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2.
Pediatrics ; 145(3)2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32051219

RESUMO

BACKGROUND: Opioid overprescription has the potential to lead to harmful medications remaining in homes and to a rise in accidental or deliberate ingestion by children and adolescents. Although methods for opioid disposal are available, many are costly or require greater than minimal effort for the patient. In this study, we used a mail-back return envelope to retrieve unused opioids after ambulatory pediatric surgery. METHODS: This feasibility study was performed to assess the rate of opioid return by using a mail-back envelope for children ages 0 to 18 prescribed opioids after outpatient surgery. Participants were provided a return envelope as well as instruction on the dangers of opioids in the home. Our primary outcome was to assess the absolute percent return rate through the use of a mail-back envelope. RESULTS: Between November 2017 and October 2018, we identified 355 patients, of whom 331 were included in the analysis. In total, 64 (19.3%) returned opioids. In total, >2000 mL of liquid opioids and >250 tablets or nearly 3000 mg of oral morphine equivalents were removed from the homes of the 64 participants. Of those patients returning unused medications, the median rate of return was 58% (interquartile range = 34.7%-86.1%) of the written prescription. CONCLUSIONS: The findings suggest that providing a free mail-back return envelope is a suitable way to remove unused opioids from the home after pediatric surgery. Additional research is needed to identify barriers to return of unused medications.


Assuntos
Procedimentos Cirúrgicos Ambulatórios , Analgésicos Opioides/uso terapêutico , Alta do Paciente , Serviços Postais , Acidentes Domésticos/prevenção & controle , Adolescente , Criança , Estudos de Viabilidade , Feminino , Hospitais Pediátricos , Humanos , Masculino , Transtornos Relacionados ao Uso de Opioides/prevenção & controle , Dor Pós-Operatória/tratamento farmacológico , Envenenamento/prevenção & controle , Desvio de Medicamentos sob Prescrição/prevenção & controle , Texas
3.
Pediatrics ; 145(3)2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32098787

RESUMO

Behavioral economics applies key principles from psychology and economics to address obstacles to behavior change. The important topic of pediatric firearm injuries has not yet been explored through a behavioral economic lens. Pediatric firearm-related injuries are a significant public health problem in the United States. Despite American Academy of Pediatrics guidelines advising that firearms be stored unloaded, in a locked box or with a locking device, and separate from ammunition, estimates suggest that ∼4.6 million children live in homes with at least 1 loaded and unlocked firearm. In this article, we use behavioral economic theory to identify specific cognitive biases (ie, present bias; in-group, out-group bias; and the availability heuristic) that may influence parental decision-making around firearm storage. We illustrate situations in which these biases may occur and highlight implementation prompts, in-group messengers, and increased salience as behaviorally informed strategies that may counter these biases and subsequently enhance safe firearm storage. We also describe other opportunities to leverage the behavioral economic tool kit. By better understanding the individual behavioral levers that may impact decision-making around firearm storage, behavioral scientists, pediatric providers, and public health practitioners can partner to design and test tailored interventions aimed at decreasing pediatric firearm injuries. Further empirical study is warranted to identify the presence of specific biases and heuristics and determine the most effective behavior change strategies for different subpopulations.


Assuntos
Economia Comportamental , Armas de Fogo , Propriedade , Segurança , Acidentes Domésticos/prevenção & controle , Humanos , Ferimentos por Arma de Fogo/prevenção & controle
4.
Zhonghua Yu Fang Yi Xue Za Zhi ; 54(2): 139-143, 2020 Feb 06.
Artigo em Chinês | MEDLINE | ID: mdl-32074699

