Incidence of childhood burn injuries and modifiable household risk factors in rural Ghana: A cluster-randomized,population-based,household survey

BackgroundWe aimed to determine the incidence of childhood burn injuries in rural Ghana and describe modifiable household risk factors to inform prevention initiatives.MethodsWe performed a cluster-randomized, population-based survey of caregivers of children in a rural district in Ghana, representing 2713 households and 14,032 children. Caregivers were interviewed regarding childhood burn injuries within the past 6 months and household risk factors.Results357 households were sampled. Most used an open fire with biomass fuel for cooking (85.8%). Households rarely cooked in a separate kitchen (10%). Stove height was commonly within reach of children under five years (<1 m; 96.0%). The weighted annualized incidence of CBI was 63 per 1000 child-years (6.4% of children per year); reported mean age was 4.4 years (SD 4.0). The most common etiology was flame burn. Older age (OR 0.89, 95% CI 0.8–1.0) and households with an older sibling ≥12 years (OR 0.58, 95% CI 0.3–1.3) seemed to be associated with lower odds of CBI.ConclusionsChildhood burn injury is common in rural Ghana. Opportunities exist to reduce the risk of childhood burn injury childhood burns in rural settings by supporting the transition to safer cooking arrangements, child barrier apparatuses in homes without older children, and/or development of formal childcare programs.     

福州城市社区空巢老人居家安全危险因素的质性研究

目的了解社区空巢老人居家安全的危险因素,为制定空巢老人居家安全干预措施提供依据。方法 2018年1～4月,采取目的抽样的方法选取13名城市社区的空巢老人为研究对象,采用半结构式访谈法深入了解城市社区空巢老人居家安全的危险因素,借助Nvivo11.0软件,并运用Colaizzi七步分析法分析资料。结果空巢老人发生居家安全问题的危险因素可归纳为4大方面:健康状况差、缺乏安全意识、不安全的环境因素、缺乏支持与帮助。结论空巢老人的生理状况、安全意识、社会支持情况及居家环境对其居家安全发生有一定影响。     

Exercise induced bronchospasm in Ghana: differences in prevalence between urban and rural schoolchildren

BACKGROUND: As more developing countries adopt a westernised style of living, an increase in the prevalence of asthma can be expected to occur in these areas. A study was undertaken to establish the normal response to exercise in Ghanaian children and to use these normal values to determine the prevalence of exercise induced bronchospasm (EIB) in urban rich (UR), urban poor (UP), and rural (R) school children. Skin test reactivity to common inhalant allergens in UR, UP, and R children with and without EIB was also investigated. METHODS: Two hundred children aged 9-16 years without a previous history of respiratory symptoms were randomly selected and underwent free running exercise testing. A normal response to exercise was defined as the group mean change in peak expiratory flow rate (PEFR) +/- 2 standard deviations. This value was used to identify the prevalence of EIB in UR, UP, and R schoolchildren. A total of 1095 children from three different schools underwent exercise testing (220 UP, 599 UR, 276 R), after which 916 children underwent skin prick testing to six common inhalant allergens (D farinae, D pteronyssinus, cat, dog, Aspergillus flavus and Candida albicans). RESULTS: From the results of exercise testing in asymptomatic children the normal range was defined as a fall in PEFR of < 12.5% after exercise. Thirty four children were classified as having EIB on the basis of the above definition, giving an overall prevalence of 3.1%. The prevalence of EIB was significantly higher in UR children (4.7%) than in both UP (2.2%; p < 0.05) and R children (1.4%; p < 0.01). However, the prevalence rates in the UP and R children were similar. The prevalence of atopy in the whole population was 4.4%. Of the children with EIB, 10% were skin test positive to at least one of the allergens tested. The prevalence of atopy was significantly higher in UR children (6.55%, 95% confidence interval (CI) 4.5% to 9.2%) than in UP (2.9%, 95% CI 0.9% to 6.7%) and R children (1.5%, 95% CI 0.4% to 3.7%), respectively (p < 0.005). CONCLUSIONS: The prevalence of EIB and atopy is higher in urban rich than in urban poor or rural children suggesting that, in addition to genetic predisposition, social and environmental factors such as wealth, life style, and housing are important determinants of these phenotypes.


