Home safety hazards associated with unintentional poisoning among children aged 0-5 years in Mongolia: A case-control study.

OBJECTIVE: To examine the association between home safety hazards and unintentional poisoning in children in Mongolia. METHODS: We conducted a case-control study using structured questionnaires to investigate safety behaviours, safety equipment use, and home hazards in households with or without children aged 0-5 years who had suffered from poisoning at home (i.e., cases and controls). We recruited 190 cases (105 medicinal and 84 non-medicinal poisonings, and one each) at the National Center for Maternal and Child Health and 379 controls in the communities between 1 March and 30 October 2021. RESULTS: There were large differences between cases' and controls' households in safety behaviours and home hazards: the failure to store all medicines out of reach of children (68% of cases vs. 25% of controls), the failure to store all medicines safely (out of reach, locked or non-existent) (61% vs. 22%), the failure to put all medicines away immediately after use (77% vs. 43%), the presence of things that a child could climb on to reach high surfaces (82% vs. 67%), the presence of medicines transferred into different containers (28% vs. 9%) and the presence of household products transferred into different containers (28% vs. 16%). These home safety hazards were strongly associated with poisoning after controlling for confounders. CONCLUSION: Children's risk of unintentional poisoning was strongly associated with the unsafe storage of potentially poisonous agents by caregivers and home hazards. Since unsafe storage is widespread, a fail-safe approach such as child-resistant closure of medicines and household products should be considered.

Carbon monoxide poisoning following a ban on household use of raw coal, Mongolia.

Objective: To examine trends in the incidence of carbon monoxide poisoning before and after a ban on domestic use of raw coal in Ulaanbaatar, Mongolia. Methods: Using injury surveillance data and population estimates, we calculated the incidence per 100 000 person-years of fatal and non-fatal domestic carbon monoxide poisoning before (May 2017 to April 2019) and after (May 2019 to April 2022) the ban in May 2019. We analysed data by age and sex, and compared areas not subjected to the ban with districts where domestic use of raw coal was banned and replaced with refined coal briquettes. Findings: We obtained complete data on 2247 people with carbon monoxide poisoning during the study period in a population of around 3 million people. In districts with the ban, there were 33 fatal and 151 non-fatal carbon monoxide poisonings before the ban, and 91 fatal and 1633 non-fatal carbon monoxide poisonings after the ban. The annual incidence of poisoning increased in districts with the ban, from 7.2 and 6.4 per 100 000 person-years in the two 12-month periods before the ban to 38.9, 42.0 and 40.1 per 100 000 in the three 12-month periods after the ban. The incidence of poisoning remained high after the ban, despite efforts to educate the public about the correct use of briquettes and the importance of ventilation. The incidence of carbon monoxide poisoning also increased slightly in areas without the ban. Conclusion: Efforts are needed to investigate heating practices among households using briquettes, and to determine factors causing high carbon monoxide concentrations at home.

Revisiting older drivers' risks of at-fault motor vehicle collisions in Japan.

BACKGROUND: In Japan, older drivers have been encouraged to surrender their driving licenses for traffic safety despite the potential adverse social and health outcomes of driving cessation. We reconsidered such policies and social pressure by comparing the risk of at-fault motor vehicle collisions (MVCs) across the age groups of drivers. METHODS: Using the national data of police-reported MVCs that occurred between 2016 and 2020, we examined the number of at-fault MVCs per licensed driver (MVC rate) and the number of fatally and non-fatally injured persons per at-fault MVC by the sex and age groups of at-fault drivers. RESULTS: The MVC rate of older drivers was higher than that of middle-aged drivers but lower than that of young drivers. The number of injured persons among the collided counterparts (collided car occupants, motorcyclists, bicyclists, and pedestrians) per MVC caused by older drivers was not greater than that by drivers in other age groups. In fatal MVCs caused by older drivers, drivers themselves or their passengers tend to be killed rather than their collided counterparts. Overall, the results were mostly consistent between male and female drivers. CONCLUSIONS: The risk of at-fault MVCs increased with the advancing age of drivers after middle age; however, this risk among older drivers did not exceed that among young drivers, without posing a high risk of injuries to their collided counterparts.

