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1.
MMWR Morb Mortal Wkly Rep ; 69(9): 225-230, 2020 Mar 06.
Artigo em Inglês | MEDLINE | ID: mdl-32134910

RESUMO

One in 10 U.S. residents aged ≥18 years reports falling each year (1). Among all age groups, falls can cause serious injury and are the second leading cause of traumatic brain injury (TBI)-related deaths (2). TBI is a head injury caused by a bump, blow, or jolt to the head or body or a penetrating head injury that results in disruption of normal brain function.* CDC estimated national and state-specific rates and trends for TBI-related deaths (TBI deaths) caused by unintentional falls (fall-related TBI deaths) among U.S. residents during 2008-2017, by selected decedent characteristics. The national age-adjusted rate of fall-related TBI deaths increased by 17% from 2008 to 2017. Rate trends at the national level increased significantly for nearly all decedent characteristics, with the most notable increases observed among persons living in noncore (i.e., most rural), nonmetropolitan counties and those aged ≥75 years. Analysis of state-specific rate trends determined that rates of fall-related TBI deaths increased significantly in 29 states over the 10-year study period. A fall can happen to anyone of any age, but falls are preventable. Health care providers and the public need to be aware of evidence-based strategies to prevent falls, given that rates of fall-related TBI deaths are increasing. Health care providers can educate patients on fall and TBI prevention, assess their risk for falls, and when needed, encourage participation in appropriate evidence-based fall prevention programs.†.


Assuntos
Acidentes por Quedas/mortalidade , Lesões Encefálicas Traumáticas/mortalidade , Acidentes por Quedas/estatística & dados numéricos , Adolescente , Adulto , Idoso , Lesões Encefálicas Traumáticas/etiologia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Estados Unidos/epidemiologia , Adulto Jovem
2.
J Forensic Sci ; 65(1): 193-195, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31433492

RESUMO

The interpretation of cranial base injuries has never been investigated from a purely anthropological perspective. Very little exists in forensic literature in order to interpret the significance of cranial base fractures. We analyzed 296 cases of deaths due to skull-brain injuries. The frequency of vault fractures was 75.7% and that of base fractures was 91.9%. We observed the distribution of cases of death according to manner of death and manner of injury and number of fossae involved. These observations were analytically compared to different variables (age, sex, manner of injury, and mode of injury). The study presented the proportion of base fractures associated with vault fractures, and the frequency of absence of base fracture in subjects with no vault fractures. Interesting associations of base fractures to age and manner of death are shown.


Assuntos
Lesões Encefálicas/mortalidade , Base do Crânio/lesões , Fraturas Cranianas/epidemiologia , Acidentes por Quedas/mortalidade , Acidentes de Trânsito/mortalidade , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Abuso Físico/estatística & dados numéricos , Distribuição por Sexo , Base do Crânio/patologia , Fraturas Cranianas/patologia , Ferimentos por Arma de Fogo/mortalidade , Adulto Jovem
3.
Lakartidningen ; 1162019 Sep 10.
Artigo em Sueco | MEDLINE | ID: mdl-31503322

RESUMO

According to the Swedish National Board of Health and Welfare, about 3200 people a year die due to accidents. Around 900 of these are classified as "Accidental exposure to other and unspecified factors". A more precise classification with the board has not been recorded in these cases due to incomplete death certificates. This study examined the death certificates for this group in 2016 and compared it to patient records. This study showed that most cases of incomplete classification are in instances of elderly persons who sustained a fall and subsequently died due to complications of the resulting injury. The doctor has in most cases not perceived the death as accidental.This study showed that there is a lack of knowledge among doctors in how to accurately complete a death certificate.


