Patterns and trends of medicinal poisoning substances: a population-based cohort study of injuries in 0-11 year old children from 1998-2018

BACKGROUND

There have been sharp increases in antidepressant and opioid prescriptions over the last 10 years, as well as increased over-the-counter medicine availability. However, the impact on childhood medicinal poisonings rates, particularly by socioeconomic deprivation is unclear. This study reports population level medicinal poisoning substance patterns in England among children aged 0-11 years, helping inform safety advice and poisoning prevention interventions.

METHODS

An open cohort study of 1,489,620 0-11 year olds was conducted from 1998 to 2018, using the Clinical Practice Research Datalink, to examine inpatient hospital admissions for poisoning. Incidence rates and adjusted incidence rate ratios (aIRR) were calculated for poisoning substance groups by age, sex, socio-economic deprivation and year.

RESULTS

3,685 medicinal poisoning hospital admissions were identified. The most common substances were paracetamol (33.2%), dependence/withdrawal risk drugs (DWRD - antidepressants, opioids, gabapentinoids, benzodiazepines) (13.5%) and other over-the-counter (OTC) analgesics/anti-common cold drugs (13.0%). Over the study period DWRD poisonings decreased 33% (aIRR 0.67, 95%CI 0.50-0.90 comparing 2013/14-2017/18 to 1998/99-2002/03), while paracetamol poisonings increased 43% (aIRR 1.43, 95%CI 1.20-1.70 for the same periods), with no change in incidence rates for other OTC drugs (aIRR 0.82, 95% CI 0.60-1.12) or all medications combined (aIRR 0.97, 95%CI 0.88-1.07). A gradient in poisonings by area-level socioeconomic deprivation was shown for all medications (aIRR 1.32, 95%CI 1.18-1.47 for most deprived compared to least deprived quintile), and DWRDs (aIRR 2.03, 95%CI 1.42-2.88 for 4th most deprived quintile and aIRR 1.88, 95%CI 1.32-2.66 for 5th most deprived quintile, compared to least deprived quintile), but not for paracetamol or other OTC drug poisonings.

CONCLUSIONS

Poisonings from DWRDs decreased by 33%, while paracetamol poisonings increased by 43% during the study period. There was a gradient by area-level socioeconomic deprivation in prescribed medication poisonings, including drugs with withdrawal/dependence risk, but not OTC medication poisonings. Households in more socioeconomically deprived areas have the potential to benefit most from measures to improve safe storage of medicines and are likely to require targeted interventions providing education and safety equipment. In addition, universal promotion of the safe storage of OTC and prescribed medicines must be provided by prescribers, community pharmacies and other outlets of such medication.

Temporal Abscess After Bicycle Accident: A Rare Cause: Case report

The most common reasons for emergency visits to a maxillofacial surgery department are infections and trauma to the mouth, jaw and face. Many infections of the facial area are of odontogenic origin. Furthermore, contaminated wounds or foreign bodies can also cause a facial infection such as an abscess. Therefore, in some cases, initial trauma and subsequent wound infection in the facial area are closely related. The following case report describes the rare cause of a temporal abscess caused by an infected key bit after bicycle accident two weeks after the initial trauma. Through a detailed anamnesis and radiological imaging, a rapid diagnosis and initiation of surgical therapy could be achieved. This case report underlines the need for a precise medical history and detailed clinical examination, including wound cleaning in the event of injuries and/or infectious swellings in the facial area by the attending physician.

Multiple nail gun injuries: suicide or homicide?

Nail gun injuries are a forensic problem; it can be difficult to distinguish self-inflicted injuries from accident and homicide instances. This kind of injuries shares some characteristics with both gunshot and puncture wounds. We describe a peculiar case of a man who committed suicide driving nails into his skull using a pneumatic nail gun. Entrance wounds were found on both temporal regions of the head. Reviewing scientific literature, this is the first case in Italy reporting the macroscopic data of bilateral head and brain nail gun injuries during an autopsy. Circumstantial elements were not sufficient to clarify if these lesions were self-inflicted, inflicted by accident, or else. Radiological examination can be helpful to show the exact location of the nails, but it has also its own limitations. We firmly believe that autopsy, especially the head section, is crucial to identify the nature and the extension of these lesions, thus giving us much more information about the mechanism of death and the circumstances in which it occurred.

From suicide to accident - Case report - The significance of the medico-legal autopsies

INTRODUCTION

Suicide is the intentional and voluntary act of destroying one's own life, while an accident is an unintended event that involuntarily causes injury to one's health or destruction of life.

CASE PRESENTATION

We report a case of a 54-year-old male who was found in a forest in late November, approximately 500 m away from his car. He was positioned bent over a trunk of a tree with his head beneath the rest of his body. His pants were down to his knees, and there were soiled blades of grass and leaves on his body. Investigation of the case circumstances revealed that he had attempted suicide by carbon monoxide poisoning, using a hose connected to the exhaust pipe and running it through the window into the cabin. Window on the driver's side was broken with glass particles on the driver's seat. Wrappers from "Rivotril" tablets, a generic benzodiazepine, were also found in the car. Autopsy revealed the following: postmortem hypostasis was of a cherry red color and well pronounced on the upper part of the front of the body and face. Numerous bruises, contusions, and erosions were present all over the body. Frostbites were especially pronounced in the knees and elbows area. The synovial membranes were partially bloodstained and reddish in color. Opening the stomach revealed erosions of the gastric mucosa (Wischnewsky sign). Chemical toxicological analysis detected presence of benzodiazepines and carboxyhemoglobin (25%).

CONCLUSION

Based on the autopsy findings, chemical toxicological analyses, and investigation of the case circumstances, it has been concluded that the death occurred due to the combined effects of hypothermia, postural asphyxia and carboxyhemoglobin and benzodiazepine intoxication. The manner of death in this case is a combination of accidental and suicidal, as the victim attempted suicide but ultimately died due to exposure to low external temperature.

A Community-Based Safety Reporting System; Development, Implementation, and Evaluation: An Experience of Safe Communities in Iran

Background

Online reporting systems can establish and maintain the community-authority connection for safety promotion initiatives and their sustainability. The aim of this study was to report the development, implementation, and evaluation of an online community safety reporting system in safe communities in Iran.

Methods

In the first place, the life cycle approach and software systems development were used for design and implementation, which included 7 steps. In the following, an online Community Safety Reporting System (CSRS) was developed with two main interfaces, including a web-based and phone application. The software was developed using suitable programming languages for the web and as a mobile application for Android and iOS systems.

Results

During the six months of implementation, we received 80 reports in different safety areas, which were managed by the administrators and provided feedback for reporters. System user-friendliness and easy to use were the main strengths declared by users. The CSRS program is implemented at two levels of usage: public users to report safety issues and city admin functional evaluation of the system through a short interview with users. Moreover, city authorities believed that the system facilitates community participation in decision-making processes. The address of the web page is www.payamiran.ir.

Conclusion

CSRS provides a way for community voices to be heard and facilitates mutual interaction between the community and authorities. CSRS could be used as a community participation tool to ensure safety promotion initiatives sustainability.

Association between air temperature and unintentional drowning risk in the United Kingdom 2012-2019: A nationwide case-crossover study

OBJECTIVE

Drowning is a leading cause of death. The World Health Organization (WHO) and United Nations (UN) emphasise the need for population-level data-driven approaches to examine risk factors to improve water safety policies. Weather conditions, have the potential to influence drowning risk behaviours as people are more likely to spend time around water and/or undertake risky activities in aquatic spaces as a behavioural thermoregulatory response (e.g., seeking coolth).