Trend in Alcohol-related Crashes Before and After the Introduction of Mandatory Breath Testing Among Commercial Truck Drivers.

BACKGROUND: Since 2011, commercial truck drivers have been required to take alcohol breath tests at the beginning and end of their working hours due to their employers' legal obligations. However, non-commercial truck drivers are not required to do so. We examined whether alcohol-related crashes had decreased after 2011 among commercial truck drivers. METHODS: Using police data, we conducted a joinpoint regression analysis to examine the trend in the proportion of alcohol-related crashes from 1995 through 2020 caused by commercial truck drivers (who were subjected to alcohol breath testing) and non-commercial truck drivers (who were not subjected to testing). The annual percentage change in this trend was also estimated. RESULTS: During the 26-year study period, truck drivers caused 1,846,321 at-fault crashes, and 0.4% of the crashes involved intoxicated driving. A significant decreasing trend in the proportion of alcohol-related crashes was identified among both commercial and non-commercial truck drivers in the 2000s, during which several legal amendments were made against drunk driving. The annual percentage change was -13.5% from 2001 to 2012 among commercial truck drivers, and -14.9% from 2001 to 2011 among non-commercial truck drivers. No decreasing trend was observed afterwards, despite the introduction of mandatory alcohol breath testing in 2011. CONCLUSION: The effect of mandatory alcohol breath testing on reducing alcohol-related crashes among commercial truck drivers was not evident.

Reduced Road Injuries While Commuting Due to Heavy Snowfall and Ensuing Modal Shifts Among Junior High School Students in Japan.

BACKGROUND: Modal shifts in transport may reduce overall road injuries. Cyclist junior high school students are at a high risk of road injuries while commuting in Japan, and injuries among junior high school students could be reduced if the cyclists switch to other transport modes. METHODS: We estimated the change in the incidence of road deaths and serious injuries while commuting in months with heavy snowfall, when cyclists are likely to switch to other transport modes. Using police data on the monthly number of road injuries while commuting among junior high school students in Japan between 2004 and 2013 and corresponding population statistics and snowfall data, we calculated the monthly injury rate (number of deaths and serious injuries divided by population) at the prefecture level. We conducted Poisson regression analysis to estimate the change in the rate in months with a snowfall of ≥100 cm, compared to months without snowfall. RESULTS: A total of 3,164 deaths and serious injuries occurred during 2004 to 2013. The injury rate among cyclists was almost zero in months with a snowfall of ≥100 cm. That among cyclists and pedestrians in these months was reduced by 68% (95% confidence interval, 43-82%). CONCLUSION: In months with heavy snowfall, road injuries while commuting were reduced due to the near-elimination of cycling injuries among junior high school students in Japan. Switching from cycling to other transport modes would reduce overall road injuries among this population, and inducing modal shifts can be an important tool for road safety.

Relationship Between Prehospital Time and 24-h Mortality in Road Traffic-Injured Patients in Laos.

BACKGROUND: Road traffic injury has long been regarded as a "time-dependent disease." However, shortening the prehospital time might not improve the outcome in developing countries given the current quality of in-hospital care. We aimed to examine the relationship between the prehospital time and 24-h mortality among road traffic victims in Laos. METHODS: A prospective observational study was conducted using the trauma registry data on traffic-injured patients who were transported by ambulance to a trauma center in the capital city of Laos from May 2018 to April 2019. The analysis focused on patients with non-mild conditions, whose outcomes could be affected by the prehospital time. To examine the relationship between a prehospital time of <60 min and 24-h mortality, a generalized estimating equation model was used incorporating the inverse probability weights utilizing the propensity score for the prehospital time. RESULTS: Of 701 patients, 73% were men, 91% were riding 2- or 3-wheel motor vehicles during the crash, and 68% had a prehospital time of <60 min. A total of 35 patients died within 24 h after the crash. Compared with those who survived, individuals who died tended to have head and torso injuries. The proportions of 24-h mortality were 4.7% and 5.4% in patients whose prehospital time was <60 min and ≥60 min, respectively. No significant relationship was found between the prehospital time and 24-h mortality. CONCLUSION: A shorter prehospital time was not associated with the 24-h survival among road traffic victims in Laos.