Assuntos
Acidentes por Quedas/mortalidade , Causas de Morte , Coleta de Dados/normas , Atestado de Óbito , Documentação/normas , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Competência Clínica/normas , Feminino , Humanos , Masculino , Registros Médicos/normas , Pessoa de Meia-Idade , Médicos/normas , Distribuição por Sexo , Suécia/epidemiologia , Fatores de Tempo
4.
NCHS Data Brief ; (343): 1-8, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31442193

RESUMO

Unintentional injury is a leading cause of death in the United States (1). Higher death rates for unintentional injury have been reported in rural areas compared with urban areas (2-4). This report describes trends in the death rates for unintentional injuries and three leading causes of deaths due to unintentional injuries (motor vehicle traffic, drug overdose, and falls) from 1999 through 2017. Given an observed increase in overall unintentional injury rates starting in 2014 (5), differences in death rates are described by urbanization level (rural, small metropolitan [metro], large fringe metro, and large central metro) for the leading causes of unintentional injury deaths for 2014 and 2017.


Assuntos
População Rural/estatística & dados numéricos , População Urbana/estatística & dados numéricos , Ferimentos e Lesões/mortalidade , Acidentes por Quedas/mortalidade , Acidentes de Trânsito/mortalidade , Causas de Morte , Overdose de Drogas/mortalidade , Humanos , Características de Residência/estatística & dados numéricos , Estados Unidos/epidemiologia , Ferimentos e Lesões/epidemiologia
5.
Am Surg ; 85(7): 721-724, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31405415

RESUMO

Despite the incorporation of anticoagulant and antiplatelet (ACAP) drugs in our trauma triage criteria, it is unclear whether trauma team activation (TTA) impacts outcomes in geriatric patients on ACAP drugs sustaining falls. We hypothesized that TTA in this cohort was associated with improved outcomes. The hospital electronic database was queried to identify normotensive, awake patients aged ≥65 years on ACAP agent from 2014 to 2018 presenting to the emergency department after falls. The outcome was in-hospital mortality. The association between TTA and mortality was examined using logistic regression analysis and 1:1 propensity score matching analysis. In this study, 4540 patients on ACAP drugs were analyzed, with TTA occurring in 500 (11%). TTA occurred in younger but more severely injured patients with lower Glasgow Coma Score. Logistic regression revealed that TTA was not associated with mortality (odds ratio [95% confidence intervals], 2.04 [0.89-4.25]). The 1:1 propensity score analysis revealed similar mortality for the matched groups (non-TTA, 1.6% vs TTA, 2.2%, P = 0.64). In the elderly patients on ACAP agents, the current triage criteria resulted in the appropriate use of TTA for more severely injured patients. The lack of outcome benefit suggests that ACAP drug use as a criterion for TTA should be re-evaluated.


Assuntos
Acidentes por Quedas/mortalidade , Anticoagulantes/uso terapêutico , Fibrinolíticos/uso terapêutico , Mortalidade Hospitalar , Centros de Traumatologia/estatística & dados numéricos , Triagem/normas , Idoso , Idoso de 80 Anos ou mais , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Modelos Logísticos , Masculino , Melhoria de Qualidade , Estudos Retrospectivos , Triagem/métodos
6.
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
7.
J Forensic Leg Med ; 65: 137-142, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31154091

