyclist involved. The multivariate analysis found that factors that increase the risk of severe injury in cyclists involved in traffic crashes were age (50 years and older), not wearing a helmet, riding in the dark on unlit roads, riding on roads zoned 70 km/h or above, on curved sections of the road, in rural locations and being involved in head-on collisions as well as off path crashes, which include losing control of vehicle, and on path crashes which include striking the door of a parked vehicle. While this study did not test effectiveness of preventative measures, policy makers should consider implementation of programs that address these risk factors including helmet programs and environmental modifications such as speed reduction on roads that are frequented by cyclists.
Rowson, Steven; Duma, Stefan M; Beckwith, Jonathan G; Chu, Jeffrey J; Greenwald, Richard M; Crisco, Joseph J; Brolinson, P Gunnar; Duhaime, Ann-Christine; McAllister, Thomas W; Maerlender, Arthur C
Recent research has suggested a possible link between sports-related concussions and neurodegenerative processes, highlighting the importance of developing methods to accurately quantify head impact tolerance. The use of kinematic parameters of the head to predict brain injury has been suggested because they are indicative of the inertial response of the brain. The objective of this study is to characterize the rotational kinematics of the head associated with concussive impacts using a large head acceleration dataset collected from human subjects. The helmets of 335 football players were instrumented with accelerometer arrays that measured head acceleration following head impacts sustained during play, resulting in data for 300,977 sub-concussive and 57 concussive head impacts. The average sub-concussive impact had a rotational acceleration of 1230 rad/s(2) and a rotational velocity of 5.5 rad/s, while the average concussive impact had a rotational acceleration of 5022 rad/s(2) and a rotational velocity of 22.3 rad/s. An injury risk curve was developed and a nominal injury value of 6383 rad/s(2) associated with 28.3 rad/s represents 50% risk of concussion. These data provide an increased understanding of the biomechanics associated with concussion and they provide critical insight into injury mechanisms, human tolerance to mechanical stimuli, and injury prevention techniques.
Hess, Gregory William
Sports participation has undergone an increase in recent decades. Injury due to sporting activity has also recently risen. The Achilles tendon has been one of the most common sports-related injuries. A 2 in 100,000 individual Achilles tendon injury rate increased to a 12 in 100,000 individual injury rate in less than 10 years. The injury is typically observed in men in the fourth to fifth decades of life. Male to female injury ratios range from 2:1 to 12:1. Running, jumping, and agility activities involving eccentric loading and explosive plyometric contractions are usual mechanisms. Natural aging allows predisposing chronic degeneration of the tendon. Blood flow decreases and stiffness increases with aging to decrease the ability to withstand stress. Noninflammatory tendinosis and chronic tendinopathy are 2 separate processes proposed for tendon degeneration and subsequent rupture. Rupture typically occurs 2 to 6 cm proximal to the calcaneal insertion. Predisposing factors are grouped into 2 categories: intrinsic and extrinsic risk factors. Avoidance of degenerative changes within the tendon is the primary method to prevent rupture. Regular physical activity as athletes age also promotes tendon hypertrophy, increases nutrient delivery, and reduces collagen fiber fatigue.
In Norway a series of complementary systems have been established for the reporting of injuries and accidents occurring during the course of hospital treatment. Alongside a number of obligations to report such matters to an external body, depending on the nature of the event, many hospitals have created their own internal reporting systems. The latter were originally conceived largely as a defence mechanism for the event that the patient should bring legal action against the hospital, but like the various external reporting mechanisms these systems are today increasingly viewed as an instrument for quality assurance, enabling the hospital to benefit from experience.Although many of the elements are in place, including an increasingly clear view on patients' rights to information, concern has to be expressed at the multiplicity of mechanisms which now exists, some simplification is called for. There is also a need to ensure much greater compliance with these systems if they are to serve their purpose.
Background Research reporting prevalence rates of self-injurious and aggressive behaviour in people with tuberous sclerosis complex (TSC) is limited. No studies have compared rates of these behaviours in TSC with those in other syndrome groups matched for degree of disability or investigated risk markers for these behaviours in TSC. Methods Data from the Challenging Behaviour Questionnaire were collected for 37 children, aged 4 to 15 years, with TSC. Odds ratios were used to compare rates of self-injury and aggression in children with TSC with children with idiopathic autism spectrum disorder (ASD), fragile X, Cornelia de Lange and Down syndromes. Characteristics were measured using the Mood Interest and Pleasure Questionnaire, the Activity Questionnaire, the Social Communication Questionnaire, the Repetitive Behaviour Questionnaire, the Wessex Behaviour Schedule and the revised Non-communicating Children Pain Checklist. Mann-Whitney U analyses were used to compare characteristics between individuals with self-injury and aggression and those not showing these behaviours. Results Rates of self-injury and aggression in TSC were 27% and 50%, respectively. These are high but not significantly different from rates in children with Down syndrome or other syndrome groups. Both self-injury and aggression were associated with stereotyped and pain-related behaviours, low mood, hyperactivity, impulsivity and repetitive use of language. Children who engaged in self-injury also had lower levels of interest and pleasure and showed a greater degree of ‘insistence on sameness’ than children who did not self-injure. Aggression was associated with repetitive behaviour. The majority of these associations remained significant when the association with level of adaptive functioning was controlled for. Conclusions Behavioural profiles can be used to identify those most at risk of developing self-injury and aggression. Further research is warranted to understand the influence of
Allison, Matthew A.; Budoff, Matthew J.; Nasir, Khurram; Wong, Nathan D.; Detrano, Robert; Kronmal, Richard; Takasu, Junichiro; Criqui, Michael H.
The aims of this study were to 1) determine the association between ethnicity and both thoracic and abdominal aortic calcium (TAC and AAC) and 2) investigate associations between cardiovascular disease (CVD) risk factors and both TAC and AAC. Participants were 1,957 men and women enrolled in the Multi-Ethnic Study of Atherosclerosis who had computed tomography scans of both the chest and abdomen. These scans were obtained at the same clinic visit and calcium scores were computed using the Agatston method. Regression analyses were conducted using relative risk regression. The mean age was 65 years and 50% were female. Forty % were White, 26% Hispanic, 21% African American and 13% Chinese. Whites had the highest prevalence of AAC (80%), which was significantly higher than Hispanics (68%, p<0.001), African Americans (63%, p<0.001) and Chinese (74%, p=0.029). Similarly, Whites had the highest prevalence of TAC (42%), which was significantly higher than Hispanics (30%, p < 0.01) and African Americans (27%, p<0.001) but was not significantly different from that in Chinese (38%). Compared to Whites and after adjustment for age, sex, body mass index, hypertension, diabetes, dyslipidemia, smoking and family history of CVD, Hispanics and African Americans, but not Chinese Americans, had a significantly lower risk for the presence of any AAC or any TAC. In these models, diabetes, smoking and dyslipidemia had stronger associations with AAC while hypertension was stronger for TAC. In conclusion, compared to Whites, African-Americans and Hispanics, but not Chinese, have evidence of less atherosclerosis in both the thoracic and abdominal aorta which does not appear to be accounted for by traditional CVD risk factors. PMID:19733716
Mertz, H J; Prasad, P
This paper describes improvements made to the injury risk curves for peak neck tension, peak neck extension moment and a linear combination of tension and extension moment that produce peak stress in the anterior-longitudinal ligament at the head-to-neck junction. Data from previously published experiments that correlated neck injuries to 10-week-old, anesthetized pigs and neck response measurements of a 3-year-old child dummy that were subjected to similar airbag deployments are updated and used to generate Normal probability curves for the risk of AIS >/= 3 neck injury for the 3-year-old child. These curves are extended to other sizes and ages by normalizing for neck size. Factors for percent of muscle tone and ligamentous failure stress as a function of age are incorporated in the risk analysis. The most sensitive predictor of AIS > 3 neck injury for this data set is peak neck tension. If two possible outliers are deleted from the data set, then the combined criterion of extension moment and axial force becomes the most sensitive predictor which is consistent with expectations.
Paul Anthikkat, Anne; Page, Andrew; Barker, Ruth
Objective. This study reviews modifiable risk factors associated with fatal and nonfatal injury from low-speed vehicle runover (LSVRO) incidents involving children aged 0–15 years. Data Sources. Electronic searches for child pedestrian and driveway injuries from the peer-reviewed literature and transport-related websites from 1955 to 2012. Study Selection. 41 studies met the study inclusion criteria. Data Extraction. A systematic narrative summary was conducted that included study design, methodology, risk factors, and other study variables. Results. The most commonly reported risk factors for LSVRO incidents included age under 5 years, male gender, and reversing vehicles. The majority of reported incidents involved residential driveways, but several studies identified other traffic and nontraffic locations. Low socioeconomic status and rental accommodation were also associated with LSVRO injury. Vehicles were most commonly driven by a family member, predominantly a parent. Conclusion. There are a number of modifiable vehicular, environmental, and behavioural factors associated with LSVRO injuries in young children that have been identified in the literature to date. Strategies relating to vehicle design (devices for increased rearward visibility and crash avoidance systems), housing design (physical separation of driveway and play areas), and behaviour (driver behaviour, supervision of young children) are discussed. PMID:23781251
Chapman, R L; Buckley, L; Sheehan, M; Shochet, I M
School connectedness is an important protective factor for adolescent risk-taking behaviour. This study examined a pilot version of the Skills for Preventing Injury in Youth (SPIY) programme, combining teacher professional development (PD) for increasing school connectedness (connectedness component) with a risk and injury prevention curriculum for early adolescents (curriculum component). A process evaluation was conducted on the connectedness component, involving assessments of programme reach, participant receptiveness and initial use, and a preliminary impact evaluation was conducted on the combined connectedness and curriculum programme. The connectedness component was well received by teacher participants, who saw benefits for both themselves and their students. Classroom observation also showed that teachers who received PD made use of the programme strategies. Grade 8 students who participated in the SPIY programme were less likely to report violent behaviour at 6-month follow-up than were control students, and trends also suggested reduced transport injuries. The results of this research support the use of the combined SPIY connectedness and curriculum components in a large-scale effectiveness trial to assess the impact of the programme on students' connectedness, risk-taking and associated injuries.
Campo, Giuseppe; Martini, Benedetta
The most recent INAIL data show that, in 2009-2011, the accident frequency rate and the severity rate of workplace injuries in the chemical industry are lower than for the total non-agricultural workforce. The chemical industry, primarily because of the complex and hazardous work processes, requires an appropriate system for assessing and monitoring specific risks.The implementation of Responsible Care, a risk management system specific for the chemical industry, in 1984, has represented a historical step in the process of critical awareness of risk management by the chemical companies. Responsible Care is a risk management system specifically designed on the risk profiles of this type of enterprise, which integrates safety, health and environment. A risk management system, suitable for the needs of a chemical company, should extend its coverage area, beyond the responsible management of products throughout the entire production cycle, to the issues of corporate responsibility.
Yun, Ilhong; Lee, Julak
Using data from the National Crime Victimization Survey (NCVS; 1992-2005), we closely examined the effects of victims' self-protective actions on the risk of injury among female nonsexual assault victims. Building on previous research, we focused on 3 important methodological and conceptual issues: (a) gradational coding of the 16 different NCVS self-protective actions, (b) separate analyses of serious injuries, and (c) the victim-offender relationship. Our analyses demonstrated that the risk of injury was strongly and positively associated with the degree of forcefulness of self-protective actions. Furthermore, the likelihood of victim injury was inversely related to the relational distance between the victim and the offender.
Meehan, William P.; Jordaan, Marc; Prabhu, Sanjay P.; Carew, Liz; Mannix, Rebekah C.; Proctor, Mark R.
Objective To estimate the risk of athletes with Chiari malformations sustaining a catastrophic injury. Design Retrospective, descriptive cohort study. Participants All patients diagnosed with Chiari malformation at our institution between June 2008 and November 2011. Assessment of Risk Factors Participants were mailed a questionnaire regarding the number of seasons they participated in organized athletics. Magnetic resonance images were reviewed to describe the characteristics of respondent’s Chiari malformations. Main Outcome Measures Whether or not the patient had sustained an injury resulting in death, coma, or paralysis. Results We had a 53% (N=147) response rate. Respondents were a mean age of 15 years (SD 2 years) at the time of diagnosis. The mean length of protrusion of the cerebellar tonsils below the foramen magnum was 11.2mm (SD 5.7mm). The majority of respondents had pointed cerebellar tonsils and some degree of crowding within the foramen magnum. During a total of 1,627 athletic seasons played by patients with Chiari malformation, 0 respondents (95% CI 0.0000, 0.0023) sustained an injury resulting in death, coma or paralysis. Likewise, during 191 collision sport athletic seasons, 0 (95% CI 0.0000, 0.0191) respondents sustained an injury resulting in death, coma or paralysis. Conclusions The risk of athletes with Chiari malformations suffering catastrophic injuries during sports participation is low. This estimate of risk should be considered when making return-to-play decisions. Given the variability of anatomical consideration for patients with Chiari malformations, however, each return-to-play decision must continue to be made on a case-by-case basis, considering all of the available information. PMID:24905537
Wilkerson, Gary B; Gupta, Ashish; Allen, Jeff R; Keith, Clay M; Colston, Marisa A
Wilkerson, GB, Gupta, A, Allen, JR, Keith, CM, and Colston, MA. Utilization of practice session average inertial load to quantify college football injury risk. J Strength Cond Res 30(9): 2369-2374, 2016-Relatively few studies have investigated the potential injury prevention value of data derived from recently developed wearable technology for measurement of body mass accelerations during the performance of sport-related activities. The available evidence has been derived from studies focused on avoidance of overtraining syndrome, which is believed to induce a chronically fatigued state that can be identified through monitoring of inertial load accumulation. Reduced variability in movement patterns is also believed to be an important injury risk factor, but no evidence currently exists to guide interpretation of data derived from inertial measurement units (IMUs) in this regard. We retrospectively analyzed archived data for a cohort of 45 National Collegiate Athletic Association Division 1-football bowl subdivision football players who wore IMUs on the upper back during practice sessions to quantify any associations between average inertial load measured during practice sessions and occurrence of musculoskeletal sprains and strains. Both the coefficient of variation for average inertial load and frequent exposure to game conditions were found to be strongly associated with injury occurrence. Having either or both of the 2 risk factors provided strong discrimination between injured and noninjured players (χ = 9.048; p = 0.004; odds ratio = 8.04; 90% CI: 2.39, 27.03). Our findings may facilitate identification of individual football players who are likely to derive the greatest benefit from training activities designed to reduce injury risk through improved adaptability to rapidly changing environmental demands.
Chanapa, Patcharin; Yoshiyuki, Tohno; Mahakkanukrauh, Pasuk
Vertebral osteophytes are a characteristic feature of intervertebral disc degeneration. In the lumbar spinal region, the two major structures in close proximity anterior to the spine are the inferior vena cava and the abdominal aorta, both of which have been reported to be affected by osteophytes. The purpose of this study was to determine the distribution, classification and lengths of osteophytes in the lumbar vertebrae. One hundred and eighty lumbar columns of 90 males and 90 females from Chiang Mai, Thailand, in the age range 15 to 96 years (mean age, 63 years) were collected. The measuring length of osteophytes was assessed on vertebral body and articular facet. Statistical analysis was performed by descriptive analysis, chi-square and Pearson Correlation. Lumbar osteophytes were presented in 175 specimens (97.2%), 88 males and 87 females. The highest frequency was at L4, most were on the superior, inferior surface of body and articular facet (39.7%, 38.4%, and 22%), respectively. The greatest mean length was 3.47±2.21 mm at L5, and the longest length of anterior superior surface of body was 28.56 mm. The osteophyte length was significantly correlated directly with age (P<0.01), and males were significantly greater than females (P<0.05). The highest prevalence of osteophytes was on the anterior side of superior surface of body (30.4%), and the classification was traction. It can be proposed that the abdominal aorta could be damaged, especially a risk of rupture of abdominal aortic aneurysm.
