Maxillofacial trauma due to traffic accidents and falls: an exploratory study of associated factors

Background

This study aimed to determine the pattern of Maxillofacial trauma (MFT) due to traffic accidents and falls in a reference hospital in a rural region of northeastern Brazil between December 2011 and December 2018 and to identify associated factors.

Material and Methods

This was a cross-sectional study using 585 medical records of patients with MFT. The data were subjected to a Poisson-Tweedie multiple regression analysis to estimate the Prevalence ratio (PR), with a 95% confidence interval (95% CI) and a significance level of p<0.05.

Results

MFT due to traffic accidents was more prevalent among patients 21 to 40 years old (PR=2.30; 95% CI=1.20-4.41; p<0.001) diagnosed with zygomatic-orbital complex fractures (PR=1.80; 95% CI=1.08-2.98; p=0.023). Falls were more frequent among older groups of 41 to 60 years (PR=1.83; 95% CI=1.09-3.06; p=0.022) and over 61 years (PR=2.23; 95% CI=1.09-3.06; p=0.022). In traffic accidents, alcohol consumption increased the length of stay (PR=2.081; 95% CI=1.553-2.787; p<0.001), and patients who did not use personal protective equipment (PPE) had higher hospital costs (PR=179.964; 95% CI=1.485-1.994; p<0.001) for this etiology. Traffic accidents and falls are two of the main etiologies of MFT, especially for males in the young adult age group (traffic accidents) and those above 41 years (falls). Alcohol consumption and the nonuse of PPE influenced the length of the hospital stay and hospital costs.

Conclusions

Strategies to confront this problem, such as road and highway improvements, effective enforcement of laws and intersectoral coordination involving the entire community to implement policies and prevention programs targeted at these populations, can be implemented.

Key words:Maxillofacial Injuries, public policy, hospital cost.

Using 137Cs measurements to estimate soil erosion rates in forest stands affected by wildfires. Results from plot experiments

The destruction of forest cover by wildfires has important consequences on the stability of forest ecosystems. It is well recognized that forests play a key role in regulating the hydrological cycle by modifying rainfall interception and evapotranspiration but also affecting hydrological and erosion responses of the soil surface. For these reasons, in areas devoted to forestry, wildfires can cause loss of biomass production and serious off-site problems related to overland flow and the amount of sediment delivered downstream. Quantifying the consequences caused by wildfires on the soil surface in terms of runoff and soil loss is a great challenge for scientists and foresters. In this paper, a plot experiment aimed at evaluating the effects on soil erosion by wildfires of different severity is firstly described. The experiment was carried out in 1999 in three small plots, located in Southern Italy, covered by pine trees planted in the early '60s. The results obtained from this experiment provided evidence of a short-time effect of wildfire on soil erosion. However, the normal conditions of the pre-fire period seemed to be re-established after a few months following fire. In order to explore possible long-term effects on soil loss, estimates of soil erosion provided by recent ¹³⁷Cs measurements carried out in the same plots were made. The overall results indicated, for the study area, the absence of a long-term effect on soil erosion caused by the passage of fire and suggested that the ¹³⁷Cs technique can be a useful tool to explore the effect of wildfires in forested ecosystems.

Excess Lead-210 and Plutonium-239+240: Two suitable radiogenic soil erosion tracers for mountain grassland sites

The expected growing population and challenges associated with globalisation will increase local food and feed demands and enhance the pressure on local and regional upland soil resources. In light of these potential future developments it is necessary to define sustainable land use and tolerable soil loss rates with methods applicable and adapted to mountainous areas. Fallout-radionuclides (FRNs) are proven techniques to increase our knowledge about the status and resilience of agro-ecosystems. However, the use of the Caesium-137 (¹³⁷Cs) method is complicated in the European Alps due to its heterogeneous input and the timing of the Chernobyl fallout, which occurred during a few single rain events on partly snow covered ground. Other radioisotopic techniques have been proposed to overcome these limitations. The objective of this study is to evaluate the suitability of excess Lead-210 (²¹⁰Pb_ex) and Plutonium-239+240 (^239+240Pu) as soil erosion tracers for three different grassland management types at the steep slopes (slope angles between 35 and 38°) located in the Central Swiss Alps. All three FRNs identified pastures as having the highest mean (± standard deviation) net soil loss of -6.7 ± 1.1, -9.8 ± 6.8 and -7.0 ± 5.2 Mg ha^-1 yr^-1 for ¹³⁷Cs, ²¹⁰Pb_ex and ^239+240Pu, respectively. A mean soil loss of -5.7 ± 1.5, -5.2 ± 1.5 and-5.6 ± 2.1 was assessed for hayfields and the lowest rates were established for pastures with dwarf-shrubs (-5.2 ± 2.5, -4.5 ± 2.5 and -3.3 ± 2.4 Mg ha^-1 yr^-1 for ¹³⁷Cs, ²¹⁰Pb_ex and ^239+240Pu, respectively). These rates, evaluated at sites with an elevated soil erosion risk exceed the respective soil production rates. Among the three FRN methods used, ^239+240Pu appears as the most promising tracer in terms of measurement uncertainty and reduced small scale variability (CV of 13%). Despite a higher level of uncertainty, ²¹⁰Pb_ex produced comparable results, with a wide range of erosion rates sensitive to changes in grassland management. ²¹⁰Pb_ex can then be as well considered as a suitable soil tracer to investigate alpine agroecosystems.

