RESUMEN
BACKGROUND: Unintentional childhood injuries are a growing public health concern, and the home is the most common location for non-fatal injuries in children less than 5 years of age. This study describes the long-term effects of two injury prevention educational interventions for caregivers-an educational pamphlet and an in-home tutorial guide-by comparing the change in the prevalence of home injury hazards before and after the interventions. METHODS: This was a pre- (June and July 2010) and post-study with short-term follow-up (November-December 2010) and long-term follow-up (November 2012- January 2013). Neighborhood one included households that received only educational pamphlets after completing a baseline assessment; neighborhood two included households that received an in-home tutorial guide after completing the baseline assessment and receiving the educational pamphlet. The main outcome of this study was the reduction in home injury hazards for children under 5 years of age. RESULTS: A total of 312 households participated in the long-term phase to compare the effect of the interventions. Between the short-term to long-term follow-up, injury hazards significantly reduced in neighborhood two compared to neighborhood one. These included fall hazards (walker use) (IRR 0.24 [95% CI 0.08-0.71]), drowning hazards (open bucket of water in the courtyard and uncovered water pool) (IRR 0.45 [95% CI 0.85-0.98] and IRR 0.46 [95% CI 0.76-0.94]), burn hazards (iron, water heater within reach of child) (IRR 0.56 [95% CI 0.33-0.78] and IRR 0.58 [95% CI 0.32-0.91]), poisoning hazards (shampoo/soap and medicine within reach of child) (IRR 0.53 [95% CI 0.44-0.77] and IRR 0.7 [95% CI 0.44-0.98]) and breakable objects within reach of child (IRR 0.62 [95% CI: 0.39-0.99]). CONCLUSION: An injury prevention tutorial to caretakers of children supplemented with pamphlets could significantly decrease the incidence of falls, drowning, burns, poisoning, and cut injury hazards for children under 5 years of age in their homes in a low-resource setting. This intervention has the potential to be integrated in existing public health programs, such as Lady Health Visitors (LHVs), to disseminate injury prevention information in routine home health visits.
Asunto(s)
Quemaduras , Ahogamiento , Heridas y Lesiones , Niño , Humanos , Preescolar , Ahogamiento/epidemiología , Ahogamiento/prevención & control , Pakistán/epidemiología , Estudios de Seguimiento , Accidentes Domésticos/prevención & control , Agua , Heridas y Lesiones/epidemiología , Heridas y Lesiones/prevención & controlRESUMEN
OBJECTIVE: To assess the characteristics of cooking-related burn injuries in children reported to the World Health Organization Global Burn Registry. METHODS: On 1 February 2021, we downloaded data from the Global Burn Registry on demographic and clinical characteristics of patients younger than 19 years. We performed multivariate regressions to identify risk factors predictive of mortality and total body surface area affected by burns. FINDINGS: Of the 2957 paediatric patients with burn injuries, 974 involved cooking (32.9%). More burns occurred in boys (532 patients; 54.6%) than in girls, and in children 2 years and younger (489 patients; 50.2%). Accidental contact and liquefied petroleum caused most burn injuries (729 patients; 74.8% and 293 patients; 30.1%, respectively). Burn contact by explosions (odds ratio, OR: 2.8; 95% confidence interval, CI: 1.4-5.7) or fires in the cooking area (OR: 3.0; 95% CI: 1.3-6.8), as well as the cooking fuels wood (OR: 2.2; 95 CI%: 1.3-3.4), kerosene (OR: 1.9; 95% CI: 1.0-3.6) or natural gas (OR: 1.5; 95% CI: 1.0-2.2) were associated with larger body surface area affected. Mortality was associated with explosions (OR: 7.5; 95% CI: 2.2-25.9) and fires in the cooking area (OR: 6.9; 95% CI: 1.9-25.7), charcoal (OR: 4.6; 95% CI: 2.0-10.5), kerosene (OR: 3.9; 95% CI: 1.4-10.8), natural gas (OR: 3.0; 95% CI: 1.5-6.1) or wood (OR: 2.8; 95% CI: 1.1-7.1). CONCLUSION: Preventive interventions directed against explosions, fires in cooking areas and hazardous cooking fuels should be implemented to reduce morbidity and mortality from cooking-related burn injuries.
