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1.
Br J Nurs ; 29(8): S20-S27, 2020 Apr 23.
Artículo en Inglés | MEDLINE | ID: mdl-32324453

RESUMEN

Vascular access device insertion is a common procedure in healthcare, and complications associated with vascular access can be serious and cause considerable patient harm. The use of care bundles to reduce the risks of these complications is well documented. However, the removal of devices, especially those associated with medical adhesive, can cause significant skin injuries, which often could be avoided if this aspect is included in the care bundle and the risk factors are better understood in healthcare. Appeel Sterile is an effective sterile silicone-based medical adhesive remover that is available in a variety of formats. It is the only sterile medical adhesive remover available, which makes it the safest choice for use with vascular access devices.


Asunto(s)
Cateterismo Periférico/enfermería , Siliconas/uso terapéutico , Cuidados de la Piel/enfermería , Heridas y Traumatismos/prevención & control , Humanos , Riesgo , Piel/lesiones , Cuidados de la Piel/métodos , Adhesivos Tisulares/efectos adversos , Heridas y Traumatismos/etiología
3.
Cochrane Database Syst Rev ; 1: CD011377, 2020 01 23.
Artículo en Inglés | MEDLINE | ID: mdl-32006460

RESUMEN

BACKGROUND: Ageing has a degenerative effect on the skin, leaving it more vulnerable to damage. Hygiene and emollient interventions may help maintain skin integrity in older people in hospital and residential care settings; however, at present, most care is based on "tried and tested" practice, rather than on evidence. OBJECTIVES: To assess the effects of hygiene and emollient interventions for maintaining skin integrity in older people in hospital and residential care settings. SEARCH METHODS: We searched the Cochrane Skin Specialised Register, CENTRAL, MEDLINE, Embase, and CINAHL, up to January 2019. We also searched five trials registers. SELECTION CRITERIA: Randomised controlled trials comparing hygiene and emollient interventions versus placebo, no intervention, or standard practices for older people aged ≥ 60 years in hospital or residential care settings. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures as expected by Cochrane. Primary outcomes were frequency of skin damage, for example, complete loss of integrity (tears or ulceration) or partial loss of integrity (fissuring), and side effects. Secondary outcomes included transepidermal water loss (TEWL), stratum corneum hydration (SCH), erythema, and clinical scores of dryness or itch. We used GRADE to assess the quality of evidence. MAIN RESULTS: We included six trials involving 1598 residential care home residents; no included trial had a hospital setting. Most participants had a mean age of 80+ years; when specified, more women were recruited than men. Two studies included only people with diagnosed dry skin. Studies were conducted in Asia, Australasia, Europe, and North America. A range of hygiene and emollient interventions were assessed: a moisturising soap bar; combinations of water soak, oil soak, and lotion; regular application of a commercially available moisturiser; use of two different standardised skin care regimens comprising a body wash and leave-on body lotion; bed bath with "wash gloves" containing numerous ingredients; and application of a hot towel after usual care bed bath. In five studies, treatment duration ranged from five days to six months; only one study had post-treatment follow-up (one to eight days from end of treatment). Outcomes in the hot towel study were measured 15 minutes after the skin was wiped with a dry towel. Three studies each had high risk of attrition, detection, and performance bias. Only one trial (n = 984) assessed frequency of skin damage via average monthly incidence of skin tears during six months of treatment. The emollient group (usual care plus twice-daily application of moisturiser) had 5.76 tears per month per 1000 occupied bed-days compared with 10.57 tears in the usual care only group (ad hoc or no standardised skin-moisturising regimen) (P = 0.004), but this is based on very low-quality evidence, so we are uncertain of this result. Only one trial (n = 133) reported measuring side effects. At 56 ± 4 days from baseline, there were three undesirable effects (itch (mild), redness (mild/moderate), and irritation (severe)) in intervention group 1 (regimen consisting of a moisturising body wash and a moisturising leave-on lotion) and one event (mild skin dryness) in intervention group 2 (regimen consisting of body wash and a water-in-oil emulsion containing emollients and 4% urea). In both groups, the body wash was used daily and the emollient twice daily for eight weeks. There were zero adverse events in the usual care group. This result is based on very low-quality evidence. This same study also measured TEWL at 56 ± 4 days in the mid-volar forearm (n = 106) and the lower leg (n = 105). Compared to usual care, there may be no difference in TEWL between intervention groups, but evidence quality is low. One study, which compared application of a hot towel for 10 seconds after a usual care bed bath versus usual care bed bath only, also measured TEWL at 15 minutes after the skin was wiped with a dry towel for one second. The mean TEWL was 8.6 g/m²/h (standard deviation (SD) 3.2) in the hot towel group compared with 8.9 g/m²/h (SD 4.1) in the usual care group (low-quality evidence; n = 42), showing there may be little or no difference between groups. A lower score is more favourable. Three studies (266 participants) measured SCH, but all evidence is of very low quality; we did not combine these studies due to differences in treatments (different skin care regimens for eight weeks; wash gloves for 12 weeks; and single application of hot towel to the skin) and differences in outcome reporting. All three studies showed no clear difference in SCH at follow-up (ranging from 15 minutes after the intervention to 12 weeks from baseline), when compared with usual care. A clinical score of dryness was measured by three studies (including 245 participants); pooling was not appropriate. The treatment groups (different skin care regimens for eight weeks; a moisturising soap bar used for five days; and combinations of water soak, oil soak, and lotion for 12 days) may reduce dryness compared to standard care or no intervention (results measured at 5, 8, and 56 ± 4 days after treatment was initiated). However, the quality of evidence for this outcome is low. Outcomes of erythema and clinical score of itch were not assessed in any included studies. AUTHORS' CONCLUSIONS: Current evidence about the effects of hygiene and emollients in maintaining skin integrity in older people in residential and hospital settings is inadequate. We cannot draw conclusions regarding frequency of skin damage or side effects due to very low-quality evidence. Low-quality evidence suggests that in residential care settings for older people, certain types of hygiene and emollient interventions (two different standardised skin care regimens; moisturising soap bar; combinations of water soak, oil soak, and lotion) may be more effective in terms of clinical score of dryness when compared with no intervention or standard care. Studies were small and generally lacked methodological rigour, and information on effect sizes and precision was absent. More clinical trials are needed to guide practice; future studies should use a standard approach to measuring treatment effects and should include patient-reported outcomes, such as comfort and acceptability.