RESUMO

Objective: To develop the environment scale of unintentional injury in the home for children aged 0-6 years living in urban area of China, and test its validity and reliability. Methods: The content of the environment scale was established through the literature review, expert consultation and pilot study. A total of 1 104 children aged 0-6 years in urban area of Changsha were enrolled in this study by using a multi-stage stratified cluster random sampling method. The questionnaire was used to collect the basic information of children, the incidence of unintentional injury and the status of home environment. The reliability of the scale was tested by using Cronbach's α coefficient and split-half reliability coefficient. The content validity and construct validity were tested by using Pearson correlation analysis and factor analysis. All children were divided into two groups according to the incidence of unintentional injury in the home and the discrimination validity of the scale was tested by using t-test. Results: The scale had 54 items in 6 dimensions. The number of eligible questionnaires was 1 074, including 554 (51.6%) from boys and 519 (48.3%) from children under 3 years old. The incidence rate of unintentional injury and in-home injury was 18.34% (197 children) and 10.71% (115 children). The internal consistency reliability (Cronbach's α) coefficient for the scale was 0.87 and the split-efficacy reliability coefficient was 0.82, both meeting the standard of reliability above 0.70. The Pearson correlation coefficient between each dimension and the whole scale ranged from 0.53 to 0.84 (all P values <0.001). The common factor cumulative variance contribution rate of the scale was 58.34%. There were 54 items with factor loadings greater than 0.30. The root mean square error of approximation, comparative fit index and goodness-of-fit index were 0.07, 0.61 and 0.71, respectively. The score of scale in children with injury was significantly higher than that in children without injury (P=0.022). Conclusion: The validity and reliability of the environment scale for unintentional injury in the home for children aged 0-6 years old in the urban area of China are good.


Assuntos
Lesões Acidentais/epidemiologia , Acidentes Domésticos/estatística & dados numéricos , Inquéritos e Questionários , População Urbana/estatística & dados numéricos , Criança , Pré-Escolar , China/epidemiologia , Análise Fatorial , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Projetos Piloto , Reprodutibilidade dos Testes
5.
Toxicol Lett ; 320: 73-79, 2020 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-31811912

RESUMO

INTRODUCTION: Choking agent exposure, among them chlorine gas, occurs in household or industrial accidents, chemical warfare and terrorist attacks. AIMS: Review of published animal and human data regarding the history, pathophysiology, clinical effects and management of chlorine exposure. PATHOPHYSIOLOGY: Highly soluble agents cause quick upper respiratory tract symptoms. Chlorine gas has a medium solubility, also causing delayed lower airway symptoms, mainly due to its oxidizing potential by releasing hypochlorous and hydrochloric acid, but also by interacting with Transient Receptor Potential channels. SYMPTOMS: Eyes may show conjunctival injection, abrasions and corrosions. Burns of the oronasal mucosa and trachea can occur. Dyspnea, bronchospasm and possible retrosternal pain occur frequently. Glottis edema or laryngospasm are acute life-threatening emergencies. Chlorine gas can cause toxic pneumonitis, lung edema and acute respiratory distress syndrome (ARDS). MANAGEMENT: General management includes physical examination, pulse oximetry and arterial blood gases. Eyes should be irrigated, humidified oxygen and inhalative bronchodilators administered. An EKG, cardiac enzymes and complete-blood-count should be obtained if there is retrosternal pain. Routine chest x-ray is not recommended - except if pulmonary edema is suspected. Laryngoscopy should be performed if glottis edema is suspected. Sodium bicarbonate inhalation after chlorine gas inhalation is discussed controversially. Mechanical ventilation with continuous-positive-airway-pressure or intubation/tracheotomy with high positive-end-expiratory-pressure may be necessary. Glucocorticoids for prevention of pulmonary edema should be applied restrictively. Prophylactic antibiotics are not recommended. In severe ARDS, extracorporeal membrane oxygenation (ECMO) can be considered. CONCLUSION: Treatment is mainly symptom oriented. New and promising therapies are in development.


