E-scooter accidents: A rising cause of kidney injury

INTRODUCTION

E-scooters recently gained mass expansion, leading to increased use-related injuries, most commonly head trauma, facial, and extremity fractures, while abdominal trauma with kidney involvement is less frequent. Here we present two cases of e-scooter-related high-grade blunt kidney trauma.

CASE REPORTS

The first case was a 24-year-old male presenting with right abdominal pain after e-scooter autonomous right fall. Focused assessment with sonography for trauma (FAST) was negative, while abdominal CT showed a 3 cm middle-renal laceration. Six-day CT showed minimal urinary extravasation. Neither anemization nor impaired kidney function was observed; the patient was discharged after 9 days. The second case was a 42-year-old male presenting with right flank pain and ipsilateral chest pain after autonomous right fall. Thoracic X-ray revealed multiple rib fractures, while abdominal echography showed a non-homogeneous right kidney with a 1.5 cm perirenal fluid layer. Abdominal CT revealed 2.5 × 4 × 3.5 cm full-thickness middle-upper renal parenchyma laceration and confirmed the perirenal hematoma, while demonstrating two hepatic lesions. A series of CT and ultrasounds confirmed the stability of the aforementioned lesions and reduction of the perirenal hematoma; laboratory findings didn't show anemization nor impaired renal function. The patient was discharged after 10 days.

DISCUSSION

Widespread usage of e-scooter is accompanied by an uptick in traumatic events. The chance of renal trauma increases when lateral fall occurs. In our cases patients were hemodynamically stable, the kidney injury severity was high-grade, and non-operative management was effective.

CONCLUSION

E-scooter accidents could lead to high-grade renal injuries, amenable of non-operative management; these events are expected to raise.

Cannabis use and work-related injuries: a cross-sectional analysis

BACKGROUND

Although the association of cannabis use with automobile accidents has been well-studied, the impact of cannabis on workplace safety and injuries is less clear.

AIMS

The purpose of this study was to examine the relationship between work-related injury and cannabis use in the past year.

METHODS

We performed a cross-sectional analysis of the Canadian Community Health Survey (2013-16) of working individuals. We used multiple logistic regression modelling to calculate the odds of experiencing a work-related injury (defined as non-repetitive strain injury) among workers who reported using cannabis more than once during the prior 12 months as compared to non-users. We repeated the analysis among participants working in high injury risk occupational groups only.

RESULTS

Among the 136 536 working participants, 2577 (2%) had a work-related injury in the last 12 months. Of these 2577 who had a work-related injury, 4% also reported being a cannabis user in the same period. We found no association between past-year cannabis use and work-related injury (odds ratio for work injury among users 0.81, 95% confidence interval 0.66-0.99). The association was unchanged in the subgroup analysis limited to high injury risk occupational groups.

CONCLUSIONS

We found no evidence that cannabis users experienced higher rates of work-related injuries. While awaiting prospective studies, occupational medicine practitioners should take a risk-based approach to drafting workplace cannabis policies.

Traumatic spinal cord injury in southern Saudi Arabia: Patterns, time to surgery and outcomes

Introduction:

Spinal cord injury (SCI) is an unbearable neurological disorder. which has a destructive socioeconomic effect of affected individual, their families and the healthcare systems. Stressful spinal cord damages are caused by road traffic misfortunes, violence, sports or falls.

Methods:

Retrospective study of 112 spinal cord injured patient admitted to Aseer Central hospital (ACH) between the years 2016 and 2018.

Results:

The present study includes 112 cases of TSCI patients who admitted to Asser Central Hospital and surgically treated, with mean age 32.1 ± 14.12 years. Males were the mostly affected by almost 90.2%. Lower level of education is seen in 69.6% of patients; while only 30.3% of patients had university education or higher. Motor vehicle accidents (MVA) and falls are the only two causes of spinal cord injuries in this study; however, MVA was the cause of SCI in (79.5%) and 20.5% for falls.

Conclusions:

MVAs are the most source of spinal cord injuries in Southern Saudi Arabia with high male predominance. Despite the lack of significance between shorter time to surgery, and improvement in ASIA score, it was found that shorter time to surgery plays an important role in reducing the post-operative intensive care unit and ward stay, potentially reducing possible long stay related complications and eventually reducing health care cost.

Bus stop design and traffic safety: An explorative analysis

One way to prioritize public transport over private vehicle mobility, is to implement curbside rather than layby bus stop designs. There is, however, uncertainty about the consequences of implementing curbside rather than layby stops for traffic collision risks. To begin investigating this issue, we describe an exploratory analysis in which national data describing bus stops, road properties, traffic collisions and built-up areas were merged based on geographical location. Analysis of the resulting data set suggests that the relative rates of traffic collisions resulting in personal injury within 60 m of the bus stop, is higher for curbside than for layby stops in built-up areas (0.32 vs. 0.22 collisions per ten million passing vehicles, respectively). Our analyses suggest that the higher risk of nearby collisions for curbside stops is not necessarily due to bus stop design, but rather because they tend to be located closer to junctions and side roads, where collisions are more likely. Our data are not consistent with hypotheses that curbside stops are associated with greater shares of head-on or rear-end collisions than layby stops, nor that layby stops are associated with greater shares of side-on collisions than curbside stops. The limitations of this exploratory analysis, and of the use of national-level data for studying the effects of bus stop design on collision risk, are related to lack of control of bus stop design features other than curbside vs. layby, statistical power, data registration and compromises made when coupling data based on geographical location. Future work should attempt to build on our approach, and supplement database analyses with analysis of in-depth reports of bus stop collisions, observations of road user conflicts near bus stops, and before-after studies following conversion from layby to curbside stops or from curbside to layby stops.

Defining crash configurations for Powered Two-Wheelers: Comparing ISO 13232 to recent in-depth crash data from Germany, India and China

The motorcyclist safety standard ISO 13232, based on crash data from Europe and the USA from the 1970s, still sets the direction for the development and evaluation of protective measures today. However, it is unclear how relevant the crash configurations in the standard are to present-day motorcycle crashes in Europe, the USA and other parts of the world. We analyzed recent in-depth crash data from Germany, India and China, examining powered two-wheeler (PTW) crash configurations in which at least one police-reported serious injury was present. After assessing the relevance of the ISO's PTW crash configurations to those we found in each country, we suggested new configurations to guide the development of safety systems that would be more effective at reducing PTW-related fatalities and serious injuries. In all three databases, passenger cars were among the top two most frequent collision partners and a car front impacting the side of the PTW was the most common configuration. Notably, although collisions with trucks constituted the most common scenario in India and ground impact (primary collision) was a common scenario in both Germany and India, the ISO did not include either configuration. Further, in three of the seven ISO crash configurations, one of the collision partners is stationary, although stationary collision partners were rare in our data. Our results show that the ISO crash configurations do not represent the most frequent PTW road crashes in Germany, India or China. However, the Chinese database was confined to crashes with a collision partner with four or more wheels. Further, weighting factors for these data were not available, so we could not extrapolate the frequency of the Chinese crash configurations across the entire population. A revised version of the ISO could serve as a basis for a full-scale PTW crash test program. However, the observed differences between countries imply that a single global standard may not be feasible. To optimize the evaluation of a PTW safety system, we recommend the inclusion of configurations which are frequent in the region or country of interest-in addition to common configurations occurring frequently all around the world.

Medical unfitness for work at sea: causes and incidence rate over a 12-year period in France

Background

The purposes of the study were first to determine the incidence rate of medical unfitness for work at sea among French seafarers, second to identify the conditions (diseases or accidents) causing such incapacity so as to set up prevention measures where possible and third to ascertain whether there were any overrepresentations of diseases according to category of unfit seafarers (fishers, merchant seafarers, shellfish farmers and professional sailors).

Methods

An exhaustive, observational, descriptive, retrospective epidemiological and nosological study was carried out based on the medical coding of files stored in the Aesculapius® national database, which registers all medical data regarding seafarers presenting at the French seafarers’ health services. The increasing rate of permanent medical unfitness for work at sea was calculated in relation to the annual number of registered seafarers. A 12-year span was chosen in an attempt to ascertain the different sociodemographic categories associated with incapacity.

Results

In all, 2392 seafarers were declared unfit for work at sea. This represents a permanent medical unfitness for work at sea incidence rate of below 1% for all French seafarers examined for medical fitness between 2005 and 2016.

