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1.
BMC Public Health ; 20(1): 1294, 2020 Aug 26.
Artigo em Inglês | MEDLINE | ID: mdl-32847576

RESUMO

BACKGROUND: Mild to moderate road traffic injury (RTI) in people of working age is associated with limited recovery. Less is known about RTI recovery in older age. This study explored the perspectives and factors associated with recovery and health-related quality of life following mild to moderate RTI in older age in New South Wales, Australia. METHODS: A qualitative study using content analysis was undertaken. Participants aged 65 or more years were purposively selected from a larger inception cohort study of health outcomes following mild to moderate RTI conducted in New South Wales, Australia. Semi-structured interviews were undertaken at approximately 12 or 24 months post-injury. Content analysis was used to code and analyse the data, with methodological rigour obtained by double-coding and discussing findings to reach consensus. Results were reported using the consolidated criteria for reporting qualitative research (COREQ). RESULTS: Nineteen participants were invited to participate in the study of which 12 completed interviews. Data saturation was reached at the twelfth interview. Recovery experiences were diverse. Five main themes were identified: recovery is regaining independence; injury and disability in older age; the burden of non-obvious disability; the importance of support; and positive personal approaches. Key facilitators of recovery were: regaining independence; support from family and friends; and positive personal approaches. Key barriers were: threats to independence; passive coping behaviours; non-obvious disabilities (chronic pain, psychological impacts); and reluctance to raise ongoing issues with General Practitioners. Threats to independence, especially not driving and self-care, appeared to have a more profound effect on recovery than physical functioning. CONCLUSION: Older people view injury as a threat to independent functioning. This is somewhat different to what younger people report. Regaining independence is key to older people's recovery and health-related quality of life following RTI, and should be a key consideration for health professionals, services and supports working with this unique cohort. Greater efforts to help older people regain their independence following RTI are needed and can be facilitated by health professionals and appropriate service provision. TRIAL REGISTRATION: Australia New Zealand clinical trial registry identification number ACTRN12613000889752 .


Assuntos
Acidentes de Trânsito/estatística & dados numéricos , Pessoas com Deficiência/psicologia , Ferimentos e Lesões/epidemiologia , Ferimentos e Lesões/reabilitação , Adaptação Psicológica , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Pessoas com Deficiência/estatística & dados numéricos , Feminino , Humanos , Vida Independente/psicologia , Masculino , New South Wales/epidemiologia , Pesquisa Qualitativa , Qualidade de Vida/psicologia
2.
J Orthop Trauma ; 34(9): e336-e342, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32815848

RESUMO

OBJECTIVES: To evaluate the effect of the COVID-19 pandemic and the "shelter-in-place" order on orthopaedic trauma presenting to a community level II trauma center. It is hypothesized that the overall number of orthopaedic trauma encounters (OTEs), the number of OTEs related to both high and low severity injuries, and the proportion of OTEs related to high severity versus low severity injuries decreased compared with previous years. METHODS: A retrospective analysis was conducted of OTEs between 2016 and 2020. High and low severity OTEs were classified according to an algorithm created by the researchers. Data were statistically analyzed and compared with external data for traffic counts, motor vehicle accidents, and Transportation Security Administration checkpoints. RESULTS: A 45.1% decrease (P = 0.0005) was seen in OTEs from March and April 2016-2019 compared with 2020. The decrease began approximately 12 days before the shelter-in-place order. There was a 58.8% decrease in high severity injuries with a fracture (P = 0.013) and a 42.9% decrease in low severities injuries (P = 0.0003). The proportion of high to low severity OTEs was unchanged. CONCLUSIONS: The quantity of OTEs was significantly affected by the COVID-19 pandemic and Michigan shelter-in-place order. A decrease in both high and low severity OTEs was found; however, there was no statistically significant change in the ratio of high to low severity OTEs compared with previous years. Although it is difficult to determine what portion of the decrease in OTE is attributable to the shelter-in-place order versus the COVID-19 pandemic in general, data suggest both play a role. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of Levels of Evidence.


