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1.
Ann R Coll Surg Engl ; 103(3): 160-166, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33645278

RESUMO

INTRODUCTION: The COVID-19 pandemic resulted in reconfiguration of the NHS. Elective services were stopped and trauma services focused on decreasing patient-clinician interactions and managing injuries nonoperatively wherever possible. The everyday life of the general public changed dramatically with the introduction of a national lockdown to prevent the spread of COVID-19. This paper looks at the experience of a South West London trauma unit. MATERIALS AND METHODS: All patients reviewed in fracture clinic and by the orthopaedic on-call team between 23 March to 23 April 2020 were included. Data on the mechanism of injury and whether this was a usual activity, the injury sustained and its management were collected. RESULTS: A total of 167 trauma injuries were seen, compared with 735 new patients with injuries in the previous month. The number of trauma operations completed decreased by 38%; 55% of injuries occurred inside the home and 44% outside the home during daily exercise. Some 31% of injuries were secondary to a new activity taken up during lockdown. Three open fractures and two polytrauma cases were seen that would have normally been managed at the local major trauma centre. CONCLUSION: Overall, both the number of injuries seen and trauma operations completed during the enforced lockdown decreased. This is probably due to a change in the way the general public are living their lives, and the reconfigurations within the NHS in response to the COVID-19 pandemic. This is an interesting time within trauma and orthopaedic departments, as they continue to adapt to the changing injuries and working environment.


Assuntos
Acidentes Domésticos/estatística & dados numéricos , Exercício Físico , Fraturas Ósseas/epidemiologia , Centros de Traumatologia , Acidentes por Quedas/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Ciclismo/lesões , Criança , Pré-Escolar , Controle de Doenças Transmissíveis , Feminino , Fraturas do Colo Femoral/epidemiologia , Fraturas do Colo Femoral/etiologia , Fraturas do Colo Femoral/cirurgia , Fixação Interna de Fraturas , Fraturas Ósseas/etiologia , Fraturas Ósseas/cirurgia , Jardinagem , Humanos , Lactente , Londres/epidemiologia , Masculino , Pessoa de Meia-Idade , Fraturas do Rádio/epidemiologia , Fraturas do Rádio/etiologia , Fraturas do Rádio/cirurgia , Adulto Jovem
3.
Gac. sanit. (Barc., Ed. impr.) ; 34(6): 572-581, nov.-dic. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-200249

RESUMO

OBJETIVO: Caracterizar la epidemiología de las asfixias accidentales en México en el periodo 1999-2017. MÉTODO: Análisis secundario de bases de mortalidad, tres encuestas nacionales de salud e información del programa de inspecciones de seguridad de la Secretaría de Salud, para caracterizar las lesiones fatales y no fatales asociadas a ahogamientos (CIE-10: W65-W74) y otras asfixias (CIE-10: W75-W84), y determinar el grado de exposición a distintos riesgos en el interior de viviendas y guarderías. RESULTADOS: Se registraron 100.834 defunciones, el 44,66% por ahogamientos, y el 77,18% eran de varones. Los ahogamientos afectan a población infantil y adolescente, ocurren con más frecuencia en abril, julio y agosto, los domingos, y en horario vespertino; las otras asfixias afectan a población infantil y adulta mayor, ocurren con más frecuencia de diciembre a febrero, en domingo, de las 4 a las 6 h. Según la ENSANut-2012, 53.065 personas sufren una asfixia no fatal al año, el 26,21% con consecuencias permanentes en su salud. Se observaron riesgos importantes de asfixia en el 38% de las guarderías y el 80% de los hogares analizados. CONCLUSIONES: Las asfixias accidentales son un problema prioritario de salud pública que debe ser atendido urgentemente para cumplir con el objetivo de desarrollo sostenible 3.2. La evidencia presentada en este trabajo es un insumo que permite informar y orientar los esfuerzos al respecto


OBJECTIVE: To characterize the epidemiology of unintentional asphyxias in Mexico from 1999 to 2017. METHOD: Secondary analysis of vital registries, three national health surveys and information from the safety inspection program of the Ministry of Health in Mexico were used to characterize fatal and non-fatal drownings (ICD-10: W65-W74) and other asphyxias including suffocation, chocking and strangulation (ICD-10: W75-W84), and to estimate the level of exposure to different risk factors within households and daycares. RESULTS: 100,834 deaths were registered, 44.66% were drowning and 77.17% male. Drownings mainly affect children and adolescents, occur in April, July and August, on Sundays, during the afternoon. Other asphyxias affect children and the elderly more frequently, occur mainly from December to February, on Sundays and from 4 to 6 h. According to ENSANut-2012, 53,065 individuals experience a non-fatal asphyxia per year, 26.21% of them with permanent consequences in their health and wellbeing. Important risks of unintentional asphyxias are present in 38% of daycares and 80% of households analyzed. CONCLUSIONS: Unintentional asphyxias are a major public health problem that needs to be urgently attended to achieve the Sustainable Development Goals, in particular the 3.2. Evidence presented in this work constitutes an input to inform and orient efforts directed to tackle this problem