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Accidentes Domésticos , Quemaduras/etiología , Culinaria/métodos , Combustibles Fósiles/efectos adversos , Quemaduras/epidemiología , Niño , Carbón Mineral/efectos adversos , Femenino , Humanos , Masculino , Gas Natural/efectos adversos , Petróleo/efectos adversos , Sistema de Registros , Factores de Riesgo , Organización Mundial de la SaludRESUMEN
A 52-year-old male accidentally ingested approximately 100 mL of 35% hydrogen peroxide (H2O2), resulting in the sudden onset of gastrointestinal and neurologic symptoms. Non-contrast abdominal CT revealed extensive portal venous gas and gastric pneumatosis. The patient was treated with hyperbaric oxygen therapy which resulted in complete resolution of symptoms. The case highlights the therapeutic value of hyperbaric oxygen therapy in the treatment of vascular gas embolism and mitigation of concentrated H2O2 ingestion toxicity.
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Antiinfecciosos Locales/envenenamiento , Embolia Aérea/terapia , Peróxido de Hidrógeno/envenenamiento , Oxigenoterapia Hiperbárica/métodos , Vena Porta , Accidentes Domésticos , Embolia Aérea/inducido químicamente , Humanos , Hígado/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Estómago/diagnóstico por imagenRESUMEN
PURPOSE: The primary aim of this study was to evaluate the effectiveness of a 6-month multicomponent intervention on physical function in socioeconomically vulnerable older adults in rural communities. As secondary aims, we evaluated the effectiveness of the intervention on frailty and other geriatric syndromes, sustained benefit at 12 months, and baseline characteristics associated with poor response. PATIENTS AND METHODS: This designed-delay study was conducted in 187 adults (mean age: 77 years; 75% women) who were living alone or on a low income in three rural regions of Korea. A 24-week multicomponent program that consisted of group exercise, nutritional supplementation, depression management, deprescribing medications, and home hazard reduction was implemented with a planned 6-month interval from August 2015 through January 2017. The primary outcome was physical function, measured using the Short Physical Performance Battery (SPPB) score (range: 0-12; minimum clinically important difference ≥1) at 6 months. Secondary outcomes included frailty phenotype, sarcopenia, Mini Nutritional Assessment-Short Form score (range: 0-14), Center for Epidemiologic Studies-Depression Scale score (range: 0-60), and falls. RESULTS: At 6 months, the SPPB score increased by 3.18 points (95% CI: 2.89, 3.48) from baseline. The program improved frailty (odds ratio: 0.06; 95% CI: 0.02, 0.16), sarcopenia (odds ratio: 0.32; 95% CI: 0.15, 0.68), Mini Nutritional Assessment-Short Form score by 1.67 points (95% CI: 1.28, 2.06), and Center for Epidemiologic Studies-Depression Scale score by -3.83 points (95% CI: -5.26, -2.39), except for fall (rate ratio: 0.99; 95% CI: 0.69, 1.43). These beneficial effects were sustained at 12 months. Body mass index ≥27 kg/m2 and instrumental activities of daily living disability at baseline were associated with poor improvement in the SPPB score. CONCLUSION: This 24-week multicomponent program had sustained beneficial effects up to 1 year on physical function, frailty, sarcopenia, depressive symptoms, and nutritional status in socioeconomically vulnerable older adults in rural communities. (ClinicalTrials.gov, NCT 02554994).
Asunto(s)
Depresión/terapia , Fragilidad/terapia , Estado Nutricional , Sarcopenia/terapia , Poblaciones Vulnerables , Accidentes por Caídas/prevención & control , Accidentes Domésticos/prevención & control , Actividades Cotidianas , Anciano , Anciano de 80 o más Años , Depresión/psicología , Suplementos Dietéticos , Ejercicio Físico , Prueba de Esfuerzo , Femenino , Evaluación Geriátrica , Humanos , Masculino , Evaluación Nutricional , Polifarmacia , Pobreza , Evaluación de Programas y Proyectos de Salud , Escalas de Valoración Psiquiátrica , República de Corea , Población RuralAsunto(s)
Encéfalo/diagnóstico por imagen , Encéfalo/patología , Intoxicación por Monóxido de Carbono/sangre , Intoxicación por Monóxido de Carbono/terapia , Oxigenoterapia Hiperbárica/métodos , Imagen por Resonancia Magnética/métodos , Accidentes Domésticos , Carboxihemoglobina/análisis , Niño , Estudios de Seguimiento , Escala de Coma de Glasgow , Humanos , Masculino , Medición de Riesgo , Índice de Severidad de la Enfermedad , Resultado del TratamientoRESUMEN
A case of a 52-year old male patient who presented to the emergency department with severe nausea and vomiting following accidental ingestion of H2O2. A computed tomography (CT) abdomen performed at our institution demonstrated extensive portal venous gas throughout the liver with few gas droplets seen in the extrahepatic portal vein portion. Pneumatosis was also noted in the wall of the gastric antrum. Upper GI Endoscopy was done revealing diffuse hemorrhagic gastritis and mild duodenal bulb erosion. The patient was treated with hyperbaric oxygen. On the second day of admission, the patient was able to eat without difficulty or pain. Accidental ingestion of high concentration H2O2 solution has been shown to cause extensive injury to surrounding tissues. The injury occurs via three main mechanisms: corrosive damage, oxygen gas formation, and lipid peroxidation. We report a case of accidental ingestion of a highly concentrated (35%) solution of H2O2 causing portal venous gas.
