Sickness absence and disability pension after road traffic accidents, a nationwide register-based study comparing different road user groups with matched references.

Background: Being injured in a road traffic accident may affect individuals' functional ability and in turn lead to sickness absence (SA) and disability pension (DP). Knowledge regarding long-term consequences in terms of SA and DP following a road traffic accident is lacking, especially comparing different groups of road users and compared to the general population. The aim was to estimate excess diagnosis-specific SA and DP among individuals of different road user groups injured in a road traffic accident compared to matched references without such injury. Methods: A nationwide register-based study, including all working individuals aged 20-59 years and living in Sweden who in 2015 had in- or specialized outpatient healthcare after a new traffic-related injury (n = 20 177) and population-based matched references (matched on: sex, age, level of education, country of birth, living in cities) without any traffic-related injury during 2014-2015 (n = 100 885). Diagnosis-specific (injury and other diagnoses) SA and DP were assessed during 5 years: 1 year before and 4 years following the accident. Mean SA and DP net days/year for each road user group and mean differences of (excess) SA and DP net days/year compared with their matched references were calculated with independent t-tests with bootstrapped 95% confidence intervals (CIs). Results: A third of all injured road users were bicyclists, 31% were car occupants, 16% were pedestrians (including fall accidents), and 19% were other and unspecified accidents. Pedestrians and other road users were the groups with the highest mean number of SA days during the first year following the accident (51 and 49 days/year respectively). The matched references had between 8 and 13 SA days/year throughout the study period. The excess SA days/year were elevated for all road user groups all five studied years. Excess SA due to injury diagnoses was 15-35 days/year during the first year following the accident. Excess SA due to diagnoses other than injuries were about eight days/year during the whole study period for pedestrians and car occupants and about zero for the bicyclists. The excess DP was low, although it increased every year after the accident for pedestrians and car occupants; for bicyclists no excess DP was seen. Conclusion: Higher levels of SA due to injury diagnoses were seen among all road user groups during the first year after the accident compared to their references. Pedestrians and car occupants had more excess SA due to other diagnoses and more excess DP four years after the accident than bicyclists and other road users.

The Movement Deviation Profile Can Differentiate Faller and Non-Faller Older Adults.

BACKGROUND: The World Health Organization considers falls the second leading cause of death by accidental injury worldwide and one of the most frequent complications in older adults during activities of daily living. Several tasks related to fall risk have been individually assessed describing kinematic changes in older adults. The study proposal was to identify which functional task differentiates faller and non-faller older adults using the movement deviation profile (MDP). METHODS: This cross-sectional study recruited 68 older adults aged ≥60 years by convenience sampling. Older adults were divided into 2 groups: with and without a history of falls (34 older adults in each group). The MDP analyzed the 3-dimensional angular kinematics data of tasks (ie, gait, walking turn, stair ascent and descent, sit-to-stand, and stand-to-sit), and the Z score of the mean MDP identified which task presented the greatest difference between fallers and non-fallers. A multivariate analysis with Bonferroni post hoc verified the interaction between groups considering angular kinematic data and the cycle time of the task. Statistical significance was set at 5% (p < .05). RESULTS: Z score of the MDPmean showed an interaction between groups (λ = 0.67, F = 5.085, p < .0001). Fallers differed significantly from non-fallers in all tasks and the greatest difference was in stair descent (Z score = 0.89). The time to complete each task was not different between groups. CONCLUSIONS: The MDP distinguished older adult fallers from non-fallers. The stair descent task should be highlighted because it presented the greatest difference between groups.

Beyond physiology: Acute effects of side-alternating whole-body vibration on well-being, flexibility, balance, and cognition using a light and portable platform A randomized controlled trial.

A good body-balance helps to prevent slips, trips and falls. New body-balance interventions must be explored, because effective methods to implement daily training are sparse. The purpose of the current study was to investigate acute effects of side-alternating whole-body vibration (SS-WBV) training on musculoskeletal well-being, flexibility, body balance, and cognition. In this randomized controlled trial, participants were randomly allocated into a verum (8.5 Hz, SS-WBV, N = 28) or sham (6 Hz, SS-WBV, N = 27) condition. The training consisted of three SS-WBV series that lasted one-minute each with two one-minute breaks in between. During the SS-WBV series, participants stood in the middle of the platform with slightly bent knees. During the breaks in between, participants could loosen up. Flexibility (modified fingertip-to-floor method), balance (modified Star Excursion Balance Test), and cognitive interference (Stroop Color Word Test) were tested before and after the exercise. Also, musculoskeletal well-being, muscle relaxation, sense of flexibility, sense of balance, and surefootedness were assessed in a questionnaire before and after the exercise. Musculoskeletal well-being was significantly increased only after verum. Also, muscle relaxation was significantly higher only after verum. The Flexibility-Test showed significant improvement after both conditions. Accordingly, sense of flexibility was significantly increased after both conditions. The Balance-Test showed significant improvement after verum, and after sham. Accordingly, increased sense of balance was significant after both conditions. However, surefootedness was significantly higher only after verum. The Stroop-Test showed significant improvement only after verum. The current study shows that one SS-WBV training session increases musculoskeletal well-being, flexibility, body balance and cognition. The abundance of improvements on a light and portable platform has great influence on the practicability of training in daily life, aiming to prevent slip trips and falls at work.

Diagnosis-specific sickness absence among injured working-aged pedestrians: a sequence analysis.

