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1.
BMC Public Health ; 20(1): 137, 2020 Jan 30.
Artigo em Inglês | MEDLINE | ID: mdl-32000733

RESUMO

BACKGROUND: Fifteen states, including West Virginia, have liberalized their laws concerning fireworks possession and sale. Effective June 1, 2016, House Bill 2852 enabled all Class C fireworks to be sold within the state. The effects of this policy on fireworks-related injuries requiring immediate medical care are unknown. The purpose of this study was to determine whether this policy may have affected the fireworks-related injury rate and/or injury severity. METHODS: Data were collected from the electronic medical records of patients treated by West Virginia University Medicine between June 1, 2015-May 31, 2017. The pre and post law periods were defined as June 1, 2015-May 31, 2016 and June 1, 2016-May 31, 2017, respectively. Fireworks-related injuries were identified via International Classification of Disease Clinical Modification codes and by free text searches of the electronic medical records. The rate of injuries pre and post-legislation were compared by Exact Poisson Regression, while demographic characteristics and injury severity were compared via Fisher's Exact tests. RESULTS: 56 individuals were treated for fireworks-related injuries during the study period. The majority of patients were over 25 years of age (64%) and male (77%). Most of the injuries occurred within 7 days of a celebrated U.S. holiday (64%), and 28% were severe in nature. Age, sex, and injury severity did not significantly differ pre and post law passage. The injury rate per 100,000 patients was 39% higher after the law was enacted (p = 0.3475; incidence rate ratio 1.39, 95% Confidence Interval 0.74, 2.68). CONCLUSION: The law increasing access to Class C fireworks may have affected the injury rate, but not injury severity among treated patients. Effective, evidence-based, public health interventions applicable to all age groups may be warranted particularly around national holidays. This study may inform other states looking to amend their legislation.


Assuntos
Traumatismos por Explosões/epidemiologia , Substâncias Explosivas/efeitos adversos , Legislação como Assunto , Política , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Férias e Feriados , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , West Virginia/epidemiologia , Adulto Jovem
2.
BMJ Case Rep ; 12(10)2019 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-31645382

RESUMO

Firework injuries, which most commonly affect hands, are increasing in frequency and severity. We present a pictorial case of a devastating hand injury following a firework explosion in a young male patient. The blast resulted in splaying of the hand with multiple fractures, neurovascular compromise and soft tissue loss. Reconstruction involved a third-ray amputation, fracture fixation, nerve and soft tissue repair resulting in an adequate hand with near-normal appearance. Firework-related hand injuries pose a significant surgical challenge due to the combination of burn and blast forces that can compromise the function of intact vessels and nerves making salvage and reconstruction particularly difficult. Here, we propose a treatment algorithm based on current literature. Our case demonstrates, what initially appeared to be an unsalvageable injury can be reconstructed to produce a functional hand if appropriate surgical measures are taken.


Assuntos
Traumatismos por Explosões/cirurgia , Fraturas Ósseas/cirurgia , Traumatismos da Mão/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Adulto , Algoritmos , Amputação , Traumatismos por Explosões/etiologia , Substâncias Explosivas/efeitos adversos , Fraturas Ósseas/etiologia , Traumatismos da Mão/etiologia , Humanos , Masculino
3.
Psychiatry Res ; 280: 112519, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31442670

RESUMO

The first of its kind, this study determined whether blast exposure interacts with genetic variant 5HTTLPR to predict posttraumatic stress (PTS) symptoms in 78 military explosives operators. In all models, blast-exposed 5HTTLPR S carriers registered definitively higher PTS symptoms in comparison to non-exposed S carriers, as well as exposed and non-exposed LL carriers (all p < 0.01). All findings were robust to confounding influences of age and traumatic brain injury diagnosis. Not only is blast exposure prevalent in EOD personnel, but it also interacts with genetic predisposition to predict trauma symptoms in this unique, at-risk military population.


