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1.
BMJ Glob Health ; 3(5): e000909, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30294459

RESUMO

Unlike other disasters, injury rates after earthquakes are still on the rise at a global scale. With an estimated one million people injured by earthquakes in the last decade, the burden of injury is considerable. Importantly, the surgical procedures carried out by healthcare facilities are capable to avert part of this burden. Yet both burdens remain unquantified using understandable metrics. We explored in this analysis a method to calculate them using disability-adjusted life years (DALYs), an internationally accepted measure expressing years of healthy life lost due to a health condition. We used data from a large standardised hospital database of earthquake-related injuries with complete information on International Classification of Diseases for injury and surgical procedures, sex and age information. DALYs and averted DALYs were calculated by injury types and per patient using disability weights available in the literature and expert opinion. We also suggested how DALYs might be further converted into an economic measure using approaches in the published literature. We estimated 10 397 DALYs as the earthquake surgical-injury burden produced in 1861 hospitalised patients treated in a single hospital (on average, 5.6 DALYs per patient). Our study also assessed that 4379 DALYs, or 2.4 DALYs per patient, were averted by surgery (42%). In economic terms, DALY losses amounted to US$36.1 million, from which US$15.2 million were averted by surgery in our case study. We urge to systematically estimate these impacts through improvements in the routine reporting of injury diagnoses and surgical procedures by health systems, potentially improving prevention policies and resource allocation to healthcare facilities.

2.
BMC Public Health ; 18(1): 108, 2018 01 05.
Artigo em Inglês | MEDLINE | ID: mdl-29304777

RESUMO

BACKGROUND: Due to a global warming-related increase in heatwaves, it is important to obtain detailed understanding of the relationship between heat and health. We assessed the relationship between heat and urgent emergency room admissions in the Netherlands. METHODS: We collected daily maximum temperature and relative humidity data over the period 2002-2007. Daily urgent emergency room admissions were divided by sex, age group and disease category. We used distributed lag non-linear Poisson models, estimating temperature-admission associations. We estimated the relative risk (RR) for urgent hospital admissions for a range of temperatures compared to a baseline temperature of 21 °C. In addition, we compared the impact of three different temperature scenarios on admissions using the RR. RESULTS: There is a positive relationship between increasing temperatures above 21 °C and the RR for urgent emergency room admissions for the disease categories 'Potential heat-related diseases' and 'Respiratory diseases'. This relationship is strongest in the 85+ group. The RRs are strongest for lag 0. For admissions for 'circulatory diseases', there is only a small significant increase of RRs within the 85+ age group for moderate heat, but not for extreme heat. The RRs for a one-day event with extreme heat are comparable to the RRs for multiple-day events with moderate heat. CONCLUSIONS: Hospitals should adjust the capacity of their emergency departments on warm days, and the days immediately thereafter. The elderly in particular should be targeted through prevention programmes to reduce harmful effects of heat. The fact that this increase in admissions already occurs in temperatures above 21 °C is different from previous findings in warmer countries. Given the similar impact of three consecutive days of moderate heat and one day of extreme heat on admissions, criteria for activation of national heatwave plans need adjustments based on different temperature scenarios.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Transtornos de Estresse por Calor/terapia , Hospitalização/estatística & dados numéricos , Temperatura Alta/efeitos adversos , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Calor Extremo/efeitos adversos , Feminino , Transtornos de Estresse por Calor/epidemiologia , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Distribuição de Poisson , Risco , Adulto Jovem
3.
Lancet Glob Health ; 6(1): e103-e110, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-29226821