Effectiveness of child burn prevention campaigns in Mongolia.

OBJECTIVE: To evaluate the effects of child burn prevention campaigns on medically attended burn injuries in Ulaanbaatar, Mongolia. METHODS: We conducted an interrupted time-series analysis using data on patients aged<5 years who were treated for burn injuries at the Emergency Department of the National Trauma and Orthopaedic Center from January 2009 to December 2018. Since the campaigns focused on scald prevention, we calculated the monthly rate of scald injuries per 10 000 children aged<5 years by sex and injury severity, regressing it on the number of months after January 2009 (the beginning of the study), after June 2014 (the first nationwide campaign started) and after January 2017 (the second facility-based campaign started). RESULTS: During the 10-year study period, there were 23 459 patients, of whom 18 433 (79%) were treated for scald injuries, including 6920 severe injuries. The monthly rate of overall scald injuries started to decrease after the first campaign, with a relative change of -32% at the end of the intervention. However, the rate started increasing before the initiation of the second campaign; this trend continued during and after the campaign. The rate of severe scald injuries did not show any significant changes throughout the study period. The results were consistent for both sexes. CONCLUSIONS: The nationwide burn prevention campaign was effective in reducing non-severe burn injuries among young children. Since the campaign was primarily aimed at increasing public awareness of child burn injury risks, further interventions should be considered with passive measures to prevent severe burn injuries.

Alleviating psychological distress associated with a positive cervical cancer screening result: a randomized control trial.

BACKGROUND: The method of communicating a positive cancer screening result should seek to alleviate psychological distress associated with a positive result. We evaluated whether the provision of information through a leaflet would help reduce psychological distress in a randomized controlled trial. METHODS: The participants were women aged 20-69 years who were about to undergo cervical cancer screening at health centers. Before the screening, they received hypothetical screening results, with a leaflet (intervention group, n = 493) or without it (control group, n = 479), randomly. Their psychological distress and intention to undergo further examination were then compared between the intervention and control groups. RESULTS: After the intervention (providing a leaflet with hypothetical screening results), psychological distress appeared to be higher in the control group than in the intervention group among those who received a hypothetical positive screening result (odds ratio: 2.57, 95% confidence interval: 1.87-3.54), while 95% and 97% of those in the intervention and control groups, respectively, reported that they would undergo further examination. CONCLUSIONS: Information provision might help reduce psychological distress but not hinder further examination among women who screen positive for cervical cancer. TRIAL REGISTRATION: UMIN Clinical Trials Registry UMIN000029894. Date of Registration: November 2017.

Area-Wide Traffic-Calming Zone 30 Policy of Japan and Incidence of Road Traffic Injuries Among Cyclists and Pedestrians.

Objectives. To quantify the impact of the "Zone 30" policy introduced in September 2011 on the incidence of cyclist and pedestrian injuries in Japan.Methods. This was an interrupted time-series study. We used the data of cyclist and pedestrian injuries recorded by the Japanese police between 2005 and 2016. We evaluated the monthly number of deaths and serious injuries per person-time on narrow roads (width < 5.5 m, subjected to the policy) compared with that on wide roads (≥ 5.5 m) to control for secular trends. We regressed the injury rate ratio on 2 predictors: the numbers of months after January 2005 and after September 2011. Using the regression results, we estimated the number of deaths and serious injuries prevented.Results. There were 266 939 deaths and serious injuries. By 2016, the cumulative changes in the rate ratio spanned from -0.26 to -0.046, depending on sex and age, and an estimated number of 1704 (95% confidence interval = 1293, 2198) injuries were prevented.Conclusions. The policy had a large preventive impact on cyclist and pedestrian deaths and serious injuries at the national level.