     

Road traffic injuries in Tanzanian children and adolescents: A cross-sectional household survey

ObjectiveTo measure annual rates of road traffic injuries (RTI) and to describe the characteristics of road traffic crashes experienced by children and adolescents in Tanga, Tanzania.MethodsWe conducted a cross-sectional household survey using geospatial population-weighted sampling in the city of Tanga in northern Tanzania. Data were collected in February and March of 2022. We report 12-month rates of road traffic crashes and RTI (reported by adult caregivers) among children and adolescents <18 years of age.ResultsA total of 2,794 adult respondents reported data on 6563 children and adolescents, among whom, 180 were reported to have experienced road traffic crashes in the past 12 months (crash incidence: 27.4 per 1,000 children, 95%CI 23.5-31.4) and 158 sustained injuries (RTI incidence: 24.1 per 1000 children, 95%CI 20.4-27.8). Almost a quarter of RTI (23%) were reported to be major (resulting in ≥30 days of missed activities). RTI was higher among adolescents (13-17 years) than children <5 years (21.5 vs. 14.1 per 1,000, p=0.039). Few children always or sometimes wore helmets when riding on motorcycles/motorbikes (12.8%) or wore safety restraints/seat belts in cars or other vehicles (11.9%).ConclusionThe high rate of road traffic crashes and RTI observed among children and adolescents in a medium-sized city in Tanzania underscores the urgent need to improve road safety and increase use of safety equipment in low resource settings.     

Equestrian injuries: incidence, injury patterns, and risk factors for 10 years of major traumatic injuries

BACKGROUND: Horseback riding is more dangerous than motorcycle riding, skiing, football, and rugby. The purpose of this study was to identify the incidence and injury patterns, as well as risk factors associated with severe equestrian trauma. METHODS: All patients with major equestrian injuries (injury severity score > or = 12) admitted between 1995 and 2005 were reviewed. A 46-question survey outlining potential rider, animal, and environmental risk factors was administered. RESULTS: Among 7941 trauma patients, 151 (2%) were injured on horseback (mean injury severity score, 20; mortality rate, 7%). Injuries included the chest (54%), head (48%), abdomen (22%), and extremities (17%). Forty-five percent required surgery. Survey results (55%) indicated that riders and horses were well trained, with a 47% recidivism rate. Only 9% of patients wore helmets, however, 64% believed the accident was preventable. CONCLUSIONS: Chest trauma previously has been underappreciated. This injury pattern may be a result of significant rider experience. Helmet and vest use will be targeted in future injury prevention strategies.     

Preferences for oral rehydration drinks among healthy individuals in Ghana: A single-blind,cross-sectional survey to inform implementation of an enterally based resuscitation protocol for burn injury

BackgroundEnterally based resuscitation for major burn injuries has been suggested as a simple, operationally superior, and effective resuscitation strategy for use in austere contexts. However, key information to support its implementation is lacking, including palatability and acceptability of widely available rehydration drinks.MethodsWe performed a single-blinded, cross-sectional survey of 60 healthy children (5–14 years), adults (15–54 years) and older adults (≥55 years) to determine palatability and overall acceptability of five oral rehydration solutions (ORS) and a positive control drink (Sprite Zero®) in Ghana. Quantitative data were described and differences between our control drink and the others across age groups were visually examined with Likert plots. Qualitative responses were analyzed using a content analysis framework.ResultsTwenty participants in each age group completed the study. Participants were as young as 5 years and as old as 84 years. Nearly two thirds of the sample identified as male (n = 38, 63% of all participants). The positive control was reported to taste ‘good or ‘very good’ by the majority of participants (89%) followed by lemon-flavored ORS (78%) and orange-flavored ORS (78%). Conversely, homemade and low-osmolarity ORS were reported to taste ‘good’ or ‘very good’ by only 20% and 15% of participants, respectively. There were no major taste differences across the age groups. However, children more frequently reported positively (i.e., tastes ‘good’ or ‘very good’) about flavored and sweet drinks than did adults and older adults. When faced with the hypothetical situation of being critically injured and needing resuscitation, participants tended to be more agreeable to consuming all the drinks, even low-osmolarity and homemade ORS.ConclusionsThese findings can be used to support the development of protocols that may be more acceptable among patients undergoing enterally based resuscitation, thus improving the effectiveness of the treatment. Specifically, enterally based resuscitation should likely include citrus-flavored ORS when available, given superior palatability and the fact that different flavor additives for patients of different ages do not seem necessary.     