RESUMO

BACKGROUND: Since March, 2011, the Syrian civil war has lowered life expectancy by as much as 20 years. We describe demographic, spatial, and temporal patterns of direct deaths of civilians and opposition combatants from conflict-related violence in 6 years of war. METHODS: We analysed conflict-related violent deaths with complete information on date, place, and cause of death and demographic group occurring from March 18, 2011, to Dec 31, 2016, recorded by the Violation Documentation Center (VDC). We included civilian and combatant deaths in all Syrian governorates, excluding government-controlled areas. We did not include detainees and missing persons, nor deaths from siege conditions or insufficient medical care. We categorised deaths based on VDC weapon type. We used χ2 testing to compare deaths from different weapons in civilian men, women, boys, and girls and adult and child combatants. We analysed deaths by governorate and over time. FINDINGS: The VDC recorded 143 630 conflict-related violent deaths with complete information between March 18, 2011, and Dec 31, 2016. Syrian civilians constituted 101 453 (70·6%) of the deaths compared with 42 177 (29·4%) opposition combatants. Direct deaths were caused by wide-area weapons of shelling and air bombardments in 58 099 (57·3%) civilians, including 8285 (74·6%) civilian women and 13 810 (79·4%) civilian children, and in 4058 (9·6%) opposition combatants. Proportions of children among civilian deaths increased from 8·9% (388 of 4254 civilian deaths) in 2011 to 19·0% (4927 of 25 972) in 2013 and to 23·3% (2662 of 11 444) in 2016. Of 7566 deaths from barrel bombs, 7351 (97·2%) were civilians, of whom 2007 (27·3%) were children. Of 20 281 deaths by execution, 18 747 (92·4%) were civilians and 1534 (7·6%) were opposition combatants. Compared with opposition child soldiers who were male (n=333), deaths of civilian male children (n=11 730) were caused more often by air bombardments (39·2% vs 5·4%, p<0·0001) and shelling (37·3% vs 13·2%, p<0·0001) and less often by shooting (12·5% vs 76·0%, p<0·0001). INTERPRETATION: Aerial bombing and shelling rapidly became primary causes of direct deaths of women and children and had disproportionate lethal effects on civilians, calling into question the use of wide-area explosive weapons in urban areas. Increased reliance on aerial bombing by the Syrian Government and international partners is likely to have contributed to findings that children were killed in increasing proportions over time, ultimately comprising a quarter of civilian deaths in 2016. The inordinate proportion of civilians among the executed is consistent with deliberate tactics to terrorise civilians. Deaths from barrel bombs were overwhelmingly civilian rather than opposition combatants, suggesting indiscriminate or targeted warfare contrary to international humanitarian law and possibly constituting a war crime. FUNDING: None.


Assuntos
Mortalidade da Criança/tendências , Mortalidade/tendências , Violência/estatística & dados numéricos , Guerra , Adulto , Criança , Bases de Dados Factuais , Feminino , Humanos , Masculino , Síria/epidemiologia
4.
Sci Rep ; 7(1): 2212, 2017 05 19.
Artigo em Inglês | MEDLINE | ID: mdl-28526850

RESUMO

Despite the intuitive connection between drought and mortality, we still lack a sound quantitative synthesis of evidence drawn from the available data. In this study, we estimate the pooled under-five death rates (U5DR) and assess the effect of drought on child death in Ethiopia. Small-scale mortality surveys were searched from the Complex Emergency Database and then aggregated spatially and temporally with drought exposure data from the Global Drought Monitor and food insecurity data from the Famine Early Warning Systems Network. A Bayesian Poisson meta-analysis was performed on 88 surveys conducted in Ethiopia between 2009 and 2014, consisting of 55,219 under-five children. The pooled U5DR was estimated at 0.323/10,000/day (95% credible interval, CrI: 0.254-0.397), which is below both the emergency and the baseline death rate thresholds of sub-Saharan Africa. We failed to find a plausible association between drought and U5DR. However, minimal food insecure areas showed elevated U5DR compared to stressed food insecure areas. Furthermore, the U5DR increases as the prevalence of acute malnutrition increases. Targeted interventions to improve the underlying causes of child malnutrition are crucial. Further, revising and updating the existing mortality thresholds, both the baseline and the emergency, is recommended.


