Sick leave and work-related accidents of social workers in Germany: an analysis of routine data

Purpose

The study aimed to explore the prevalence of sick leave and the risk of work-related accidents among German social workers and to describe causes and time trends in sick leave and accident claims.

Methods

A retrospective analysis of routine data was carried out. Aggregated sick leave data of 195,100 social workers from four health insurance funds and 3037 accident claims of social workers from an accident insurance institution were analysed. Causes of accidents were examined by statistics of the German Social Accident Insurance (DGUV). Sick leave rates per 100 insured person-years were calculated. Relative risks (RR) of accidents were calculated in a multivariate analysis for three occupational groups (social workers and therapists, caregivers in sheltered workshops and teachers in residential institutions) and compared to other health and welfare service workers.

Results

Mental disorders caused about one-fifth of the sick leave days of social workers. Sick leave due to mental disorders slightly increased in 2015 compared to 2012 (+ 3% and + 18%). Among the three subgroups of social workers, caregivers in sheltered workshops (RR 1.30; 95% CI 1.14–1.49) and teachers in residential institutions (RR 1.41; 95% CI 1.17–1.70) were at an increased risk of accidents at the workplace. Accidents were mostly caused by slipping (30%) and by violence (22%).

Conclusions

This study confirms that sick leave of social workers is frequently caused by mental disorders. Future studies could further examine differences between practice fields, long-term effects of work hazards and effective workplace interventions.

Electronic supplementary material

The online version of this article (10.1007/s00420-018-1370-z) contains supplementary material, which is available to authorized users.

Dash Cam videos on YouTube™ offer insights into factors related to moose-vehicle collisions

To gain a better understanding of the dynamics of moose-vehicle collisions, we analyzed 96 videos of moose-vehicle interactions recorded by vehicle dash-mounted cameras (Dash Cams) that had been posted to the video-sharing website YouTube™. Our objective was to determine the effects of road conditions, season and weather, moose behavior, and driver response to actual collisions compared to near misses when the collision was avoided. We identified 11 variables that were consistently observable in each video and that we hypothesized would help to explain a collision or near miss. The most parsimonious logistic regression model contained variables for number of moose, sight time, vehicle slows, and vehicle swerves (AIC_cw = 0.529). This model had good predictive accuracy (AUC = 0.860, SE = 0.041). The only statistically significant variable from this model that explained the difference between moose-vehicle collisions and near misses was 'Vehicle slows'. Our results provide no evidence that road surface conditions (dry, wet, ice or snow), roadside habitat type (forested or cleared), the extent to which roadside vegetation was cleared, natural light conditions (overcast, clear, twilight, dark), season (winter, spring and summer, fall), the presence of oncoming traffic, or the direction from which the moose entered the roadway had any influence on whether a motorist collided with a moose. Dash Cam videos posted to YouTube™ provide a unique source of data for road safety planners trying to understand what happens in the moments just before a moose-vehicle collision and how those factors may differ from moose-vehicle encounters that do not result in a collision.

The acute and residual effects of escalating, analgesic-range doses of ketamine on driving performance: A simulator study

Ketamine hydrochloride elicits potent psychotomimetic and neurobehavioural effects which make it incompatible with driving; however, the direct effect on driving performance is yet to be assessed. Using an open label, within-subjects protocol, 15 males and 5 females (mean age = 30.8 years) were administered three fixed, stepwise increasing sub-anaesthetic doses of intravenous (IV) ketamine solution [(i) 8 mg/h IV infusion plus 30 mg bolus, (ii) 12 mg/h IV infusion and (iii) 20 mg/h infusion]. Whole blood ketamine and norketamine concentrations were determined at each treatment step and at 2 h post-infusion. Driving performance was assessed at baseline, at each treatment step and at 2 h post-treatment using a validated computerised driving simulator. Standard Deviation of Lateral Position (SDLP) and Steering Variability (SV) were assessed. Linear Fixed Effect Modelling indicated a main effect for time (dose) for SDLP (F_[4,72] = 33.22, p < 0.0001) and SV (F_[4,72] = 4.65, p < 0.002). Post-hoc analyses revealed significant differences from baseline at each treatment step for SDLP (all p < 0.001), and for 12 mg/h treatment step for SV (p = 0.049). Post-treatment driving performance returned to baseline levels. Weak positive linear associations were observed between SDLP and whole blood ketamine concentrations (R² = 0.11, β = 29.96, p = 0.001) and norketamine (R² = 0.09, β = 28.87, p = 0.003). These findings suggest that even under highly controlled conditions, ketamine intoxication significantly alters simulated driving performance. At the highest dose, ketamine produced changes to SDLP considered incompatible with safe driving, highlighting how ketamine consumption may translate to an increased risk of road trauma.

Characteristics of single-vehicle crashes with e-bikes in Switzerland

In Switzerland, the usage and accident numbers of e-bikes have strongly increased in recent years. According to official statistics, single-vehicle accidents constitute an important crash type. Up to date, very little is known about the mechanisms and causes of these crashes. To gain more insight, a survey was conducted among 3658 e-cyclists in 2016. The crash risk and injury severity were analysed using logistic regression models. 638 (17%) e-cyclists had experienced a single-vehicle accident in road traffic since the beginning of their e-bike use. Risk factors were high riding exposure, male sex, and using the e-bike mainly for the purpose of getting to work or school. There was no effect of age on the crash risk. Skidding, falling while crossing a threshold, getting into or skidding on a tram/railway track and evasive actions were the most important accident mechanisms. The crash causes mentioned most often were a slippery road surface, riding too fast for the situation and inability to keep the balance. Women, elderly people, riders of e-bikes with a pedal support up to 45 km/h and e-cyclists who considered themselves to be less fit in comparison to people of the same age had an increased risk of injury. This study confirms the high relevance of single-vehicle crashes with e-bikes. Measures to prevent this type of accident could include the sensitisation of e-cyclists regarding the most common accident mechanisms and causes, a regular maintenance of bicycle pathways, improvements regarding tram and railway tracks and technological advancements of e-bikes.

Accidental fatal craniocerebral injury caused by broken chain of sawing tool

The case of an accidental fatal penetrating craniocerebral injury to a 26-year-old man at work when cutting wood is reported. There was used an angle grinder with an accessory for cutting similar to a chainsaw. The injury was caused by a fragment of the broken chain. The chain fragment broke through the facial part of the head to the left and penetrated the brain in the region of the left parietal bone of the cranial vault. The immediate cause of death was a failure of the central nervous system (brain death). The toxicological analysis of biological materials was negative. The death occurred as a result of a triple violation of safety precautions. The presented case is extremely rare in terms of fatal injuries caused by power tools for sawing having been published in the forensic literature.

Informing decisions on the purchase of equipment used by health services in response to incidents involving hazardous materials

Accidents involving release of chemical, biological, radiological or nuclear substances may prompt the need to decontaminate exposed casualties prior to further medical treatment. Health service workers who carry out decontamination procedures wear protective suits to avoid direct contact with contaminants. We developed an analytical framework based on queueing theory to inform UK Department of Health's decisions on the stock of protective suits that ambulance services and hospitals with emergency departments in England should hold. Our aim was to ensure that such allocation gave an accepted degree of resilience to locally identified hazards. Here we give an overview of our work and describe how we incorporated information in the public domain about local hazards with expert opinion about the patterns of demand for decontamination associated with different types of incident. We also give an account of how we worked with decision makers to inform national guidance on this topic.