Bone health in urban midlife Malaysian women: risk factors and prevention

The aim of this study was to identify risk factors associated with osteoporosis in urban midlife Malaysian women and to assess the effectiveness of lifestyle intervention in bone loss prevention with hormone replacement therapy (HRT) as a positive control. A total of 514 disease-free, uterus-intact, non-HRT-using women aged 45 years and older were recruited into the study. After initial bone mineral density (BMD) assessments, they were randomized into three groups: GI (control), G2 (lifestyle intervention), and G3 (lifestyle intervention with HRT). The study group was composed of 67.5% Chinese, 27.8% Malay, and 4.2% Indians with a mean age of 51.07±5.28 years. Two-fifths were postmenopausal, and the prevalence of osteoporosis was 24.1%, seen predominantly at the hip. Postmenopausal women had significantly lower mean BMD and a higher incidence of osteoporosis compared with the premenopausal women, 42.1% vs. 11.1% (p<0.0005). A lower incidence of osteoporosis was found in women who took calcium supplementation regularly as opposed to those who do not, 18.7% vs. 29.3% (p=0.036). Age and a greater postmenopausal duration showed a significant negative association with BMD, whereas higher family income, weight, body mass index, and waist and hip circumference were positively correlated. After 18–20 months, the effect of intervention was assessed based on BMD values of 279 women at baseline and after intervention. Lifestyle intervention alone was effective in premenopausal women, preventing over 90% of spinal bone loss compared with the controls, who lost 11.6% (0.046 g/cm²) bone mass with similar losses of hip bone, 2.0% (0.026 g/cm²) vs. 1.5% (0.020 g/cm²). Premenopausal women on HRT also showed a substantial decrease in spine and hip BMD, 18.6% (0.081 g/cm²) and 9.0% (0.122 g/cm²), respectively. The lifestyle intervention program retarded postmenopausal bone loss by 21% and 37% compared with controls, who lost 9.6% (0.141 g/cm²) and 6.0% (0.138 g/cm²) bone mass at the spine and hip. In comparison, lifestyle intervention with HRT increased postmenopausal BMD by 12.7% (0.216 g/cm²) at the spine and 1.9% (0.042 g/cm²) at the hip. The changes in hip BMD were influenced by current age, ethnicity, and income, while intervention had the strongest effect on spine BMD changes. In conclusion, lifestyle intervention prevented spinal bone loss in premenopausal women and retarded postmenopausal spine and hip bone loss compared with controls. The benefits of physical activity on spine and hip BMD highlight its potential as a safe and cost-effective alternative to HRT, which is not advocated because of its potential adverse effects.     

Differences between burns in rural and in urban areas: implications for prevention

This study aimed to identify typical features of burns in rural areas and to improve their prevention by comparing the characteristics of burnt patients and their burns in rural and urban areas. A cross-sectional survey was conducted in 19 of the 23 French burns units over one year, using a structured questionnaire. We analysed the resulting database. Of the 1422 patients, excluding 188 burnt in unclassified areas, 420 (34%) were burnt in rural areas. Burns were more frequent in rural than in urban areas. Occupational burns were more frequent in rural than in urban areas. The characteristics of patients and burns did not differ between the areas. Patients burnt during everyday activities were older and more frequently had predisposing factors in rural than in urban areas. Burns occurred outdoors more often in rural than in urban areas and were frequently due to flames or explosions or to the use of barbecues or open fires. The hands and perineum were burnt more frequently in rural than in urban areas. Rural burns were more severe than urban burns: they were deeper, involved a larger body surface area and caused more deaths. Preventive measures in rural areas should take into account occupation and everyday activities. They should be specifically adapted to the profiles of burnt patients.     

Differences in fracture pattern between an urban and a rural population: A comparative population-based study in Southern Sweden

Differences in the incidence of hip fractures have been reported between urban and rural areas. In this population-based study the characteristics of fracture patterns between the city of Malmö and the nearby rural district of Sjöbo were compared. A total of 782 individuals in Malmö and 486 in Sjöbo were invited to participate. Fracture history for all invited was registered. The odds ratio for fracture was higher in Malmö, particularly for women over 70. More than half of the urban women aged 70 had a history of a fracture. A fourfold increase in fracture prevalence between the ages of 60 and 70 was observed in women in Malmö, whereas the prevalence doubled in Sjöbo. The differences in fracture patterns between these two urban and rural communities may be explained by different lifestyles.     

Incidence, risk factors, and prevention of biliary tract injuries during laparoscopic cholecystectomy in Switzerland

Bile duct injury (BDI) during laparoscopic cholecystectomy (LC) which may result in patient disability or death are reported to occur more frequently when compared to open surgery. The aim of this nationwide prospective study beyond the laparoscopic learning curve was to analyze the incidence, risk factors, and management of major BDI. During a 3-year period (1995–1997) 130 items of all LC data were collected on a central computer system from 84 surgical institutions in Switzerland by the Swiss Association of Laparoscopic and Thoracoscopic Surgery and evaluated for major BDIs. Simple biliary leakage was excluded from analysis. There were 12,111 patients with a mean age of 55 years (3–98 years) enrolled in the study. The overall BDI incidence was 0.3%, 0.18% for symptomatic gallstones, and 0.36% for acute cholecystitis. In cases of severe chronic cholecystitis with shrunken gallbladder, the incidence was as high as 3%. Morbidity and mortality rates were significantly increased in BDIs. BDI was recognized intraoperatively in 80.6%, in 64% of cases by help of intraoperative cholangiography. Immediate surgical repair was performed laparoscopically (suture or T-drainage) in 21%; in 79%, open repair (34% simple suture, 66% Roux-en-Y reconstruction) was needed. The BDI incidence did not decrease during the last 7 years. In 47%, BDIs were caused by experienced laparoscopic surgeons, perhaps because they tend to operate on more difficult patients. In conclusion, the incidence of major BDIs remains constant in Switzerland at a level of 0.3%, which is still higher when compared to open surgery. However, most cases are now detected intraoperatively and immediately repaired which ensures a good long-term outcome. For preventing such injuries, exact anatomical knowledge with its variants and a meticulous surgical dissecting technique especially in case of acute inflammation or shrunken gallbladder are mandatory.     