Assuntos
Humanos , Afogamento/epidemiologia , Afogamento Iminente/epidemiologia , Ressuscitação/estatística & dados numéricos , Acidentes/estatística & dados numéricos , Asfixia/epidemiologia , Acidentes Domésticos/estatística & dados numéricos , México/epidemiologia , Fatores de Risco , Inquéritos Epidemiológicos/estatística & dados numéricos , Mortalidade
4.
Bol. méd. postgrado ; 36(2): 53-58, dic.2020. tab
Artigo em Espanhol | LILACS, LIVECS | ID: biblio-1117901

RESUMO

Se realizó una investigación de tipo no experimental, transversal y descriptiva para establecer las características epidemiológicas de los accidentes en el hogar de 112 pacientes entre 2 a 13 años de edad que ingresaron a la Atención Médica Inmediata (AMI) del Servicio Desconcentrado Hospital Pediátrico Dr. Agustín Zubillaga entre diciembre 2018 y enero 2019. La mayoría de los pacientes son preescolares (46%), del sexo masculino (71%) y de procedencia urbana (59,8%). En cuanto a las madres, predominaron aquellas mayores de 30 años (39,2%), con grado de instrucción secundaria (44,6%) y amas de casa (69,6%). La mayoría de los padres son mayores de 30 años (54,5%), tienen educación primaria (37,5%) y trabajan fuera del hogar (90,1%). Con respecto a los cuidadores, predominaron los mayores de 30 años (67%) y en su mayoría son familiares del niño (93%). El día de mayor frecuencia de los accidentes en el hogar fueron los viernes (18,8%), en el horario de 1 a 6:59 pm (46%) y el lugar más frecuente fue en el patio (36,6%). El tipo de accidente predominante fueron las caídas (34,9%), seguida de las quemaduras (25%) e intoxicaciones (21,4%). Este estudio permitió conocer las características epidemiológicas de los accidentes en el hogar y aporta datos para la toma de decisiones y la elaboración de protocolos de prevención(AU)


A non-experimental, transversal, descriptive study was conducted to establish the epidemiological characteristics of accidents in the home of 112 patients between 2 and 13 years of age who attended the Atención Médica Inmediata (AMI) of the Servicio Desconcentrado Hospital Pediátrico Dr. Agustín Zubillaga between December 2018 and January 2019. Most patients are preschoolers (46%), male sex (71%) and from urban areas (59.8%). In most cases, mothers were older than 30 years (39.2%), with secondary education (44.6%) and homemakers (69.6%). The majority of fathers were older than 30 years (54.5%), with primary education (37.5%) and worked outside the home (90.1%). Most caregivers were older than 30 years (67%) and relatives of the child (93%). Accidents occurred predominantly on Friday (18.8%), from 1 to 6:59 pm (46%) and in the yard (36.6%). Most frequent type of accident were falls (34.9%), followed by burns (25%) and poisoning (21.4%). This study allowed us to know the epidemiological characteristics of accidents in the home and provides data for decision-making and the development of prevention protocols(AU)


Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Adolescente , Acidentes por Quedas , Acidentes Domésticos/estatística & dados numéricos , Características de Estudos Epidemiológicos , Lesões Acidentais , Pediatria , Cuidado da Criança , Hospitais Pediátricos
5.
Am J Emerg Med ; 38(9): 1782-1786, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32739848

RESUMO

BACKGROUND: Although dog ownership may provide health benefits, interactions with dogs and their leashes can result in injuries. The intent of this study was to describe dog leash-related injuries treated at United States (US) emergency departments (EDs). METHODS: Cases were dog leash-related injuries during 2001-2018 reported to the National Electronic Injury Surveillance System (NEISS), from which national estimates of dog leash-related injuries treated at US EDs were calculated. The distribution of the cases and estimated number of dog leash-related injuries was determined for selected variables, such as the circumstances of the injury, patient demographics, and diagnosis. RESULTS: A dog leash was involved in 8189 injuries, resulting in a national estimate of 356,746 injuries and an estimated rate of 63.4 injuries per 1,000,000 population. Of these injuries, 193,483 resulted from a pull, 136,767 from a trip/tangle, and 26,496 from other or unknown circumstances. The total injury rate per 1,000,000 population increased from 25.4 in 2001 to 105.5 in 2018. Adults accounted for 314,712 (88.2%) of the patients; 260,328 (73.0%) of the patients were female. The injury occurred at home in 133,549 (37.4%) cases. The most common injuries were 95,677 (26.8%) fracture, 92,644 (26.0%) strain or sprain, and 62,980 (17.7%) contusions or abrasions. CONCLUSION: The most common type of dog leash-related injuries resulted from a pull followed by a trip/tangle. The number of dog leash-related injuries increased during the time period. The majority of the persons sustaining such injuries were adults and female. Over one-third of the injuries occurred at home.