Assuntos
Betacoronavirus , Controle de Doenças Transmissíveis , Infecções por Coronavirus/prevenção & controle , Fraturas Ósseas/epidemiologia , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Acidentes de Trânsito/estatística & dados numéricos , Algoritmos , Infecções por Coronavirus/epidemiologia , Humanos , Pneumonia Viral/epidemiologia , Estudos Retrospectivos , Isolamento Social , Centros de Traumatologia , Índices de Gravidade do Trauma
3.
J Orthop Trauma ; 34(9): e343-e348, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32815849

RESUMO

OBJECTIVES: To compare orthopaedic trauma volume and mechanism of injury before and during statewide social distancing and stay-at-home directives. DESIGN: Retrospective. SETTING: Level 1 trauma center. PATIENTS/PARTICIPANTS: One thousand one hundred thirteen patients sustaining orthopaedic trauma injuries between March 17 and April 30 of years 2018, 2019, and 2020. INTERVENTION: Statewide social distancing and stay-at-home directives. MAIN OUTCOME MEASUREMENTS: Number of consults, mechanism of injury frequency, and type of injury frequency. RESULTS: During the COVID-19 pandemic, orthopaedic trauma consult number decreased. Injuries due to gunshot wounds increased and those due to automobile versus pedestrian accidents decreased. Time-to-presentation increased and length of stay decreased. Operative consults remained unchanged. CONCLUSIONS: Orthopaedic trauma injuries continued to occur during the COVID-19 pandemic at an overall decreased rate, however, with a different distribution in mechanism and type of injury. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.


Assuntos
Betacoronavirus , Controle de Doenças Transmissíveis , Infecções por Coronavirus/prevenção & controle , Fraturas Ósseas/epidemiologia , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Isolamento Social , Centros de Traumatologia , Acidentes por Quedas/estatística & dados numéricos , Acidentes de Trânsito/estatística & dados numéricos , Adulto , Idoso , Infecções por Coronavirus/epidemiologia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/epidemiologia , Estudos Retrospectivos , Adulto Jovem
4.
PLoS One ; 15(8): e0237408, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32776981

RESUMO

Mountainous freeways with high bridge and tunnel ratios are a new type of road that rarely contain many special road sections formed by various structures. The crash characteristics of the road are still unclear, but it also provides conditions for studying how various road environments affect traffic. In view of the various structures and differences in the driving environments, a scenario-based discretization method for such a road was established. The traffic-influence areas of elementary and composite structures were proposed and defined. Actual data were analyzed to investigate the crash patterns in an entire freeway and in each special section through statistical and comparative research. The results demonstrate the applicability and validity of this method. The crash rates were found to be the highest in interchange and service areas, lower in ordinary sections, and the lowest in tunnels, being mostly attributed to collisions with fixtures. The crash severity on bridges and bridge groups was significantly higher than that on the other types of road sections, being mostly attributed to single-vehicle crashes. The annual average daily traffic and driving adaptability were found to be related to crashes. The findings shed some light on the road design and traffic management implications for strengthening the traffic safety of mountainous freeways.


Assuntos
Acidentes de Trânsito/estatística & dados numéricos , Condução de Veículo , Planejamento Ambiental , Humanos , Fatores de Risco , Segurança
5.
J Orthop Trauma ; 34(9): e336-e342, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: covidwho-601454

RESUMO

OBJECTIVES: To evaluate the effect of the COVID-19 pandemic and the "shelter-in-place" order on orthopaedic trauma presenting to a community level II trauma center. It is hypothesized that the overall number of orthopaedic trauma encounters (OTEs), the number of OTEs related to both high and low severity injuries, and the proportion of OTEs related to high severity versus low severity injuries decreased compared with previous years. METHODS: A retrospective analysis was conducted of OTEs between 2016 and 2020. High and low severity OTEs were classified according to an algorithm created by the researchers. Data were statistically analyzed and compared with external data for traffic counts, motor vehicle accidents, and Transportation Security Administration checkpoints. RESULTS: A 45.1% decrease (P = 0.0005) was seen in OTEs from March and April 2016-2019 compared with 2020. The decrease began approximately 12 days before the shelter-in-place order. There was a 58.8% decrease in high severity injuries with a fracture (P = 0.013) and a 42.9% decrease in low severities injuries (P = 0.0003). The proportion of high to low severity OTEs was unchanged. CONCLUSIONS: The quantity of OTEs was significantly affected by the COVID-19 pandemic and Michigan shelter-in-place order. A decrease in both high and low severity OTEs was found; however, there was no statistically significant change in the ratio of high to low severity OTEs compared with previous years. Although it is difficult to determine what portion of the decrease in OTE is attributable to the shelter-in-place order versus the COVID-19 pandemic in general, data suggest both play a role. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of Levels of Evidence.