Asunto(s)
Emolientes/uso terapéutico , Higiene , Prurito/prevención & control , Cuidados de la Piel/métodos , Heridas y Traumatismos/prevención & control , Administración Tópica , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Satisfacción del Paciente , Ensayos Clínicos Controlados Aleatorios como Asunto , Jabones/química , Jabones/uso terapéutico
4.
Am Fam Physician ; 101(3): 159-166, 2020 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-32003952

RESUMEN

Chronic wounds are those that do not progress through a normal, orderly, and timely sequence of repair. They are common and are often incorrectly treated. The morbidity and associated costs of chronic wounds highlight the need to implement wound prevention and treatment guidelines. Common lower extremity wounds include arterial, diabetic, pressure, and venous ulcers. Physical examination alone can often guide the diagnosis. All patients with a nonhealing lower extremity ulcer should have a vascular assessment, including documentation of wound location, size, depth, drainage, and tissue type; palpation of pedal pulses; and measurement of the ankle-brachial index. Atypical nonhealing wounds should be biopsied. The mainstay of treatment is the TIME principle: tissue debridement, infection control, moisture balance, and edges of the wound. After these general measures have been addressed, treatment is specific to the ulcer type. Patients with arterial ulcers should be immediately referred to a vascular surgeon for appropriate intervention. Treatment of venous ulcers involves compression and elevation of the lower extremities, plus exercise if tolerated. Diabetic foot ulcers are managed by offloading the foot and, if necessary, treating the underlying peripheral arterial disease. Pressure ulcers are managed by offloading the affected area.


Asunto(s)
Cicatrización de Heridas/fisiología , Heridas y Traumatismos/terapia , Enfermedad Crónica/terapia , Pie Diabético/fisiopatología , Pie Diabético/terapia , Humanos , Úlcera por Presión/fisiopatología , Úlcera por Presión/terapia , Úlcera Varicosa/fisiopatología , Úlcera Varicosa/terapia , Heridas y Traumatismos/prevención & control
5.
BMJ ; 368: m453, 2020 Feb 26.
Artículo en Inglés | MEDLINE | ID: mdl-32102784

RESUMEN

The studyCleland LC, McComb L, Kee F, et al. Effects of 20 mph interventions on a range of public health outcomes: a meta-narrative evidence synthesis. J Transp Health 2019. doi:10.1016/j.jth.2019.100633This project was funded by the NIHR Policy Research Programme (project number 17/149/19).To read the full NIHR Signal, go to: https://discover.dc.nihr.ac.uk/content/signal-000853/twenty-mph-speed-zones-reduce-the-danger-to-pedestrians-and-cyclists.