Assuntos
Utensílios Domésticos , Ferimentos e Lesões/terapia , Acidentes por Quedas/estatística & dados numéricos , Acidentes Domésticos/estatística & dados numéricos , Animais , Cães , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Estudos Retrospectivos , Entorses e Distensões/epidemiologia , Entorses e Distensões/terapia , Estados Unidos/epidemiologia , Ferimentos e Lesões/epidemiologia
6.
Clin Interv Aging ; 15: 971-989, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32612356

RESUMO

Purpose: Approximately, 14% of older adults aged 65 years and over experience a fall within 1 month post-hospital discharge. Adequate self-management may minimize the impact of these falls; however, research is lacking on why some older adults engage in self-management to prevent falls while others do not. Methods: We conducted a scoping review to identify barriers and facilitators to older adults participating in fall-prevention strategies after transitioning home from acute hospitalization. Eligibility criteria were peer-reviewed journal articles published during 2009-2019 which were written in English and contained any of the following keywords or their synonyms: "fall-prevention," "older adults," "post-discharge" and "transition care." We systematically and selectively summarized the findings of these articles using the Joanna Briggs Institute guidelines and the PRISMA-ScR reporting guidelines. Seven bibliographic databases were searched: PubMed/MEDLINE, ERIC, CINAHL, Cochrane Library, Scopus, PsycINFO, and Web of Science. We used the Capability-Opportunity-Motivation-Behavior (COM-B) model of health behavior change as a framework to guide the content, thematic analysis, and descriptive results. Results: Seventeen articles were finally selected. The most frequently mentioned barriers and facilitators for each COM-B dimension differed. Motivation factors include such as older adults lacking inner drive and self-denial of being at risk for falls (barriers) and following-up with older adults and correcting inaccurate perceptions of falls and fall-prevention strategies (facilitators). Conclusion: This scoping review revealed gaps and future research areas in fall prevention relative to behavioral changes. These findings may enable tailoring feasible fall-prevention interventions for older adults after transitioning home from acute hospitalization.


Assuntos
Prevenção de Acidentes/métodos , Acidentes por Quedas/prevenção & controle , Acidentes Domésticos/prevenção & controle , Idoso Fragilizado/estatística & dados numéricos , Alta do Paciente/estatística & dados numéricos , Idoso , Humanos , Fatores de Risco , Estações do Ano
7.
Am J Public Health ; 110(8): 1242-1247, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32552030

RESUMO

Objectives. To evaluate the effect of the voluntary safety standard for liquid laundry packets on the rate of injury involving children younger than 5 years in the United States.Methods. Semiannual national estimates of child injuries involving liquid laundry packets treated in US hospital emergency departments were developed for the July 2012 through December 2018 study period. We used a negative binomial regression model to estimate the effect of the voluntary standard on the injury rate following the standard's publication at the end of 2015. The analysis controlled for the rapid growth of laundry packet use during the study period. Results are presented as relative risks and percentage changes in the injury rate.Results. The voluntary standard was associated with a 49.4% to 61.6% reduction in the rate of child injury.Conclusions. The results suggest that the requirements of the voluntary standard have effectively reduced the rate of child injury involving liquid laundry packets and may have prevented 9200 to 23 000 emergency department-treated injuries during the study period.


Assuntos
Detergentes/toxicidade , Serviço Hospitalar de Emergência/estatística & dados numéricos , Centros de Controle de Intoxicações , Segurança/normas , Acidentes Domésticos/prevenção & controle , Pré-Escolar , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Lactente , Masculino , Centros de Controle de Intoxicações/estatística & dados numéricos , Centros de Controle de Intoxicações/tendências , Estados Unidos
10.
Cutis ; 105(1): 32-34, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32074144

RESUMO

Thermal burn injuries are common and are associated with physical and psychologic repercussions. For epileptic patients, the risk for environmental injuries is remarkably higher. We present 2 cases of thermal burn injuries following nocturnal seizures. Many epileptic patients are educated on ways to prevent injury; however, these safety precautions tend to focus primarily on daytime activities. We highlight the potential presentation and impacts of the thermal lesions. In addition, we offer suggestions for improvements in patient education and injury prevention.