Bouyou, J; Gaujoux, S; Marcellin, L; Leconte, M; Goffinet, F; Chapron, C; Dousset, B
Abdominal emergencies during pregnancy (excluding obstetrical emergencies) occur in one out of 500-700 pregnancies and may involve gastrointestinal, gynecologic, urologic, vascular and traumatic etiologies; surgery is necessary in 0.2-2% of cases. Since these emergencies are relatively rare, patients should be referred to specialized centers where surgical, obstetrical and neonatal cares are available, particularly because surgical intervention increases the risk of premature labor. Clinical presentations may be atypical and misleading because of pregnancy-associated anatomical and physiologic alterations, which often result in diagnostic uncertainty and therapeutic delay with increased risks of maternal and infant morbidity. The most common abdominal emergencies are acute appendicitis (best treated by laparoscopic appendectomy), acute calculous cholecystitis (best treated by laparoscopic cholecystectomy from the first trimester through the early part of the third trimester) and intestinal obstruction (where medical treatment is the first-line approach, just as in the non-pregnant patient). Acute pancreatitis is rare, usually resulting from trans-ampullary passage of gallstones; it usually resolves with medical treatment but an elevated risk of recurrent episodes justifies laparoscopic cholecystectomy in the 2nd trimester and endoscopic sphincterotomy in the 3rd trimester. The aim of the present work is to review pregnancy-induced anatomical and physiological modifications, to describe the main abdominal emergencies during pregnancy, their specific features and their diagnostic and therapeutic management.
SHADLOO, Behrang; MOTEVALIAN, Abbas; RAHIMI-MOVAGHAR, Vafa; AMIN-ESMAEILI, Masoumeh; SHARIFI, Vandad; HAJEBI, Ahmad; RADGOODARZI, Reza; HEFAZI, Mitra; RAHIMI-MOVAGHAR, Afarin
Background: Injuries and psychiatric disorders, notably both major public health concerns, are associated with a high burden and are believed to be bi-directionally correlated. Those inflicted with injuries face increased risks of mental illnesses. Psychiatric disorders may make the individual prone to injuries. The objective of the study was to assess the correlation of mental disorders with non-fatal injuries. Methods: A total of 7886 participants aged 15 to 64 yr were interviewed in a national household survey in 2011 in Iran. Composite International Diagnostic Interview (CIDI v2.1) was implemented to assess the prevalence of psychiatric disorders in the past twelve months. Injuries were assessed using Short Form Injury Questionnaire (SFIQ-7). Results: Injury was reported in 35.9% and 22.8% of participants in the past twelve and past three months, respectively. Using multivariate logistic regression analysis, mental disorders were significantly associated with injuries in the past three months (OR=1.6, 95% CI:1.36–1.87), recurrent injuries (OR=1.7, 95% CI: 1.21–2.41) and road/traffic accidents (OR=2.4, 95% CI: 1.28–4.49). Conclusion: Psychiatric disorders were found to be associated with an increased risk of injuries. Early detection and treatment of mental illnesses can contribute to injury prevention. PMID:27398335
Janev Holcer, Nataša; Pucarin-Cvetković, Jasna; Mustajbegović, Jadranka; Zuškin, Eugenija
Injuries and diseases can significantly affect the creativity and artistic performance. The link between working conditions and artistic performance had been recognised as early as the medieval age. Physically demanding performance arts such as dance can sometimes result in injuries, illnesses, inability to perform, and even end artist's career. Dancers are exposed to specific risks and in need of specific medical care. Many dancers often stretch their physical capabilities and endurance and neglect their physical limitations. Their health problems include a number of work-related illnesses that range from stress and stage fright to metabolic and nutritional disorders. They also include musculoskeletal injuries due to overload training that are often the beginning of chronic health problems.
Acevedo, Rafael J; Rivera-Vega, Alexandra; Miranda, Gerardo; Micheo, William
Injury to the anterior cruciate ligament (ACL) is common and affects young individuals, particularly girls, who are active in sports that involve jumping, pivoting, as well as change of direction. ACL injury is associated with potential long-term complications including reduction in activity levels and osteoarthritis. Multiple intrinsic and extrinsic risk factors have been identified, which include anatomic variations, neuromuscular deficits, biomechanical abnormalities, playing environment, and hormonal status. Multicomponent prevention programs have been shown to be effective in reducing the incidence of this injury in both girls and boys. Programs should include a combination of strengthening, stretching, aerobic conditioning, plyometrics, proprioceptive and balance training, as well as education and feedback regarding body mechanics and proper landing pattern. Preventive programs should be implemented at least 6 wk prior to competition, followed by a maintenance program during the season.
Baumann, Donald P.; Butler, Charles E.
Lateral abdominal wall (LAW) defects can manifest as a flank hernias, myofascial laxity/bulges, or full-thickness defects. These defects are quite different from those in the anterior abdominal wall defects and the complexity and limited surgical options make repairing the LAW a challenge for the reconstructive surgeon. LAW reconstruction requires an understanding of the anatomy, physiologic forces, and the impact of deinnervation injury to design and perform successful reconstructions of hernia, bulge, and full-thickness defects. Reconstructive strategies must be tailored to address the inguinal ligament, retroperitoneum, chest wall, and diaphragm. Operative technique must focus on stabilization of the LAW to nonyielding points of fixation at the anatomic borders of the LAW far beyond the musculofascial borders of the defect itself. Thus, hernias, bulges, and full-thickness defects are approached in a similar fashion. Mesh reinforcement is uniformly required in lateral abdominal wall reconstruction. Inlay mesh placement with overlying myofascial coverage is preferred as a first-line option as is the case in anterior abdominal wall reconstruction. However, interposition bridging repairs are often performed as the surrounding myofascial tissue precludes a dual layered closure. The decision to place bioprosthetic or prosthetic mesh depends on surgeon preference, patient comorbidities, and clinical factors of the repair. Regardless of mesh type, the overlying soft tissue must provide stable cutaneous coverage and obliteration of dead space. In cases where the fasciocutaneous flaps surrounding the defect are inadequate for closure, regional pedicled flaps or free flaps are recruited to achieve stable soft tissue coverage. PMID:23372458
Viano, D C; Gargan, M F
The gap and relative height of headrest behind drivers were determined for 1915 vehicles approaching an intersection on a two lane road. Vehicle type and headrest adjustment were also evaluated using film of normal driving taken by the Insurance Institute for Highway Safety. Only 10% of drivers had headrests in the most favorable position to prevent neck extension during a rearend crash. 73% of cars had adjustable headrests, but only a quarter were placed in the up position. 83% of the adjustable headrests could have been raised to better protect the driver. Hyge sled tests were run to determine biomechanical responses for the various conditions observed in normal driving. This included three headrest heights and three gaps behind the head. Neck extension from the Hybrid III dummy was normalized to the response for a high, close headrest, and injury risk was assumed to be proportional to neck extension. The current driving situation has a relative injury risk of 3.4 in rearend crashes, compared to 1.0 for the favorable condition. If all adjustable headrests were placed in the up position, the relative risk would be lowered to 2.4, a 28.3% reduction in whiplash injury risk. Public education and vehicle design should address the importance of proper headrest placement for driving safety.
Mir, Seyed Mohsen; Talebian, Saeed; Naseri, Nasrin; Hadian, Mohammad-Reza
[Purpose] Knee joint proprioception combines sensory input from a variety of afferent receptors that encompasses the sensations of joint position and motion. Poor proprioception is one of the risk factors of anterior cruciate ligament injury. Most studies have favored testing knee joint position sense in the sagittal plane and non-weight-bearing position. One of the most common mechanisms of noncontact anterior cruciate ligament injury is dynamic knee valgus. No study has measured joint position sense in a manner relevant to the mechanism of injury. Therefore, the aim of this study was to measure knee joint position sense in the noncontact anterior cruciate ligament injury risk position and normal condition. [Subjects and Methods] Thirty healthy male athletes participated in the study. Joint position sense was evaluated by active reproduction of the anterior cruciate ligament injury risk position and normal condition. The dominant knees of subjects were tested. [Results] The results showed less accurate knee joint position sense in the noncontact anterior cruciate ligament injury risk position rather than the normal condition. [Conclusion] The poorer joint position sense in non-contact anterior cruciate ligament injury risk position compared with the normal condition may contribute to the increased incidence of anterior cruciate ligament injury.
Fabio, Anthony; Chen, Chung-Yu; Dearwater, Steven; Jacobs, David R; Erickson, Darin; Matthews, Karen A; Iribarren, Carlos; Sidney, Stephen; Pereira, Mark A
Individuals with high levels of hostility may be more susceptible to the influence of television on violence and risk taking behaviors. This study aimed to examine whether hostile personality trait modifies the association between TV viewing and injuries. It is a prospective study of 4,196 black and white adults aged 23 to 35 in 1990/1. Cross-lagged panel models were analyzed at three 5-year time periods to test whether TV viewing predicted injuries. Covariates were gender, race, and education. Individuals who watched more TV (0 hours, 1-3 hours, 4-6 hours, and ≥7 hours) were more likely to have a hospitalization for an injury in the following 5 years across each of the three follow-up periods [OR = 1.5 (95%CI = 1.2, 1.9), 1.5 (1.1, 1.9), and 1.9 (1.3, 2.6)]. The cross-lagged effects of TV viewing to injury were significant in the high hostility group [OR = 1.4 (95%CI = 1.1, 1.8), 1.3 (1.0, 1.8), and 2.0 (1.3, 2.9)] but not in the low hostility group [OR = 1.3 (95%CI = 0.6, 2.2), 1.1 (0.6, 2.1), and 1.4 (0.7, 2.8)]. Additionally, a statistically significant difference between the two models (P < 0.001) suggested that hostility moderated the relationship between TV watching and injury. These findings suggest that individuals who watch more TV and have a hostile personality trait may be at a greater risk for injury.
Soriano, Evelyne Pessoa; Caldas, Arnaldo de França; Diniz De Carvalho, Marcus Vitor; Amorim Filho, Hugo De Andrade
The aim of this study was to investigate the risk factors associated with the occurrence of dental trauma in permanent anterior teeth of schoolchildren in Recife, Brazil. It included a random sample of 1046 boys and girls aged 12 attending both public and private schools. The sample size was calculated using a 95% confidence interval level; a statistical significance of 5% (alpha); a sample power of 80%; and an odds ratio of 1.55. The sample selection was carried out in two stages: first, schools were selected by simple sampling, and then children were chosen using a proportionality coefficient. Data were collected through clinical examinations and interviews, after examiner calibration. Dental trauma was classified according to Andreasen criteria. Overjet was considered a risk factor when it presented values higher than 5 mm. Lip coverage was classified as adequate or inadequate, while obesity was considered according to National Center for Health Statistics procedures for the assessment of nutritional status. Data were summarized and analyzed using the statistical software SPSS. The prevalence of dental injuries was 10.5%. Boys experienced more injuries than girls, 12.2% and 8.8%, respectively (P > 0.05). Children attending public schools presented more traumatic injuries than those from private schools, 11.4% and 9.5%, respectively, but there was no statistically significant difference (P > 0.05). There was a statistically significant difference between traumatic dental injuries and overjet (P < 0.05); between traumatic dental injuries and inadequate lip coverage (P = 0.000), and between obesity and dental trauma (P < 0.05). It was concluded that boys attending public schools and presenting an overjet size >5 mm, inadequate lip coverage, and obesity were more likely to have traumatic dental injuries in Recife, Brazil.
Rouhana, Stephen W; El-Jawahri, Raed E; Laituri, Tony R
While seat belts are the most effective safety technology in vehicles today, there are continual efforts in the industry to improve their ability to reduce the risk of injury. In this paper, seat belt pretensioners and current trends towards more powerful systems were reviewed and analyzed. These more powerful systems may be, among other things, systems that develop higher belt forces, systems that remove slack from belt webbing at higher retraction speeds, or both. The analysis started with validation of the Ford Human Body Finite Element Model for use in evaluation of abdominal belt loading by pretensioners. The model was then used to show that those studies, done with lap-only belts, can be used to establish injury metrics for tests done with lap-shoulder belts. Then, previously-performed PMHS studies were used to develop AIS 2+ and AIS 3+ injury risk curves for abdominal interaction with seat belts via logistic regression and reliability analysis with interval censoring. Finally, some considerations were developed for a possible laboratory test to evaluate higher-powered pretensioners.
Garrett, W E
One of the most common injuries seen in the office of the practicing physician is the muscle strain. Until recently, little data were available on the basic science and clinical application of this basic science for the treatment and prevention of muscle strains. Studies in the last 10 years represent action taken on the direction of investigation into muscle strain injuries from the laboratory and clinical fronts. Findings from the laboratory indicate that certain muscles are susceptible to strain injury (muscles that cross multiple joints or have complex architecture). These muscles have a strain threshold for both passive and active injury. Strain injury is not the result of muscle contraction alone, rather, strains are the result of excessive stretch or stretch while the muscle is being activated. When the muscle tears, the damage is localized very near the muscle-tendon junction. After injury, the muscle is weaker and at risk for further injury. The force output of the muscle returns over the following days as the muscle undertakes a predictable progression toward tissue healing. Current imaging studies have been used clinically to document the site of injury to the muscle-tendon junction. The commonly injured muscles have been described and include the hamstring, the rectus femoris, gastrocnemius, and adductor longus muscles. Injuries inconsistent with involvement of a single muscle-tendon junction proved to be at tendinous origins rather than within the muscle belly. Important information has also been provided regarding injuries with poor prognosis, which are potentially repairable surgically, including injuries to the rectus femoris muscle, the hamstring origin, and the abdominal wall. Data important to the management of common muscle injuries have been published. The risks of reinjury have been documented. The early efficacy and potential for long-term risks of nonsteroidal antiinflammatory agents have been shown. New data can also be applied to the field
tissue injury (laceration, contusion, hematoma ): 14 Lung injury (pneumothorax, contusion): 9 Brain/head injury ( subdural hematoma , intraparenchymal...corneal foreign body): 6 Nonfracture orthopedic injury (sprain, open joint): 3 Renal injury ( hematoma , contusion): 2 Intra-abdominal injury (spleen
Andersen, J. C
Reference: Herbert RD, Gabriel M. Effects of stretching before and after exercise on muscle soreness and risk of injury: systematic review. BMJ. 2002;325:468. Clinical Question: Among physically active individuals, does stretching before and after exercise affect muscle soreness and risk of injury? Data Sources: Studies were identified by searching MEDLINE (1966–February 2000), EMBASE (1988–February 2000), CINAHL (1982–1999), SPORT Discus (1949–1999), and PEDro (to February 2000). I searched the reference lists of identified studies manually until no further studies were identified. The search terms stretch, exercise, warm-up, and cool down were used in all databases except MEDLINE. In MEDLINE, an optimized OVID search strategy was used. This strategy included the terms searched in the other databases as well as terms such as flexibility, athletic injuries, sports, soreness, and muscle. Study Selection: The search was limited to English-language articles obtained from the electronic searches and the subsequent manual searches. This review included randomized or quasirandomized investigations that studied the effects of any stretching technique, before or after exercise, on delayed-onset muscle soreness, risk of injury, or athletic performance. Studies were included only if stretching occurred immediately before or after exercising. Data Extraction: Data extraction and assessment of study quality were well described. The principal outcome measures were measurements of muscle soreness and indices of injury risk. Results from the soreness studies were pooled by converting the numeric scores to percentages of the maximum possible score. These data were then reported as millimeters on a 100-mm visual analogue scale. Results of comparable studies were pooled using a fixed-effects model meta-analysis. Survival analysis using a Cox regression model was calculated on the time-to-event (injury) data. Main Results: The total number of articles identified using the
Symons, Frank J; Tervo, Raymond C; Barney, Chantel C; Damerow, John; Selim, Mona; McAdams, Brian; Foster, Shawn; Wendelschafer Crabb, Gwen; Kennedy, William
The relation between somatosensory mechanisms and self-injury among children with neurologic impairments associated with developmental delay is not well understood. We evaluated the feasibility of procuring skin biopsies to examine epidermal nerve fiber density and reported self-injury. Following informed parental consent, epidermal skin biopsies were obtained from a distal leg site with no pre-existing skin damage from 11 children with global developmental delay (55% male; mean age = 36.8 months, 17-63 months). Visual microscopic examination and quantitative analyses showed extremely high epidermal nerve fiber density values for some children. Children with reported self-injury (5/11) had significantly (P < .02) greater density values (138.8, standard deviation = 45.5) than children without self-injury (80.5, standard deviation = 17.5). Results from this novel immunohistologic analysis of skin in very young children with neurodevelopmental delays suggest it may be a useful tool to study peripheral innervation as a possible sensory risk factor for self-injury.