Assuntos
Acidentes Domésticos , Acidentes de Trabalho , Queimaduras Químicas/terapia , Substâncias para a Guerra Química/envenenamento , Cloro/envenenamento , Queimaduras Oculares/terapia , Doenças Respiratórias/terapia , Animais , Queimaduras Químicas/etiologia , Queimaduras Químicas/história , Queimaduras Químicas/fisiopatologia , Substâncias para a Guerra Química/história , Cloro/história , Queimaduras Oculares/induzido quimicamente , Queimaduras Oculares/história , Queimaduras Oculares/fisiopatologia , História do Século XX , História do Século XXI , Humanos , Exposição por Inalação/efeitos adversos , Exposição Ocupacional/efeitos adversos , Prognóstico , Doenças Respiratórias/induzido quimicamente , Doenças Respiratórias/história , Doenças Respiratórias/fisiopatologia , Medição de Risco
6.
Am J Forensic Med Pathol ; 41(1): 67-69, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31789819

RESUMO

The patient was a 5-year-old boy who was found in a state of cardiorespiratory arrest in the tub of a washing machine without water with the door closed. The autopsy findings included severe facial congestion and petechiae of the facial skin and palpebral conjunctiva. Several organs exhibited congestion. Hemorrhagic spots were seen on the serous membranes of various organs, with particularly marked hemorrhagic spots seen on the lungs. The heart contained fluid blood without soft clots. There were no findings indicative of marked trauma, intoxication, or hyperthermia. The examination results suggested that asphyxia had occurred in this case. However, there were no findings indicative of cervical compression, oronasal obstruction, or the presence of a foreign body in the respiratory tract. Image analysis showed the child could make postural changes inside the washing machine tub. Consequently, impaired thoracic movement and postural asphyxia were considered unlikely to have occurred. The results of blood gas analysis showed no evidence of marked hypercapnia. We, therefore, concluded that the cause of the child's death was asphyxia due to hypoxia caused by being in a closed space, that is, a washing machine tub.


Assuntos
Asfixia/etiologia , Espaços Confinados , Hipóxia/etiologia , Lavanderia/instrumentação , Parada Cardíaca Extra-Hospitalar/etiologia , Acidentes Domésticos , Pré-Escolar , Humanos , Hipóxia/complicações , Deficiência Intelectual , Masculino
7.
Pan Afr Med J ; 33: 142, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31558940

RESUMO

Introduction: Hand injuries constitute a major proportion of trauma emergencies in developing countries. The hand establishes the individual in society, allowing them to meet social and economic responsibilities. Previously hand traumas accounted for 12% of major limb traumas in Addis Ababa, Ethiopia; but data on the specific types of tissue injuries and pattern of occurrence of these injuries over the years is limited. Methods: A retrospective study of sampled 178 patients with hand injury that presented to Yekatit 12 Hospital with hand injuries was done by reviewing the patient's medical records. Results: Hand trauma is the second commonest injury following burns that present to the Plastic and Reconstructive Surgery unit in Yekatit 12 hospital. It commonly occurs in males with ratio of 4:1. Average age of patients was 24.5 years. The right hand was more commonly injured than the left hand. Home and fall accidents were commonest cause of injury followed by machine injuries. Commonly occurring injuries were tendon injuries followed by fingertip injuries. The number of patients presenting to the hospital with hand injuries has doubled over the two year study period. Conclusion: The number of hand injury cases that presented to the hospital has doubled over the two years study period. Types of hand injuries presenting to the hospitals ranged from simple lacerations to deep tissue injuries requiring long duration of treatment and rehabilitation which has an impact on the productivity of the younger age group that was identified as the most at risk population.


Assuntos
Queimaduras/epidemiologia , Traumatismos da Mão/epidemiologia , Lacerações/epidemiologia , Acidentes por Quedas/estatística & dados numéricos , Acidentes Domésticos/estatística & dados numéricos , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Etiópia , Feminino , Traumatismos dos Dedos/epidemiologia , Traumatismos da Mão/etiologia , Traumatismos da Mão/terapia , Hospitais , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Distribuição por Sexo , Traumatismos dos Tendões/epidemiologia , Adulto Jovem
8.
Home Healthc Now ; 37(5): 265-272, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31483358