Asunto(s)
Accidentes de Tránsito/prevención & control , Conducción de Automóvil/legislación & jurisprudencia , Ciclismo/lesiones , Peatones , Heridas y Traumatismos/prevención & control , Ciclismo/legislación & jurisprudencia , Humanos , Reino Unido
6.
Occup Environ Med ; 77(2): 94-99, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31896614

RESUMEN

OBJECTIVES: To understand and characterise the construct of 'near misses' from the perspective of temporary construction workers and to describe the safety and health risks associated with and contributing to near misses and injuries in temporary workers in the construction industry. METHODS: Six semistructured language-sensitive (ie, English and Spanish) focus group discussions were conducted with workers (n=43) employed with temporary staffing agencies in South Florida. This convenience sample completed a demographic questionnaire prior to the focus group discussion. A general inductive approach was used to examine near misses in the construction industry and the unique safety and health concerns of temporary workers. RESULTS: Four broad themes describing near misses, reporting practices and workplace safety hazards in the construction industry were derived from the group discussions: (1) non-standard workers in the construction industry draw a clear distinction between near misses and injury and believe their best protections from both occur at the worker level; (2) social network structure on construction worksites is an effective way to protect workers against injury and near misses; (3) safety and health priorities and policies at the organisational level differ from those at the worker level, which contributes to workplace injury; and (4) reporting of safety concerns and near misses is influenced by injury severity. CONCLUSIONS: Temporary workers in the construction industry are familiar with near misses but have limited resources to protect themselves against potential health and safety hazards. These non-standard workers addressed unique barriers to staying safe at work and identified potential improvements.


Asunto(s)
Accidentes de Trabajo/prevención & control , Industria de la Construcción , Empleo , Salud Laboral , Seguridad , Recursos Humanos , Heridas y Traumatismos/prevención & control , Adulto , Actitud , Femenino , Grupos Focales , Humanos , Masculino , Persona de Mediana Edad , Organizaciones , Políticas , Informe de Investigación , Encuestas y Cuestionarios , Lugar de Trabajo , Adulto Joven
7.
Accid Anal Prev ; 134: 105336, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31704640

RESUMEN

Electric two-wheelers (E2Ws) have become newly popular transportation tools with the associated growing traffic safety concerns. E2W riders and bicyclists behave similarly as vulnerable road users (VRUs), while exhibited dissimilarities in riding postures and interactions with the two-wheelers. Existing epidemiology reveals prominent differences in injury risks between E2W riders and other vulnerable road users in collisions with motor vehicles. The objective of this study is to investigate the factors influencing kinematics and head injury risks of two-wheeler rides in two-wheeler-vehicle collisions and compare between E2W-vehicle and bicycle-vehicle collisions. Via multi-body modeling of two two-wheeler types, two vehicle types, and three rider statures in MADYMO, twelve collision scenarios were developed. A simulation matrix considering a range of impact velocities and relative positions was performed for each scenario. A subsequent parametric analysis was conducted with focus on the kinematics and head injury risks of two-wheeler riders. Results show that the head injury risk increased with vehicle moving velocity, while the two-wheeler velocity and relative location between rider and vehicle prior to the collision exhibited highly non-linear influence on the kinematical response. The rider with larger stature had higher possibilities to miss head impact on the vehicle. In collisions with the sedan, E2W riders would sustain lower head injury risks with lower contacting velocity on the windshield than bicyclists. While in collisions with the SUV, E2W riders would sustain increasing head injury risks due to the higher structural stiffness at contact, and the risk level was about the same as bicyclists. The findings revealed the loading mechanisms behind the different head injury risks between E2W riders and bicyclists.


