A historical review of the U.S. Navy's busiest recompression chamber in the Pacific theater with a current perspective on caring for civilian divers within its area of responsibility: short communication.

On the island Nation of Guam, the United States Department of Defense has stationed military personnel from every service branch. Guam is utilized as a strategic waypoint for the U.S. military in the Pacific theater. As the largest service branch in the region, the Navy has placed a few Diving Medical Officers in Guam to collectively manage and treat patients with recompression therapy. Guam is also a popular tourist destination, with multiple recreational diving companies certifying individuals who are looking to take advantage of the beautiful warm water and exotic marine life. Unfortunately, with an increase in training and certifying inexperienced divers, came an increase in the operational tempo of the U.S. Navy's recompression chamber on Guam. The recompression chamber on Naval Base Guam (NBG) has been treating patients since 1971. With the only multiplace chamber in the Mariana Islands, Diving Medical Officers, with the accompanying chamber staff, treat military personnel, active-duty sponsored patients and civilian patients. Treating civilian patients by military providers through military treatment facilities presents multiple issues that must be addressed in an effort to provide efficient quality medical care. This article reviews the records, documents, and activity of the NBG chamber over the last four decades. Through the obtained data the information provides projected financial reimbursement from civilian patients. The article also sheds light on areas of needed improvement with regard to data collection, third-party financial collection efforts and the necessity of an inclusive electronic health record (EHR) for military and civilian patients.

[Cash value body, care of the accident and the injured body]. / Corps monnayable, prise en charge de l'accident et du corps accidenté

In our contemporary societies, physical injury resulting from a severe accident triggers a support process involving medical care and financial compensation, calculated according to the technical expertise of disability. Since 1958, the obligation for every individual to purchase an insurance has created the legal concept of pretium doloris ("prize of the pain") referring to a damage due to the physical and moral suffering of an individual. This concept also involves the idea that the injured person should be defined as a "victim" of a "prejudice" from which this person is entitled to expect compensation. The notion of compensation, whether financial or through medical care, contribute to give a social definition of the accident conceived as an existential phenomenon. In this paper, we undertake a philosophical analysis of these categories that allows to address the issue of care and that of evaluation - including financial - of the physical injury caused by the accident. We will see in particular that the problem of compensation refers both to the status of the body and the "recognition" of physical disability in financial terms. More broadly, the study of the repairing process of the physical injury will allow us to examine the contemporary issue of "cash value body" from a new perspective.

Seismic hazard analysis and financial impact assessment of railway infrastructure in the US West Coast: A machine learning approach.

This research examines the seismic hazard impact on railway infrastructure along the U.S. West Coast (Washington, Oregon and California), using machine learning to explore how measures of seismic hazard such as fault density, earthquake frequency, and ground shaking relate to railway infrastructure accidents. By comparing linear and non-linear models, it finds non-linear approaches superior, particularly noting that higher fault densities and stronger peak ground shaking correlate with increased infrastructure accident rates. Shallow earthquakes with magnitudes of 3.5 or greater and hypocentral depths <20 km also exhibit a pronounced correlation with the incidence of railway infrastructure accidents The study extends to financial impact analysis through Net Present Value and Monte Carlo Simulation, and evaluates damage costs from 2000-2023 to guide financial planning and risk management strategies. It highlights the crucial role of advanced financial tools in optimizing maintenance and long-term planning that could result in better preparedness in high seismic hazard regions and emphasizes the need for robust risk management strategies in enhancing railway operational safety that considers the local and regional tectonic and seismic activity and local ground shaking intensity.

Public health implications of sleep loss: the community burden.

Poor sleep imparts a significant personal and societal burden. Therefore, it is important to have accurate estimates of its causes, prevalence and costs to inform health policy. A recent evaluation of the sleep habits of Australians demonstrates that frequent (daily or near daily) sleep difficulties (initiating and maintaining sleep, and experiencing inadequate sleep), daytime fatigue, sleepiness and irritability are highly prevalent (20%-35%). These difficulties are generally more prevalent among females, with the exception of snoring and related difficulties. While about half of these problems are likely to be attributable to specific sleep disorders, the balance appears attributable to poor sleep habits or choices to limit sleep opportunity. Study of the economic impact of sleep disorders demonstrates financial costs to Australia of $5.1 billion per year. This comprises $270 million for health care costs for the conditions themselves, $540 million for care of associated medical conditions attributable to sleep disorders, and about $4.3 billion largely attributable to associated productivity losses and non-medical costs resulting from sleep loss-related accidents. Loss of life quality added a substantial further non-financial cost. While large, these costs were for sleep disorders alone. Additional costs relating to inadequate sleep from poor sleep habits in people without sleep disorders were not considered. Based on the high prevalence of such problems and the known impacts of sleep loss in all its forms on health, productivity and safety, it is likely that these poor sleep habits would add substantially to the costs from sleep disorders alone.