Assuntos
Betacoronavirus , Controle de Doenças Transmissíveis , Infecções por Coronavirus/prevenção & controle , Fraturas Ósseas/epidemiologia , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Acidentes de Trânsito/estatística & dados numéricos , Algoritmos , Infecções por Coronavirus/epidemiologia , Humanos , Pneumonia Viral/epidemiologia , Estudos Retrospectivos , Isolamento Social , Centros de Traumatologia , Índices de Gravidade do Trauma
6.
J Orthop Trauma ; 34(9): e343-e348, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: covidwho-682755

RESUMO

OBJECTIVES: To compare orthopaedic trauma volume and mechanism of injury before and during statewide social distancing and stay-at-home directives. DESIGN: Retrospective. SETTING: Level 1 trauma center. PATIENTS/PARTICIPANTS: One thousand one hundred thirteen patients sustaining orthopaedic trauma injuries between March 17 and April 30 of years 2018, 2019, and 2020. INTERVENTION: Statewide social distancing and stay-at-home directives. MAIN OUTCOME MEASUREMENTS: Number of consults, mechanism of injury frequency, and type of injury frequency. RESULTS: During the COVID-19 pandemic, orthopaedic trauma consult number decreased. Injuries due to gunshot wounds increased and those due to automobile versus pedestrian accidents decreased. Time-to-presentation increased and length of stay decreased. Operative consults remained unchanged. CONCLUSIONS: Orthopaedic trauma injuries continued to occur during the COVID-19 pandemic at an overall decreased rate, however, with a different distribution in mechanism and type of injury. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.


Assuntos
Betacoronavirus , Controle de Doenças Transmissíveis , Infecções por Coronavirus/prevenção & controle , Fraturas Ósseas/epidemiologia , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Isolamento Social , Centros de Traumatologia , Acidentes por Quedas/estatística & dados numéricos , Acidentes de Trânsito/estatística & dados numéricos , Adulto , Idoso , Infecções por Coronavirus/epidemiologia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/epidemiologia , Estudos Retrospectivos , Adulto Jovem
7.
Chin J Traumatol ; 23(4): 219-223, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32669222

RESUMO

PURPOSE: Motorcycle accident is a major cause of road traffic injuries and the motorcyclists are considered as vulnerable road users. The present study aimed to determine the epidemiological characteristics of fatal motorcycle crashes in Iran. METHODS: In this cross-sectional study, a total of 28,356 motorcycle traffic fatalities registered in the Legal Medicine Organization of Iran were analyzed during the period between March 2011 and March 2017. The examined variables included demographic characteristics, helmet use, crash mechanisms, crash location, position state, type of counterpart vehicle, cause of death and place of death. In the study, road traffic mortalities involving drivers and/or passenger of motorcycles were included. Cases or events registered without these conditions were excluded from the study. To analyse the data, SPSS statistics 25 and GraphPad Prism 8 softwares were used. RESULTS: Of the 122,682 fatal traffic injury cases, 28,356 (23.1%) were motorcycle users, of whom 95.3% were male and 4.7% were female. Most of the motorcycle fatalities belonged to the age group of 18-24 years (29.1%). Head trauma was the major cause of death (59.0%). Also, the overall proportion of safety helmet use among motorcycle crash victims was estimated at 37.4%. Most of the road traffic crash cases (46.8%) happened out of city and half of people (49.9%) died in hospital. About 77.4% of the victims were motorcycle riders and 21.1% were pillion passengers. The highest rate of mortality belonged to the self-employed (38.4%) and then workers (21.8%) and students (10.2%). In addition, most fatalities occurred in people with low education (77.5%) and the least occurred in university graduates (5.5%). Among 31 provinces of Iran, Fars had the highest (9.3%) occurrence rate and Kohgiluyeh and Buyer-Ahmad had the lowest (0.5%). Most of the crash mechanisms were due to motorcycle-vehicle crashes (80.2%), followed by rollover (9.8%). CONCLUSION: Comprehensive public education and special rules are needed to reduce the rate of deaths in motorcycle crashes.


Assuntos
Lesões Acidentais/epidemiologia , Lesões Acidentais/mortalidade , Acidentes de Trânsito/mortalidade , Acidentes de Trânsito/estatística & dados numéricos , Motocicletas , Lesões Acidentais/prevenção & controle , Acidentes de Trânsito/prevenção & controle , Adolescente , Adulto , Criança , Estudos Transversais , Escolaridade , Feminino , Dispositivos de Proteção da Cabeça/estatística & dados numéricos , Educação em Saúde , Humanos , Irã (Geográfico)/epidemiologia , Masculino , Pessoa de Meia-Idade , Sistema de Registros , Adulto Jovem
8.
Chin J Traumatol ; 23(4): 216-218, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32680705

RESUMO

High-quality data are the foundation to monitor the progress and evaluate the effects of road traffic injury prevention measures. Unfortunately, official road traffic injury statistics delivered by governments worldwide, are often believed somewhat unreliable and invalid. We summarized the reported problems concerning the road traffic injury statistics through systematically searching and reviewing the literature. The problems include absence of regular data, under-reporting, low specificity, distorted cause spectrum of road traffic injury, inconsistency, inaccessibility, and delay of data release. We also explored the mechanisms behind the problematic data and proposed the solutions to the addressed challenges for road traffic statistics.