Asunto(s)
Accidentes de Tránsito , Ciclismo/lesiones , Motocicletas , Heridas y Traumatismos/etiología , Fenómenos Biomecánicos , Simulación por Computador , Femenino , Humanos , Masculino , Medición de Riesgo , Seguridad , Heridas y Traumatismos/prevención & control
8.
J Nurs Care Qual ; 35(1): 77-82, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-30998559

RESUMEN

BACKGROUND: Injurious falls continue to challenge health care. Causes of serious falls from the largest health care system in the United States can direct future prevention efforts. PURPOSE: This article analyzes injurious falls in the Veterans Health Administration and provides generalizable recommended actions to prevent future events. METHODS: We categorized root cause analysis (RCA) reports and coded injury type, fall type, location, and root causes. We describe interventions during the fall and provide resources for future prevention. RESULTS: There were 154 reported fall RCAs during this time. Most (83%, n = 128) resulted in major injury: hip fractures (43%, n = 66), other fractures (25%, n = 38), and head injury (16%, n = 24). Most falls were unwitnessed (75%, n = 116). CONCLUSIONS: Patients who fell were not wearing hip or head protection. Most falls were unwitnessed, and none were on 1:1 observation. Such interventions may help prevent future injurious falls.


Asunto(s)
Accidentes por Caídas/estadística & datos numéricos , Heridas y Traumatismos/etiología , Heridas y Traumatismos/prevención & control , Accidentes por Caídas/prevención & control , Anciano , Femenino , Humanos , Masculino , Estudios Retrospectivos , Factores de Riesgo , Análisis de Causa Raíz , Estados Unidos/epidemiología , United States Department of Veterans Affairs/organización & administración , United States Department of Veterans Affairs/estadística & datos numéricos , Veteranos/estadística & datos numéricos , Heridas y Traumatismos/epidemiología
9.
Zhonghua Liu Xing Bing Xue Za Zhi ; 40(11): 1350-1355, 2019 Nov 10.
Artículo en Chino | MEDLINE | ID: mdl-31838803

RESUMEN

Injury is an important public health problem that threatening children's health. Researches have been carried out to prevent child injuries in China. Disease burden on injury for children have been moderated, but remained as the first cause of death in Chinese children, so injury prevention among children should still be treated as priority to promote children's health. It is necessary to establish and improve strategies in injury prevention which should be led by the government and correlated institutes, as to carry out a systematic, comprehensive and scientific system for children injury prevention and control. In order to reduce children's injuries and promote children's health, relevant policies and regulations should base on "Healthy China 2030" to formulate and implement action plans, to carry out practice and scientific research on children injury prevention, and to strengthen the team construction and talent training on this issue.


Asunto(s)
Prevención de Accidentes , Salud Pública , Heridas y Traumatismos/prevención & control , Niño , China , Humanos
10.
Zhonghua Liu Xing Bing Xue Za Zhi ; 40(11): 1381-1385, 2019 Nov 10.
Artículo en Chino | MEDLINE | ID: mdl-31838808

RESUMEN

Objective: To understand the current situation of road traffic injuries among primary and secondary school students in Mengzi city. Methods: Using the cluster random sampling method, more than 9 000 primary and secondary school students from 20 primary and secondary schools in Mengzi city, were randomly sampled. A questionnaire survey was conducted on the occurrence of road traffic injuries in school students. Results: A total of 9 197 students were surveyed, including 150 from road traffic injuries. The incidence rates of road traffic injuries was 1.63% among students in Mengzi city and 2.85% among junior high school students, with the high incidence in May. The leading places of injuries were village roads (38.00%), city roads (33.33%) and district roads (12.67%), respectively. 26.67% of the traffic injuries occurred on the way to or from schools, with riding on electric bicycle (52.00%) as the major cause and contusion/abrasion (75.33%) appeared as the major signs. Both lower and upper limbs plus multiple parts were accounting for 45.51%, 22.16% and 16.17%, respectively of all the injuries. 70.67% of all the cases with road traffic injuries in children, recovered after treatment. Children with road traffic injuries would stay in the hospital for up to 90 days but spent less than 30 000 Yuan. Conclusion: The incidence of road traffic injuries among students in Mengzi city seemed relatively high, with junior high school students reached the highest. Riding electric bicycle appeared as the leading cause for traffic injuries in children in Mengzi city of Yunnan province.