Asunto(s)
Sobredosis de Droga/diagnóstico por imagen , Embolia Aérea/inducido químicamente , Embolia Aérea/diagnóstico por imagen , Peróxido de Hidrógeno/envenenamiento , Hígado/diagnóstico por imagen , Vena Porta/diagnóstico por imagen , Accidentes Domésticos , Diagnóstico Diferencial , Sobredosis de Droga/complicaciones , Sobredosis de Droga/terapia , Duodeno/patología , Gastritis/inducido químicamente , Hemorragia Gastrointestinal/inducido químicamente , Humanos , Oxigenoterapia Hiperbárica , Masculino , Persona de Mediana Edad , Náusea/inducido químicamente , Antro Pilórico/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Ultrasonografía , Vómitos/inducido químicamenteRESUMEN
BACKGROUND: The incidence of liquefied petroleum gas (LPG)-related burns has increased over recent years, and it has become a serious public health issue in developing countries such as India and Turkey. This paper aims to investigate the epidemiological characteristics of LPG-related burns to provide assistance and suggestions for planning prevention strategies. METHODS: A 5-year retrospective study was conducted in patients with LPG-related burns admitted to the Department of Burns & Wound Care Center, Second Affiliated Hospital of Zhejiang University, College of Medicine, between 1st January 2011 and 31st December 2015. Information obtained for each patient included age, gender, education status, occupation, medical insurance, average hospital cost, length of hospital stay, monthly distribution of incidence, place of burns, mechanism of burns, extent of burns, site of burns, accompanying injuries, and treatment outcomes. RESULTS: For the first 4 years (2011-2014), the yearly incidence of LPG-related burns was at approximately 10% of all burns; however, in the fifth year (2015) alone, there was a surge to 26.94%. A total of 1337 burn patients were admitted during this period. Of these, 195 patients were admitted because of 169 LPG-related accidents; there were 11 accidents involving more than one victim. LPG-related burns occurred most frequently in patients aged 21-60 years (73.85%). The majority of injuries occurred from May to August (56.41%), and the most common place was home (83.08%, 162 patients). Gas leak (81.03%) was the main cause of LPG-related burns, followed by inappropriate operation (7.69%) and cooking negligence (2.05%). The mean burn area was 31.32±25.40% of TBSA. The most common sites of burns were the upper extremities (37.47%), followed by the head/face and neck (24.80%) and lower extremities (19.95%). The most common accompanying injuries included inhalation injury (23.59%), shock (8.71%), and external injury (7.18%). The average hospital stay was 22.90±19.47days (range 2-84 days). Only 48 patients (24.62%) had medical insurance, while 124 patients (63.59%) had no medical insurance. The average hospital cost of the no medical insurance group was significantly higher (p<0.0001) than that of the medical insurance group. In addition, 72.73% of patients who left against medical advice (LAMA) were uninsured. The number of patients who recovered at our hospital was 165 (84.62%), while 22 patients (11.28%) LAMA. The overall mortality rate was 4.10% (8 patients). CONCLUSION: Our study shows that the exponential increase in LPG-related burns is alarming. This calls for rigorous precautions. Because gas leak was the main cause of LPG-related burns, any part of LPG stove system that shows signs of weathering should be replaced regularly. In addition, we also found that most of the LAMA patients were uninsured. Thus, comprehensive medical insurance should be involved early in the recovery process to assure a safe and adequate discharge.