Assuntos
Traumatismos por Explosões/genética , Traumatismos por Explosões/psicologia , Militares/psicologia , Proteínas da Membrana Plasmática de Transporte de Serotonina/genética , Transtornos de Estresse Pós-Traumáticos/genética , Transtornos de Estresse Pós-Traumáticos/psicologia , Adulto , Traumatismos por Explosões/epidemiologia , Lesões Encefálicas Traumáticas/epidemiologia , Lesões Encefálicas Traumáticas/genética , Lesões Encefálicas Traumáticas/psicologia , Substâncias Explosivas/efeitos adversos , Predisposição Genética para Doença/epidemiologia , Predisposição Genética para Doença/genética , Predisposição Genética para Doença/psicologia , Variação Genética/genética , Humanos , Masculino , Valor Preditivo dos Testes , Transtornos de Estresse Pós-Traumáticos/epidemiologia
4.
N Z Vet J ; 67(6): 323-328, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31262239

RESUMO

Aims: To provide updated results on the adverse behavioural effects of fireworks on companion animals in New Zealand, measures that owners use to mitigate these effects, and opinions on a ban on the sale of fireworks. Method: A cross-sectional survey of companion animal owners in New Zealand was conducted between 2 November and 5 December 2016 using an online survey. The survey was modelled after a similar study conducted in 2006. Owners were asked to provide information on the types and severity of behaviours observed in their animals that were frightened by fireworks, what they did for their frightened animals and whether they would support a ban on the sale of fireworks. Results: There were 4,293 respondents who completed the online survey and they owned 15,871 companion animals, of which 11,750 (74.4%) were frightened of fireworks. For the 7,464 fearful animals with individual data available, the most commonly reported adverse behaviours were hiding (5,287; 70.8%), shivering (4,058; 54.3%) and cowering (3,324; 44.5%). Owners reported that 345 animals had been physically injured as the result of fireworks. Of 3,682 owners with frightened animals, 2,649 (71.9%) had not sought help or treatment for their animal. Frightened animals were mostly kept inside (3,479/7,464; 46.%) or comforted (2,112/7,464; 28.2%). Of all 4,325 respondents, 3,631 (84.0%) were supportive of a ban on the private sale of fireworks, with 370 (8.6%) against and 315 (7.3%) undecided. Owners with ≥1 animal that was fearful towards fireworks were more likely to support a ban (3,137/3,412; 91.9%) than owners whose animals were not afraid (466/561; 83.1%) (OR = 2.32; 95% CI = 1.80-2.98). Conclusion and Clinical Relevance: Among respondents to this survey, many owners of companion animals reported that their animals were adversely affected by fireworks, but few of them sought advice about strategies to mitigate the impacts. The majority of respondents supported a ban on the private sale of fireworks. Campaigns to raise public awareness of treatment strategies for managing fear behaviours during anticipated fireworks displays may be beneficial.


Assuntos
Comportamento Animal/fisiologia , Substâncias Explosivas/efeitos adversos , Animais de Estimação/psicologia , Animais , Estudos Transversais , Medo , Humanos , Propriedade
7.
Can J Surg ; 61(6): S203-S207, 2018 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-30418007