Asunto(s)
Accidentes de Tránsito/estadística & datos numéricos , Ciclismo/estadística & datos numéricos , Salud Pública , Instituciones Académicas , Estudiantes/estadística & datos numéricos , Caminata/estadística & datos numéricos , Heridas y Traumatismos/epidemiología , Accidentes de Tránsito/prevención & control , Niño , China/epidemiología , Femenino , Humanos , Incidencia , Masculino , Encuestas y Cuestionarios , Transportes , Heridas y Traumatismos/prevención & control
11.
CuidArte, Enferm ; 13(2): 205-207, dez.2019.
Artículo en Portugués | BDENF - Enfermería | ID: biblio-1087691

RESUMEN

Introdução: Para os enfermeiros brasileiros identificar e diagnosticar uma ferida por meio de exames microbiológicos ainda é um desafio, pois não têm autonomia na solicitação destes exames microbiológicos para diagnosticar a infecção no cuidado de feridas crônicas. Objetivo: Refletir sobre a importância da utilização de exames microbiológicos como parâmetros aos profissionais enfermeiros para o tratamento de feridas. Método: Estudo descritivo desenvolvido sob a forma de resenha. Resultados: Necessário compreender todos os fatores que envolvem o dia a dia do portador da ferida, suas particularidades, comorbidades e principalmente, entender qual microorganismo é responsável pelo atraso da cicatrização e possível formação de biofilme. Desenvolver instrumentos de colheitas requer padronização e protocolo. Conclusão: Os enfermeiros precisam desenvolver mais autonomia, aperfeiçoar tratamentos e contribuir para a redução de atrasos no processo cicatricial das feridas.(AU)


Introduction: For Brazilian nurses to identify and diagnose a wound through microbiological exams is still a challenge, as they do not have autonomy to request these microbiological exams to diagnose infection in the care of chronic wounds. Objective: To reflect on the importance of using microbiological exams as parameters for professional nurses to treat wounds. Method: Descriptive study developed as a review. Results: It is necessary to understand all the factors that involve the daily life of the wound bearer, their particularities, comorbidities and, above all, to understand which microorganism is responsible for delayed healing and possible biofilm formation. Developing harvesting instruments requires standardization and protocol. Conclusion: Nurses need to develop more autonomy, improve treatments and contribute to reducing delays in wound healing.(AU)


Introducción: Para la enfermera brasileña, identificar y diagnosticar una herida mediante exámenes microbiológicos sigue siendo un desafío, ya que no tienen autonomía para solicitar estos exámenes microbiológicos para diagnosticar infecciones en el cuidado de heridas crónicas. Objetivo: Reflexionar sobre la importancia de utilizar exámenes microbiológicos como parámetros para enfermeras profesionales para tratar heridas. Método: Estudio descriptivo desarrollado como revisión. Resultados: Es necesario comprender todos los factores que involucran la vida diaria del portador de la herida, sus particularidades, comorbilidades y, sobre todo, comprender qué microorganismo es responsable de la cicatrización tardía y la posible formación de biopelículas. El desarrollo de instrumentos de cosecha requiere estandarización y protocolo. Conclusión: Las enfermeras necesitan desarrollar más autonomía, mejorar los tratamientos y contribuir a reducir los retrasos en la cicatrización de heridas.(AU)


Asunto(s)
Humanos , Cicatrización de Heridas , Infección de Heridas , Heridas y Traumatismos , Heridas y Traumatismos/prevención & control , Atención de Enfermería , Heridas y Traumatismos/tratamiento farmacológico
12.
J Safety Res ; 70: 201-206, 2019 09.
Artículo en Inglés | MEDLINE | ID: mdl-31847996

RESUMEN

INTRODUCTION: Pedestrian injuries are a significant pediatric public health concern worldwide. Younger children are at particular risk for pedestrian injuries in parking lots, but there is limited research regarding children's pedestrian behaviors in parking lots. METHOD: This study examined children's behaviors and safety risks in parking lots through unobtrusive and unannounced observation of 124 children ages 2-10 years and their adult supervisors as they crossed a parking lot from their parked vehicle into a community recreation center. RESULTS: Adult supervision was inadequate: over 67% of children 10 years of age and younger were unsupervised in the parking lot at some point between the vehicle parking and the child entering into the building. Approximately 90% of all children were outside of arm's length of the accompanying adult at some point while in the parking lot. Additionally, children exited the vehicle prior to the adult in over 50% of observations. Age was associated with safety risk, with older children being unsupervised more often than younger ones. CONCLUSIONS: Adult supervision of children in a parking lot setting was poor, creating significant safety risks. In addition, many children failed to follow basic pedestrian safety practices themselves, such as looking for moving cars. Injury prevention strategies should be implemented. Practical applications: As researchers gain better understanding about the safety risks for children in parking lots, interventions could target adult and child behaviors through improved supervision, altered perception of risk, and mandated behavioral guidelines for child behavior, such as how and when children exit vehicles in parking lots.