METHODS

A case-crossover approach assessed associations between changes in daily maximum air temperature (data from the nearest weather station to each drowning event) and unintentional drowning risk using anonymous data from the validated UK Water Incident Database 2012-2019 (1945 unintentional deaths, 82% male). Control days were selected using a unidirectional time-stratified approach, whereby seven and 14 days before the hazard day were used as the controls.

RESULTS

Mean maximum air temperature on case and control days was 15.36 °C and 14.80 °C, respectively. A 1 °C increase in air temperature was associated with a 7.2% increase in unintentional drowning risk. This relationship existed for males only. Drowning risk was elevated on days where air temperature reached 15-19.9 °C (Odds Ratio; OR: 1.75), 20-24.9 °C (OR: 1.87), and ≥ 25 °C (OR: 4.67), compared with days <10 °C. The greatest elevations in risk appeared to be amongst males and when alcohol intoxication was suspected. Precipitation showed no significant association with unintentional drowning risk.

CONCLUSIONS

Identifying such relationships highlights the value of considering weather conditions when evaluating environmental risk factors for drowning, and may inform water safety policy and allocating resources to prevention and rescue.

Fuzzy multi-criteria decision-making framework for controlling methane explosions in coal mines

The structure of underground coal mines is vulnerable to many mishaps because of the challenging conditions of production and the unique features of the earth. These incidents could cause significant financial and production losses for the mines in addition to worker injury, disability, or death. In coal mines, methane explosions are a frequent threat. Establishing a safe work environment requires managing these problems with an accident control method. The current study used the fuzzy TOPSIS and fuzzy AHP techniques for this aim. The framework was used to tackle the four-alternative problem of underground coal mine explosion control method selection. To identify potential risks of a methane explosion, a data gathering survey was conducted as part of the suggested hybrid methodology. The fuzzy AHP was used to compute the fuzzy weights of the hazards. "Improper ventilation system" is ranked highest out of the 34 sub-risk factors. The fuzzy TOPSIS was then utilized to rank the explosion control methods using the weights. To assess the viability of the study's conclusions, a sensitivity analysis was carried out. The findings indicate that "improving safety technology" and "financial investments" are the best ways to reduce such events. The results additionally indicate that the fuzzy TOPSIS approach in combination with the fuzzy AHP provides a helpful framework for dynamically assessing mine methane explosion accidents.

A pilot study evaluating the preventive effects of platform-end lengthwise fencing on trespassing, person struck by train and traffic delays

BACKGROUND

Trespassing at train tracks and "person under train" (PUT) incidents are serious health, societal and transportation concerns. There is a need for developing different measures to prevent these events. Here, we hypothesized that platform-end lengthwise fences (PLF) reduce trespassing, the number of PUT incidents (suicides and accidents), and train traffic delays.

METHOD

PLFs were installed as the intervention at one station in Stockholm in 2020. The number of trespassers detected using CCTV-cameras was compared before and after at the intervention station over a total period of 29 months (using incidence rate ratio, IRR). The reduction in the number of PUT (over 20 years) and train traffic delays (over 9 years) was also investigated by IRR, and by using three control groups.

RESULTS

After installation of PLF there was a significant ∼90% reduction in trespasses (IRR = 0.10, 95%CI 0.04-0.23; one-sided exact p < 0.0001). No PUT incident occurred at the intervention station after the installation, compared to 1.11 per year before installation (IRR = 0.32, 95%CI 0-1.82; one-sided exact p = 0.1216). There was a significant reduction in delay minutes post installation compared to before the installation (Mann Whitney U = 0, upper one-sided exact p = 0.0357). The effect of the PLF was also observable in comparison to the three control groups, suggesting that the preventive effect was not due to wider societal events affecting all stations.

CONCLUSION

PLF had a large effect on reducing the number of trespasses and the number of delay minutes due to trespasses and PUT incidents. PLF may also have an effect of reducing PUT incidents.

PRACTICAL APPLICATIONS

PLF is deemed to be relatively easy and cheap to install and thus scalable (as compared to full barriers, e.g., platform screen doors) and may be considered at platform-ends having an exit, provided there is enough space to install them.

Economic Burden of Accidents and Injuries in India: What Does 75th Round of National Sample Survey Imply?

Background

Accidents and injuries constitute a sizable share of mortality and morbidity in low- and middle-income countries. This affects the most productive age group and increases disability-adjusted life years (DALYs). It results in a substantial financial burden on the households. To explore the economic burden of accidents and Injuries on Indian households and to find how the catastrophic health expenditure (CHE) from accidents and injuries affects the population. Another objective is to explore Catastrophic out-of-pocket expenditures (OOPE) patterns and distressed financing of households in India.

Materials and Methods

The study used data from the 75th round of nationally representative surveys, that is, the National Sample Survey (NSS). Authors have analyzed the data using descriptive binary logistic regression analysis to estimate the rate and average days of hospitalization, average OOPE, and share of the population experiencing the catastrophic impact from the health expenditure separately from the public and private healthcare institutions.

Results

The study observed that hospitalization in the private sector imposes 72% of households incur CHE at more than 10% cut-off and 41% at more than 25% cut-off. In comparison, it is less in the public sector, with 22% of households incurring CHE at more than 10% of annual per capita household income and 9% at more than 25%.

Conclusion

The increasing incidence of road traffic accidents (RTA) is a concern for the overstretched health system. The government should provide better healthcare facilities and universal health insurance coverage to ensure patients' speedy recovery and financial security.

[Trauma emergency room cases before and during the COVID-19 pandemic : Data from an alpine trauma center]

INTRODUCTION

The COVID-19 pandemic had a strong impact on the work of trauma medical teams. The aim of the study was to compare the trauma emergency room (TER) incidence and trauma mechanisms before and during the pandemic at a level I trauma center.

OBJECTIVE

The TER incidence before and during the pandemic should be assessed to be prepared for future pandemics or new COVID-19 outbreaks.

MATERIAL AND METHODS

Medical charts from all TER patients from March 2019 to February 2021 were analyzed. The incidence and trauma mechanisms of the 12 months before and the 12 months during the pandemic were compared. The trauma distribution and severity were described by the AIS and ISS, and the patients' country of residency was noted.

RESULTS

The TER cases decreased from 694 before the COVID-19 pandemic to 477 cases during the pandemic (Incidence rate 0.69). The strongest decrease in trauma cases was noted in sports injuries (0.55), followed by suicide attempts (0.63), traffic accidents (0.71) and leisure accidents (0.76). The rate of patients with severe injuries (ISS ≥ 16) was comparable with 40% before the pandemic and 44% during the pandemic. Foreign residency of TER patients shifted from 37% before the pandemic to 16% during the pandemic. The number of foreign patients was significantly reduced during the pandemic (257 vs. 77).

DISCUSSION

The TER incidence significantly decreased during the pandemic due to the imposed lockdowns during the peak winter tourism season. The rate of foreign TER patients changed during the pandemic, while the rate of severely injured patients remained stable.