Costs of injury in New Zealand: Accident Compensation Corporation spending, personal spending and quality-adjusted life years lost.

BACKGROUND: New Zealand offers a unique opportunity for cost-of-injury research due to its comprehensive, no-fault injury compensation insurance scheme, which is managed by the government-controlled Accident Compensation Corporation (ACC). OBJECTIVES: To estimate the costs of injury in New Zealand with respect to ACC's spending for entitlement claimants (ie, people with injuries requiring more than 'treatment only'), as well as injured individuals' out-of-pocket personal spending and non-pecuniary costs in terms of effects on health-related quality of life (HRQoL). METHODS: A prospective cohort study of people injured between June 2007 and May 2009 was followed for 12 months after injury. ACC's spending for each participant (n=2215) was estimated from ACC data. Out-of-pocket personal spending and quality-adjusted life years (QALYs) lost were estimated based on interviews conducted at 3, 5 and 12 months post injury. RESULTS: For the cohort studied, most of the reported financial costs of injury were met by ACC. ACC spending was higher for individuals with more severe injuries and ones admitted to hospital. There was no difference in mean personal spending between people who were hospitalised or not, or between those with minor or moderate injuries, although individuals with more severe injuries reported higher personal spending. CONCLUSIONS: Overall, the ACC appears to be performing well supporting injured people financially. Nonetheless, people with more severe injuries incur substantial out-of-pocket expenses. Costs are higher for hospitalised and more severe injuries, but non-hospitalised and less severe cases can still incur substantial costs. The HRQoL effects of injury-naturally, borne by injured individuals themselves-are relatively large on average.

Is this the new smoking? An expert panel review of the York University OHV health benefits study.

Recently, a study by Burr and his associates culminating in three peer reviewed journal articles and a string of press releases emanating from the off-highway vehicle (OHV) industry claimed that increasing riding time on all terrain recreational vehicles (ATVs) and off road motorcycles (ORMs) could meet the basic guidelines of the American College of Sports Medicine and Health Canada for sufficient physical activity leading to positive health adaptations. Should this be true, this study could revolutionize the way that health professionals prescribe physical activity. To examine the efficacy of these claims, the authors convened an expert panel to examine these publications to particularly focus on the problem conceptualization, the research methodology including sample selection and controls, the presentation and interpretation of results and the veracity of their conclusions. The experts concluded, while never questioning the laboratory and field measurements, that there were a number of conceptual, methodological and interpretive limitations and errors that rendered the claims of health benefits indefensible. Furthermore, the researchers largely failed to take account of the healthcare costs associated with riding OHVs which according to the epidemiology literature, and particularly for ATVs, are considerable.

Determining the effect of environmental accidents on responses to a Gulf of Mexico recreational for-hire fishing industry survey.

A survey designed to collect economic, attitudinal and policy data from the recreational for-hire (RFH) fishing industry in the U.S. Gulf of Mexico was conducted before and during the largest marine oil spill in U.S. history (the April 2010 Deepwater Horizon blowout). Respondents were grouped into two time periods based on when the survey was completed, where the break in groups was determined through the examination of the Pew Research Center's media coverage index and the per cent of fishing area closures due to the oil spill. A logistic regression was used to test variables that might predict the time period of a response. Results indicated that recall bias was not present in the financial variables examined, but that firm operating and demographic characteristics (i.e. vessel size, annual number of trips, number of vessels operating in the firm, tenure and household income) were significant in explaining the time period in which surveys were completed.

Mammography screening: how far is too far?