BACKGROUND: The knowledge about the long-term consequences in terms of sickness absence (SA) among pedestrians injured in a traffic-related accident, including falls, is scarce. Therefore, the aim was to explore diagnosis-specific patterns of SA during a four-year period and their association with different sociodemographic and occupational factors among all individuals of working ages who were injured as a pedestrian. METHODS: A nationwide register-based study, including all individuals aged 20-59 and living in Sweden, who in 2014-2016 had in- or specialized outpatient healthcare after a new traffic-related accident as a pedestrian. Diagnosis-specific SA (> 14 days) was assessed weekly from one year before the accident up until three years after the accident. Sequence analysis was used to identify patterns (sequences) of SA, and cluster analysis to form clusters of individuals with similar sequences. Odds ratios (ORs) with 95% confidence intervals (CIs) for association of the different factors and cluster memberships were estimated by multinomial logistic regression. RESULTS: In total, 11,432 pedestrians received healthcare due to a traffic-related accident. Eight clusters of SA patterns were identified. The largest cluster was characterized by no SA, three clusters had different SA patterns due to injury diagnoses (immediate, episodic, and later). One cluster had SA both due to injury and other diagnoses. Two clusters had SA due to other diagnoses (short-term and long-term) and one cluster mainly consisted of individuals with disability pension (DP). Compared to the cluster "No SA", all other clusters were associated with older age, no university education, having been hospitalized, and working in health and social care. The clusters "Immediate SA", "Episodic SA" and "Both SA due to injury and other diagnoses" were also associated with higher odds of pedestrians who sustained a fracture. CONCLUSIONS: This nationwide study of the working-aged pedestrians observed diverging patterns of SA after their accident. The largest cluster of pedestrians had no SA, and the other seven clusters had different patterns of SA in terms of diagnosis (injury and other diagnoses) and timing of SA. Differences were found between all clusters regarding sociodemographic and occupational factors. This information can contribute to the understanding of long-term consequences of road traffic accidents.

Intervenção de enfermagem para prevenção de queda da pessoa idosa com transtorno mental / Nursing intervention to prevent fall of the elderly person with mental disorder / Intervención enfermera para evitar que los ancianos caigan con transtorina mental

Objetivo: aplicar intervenções de enfermagem sobre prevenção de quedas a pessoas idosas com transtornos mentais. Material e Método: Trata-se de uma pesquisa- cuidado, para subsidiar a aplicação das intervenções de enfermagem foi utilizado componentes do Modelo Teórico de Promoção da Saúde, desenvolvido por Nola J. Pender. A primeira etapa do estudo foi desenvolvida em um Centro de Atenção Psicossocial e a segunda etapa no domicilio dos idosos. A coleta de dados foi realizada entre os meses de agosto a novembro de 2022, com idosos de idade igual ou superior a 60 anos, que estivessem sendo acompanhados no serviço. A amostra foi composta por 15 idosos. Para a coleta de dados, foi utilizado um formulário estruturado com variáveis sociodemográficas, investigação de saúde e doença e características do domicílio e um instrumento utilizado para avaliar o risco de quedas em idosos. A análise descritiva dos dados, ocorreu por meio do cálculo de frequências absolutas e relativas. Os aspectos éticos da resolução 466/12 foram respeitados em todas as fases do estudo. Resultados: Predominaram mulheres (80,00%), casadas (53,33%), com uma média de idade de 70,52 anos, de cor branca (53,33%) e analfabetos (55,33%). No que se refere às condições de saúde e doença, foi possível observar que o tipo de transtorno mental que mais predominou foi a depressão (60,00%) e a ansiedade (33,33%). Grande parte dos participantes do estudo (73,33%) relataram que já caíram ao menos 6 vezes, em um tempo médio de 1 ano. Ressalta-se que (93,33%) dos idosos não receberam orientações sobre prevenção de quedas no domicilio. Todos os idosos apresentaram alto risco de quedas. As intervenções de enfermagem foram realizadas aos idosos com transtornos mentais com alto risco para quedas. Considerações Finais: A maioria dos idosos tiveram quedas dentro do domicilio, a ocorrência de quedas nesse espaço está relacionada a insegurança do ambiente. Diante disso, a realização da intervenção foi de grande importância para a prevenção a quedas com enfoque na saúde do idoso direcionados aos gestores, profissionais e comunidade.

Objective: To apply nursing interventions on prevention of falls to elderly people with mental disorders. Material and Method: It is a research-care, to subsidise the application of nursing interventions was used components of the Theoretical Model of Health Promotion, developed by Nola J. Pender. The first stage of the study was developed at a Psychosocial Care Centre and the second stage in the home of the elderly. Data collection has been conducted between August and November 2022, with elderly people aged 60 and over, who were being accompanied in the service. The sample consisted of 15 elderly people. For the data collection, a structured form was used with sociodemographic variables, health and disease research and characteristics of the household, and an instrument used to assess the risk of falls in the elderly. Descriptive analysis of the data, occurred by calculating absolute and relative frequencies. The ethical aspects of resolution 466/12 were respected at all stages of the study. Results: Women predominated (80.00%), married (53.33%), with an average age of 70.52 years, white (53.33%) and illiterate (55.33%). With regard to health and illness conditions, it was observed that the type of mental disorder that predominated most was depression (60.00%) and anxiety (33.33%). A large number of the study's participants (73.33%) reported that they have already fallen at least 6 times, in an average time of 1 year. It should be noted that (93.33%) of the elderly did not receive guidelines on the prevention of falls in the home. All older adults were at high risk of falls. Nursing interventions were performed for elderly with mental disorders at high risk for falls. Final Considerations: Most of the elderly have had falls within the home, the occurrence of falls in this space is related to environmental insecurity. In view of this, the implementation of the intervention was of great importance for the prevention of falls with a focus on the health of the elderly directed towards managers, professionals and community.