Assuntos
Lesões Acidentais/epidemiologia , Lesões Acidentais/prevenção & controle , Acidentes de Trânsito/prevenção & controle , Acidentes de Trânsito/estatística & dados numéricos , Saúde Global , Humanos
9.
Rev Bras Epidemiol ; 23 Suppl 1: e200011.SUPL.1, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32638982

RESUMO

OBJECTIVE: To analyze the effect of helmet use on injury severity among motorcyclists and passengers involved in traffic accidents. METHODS: Cross-sectional study of traffic accidents involving motorcyclists attended at the emergency healthcare units participating in the Violence and Accidents Survey Conducted in Sentinel Emergency Departments (Viva Survey) 2017. RESULTS: There was a predominance of individuals aged 18 to 29 years old (46.6%), black (75.2%), with high school education (50.6%). Alcohol use was observed in 14.1% of cases. Helmet use was associated with a 76% reduction in the occurrence of head trauma and a 28% reduction in the referral, hospitalization or death. CONCLUSION: Young, male, black individuals and those with low education were the most frequent victims of accidents. Helmet use was protective for severe injuries.


Assuntos
Acidentes de Trânsito/estatística & dados numéricos , Dispositivos de Proteção da Cabeça/estatística & dados numéricos , Motocicletas , Ferimentos e Lesões/epidemiologia , Adolescente , Adulto , Brasil/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , Fatores Socioeconômicos , Inquéritos e Questionários , Índices de Gravidade do Trauma , Ferimentos e Lesões/prevenção & controle , Adulto Jovem
10.
Rev Bras Epidemiol ; 23: e200085, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32696932

RESUMO

INTRODUCTION: Distracted driving (DD) of a motor vehicle is considered an increasing risk factor for land transport accidents. OBJECTIVE: To identify the tendency in the number of victims in DD accidents and in the number of offences due to cell phone use on Brazilian federal highways, as well as analyze the DD category in depth as it is being used in the country. METHOD: A time series study with data on accidents with victims, made available by the Federal Highway Police, whose cause was distracted driving, from 2007 to 2016 and data on offences for driving using a cell phone. RESULTS: There was a tendency towards a monthly increase in the number of distracted driving accident victims in the country up to mid-2011 (percentage monthly variation - PMV = 0.57%), followed by a significant decrease (PMV = -0.45%). Macro-regions showed similar behavior, except in the Southeast. There was a monthly increase in the number of offences caused by drivers using cell phones from 2007 to 2013. CONCLUSION: There was a tendency towards monthly increases in the number of victims of distracted driving in Brazil and in most macro-regions up to 2011, followed by a subsequent downward tendency. The inaccurate nature of the expression "distraction" compromises the quality of the data and, consequently, the adequate estimation of victims attributable to this risk factor. The cell phone-driving dyad could be the root cause of accidents with victims caused by distracted driving in the country.


Assuntos
Acidentes de Trânsito/estatística & dados numéricos , Direção Distraída/estatística & dados numéricos , Brasil , Humanos
11.
PLoS One ; 15(7): e0235325, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32614872

RESUMO

Distracted driving has been considered one of the main reasons for traffic crashes in recent times, especially among young drivers. The objectives of this study were to identify the distracting activities in which young drivers engage, assess the most distracting ones based on their experiences, and investigate the factors that might increase crash risk. The data were collected through a self-report questionnaire. Most participants reported frequent cell phone use while driving. Other reported activities include adjusting audio devices, chatting with passengers, smoking, eating, and drinking. A structural equation model was constructed to identify the latent variables that have a significant influence on crash risk. The analysis showed that in-vehicle distractions had a high effect on the crash likelihood. The results also indicated that dangerous driving behavior had a direct effect on the crash risk probability, as well as on the rash driving latent variables. The results provide insight into distracted driving behavior among young drivers and can be useful in developing enforcement and educational strategies to reduce this type of behavior.