Sediment source fingerprinting as an aid to catchment management: A review of the current state of knowledge and a methodological decision-tree for end-users

The growing awareness of the environmental significance of fine-grained sediment fluxes through catchment systems continues to underscore the need for reliable information on the principal sources of this material. Source estimates are difficult to obtain using traditional monitoring techniques, but sediment source fingerprinting or tracing procedures, have emerged as a potentially valuable alternative. Despite the rapidly increasing numbers of studies reporting the use of sediment source fingerprinting, several key challenges and uncertainties continue to hamper consensus among the international scientific community on key components of the existing methodological procedures. Accordingly, this contribution reviews and presents recent developments for several key aspects of fingerprinting, namely: sediment source classification, catchment source and target sediment sampling, tracer selection, grain size issues, tracer conservatism, source apportionment modelling, and assessment of source predictions using artificial mixtures. Finally, a decision-tree representing the current state of knowledge is presented, to guide end-users in applying the fingerprinting approach.

Exploring the potential for using 210Pbex measurements within a re-sampling approach to document recent changes in soil redistribution rates within a small catchment in southern Italy

In recent years, the fallout radionuclides caesium-137 (¹³⁷Cs) and unsupported lead-210 (²¹⁰Pb_ex) have been successfully used to document rates of soil erosion in many areas of the world, as an alternative to conventional measurements. By virtue of their different half-lives, these two radionuclides are capable of providing information related to different time windows. ¹³⁷Cs measurements are commonly used to generate information on mean annual erosion rates over the past ca. 50-60 years, whereas ²¹⁰Pb_ex measurements are able to provide information relating to a longer period of up to ca. 100 years. However, the time-integrated nature of the estimates of soil redistribution provided by ¹³⁷Cs and ²¹⁰Pb_ex measurements can be seen as a limitation, particularly when viewed in the context of global change and interest in the response of soil redistribution rates to contemporary climate change and land use change. Re-sampling techniques used with these two fallout radionuclides potentially provide a basis for providing information on recent changes in soil redistribution rates. By virtue of the effectively continuous fallout input, of ²¹⁰Pb, the response of the ²¹⁰Pb_ex inventory of a soil profile to changing soil redistribution rates and thus its potential for use with the re-sampling approach differs from that of ¹³⁷Cs. Its greater sensitivity to recent changes in soil redistribution rates suggests that ²¹⁰Pb_ex may have advantages over ¹³⁷Cs for use in the re-sampling approach. The potential for using ²¹⁰Pb_ex measurements in re-sampling studies is explored further in this contribution. Attention focuses on a small (1.38 ha) forested catchment in southern Italy. The catchment was originally sampled for ²¹⁰Pb_ex measurements in 2001 and equivalent samples were collected from points very close to the original sampling points again in 2013. This made it possible to compare the estimates of mean annual erosion related to two different time windows. This comparison suggests that mean annual rates of net soil loss had increased during the period between the two sampling campaigns and that this increase was associated with a shift to an increased sediment delivery ratio. This change was consistent with independent information on likely changes in the sediment response of the study catchment provided by the available records of annual sediment yield and changes in the annual rainfall documented for the local area.

A multi-radionuclide approach to evaluate the suitability of (239+240)Pu as soil erosion tracer

Fallout radionuclides have been used successfully worldwide as tracers for soil erosion, but relatively few studies exploit the full potential of plutonium (Pu) isotopes. Hence, this study aims to explore the suitability of the plutonium isotopes (239)Pu and (240)Pu as a method to assess soil erosion magnitude by comparison to more established fallout radionuclides such as (137)Cs and (210)Pbex. As test area an erosion affected headwater catchment of the Lake Soyang (South Korea) was selected. All three fallout radionuclides confirmed high erosion rates for agricultural sites (>25tha(-1)yr(-1)). Pu isotopes further allowed determining the origin of the fallout. Both (240)Pu/(239)Pu atomic ratios and (239+240)Pu/(137)Cs activity ratios were close to the global fallout ratio. However, the depth profile of the (239+240)Pu/(137)Cs activity ratios in undisturbed sites showed lower ratios in the top soil increments, which might be due to higher migration rates of (239+240)Pu. The activity ratios further indicated preferential transport of (137)Cs from eroded sites (higher ratio compared to the global fallout) to the depositional sites (smaller ratio). As such the (239+240)Pu/(137)Cs activity ratio offered a new approach to parameterize a particle size correction factor that can be applied when both (137)Cs and (239+240)Pu have the same fallout source. Implementing this particle size correction factor in the conversion of (137)Cs inventories resulted in comparable estimates of soil loss for (137)Cs and (239+240)Pu. The comparison among the different fallout radionuclides highlights the suitability of (239+240)Pu through less preferential transport compared to (137)Cs and the possibility to gain information regarding the origin of the fallout. In conclusion, (239+240)Pu is a promising soil erosion tracer, however, since the behaviour i.e. vertical migration in the soil and lateral transport during water erosion was shown to differ from that of (137)Cs, there is a clear need for a wider agro-environmental testing.