Objetivo: aplicar intervenciones de enfermería en la prevención de caídas a personas mayores con trastornos mentales. Material y método: Se trata de una investigación cuidadosa, para subsidiar la aplicación de las intervenciones de enfermería, se utilizaron componentes del Modelo Teórico para la Promoción de la Salud, desarrollado por Nola J. Pender. La primera etapa del estudio se desarrolló en un Centro de Atención Psicosocial y la segunda etapa en los hogares de ancianos. La colección de datos tiene entre agosto y noviembre de 2022, se llevaron a cabo con personas mayores de 60 años que estaban acompañadas en el servicio. La muestra consistió en 15 ancianos. Para la recolección de datos se utilizó una forma estructurada con variables sociodemográficas, investigación de la salud y las enfermedades y características del hogar, así como un instrumento utilizado para evaluar el riesgo de caída en los ancianos. El análisis descriptivo de los datos se realizó mediante el cálculo de frecuencias absolutas y relativas. En todas las etapas del estudio se respetaron los aspectos éticos de la resolución 466/12. Resultados: mujeres predominantes (80,00%), casadas (53,33%), con una edad media de 70,52 años, blancas (53,33%) y analfabetas (55,33%). En cuanto a la salud y las enfermedades, se observó que el tipo de trastorno mental más prevalente fue depresión (60,00%) y ansiedad (33,33%). Un gran número de participantes en el estudio (73,33%) informó que ya habían caído al menos seis veces en un período medio de un año. Cabe señalar que (93,33%) de las personas de edad avanzada no recibieron directrices sobre la prevención de las caídas desde el hogar. Todos los ancianos mostraron un alto riesgo de caída. Las intervenciones de enfermería se realizaron en ancianos con trastornos mentales con alto riesgo de caída. Consideraciones finales: La mayoría de las personas de edad se habían refugiado en el hogar, la aparición de caídas en este espacio está relacionada con la inseguridad del medio ambiente. A la luz de ello, la aplicación de la intervención fue de gran importancia para la prevención de caídas, centrándose en la salud de las personas de edad, dirigida a los directivos, los profesionales y la comunidad. PALABRAS CLAVE: Salud Mental; Enfermería; Ancianos; Crash.

Síndrome de caídas y factores asociados en personas mayores indígenas de nariño, colombia

Objetivo: Determinar los factores asociados al síndrome de caída en un grupo de personas mayores indígenas. Material y Método: Estudio descriptivo transversal, realizado con 518 indígenas mayores de 60 años, que estimó la prevalencia del síndrome de caída durante el año 2019. Los instrumentos utilizados fueron entrevista demográfica y antecedentes médicos, Evaluación Mini Nutricional (MNA por su sigla en inglés) para evaluar estado nutricional, Mini Examen del Estado Mental (MMSE por su sigla en inglés) y The Rowland Universal Dementia Assessment Scale (RUDAS) para determinar nivel cognitivo; la sintomatología depresiva se evaluó con la Escala de Depresión Geriátrica de Yesavage; el nivel funcional se valoró con la escala de Actividades Instrumentales de la Vida Diaria IADL. Se utilizaron modelos de regresión logística multivariable para examinar la asociación entre las variables sociodemográficas y la presencia de morbilidades. Se construyeron perfiles de riesgo entre individuos para estimar la probabilidad de caer a través del análisis de clases latentes. Resultados: 35,9% de los participantes presentó al menos una caída. Hombres (OR 0,55 IC del 95%: 0,38-0,80), personas con hipertensión arterial (OR 3,4 IC del 95%: 1,4-8,2), enfermedad coronaria (OR 2,5 IC del 95%: 1,3 -5,0), artritis o artrosis (OR 1,5 IC del 95%: 1,0-2,0), personas con quejas de memoria (OR 1,6 95% CI 1,1-2,5) y dependencia funcional (OR 1,6 95% CI 1,1-2,2), mostraron una asociación con este síndrome. El perfil de riesgo mostró que los sujetos con mayor número de comorbilidades tenían mayor probabilidad de caídas (0,163). Conclusiones: La prevalencia del síndrome de caídas es similar a la reportada en estudios previos. Comorbilidades propias de la vejez mostraron relación con un mayor riesgo de caídas. Se observa una relación directamente proporcional entre la cantidad de comorbilidades y mayor riesgo de caídas.

Objective: To determine the factors associated with the fall syndrome in a group of indigenous older adults. Materials and Methods: Cross-sectional descriptive study carried out with 518 indigenous people over 60 years of age that estimated the prevalence of the fall syndrome during the year 2019. Research instruments included demographic interview and medical history, Mini Nutritional Assessment (MNA) to assess nutritional status, Mini-Mental State Examination (MMSE) and RUDAS to determine cognitive performance; depressive symptomatology was assessed with the Geriatric Depression Scale by Yesavage; functional level was assessed using Instrumental Activities of Daily Living scale (IADL). Multivariate logistic regression models were used to examine the association between sociodemographic variables and the presence of morbidities. Between-individual risk profiles were set up to estimate the probability of falling, using latent class analysis. Results: 35.9% of participants had at least suffered one fall. Men (OR 0.55 95% CI 0.38-0.80), people with high blood pressure (OR 3.4 95% CI 1.4-8.2), coronary heart disease (OR 2.5 95% CI 1.3 -5.0), arthritis or osteoarthritis (OR 1.5 95% CI 1.0-2.0), people with memory complaints (OR 1.6 95% CI 1.1-2.5) and functional dependency (OR 1.5 95% CI 1.0-2.2), showed an association with this syndrome. The risk profile showed that subjects with a greater number of comorbidities were more likely to suffer a fall (0.163). Conclusions: The prevalence of the falls syndrome is similar to that reported in previous studies. Comorbidities associated with old age showed a relationship with a higher risk of falls. A directly proportional relationship was observed between the number of comorbidities and the increased risk of falls.