The average age of the population of unfit seafarers was 48. The average time spent at sea before being declared unfit for work at sea was 15.5 years. Sixty-seven percent of the seafarers declared unfit had been working in the fishing sector.

The main reasons for deciding permanent unfitness for work at sea were: rheumatological conditions associated specifically with the spine; injuries relating to accidents or other external causes, mostly affecting the upper limbs; mental and behavioural disorders, including mood disorders and particularly addictions; and diseases of the circulatory system, namely coronopathies. The incidence rate of medical unfitness for work at sea was seen to increase between 2005 and 2016, but a decrease due to the dilution effect was noted in 2015.

Conclusions

Permanent unfitness seldom occurs among French professional seafarers. Prevention measures must be focused on musculoskeletal disorders, psychiatric affections and coronary conditions as well as on combatting maritime accidents, especially in the professional fishing sector, where such affections and accidents are overrepresented.

Survey on Agricultural Accidents or Injuries in Taiwan

The agricultural industry has been identified as one of the most hazardous industries in developed countries. The main purpose of this paper was to conduct a comprehensive analysis of agricultural accidents (or injuries) in Taiwan during the period of 2009 to 2018. The occupational accident rates (per 1,000 farmers employed) in Taiwan's agricultural industry showed a decreasing trend over the past decade from 1,486 in 2009 to 1,053 in 2018. This trend could be attributed to the joint-cooperation efforts of the industrial, official, academic, and non-profit parties under the Occupational Safety and Health Act (OSHA) revised in 2013. Although the occupational accident, disability, and other injury rates in all non-agriculture industries were higher than those in the agricultural industry during this period, the fatality rates in the agricultural industry were higher than those in all industries. Finally, some inter-ministerial measures on occupational safety and health issues in the agricultural industry for preventing agricultural accidents or injuries were recommended in the paper.

Hospital Seeing More Personal Mobility Device Accidents and Serious Injuries Despite Active Mobility Act

Introduction:

E-scooters or personal mobility devices (PMDs) have recently been growing in popularity in Singapore. These devices can be especially helpful for those who have reduced mobility or who need to move between several relatively near locations multiples times per day or who simply appreciate the added convenience of having another transportation option. The increasing popularity of PMD has met with growing public concern over safety. Singapore government passed the Active Mobility Act (AMA) in January 2017 to regulate the usage of PMD. In Khoo Teck Puat Hospital, PMD-related accident has increased year on year by 20%–30%. Our study is to compare the incidence and severity of PMD-related accidents before and after the implementation of the AMA.

Materials and Methods:

A retrospective study of patients presented to the emergency department (ED) of Khoo Teck Puat Hospital for PMD-related accidents between November 2014 and October 2017. In year 1 of the study, we included patients presenting between November 2014 and October 2015. In years 2 and 3, we included patients presenting between November 2015 and October 2016 and November 2016 and October 2017, respectively. Data collected included demographic information, type of device used and impact, outcome, and injury severity score (ISS).

Results:

A total of 697 PMD-related accidents were seen in our center. We observed an increasing trend of accidents with significant injuries. There were 157 accidents reported in year 1, 233 in year 2, and 307 in year 3. The mean age of patients increased from 28 ± 15 years (range, 5–89 years) in year 1 to 33 ± 15 years (range, 4–83 years). Most patients were males (61.8% in year 1, 76.8% in year 2, and 73.3% in year 3) and Chinese (55.4% in year 1, 62.7% in year 2, and 65.5% in year 3), followed by Malays, Indians, and others. Devices commonly associated with injury were E-scooters, skateboards, and E-bicycles. E-scooters accidents had increased drastically from 12.1% in year 1 to 58.3% in year 3, but E-bicycles and other PMD accidents had decreased in year 3. Most patients were injured from falling off their devices (83.4% in year 1, 83.7% in year 2, and 79.5% in year 3), followed by collisions. Most patients arrived to the ED with own transports and were triaged to the patient acuity category 3 or 4. Most injuries were mild, with ISS <9 (97.5% in year 1 and 94.9% and 94.1% in year 2 and 3, respectively). The most common PMD-related injuries involved external injuries, followed by upper and lower extremities injuries. For more severe injuries (ISS ≥9), the number had increased from 4 in year 1 to 18 in year 3. Most patients were discharged. The number of patients required admissions increased from 12 to 44 in year 3, with two high-dependency or intensive care unit admissions. The mean hospital stay reduced from 5.0 ± 6.0 days to 3.6 ± 4.1 days, with the survival rate remained at 100%. There was only one fatality was reported in year 2.

Conclusion:

There is an increase in injuries and severity of PMD accidents despite AMA being implemented in January 2017. More need to be done to ensure the safety of PMD-related use in Singapore footpaths and roads.

Characterization of fatal injuries in oil and gas industry-related helicopter accidents in the Gulf of Mexico, 2004-2014

Background

Transportation events are the most common cause of offshore fatalities in the oil and gas industry, of which helicopter accidents comprise the majority. Little is known about injury distributions in civilian helicopter crashes, and knowledge of injury distributions could focus research and recommendations for enhanced injury prevention and post-crash survival. This study describes the distribution of injuries among fatalities in Gulf of Mexico oil and gas industry-related helicopter accidents, provides a detailed injury classification to identify potential areas of enhanced safety design, and describes relevant safety features for mitigation of common injuries.

Methods

Decedents of accidents during 2004–2014 were identified, and autopsy reports were requested from responsible jurisdictions. Documented injuries were coded using the Abbreviated Injury Scale (AIS), and frequency and proportion of injuries by AIS body region and severity were calculated. Injuries were categorized into detailed body regions to target areas for prevention.

Results

A total of 35 autopsies were coded, with 568 injuries documented. Of these, 23.4% were lower extremity, 22.0% were thorax, 13.6% were upper extremity, and 13.4% were face injuries. Minor injuries were most prevalent in the face, neck, upper and lower extremities, and abdomen. Serious or worse injuries were most prevalent in the thorax (53.6%), spine (50.0%), head (41.7%), and external/other regions (75.0%). The most frequent injuries by detailed body regions were thoracic organ (23.0%), thoracic skeletal (13.3%), abdominal organ (9.6%), and leg injuries (7.4%). Drowning occurred in 13 (37.1%) of victims, and drowning victims had a higher proportion of moderate brain injuries (7.8%) and lower number of documented injuries (3.8) compared with non-drowning victims (2.9 and 9.4%, respectively).

Conclusions

Knowledge of injury distributions focuses and prioritizes the need for additional safety features not routinely used in helicopters. The most frequent injuries occurred in the thorax and lower extremity regions. Future research requires improved and expanded data, including collection of detailed data to allow characterization of both injury mechanism and distribution. Improved safety systems including airbags and helmets should be implemented and evaluated for their impact on injuries and fatalities.

Epidemiology of road traffic crashes in Ilam Province, Iran, 2009-2013

Objective

Road traffic crashes (RTCs) are major public health challenges of world health systems, and the main leading cause of death in children and young adults aged 5 to 29 years. This study aimed to assess the epidemiology of RTCs in Ilam, Iran.

Results

The total mortality rate due to RTCs has been increasing every year. There was a statistically significant relationship between age/sex and death or injury from RTCs in pedestrians, drivers, and passengers (p < 0.05). There was a significant relationship between the part of body trauma and RTCs in pedestrians (p < 0.001). Furthermore, a significant relationship was found between the type of vehicle and using seat belt with RTCs in drivers and passengers (p = 0.000).

Absence epilepsy: Characteristics, pathophysiology, attention impairments, and the related risk of accidents. A narrative review

OBJECTIVE

Absence epilepsy (AE) is related to both cognitive and physical impairments. In this narrative review, we critically discuss the pathophysiology of AE and the impairment of attention in children and adolescents with AE. In particular, we contextualize the attentive dysfunctions of AE with the associated risks, such as accidental injuries.

DATA SOURCE

An extensive literature search on attention deficits and the rate of accidental injuries in AE was run. The search was conducted on Scopus, Pubmed, and the online libraries of the University of Twente and Maastricht University. Relevant references of the included articles were added. Retrospective and prospective studies, case reports, meta-analysis, and narrative reviews were included. Only studies written in English were considered. Date of last search is February 2020. The keywords used were "absence epilepsy" AND "attention"/"awareness", "absence epilepsy" AND "accidental injuries"/"accident*"/"injuries".