Beware when danger on the road has passed. The state of relief impairs a driver's ability to avoid accidents

A driver is often required to react adequately to sudden, dangerous situations. If the driver successfully negotiates the challenge, a state of emotional relief is then experienced that arises at the moment the strong fear dissipates. Previous experimental studies described in the psychological literature have shown that in a state of relief, people exhibit a decline in cognitive functioning. The article's authors posed the question of how well a driver functions in this unique state. They conducted research using an AutoSim AS 1200-6 driving simulator in two road conditions: outside the city and in urban driving conditions. In fear-then-relief conditions, a few seconds after the driver managed to avoid an accident, another difficult situation arose on the road. It was examined how frequently a collision takes place in such a situation in comparison to a group that did not experience a state of relief resulting from the avoidance of an earlier accident. It occurred that while being outside the city the likelihood of an accident grew with the speed at which the car was traveling. The state of relief, however, did not lead to any disruptions in a driver's functioning in those conditions. In urban driving conditions the likelihood was not, however, associated with speed. Yet the emotional condition of the driver was of importance. There was a nearly three-fold increase in the probability that the driver would fail to avoid an accident in fear-then relief conditions when compared to control conditions. This is entirely consistent with earlier studies demonstrating disruptions in the cognitive functioning of people experiencing relief. The practical implications of these results are discussed.

Survival and health related quality of life after severe trauma - a 15 years follow up study

INTRODUCTION

As the primary treatment of patients with severe trauma continues to improve, increasing interest has been directed towards long-term survival and Health Related Quality of Life (HRQoL). In trauma patients, there are few studies describing long-term outcome using tools specifically directed at HRQoL.

HYPOTHESIS

HRQoL measured with EQ-5D is significantly reduced compared to the Danish norm score 15 years after severe injury.

MATERIALS AND METHODS

All patients more than 18 years of age, admitted to a level 1 trauma center from March 1996 to September 1997 were prospectively included and scored with Injury Severity Score (ISS). Survival status was recorded in May 2012 and EQ-5D questionnaires were sent out.

RESULTS

95 of the original 154 trauma patients were eligible for participation. The response rate was 66%. The average EQ-5D index score in the trauma population was significantly reduced compared to the index score in the Danish norm population (P=0.00, one-sample t-test). In addition, ISS is associated with HRQoL and ISS≥16 predicts poorer HRQoL.

CONCLUSION

EQ-5D is significantly reduced 15years after severe trauma High ISS was associated with low HRQoL. Knowledge of the distribution and predictors of long-term disability can be used to develop more efficient prevention policies and to improve trauma care in general.

Frequency of acute cervical and lumbar pathology in common types of motor vehicle collisions: a retrospective record review

Background

There are more than 5 million motor vehicle collisions annually in the United States, resulting in more than 2 million injured occupants. The most common types of collisions are head-on impacts, rear-ends, side-swipes, and t-bones, whilst the most common injury sites are the cervical and lumbar spine. The purpose of this retrospective record review was to examine the differences in frequency of cervical and lumbar pathology across and between these common collision types.

Methods

Nine-hundred and three patients were included in this analysis, 88 of whom described being in a head-on collision, 546 in a rear-end, 123 in a side-swipe, and 146 in a t-bone. Four diagnoses were examined, two each for the cervical and lumbar regions: disc derangement and radiculitis. Pearson’s Chi-squared contingency tables were used to test whether there were differences in clinical diagnosis frequencies across collision type, while Marascuilo’s post hoc multiple proportion comparisons were conducted to determine inter-group differences.

Results

There were significant differences across collision type for cervical disc derangement (p < 0.0001), cervical radiculitis (p < 0.00001), lumbar disc derangement (p = 0.0002) and lumbar radiculitis (p < 0.00001). There were also significant differences in pathology frequency between collision types.

Conclusions

Symptomatic cervical disc derangements were more common among patients who were involved in aside-swipe, whereas symptomatic lumbar disc derangements were more common among those in head-on or side-swipe collisions. Expanded controlled prospective studies are encouraged to better understand the mechanisms of injury and determine radiculitis tolerance limits.

Electronic supplementary material

The online version of this article (10.1186/s12891-017-1797-5) contains supplementary material, which is available to authorized users.

Part-time farmers and accidents with agricultural machinery: a moderated mediated model on the role played by frequency of use and unsafe beliefs

Objectives:

We aimed at testing a model of the direct and indirect effects of being a part-time farmer on the probability of being involved in an agricultural machinery-related accident, considering the role played by unsafe beliefs and the frequency of use of machinery.

Methods:

Two-hundred and fifty-two Italian men, regular users of agricultural machinery (age: Mean = 45.1 years, standard Deviation = 17.5), were administered a paper-and-pencil questionnaire addressing their relation with work, unsafe beliefs, and previous experience of machinery-related accidents.

Results:

Being a part-time farmer showed a positive association with unsafe beliefs only among occasional machinery users. Unsafe beliefs in turn showed a positive association with accidents.

Conclusions:

The study gave a novel contribution to the knowledge of the chain of events connecting part-time farmers with machinery-related accidents. Preventive training interventions targeting part-timer farmers using agricultural machinery just occasionally should be developed.

[Influence of trauma mechanisms on thoracic and lumbar spinal fractures]

BACKGROUND

Vertebral body fractures (VBF) can be caused by various trauma mechanisms. The AOSpine classification system differentiates three main types of fractures according to the grade of instability. How the increasing energy of various accident mechanisms changes the complexity of the individual fracture, its localization and the occurrence of further fractures has not yet been finally investigated.

OBJECTIVE

What influence do traumatic events with different kinematics have on the localization, complexity and number of VBF in the thoracic and lumbar spine?

MATERIAL AND METHODS

In this retrospective study data from patients with a freshly traumatized VBF were analyzed. The patients were divided into six trauma groups (UFG) depending on the trauma mechanism. The VBF were classified on the basis of computed tomography (CT) imaging according to the AOSpine classification system. Testing was performed bilaterally and a significance level of 5% was used. The statistical calculations were carried out using IBM SPSS Statistics.

RESULTS

A significant increase in the severity of fractures (AO classification) was found in the high energy trauma groups (UFG III and V). In addition, the incidence of thoracic (TH) VBF was significantly increased for TH7 (p = 0.011) and TH10 (p = 0.001). In comparison to the other low energy trauma groups, the risk of a TH7 fracture was 7‑times higher after a high energy trauma (odds ratio OR = 7.0; 95% confidence interval CI = 1.4; 35.2). The UFG III (falls > 3 m) showed the highest number of fractures with a median of 2.5 (SD 1.84) VBF.

CONCLUSION

An exact reproduction of the traumatic event enables a distinction between high and low energy trauma groups to be made. In previous studies traffic accidents were recorded as one group, so an influence of the increasing kinematic energy could not be assessed. The accident kinematics can be taken into account by differentiating between high and low-energy trauma groups. In high-energy accidents the TH7 and TH10 vertebrae were found to be at risk vertebrae. In addition to the force direction, the force strength also has a decisive influence on the distribution pattern of VBF.

An evaluation of the effectiveness of the Behaviour Based Safety Initiative card system at a cement manufacturing company in Zimbabwe

Background

A behavior-based safety initiative card-issuing system was introduced at a cement-manufacturing company in Zimbabwe in 2008 to try and curb accident occurrence. The purpose of this study was to evaluate the effectiveness of the Behaviour Based Safety Initiative card system as a tool used for reducing accident frequencies.

Methods

A mixed-method approach that involving administering piloted questionnaires to 40 out of 244 randomly selected employees, making observations, and reviewing secondary data were done to collect data from different sources in the organization in 2013. A paired t-test was conducted to test whether there was significant difference in accident occurrence before and after the implementation of the BBSI. Scatterplots were also used to establish the correlation between the issuance of cards and the accident and injury occurrence.

Results

The findings suggest that the introduction of the card system brought a significant decrease in accident and injury occurrence. A negative correlation between card issuance and accident occurrence was observed, i.e., the greater the number of cards issued, the fewer the number of accidents. It was also noted that the card system positively influenced the mindset of workers towards safe work practices.

Conclusion

The card system had an influence on the reduction of accidents and injuries. The organization should leverage on issuing more cards to further reduce the number of accidents and injuries to zero.

Causal effects of informal care and health on falls and other accidents among the elderly population in China

PURPOSE

This article analyzes the causal effects of informal care, mental health, and physical health on falls and other accidents (e.g., traffic accidents) among elderly people. We also examine if there are heterogeneous impacts on elderly of different gender, urban status, and past accident history.