Assuntos
Mortalidade da Criança , Secas , Teorema de Bayes , Criança , Transtornos da Nutrição Infantil/epidemiologia , Transtornos da Nutrição Infantil/mortalidade , Pré-Escolar , Bases de Dados Factuais , Etiópia/epidemiologia , Abastecimento de Alimentos , Humanos
5.
Bull World Health Organ ; 95(2): 94-102, 2017 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-28250509

RESUMO

OBJECTIVE: To estimate the prevalence of childhood wasting and to investigate the effects of drought and conflict on wasting in crisis-affected areas within Ethiopia. METHODS: We searched the Complex Emergency Database for nutrition surveys carried out in Ethiopia over the period 2000-2013. We extracted data on the prevalence of wasting (weight-for-height z-scores below -2) among children aged 6-59 months for areas of Ethiopia that had sufficient data available. Data on any conflict events (irrespective of magnitude or impact) and episodes of seasonal drought affecting the survey areas were extracted from publicly available data sources. Random-effects Bayesian meta-analysis was used to synthesize the evidence from 231 small-scale surveys. FINDINGS: From the total sample of 175 607 children analysed, the pooled number of children wasted was 21 709. The posterior median prevalence of wasting was 11.0% (95% credible interval, CrI: 10.3-11.7) over the 14-year period. Compared with areas unaffected by drought, the estimated prevalence of wasting was higher in areas affected by moderate levels of drought (posterior odds ratio, OR: 1.34; 95% CrI: 1.05-1.72) but similar in severe drought-affected areas (OR: 0.96; 95% CrI: 0.68-1.35). Although the pooled prevalence of wasting was higher in conflict-affected than unaffected areas, the difference was not plausible (OR: 1.02; 95% CrI: 0.82-1.26). CONCLUSION: Despite an overall declining trend, a wasting problem persists among children in Ethiopia. Conflict events did not have a major impact on childhood wasting. Nutrition interventions should go beyond severe drought-prone areas to incorporate areas where moderate droughts occur.


Assuntos
Conflitos Armados/estatística & dados numéricos , Transtornos da Nutrição Infantil/epidemiologia , Secas/estatística & dados numéricos , Teorema de Bayes , Pré-Escolar , Etiópia/epidemiologia , Feminino , Humanos , Lactente , Masculino , Prevalência , Análise de Regressão
6.
PLoS One ; 11(12): e0168820, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27992563

RESUMO

Hosting refugees may represent a drain on local resources, particularly since external aid is frequently insufficient. Between 2004 and 2011, over 100,000 refugees settled in the eastern border of Cameroon. With little known on how refugee influx affects health services of the hosting community, we investigated the impact of refugees on mother and child health (MCH) services in the host community in Cameroon. We used Cameroon's 2004 and 2011 Demographic and Health Surveys to evaluate changes in MCH indicators in the refugee hosting community. Our outcome variables were antenatal care (ANC) coverage, caesarean delivery rate, place of delivery and child vaccination coverage; whereas the exposure variable was residence in the refugee hosting community. We used a difference-in-differences analysis to compare indicators of the refugee hosting community to a control group selected through propensity score matching from the rest of the country. A total of 10,656 women were included in our 2004 analysis and 7.6% (n = 826) of them resided in the refugee hosting community. For 2011, 15,426 women were included and 5.8% (n = 902) of them resided in the hosting community. Between 2004 and 2011, both the proportion of women delivering outside health facilities and children not completing DPT3 vaccination in the refugee hosting community decreased by 9.0% (95% Confidence Interval (CI): 3.9-14.1%) and 9.6% (95% CI: 7.9-11.3%) respectively. However, ANC attendance and caesarean delivery did not show any significant change. Our findings demonstrate that none of the evaluated MCH service indicators deteriorated (in fact, two of them improved: delivery in health facilities and completing DPT3 vaccine) with the presence of refugees. This suggests evidence disproving the common belief that refugees always have a negative impact on their hosting community.


Assuntos
Cuidado da Criança/estatística & dados numéricos , Refugiados/estatística & dados numéricos , Adulto , Camarões , Cesárea/estatística & dados numéricos , Criança , Serviços de Saúde da Criança , Feminino , Acesso aos Serviços de Saúde , Humanos , Serviços de Saúde Materna , Cuidado Pré-Natal , Estudos Retrospectivos , Vacinação/estatística & dados numéricos , Serviços de Saúde da Mulher , Adulto Jovem
7.
Artigo em Inglês | MEDLINE | ID: mdl-27834925