The Risk of Functional Limitations After Driving Cessation Among Older Japanese Adults: The JAGES Cohort Study.

BACKGROUND: Population ageing and stringent licensing policies will increase the number of older drivers who stop driving. Adverse health outcomes owing to driving cessation and their prevention are emerging concerns. Therefore, we longitudinally examined the impact of driving cessation and alternative transportation use after cessation on the risk of functional limitations in a cohort of community-dwelling people (65 years and older) in Japan. METHODS: Using cohort data of those who drove as of 2006/07, we compared the risk of functional limitations between 2,704 current drivers and 140 former drivers (who stopped driving by 2010). Of the former drivers, 77 did not use public transportation or bicycles after driving cessation (thus losing independent mobility). We calculated the hazard ratios (HRs) for the incidence of functional limitations with 95% confidence intervals (CIs) based on the Cox proportional hazards model with the covariates influencing the functional limitations. RESULTS: From 2010 through 2016, 645 people had functional limitations, which included 38, 82, and 119 per 1,000 person-years among current drivers, former drivers who used public transportation or bicycles, and former drivers who were only driven by others, respectively (HR 1.69; 95% CI, 1.15-2.49 and HR 2.16; 95% CI, 1.51-3.10, relative to current drivers). CONCLUSION: Driving cessation is associated with an increased risk of functional limitations among older adults, but this risk might be alleviated if they are able to maintain independent mobility using public transportation or bicycles after driving cessation.

Effect of a cognitive test at license renewal for older drivers on their crash risk in Japan.

OBJECTIVE: To evaluate the effect of adding a cognitive test to a license renewal procedure for drivers aged 75 years or older in reducing their motor vehicle collisions (MVCs). The test has been obligatory since June 2009. METHODS: Using monthly police-reported national data on MVCs from January 2005 through December 2016, we calculated the rates of MVCs per licensed driver-year by sex and age group (70-74, 75-79, 80-84 and 85 years or older) for each month together with the ratios of MVC rates of drivers in the three oldest age groups (which are subject to the test) to those of the 70-74 years group (not subject to the test) to control for extraneous factors affecting MVCs over the study period. Then, we conducted an interrupted time-series analysis by regressing the rate ratio stratified by sex and age group on the number of months from January 2005, June 2009 (when the cognitive test was introduced to a license renewal procedure) and June 2012 (when all drivers subject to the test have taken it at least once). RESULTS: The rates showed a longitudinal decrease in male and female drivers over the study period without any apparent effects of the introduction of the cognitive test while no significant decrease was observed in the rate ratios after the introduction of the cognitive test. CONCLUSIONS: There were no clear safety benefits of the cognitive test for drivers aged 75 years or older to reduce their MVCs.

Accuracy and clinical value of an adhesion scoring system: A preoperative diagnostic method using transvaginal ultrasonography for endometriotic adhesion.

AIM: To investigate the accuracy and clinical value of an adhesion scoring system using transvaginal ultrasonography for endometriotic adhesion. METHODS: In this prospective observational study, we included 131 patients with endometriosis who underwent surgery. Before surgery, transvaginal ultrasonography and adhesion mapping were performed to determine the presence or absence of adhesions at 10 sites of the pelvis. Mapping accuracy was determined by comparing the mapping findings with the surgical findings. To determine the severity of pelvic adhesions, we developed an adhesion score (0-10). With the adhesion score, we assessed the effect of surgical adhesiolysis and evaluated the relationship between postoperative adhesions and infertility. RESULTS: Of the 10 sites assessed for adhesions, the most frequent site of adhesions was the site between the left ovary and the uterus (70.5%). The overall sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio and accuracy of adhesion mapping were 80.4%, 86.1%, 78.8%, 87.2%, 5.79, 0.23 and 83.9%, respectively. The adhesion score in this system was significantly correlated with the adhesion-related score in the revised American Society for Reproductive Medicine classification (R2 = 0.734). Surgical adhesiolysis yielded only about 30% improvement postoperatively. The adhesion score 1 month after surgery in the non-in vitro fertilization (IVF) pregnancy group was significantly lower than that in the IVF pregnancy group (3.45 vs 5.21; P = 0.02). CONCLUSION: Our adhesion scoring system allowed an accurate prediction of the pelvic adhesion status and may potentially be an indicator of postoperative adhesions and infertility.

