Characteristics of drowning deaths in an inner city river

A study was undertaken of all drowning deaths that occurred over a 30-year period from 1988 to 2017 in the urban section of the River Torrens, Adelaide, South Australia, an augmented waterway that runs through the central business district. Autopsy records from Forensic Science South Australia (FSSA) were reviewed. There were 34 drownings (0–5 cases/yr) with 28 males and 6 females (M;F = 4.6:1), with an age range for males of 18-76yrs (mean 42.0; SD 18.0) and for females of 20-84yrs (mean 69.3; SD 24.5). There were 15 (44%) accidents, 11 (32%) suicides, 1 (3%) homicide and 7 (21%) undetermined. Of the 22 cases during or after 1994 with complete toxicology reports, 10 (45%) had a blood alcohol concentration (BAC) of greater than 0.05% (g/100 mL) with an illicit substance detected in 4 (18%) cases: (MDMA (3,4-methylenedioxymethamphetamine), methylamphetamine and THC (delta-9-tetrahydrocannabinol) acid). The presence of various therapeutic drugs was also detected in 10 cases (45%) including temazepam, fluoxetine, diazepam, olanzapine, amitriptyline, carbamazepine, codeine, citalopram and valproate. Although the numbers of cases were not high, the urban portion of the River Torrens had a much higher number of drowning events per kilometre compared to other inland waterways in South Australia such as the Murray River. This is most likely due to the vulnerability that exists for intoxicated individuals in the city from falls into the water and to the availability of the river as a means of suicide to members of the adjacent urban population.     

Using stories to battle unintentional injuries: Narratives in safety and health communication

After 14 years of rising death rates due to unintentional injuries in the U.S., it is time to ask how safety messages can be redesigned to have a greater impact on risky behavior. To this end, many researchers have called for a new, narrative approach to prevention messages—based on persuasive stories about people who have suffered injuries and illnesses in the past. Still, there is scant evidence that story-based communications are more effective than equivalent non-narrative messages at changing actual (rather than self-reported) safety and health behavior. Our research examined the impact of injury stories on actual safety behavior in a controlled experimental setting at a US university. Teams of participants assembled a product (a child's swing) using written instructions. The instructions contained safety messages targeting assembly mistakes that have been linked to serious injuries in children who play on swings. Participant teams were randomly assigned to three conditions: assembly instructions containing story-based safety messages, instructions with concrete (but non-anecdotal) safety messages, and instructions with traditional abstract safety messages. After adjustment for covariates, story-based messages resulted in a 19 percent improvement in safety behavior, compared with non-narrative communications. Importantly, injury stories did not create undue fear of the message object, demonstrating that brief anecdotes about accident victims can convince people to take reasonable precautions without creating unwarranted alarm about risks.     

Expertises pour la sécurité sociale : méthodologie et spécificités

Mental disorders represent in France for the Social Security the second post of spending in consumption of care with 11,4 billion euro, that is 10,6% of the spending, behind the diseases of the circulatory system. They stay in the rank of the pathologies justifying the allocation of a disability pension, representing 26,7% of invalids. It is to say the importance of the psychiatric expertise for the Social Security. This type of expertises is particular among the expertises in psychiatry because the objective of the expertise is to establish an arbitrage between the position of CPAM's doctor and his regular doctor. Effectively, except legal flaw, the opinion of the expert imposes upon the parts (parties). The realization of the expertise and its editorial staff are detailed in their specificities. Problem specific of the psychiatry are approached as well as the functions (offices) of the expert which are well beyond arbitrator's role towards a function of teacher and intermediary.     

Neurophysiological aspects of chronic motor cortex stimulation

Chronic motor cortex stimulation is a treatment option for neuropathic drug-resistant pain and possibly associated movement disorders. Preliminary studies suggest the possibility to treat symptoms of Parkinson disease in selected patients. Recently, MCS has been suggested to enhance motor recovery in patients with poststroke hemiparesis. One or more electrodes are placed extradurally over the motor cortex through a burr hole or a small craniotomy, and then connected to a totally implantable neurostimulator. The accurate positioning of the stimulating electrodes over the motor cortex is the key point of the surgical procedure. Motor cortex identification results from the integration of anatomical, neuroradiological, functional, and neurophysiological data, taking into account the huge population variability. Intraoperative neurophysiological mapping of the motor cortex is of paramount importance, in spite of very sophisticated neuroradiological mathematical reconstructions of the motor area. We discuss and compare the different techniques that are utilized by different authors. Moreover, clinical neurophysiology is also helpful in evaluating the results of this neuromodulation procedure and in hypothesizing the mechanisms that are put in play by MCS.     

强迫症疾病行为的精神病理机制研究

目的对研究获得的强迫症疾病行为特征探索其精神病理学机制。方法以符合CCMD-Ⅱ的门诊强迫症患者50例为对象，选取非精神科病人50例组成对照，应用“强迫症疾病行为特征量表（OBPS）”，确定其有无强迫症疾病行为。同时调查研究组与对照组的人格特质、偶发事件、应对策略等方面，研究这些因素在疾病发生、发展中的作用。结果①研究组全部符合李一高量表的疾病行为特征，积分明显高于对照组（t=26．480，P〈0．01）；②强迫症患者人格当中的强迫质偏高，积分明显高于对照组（t=15．93，P〈0．01）；③研究组中绝大多数患者存在偶发事件，而对照组中偶发事件的发生率低于研究组（X^2=21．374，P〈0．01）；④应对策略特征方面研究组不成熟应对方式的应用明显多于对照组。结论强迫神经症形成中人格特质作为基础，偶发事件起到启动对“不完全的恐怖”，错误的应对策略不断强化病感，促进疾病形成。李一高强迫症疾病行为理论的3项内容，特征性的反映了强迫症的疾病行为。     