RESUMO

Background: We have previously reported a higher than expected rate of upper-extremity amputation (UEA) in victims of an antipersonnel improvised explosive device (AP-IED) compared with a similar cohort injured by antipersonnel mines (APM). The goal of this study was to describe the rate, severity and impact of UAE caused by an AP-IED. Methods: We analyzed a prospective database of 100 consecutive dismounted AP-IED victims with pattern 1 injuries to compare the outcomes of the cohort with UEA to that without. Results: We found that UEA (8 above elbow, 19 below elbow, 1 through elbow, 3 hand, 15 digit(s)) was much more prevalent with AP-IED than with APM (40% v. 6%, p < 0.001). In addition, UEA was associated with a higher rate of multiple amputations (39 [98%] v. 32 [53%], p < 0.001), bilateral lower-extremity amputation (LEA; 33 [82.5%] v. 30 [53.3%], p = 0.003) and facial injury (8 [20%] v. 4 [6.4%], p = 0.044), but not with pelvic disruption (10 [25%]), genitoperineal mutilation (19 [48%]), eye injury (6 [15%]), or skull fracture (6 [15%]). The fatality rate was higher in patients with UEA than in those without (12 [30%] v. 7 [12%], p = 0.022). Conclusion: Upper-extremity amputation is more prevalent with AP-IED than APM. Presence of UEA is associated with more severe injury and increased risk of death in AP-IED victims. Upper-limb injury has significant consequences for rehabilitation from LEA, which universally accompanies UEA in AP-IED victims. Upper-extremity injury should be amenable to prevention by innovative personal protective equipment designed to protect the flexed elbow.


Assuntos
Amputação Traumática/epidemiologia , Traumatismos do Braço/epidemiologia , Traumatismos por Explosões/epidemiologia , Substâncias Explosivas/efeitos adversos , Lesões Relacionadas à Guerra/epidemiologia , Adolescente , Adulto , Campanha Afegã de 2001- , Amputação Traumática/etiologia , Traumatismos do Braço/etiologia , Traumatismos por Explosões/etiologia , Criança , Humanos , Masculino , Prevalência , Estudos Prospectivos , Lesões Relacionadas à Guerra/etiologia , Adulto Jovem
8.
World J Emerg Surg ; 13: 38, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30181768

RESUMO

Background: The triage system used during an actual mass burn casualty (MBC) incident is a major focus of concern. This study introduces a MBC triage system that was used by a burn center during an actual MBC incident following a powder explosion in New Taipei City, Taiwan. Methods: This study retrospectively analyzed data from patients who were sent to the study hospital during a MBC incident. The patient list was retrieved from a national online management system. A MBC triage system was developed at the study hospital using the following modifiers: consciousness, breathing, and burn size. Medical records were retrieved from electronic records for analysis. Patient outcomes consisted of emergency department (ED) disposition and intervention. Results: The patient population was predominantly female (56.3%), with an average age of 24.9 years. Mean burn sizes relative to the TBSA of triage level I, II, and III patients were 57.9%, 40.5%, and 8.7%, respectively. ICU length of stay differed markedly according to triage level (mean days for levels I vs II vs III: 57.9 vs 39.9 vs 2.5 days; p < 0.001). Triage system levels I and II indicate ICU admission with a sensitivity of 93.9% (95%CI 80.4-98.3%) and a specificity of 86.7% (62.1-96.3%).Overall, 3 (6.3%) patients were under-triaged. Two (4.2%) patients were over-triaged. Sixteen (48.5%) and 21 (63.6%) patients of triage levels I and II received endotracheal intubation and central venous catheterization, respectively. Sorting of the study population with simple triage and rapid treatment (START) showed great sensitivity (100.0%) but poor specificity (53.3%). The Taiwan Triage and Acuity Scale (TTAS) presented 87.9% sensitivity and 93.9% specificity. Conclusions: The current MBC triage algorithm served as a good indicator of ED disposition but might have raised excessive immediate attention and had the potential to exhaust the available resources. These findings add to our knowledge of the MBC triage system and should help future researchers in adjusting the triage criteria to fit actual disasters.