Comparative analysis of characteristics and risk factors of traffic injury in aged people from urban and rural areas in Chongqing

Objective:To study the epidemiologic characteristics of traffic injuries among people over 60 years old in the Nan' an district(urban)and Jiangjin district(rural)of Chongqing,and to discuss the corresp...     

Alpine ski and snowboarding traumatic injuries: incidence, injury patterns, and risk factors for 10 years

Background

Alpine skiing and snowboarding are popular winter sports in Canada. Every year participation in these activities results in traumatic injury. The purpose of this study was to identify the incidence and injury patterns, as well as risk factors associated with ski and snowboarding injuries.

Methods

A comprehensive 10-year retrospective review of Alpine ski and snowboarding injuries from 1996 to 2006 was conducted. The Alberta Trauma Registry was used as the primary source of data.

Results

A total of 196 patients (56.6% skiers, 43.4% snowboarders) were identified as having major traumatic injuries (Injury Severity Score, ≥12). Forty-three patients required intensive care unit support. The majority of injuries were related to falls and collisions with natural objects. Head injuries were most common, followed by chest, spinal, and extremity trauma. Seventy-nine patients required emergency surgery.

Conclusions

Skiing and snowboarding represent activities with high potential for traumatic injury. Safety initiatives should be developed to target this population.     

某特种部队新兵训练损伤及内在危险因素调查

[目的]探讨特种部队新兵训练损伤的特点,找出内在危险因素和保护因素,为有效防治训练损伤和兵员选择提供依据.[方法]对某特种部队345名新兵2008年1～3月新兵训练期间,训练损伤、个人信息、人体形态特征进行调查.资料数量化后输入计算机,采用SPSS 13.0软件行描述性分析、二分变量Logistic分析和多元逐步回归分析.[结果] 345人中101人在3个月新兵训练期间发生训练伤,发病率为29.3％.损伤的部位以膝关节以下部位为最多,占所有损伤的43.6％.损伤主要发生在3 km跑、5 km跑和战术训练等科目.Logistic回归分析表明,下肢长( OR=1.062,95％ CI:1.001,1.127),X型腿(OR=1.007,95％CI:1.001,1.022)是危险因素；腰围(OR=0.914,95％CI:0.852,0.981)、无入伍前骨骼肌肉系统损伤史(OR=0.450,95％CI:0.216,0.939),肩宽比身高( OR=0.010,95％ CI:0.001,0.011)是保护因素.多元逐步线性回归分析表明,身高(B=0.0204,P=0.0003)、X型腿(B=0.216 4,P=0.061 6),以及腰围(B=-0.010 6,P=0.058 3)、入伍前劳动强度(B=-0.132 2,P=0.067 4)、水果摄入量(B=-0.080 2,P=0.078 7)入选方程.[结论]下肢是新兵训练损伤的主要部位.3 km跑、5 km跑和战术训练等科目是造成新兵训练损伤的主要科目.X型腿、下肢长、身高是新兵训练损伤的危险因素:无入伍前骨骼肌肉系统损伤史、入伍前劳动强度、水果摄入量、腰围、肩宽比身高是保护因素.     

Emergence agitation in children: risk factors,prevention, and treatment

Emergence agitation (EA) in children is a major postoperative issue that increases the risk of patient self-harm, places a burden on nursing staff, and reduces parent satisfaction with treatment. Risk factors for EA include age, preoperative anxiety, patient personality, pain, anesthesia method, and surgical procedure. Sevoflurane and desflurane are widely used anesthetics due to their low blood/gas partition coefficients, but they have recently been posited as a cause of EA in children. The perioperative administration of opioids, midazolam, ketamine, alpha-2 agonist sedatives, and nonsteroidal anti-inflammatory drugs has demonstrated efficacy in the prevention and treatment of EA. Maintenance of anesthesia using propofol has also been shown to prevent EA. In children, anesthesia methods that are unlikely to cause EA should be selected, with the prompt adminstration of appropriate treatment in cases of EA.