Assuntos
Acidentes de Trânsito/estatística & dados numéricos , Direção Distraída/estatística & dados numéricos , Adolescente , Adulto , Atenção , Uso do Telefone Celular/estatística & dados numéricos , Comportamento Perigoso , Feminino , Humanos , Análise de Classes Latentes , Masculino , Fatores de Risco , Assunção de Riscos , Autorrelato , Adulto Jovem
12.
BMC Psychol ; 8(1): 70, 2020 Jul 06.
Artigo em Inglês | MEDLINE | ID: mdl-32631418

RESUMO

BACKGROUND: Fatigue can affect the behavior of drivers. While the driver must be able to respond and cope appropriately to the critical situations, which is known as the ability to cope with a crisis. It is likely that the fatigue can change the people's coping style and thereby increase the chance of the crashes. Therefore, the present study aimed to investigate the effects of fatigue on the coping behavior of international truck drivers. METHODS: This study was conducted on 239 of international truck drivers employed in Iran. The Endler and Parker coping strategies questionnaire (CISS) and Persian version of the Fatigue Multidimensional Fatigue Inventory (MFI) were used to evaluate the coping styles of the drivers and the drivers' fatigue, respectively. RESULTS: The mean values of the total fatigue before and after traveling were 36.77 and 76.13, respectively. The mean values of coping styles of the problem-oriented, emotion-oriented, and avoidance before traveling were 53.66, 40.91, and 38.17, respectively, and those after traveling were 45.59, 51.18, and 36.45, respectively. The chi-square test demonstrated that there was a significant difference in the coping style of drivers before and after the trip (P <  0.001), and the percent of individuals with emotion-oriented increased. CONCLUSIONS: In general, the results showed that fatigue due to traveling could change the coping styles of subjects from problem-oriented to emotion-oriented and avoidance. This can increase the statistics of driving accidents.


Assuntos
Adaptação Psicológica , Condução de Veículo/psicologia , Fadiga , Veículos Automotores , Acidentes de Trânsito/estatística & dados numéricos , Adulto , Emoções , Emprego , Feminino , Humanos , Internacionalidade , Irã (Geográfico) , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários
13.
PLoS One ; 15(7): e0235564, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32628689

RESUMO

The fatal accidents on the roads remain a global concern. Daily, approximately 18 traffic accidents occur in the Peninsular Malaysia that cause on an average one death in every hour, a situation that needs preventive measures. The development of the effective strategies to reduce such fatal accidents requires the identification of various risk factors including the road condition. We identified such accident severity issues using the public work and police department databases that consisted of 1067 cases of various severity levels occurred on the Malaysian federal roads during 2008 to 2015. These records were used to develop ordered logistic regression model for the accident severity and nine variables were analyzed. The results revealed that the presence of poor horizontal alignment affected the model outcomes. The likelihood of the more serious accident severity due to the poor horizontal alignment was correspondingly about 0.4 times less compared to the absence of such factors. It is established that the present findings may assist the local authorities to take proactive actions to prevent serious road accidents on the road segments possessing the standard horizontal alignment.


Assuntos
Acidentes de Trânsito/estatística & dados numéricos , Governo Federal , Humanos , Modelos Logísticos , Malásia , Fatores de Risco
14.
West J Emerg Med ; 21(4): 819-822, 2020 May 22.
Artigo em Inglês | MEDLINE | ID: covidwho-682439

RESUMO

INTRODUCTION: The COVID-19 pandemic has led to social distancing and decreased travel in the United States. The impact of these interventions on trauma and emergency general surgery patient volume has not yet been described. METHODS: We compared trauma admissions and emergency general surgery (EGS) cases between February 1-April 14 from 2017-2020 in five two-week time periods. Data were compared across time periods with Poisson regression analysis. RESULTS: There were significant decreases in overall trauma admissions (57.4% decrease, p<0.001); motor vehicle collisions (MVC) (80.5% decrease, p<0.001); and non-MVCs (45.1% decrease, p<0.001) from February-April 2020. We found no significant change in EGS cases (p = 0.70). Nor was there was a significant change in trauma cases in any other year 2017-2019. CONCLUSION: The COVID-19 pandemic's burden of disease correlated with a significant decrease in trauma admissions, with MVCs experiencing a larger decrease than non-MVCs.