METHODS

To purge potential reversal causal effects, e.g., past accidents induce more future informal care, we use two-stage least squares to identify the impacts. We use longitudinal data from a representative national China Health and Retirement Longitudinal Study of people aged 45 and older in China. A total of 3935 respondents with two-wave data are included in our study. Each respondent is interviewed to measure health status and report their accident history. Mental health is assessed using CES-D questions.

RESULTS

Our findings indicate that while informal care decreased the occurrence of accidents, poor health conditions increase the occurrence of accidents. We also find heterogeneous impacts on the occurrence of accidents, varying by gender, urban status, and past accident history.

CONCLUSIONS

Our findings suggest the following three policy implications. First, policy makers who aim to decrease accidents should take informal care of elders into account. Second, ease of birth policy and postponed retirement policy are urgently needed to meet the demands of informal care. Third, medical policies should attach great importance not only to physical health but also mental health of elderly parents especially for older people with accident history.

Occupational safety and health in construction: a review of applications and trends

Due to the high number of accidents that occur in construction and the consequences this has for workers, organizations, society and countries, occupational safety and health (OSH) has become a very important issue for stakeholders to take care of the human resource. For this reason, and in order to know how OSH research in the construction sector has evolved over time, this article-in which articles published in English were studied-presents an analysis of research conducted from 1930 to 2016. The classification of documents was carried out following the Occupational Safety and Health Cycle which is composed of five steps: regulation, education and training, risk assessment, risk prevention, and accident analysis. With the help of tree diagrams we show that evolution takes place. In addition, risk assessment, risk prevention, and accident analysis were the research topics with the highest number of papers. The main objective of the study was to contribute to knowledge of the subject, showing trends through an exploratory study that may serve as a starting point for further research.

Survival pattern of first accident among commercial drivers in the Greater Accra Region of Ghana

In this study, the average accident risk of commercial drivers in the Greater Accra region of Ghana and its associated risks were examined based on a survey data collected using paper-based questionnaires from 204 commercial drivers from the Greater Accra Region of Ghana. The Cox Proportional Hazards Model was used for multivariate analysis while the Kaplan-Meier (KM) Model was used to study the survival patterns of the commercial drivers. The study revealed that the median survival time for an accident to happen is 2.50 years. Good roads provided a better chance of survival than bad roads and experienced drivers have a better chance of survival than the inexperienced drivers. Age of driver, alcohol usage of driver, marital status, condition of road and duration of driver's license were found to be related to the risk of accident.

My Home is My Marae: Kaupapa Māori evaluation of an approach to injury prevention

OBJECTIVE

The objective of this study was to evaluate the New Zealand Accident Compensation Corporation's (ACC) 'My Home is My Marae' approach to injury prevention for whānau (families).

SETTING

Over an 18 month period from November 2013 to June 2014, 14 'My Home is My Marae' trials were conducted across the South Auckland and Far North regions of New Zealand. ACC engaged with local Māori providers of healthcare, education and social services to deliver the home safety intervention.

PARTICIPANTS

Participants of this evaluation were a purposive sample of 14 staff from six provider organisations in South Auckland and the Far North regions of New Zealand.

METHODS

Kaupapa Māori theory-based evaluation and appreciative inquiry methodologies underpinned the evaluation. Interview participants led discussions about strengths and weaknesses of the approach, and partnerships with ACC and other organisations. The evaluation was also supported by pre-existing information available in project documentation, and quantitative data collected by Māori providers.

RESULTS

Five key critical success factors of 'My Home is My Marae' were found from interviews: mana tangata (reputation, respect and credibility); manākitanga (showing care for people); kānohi-ki-te-kānohi (face-to-face approach); capacity building for kaimahi, whānau and providers and 'low or no cost' solutions to hazards in the home. Data collected for the Far North area showed that 76% of the hazards identified could be resolved through 'low or no cost' solutions. Unfortunately, similar data were not available for South Auckland.

CONCLUSIONS

Injury prevention or health promotion approaches that seek to engage with whānau and/or Māori communities would benefit from applying critical success factors of 'My Home is My Marae'.

A comprehensive study of worldwide selfie-related accidental mortality: a growing problem of the modern society

Since Oxford dictionary has described 'Selfie', selfie deaths have received a fair amount of coverage but the extent of the problem and the data behind it have not been appropriately explored. The aim of our study is to obtain epidemiological characteristics of selfie-related mortality worldwide with the objective of providing an insight to 'Why selfie', 'Why risky', 'Psychological basis' and 'measures of control.' Despite thousands of web pages, very few scientific articles are available in medical journals. So, we went online via Google search engine compiling every reported instance after confirming it and verifying the information in Wikipedia. Non-fatal injuries and non-selfie type of photography-related deaths were excluded from the study. From 2014 to mid-2016, 75 people have died while attempting selfie in 52 incidents worldwide. Mean age of the victims was 23.3 and 82% were male. India is the most affected country and Russia and US being second. Fall from height, drowning and rail accidents are the top three modes of death. Large-scale use of cell phone worldwide and underlying risk in selfie behaviour seems the culprit. Inability to compare selfie with non-selfie photography due to lack of data is definitely a limitation. Worldwide initiatives are being taken like 'NO SELFIE ZONES' but still a multifactorial approach is required before it gets too late.

Perception of side rollover hazards in a Pennsylvania rural population while operating an all-terrain vehicle (ATV)

BACKGROUND

All-terrain vehicles (ATVs) are unstable on steep and rough terrain, and thus, rollover is the most common accident which can result in a high rate of fatal outcomes, with higher rates for young and male drivers.

OBJECTIVE

This paper investigates the ability of rural Pennsylvania ATV drivers to correctly evaluate slopes, and the mean slope angle at which the most and least conservative drivers indicate a beginning of concern of a roll-over.

METHOD

The study was conducted using a simulator, a commercial ATV firmly fixed on an hydraulically-lifted platform. As the platform was being raised, participants were asked to report when they became uncomfortable and then when they would not drive across a slope at such an angle. The difference between the reported and the actual angles in both conditions were analyzed.

RESULTS

Fifty-five individuals, mostly male and younger than 20 years, participated in riding on the simulator. Between 1/3 and 1/4 of the participants correctly estimated the angle while approximately 2/3 of participants overestimated the angles at which they felt they would be uncomfortable and they would not drive across. Participants began to feel uncomfortable at 15.9±5.7 degrees and became so uncomfortable that they felt they would not drive at 22.7±3.7 degrees.

CONCLUSIONS

Overestimation of lateral roll angles is the most common result. This is in favor of safety when drivers are informed about a slope limit ATVs should not be operated on.

Association Between Maternal Postpartum Depression and Unintentional Injury Among 4-Month-Old Infants in Japan

OBJECTIVES

Unintentional injury among infants is a major public health issue; however, the relationship between unintentional infant injury and postpartum depression remains unclear. In this study, we aim to investigate the association between the two.

METHODS

We administered an original questionnaire to mothers participating in a 3- or 4-month health check-up program (target n = 9707). This questionnaire assessed infant health, including types of unintentional injury experiences used in previous study, and maternal mental health such as postpartum depression, by the validated screening tool, the Edinburgh Postnatal Depression Scale (EPDS). Associations between infant injury and postpartum depression were assessed using logistic regression adjusted for covariates, including parental, infant, and household characteristics.

RESULTS

In total, 6534 women responded to the questionnaire with valid answers on the EPDS (valid response rate, 67 %). Of the sample, 9.8 % of infants experienced unintentional injury (fall: 5.6 %; near-drowning: 1.2 %), and 9.5 % of mothers had postpartum depression (EPDS score of 9+). After adjusting for covariates, postpartum depression was significantly positively associated with any unintentional injury (odds ratio [OR] 1.59, 95 % confidence interval [CI] 1.24-2.04), and falls (OR 1.41, 95 % CI 1.02-1.95), although near-drowning was not significantly associated.

CONCLUSION

Postpartum depression might be a risk factor for unintentional injury of infants aged up to 4 months. Further prospective studies are needed to confirm the association between postpartum depression and unintentional injury of infants.