RESUMO

INTRODUCTION: Bereavement is usually difficult to come to terms with. However, sudden, violent or traumatic death can be particularly hard to accept for any family, group or nation as a whole. A retrospective study of all autopsies on unnatural and traumatic deaths of medico-legal importance was made at the Komfo Anokye Teaching Hospital from 2008 to 2016. METHODS: Information on cause of death and other relevant detail as well as demographics were extracted from the Autopsy Log Book of the department of pathology, Komfo Anokye Teaching Hospital where data on cause of death from autopsy findings and other relevant data were gathered and kept secured. The data was then analyzed using SPSS version 22. RESULTS: Findings from the study showed that Road Traffic Accidents (RTA) contributed to 58.51% of the total forensic death cases of a total of the 1470 registered unnatural deaths. Males accounted for 75.37% of deaths as compared to 24.63% for females. The mean age for the various cause of unnatural deaths was 34 years. The age ranges from a minimum of 0.02 year (1 week) to a maximum of 97 years with median age of 33. The modal age is 30 years with 75 cases. 1108 males and 362 females were involved, resulting in a gender ratio of 3:1. The age group 30-39 recorded the highest percentage of deaths due to Hanging, Gunshots, RTA and Falls with 22.45%, 34.69%, 21.75% and 25.44% respectively. Children aged ≤9 recorded the highest number of deaths due to chemical poisoning and drowning with 25.5 8% and 40.00% of cases respectively. People in the extremes of ages (≤9 and ≥ 70) recorded the least number of death cases by percentage. CONCLUSION: Road traffic accident is therefore the leading cause of unnatural traumatic deaths as it accounted for more than half of all unnatural traumatic death cases reported in the forensics department. Men, especially the youth are also more prone to violent unnatural deaths compared to women in general. It is shown that, men die more in the various categories than women. Males are likely to die on the average, 3 times more than the females by any of the manner of deaths.


Assuntos
Causas de Morte , Acidentes por Quedas/mortalidade , Acidentes de Trânsito/mortalidade , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Asfixia/mortalidade , Criança , Pré-Escolar , Afogamento/mortalidade , Feminino , Medicina Legal , Gana/epidemiologia , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Lesões do Pescoço/mortalidade , Abuso Físico/estatística & dados numéricos , Envenenamento/mortalidade , Estudos Retrospectivos , Distribuição por Sexo , Suicídio/estatística & dados numéricos , Ferimentos por Arma de Fogo/mortalidade , Adulto Jovem
9.
PLoS One ; 14(5): e0216613, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31075117

RESUMO

BACKGROUND: Two decomposition methods have been widely used to attribute death differences between two populations to population size, age structure of the population, and age-specific mortality rate (ASMR), but their properties remain uninvestigated. METHODS: We assess how the two established decomposition methods yield varying results with three-factor factorial experimental designs, illustrating that they are sensitive to the choice of the reference group. We then propose a novel decomposition method to obtain robust decomposition results and use three cases to demonstrate its advantage. RESULTS: The three decomposition methods differ fundamentally in their allocation of interactions to the contributions of the three factors. In comparison with the existing methods, the new method is robust to the choice of the reference group. Three case studies showed inconsistent attribution results for the two existing methods but robust results for the new method when the choice of the reference population changes. CONCLUSIONS: The proposed method offers robust and more justifiable attribution results compared to the two existing methods. This method could be generalized to attribution of group differences of other health indicators.


Assuntos
Acidentes por Quedas/mortalidade , Mortalidade/tendências , Adolescente , Adulto , Distribuição por Idade , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Criança , Pré-Escolar , China/epidemiologia , Humanos , Pessoa de Meia-Idade , Densidade Demográfica , Projetos de Pesquisa , Estados Unidos/epidemiologia , Adulto Jovem
11.
J Glob Health ; 9(1): 010603, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30992985

RESUMO

Background: To examine trends in unintentional falls mortality from 2006 to 2016 in China by location (urban/rural), sex, age group and mechanism. Methods: Mortality data were retrieved from the National Disease Surveillance Points system (DSPs) of China, a nationally representative data source. Percent change in mortality between 2006 and 2016 was calculated as "mortality rate ratio - 1" based on a negative binomial regression model. Results: The crude unintentional falls mortality was 9.55 per 100 000 population in 2016. From 2006 to 2016, the age-adjusted unintentional falls mortality increased by 5% (95% confidence interval (CI) = 1%-9%), rising from 7.65 to 8.03 per 100 000 population. Males, rural residents and older age groups consistently had higher falls mortality rates than females, urban residents and younger age groups. Falls on the same level from slipping, tripping and stumbling (W01) was the most common mechanisms of falls mortality, accounting for 29% of total mortality. Conclusions: Unintentional falls continued to be a major cause of death in China from 2006 to 2016. Empirically-supported interventions should be implemented to reduce unintentional falls mortality.