Objetivo: Determinar os fatores associados à síndrome de queda em um grupo de idosos indígenas. Material e Métodos: Estudo descritivo transversal, realizado com 518 indígenas com mais de 60 anos de idade, que estimou a prevalência da síndrome de quedas durante o ano de 2019. Os instrumentos utilizados incluíram entrevista demográfica e histórico médico, Mini Avaliação Nutricional (MNA sigla em inglês) para avaliar o estado nutricional, Mini Exame do Estado Mental (MMSE sigla em inglês) e RUDAS para determinar o nível cognitivo; a sintomatologia depressiva foi avaliada com a escala de Depressão Geriátrica de Yesavage; o nível funcional foi avaliado com a escala Atividades Instrumentais de Vida Diária (AIVD). Modelos de regressão logística multivariada foram usados para examinar a associação entre variáveis sociodemográficas e a presença de morbidades. Perfis de risco entre indivíduos foram construídos para estimar a probabilidade de queda, por meio de análise de classe latente. Resultados: 35,9% dos participantes sofreram pelo menos uma queda. Homens (OR 0,55 IC 95% 0,38-0,80), pessoas com hipertensão arterial (OR 3,4 IC 95% 1,4-8,2), doença coronariana (OR 2,5 IC 95% 1,3-5,0), artrite ou osteoartrite (OR 1,5 IC 95% 1,0-2,0), pessoas com queixas de memória (OR 1,6 IC 95% 1,1-2,5) e dependência funcional (OR 1,5 IC 95% 1,0-2,2) apresentaram associação com essa síndrome. O perfil de risco mostrou que indivíduos com um número maior de comorbidades tinham maior probabilidade de cair (0,163). Conclusões: A prevalência da síndrome de quedas é semelhante à descrita em estudos anteriores. As comorbidades características da idade avançada mostraram uma relação com o aumento do risco de quedas. Observa-se uma relação diretamente proporcional entre o número de comorbidades e o aumento do risco de quedas.

Falls Suffered by Hospitalized Adult Patients: Support to the Nursing Team as the Second Victim / Caidas de pacientes adultos hospitalizados: soporte al equipo de enfermería como segunda víctima / Quedas de pacientes adultos hospitalizados: suporte à equipe de enfermagem como segunda vítima

Abstract Objective: To describe the support received by the second victim in falls suffered by hospitalized adult patients from the nursing team's perspective. Materials and Methods: This is an exploratory and descriptive study with a qualitative approach, conducted in a large general hospital in the southern region of Brazil. Data collection was carried out through semi-structured interviews with 21 nursing professionals (seven nurses and fourteen nursing technicians) selected by random sampling, who worked in the inpatient units where falls occurred with a level of harm ranging from moderate to severe during March and May of 2020. The data were submitted to content analysis from July to August of the same year. Results: On the one hand, from the nursing team's perspective, support for the second victim was considered incipient by the hospital institution. On the other, participants highlighted the support received by their families and peers in the work environment. The study followed the guidelines of the Consolidated Criteria for Reporting Qualitative Research (COREQ) . Conclusions: An institutional flow of support for the second victim needs to be formalized to mitigate the repercussions on staff.

Resumen Objetivo: describir el soporte recibido por la segunda víctima en las caídas de pacientes adultos hospitalizados desde la perspectiva del equipo de enfermería. Materiales y método: estudio exploratorio y descriptivo, con enfoque cualitativo, realizado en hospital general de gran tamaño en la región sur de Brasil. Se realizó la recolección de dados por medio de entrevista semiestructurada con 21 trabajadores de enfermería (siete enfermeros y 14 técnicos de enfermería) seleccionados por muestra aleatoria y que trabajaban en las unidades de hospitalización en que ocurrieron caídas con grado de daño comprendido de moderado a grave, de marzo a mayo de 2020. Se sometieron los datos al análisis de contenido, de julio a agosto de dicho año. Resultados: por una parte, desde la percepción del equipo de enfermería, el soporte a la segunda víctima se consideró incipiente por la institución hospitalaria. Por otra, los participantes destacan el apoyo recibido por sus familiares y pares en el entorno laboral. El estudio siguió las directrices del Consolidated Criteria for Reporting Qualitative Research (Coreq). Conclusiones: hay necesidad de formalizar un flujo institucional de soporte a la segunda víctima con el fin de mitigar las implicaciones a los trabajadores.

Resumo Objetivo: descrever o suporte recebido pela segunda vítima nas quedas de pacientes adultos hospitalizados sob a perspectiva da equipe de enfermagem. Materiais e método: estudo exploratório e descritivo, de abordagem qualitativa, realizado em hospital geral de grande porte na região sul do Brasil. A coleta de dados foi realizada por meio de entrevista semiestruturada com 21 trabalhadores de enfermagem (sete enfermeiros e 14 técnicos de enfermagem) selecionados por amostragem aleatória e que trabalhavam nas unidades de internação em que aconteceram quedas com grau de dano compreendido de moderado a grave, de março a maio de 2020. Os dados foram submetidos à análise de conteúdo, de julho a agosto do mesmo ano. Resultados: por um lado, na percepção da equipe de enfermagem, o suporte à segunda vítima foi considerado incipiente pela instituição hospitalar. Por outro, os participantes destacam o apoio recebido pelos seus familiares e por pares no ambiente de trabalho. O estudo seguiu as diretrizes do Consolidated Criteria for Reporting Qualitative Research (Coreq). Conclusões: há necessidade de formalizar um fluxo institucional de suporte à segunda vítima a fim de mitigar as repercussões sobre os trabalhadores.

Characteristic analysis and reconstruction method of falls from windows.

Fall accidents from windows usually start indoors, so it is impossible to secure witnesses or video clips of the initial fall situation, and there are difficulties such as a complicated fall process, but related studies are rare. In this study, the types of window fall accidents are classified, and behavior characteristics are analyzed through multibody simulation analysis based on the initial fall postures and speed values from the experimental results. And, in case studies of carefully selected real events, a method for specifying the type of window fall accident is presented along with the reconstruction simulation results using a fuzzy tool for type estimation. It is believed that the results of the characteristic analysis for each type of window fall accidents and the reconstruction method proposed in this paper will be useful for related forensic investigations.

Sickness absence and disability pension among injured working-aged pedestrians - a population-based Swedish register study.