Assuntos
Betacoronavirus , Infecções por Coronavirus , Pandemias , Pneumonia Viral , Ferimentos e Lesões/epidemiologia , Acidentes de Trânsito/estatística & dados numéricos , Serviço Hospitalar de Emergência , Hospitalização , Humanos , Fatores de Tempo , Estados Unidos
15.
West J Emerg Med ; 21(4): 819-822, 2020 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-32726250

RESUMO

INTRODUCTION: The COVID-19 pandemic has led to social distancing and decreased travel in the United States. The impact of these interventions on trauma and emergency general surgery patient volume has not yet been described. METHODS: We compared trauma admissions and emergency general surgery (EGS) cases between February 1-April 14 from 2017-2020 in five two-week time periods. Data were compared across time periods with Poisson regression analysis. RESULTS: There were significant decreases in overall trauma admissions (57.4% decrease, p<0.001); motor vehicle collisions (MVC) (80.5% decrease, p<0.001); and non-MVCs (45.1% decrease, p<0.001) from February-April 2020. We found no significant change in EGS cases (p = 0.70). Nor was there was a significant change in trauma cases in any other year 2017-2019. CONCLUSION: The COVID-19 pandemic's burden of disease correlated with a significant decrease in trauma admissions, with MVCs experiencing a larger decrease than non-MVCs.


Assuntos
Betacoronavirus , Infecções por Coronavirus , Pandemias , Pneumonia Viral , Ferimentos e Lesões/epidemiologia , Acidentes de Trânsito/estatística & dados numéricos , Serviço Hospitalar de Emergência , Hospitalização , Humanos , Fatores de Tempo , Estados Unidos
16.
Int. j. odontostomatol. (Print) ; 14(2): 257-267, June 2020. tab
Artigo em Inglês | LILACS | ID: biblio-1090683

RESUMO

The etiology of facial fractures is directly related to the studied country, varying according to the socioeconomic, cultural condition of the population, besides the period of investigation. The objective of the present study is to evaluate the epidemiological characteristics of the prevalence, treatment modalities and complications rates of maxillofacial fractures in a hospital in the state of Espírito Santo, over a period of 5 years. A total of 428 patients presented a facial fracture, with a prevalence of males (436), with a mean age of 40 years. Regarding the number of fractures, 291 individuals suffered fractures only in the fixed skeleton, 97 only in the mandible, and 48 suffered fractures in both fixed and mandibular skeletons. The predominant anatomical site in fixed skeletal fractures was zygomatic complex (56.6 %), orbit (31.9 %) and nose (29.2 %); while in the mandible the condyle (33.8 %), body (17.9 %) and angle (13.1 %). The frequent etiology was falls, physical aggression, sports accidents. Regarding the type of treatment, in fixed skeleton 192 fractures were treated conservatively and 303 by surgery. Already in the mandible, the numbers were 43 and 143, respectively. In addition, 24 patients progressed with some type of complication in one or more operated sites. It is worth mentioning that epidemiological assessments provide important support in the creation of legislation in the attempt to reduce important for the establishment of clinical and research priorities, since risk factors and patterns of presentation can be identified. Accordingly in an attempt to reduce these rates.


La etiología de las fracturas faciales está directamente relacionada con el país estudiado, variando según la condición socioeconómica y cultural de la población, además del período de investigación. El objetivo del presente estudio fue evaluar las características epidemiológicas de la prevalencia, las modalidades de tratamiento y las tasas de complicaciones de las fracturas maxilofaciales en un hospital en el estado de Espírito Santo, durante un período de 5 años. Un total de 428 pacientes presentaron fractura facial, con una prevalencia de varones (436), con una edad media de 40 años. Con respecto al número de fracturas, 291 individuos sufrieron fracturas solo en el esqueleto fijo, 97 solo en la mandíbula y 48 sufrieron fracturas tanto en el esqueleto fijo como en el mandibular. El sitio anatómico predominante en las fracturas esqueléticas fijas fue el complejo cigomático (56,6 %), la órbita (31,9 %) y la nariz (29,2 %); mientras que en la mandíbula el cóndilo (33,8 %), el cuerpo (17,9 %) y el ángulo (13,1 %). La etiología frecuente fue caídas, agresión física, accidentes deportivos. En cuanto al tipo de tratamiento, en el esqueleto fijo se trataron 192 fracturas de forma conservadora y 303 mediante cirugía. Ya en la mandíbula, los números eran 43 y 143, respectivamente. Además, 24 pacientes progresaron con algún tipo de complicación en uno o más sitios operados. Cabe mencionar que las evaluaciones epidemiológicas brindan un apoyo importante en la creación de legislación en estos casos, para establecer prioridades clínicas y de investigación, debido a que se pueden identificar factores de riesgo y patrones de presentación. En consecuencia, en un intento de reducir estas tasas.


Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Adulto Jovem , Traumatismos Faciais/epidemiologia , Acidentes por Quedas , Brasil/epidemiologia , Acidentes de Trânsito/estatística & dados numéricos , Prevalência , Estudos Retrospectivos , Estudos Longitudinais , Agressão , Distribuição por Idade e Sexo , Traumatismos Faciais/complicações , Traumatismos Faciais/etiologia , Traumatismos Faciais/terapia , Traumatismos Mandibulares/epidemiologia
17.
PLoS One ; 15(6): e0233838, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32555645

RESUMO

BACKGROUND: The predictive value of platelet-to-lymphocyte ratio (PLR) in acute illness is well known, but further evaluation is needed in traffic accident patients. METHODS: This retrospective observational study enrolled consecutive adult patients involved in traffic accidents who were admitted to the study hospital's emergency department during 1 year. The initial platelet and lymphocyte counts after arrival at the emergency department were the variables of interest. The primary outcome was in-hospital mortality. Data on baseline characteristics, comorbidities, and physiological and laboratory variables were collected. Multivariate Cox proportional hazard modelings were used to identify the variables independently associated with the outcome. RESULTS: A total of 1,522 traffic accident patient were screened, and 488 patients were enrolled. In all, 43 (8.8%) patients died in the hospital. The median PLR was 115.3 (interquartile range 71.3;181.8). The in-hospital mortality rate of the 1st tertile of PLR (21.5%) was significantly higher than the rates of the 2nd (2.5%) and 3rd (2.5%) tertiles. The area under the receiver operating characteristic curve of PLR for in-hospital survival was 0.82 (95% confidential interval [CI], 0.74-0.89), which was greater than that of lymphocyte count (0.72; 95% CI 0.63-0.81) and platelet count (0.67; 95% CI 0.57-0.76). The Kaplan-Meier curves showed a significant difference in survival between the tertiles (p<0.001). The Cox regression model showed that the 2nd tertile of PLR was independently associated with lower in-hospital mortality (adjusted hazard ratio 0.30; 95% CI, 0.09-0.98), compared to the 1st tertile. CONCLUSION: PLR was significantly associated with an increased risk of in-hospital mortality in admitted adult traffic accident patients.


Assuntos
Lesões Acidentais/sangue , Acidentes de Trânsito/estatística & dados numéricos , Mortalidade Hospitalar , Lesões Acidentais/etiologia , Lesões Acidentais/mortalidade , Idoso , Feminino , Humanos , Contagem de Linfócitos , Masculino , Pessoa de Meia-Idade , Contagem de Plaquetas
18.
Medicine (Baltimore) ; 99(23): e20520, 2020 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-32502002

RESUMO

The objective of this study is to describe the epidemiology and causes of traumatic cardiac arrest (TCA) in Kuwait aiming to provide a preliminary background to update the current guidelines and improve patients' management.This is a retrospective analysis of TCA cases retrieved from emergency medical services archived data between 1 January and 31 December 2017. The TCA cases were sub-grouped based on mechanism of injury then compared in terms of patient demographics, vital signs, patterns of injuries, resuscitation practices, and outcomes.Outcomes; On scene mortality rate and pre-hospital return of spontaneous circulation.Among the 204 TCA patients, 140 patients met the inclusion criteria. This whole group was then divided in to 4 subgroups: road traffic accident (RTA) 76% (n=106), fall from height (FFH) 13% (n = 18), slip/fall 4% (n = 6), and assaults 7% (n = 10). There was significant difference between the four mechanisms in: mean age (P =  < .001), type of injury (P = .005), head injury (P = .005), chest injury (P = .003), GCS score < 9 (P = .004) and initial hypertension (P =  < .001). Initial hypertension and GCS score < 9 were only documented in head injuries of RTA and slip/fall groups. Significant difference was also seen in cardiopulmonary resuscitation (P = .006), airway management (P = .035) and on scene mortality rate (P = .003). All patients who had isolated head injury in FFH were pronounced dead on scene, 60%.Not all TCA incidents are the same, there are different pattern of injuries in each TCA mechanism. Head injuries are predominantly seen in RTA, FFH, slip /falls and chest injuries are seen in assaults. This can influence emergency medical services personals resuscitation plan. Further research is required to address the resuscitation of TCA of different mechanisms.