Evaluation of the cardiovascular risk induced by cannabis use from a series of 43 autopsy cases

The aim of this monocentric observational autopsy study was to confirm the existence of a link between cannabis use and cardiovascular risk. It was based on the analysis of autopsy findings, cardiovascular pathological findings, and toxicological data in 43 autopsy cases of people who died with tetrahydrocannabinol (THC) in their blood over a 2-year period. Hair analysis was performed when available (n = 40) to distinguish between occasional and chronic cannabis use and to take into account other possible exposures, including smoking, drug consumption, and the use of other drugs of abuse (mainly cocaine, heroin, and amphetamine). A statistically significant association (Fisher's exact test, p < 0.001) was found between cannabis use, an undetermined manner of death, and the presence of an arrhythmogenic cardiac condition. An association was also found between cannabis use and the presence of advanced coronary heart disease (p = 0.01), heart disease (including ischemic heart disease, p = 0.003), or cardiomyopathy (p = 0.01). Through its systemic vascular action, cannabis could be a factor in triggering sudden death in subjects with arrhythmogenic cardiac conditions. In view of this finding, the mode of death of subjects who died in the presence of THC in the blood would in most cases be an "accident." These results highlight the potential adverse cardiac effects associated with cannabis use.

Work accident effect on the use of psychotropic drugs: the case of benzodiazepines

BACKGROUND

A work accident constitutes a shock to health, likely to alter mental states and affect the use of psychotropic drugs. We focus on the use of benzodiazepines, which are a class of drugs commonly used to treat anxiety and insomnia. Prolonged use can lead to dependence. Our objective is to determine the extent to which work accidents lead to benzodiazepine use and overuse (i.e. exceedance of medical guidelines).

METHOD

We use a two-step selection model (the Heckman method) based on data from the French National Health Data System (Système National des Données de Santé, SNDS). Our study sample includes all general plan members who experienced a single work accident in 2016 (and not since 2007). This sample includes 350,000 individuals in the work accident group and more than 1.1 million people randomly drawn from the population without work accidents from 2007 to 2017 (the non-work accident group).

RESULTS

The occurrence of a work accident leads to an increase in benzodiazepine use and overuse the following year. The selection model shows a clear influence of the accident on the use probability (+ 39%), but a very slight impact on the risk of overuse among users (+ 1.7%), once considered the selection effect. The effect on overuse risk is higher for more severe accidents and among women.

CONCLUSION

The increase in the risk of benzodiazepine overuse is due to an increase in the likelihood of using benzodiazepines after a work accident that leads to overuse, rather than an increase in likelihood of overuse among people who use benzodiazepines. Results call for targeting the first-time prescription to limit the risk of overuse after a work accident.

A hybrid of regularization method and generalized path analysis: modeling single-vehicle run-off-road crashes in a cross-sectional study

BACKGROUND

Determining risk factors of single-vehicle run-off-road (SV-ROR) crashes, as a significant number of all the single-vehicle crashes and all the fatalities, may provide infrastructure for quicker and more effective safety measures to explore the influencing and moderating variables in SV-ROR. Therefore, this paper emphasizes utilizing a hybrid of regularization method and generalized path analysis for studying SV-ROR crashes to identify variables influencing their happening and severity.

METHODS

This cross-sectional study investigated 724 highway SV-ROR crashes from 2015 to 2016. To drive the key variables influencing SV-ROR crashes Ridge, Least Absolute Shrinkage and Selection Operator (Lasso), and Elastic net regularization methods were implemented. The goodness of fit of utilized methods in a testing sample was assessed using the deviance and deviance ratio. A hybrid of Lasso regression (LR) and generalized path analysis (gPath) was used to detect the cause and mediators of SV-ROR crashes.

RESULTS

Findings indicated that the final modified model fitted the data accurately with [Formula: see text]= 16.09, P < .001, [Formula: see text]/ degrees of freedom = 5.36 > 5, CFI = .94 > .9, TLI = .71 < .9, RMSEA = 1.00 > .08 (90% CI = (.06 to .15)). Also, the presence of passenger (odds ratio (OR) = 2.31, 95% CI = (1.73 to 3.06)), collision type (OR = 1.21, 95% CI = (1.07 to 1.37)), driver misconduct (OR = 1.54, 95% CI = (1.32 to 1.79)) and vehicle age (OR = 2.08, 95% CI = (1.77 to 2.46)) were significant cause of fatality outcome. The proposed causal model identified collision type and driver misconduct as mediators.

CONCLUSIONS

The proposed HLR-gPath model can be considered a useful theoretical structure to describe how the presence of passenger, collision type, driver misconduct, and vehicle age can both predict and mediate fatality among SV-ROR crashes. While notable progress has been made in implementing road safety measures, it is essential to emphasize that operative preventative measures still remain the most effective approach for reducing the burden of crashes, considering the critical components identified in this study.

Post-traumatic Tietze syndrome as an occupational accident: A case report study

Tietze syndrome is an inflammatory arthropathy of costochondral junction characterized by chest pain, tenderness and swelling. We reported the case of a 35-year-old worker with post traumatic Tietze syndrome. He had a history of two occupational chest traumas. They both occurred in the third left costo-chondral joint. Chest computed tomography showed located osteolysis. Differential diagnoses were excluded. He was treated with non-steroidal anti-inflammatory drugs and analgesics. As for partial permanent disability, we suggested 17% given the importance of the pain and its impact on mobility. Tietze syndrome diagnosis was based on eliminating differential diagnoses. This study raises knowledge about post-traumatic etiology in Tietze syndrome. A better understanding of this pathology could help practitioners with patients facing chest wall pain.

Accidents and injuries related to paragliding on mount Babadağ, Turkey: A cross-sectional study

OBJECTIVES

In light of the growing popularity of paragliding, this cross-sectional study aimed to investigate the epidemiology of paragliding accidents, providing insights into the types and severity of injuries sustained as well as the body regions most commonly affected.

METHODS

This cross-sectional retrospective study utilized data on adverse paragliding events on Mount Babadağ in Turkey, collected by the Muğla Sports Tourism Board (STB) between January 2020 and December 2021, with data sources including out-of-hospital STB forms and in-hospital electronic health records.

RESULTS

Out of 241,420 paragliding flights, a total of 44 accidents were identified, with only three resulting in fatalities. Most of the accidents occurred during take off and landing, but the deadliest phase was during flight. The majority of accidents were of low severity, with a median National Advisory Committee for Aeronautics score of 1 (interquartile range [IQR] 1-3) and a median injury severity score of 1 (IQR 1-7.75). The lower limb was the most commonly injured body part, accounting for 55.8% of injuries, followed by the upper limb at 30.8%.

CONCLUSIONS

Despite being considered an extreme sport, paragliding carries a relatively low risk of accidents and serious injuries, owing to advancements in training, equipment inspection, and protective gear.

Non-fatal traffic crashes among food delivery riders in Vietnam: What is the problem?

OBJECTIVE

The rapid development of information technologies and the COVID-19 pandemic have resulted in the proliferation of online food shopping and food delivery motorcyclists. In contrast to the relatively ample literature on factors influencing fatalities and risky riding behaviors of food delivery motorcyclists, little is known about the determinants of non-fatal crashes involving online food delivery riders. The present study examines the prevalence and factors of non-fatal crashes among food delivery riders.

METHODS

The self-reported data of 393 online food delivery riders were collected in Hanoi and Hochiminh city, Vietnam. Binary logit regression was used to investigate the factors associated with non-fatal crashes.