BACKGROUND: The knowledge is scarce about sickness absence (SA) and disability pension (DP) among pedestrians injured in a traffic-related accident, including falls. Thus, the aim was to explore the frequencies of types of accidents and injuries and their association with SA and DP among working-aged individuals. METHODS: A nationwide register-based study, including all individuals aged 16-64 and living in Sweden, who in 2010 had in- or specialized outpatient healthcare after a new traffic-related accident as a pedestrian. Information on age, sex, sociodemographics, SA, DP, type of accident, injury type, and injured body region was used. Frequencies of pedestrians with no SA or DP, with ongoing SA or full-time DP already at the time of the accident, and with a new SA spell >14 days in connection to the accident were analyzed. Crude and adjusted odds ratios (ORs) with 95% confidence intervals (CIs) for new SA were estimated by logistic regression. RESULTS: In total, 5576 pedestrians received healthcare due to a traffic-related accident (of which 75% were falls, with half of the falls related to snow and ice). At the time of the accident, 7.5% were already on SA and 10.8% on full-time DP, while 20% started a new SA spell. The most common types of injuries were fractures (45%) and external injuries (30%). The body region most frequently injured was the lower leg, ankle, foot, and other (in total 26%). Older individuals had a higher OR for new SA compared with younger (OR 1.91; 95% CI 1.44-2.53, for ages: 45-54 vs. 25-34). The injury type with the highest OR for new SA, compared with the reference group external injuries, was fractures (9.58; 7.39-12.43). The injured body region with the highest OR for new SA, compared with the reference group head, face, and neck, was lower leg, ankle, foot, and other (4.52; 2.78-7.36). CONCLUSIONS: In this explorative nationwide study of the working-aged pedestrians injured in traffic-related accidents including falls, one fifth started a new SA spell >14 days. Fractures, internal injuries, collisions with motor vehicle, and falls related to snow and ice had the strongest associations with new SA.

Perfil epidemiológico do trauma facial em um hospital regional do interior da bahia / Epidemiological profile of facial trauma at a regional hospital in the interior of Bahia / Perfil epidemiológico de trauma facial en un hospital regional del interior de Bahia

Introdução:Estudos retrospectivos sobre trauma facial são importantes para quantificar sua demanda para os serviços de saúde, além de contribuir parao planejamento de ações de educação e prevenção. Objetivo:Este estudo teve por objetivo traçar o perfil epidemiológico do trauma facial em um hospital regional do interior da Bahia. Metodologia:Realizou-se um estudo descritivo, transversal, por meio de análise retrospectiva dos prontuários de pacientes vítimas de trauma facial, atendidos no Hospital Geral Prado Valadares, em Jequié-Bahia,Brasil,durante o período de janeiro de 2012 a dezembro de 2014.A análise estatística foi descritiva, sendo calculada em proporções e frequências absolutas e relativas.Para a comparação entre as variáveis foi realizado o teste do Qui-quadrado ou teste exato de Fisher.Resultados:Foram analisados 499 prontuários e observou-se que o sexo masculino (81,6%) e a etnia parda (50,3%) foram os mais acometidos pelo trauma facial. A faixa etária de maior prevalência foi de 25 a 34 anos (25,5%).O principal fator etiológico foi o acidente por motocicleta (30,1%) e houve elevada prevalência de traumatismo cranioencefálico (33,5%).Conclusões:No período estudado, verificou-se que indivíduos do sexo masculinoeadultos jovens foram os mais acometidos pelo trauma facial. Os traumas relacionados aos acidentes de motocicletae quedaforam os mais prevalentes (AU).

Introduction:Retrospective studies on facial trauma are important to quantify their demand for health services, in addition to contributing to the planning of education and prevention actions. Objective:This study aimed to trace the epidemiological profile of the facial trauma at a regional hospital in the interior of Bahia. Methodology:A descriptive, cross-sectional study was carried out through the retrospective analysis of medical records of patients who were victims of facial trauma, attended at the Prado Valadares General Hospital, Jequié-Bahia, Brazil, during the period from January 2012 to December 2014. The statistical analysis was descriptive, being calculated in absolute and relative proportionsand frequencies. The Chi-square test or Fisher's exact test were used to compare the variables.Results:499 medical records were analyzed and it was observed that males (81.6%) and mixed race (50.3%) were the most affected by facial trauma. The most prevalent age group was 25 to 34 years old (25.5%). The main etiological factor was the motorcycle accident (30.1%) and there was a high prevalence of traumatic brain injury (33.5%). Conclusions:During the study period, it was found that male individuals and young adults were the most affected by facial trauma. Traumas related to motorcycle accidents and falls were the most prevalent (AU).

Introducción: Los estudios retrospectivos sobre trauma facial son importantes para cuantificar su demanda de servicios de salud, además de contribuir a la planificación de acciones de educación y prevención. Objetivo: Este estudio tuvo como objetivo rastrear el perfil epidemiológico del trauma facial en un hospital regional del interior de Bahía. Metodología: Se realizó un estudio descriptivo, transversal, mediante un análisis retrospectivo de las historias clínicas de pacientes con trauma facial atendidos en el HospitalGeral Prado Valadares, en Jequié-Bahia, Brasil, desde enero de 2012 a diciembre de 2014. El análisis estadístico fue descriptivo, siendo calculado en proporciones y frecuencias absolutas y relativas. Para comparar las variables se utilizó la prueba de Chi-cuadrado o la prueba exacta de Fisher. Resultados:se analizaron 499 historias clínicas y se observó que los hombres (81,6%) y mestizos (50,3%) fueron los más afectados por el traumatismo facial. Elgrupo de edad más prevalente fue el de 25 a 34 años (25,5%). El principal factor etiológico fue el accidente de motocicleta (30,1%) y hubo una alta prevalencia de traumatismo craneoencefálico (33,5%). Conclusiones: Durante el período de estudio, se encontró que los hombres y los adultos jóvenes fueron los más afectados por el trauma facial. Los traumatismos relacionados con accidentes de motocicleta y caídas fueron los más prevalentes (AU).

A 10-week judo-based exercise programme improves physical functions such as balance, strength and falling techniques in working age adults.