RESUMO

Home healthcare workers (HHWs) are routinely exposed to occupational safety hazards when servicing patients in their homes that put them at risk for injury. These hazards can be broadly classified as "electric, fire and burn," "environmental," or "slip, trip, and lift" hazards. To better train HHWs regarding their potential exposure to these hazards, a home healthcare virtual simulation training system (HH-VSTS) was developed. The HH-VSTS contains three training modules, corresponding to the aforementioned hazard categories, and an assessment module. In each training module, the trainee must navigate the virtual space, via a mouse click, and identify items or conditions that represent hazards. Once an item has been clicked on, the HH-VSTS asks the user if the item or condition is a hazard. For items or conditions that are hazards, additional text boxes present material to the user as to why the item constitutes a hazard and potential remediation approaches. Thus, it is important that hazards be identified and clicked on for the trainee to receive the educational component of the training system. This article evaluated the ability of 49 HHWs to find hazards in each of the three categories. In all modules, participants found the most salient hazards (e.g., clutter on stairs, unattended candles, biohazard stains) but struggled to find some of the less salient hazards. Several less salient hazards included the pet food bowls in the path of travel, the frayed electrical cord, oxygen tube leaking into a mattress, hot water that was too hot, and elevated room temperatures. Overall, this analysis found that most of the hazards within the training modules could be found by naïve HH-VSTS users. These data suggest the need for including hints that guide users toward hazards with which they are less familiar.


Assuntos
Enfermeiros de Saúde Comunitária , Saúde do Trabalhador , Interface Usuário-Computador , Acidentes por Quedas/prevenção & controle , Acidentes Domésticos/prevenção & controle , Acidentes de Trabalho/prevenção & controle , Adulto , Idoso , Feminino , Humanos , Remoção/efeitos adversos , Masculino , Pessoa de Meia-Idade , Enfermeiros de Saúde Comunitária/educação , Enfermeiros de Saúde Comunitária/psicologia , Adulto Jovem
9.
Pan Afr Med J ; 33: 108, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31489086

RESUMO

Home accidents are a serious public health problem in Pediatrics. They are responsible for heavy morbidity and mortality in the paediatric population. We conducted a retrospective study of 231 cases of domestic accidents in childhood in the Division of General Pediatrics at the Hedi Chaker Hospital, Sfax over a period of 5 years (2008-2012). During the study period, we collected data from 231 domestic accidents. The study involved 124 boys (53.7 %) and 107 girls (46.3%). The average age of patients was 2 years, ranging from 1 day to 14 years; children under 4 years were the most exposed to home accidents (88.7%). Accidental poisonings were the most common accidents (105 cases). Caustics were the most common toxic agents (33 cases), followed by drugs (28 cases) and hydrocarbons (16 cases). Foreign body accidents were the second most common mechanism of injury (64 cases). They included 43 cases of inhalation of foreign bodies and 21 cases of foreign body ingestion. We recorded 28 cases of trauma, 25 cases were caused by a fall from a certain height. We noted 26 cases of scorpion envenomation, 5 cases of drowning, 2 cases of burn and a single case of electric shock. Accidental poisonings and foreign body accidents were the main home accidents noted during our study and the age group 1 -4 years was the most exposed to home accidents.


Assuntos
Acidentes por Quedas/estatística & dados numéricos , Acidentes Domésticos/estatística & dados numéricos , Corpos Estranhos/epidemiologia , Envenenamento/epidemiologia , Adolescente , Fatores Etários , Queimaduras/epidemiologia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Envenenamento/etiologia , Estudos Retrospectivos , Picadas de Escorpião/epidemiologia , Tunísia/epidemiologia
10.
J Trauma Acute Care Surg ; 87(3): 672-677, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31454338