RESULTS

Ten retrospective and two prospective studies on cognition and AE were fully screened. Seventeen papers explicitly referring to attention in AE were reviewed. Just one paper was found to specifically focus on accidental injuries and AE, while twelve studies generally referring to epilepsy syndromes - among which AE - and related accidents were included.

CONCLUSION

Absence epilepsy and attention deficits show some patterns of pathophysiological association. This relation may account for dysfunctions in everyday activities in the pediatric population. Particular metrics, such as the risk related to biking in children with AE, should be used in future studies to address the problem in a novel way and to impact clinical indications.

Electric scooters: convenient transport or ED headache?

Electric scooters (e-scooters) provide a potentially attractive means of private transportation in the pandemic era, during which use of public transport is discouraged. E-scooter use has become widespread recently, and we have noticed a concomitant rise in related craniomaxillofacial injuries, often associated with alcohol consumption and lack of protective equipment. We present here the first-published UK data on electric scooter injuries which, in the post-lockdown period, included facial lacerations, mandibular and midface fractures, avulsed teeth, and cervical spine injury. We urge that forthcoming legislation make e-scooters subject to at least the same requirements in lighting, helmet wear, and sobriety as bicycles and that, in this way, their benefits can be enjoyed while reducing associated morbidity and mortality.

Increasing evacuation flow through school bus emergency roof hatches

Emergency escape roof hatches are used to evacuate school buses in rolled-over orientations. In the United States, the minimum opening size of a roof hatch is defined by Federal Motor Vehicle Safety Standard (FMVSS) no. 217. With the prevalence of rising obesity rates among children, the minimum roof hatch opening size may not be large enough to accommodate larger passengers. Post-accident conditions such as injuries, disorientation, and exit obstructions may also prevent unobstructed passage for egress within acceptable time limits. The purpose of this study was to redesign and fabricate a roof hatch with a larger opening and evaluate its egress characteristics for a range of typical school bus passengers. The larger roof hatch opening allows greater evacuation flow rates, and is almost functionally equivalent to the evacuation flow rate of the front door on an upright school bus.

Integrated Highway Safety Information System (HSIS) datasets by means of a Roadway Safety Data Integrator (RSDI) tool

The datasets and tool presented in this article are related to the research article entitled "Improving crash predictability of the Highway Safety Manual through optimizing local calibration process" (Dadvar et al., 2020) [1], in which these datasets were used to investigate alternative local calibration methods for the Highway Safety Manual (HSM) [2] local application. The datasets are integrated Highway Safety Information System (HSIS) [3] state-wide rural two-lane, two-way roads (R2U) data from states of Illinois and Washington. The HSIS is a database that maintains motor vehicle crash data, roadway inventory, and traffic volume data for several US states. It is an excellent source of data to highway safety research and can be used to investigate many research questions. However, to prepare an analysis-ready roadway safety dataset based on the HSIS or any databases that store the relevant data in multiple different datasets, the researchers should integrate multiple datasets, merge or unmerge and remove certain inconsistent records, and finally clean the integrated dataset. The HSIS staff is usually accommodating and eager to help, but sometimes the nature of data needs is complicated and laborious. A tool named Roadway Safety Data Integrator (RSDI) was developed for combining, segmenting, and selecting homogeneous (unchanged during the study period for certain variables of interest) HSIS roadway segments and also crash assignment by desired crash attributes (e.g., crash severity or type). The RSDI tool can be helpful for integrating different safety-related datasets such as roadway inventory (including grade, curve, and other subsets), traffic volume, and motor vehicle crash data; also, it can do required segmentation and identify the homogeneous roadway segments over the desired years of study that are the basis for development and calibration of the HSM predictive models. The shared datasets contain homogeneous roadway segments, geometric details, and crash data for six years from Illinois (2005-10) and Washington (2010-15). The datasets and RSDI tool would be important sources generally for investigating highway safety research questions and in particular, for HSM-related analyses. The RSDI tool can be used for similar purposes and it is not limited to the HSIS data. It can be used for segmentation and finding homogeneous segments of any datasets that follow linear referencing. The datasets and RSDI tool are hosted in the Mendeley Data repository [4].

Air carrier's liability for the safety of passengers during COVID-19 pandemic

The paper aims to determine the situations when the air carrier is liable for the transmission of COVID-19 in the course of air transport. It must be emphasized here that the carrier's liability results from bodily injury or death that are caused by an accident on board an aircraft or during the operations of embarking or disembarking. Accordingly, in this paper, we addressed if the transmission of COVID-19 an 'accident' within the Conventions' meaning and the period of air carrier's liability for passengers' contraction of COVID-19, taking into consideration the exoneration of air carrier's liability in COVID-19 cases. In addition, this paper will study the scope of the safety measures as required by ICAO to prevent the spread of COVID-19 and therefore protect the passengers' safety. In our opinion, we found that the estimate is left to the judge because the assessment of this matter is based on an objective criterion based on the reasonable person test and the fact of each case.

A review of deadly accidents involving fireworks in Denmark

The aim of this study was to describe the circumstances surrounding firework-related deaths in Denmark, locate similarities and compare findings to the other known literature. Autopsy files, including police reports, located through searches in the archives of the three Danish institutes of forensic medicine were accessed. Data describing the age, gender, toxicology findings, circumstances of the accident, cause of death, autopsy findings and type of fireworks were examined. Eight cases involving firework-related deaths matched the search criteria, two of which occurred on New Year's Eve. An unknown number of cases that had not been autopsied were confirmed to exist. Data from the included cases suggested that using illegal fireworks, being male and handling fireworks directly played a key role in deaths. Most notably, illegal fireworks account for few injuries overall but caused the most deaths found in this study. Firework-related deaths are a rare occurrence. Autopsy findings often reveal blast wave injury to be the cause of death. Only one of the eight decedents included in this study were intoxicated with alcohol. Thus it can be assumed that powerful illegal fireworks are, by themselves, a risk factor for a deadly accident, independent of alcohol intoxication.

Epidemiology of injuries in Australian junior rugby league players

OBJECTIVES

Conduct a large-scale epidemiological study of injury characteristics (location, type, mechanism, severity, burden) and incidence in community junior rugby league.

DESIGN

Prospective cohort epidemiology study.

METHODS

Injury surveillance was conducted in three district leagues (Penrith, Canberra, Melbourne) in under 6 (U6) to under 18 years (U18) age groups across the 2016 season. Club sports trainers recorded all match/training medical-attention injuries using a commercial electronic application which recorded injury circumstances and characteristics.

RESULTS

A total of 13,169 players from 897 teams participated and 408 (89% male) players sustained 485 injuries, 94% of which were match related. The overall injury incidence was 5.9 injuries/1000 player hours and highest in U13-U18 female players (22.2 injuries/1000 player hours). The mean injury severity of 16±31 days missed training/match-play caused an overall injury burden of 94.2 days missed/1000 player hours). Tackles accounted for 84% of injuries. Joint and contusion injuries were the most prevalent injury type and the head (35% total injuries, primarily bruising and bleeding) was the most injured body site.

CONCLUSIONS

This is the first study to report injuries across a large cohort of all-age Australian community junior rugby league players over one season. Injury prevalence was lower than previously reported in junior rugby league suggesting the sport has not become more dangerous for junior players. These findings provide an evidence-base to inform or revise policy, training and injury prevention programs and athlete development pathways in relation to game-wide safety and develop best-practice protocols in injury management for rugby league athlete support personnel.