BACKGROUND: Falls and fall-related injuries are major threats not only for older adults but also for younger age groups such as working-age adults. It has been shown that it is possible to reduce the risk of falls and fall-related injuries, to some extent. However, interventions aiming at reducing both the risk of falls and mitigating fall-related injuries through teaching safe falling techniques are still sparsely investigated. The aim with this study was to investigate the effect of a 10-week workplace-based judo inspired exercise programme (Judo4Balance). The measures in the study include physical functions, fall-related self-efficacy and safe falling techniques. METHODS: A total of 142 working-age adults participated in this non-randomised controlled study. The participants were allocated to the Judo4Balance group (n = 79), or to a waiting list control group (n = 63). The mean age was 47 years (18-68). The recruitment period was from May 2018 to October 2019. A total of 128 participants were included in the analysis. Logistic Regression models were used to analyse the outcomes: physical function, balance and fall-related self-efficacy as well as falling techniques (backwards and forwards). RESULTS: At the 10-week follow-up, the results displayed significant differences between the two groups in all measurements, except for the fall-related self-efficacy with OR = 1.8. Techniques for falling forwards and backwards displayed the highest OR = 124.1 and OR = 98.9. Physical function and balance showed OR = 3.3 and OR = 6.4. CONCLUSIONS: This exercise programme under study displayed significant differences in strength, balance and safe falling techniques between the groups. It is suggested that these functions, which were studied here, can effectively be trained in working-age adults by using the Judo4Balace exercise programme. Thus, it may be beneficial to further investigate and include training in proper falling techniques when designing fall prevention exercise programmes. Furthermore, it may be a novel way of addressing fall-related injuries, which are of utmost importance to prevent in near future. TRIAL REGISTRATION: NCT04294342 . Registered 4 March 2020 - The Impact of Specifically Adapted Judo-based Training Program on Risk Factors for Falls Among Adults - Full Text View - ClinicalTrials.gov.

Overview of falls in Brazilian public policies / Panorama das quedas nas políticas públicas brasileiras

Abstract Public policies portray the proposals of actions on circumstances that affect the population unfavorably. Falls represent an important factor of morbidity and mortality and damage to aging. Thus, the objective of the research was to outline the panorama of falls in the governmental sphere by analyzing and identifying its relevance in official publications. The research, qualitative of document analysis, started with the content analysis of 14 documents and verified that falls are addressed concisely, in most of the documents, and aimed at health professionals. It is noteworthy that falls are highlighted as preventable occurrences and subject to intervention by the elderly themselves, family members, health professionals, and managers.

Resumo As políticas públicas retratam as propostas de ações sobre circunstâncias que afetam a população desfavoravelmente. As quedas representam um fator importante de morbimortalidade e prejuízos ao envelhecimento. Assim, o objetivo da pesquisa foi delinear o panorama das quedas na esfera governamental por meio da análise e identificar sua relevância nas publicações oficiais. A pesquisa, qualitativa de análise documental, partiu da análise de conteúdo de 14 documentos e verificou que as quedas são abordadas de forma concisa, na maior parte dos documentos e destinada aos profissionais de saúde. Ressalta-se que as quedas são destacadas como ocorrências preveníveis e passíveis de intervenção por parte dos próprios idosos, familiares, profissionais de saúde e gestores.

Feasibility of a novel Judo4Balance - fall preventive exercise programme targeting community-dwelling older adults.

OBJECTIVES: It is of utmost importance to investigate risk factors for falls and learning techniques for falling safely. Therefore, the aim of this study was to assess the feasibility of a novel judo-inspired exercise intervention for community-dwelling older adults. METHODS: We included 28 participants, 60-88 years of age, in this study. In three different settings, the feasibility of carrying out a full-scale study was evaluated by the following: the study process, resource management and scientific aspects. The outcome measures evaluated were physical performance, fall related self-efficacy and fall techniques (backwards and forwards) among the older adults. RESULTS: The intervention was judged to be feasible in the different settings used in this study. Some changes regarding duration of the intervention were suggested as being important. Significant improvements were seen in the selected outcome measures, physical performance (p=.030) and fall techniques (p=<.001). A corresponding difference was not found for fall related self- efficacy (p=.113). CONCLUSIONS: This study confirms the judo inspired exercise programme, Judo4Balance, to be a feasible intervention for active older adults. This study will provide a safe and thoroughly planned protocol for the planned study and provides indication of appropriate setting depending on the target group.

An observational ergonomic tool for assessing the worn condition of slip-resistant shoes.

Worn shoes are known to contribute to slip-and-fall risk, a common cause of workplace injuries. However, guidelines for replacing shoes are not well developed. Recent experiments and lubrication theory suggest that the size of the worn region is an important contributor to the shoe tread's ability to drain fluid and therefore the under-shoe friction. This study evaluated a simple test for comparing the size of the worn region relative to a common object (AAA and AA battery) as a means of determining shoe replacement. This study consisted of three components involving slip-resistant shoes: Experiment #1: a longitudinal, mechanical, accelerated wear experiment; Experiment #2: a longitudinal experiment where the same shoes were tested after each month of worker use; and Experiment #3: a cross-sectional experiment that exposed participants to a slippery condition, while donning their own worn shoes. The COF (Experiments #1 and #2); under-shoe fluid pressure (all experiments); and slip severity (Experiment #3) were compared across outcomes (fail/pass) of the battery tests. Larger fluid pressures, lower coefficient of friction, and more severe slips were observed for shoes that failed the battery tests compared with those passing the tests. This method offers promise for assessing loss in friction and an increase in slip risk for slip-resistant shoes.

Could a Compliant Foam Anvil Characterize the Biofidelic Impact Response of Equestrian Helmets?

The performance of equestrian helmets to protect against brain injuries caused by fall impacts against compliant surfaces such as turf has not been studied widely. We characterize the kinematic response of simulated fall impacts to turf through field tests on horse racetracks and laboratory experiments. The kinematic response characteristics and ground stiffness at different going ratings (GRs) (standard measurement of racetrack condition) were obtained from 1 m and 2 m drop tests of an instrumented hemispherical impactor onto a turf racetrack. The "Hard" rating resulted in higher peak linear accelerations and stiffness, and shorter impact durations than the "Soft" and "Heavy" ratings. Insignificant differences were found among the other GRs, but a strong overall relationship was evident between the "going rating" and the kinematic response. This relationship was used to propose a series of three synthetic foam anvils as turf surrogates in equestrian falls corresponding to ranges of GRs of (i) heavy-soft (H-S), (ii) good-firm (G-F), and (iii) firm-hard (F-H). Laboratory experiments consisted of a helmeted headform being dropped onto natural turf and the turf surrogate anvils using a monorail drop rig. These experiments revealed that the magnitudes and durations of the linear and rotational accelerations for helmeted impacts to turf/turf surrogates were similar to those in concussive sports falls and collisions. Since the compliance of an impacted surface influences the dynamic response of a jockey's head during a fall impact against the ground, it is important that this is considered during both accident reconstructions and helmet certification tests.