Taylor, Jennifer A; Davis, Andrea L; Barnes, Brittany; Lacovara, Alicia V; Patel, Reema
Objectives We analysed near-miss and injury events reported to the National Fire Fighter Near-Miss Reporting System (NFFNMRS) to investigate the workplace hazards and safety concerns of Emergency Medical Services (EMS) responders in the USA. Methods We reviewed 769 ‘non-fire emergency event’ reports from the NFFNMRS using a mixed methods approach. We identified 185 emergency medical calls and analysed their narrative text fields. We assigned Mechanism of Near-Miss/Injury and Nature of Injury codes and then tabulated frequencies (quantitative). We coded major themes regarding work hazards and safety concerns reported by the EMS responders (qualitative). Results Of the 185 emergency medical calls, the most commonly identified Mechanisms of Near-Miss/Injury to EMS responders was Assaults, followed by Struck-by Motor Vehicle, and Motor Vehicle Collision. The most commonly identified weapon used in an assault was a firearm. We identified 5 major domains of workplace hazards and safety concerns: Assaults by Patients, Risks from Motor Vehicles, Personal Protective Equipment, Relationships between Emergency Responders, and Policies, Procedures and Practices. Conclusions Narrative text from the NFFNMRS is a rich source of data that can be analysed quantitatively and qualitatively to provide insight into near-misses and injuries sustained by EMS responders. Near-miss reporting systems are critical components for occupational hazard surveillance. PMID:26068510
Helgeson, Melvin D; Potter, Benjamin K; Burns, Travis C; Hayda, Roman A; Gajewski, Donald A
We studied patients with combat-related injuries that required delayed amputation at least 4 months after the initial injury due to dysfunction, persistent pain, and patient desires. Late amputations were performed 22 times in 22 patients (21 men, 1 woman) since 2003. Fourteen patients underwent transtibial amputation, 5 transfemoral amputations, 1 knee disarticulation, and 2 transradial amputations. The primary indications for late amputation were neurologic dysfunction in 6 patients, persistent or recurrent infection in 6, neurogenic pain in 3, non-neurogenic pain in 5, and a globally poor functional result in 2. Sixteen of 22 patients reported multiple indications for electing to undergo amputation, with an average of 2.1 specific indications per patient. At final clinical follow-up an average of 13 months after amputation, all patients reported subjectively improved function and reported that they would undergo amputation again under similar circumstances. When medically and functionally practicable, every effort is given to limb salvage following severe combat-related extremity injuries. There is no single risk factor that increases the likelihood of delayed amputation, but the combination of complex pain symptoms with neurologic dysfunction appears to increase the risk, particularly if the initial insult is a severe hindfoot injury or distal tibia fracture. With appropriately selected and counseled patients, elective late amputation results in a high degree of patient satisfaction and subjectively improved function.
Page, Rita D; Gupta, Sumeet K; Jenkins, Thomas L; Karcioglu, Zeynel A
Purpose The aim of this study was to identify the risk factors that are predictive of poor outcomes in penetrating globe trauma. Patients and methods This retrospective case series evaluated 103 eyes that had been surgically treated for an open-globe injury from 2007 to 2010 at the eye clinic of the University of Virginia. A total of 64 eyes with complete medical records and at least 6 months of follow-up were included in the study. Four risk factors (preoperative best-corrected visual acuity [pre-op BCVA], ocular trauma score [OTS], zone of injury [ZOI], and time lapse [TL] between injury and primary repair) and three outcomes (final BCVA, monthly rate of additional surgeries [MRAS], and enucleation) were identified for analysis. Results Pre-op BCVA was positively associated with MRAS, final BCVA, and enucleation. Calculated OTS was negatively associated with the outcome variables. No association was found between TL and ZOI with the outcome variables. Further, age and predictor variable-adjusted analyses showed pre-op BCVA to be independently positively associated with MRAS (P=0.008) and with final BCVA (P<0.001), while the calculated OTS was independently negatively associated with final BCVA (P<0.001), but not uniquely associated with MRAS (P=0.530). Conclusion Pre-op BCVA and OTS are best correlated with prognosis in open-globe injuries. However, no conventional features reliably predict the outcome of traumatized eyes. PMID:27536059
Li, Guibing; Yang, Jikuang; Simms, Ciaran
The effect of pedestrian gait on lower limb kinematics and injuries has not been analyzed. The purpose of this paper was therefore to investigate the effect of pedestrian gait on kinematics and injury risk to the lower limbs using the Total Human Model for Safety adult male pedestrian model together with FE models of vehicle front structures. The modeling results indicate that the tibia and femur cortical bone von-Mises stress and the lateral knee bending angle of an adult pedestrian are strongly dependent on the gait stance when struck by both a sedan car and an SUV at 40km/h. The gait analysis shows that generally the leg of an adult pedestrian has lower injury risk when the knee is flexed and linear regressions show high negative correlation between knee flexion angle during impact and knee lateral bending angle and also high negative correlation between lower leg axial rotation during impact and knee lateral bending angle. Furthermore, in some gait stances a self-contact between the legs occurs, and the peak bones stresses and knee shearing displacement in the leg are then increased. Assessment of pedestrian lower limb injury should take account of these gait stance effects.
Lavender, Steven A; Marras, William S; Ferguson, Sue A; Splittstoesser, Riley E; Yang, Gang
Using our ultrasound-based "Moment Monitor," exposures to biomechanical low back disorder risk factors were quantified in 195 volunteers who worked in 50 different distribution center jobs. Low back injury rates, determined from a retrospective examination of each company's Occupational Safety and Health Administration (OSHA) 300 records over the 3-year period immediately prior to data collection, were used to classify each job's back injury risk level. The analyses focused on the factors differentiating the high-risk jobs (those having had 12 or more back injuries/200,000 hr of exposure) from the low-risk jobs (those defined as having no back injuries in the preceding 3 years). Univariate analyses indicated that measures of load moment exposure and force application could distinguish between high (n = 15) and low (n = 15) back injury risk distribution center jobs. A three-factor multiple logistic regression model capable of predicting high-risk jobs with very good sensitivity (87%) and specificity (73%) indicated that risk could be assessed using the mean across the sampled lifts of the peak forward and or lateral bending dynamic load moments that occurred during each lift, the mean of the peak push/pull forces across the sampled lifts, and the mean duration of the non-load exposure periods. A surrogate model, one that does not require the Moment Monitor equipment to assess a job's back injury risk, was identified although with some compromise in model sensitivity relative to the original model.
Rupp, Jonathan D; Flannagan, Carol A C; Kuppa, Shashi M
To facilitate the assessment of hip injury risk in frontal motor-vehicle crashes, an injury risk curve that relates peak force transmitted to the hip to the probability of hip fracture was developed by using survival analysis to fit a lognormal distribution to a recently published dataset of hip fracture forces. This distribution was parameterized to account for the effect of subject stature, which was the only subject characteristic found to significantly affect hip fracture force (X(2)(1)=6.03, p=0.014). The distribution was further parameterized to account for the effects of hip flexion and abduction from a standard driving posture on hip fracture force using relationships between mean hip fracture force and hip flexion/abduction reported in the literature. The resulting parametric distribution was used to define relationships between force applied to the hip and the risk of hip fracture for the statures associated with the small female, midsize male, and large male crash-test dummies, thus allowing these dummies to assess hip fracture/dislocation risk in frontal crashes, provided that such dummies are sufficiently biofidelic. For the midsize male crash test dummy, a 50% risk of hip fracture was associated with a force of 6.00kN. For the small female and large male dummies, a 50% risk of hip fracture was associated with forces of 4.46 and 6.73kN, respectively.
Powell-Cope, Gail; Campbell, Robert; Hahm, Bridget; Bulat, Tatjana; Westphal, John
The goal of this study was to apply sociotechnical probabilistic risk assessment to prioritize risks and prevention strategies for serious injurious falls of residents in nursing homes. Risk modeling teams consisted of 26 clinical and nonclinical staff from three Department of Veterans Affairs community living centers and one state Veteran's nursing home. Participants met in groups several times to identify and assign probabilities to provider and resident at-risk behaviors and equipment failures. They identified prevention strategies for the failures that accounted for the highest levels of risk. Six scenarios were modeled: (1) transferring from bed to wheelchair, (2) propelling from bedside to bathroom, (3) transferring from wheelchair to toilet, (4) transferring from toilet to wheelchair, (5) propelling from bathroom to bedside, and (6) transferring from wheelchair to bed. The greatest paths of risk were for residents with impaired mobility and high fragility. A 26% reduction in injurious falls could be achieved by (1) reducing the number of unassisted transfers through a modest improvement in response time to alarms, (2) installing automatic brake locks on 90% of wheelchairs, (3) making the wheelchair maintenance process highly reliable, and (4) decreasing improper transfer techniques by 10%.
Ikeda, Nayu; Inoue, Manami; Iso, Hiroyasu; Ikeda, Shunya; Satoh, Toshihiko; Noda, Mitsuhiko; Mizoue, Tetsuya; Imano, Hironori; Saito, Eiko; Katanoda, Kota; Sobue, Tomotaka; Tsugane, Shoichiro; Naghavi, Mohsen; Ezzati, Majid; Shibuya, Kenji
Background The population of Japan has achieved the longest life expectancy in the world. To further improve population health, consistent and comparative evidence on mortality attributable to preventable risk factors is necessary for setting priorities for health policies and programs. Although several past studies have quantified the impact of individual risk factors in Japan, to our knowledge no study has assessed and compared the effects of multiple modifiable risk factors for non-communicable diseases and injuries using a standard framework. We estimated the effects of 16 risk factors on cause-specific deaths and life expectancy in Japan. Methods and Findings We obtained data on risk factor exposures from the National Health and Nutrition Survey and epidemiological studies, data on the number of cause-specific deaths from vital records adjusted for ill-defined codes, and data on relative risks from epidemiological studies and meta-analyses. We applied a comparative risk assessment framework to estimate effects of excess risks on deaths and life expectancy at age 40 y. In 2007, tobacco smoking and high blood pressure accounted for 129,000 deaths (95% CI: 115,000–154,000) and 104,000 deaths (95% CI: 86,000–119,000), respectively, followed by physical inactivity (52,000 deaths, 95% CI: 47,000–58,000), high blood glucose (34,000 deaths, 95% CI: 26,000–43,000), high dietary salt intake (34,000 deaths, 95% CI: 27,000–39,000), and alcohol use (31,000 deaths, 95% CI: 28,000–35,000). In recent decades, cancer mortality attributable to tobacco smoking has increased in the elderly, while stroke mortality attributable to high blood pressure has declined. Life expectancy at age 40 y in 2007 would have been extended by 1.4 y for both sexes (men, 95% CI: 1.3–1.6; women, 95% CI: 1.2–1.7) if exposures to multiple cardiovascular risk factors had been reduced to their optimal levels as determined by a theoretical-minimum-risk exposure distribution. Conclusions
Bowerman, Erin Anne; Whatman, Chris; Harris, Nigel; Bradshaw, Elizabeth
The objective of this study was to review the evidence for selected risk factors of lower extremity overuse injuries in young elite female ballet dancers. An electronic search of key databases from 1969 to July 2013 was conducted using the keywords dancers, ballet dancers, athletes, adolescent, adolescence, young, injury, injuries, risk, overuse, lower limb, lower extremity, lower extremities, growth, maturation, menarche, alignment, and biomechanics. Thirteen published studies were retained for review. Results indicated that there is a high incidence of lower extremity overuse injuries in the target population. Primary risk factors identified included maturation, growth, and poor lower extremity alignment. Strong evidence from well-designed studies indicates that young elite female ballet dancers suffer from delayed onset of growth, maturation, menarche, and menstrual irregularities. However, there is little evidence that this deficit increases the risk of overuse injury, with the exception of stress fractures. Similarly, there is minimal evidence linking poor lower extremity alignment to increased risk of overuse injury. It is concluded that further prospective, longitudinal studies are required to clarify the relationship between growth, maturation, menarche, and lower extremity alignment, and the risk of lower extremity overuse injury in young elite female ballet dancers.
Ruedl, Gerhard; Ploner, Patrick; Linortner, Ingrid; Schranz, Alois; Fink, Christian; Sommersacher, Renate; Pocecco, Elena; Nachbauer, Werner; Burtscher, Martin
Oral contraceptive use and menstrual cycle phase are suggested to influence the risk of anterior cruciate ligament (ACL) injuries in female athletes. However, only few data are available for recreational sports. Therefore, female recreational skiers with a non-contact ACL injury and age-matched controls completed a self-reported questionnaire relating to menstrual history, oral contraceptive use and previous knee injuries. Menstrual history data were used to group subjects into either preovulatory or postovulatory phases of menstrual cycle. Our findings suggest that oral contraceptive use did not show any protective effect against ACL injuries nor did self-reported previous knee injuries show any association with ACL injury rate in recreational alpine skiing. Analysis of menstrual history data revealed that recreational skiers in the preovulatory phase were significantly more likely to sustain an ACL injury than were skiers in the postovulatory phase.
Sharan, Deepak; Ajeesh, P S
Use of mobile phone and sending text message is a very common in today's life. While sending a text message the users need to use their thumb and other palm muscles extensively. The thumb most of the time adducted on the key pad of the mobile and use high force to type the letters. Studies in literature showed that text messaging has an adverse effect on musculoskeletal system of hand. But the extensive study on the type of disorders set in among the users who extensively use mobile phone for texting. This study aims at to evaluate risk factor and clinical feature of the MSD due to hand held devices. Twenty seven subjects participated in this study. Predefined protocols were used to evaluate type of MSD occurred among the subjects. The study revealed that development of tendinitis in extensor pollicis longus, myofascial pain syndrome (70.37%) of adductor pollicis, 1st interossei and extensor digitorum communis . Other associated problems diagnosed were thoracic outlet syndrome (51.85%), fibromyalgia syndrome (25.93%), hypothyroidism (7.41%), wrist tendinitis (14.81%) and De Quervain's syndrome (7.41%). It has been observed that the pathology were tendinitis of extensor pollicis longus, myofascial pain syndrome of thenar muscles and 1st interossei, extensor digitorum communis.
Tak, Sangwoo; Paquet, Victor; Woskie, Susan; Buchholz, Bryan; Punnett, Laura
This study investigated sources of variance in exposure to risk factors for knee pain in a variety of highway construction trades, operations, and tasks. Over 15,000 discrete observations of leg postures and weights handled were made on 120 construction workers in five construction trades, in nine operations over 79 days. The contributions of trade, operation, task, and worker to the variability in work time spent kneeling, squatting, and carrying loads were evaluated with multilevel random effects models. Construction operation and task explained about 20% to 30% of total variation in kneeling, squatting, and carrying loads. There was a large unexplained component of variance thought to represent day-to-day variability of exposure within task. Reliable assessments of knee exposures require multiple days to accommodate the high variability of exposures among operations and tasks and over time. These sources of variability should be carefully considered in efforts to estimate exposures to knee loading for epidemiologic or intervention studies. Homogenous exposure groups are not easily defined from the readily available organizational features of construction work.
