Where is the true location of the femoral piriform fossa?

ObjectiveTo analyze knowledge of the anatomic location of the piriform fossa using a questionnaire with anatomic figures.Materials and methodsParticipants taking AO Trauma Brasil courses were requested to complete a questionnaire containing a photograph of the superior surface and a photograph of the lateral surface of the femur and answer a question asking which of four numbered points corresponded to the piriform fossa.ResultsJust 4.5% of respondents correctly chose point 2 (the piriform fossa) in both images, while 75.4% of respondents chose point 4 (the trochanteric fossa) as the correct anatomic structure. The subset of 4th-year residents’ answers was significantly different from those of the other subsets, with 7.5% of correct answers.ConclusionsThe low rate of correct answers indicates a tendency for the respondents to be influenced by illustrations in text books or examples in scientific publications that indicate the site of the piriform fossa incorrectly. Interest in the specialty of traumatology is possibly the reason why the subset of 4th-year residents had a better- than-average rate of correct answers.     

Involving Fathers in Teaching Youth About Farm Tractor Seatbelt Safety—A Randomized Control Study

PurposeFarm youth continue to experience high rates of injury and deaths as a result of agricultural activities. Farm machinery, especially tractors, is the most common cause of casualties to youth. A Roll-Over Protection Structure (ROPS) along with a fastened seatbelt can prevent almost all injuries and fatalities from tractor overturns. Despite this knowledge, the use of seatbelts by farmers on ROPS tractors remains low. This study treats farm safety as a family issue and builds on the central role of parents as teachers and role models of farm safety for youth.MethodsThis research study used a longitudinal, repeated-measures, randomized-control design in which youth 10–19 years of age were randomly assigned to either of two intervention groups (parent-led group and staff-led group) or the control group.ResultsFathers in the parent-led group were less likely to operate ROPS tractors without a seatbelt compared with other groups. They were more likely to have communicated with youth about the importance of wearing seatbelts on ROPS tractors. Consequently, youth in the parent-led group were less likely to operate a ROPS tractor without a seatbelt than the control group at post-test.ConclusionsThis randomized control trial supports the effectiveness of a home-based, father-led farm safety intervention as a promising strategy for reducing youth as well as father-unsafe behaviors (related to tractor seatbelts) on the farm. This intervention appealed to fathers' strong motivation to practice tractor safety for the sake of their youth. Involving fathers helped change both father as well as youth unsafe tractor-seatbelt behaviors.     

An evaluation of a nurse-led rehabilitation programme (the ProBalance Programme) to improve balance and reduce fall risk of community-dwelling older people: A randomised controlled trial

ObjectiveThis study aims to assess the effect of a nurse-led rehabilitation programme (the ProBalance Programme) on balance and fall risk of community-dwelling older people from Madeira Island, Portugal.DesignSingle-blind, randomised controlled trial.SettingUniversity laboratory.Participants: Community-dwelling older people, aged 65–85, with balance impairments. Participants were randomly allocated to an intervention group (IG; n = 27) or a wait-list control group (CG; n = 25).InterventionA rehabilitation nursing programme included gait, balance, functional training, strengthening, flexibility, and 3D training. One trained rehabilitation nurse administered the group-based intervention over a period of 12 weeks (90 min sessions, 2 days per week). A wait-list control group was instructed to maintain their usual activities during the same time period.OutcomeBalance was assessed using the Fullerton Advanced Balance (FAB) scale. The time points for assessment were at zero (pre-test), 12 (post-test), and 24 weeks (follow up).ResultsChanges in the mean (SD) FAB scale scores immediately following the 12-week intervention were 5.15 (2.81) for the IG and −1.45 (2.80) for the CG. At follow-up, the mean (SD) change scores were −1.88 (1.84) and 0.75 (2.99) for the IG and CG, respectively. The results of a mixed between-within subjects analysis of variance, controlling for physical activity levels at baseline, revealed a significant interaction between group and time (F (2, 42) = 27.89, p < 0.001, Partial Eta Squared = 0.57) and a main effect for time (F (2, 43) = 3.76, p = 0.03, Partial Eta Squared = 0.15), with both groups showing changes in the mean FAB scale scores across the three time periods. A significant main effect comparing the two groups (F (1, 43) = 21.90, p < 0.001, Partial Eta Squared = 0.34) confirmed a clear positive effect of the intervention when compared to the control.ConclusionThis study demonstrated that the rehabilitation nursing programme was effective in improving balance and reducing fall risk in a group of older people with balance impairment, immediately after the intervention. A decline in balance was observed for the IG after a period of no intervention.Clinical Trial Registration NumberACTRN12612000301864.     