Assuntos
Parada Cardíaca/etiologia , Traumatismos Torácicos/complicações , Acidentes de Trânsito/mortalidade , Acidentes de Trânsito/estatística & dados numéricos , Adulto , Distribuição de Qui-Quadrado , Feminino , Parada Cardíaca/epidemiologia , Parada Cardíaca/mortalidade , Humanos , Escala de Gravidade do Ferimento , Kuweit/epidemiologia , Masculino , Pessoa de Meia-Idade , Sistema de Registros/estatística & dados numéricos , Estudos Retrospectivos , Traumatismos Torácicos/epidemiologia
19.
PLoS One ; 15(6): e0234564, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32525933

RESUMO

OBJECTIVE: Single vehicle run-off crashes in urban areas constitute a growing problem that deserves more attention from authorities and researchers. This study aims to detect geometric road design risk factors characterizing places where urban run-off crashes might happen. METHODS: A case-control study was performed in the urban area of Valladolid (Spain) with data corresponding to a four-year period. Logistic regression models were used to analyze data, considering different variables related to design parameters in the models: type of intersection, radius of curvature, width of the pavement, width of the traffic lane, number of lanes for traffic in the same direction, direction of the traffic, length of the previous straight section, distance to the previous traffic light, slope, and finally, priority regulation. Two different scenarios were investigated: intersections and curves. RESULTS: The Adjusted Odds-Ratio of a run-off crash was five times higher in double direction roads with median strip than in one-way urban roads, for both curves and intersections, and almost nine times higher on road sections with previous straight lengths greater than 500 meters. Specific risk factors for intersections are "number of lanes for traffic in the same direction" (the odds of a run-off crash are more than five times higher on a road with two or more lanes), "length of preceding straight section" (the odds on road sections with lengths greater than 500 meters are more than nine times that of road sections with a length of less than 150 meters). For curves, specific factors are "width of the traffic lane" (the odds of a run-off crash on curves with lanes wider than 3.75m are more than six times higher) and "priority regulation" (the odds of a run-off crash increases more than twelve times on road sections with traffic light regulation over those without any regulation). CONCLUSIONS: The current study identifies urban road configurations that might require redesigning with the aim of decreasing the odds of a run-off crash, or the implementation of passive protective systems to mitigate their consequences. Specifically, intersections in two direction roads with median strip, more than two lanes per direction and a long preceding straight section, as well as curves with wide lanes and traffic light regulation, are the places that require attention.


Assuntos
Prevenção de Acidentes/métodos , Acidentes de Trânsito/estatística & dados numéricos , Planejamento de Cidades/métodos , Modelos Logísticos , Veículos Automotores/estatística & dados numéricos , Acidentes de Trânsito/prevenção & controle , Estudos de Casos e Controles , Espanha
20.
Accid Anal Prev ; 143: 105579, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32480016

RESUMO

INTRODUCTION/OBJECTIVE: This paper evaluates the causal effects of cellphone distraction on traffic crashes using propensity score weighting approaches and naturalistic driving study (NDS) data. METHODS: We adopt three propensity score weighting approaches to estimate the causal odds ratio (OR) of cellphone use on three different event-populations, including average treatment effect (ATE) on the whole population, average treatment effect on the treated population (ATT), and average treatment effect on the overlapping population (ATO). Three types of cellphone distractions are evaluated: overall cellphone use, talking, and visual-manual tasks. The propensity scores are estimated based on driver, roadway, and environmental characteristics. The Second Strategic Highway Research Program NDS data used in this study include 3400 participant drivers with 1047 severe crashes and 19,798 random case-cohort control driving segments. RESULTS: The study reveals several highly imbalanced potential confounding factors among cellphone use groups, e.g., income, age, and time of day, which could lead to biased risk estimation. All three propensity score approaches improve the balance of the baseline characteristics. The propensity score adjusted ORs differ from unweighted ORs substantially, ranging from -44.25% to 54.88%. Specifically, the adjusted ORs for young drivers are higher than unweighted ORs and these for middle-age drivers are lower. Among different cellphone related distractions, the ORs associated with visual-manual tasks (OR range: 3.47-6.63) are uniformly higher than overall cellphone distraction and cellphone talking (OR range: 0.63-4.15). Cellphone talking increases the risk for young drivers but has no significant impact on middle-age drivers. CONCLUSION: Propensity score approaches effectively mitigate potential confounding effect caused by imbalanced driver environmental characteristics in the observational NDS data. The ATT and ATO estimands are recommended for NDS case-cohort studies. ATT reflects the effect among exposed events, i.e. crashes or controls with cellphone exposure and ATO reflects the effect among events with similar characteristics. The study confirms the significant causal effect of overall cellphone distraction on crash risk and the heterogeneity in safety impact by age group.


Assuntos
Acidentes de Trânsito/estatística & dados numéricos , Uso do Telefone Celular/estatística & dados numéricos , Direção Distraída/estatística & dados numéricos , Adolescente , Adulto , Estudos de Casos e Controles , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Pontuação de Propensão , Adulto Jovem
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