Aleman, Kylee B; Meyers, Michael C
Over the last decade, the sport of mountain biking has experienced extensive growth in youth participation. Due to the unpredictable nature of outdoor sport, a lack of rider awareness and increased participation, the number of injuries has unnecessarily increased. Many believe that the actual incidence of trauma in this sport is underestimated and is just the 'tip of the iceberg'. The most common mechanism of injury is usually attributed to downhill riding and forward falling. Although rare, this type of fall can result in serious cranial and thoraco-abdominal trauma. Head and neck trauma continue to be documented, often resulting in concussions and the possibility of permanent neurological sequelae. Upper limb injuries range from minor dermal abrasions, contusions and muscular strains to complex particular fracture dislocations. These are caused by attempting to arrest the face with an outstretched hand, leading to additional direct injury. Common overuse injuries include repeated compression from the handlebars and vibration leading to neurovascular complications in the hands. Along with reports of blunt abdominal trauma and lumbar muscle strains, lower extremity injuries may include various hip/pelvic/groin contusions, patellofemoral inflammation, and various muscle strains. The primary causes of mountain biking injuries in children and adolescents include overuse, excessive fatigue, age, level of experience, and inappropriate or improperly adjusted equipment. Additional factors contributing to trauma among this age group involve musculoskeletal immaturity, collisions and falls, excessive speed, environmental conditions, conditioning and fitness status of the rider, nonconservative behavioural patterns, and inadequate medical care. The limited available data restrict the identification and understanding of specific paediatric mountain biking injuries and injury mechanisms. Education about unnecessary risk of injury, use of protective equipment, suitable bikes
Decker, Michael John; Shaw, Matthew; Maddan, Casey; Campbell, Julie; Davidson, Bradley
Objectives: Female soccer athletes have a three-fold greater risk of sustaining an ACL injury compared with their male counterparts yet only 1 in 5 teams engage in ACL risk reduction programs due to several participation barriers. The purpose of this study was to determine the effects of a wearable neuromuscular (WNM) device on postural control, performance and ACL injury risk in female soccer athletes. Methods: Seventy-nine elite youth and collegiate female soccer athletes (age range: 12-25 y) trained with a WNM device that applied bi-lateral, topical pressure to the medial quadriceps and hamstrings muscles (Topical Gear, Austin, TX). The athletes performed 7-9 weeks of pre-season training with the WNM device consisting of strength and conditioning exercises and on-field team practices (46-64 total hours of exposure). Postural control was measured in 15 athletes with and without the WNM device before and after the training program; and performance was measured in 25 athletes without the WNM device before and after the training program. Postural control was determined from a single-leg landing on a force plate from a horizontal distance normalized to leg length. The athletes were instructed to gain their balance as fast as possible upon landing and remain balanced for 5 seconds. The peak ground reaction forces (GRF) and the medial-lateral, anterior-posterior and net center of pressure (COP) velocities and displacement ranges were calculated during 2 seconds of single-leg stance. Performance measures including speed, power and endurance were measured from the 40 yard dash, vertical jump for height and the Beep test, respectively. A two-way repeated measures ANOVA and post-hoc comparisons were used to compare the postural variables; and t-tests were used to compare the performance tests (p=.05). ACL injury rates, the absolute risk reduction (ARR) and the number needed to treat (NNT) to prevent one ACL injury were calculated between the WNM intervention group and 11
Dimian, Adele F; Botteron, Kelly N; Dager, Stephen R; Elison, Jed T; Estes, Annette M; Pruett, John R; Schultz, Robert T; Zwaigenbaum, Lonnie; Piven, Joseph; Wolff, Jason J
Prevalence of self-injurious behavior (SIB) is as high as 50% among children with autism spectrum disorder (ASD). Identification of risk factors for the development of SIB is critical to early intervention and prevention. However, there is little empirical research utilizing a prospective design to identify early risk factors for SIB. The purpose of this study was to evaluate behavioral characteristics predicting SIB at age 2 years among 235 infants at high familial risk for ASD. Logistic regression results indicated that presence of SIB or proto-SIB and lower developmental functioning at age 12 months significantly predicted SIB at 24 months. A pattern of persistent SIB over this period was associated with a diagnosis of autism and poorer cognitive and adaptive outcomes.
Long, Rachel N.; Sun, Kan; Neitzel, Richard L.
Occupational injury is one of many health concerns related to small-scale gold mining (ASGM), but few data exist on the subject, especially in sub-Saharan Africa. In 2011 and 2013, we examined accidents, injuries, and potential risk factors in a Ghanaian ASGM community. In 2011, 173 participants were surveyed on occupational history and health, and 22 of these were surveyed again in 2013. Injury rates were estimated at 45.5 and 38.5 injuries per 100 person-years in 2011 and in 2013, respectively; these rates far surpass those of industrialized mines in the U.S. and South Africa. Demographic and job characteristics generally were not predictive of injury risk, though there was a significant positive association with injury risk for males and smokers. Legs and knees were the most common body parts injured, and falling was the most common cause of injury. The most common type of injuries were cuts or lacerations, burns and scalds, and contusions and abrasions. Only two miners had ever received any occupational safety training, and PPE use was low. Our results suggest that injuries should be a priority area for occupational health research in ASGM. PMID:26213958
risk factors associated with exercise and questionnaires on past activities and sports participa- physical activity are also meager. The scientifically...al: Effects of frequency and of exercise and physical activity , the intensity of training, duration of training on attrition and incidence of injury...army trainees. For 8 weeks of basic training, 124 men and past physical activity .’ and 186 women (79.3%) were studied. They answered Civilian data on
Pappas, Evangelos; Shiyko, Mariya P.; Ford, Kevin R.; Myer, Gregory D.; Hewett, Timothy E.
Purpose To quantify the prevalence of biomechanical deficit patterns associated with ACL injury risk and their inter-connections in a large cohort of female athletes during an unanticipated cutting task. Methods High school female athletes (N=721) performed an unanticipated cutting task in the biomechanics laboratory. Trunk and lower extremity 3D kinetics and kinematics were measured and entered into a latent profile analysis model. Results Approximately 40% of female athletes demonstrated no biomechanical deficits and were categorized into the low risk group. The second most prevalent profile (24%) demonstrated a combination of high quadriceps and leg dominance deficits and was labeled as quadriceps-leg. The third most prevalent profile (22%) demonstrated a combination of trunk and leg dominance deficits and to lesser extent ligament dominance deficits, and was labeled as trunk-leg-ligament. Finally, the fourth profile (14%) demonstrated very high ligament dominance deficits only and it was labeled as ligament dominance profile. Conclusions This is the first study to identify the most common biomechanical profiles associated with ACL injury during a cutting task in a large cohort of female athletes. Approximately 60% of female athletes belong to one of the high-risk profiles. With the exception of the ligament dominance profile, the current analysis indicates that risk profiles consist of a combination of biomechanical deficits. The findings provide important insight into the prevalence of biomechanical deficits and future directions for the development of injury prevention programs. The findings can be used to guide the development of quick and easy tests that accurately categorize athletes into one of the profiles and subsequently prescribe tailored injury prevention programs that will be more effective and efficient than the current generic ones. PMID:26258858
Savall, Frederic; Dedouit, Fabrice; Telmon, Norbert; Rougé, Daniel
Candida albicans spondylodiscitis is a fungal infection of the spine which is still unusual in spite of the increasing frequency of predisposing factors. A 22-year-old man received an abdominal stab wound during a physical assault. Initial medical care included surgery, prolonged use of indwelling vascular catheters with administration of broad-spectrum antibiotics, and hospitalization in intensive care. Two months after the event, the victim experienced back pain in the right lumbar region and septic spondylodiscitis secondary to C. albicans was diagnosed three weeks later. This case is noteworthy because of its clinical forensic context. In France, the public prosecutor orders a medico-legal assessment after an assault for all living victims in order to establish a causal relationship between the assault and its complications. In our case, the patient presented numerous risk factors for candidemia and the forensic specialist reasonably accepted that the causal relationship was certain but indirect. We have only found one published case of spondylodiscitis after an abdominal penetrating injury and the pathogenic agent was not mentioned. We have found no case reported in a forensic context. This unusual observation shows that it may be genuinely difficult to prove the causal relationship between an abdominal penetrating injury and an unusual infectious complication such as fungal spondylodiscitis.
Schwebel, David C.; Brezausek, Carl M.
Unintentional injury is the leading cause of pediatric mortality among American children, but the role of environmental context remains poorly understood as a risk for child injury. Couched in Bronfenbrenner's (1977) ecological theory, this study analyzed data from a sample of almost 900 children to identify relations between the home and…
Steelman, Eric D; Alexander, Jeffrey L
Little is known regarding the risk perceptions and attitudes of laboratory animal care workers toward biologic safety. The purpose of this descriptive study was to assess the attitudes and perceptions of laboratory animal workers toward occupational and injury risk. Subscribers to the CompMed and TechLink listservs (n = 4808) were surveyed electronically, and 5.3% responded; data from 215 respondents were included in the final analysis. Primary variables of interest included AALAS certifications status, level of education, and responses to Likert-scale questions related to attitudes and perceptions of occupational risk and injury. Nonparametric (χ2) testing and measures of central tendency and dispersion were used to analyze and describe the data. According to 88.6% of respondents, biologic safety training is provided with information about zoonotic diseases of laboratory animals. Level of education was significantly related to perception of importance regarding wearing personal protective equipment. Participants indicated that appropriate support from coworkers and management staff is received, especially when performance and perception are hindered due to stress and fatigue. Laboratory animal staff are susceptible to injury and exposure to dangerous organisms and toxic substances. For this reason, to maximize safety, yearly biologic safety training should be provided, the importance of protective equipment adherence strengthened, and the culture of safety made a priority within the institution. PMID:27423148
Naidoo, T D; Moodley, J
The prevalence of obstetric perineal injuries and risk factors vary between affluent and resource-constrained settings. This prospective observational study reports on the factors associated with perineal lacerations in a cohort of Black African and Indian women delivering at two regional hospitals in South Africa. Binary logistic regression analysis was used to test for associations between independent variables and the dependent variable on multivariate analysis. All variables significant on bivariate analysis (P < 0.05) were included in the multivariate model. There were 202 (16.2%) perineal tears. Variables significant with having a perineal tear on bivariate and multivariate analysis included: Black African race (OR: 2.4; 95% CI: 1.2-4.6); duration of labour ≥6.3h (OR: 1.5; 95% CI: 1.1-2.1); and epidural analgesia (OR: 2.9; 95% CI: 1.9-4.7). Having an episiotomy was protective against perineal tears (OR: 0.06; 95% CI: 0.03-0.1). Obstetric perineal injury commonly occurs in our resourced-constrained setting and the risk factors are similar to those in well-resourced settings. Identification of those at risk may reduce obstetric perineal injury.
Steelman, Eric D; Alexander, Jeffrey L
Little is known regarding the risk perceptions and attitudes of laboratory animal care workers toward biologic safety. The purpose of this descriptive study was to assess the attitudes and perceptions of laboratory animal workers toward occupational and injury risk. Subscribers to the CompMed and TechLink listservs (n = 4808) were surveyed electronically, and 5.3% responded; data from 215 respondents were included in the final analysis. Primary variables of interest included AALAS certifications status, level of education, and responses to Likert-scale questions related to attitudes and perceptions of occupational risk and injury. Nonparametric (χ(2)) testing and measures of central tendency and dispersion were used to analyze and describe the data. According to 88.6% of respondents, biologic safety training is provided with information about zoonotic diseases of laboratory animals. Level of education was significantly related to perception of importance regarding wearing personal protective equipment. Participants indicated that appropriate support from coworkers and management staff is received, especially when performance and perception are hindered due to stress and fatigue. Laboratory animal staff are susceptible to injury and exposure to dangerous organisms and toxic substances. For this reason, to maximize safety, yearly biologic safety training should be provided, the importance of protective equipment adherence strengthened, and the culture of safety made a priority within the institution.
Senserrick, Teresa M; Kallan, Michael J; Winston, Flaura K
Several international jurisdictions allow family exemptions to graduated driver licensing passenger restrictions. The objective of this research was to examine differences in injury risk to US child passengers in crashes involving sibling versus non-sibling teen drivers, and to compare outcomes with crashes involving adult drivers. Insurance claim and telephone survey data were collected on 16 233 child passengers (representing 289 329 children) in 17 US jurisdictions. There was a trend toward higher restraint non-use by child passengers in the non-sibling group than in the sibling group (9.6% vs 4.7%; p = 0.08). Children in the sibling group had a 40% lower risk of injury than those in the non-sibling group (adjusted OR 0.60, 95% CI 0.40 to 0.90); however, injury risk was higher in the sibling group than in children traveling with adults (adjusted OR 1.57, 95% CI 1.09 to 2.26). Child passengers riding with sibling teen drivers may be safer than those riding with non-sibling teens, but not as safe as those riding with adult drivers.
Malisoux, L; Ramesh, J; Mann, R; Seil, R; Urhausen, A; Theisen, D
The aim of this study was to determine if runners who use concomitantly different pairs of running shoes are at a lower risk of running-related injury (RRI). Recreational runners (n = 264) participated in this 22-week prospective follow-up and reported all information about their running session characteristics, other sport participation and injuries on a dedicated Internet platform. A RRI was defined as a physical pain or complaint located at the lower limbs or lower back region, sustained during or as a result of running practice and impeding planned running activity for at least 1 day. One-third of the participants (n = 87) experienced at least one RRI during the observation period. The adjusted Cox regression analysis revealed that the parallel use of more than one pair of running shoes was a protective factor [hazard ratio (HR) = 0.614; 95% confidence interval (CI) = 0.389-0.969], while previous injury was a risk factor (HR = 1.722; 95%CI = 1.114-2.661). Additionally, increased mean session distance (km; HR = 0.795; 95%CI = 0.725-0.872) and increased weekly volume of other sports (h/week; HR = 0.848; 95%CI = 0.732-0.982) were associated with lower RRI risk. Multiple shoe use and participation in other sports are strategies potentially leading to a variation of the load applied to the musculoskeletal system. They could be advised to recreational runners to prevent RRI.
Hayes, Jasmeet P; Logue, Mark W; Sadeh, Naomi; Spielberg, Jeffrey M; Verfaellie, Mieke; Hayes, Scott M; Reagan, Andrew; Salat, David H; Wolf, Erika J; McGlinchey, Regina E; Milberg, William P; Stone, Annjanette; Schichman, Steven A; Miller, Mark W
Moderate-to-severe traumatic brain injury is one of the strongest environmental risk factors for the development of neurodegenerative diseases such as late-onset Alzheimer's disease, although it is unclear whether mild traumatic brain injury, or concussion, also confers risk. This study examined mild traumatic brain injury and genetic risk as predictors of reduced cortical thickness in brain regions previously associated with early Alzheimer's disease, and their relationship with episodic memory. Participants were 160 Iraq and Afghanistan War veterans between the ages of 19 and 58, many of whom carried mild traumatic brain injury and post-traumatic stress disorder diagnoses. Whole-genome polygenic risk scores for the development of Alzheimer's disease were calculated using summary statistics from the largest Alzheimer's disease genome-wide association study to date. Results showed that mild traumatic brain injury moderated the relationship between genetic risk for Alzheimer's disease and cortical thickness, such that individuals with mild traumatic brain injury and high genetic risk showed reduced cortical thickness in Alzheimer's disease-vulnerable regions. Among males with mild traumatic brain injury, high genetic risk for Alzheimer's disease was associated with cortical thinning as a function of time since injury. A moderated mediation analysis showed that mild traumatic brain injury and high genetic risk indirectly influenced episodic memory performance through cortical thickness, suggesting that cortical thinning in Alzheimer's disease-vulnerable brain regions is a mechanism for reduced memory performance. Finally, analyses that examined the apolipoprotein E4 allele, post-traumatic stress disorder, and genetic risk for schizophrenia and depression confirmed the specificity of the Alzheimer's disease polygenic risk finding. These results provide evidence that mild traumatic brain injury is associated with greater neurodegeneration and reduced memory performance
Burgess-Limerick, Robin; Peeters, Geeske
Study Design. Prospective cohort study. Objective. To determine if a job-specific pre-employment functional assessment (PEFA) predicts musculoskeletal injury risk in healthy mineworkers. Summary of Background Data. Traditional methods of pre-employment screening, including radiography and medical screenings, are not valid predictors of occupational musculoskeletal injury risk. Short-form job-specific functional capacity evaluations are increasing in popularity, despite limited evidence of their ability to predict injury risk in healthy workers. Methods. Participants were recruited from an Australian coal mine between 2002 and 2009 as part of the hiring process. At baseline, participants were screened with the JobFit System PEFA, and classified as PEFA 1 if they met job demands and PEFA>1, if not. Males who completed the PEFA and were employed were included. Injury data from company records were coded for body part, mechanism, and severity. The relationship between PEFA classification and time to first injury was analyzed using Cox proportional hazards regression with adjustments for department and post hoc stratification for time (0–1.3 yr, 1.3–6 yr). Results. Of the 600 participants (median age, 37 yr, range, 17.0–62.6 yr), 427 scored PEFA 1. One hundred ninety-six sprain/strain injuries were reported by 121 workers, including 35 back injuries from manual handling. Significant differences between PEFA groups were found in time to first injury for all injury types during the long term (any injury: adjusted hazard ratio [HR] = 2.3, 95% confidence interval [CI] = 1.4–3.9; manual handling injury: HR = 3.3, CI = 1.6–7.2; any back injury: HR = 3.3, CI = 1.6–6.6; back injuries from manual handling HR = 5.8, CI = 2.0–16.7), but not during the short term. An area under the receiver operator curve value of 0.73 (CI = 0.61–0.86) demonstrated acceptable predictive ability for back injuries from manual handling during the long term. Conclusion. JobFit System
Wheaton, Anne G; Olsen, Emily O'Malley; Miller, Gabrielle F; Croft, Janet B
Insufficient sleep is common among high school students and has been associated with an increased risk for motor vehicle crashes (1), sports injuries (2), and occupational injuries (3). To evaluate the association between self-reported sleep duration on an average school night and several injury-related risk behaviors (infrequent bicycle helmet use, infrequent seatbelt use, riding with a driver who had been drinking, drinking and driving, and texting while driving) among U.S. high school students, CDC analyzed data from 50,370 high school students (grades 9-12) who participated in the national Youth Risk Behavior Surveys (YRBSs) in 2007, 2009, 2011, or 2013. The likelihood of each of the five risk behaviors was significantly higher for students who reported sleeping ≤7 hours on an average school night; infrequent seatbelt use, riding with a drinking driver, and drinking and driving were also more likely for students who reported sleeping ≥10 hours compared with 9 hours on an average school night. Although insufficient sleep directly contributes to injury risk, some of the increased risk associated with insufficient sleep might be caused by engaging in injury-related risk behaviors. Intervention efforts aimed at these behaviors might help reduce injuries resulting from sleepiness, as well as provide opportunities for increasing awareness of the importance of sleep.