Characteristics of drowning deaths in an inner city river

A study was undertaken of all drowning deaths that occurred over a 30-year period from 1988 to 2017 in the urban section of the River Torrens, Adelaide, South Australia, an augmented waterway that runs through the central business district. Autopsy records from Forensic Science South Australia (FSSA) were reviewed. There were 34 drownings (0-5 cases/yr) with 28 males and 6 females (M;F = 4.6:1), with an age range for males of 18-76yrs (mean 42.0; SD 18.0) and for females of 20-84yrs (mean 69.3; SD 24.5). There were 15 (44%) accidents, 11 (32%) suicides, 1 (3%) homicide and 7 (21%) undetermined. Of the 22 cases during or after 1994 with complete toxicology reports, 10 (45%) had a blood alcohol concentration (BAC) of greater than 0.05% (g/100 mL) with an illicit substance detected in 4 (18%) cases: (MDMA (3,4-methylenedioxymethamphetamine), methylamphetamine and THC (delta-9-tetrahydrocannabinol) acid). The presence of various therapeutic drugs was also detected in 10 cases (45%) including temazepam, fluoxetine, diazepam, olanzapine, amitriptyline, carbamazepine, codeine, citalopram and valproate. Although the numbers of cases were not high, the urban portion of the River Torrens had a much higher number of drowning events per kilometre compared to other inland waterways in South Australia such as the Murray River. This is most likely due to the vulnerability that exists for intoxicated individuals in the city from falls into the water and to the availability of the river as a means of suicide to members of the adjacent urban population.

Applying health, safety, and environmental risk assessment at academic settings

Background

Students, staff, and faculties are involved in activities that exposed them to a range of minor to severe or even fatal accidents in academic settings. Managing work environment risks is crucial to any safety and health prevention program. This study developed a risk assessment using combinations of hazards and risk factors to establish a scale of measures in a risk reduction action plan.

Methods

This cross-sectional study was conducted in an Iranian medical sciences university in 2018. A structured method of risk assessment was developed, applying a three-step procedure to identify hazards, consequences, and risk evaluation. Data were collected through detailed health, safety, and environment checklist in 38 different sites. Finally, the risks quantified, prioritized, and control measures proposed accordingly. Chi-square and correlation tests assessed how environmental factors were associated with hazard consequences. The analysis results were evaluated at the significance level of 0.05.

Results

The frequencies of moderate and high-risk levels were 22.7 and 2.9%, respectively. Thus, corrective measures should be considered as soon as possible and immediately for these risk groups. Facilities and functions within laboratories, library, and powerhouse were more vulnerable to serious risks. The type of hazard had associated with the sites and total risk score at the significance level of 0.05 (P-value = 0.017). Similarly, risk severity was significantly related to the sites (P-value = 0.003). Safety hazards had a statistically higher contribution to the total risk score when compared to health and environmental hazards.

Conclusion

The study revealed complex risks and hazardous circumstances with significant variances in academic sites and activities. Universities should provide training in risk reduction programs to increase the awareness of students, staff, and faculties, which can improve life safety in a university environment.

Driving-Related Adverse Events in the Elderly Men: A Population-Based Prospective Cohort Study

OBJECTIVE

This study estimated the incidence of driving-related adverse events and examined the association of cognitive function with the risk of future driving-related adverse events in the elderly Korean male population.

METHODS

We analyzed 1,172 male drivers aged 60 years or older in the Korean Longitudinal Study on Cognitive Aging and Dementia (KLOSCAD). Using the data from Korean National Police Agency, we classified the participants into three groups: safe driving (drove for 2 years after baseline without a traffic accident or repeated violations), driving cessation (stopped driving), and risky driving (one or more traffic accidents or repeated violations). We estimated the incidences of driving cessation and risky driving, and examined the effect of cognitive function on their risks.

RESULTS

The incidence of driving cessation and risky driving in the Korean male drivers aged 60 years or older was 19.3 and 69.9 per 1,000 person-years respectively and increased in the late 80s. Drivers with better baseline Word List Memory Test scores showed less risky driving (OR=0.94, p=0.039).

CONCLUSION

Driving-related adverse events increased in late 80s, and better memory function was protective against these events.

Use of psychoactive substances among patients presenting at the emergency department of a tertiary hospital

Background

Psychoactive substance use is frequently encountered in hospitals' emergency departments (EDs). It accounts for major health-care problems frequently leading to accident and ED admissions, yet it is frequently unidentified. The aim of this study was to determine the prevalence and pattern of psychoactive substance use among patients presenting in the Accident and EDs and to compare the case detection rate of psychoactive substance use between self-report questionnaire and biochemical markers (e.g., urine toxicology).

Methods

To achieve this, 200 consenting participants attending the accident and emergency unit of a tertiary hospital were consecutively enlisted into the study within 2 weeks. They were screened for psychoactive substance use with the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) and the urine drug test (UDT).

Results

The lifetime prevalence of psychoactive substance use was 45.5%, while the past 3 months (recent use) prevalence was 27.0%. The pattern of psychoactive substance use revealed that alcohol was the predominant psychoactive substance use with a lifetime prevalence of 13.0% and recent use of 12.0%. The UDT significantly detected more patients who used psychoactive substance compared to self-report (P < 0.001).

Conclusion

The prevalence of drug use recorded among attendees of the accident and emergency unit was high in this study. The UDT significantly detected more patients who used psychoactive substances compared to self-report (P < 0.001). Several patients with major health problems as a result of psychoactive substance use were identified with the aid of these screening tools.

Fatal craniofacial circular-saw-related injury: a rare case of accidental death

Fatal injuries caused by circular saws are rare and mainly self-inflicted. To the best of our knowledge this is the first recorded case of accidental death of a woman caused by an injury to the head region inflicted by a saw blade. The autopsy showed a 35 cm long wound, stretching from the right half of the jaw along the right side of the face and the right temporal region up to the parietal region. The cut went through the right hemisphere of the brain in the temporal and parietal lobe regions, damaging the sagittal sinus. Air embolism was considered to be the cause of death. Fatalities involving power tools, such as a circular saw, warrant a high degree of suspicion of criminal activity and require a comprehensive medicolegal investigation. Placing guards over the blade and around the driving system, i.e. the motor, belt, arbor, is of great importance for the prevention of potentially fatal injuries.

The self-sustaining decomposition of ammonium nitrate fertiliser: Case study, Escombreras valley, Spain

Fertilisers containing ammonium nitrate have caused several accidents over the years, including toxic clouds, fires and explosions. For this reason, this work examines the accident that occurred in Escombreras valley (Cartagena, Spain) related to the decomposition of NPK 15-15-15 fertiliser, composed basically of monoammonium phosphate, ammonium nitrate and potassium chloride. The fertiliser was stored in a silo and its decomposition produced a toxic cloud formed of nitrogen oxides. Calculations have been made to determine the amount of heat released in the accident and the temperature gradient in the stored pile. The causes of the accident are not clear but could be related to the presence of decomposing organic matter. Fault tree analysis has revealed several weak points in the storage conditions. The dispersion of the gases produced has been simulated to evaluate the distance that dangerous concentrations of gases would reach. Almost 4000 people suffered the consequences of the accident, although most of them experienced only minor irritations and episodes of confinement due to their proximity to the site. To conclude, a series of lessons have been extracted that can help avoid similar accidents in the future.

Short and Long-Term Parental Posttraumatic Stress After a Child's Accident: Prevalence and Associated Factors

Studies on the long-term prevalence of parental posttraumatic stress symptoms (PTSS) following child accidental injury are scarce, and findings on risk factors vary. In this follow-up study (T2, n = 69) we determined the prevalence of parental PTSS 2-4 years after accidental injury of their child, compared with 3 months after the accident (T1, n = 135). Additionally, we examined the association between parental and child factors and PTSS severity. Children were 8-18 years old at the time of the accident. Parent and child PTSS was assessed by self-report. Other data were retrieved from medical records and a telephone interview. Parental PTSS was 9.6% at T1 and 5.8% at T2. Acute parental stress as measured within 2 weeks of the child's accident was significantly associated with parental PTSS severity (T1 and T2), as was the child's hospitalization of more than 1 day at T1 and the child's permanent physical impairment at T2. To prevent adverse long-term psychological consequences we recommend identifying and monitoring parents at risk and offering them timely treatment.

The Application of Non-Parametric Count Models for the Modeling of Female's Accident Rates in Hamadan Province from 2009 to 2016

BACKGROUND

Accidents were just one of the general health problems. According to WHO forecasts (2013), deaths from road accidents will become the fifth-highest cause of death in the world by 2030. Therefore, we have attempted the application of non-parametric count models for modeling female's accident rates.

METHODS

All accidents in Hamadan Province, western Iran are referred to as one of the emergency centers located in the hospitals. Data regarding the accidents were obtained from 21 emergency centers across Hamadan for the period 2009-2016. To assess the trend and pattern of the accidents, the Generalized Additive Model for the accident rate has been utilized.