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Quemaduras/epidemiología , Incendios/estadística & datos numéricos , Petróleo , Accidentes Domésticos/estadística & datos numéricos , Adolescente , Adulto , Distribución por Edad , Anciano , Análisis de Varianza , Unidades de Quemados/estadística & datos numéricos , Quemaduras/etiología , Niño , Preescolar , China/epidemiología , Femenino , Humanos , Incidencia , Puntaje de Gravedad del Traumatismo , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Distribución por Sexo , Adulto JovenRESUMEN
This study surveyed awareness of, and adherence to, six national fall prevention recommendations among community-dwelling older adults (n = 1050) in Ottawa. Although 76 per cent of respondents agreed falling is a concern and preventable, fewer perceived susceptibility to falling (63%). Respondents had high awareness that home modifications and physical activity can prevent falls. Reported modifications included grab bars (50%), night lights (44%), and raised toilet seats (19%). Half met aerobic activity recommendations; 38 per cent met strength recommendations. Respondents had lower awareness that an annual medication review, annual eye and physical examination, and daily vitamin D supplementation could reduce fall risk. However, reported annual medication review (79%) and eye examination (75%) was high. Nearly half met recommendations for vitamin D intake. These findings suggest a gap in knowledge of awareness and adherence to national recommendations, highlighting the ones that may require attention from those who work to prevent falls.
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Accidentes por Caídas/prevención & control , Accidentes Domésticos/prevención & control , Evaluación Geriátrica , Conocimientos, Actitudes y Práctica en Salud , Vida Independiente/psicología , Anciano , Anciano de 80 o más Años , Canadá , Ejercicio Físico , Femenino , Humanos , Vida Independiente/estadística & datos numéricos , Masculino , Factores de Riesgo , Encuestas y CuestionariosRESUMEN
OBJECTIVE: Hot beverage scalds are a leading cause of burns in young children. The aim of this study was to look at the circumstances surrounding these injuries in terms of setting, mechanism, supervision and first aid to inform a prevention campaign. METHODS: A cross-sectional study was delivered via iPad to parents and caregivers presenting with a child aged 0-36 months with a hot beverage scald at a major paediatric burns centre. RESULTS: Of the 101 children aged 0-36 months that presented with a hot beverage scald over a 12-month period, 54 participants were included. The scald aetiology was as expected with the peak prevalence in children aged 6-24 months, pulling a cup of hot liquid down over themselves. The majority of injuries occurred in the child's home and were witnessed by the caregiver or parent. The supervising adult was often in close proximity when the scald occurred. Less than a third (28%) of participants received recommended first aid treatment at the scene, with an additional 18% receiving this treatment with three hours of the injury-usually at an emergency department. CONCLUSIONS: While the aetiology of these scalds were as expected, the low use of recommended burn first aid was of concern. Although supervision was present in almost all cases, with the parent/caregiver close-by, this proximity still permitted injury. Attentiveness and continuity of supervision, which can be difficult with competing parental demands, appear to play a more important role role; as do considerations of other safety mechanisms such as hazard reduction through keeping hot drinks out of reach and engineering factors such as improved cup design. By incorporating the findings from this study and other research into a hot beverage scald prevention campaign, we hope to see a change in knowledge and behaviour in parents and caregivers of young children, and ultimately a reduction in the incidence of hot beverage scalds.
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Quemaduras/etiología , Primeros Auxilios/normas , Calor/efectos adversos , Té , Accidentes Domésticos/estadística & datos numéricos , Quemaduras/epidemiología , Quemaduras/prevención & control , Quemaduras/terapia , Cuidadores , Niño , Preescolar , Estudios Transversales , Servicio de Urgencia en Hospital/estadística & datos numéricos , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Lactante , Masculino , Responsabilidad Parental , Padres , PrevalenciaRESUMEN
OBJECTIVE: It remains unclear whether Tai Chi is effective for preventing falls in older adults. We undertook this systematic review to evaluate the preventive effect of Tai Chi by updating the latest trial evidence. DESIGN: Systematic review and meta-analysis. METHODS: The Cochrane Library, MEDLINE and EMBASE were searched up to February 2016 to identify randomised trials evaluating Tai Chi for preventing falls in older adults. We evaluated the risk of bias of included trials using the Cochrane Collaboration's tool. Results were combined using random effects meta-analysis. OUTCOME MEASURES: Number of fallers and rate of falls. RESULTS: 18 trials with 3824 participants were included. The Tai Chi group was associated with significantly lower chance of falling at least once (risk ratio (RR) 0.80, 95% CI 0.72 to 0.88) and rate of falls (incidence rate ratio (IRR) 0.69, 95% CI 0.60 to 0.80) than the control group. Subgroup analyses suggested that the preventive effect was likely to increase with exercise frequency (number of fallers: p=0.001; rate of falls: p=0.007) and Yang style Tai Chi was likely to be more effective than Sun style Tai Chi (number of fallers: p=0.01; rate of falls: p=0.001). The results might be influenced by publication bias as the funnel plots showed asymmetry. Sensitivity analyses by sample size, risk of bias and comorbidity showed no major influence on the primary results. CONCLUSIONS: Tai Chi is effective for preventing falls in older adults. The preventive effect is likely to increase with exercise frequency and Yang style Tai Chi seems to be more effective than Sun style Tai Chi.