Karttunen, Janne P; Rautiainen, Risto H
The aim of this retrospective cohort study was to evaluate the incidence of and risk factors for compensated occupational injuries and diseases in agriculture. The study population consisted of 78,679 Finnish farmers, spouses, and salaried family members covered by mandatory workers' compensation insurance. This population had a total of 24,424 occupational injuries and 1684 diseases from 2000 to 2004. In the 5-year period, 20.2% of the population had (one or more) injuries and 2.0% had occupational diseases. Multiple claims were common particularly among livestock producers. Using Poisson regression analyses, we identified several personal and farm-related risk factors, with relative risk estimates ranging from 1.07 to 3.08 for injuries and from 1.45 to 3.01 for diseases. Cattle-intensive geographic regions, occupational health service membership, large farm size, and farming alone were identified as risk factors for both outcomes. Further, male gender, higher number of insurance years, and residing on the farm were among risk factors for injury. These risk factors identified from a large longitudinal data set can be considered for developing and targeting interventions for farmers at highest risk of occupational injury and disease.
McDonnell, Lisa K; Hume, Patria A; Nolte, Volker
Rib stress fractures (RSFs) can have serious effects on rowing training and performance and accordingly represent an important topic for sports medicine practitioners. Therefore, the aim of this review is to outline the definition, epidemiology, mechanisms, intrinsic and extrinsic risk factors, injury management and injury prevention strategies for RSF in rowers. To this end, nine relevant books, 140 journal articles, the proceedings of five conferences and two unpublished presentations were reviewed after searches of electronic databases using the keywords 'rowing', 'rib', 'stress fracture', 'injury', 'mechanics' and 'kinetics'. The review showed that RSF is an incomplete fracture occurring from an imbalance between the rate of bone resorption and the rate of bone formation. RSF occurs in 8.1-16.4% of elite rowers, 2% of university rowers and 1% of junior elite rowers. Approximately 86% of rowing RSF cases with known locations occur in ribs four to eight, mostly along the anterolateral/lateral rib cage. Elite rowers are more likely to experience RSF than nonelite rowers. Injury occurrence is equal among sweep rowers and scullers, but the regional location of the injury differs. The mechanism of injury is multifactorial with numerous intrinsic and extrinsic risk factors contributing. Posterior-directed resultant forces arising from the forward directed force vector through the arms to the oar handle in combination with the force vector induced by the scapula retractors during mid-drive, or repetitive stress from the external obliques and rectus abdominis in the 'finish' position, may be responsible for RSF. Joint hypomobility, vertebral malalignment or low bone mineral density may be associated with RSF. Case studies have shown increased risk associated with amenorrhoea, low bone density or poor technique, in combination with increases in training volume. Training volume alone may have less effect on injury than other factors. Large differences in seat and handle
Togan, Turhan; Azap, Ozlem Kurt; Durukan, Elif; Arslan, Hande
Background: Urinary tract infections (UTIs) are important causes of morbidity and mortality in patients with spinal cord injury and 22% of patients with acute spinal cord injury develop UTI during the first 50 days. Objectives: The aim of this study was to determine the prevalence, etiologic agents and risk factors for asymptomatic bacteriuria and symptomatic urinary tract infections in patients with spinal cord injury. Patients and Methods: This was a prospective investigation of spinal cord injury patients with asymptomatic bacteriuria and symptomatic urinary tract infections in Baskent University Medical Faculty Ayas Rehabilitation Center and Ankara Physical Therapy and Rehabilitation Center between January 2008 and December 2010. The demographic status, clinical and laboratory findings of 93 patients with spinal cord injury were analyzed in order to determine the risk factors for asymptomatic or symptomatic bacteriuria Results: Sixty three (67.7%) of 93 patients had asymptomatic bacteriuria and 21 (22.6%) had symptomatic urinary tract infection. Assessment of the frequency of urinary bladder emptying methods revealed that 57 (61.3%) of 93 patients employed permanent catheters and 24 (25.8%) employed clean intermittent catheterization. One hundred and thirty-five (48.0%) of 281 strains isolated form asymptomatic bacteriuria attacks and 16 (66.6%) of 24 strains isolated from symptomatic urinary tract infection attacks, totaling 151 strains, had multidrug resistance (P > 0.05). One hundred (70.4%) of 142 Escherichia coli strains and 19 (34.5%) of 55 Klebsiella spp strains proliferated in patients with asymptomatic bacteriuria; 8 (80%) of 10 E. coli strains and 4 (80%) of 5 Klebsiella spp. strains were multidrug resistant. Conclusions: The most common infectious episode among spinal cord injury patients was found to be urinary tract ınfection. E. coli was the most common microorganism isolated from urine samples. Antibiotic use in the previous 2 weeks or 3 months
Inpatient falls are the most common adverse events that occur in a hospital, and about 3 to 10% of falls result in serious injuries such as bone fractures and intracranial haemorrhages. We previously reported that bone fractures and intracranial haemorrhages were two major fall-related injuries and that risk assessment score for osteoporotic bone fracture was significantly associated not only with bone fractures after falls but also with intracranial haemorrhage after falls. Based on the results, we tried to establish a risk assessment tool for predicting fall-related severe injuries in a hospital. Possible risk factors related to fall-related serious injuries were extracted from data on inpatients that were admitted to a tertiary-care university hospital by using multivariate Cox' s regression analysis and multiple logistic regression analysis. We found that fall risk score and fracture risk score were the two significant factors, and we constructed models to predict fall-related severe injuries incorporating these factors. When the prediction model was applied to another independent dataset, the constructed model could detect patients with fall-related severe injuries efficiently. The new assessment system could identify patients prone to severe injuries after falls in a reproducible fashion.
Fletcher, Paula C; Hirdes, John P
Using data from the Survey on Ageing and Independence (SAI), risk factors for unintentional injuries occurring within the homes of individuals older than 65 are identified. For the SAI, conducted by Statistics Canada in 1991, data were collected on a representative sample of approximately 20,000 individuals between ages 45 and 102. For each household contacted, one individual older than 45 was interviewed via the telephone. For the present analysis, only individuals older than 65 (n = 10,059) were used. Approximately 5% of senior citizens experienced an injury that limited their activity for at least 1 day. Using logistic regression, the following risk factors for injury were identified: education, alcohol consumption, smoking, rest and sleep patterns, support, and interactions between age and gender, activity limitations and age, and home maintenance and gender. The present findings are important to the body of research concerning injuries among older adults. The results expand current univariate analysis of data identifying risk factors for injuries within the literature and provide comprehensive information pertaining to risk factors for accidental injuries at the multivariate level. Identification of risk factors provides health care professionals, particularly front line nurses, with insight into factors that, if modified, have the potential to decrease accidental injuries and improve or maintain quality of life.
Pollack, E S; Franklin, G M; Fulton-Kehoe, D; Chowdhury, R
This study attempts to determine whether a diagnosis of substance abuse among construction laborers is associated with an increased risk of work-related injuries. Records for construction laborers in Washington State who were covered by health insurance through the local union were matched against workers' compensation records in the Washington State Department of Labor and Industries. Using the health insurance records, we identified those who had a diagnosis of substance abuse during the two-year period 1990-1991. Using the workers' compensation records, we were then able to compare injury rates for those with substance abuse diagnoses with the rates for those without such diagnoses. The total cohort consisted of 7,895 laborers. Among the 422 who had a substance abuse diagnosis, the rate of time-loss injuries per 100 full-time equivalent workers was 15.1, compared with 10.9 among the remainder of the cohort. Most of the difference appeared in the 25-34-year age group, in which the rate of injury per 100 full-time equivalent workers was 23.6 for substance abusers, compared with a rate of 12.2 for non-substance abusers, for a statistically significant relative risk of 1.93. The study suggests that younger workers might be an appropriate target for interventions aimed at reducing the level of substance abuse as a way of preventing injuries on the job. Studies by others have indicated some degree of success in this direction through the use of employee assistance programs in which the worker is referred to specific programs or providers for treatment. The state legislature in Washington has recently passed legislation providing incentives for the use of employee assistance programs. More effort is needed, however, to evaluate the effectiveness of such programs.
Burnett, Roger; Carter, Jarrod; Roberts, Verne; Myers, Barry
The determination of the optimum seatback characteristics for the mitigation of serious and catastrophic neck injury during high-speed rear-end collisions remains a topic of continued investigation. Despite a number of prior research efforts, both field data and sled test studies have yet to define a single optimal seatback performance criterion. Further, recent developments in seatbacks have introduced new designs into the field that have not been compared to more traditional designs. Analysis of NASS data from 1980 to 1999 demonstrated that at changes in velocity (DeltaV) above 40 kph, rear-end collisions have a dramatically lower risk for catastrophic injury than frontal, near-side or far-side impacts. Unfortunately, owing to the small penetration of newer seatback designs in the automotive fleet, it is not possible to examine the influence of seatback design parameters on serious neck injury using these data alone. Accordingly, seven rear impact HYGE sled tests were conducted using a wide range of seat designs. Upper and lower neck load cells were used to measure neck forces and moments in restrained 50th male Hybrid III anthropomorphic test devices (ATD). Additionally, the neck injury criteria (Nij) was computed. Unlike prior studies that have examined the standard seated ATD or the dramatically out-of-position ATD, these tests were conducted using an ATD seated in non-standard but typical driving position. The results of this study indicate that several descriptions of seatback behavior, such as quasi-static ultimate force are poor predictors of ATD neck loading. It also suggests that, for the severe crash studied, an optimum range of seatback stiffness exists, which appears to be in the mid-range of seatback stiffnesses available in current production vehicles. These data continue to illustrate the complex relationship of seatback design parameters to neck injury risk.
Vincent, Andrea S; Roebuck-Spencer, Tresa M; Cernich, Alison
Traumatic brain injury (TBI) is recognized as an important risk factor for the long-term cognitive health of military personnel, particularly in light of growing evidence that TBI increases risk for Alzheimer's disease and other dementias. In this article, we review the neurocognitive and neuropathologic changes after TBI with particular focus on the potential risk for cognitive decline across the life span in military service members. Implications for monitoring and surveillance of cognition in the aging military population are discussed. Additional studies are needed to clarify the factors that increase risk for later life cognitive decline, define the mechanistic link between these factors and dementia, and provide empirically supported interventions to mitigate the impact of TBI on cognition across the life span.
Sharma, Richa; Rosenberg, Alexandra; Bennett, Ellen R.; Laskowitz, Daniel T.; Acheson, Shawn K.
Mild traumatic brain injury (TBI) accounts for the vast majority of the nearly two million brain injuries suffered in the United States each year. Mild TBI is commonly classified as complicated (radiographic evidence of intracranial injury) or uncomplicated (radiographically negative). Such a distinction is important because it helps to determine the need for further neuroimaging, potential admission, or neurosurgical intervention. Unfortunately, imaging modalities such as computed tomography (CT) and magnetic resonance imaging (MRI) are costly and not without some risk. The purpose of this study was to screen 87 serum biomarkers to identify a select panel of biomarkers that would predict the presence of intracranial injury as determined by initial brain CT. Serum was collected from 110 patients who sustained a mild TBI within 24 hours of blood draw. Two models were created. In the broad inclusive model, 72kDa type IV collagenase (MMP-2), C-reactive protein (CRP), creatine kinase B type (CKBB), fatty acid binding protein—heart (hFABP), granulocyte-macrophage colony-stimulating factor (GM-CSF) and malondialdehyde modified low density lipoprotein (MDA-LDL) significantly predicted injury visualized on CT, yielding an overall c-statistic of 0.975 and a negative predictive value (NPV) of 98.6. In the parsimonious model, MMP-2, CRP, and CKBB type significantly predicted injury visualized on CT, yielding an overall c-statistic of 0.964 and a negative predictive value (NPV) of 97.2. These results suggest that a serum based biomarker panel can accurately differentiate patients with complicated mild TBI from those with uncomplicated mild TBI. Such a panel could be useful to guide early triage decisions, including the need for further evaluation or admission, especially in those environments in which resources are limited. PMID:28355230
Background The rapidly increasing number of activity-induced musculoskeletal injuries among adolescents and young adults is currently a true public health burden. The objective of this study was to investigate whether a neuromuscular training programme with injury prevention counselling is effective in preventing acute musculoskeletal injuries in young men during military service. Methods The trial design was a population-based, randomised study. Two successive cohorts of male conscripts in four companies of one brigade in the Finnish Defence Forces were first followed prospectively for one 6-month term to determine the baseline incidence of injury. After this period, two new successive cohorts in the same four companies were randomised into two groups and followed prospectively for 6 months. Military service is compulsory for about 90% of 19-year-old Finnish men annually, who comprised the cohort in this study. This randomised, controlled trial included 968 conscripts comprising 501 conscripts in the intervention group and 467 conscripts in the control group. A neuromuscular training programme was used to enhance conscripts' motor skills and body control, and an educational injury prevention programme was used to increase knowledge and awareness of acute musculoskeletal injuries. The main outcome measures were acute injuries of the lower and upper limbs. Results In the intervention groups, the risk for acute ankle injury decreased significantly compared to control groups (adjusted hazards ratio (HR) = 0.34, 95% confidence interval (95% CI) = 0.15 to 0.78, P = 0.011). This risk decline was observed in conscripts with low as well as moderate to high baseline fitness levels. In the latter group of conscripts, the risk of upper-extremity injuries also decreased significantly (adjusted HR = 0.37, 95% CI 0.14 to 0.99, P = 0.047). In addition, the intervention groups tended to have less time loss due to injuries (adjusted HR = 0.55, 95% CI 0.29 to 1.04). Conclusions A
Kapoor, V. K.
Tuberculosis has staged a global comeback and forms a dangerous combination with AIDS. The abdomen is one of the common sites of extrapulmonary involvement. Patients with abdominal tuberculosis have a wide range and spectrum of symptoms and signs; the disease is therefore a great mimic. Diagnosis, mainly radiological and supported by endoscopy, is difficult to make and laparotomy is required in a large number of patient. Management involves judicious combination of antitubercular therapy and surgery which may be required to treat complications such as intestinal obstruction and perforation. The disease, though potentially curable, carries a significant morbidity and mortality. Images Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Figure 9 Figure 10 Figure 11 Figure 12 Figure 13 PMID:9926119
Background Literature shows that not only are traffic injuries due to accidents, but that there is also a correlation between different chronic conditions, the consumption of certain types of drugs, the intake of psychoactive substances and the self perception of risk (Health Belief Model) and the impact/incidence of traffic accidents. There are few studies on these aspects in primary health care. The objectives of our study are: Main aim: To outline the distribution of risk factors associated with Road Traffic Injuries (RTI) in a driving population assigned to a group of primary health care centres in Barcelona province. Secondly, we aim to study the distribution of diverse risk factors related to the possibility of suffering an RTI according to age, sex and population groups, to assess the relationship between these same risk factors and self risk perception for suffering an RTI, and to outline the association between the number of risk factors and the history of reported collisions. Methods/Design Design: Cross-sectional, multicentre study. Setting: 25 urban health care centres. Study population: Randomly selected sample of Spanish/Catalan speakers age 16 or above with a medical register in any of the 25 participating primary health care centres. N = 1540. Unit of study: Basic unit of care, consisting of a general practitioner and a nurse, both of whom caring for the same population (1,500 to 2,000 people per unit). Instruments of measurement: Data collection will be performed using a survey carried out by health professionals, who will use the clinical registers and the information reported by the patient during the visit to collect the baseline data: illnesses, medication intake, alcohol and psychoactive consumption, and self perception of risk. Discussion We expect to obtain a risk profile of the subjects in relation to RTI in the primary health care field, and to create a group for a prospective follow-up. Trial Registration Clinical Trials.gov Identifier
USAARL Report No. 96-05 Injury Risk for Research Subjects With Spina Bifida Occulta in a Repeated Impact Study: A Case Review By John P. Albano...TITLE (Include Security Classification) Injury risk for research subjects with spina bifida occulta in a repeated impact study: A case review 12...block number) FIELD GROUP SUB-GROUP repeated impact, spina bifida occulta, axial loading 19. ABSTRACT (Continue on reverse if necessary and identify by
[Differential surgical treatment of victims with damage to the small and large intestines in a closed abdominal injury combined, depending on the prediction of traumatic disease course and morphological changes of the intestinal wall].