RESULTS

The findings showed that more than half of riders (54%) reported being involved in at least one crash in the last 12 months. The most common risky riding behaviors associated with the crashes included using a mobile phone while riding, neglecting turn signals, red-light running, riding when tired/sleepy, and speeding. The riders who were national migrants, married, and worked on planned delivery routes mainly alone were more likely to experience crashes. At the same time, adequate perceived rewards for their work prevent crash involvement. Perceived risk was not a significant predictor of self-reported crashes.

CONCLUSIONS

Ensuring road safety for delivery riders requires a systemic effort involving multiple stakeholders, and the private sector plays a crucial role in discouraging risky riding behaviors. It is imperative for the government and regulatory bodies to redefine the delivery job to alleviate the strain on riders and provide resources such as rewards. Specifically, riders should be considered employees rather than partners. Furthermore, it is crucial for the police to take a more active role in preventing dangerous behaviors among delivery riders, such as running red lights. At the same time, supporting financial strategies should be implemented for delivery riders, particularly for those who are migrants or married and may face additional challenges.

Impact of mobile phone use on accidental falls risk in young adult pedestrians

Background

Mobile phone use is known to be a distraction to pedestrians, increasing their likelihood of crossing into oncoming traffic or colliding with other people. However, the effect of using a mobile phone to text while walking on gait stability and accidental falls in young adults remains inconclusive. This study uses a 70 cm low friction slip hazard and the threat of hazard to investigate the effects of texting while walking on gait stability, the ability to recover balance after a slip hazard and accidental falls.

Methods

Fifty healthy young adults performed six walking tasks, and one seated texting task in random order. The walks were conducted over a 10-m walkway. Four progressive hazard levels were used: 1) Seated; 2) Normal Walk (walking across the walkway with no threat of a slip); 3) Threat (walking with the threat of a slip); and 4) Slip (walking with an actual 70 cm slip hazard). The three walking conditions were repeated twice with and without the mobile phone texting dual-task. Gait kinematics and trunk posture were recorded using wearable sensors attached to the head, trunk, pelvis and feet. Study outcomes were analyzed using repeated measures analysis of variance with significance set to P≤.05.

Results

Mobile phone use significantly impaired postural balance recovery when slipping, as demonstrated by increased trunk sway. Mobile phone use negatively impacted gait stability as demonstrated by increased step time variability and decreased harmonic ratios. Increased hazard levels also led to reduced texting accuracy.

Conclusions

Using a mobile phone to text while walking may compete with locomotor tasks, threat assessment and postural balance control mechanisms, which leads to an increased risk of accidental falls in young adults. Pedestrians should therefore be discouraged through new educational and technology-based initiatives (for example a "texting lock" on detection of walking) from texting while walking on roadside footpaths and other environments where substantial hazards to safety exist.

Frequency and type of domestic injuries among children during COVID-19 lockdown: what changes from the past? An Italian multicentre cohort study

Accidents are the main cause of injury in children, more than half events happen at home. Aims of this study were to assess if SARS-CoV-2 lockdown influence emergency department (ED) visits due to children domestic accident (DAs) and to identify factors associated with hospitalization. This was a multicentre, observational, and retrospective cohort study involving 16 EDs in Italy and enrolling children (3-13 years) receiving a visit in ED during March-June 2019 and March-June 2020. Risk factors for hospitalization were identified by logistic regression models. In total, 8860 ED visits due to domestic accidents in children occurred before (4380) and during (4480) lockdown, with a mean incidence of DA of 5.6% in 2019 and 17.9% in 2020 (p < 0.001) (IRR: 3.16; p < 0.001). The risk of hospitalization was influenced by the type of occurred accident, with fourfold higher for poisoning and twofold lower risk for stab-wound ones. In addition, a higher risk was reported for lockdown period vs 2019 (OR: 1.9; p < 0.001), males (OR: 1.4; p < 0.001), and it increased with age (OR: 1.1; p < 0.001).    Conclusions: The main limitation of this study is the retrospective collection of data, available only for patients who presented at the hospital. This does highlight possible differences in the total number of incidents that truly occurred. In any case, the COVID-19 lockdown had a high impact on the frequency of DAs and on hospitalization. A public health campaign aimed at caregivers would be necessary to minimize possible risks at home. What is Known: • In Italy, domestic accidents are the second leading cause of paediatric mortality after cancer. • During the first SARS-CoV-2 lockdown in 2020, a sharp decrease in the total number of Emergency Departments visits for all causes was observed, both in children and in adults. What is New: • During the first SARS-CoV-2 lockdown in 2020, domestic accidents involving children increased threefold from the previous year. • Higher risk of hospitalization was showed in minors accessing during 2020 vs 2019, in males than in females and it increased with advancing age. Considering the type of injury, a significant higher risk of hospitalization for poisoning was observed.

An Analysis of Failures Leading to Fire Accidents in Hospitals; with Specific Reference to India

Fire can be especially dangerous when it occurs in hospitals because many patients in any typical hospital are not physically fit enough to quickly respond to emergency measures, especially evacuation calls. The present paper reports an in-depth assessment of the factors which have led to major fire accidents in Indian hospitals. The study reveals that several building safety codes, acts and guidelines are available, not only to prevent accidental fires but also to minimize harm when such fires do take place. However, observance of the stipulations is very lax, and seems to be exercised more in breach than in compliance. The study reveals that hospitals have zones like the intensive care units which are not only more prone to accidents than other zones but can also cause greater loss of lives due to the presence of critically ill patients, or persons who are extremely vulnerable (for instance newborn babies). Special codes and practices need to be framed for such zones. The study has also identified and catalogued a series of measures which must be implemented in future to prevent accidental fires in hospitals. The study is with reference to accidents that have occurred in India from 2010 to the present but is representative of the situation prevailing in most developing countries.

A Hybrid of Random Forests and Generalized Path Analysis: A Causal Modeling of Crashes in 52,524 Suburban Areas

BACKGROUND

Determining suburban area crashes' risk factors may allow for early and operative safety measures to find the main risk factors and moderating effects of crashes. Therefore, this paper has focused on a causal modeling framework.

STUDY DESIGN

A cross-sectional study.

METHODS

In this study, 52524 suburban crashes were investigated from 2015 to 2016. The hybrid-random-forest-generalized-path-analysis technique (HRF-gPath) was used to extract the main variables and identify mediators and moderators.

RESULTS

This study analyzed 42 explanatory variables using a RF model, and it was found that collision type, distinct, driver misconduct, speed, license, prior cause, plaque description, vehicle maneuver, vehicle type, lighting, passenger presence, seatbelt use, and land use were significant factors. Further analysis using g-Path demonstrated the mediating and predicting roles of collision type, vehicle type, seatbelt use, and driver misconduct. The modified model fitted the data well, with statistical significance ( χ230 =81.29, P<0.001) and high values for comparative-fit-index and Tucker-Lewis-index exceeding 0.9, as well as a low root-mean-square-error-of-approximation of 0.031 (90% confidence interval: 0.030-0.032).

CONCLUSION

The results of our study identified several significant variables, including collision type, vehicle type, seatbelt use, and driver misconduct, which played mediating and predicting roles. These findings provide valuable insights into the complex factors that contribute to collisions via a theoretical framework and can inform efforts to reduce their occurrence in the future.