INTRODUCTION: This study answers the question: 'How far must a Canadian woman travel before the risk of a motor vehicle accident (MVA) outweighs the benefits of mammography screening?'. METHODS: Numbers needed to screen and false positive rates were extracted from information in the breast screening guidelines from the Canadian Task Force on screening for breast cancer. Motor vehicle accidents per billion vehicle kilometres were extracted from Transport Canada. The charts of women undergoing screening mammograms were reviewed to determine the average number of extra trips generated from a false positive mammogram. A formula was devised to determine when the distance travelled and risk of MVA outweighed the benefits of mammogram screening. RESULTS: How far a woman would need travel before the risk of that travel outweighed the benefits of screening mammography is determined by the province in which she lives (location) and her age. The distance of a round trip before the risk of travel outweighed the benefit of screening mammography varied from 65 km to 1151 km, according the patient's age and location. CONCLUSION: Travel risk is rarely discussed in recommending screening examinations. Nevertheless the benefits of screening can be outweighed by the risk of travel. Knowledge of travel risk is essential before recommending screening procedures.

The burden of childhood injuries and evidence based strategies developed using the injury surveillance system in Pasto, Colombia.

OBJECTIVE: This article characterises the burden of childhood injuries and provides examples of evidence-based injury prevention strategies developed using a citywide injury surveillance system in Pasto, Colombia. METHODS: Fatal (2003-2007) and non-fatal (2006-2007) childhood injury data were analysed by age, sex, cause, intent, place of occurrence, and disposition. RESULTS: Boys accounted for 71.5% of fatal and 64.9% of non-fatal injuries. The overall fatality rate for all injuries was 170.8 per 100,000 and the non-fatal injury rate was 4,053 per 100,000. Unintentional injuries were the leading causes of fatal injuries for all age groups, except for those 15-19 years whose top four leading causes were violence-related. Among non-fatal injuries, falls was the leading mechanism in the group 0-14 years. Interpersonal violence with a sharp object was the most important cause for boys aged 15-19 years. Home was the most frequent place of occurrence for both fatal and non-fatal injuries for young children 0-4 years old. Home, school and public places became an important place for injuries for boys in the age group 5-15 years. The highest case-fatality rate was for self-inflicted injuries (8.9%). CONCLUSIONS: Although some interventions have been implemented in Pasto to reduce injuries, it is necessary to further explore risk factors to better focus prevention strategies and their evaluation. We discuss three evidence-based strategies developed to prevent firework-related injuries during festival, self-inflicted injuries, and road traffic-related injuries, designed and implemented based on the injury surveillance data.

Population based estimates of non-fatal injuries in the capital of Iran.

BACKGROUND: Fatal injuries are at the top of the injury pyramid; however, non-fatal injuries are quite common and impose huge medical expenses on the population. Relying on hospital data will underestimate the incidence of non-fatal injuries. The aim of this study was to estimate the annual incidence and out of pocket medical expenses of all injuries in urban population of Tehran (the capital city of Iran). METHODS: Using the cluster random sampling approach, a household survey of residents of greater Tehran was performed on April 2008. At randomly selected residential locations, interviewers asked one adult person to report all injuries which have occurred during the past year for all household members, as well as the type of injury, place of occurrence, the activity, cause of accidents resulting in injuries, the amount of out of pocket medical expenses for injury, and whether they referred to hospital. RESULTS: This study included 2,450 households residing in Tehran during 2007-8. The annual incidence of all injuries was 188.7 (180.7-196.9), significant injuries needing any medical care was 68.8 (63.7-74.2), fractures was 19.3 (16.6 - 22.4), and injuries resulted in hospitalization was 16.7 (14.2 - 19.6) per 1000 population. The annual incidence of fatal injuries was 33 (7-96) per 100,000 Population. In children aged 15 or less, the annual incidence of all injuries was 137.2 (120.0 - 155.9), significant injuries needing any medical care was 64.2 (52.2 - 78.0), fractures was 21.8 (15.0 - 30.7), and injuries resulted in hospitalization was 6.8 (3.3 - 12.5) per 1000 population. The mean out of pocket medical expense for injuries was 19.9 USD. CONCLUSION: This population based study showed that the real incidence of non-fatal injuries in the capital of Iran is more than the formal hospital-based estimates. These injuries impose non trivial medical and indirect cost on the community. The out of pocket medical expense of non-fatal injuries to Tehran population is estimated as 27 million USD per year. Effective strategies should be considered to minimize these injuries and decrease the great financial burden to public and the health system.

The global burden of unintentional injuries and an agenda for progress.