RESUMO

National heatwave plans are aimed at reducing the avoidable human health consequences due to heatwaves, by providing warnings as well as improving communication between relevant stakeholders. The objective of this study was to assess the perceptions of key stakeholders within plans in Belgium and The Netherlands on their responsibilities, the partnerships, and the effectiveness of the local implementation in Brussels and Amsterdam. Key informant interviews were held with stakeholders that had an important role in development of the heatwave plan in these countries, or its implementation in Brussels or Amsterdam. Care organisations, including hospitals and elderly care organisations, had a lack of familiarity with the national heatwave plan in both cities, and prioritised heat the lowest. Some groups of individuals, specifically socially isolated individuals, are not sufficiently addressed by the current national heatwave plans and most local plans. Stakeholders reported that responsibilities were not clearly described and that the national plan does not describe tasks on a local level. We recommend to urgently increase awareness on the impact of heat on health among care organisations. More emphasis needs to be given to the variety of heat-risk groups. Stakeholders should be involved in the development of updates of the plans.


Assuntos
Política Ambiental/legislação & jurisprudência , Temperatura Alta/efeitos adversos , Saúde Pública , Opinião Pública , Bélgica , Humanos , Países Baixos , Percepção
8.
Bull World Health Organ ; 94(9): 667-674, 2016 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-27708472

RESUMO

OBJECTIVE: To determine whether pre-emptive oral cholera vaccination reduces disease severity and mortality in people who develop cholera disease during an outbreak. METHODS: The study involved a retrospective analysis of demographic and clinical data from 41 cholera treatment facilities in South Sudan on patients who developed cholera disease between 23 April and 20 July 2014 during a large outbreak, a few months after a pre-emptive oral vaccination campaign. Patients who developed severe dehydration were regarded as having a severe cholera infection. Vaccinated and unvaccinated patients were compared and multivariate logistic regression analysis was used to identify factors associated with developing severe disease or death. FINDINGS: In total, 4115 cholera patients were treated at the 41 facilities: 1946 (47.3%) had severe disease and 62 (1.5%) deaths occurred. Multivariate analysis showed that patients who received two doses of oral cholera vaccine were 4.5-fold less likely to develop severe disease than unvaccinated patients (adjusted odds ratio, aOR: 0.22; 95% confidence interval, CI: 0.11-0.44). Moreover, those with severe cholera were significantly more likely to die than those without (aOR: 4.76; 95% CI: 2.33-9.77). CONCLUSION: Pre-emptive vaccination with two doses of oral cholera vaccine was associated with a significant reduction in the likelihood of developing severe cholera disease during an outbreak in South Sudan. Moreover, severe disease was the strongest predictor of death. Two doses of oral cholera vaccine should be used in emergencies to reduce the disease burden.


Assuntos
Vacinas contra Cólera/farmacologia , Cólera/prevenção & controle , Cólera/fisiopatologia , Administração Oral , Adolescente , Adulto , Criança , Pré-Escolar , Cólera/mortalidade , Surtos de Doenças , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Índice de Gravidade de Doença , Sudão do Sul/epidemiologia , Adulto Jovem
9.
Glob Health Action ; 9: 30204, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27388539

RESUMO

BACKGROUND: Women's malnutrition, particularly undernutrition, remains an important public health challenge in Ethiopia. Although various studies examined the levels and determinants of women's nutritional status, the influence of living close to an international border on women's nutrition has not been investigated. Yet, Ethiopian borders are regularly affected by conflict and refugee flows, which might ultimately impact health. OBJECTIVE: To investigate the impact of living close to borders in the nutritional status of women in Ethiopia, while considering other important covariates. DESIGN: Our analysis was based on the body mass index (BMI) of 6,334 adult women aged 20-49 years, obtained from the 2011 Ethiopian Demographic and Health Survey (EDHS). A Bayesian multilevel multinomial logistic regression analysis was used to capture the clustered structure of the data and the possible correlation that may exist within and between clusters. RESULTS: After controlling for potential confounders, women living close to borders (i.e. ≤100 km) in Ethiopia were 59% more likely to be underweight (posterior odds ratio [OR]=1.59; 95% credible interval [CrI]: 1.32-1.90) than their counterparts living far from the borders. This result was robust to different choices of border delineation (i.e. ≤50, ≤75, ≤125, and ≤150 km). Women from poor families, those who have no access to improved toilets, reside in lowland areas, and are Muslim, were independently associated with underweight. In contrast, more wealth, higher education, older age, access to improved toilets, being married, and living in urban or lowlands were independently associated with overweight. CONCLUSIONS: The problem of undernutrition among women in Ethiopia is most worrisome in the border areas. Targeted interventions to improve nutritional status in these areas, such as improved access to sanitation, economic and livelihood support, are recommended.