Assuntos
Substâncias Explosivas/efeitos adversos , Incidentes com Feridos em Massa , Triagem/métodos , Triagem/normas , Adulto , Queimaduras/terapia , Planejamento em Desastres/métodos , Serviços Médicos de Emergência/métodos , Serviços Médicos de Emergência/tendências , Feminino , Hospitais , Humanos , Masculino , Estudos Retrospectivos , Taiwan
9.
Mil Med ; 183(suppl_2): 24-28, 2018 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-30189069

RESUMO

The purpose of this Clinical Practice Guide is to provide details on the procedures to safely remove unexploded ordnance from combat patients, both loose and impaled, to minimize the risks to providers and the medical treatment facility while ensuring the best outcome for the patient. Military ordnance, to include bullets, grenades, flares, and explosive ordnance, retained by a patient can be a risk to all individuals and equipment along the continuum of care. This is especially true from the point of injury to the first treatment facility. Management of patients with unexploded ordnance either on or in their body is a rare event during combat surgery. Loose munitions are usually noted and easily removed prior to the patient receiving medical treatment. However, impaled munitions provide a significant challenge. These are usually caused by large caliber, high-velocity projectiles. Patients who survive to arrive at a treatment facility must be triaged safely and simultaneously treated appropriately to ensure both the survival of the patient and the treatment team. Between WWII and the Somalia conflict, there have been 36 reported cases of unexploded ordnance from U.S. soldiers. Since 2005, there have been six known cases during the U.S. wars in Afghanistan and Iraq and one additional case in Pakistan. Optimal outcomes require a basic knowledge of explosives and triggering mechanisms, as well as adherence to basic principles of trauma resuscitation and surgery.


Assuntos
Substâncias Explosivas/efeitos adversos , Manobra Psicológica , Traumatismos por Explosões/prevenção & controle , Traumatismos por Explosões/terapia , Substâncias Perigosas/administração & dosagem , Substâncias Perigosas/efeitos adversos , Humanos , Salas Cirúrgicas/métodos , Salas Cirúrgicas/tendências , Estados Unidos
10.
US Army Med Dep J ; (1-18): 60-66, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30165723

RESUMO

New materials are constantly being created to address the operational needs of the US Army. These materials provide challenges to occupational health practitioners by presenting unknown health risks and possible effects to workers they evaluate. The responsibility for developing a medical surveillance exam, as part of a comprehensive workplace surveillance program, may become the responsibility of the provider working in a clinic on a military installation where manufacturing, testing, and/or use of the material is being conducted. Insensitive munitions explosive (IMX) has presented such an opportunity for Army occupational medicine providers within the last few years. This article describes the course of action taken by the occupational health clinics, personnel of Army ammunition plants producing IMX-101, and the US Army Public Health Center-Army Institute of Public Health to address the situation of developing a medical surveillance examination during a time when little to no information existed about the components of this new explosive compound.


Assuntos
Anisóis/efeitos adversos , Substâncias Explosivas/efeitos adversos , Medicina Militar/métodos , Saúde do Trabalhador , Exame Físico/métodos , Triazóis/efeitos adversos , Humanos
11.
J Toxicol Environ Health A ; 81(6): 154-159, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29336681

RESUMO

In the production of fireworks, various pollutants including particles of metals and organic compounds are released into the environment. Although the adverse effects of these air pollutants are known, the impact on pregnant women residing in this area remains to be determined. The aim of this study was to examine the association between maternal exposure to fireworks production chemicals and frequency of preterm birth in Liuyang, China. Maternal exposure to fireworks production was estimated at the residential district level and assessed using factory density, which was defined as the number of fireworks factories per 1000 residents in each district. The association of maternal exposure to particulates released from fireworks production plants with frequency of preterm birth was determined using data obtained from a cohort study conducted in Liuyang, China. Data were analyzed utilizing linear regression and logistic regression. There was no significant association between factory density and spontaneous preterm or medically induced preterm birth. Unexpectedly, pregnant women residing in areas with higher density of fireworks factories were at a reduced risk of preterm premature rupture of membranes (PPROM). Data demonstrated that residential density of fireworks factories appeared to be negatively correlated with preterm birth rate as evidenced by PPROM. At present, it is difficult to reconcile the inverse relationship between firework chemical exposure and frequency of preterm births as ambient particulate inhalation is known to adversely affect preterm birth occurrence.