Assuntos
Acidentes Domésticos , Queimaduras/etiologia , Epilepsia/complicações , Adulto , Feminino , Calefação , Humanos , Fatores de Risco , Convulsões/complicações , Fatores de Tempo
11.
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
12.
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
13.
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
14.
Rev. Rol enferm ; 43(1,supl): 381-386, ene. 2020. tab
Artigo em Português | IBECS | ID: ibc-193332

RESUMO

Introduction: In good organizational practice, health professionals should be provided with training programs for fall prevention. Aims: To evaluate the impact of an educational program for nurses on the prevention of falls in the elderly population in a community context. Method: This study supports the intervention phase of an Action-Research investigation. Was implemented a training program, with two steps: sensitization (S) and formation (F) held in a group of North Health Centers of Portugal. In the S step, 154 professionals from different areas participated. In the F step, 67 nurses participated. The S step occurred between February and March of 2017. The satisfaction of the training was assesseded. The F step enrolled five sessions, performed between May and June 2017. The target group of this stage were only nurses. In addition to the assessment of training satisfaction, a questionnaire was useded (pre-test). We used descriptive analysis and comparison of means using the IBM SPSS 25.0 software. The Ethics Committee for North Health centers (nº 97/2014) approved the study. Results: In the S step, were represented all the professional areas, but the physi-cians (43.8%) were more representative. In F step, the sample of nurses is mostly female (80.6%), with an age between 32-60 years. The professional activity years of nurses vary between 8 and 36 years. In the overall assessment of training satisfaction, it was verified that the training dimension (mean 3.71 and mean 3.67), respectively in sessions 3 and 5, was the most valued. Conclusion: The program revealed improvement in nurses' knowledge


No disponible


Assuntos
Humanos , Idoso , Acidentes por Quedas/prevenção & controle , Acidentes Domésticos/prevenção & controle , Prevenção de Acidentes/métodos , Enfermagem Geriátrica/métodos , Cuidados de Enfermagem/métodos , Conhecimentos, Atitudes e Prática em Saúde , Avaliação de Resultado de Ações Preventivas/métodos , Papel do Profissional de Enfermagem , Epidemiologia Descritiva , Educação em Saúde/métodos , Idoso Fragilizado/estatística & dados numéricos
15.
Rev. Rol enferm ; 43(1,supl): 387-394, ene. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-193333

RESUMO

Introduction: Several studies have shown independent risk factors for falling among community older people. However, there is few researches showing the importance of older person's perception of their own fall risk. Aims: The study purpose was to identify independent risk factors for falls and to explore predictive factors related to the occurrence of falls in community-dwelling older people. Method: A cross-sectional study was conducted from January to April 2015. All data were based on self-report of older persons. An study-specific questionnaire was used. Univariate and logistic regression analyses were used. Results: The sample comprised 562 men and 760 women. Among the participants, 24.5% reported having had falls in the previous six months, scoring a total of 467 falling events. Of the individuals who had fallen, 36.8% had experienced recurrent falls. The risk of fall was nearly twice as high in women than in men (OR=1.85; 95% CI: 1.40-2.43). Being 75 years old or older was associated with an increased risk of falling compared with being 65-74 years old (OR=2.38; 95% CI:1.82-3.11). The elderly who had fallen reported injuries (48.3%) associated with falls, and 36% required heal-th care. Conclusion: Six independent risk factors for falling into the community dwelling older people were identified, some of which are potentially modifiable


No disponible


Assuntos
Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Acidentes por Quedas/estatística & dados numéricos , Acidentes Domésticos/estatística & dados numéricos , Prevenção de Acidentes/métodos , Enfermagem Geriátrica/métodos , Cuidados de Enfermagem/métodos , Risco Ajustado/métodos , Idoso Fragilizado/estatística & dados numéricos , Fatores de Risco , Inquéritos e Questionários/estatística & dados numéricos , Autorrelato/estatística & dados numéricos , Envelhecimento , Estudos Transversais , Múltiplas Afecções Crônicas/epidemiologia
16.
Pediatr Int ; 62(2): 146-150, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31838766