Asunto(s)
Accidentes de Tránsito/prevención & control , Automóviles , Conducta Infantil , Cuidado del Niño , Salud del Niño , Peatones , Seguridad , Adulto , Niño , Preescolar , Femenino , Humanos , Masculino , Heridas y Traumatismos/prevención & control
13.
J Safety Res ; 70: 207-212, 2019 09.
Artículo en Inglés | MEDLINE | ID: mdl-31847997

RESUMEN

INTRODUCTION: Despite the proven safety benefits, crashes still occur at roundabouts. This study examined long-term trends in total crash counts, crash severity, and crashes involving common driver errors (failing to yield the right-of-way and speeding) in the period following the completion of single- and double-lane roundabouts in Washington state. METHOD: Crashes occurring during 2010-2016 at single- and double-lane roundabouts completed between 2009 and 2015 in Washington state were included. Poisson regression examined changes in annual total crash counts over time. Logistic regression estimated average annual changes in the odds that a crash involved an evident/incapacitating/fatal injury and that a crash involved a driver error. Regression models were estimated for single- and double-lane roundabouts separately. RESULTS: Annual total crash counts declined significantly by 8.8% over time at double-lane roundabouts and increased nonsignificantly over time at single-lane roundabouts. The study estimated a significant 32.1% annual reduction in the odds that a crash involved an evident or incapacitating injury at double-lane roundabouts and a nonsignificant 18.9% reduction at single-lane roundabouts. There was a significant 10.6% annual decline in the odds that a crash was right-of-way related at double-lane roundabouts and a significant 19.1% annual decline in the odds that a crash was speeding-related at single-lane roundabouts. CONCLUSIONS: The current study demonstrates that safety can improve over time at double-lane roundabouts as drivers gain experience navigating them. At the same time, it is important that roundabouts include design elements that will prevent right-of-way mistakes and reduce speeds. Practical applications: Communities installing double-lane roundabouts may find that their benefits will increase the longer they are in place, even if initial changes in crashes and injuries are underwhelming.


Asunto(s)
Accidentes de Tránsito/prevención & control , Conducción de Automóvil , Planificación Ambiental , Seguridad , Humanos , Modelos Logísticos , Washingtón , Heridas y Traumatismos/prevención & control
14.
J Safety Res ; 70: 223-232, 2019 09.
Artículo en Inglés | MEDLINE | ID: mdl-31847999

RESUMEN

INTRODUCTION: Vehicles in transport sometimes leave the travel lane and encroach onto natural or artificial objects on the roadsides. These types of crashes are called run-off the road crashes, which account for a large proportion of fatalities and severe crashes to vehicle occupants. In the United States, there are about one million such crashes, with roadside features leading to one third of all road fatalities. Traffic barriers could be installed to keep vehicles on the roadways and to prevent vehicles from colliding with obstacles such as trees, boulder, and walls. The installation of traffic barriers would be warranted if the severity of colliding with the barrier would be less severe than colliding with other fix objects on the sides of the roadway. However, injuries and fatalities do occur when vehicle collide with traffic barriers. A comprehensive analysis of traffic barrier features is lacking due to the absence of traffic barrier features data. Previous research has focused on simulation studies or only a general evaluation of traffic barriers, without accounting for different traffic barrier features. METHOD: This study is conducted using an extensive traffic barrier features database for the purpose of investigating the impact of different environmental and traffic barrier geometry on this type of crash severity. This study only included data related to two-lane undivided roadway systems, which did not involve median barrier crashes. Crash severity is modeled using a mixed binary logistic regression model in which some parameters are fixed and some are random. RESULTS: The results indicated that the effects of traffic barrier height, traffic barrier offset, and shoulder width should not be separated, but rather considered as interactions that impact crash severity. Rollover, side slope height, alcohol involvement, road surface conditions, and posted speed limit are some factors that also impact the severity of these crashes. The effects of gender, truck traffic count, and time of a day were found to be best modeled with random parameters in this study. The effects of these risk factors are discussed in this paper. PRACTICAL APPLICATIONS: Results from this study could provide new guidelines for the design of traffic barriers based upon the identified roadway and traffic barrier characteristics.