An exemplum and its road safety morals

With the design of an existing bike-lane in mind I discuss several general issues: accident causation and its linkage to the formulation of prevention strategies; the myopia afflicting major studies of causation and their misleading 'the-driver-did-it' message; the question of who is responsible for what in the management of road safety; and the difficult position in which the professionals find themselves when the 'State' does not embrace its responsibility to road safety. I think that were the public aware of this state of affairs in North America it might insist on change.

Work Incapacity and Treatment Costs After Severe Accidents: Standard Versus Intensive Case Management in a 6-Year Randomized Controlled Trial

Purpose Case management is widely accepted as an effective method to support medical rehabilitation and vocational reintegration of accident victims with musculoskeletal injuries. This study investigates whether more intensive case management improves outcomes such as work incapacity and treatment costs for severely injured patients. Methods 8,050 patients were randomly allocated either to standard case management (SCM, administered by claims specialists) or intensive case management (ICM, administered by case managers). These study groups differ mainly by caseload, which was approximately 100 cases in SCM and 35 in ICM. The setting is equivalent to a prospective randomized controlled trial. A 6-year follow-up period was chosen in order to encompass both short-term insurance benefits and permanent disability costs. All data were extracted from administrative insurance databases. Results Average work incapacity over the 6-year follow-up, including contributions from daily allowances and permanent losses from disability, was slightly but insignificantly higher under ICM than under SCM (21.6 vs. 21.3 % of pre-accident work capacity). Remaining work incapacity after 6 years of follow-up showed no difference between ICM and SCM (8.9 vs. 8.8 % of pre-accident work incapacity). Treatment costs were 43,500 Swiss Francs (CHF) in ICM compared to 39,800 in SCM (+9.4 %, p = 0.01). The number of care providers involved in ICM was 10.5 compared to 10.0 in ICM (+5.0 %, p < 0.001). Conclusions Contrary to expectations, ICM did not reduce work incapacity as compared to SCM, but did increase healthcare consumption and treatment costs. It is concluded that the intensity of case management alone is not sufficient to improve rehabilitation and vocational reintegration of accident victims.

Short-term health effects in the general population following a major train accident with acrylonitrile in Belgium

BACKGROUND

Following a train derailment, several tons of acrylonitrile (ACN) exploded, inflamed and part of the ACN ended up in the sewage system of the village of Wetteren. More than 2000 residents living in the close vicinity of the accident and along the sewage system were evacuated. A human biomonitoring study of the adduct N-2-cyanoethylvaline (CEV) was carried out days 14-21 after the accident.

OBJECTIVES

(1) To describe the short-term health effects that were reported by the evacuated residents following the train accident, and (2) to explore the association between the CEV concentrations, extrapolated at the time of the accident, and the self-reported short-term health effects.

METHODS

Short-term health effects were reported in a questionnaire (n=191). An omnibus test of independence was used to investigate the association between the CEV concentrations and the symptoms. Dose-response relationships were quantified by Generalized Additive Models (GAMs).

RESULTS

The most frequently reported symptoms were local symptoms of irritation. In non-smokers, dose-dependency was observed between the CEV levels and the self-reporting of irritation (p=0.007) and nausea (p=0.007). Almost all non-smokers with CEV concentrations above 100pmol/g globin reported irritation symptoms. Both absence and presence of symptoms was reported by non-smokers with CEV concentrations below the reference value and up to 10 times the reference value. Residents who visited the emergency services reported more symptoms. This trend was seen for the whole range of CEV concentrations, and thus independently of the dose.

DISCUSSION AND CONCLUSION

The present study is one of the first to relate exposure levels to a chemical released during a chemical incident to short-term (self-reported) health effects. A dose-response relation was observed between the CEV concentrations and the reporting of short-term health effects in the non-smokers. Overall, the value of self-reported symptoms to assess exposure showed to be limited. The results of this study confirm that a critical view should be taken when considering self-reported health complaints and that ideally biomarkers are monitored to allow an objective assessment of exposure.

Pedestrian- and driver-related factors associated with the risk of causing collisions involving pedestrians in Spain

This study aimed to quantify the association between pedestrian- and driver-related factors and the risk of causing road crashes involving pedestrians in urban areas in Spain between 1993 and 2011. From the nationwide police-based registry of road crashes with victims in Spain, we analyzed all 63,205 pairs of pedestrians and drivers involved in crashes in urban areas in which only the pedestrian or only the driver was at fault. Logistic regression models were used to obtain adjusted odds ratios to assess the strength of association between each individual-related variable and the pedestrian's odds of being at fault for the crash (and conversely, the driver's odds of not being at fault). The subgroups of road users at high risk of causing a road crash with a pedestrian in urban areas were young and male pedestrians, pedestrians with psychophysical conditions or health problems, the youngest and the oldest drivers, and drivers with markers of high-risk behaviors (alcohol use, nonuse of safety devices, and driving without a valid license). These subgroups should be targeted by preventive strategies intended to decrease the rate of urban road crashes involving pedestrians in Spain.

Outdoor difficulties experienced by a group of visually impaired Iranian people

Propose

A qualitative approach using semi-structured individual interviews was used to elicit common outdoor difficulties in individuals with visual impairment.

Methods

Interviews were recorded and then transcribed verbatim into text for thematic analysis. Twenty legally-blind individuals aged 34.25 ± 2.41 years with different etiologies were included in this study.

Results

All participants had experienced some sort of difficulty in outdoor environments. The most important problems as perceived by the participants are installation of tactile ground surface indicators, unsafe sidewalks, existence of obstacles on sidewalks, difficulty reading bus numbers, disorientation, fear of falling, recognition of faces, inability to read street names, the presence of spaces between platforms and buses, walking into glass doors, crossing streets, and the risk of Arial barriers.

Conclusions

As a visually impaired person might say, sidewalks can be the most dangerous of places. Appropriate urban modification can be very beneficial.

Early mortality from external causes in Aboriginal mothers: a retrospective cohort study

Background

Maternal loss can have a deep-rooted impact on families. Whilst a disproportionate number of Aboriginal women die from potentially preventable causes, no research has investigated mortality in Aboriginal mothers. We aimed to examine the elevated mortality risk in Aboriginal mothers with a focus on external causes.

Methods

We linked data from four state administrative datasets to identify all women who had a child from 1983 to 2010 in Western Australia and ascertained their Aboriginality, socio-demographic details, and their dates and causes of death prior to 2011. Comparing Aboriginal mothers with other mothers, we estimated the hazard ratios (HRs) for death by any external cause and each of the sub-categories of accident, suicide, and homicide, and the corresponding age of their youngest child.

Results

Compared to non-Aboriginal mothers and after adjustment for parity, socio-economic status and remoteness, Aboriginal mothers were more likely to die from accidents [HR = 6.43 (95 % CI: 4.9, 8.4)], suicide [HR = 3.46 (95 % CI: 2.2, 5.4)], homicide [HR = 17.46 (95 % CI: 10.4, 29.2)] or any external cause [HR = 6.61 (95 % CI: 5.4, 8.1)]. For mothers experiencing death, the median age of their youngest child was 4.8 years.

Conclusion

During the study period, Aboriginal mothers were much more likely to die than other mothers and they usually left more and younger children. These increased rates were only partly explained by socio-demographic circumstances. Further research is required to examine the risk factors associated with these potentially preventable deaths and to enable the development of informed health promotion to increase the life chances of Aboriginal mothers and their children.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-016-3101-2) contains supplementary material, which is available to authorized users.