Prediction of severity of aviation landing accidents using support vector machine models

The purpose of this study was to apply support vector machine (SVM) models to predict the severity of aircraft damage and the severity of personal injury during an aircraft approach and landing accident and to evaluate and rank the importance of 14 accident factors across 39 sub-categorical factors. Three new factors were introduced using the theory of inattentional blindness: The presence of visual area surface penetrations for a runway, the Federal Aviation Administration's (FAA) visual area surface penetration policy timeframe, and the type of runway approach lighting. The study comprised 1,297 aircraft approach and landing accidents at airports within the United States with at least one instrument approach procedure. Support vector machine models were developed in using the linear, polynomial, radial basis function (RBF), and sigmoid kernels for the severity of aircraft damage and additional SVM models were developed for the severity of personal injury. The SVM models using the RBF kernel produced the best machine learning models with a 96% accuracy for predicting the severity of aircraft damage (0.94 precision, 0.95 recall, and 0.95 F1-score) and a 98% accuracy for predicting the severity of personal injury (0.99 precision, 0.98 recall, and 0.99 F1-score). The top predictors across both models were the pilot's total flight hours, time of the accident, pilot's age, crosswind component, landing runway number, single-engine land certificate, and any obstacle penetration. This study demonstrates the benefit of SVM modeling using the RBF kernel for accident prediction and for datasets with categorical factors.

Prior cancer diagnosis and mortality profile in US adults

BACKGROUND

Mortality profiles with multivariate adjustment in patients with a prior cancer diagnosis are scarce. This study aimed to investigate multivariate-adjusted mortality profile in US adults with a prior cancer diagnosis.

METHODS

This cohort study included 58,109 US adults (5,016 with a prior cancer diagnosis) who attended the National Health and Nutrition Examination Survey. Mortality outcomes were ascertained by linkage to the National Death Index records. Cox proportional hazards models were used to estimate hazard ratios (HRs) and confidence intervals (CIs) of prior cancer diagnosis for mortality.

RESULTS

This cohort was followed up for 646,033 person-years with a mean follow-up of 11.1 years. Compared with those without cancer, participants with a prior cancer diagnosis had increased crude cumulative mortality rates in each leading cause. Prior cancer diagnosis was associated with a higher multivariate-adjusted risk of mortality from all causes (HR, 1.29; 95% CI, 1.22-1.35), cancer (HR, 2.32; 95% CI, 2.10-2.56), and accidents (HR, 1.90; 95% CI, 1.34-2.68). Prior cancer diagnosis-associated increase in accident mortality appeared only in males and was significant only in non-Hispanic black participants. Prior cancer diagnosis-associated increase in cancer mortality appeared high in non-Hispanic black participants.

CONCLUSIONS

This study found that patients with a prior cancer diagnosis had higher multivariate-adjusted accident mortality risks, suggesting that oncologists may need to evaluate accident risks in cancer patients and provide preventive interventions in particular for male and non-Hispanic black patients. Increased cancer mortality risk associated with prior cancer diagnosis in non-Hispanic black participants may also need clinical attention.

Pattern of deaths in paediatric population- An autopsy based study done at a tertiary care hospital in New Delhi

The study was done retrospectively at Lady Hardinge Medical College, New Delhi to assess the pattern of Paediatric deaths among total paediatric autopsies conducted from year 2019-2021. All Deaths among the individuals less than 18 years of age were studied and statistical analysis was done. During the three-year study period from year 2019-2021, 41.2% were females and 58.8% were males in total 17 paediatric autopsies conducted in the year 2019. 60% female, 40% male among total 15 cases in the year 2020 and 58.3% female, 41.7% male among total 12 cases of paediatric autopsies conducted in the year 2021. On distribution of number of cases in a particular year of study as per the manners of paediatric autopsy cases conducted from year 2019-2021, 40% accidental deaths were recorded in 2019 and 2020 each. The accidental deaths were recorded in 20% cases in the year 2021 among total cases of paediatric autopsy done. Total number of homicidal deaths recorded was 50%, 12.5% and 37.5% in 2019, 2020 and 2021, respectively. The natural cause of death was in 38.5% cases in the year 2019; 46.2% and 15.4% were died of natural cause in the 2020 and 2021, respectively. Total number of suicidal deaths recorded was 25% in 2019 and 2020 each year and 50% in 2021. Out of total number of cases 23% and 21% were having history of hospital deaths and fall from height, respectively. Out of the total cases of paediatric autopsy done 16% cases each were died due to asphyxia deaths and septic shock. The cerebral damage was cause of death in 14% cases and 11% cases each were died of craniocerebral damage and haemorrhagic shock. The bilateral pneumonitis was cause of death in 7% cases and 5% cases each were died of strangulation, aspiration pneumonia, poisoning.

[One and a half years of e-scooters in Hamburg]

Background

Since electric scooters were introduced as an urban means of transportation in Hamburg in June 2019, a high number of violations of the current laws regarding alcohol consumption by e‑scooter riders have been recorded.

Objective

The aim of this study is to obtain an overview of traffic offences committed by e‑scooter drivers under the influence of alcohol, to classify their relevance in relation to other road user groups, and to draw a first interim balance with respect to their frequency after 1.5 years.

Material and methods

The data of all e‑scooter drivers (n = 342) examined concerning their blood alcohol values analyzed at the Institute of Legal Medicine of the University Medical Centre Hamburg-Eppendorf between 15.06.2019 and 31.12.2020 were retrospectively evaluated with respect to their demographic information and the medical examination results. These were brought into context with the total number of offences against the road traffic regulations with subsequent blood alcohol measurement.

Results

9.6% of the total number of offences against the road traffic regulations in connection with subsequent determination of the blood alcohol concentration were committed by e‑scooter drivers. 87.7% of those examined were male. The blood alcohol concentration was above the limit of 1.10 ‰ for absolute driving incapacity when using a passenger car in 76.9% of those examined. An accumulation of cases was particularly noticeable at night and at weekends.Due to imprecise records, a certain number of unreported e‑scooter incidents can be assumed among the unspecified motor vehicles.

Conclusion

As e‑scooter drivers make up a considerable proportion of drunken road users and the accidents mostly occur at night and at weekends, increased education and, if necessary, a driving ban at these times would seem to make sense.

Factors influencing the occurrence and progress of sodium hypochlorite accident: A narrative and update review

Sodium hypochlorite (NaOCl) is one of the most commonly used irrigant because of its several advantages. However, it is highly cytotoxic and can lead to severe tissue damage. NaOCl accident occurs when it is extruded beyond root confines into periapical or periradicular tissues. It is an irrigant mishap which can be life threatening and/or cause residual or long term or permanent consequences with malpractice and medico-legal implications. There are many factors which can influence the occurrence and progress of NaOCl accident. These factors can be broadly categorized as patient (host)-, tooth-, operator-, and NaOCl-related factors. They can be further categorized as predisposing and extent factors. It is vital for a clinician to thoroughly understand and identify various influencing factors to prevent NaOCl accident with its associated consequences including any potential medico-legal issues. The purpose of this article is to provide a narrative review on various factors which predispose to the occurrence of NaOCl accident and influence its extent and/or outcome.

A pilot study evaluating the effectiveness of preventing railway suicides by mid-track fencing, which restrict easy access to high-speed train tracks

BACKGROUND

Suicides in the railway system is a serious health, societal, and transportation concern. Restriction of the access to suicide methods in the form of different physical barriers is a promising approach for suicide prevention.