According to the World Health Organization, unintentional injuries were responsible for over 3.9 million deaths and over 138 million disability-adjusted life-years in 2004, with over 90% of those occurring in low- and middle-income countries (LMIC). This paper utilizes the year 2004 World Health Organization Global Burden of Disease Study estimates to illustrate the global and regional burden of unintentional injuries and injury rates, stratified by cause, region, age, and gender. The worldwide rate of unintentional injuries is 61 per 100,000 population per year. Overall, road traffic injuries make up the largest proportion of unintentional injury deaths (33%). When standardized per 100,000 population, the death rate is nearly double in LMIC versus high-income countries (65 vs. 35 per 100,000), and the rate of disability-adjusted life-years is more than triple in LMIC (2,398 vs. 774 per 100,000). This paper calls for more action around 5 core areas that need research investments and capacity development, particularly in LMIC: 1) improving injury data collection, 2) defining the epidemiology of unintentional injuries, 3) estimating the costs of injuries, 4) understanding public perceptions about injury causation, and 5) engaging with policy makers to improve injury prevention and control.

Cervical spine injuries resulting from diving accidents in swimming pools: outcome of 34 patients.

Cervical spine injuries after diving into private swimming pools can lead to dramatic consequences. We reviewed 34 patients hospitalized in our center between 1996 and 2006. Data was collected from their initial admission and from follow-up appointments. The injuries were sustained by young men in 97% (mean age 27) and the majority happened during the summer (88%). Fractures were at C5-C7 in 70%. American Spinal Injury Association class (ASIA) on admission was A for 8 patients, B for 4, C for 4, D for 1, and E for 17. There were 23 surgical spine stabilizations. Final ASIA class was A for 6 patients, B for 1, C for 3, D for 5, and E for 18. The mean duration of hospitalization was 21.3 days in our neurosurgical center (mean overall cost: 36,000 Euros/patient) plus 10.6 months in rehabilitation center for the 15 patients admitted who had an ASIA class A to C. Mean overall direct cost for a patient with class A is almost 300,000 Euros, compared to around 10,000 Euros for patients with class D and E. In addition, a profound impact on personal and professional life was seen in many cases including 11 divorces and 7 job losses. Dangerous diving into swimming pools can result in spinal injuries with drastic consequences, including permanent physical disability and a profound impact on socio-professional status. Moreover, there are significant financial costs to society. Better prevention strategies should be implemented to reduce the impact of this public health problem.

The true cost of child abuse at a level 1 pediatric trauma center.

BACKGROUND: Child physical abuse (CPA) is a significant cause of morbidity and mortality. Children who sustain CPA consume significant healthcare resources. We hypothesized that the costs to care for children who sustain for children with CPA-type injuries are greater than the costs to care for children who sustain accidental injuries. METHODS: All confirmed CPA patients between the ages of 0 and 19 years old, who were admitted to a level 1 pediatric trauma center between January 2010 and September 2018, were retrospectively reviewed. We compared outcomes, including mortality, length of stay (LOS), diagnostic work-up, and overall cost using propensity matching between CPA and accidentally injured trauma patients. Patients were matched based on injury severity score (ISS). RESULTS: The CPA cohort (n = 595) was younger (1.31 +/- 1.96 years, p < 0.0001) than the accidental trauma patients (8.6 +/-5.54 years). The majority of the CPA patients had Medicaid coverage (75.1%), when compared to accidental trauma patients (37.5%; p < 0.0001). CPA patients had longer ICU LOS (2.43 days; p < 0.0001), increased ventilation days (2.57 days; p < 0.0001), and longer hospital LOS (6.56 days; p = 0.0004). The overall mortality rate for CPA patients was higher than accidental trauma patients (9.9% vs. 1.2%; p < 0.0001). The median hospital cost was significantly higher for those with CPA ($18,000) than accidental trauma ($10,100; p < 0.0001). CONCLUSION: The costs to care for children who sustain CPA-type injuries are significantly greater than the costs to care for children who sustain accidental trauma. Better screening tools, more provider education and broader community outreach efforts are needed to reduce the societal and economic costs associated with child physical abuse. STUDY TYPE: Treatment. LEVEL OF EVIDENCE: Level III.

Regional healthcare costs and burden of injury associated with electric scooters.