RESULTS

The Mean±SD age of the females in study was 31.23±12.88 yr old. For each of the three kinds of road accidents (car accidents, motor accidents and pedestrian crashes), the accident rates in the "residential urban" areas are lesser than in the "non-residential" area (P=<0.001) and in "public and sports grounds" and "great roads, avenues and streets" are more than in "others". For the three kinds of accidents, the functional effect in the monthly trend of the accidents was signification (P=<0.001).

CONCLUSION

The rates for all three kinds of accidents decreased. The increase in accident rates from the beginning of 2014 to Mar 2016 maybe due to the generalization of insurances in Iran and the increase in the number of accident victims being referred to the hospitals, which was the same with the results of other studies.

(Side) effects of the rule of the road and neurophysiology on traffic safety: A hypothesis

Nowadays, the roots of left-hand traffic (LHT) and right-hand traffic (RHT) - including fighting on horse-back and whipping horses that are drawing carriages - are at an all-time low; thus, it is time to assess and appreciate the nexus of road-safety practices and human neurophysiology. We hypothesize that safety of LHT and RHT can be associated with neurophysiology. We summarize scattered empirical research into plausible links between neurophysiological aspects such as handedness, eye movement bias, and hemispheric lateralisation and how safe, in theory, LHT vs. RHT may be for whom. The scarcity and limitations of empirical data into road traffic accidents associated with LHT or RHT are surprising. Even though it was claimed that countries with LHT have lower collision rates than countries with RHT some 50 years ago, we lack informative analyses of traffic accidents in countries with either LHT or RHT which consider plausibly associated neurophysiology. Overall, we predict that LHT (with the driver sitting on the right) is safer than RHT. As 'the rule of the road' and neurophysiology may have important unrecognized "side" effects, we suggest that (and how) this rationale should be tested.

Circumstances and causes of death of hikers at different altitudes: A retrospective analysis of hiking fatalities from 2003-2018

INTRODUCTION

The number of hikers and the popularity of hiking in the Alpine region is great. Inevitably linked to this, natural deaths as well as fatal and non-fatal accidents occur. Nevertheless, there is little data available on hiking accidents in particular. This study examines the circumstances of accidents and the causes of death of hikers who have suffered fatal accidents.

METHODS

Retrospectively, the police files and forensic medical reports of hiking fatalities in the Canton of Berne (Switzerland) from 2003 to 2018 were analyzed. In this process 25 predefined parameters were collected (e.g. manner of death, causes of death, height of fall). Subsequently, all fatal hiking accidents were evaluated and compared by altitude (<1800 m vs. >1800 m).

RESULTS

77 fatal hiking accidents were recorded in the given period, all of which were caused by a fall. Over 1800 m significantly more traumatic brain injuries occurred than under 1800 m (85 vs. 62.2 %, p = 0.022). Besides, significantly more accidents occurred during descent in the group above 1800 m than below 1800 m (60.9 vs. 84.8 %, p = 0.041). A large share of accidents occurred off official hiking trails (45.9 vs. 32.5 %). Significantly more equipment shortages were found in the group below 1800 m (32.4 vs. 12.5 %, p = 0.035). The accident victims with equipment shortages were on average 10.35 years younger.

CONCLUSION

Causes and circumstances of death of hikers differ in some points significantly at different altitudes. Prevention in the form of education about the dangers of hiking off the official hiking trails and equipment shortages could prevent deaths in the future. The education should primarily be aimed at foreign, young and inexperienced hikers.

Self-assessed competencies of nurses at an emergency department in Ghana

Introduction

The nature and scope of emergency nursing exposes nurses to a wide array of patient populations with rapidly changing and unexpected clinical conditions, sophisticated logistics and procedures. Hence, emergency centre (EC) nurses ought to be ready to face diverse clinical challenges and deliver care to patients in a timely cost-effective manner and with the needed competence. The current study aimed at examining the self-assessed competencies of nurses, and comparing ratings among certified emergency nurses (ENs) and general nurses (GNs) working at an EC of a tertiary hospital in Ghana.

Methods

A descriptive cross-sectional quantitative study was carried out among 109 conveniently sampled nurses. Participants evaluated their perceived competencies on a validated instrument under five domains, namely: diagnostic function (DF), administering and monitoring therapeutic interventions (AMTI), effective management of rapidly changing situations (EMRCS), organisational and work load competency (OWLC), and the helping role (HR). Descriptive and inferential data analyses were by SPSS version 25.

Results

Participants generally had good competencies in the performance of emergency nursing procedures. Highest scores were obtained in OWLC (median score of 83.3%) while EMRCS recorded the least scores (median score of 57.9%). With the exception of the DF domain (p = 0.166), ENs perceived themselves as significantly more competent than their counterpart GNs in 4 (OWLC, HR, AMTI, EMRCS) out of the five studied domains (p < 0.05).

Discussion

Specialist training enhances nurses' perceived competences in emergency nursing procedures. This reiterates the need for regular theory and practice-based education for GNs on intermediate and advanced procedures as they prepare to enrol in specialist programmes. As nurses take on expanded professional roles in this emerging nursing specialty in low- and middle-income countries, it is important the needed capacity is developed to adequately address the needs of patients and families that require services in ECs.

Descriptive analysis of the effect of back protector on the prevention of vertebral and thoracolumbar injuries in serious motorcycle accident

CONTEXT AND OBJECTIVE

Among the different products and protective gear used by riders of two-wheeled motorized vehicles, back protectors that are designed to prevent damage to the spinal column are widely used today compared other protections. However, few studies measure their effectiveness. Can their effectiveness be measured? How do they help decrease or change the nature of thoracolumbar traumas that occur? To address these questions and remedy the lack of objective data regarding these products, an epidemiological, clinical, and biomechanical analysis of motorcycle riders who were admitted to a French trauma center after an accident was performed. So, this study investigates the effectiveness of back protectors, including their ability to prevent specific mechanisms of thoracic and lumbar spinal injuries related to TWMV accidents.

METHOD

A questionnaire was administered to victims of accidents involving two-wheeled motorized vehicles who were admitted to the trauma room at the Marseille trauma center over the course of 2016. Collect data are related to the victim, the accident scenario, and a detailed description of the observed injuries using AIS (Abbreviated Injury Scale) coding and Magerl classification. Univariate analyses and Fisher tests were performed for victims who were or were not wearing back protectors.

RESULTS

This study collected data from 124 victims. Almost half of the victims were wearing a back protector at the time of the accident (53 victims, thus 43% of riders). Collectively, twenty-nine victims who were wearing back protectors had 57 thoracolumbar injuries, and twenty eight victims who were not wearing back protectors had 75 thoracolumbar lesions. The results from this study show that there is no significant difference in the nature and mechanism of thoracolumbar injuries as a function of back protection. The majority of the thoracolumbar injuries were not severe. They were primarily bone injuries, essentially compression fractures, regardless of whether a back protector was worn.

CONCLUSION

This study shows that the use of back protection does not decrease the number, type, or mechanism of thoracolumbar injuries associated with accidents involving two-wheeled motorized vehicles. However, it suggests that lumbar vertebral injuries are deflected towards the thoracic vertebrae when back protectors are worn. Finally, it suggests that the design of back protectors should be reconsidered to better protect riders from what are referred to as compression fractures (craniocaudal force), which remain the primary form of fracture regardless of the rider's characteristics, based on the data analyzed.

Empirical study of gap and correlation between philosophies Safety-I and Safety-II: A case of Beijing taxi service system

In contrast to the conventional safety philosophy (Safety-I) which focuses on 'what goes wrong', a newborn one (Safety-II) focusing on 'what goes right' endows people with more opportunities to realize productive safety in complex socio-technical systems. Yet, it is challenging to make the best of both the philosophies in a period of knowledge transition when they may have to coexist. This work investigates how Safety-II may resemble, differ from, and correlate to Safety-I. From individual, environmental and organizational aspects, 9 impacting factors are identified and expounded comparatively in the two philosophies. To examine impact of the factors on accidents and resilience respectively, an empirical approach is presented in the context of Beijing taxi service system (BTSS). Multiple means such as questionnaire surveys, semi-structured interviews, and statistical analysis with bi-method (Correlation Analysis, and Data Envelopment Analysis) cross-checking are utilized comprehensively to support the empirical study. The results show that: a) individual factors play a dominant role in system risk/performance management, in respect to views of both Safety-I and II; and b) organizational factors are more influential in creating and maintaining system resilience. Based on the findings, possible patterns of integrating the two philosophies are instantiated through mutually complementary application to BTSS. Despite the context of BTSS, this work provides a feasible way of comparing between Safety-I and Safety-II, for beneficial reference of other socio-technical systems.