METHOD

Mid-track fencing, which is fencing placed in-between the high-speed and commuter train tracks, was installed at one out of seven stations along a train line outside of Stockholm in the years 2013/2014. The number of suicides at the intervention station was compared to six other stations used as controls, over a total period of 20 years (2002-2021).

RESULTS

Suicides at high-speed tracks occurring at stations was the major cause of death on the investigated railway line. Prior to the year 2014, the intervention and control stations displayed similar time trends in the number of suicides. After installation of the mid-track fencing in 2014, there was a 62.5% reduction in the rate of suicides occurring at the intervention station. Compared to the six other control stations, the intervention station displayed a significant reduction in the number of suicides during the years 2014-2021 (OR = 0.14, 95%CI 0.013-0.95). Suicides at the railway lines in-between stations were not increased post-intervention. However, nearby control stations showed a 162% increase in suicides after the intervention, suggesting the induction of transfer effects.

CONCLUSION

Mid-track fences restricting access to high-speed train tracks may have a large effect on reducing the number of railway suicides at intervention stations, but may also induce an increase in suicides at nearby stations without mid-track fences.

PRACTICAL APPLICATIONS

Partial physical barriers such as mid-track fencing is deemed to be relatively easy and cheap to install (as compared to full barriers; e.g., full height platform screen doors) and should be considered at all stations on railway lines that have high-speed trains passing by.

Bicycle-Related Injuries of the Upper Extremity

Background

In recent years, the increasing popularity of cycling for commuting and leisure has led to a corresponding increase in bicycle-related injuries. However, there is a lack of extensive analysis of bicycle-related injuries to the upper limb in the literature.

Methods

A retrospective review of all patients with conventional bicycle-related injuries of the upper limb was performed. Data on demographics, mechanisms of injury, region of injury, fracture type, management type, and length of hospital stay were extracted and analyzed.

Results

A total of 177 of 733(24%) patients with bicycle-related upper limb injuries were identified. The most common mechanism of injury was a collision with another vehicle (60%). Frequently affected regions were the shoulder (48%), hand (19%), and wrist (19%). Eighty-eight (50%) patients sustained bony injuries, while the remainder (50%) had isolated soft tissue injuries. Fifty-three (30%) patients required a mean of 3.9 days of hospitalization, whereas 13 (25%) patients required high dependency or intensive care unit treatment. Surgical interventions were required in 47 (27%) patients.

Conclusion

Bicycle-related injuries to the upper limb are common and result in significant morbidity. The most common regions affected are the shoulder, wrist, and hand. Most of the injuries were caused by collisions with other vehicles. A third of affected patients required hospitalization, and a quarter required surgical intervention.

Repentance as Rebuke: Betrayal and Moral Injury in Safety Engineering

Following other contributions about the MAX accidents to this journal, this paper explores the role of betrayal and moral injury in safety engineering related to the U.S. federal regulator's role in approving the Boeing 737MAX-a plane involved in two crashes that together killed 346 people. It discusses the tension between humility and hubris when engineers are faced with complex systems that create ambiguity, uncertain judgements, and equivocal test results from unstructured situations. It considers the relationship between moral injury, principled outrage and rebuke when the technology ends up involved in disasters. It examines the corporate backdrop against which calls for enhanced employee voice are typically made, and argues that when engineers need to rely on various protections and moral inducements to 'speak up,' then the ethical essence of engineering-skepticism, testing, checking, and questioning-has already failed.

Global prevalence of falls in the older adults: a comprehensive systematic review and meta-analysis

BACKGROUND

With increasing life expectancy, declining mortality, and birth rates, the world's geriatric population is increasing. Falls in the older people are one of the most common and serious problems. Injuries from falls can be fatal or non-fatal and physical or psychological, leading to a reduction in the ability to perform activities of daily living. The aim of this study was to determine the prevalence of falls in the older people through systematic review and meta-analysis.

METHODS

In this systematic review and meta-analysis, the data from studies on the prevalence of falls in the older people in the world were extracted in the databases of Scopus, Web of Science (WoS), PubMed and Science Direct, and Google Scholar, Magiran and Scientific Information Database (SID) without any time limit until August 2020. To analyze the eligible studies, the stochastic effects model was used, and the heterogeneity of the studies with the I² index was investigated. Data analysis was conducted with Comprehensive Meta-Analysis software (Version 2).

RESULTS

In the review of 104 studies with a total sample size of 36,740,590, the prevalence of falls in the older people of the world was 26.5% (95% CI 23.4-29.8%). The highest rate of prevalence of falls in the older people was related to Oceania with 34.4% (95% CI 29.2-40%) and America with 27.9% (95% CI 22.4-34.2%). The results of meta-regression indicated a decreasing trend in the prevalence of falls in the older people of the world by increasing the sample size and increasing the research year (P < 0.05).

CONCLUSION

The problem of falls, as a common problem with harmful consequences, needs to be seriously considered by policymakers and health care providers to make appropriate plans for preventive interventions to reduce the rate of falls in the older people.

Travel-Related Diseases and Injuries in Children and Adolescents: A Post-Travel Surveillance Questionnaire Assessment

INTRODUCTION

Children and adolescents are a relevant and increasing proportion of travelers. Injuries and infectious diseases in children are safety concerns when traveling. However, data on diseases and injuries during international travels in children are not available. The aims of this study were to analyze travel-related diseases and injuries among pediatric travelers during and after international trips, to identify risk factors for travel-associated disease, and to evaluate the compliance and effectiveness of the recommendations provided in pre-travel appointments.

MATERIAL AND METHODS

We enrolled travelers aged under 18 years attending a pre-travel clinic, in a tertiary hospital (2017 - 2019); 223 of the 370 pediatric travelers attending the pre-travel clinic were included. The study was based on a questionnaire designed to address health and safety issues - vaccines and chemoprophylaxis, including side effects, the occurrence of disease or injury, diagnosis, treatment, and outcomes.

RESULTS

The median age at pre-travel evaluation was eight years; 39.7% of the travelers were adolescents, 52.5% were female. The participants traveled to 40 countries across four continents, with a median travel duration of 14.5 days. Asia was the most visited continent. Traveling was safe for 84.8%. From 34 travelers who had illness/injury, gastrointestinal symptoms were elicited in 41.2%. Sixteen (47.1%) travelers required an urgent medical appointment at the destination, and no one was hospitalized. Destinations in Africa and longer trips were significantly associated with a higher occurrence of disease/injury (p = 0.023 and p < 0.001, respectively). In a multivariable model, traveling to Africa was still significantly associated with travel-related disease/injury [OR = 2.736 (1.037 - 7.234)].

CONCLUSION

Disease/injury occurred in 15.2% of pediatric travelers. Even though 47.1% of the travelers required an urgent medical appointment, the developed conditions were not severe enough to warrant hospitalization. Travels to Africa and longer trips seem to be associated with a higher risk of disease and injury.

Detection of areas vulnerable to scorpionism and its association with environmental factors in São Paulo, Brazil

Accidents caused by scorpions are considered a neglected condition and represent a major health problem in most tropical countries, especially for children and elderly people. In Brazil, scorpionism is recurrent in the southeast region, mainly in the state of São Paulo, due to the progressive increase in scorpions found in urban habitats. Thus, our study aimed to provide better insights into the geographic and epidemiological characteristics of scorpion envenomation in São Paulo state and identify the environmental factors that are associated with these accidents. This is an ecological and retrospective study with secondary data on scorpion accidents in the state of São Paulo from 2008 to 2018 obtained from the Notifiable Disease Information System. The SatScan software was used to identify the higher- and lower-risk spatiotemporal clusters. A total of 145,464 scorpion sting cases were recorded in the state of São Paulo, between 2008 and 2018; there was a four-fold increase in the incidence rate. Accidents occurred more frequently in the spring season, wherein higher-risk clusters were in the north and northwest regions of the state. High temperatures, low precipitation, and poor natural vegetation are associated with higher risk areas. Our study mapped vulnerable areas for scorpion accidents that can aid in the design of efficient public health policies, which should be intensified during the spring season.