Asunto(s)
Accidentes de Tránsito/prevención & control , Planificación Ambiental , Heridas y Traumatismos/prevención & control , Accidentes de Tránsito/mortalidad , Adulto , Consumo de Bebidas Alcohólicas , Bases de Datos Factuales , Etanol , Femenino , Humanos , Modelos Logísticos , Masculino , Vehículos a Motor , Factores de Riesgo , Seguridad , Viaje , Estados Unidos , Heridas y Traumatismos/mortalidad
15.
J Safety Res ; 70: 253-262, 2019 09.
Artículo en Inglés | MEDLINE | ID: mdl-31848003

RESUMEN

INTRODUCTION: The 2.5 h Foundations for Safety Leadership (FSL) training program teaches construction supervisors the leadership skills they need to strengthen jobsite safety climate and reduce adverse safety-related outcomes. METHODS: Using a quasi-experimental prospective switching replications study design, we examined (1) if FSL-trained jobsite safety leaders would report improved understanding and practice of the FSL leadership skills, safety practices and crew reporting of safety related conditions, and (2) if their crew perceived a change in (a) their supervisors' practices, (b) their own safety practices and reporting of safety-related conditions, and (c) overall jobsite safety climate. Twenty construction sub-contracting companies were recruited and randomly assigned to either an early or lagged-control training group. Participating supervisors and workers completed surveys at multiple time points before and after the FSL training. We used linear mixed modeling to test changes over time. RESULTS: Only supervisors in the early group reported a statistically significant improvement in their understanding and practice of the leadership skills as well as safety practices from before to 2- and 4-weeks post-training. Overall, no significant change was detected in crew-reported outcomes from before to after their supervisors' participated in the FSL training. CONCLUSIONS: These results provide evidence that the FSL training can, at least in the short-term, improve construction frontline leaders' jobsite leadership skills. Future research could include an evaluation of FSL refresher activities and a longer-term follow-up. Practical applications: The Foundations for Safety Leadership (FSL) program fills an identified need for construction frontline supervisors to learn and practice critical safety leadership skills on the jobsite. It has already reached over 60,000 leaders and has the potential to reach over 100,000 each year during either an OSHA 30-h or a stand-alone course.


Asunto(s)
Accidentes de Trabajo/prevención & control , Industria de la Construcción , Liderazgo , Aprendizaje , Salud Laboral/educación , Cultura Organizacional , Lugar de Trabajo , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Seguridad , Encuestas y Cuestionarios , Heridas y Traumatismos/prevención & control
16.
J Safety Res ; 70: 263-271, 2019 09.
Artículo en Inglés | MEDLINE | ID: mdl-31848004

RESUMEN

INTRODUCTION: Construction foremen may lack the leadership skills needed to create a strong jobsite safety climate. Many construction companies address this by sending their lead workers to the OSHA 30-h course; however the course does not include a leadership training module. This article describes the development and pilot testing of such a module and evaluation surveys designed to address this training gap. METHODS: A 17-member curriculum development team, numerous subject matter experts, and an instructional design company helped us develop a comprehensive set of teaching resources and a set of survey instruments for evaluating the materials' effectiveness on improving safety leadership and safety climate. All materials and surveys were pilot tested with representative members of the target population. RESULTS: Pilot surveys showed high reliability and data collected on the resulting Foundations for Safety Leadership (FSL) module indicated that the majority of foremen thought the training was helpful or valuable, particularly the discussion questions. The majority said they intended to use the skills on the jobsite. With the exception of the role-play activities, the trainers rated highly all other components, especially the videos and discussion questions. Modifications were made to the training materials and surveys based on pilot test findings. The most important result of the development and pilot testing efforts is that the OSHA Training Institute (OTI) included the FSL as an elective in the OSHA 30-h course. CONCLUSIONS: The FSL module fills a needed skills gap by providing safety leadership training to all foremen who might otherwise not have access to it through their company or union. The continued success of the FSL training will be ensured by dissemination via the OSHA 30-h course, an established nationwide safety training program. Practical applications: The FSL training module has already been widely accepted by the construction industry as a useful approach for providing construction foremen/See new abstract lead workers with the knowledge and skills they need to become more effective jobsite safety leaders.