Pesticide poisoning and depressive symptoms among farm residents

PURPOSE: The purpose of the study presented is to evaluate the association between pesticides and depressive symptoms among a population exposed to chemicals as a result of agricultural use. Chronic sequelae of acute pesticide poisoning from organophosphate compounds may include anxiety and depression. In some states, farmers have been reported to have higher rates of depression than other population groups. Little work has been done to describe the effects of exposure to organophosphate compounds and depressive symptoms among the farming population. METHODS: Data for this study came from a cross sectional survey of farmers and their spouses conducted in an eight county area in northeastern Colorado. Personal interviews were conducted with the study participants. Depressive symptoms were assessed using the Center for Epidemiologic Studies-Depression (CES-D) scale. Pesticides applied on the farms were assessed using self-reported questionnaires. Conditional logistic regression was used to model the relationship between depression and pesticide-related illness in a stratified analysis. RESULTS: Between 1992-1997, 761 individuals were enrolled in this cross sectional survey. Adjusting for a number of potential confounders, the odds ratio for depression associated with pesticide-related illness was 5.87 [95% confidence interval (CI) = 2.56-13.44]. CONCLUSIONS: Exposure to pesticides at a high enough concentration to cause self reported poisoning symptoms was associated with high depressive symptoms independently of other known risk factors for depression among farm residents.     

The Driver's Angry Thoughts Questionnaire: A Measure of Angry Cognitions When Driving

Five forms of driving-related angry cognitions were identified—Judgmental/Disbelieving Thinking ( = .94), Pejorative Labeling/Verbally Aggressive Thinking ( = .92), Revenge/Retaliatory Thinking ( = .93), Physically Aggressive Thinking ( = .93), and Coping Self-instruction ( = .83). Pejorative labeling/verbally aggressive, physically aggressive, and revengeful/retaliatory thinking correlated positively with each other and with driving anger, aggressive driving anger expression, aggression, and risky driving behavior. Coping self-instruction tended to correlate negatively with these variables. Judgmental/disbelieving thinking correlated positively with other forms of angry thinking, but was only somewhat correlated with other variables. Driving-related angry thoughts, except coping self-instruction, correlated positively with general hostile automatic thoughts. Differences in strengths of correlations with specific variables, and contributions to regression analyses supported the discriminant and incremental validity of driving-related angry thoughts. Implications for cognitive processes in anger and interventions were discussed.     