Amphetamine-type stimulant use and the risk of injury or death as a result of a road-traffic accident: A systematic review of observational studies

Amphetamine-type substances are frequently detected among drivers injured or killed due to road-trauma. However, the role of this substance in crash causation remains equivocal. We performed a systematic review to evaluate existing evidence regarding the association between amphetamine use and the risk of injury or death due to road traffic accidents. A bibliographical search of PubMed, SafetyLit, Scopus, and Science Direct literature databases from 01 January 1980 until May 2015 was performed. The quality of included studies was assessed using the Newcastle-Ottowa Scale (NOS) (cut-off of ≥7 indicated high quality). Inter-rater reliability between three independent reviewers for the NOS was calculated using Cohens kappa (κ) statistic, and best-evidence synthesis was performed. A total of 182 articles were found. Nine studies met eligibility criteria for inclusion for review, and seven studies were included for best-evidence synthesis. Best-evidence synthesis demonstrated a conflicting level of evidence for associations between the use of-amphetamine-type substances and the risk of sustaining an injury, and a moderate level of evidence between amphetamine use and the risk of death due to road trauma. This is the first review to synthesise evidence regarding the association between amphetamine-type substance use and the risk of injury or death due to a road traffic accident. More conclusive evidence of death due to road trauma among amphetamine users may reflect significant and global deficits in functioning associated with effective vehicular control under the influence of this substance. Additional high quality, sufficiently powered studies are required to elucidate the magnitude of these associations.

Sleep-deprived motor vehicle operators are unfit to drive: a multidisciplinary expert consensus statement on drowsy driving

OBJECTIVES

This article presents the consensus findings of the National Sleep Foundation Drowsy Driving Consensus Working Group, which was an expert panel assembled to establish a consensus statement regarding sleep-related driving impairment.

METHODS

The National Sleep Foundation assembled a expert panel comprised of experts from the sleep community and experts appointed by stakeholder organizations. A systematic literature review identified 346 studies that were abstracted and provided to the panelists for review. A modified Delphi RAND/UCLA Appropriateness Method with 2 rounds of voting was used to reach consensus.

RESULTS

A final consensus was reached that sleep deprivation renders motorists unfit to drive a motor vehicle. After reviewing growing evidence of impairment and increased crash risk among drivers who obtained less than optimal sleep duration in the preceding 24 hours, the panelists recognized the need for public policy guidance as to when it is certainly unsafe to drive. Toward this end, the panelists agreed upon the following expert consensus statement: "Drivers who have slept for two hours or less in the preceding 24 hours are not fit to operate a motor vehicle." Panelists further agreed that most healthy drivers would likely be impaired with only 3 to 5 hours of sleep during the prior 24 hours.

CONCLUSIONS

There is consensus among experts that healthy individuals who have slept for 2 hours or less in the preceding 24 hours are too impaired to safely operate a motor vehicle. Prevention of drowsy driving will require sustained and collaborative effort from multiple stakeholders. Implications and limitations of the consensus recommendations are discussed.

Development of an Accident Reproduction Simulator System Using a Hemodialysis Extracorporeal Circulation System

Background:

Accidents that occur during dialysis treatment are notified to the medical staff via alarms raised by the dialysis apparatus. Similar to such real accidents, apparatus activation or accidents can be reproduced by simulating a treatment situation. An alarm that corresponds to such accidents can be utilized in the simulation model.

Objectives:

The aim of this study was to create an extracorporeal circulation system (hereinafter, the circulation system) for dialysis machines so that it sets off five types of alarms for: 1) decreased arterial pressure, 2) increased arterial pressure, 3) decreased venous pressure, 4) increased venous pressure, and 5) blood leakage, according to the five types of accidents chosen based on their frequency of occurrence and the degree of severity.

Materials and Methods:

In order to verify the alarm from the dialysis apparatus connected to the circulation system and the accident corresponding to it, an evaluation of the alarm for its reproducibility of an accident was performed under normal treatment circumstances. The method involved testing whether the dialysis apparatus raised the desired alarm from the moment of control of the circulation system, and measuring the time it took until the desired alarm was activated. This was tested on five main models from four dialyzer manufacturers that are currently used in Japan.

Results:

The results of the tests demonstrated successful activation of the alarms by the dialysis apparatus, which were appropriate for each of the five types of accidents. The time between the control of the circulatory system to the alarm signal was as follows, 1) venous pressure lower limit alarm: 7 seconds; 2) venous pressure lower limit: 8 seconds; 3) venous pressure upper limit: 7 seconds; 4) venous pressure lower limit alarm: 2 seconds; and 5) blood leakage alarm: 19 seconds. All alarms were set off in under 20 seconds.

Conclusions:

Thus, we can conclude that a simulator system using an extracorporeal circulation system can be set to different models of dialyzers, and that the reproduced treatment scenarios can be used for simulation training.

Factors affecting adherence to treatment and follow-up of burns in children: A single centre experience

Aim:

Children are prone to burn injury. Burns can be seen as a part of child abuse. The aim of this study was to investigate the factors affecting adherence to the treatment of burn patients, and to emphasize the role of the physician in identifying children's non-accidental burn injuries.

Materials and Methods:

Children who were hospitalized in the burn unit were analyzed retrospectively. Results were assessed for significance using the Chi-square test.

Results:

A total of 189 patients were included. Some patients (n = 52; 27.5%) were discharged against medical advice (DAMA) before completion of treatment. Although we could not demonstrate a relationship between non-accidental etiology and DAMA group, it was significant that these patients did not contact the outpatient clinic after discharge. It was evident from records that two of these cases were abused. The reasoning of the parents in the DAMA group for the early discharge was siblings at home, financial and accommodation problems.

Conclusion:

Although burns in children commonly occur due to an accident, each burn case should be examined for a non-accidental etiology and findings suggesting abuse should be noted. Physicians should be alert for the detection of signs of burn related child abuse.

Step training improves reaction time, gait and balance and reduces falls in older people: a systematic review and meta-analysis

OBJECTIVE

To examine the effects of stepping interventions on fall risk factors and fall incidence in older people.

DATA SOURCE

Electronic databases (PubMed, EMBASE, CINAHL, Cochrane, CENTRAL) and reference lists of included articles from inception to March 2015.

STUDY SELECTION

Randomised (RCT) or clinical controlled trials (CCT) of volitional and reactive stepping interventions that included older (minimum age 60) people providing data on falls or fall risk factors.

RESULTS

Meta-analyses of seven RCTs (n=660) showed that the stepping interventions significantly reduced the rate of falls (rate ratio=0.48, 95% CI 0.36 to 0.65, p<0.0001, I²=0%) and the proportion of fallers (risk ratio=0.51, 95% CI 0.38 to 0.68, p<0.0001, I²=0%). Subgroup analyses stratified by reactive and volitional stepping interventions revealed a similar efficacy for rate of falls and proportion of fallers. A meta-analysis of two RCTs (n=62) showed that stepping interventions significantly reduced laboratory-induced falls, and meta-analysis findings of up to five RCTs and CCTs (n=36-416) revealed that stepping interventions significantly improved simple and choice stepping reaction time, single leg stance, timed up and go performance (p<0.05), but not measures of strength.

CONCLUSIONS

The findings indicate that both reactive and volitional stepping interventions reduce falls among older adults by approximately 50%. This clinically significant reduction may be due to improvements in reaction time, gait, balance and balance recovery but not in strength. Further high-quality studies aimed at maximising the effectiveness and feasibility of stepping interventions are required.

SYSTEMATIC REVIEWS REGISTRATION NUMBER

CRD42015017357.

Glutamatergic system abnormalities in posttraumatic stress disorder

RATIONALE

Accumulating evidence suggests involvement of the glutamatergic system in the biological mechanisms of posttraumatic stress disorder (PTSD), but few studies have demonstrated an association between glutamatergic system abnormalities and PTSD diagnosis or severity.

OBJECTIVE

We aimed to examine whether abnormalities in serum glutamate and in the glutamine/glutamate ratio were associated with PTSD diagnosis and severity in severely injured patients at risk for PTSD and major depressive disorder (MDD).

METHODS

This is a nested case-control study in TPOP (Tachikawa project for prevention of posttraumatic stress disorder with polyunsaturated fatty acid) trial. Diagnosis and severity of PTSD were assessed 3 months after the accidents using the Clinician-Administered PTSD Scale. The associations of glutamate levels and the glutamine/glutamate ratio with diagnosis and severity of PTSD and MDD were investigated by univariate and multiple linear regression analyses.