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Accidentes por Caídas/prevención & control , Accidentes por Caídas/estadística & datos numéricos , Taichi Chuan , Accidentes Domésticos/prevención & control , Anciano , Ejercicio Físico , Humanos , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
"BACKGROUND: Fall-related injuries among the elderly (age 65 and older) are the cause of nearly 750,000 hospitalizations and 25,000 deaths per year in the United States, yet prevention research is lagging. Using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology, the Eastern Association for the Surgery of Trauma produced this practice management guideline to answer the following injury prevention-related population, intervention, comparator, outcomes (PICO) questions:PICO 1: Should bone mineral-enhancing agents be used to prevent fall-related injuries in the elderly?PICO 2: Should hip protectors be used to prevent fall-related injuries in the elderly?PICO 3: Should exercise programs be used to prevent fall-related injuries in the elderly?PICO 4: Should physical environment modifications be used to prevent fall-related injuries in the elderly?PICO 5: Should risk factor screening be used to prevent fall-related injuries in the elderly?PICO 6: Should multiple interventions tailored to the population or individual be used to prevent fall-related injuries in the elderly? METHODS: A comprehensive search and review of all the available literature was performed. We used the GRADE methodology to assess the breadth and quality of the data specific to our PICO questions. RESULTS: We reviewed 50 articles that met our inclusion and exclusion criteria as they applied to our PICO questions. CONCLUSION: Given the data constraints, we offer the following suggestions and recommendations:PICO 1: We conditionally recommend vitamin D and calcium supplementation for frail elderly individuals.PICO 2: We conditionally recommend hip protectors for frail elderly individuals, in the appropriate environment.PICO 3: We conditionally recommend evidence-based exercise programs for frail elderly individuals.PICO 4: We conditionally recommend physical environment modification for frail elderly people.PICO 5: We conditionally recommend frailty screening for the elderly.PICO 6: We strongly recommend risk stratification with targeted comprehensive risk-reduction strategies tailored to particular high-risk groups. LEVEL OF EVIDENCE: Systematic review, level III"
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Humanos , Masculino , Femenino , Anciano , Accidentes por Caídas , Accidentes por Caídas/prevención & control , Accidentes Domésticos/prevención & control , Equipos de Seguridad , Accidentes Domésticos , Evaluación Geriátrica , Factores de Riesgo , Planificación Ambiental , Conservadores de la Densidad Ósea , Conservadores de la Densidad Ósea/uso terapéutico , Terapia por EjercicioRESUMEN
OBJECTIVE: to determine the effect of exercise interventions on fear of falling in community-living people aged ≥65. DESIGN: systematic review and meta-analysis. Bibliographic databases, trial registers and other sources were searched for randomised or quasi-randomised trials. Data were independently extracted by pairs of reviewers using a standard form. RESULTS: thirty trials (2,878 participants) reported 36 interventions (Tai Chi and yoga (n = 9); balance training (n = 19); strength and resistance training (n = 8)). The risk of bias was low in few trials. Most studies were from high-income countries (Australia = 8, USA = 7). Intervention periods (<12 weeks = 22; 13-26 weeks = 7; >26 weeks = 7) and exercise frequency (1-3 times/week = 32; ≥4 times/week = 4) varied between studies. Fear of falling was measured by single-item questions (7) and scales measuring falls efficacy (14), balance confidence (9) and concern or worry about falling (2). Meta-analyses showed a small to moderate effect of exercise interventions on reducing fear of falling immediately post-intervention (standardised mean difference (SMD) 0.37, 95% CI 0.18, 0.56; 24 studies; low-quality evidence). There was a small, but not statistically significant effect in the longer term (<6 months (SMD 0.17, 95% CI -0.05, 0.38 (four studies) and ≥6 months post-intervention SMD 0.20, 95% CI -0.01, 0.41 (three studies)). CONCLUSIONS: exercise interventions probably reduce fear of falling to a small to moderate degree immediately post-intervention in community-living older people. The high risk of bias in most included trials suggests findings should be interpreted with caution. High-quality trials are needed to strengthen the evidence base in this area.
