Unintentional injuries among school adolescents in Kathmandu, Nepal: a descriptive study

OBJECTIVE: To describe detailed mechanisms and activities at the time of unintentional injuries among adolescents in Kathmandu, Nepal. METHODS: A school-based study was conducted on 1557 students in grades 6-8 across 14 schools, using a self-administered questionnaire during August-September 2003. Mechanisms and activities were coded using the Nordic Medico Statistical Committee's classification. FINDINGS: Falls (65%) and cuts (63%) were the most common injuries, followed by transport-related injuries (36%) and burns (22%). In urban areas, falls (59%) were the most common injuries, followed by transport-related injuries (50%); in semi-urban areas, falls (66%) and cuts (65%) were the most common injuries, followed by transport-related injuries (34%). At the time of falls, boys were generally engaged in sports while girls were engaged in walking on streets or on stairs in houses, in both areas. Falls from trees among boys and falls from roofs among girls were also common in semi-urban areas. Cut injuries while processing food were common among boys and girls in both areas, whereas agricultural work was also a source of injury in semi-urban areas. Pedestrian injuries were common during transport among boys and girls in both areas; boys in semi-urban areas were almost equally likely to be injured during cycling. Burn injuries while cooking and serving food were more common among girls in semi-urban areas. CONCLUSION: Falls, cuts, transport-related injuries, and burn injuries were quite prevalent among adolescents in Kathmandu. The reported injury mechanisms and activities posing injury risks have implications for future interventions.     

深圳市社区儿童伤害监测干预模式的研究

目的建立并实施＂社区儿童伤害监测干预模式＂,降低儿童伤害发生率,改善儿童生存质量。方法选择伤害发生率比较高的深圳市龙岗区横岗镇作为社区儿童伤害监测干预点,干预前后分别进行伤害发生情况的问卷调查。结果建立了＂社区儿童伤害监测干预模式＂,伤害发生率由8.36%下降至6.40%,差异有统计学意义。与干预前比较,机械伤、中毒、意外跌落差异均有统计学意义。结论 ＂社区儿童伤害监测干预模式＂能有效地控制儿童伤害发生,为深圳市社区儿童伤害预防提供了新的方法。     

Unintentional home-related injuries in the Islamic Republic of Iran: findings from the first year of a national programme

BACKGROUND: As elsewhere, unintentional injuries are a leading cause of death in Iran, but non-fatal injuries occurring in the home environment have not been analysed. OBJECTIVES: The primary purposes of this study were to describe the pattern of home-related injuries and to obtain incidence rates for their determinants in order to monitor intervention programmes for preventive purposes. METHODS: A surveillance system for home-related injuries in selected rural and urban areas was established for the systematic collection of data. The information obtained covers emergency department visits and health services provided between March 1998 and March 1999. RESULTS: In total, 79,723 unintentional home-related injuries were reported, primarily burns (49%, incidence of 19/10,000 rural and 13/10,000 urban inhabitants) and lacerations/cuts caused by contact with sharp instruments (30%, incidence of 8.4/10,000 rural and 11/10,000 urban inhabitants). Injury rates were highest among children aged 0--4 years and lowest among the elderly (60 years or over). Rates varied between the sexes; among children under 15 years of age, most patients were male, but the opposite applied to all groups >15 years of age. Leading causes of death were burns, falls and poisoning among 628 people who died because of home-related injuries. CONCLUSIONS: The injury pattern found in this study is generally similar to that of many other countries, with the striking exception of burns. Other reports focus on the same problem, particularly with regard to Iran. The prevention of burns should be an important feature of any national injury prevention programme. Due to the varied causes of home-related injuries in Iran, interventions should be targeted at people at the greatest risk, namely children. Home visitation as a tool for face-to-face training with a sharper focus on burns, falls and poisoning prevention can be recommended as a part of primary health care policy. Greater investment in surveillance also provides a way of reducing the threat of injury in the community.     

Orthopaedic operations: variation in case-mix over a 10-year period.

The variation in case-mix of patients admitted for routine (non-emergency) orthopaedic surgery at a Staffordshire orthopaedic hospital over a 10-year period was studied, with the aid of the BUPA Schedule of Surgical Procedures. Over this period there was a 2% decrease in the total number of operations performed. There was a marked reduction in the number of 'minor' operations performed, and a marked increase in the number of 'major' and more complex operations performed. The overall workload, as judged by estimated surgeons' fees, rose by 43%. This study offers clear support to the claim that the complexity of orthopaedic operations performed has significantly increased over a ten-year period.     

