Repeat assessment of examination signs among children in Malawi with fast-breathing pneumonia.

BACKGROUND: As part of a randomised controlled trial of treatment with placebo versus 3 days of amoxicillin for nonsevere fast-breathing pneumonia among Malawian children aged 2-59 months, a subset of children was hospitalised for observation. We sought to characterise the progression of fast-breathing pneumonia among children undergoing repeat assessments to better understand which children do and do not deteriorate. METHODS: Vital signs and physical examination findings, including respiratory rate, arterial oxygen saturation measured by pulse oximetry (S pO2 ), chest indrawing and temperature were assessed every 3 h for the duration of hospitalisation. Children were assessed for treatment failure during study visits on days 1, 2, 3 and 4. RESULTS: Hospital monitoring data from 436 children were included. While no children had S pO2 90-93% at baseline, 7.4% (16 of 215) of children receiving amoxicillin and 9.5% (21 of 221) receiving placebo developed S pO2 90-93% during monitoring. Similarly, no children had chest indrawing at enrolment, but 6.6% (14 of 215) in the amoxicillin group and 7.2% (16 of 221) in the placebo group went on to develop chest indrawing during hospitalisation. CONCLUSION: Repeat monitoring of children with fast-breathing pneumonia identified vital and physical examination signs not present at baseline, including S pO2 90-93% and chest indrawing. This information may support providers and policymakers in developing guidance for care of children with nonsevere pneumonia.

Occupational Injuries of Aquaculture Workers: Washington State.

OBJECTIVE: To characterize occupational injuries of aquaculture workers in Washington State. METHODS: We reviewed accepted Washington State workers' compensation claims from January 1, 2006 to December 31, 2014. Trends in employment, worker demographics (including age, sex, and body mass index), claim rate, and injury characteristics were summarized for accepted claims in the Washington State risk classes that include aquaculture workers. RESULTS: During the nine-year study period, there were 1,180 accepted claims, 836 (65.1%) were medical-aid only and 344 (26.8%) were compensable. Most commonly reported injury types included being struck by/against an object (n = 420) and work-related musculoskeletal disorders (n = 310). Over the study period, there was no statistically significant change in claim rates in aquaculture (p = 0.77), though they were elevated compared to claim rates for all WA industries combined. A significant upward trend (p = 0.003) in aquaculture employment was observed during our study period. CONCLUSIONS: Given the growth in aquaculture production, and that aquaculture workers in Washington are experiencing higher occupational injury rates compared to other workers in the state, our study suggests that the industry should devote greater attention to prevention of work-related injuries, especially those resulting in being struck by/against objects or work-related musculoskeletal disorders. Enhanced occupational safety and health programs for this industry could help reduce injuries, as well as the cost of workers' compensation claims.