Assuntos
Acidentes por Quedas/mortalidade , Adolescente , Adulto , Idoso , Causas de Morte/tendências , Criança , Pré-Escolar , China/epidemiologia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Fatores de Risco , População Rural/estatística & dados numéricos , População Urbana/estatística & dados numéricos , Adulto Jovem
12.
BMC Geriatr ; 19(1): 80, 2019 03 13.
Artigo em Inglês | MEDLINE | ID: mdl-30866845

RESUMO

BACKGROUND: Orthostatic hypotension (OH; profound falls in blood pressure when upright) is a common deficit that increases in incidence with age, and may be associated with falling risk. Deficit accumulation results in frailty, regarded as enhanced vulnerability to adverse outcomes. We aimed to evaluate the relationships between OH, frailty, falling and mortality in elderly care home residents. METHODS: From the Minimum Data Set (MDS) document, a frailty index (FI-MDS) was generated from a list of 58 deficits, ranging from 0 (no deficits) to 1.0 (58 deficits). OH was evaluated from beat-to-beat blood pressure and heart rate (finger plethysmography) collected during a 15-min supine-seated orthostatic stress test. Retrospective and prospective falling rates (falls/year) were extracted from facility falls incident reports. All-cause 3-year mortality was determined. Data are reported as mean ± standard error. RESULTS: Data were obtained from 116 older adults (aged 84.2 ± 0.9 years; 44% males) living in two long term care facilities. The mean FI-MDS was 0.36 ± 0.01; FI-MDS was correlated with age (r = 0.277; p = 0.003). Those who were frail (FI ≥ 0.27) had larger Initial (- 17.8 ± 4.2 vs - 6.1 ± 3.3 mmHg, p = 0.03) and Consensus (- 22.7 ± 4.3 vs - 11.5 ± 3.3 mmHg, p = 0.04) orthostatic reductions in systolic arterial pressure. Frail individuals had higher prospective and retrospective falling rates and higher 3-year mortality. Receiver operating characteristic curves evaluated the ability of FI-MDS alone to predict prospective falls (sensitivity 72%, specificity 36%), Consensus OH (sensitivity 68%, specificity 60%) and 3-year mortality (sensitivity 77%, specificity 49%). Kaplan Meier survival analyses showed significantly higher 3-year mortality in those who were frail compared to the non-frail (p = 0.005). CONCLUSIONS: Frailty can be captured using a frailty index based on MDS data in elderly individuals living in long term care, and is related to susceptibility to orthostatic hypotension, falling risk and 3-year mortality. Use of the MDS to generate a frailty index may represent a simple and convenient risk assessment tool for older adults living in long term care. Older adults who are both frail and have impaired orthostatic blood pressure control have a particularly high risk of falling and should receive tailored management to mitigate this risk.


Assuntos
Acidentes por Quedas/mortalidade , Idoso Fragilizado , Instituição de Longa Permanência para Idosos , Hipotensão Ortostática/mortalidade , Hipotensão Ortostática/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Pressão Sanguínea/fisiologia , Feminino , Fragilidade , Avaliação Geriátrica/métodos , Frequência Cardíaca/fisiologia , Humanos , Hipotensão Ortostática/diagnóstico , Assistência de Longa Duração/métodos , Masculino , Estudos Prospectivos , Estudos Retrospectivos , Medição de Risco
13.
Scand J Trauma Resusc Emerg Med ; 27(1): 24, 2019 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-30871611