Teleconsultation: changes in technology and costs over a 12-year period

In our previous study, in 1997, we evaluated the cost of teleconsultations in a primary care centre compared with the cost of the conventional alternative, travelling to the hospital. The results showed that teleconsultations were cheaper than patient travel when the annual workload was more than 110 patients in ophthalmology and 115 patients in dermatology. Using the same method of analysis for 2009 data showed that cost savings would occur if the annual workload was 20 patients in ophthalmology and 17 patients in dermatology. The main differences between the two studies are the reduced cost of the technology (which was based on PCs in 2009) and the increased cost of staff. Both studies show that teleconsultations can be cost-effective in a relatively small health centre. The cost of technology continues to decrease, although the other costs in our break-even analysis continue to increase. However, the usability of technology continues to improve, and this will make telemedicine a more attractive alternative in the future.     

Transtheoretical model-based exercise counselling for older adults in Switzerland: Quantitative results over a 1-year period

Summary. Objectives: To develop and test a counselling programme based on the Transtheoretical Model of behavioural change, for promoting exercise in people over the age of 65. Method: The sample (n = 448) consisted of women and men aged between 65 and 92, recruited from Swiss GPs’ practices between 2000 and 2004. After a baseline measurement (T1) and an initial counselling session, they received two counselling sessions, followed by a 12-month follow-up (T2). Changes in exercise behaviour were recorded by means of stage classifi cation and the time spent on everyday moderate-intensity activities that increase the breathing rate. Results: At T1 there was a tendency for women to be less physically active than men. T1 to T2 the proportion of inactive people fell from 12.2% to 4.2%, and the proportion of people sufficiently active rose from 19.0% to 31.3%. The changes in stage were significant in both men and women. At T2 more than half of the participants in the study spent more time exercising. Conclusions: The results indicate that, with counselling, the exercise behaviour of the elderly can be positively infl uenced over a 1-year period.

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Zusammenfassung. Bewegungsberatung für ?ltere Menschen auf Basis des Transtheoretischen Modells der Verhaltens?nderung: quantitative Ergebnisse im 1-Jahres-Verlauf Fragestellung: Ziel dieser Studie war die Bewegungsf?rderung bei über 65-J?hrigen anhand eines auf dem Transtheoretischen Modell der Verhaltens?nderung (TTM) beruhenden Beratungsprogramms. Methode: Studienteilnehmende wurden in den Jahren 2000–20004 über Schweizer Hausarztpraxen rekrutiert. Die Stichprobe (n = 448) setzte sich aus Frauen und M?nnern im Alter von 65 bis 92 Jahren zusammen (Durchschnittsalter M = 74.1, SD = 5.64, Median = 73.3). Nach einer Baselineerhebung (T1) führten spezifisch geschulte Pflegefachfrauen eine erste systematische Bewegungsberatung durch und im Abstand von rund vier Monaten w?hrend Hausbesuchen zwei weitere, gefolgt von einem 12-Monats-Follow-up (T2). Mittels Stufeneinteilung für moderate k?rperliche Alltagsaktivit?ten und aufgewendeter Zeit wurden die Ver?nderungen im Bewegungsverhalten erfasst. Ergebnisse: Frauen waren bei T1 wie auch bei T2 weniger k?rperlich aktiv als M?nner, was sich jedoch nur bei T2 signifikant unterschied. Der Anteil Inaktiver nahm von T1 zu T2 von 12.2% auf 4.2% ab, der Anteil gesundheitswirksam aktiver Personen stieg von 19.0% auf 31.3%. Die Stufenver?nderungen waren bei beiden Geschlechtern signifikant. Mehr als die H?lfte der Studienteilnehmenden wendeten bei T2 mehr Zeit für Bewegung auf. Schlussfolgerungen: Die Ergebnisse weisen darauf hin, dass sich mittels Beratungen das Bewegungsverhalten ?lterer Menschen im 1-Jahres-Verlauf positiv beeinflussen l?sst.

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Résumé. Promotion de l’activité physique auprès des personnes agées sur la base du Modèle Transthéorique de changement des comportements en Suisse: résultats quantitatifs sur 1 an Objectifs: Développer et tester un programme de promotion de l’activité physique basé sur le Modèle Transthéorique de changement de comportement et ciblant des personnes agées de plus de 65 ans. Méthodes: Un échantillon (n = 448) de femmes et d’hommes agés de 65 à 92 ans a été recruté auprès de médecins généralistes en Suisse entre 2000 et 2004. Après une mesure de base (T1) et une séance de conseil initial, ces participants ont béné- ficié de deux autres séances et d’un suivi à 12 mois (T2). Les modifications dans la pratique de l’activité physique ont été classifiées selon les différentes étapes du modèle et selon le temps consacré à une activité physique quotidienne augmentant le rythme respiratoire. Résultats: A T1, les femmes tendaient à être moins actives que les hommes. Entre T1 et T2, la proportion de personnes inactives est tombée de 12.2% à 4.2% ; la proportion de personnes suffisamment actives a augmenté de 19.0% à 31.3%. L’évolution dans les étapes du modèle était significative pour les hommes et les femmes. A T2, plus de la moitié des participants consacraient plus de temps à la pratique d’une activité physique. Conclusions: Par le conseil, l’activité physique des personnes agées peut être positivement influencée sur une période d’une année.