核电站事故的公众防护行动

随着核能发展不断推进,居住在核电站周围的公众数量越来越多,但是他们普遍缺乏对核辐射的基础知识,对核事故的防护行动也知之甚少。而及时、正确的防护行动可以将核电站事故对公众的健康危害降到最低。本文介绍了核电站事故后,公众的防护行动：隐蔽、体表污染去污、撤离、服用稳定性碘、食品和饮用水控制、个人防护措施、宠物照料、心理援助等,以指导公众在事故后开展正确的自救与互救,提高公众对核电站事故的应急响应能力。     

The effect of accident mechanisms and initial findings on the long-term course of whiplash injury

The aim of this study was to assess the relationships between accident mechanisms as well as initial findings and the long-term course of whiplash injury. A representative sample of 117 consecutive patients referred by primary care physicians was followed-up over 12 months. Fractures or dislocations of the cervical spine, head trauma and pre-existing neurological disorders were exclusion criteria. The interval between the accident and the baseline examination was 7.4 days (SD 4.2 days). Assessment included accident features (e.g. passenger position in the car, head restraint, head position, type of collision), initial symptoms (e.g. intensity and onset of pain, symptoms of neurological dysfunction, multiple symptom score), and signs (restricted neck movement, neurological deficits). At the 1-year examination, patients were divided into an asymptomatic and a symptomatic group and were compared with respect to accident features and baseline findings. Twenty-four percent of patients were still symptomatic after 1 year. Analysing accident mechanisms separately, rotated or inclined head position was the primary feature related to symptom persistence (P=0.005). The symptomatic group scored higher at baseline on the multiple symptom rating (P=0.004) and had a higher incidence of initial headache (P=0.004) and neurological symptoms (P=0.008) together with a higher intensity of headache (P=0.0002) and neck pain (P=0.0009). The following set of initial variables predicted persistence of symptoms at 1 year (logistic regression): intensity of neck pain (P=0.001) and headache (P=0.009), rotated or inclined head position (P=0.02), unpreparedness at the time of impact (P=0.01) and car stationary when hit (P=0.01). In conclusion, accident mechanisms and initial findings suggestive of more severe injury were significantly related to long-term persistence of symptoms after whiplash injury.This study was supported by the Swiss National Science Foundation (project number: 3.883-0.88) and the Swiss Accident Insurance Company (Schweizerische Unfallversicherungsanstalt), Berne     

Can a community development model be used for health programmes in an industrialized country?

Injury resulting from accident is a serious public health problem in Sweden, as it is in the rest of the world. Theoretically, almost all incidents can be prevented. However, in practice, injury-prevention is a complex problem. A community-level intervention programme for prevention of accidents was developed in the municipality of Sollentuna, Stockholm County. The primary strategy has been to involve the community through representatives as well as through local organizations and groups. Project organization has been built up in cooperation with the municipal primary health-care department, local authorities, voluntary organizations and citizen agencies. A common opinion is that it is the actual process in a community programme which is important, that alters the type of involvement from a ‘top-down’ to a ‘bottom-up’ approach. Can a local community take over responsibility for running such a programme which has been initiated by an external authority or organization? We think that, at least for Swedish circumstances, the community development approach is far too optimistic in its expectation that community members should and can stay actively involved in programme decisions. Based on our experience, it does not seem possible to maintain a broad self-sustained programme solely with input from community members.     

不同电针刺激频率对脑卒中患者脑血流灌注和脑功能的影响

目的:寻找治疗脑卒中的适宜电针刺激频率.方法:47例脑卒中患者电针头皮运动区,根据其频率分为2 Hz、2/15 Hz、100 Hz组,应用单光子发射型计算机断层(SPECT)观察3组患者电针前和电针中脑血流灌注和脑功能的变化.结果:三种不同的电针刺激频率均能改善脑卒中患者的局部脑血流灌注和脑细胞功能活动,2/15 Hz和100 Hz组较2 Hz组为强.结论:在刺激强度固定的条件下,2/15 Hz、100 Hz的刺激频率治疗脑卒中疗效较好.     

1989至2003年全国金属及类金属化合物重大急性职业中毒的特征

目的通过分析我国报告发生的金属及类金属化合物重大急性职业中毒事故的发生特点,提出优先、重点的防制建议。方法对1989至2003年全国报告发生的金属及类金属化合物重大急性职业中毒资料进行整理和分析。结果15年间共报告金属及类金属化合物重大急性职业中毒39起,年均2．6起,直接导致中毒的金属及类金属化合物约13种。确诊中毒609例,死亡32例,平均每起事故中毒15．6例,中毒死亡0．8例,总中毒率为52．9%,总中毒死亡率为5．3%；平均中毒年龄(29．2±9．0)岁,平均中毒死亡年龄(32．3±9．9)岁。自1997年起报告的中毒事故增多,43．6%的中毒由砷化氢导致；发生在制造业和化学工业的中毒较多,清洗和搬运作业易发生中毒。导致中毒事故发生的主要原因是没有密闭通风排毒设备或效果不好(22．5%)、没有个人防护设备(19．8%)、缺乏安全教育(19．8%)和没有安全操作规程(15．3%)等。结论加强砷化氢、砷及其化合物的急性中毒防治,注意在冬夏两季有针对性地加强安全教育和个人防护。