Psychotic experiences and accidents, injuries, and poisonings among adults in the United States

Psychotic experiences (PEs) have been linked to an increased risk for accidents and injuries. However, this association remains little researched in many countries. To address this research gap, the current study used cross-sectional data from the United States to examine the association between PEs and accidents, injuries, and poisoning in a general population sample. Data were analyzed from 2274 individuals who completed the psychosis screen as part of the National Comorbidity Survey Replication (NCS-R). Information was obtained on PEs (hallucinations and delusions) and the experience of past 12-month accidents, injuries, and poisoning. Logistic regression analysis was used to examine the association while adjusting for demographic variables and common mental disorders (CMDs). In a fully adjusted model past 12-month PEs were associated with almost three times higher odds for reporting accidents, injuries, and poisoning (odds ratio [OR]: 2.97, 95% confidence interval [CI]: 1.13-7.74). The results of this study indicate that PEs are associated with higher odds for accidents and injuries among adults in the United States. Research is now needed to determine the direction of this association and the factors linked to it.

Comparison of the characteristics of hot tap water scalds and other scalds in Germany

BACKGROUND/AIM

Mortality associated with hot tap water scalds remains significant, owing to a lack of up-to-date regulations on tap water temperature. We aimed to evaluate the effect of hot tap water scalds on patients admitted to our adult burn intensive care unit (BICU), and compare them to those with other scald types.

METHODS

We enrolled patients treated for scalds at the BICU of Cologne-Merheim Medical Center from 1989 to 2014, and retrospectively analyzed their age, sex-specific differences, characteristics, length of hospital stay, number of operations, and mortality. Patients were categorized into two groups: patients with hot tap water scalds and those with all other types of scalds.

RESULTS

A total of 333 patients were enrolled. In 23.4% (n=78) of the cases, the scalds were associated with hot tap water. Such injuries were more commonly observed in older men than women. Hot tap water scalds involved a significantly higher total burned surface area (TBSA) than other scalds, with TBSA values of 24.0% and 15.9% for men, and 21.8% and 10.9% for women, respectively. Hot tap water scald patients had a greater number of surgeries and longer BICU stays (27.8 days vs 9.1 days), and significantly higher mortality values (30.8% (n=24) vs 4.7% (n=12)) than those with the other scald types.

CONCLUSIONS

Hot water scalds are associated with large TBSAs, long stays in the BICU, and worse outcomes compared to the other scald types.

Heroin overdose masquerades as methomyl poisoning: a case report

BACKGROUND

Methomyl is the most common cause of suicidal death but heroin is the most common cause of accidental death. The problem is to determine the exact cause and manner of death between methomyl or heroin toxicity. The evidence from autopsy includes crime scene investigation, toxicological analysis by liquid chromatography with mass spectrometry, and knowledge of methomyl and heroin intoxication.

CASE PRESENTATION

A 35-year-old Thai man and a 30-year-old Thai woman were found showing evidence of cyanosis, with a fine froth around the nose and mouth. Postmortem interval time was 24 hours. According to the police's and hotel owner's records, the couple stayed together for 1 day before being found dead in bed, naked, with a foul and a fine froth around the nose and mouth. A methomyl insecticide sachet and a plastic box containing white powder form of heroin were found at the scene. Laboratory tests of the male corpse identified the presence of methomyl in the blood of the stomach and morphine, codeine, methadone, and tramadol in the systemic blood. Blood cholinesterase enzyme activity and morphine concentration was 3416 U/L or 53% (normal 6400 U/L) and 0.058 μg/ml respectively. Laboratory test of the female corpse identified the presence of methomyl in the stomach and blood, and cholinesterase enzyme activity was 1965 U/L or 30.7%.

CONCLUSIONS

Cause of death of the male corpse was deemed to be due to heroin intoxication as the blood concentration of morphine was more than the lethal concentration with a morphine/codeine ratio of more than 1:1. Methomyl intoxication of the male corpse was unlikely to be the cause of death because methomyl systemic blood concentration was found to be very low, < 2.5 μg/ml, and cholinesterase enzyme levels did not indicate lethal activity (< 10-15% of normal). The main problem regarding an insurance claim is that the policy will not pay out in the case of heroin-associated deaths, as it is an addictive drug. The policy would pay out on death by suicide with methomyl insecticide, which was not prohibited by the insurance company after 1 year of insurance. So, it is not clear whether or not the family will receive money from the insurance company.

Dental Trauma in Children: A Quick Overview on Management

Traumatic dental injuries (TDI) or tooth trauma have a global prevalence of 10-15%. These are often the cause of first visit to emergency room. Prognosis of teeth after injury is dependent on type of TDI, emergency treatment and time elapsed till definitive care. The low level of awareness among general public and medical practitioners often leads to delay in seeking treatment which often leads to pain, severe symptoms and poor prognosis. Pediatricians can play a significant role in identification of TDI, health advise, emergency care and referral to dentists. This paper highlights the important features to be noted in children with history of TDI and the key steps which needs to be taken in these situations.

Characteristics of unnatural deaths in Tierra del Fuego, Argentina: A 10-year study (2008-2017)

A retrospective review was undertaken of 287 unnatural deaths undergoing medicolegal investigation over a 10-year period from January 2008 to December 2017 in Rio Grande, Tierra del Fuego, Argentina. There were 219 males and 68 females, age range 7 months to 88 years (average 38.4 years). The 135 accidental deaths (47%) were due mainly to vehicle crashes ( N = 62) and carbon monoxide toxicity from fires ( N = 31). The 115 cases of suicides (40.1%) were predominantly due to hanging ( N = 75) and gunshot wounds ( N = 20). The 37 cases of homicide (12.9%) were mainly due to stabbing/sharp force injury ( N = 20) and blunt force trauma ( N = 9). Carbon monoxide toxicity from faulty heating accounted for a substantial percentage (8.1%) of the accidental deaths. Firearm homicides and suicides related to drug toxicity and carbon monoxide inhalation were relatively uncommon medicolegal cases in this centre.

Epidemiology of injuries presenting to the accident centre of Korle-Bu Teaching Hospital, Ghana

Background

Injuries directly lead to 5 million deaths every year, accounting for 9% of all deaths worldwide. While knowledge of the pattern of injuries is essential to plan health interventions to reduce the incidence of injuries, these are not thoroughly described in Ghana. The aim of this study was to describe the epidemiology of injuries seen at the Accident centre of the Korle-Bu Teaching Hospital, Ghana’s main referral hospital.

Method

A retrospective review of two-year records of all patients who attended the Accident centre of the Korle-Bu Teaching Hospital from January 2016 to December 2017 was done. Data on the cause of injuries was the main focus of this review.

Results

A total of 17,860 patients’ records were included in the study. There were 12,116 (67.8%) males and 5,744 (32.2%) females. The ages of the patients seen during the period ranged from three (3) days to 101 years. The overall mean age was 27.9 (±18.2). Majority of the injuries resulted from road traffic accidents and falls, accounting for 39.1 and 19.7% respectively.

Conclusion

Road Traffic accidents (RTA), especially motorcycle related, are a significant cause of injuries in Ghana. Future studies should focus on interventions that can reduce the incidence of RTA’s to reduce the number of injuries that present to the Korle-Bu Teaching Hospital.