Asunto(s)
Accidentes de Trabajo/prevención & control , Industria de la Construcción , Curriculum , Liderazgo , Salud Laboral/educación , Cultura Organizacional , Seguridad , Actitud , Humanos , Reproducibilidad de los Resultados , Encuestas y Cuestionarios , Lugar de Trabajo , Heridas y Traumatismos/prevención & control
17.
J Safety Res ; 70: 272-274, 2019 09.
Artículo en Inglés | MEDLINE | ID: mdl-31848005

RESUMEN

INTRODUCTION: In 2017, unintentional injuries were the seventh leading cause of death among older adults (age ≥ 65), resulting in over 55,000 deaths. Falls accounted for more than half of these deaths. Given that older adults are the fastest growing age group in the United States, we can anticipate that injuries will become an even greater health concern in the near future. METHODS: Aging without injury is possible. There are evidence-based strategies that can reduce falls. However, older adults may not realize that falls can be prevented or they may be afraid to admit their fear of falling or difficulty with walking as these issues may signal their inability to live independently. RESULTS: In this commentary, we will highlight what the Centers for Disease Control and Prevention is doing to prevent older adult falls. We also highlight the importance of broadening older adults' awareness about falls to successfully empower them to begin contemplating and preparing to adopt fall prevention strategies that can help them age in place. CONCLUSIONS: Older adult falls are common and can result in severe injury and death but they can be prevented. Broadening older adults' awareness about falls can empower them to take the actions necessary to reduce their fall risk. Practical applications: Increasing awareness about falls can help older adults, healthcare providers, and local and state health departments take steps to reduce fall risk.


Asunto(s)
Accidentes por Caídas/prevención & control , Envejecimiento , Seguridad , Caminata , Heridas y Traumatismos/prevención & control , Anciano , Anciano de 80 o más Años , Concienciación , Centers for Disease Control and Prevention, U.S. , Femenino , Personal de Salud , Humanos , Masculino , Estados Unidos
18.
East Asian Arch Psychiatry ; 29(4): 129-135, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31871310

RESUMEN

OBJECTIVE: The application of restraints during psychiatric crises is a serious adverse event. We aimed to reduce the number of injuries sustained by patients during the application of restraints. METHODS: Structured interviews were conducted with 10 staff to determine six root causes of patient injury during restraint. Three plan-do-study-act cycles were implemented: (1) reorganising shift rosters to pair trained staff with inexperienced staff, (2) holding monthly session for practising de-escalation and restraint techniques as a team in a supervised setting, and (3) rotating the responsibility for leading the de-escalation in real crises. RESULTS: Pre-intervention period was from January 2014 to December 2014 (28 251 inpatient bed days). Intervention period was from January 2015 to March 2015 (7121 inpatient bed days). Post-intervention period was from April 2015 to December 2016 (51 735 inpatient bed days). Data extracted included the dates and numbers of crises, activation of the crisis team, use of restraints, and injuries. During pre-intervention and intervention periods, only two minor and three moderate injuries were recorded. During post-intervention period, no injury was recorded and the number of restraints decreased gradually although the number of crisis team activations increased in the early phase. Eventually restraints were used only upon arrival of the crisis team. CONCLUSION: Our quality improvement project identified six root causes and implemented three plan-do-study-act cycles to successfully eliminated patient injuries during the use of restraints.


Asunto(s)
Intervención en la Crisis (Psiquiatría)/métodos , Servicio de Psiquiatría en Hospital , Restricción Física/métodos , Heridas y Traumatismos/prevención & control , Adulto , Humanos , Pacientes Internos , Entrevistas como Asunto , Masculino , Restricción Física/efectos adversos , Singapur
20.
Lakartidningen ; 1162019 Nov 14.
Artículo en Sueco | MEDLINE | ID: mdl-31742653

RESUMEN

In Sweden equestrian sport activities are the sixth most popular sport and predominantly women and girls are engaged. Horses are prey animals and humans are predators, and the two species therefore act in completely different ways. It is well known that accidents can occur when horses and humans interact. Literature from different countries in the world reveals that most accidents happen to females and also children are at risk. The most common accident is when a rider falls from a horse, but also unmounted humans are at risk for injuries. Most of the injuries are uncomplicated, but there are several reports of serious injuries and death. Prevention of injuries is very important. Education about how horses behave and react in different situations and how to communicate with horses according to Natural Horsemanship strategies make the horses less inclined to escape. The effectiveness of helmets in preventing serious head injury has been well established.


Asunto(s)
Traumatismos en Atletas , Caballos , Heridas y Traumatismos , Prevención de Accidentes , Accidentes/estadística & datos numéricos , Adolescente , Adulto , Animales , Traumatismos en Atletas/epidemiología , Traumatismos en Atletas/prevención & control , Niño , Humanos , Equipos de Seguridad , Suecia/epidemiología , Heridas y Traumatismos/epidemiología , Heridas y Traumatismos/prevención & control , Adulto Joven
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