Factors associated with motorcycle-related road traffic crashes in Africa, a Scoping review from 2016 to 2022

Background

The toll associated with road traffic crashes (RTC) is high, and the burden of injury is disproportionately borne by pedestrians and motor riders, particularly in developing countries. This study synthesized the factors associated with motorcycle-related RTC in Africa.

Methods

The PICO framework and the PRISMA guidelines for conducting reviews were incorporated in searching, screening, and reporting the findings. Advanced search in five electronic databases (Google Scholar, PubMed Central, Scopus, CINAHL, and Embase) yielded 2552 titles and 22 from manual search, filtered for 2016 to 2022 (to generate 1699) and then further for primary studies (854). Through the title, abstract and full-text screening, 22 were appropriate for this review. Data extraction was done by the two researchers independently, and the results were compared. Convergent synthesis was adopted to integrate results, transformed into a narrative, and analyzed using thematic synthesis.

Results

The four main themes identified were the rider-related, non-rider-related factors, prevalence and severity of injuries from RTC, and the measures to reduce RTC. The behavioral factors associated with RTC were alcohol use, smoking, use of illicit drugs, tiredness of rider, poor knowledge on traffic regulations, more than one pillow rider, lack of rider license, non-observance of traffic regulations, and non-use of personal protective equipment. Road traffic crashes were common among younger age and male gender. Other factors identified included poor road network, unplanned stoppage by police, unlawful vehicular packing, increased urbanization, and slippery floors.

Conclusion

There is the need to institute multi-sectoral measures that target riders’ behavior change. Coordinated efforts should target governments, enforcement authorities, and regulatory bodies to enforce enactment that ensures safe use of roads.

Modelling the radioactive contamination of commercial fish species in the Barents Sea following a hypothetical short-term release to the Stepovogo Bay of Novaya Zemlya

A dynamic modelling of radionuclides accumulation in commercial species in the Barents Sea is performed for hypothetical SCR accident with the dumped submarine K-27 at the Stepovogo Bay. Box radioecological model is employed for calculating the radionuclides dynamics in water, bottom sediments and marine biota. The model takes into account the seasonal fish migrations in the Barents Sea. The model allows predicting the dynamic effects of the radionuclide transfer in fish in case of an accidental water contamination. Maximum ¹³⁷Cs activity concentrations in bottom sediments from the eastern part of the Barents Sea could be reached as late as 5-6 years after the accidental release. Based on the results of model calculations, assessment was made of doses to humans from consumption of seafood contaminated after a hypothetical SCR accident with K-27 at the Stepovogo Bay. The peak activity concentration of the released ¹³⁷Cs in fish from the Stepovogo Bay is calculated to be 109 Bq∙kg^-1, ⁹⁰Sr - 12 Bq∙kg^-1; both estimates are below the permissible activity concentrations of these radionuclides in commercial fish. Predicted maximum annual dose from consumption of fish from the Stepovogo Bay is 47 ± 18 μSv∙year^-1, the Barents Sea fish - less than 3∙10^-6 μSv∙year^-1.¹³⁷Cs is the major dose contributor; it provides more than 99% to the annual dose Radiation risks from consumption of the Barents Sea commercial fish are evaluated to be negligible in case of a hypothetical SCR accident with the submerged submarine K-27 in Stepovogo Bay of Novaya Zemlya.

Accident or suicide? Improvement in the classification of suicides among road traffic fatalities in Sweden by extended psychosocial investigations, during the years 2010-2019

INTRODUCTION

Suicide is the second leading cause of death in the ages 15-29 worldwide, exceeded only by road injury. However, fatalities in road traffic may be either accidents or suicides. In 2010 Sweden began efforts to separately report deaths in road traffic as either accidents or suicides.

METHOD

Three alternative criteria defining what constitutes a fatality by suicide were introduced. After exclusion of natural deaths, fatalities were also classified on a five-level graded scale, which distinguished between accident, undetermined, and suicide. The investigations of fatalities were complemented by extended psychosocial investigations in 2012. The improvement in the classification of suicide deaths was evaluated by an intra-year 2012 comparison, as well as using the 2010-2012 period as a control to evaluate the continued use of extended psychosocial investigations during the 2013-2019 period.

RESULTS

The 2012 intra-year comparison showed a 63% increase in the number of identified suicides when using extended psychosocial investigations. The additional 14 suicides identified in 2012 were mainly attributed to a resolution of 12 "undetermined" causes of deaths. Suicides of all road fatalities increased from 5.7-6.8% in 2010-2011, to 11.2% in 2012. Over the subsequent period 2013-2019 with extended psychosocial investigations, suicides of all road fatalities averaged 10%, a 60% increase over prior years. An average of ∼9 additional suicides was identified each year during 2013-2019, which was accompanied by an annual reduction of ∼6 "undetermined" fatalities.

CONCLUSION

The use of extended psychosocial investigations is of major importance for our knowledge about the occurrence of suicides in road traffic. Practical applications: A standardized and in-depth classification of suicide deaths is a basic prerequisite needed for the cooperation, implementation, and effect-evaluations of suicide intervention and prevention efforts, with potential to include the entire Swedish transportation system.

NSAID use and unnatural deaths after cancer diagnosis: a nationwide cohort study in Sweden

BACKGROUND

Cancer patients experience increased risk of death from accident and suicide. Cognitive impairment induced by cancer-related inflammation and stress-related psychiatric symptoms may be underlying mechanisms. We therefore studied the association between use of nonsteroidal anti-inflammatory drugs (NSAIDs) and risk of these outcomes.

METHODS

Following a cohort of 388,443 cancer patients diagnosed between October 2005 and December 2014 in Sweden, we ascertained dispense of aspirin or non-aspirin NSAIDs from 3 months before cancer diagnosis onward and defined the on-medication period as from date of drug dispense until the prescribed dosage was consumed. Follow-up time outside medicated periods and time from unexposed patients were defined as off-medication periods. We used Cox models to estimate hazard ratios (HRs) of death due to suicide or accident, by comparing the on-medication periods with off-medication periods.

RESULTS

In total, 29.7% of the cancer patients had low-dose aspirin dispensed and 29.1% had non-aspirin NSAIDs dispensed. Patients with aspirin use were more likely to be male than patients without aspirin use. Compared with off-medication periods, there was a 22% lower risk of accidental death (N = 651; HR 0.78, 95% confidence interval [CI]: 0.70 to 0.87) during on-medication periods with aspirin. The use of aspirin was not associated with risk of suicide (N = 59; HR 0.96, 95% CI: 0.66 to 1.39). No association was noted between use of non-aspirin NSAIDs and the risk of suicide (N = 13; HR 0.95, 95% CI: 0.42 to 2.18) or accidental death (N = 59; HR 0.92, 95% CI: 0.68 to 1.26).