RESUMO

BACKGROUND: The purpose of the study was to evaluate whether the higher level of care significantly affected the outcomes of elderly patients who fell from ground level at home and had a normal physiological examination at the scene. METHODS: Patients 65 years and older, with normal physiological measures at the scene (Glasgow Coma Scale score = 15, systolic blood pressure > 90 and <160 mm Hg, heart rate (HR) ≥ 60 and ≤100) from the 2012 to 2014 National Trauma Data Bank data sets were included in the study. Patients' characteristics, existing comorbidities, and outcomes were compared between Level I or Level II designated trauma centers (higher level care [group 1]) and Levels III, IV, and unranked/nontrauma centers (lower level care [group 2]). Following initial analyses, propensity score matching was performed, and the rate of in-hospital mortality, median time (days) to death or discharge, and discharge disposition were compared. RESULTS: Of the 40,800 patients who met inclusion criteria, 18,813 patients were matched from each group on age, sex, race, systolic blood pressure, HR, respiratory rate, Injury Severity Score, and comorbidity statuses. There was no evidence of a significant difference regarding in-hospital mortality (2.5% vs. 2.3%), time to death (median [interquartile range]: 6 [3-11] vs. 6 [3-11]), or time to hospital discharge (median [interquartile range]: 5 [5-5] vs. 5 [5-5]). However, the rate of required postdischarge care (78.9% vs. 81.7%) varied significantly between the groups. CONCLUSION: Higher levels of care failed to show any significant survival benefits or shorten the time to hospital discharge; however, a significantly higher proportion of patients from lesser-care facilities required follow-up services after discharge. LEVEL OF EVIDENCE: Therapeutic/Care management, level IV. STUDY TYPE: Observational case-control.


Assuntos
Acidentes por Quedas/estatística & dados numéricos , Acidentes Domésticos/estatística & dados numéricos , Sinais Vitais , Acidentes por Quedas/mortalidade , Acidentes Domésticos/mortalidade , Idoso , Idoso de 80 Anos ou mais , Pressão Sanguínea , Bases de Dados Factuais , Feminino , Escala de Coma de Glasgow , Frequência Cardíaca , Humanos , Tempo de Internação , Masculino , Centros de Traumatologia/estatística & dados numéricos , Resultado do Tratamento , Estados Unidos/epidemiologia , Ferimentos e Lesões/epidemiologia , Ferimentos e Lesões/etiologia , Ferimentos e Lesões/mortalidade , Ferimentos e Lesões/terapia
11.
BMC Public Health ; 19(1): 872, 2019 Jul 04.
Artigo em Inglês | MEDLINE | ID: mdl-31272445

RESUMO

BACKGROUND: Domestic fire-related injuries and deaths among the aged remain a concern of many countries including Australia. This study aimed to assess the impact of a home fire safety visit project on domestic fire emergency escape plans among the 373 aged persons using multivariate analyses. METHOD: The study used data from a collaborative intervention program by three emergency agencies in New South Wales. It covered 373 older people at registration and 156 at post home visit follow-up. The five fire emergency escape plan outcome measures (participants having a working smoke alarm, finding out what to do if there was a fire at their home, making a plan to escape their home in the event of a fire, finding out how to escape their home in an emergency and finding out how to maintain their installed smoke alarm) were examined by adjusting for key characteristics of participants, using a generalized estimating equation (GEE) model that adjusted for repeated measures in order to examine the association between the home visit program and fire emergency escape plans. RESULTS: There were significant improvements in participants' likelihood of finding out what to do if there was a fire in their home [AOR; 95% CI 1.89 (1.59-2.26)], making a plan to escape their home [AOR; 95% CI 1.80 (1.50-2.17)], how to escape their home in an emergency [AOR; 95% CI 1.33 (1.07-1.66)] and how to maintain their smoke alarm [AOR; 95% CI 1.77 (1.48-2.12)]. Female participants were less likely to have a plan to escape their home in the event of a fire [AOR; 95% CI 0.86 (0.75-0.99)] and to find out how to escape their home in an emergency [AOR; 95% CI 0.71 (0.61-0.82)] compared with their male counterparts. Additionally, participants who spoke languages other than English at home were significantly less likely to have a working smoke alarm [AOR; 95% CI 0.88 (0.38-0.69)]. CONCLUSION: Our findings suggest that home visit programs are able to increase fire safety of vulnerable and isolated older people.