10.
PeerJ ; 4: e1741, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26966670

RESUMO

Background. Child undernutrition and flooding are highly prevalent public health issues in many developing countries, yet we have little understanding of preventive strategies for effective coping in these circumstances. Education has been recently highlighted as key to reduce the societal impacts of extreme weather events under climate change, but there is a lack of studies assessing to what extent parental education may prevent post-flood child undernutrition. Methods and Materials. One year after large floods in 2008, we conducted a two-stage cluster population-based survey of 6-59 months children inhabiting flooded and non-flooded communities of Jagatsinghpur district, Odisha (India), and collected anthropometric measurements on children along with child, parental and household level variables through face-to-face interviews. Using multivariate logistic regression models, we examined separately the effect of maternal and paternal education and other risk factors (mainly income, socio-demographic, and child and mother variables) on stunting and wasting in children from households inhabiting recurrently flooded communities (2006 and 2008; n = 299). As a comparison, separate analyses on children in non-flooded communities were carried out (n = 385). All analyses were adjusted by income as additional robustness check. Results. Overall, fathers with at least completed middle education (up to 14 years of age and compulsory in India) had an advantage in protecting their children from child wasting and stunting. For child stunting, the clearest result was a 100-200% lower prevalence associated with at least paternal secondary schooling (compared to no schooling) in flooded-areas. Again, only in flooded communities, an increase in per capita annual household income of 1,000 rupees was associated to a 4.7-4.9% lower prevalence of child stunting. For child wasting in flooded areas, delayed motherhood was associated to better nutritional outcomes (3.4% lower prevalence per year). In flooded communities, households dedicated to activities other than agriculture, a 50-51% lower prevalence of child wasting was estimated, suggesting farmers and fishermen as the most vulnerable livelihoods under flooding. In flooded areas, lower rank castes were at higher odds of both child wasting and stunting. Conclusions. In the short-term, protracted nutritional response in the aftermath of floods should be urgently implemented and target agricultural livelihoods and low-rank castes. Education promotion and schooling up to 14 years should have positive impacts on improving children nutritional health in the long run, especially under flooding. Policies effectively helping sustainable livelihood economic development and delayed motherhood are also recommended.

11.
Int J Environ Res Public Health ; 13(2): 210, 2016 Feb 06.
Artigo em Inglês | MEDLINE | ID: mdl-26861372

RESUMO

BACKGROUND: Child undernutrition and flooding are highly prevalent public health issues in Asia, yet epidemiological studies investigating this association are lacking. METHODS: To investigate to what extent floods exacerbate poor nutritional status in children and identify most vulnerable groups, we conducted a population-based survey of children aged 6-59 months inhabiting flooded and non-flooded communities of the Jagatsinghpur district, Odisha (India), one year after large floods in 2008. Anthropometric measurements on 879 children and child, parental and household level variables were collected through face-to-face interviews in September 2009. The association between flooding and the prevalence of wasting, stunting and underweight was examined using weighted multivariate logistic regression for children inhabiting communities exposed solely to floods in 2008 and those communities repeatedly flooded (2006 and 2008) controlling for parental education and other relevant variables. We examined the influence of age on this association. Propensity score matching was conducted to test the robustness of our findings. RESULTS: The prevalence of wasting among children flooded in 2006 and 2008 was 51.6%, 41.4% in those flooded only in 2008, and 21.2% in children inhabiting non-flooded communities. Adjusting by confounders, the increased prevalence relative to non-flooded children in the exposed groups were 2.30 (adjusted prevalence ratio (aPR); 95% CI: 1.86, 2.85) and 1.94 (95% CI: 1.43, 2.63), respectively. Among repeatedly flooded communities, cases of severe wasting in children were 3.37 times more prevalent than for children inhabiting in those non-flooded (95% CI: 2.34, 4.86) and nearly twice more prevalent relative to those flooded only once. Those children younger than one year during previous floods in 2006 showed the largest difference in prevalence of wasting compared to their non-flooded counterparts (aPR: 4.01; 95% CI: 1.51, 10.63). RESULTS were robust to alternative adjusted models and in propensity score matching analyses. For similar analyses, no significant associations were found for child stunting, and more moderate effects were observed in the case of child underweight. CONCLUSIONS: Particularly in low-resource or subsistence-farming rural settings, long-lasting nutritional response in the aftermath of floods should be seriously considered to counteract the long-term nutritional effects on children, particularly infants, and include their mothers on whom they are dependent. The systematic monitoring of nutritional status in these groups might help to tailor efficient responses in each particular context.