A new approach for resource allocation for black spot treatment (case study: The road network of Iran)

Currently, spatial and temporal distribution of safety resources in Iran is entirely based on expert opinions, regardless of network priorities. Considering the lack of resources for implementing safety treatments, prioritizing unsafe points is an important and complicated issue where the effectiveness of each safety treatment option should be thoroughly investigated. The political, social, and environmental aspects should also be taken into consideration, including social and political pressures and officials talks on less important topics. Obviously, this inappropriate resource allocation poses a serious challenge to the expected goals. In this study, a methodology based on economic and social issues is proposed to optimize the annual budget allocation for eliminating or reducing the risk of accident-prone points. In this methodology, the spatial and temporal distribution of budget is determined using a mathematical model aimed to maximize the benefits of reducing the accidents after deducting the costs of implementing the safety countermeasures. The outputs of this model include the safety countermeasure alternatives and a five-year time schedule for implementing them, or the alternative of no action with regard to budget, social, and judicial constraints. In order to evaluate the proposed method, it is applied to the road network of Iran and the results are compared with those of the conventional method that is currently used for resource allocation in this country. The results show that the proposed method leads to 15% higher benefits compared to the conventional method. Moreover, this method makes 641 safe points, which is about 17% more than the safe points resulted from the existing method. Therefore, the proposed method brings about a safer network as a result of the optimal allocation of available resources.

Analysis of Injuries in the Ghanaian Mining Industry and Priority Areas for Research

BACKGROUND

Despite improvements in safety performance, the number and severity of mining-related injuries remain high and unacceptable, indicating that further reduction can be achieved. This study examines occupational accident statistics of the Ghanaian mining industry and identifies priority areas, warranting intervention measures and further investigations.

METHODS

A total of 202 fatal and nonfatal injury reports over a 10-year period were obtained from five mines and the Inspectorate Division of the Minerals Commission of Ghana, and they were analyzed.

RESULTS

Results of the analyses show that the involvement of mining equipment, the task being performed, the injury type, and the mechanism of injury remain as priorities. For instance, mining equipment was associated with 85% of all injuries and 90% of all fatalities, with mobile equipment, component/part, and hand tools being the leading equipment types. In addition, mechanics/repairmen, truck operators, and laborers were the most affected ones, and the most dangerous activities included maintenance, operating mobile equipment, and clean up/clearing.

CONCLUSION

Results of this analysis will enable authorities of mines to develop targeted interventions to improve their safety performance. To improve the safety of the mines, further research and prevention efforts are recommended.

Rethinking suicides as mental accidents: Towards a new paradigm

BACKGROUND

Since its beginnings, suicide research has made great progress in terms of empirical findings. However, in contrast to empirical knowledge, the theoretical understanding of suicides has shown only minimal progress. Missing interdisciplinary bridges and the lack of a unifying paradigm have been major obstacles. This paper examines the starting points for a rethink.

METHODS

In the first step, we identified major challenges in suicide research, which have been obstructing a better understanding. In the second step, we determined a new concept of suicide that is highly compatible with epidemiological results and meets the requirements of interdisciplinary usability. In the third step, the implications of this paradigm were explored by relating it to two process typologies, the one characterizing the temporal dynamics of suicide processes, and the other representing risk mechanisms / factors occurring at different stages of suicide processes.

RESULTS

Since suicides are rare events and often appear to be "rash acts", they can be conceived of as mental accidents or, more precisely, as failures to withstand temporary suicide impulses. This paradigm is suitable for synchronously implementing different personal, psychopathological, societal and situational perspectives. It applies to a high proportion of suicides and works well when being exposed to different typologies of suicide processes.

CONCLUSIONS

The mental accident paradigm provides an interdisciplinary starting point in suicidology that offers new perspectives in research, prediction and prevention.

Timing of fatal BASE jumping incidents: 1981-2018

BASE jumping, or fixed object parachuting, is a high-risk sport that has evolved significantly since its inception in the 1960s. Differences in parachute technology, teaching methods, jumping locations, practices, and popularity, among other factors, have qualitatively transformed the sport, particularly since 2000. The current study seeks to better understand how the rate of BASE jumping fatalities have changed as BASE jumping has grown. Using data from the BASE Fatality List, a resource continuously compiled by the BASE community with information on all known BASE fatalities, temporal trends in BASE fatalities that accompanied these changes over time are explored. The number of annual fatalities stayed between 0 and 5 from 1981 to 1999, but around the year 2000 began an upward trend that has continued through 2018. There appears to be large seasonal variation in monthly fatality rate, with the most deaths occurring in the northern hemisphere's summer months, the peak being in August, and the fewest deaths occurring in the northern hemisphere's winter months. The years 2013-2018 have continued the increasing fatality trend, but have otherwise deviated through increased variability in short-term and seasonal trends. Potential causes of these short-term trends, changing trends in the causes of fatal accidents, factors potentially unique to anomalous events, and directions for future research are also discussed.

Analysis of the severity of occupational injuries in the mining industry using a Bayesian network

OBJECTIVES

Occupational injuries are known to be the main adverse outcome of occupational accidents. The purpose of the current study was to identify control strategies to reduce the severity of occupational injuries in the mining industry using Bayesian network (BN) analysis.

METHODS

The BN structure was created using a focus group technique. Data on 425 mining accidents was collected, and the required information was extracted. The expectation-maximization algorithm was used to estimate the conditional probability tables. Belief updating was used to determine which factors had the greatest effect on severity of accidents.

RESULTS

Based on sensitivity analyses of the BN, training, type of accident, and activity type of workers were the most important factors influencing the severity of accidents. Of individual factors, workers’ experience had the strongest influence on the severity of accidents.

CONCLUSIONS

Among the examined factors, safety training was the most important factor influencing the severity of accidents. Organizations may be able to reduce the severity of occupational injuries by holding safety training courses prepared based on the activity type of workers.

Parent's knowledge, attitude, and practice about children car seats at Unaizah city, KSA

Background:

Motor vehicle collision (MVC) is a major cause of death in children worldwide. Using children car seats will stabilize them during accidents and decrease the morbidity and mortality from MVC dramatically. There is no study in Saudi Arabia about car seat use and relationship between using it and children morbidity and mortality following a car accident.

Objectives:

To assess knowledge, attitude, and practice of children car seats among parents at Unaizah city, KSA, to assess the level of awareness regarding the children car safety system, to determine the parent level of education, socioeconomic status, and other factors affecting their behavior regarding car seats, to determine the prevalence of car seat use among parents in Unaizah city, and to assess the effectiveness of car seat policies on parents’ behavior.

Design:

Cross-sectional study.

Settings:

Public and private pediatric clinics at Unaizah city in Qassim region.

Materials and Methods:

The study was conducted from May to June 2018, among parents with child ≤7 years old. Anyone who could not complete the questionnaire for any reason was excluded from our study. SPSS version 20 has been used to analyze all data.

Main Outcome Measures:

To assess knowledge, attitude, and practice of children car seats among parents at Unaizah city, KSA.

Sample Size:

350.

Results:

There were 350 participants who were included in this study of which females were dominant 77.1%. The age range of parents was 25–35 years old. Most of them complied with the seatbelt policy (56.7%). Among these numbers, 130 participants use a seatbelt for security reason while others were to protect from irregularities. More parents do not put baby seat in the car (57.3%) while 57 participants use child seat every time the child rides in the car.

Conclusion:

The overall knowledge, attitude, and practices toward children car safety seat in this study was relatively low. This signifies the need of parents to step up their awareness to safe guard their children while on the road.

Limitations:

Small sample size and limited to pediatrics clinics visitors.

Pedestrian crashes at priority-controlled junctions, roundabouts, and signalized junctions: The UK case study

Objectives: Over half of pedestrians killed and seriously injured in Great Britain in 2015 were involved in crashes at junctions. This study investigates the nature of these crashes. Methods: A study was conducted into pedestrian casualty crashes at priority controlled junctions, roundabouts and signalised junctions in England between 2005 and 2015 using information from the UK STATS19 accident database, the UK National Travel Survey and the UK National Census. Consideration was given to coding frequencies of contributory factors, exposure (in terms of miles walked or driven) as well as age, gender and the resident deprivation index of the road users involved. Results and Conclusions: In terms of indicative blame, the coding frequencies of subjectively determined pedestrian actions and behaviour factors which might have contributed to pedestrian casualty crashes were found to be between 1.6 and 2.8 times the frequencies of driver actions and behavioural factors. Substantial social gradients were found in pedestrian casualty rates per miles walked and in the driver involvement rates per mile driven with those from the most deprived quintile having higher rates. In addition, it was found that female pedestrians, aged 60 years and over, had higher pedestrian casualty rates, per billion miles walked, for all three junction types, when compared with males and females under the age of 60 years, apart from male pedestrians aged 16 years and younger at priority controlled junctions.