Assuntos
Acidentes Domésticos , Planejamento em Desastres/estatística & dados numéricos , Fogo , Visita Domiciliar , Segurança , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , New South Wales , Avaliação de Programas e Projetos de Saúde , Equipamentos de Proteção/estatística & dados numéricos , Medição de Risco
12.
Pediatrics ; 144(1)2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31160344

RESUMO

OBJECTIVES: To investigate exposures to liquid laundry detergent packets among children <6 years old in the United States and to evaluate the impact of the American Society for Testing and Materials voluntary product safety standard. METHODS: Data from the National Poison Data System involving exposures to liquid laundry detergent packets from 2012 to 2017 were analyzed. RESULTS: From January 2012 to December 2017, there were 72 947 single and polysubstance exposures to liquid laundry detergent packets. Most exposures (91.7%) were documented among children <6 years old. The annual number and rate of exposures for children <6 years old increased by 110.4% and 111.9%, respectively, from 2012 to 2015. From 2015 to 2017, the number and rate of exposures in this age group decreased by 18.0%. Among individuals ≥6 years old, the annual number and rate of exposures increased by 292.7% and 276.7%, respectively, from 2012 to 2017. Annual hospital admissions among children <6 years old increased by 63.4% from 2012 to 2015 and declined by 55.5% from 2015 to 2017. Serious outcomes among children <6 years old increased by 78.5% from 2012 to 2015 and declined by 32.9% from 2015 to 2017. CONCLUSIONS: The number, rate, and severity of liquid laundry detergent packet exposures have decreased modestly in recent years among children <6 years old, likely attributable, in part, to the voluntary product safety standard and public awareness efforts. Exposures among older children and adults are increasing. Opportunities exist to strengthen the current product safety standard to further reduce exposures.


Assuntos
Qualidade de Produtos para o Consumidor , Detergentes/envenenamento , Lavanderia , Acidentes Domésticos/prevenção & controle , Criança , Pré-Escolar , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Envenenamento/epidemiologia , Envenenamento/prevenção & controle , Rotulagem de Produtos , Embalagem de Produtos , Estados Unidos/epidemiologia
13.
Matern Child Health J ; 23(12): 1670-1678, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31243626

RESUMO

Objectives (a) Update previous descriptions of trends in ASSB; (b) determine if factors previously associated with ASSB are replicated by updated data; and (c) generate new hypotheses about the occurrence of ASSB and racial inequalities in ASSB mortality. Methods National Center for Health Statistics files (International Classification of Diseases, Tenth Edition) Code W75 to describe race-ethnicity-specific ASSB occurrence. Results (a) ASSB mortality continues to increase significantly; for 1999-2016, 4.4-fold for NHB girls (45.8 per 100,000 in 2016), 3.5-fold for NHB boys (53.8), 2.7-fold for NHW girls (15.8) and 4.0-fold for NHW boys (25.9); (b) F actors previously associated with ASSB (unmarried mothers and mothers with low educational attainment, low infant birth weight, low gestational age, lack of prenatal care, male infant, multiple birth, high birth order) continue to be associated with both overall ASSB and inequalities adversely affecting NHB; (c) (1) geographic differences and similarities in ASSB occurrence support hypotheses related to positive deviance; (2) lower ASSB mortality for births attended by midwives as contrasted to physicians generate hypotheses related to both medical infrastructure and maternal engagement; (3) high rates of ASSB among infants born to teenage mothers generate hypotheses related to the possibility that poor maternal health may be a barrier to ASSB prevention based on education, culture and tradition. Conclusions for Practice These descriptive data may generate new hypotheses and targets for interventions for reducing both ASSB mortality and racial inequalities. Analytic epidemiologic studies designed a priori to do so are required to address these hypotheses.