Use of a (137)Cs re-sampling technique to investigate temporal changes in soil erosion and sediment mobilisation for a small forested catchment in southern Italy

Soil erosion and both its on-site and off-site impacts are increasingly seen as a serious environmental problem across the world. The need for an improved evidence base on soil loss and soil redistribution rates has directed attention to the use of fallout radionuclides, and particularly (137)Cs, for documenting soil redistribution rates. This approach possesses important advantages over more traditional means of documenting soil erosion and soil redistribution. However, one key limitation of the approach is the time-averaged or lumped nature of the estimated erosion rates. In nearly all cases, these will relate to the period extending from the main period of bomb fallout to the time of sampling. Increasing concern for the impact of global change, particularly that related to changing land use and climate change, has frequently directed attention to the need to document changes in soil redistribution rates within this period. Re-sampling techniques, which should be distinguished from repeat-sampling techniques, have the potential to meet this requirement. As an example, the use of a re-sampling technique to derive estimates of the mean annual net soil loss from a small (1.38 ha) forested catchment in southern Italy is reported. The catchment was originally sampled in 1998 and samples were collected from points very close to the original sampling points again in 2013. This made it possible to compare the estimate of mean annual erosion for the period 1954-1998 with that for the period 1999-2013. The availability of measurements of sediment yield from the catchment for parts of the overall period made it possible to compare the results provided by the (137)Cs re-sampling study with the estimates of sediment yield for the same periods. In order to compare the estimates of soil loss and sediment yield for the two different periods, it was necessary to establish the uncertainty associated with the individual estimates. In the absence of a generally accepted procedure for such calculations, key factors influencing the uncertainty of the estimates were identified and a procedure developed. The results of the study demonstrated that there had been no significant change in mean annual soil loss in recent years and this was consistent with the information provided by the estimates of sediment yield from the catchment for the same periods. The study demonstrates the potential for using a re-sampling technique to document recent changes in soil redistribution rates.

Validating the use of 137Cs and 210Pbex measurements to estimate rates of soil loss from cultivated land in southern Italy

Soil erosion represents an important threat to the long-term sustainability of agriculture and forestry in many areas of the world, including southern Italy. Numerous models and prediction procedures have been developed to estimate rates of soil loss and soil redistribution, based on the local topography, hydrometeorology, soil type and land management. However, there remains an important need for empirical measurements to provide a basis for validating and calibrating such models and prediction procedures as well as to support specific investigations and experiments. In this context, erosion plots provide useful information on gross rates of soil loss, but are unable to document the efficiency of the onward transfer of the eroded sediment within a field and towards the stream system, and thus net rates of soil loss from larger areas. The use of environmental radionuclides, particularly caesium-137 ((137)Cs) and excess lead-210 ((210)Pb(ex)), as a means of estimating rates of soil erosion and deposition has attracted increasing attention in recent years and the approach has now been recognised as possessing several important advantages. In order to provide further confirmation of the validity of the estimates of longer-term erosion and soil redistribution rates provided by (137)Cs and (210)Pb(ex) measurements, there is a need for studies aimed explicitly at validating the results obtained. In this context, the authors directed attention to the potential offered by a set of small erosion plots located near Reggio Calabria in southern Italy, for validating estimates of soil loss provided by (137)Cs and (210)Pb(ex) measurements. A preliminary assessment suggested that, notwithstanding the limitations and constraints involved, a worthwhile investigation aimed at validating the use of (137)Cs and (210)Pb(ex) measurements to estimate rates of soil loss from cultivated land could be undertaken. The results demonstrate a close consistency between the measured rates of soil loss and the estimates provided by the (137)Cs and (210)Pb(ex) measurements and can therefore been seen as validating the use of these fallout radionuclides to document soil erosion rates in that environment. Further studies are clearly required to exploit other opportunities for validation in contrasting environments and under different land use conditions.

"Second ear" stapedotomy: is it safe?

This study reports the evaluation of "second ear" stapedotomiesy results in 23 patients with otosclerosis. All pre- and post-operative audiological data, all relevant surgical information and patients' features were analyzed retrospectively. The air-bone gap showed a significant improvement in all patients. The bilateral audiometric thresholds improved in 20 (87.0%) patients; in 1 (4.3%) patient, unilateral improvement occurred with no changes in the other ear and in 2 (8.7%) patients improvement occurred in first operated ear and dropped in the second ear after the last procedure. During the follow-up, there were no incapacitating complications. Based on these findings, we can conclude Our study concluded that second ear stapedotomy is a safe procedure with good results.