Differences in Friction Performance between New and Worn Shoes.

Occupational ApplicationsSlips and falls are among the most common reason for non-fatal work accidents. Preventing slips in the workplace can be achieved by ensuring sufficient friction between the shoe and floor. As shoes are worn down, there is a decrease in the coefficient of friction, which increases the risk of injury from a slip and fall for the wearer. We found that shoes worn in the workplace commonly had friction performance that is about 25% lower than their new condition and that this effect was largest for shoes with the highest initial friction performance. These results inform the magnitude of improvement in friction performance that can be achieved through footwear replacement programs.

TECHNICAL ABSTRACTBackground As slip-resistant shoes are naturally worn, the coefficient of friction (COF) decreases. Proper and timely shoe replacement is an important factor for preventing injuries related to slips. Knowledge of the change in COF for naturally worn shoes in the workplace, relative to the COF of their new counterparts, is needed for a better understanding in this area. Methods: Slip-resistant shoes worn in the workplace and their new counterparts were mechanically tested to assess their COF. Eighteen pairs of shoes (new and worn) were tested on a whole-shoe slip testing device that simulates under-shoe slipping conditions. The COF was calculated for each pair of shoes at a shoe-floor angle of 17 ± 1° relative to the ground surface, a speed of 0.5 m/s, and a mean normal force of 250 ± 10 N. Results: A mean decrease in COF of 0.055 (25%) was observed when comparing the naturally worn shoes with the new shoes. New shoes with an initial higher COF showed a larger loss in COF due to wear. Conclusions: Naturally worn, slip-resistant shoes have substantively reduced COF compared to their new counterparts. These findings demonstrate the potential for programs that monitor and replace slip-resistant shoes as a means to prevent slips.

Accidental falls in middle-aged women / Quedas acidentais em mulheres de meia-idade

ABSTRACT OBJECTIVE To estimate the prevalence of accidental falls in women and to identify possible associations of sociodemographic, clinical and lifestyle variables with falls, in 2007 and 2014. METHODS Two cross-sectional studies were performed, in 2007 and 2014, within the Projeto de Saúde de Pindamonhangaba (PROSAPIN - Pindamonhangaba Health Project), with women aged between 35 to 75 years. Probabilistic samples were selected among women living in the municipality and participating in the Health Family Strategy. Data collection included: face-to-face interview, anthropometric examination and blood test. The outcome variable "have you fallen in the last six months?" was raised during the interview. The prevalence of falls in 2007 and 2014 were estimated by score with a 95% confidence interval (95%CI). Multiple logistic regression models were constructed to identify the association of independent variables with the occurrence of falls for each year based on the odds ratio (OR). We used the Stata 14.0 software for statistical analysis. RESULTS The prevalence of accidental falls were: 17.6% (95%CI 14.9-20.5) in 2007 and 17.2% (95%CI 14.8-19.8) in 2014. In 2007, factors associated with falls were: aged 50-64 years (OR = 1.81; 95%CI 1.17-2.80), high school (OR = 1.76; 95%CI 1.06-2.93), hyperuricemia (OR = 3.74; 95%CI 2.17-6.44), depression (OR = 2.07; 95%CI 1.31-3.27), poor sleep (OR = 1.78; 95%CI 1.12-2.82) and daytime sleepiness (OR = 1.86; 95%CI 1.16-2.99). In 2014, they were: aged 50-64 years (OR = 1.64; 95%CI 1.04-2.58), hyperuricemia (OR = 1.91; 95%CI 1.07-3.43) and depression (OR = 1.56; 95%CI 1.02-2.38), plus metabolic syndrome (OR = 1.60; 95%CI 1.03-2.47) and musculoskeletal pain (OR = 1.81; 95%CI 1.03-3.18). CONCLUSIONS Falls occur significantly in women aged 50 years or over, indicating that they are not restricted to older adults and that there is a need to initiate preventive measures earlier. Both studies showed similar magnitudes of occurrence of accidental falls and reinforced their multifactorial nature. In addition, hyperuricemia may be a potential new factor associated with falls.

RESUMO OBJETIVO Estimar a prevalência de quedas acidentais em mulheres e identificar possíveis associações de variáveis sociodemográficas, clínicas e de hábitos de vida com as quedas, em 2007 e 2014. MÉTODOS Foram realizados dois estudos transversais, em 2007 e 2014, dentro do Projeto de Saúde de Pindamonhangaba (PROSAPIN), com mulheres com idades variando de 35 a 75 anos. As amostras probabilísticas foram selecionadas dentre as mulheres residentes no município e participantes da Estratégia Saúde da Família. A coleta de dados incluiu: entrevista face a face, exame antropométrico e exame sanguíneo. A variável de desfecho "Sofreu queda nos últimos seis meses?" foi levantada durante a entrevista. Foram estimadas as prevalências de quedas em 2007 e 2014 por ponto e intervalo de confiança de 95% (IC95%). Modelos de regressão logística múltipla foram construídos para identificar a associação das variáveis independentes e a ocorrência de quedas para cada ano a partir da odds ratio (OR). Utilizou-se o software Stata 14.0 para análise estatística. RESULTADOS As prevalências de quedas acidentais foram: 17,6% (IC95% 14,9-20,5) em 2007 e 17,2% (IC95% 14,8-19,8) em 2014. Em 2007 os fatores associados a quedas foram: idade de 50-64 anos (OR = 1,81; IC95% 1,17-2,80), ensino médio (OR = 1,76; IC95% 1,06-2,93), hiperuricemia (OR = 3,74; IC95% 2,17-6,44), depressão (OR = 2,07; IC95% 1,31-3,27), sono ruim (OR = 1,78; IC95% 1,12-2,82) e sonolência diurna (OR = 1,86; IC95% 1,16-2,99). Em 2014 permaneceram: idade de 50-64 anos (OR = 1,64; IC95% 1,04-2,58), hiperuricemia (OR = 1,91; IC95% 1,07-3,43) e depressão (OR = 1,56; IC95% 1,02-2,38), acrescidos da síndrome metabólica (OR = 1,60; IC95% 1,03-2,47) e da dor musculoesquelética (OR = 1,81; IC95% 1,03-3,18). CONCLUSÕES As quedas ocorrem de maneira importante em mulheres a partir dos 50 anos, indicando que não são restritas a idosos e que há necessidade de iniciar medidas preventivas mais precocemente. Os dois estudos mostraram magnitudes semelhantes de ocorrência de quedas acidentais e reforçaram sua multifatorialidade. Além disso, a hiperuricemia pode ser um potencial novo fator associado a quedas.