Case of ovarian steroid cell tumor diagnosed after presenting acute heart failure.

We report a rare case of an ovarian steroid cell tumor with a diagnosis prompted by heart failure symptoms. A 28-year-old Japanese nulligravida/nullipara with a chief complaint of respiratory discomfort during physical exertion and exhibiting heart failure symptoms was referred to our hospital. She also had signs of virilization, including secondary menorrhea since the age of 20, hirsutism and balding. Cushing's syndrome was suspected, and further examinations showed hypertestosteronemia and right ovarian tumor. Symptomatic treatment for heart failure with diuretics and antihypertensives was followed by abdominal right adnexectomy performed due to the androgen-producing ovarian tumor. The tumor was solid and larger than a fist, and confirmed as a steroid cell tumor through postoperative histopathology. Serum total testosterone levels normalized at day 3 postoperatively, and menstruation resumed 2 months later. Our case was diagnosed due to heart failure symptoms, and its treatment resulted in improvement in virilization signs.

Development of an emergency medical system model for resource-constrained settings.

OBJECTIVES: An emergency care system is an important aspect for healthcare organisations in low- and middle-income countries (LMICs) with a growing burden from emergency disease conditions. Evaluations of emergency care systems in LMICs in broader contexts are lacking. Thus, this study aimed to develop a comprehensive emergency medical system model appropriate for resource-constrained settings, based on expert opinions. METHODS: We used the Delphi method, in which questionnaire surveys were administered three times to an expert panel (both emergency medical care providers and healthcare service researchers), from which opinions on the model's components were compiled. The panel members were mostly from Asian countries. In the first round, the questionnaire drew a list of model components developed through a literature review; the panel members then proposed new components to create a more comprehensive list. In the second and third rounds, the panel members rated the listed components to achieve consensus, as well as to remove components with low ratings. Finally, we rearranged the list to improve its usability. RESULTS: In total, 32 experts from 12 countries participated. The final model totalled 177 components, categorised into 8 domains (leadership, community-based actions, emergency medical services, upward referral, definitive care, rehabilitation, downward referral, and evaluation and research). No components needed removal. CONCLUSIONS: We developed a comprehensive emergency care system model, which could provide a basis to evaluate emergency care systems in resource-constrained LMICs; however, field-testing and validation of this system model remain to be done.

OBJECTIFS: Un système de soins d'urgence est un aspect important pour les organisations de soins de santé dans les pays à revenu faible ou intermédiaire (PRFI), qui subissent une charge croissante d'affections de maladie d'urgence. Les évaluations des systèmes de soins d'urgence dans les PRFI dans des contextes plus larges font défaut. Cette étude visait donc à élaborer un modèle de système médical d'urgence complet, adapté aux contextes à ressources limitées, sur la base d'opinions d'experts. MÉTHODES: Nous avons utilisé la méthode Delphi, dans laquelle des enquêtes par questionnaire avaient été administrées à trois reprises à un groupe d'experts (prestataires de soins médicaux d'urgence et chercheurs en services de santé), à partir desquelles des avis sur les composants du modèle ont été compilés. Les membres du panel venaient principalement de pays asiatiques. Lors du premier tour, le questionnaire a dressé une liste des composants du modèle développés à travers une revue de la littérature; les membres du panel ont ensuite proposé de nouveaux composants pour créer une liste plus complète. Lors des deuxième et troisième tours, les membres du panel ont évalué les composants énumérés afin de parvenir à un consensus et d'éliminer les composants faiblement cotés. Enfin, nous avons réorganisé la liste pour en améliorer la convivialité. RÉSULTATS: Au total, 32 experts de 12 pays ont participé. Le modèle final comprenait 177 composants, classés en 8 domaines (leadership, actions communautaires, services médicaux d'urgence, référence ascendante, soins définitifs, suivi, référence postérieure, évaluation et recherche). Aucun composant ne nécessitait d'être exclus. CONCLUSIONS: Nous avons élaboré un modèle complet de système de soins d'urgence qui pourrait servir de base à l'évaluation des systèmes de soins d'urgence dans les PRFI aux ressources limitées. Cependant, les essais sur le terrain et la validation de ce modèle de système restent à faire.