Assuntos
Asfixia/mortalidade , Grupos de Populações Continentais/estatística & dados numéricos , Mortalidade Infantil/etnologia , Morte Súbita do Lactente/etnologia , Acidentes Domésticos/mortalidade , Acidentes Domésticos/estatística & dados numéricos , Adolescente , Grupos Étnicos/estatística & dados numéricos , Feminino , Humanos , Lactente , Mortalidade Infantil/tendências , Recém-Nascido , Masculino , Idade Materna , Vigilância da População , Gravidez , Inquéritos e Questionários , Estados Unidos/epidemiologia , Adulto Jovem
15.
JAMA Pediatr ; 173(7): 657-662, 2019 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-31081861

RESUMO

Importance: Firearm injury is the second leading cause of death in the United States for children and young adults. The risk of unintentional and self-inflicted firearm injury is lower when all household firearms are stored locked. Objective: To estimate the reduction in youth firearm suicide and unintentional firearm mortality that would result if more adults in households with youth stored household guns locked. Design, Setting, and Participants: A modeling study using Monte Carlo simulation of youth firearm suicide and unintentional firearm mortality in 2015. A simulated US national sample of firearm-owning households where youth reside was derived using nationally representative rates of firearm ownership and storage and population data from the US Census to test a hypothetical intervention, safe storage of firearms in the home, on youth accidental death and suicide. Data analyses were performed from August 3, 2017, to January 9, 2018. Exposures: Observed and counterfactual household-level safe firearm storage (ie, storing all firearms locked), the latter estimated by varying the probability that a hypothetical intervention increased safe firearm storage beyond that observed in 2015. Main Outcomes and Measures: Observed and counterfactual counts of firearm suicide and unintentional firearm mortality among youth aged 0 to 19 years, the latter estimated by incorporating an empirically based estimate of the mortality benefit expected from additional safe storage (beyond that observed in 2015). Results: A hypothetical intervention among firearm owners residing with children with a 20% probability of motivating these owners to lock all household firearms was significantly associated with a projected reduction in youth firearm mortality (median incidence rate ratio = 0.90; interquartile range, 0.87-0.93). In the overall model, 6% to 32% of deaths were estimated to be preventable depending on the probability of motivating safer storage. Conclusions and Relevance: Results of this modeling study suggest that a relatively modest uptake of a straightforward safe storage recommendation-lock all household firearms-could result in meaningful reductions in firearm suicide and unintentional firearm fatalities among youth. Approaches that will motivate additional parents to store firearms safely are needed.


Assuntos
Acidentes Domésticos/prevenção & controle , Características da Família , Armas de Fogo , Suicídio/prevenção & controle , Ferimentos por Arma de Fogo/epidemiologia , Acidentes Domésticos/tendências , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Massachusetts/epidemiologia , Método de Monte Carlo , Estudos Retrospectivos , Suicídio/tendências , Taxa de Sobrevida/tendências , Ferimentos por Arma de Fogo/prevenção & controle , Adulto Jovem
16.
Rev. enferm. UFPE on line ; 13(5): 1361-1369, maio 2019. ilus, tab, graf
Artigo em Português | BDENF - Enfermagem | ID: biblio-1024411

RESUMO

Objetivo: descrever o acidente e o perfil de crianças e adolescentes vítimas de queimaduras internados em um Centro de Terapia de Queimados de um Hospital Geral. Método: trata-se de um estudo quanti-qualitativo, descritivo, observacional, transversal realizado com dados dos registros de prontuário de internos na faixa etária de um dia a 18 anos, de 2014 a 2016, e entrevista com os responsáveis pelos internos, e apresentaramse os resultados em forma de tabelas. Resultados: ressalta-se que a maioria dos acidentes ocorreu em crianças do sexo masculino (63,33%), na faixa etária menor que cinco anos de idade (62,22%). O principal fator causal foi a escaldadura (65,00 %), com lesão de segundo grau (58,88%) e com topografia múltipla (63,33%). Conclusão: conclui-se que a maioria dos acidentes por queimaduras aconteceu no ambiente doméstico com a presença da mãe ou responsável no ambiente, sugere que a prevenção deve ser trabalhada, com educação para riscos e modificação do ambiente em que a criança vive.(AU)