Assuntos
Poluentes Ambientais/efeitos adversos , Substâncias Explosivas/efeitos adversos , Exposição Materna/efeitos adversos , Nascimento Prematuro/epidemiologia , Adulto , China/epidemiologia , Estudos de Coortes , Feminino , Humanos , Incidência , Indústria Manufatureira , Instalações Industriais e de Manufatura , Gravidez , Nascimento Prematuro/induzido quimicamente , Risco , Adulto Jovem
12.
J Emerg Med ; 54(5): 645-650, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29366618

RESUMO

BACKGROUND: The management of patients with impaled unexploded devices is rare in the civilian setting. However, as the lines of the traditional battlefield are blurred by modern warfare and terrorist activity, emergency providers should be familiar with facility protocols, plans, and contact information of their local resources for unexploded devices. CASE REPORT: A 44-year-old male sustained a close-proximity blast injury to his lower extremities while manipulating a mortar-type firework. He presented to the regional trauma center with an open, comminuted distal femur fracture and radiographic evidence of a potential explosive device in his thigh. His management was coordinated with the local Explosive Ordinance Disposal and the fire department. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Explosive devices pose a grave threat when encountered. Familiarization with protocols to manage these patients can mitigate disaster. Emergency providers should expect and be prepared to coordinate care for these patients.


Assuntos
Substâncias Explosivas/efeitos adversos , Corpos Estranhos/complicações , Ferimentos e Lesões/etiologia , Adulto , Corpos Estranhos/cirurgia , Cirurgia Geral/métodos , Humanos , Masculino , Radiografia/métodos
13.
Disaster Med Public Health Prep ; 12(3): 379-385, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28929984

RESUMO

Mass casualty incidents (MCIs) are becoming more frequent worldwide, especially in the Middle East where violence in Syria has spilled over to many neighboring countries. Lebanon lacks a coordinated prehospital response system to deal with MCIs; therefore, hospital preparedness plans are essential to deal with the surge of casualties. This report describes our experience in dealing with an MCI involving a car bomb in an urban area of downtown Beirut, Lebanon. It uses general response principles to propose a simplified response model for hospitals to use during MCIs. A summary of the debriefings following the event was developed and an analysis was performed with the aim of modifying our hospital's existing disaster preparedness plan. Casualties' arrival to our emergency department (ED), the performance of our hospital staff during the event, communication, and the coordination of resources, in addition to the response of the different departments, were examined. In dealing with MCIs, hospital plans should focus on triage area, patient registration and tracking, communication, resource coordination, essential staff functions, as well as on security issues and crowd control. Hospitals in other countries that lack a coordinated prehospital disaster response system can use the principles described here to improve their hospital's resilience and response to MCIs. (Disaster Med Public Health Preparedness. 2018; 12: 379-385).


Assuntos
Defesa Civil/métodos , Incidentes com Feridos em Massa , Desenvolvimento de Programas/métodos , Terrorismo/tendências , Algoritmos , Defesa Civil/estatística & dados numéricos , Serviços Médicos de Emergência , Serviço Hospitalar de Emergência/organização & administração , Serviço Hospitalar de Emergência/estatística & dados numéricos , Substâncias Explosivas/efeitos adversos , Humanos , Israel , Líbano , Desenvolvimento de Programas/normas , População Urbana
14.
Disaster Med Public Health Prep ; 12(3): 360-365, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-28925342