BACKGROUND: The introduction of shared electric scooters (e-scooters) to New Zealand has resulted in a large number of injuries. Within the past year, there have been studies addressing some of the impact of these e-scooter injuries, but none have included outpatient data or total regional costs. METHODS: This was a retrospective review of e-scooter associated injuries presenting to Auckland region healthcare providers in the seven months since their introduction using Accident Compensation Corporation (ACC) Claims data. The type of injuries and key metrics of their overall hospital burden were assessed between September 2018 and April 2019. The financial cost of these injuries was also estimated. RESULTS: A total of 770 patient presentations associated with e-scooters were identified during the study period. Of these, 524 (68.1%) were treated in the community by primary care physicians and 246 (31.9%) were treated in Auckland hospitals. The 246 hospital presentations used a total of 5,569 hospital bed-hours with 75 patients (30.5%) requiring admission and inpatient care. Of the hospital presentations, 49 patients (19.9%) required at least one operation, and 105 (42.7%) required specialist follow up care. 26.8% of injuries were thought to be associated with alcohol use. The estimated injury rate was 60 per 100,000 trips and hospital presentation rate was 20 per 100,000 trips. The combined cost attributable to these injuries was $608,843 (NZD) for Auckland City Hospital and $1,303,155 for the whole Auckland region. CONCLUSIONS: The overall burden of care due to the introduction of e-scooters to New Zealand has had significant impact both on the primary urban trauma center as well as community care facilities. E-scooter related injuries have had a large impact on regional healthcare costs.

The economic burden of insomnia: direct and indirect costs for individuals with insomnia syndrome, insomnia symptoms, and good sleepers.

BACKGROUND AND PURPOSE: Insomnia is a highly prevalent problem that is associated with increased use of health care services and products, as well as functional impairments. This study estimated from a societal perspective the direct and indirect costs of insomnia. PARTICIPANTS AND METHODS: A randomly selected sample of 948 adults (mean age = 43.7 years old; 60% female) from the province of Quebec, Canada completed questionnaires on sleep, health, use of health-care services and products, accidents, work absences, and reduced productivity. Data were also obtained from the Quebec government administered health insurance board regarding consultations and hospitalizations. Participants were categorized as having insomnia syndrome, insomnia symptoms or as being good sleepers using a standard algorithm. Frequencies of target cost variables were obtained and multiplied by unit costs to generate estimates of total costs for the adult population of the province of Quebec. RESULTS: The total annual cost of insomnia in the province of Quebec was estimated at $6.6 billion (Cdn$). This includes direct costs associated with insomnia-motivated health-care consultations ($191.2 million) and transportation for these consultations ($36.6 million), prescription medications ($16.5 million), over the-counter products ($1.8 million) and alcohol used as a sleep aid ($339.8 million). Annual indirect costs associated with insomnia-related absenteeism were estimated at $970.6 million, with insomnia-related productivity losses estimated at $5.0 billion. The average annual per-person costs (direct and indirect combined) were $5,010 for individuals with insomnia syndrome, $1431 for individuals presenting with symptoms, and $421 for good sleepers. CONCLUSIONS: This study suggests that the economic burden of insomnia is very high, with the largest proportion of all expenses (76%) attributable to insomnia-related work absences and reduced productivity. As the economic burden of untreated insomnia is much higher than that of treating insomnia, future clinical trials should evaluate the cost-benefits, cost-utility, and cost-effectiveness of insomnia therapies.

The need to reform personal injury law leaving scientific disputes to scientists.

Personal injury law is staggeringly inefficient as a system of victim compensation. There is little reason to assume that it importantly curtails unreasonably dangerous conduct, yet there is good reason to conclude that it promotes socially undesirable behavior. Moreover, the tort law system ill serves the goal of individual justice, in part because it assumes that lay juries can correctly decide complex scientific issues. Several methods of replacing tort law with other compensation systems are surveyed and a specific, balanced reform package is proposed.

Framing the problem: injuries and public health.

OBJECTIVES: To introduce the field of injury control and public health approaches to injury prevention. METHODS: A review of injury epidemiology, definitions, intervention approaches, and the importance of injury as a public health problem. RESULTS: Injuries are a large national and international problem affecting families and communities. Injuries are predictable and preventable. Behavioral, environmental, and technological solutions will be necessary to reduce or eliminate injuries. CONCLUSIONS: Reductions in injury and their costs to families and communities are possible but will need support, collaboration, and partnering at the local level.

Total costs of injury from accidents in the home and during education, sports and leisure activities: estimates for Norway with assessment of uncertainty.

Injury accidents occurring in the home, during educational, sports or leisure activities were estimated from samples of hospital data, combined with fatality data from vital statistics. Uncertainty of estimated figures was assessed in simulation-based analysis. Total economic costs to society from injuries and fatalities due to such accidents were estimated at approximately NOK 150 billion per year. The estimated costs reveal the scale of the public health problem and lead to arguments for the establishment of a proper injury register for the identification of preventive measures to reduce the costs to society.