RESUMO

BACKGROUND: A female survival advantage after injury has been observed, and animal models of trauma have suggested either hormonal or genetic mechanisms as component causes. Our aim was to compare age and risk-adjusted sex-related mortality in hospital for the three most common mechanisms of injury in relation to hormonal effects as seen by age. METHODS: All hospital admissions for injury in Sweden during the period 2001-2011 were retrieved from the National Patient Registry and linked to the Cause of Death Registry. The International Classification of Diseases Injury Severity Score (ICISS) was used to adjust for injury severity, and the Charlson Comorbidity Index to adjust for comorbidity. Age categories (0-14, 15-50, and ≥ 51 years) were used to represent pre-menarche, reproductive and post- menopausal women. RESULTS: Women had overall a survival benefit (OR 0.51; 95% CI 0.50 to 0.53) after adjustment for injury severity and comorbidity. A similar pattern was seen across the age categories (0-14 years OR 0.56 (95% CI 0.25 to 1.25), 15-50 years OR 0.70 (95% CI 0.57 to 0.87), and ≥ 51 years OR 0.49 (95% CI 0.48 to 0.51)). CONCLUSION: In this 11-year population-based study we found no support for an oestrogen-related mechanism to explain the survival advantage for females compared to males following hospitalisation for injury.


Assuntos
Acidentes por Quedas/mortalidade , Acidentes de Trânsito/mortalidade , Previsões , Vigilância da População , Sistema de Registros , Ferimentos e Lesões/etiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Causas de Morte/tendências , Criança , Pré-Escolar , Feminino , Seguimentos , Hospitalização/tendências , Humanos , Lactente , Recém-Nascido , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Distribuição por Sexo , Fatores Sexuais , Taxa de Sobrevida/tendências , Suécia/epidemiologia , Ferimentos e Lesões/mortalidade , Adulto Jovem
14.
J Pediatr Surg ; 54(5): 968-974, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30826118

RESUMO

PURPOSE: Given limited resources, it is essential to determine which Mechanisms of Injury (MOIs) to prioritize for injury prevention policy and research. We developed objective, evidence-based Injury Prevention Priority Scores (IPPSs) for Canadian children across three prevention perspectives: mortality, injury severity, and resource utilization. METHODS: We performed a retrospective cohort study of all injuries in Canada in individuals aged 0 to 19 years old from 2009 to 2014. For each MOI, an IPPS was calculated as a balanced measure of frequency and either mortality rate, median ICD-10 derived Injury Severity Score (ICISS), or median cost per hospitalization. RESULTS: Of 87,017 injuries, 83,112 were nonfatal hospitalizations, and 3905 were deaths. Overall mortality rate was 0.04 deaths/injury, median ICISS was 0.994 (IQR 0.75-0.996), and median cost per hospitalization was CAD$3262 (IQR $2118-$5001). The top three mechanisms were falls (IPPS 72), intentional self-harm (IPPS 68), and drowning (IPPS 65) for mortality, falls (IPPS73), drowning (IPPS 61), and suffocation (IPPS 61) for injury severity and falls (IPPS 70), fires (IPPS 65), and intentional self-harm (IPPS 60) for resource utilization. CONCLUSION: Falls, if prevented, would provide the most benefit to the largest proportion of the Canadian pediatric population and should be targeted for injury prevention. LEVEL OF EVIDENCE: Level III.


Assuntos
Custos de Cuidados de Saúde/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Recursos em Saúde/estatística & dados numéricos , Ferimentos e Lesões/etiologia , Ferimentos e Lesões/mortalidade , Acidentes por Quedas/mortalidade , Acidentes por Quedas/estatística & dados numéricos , Adolescente , Asfixia/mortalidade , Canadá/epidemiologia , Criança , Pré-Escolar , Afogamento/mortalidade , Fogo/estatística & dados numéricos , Hospitalização/economia , Humanos , Lactente , Recém-Nascido , Escala de Gravidade do Ferimento , Estudos Retrospectivos , Comportamento Autodestrutivo/complicações , Comportamento Autodestrutivo/epidemiologia , Ferimentos e Lesões/economia , Ferimentos e Lesões/prevenção & controle , Adulto Jovem
15.
Forensic Sci Int ; 296: 80-84, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30710812