Patterns of burns and scalds in Mongolian children: a hospital-based prospective study.

OBJECTIVE: To describe the circumstances of burn injury occurrence among Mongolian children and the products involved. METHODS: Study participants were children aged 15 years and younger who were admitted to the Burn Unit of the National Trauma Orthopedic Research Center from August 2015 to July 2016. We collected data on participant demographics and the aetiology and clinical features of their burn injuries, and we analysed the data based on the NOMESCO Classification model. FINDINGS: Of 906 children, 83% were aged 0-3 years, 66% were injured around the cooking area in the traditional tent-like dwelling called a ger or a detached house where no specified kitchen exists, and 28% were injured in a kitchen. Burn injuries resulted mostly from exposure to overflowing hot liquids (93%). Electric pots and electric kettles were the products most frequently involved in causing burn injuries (41% and 14%, respectively). Of 601 major burn injuries, 52% were due to electric pots. Moreover, burn injuries inflicted by electric pots were most likely to be major burn injuries (83%). Children typically fell into electric pots, while electric kettles were often pulled down by children. CONCLUSION: Burn injuries among Mongolian children mainly occurred in cooking area of a ger involving electric pots. The current practice of cooking on the floor should be reconsidered for child burn prevention.

Perioperative nutrition management as an important component of surgical capacity in low- and middle-income countries.

Needs for surgical care are growing in low- and middle-income countries. Existing surgical care capacity indicators, focusing on the availability of equipment, personnel, and operation and anaesthetic skills, are not intended to evaluate perioperative nutrition management, which influences surgical outcomes. In this narrative review, we describe the prevalence of malnutrition and its clinical consequences among surgical patients in low- and middle-income countries, suggest potential measures to improve nutrition management and discuss the necessity of considering nutrition management as a component of surgical care capacity.

Effectiveness of Prehospital Epinephrine Administration in Improving Long-term Outcomes of Witnessed Out-of-hospital Cardiac Arrest Patients with Initial Non-shockable Rhythms.

OBJECTIVE: We evaluated the association between prehospital epinephrine administration by emergency medical services (EMS) and the long-term outcomes of out-of-hospital cardiac arrest (OHCA) with initial pulseless electrical activity (PEA) or asystole. METHODS: We conducted a controlled, propensity-matched, retrospective cohort study by using Japan's nationwide OHCA registry database. We studied 110,239 bystander-witnessed OHCA patients aged 15-94 years with initial non-shockable rhythms registered between January 2008 and December 2012. We created 1-1 matched pairs of patients with or without epinephrine by using sequential risk set matching based on time-dependent propensity scores to balance the patients' severity and characteristics. We compared overall and neurologically intact survival 1 month after OHCA between cases and controls using conditional logistic regression models by category of the initial rhythm. RESULTS: Propensity matching created 7,431 pairs in patients with PEA and 8,906 pairs in those with asystole. Epinephrine administration was associated with higher overall survival (4.49% vs. 2.96%; odds ratio [OR], 1.55; 95% confidence interval [CI], 1.30-1.85) but not with neurologically intact survival (0.98% vs. 0.78%; OR, 1.26; 95% CI, 0.89-1.78) in patients with PEA, and with higher overall survival (2.38% vs. 1.04%; OR, 2.34; 95% CI, 1.82-3.00) and neurologically intact survival (0.48% vs. 0.22%; OR, 2.28; 95% CI, 1.31-3.96) in those with asystole. CONCLUSIONS: Prehospital epinephrine administration by EMS is favorably associated with long-term neurological outcomes in patients with initial asystole and with long-term survival outcomes in those with PEA.