Objective: to describe the accident and the profile of children and adolescents victims of burns hospitalized at a Burnout Therapy Center of a General Hospital. Method: this is a quantitative, descriptive, observational, cross-sectional study carried out with records of records of inmates in the age group from one day to 18 years, from 2014 to 2016, and interviews with those responsible for inmates, and the results were presented in the form of tables. Results: most of the accidents occurred in male children (63.33%), in the age group less than five years old (62.22%). The main causal factor was scald (65.00%), with second degree lesion (58.88%) and multiple topography (63.33%). Conclusion: it is concluded that the majority of burn injuries happened in the home environment with the presence of the mother or responsible in the environment, suggests that prevention should be worked out, with education for risks and modification of the environment in which the child lives.(AU)


Objetivo: describir el accidente y el perfil de niños y adolescentes víctimas de quemaduras internados en un Centro de Terapia de Quemados de un Hospital General. Método: se trata de un estudio cuali-cuantitativo, descriptivo, observacional, transversal realizado con datos de los registros de prontuario de internos en el grupo de edad de un día a 18 años, de 2014 a 2016, y entrevista con los responsables de los internos, y se presentaron los resultados en forma de tablas. Resultados: se resalta que la mayoría de los accidentes ocurrió en niños del sexo masculino (63,33%), en el grupo de edad menor a cinco años de edad (62,22%). El principal factor causal fue la escaldadura (65,00%), con lesión de segundo grado (58,88%) y con topografía múltiple (63,33%). Conclusión: se concluye que la mayoría de los accidentes por quemaduras ocurrió en el ambiente doméstico con la presencia de la madre o responsable en el ambiente, sugiere que la prevención debe ser trabajada, con educación para riesgos y modificación del ambiente en que el niño vive.(AU)


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Ferimentos e Lesões , Unidades de Queimados , Queimaduras , Acidentes , Criança , Adolescente , Prevenção de Acidentes , Hospitalização , Acidentes Domésticos , Registros Médicos , Epidemiologia Descritiva , Estudos Transversais
19.
Am J Emerg Med ; 37(4): 627-631, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30914132

RESUMO

INTRODUCTION: Refrigerators and freezers (R/F) are a common household item and injury patterns associated with these appliances are not well characterized. We aimed to characterize the injury patterns, mechanisms, and affected body parts in patients treated in the emergency departments nationally, hypothesizing that injury patterns would differ by age group. METHODS: A retrospective review of the National Electronic Injury Surveillance System for all patients injured using R/F during 2010-2016 was performed. Patient narrative was reviewed for injury mechanism. Comparative and multivariable analyses were performed with effects reported as odds ratios with 95% confidence intervals (CI). RESULTS: During the study period (January 1, 2010-December 31, 2016) there were 6913 R/F related injuries. The study cohort was predominantly male 3734 (55%) and the median [IQR] age was 38 [22-56] years. The annual frequency of R/F related injuries was stable between years. The most common injury mechanism was falling while using R/F (31%) followed up injuries sustained while moving the appliance (25%). Teenaged patients more frequently struck the appliance compared to adults (39% vs 14%, p < 0.001). On regression, pediatric and elderly patients, mechanical fall mechanism, and cranial injury were risk factors independently associated with the need for hospitalization. CONCLUSIONS: Falls in proximity to R/F were the most common injuries sustained and teenagers were more likely to strike/punch the appliance. Injury prevention efforts should support ongoing efforts of fall risk reduction for elderly populations. LEVEL OF EVIDENCE: IV. STUDY TYPE: Retrospective.


Assuntos
Acidentes por Quedas/estatística & dados numéricos , Acidentes Domésticos/estatística & dados numéricos , Refrigeração , Ferimentos e Lesões/epidemiologia , Ferimentos e Lesões/etiologia , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Hospitalização , Humanos , Lactente , Recém-Nascido , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Estudos Retrospectivos , Fatores de Risco , Estados Unidos/epidemiologia , Adulto Jovem
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