RESUMO

OBJECTIVES: Despite the frequency of disasters in Africa, almost nothing is known about ethnic affiliations in relation to psychopathology after such incidents. This study examined the mental health outcomes of members of 7 major ethnic groups exposed to the 1998 terrorist bombing of the US Embassy in Nairobi, Kenya. METHODS: Approximately 8 to 10 months after the disaster, 229 civilian employees, 99 locally engaged staff workers of the US State Department and the US Agency for International Development, and 64 workers of the Kenyan Red Cross Society (total N=392) were assessed with the Diagnostic Interview Schedule for the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition). Additional data were gathered on demographic characteristics, disaster exposures and injuries, and ethnic affiliations. RESULTS: Disaster-related post-traumatic stress disorder (PTSD) was significantly less prevalent among members of the Kikuyu group (28%) and post-disaster major depression was significantly more prevalent among members of the Meru group (64%), compared with all others in the sample. Preexisting psychopathology and disaster injury were independently associated with bombing-related psychopathology. CONCLUSIONS: Further study of disaster-related psychopathology in relation to African ethnic affiliations is needed to better understand these associations and to assist in planning resources and interventions for African disaster survivors. (Disaster Med Public Health Preparedness. 2018; 12: 360-365).


Assuntos
Grupos Étnicos/psicologia , Transtornos de Estresse Pós-Traumáticos/etiologia , Terrorismo/psicologia , Adaptação Psicológica , Adulto , Grupos Étnicos/estatística & dados numéricos , Substâncias Explosivas/efeitos adversos , Feminino , Humanos , Quênia/etnologia , Masculino , Pessoa de Meia-Idade , Prevalência , Psicopatologia/estatística & dados numéricos , Transtornos de Estresse Pós-Traumáticos/etnologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Sobreviventes/psicologia , Terrorismo/etnologia
15.
Ned Tijdschr Geneeskd ; 161: D2249, 2017.
Artigo em Holandês | MEDLINE | ID: mdl-29219800

RESUMO

- Describe the problem, and show why a social awareness campaign is needed- Know what you are talking about, and explain the medical jargon in plain language- Collect data and facts- Create support among colleagues- Get the media involved- Get support from the community- Create a coalition of supporters via a website- You will discover who the opposition is when you are on the barricade- Offer a safe and healthy alternative - Draw up a long-term roadmap, and persevere.


Assuntos
Conscientização , Substâncias Explosivas/efeitos adversos , Promoção da Saúde , Humanos , Médicos
16.
Lancet Public Health ; 2(6): e286-e296, 2017 06.
Artigo em Inglês | MEDLINE | ID: mdl-29253366

RESUMO

BACKGROUND: Explosive remnants of war (ERW)-landmines, unexploded ordnance (UXO), and abandoned explosive ordnance (AXO)-have been recognised as a threat to health since the 1990s. We aimed to study the effect of ERW on global public health. METHODS: In this systematic mixed-studies review, we searched the Web of Science, Scopus, PubMed, and ProQuest databases, and hand searched relevant websites, for articles published between Jan 1, 1990, and Aug 31, 2015. We used keywords and Medical Subject Headings related to ERW, landmines, UXO, and AXO to locate original peer-reviewed quantitative, qualitative, or mixed-methods studies in English of the direct physical or psychological effects of ERW on direct victims of the explosive device or reverberating social and economic effects on direct victims and indirect victims (their families and the wider at-risk community). We excluded studies if more than 20% of participants were military, if they were of deminers, if they were from high-income countries, or if they were of chemical weapons. We identified no peer-reviewed studies of AXO effects, so we extended the search to include grey literature. We critically appraised study quality using a mixed methods appraisal tool. We used a narrative synthesis approach to categorise and synthesise the literature. We extracted quantitative data and calculated means and percentages. FINDINGS: The initial search identified 10 226 studies, leaving 8378 (82%) after removal of duplicates, of which we reviewed 54 (26 [48%] were quantitative descriptive studies, 20 [37%] were quantitative non-randomised studies, four [7%] were mixed-methods studies, and four [7%] were grey literature). The direct psychological effects of landmines or UXO appear high. We identified comorbidity of anxiety and depression in landmine or UXO victims in four studies, more women presented with post-traumatic stress disorder than did men in two studies, and landmine or UXO victims reported a greater prevalence of post-traumatic stress disorder, anxiety, or depression than did control groups in two studies. Overall injury and mortality rates caused by landmines or UXO decreased over time across five studies and increased in one. More men were injured or killed by landmines or UXO than were women (0-30·6% of women), the mean ages of casualties ranged from 18·5 years to 38·1 years, and victims were likely to be doing an activity of economic necessity at the time of injury. The proportion of casualties of landmines or UXO younger than 18 years ranged from 22% to 55% across twelve studies. Landmine or UXO victims who had one or more limbs amputated ranged from 19·5% to 82·6%. Landmines and UXO had a negative effect on internally displaced populations and returning refugees, physical security, economic productivity, child health and educational attainment, food security, and agriculture in studies from seven countries. We could not establish the proportion of casualties caused by AXO from unplanned explosions at munitions sites, although the grey literature suggests that AXO is a substantial problem. INTERPRETATION: Individually, these landmine and UXO results are not new and substantiate findings from existing research. Taken together, however, these findings provide a picture of the effect of landmines and UXO that stretches far beyond injury and mortality prevalence, making landmine and UXO clearance a more favourable option for funders. AXO effects are understudied and warrant further research. FUNDING: King's College London.