Zaruts'kyĭ, Ia L; Denysenko, V M; Khomenko, I P; Levkivskyĭ, R H
Use of differentiated surgical approach to the management of surgical treatment, depending on the degree of violation of systemic hemodynamics, the timing and volume of surgical procedures, depending on the prognosis of traumatic disease course of cardiac index, interventions in the small and large intestine depending on morphological changes of the intestinal wall by cardiac and stroke indexes, put method extra-enteric anastomosis in patients with damage to the small intestine and colon combined with closed abdominal injury permitted to reduce the rate of postoperative complications from 22.2 to 10.1%, mortality at 2.1 times in shock period (from 19.3 to 9.2%) and the overall mortality from 33.3 to 21.1%.
Li, Guibing; Lyons, Mathew; Wang, Bingyu; Yang, Jikuang; Otte, Dietmar; Simms, Ciaran
Quantified relationships between passenger car front shape and pedestrian injury risk derived from accident data are sparse, especially considering the significant recent changes in car front design. The purpose of this paper is therefore to investigate the detailed effects of passenger car front shape on injury risk to a pedestrian's head, thorax, pelvis and leg in the event of a vehicle pedestrian impact. Firstly, an accident sample of 594 pedestrian cases captured during 2000-2015 from the German In-Depth Accident Study (GIDAS) database was employed. Multicollinearity diagnostic statistics were then used to detect multicollinearity between the predictors. Following this, logistic regression was applied to quantify the effects of passenger car front shape on injury risks while controlling for impact speed and pedestrian age. Results indicate that the bumper lower depth (BLD), bumper lower height (BLH), bumper upper height (BUH) and normalised bumper lower/upper height (NBLH/NBUH) are statistically significant for AIS2+ leg injury risk. The normalised bonnet leading edge height (NBLEH) has a statistically significant influence on AIS2+ femur/pelvis injury occurrence. The passenger car front shape did not show statistical significance for AIS3+ thorax and head injuries. The impact speed and pedestrian age are generally significant factors influencing AIS2+ leg and pelvis injuries, and AIS3+ thorax and head injuries. However, when head impacts are fixed on the central windscreen region both pedestrian age and impact speed are not statistically significant for AIS3+ head injury. For quantified effects, when controlling for speed, age and BUH, an average 7% and 6% increase in AIS2+ leg injury odds was observed for every 1cm increase in BLD and BLH respectively; 1cm increase in BUH results in a 7% decrease in AIS2+ leg injury odds when the BLD or BLH are fixed respectively (again controlling for impact speed and pedestrian age); the average AIS2+ femur/pelvis injury
The relationship of breakfast skipping and type of breakfast consumed with overweight/obesity, abdominal obesity, other cardiometabolic risk factors and the metabolic syndrome in young adults. NHANES 1999-2006
The goal of this study was to examine the association between breakfast skipping and type of breakfast consumed with overweight /obesity, abdominal obesity, other cardiometabolic risk factors and the metabolic syndrome. Three breakfast groups were identified (breakfast skippers, ready-to-eat-cereal ...
Kim, Sunwook; Nussbaum, Maury A; Jia, Bochen
New technology designed to increase productivity in residential construction may exacerbate the risk of work-related musculoskeletal disorders (WMSDs) among residential construction workers. Of interest here are panelised (prefabricated) wall systems (or panels) and facilitating an ongoing effort to provide proactive control of ergonomic exposures and risks among workers using panels. This study, which included 24 participants, estimated WMSD risks using five methods during common panel erection tasks and the influences of panel mass (sheathed vs. unsheathed) and size (wall length). WMSD risks were fairly high overall; e.g. 34% and 77% of trials exceeded the 'action limits' for spinal compressive and shear forces, respectively. Heavier (sheathed) panels significantly increased risks, although the magnitude of this effect differed with panel size and between tasks. Higher levels of risk were found in tasks originating from ground vs. knuckle height. Several practical recommendations based on the results are discussed. STATEMENT OF RELEVANCE: Panelised wall systems have the potential to increase productivity in residential construction, but may result in increased worker injury risks. Results from this study can be used to generate future panel design and construction processes that can proactively address WMSD risks.
Probst, Pascal; Haller, Sebastian; Dörr-Harim, Colette; Bruckner, Thomas; Ulrich, Alexis; Hackert, Thilo; Diener, Markus K
Background The influence of patients’ preoperative nutritional status on their clinical outcome has already been proven. Therefore, patients with malnutrition are in need of additional therapeutic efforts. However, for pancreatic surgery, evidence suggesting the adequacy of existing nutritional assessment scores to estimate malnutrition associated with postoperative outcome is limited. Objective The aim of the observational trial “Nutritional Risk in Major Abdominal Surgery (NURIMAS) Pancreas” is to prospectively assess and analyze different nutritional assessment scores for their prognostic value on postoperative complications in patients undergoing pancreatic surgery. Methods All patients scheduled to receive elective pancreatic surgery at the University Hospital of Heidelberg will be screened for eligibility. Preoperatively, 12 nutritional assessment scores will be collected and patients will be assigned either at risk or not at risk for malnutrition. The postoperative course will be followed prospectively and complications according to the Clavien-Dindo classification will be recorded. The prognostic value for complications will be evaluated for every score in a univariable and multivariable analysis corrected for known risk factors in pancreatic surgery. Results Final data analysis is expected to be available during Spring 2016. Conclusions The NURIMAS Pancreas trial is a monocentric, prospective, observational trial aiming to find the most predictive clinical nutritional assessment score for postoperative complications. Using the results of this protocol as a knowledge base, it is possible to conduct nutritional risk-guided intervention trials to prevent postoperative complications in the pancreatic surgical population. Trial Registration germanctr.de: DRKS00006340; https://drks-neu.uniklinik-freiburg.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00006340 (Archived by WebCite at http://www.webcitation.org/6bzXWSRYZ) PMID:26573991
Boffano, Paolo; Roccia, Fabio; Gallesio, Cesare; Karagozoglu, K.; Forouzanfar, Tymour
The aim of the study was to investigate the incidence of the inferior alveolar nerve (IAN) injury in mandibular fractures. This study is based on two databases that have continuously recorded patients hospitalized with maxillofacial fractures in two departments—Department of Maxillofacial Surgery, Vrije Universiteit University Medical Center, Amsterdam, the Netherlands, and Division of Maxillofacial Surgery, San Giovanni Battista Hospital, Turin, Italy. Demographic, anatomic, and etiology variables were considered for each patient and statistically assessed in relation to the neurosensory IAN impairment. Statistically significant associations were found between IAN injury and fracture displacement (p = 0.03), isolated mandibular fractures (p = 0.01), and angle fractures (p = 0.004). A statistically significant association was also found between IAN injury and assaults (p = 0.03). Displaced isolated mandibular angle fractures could be considered at risk for increased incidence of IAN injury. Assaults seem to be the most important etiological factor that is responsible for IAN lesions. PMID:25383147
Lee, Y-J; Chang, C-C; Chan, J P-W; Hsu, W-L; Lin, K-W; Wong, M-L
A retrospective case-series study evaluated the prognosis of 853 dogs with acute kidney injury (AKI) based on the RIFLE (Risk, Injury, Failure, Loss and End-stage renal failure) criteria, derived from human medicine. The 30-day mortality of dogs with AKI in each class was found to be 23.8 per cent (40 of 168) dogs for Risk, 41.0 per cent (107 of 261) dogs for Injury and 78.5 per cent (333 of 424) dogs for Failure. Using the dogs in the Risk class as the reference, the mortality of dogs in either the Injury or Failure class was significantly higher than that of dogs in the Risk class (P<0.05). The longest median survival time was observed in the Risk class (nine days) and the shortest median survival time was observed in the Failure class (three days). Using a multiple logistic regression model, a new score that simultaneously considered RIFLE class, diarrhoea status and serum phosphorus level was calculated to predict prognosis. Evaluation using the area under the receiver-operating characteristic curve (AUROC) indicated that the new scoring method (AUROC 0.80) was a better prognostic indicator than using RIFLE criteria alone (AUROC 0.73).
Grant, John A.; Bedi, Asheesh; Kurz, Jennifer; Bancroft, Richard; Gagnier, Joel J.; Miller, Bruce S.
Background: Injuries in collegiate ice hockey can result in significant time lost from play. The identification of modifiable risk factors relating to a player’s physical fitness allows the development of focused training and injury prevention programs targeted at reducing these risks. Purpose: To determine the ability of preseason fitness outcomes to predict in-season on-ice injury in male collegiate ice hockey players. Study Design: Prognostic cohort study. Level of Evidence: Level 3. Methods: Athlete demographics, percentage body fat, aerobic capacity (300-m shuttle run; 1-, 1.5-, 5-mile run), and strength assessment (sit-ups, push-ups, grip strength, bench press, Olympic cleans, squats) data were collected at the beginning of 8 successive seasons for 1 male collegiate ice hockey team. Hockey-related injury data and player-level practice/game athlete exposure (AE) data were also prospectively collected. Seventy-nine players participated (203 player-years). Injury was defined as any event that resulted in the athlete being unable to participate in 1 or more practices or games following the event. Multivariable logistic regression was performed to determine the ability of the independent variables to predict the occurrence of on-ice injury. Results: There were 132 injuries (mean, 16.5 per year) in 55 athletes. The overall injury rate was 4.4 injuries per 1000 AEs. Forwards suffered 68% of the injuries. Seventy percent of injuries occurred during games with equal distribution between the 3 periods. The mean number of days lost due to injury was 7.8 ± 13.8 (range, 1-127 days). The most common mechanism of injury was contact with another player (54%). The odds of injury in a forward was 1.9 times (95% CI, 1.1-3.4) that of a defenseman and 3 times (95% CI, 1.2-7.7) that of a goalie. The odds of injury if the player’s body mass index (BMI) was ≥25 kg/m2 was 2.1 times (95% CI, 1.1-3.8) that of a player with a BMI <25 kg/m2. The odds ratios for bench press
Williams, S; Trewartha, G; Kemp, S P T; Michell, R; Stokes, K A
This prospective cohort study investigated the influence of an artificial playing surface on injury risk and perceptions of muscle soreness in elite English Premiership Rugby Union players. Time loss (from 39.5 matches) and abrasion (from 27 matches) injury risk was compared between matches played on artificial turf and natural grass. Muscle soreness was reported over the 4 days following one match played on each surface by 95 visiting players (i.e., normally play on natural grass surfaces). There was a likely trivial difference in the overall injury burden relating to time-loss injuries between playing surfaces [rate ratio = 1.01, 90% confidence interval (CI): 0.73-1.38]. Abrasions were substantially more common on artificial turf (rate ratio = 7.92, 90% CI: 4.39-14.28), although the majority of these were minor and only two resulted in any reported time loss. Muscle soreness was consistently higher over the 4 days following a match on artificial turf in comparison with natural grass, although the magnitude of this effect was small (effect sizes ranging from 0.26 to 0.40). These results suggest that overall injury risk is similar for the two playing surfaces, but further surveillance is required before inferences regarding specific injury diagnoses and smaller differences in overall injury risk can be made.
Lu, Ren-Jie; Zhang, Yan; Tang, Feng-Lei; Zheng, Zhong-Wei; Fan, Zheng-Da; Zhu, Shan-Mei; Qian, Xian-Feng; Liu, Na-Na
Drug-induced liver injury (DILI) is often undiagnosed or misdiagnosed clinically because of diagnostic difficulties caused by lack of laboratory-specific serological markers. In this study, we comprehensively assessed the clinical characteristics, laboratory indices, hepatotoxic drugs, risk factors and outcomes concerning DILI, and explored the similarities in mechanisms between Chinese and Western drug-induced DILI. Patients with a first diagnosis of DILI and a Roussel Uclaf Causality Assessment Method (RUCAM) score >3 points were enrolled for systematic retrospective study. Their clinical characteristics, clinical classification, risk factors, laboratory indices, hepatotoxic drugs and outcomes were analyzed. Cholestatic patients had the highest alkaline phosphatase (ALP) and prothrombin time activity (PTA) levels (P<0.05). Patients with medication time ≥30 days had significantly higher positive rate of autoantibodies than those with medication time <30 days. Odds ratio values for DILI-related factors such as hepatobiliary diseases, immune dysfunction, diabetes, hypertension, chronic alcohol consumption and age ≥45 years were 6.552, 6.130, 3.774, 2.801, 2.002 and 1.838, respectively. Pathogeneses of Chinese and Western drug-induced DILI may be substantially the same. DILI accompanied with autoantibody positivity may indicate severe liver injury outcome. Hepatobiliary diseases, diabetes and hypertension are likely to increase drug susceptibility, and more prone to cause liver injury.
Bossuyt, F M; García-Pinillos, F; Raja Azidin, R M F; Vanrenterghem, J; Robinson, M A
This study investigated the utility of a 5-min high-intensity exercise protocol (SAFT(5)) to include in prospective cohort studies investigating ACL injury risk. 15 active females were tested on 2 occasions during which their non-dominant leg was analysed before SAFT(5) (PRE), immediately after (POST0), 15 min after (POST15), and 30 min after (POST30). On the first occasion, testing included 5 maximum isokinetic contractions for eccentric and concentric hamstring and concentric quadriceps and on the second occasion, 3 trials of 2 landing tasks (i. e., single-leg hop and drop vertical jump) were conducted. Results showed a reduced eccentric hamstring peak torque at POST0, POST15 and POST30 (p<0.05) and a reduced functional HQ ratio (Hecc/Qcon) at POST15 and POST30 (p<0.05). Additionally, a more extended knee angle at POST30 (p<0.05) and increased knee internal rotation angle at POST0 and POST15 (p<0.05) were found in a single-leg hop. SAFT(5) altered landing strategies associated with increased ACL injury risk and similar to observations from match simulations. Our findings therefore support the utility of a high-intensity exercise protocol such as SAFT(5) to strengthen injury screening tests and to include in prospective cohort studies where time constraints apply.
Sugimoto, Jonathan D; Labrique, Alain B; Ahmad, Salahuddin; Rashid, Mahbubur; Shamim, Abu Ahmed; Ullah, Barkat; Klemm, Rolf D W; Christian, Parul; West, Keith P
The epidemiology of tornado-related disasters in the developing world is poorly understood. An August 2005 post-tornado cohort study in rural Bangladesh identified elevated levels of death and injury among the elderly (≥ 60 years of age) (adjusted odds ratio (AOR) = 8.9 (95 per cent confidence interval (CI): 3.9-20.2) and AOR = 1.6 (95 per cent CI: 1.4-1.8), respectively), as compared to 15-24 year-olds, and among those outdoors versus indoors during the tornado (AOR = 10.4 (95 per cent CI: 5.5-19.9) and AOR = 6.6 (95 per cent CI: 5.8-7.5), respectively). Females were 1.24 times (95 per cent CI: 1.15-1.33) more likely to be injured than males. Elevated risk of injury was significantly associated with structural damage to the house and tin construction materials. Seeking treatment was protective against death among the injured, odds ratio = 0.08 (95 per cent CI: 0.03-0.21). Further research is needed to develop injury prevention strategies and to address disparities in risk between age groups and between men and women.