Assuntos
Transtornos da Nutrição Infantil/epidemiologia , Inundações , Desnutrição/epidemiologia , Estado Nutricional , População Rural/estatística & dados numéricos , Magreza/epidemiologia , Pré-Escolar , Feminino , Humanos , Índia/epidemiologia , Lactente , Modelos Logísticos , Masculino , Prevalência , Medição de Risco
12.
Environ Health ; 12: 115, 2013 Dec 20.
Artigo em Inglês | MEDLINE | ID: mdl-24359448

RESUMO

Despite rising interest on the concept of societal resilience and its measurement, little has been done to provide operational indicators. Importantly, an evidence-based approach to assess the suitability of indicators remains unexplored. Furthermore few approaches that exist do not investigate indicators of psychological resilience, which is emerging as an important component of societal resilience to disasters. Disasters are events which overwhelm local capacities, often producing human losses, injury and damage to the affected communities. As climate hazards and disasters are likely to increase in the coming decades, strengthening the capacity of societies to withstand these shocks and recover quickly is vital. In this review, we search the Web of Knowledge to summarize the evidence on indicators of psychological resilience to disasters and provided a qualitative assessment of six selected studies. We find that an evidence-based approach using features from systematic reviews is useful to compile, select and assess the evidence and elucidate robust indicators. We conclude that strong social support received after a disaster is associated with an increased psychological resilience whereas a female gender is connected with a decrease in the likelihood of a resilient outcome. These results are consistent across disaster settings and cultures and are representative of approximately 13 million disaster-exposed civilians of adult age. An approach such as this that collects and evaluates evidence will allow indicators of resilience to be much more revealing and useful in the future. They will provide a robust basis to prioritize indicators to act upon through intersectoral policies and post-disaster public health interventions.


Assuntos
Desastres , Resiliência Psicológica , Adulto , Feminino , Objetivos , Humanos , Masculino , Saúde Pública , Caracteres Sexuais , Apoio Social
13.
PLoS One ; 8(4): e61371, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23585897

RESUMO

INTRODUCTION: Earthquakes are the most violent type of natural disasters and injuries are the dominant medical problem in the early phases after earthquakes. However, likely because of poor data availability, high-quality research on injuries after earthquakes is lacking. Length of hospital stay (LOS) has been validated as a proxy indicator for injury severity in high-income settings and could potentially be used in retrospective research of injuries after earthquakes. In this study, we assessed LOS as an adequate proxy indicator for severe injury in trauma survivors of an earthquake. METHODS: A retrospective analysis was conducted using a database of 1,878 injured patients from the 2008 Wenchuan earthquake. Our primary outcome was severe injury, defined as a composite measure of serious injury or resource use. Secondary outcomes were serious injury and resource use, analysed separately. Non-parametric receiver operating characteristics (ROC) and area under the curve (AUC) analysis was used to test the discriminatory accuracy of LOS when used to identify severe injury. An 0.7

Assuntos
Desastres , Terremotos , Indicadores Básicos de Saúde , Tempo de Internação/estatística & dados numéricos , Traumatismo Múltiplo/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Área Sob a Curva , Criança , Pré-Escolar , China , Feminino , Humanos , Lactente , Recém-Nascido , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Traumatismo Múltiplo/cirurgia , Traumatismo Múltiplo/terapia , Curva ROC , Estudos Retrospectivos
14.
Crit Care ; 16(3): R87, 2012 May 17.
Artigo em Inglês | MEDLINE | ID: mdl-22594875