     

Transtheoretical Model-based exercise counselling for older adults in Switzerland: quantitative results over a 1-year period

Objectives:  

To develop and test a counselling programme based on the Transtheoretical Model of behavioural change, for promoting exercise in people over the age of 65.     

Asthma in the community Observations by the Swiss Sentinel Surveillance Network over a ten year period (1988-1997)

Purpose: The overall prevalence and incidence of asthma attacks reported by primary care physicians (general practitioners, general internists and paediatricians) between 1988 and 1997 was assessed. Special attention was paid to the observation of seasonal patterns in different age groups of the consulting population.

Methods: About 200 private practice physicians participated in the collection of data each year. Only data from doctors who reported 39 weeks or more each year were included in the analysis. Physicians were recruited on the basis of a stratification by geographic area, sociodemographic characteristics and speciality, with even distributions over the whole country. They represent about 3% of all family practitioners in Switzerland. Weekly attack rates per physician were investigated using time series analysis. Seasonal smoothing was used to visualise and explore the series.

Results: Asthma attack rates (all ages) increased from 5.7 attacks per physician (0.18 per 100 consultations) in 1988/1989 to 11.8 (0.22 per 100 consultations) in 1994. The rates then decreased to 8.8 (0.19 per 100 consultations) in 1996 and rose to 10.4 (0.22 per 100 consultations) in 1997. Peak incidence occurred in June (particularly for the 5-16 years age group) and in November (particularly for the 0-4 years age group). Seasonality dwindled with increasing age. Attack rates were highest in January and July in the 46-65 years and above 65 years age groups. An August/September trough was repeatedly found in all age groups. First asthma attacks (registered since 1994) accounted for a third of all asthma attacks. Hospital admission rates, expressed as a percentage of attacks, were low by international standards.

Conclusions: Sentinel practices in Switzerland are useful for measuring the asthma morbidity seen in the primary care setting. We observed a rising trend in asthma rates until 1994 and a fluctuating course until 1997. We believe that the temporal changes over time in asthma rates reflect societal changes, with a tendency to early therapeutic interventions by both patients and professionals. Differences in seasonal patterns signal the presence of environmental and age-related diagnostic effects which overlap with virus-induced wheezing, allergic asthma and bronchitis-related broncho-constrictive disorders.     

Socio-economic status inequality and major causes of death in adults: a 5-year follow-up study in rural Vietnam

OBJECTIVES: This study aimed to analyse the associations between cause-specific mortality in adults (aged 20 years and above) and socio-economic status (SES) in a rural setting of Vietnam during a time of economic transition. STUDY DESIGN: The study was carried out as part of the FilaBavi demographic surveillance system, with a dynamic cohort of 50,000 inhabitants from January 1999 to December 2003. METHODS: Causes of death in the adult population were derived using verbal autopsy. A Cox regression model was employed to check the association of SES with three major causes of death: communicable diseases; non-communicable diseases; and injuries. RESULTS: The crude mortality rates were 9.2 and 6.6 per 1000 person-years in adult males and females, respectively. Men had higher mortality rates than women for all mortality categories and for all levels of education and household economic situation (HES). Mortality rates increased substantially with age, and showed similar age effects for all mortality categories with the strongest association for non-communicable diseases. Education was an important factor for survival in general, and high HES seemed to benefit men more than women. CONCLUSIONS: Interventions and policies to reduce exposure to risk factors for non-communicable diseases are needed in low-education groups. However, further study is needed to analyse the mortality inequity across all age groups.     

浙江省医院急诊室故意伤害监测分析

目的了解浙江省急诊室伤害监测中故意伤害发生情况及特征。方法对2004年10月~2006年10月期间首次就诊于浙江省6个县(市、区)18家监测医院门急诊的故意伤害病例进行调查。数据统计采用SPSS统计学软件,率的差异用χ2检验,P0.05为差异有统计学意义。结果两年期间共监测故意伤害者6 023例,占伤害监测总数13.61%,他伤/杀与自伤/杀人数比为9.11∶1;故意伤害年龄分布以15~44岁(77.89%)为主,男女性别比为2.38∶1,农民工(30.32%)在各职业人群中所占比例最高;他伤/杀主要发生在街道/城区(41.39%)和家中(23.28%),自伤/杀高发于家中(77.14%);发生时间以空闲时(65.08%)居多;受伤性质自伤/杀以中毒(46.70%)和刀割伤(25.38%)常见,他伤/杀主要为裂伤(30.90%)、血肿/瘀伤(18.76%)和击伤(12.37%);受伤程度多为中等(52.45%)或轻微(41.28%)。结论本研究表明故意伤害的预防控制已不容忽视,应针对重点人群采取有效干预策略以减少故意伤害发生。     