Lu, Ren-Jie; Zhang, Yan; Tang, Feng-Lei; Zheng, Zhong-Wei; Fan, Zheng-Da; Zhu, Shan-Mei; Qian, Xian-Feng; Liu, Na-Na
Drug-induced liver injury (DILI) is often undiagnosed or misdiagnosed clinically because of diagnostic difficulties caused by lack of laboratory-specific serological markers. In this study, we comprehensively assessed the clinical characteristics, laboratory indices, hepatotoxic drugs, risk factors and outcomes concerning DILI, and explored the similarities in mechanisms between Chinese and Western drug-induced DILI. Patients with a first diagnosis of DILI and a Roussel Uclaf Causality Assessment Method (RUCAM) score >3 points were enrolled for systematic retrospective study. Their clinical characteristics, clinical classification, risk factors, laboratory indices, hepatotoxic drugs and outcomes were analyzed. Cholestatic patients had the highest alkaline phosphatase (ALP) and prothrombin time activity (PTA) levels (P<0.05). Patients with medication time ≥30 days had significantly higher positive rate of autoantibodies than those with medication time <30 days. Odds ratio values for DILI-related factors such as hepatobiliary diseases, immune dysfunction, diabetes, hypertension, chronic alcohol consumption and age ≥45 years were 6.552, 6.130, 3.774, 2.801, 2.002 and 1.838, respectively. Pathogeneses of Chinese and Western drug-induced DILI may be substantially the same. DILI accompanied with autoantibody positivity may indicate severe liver injury outcome. Hepatobiliary diseases, diabetes and hypertension are likely to increase drug susceptibility, and more prone to cause liver injury. PMID:27703513
Prasad, Priya; Dalmotas, Dainius; Chouinard, Aline
Light duty vehicles in the US are designed to meet and exceed regulatory standards, self-imposed industry agreements and safety rating tests conducted by NHTSA and IIHS. The evolution of side impact regulation in the US from 1973 to 2015 is discussed in the paper along with two key industry agreements in 2003 affecting design of restraint systems and structures for side impact protection. A combination of all the above influences shows that vehicles in the US are being designed to more demanding and comprehensive requirements than in any other region of the world. The crash environment in the US related to side impacts was defined based on data in the nationally representative crash database NASS. Crash environment factors, including the distribution of cars, light trucks and vans (LTV's), and medium-to-heavy vehicles (MHV's) in the fleet, and the frequency of their interactions with one another in side impacts, were considered. Other factors like, crash severity in terms of closing velocity between two vehicles involved in crash, gender and age of involved drivers in two-vehicle and single vehicle crashes, were also examined. Injury risks in side impacts to drivers and passengers were determined in various circumstances such as near-side, far-side, and single vehicle crashes as a function of crash severity, in terms of estimated closing speed or lateral delta-V. Also injury risks in different pairs of striking and struck cars and LTV's, were estimated. A logistic regression model for studying injury risks in two vehicle crashes was developed. The risk factors included in the model include case and striking vehicles, consisting of cars, SUV's, vans, and pickup trucks, delta-V, damage extent, occupant proximity to the impact side, age and gender of the occupant, and belt use. Results show that car occupants make up the vast majority of serious-to-fatally injured occupants. Injury rates of car occupants in two-vehicle collision are highest when the car is struck by a
Sangster, Guillermo P.; Previgliano, Carlos H.; Nader, Mathieu; Chwoschtschinsky, Elisa; Heldmann, Maureen G.
Hepatic cirrhosis is the clinical and pathologic result of a multifactorial chronic liver injury. It is well known that cirrhosis is the origin of multiple extrahepatic abdominal complications and a markedly increased risk of hepatocellular carcinoma (HCC). This tumor is the sixth most common malignancy worldwide and the third most common cause of cancer related death. With the rising incidence of HCC worldwide, awareness of the evolution of cirrhotic nodules into malignancy is critical for an early detection and treatment. Adequate imaging protocol selection with dynamic multiphase Multidetector Computed Tomography (MDCT) and reformatted images is crucial to differentiate and categorize the hepatic nodular dysplasia. Knowledge of the typical and less common extrahepatic abdominal manifestations is essential for accurately assessing patients with known or suspected hepatic disease. The objective of this paper is to illustrate the imaging spectrum of intra- and extrahepatic abdominal manifestations of hepatic cirrhosis seen on MDCT. PMID:23986608
Poulos, Roslyn G; Hayen, Andrew; Chong, Shanley S S; Finch, Caroline F
Burns are a significant cause of morbidity and mortality in children. Although industrialized countries have achieved significant declines in deaths and hospitalizations for these injuries in recent decades, the benefits have not been shared equally by children across all socioeconomic groups. We used Bayesian methods to map posterior expected relative risks, as an estimate of smoothed hospital separation ratios for fire and burns in children, across local government areas in New South Wales, Australia. The geographic pattern of relative risk varied by age group; higher than average risks were observed for children residing in rural and remote areas, as well as in scattered local government areas closer to the coast and in some metropolitan regions. Mapping the occurrence of injury gives injury practitioners the opportunity to identify high risk communities for further investigation of risk factors and implementation of targeted interventions within a defined area.
Esparaz, Anthony M.; Pearl, Jeffrey A.; Herts, Brian R.; LeBlanc, Justin; Kapoor, Baljendra
Iatrogenic injury to the urinary tract, including the kidneys, ureters, bladder, and urethra, is a potential complication of surgical procedures performed in or around the retroperitoneal abdominal space or pelvis. While both diagnostic and interventional radiologists often play a central and decisive role in the identification and initial management of a variety of iatrogenic injuries, discussions of these injuries are often directed toward specialists such as urologists, obstetricians, gynecologists, and general surgeons whose procedures are most often implicated in iatrogenic urinary tract injuries. Interventional radiologic procedures can also be a source of an iatrogenic urinary tract injury. This review describes the clinical presentation, risk factors, imaging findings, and management of iatrogenic renal vascular and urinary tract injuries, as well as the radiologist's role in the diagnosis, treatment, and cause of these injuries. PMID:26038626
Turner, Cathy; McClure, Rod
This study was designed to quantify the increased risk of road crash-related injury, which can be attributed to risk-taking behaviour. A case-control study was conducted to compare motor vehicle drivers (car and bike) who had been hospitalised for injuries following crashes with population-based controls. Cases were recruited prospectively over 12 months and controls were randomly selected from license holders (car and bike) living in the same geographical location as cases. A self-administered questionnaire was used to ascertain participants' driving behaviour, general risk-taking behaviour and selected demographic characteristics. After adjusting for demographic variables, number of years of driving and total distance driven per week, logistic regression analysis showed that a high risk acceptance was associated with an eight-fold increased risk of having a crash that resulted in serious injury (OR 7.8, 95% CI 4.2-15.8). The findings of this study support the suggestion that certain host factors increase the risk of crash-related serious injury. There would appear to be a reasonable argument for persisting with injury prevention programmes, which concentrate on host as well as environment risk factor reduction.
Brooks, Alison; Loud, Keith J; Brenner, Joel S; Demorest, Rebecca A; Halstead, Mark E; Kelly, Amanda K Weiss; Koutures, Chris G; LaBella, Cynthia R; LaBotz, Michele; Martin, Stephanie S; Moffatt, Kody
Ice hockey is an increasingly popular sport that allows intentional collision in the form of body checking for males but not for females. There is a two- to threefold increased risk of all injury, severe injury, and concussion related to body checking at all levels of boys' youth ice hockey. The American Academy of Pediatrics reinforces the importance of stringent enforcement of rules to protect player safety as well as educational interventions to decrease unsafe tactics. To promote ice hockey as a lifelong recreational pursuit for boys, the American Academy of Pediatrics recommends the expansion of nonchecking programs and the restriction of body checking to elite levels of boys' youth ice hockey, starting no earlier than 15 years of age.
Han, Seung Rim; Heo, Seon-Hee; Woo, Shin-Young; Park, Yang Jin; Kim, Dong Ik; Yang, Jeonghoon; Choi, Seung-Hyuk; Kim, Duk-Kyung
Purpose We aimed to see the frequency of concomitant ischemic heart disease (IHD) in Korean patients with abdominal aortic aneurysm (AAA) and to determine risk factors for an early postoperative acute myocardial infarction (PAMI) after elective open or endovascular AAA repair. Methods We retrospectively reviewed a database of patients who underwent elective AAA repair over the past 11 years. Patients were classified into 3 groups: control group; group I, medical IHD treatment; group II, invasive IHD treatment. Rates of PAMI and mortality at 30 days were compiled and compared between groups according to the type of AAA repair. Results Six hundred two elective repairs of infrarenal or juxtarenal AAAs were enrolled in this study. The patients were classified into control group (n = 398, 66.1%), group I (n = 73, 12.1%) and group II (n = 131, 21.8%). PAMI developed more frequently after open surgical repair (OSR) than after endovascular aneurysm repair (EVAR) (5.4% vs. 1.3%, P = 0.012). In OSR patients (n = 373), PAMI developed 2.1% in control group, 18.0% in group I and 7.1% in group II (P < 0.001). In EVAR group (n = 229), PAMI developed 0.6% in control group, 4.3% in group I and 2.2% in group II (P = 0.211). On the multivariable analysis of risk factors of PAMI, PAMI developed more frequently in patients with positive functional stress test. Conclusion The prevalence of concomitant IHD was 34% in Korean AAA patients. The risk of PAMI was significantly higher after OSR compared to EVAR and in patients with IHD compared to control group. Though we found some risk factors for PAMI, these were not applied to postoperative mortality rate. PMID:26942161
Anderson, C.; Agran, P.; Winn, D.; Tran, C.
Objectives—To determine the effects of neighborhood levels of poverty, household crowding, and acculturation on the rate of injury to Hispanic and non-Hispanic white children. Setting—Orange County, California. Methods—An ecologic study design was used with census block groups as the unit of analysis. Measures of neighborhood poverty, household crowding, and acculturation were specific to each ethnic group. Poisson regression was used to calculate mutually adjusted incidence rate ratios (IRRs) corresponding to a 20% difference in census variables. Results—Among non-Hispanic white children, injury rates were more closely associated with neighborhood levels of household crowding (adjusted IRR 2.36, 95% confidence interval (CI) 1.22 to 4.57) than with neighborhood poverty (adjusted IRR 1.06, 95% CI 0.89 to 1.26). For Hispanic children, the strongest risk factors were the proportion of Hispanic adults who spoke only some English (compared with the proportion who spoke little or no English, adjusted IRR 1.26, 95% CI 1.04 to 1.53) and the proportion who were US residents for <5 years (adjusted IRR 1.20, 95% CI 1.001 to 1.43). Neighborhood levels of household crowding were not related to injury among Hispanic children (adjusted IRR 0.98, 95% CI 0.89 to 1.08), but surprisingly, neighborhood poverty was associated with lower injury rates (adjusted IRR 0.89, 95% CI 0.81 to 0.97). Conclusions—Cultural and geographic transitions, as well as socioeconomic differences, appear to contribute to differences in childhood injury rates between ethnic groups. PMID:9595329
Lehance, C; Binet, J; Bury, T; Croisier, J L
Muscle strength and anaerobic power of the lower extremities are neuromuscular variables that influence performance in many sports activities, including soccer. Despite frequent contradictions in the literature, it may be assumed that muscle strength and balance play a key role in targeted acute muscle injuries. The purpose of the present study was to provide and compare pre-season muscular strength and power profiles in professional and junior elite soccer players throughout the developmental years of 15-21. One original aspect of our study was that isokinetic data were considered alongside the past history of injury in these players. Fifty-seven elite and junior elite male soccer players were assigned to three groups: PRO, n=19; U-21, n=20 and U-17, n=18. Players benefited from knee flexor and extensor isokinetic testing consisting of concentric and eccentric exercises. A context of lingering muscle disorder was defined using statistically selected cut-offs. Functional performance was evaluated throughout a squat jump and 10 m sprint. The PRO group ran faster and jumped higher than the U-17 group (P<0.05). No significant difference in isokinetic muscle strength performance was observed between the three groups when considering normalized body mass parameters. Individual isokinetic profiles enabled the identification of 32/57 (56%) subjects presenting lower limb muscular imbalance. Thirty-six out of 57 players were identified as having sustained a previous major lower limb injury. Of these 36 players, 23 still showed significant muscular imbalance (64%). New trends in rational training could focus more on the risk of imbalance and implement antagonist strengthening aimed at injury prevention. Such an intervention would benefit not only athletes recovering from injury, but also uninjured players. An interdisciplinary approach involving trainers, a physical coach, and medical staff would be of interest to consider in implementing a prevention programme.
Li, Chung-Hsien; Hsieh, Tsung-Cheng; Hsiao, Tsung-Hsien; Wang, Pin-Chao; Tseng, Tai-Chung; Lin, Hans Hsienhong; Wang, Chia-Chi
Gastroesophageal reflux disease (GERD) is diagnosed based on typical symptoms in clinical practice. It can be divided into two groups using endoscopy: erosive and nonerosive reflux disease (NERD). This study aims to determine the risk factors of reflux symptoms and mucosal injury. This was a two-step case-control study derived from a cohort of 998 individuals having the data of reflux disease questionnaire (RDQ) and endoscopic findings. Those with minor reflux symptoms were excluded. The first step compared symptomatic GERD patients with healthy controls. The 2(nd) step compared patients with erosive esophagitis with healthy controls. In this study, the prevalence of symptomatic GERD and erosive esophagitis were 163 (16.3%) and 166 (16.6%), respectively. A total of 507 asymptomatic individuals without mucosal injury of the esophagus on endoscopy were selected as healthy controls. Compared with healthy controls, multivariate analyses showed that symptomatic GERD patients had a higher prevalence of hypertriglyceridemia [odds ratio (OR), 1.83; 95% confidence interval (CI) 1.13-2.96] and obesity (OR, 1.85; 95% CI 1.08-3.02). By contrast, male sex (OR, 2.24; 95% CI 1.42-3.52), positive Campylo-like organism (CLO) test (OR, 0.56; 95% CI 0.37-0.84), and hiatus hernia (OR, 14.36; 95% CI 3.05-67.6) were associated with erosive esophagitis. In conclusion, obesity and hypertriglyceridemia were associated with reflux symptoms. By contrast, male sex, negative infection of Helicobacter pylori, and hiatus hernia were associated with mucosal injury. Our results suggested that risk factors of reflux symptoms or mucosal injury might be different in GERD patients. The underlying mechanism awaits further studies to clarify.
Cortes, Nelson; Porter, Larissa D; Ambegaonkar, Jatin P; Caswell, Shane V
Dancers have a lower incidence of anterior cruciate ligament (ACL) injury compared to athletes in sports that involve cutting and landing motions. Balance can impact ACL injury risk and is related to neuromuscular control during movement. The purpose of this study was to investigate whether balance differences exist among female dancers and female soccer and basketball athletes. Fifty-eight female dancers, soccer, and basketball athletes (16.5 ± 1.6 yrs, 1.6 ± 0.2 m, 60.2 ± 14.1 kg) completed the Stability Evaluation Test (SET) on the NeuroCom VSR Sport (NeuroCom International, Clackamas, OR) to measure sway velocity. Video records of the SET test were used for Balance Error Scoring System (BESS) test scoring. A oneway ANCOVA compared composite sway velocity and BESS scores among sports. There was no statistically significant difference for sway velocity or BESS among sports (sway velocity soccer 2.3 ± 0.4, dance 2.2 ± 0.4, and basketball 2.4 ± 0.4; BESS soccer 13.6 ± 5.0, dance 11.9 ± 5.5, and basketball 14.9 ± 5.1, p>0.05). Balance was similar among athletes participating in different sports (dance, basketball, and soccer). Quasi-static balance may not play a significant role in neuromuscular control during movement and not be a significant risk factor to explain the disparity in ACL injury incidence among sports. Future research should examine the effects of dynamic balance and limb asymmetries among sports to elucidate on the existing differences on ACL injury incidence rates.
Barber, R; Aragaki, C; Rivera-Chavez, F; Purdue, G; Hunt, J; Horton, J
Context: Sepsis, organ failure, and shock remain common among patients with moderate to severe burn injuries. The inability of clinical factors to identify at-risk patients suggests that genetic variation may influence the risk for serious infection and the outcome from severe injury. Objective: Resolution of genetic variants associated with severe sepsis following burn injury. Patients: A total of 159 patients with burns ⩾20% of their total body surface area or any smoke inhalation injury without significant non-burn related trauma (injury severity score (ISS)⩾16), traumatic or anoxic brain injury, or spinal cord injury and who survived more than 48 h post-admission. Methods: Candidate single nucleotide polymorphisms (SNPs) within bacterial recognition (TLR4 +896, CD14 –159) and inflammatory response (TNF-α –308, IL-1ß –31, IL-6 –174) loci were evaluated for association with increased risk for severe sepsis (sepsis plus organ dysfunction or septic shock) and mortality. Results: After adjustment for age, full-thickness burn size, ethnicity, and gender, carriage of the TLR4 +896 G-allele imparted at least a 1.8-fold increased risk of developing severe sepsis following a burn injury, relative to AA homozygotes (adjusted odds ratio (aOR) 6.4; 95% confidence interval (CI) 1.8 to 23.2). Carriage of the TNF-α –308 A-allele imparted a similarly increased risk, relative to GG homozygotes (aOR = 4.5; 95% CI 1.7 to 12.0). None of the SNPs examined were significantly associated with mortality. Conclusions: The TLR4 +896 and TNF-α –308 polymorphisms were significantly associated with an increased risk for severe sepsis following burn trauma. PMID:15520404
Krugner-Higby, Lisa; Luck, Melissa; Hartley, Deborah; Crispen, Heather M.; Lubach, Gabriele R.; Coe, Christopher L.