Nonoccupational and Occupational Injuries to US Workers With Disabilities

Objectives. We examined medically treated injuries among US workers with disability.Methods. Using 2006–2010 National Health Interview Survey data, we compared 3-month rates of nonoccupational and occupational injuries to workers with disability (n = 7729) and without disability (n = 175 947). We fitted multivariable logistic regression models to calculate odds ratios and 95% confidence intervals of injuries by disability status, controlling for sociodemographic variables. We also compared leading causes of injuries by disability status.Results. In the 3-month period prior to the survey, workers with disability were more likely than other workers to have nonoccupational injuries (odds ratio [OR] = 2.35; 95% confidence interval [CI] = 2.04, 2.71) and occupational injuries (OR = 2.39; 95% CI = 1.89, 3.01). For both groups, the leading cause was falls.Conclusions. Disability status was strongly associated with risk of nonoccupational and occupational injuries among US workers. The safety issues facing US workers with disability in the workplace warrant future research. Federal agencies with an interest in the employment of workers with disability and their safety in the workplace should take a lead in further assessing injury risk and in promoting a safe working environment for workers with disability.In the United States, persons with disabilities constitute 12.0% of the population.1 Both the World Health Organization and the US surgeon general have released reports addressing disparities in the health of persons with disabilities.2,3 These reports identify community participation and health promotion as societal priorities. According to the 2008 American Community Survey, about 4.6 million adults (aged 16–64 years) with disabilities are employed in the United States, and the number of workers with disabilities is expected to increase in the coming years as the workforce ages.4 A public health concern is that workers with disabilities may be at high risk of occupational injuries.5–8 Reducing the proportion of individuals with disabilities who report nonfatal injuries is among the objectives of US Healthy People 2020.9A number of studies have shown that adults with disabilities are more vulnerable to injuries than nondisabled adults.10–14 Studies using nationally representative data sets have found that the odds of injury increased with increasing severity of disability10,12 and with the number of disabilities.13 The settings and external causes of these injuries differed between individuals with and without disabilities.11,12 Falls, for example, were a leading mechanism of injury reported more frequently among those with disabilities.10–12Occupational injuries among workers with disabilities have also been previously studied.5,15–19 A number of studies from the 1990s showed an elevated risk of injury among workers with disabilities.5,15–17,19 However, much of the prior research examined only those with specific types of disabilities.15–19 For example, older workers with poor hearing and poor vision were shown to have an elevated risk for occupational injuries.17 By contrast, recent research based on workers’ compensation insurance claims found that workers with cognitive disabilities sustained fewer injuries and experienced fewer absences due to injury than workers without cognitive disabilities.18Previous work has also been critiqued because of the conceptualization and definition of disability5 and because environmental factors or work accommodations for workers with disability could not be taken into account.20,21 Zwerling et al. found that approximately 12% of workers with impairments reported receiving some type of workplace accommodation.22 Recent work by Leff et al. explored the role of environmental factors (e.g., societal attitudes, the natural environment, and policies) in the functioning and societal participation of people with disabilities.14 Environmental factors were found to be independently associated with injury regardless of disability status; however, disability status remained a risk factor for injury, although environmental factors attenuated the association. One current conceptualization of disability, the World Health Organization’s International Classification of Functioning, Disability and Health (ICF), emphasizes environmental factors and has been used in recent studies to evaluate injury risks of persons with disabilities.10,12,23 The ICF defines disability as physical impairments, activity limitations, and participation restrictions that affect one’s interaction with the physical and social environment.24 However, the impact of this refined definition on the number of injuries to workers with disabilities has yet to be determined.Given the significant number of US workers with disabilities and the advancements in disability and injury definitions,25 we compared medically attended nonoccupational and occupational injuries among workers with and without disabilities, using data from the 2006–2010 National Health Interview Survey (NHIS). Our current study improves on previous studies by our team and other researchers by examining both nonoccupational and occupational injuries to workers with disabilities using a single data source and a newer definition of disability based on the ICF.     

Gender‐specific Research on Mental Illness in the Emergency Department: Current Knowledge and Future Directions

Mental illness is a growing, and largely unaddressed, problem for the population and for emergency department (ED) patients in particular. Extensive literature outlines sex and gender differences in mental illness' epidemiology and risk and protective factors. Few studies, however, examined sex and gender differences in screening, diagnosis, and management of mental illness in the ED setting. Our consensus group used the nominal group technique to outline major gaps in knowledge and research priorities for these areas, including the influence of violence and other risk factors on the course of mental illness for ED patients. Our consensus group urges the pursuit of this research in general and conscious use of a gender lens when conducting, analyzing, and authoring future ED‐based investigations of mental illness.