Asunto(s)
Accidentes por Caídas/prevención & control , Accidentes Domésticos/prevención & control , Ejercicio Físico/fisiología , Miedo/psicología , Vida Independiente/psicología , Calidad de Vida , Anciano , Anciano de 80 o más Años , Femenino , Evaluación Geriátrica , Humanos , Vida Independiente/lesiones , Masculino , Equilibrio Postural/fisiología , Ensayos Clínicos Controlados Aleatorios como Asunto , Medición de Riesgo , Resultado del TratamientoRESUMEN
BACKGROUND: Fall-related injuries among the elderly (age 65 and older) are the cause of nearly 750,000 hospitalizations and 25,000 deaths per year in the United States, yet prevention research is lagging. Using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology, the Eastern Association for the Surgery of Trauma produced this practice management guideline to answer the following injury prevention-related population, intervention, comparator, outcomes (PICO) questions:PICO 1: Should bone mineral-enhancing agents be used to prevent fall-related injuries in the elderly?PICO 2: Should hip protectors be used to prevent fall-related injuries in the elderly?PICO 3: Should exercise programs be used to prevent fall-related injuries in the elderly?PICO 4: Should physical environment modifications be used to prevent fall-related injuries in the elderly?PICO 5: Should risk factor screening be used to prevent fall-related injuries in the elderly?PICO 6: Should multiple interventions tailored to the population or individual be used to prevent fall-related injuries in the elderly? METHODS: A comprehensive search and review of all the available literature was performed. We used the GRADE methodology to assess the breadth and quality of the data specific to our PICO questions. RESULTS: We reviewed 50 articles that met our inclusion and exclusion criteria as they applied to our PICO questions. CONCLUSION: Given the data constraints, we offer the following suggestions and recommendations:PICO 1: We conditionally recommend vitamin D and calcium supplementation for frail elderly individuals.PICO 2: We conditionally recommend hip protectors for frail elderly individuals, in the appropriate environment.PICO 3: We conditionally recommend evidence-based exercise programs for frail elderly individuals.PICO 4: We conditionally recommend physical environment modification for frail elderly people.PICO 5: We conditionally recommend frailty screening for the elderly.PICO 6: We strongly recommend risk stratification with targeted comprehensive risk-reduction strategies tailored to particular high-risk groups. LEVEL OF EVIDENCE: Systematic review, level III.
Asunto(s)
Accidentes por Caídas/prevención & control , Accidentes Domésticos/prevención & control , Anciano , Conservadores de la Densidad Ósea/uso terapéutico , Planificación Ambiental , Terapia por Ejercicio , Femenino , Evaluación Geriátrica , Humanos , Masculino , Equipos de Seguridad , Factores de Riesgo , Estados UnidosRESUMEN
BACKGROUND: Steam inhalation has long been considered a beneficial home remedy to treat children with viral respiratory tract infections, but there is no evidence to suggest a benefit and children are at risk of serious burn injuries. AIM: To determine the demographics, mechanism, management, and costs of steam inhalation therapy scalds to a regional burns centre in the UK, and to ascertain whether this practice is recommended by primary care providers. DESIGN AND SETTING: A retrospective study of all patients admitted to a regional burns centre in Swansea, Wales, with steam inhalation therapy scalds. METHOD: Patients who attended the burns centre for steam inhalation therapy scalds between January 2010 and February 2015 were identified using the burns database and data on patient demographics, treatment, and costs incurred were recorded. In addition, an electronic survey was e-mailed to 150 local GPs to determine whether they recommended steam inhalation therapy to patients. RESULTS: Sixteen children attended the burns centre with steam inhalation scalds. The average age attending was 7.4 years (range 1-15 years) and, on average, three children per year were admitted. The most common indication was for the common cold (n = 9). The average size of the burns was 3.1% (range: 0.25-17.0%) of total body area. One child was managed surgically; the remainder were treated with dressings, although one patient required a stay in a high-dependency unit. The total cost of treatment for all patients was £37,133. All in all, 17 out of 21 GPs surveyed recommended steam inhalation to their patients; eight out of 19 GPs recommended it for children aged <5 years. CONCLUSION: Steam inhalation incurs a significant cost to patients and the healthcare system. Its practice continues to be recommended by GPs but children, due to their limited motor skills, curiosity, and poor awareness of danger, are at significant risk of burn injuries and this dangerous practice should no longer be recommended.