RESUMO

INTRODUCTION: Multiple injuries have been highlighted as an important clinical dimension of the injury profile following earthquakes, but studies are scarce. We investigated the pattern and combination of injuries among patients with two injuries following the 2008 Wenchuan earthquake. We also described the general injury profile, causes of injury and socio-demographic characteristics of the injured patients. METHODS: A retrospective hospital-based analysis of 1,871 earthquake injured patients, totaling 3,177 injuries, admitted between 12 and 31 May 2008 to the People's Hospital of Deyang city (PHDC). An electronic, webserver-based database with International Classification of Diseases (ICD)-10-based classification of earthquake-related injury diagnoses (IDs), anatomical sites and additional background variables of the inpatients was used. We analyzed this dataset for injury profile and number of injuries per patient. We then included all patients (856) with two injuries for more in-depth analysis. Possible spatial anatomical associations were determined a priori. Cross-tabulation and more complex frequency matrices for combination analyses were used to investigate the injury profile. RESULTS: Out of the 1,871 injured patients, 810 (43.3%) presented with a single injury. The rest had multiple injuries; 856 (45.8%) had two, 169 (9.0%) patients had three, 32 (1.7%) presented with four injuries, while only 4 (0.2%) were diagnosed with five injuries. The injury diagnoses of patients presenting with two-injuries showed important anatomical intra-site or neighboring clustering, which explained 49.1% of the combinations. For fractures, the result was even more marked as spatial clustering explained 57.9% of the association pattern. The most frequent combination of IDs was a double-fracture, affecting 20.7% of the two-injury patients (n = 177). Another 108 patients (12.6%) presented with fractures associated with crush injury and organ-soft tissue injury. Of the 3,177 injuries, 1,476 (46.5%) were fractures. Most injuries were located in the head (22.9%) and lower extremities (30.8%). CONCLUSIONS: Multiple injuries are put forward as an important component of the injury profile after this earthquake. A pattern of injury combinations and spatial aggregation of injuries was also found. Clinical diagnosis and treatment should be adapted to care of these patients. More studies are needed to generalize these findings.


Assuntos
Desastres , Terremotos , Hospitalização/tendências , Traumatismo Múltiplo/diagnóstico , Traumatismo Múltiplo/epidemiologia , Adolescente , Adulto , Idoso , China/epidemiologia , Desastres/estatística & dados numéricos , Terremotos/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Traumatismo Múltiplo/terapia , Estudos Retrospectivos , Adulto Jovem
15.
BMJ Open ; 1(2): e000109, 2011 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-22080535

RESUMO

Objectives This study aims to improve the understanding of the relationship between exposure to floods and malnutrition in children aged 6-59 months in rural India. Research has focused exclusively on Bangladeshi children, and few controlled epidemiological studies are available. Method A community-based cross-sectional study of child nutritional status was carried out in 14 flooded and 18 non-flooded villages of Jagatsinghpur district (Orissa) within one month of the September 2008 floods, and similarly affected by flooding in August 2006. Face-to-face interviews were conducted in 757 households in the flooded villages and 816 in the non-flooded communities. Data used in this study were from those households with children aged 6-59 months. In total, 191 and 161 children were measured, respectively. The association between various malnutrition indicators and the exposure to floods was assessed by univariate and multivariate logistic regression. Results Adjusted analyses revealed that children in flooded households were more likely stunted compared with those in non-flooded ones (adjusted prevalence ratio 1.60; 95% CI 1.05 to 2.44). The prevalence of underweight was also higher in children living in the flooded communities (adjusted prevalence ratio 1.86; 95% CI 1.04 to 3.30). Further analyses found that the 26-36-month flooded cohort, thus those children younger than 1 year during the precedent flood in August 2006, attained the largest difference in levels of stunting compared with the unexposed group of the same age. Conclusion Exposure to floods is associated with long-term malnutrition in these rural communities of Orissa, India. Children exposed to floods during their first year of life presented higher levels of chronic malnutrition. Long-term malnutrition prevention programmes after floods should be implemented in flood-prone areas.

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