Epidemiology and susceptibility of serratia marcescens in a large general hospital over an 8-year period

Over the 8 year period 1988-1995, 1367 isolates of Serratia marcescens were isolated from 582 patients on 12 different wards of a large Dublin hospital and were particularly associated with the surgical intensive care unit. The annual incidence was over 200 isolates from 1990 to 1992 but fell to below 100 following the opening in April 1992 of a replacement surgical hospital incorporating a new intensive care unit on the same site. The most common source of S. marcescens was sputum from patients. Strain identities were determined by serotyping and phage typing at least one isolate from each of 311 of the 582 patients. The results showed that a single epidemic strain of serotype O14:K14 was present in 69% of these patients, and persisted throughout the hospital for the whole of the eight-year period. This strain was recovered from a variety of clinical specimens, including blood cultures. A minor outbreak involving a serotype O16:K28 strain also occurred and this strain also persisted from at least 1989 to 1994. Extensive surveillance failed to reveal an environmental source or faecal carriage. The likely mode of transmission appears to have been via staff hands from both symptomatic and asymptomatic patients acting as reservoirs of the organism, as has commonly been reported for this species.     

Decline of infant and child mortality rates in rural Senegal over a 37-year period (1963-1999)

BACKGROUND: In spite of an improving trend, childhood mortality in rural sub-Saharan Africa remains high and has recently risen in some countries. The factors associated with the long-term decline in childhood mortality are poorly known, due to a lack of data. METHODS: A Senegalese rural population has been under demographic surveillance since 1963. Infant and under-5 mortality rates were calculated for different periods to generate a long-term trend in childhood mortality. Evolution of age and seasonal patterns of mortality were observed. FINDINGS: During the observation period (1963-1999), infant and under-5 mortality rates decreased from 223 per thousand to 80 per thousand and 485 per thousand to 213 per thousand , respectively, with a constant annual rate of decline in the probability of dying since the 1960s (-3.7% and -3.1%, respectively). The age pattern of the under-5 mortality changed drastically, with a large decrease in the death rate between 6 and 24 months of age (from 321 per thousand to 87 per thousand ). This change took place during the 1970s. The seasonal variation, characterized by a greater proportion of deaths during the rainy season, was very marked during the 1960s, then decreased during the 1980s but it has tended to increase again in the 1990s, particularly among children 1-4 years old. CONCLUSION: This study confirms the long-term trend of decrease in child mortality in rural West Africa. Historical knowledge on healthcare developments suggests that immunizations have contributed to the decrease and the change in the age pattern. The re-emergence of malaria seems the most likely explanation for the recent rebound in seasonal variation. Attention to immunization and malaria should continue to be a priority.     

Towards a filariasis-free community: evaluation of filariasis control over an eleven year period in Flores, Indonesia

A population of 202 residents in an area endemic for Brugia timori lymphatic filariasis was treated in a diethylcarbamazine control programme commencing in 1977. All individuals were treated twice with diethylcarbamazine on a mass basis with additional selected treatment for cases with manifestations of infection. Clinical features of lymphatic filariasis were recorded annually until 1982, and the population re-assessed in 1988, six years after the completion of chemotherapy. Microfilarial counts were made on each occasion, and circulating filarial antigen levels measured for 1982 and 1988. The results showed a dramatic and sustained reduction in the rate of elephantiasis and adenolymphangitic disease, and of circulating antigenaemia, and the prevalence of microfilaraemia was reduced to zero by the end of the study.     

珠海市某农村社区学龄前儿童伤害健康促进的效果评价

目的评价在珠海市某农村社区学龄前儿童中,实施伤害健康促进项目一年后的效果。方法采用整群分层抽样的方法,在实施干预的9个幼儿园中抽样调查211名儿童、298名家长、51名教师,进行儿童伤害相关知识及危险因素调查。结果干预后,家长的儿童伤害急救知识正确率有明显提高(P<0.05);儿童的学习环境、生活环境中伤害危险因素及伤害相关危险行为与习惯存在率均有明显降低(P<0.05)。干预后伤害发生率为13.7%,高于干预前的水平(5.0%,P<0.05);儿童伤害单次平均医疗费为357.6元;单次伤害的间接经济损失平均为526.8元,均较干预前明显减少。结论健康促进策略是预防控制农村学龄前儿童伤害的行之有效的措施。