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Accidentes Domésticos/estadística & datos numéricos , Quemaduras , Resfriado Común/terapia , Medicina Tradicional , Padres/educación , Terapia Respiratoria/efectos adversos , Autocuidado/efectos adversos , Vapor/efectos adversos , Accidentes Domésticos/prevención & control , Adolescente , Distribución por Edad , Quemaduras/etiología , Quemaduras/prevención & control , Niño , Preescolar , Femenino , Conocimientos, Actitudes y Práctica en Salud , Hospitalización/estadística & datos numéricos , Humanos , Tiempo de Internación , Masculino , Estudios Retrospectivos , Gales/epidemiologíaRESUMEN
Admission rate and length of stay (LOS) are two hospital performance indicators that affect the quality of care, patients' satisfaction, bed turnover, and health cost expenditures. The aim of the study was to identify factors associated with higher admission rates and extended average LOS among acutely poisoned children at a single poison center, central Saudi Arabia.This is a cross-sectional, poison and medical chart review between 2009 and 2011. Exposures were child characteristics, that is, gender, age, body mass index (BMI), health history, and Canadian 5-level triage scale. Poison incident characteristics were, that is, type, exposure route, amount, form, home remedy, and arrival time to center. Admission status and LOS were obtained from records. Chronic poisoning, plant allergies, and venomous bites were excluded. Bivariate and regression analyses were applied. Significance at Pâ<â0.05.Of the 315 eligible cases, (72%) were toddlers with equal gender distribution, (58%) had normal BMI, and (77%) were previously healthy. Poison substances were pharmaceutical drugs (63%) versus chemical products (37%). Main exposure route was oral (98%). Home remedy was observed in (21.9%), which were fluids, solutes, and/or gag-induced vomiting. Almost (52%) arrived to center >1âh. Triage levels: non-urgent cases (58%), less urgent (11%), urgent (18%), emergency (12%), resuscitative (1%). Admission rate was (20.6%) whereas av. LOS was 13â±â22âh. After adjusting and controlling for confounders, older children (adj.ORâ=â1.19) and more critical triage levels (adj.ORâ=â1.35) were significantly associated with higher admission rates compared to younger children and less critical triage levels (adj.Pâ=â0.006) and (adj.Pâ=â0.042) respectively. Home remedy prior arrival was significantly associated with higher av. LOS (Betaâ=â9.48, tâ=â2.99), compared to those who directly visited the center, adj.Pâ=â0.003.Hospital administrators are cautioned that acutely poisoned children who received home remedies prior arrival are more likely to endure an extended LOS. This non-conventional practice is not recommended.
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Accidentes Domésticos/estadística & datos numéricos , Servicios Médicos de Urgencia , Servicio de Urgencia en Hospital/estadística & datos numéricos , Intoxicación , Triaje , Adolescente , Niño , Preescolar , Estudios Transversales , Servicios Médicos de Urgencia/métodos , Servicios Médicos de Urgencia/estadística & datos numéricos , Femenino , Sustancias Peligrosas/toxicidad , Humanos , Lactante , Tiempo de Internación/estadística & datos numéricos , Masculino , Preparaciones Farmacéuticas , Intoxicación/diagnóstico , Intoxicación/epidemiología , Intoxicación/etiología , Intoxicación/terapia , Arabia Saudita/epidemiología , Triaje/métodos , Triaje/normasRESUMEN
The Bedouins comprise one of the ethnic groups in Israeli society. They are Muslims, most of who live in the Negev desert region of southern Israel and live by their unique traditions and customs. At the present they are going through a period of "society in transition", a unique condition that has ramifications for health and morbidity. In recent years the number of publications on the health of Bedouins in the Negev has increased. Recognition of unique socio-economic features, characteristics of health and diseases can help the medical team treat various health problems in this population as well as other populations with similar characteristics. In the present paper we survey and discuss publications on the health of Bedouin children over the past 20 years.