Several cases of abdominal pregnancy have been described in nonhuman primates. These previous occurrences have been mummified fetuses found in the abdominal cavity. This report describes a case of abdominal pregnancy in a timed-bred rhesus monkey with delivery of a live term infant. The mother died 14 days later from complications of septic peritonitis. At necropsy, the monkey had an intestinal adenocarcinoma that may have allowed leakage of intestinal contents into the abdomen. The second case of pregnancy complication was a rhesus monkey found to have gestational diabetes that later developed pre-eclampsia. She was treated for 5 days with a regimen similar to that used in women, and a live infant was delivered at day 157 of gestation by Caesarian section. These cases of high-risk pregnancy underscore the value of timed-breeding and careful monitoring of pregnant monkeys and the similarities between pregnancy complications in women and in nonhuman primates. PMID:19490364
Brausch, Amy M.; Decker, Kristina M.; Hadley, Andrea G.
This study examined adolescent participation in self-asphyxial risk-taking behaviors (SAB), sometimes known as the "choking game," and its relationship with other adolescent risk behaviors, including non-suicidal self-injury (NSSI). Researchers proposed that participation in SAB and NSSI would be associated with suicidal behavior, disordered…
Masudi, Tahir; McMahon, Helen Capitelli; Scott, Jennifer L.; Lockey, Andrew S.
Introduction: Legislation making seatbelt use mandatory is considered to have reduced fatal and serious injuries by 25%, with UK government estimates predicting more than 50,000 lives saved since its introduction. However, whilst the widespread use of seatbelts has reduced the incidence of major traumatic injury and death from road-traffic collisions (RTCs), their use has also heralded a range of different injuries. The first ever seatbelt related injury was described in 1956, and since then clear patterns of seatbelt-related injuries have been recognised. Methodology and Findings: This review of the published literature demonstrates that the combination of airbags and three-point seatbelts renders no part of the body free from injury. Serious injuries can, and do, occur even when passengers are properly restrained and attending clinicians should have a high index of suspicion for overt or covert intra-abdominal injuries when patients involved in RTCs attend the Emergency Department. Bruising to the trunk and abdomen in a seatbelt distribution is an obvious sign that suggests an increased risk of abdominal and thoracic injury, but bruising may not be apparent and its absence should not be falsely reassuring. A high index of suspicion should be retained for other subtler signs of injury. Children and pregnant women represent high-risk groups who are particularly vulnerable to injuries. Conclusion: In this review we highlight the common patterns of seatbelt-related injuries. A greater awareness of the type of injuries caused by seatbelt use will help clinicians to identify and treat overt and covert injuries earlier, and help reduce the rates of morbidity and mortality following RTCs. PMID:28367011
Paige, Sarah B.; Frost, Simon D.W.; Gibson, Mhairi A.; Holland, James; Shankar, Anupama; Switzer, William M.; Ting, Nelson
Zoonotic pathogens cause an estimated 70% of emerging and re-emerging infectious diseases in humans. In sub-Saharan Africa, bushmeat hunting and butchering is considered the primary risk factor for human-wildlife contact and zoonotic disease transmission, particularly for the transmission of simian retroviruses. However, hunting is only one of many activities in sub-Saharan Africa that bring people and wildlife into contact. Here, we examine human-animal interaction in western Uganda, identifying patterns of injuries from animals and contact with nonhuman primates. Additionally, we identify individual-level risk factors associated with contact. Nearly 20% (246/ 1,240) of participants reported either being injured by an animal or having contact with a primate over their lifetimes. The majority (51.7%) of injuries were dog bites that healed with no long term medical consequences. The majority (76.8%) of 125 total primate contacts involved touching a carcass; however, butchering (20%), hunting (10%), and touching a live primate (10%) were also reported. Red colobus (Piliocolobus rufomitratus tephrosceles) accounted for most primate contact events. Multivariate logistic regression indicated that men who live adjacent to forest fragments are at elevated risk of animal contact and specifically primate contact. Our results provide a useful comparison to West and Central Africa where “bushmeat hunting” is the predominant paradigm for human-wildlife contact and zoonotic disease transmission. PMID:24845574
Tenn, L; Dewis, M E
The mortality and morbidity resulting from serious trauma in adolescence, particularly head and spinal cord injury, constitutes a health problem of major proportions. Although many community-based prevention programmes have been reported in this last decade, few of these describe an evaluation component. In this study, a school-based prevention programme was developed by a peer group and presented by them to high-risk adolescents. The study aimed to test the efficacy of this intervention compared to the delivery of a prevention presentation to a similar group by a health care professional and compared to a control group. Measures of health locus of control, self-efficacy and behavioural intent were supplemented by open-ended items related to risk-taking behaviour change. At post-test and at 4-month follow-up, there was little evidence in the quantitative measures to support the effectiveness of the intervention for reducing injury risk factors. More encouraging findings were seen in the qualitative data. Explanations for why the intervention did not result in the expected outcomes are offered.
Ore, T; Stout, N A
Over 3700 occupational fatalities among all US construction laborers 16 years of age and older during 1980-1992 were analyzed from death certificates to identify differences in mortality rates, higher risk groups, and leading causes of death to be targeted for prevention and monitored over time. Female laborers had an average fatality rate (17.4 deaths/100,000 workers) similar to that for all male construction workers (17.3 deaths/100,000 workers), and ten times higher than for all female construction workers. On average, nonwhite laborers had 27% greater mortality than white laborers. Women were at a higher risk (10.8 deaths/100,000 workers) for motor vehicle injury than were men (6.1 deaths/100,000 workers). The smallest percentage annual decline in cause-specific mortality rates was from motor vehicle for construction laborers (0.1%) and all construction workers (1.4%). Environmental-related fatality rates for laborers rose an average of 0.8% annually. The average years of potential life lost (to age 65) ranged from 27.4 years from explosion to 34.3 years from electrocution. Prevention measures aimed at addressing the highest risk areas, along with research needs, are discussed. With over a quarter of construction fatalities occurring among laborers, occupational injury research on laborers should become a priority.
Background Intimate partner violence (IPV) related injuries have been recognized among health care professionals. However, few studies have provided detailed information on injuries to the head, neck and face regions in Chinese women. As abused Chinese women are generally unwilling to disclose IPV and there are differences in socio-demographic characteristics, societal norms and behaviours, the women may exhibit different patterns, aetiology and risk factors of IPV-related HNF injuries. This study aims to examine the patterns of head, neck and face injuries presenting to Accident and Emergency departments, including the anatomical regions, types, severity, aetiology and demographic and non-demographic risk factors of injuries inflicted by intimate partners in Chinese context. Methods Medical charts of 223 women presented to the Accident and Emergency departments of two regional hospitals in Hong Kong between January 2010 and December 2011 were reviewed independently by two reviewers. Results Head, neck and face injuries remained the most common injuries found in abused Chinese women (77.6%), and punching with a fist was the most common aetiology (60.2%). In particular, punching with a fist was significantly associated on the upper third of the maxillofacial region (p = .01) and the back part of the head (p = .03). Moreover, cohabiting and separated women were more likely to have multiple injuries than those who were married (OR = 3.3, 95% CI = 1.4, 7.8; OR = 2.1, 95% CI = .4, 11.9). Conclusions The findings enhance the understanding of head, neck and face injuries and inform clinicians about the linkage among injuries and risks in abused Chinese women. PMID:24410868
Ekstrand, J; Timpka, T; Hägglund, M
Objective To compare injury risk in elite football played on artificial turf compared with natural grass. Design Prospective two‐cohort study. Setting Male European elite football leagues. Participants 290 players from 10 elite European clubs that had installed third‐generation artificial turf surfaces in 2003–4, and 202 players from the Swedish Premier League acting as a control group. Main outcome measure Injury incidence. Results The incidence of injury during training and match play did not differ between surfaces for the teams in the artificial turf cohort: 2.42 v 2.94 injuries/1000 training hours and 19.60 v 21.48 injuries/1000 match hours for artificial turf and grass respectively. The risk of ankle sprain was increased in matches on artificial turf compared with grass (4.83 v 2.66 injuries/1000 match hours; rate ratio 1.81, 95% confidence interval 1.00 to 3.28). No difference in injury severity was seen between surfaces. Compared with the control cohort who played home games on natural grass, teams in the artificial turf cohort had a lower injury incidence during match play (15.26 v 23.08 injuries/1000 match hours; rate ratio 0.66, 95% confidence interval 0.48 to 0.91). Conclusions No evidence of a greater risk of injury was found when football was played on artificial turf compared with natural grass. The higher incidence of ankle sprain on artificial turf warrants further attention, although this result should be interpreted with caution as the number of ankle sprains was low. PMID:16990444
Fox, Kathryn R.; Franklin, Joseph C.; Ribeiro, Jessica D.; Kleiman, Evan M.; Bentley, Kate H.; Nock, Matthew K.
Nonsuicidal self-injury (NSSI) is a prevalent and dangerous phenomenon associated with many negative outcomes, including future suicidal behaviors. Research on these behaviors has primarily focused on correlates; however, an emerging body of research has focused on NSSI risk factors. To provide a summary of current knowledge about NSSI risk factors, we conducted a meta-analysis of published, prospective studies longitudinally predicting NSSI. This included 20 published reports across 5078 unique participants. Results from a random-effects model demonstrated significant, albeit weak, overall prediction of NSSI (OR = 1.59; 95% CI: 1.50 to 1.69). Among specific NSSI risk factors, prior history of NSSI, cluster b, and hopelessness yielded the strongest effects (ORs > 3.0); all remaining risk factor categories produced ORs near or below 2.0. NSSI measurement, sample type, sample age, and prediction case measurement type (i.e., binary versus continuous) moderated these effects. Additionally, results highlighted several limitations of the existing literature, including idiosyncratic NSSI measurement and few studies among samples with NSSI histories. These findings indicate that few strong NSSI risk factors have been identified, and suggest a need for examination of novel risk factors, standardized NSSI measure ment, and study samples with a history of NSSI. PMID:26416295
Jonasdottir Bergman, Gudrun; Fastbom, Johan; Danielsson, Bengt; Borg, Natalia; Salmi, Peter
Objective To investigate whether psychotropics are associated with an increased risk of fall injuries, hospitalizations, and mortality in a large general population of older adults. Methods We performed a nationwide matched (age, sex, and case event day) case–control study between 1 January and 31 December 2011 based on several Swedish registers (n = 1,288,875 persons aged ≥65 years). We used multivariate conditional logistic regression adjusted for education, number of inpatient days, Charlson co‐morbidity index, dementia and number of other drugs. Results Antidepressants were the psychotropic most strongly related to fall injuries (ORadjusted: 1.42; 95% CI: 1.38–1.45) and antipsychotics to hospitalizations (ORadjusted: 1.22; 95% CI: 1.19–1.24) and death (ORadjusted: 2.10; 95% CI: 2.02–2.17). Number of psychotropics was associated with increased the risk of fall injuries, (4 psychotropics vs 0: ORadjusted: 1.53; 95% CI: 1.39–1.68), hospitalization (4 psychotropics vs 0: ORadjusted: 1.27; 95% CI: 1.22–1.33) and death (4 psychotropics vs 0: ORadjusted: 2.50; 95% CI: 2.33–2.69) in a dose–response manner. Among persons with dementia (n = 58,984), a dose–response relationship was found between number of psychotropics and mortality risk (4 psychotropics vs 0: ORadjusted: 1.99; 95% CI: 1.76–2.25). Conclusions Our findings support a cautious prescribing of multiple psychotropic drugs to older patients. © 2016 The Authors. International Journal of Geriatric Psychiatry Published by John Wiley & Sons, Ltd. PMID:27113813
... HUMAN SERVICES Centers for Disease Control and Prevention Preventing Deaths and Injuries of Fire Fighters Using Risk Management Principles at Structure Fires AGENCY: National Institute for Occupational... Fire Fighters Using Risk Management Principles at Structure Fires.'' The final document can be found...
Morales Hernández, Sara; Díaz Velázquez, Mary Flor; Puello Tamara, Edgardo; Morales Hernández, Jorge; Basavilvazo Rodríguez, Maria Antonia; Cruz Cruz, Polita del Rocío; Hernández Valencia, Marcelino
Abdominal pregnancies are the implantation of gestation in some of the abdominal structures. This kind of pregnancies represents sevenfold maternal death risk than tubarian ectopic pregnancies, and 90-fold death risk than normal ones. Previous cases have erroneously reported as abscess in Douglas punch, and frequently result in obitus or postnatal deaths. We report a case of a patient with 27 years old, and diagnosis of 25.2 weeks of pregnancy, prior placenta and anhidramnios, referred due to difficult in uterine contour delimitation, easy palpation of fetal parts, cephalic pole in left hypochondrious and presence of mass in hypogastria, no delimitations, pain with mobilization, no transvaginal bleed and fetal movements. Interruption of pregnancy is decided by virtue of severe oligohidramnios, retardation in fetal intrabdominal growth, and recurrent maternal abdominal pain. Surgical intervention was carried out for resolution of the obstetrical event, in which was found ectopic abdominal pregnancy with bed placental in right uterine horn that corresponded to a pregnancy of 30 weeks of gestation. Abdominal pregnancy is still a challenge for obstetrics due to its diagnosis and treatment. Early diagnosis is oriented to prevent an intrabdominal hemorrhage that is the main maternal cause of mortality.
Shumway, K; Pate, M L; McNeal, L G
The purpose of this study was to provide a formative needs assessment of Diné (Navajo) parents for the prevention of childhood injuries resulting from livestock and horses. The research objectives were to identify parents' perceived livestock and horse related injury risks to Diné children and describe Diné community stakeholder input on prevention interventions for reducing injury risks to children associated with livestock and horse related activities on farms or ranches. The assessment used a survey constructed of closed and open-response questions to gauge Diné farmers' and ranchers' perceptions of injury risks to children who live or work on agricultural operations. Additional questions were asked to gauge Diné acceptance of an online training program as a prevention intervention to reduce livestock and horse related injuries to children. A total of 96 individuals agreed to participate in the survey and provided usable responses. A total of 53.2% (f = 50) of participants were female. Sixty-three percent of participants (f = 58) perceived that youth who work with intact male livestock were at high risk for injury. A total of 25 individuals perceived that youth who ride horses without equestrian helmets were at high risk for injury. Approximately 96% (f = 89) of those surveyed agreed or strongly agreed that they would use an online training program to promote agricultural health and safety for Diné youth. When participants were asked if there were safety issues associated with having youth working on a farm or ranch, a very large portion felt that the biggest issue was a lack of education and instruction from elders. A recommendation for an injury prevention practice included developing a user-friendly online network, giving parents and community leaders access to resources to assist in educating youth in local agricultural traditions integrated with safety training.
Furushima, Kozo; Itoh, Yoshiyasu; Mitsui, Yasuhiro; Kusano, Hiroshi
Objectives: Many baseball players with UCL injuries have avulsed persistent fragments by throwing disorder in the youth. The presence of fragments results in discontinuity of the medial elbow joint support structures; therefore, a ligament with fragments is considered more fragile than the normal ligament. This study compared three types (fragment, malunion, and normal) of throwing-related UCL injuries and prospectively examined the risk of surgical treatment. Methods: The total subjects were 439 baseball players (age 14-30 years; mean age, 17.5 years) diagnosed with UCL injuries at our hospital between November 2009 and June 2013. At the time of the initial examination, the medial epicondyle was assessed on plain frontal radiographs with the elbow flexed at 45°. Based on this assessment, subjects were divided into three groups: group with persistent fragments (fragment [F] group), group with complete union following avulsion fracture (malunion [M] group), and a group with no history of avulsion fracture (normal [N] group). Each patient’s ability to return to playing baseball was assessed after at least 3 months of systematic rehabilitation. Subjects who failed to comply with rehabilitation, played only recreationally, or with pain in sites other than the