RESUMO

BACKGROUND: Although attention has recently been afforded to home injury prevention for young children, we often encounter young children who have experienced indoor injuries at places other than the home. We aimed to identify characteristics of unintentional indoor injuries that occurred when young children were not at home. METHODS: We retrospectively reviewed the medical records of young children (aged <6 years) with indoor injuries from January to June 2017. We classified patients injured in hotel rooms as the "Hotel group" and compared them to patients injured at home ("Home group"). RESULTS: Among 102 patients who met the study criteria, 33 patients (32.4%) were classified as the Hotel group. Falls were the most frequent cause of injury in both groups (Home, 56.5% versus Hotel, 87.9%). Falls from beds were more likely to happen in hotel rooms (1.4% versus 48.5%). In regard to fall-associated injuries, head and / or facial injury was most frequent in both groups (Home, 92.3% versus Hotel, 89.7%). A suture and follow-up were less likely in the Home group than in the Hotel group (18.8% versus 42.4%, 39.1% versus 69.7%, respectively). CONCLUSIONS: In hotel rooms, head and / or facial injuries due to falling from a bed were the most common types of injury, and they often needed more invasive procedures than home injuries. Injuries that tended to occur in hotel rooms are more predictable than home injuries. Modification of the surrounding environment has the potential to prevent unintentional injuries not only in the home environment but also in hotel rooms.


Assuntos
Acidentes por Quedas/estatística & dados numéricos , Lesões Acidentais/epidemiologia , Acidentes Domésticos/estatística & dados numéricos , Habitação/estatística & dados numéricos , Fatores Etários , Leitos , Pré-Escolar , Feminino , Humanos , Lactente , Japão/epidemiologia , Masculino , Estudos Retrospectivos
17.
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
18.
Injury ; 51(2): 260-266, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31858987

RESUMO

OBJECTIVE: The purpose of this study was to examine risk factor and temporal associations between acute care hospitalization and post-discharge home injury falls in a population-based analysis sample of community dwelling older adults. METHODS: We applied a unidirectional case-crossover design to a retrospective analysis sample derived from healthcare administrative data from all non-federal licensed hospitals in the State of California. The analysis sample was comprised of California residents age 65 years or older with a record of treatment for injury fall occurring at home from January 1, 2014 to December 31, 2014. A conditional Poisson regression with fixed person effects and a robust estimator of variance was used to calculate the incidence rate ratio of acute care admissions during the 90 day period immediately preceding an injury fall, with the period of 360-271 days prior to index fall as reference. RESULTS: The rate of acute care admissions was 121% greater (IRR: 2.21; 95% CI 2.15-2.27) during the 90 days immediately preceding the index injury fall than 181-360 days prior. Period effects on rates of admissions were significantly higher in the acute care treatment subsample (IRR 2.63; 95% CI 2.51-2.76) than the emergency department treatment subsample (IRR 2.00; 95% CI 1.94-2.07). Discharge to post-acute care facilities; discharge to home health and Elixhauser comorbidity index all significantly modified period effects on acute care admissions. CONCLUSIONS: Older adults have an increased risk of falling at home after being discharged from an acute care hospitalization, with highest risk occurring during the 90-day post-discharge period. Special consideration should be given to assessing hospital-associated changes in fall risk among geriatric patients prior to discharge directly home. Discharge planning should include efforts to reduce home fall risk during the period of transition from hospital care.


Assuntos
Acidentes por Quedas/estatística & dados numéricos , Acidentes Domésticos/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Acidentes Domésticos/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , California/epidemiologia , Estudos Cross-Over , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Incidência , Vida Independente , Masculino , Alta do Paciente/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo
19.
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
20.
J Pharm Pract ; 33(1): 90-95, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29673294

RESUMO

Ingestion of hydrocarbons is a common cause of childhood poisoning in low and middle-income countries. Although mild ingestions are usually devoid of complications, the morbidity and mortality associated with such poisoning are primarily related to pulmonary aspiration. Subsequent complications, most importantly, secondary bacterial infections can worsen the clinical condition. Standard treatment protocol for acute accidental hydrocarbon poisoning does not advocate routine use of steroids or antibiotics. However, some studies have demonstrated beneficial effects of prophylactic steroid and antibiotic to prevent chemical pneumonitis. In this article, we have summarized the findings of the clinical studies from literature, which have evaluated the advantages of early administration of steroids and antibiotics to prevent chemical pneumonitis in acute hydrocarbon poisoning in children. From these studies, we have found that there is no convincing evidence for initiating steroid and antibiotic to improve outcome in these children.


Assuntos
Antibacterianos/administração & dosagem , Hidrocarbonetos/envenenamento , Pneumonia/induzido quimicamente , Pneumonia/prevenção & controle , Esteroides/administração & dosagem , Acidentes Domésticos , Antibacterianos/uso terapêutico , Criança , Pré-Escolar , Humanos , Pneumonia/tratamento farmacológico , Envenenamento , Esteroides/uso terapêutico
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