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Estado de Salud , Islamismo , Accidentes Domésticos , Lactancia Materna , Niño , Trastornos de la Nutrición del Niño/etnología , Enfermedades Transmisibles , Anomalías Congénitas/etnología , Consanguinidad , Humanos , Israel , Medicina Tradicional , Intoxicación/etnología , VacunaciónRESUMEN
UNLABELLED: New concentrated laundry pods, available on the European market for approximately 10 years, are associated with more severe intoxications compared to classic laundry detergents. AIM: To compare symptoms and severity after exposure to classic laundry detergents and new laundry pods in a pediatric population. MATERIAL AND METHODS: Retrospective study conducted between 1st January 2002 and 30th June 2013 including all laundry detergent exposure patients admitted to our tertiary level pediatric emergency unit. Collected data were age, sex, date, time and location of exposure, type of product (powder, liquid, tablets, pods), estimated ingested quantity, time of admission, clinical symptoms, severity, complications, and progression. RESULTS: Descriptive analysis: eighty-nine children were included. The mean age was 2.1 ± 1.5 years (range, 36 days to 10 years), 65% of patients were aged less than 2 years. The male:female ratio was 1.5 (males, 60%). After exposure, 57% of children were symptomatic and most frequently developed digestive symptoms (75%). Comparative analysis: compared to classic laundry detergent, children exposed to laundry pods were more symptomatic (96% versus 51%, P<0.0001), had more digestive signs (P=0.003), more frequently had bronchospasm (P=0.02), had a higher risk of ocular lesions (P=0.04), and exposure was more severe (poisoning severity score grade 2, 92% versus 59%, P<0.0001). COMMENTS: Laundry pod toxicity is more severe. The chemical composition of laundry pods has a higher concentration of surfactants and ethoxylated alcohols; they have a higher viscosity and hydrotropic power. The addition of water seems to modify the alkalinity, which explains the severity of ENT, gastric, and corneal lesions. CONCLUSION: The declaration to national poison centers of these intoxications should be pursued by emergency pediatricians, physicians, and pediatric intensivists. Family physicians can encourage parents to declare adverse effects to the National Consumer Product Safety Commission. Parents need to be better informed of the risk of laundry pods and strictly keep this type of product out of the reach of children. Given that it took 7 years after the first warning by the French poison centers to obtain safety recommendations for manufacturers, it is important to maintain pressure on companies to obtain the necessary modification of the physicochemical properties and child-resistant packaging.
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Accidentes Domésticos/estadística & datos numéricos , Detergentes/efectos adversos , Servicio de Urgencia en Hospital , Lavandería , Embalaje de Productos , Dolor Abdominal/inducido químicamente , Espasmo Bronquial/inducido químicamente , Niño , Preescolar , Conjuntivitis/inducido químicamente , Tos/inducido químicamente , Detergentes/química , Femenino , Francia , Humanos , Lactante , Queratitis/inducido químicamente , Laringitis/inducido químicamente , Masculino , Estudios Retrospectivos , Vómitos/inducido químicamenteRESUMEN
OBJECTIVE: To identify Department of Health programs with high potential to integrate evidence-based interventions to prevent falls among older people. METHODS: Broad consultation within the Department followed by structured decision making. This work was informed by an analysis of Victorian hospital separations data and a Cochrane Systematic Review to identify relevant target groups and interventions. Ranking of the integration potential of interventions for a broad range of Department program areas was achieved through a facilitated workshop. A short list of program areas was then developed and scored, using pre-defined criteria, for their match with the interventions. RESULTS: The ranked order of interventions, from most to least suitable for integration, were: multifactorial risk assessment and intervention; multi-component group exercise; medication review; occupational therapy-based home safety; home-based exercise; and first eye cataract surgery. Four of six program areas had a strong match (a score of ≥75% of the maximum score) with one or more of three interventions. Two program areas (Primary Care Partnerships, and Home and Community Care) had strong matches with three interventions (group- and home-based exercise; occupational therapy-based home safety) and were selected as priority areas. The Hospital Admissions Risk Program had strong and good matches respectively with home-based exercise and medication review, and was also selected. CONCLUSIONS: Our systematic methods identified Department programs with strong potential for integration of proven falls prevention interventions. IMPLICATIONS: Matching departmental programs and evidence-based interventions for integration may lead to more efficient resource allocation for falls prevention in Victoria.
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Accidentes por Caídas/prevención & control , Accidentes Domésticos/prevención & control , Programas de Gobierno , Anciano de 80 o más Años , Planificación Ambiental , Medicina Basada en la Evidencia , Ejercicio Físico , Femenino , Humanos , Masculino , Características de la Residencia , Taichi Chuan , VictoriaRESUMEN
The aim of this study is to understand the aetiological factors and pattern of burns caused by the use of liquefied petroleum gas (LPG). This hospital based study was conducted on consecutive patients admitted with major burns from September 2011 to August 2012. The data was recorded on predesigned data sheet. Age, gender, mode of injury, its exact mechanism, place of incidence, extent of burn and inhalation injury were recorded for every patient. 182 patients with LPG related burn injury were admitted in one year. This is 11% of total burn patients received during the same period (182/1656). 147 incidents caused these burns due to gas leak from various parts of the LPG cooking system. Leakage was either from the cylinder, pipe or stove in 52%, 36% and 2% incidents respectively. Human error accounted for 3% incidents while in 7% the mechanism could not be ascertained. Leakage from 5kg cylinder with pipe was the commonest aetiological factor. There were 14 group casualties with more than one victim involved. LPG related burns are preventable to a large extent. There is a need to improve the safety standards in the LPG stove system. Public awareness needs to be improved.