RESUMO

BACKGROUND: The main aim of the present population-based study was to compare drugs in fall versus non-fall accidents causing major trauma, including both clinical and medico-legal autopsy data. METHODS: All individuals with accidents resulting in major trauma, a new injury severity score (NISS)>15 or lethal outcome was identified at hospital and/or the Department of Forensic Medicine between 2011 and 2013. Modified Downton Fall Risk Index ranged from 0 to 7, and was based on specific pharmaceuticals (max 5 points), previous fall (1 point) and cognitive impairment (1 point). RESULTS: One hundred and four individuals with major traumatic accidents were identified, 38 (36.5%) died. The median modified Downton Fall Risk Index was 2 for fall accidents and 0 for non-fall accidents (p < 0.001). Modified Downton Fall Risk Index was an age-independent factor associated with fall accident (p < 0.001). The medico-legal autopsy rate for in-hospital patients was 50% (6/12) for fatal fall accidents in comparison with 92.3% (12/13) for fatal non-fall accidents (p = 0.03). In individuals undergoing medico-legal autopsy, the proportion of individuals with any detected drug was 77% in fall accidents compared to 39% in non-fall accidents (p = 0.036). The presence of sedatives (p = 0.002) and bensodiazepines (p = 0.023) were higher for fall accidents compared to non-fall accidents. CONCLUSION: This population-based study on accidents with major trauma showed that drugs had high impact on fall accidents with major trauma. It seems warranted from a public health perspective to study if implementation of medication review guidelines at hospital managing polypharmacy issues may prevent fall accident recidivism.


Assuntos
Acidentes por Quedas/mortalidade , Acidentes/mortalidade , Preparações Farmacêuticas/análise , Ferimentos e Lesões/mortalidade , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Serviço Hospitalar de Emergência , Feminino , Medicina Legal , Toxicologia Forense , Mortalidade Hospitalar , Humanos , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Polimedicação , Suécia/epidemiologia , Adulto Jovem
16.
Health Promot Chronic Dis Prev Can ; 39(2): 35-44, 2019 Feb.
Artigo em Inglês, Francês | MEDLINE | ID: mdl-30767853

RESUMO

INTRODUCTION: The association between health outcomes and socioeconomic status (SES) has been widely documented, and mortality due to unintentional injuries continues to rank among the leading causes of death among British Columbians. This paper quantified the SES-related disparities in the mortality burden of three British Columbia's provincial injury prevention priority areas: falls among seniors, transport injury, and youth suicide. METHODS: Mortality data (2009 to 2013) from Vital Statistics and dissemination area or local health area level socioeconomic data from CensusPlus 2011 were linked to examine age-standardized mortality rates (ASMRs) and disparities in ASMRs of unintentional injuries and subtypes including falls among seniors (aged 65+) and transport-related injuries as well as the intentional injury type of youth suicide (aged 15 to 24). Disparities by sex and geography were examined, and relative and absolute disparities were calculated between the least and most privileged areas based on income, education, employment, material deprivation, and social deprivation quintiles. RESULTS: Our study highlighted significant sex differences in the mortality burden of falls among seniors, transport injury, and youth suicide with males experiencing significantly higher mortality rates. Notable geographic variations in overall unintentional injury ASMR were also observed across the province. In general, people living in areas with lower income and higher levels of material deprivation had increasingly higher mortality rates compared to their counterparts living in more privileged areas. CONCLUSION: The significant differences in unintentional and intentional injury-related mortality outcomes between the sexes and by SES present opportunities for targeted prevention strategies that address the disparities.