Assuntos
Substâncias Explosivas/efeitos adversos , Saúde Global/estatística & dados numéricos , Guerra , Humanos , Narração
18.
Sci Total Environ ; 599-600: 314-323, 2017 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-28478360

RESUMO

Shells fired during World War I exhibited different explosive compounds and some of these weapons also contained a wide variety of chemical warfare agents. At the end of the war, for safety purposes, the large quantity of weapons remaining on the former front needed to be dismantled and destroyed. A large amount of the remaining shells was destroyed in specific sites which led to the contamination of the surroundings in Belgium and France. In the 1920s, 1.5 million chemical shells and 30,000 explosive shells were destroyed in a place close to the city of Verdun, in the East of France. In this paper, the risk for human health related to the consumption of foodstuffs produced on this site was assessed. To this end, food products of plant and animal origin were sampled in 2015-2016 and contaminant analyses were conducted. Human exposure was assessed using a specifically built methodology. The contaminants considered in this study were trace elements (TEs - primarily Zn, As, Pb and Cd), nitroaromatic explosives (trinitrotoluene, 2,4-dinitrotoluene, 2,6-dinitrotoluene, 2-amino-4,6-dinitroluene and 4-amino-2,6-dinitrotoluene), phenylarsenic compounds including diphenylarsinic acid and triphenylarsine, perchlorate, tetrabromoethane and vinyl bromide. Depending on the compound, different approaches were used to assess the risk for both adults and children. Exposure to these contaminants through the consumption of foodstuffs produced locally on the considered site was unlikely to be a health concern. However, as for inorganic arsenic, given the presence of highly contaminated zones, it was suggested that cereals should not be grown on certain plots.


Assuntos
Produtos Agrícolas/efeitos adversos , Carne/efeitos adversos , Poluentes do Solo/efeitos adversos , Animais , Arsênico/efeitos adversos , Bélgica , Bombas (Dispositivos Explosivos) , Substâncias Explosivas/efeitos adversos , França , Humanos , Metais Pesados/efeitos adversos , Medição de Risco , I Guerra Mundial
19.
Am J Emerg Med ; 35(10): 1469-1473, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28495236