Incidência e fatores preditivos de quedas em idosos na comunidade: um estudo longitudinal / Incidence and predictive factors of falls in community-dwelling elderly: a longitudinal study

Resumo Objetivou-se estimar a incidência de quedas entre os idosos e determinar os fatores preditivos de quedas e quedas recorrentes. Estudo longitudinal (2014-2016) conduzido com 345 idosos da área urbana em Uberaba-MG. Utilizou-se: instrumento estruturado referente aos dados socioeconômicos e à ocorrência de quedas; Escalas de Katz e Lawton e Brody; Short Physical Performance Battery (SPPB) e Falls Efficacy Scale-International (FES-I) Brasil. Procedeu-se à análise de regressão logística multinomial (p < 0,05). A incidência de quedas no período de acompanhamento representou 37,1%, sendo 20% recorrentes e 17,1% em um único evento. O modelo final indicou que o aumento em uma unidade do SPPB diminuiu em aproximadamente 15% e 17%, respectivamente, a chance de quedas e quedas recorrentes. O maior escore da FES-I Brasil associou-se à maior ocorrência de quedas recorrentes. Os resultados encontrados sobre a ocorrência de quedas e quedas recorrentes e sua associação com pior desempenho físico e ao medo de cair fornecem subsídios para ações direcionadas ao monitoramento e controle dos fatores interferentes.

Abstract This study aimed to estimate the incidence of falls among the elderly and to determine the predictive factors of falls and recurrent falls. This is a longitudinal study (2014-2016) conducted with 345 elderly in the urban area of Uberaba-MG. A structured tool related to socioeconomic data and occurrence of falls, Katz and Lawton-Brody Scales, the Short Physical Performance Battery (SPPB) and Falls Efficacy Scale-International (FES-I) Brazil were used. The multinomial logistic regression analysis was performed (p < 0.05). The incidence of falls in the follow-up period was 37.1%, with 20% recurrent falls and 17.1% single-event falls. The final model showed that the increase in one SPPB unit decreased by approximately 15% and 17%, respectively, the probability of falls and recurrent falls. The highest FES-I Brazil score was associated with a higher occurrence of recurrent falls. The results found on the occurrence of falls and recurrent falls and their association with worse physical performance and fear of falling provide subsidies for actions directed to the monitoring and control of the interfering factors.

Letramento funcional em saúde de idosos acerca de acidentes por quedas e sua prevenção / Functional health literacy of elderly people about fall accidents and their prevention / Letra funcional en salud de ancianos sobre accidentes por caída y su prevención

Objetivou-se conhecer o nível de letramento sobre acidentes por queda e sua prevenção relativamente a idosos frequentadores de praças públicas no município de Belém, estado do Pará, Brasil. Pesquisa exploratório-descritiva com abordagem qualitativa, realizada com 80 idosos, cujos dados foram coletados por meio da aplicação assistida do instrumento "Alfabetização em saúde". As baixas percentagens de respostas mostraram o baixo nível do letramento funcional em saúde dos idosos, revelando aparente conformidade e passividade acerca das informações de saúde.

This study aimed to know the level how elderly that frequent public parks health information about preventing falls accidents in the municipality of Belém, Pará, Brazil. An exploratory descriptive research with a qualitative approach was conducted with 80 elderly. The data collection occurred through an assisted application of the instrument "Health Literacy". The low percentages of answers showed the poor level of the functional literacy in the elderly, revealing apparent compliance and passivity about health.

Conocer el nivel de letra funcional em salud sobre prevención de accidentes por caídas de ancianos frecuentadores de plazas públicas en el municipio de Belém, Pará, Brasil. La investigación exploratorio-descriptiva con abordaje cualitativo, realizada con 80 ancianos, cuyas informaciones fueron recogidas por medio de aplicación asistida del instrumento de "Alfabetización en salud". Las bajas porcentajes de respuestas mostraron el bajo nivel del letra funcional en salud de los ancianos, revelando aparente conformidad y pasividad acerca de dicha condición.

Current playground surface test standards underestimate brain injury risk for children.

Playgrounds surface test standards have been introduced to reduce the number of fatal and severe injuries. However, these test standards have several simplifications to make it practical, robust and cost-effective, such as the head is represented with a hemisphere, only the linear kinematics is evaluated and the body is excluded. Little is known about how these simplifications may influence the test results. The objective of this study was to evaluate the effect of these simplifications on global head kinematics and head injury prediction for different age groups. The finite element human body model PIPER was used and scaled to seven different age groups from 1.5 up to 18 years old, and each model was impacted at three different playground surface stiffness and three head impact locations. All simulations were performed in pairs, including and excluding the body. Linear kinematics and skull bone stress showed small influence if excluding the body while head angular kinematics and brain tissue strain were underestimated by the same simplification. The predicted performance of the three different playground surface materials, in terms of head angular kinematics and brain tissue strain, was also altered when including the body. A body and biofidelic neck need to be included, together with suitable head angular kinematics based injury thresholds, in future physical or virtual playground surface test standards to better prevent brain injuries.