Horse-related injury patterns: a single center report.

BACKGROUND: For ages, humankind and horses have been closely related to occupational and recreational activities. The dangers of engaging with horses have been previously reported. Among sporting activities, horse riding is well-known for its risks. Despite multiple recommendations to wear protective gear, horse-related activities still comprise the risk of severe injuries. This study aimed to examine: (1) if specific mechanisms are correlated to particular injury patterns and (2) if injury types are related to patient demographics. METHODS: From one level I trauma center, between July 2019 and July 2022 (3 years) all emergency reports and discharge letters were retrospectively reviewed by full-text search regarding horse-related injuries. Patient demographics, body mass index, trauma mechanism, injury types, and initiated treatment were extracted from medical records and analyzed. RESULTS: During the study period, 95 patients with 99 horse-related injuries were included. The overwhelming majority of the patients was female (93.7%). Age averaged 35.3 years (range 6 to 71). BMI was 23.6 kg/m2. Inpatient treatment was required in 60.6%. Length of hospital stay averaged 10 days. Surgical treatment was performed in 55 patients (55.6%). Open reduction and internal fixation was the most common procedure (74.5%). Trauma mechanism was fall from a horse followed by being hit by a horse (60.6% and 23.2%, respectively). Injured upper extremities counted up for 52.5% followed by spinal and pelvic injuries (23.2%). Spinal and pelvic injuries were related to fall from a horse (p < 0.001). Injuries to the lower extremities were predominantly caused by a kick of the horse when the rider was unmounted (p = 0.001) and negatively related to a fall from a horse (p = 0.002). Ten patients got their fingers tangled while holding the reins and suffered from injuries to the upper extremity (p < 0.001). Three of them required an amputation (30%). CONCLUSION: Despite the fact that patients are young and healthy, horse related injuries must not be underestimated. In our study, almost two-thirds of the patients required inpatient treatment and 50% underwent surgery. We could show that patient age was related to injury severity according to the Abbreviated Injury Scale (AIS). Spinal and pelvic injuries were significantly related to a fall from a horse with a significantly greater trauma impact according to the AIS. Therefore, these severe entities need to be ruled out in such events. Accidents caused by holding the reins, may result in serious injuries to the hand with 30% requiring an amputation. Doctors need to be aware of possible horse-related injury patterns to reduce morbidity.

Bait acceptability for delivery of oral rabies vaccine to free-ranging dogs on the Navajo and Hopi Nations.

In many areas of the world, only 30 to 50% of dogs are vaccinated against rabies. On some US Indian Reservations, vaccination rates may be as low as 5 to 20%. In 2003 and 2004, we evaluated the effectiveness of commercially available baits to deliver oral rabies vaccine to feral and free-ranging dogs on the Navajo and Hopi Nations. Dogs were offered one of the following baits containing a plastic packet filled with placebo vaccine: vegetable shortening-based Ontario slim baits (Artemis Technologies, Inc.), fish-meal-crumble coated sachets (Merial, Ltd.), dog food polymer baits (Bait-Tek, Inc.), or fish meal polymer baits (Bait-Tek, Inc.). One bait was offered to each animal and its behaviour toward the bait was recorded. Behaviours included: bait ignored, bait swallowed whole, bait chewed and discarded (sachet intact), bait chewed and discarded (sachet punctured), or bait chewed and consumed (sachet punctured). Bait acceptance ranged from 30.7% to 77.8% with the fish-meal-crumble coated sachets having the highest acceptance rate of the tested baits.

Parent orientation meetings to improve attendance and access at a child psychiatric clinic.

As one of several strategies to improve attendance and reduce the size of the waiting list at a child psychiatric clinic serving urban, multiproblem clients, parents were required to attend a free pretreatment orientation group meeting. The rate of missed appointments among families not oriented to the clinic was compared with that of families who attended the orientation meeting. The orientation process significantly improved attendance at intake appointments but did not appear to affect attendance at subsequent appointments. It screened out unmotivated parents, reduced the size of the waiting list, and allowed greater access to clinic services.

Borderline children: a closer look at diagnosis and treatment.

In a follow-up study, children who met research criteria for childhood borderline personality disorder were examined for vulnerability to the affective, personality, and anxiety disorders as defined in DSM-III. In addition to provisional borderline, antisocial, or schizotypal personality diagnoses, many subjects had chronic affective conditions, the symptoms of which resembled those typically associated with borderline personality disorder.

Mood disorders in children with oppositional defiant disorder: a pilot study.

The nature and prevalence of comorbid mood disorders were explored in a group of 28 latency-age children diagnosed with oppositional defiant disorder. Findings are preliminary in nature but suggest that children with oppositional defiant disorder are at significant risk for low-grade depressive illness and that this may commonly be overlooked in the presence of their primary disorder's more overt symptoms.

Long-term psychotherapy and informed consent.

Many long-term psychotherapies begin without sufficient attention to an informed-consent process. Failure to obtain informed consent may leave patients ill prepared to question the recommendation for long-term psychotherapy or to make alternate treatment choices. The author presents a model for informed consent to stimulate debate on ethical approaches to this type of treatment. The approach covers six areas therapists should discuss with candidates for long-term psychotherapy: the diagnostic model used and the recommendation for treatment, potential risks and benefits of treatment, availability of less expensive short-term interventions, clarification of the necessity for psychotherapy, limits of insurance coverage, and plans for measuring the patient's response to treatment. The decision to recommend long-term psychotherapy should be made through careful analysis of indications and contraindications for such treatment and in the context of informed consent.