RESULTS

Ninety-seven of 110 participants (88 %) completed assessments at 3 months. Serum glutamate levels were significantly higher for participants with full or partial PTSD than for participants without PTSD (p = 0.049) and for participants with MDD than for participants without MDD (p = 0.048). Multiple linear regression analyses showed serum glutamate levels were significantly positively associated with PTSD severity (p = 0.02) and MDD severity (p = 0.03). The glutamine/glutamate ratio was also significantly inversely associated with PTSD severity (p = 0.03), but not with MDD severity (p = 0.07).

CONCLUSIONS

These findings suggest that the glutamatergic system may play a major role in the pathogenesis of PTSD and the need for new treatments targeting the glutamatergic system to be developed for PTSD.

[Epidemiology of accidents in a cohort of adults over 64 years old in the Autonomous Community of the Basque Country]

INTRODUCTION

Accidents represent a significant health problem for elderly people. The objective of this study was to assess the incidence of accidents in over-64-year-olds in the Basque Country population, and to describe the clinical-epidemiological features leading to them.

MATERIAL AND METHODS

This was a prospective cohort study of 15,192 non-institutionalised individuals over 64 years of age, conducted under the auspices of the Basque Sentinel Practice Network (Red Vigía) over one year. A questionnaire was completed for each accident. The rates and risks of accidents were calculated by sex and age group of the individuals who had the accidents.

RESULTS

The rates of accidents were 46.52 and 81.87 per 1000 men and women, respectively. The most common type of accident was a fall (92%), and the most severe injuries were fractures (17%), with the risk of an accident being significantly higher in women and in the over-75-year-olds.

CONCLUSIONS

These data reflect the scale of accidents in over-64-year-olds in the Basque Country. The most frequent accident was the fall, which represents a dramatic event among the elderly, being one of the main causes of injury, disability and institutionalisation among this population group.

Exposure measurement in bicycle safety analysis: A review of the literature

BACKGROUND

Cycling, as an active mode of transportation, has well-established health benefits. However, the safety of cyclists in traffic remains a major concern. In-depth studies of potential risk factors and safety outcomes are needed to ensure the most appropriate actions are taken to improve safety. However, the lack of reliable exposure data hinders meaningful analysis and interpretation. In this paper, we review the bicycle safety literature reporting different methods for measuring cycling exposure and discuss their findings.

METHODS

A literature search identified studies on bicycle safety that included a description of how cycling exposure was measured, and what exposure units were used (e.g. distance, time, trips). Results were analyzed based on whether retrospective or prospective measurement of exposure was used, and whether safety outcomes controlled for exposure.

RESULTS

We analyzed 20 papers. Retrospective studies were dominated by major bicycle accidents, whereas the prospective studies included minor and major bicycle accidents. Retrospective studies indicated higher incidence rates (IR) of accidents for men compared to women, and an increased risk of injury for cyclists aged 50 years or older. There was a lack of data for cyclists younger than 18 years. The risk of cycling accidents increased when riding in the dark. Wearing visible clothing or a helmet, or having more cycling experience did not reduce the risk of being involved in an accident. Better cyclist-driver awareness and more interaction between car driver and cyclists, and well maintained bicycle-specific infrastructure should improve bicycle safety.

CONCLUSION

The need to include exposure in bicycle safety research is increasingly recognized, but good exposure data are often lacking, which makes results hard to interpret and compare. Studies including exposure often use a retrospective research design, without including data on minor bicycle accidents, making it difficult to compare safety levels between age categories or against different types of infrastructure. Future research should focus more on children and adolescents, as this age group is a vulnerable population and is underrepresented in the existing literature.

Global deposition and transport efficiencies of radioactive species with respect to modelling credibility after Fukushima (Japan, 2011)

In this study we conduct a detailed comparison of the modelling response of the Fukushima Dai-ichi Nuclear Power Plant (FDNPP) accident with global and local observations. We use five different model versions characterized by different horizontal and vertical resolutions of the same General Circulation Model (GCM). Transport efficiencies of (137)Cs across the world are presented as an indication of the expected radioactive impact. Activity concentrations were well represented showing lower Normalized Mean Biases (NMBs) when the better resolved versions of the GCM were used. About 95% of the results using the zoom configuration over Europe (zEur) remained within a factor of 10 from the observations. Close to Japan, the model reproduced well (137)Cs concentrations using the zoom version over Asia (zAsia) showing high correlations, while more than 64% of the modelling results were found within a factor of two from the observations and more than 92% within a factor of 10. Labile and refractory rare radionuclides calculated indirectly showed larger deviations, with about 60% of the simulated concentrations within a factor of 10 from the observations. We estimate that around 23% of the released (137)Cs remained into Japan, while 76% deposited in the oceans. Around 163 TBq deposited over North America, among which 95 TBq over USA, 40 TBq over Canada and 5 TBq over Greenland). About 14 TBq deposited over Europe (mostly in the European part of Russia, Sweden and Norway) and 47 TBq over Asia (mostly in the Asian part of Russia, Philippines and South Korea), while traces were observed over Africa, Oceania and Antarctica. Since the radioactive plume followed a northward direction before its arrival to USA and then to Europe, a significant amount of about 69 TBq deposited in the Arctic, as well. These patterns of deposition are fully consistent with the most recent reports for the accident.

Characteristics of Traumatic Brain Injury among Accident and Falling Down Cases

Motor vehicle and falling down are responsible for the most number of traumatic injuries. This study aimed to compare the characteristics of traumatic brain injury among accident and falling down cases. In this analytical cross-sectional study, data were collected from the records of cadavers who died due to accident or falling down and referred to Kahrizak dissection hall, Tehran forensic medicine organization during 2013. A total of 237 subjects (183 (77.2%) accident and 54 (22.8%) falling down) with a mean age of 35.62 (SD=15.75) were evaluated. A number of 213 (89.9%) were male. From accident group, scalp injury was seen in 146 (79.8%), scalp abrasion in 122 (66.7%), scalp laceration in 104 (56.8%), sub skull bruising in 176 (96.3%), skull fracture in 119 (65%), hemorrhage in 166 (90.7%), Subdural hemorrhage (SDH) in 155 (84.7%), Subarachnoid hemorrhage (SAH) in 161 (88%), Epidural hemorrhage (EDH) in 41 (22.4%), contusion in 140 (76.5%), and skull base fracture in 140 (76.5%) of cases. In falling down group scalp injury was seen in 42 (77.8%) cadavers, scalp abrasion in 38 (70.4%), scalp laceration in 30 (55.6%), sub skull bruising in 49 (90.7%), skull fracture in 39 (72.2%), Hemorrhage in 49 (90.7%), SDH in 43 (79.6%), SAH in 47 (87%), EDH in 10 (18.5%), contusion in 33 (61.1%), and skull base fracture in 39 (72.2%) of cases. There was no significant difference between these two groups (P Value> 0.05). Accident and falling down had no difference in terms of any injury or hemorrhage.

Macroscopic and histopathological aspects of chemical damage to human tissues depending on the survival time

The ingestion of corrosive substances is a widely treated topic in clinical and forensic practice, as an accidental event or as a consequence of voluntary assumption to commit suicide. However, thorough macroscopic and microscopic surveys focused on the correlation between the ingestion of the substance and different survival times have never been performed. Are the ingestion and the metabolism of the substance within the human tissues still recognizable? How could it be related to death? The study concerns a retrospective analysis on ten cases (two accidental, eight suicides) of lethal ingestion of different types of liquid caustic substances, without instant death and survival times ranging from 12 h to 6 months. For each case, a full autopsy and histological examination of the internal organs were performed. The results showed that the early direct effect of the substances is exerted mainly on the gastrointestinal tract, but as survival time increased, the metabolism of the substance exerted its effects in different target organs. When the cause of death was not directly linkable to the ingestion of the substance (i.e., related to cardiac stress, electrolyte disorders, pneumonia) and macroscopic findings were nonspecific, histological analyses allowed for providing crucial elements towards a link between death and assumption of the substance.