RESUMO

BACKGROUND: There is a paucity of clinical data on severe fireworks-related injuries, and the relationship between firework types, injury patterns, and magnitude of impairment is not well understood. Our objective was to describe the relationship between fireworks type, injury patterns, and impairment. METHODS: Retrospective case series (2005-2015) of patients who sustained consumer fireworks-related injuries requiring hospital admission and/or an operation at a Level 1 Trauma/Burn Center. Fireworks types, injury patterns (body region, injury type), operation, and permanent impairment were examined. RESULTS: Data from 294 patients 1 to 61years of age (mean 24years) were examined. The majority (90%) were male. 119 (40%) patients were admitted who did not undergo surgery, 163 (55%) patients required both admission and surgery, and 12 (5%) patients underwent outpatient surgery. The greatest proportion of injuries was related to shells/mortars (39%). There were proportionally more rocket injuries in children (44%), more homemade firework injuries in teens (34%), and more shell/mortar injuries in adults (86%). Brain, face, and hand injuries were disproportionately represented in the shells/mortars group. Seventy percent of globe-injured patients experienced partial or complete permanent vision loss. Thirty-seven percent of hand-injured patients required at least one partial or whole finger/hand amputation. The greatest proportion of eye and hand injuries resulting in permanent impairment was in the shells/mortars group, followed by homemade fireworks. Two patients died. CONCLUSIONS: Severe fireworks-related injuries from homemade fireworks and shells/mortars have specific injury patterns. Shells/mortars disproportionately cause permanent impairment from eye and hand injury.


Assuntos
Queimaduras/epidemiologia , Substâncias Explosivas/efeitos adversos , Traumatismos Oculares/epidemiologia , Fogo , Traumatismos da Mão/epidemiologia , Adolescente , Adulto , Queimaduras/patologia , Criança , Pré-Escolar , Serviço Hospitalar de Emergência , Traumatismos Oculares/patologia , Feminino , Traumatismos da Mão/patologia , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Índices de Gravidade do Trauma , Adulto Jovem
20.
J Hand Surg Am ; 42(5): 385.e1-385.e8, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-28341070

RESUMO

PURPOSE: The purpose of this study was to characterize injury patterns and outcomes of fireworks-related hand injuries and determine if there was an association with certain fireworks types. METHODS: A retrospective cohort study was conducted on patients treated at a trauma center between 2005 and 2015. A total of 105 patients sustaining operative hand injuries due to fireworks were identified. Medical records were reviewed to identify injury patterns, treatment outcomes, and fireworks types. RESULTS: Eighty-eight patients (84%) sustained 92 thumb and/or first web space injuries. There were 12 thumb soft tissue-only injuries (13%) and 80 thumb fractures/dislocations (87%). Of these, there were 52 thumb carpometacarpal (CMC) joint dislocations (57%) and 36 thumb fractures outside the thumb CMC joint (39%). Fifteen hands (16%) sustained both thumb CMC joint dislocations and additional thumb fractures. Twenty-three hands (25%) required thumb revision amputation. The number of surgeries for acute reconstruction ranged from 1 to 7, with 17 patients (19%) requiring 3 or more. Sixty-three hands had deep first web space injuries, and 11 (17%) required flaps acutely for first web space reconstruction. Six hands required secondary reconstruction of a first web space contracture. An external fixator was applied to 6 hands to maintain the first web space; none of these required secondary web reconstruction. Excluding isolated pin removals and dressing changes under anesthesia, 19 patients (22%) required later-stage surgeries. Shells/mortars (59%) were the most common fireworks type causing injury. CONCLUSIONS: Among operative hand injuries, fireworks most commonly fracture the thumb, destabilize the thumb CMC joint, and deeply damage the first web space. The first web space requires particular consideration because deep injury may result in adduction contracture and require secondary reconstruction if not prevented. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.


Assuntos
Explosões , Substâncias Explosivas/efeitos adversos , Fogo , Traumatismos da Mão/etiologia , Traumatismos da Mão/patologia , Adolescente , Adulto , Amputação , Criança , Pré-Escolar , Feminino , Fixação Interna de Fraturas , Fraturas Ósseas/etiologia , Fraturas Ósseas/patologia , Fraturas Ósseas/cirurgia , Traumatismos da Mão/cirurgia , Humanos , Luxações Articulares/etiologia , Luxações Articulares/patologia , Luxações Articulares/cirurgia , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Reconstrutivos , Estudos Retrospectivos , Lesões dos Tecidos Moles/etiologia , Lesões dos Tecidos Moles/patologia , Lesões dos Tecidos Moles/cirurgia , Retalhos Cirúrgicos , Adulto Jovem
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