Assuntos
Acidentes por Quedas/mortalidade , Acidentes de Trânsito/mortalidade , Fatores Socioeconômicos , Suicídio/estatística & dados numéricos , Ferimentos e Lesões/mortalidade , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Colúmbia Britânica/epidemiologia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Áreas de Pobreza , Fatores Sexuais , Adulto Jovem
17.
Inj Prev ; 25(1): 47-51, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-29691315

RESUMO

BACKGROUND: Epidemiological characteristics and recent trends in unintentional drowning at the national level in China are unreported. METHODS: Using data from the Disease Surveillance Points system, the overall, sex-, location-, age- and cause-specific age-standardised mortality from unintentional drowning in China were calculated and compared. Linear regression was used to examine the significance of mortality trend changes over time. RESULTS: The average mortality was 4.05 per 100 000 persons between 2006 and 2013. Men and rural residents had much higher drowning mortality rates than women and urban residents at all time points. Drowning following a fall into natural water was the most common mechanism (46% of all drowning deaths). The overall drowning mortality rate remained stable for all subgroups except for distinct decreases in urban residents, children aged 5-9 years, and other specified and unspecified drowning (-10%, -36% and -25%, respectively). CONCLUSIONS: The overall drowning mortality rate remained high and stable in China between 2006 and 2013. Effective prevention measures like removing or covering water hazards, wearing personal floatation devices, supervision of children, and teaching survival swimming and resuscitation skills should be implemented nationwide.


Assuntos
Prevenção de Acidentes , Acidentes por Quedas/mortalidade , Afogamento/mortalidade , Saúde Pública , Natação/estatística & dados numéricos , Adolescente , Adulto , Distribuição por Idade , Criança , Pré-Escolar , China/epidemiologia , Feminino , Inquéritos Epidemiológicos , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Formulação de Políticas , Vigilância da População , Distribuição por Sexo , Adulto Jovem
18.
Inj Prev ; 25(2): 129-135, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-29056585

RESUMO

OBJECTIVES: To investigate temporal trend in fall mortality among adults (aged ≥20 years) in southern Sweden using multiple cause of death data. METHODS: We examined all death certificates (DCs, n=2 01 488) in adults recorded in the Skåne region during 1998-2014. We identified all fall deaths using International Statistical Classification of Diseases (ICD)-10 codes (W00-W19) and calculated the mortality rates by age and sex. Temporal trends were evaluated using joinpoint regression and associated causes were identified by age-adjusted and sex-adjusted observed/expected ratios. RESULTS: Falls were mentioned on 1.0% and selected as underlying cause in 0.7% of all DCs, with the highest frequency among those aged ≥70 years. The majority (75.6%) of fall deaths were coded as unspecified fall (ICD-10 code: W19) followed by falling on or from stairs/steps (7.7%, ICD-10 code: W10) and other falls on the same level (6.3%, ICD-10 code: W18). The mean age at fall deaths increased from 77.5 years in 1998-2002 to 82.9 years in 2010-2014 while for other deaths it increased from 78.5 to 79.8 years over the same period. The overall mean age-standardised rate of fall mortality was 8.3 and 4.0 per 1 00 000 person-years in men and women, respectively, and increased by 1.7% per year in men and 0.8% per year in women during 1998-2014. Head injury and diseases of the circulatory system were recorded as contributing cause on 48.7% of fall deaths. CONCLUSIONS: There is an increasing trend of deaths due to falls in southern Sweden. Further investigations are required to explain this observation particularly among elderly men.


Assuntos
Acidentes por Quedas/mortalidade , Causas de Morte/tendências , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Atestado de Óbito , Feminino , Inquéritos Epidemiológicos , Humanos , Classificação Internacional de Doenças , Masculino , Suécia/epidemiologia
19.
J Thromb Thrombolysis ; 47(2): 331-335, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30449000