Rattlesnakes bites in the Brazilian Amazon: Clinical epidemiology, spatial distribution and ecological determinants

Crotalus bites are considered a public health problem especially in Latin America. This study was performed to describe the epidemiology, spatial distribution and environmental determinants of Crotalus durissus bites in the Brazilian Amazon. Crotalus durissus envenomings official database included cases reported from 2010 to 2015. A total of 70,816 snakebites were recorded in the Amazon Region, 3058 (4.3%) cases being classified as crotalid, with a mean incidence rate of 11.1/100,000 inhabitants/year. The highest mean incidence rates were reported in Roraima, Tocantins and Maranhão. Area covered by water bodies, precipitation and soil humidity were negatively associated to rattlesnake encountering. Rattlesnake bites incidence was positively associated to tree canopy loss and altitude. In the Amazon, severe manifestations at admission, delayed medical assistance, lack of antivenom administration and ages ≥61 and 0-15 years were predictors of death in C. durissus snakebites. Spatial distribution of rattlesnake bites across the Brazilian Amazon showed higher incidence in areas of transition from the equatorial forest to the savanna, and in the savanna itself. Such results may aid focused policy-making in order to mitigate the burden, clinical complications and death as well as to manage Crotalus rattlesnake populations in the Brazilian Amazon.

Time after time: individuals with multiple fractures and injury recidivists in long eighteenth-century (c. 1666-1837) London

Investigating injury recidivism and individuals with multiple injuries is an area of growing interest in bioarchaeology. Differentiating between whether an individual sustained multiple injuries, represented by antemortem healed fractures, in one incident or in multiple incidents over the life course, is a major challenge. This research analyzed the skeletal remains of 721 adults (402 males, 319 females) from five post-medieval cemeteries from London, UK, known to include working class individuals for evidence of skeletal trauma - fractures, myositis ossificans, subluxations/dislocations, blunt force trauma, and sharp force trauma. A total of 164 individuals had more than two fractures; males were significantly more likely to have multiple (2+) fractures than females. An investigation of fracture recidivism incorporating a relative timeline of fracture events was possible because 14 individuals (12 males, two females) were identified as injury recidivists, meaning they had a combination of antemortem healed, antemortem healing, and/or perimortem fractures. This paper examines the distribution and relative timing of these fractures, incorporating contemporary clinical as well as social and historical context, noting that the majority of the fractures were likely to be caused by accidental mechanisms.

How to manage accidental and unintended exposure in radiology: an ESR white paper

Since February 2018, the Directive 2013/59/EURATOM (EU-BSS) requires all EU member states to implement a system for recording and analysis of all accidental or unintended medical exposures (Article 63). An ESR questionnaire in May 2018 among ESR member countries including all EU member states (MS) revealed a very heterogeneous and unsatisfactory situation in transposition of the EU-BSS. Some MS just translated this part of the directive, others used effective dose as reporting criteria and others used physical dose parameters from the modalities. This white paper will help national scientific organisations advice their national regulators and authorities on how to provide a simple and practicable implementation of the directive. ESR recommends notification and reporting criteria for significant events based on physical quantities and units and not on effective dose or text-based criteria like "significantly different" (EU-BSS, Article 4 (99)).

The association between sensation seeking and driving outcomes: A systematic review and meta-analysis

The purpose of this study was to evaluate the association between sensation seeking (SS) and driving outcomes (including four aberrant driving behaviors, accident involvement and tickets received) through a systematic review and meta-analysis. Forty-four eligible studies, representing 48 individual trials, were identified from a systematic literature search of four electronic databases, and included in the meta-analysis. Overall, the meta-analysis results showed that SS yielded significant positive correlations with risky driving (pooled r = 0.24, p < 0.001), aggressive driving (pooled r = 0.23, p = 0.019), and errors (pooled r = 0.22, p = 0.016). SS was also positively correlated with accident involvement (pooled r = 0.08, p < 0.001) and tickets received (pooled r = 0.19, p < 0.001), though at weaker levels. The correlations could also be moderated by a number of study and sample characteristics, such as country of origin, publication year, age, gender, driving experience and type of SS measure. The findings help facilitate our understanding of the role of SS in aberrant driving behaviors and accident risk, and provide new insight into the design of evidence-based driving education and accident prevention interventions.

Hazard Exposure with Health and Safety Outcomes Hinder the Work Ability of Salt Farm Workers in Thailand

OBJECTIVE

Unsafe environments and occupational hazards have been documented and are contributing to health risks for salt farm workers in Thailand. Whether exposures with various health hazards and outcomes affect work ability among these workers is uncertain. This study aimed to examine the effects of hazard exposures with health risks and outcomes, including accidents, for work ability among salt farm workers.

METHODS

A cross-sectional study was completed with 120 salt farm workers recruited from the largest salt farm company in Samutsakorn Province during January and February 2014. Face to face interviews were conducted using a structured questionnaire comprised of worker characteristics, working conditions, safety and health problems related to work, and a work ability index (questionnaire reliability =0.84) through a worksite visit. The MIMIC model was used to determine direct and indirect causal effects of work-related health hazards and outcomes on work ability.

RESULTS

Among 120 salt farmers, 61% were female and 77% had primary educations. Average age and work experience was 49.5 years (SD = 13.7) and 23.7 years (SD = 13.5), respectively. 66% worked more than 5 days per week and 21.3% had at least one accident in the past 3 months. The results of structure equation analysis revealed that healthy skin was related to heat exposure (β=.35, p=.01) and directly influenced work ability (β=.37, p=.01), Eye irritation was influenced by length of work time (β=.24, p=.05), and harmonized the predictive value of the model at a high level (χ²=94.51, df=73, p-value =0.05, χ²/df=1.29. RMSEA= 0.066).

CONCLUSION

Results for the MIMIC model indicate that two factors, bright sunlight and strong wind exposure over an extended work period, could be having crucial impacts on skin and eye health of salt farm workers. These factors might be protected against using PPE and health examinations with positive health outcomes directly improving work ability. Substantial governmental action with community leadership is needed immediately so action plans are instituted to improve occupational safety and health.

Simon's hemorrhages in a case of a fatal construction site accident as the result of body hyperextension in the upside-down position - a possible reconstruction of the injury mechanism

An accident occurred at a construction site and a 27-year-old worker was fatally injured. Equipped with personal protective equipment (helmet and a safety belt), he was standing on an 8-meter-high platform holding a large hose that was attached to a pipe connected to a concrete pump truck. Whilst in use the pipe broke and the hose sent the man flying with force, knocking down the platform railing. Autopsy examination showed that man fell to the ground landing on his head. Prominent Simon's hemorrhages were noted on the L5-S1 and L4-L5 intervertebral discs. When the hose threw the man from the platform, for one brief moment he was suspended in the air, with the safety belt tied firmly to his waist. Simon's hemorrhages most probably emerged at that moment, due to forceful hyperextension and traction of the body in the upside-down position. A relatively unexpected appearance of Simon's hemorrhages contributed to the reconstruction of the injury mechanism.

Analysis and Forecasting the Accident Mortality Trends in the Islamic Republic of Iran Applying Lee-Carter Model During the Years 2006 to 2035

Objective:

To predict the accident mortality trend in next two decades in Iran.

Methods:

The study population comprised all deaths recorded in the system of registration and classification of causes of death of Ministry of Health and Medical Education of Iran during the years 2006 to 2015. The information was collected via death certificate, burial permit, and reporting forms. To forecast the trends of causes-of-death, Lee Carter model was employed in a demographic package 18.1 of R software version 3.3.1.

Results:

Based on the results, the highest percentage of all causes of death from accidents (in unintentional accidents) goes to transport accidents, and most top intentional accidents belonged to intentional self-harm. The trends of unintentional accidents in the whole population and both sexes have reduced from 2006 to 2035, such that the rate has reduced from 62.2 in 2006 to 12.1 per 100 thousand populations in 2035. It is anticipated that the causes of death due to intentional accidents with the rate of 8.86 in 2006, will be 1.89 (per 100,000 population) in the year 2035.

Conclusion:

Accident mortalities have a significant role in the deaths of Iranian population; therefore, to reduce the impact of accident mortality on society, a precise approach is needed to monitor the trends as well as preventing measures and increasing the safety standards.