[Risk factors for provoking collisions between cyclists and pedestrians in Spain, 1993-2011]

OBJECTIVE

To identify and quantify the factors depending on pedestrians, cyclists and the environment associated with the risk of causing a collision between a cyclist and a pedestrian in Spain from 1993 to 2011.

METHODS

STUDY DESIGN

retrospective case series.

POPULATION

1228 pedestrian-cyclist pairs involved in the same number of collisions in an urban area, only one of whom committed an infraction.

SOURCE

Register of Traffic Accidents with Victims, supported by the Spanish Traffic General Directorate.

VARIABLES

committing an infraction (yes/no), age, sex, helmet use (cyclist), hour, type of day, year, existence of sidewalks, place of the accident, and priority regulated.

ANALYSIS

logistic regression model to estimate the strength of the association between the pedestrian's responsibility and independent variables. The association with the cyclist's responsibility was assessed by reversing the value of the odds ratios obtained.

RESULTS

In both groups of users, the risk of causing a collision was higher in extreme ages. Female cyclists had a slightly higher risk than male cyclists, while the use of a helmet had a protective effect. The risk of the pedestrian causing an accident was higher in the absence of sidewalks. Cyclists more frequently provoked accidents in crosswalks.

CONCLUSION

We recommend the implementation of safety campaigns aimed at pedestrians and cyclists, with special attention paid to the youngest and older people. Interventions for correct road use would also be advisable.

[Drug use and involvement in risky driving styles in a sample of university students. The uniHcos project]

OBJECTIVE

Drug and alcohol use are known to increase the risk of traffic accidents, especially among youth. However, the association between habitual drug use and the adoption of risky driving behavior is not well known. The aim of this study was to identify and quantify the association between habitual drug use and involvement in risky driving practices overall and by gender among university students.

METHODS

A cross sectional study was conducted. The study population was composed of 559 car drivers younger than 31 years who completed an online questionnaire during the 2011-2012 academic year. Among other factors, the questionnaire assessed the following items: habitual drug consumption (20 or more days) during the last year and involvement in other risky driving practices during the last month.

RESULTS

A total of 27.7% of students reported they had used drugs regularly during the last year. Drug use was associated with a higher frequency of involvement in risky driving practices. In men, the factors most strongly associated with drug consumption were speeding, driving under influence of alcohol, and feeling drowsy while driving. In women, drug consumption was mainly associated with smoking while driving, drunk driving, and driving without rest.

CONCLUSION

The results of our study support the hypothesis that habitual drug use is associated with an increased frequency of risky driving behavior.

Comparing three diagnostic algorithms of posttraumatic stress in young children exposed to accidental trauma: an exploratory study

BACKGROUND

Both the DSM-5 algorithm for posttraumatic stress disorder (PTSD) in children 6 years and younger and Scheeringa's alternative PTSD algorithm (PTSD-AA) aim to be more developmentally sensitive for young children than the DSM-IV PTSD algorithm. However, very few studies compared the three algorithms simultaneously. The current study explores diagnostic outcomes of the three algorithms in young child survivors of accidental trauma.

METHODS

Parents of 98 young children (0-7 years) involved in an accident between 2006 and 2012 participated in a semi-structured telephone interview. Child posttraumatic stress symptoms (PTSS) were measured with the Anxiety Disorders Interview Schedule for DSM-IV-Child Version (ADIS-C/P), complemented with items from the Diagnostic Infant and Preschool Assessment (DIPA). Descriptive statistics were used to analyze the characteristics of the children, accident related information and PTS symptoms. We compared the three PTSD algorithms in order to explore the diagnostic outcomes.

RESULTS

A total of 9 of the children (9.2 %) showed substantial PTSS. Of these children 2 met the criteria of all three algorithms, 7 met both the DSM-5 subtype for children 6 years and younger and the PTSD-AA algorithm, and 2 did not fully meet any of the algorithms (subsyndromal PTSD).

CONCLUSIONS

For young children, the DSM-5 subtype for children 6 years and younger and the PTSD-AA algorithm appear to be better suited than the previous DSM-IV algorithm. It remains important that clinicians pay attention to children with subsyndromal PTSD.

Types and causalities in dead patients due to traumatic injuries

Background:

Trauma constitutes a major public health problem in our country and contributes significantly to unacceptably high morbidity and mortality.

Objectives:

This study aimed to evaluate the epidemiology of trauma in dead patients referred to Shahid Rajaee Trauma Hospital, Shiraz, Iran.

Patients and Methods:

In a cross-sectional study, all patients with trauma admitted to our center were enrolled between March 2011 and February 2012. Age, gender, months of referring, causalities, and injured body parts of the victims were extracted from the data registry and analyzed.

Results:

A total of 9113 patients, including 7163 (78.6%) males and 1950 (21.4%) females were evaluated. Among them, 479 patients (5.3%) had died. There was a significant difference between the age of alive and dead patients (35.70 ± 0.18 and 45.44 ± 1.01 years, respectively (P < 0.001)). In addition, dead men had significantly higher percentage than alive men (83.7% and 78.3%, respectively, P = 0.005). The highest percentages of men and women who referred to our center and died were in September. Crashing by car had the most frequency of dead (247 cases) in referred patients and motorcycle accident, stabbing, and falling related injuries with 67, 36 and 26 dead cases were in the next ranks. Thorax injury had the most frequency between dead patients (53.2% of all dead) and the intracranial injury and trauma to extremities altogether were in the next ranks, which constituted more than 18.8% of all dead.

Conclusions:

Our data demonstrated that car and motorcycle accidents are the most important cause of trauma and thorax trauma had the most frequency among dead patients. Epidemiological evaluations and preventive measures such as this study should be conducted to provide valuable data.

Building a model using bayesian network for assessment of posterior probabilities of falling from height at workplaces

BACKGROUND

Falls from height are one of the main causes of fatal occupational injuries. The objective of this study was to present a model for estimating occurrence probability of falling from height.

METHODS

In order to make a list of factors affecting falls, we used four expert group's judgment, literature review and an available database. Then the validity and reliability of designed questionnaire were determined and Bayesian networks were built. The built network, nodes and curves were quantified. For network sensitivity analysis, four types of analysis carried out.

RESULTS

A Bayesian network for assessment of posterior probabilities of falling from height proposed. The presented Bayesian network model shows the interrelationships among 37 causes affecting the falling from height and can calculate its posterior probabilities. The most important factors affecting falling were Non-compliance with safety instructions for work at height (0.127), Lack of safety equipment for work at height (0.094) and Lack of safety instructions for work at height (0.071) respectively.

CONCLUSION

The proposed Bayesian network used to determine how different causes could affect the falling from height at work. The findings of this study can be used to decide on the falling accident prevention programs.

Why do organizations not learn from incidents? Bottlenecks, causes and conditions for a failure to effectively learn

If organizations would be able to learn more effectively from incidents that occurred in the past, future incidents and consequential injury or damage can be prevented. To improve learning from incidents, this study aimed to identify limiting factors, i.e. the causes of the failure to effectively learn. In seven organizations focus groups were held to discuss factors that according to employees contributed to the failure to learn. By use of a model of the learning from incidents process, the steps, where difficulties for learning arose, became visible, and the causes for these difficulties could be studied. Difficulties were identified in multiple steps of the learning process, but most difficulties became visible when planning actions, which is the phase that bridges the gap from incident investigation to actions for improvement. The main causes for learning difficulties, which were identified by the participants in this study, were tightly related to the learning process, but some indirect causes - or conditions - such as lack of ownership and limitations in expertise were also mentioned. The results illustrate that there are two types of causes for the failure to effectively learn: direct causes and indirect causes, here called conditions. By actively and systematically studying learning, more conditions might be identified and indicators for a successful learning process may be determined. Studying the learning process does, however, require a shift from learning from incidents to learning to learn.