RESUMO

Ischemic stroke and major bleeding, mostly due to intracranial hemorrhage (ICH), cause about the same rates of death in pivotal randomized trials of direct oral anticoagulants (DOACs) versus warfarin for stroke prevention in atrial fibrillation (AF). We analyzed our AF inpatient database to determine whether any ICH-related deaths were potentially preventable. Among 5008 patients admitted to our institution between May 2008 and September 2014 with a diagnosis of AF, eight had fatal ICH between admission and 90 days follow-up. The mean age of these patients was 85 years; 62% were male. Localization of the ICH was intraparenchymal in 62% and subdural in 38%. CHA2DS2-VASc scores ranged from 4 to 7, and the HAS-BLED scores ranged from 3 to 7. Three of the eight fatal ICHs were directly due to falls. All 8 patients were taking warfarin. One was taking concomitant aspirin. At the time ICH was diagnosed, one patient had an INR of 5.4. Five patients had an INR within the target therapeutic range of 2.0-3.0, and two had an INR less than 2.0. After multivariate adjustment, a history of falls was the sole independent predictor of fatal ICH (OR 22.3; 95% CI 2.5-60.3). In conclusion, most patients had achieved the target INR at the time of ICH, and the primary precipitant of fatal ICH was often a fall. Using DOACs instead of warfarin and implementing structured fall-prevention programs in high-risk patients could further reduce mortality from ICH in AF.


Assuntos
Anticoagulantes/efeitos adversos , Fibrilação Atrial/tratamento farmacológico , Coagulação Sanguínea/efeitos dos fármacos , Pacientes Internados , Hemorragias Intracranianas/induzido quimicamente , Varfarina/efeitos adversos , Acidentes por Quedas/mortalidade , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/sangue , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/mortalidade , Bases de Dados Factuais , Feminino , Humanos , Coeficiente Internacional Normatizado , Hemorragias Intracranianas/diagnóstico por imagem , Hemorragias Intracranianas/mortalidade , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do Tratamento
20.
J Surg Res ; 234: 283-286, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30527486

RESUMO

BACKGROUND: When ground-level falls occur in the bathroom, there is particular potential for morbidity and mortality given the high density of hard surfaces. Risk factors are not clearly defined by the existing literature. The objective of this study was to define the epidemiology, injury patterns, and outcomes after falls in the bathroom. MATERIALS AND METHODS: All patients presenting to LAC+USC Medical Center (01/2008-05/2015) after a fall in the bathroom (ICD-9 code E884.6) were included. Demographics, injury data, investigations, procedures, and outcomes were collected. RESULTS: Fifty-seven patients were included, with mean age 45 y (range 0-92). All ages were affected, with ages 41-60 y at highest risk. Common comorbidities included cardiovascular disease (n = 23, 40%), neuromuscular disorders (n = 13, 23%), and diabetes (n = 9, 16%). Ten patients (18%) were intoxicated. Home medications included antihypertensives (n = 18, 32%), antipsychotics (n = 9, 16%), and anticoagulants (n = 8, 14%). Common investigations included X-rays (n = 41, 72%) and CT scans of the head (n = 20, 35%). The most frequent injuries were contusion/laceration (n = 45, 79%), fracture (n = 12, 21%), and traumatic brain injury (n = 7, 12%). Most patients did not require hospital admission (n = 46, 81%), although 4 (7%) needed intensive care unit care and operative intervention (ORIF [n = 2, 4%] or craniectomy [n = 2, 4%]). Mortality was low (n = 1, 2%). Most patients were discharged home (n = 40, 70%). CONCLUSIONS: All ages, especially 41-60 y, are susceptible to falls in the bathroom. Despite the potential for serious injury, most do not require hospital admission. Risk factors include drugs/alcohol, cardiovascular disease, neuromuscular disorders, and diabetes. Efforts to minimize fall risk should be directed toward these individuals.


Assuntos
Acidentes por Quedas/estatística & dados numéricos , Toaletes , Ferimentos e Lesões/etiologia , Acidentes por Quedas/mortalidade , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Los Angeles/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Ferimentos e Lesões/diagnóstico , Ferimentos e Lesões/terapia , Adulto Jovem
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