Accident involving a 2-year-old child and Lonomia obliqua venom: clinical and coagulation abnormalities

Poisons of caterpillars have different effects on inflammatory and coagulation systems. This is a case report of a 2-year-old child that accidentally came in contact with several caterpillars of the species Lonomia obliqua. At first, the patient's exams presented abnormal coagulation and decreased fibrinogen, but the patient did not evolve to active bleeding or acute renal failure. The patient received antilonomic serum 15 h after the accident and the treatment was repeated after another 12 h due to persistent alterations shown by the coagulation exams. The venom of L. obliqua has several substances that act on the coagulation and inflammatory systems. The event is characterized by a hemorrhagic syndrome with decreases in fibrinogen. L. obliqua Stuart-factor activator (Losac) and L. obliqua prothrombin activator protease (Lopap) are components that act with procoagulatory effects. The pro-inflammatory action occurs due to metalloproteases, hyaluronidases and other substances with inflammatory activity. Studies on caterpillar venom can give new perspectives on the treatment of cancer and other diseases that cause dysfunction of the extra-cellular matrix.

The health status of people claiming compensation for musculoskeletal injuries following road traffic crashes is not altered by an early intervention programme: a comparative study

OBJECTIVE

To compare health outcomes among claimants compared to those who were ineligible or choose not to lodge a compensation claim. We also evaluated the effect of an early intervention programme on the health outcomes of the participants.

DESIGN

Prospective comparative study using sequential cohorts.

SUBJECTS

People presenting to hospital emergency departments with mild to moderate musculoskeletal injuries following road traffic crashes.

INTERVENTION

referral to an early intervention programme for assessment by musculoskeletal physician, pain management education, promotion of self-management and encouragement of early activity.

MAIN OUTCOMES

The 36-Item Short-Form Survey (SF-36); Hospital Anxiety and Depression Scale (HADS) and Functional Rating Index (FRI) scores were assessed at post-crash and at 12 months.

RESULTS

At 12 months, mean scores in six and five of the SF-36 domains were significantly lower among participants who claimed compensation versus those who chose not to claim or were ineligible, respectively. Differences in mean SF-36 scores ranged from 3.0 ('general health perception') to 8.0 units ('role limitations due to physical problems'). Participants who claimed compensation had 6.3- and 4.6-units lower SF-36 physical component score compared to those who were ineligible (p=0.001) or chose not to claim (p=0.01), respectively. Participants who claimed compensation reported a worse HADS-depression score of 6.46 versus 4.97 and 4.69 observed in those who were ineligible (p=0.04) or did not claim (p=0.01). Claimants had worse FRI scores compared to non-claimants (p=0.01) and those who were ineligible (p=0.01). The early intervention did not improve health outcomes, 12 months after injury.

CONCLUSIONS

Claiming compensation was associated with a worse health status for people with soft tissue injuries caused by road traffic crashes. The health status in people claiming compensation was not altered by an early intervention programme.

The Characteristics of Road Traffic Fatalities in Kazakhstan's Semey Region, 2006-2010: A Descriptive Retrospective Study

BACKGROUND

Kazakhstan, a developing middle-income country, has the highest road traffic collision (RTC) mortality in the European Region. The aims of this study were to determine main characteristics of road traffic fatalities in Semey region, Kazakhstan and to compare findings with National data and middle-income European countries.

METHODS

This descriptive surveillance study assesses RTC mortality rates and epidemiology in the Semey Region of East Kazakhstan Oblast. Data of all 318 road traffic fatalities form the Semey Regional Center for Forensic Medicine were analyzed for the 5-year period of January 1, 2006 through December 31, 2010.

RESULTS

Over the study period, the average road traffic mortality in the Semey Region was 12.1 per 100,000 population with downward trend by 35.1% (p=0.002). The victims mean age was 37.1 (SD=17) years. Males predominated at 74.5%. Vehicle fatality was the most common mode of fatality at 61.3%. The majority of collisions, 53.1%, occurred on highways. Most victims, 67.3%, have died at the scene of collision; in 67.3% of fatalities, autopsies identified multiple injuries as cause of death. The high number of fatal collisions took place in "no snow" season (P<0.001), with an overall 5-years downward dynamic.

CONCLUSION

High proportion of males, pedestrians and car occupants among road traffic fatalities; high proportion of death on scene in case of highway collisions are specifics for Semey region, Kazakhstan. These findings can be used to formulate preventive strategies to reduce fatalities and to improve the medical care system for road traffic fatalities.

Epidemiology of patients with multiple trauma and the quality of their prehospital respiration management in kashan, iran: six months assessment

Background:

Respiration management is an important and critical issue in prehospital transportation phase of multiple trauma patients. However, the quality of this important care has not been assessed in Iran Emergency Medical Services’ (EMS).

Objectives:

This study was conducted to investigate the quality of prehospital respiration management in patients with multiple trauma, referred to the Shahid Beheshti Trauma Center, Kashan, Iran.

Patients and Methods:

This cross-sectional study was conducted in the first six months of 2013. All the 400 patients with multiple trauma, transferred by EMS to the Shahid Beheshti Medical Center, were recruited. The study instrument was a checklist, which was completed through observation. Descriptive statistics were presented.

Results:

Out of all included individuals, 301 were males (75.2%) and 99 were females (24.8%). The most common mechanism of trauma was traffic accident (87.25%). Furthermore, 71.7% of the patients were injured in head and neck and chest areas. The quality of consciousness monitoring and airway management was desirable in 95% of the cases. However, the quality of monitoring patients’ respiration was only desirable in 42% of the cases. Only 18.6% of the patients received oxygen therapy during prehospital transportation.

Conclusions:

The quality of monitoring patients’ respiration and oxygen therapy was undesirable in most patients with multiple trauma. Therefore, the EMS workers should be retrained to apply proper respiration management in patients with multiple trauma.

Estimated rate of agricultural injury: the Korean Farmers' Occupational Disease and Injury Survey

Objectives

This study estimated the rate of agricultural injury using a nationwide survey and identified factors associated with these injuries.

Methods

The first Korean Farmers’ Occupational Disease and Injury Survey (KFODIS) was conducted by the Rural Development Administration in 2009. Data from 9,630 adults were collected through a household survey about agricultural injuries suffered in 2008. We estimated the injury rates among those whose injury required an absence of more than 4 days. Logistic regression was performed to identify the relationship between the prevalence of agricultural injuries and the general characteristics of the study population.

Results

We estimated that 3.2% (±0.00) of Korean farmers suffered agricultural injuries that required an absence of more than 4 days. The injury rates among orchard farmers (5.4 ± 0.00) were higher those of all non-orchard farmers. The odds ratio (OR) for agricultural injuries was significantly lower in females (OR: 0.45, 95% CI = 0.45–0.45) compared to males. However, the odds of injury among farmers aged 50–59 (OR: 1.53, 95% CI = 1.46–1.60), 60–69 (OR: 1.45, 95% CI = 1.39–1.51), and ≥70 (OR: 1.94, 95% CI = 1.86–2.02) were significantly higher compared to those younger than 50. In addition, the total number of years farmed, average number of months per year of farming, and average hours per day of farming were significantly associated with agricultural injuries.

Conclusions

Agricultural injury rates in this study were higher than rates reported by the existing compensation insurance data. Males and older farmers were at a greater risk of agriculture injuries; therefore, the prevention and management of agricultural injuries in this population is required.

Investigation of an accident in a resins manufacturing site: the role of accelerator on polymerisation of methyl methacrylate

This paper analyzes the effect of an accelerator on the polymerisation of methyl methacrylate (MMA). This study is based on the results of an investigation of an accident in a manufacturing site for resins located in the United Kingdom. As sequence of event to cause the accident the following was assumed: during an unattended batch process a runaway undesired polymerisation of methyl methacrylate occurred, generating rapid vaporisation of monomer, which in contact with an ignition source, led to an explosion followed by a fire. Since no initiator for the polymerisation reaction had been jet added to the blend, it was supposed that the accelerator contributed to the onset of the undesired polymerisation. The accelerator involved in the accident t has therefore been tested by differential scanning calorimetry and adiabatic calorimetry. The experimental data allowed the authors to prove the hypothesis made and to define safety ranges for the polymerisation reaction.