CONCLUSIONS

Intake of low-dose aspirin after cancer diagnosis was associated with a lower risk of unnatural deaths among cancer patients.

A Bayesian network based study on determining the relationship between job stress and safety climate factors in occurrence of accidents

BACKGROUND

Job stress and safety climate have been recognized as two crucial factors that can increase the risk of occupational accidents. This study was performed to determine the relationship between job stress and safety climate factors in the occurrence of accidents using the Bayesian network model.

METHODS

This cross-sectional study was performed on 1530 male workers of Asaluyeh petrochemical company in Iran. The participants were asked to complete the questionnaires, including demographical information and accident history questionnaire, NIOSH generic job stress questionnaire, and Nordic safety climate questionnaire. Also, work experience and the accident history data were inquired from the petrochemical health unit. Finally, the relationships between the variables were investigated using the Bayesian network model.

RESULTS

A high job stress condition could decrease the high safety climate from 53 to 37% and increase the accident occurrence from 72 to 94%. Moreover, a low safety climate condition could increase the accident occurrence from 72 to 93%. Also, the concurrent high job stress and low safety climate could raise the accident occurrence from 72 to 93%. Among the associations between the job stress factor and safety climate dimensions, the job stress and worker's safety priority and risk non-acceptance (0.19) had the highest mean influence value.

CONCLUSION

The adverse effect of high job stress conditions on accident occurrence is twofold. It can directly increase the accident occurrence probability and in another way, it can indirectly increase the accident occurrence probability by causing the safety climate to go to a lower level.

Analgesia in pediatric trauma patients in physician-staffed Austrian helicopter rescue: a 12-year registry analysis

BACKGROUND

As pediatric patients are typically rare among helicopter emergency medical systems (HEMS), children might be at risk for oligo-analgesia due to the rescuer's lack of experience and the fear of side effects.

METHODS

In this retrospective analysis, data was obtained from the ÖAMTC HEMS digital database including 14 physician staffed helicopter bases in Austria over a 12-year timeframe. Primary missions involving pediatric trauma patients (< 15 years) not mechanically ventilated on-site were included. Analgesia was assessed and compared between the age groups 0-5, 6-10 and 11-14 years.

RESULTS

Of all flight missions, 8.2% were dedicated to children < 15 years. Analgetic drugs were administered in 31.4% of all primary missions (3874 of 12,324), wherefrom 2885 were injured and non-ventilated (0-5 yrs.: n = 443; 6-10 yrs.: n = 902; 11-14 yrs.: n = 1540). The majority of these patients (> 75%) suffered moderate to severe pain, justifying immediate analgesia. HEMS physicians typically chose a monotherapy with an opioid (n = 1277; 44.3%) or Esketamine (n = 1187; 41.1%) followed by the combination of both (n = 324; 11.2%). Opioid use increased (37.2% to 63.4%) and Esketamine use decreased (66.1% to 48.3%) in children < 6 vs. > 10 years. Esketamine was more often administered in extremity (57.3%) than in head (41.5%) or spine injuries (32.3%). An intravenous access was less often established in children < 6 years (74.3% vs. 90.8%; p < 0.001). Despite the use of potent analgesics, 396 missions (13.7%) were performed without technical monitoring. Particularly regarding patient data at handover in hospital, merely < 10% of all missions featured complete documentation. Therefore, sufficient evaluation of the efficacy of pain relief was not possible. Yet, by means of respiratory measures required during transport, severe side effects such as respiratory insufficiency, were barely noted.

CONCLUSIONS

In the physician-staffed HEMS setting, pediatric trauma patients liberally receive opioids and Esketamine for analgesia. With regard to severe respiratory insufficiency during transport, the application of these potent analgesics seems safe.

Analysis of Fall Incident Rate among Hospitalized Korean Children Using Big Data

PURPOSE

This study was conducted to identify the characteristics of fall incidents and fall rate among hospitalized children in South Korea.

DESIGN AND METHODS

A secondary analysis was carried out using patient safety reports for those aged 0-19 years from Korean Patient Safety Reporting & Learning System (KOPS) and the National Health Insurance Corporation from January 1, 2018, to December 31, 2018.

RESULTS

A total of 723 safety accidents were reported to KOPS in 2018, of which 461 (63.8%) were medication errors and 117 (16.2%) were fall incidents. The fall rate of hospitalized children was 0.10 per 1000 patient days. By gender, boys were more affected (62.4%), and by age, 80 (68.4%) were aged 1-9 years. About 16% of children who sustained falls incurred temporary or long-term damage.

CONCLUSION

The findings demonstrate the national-level fall rate of hospitalized children as well as various features of safety accidents including pediatric falls that occurred in Korean children's hospitals. Younger children, and particularly boys, were likely to experience more falls than older children and girls, respectively.

PRACTICE IMPLICATIONS

Nurses and other healthcare providers should recognize the important features of fall incidents among hospitalized children to ensure better quality of care and patient safety.

Couriers' safety and health risks before and during the COVID-19 pandemic

Objectives

This study aimed to examine the safety and health hazards of motorized couriers and investigate working conditions and driving behavior possibly associated with involvement in road accidents while driving motorcycles or cars. In light of the outbreak of COVID-19, the study was aimed to explore factors that affect the couriers’ behaviors related to decreasing the risk of contracting an infectious disease.

Methods

A sample of 237 Israeli couriers, about half who drove a two-wheeled vehicles and the others who drove cars, answered an online survey questionnaire. The questionnaire examined organizational, occupational, and personal factors regarding their working conditions, behavior on the road, musculoskeletal disorders, road accidents, and perceptions of and compliance with regulations regarding COVID-19. The data were analyzed by multiple regression in SPSS 25, structural equation modeling and mediation tests in R 3.6.2.

Results

According to the couriers’ self-report, 37% reported musculoskeletal pains at least once a day, 13% of them were involved in work-related road accidents and 10% reported feeling stress at least once a week. More than 60% of the couriers reported increased stress due to the COVID-19 pandemic. Weekly working hours, shift duration and stress were related to involvement in accidents through the mediation of driving while feeling unwell. Reported stress and the weight of parcels were related to musculoskeletal pains.

Conclusions

The findings suggest that stress and attributes of work overloads experienced by couriers are associated with reduced safety and impaired health. Organizational, individual, and societal factors were correlated with the degree to which the couriers adhered to COVID-19 regulations. The increased prevalence of new modes of employment relationships in the field highlights the importance of research on employment conditions and safety and health aspects related to this occupation.

Accidental Extrusion of Sodium Hypochlorite in a Patient Taking Alendronate: A Case Report With an 8-Year Follow-up

Extrusion of sodium hypochlorite (NaOCl) is a very rare accident with the most common complications including pain, swelling, and hematoma. It can occur even if procedural guidelines, predisposing conditions, and risk factors are taken into consideration. A 59-year-old female patient was admitted to the endodontics department to treat a left maxillary first premolar (World Dental Federation tooth 24). The medical history included osteoporosis and systemic medication with alendronate. Initially, the diagnosis was "symptomatic irreversible pulpitis" with "normal apical tissues." During instrumentation of the buccal canal, accidental extrusion of 2.5% NaOCl occurred into the periapical tissues, resulting from misinterpretation of the working length, and caused severe pain and bleeding. The canal was immediately flushed using copious irrigation with saline solution. An analgesic and corticosteroid were prescribed. At 3 and 7 days, ecchymosis and slight hematoma were observed extraorally in the area of the affected tooth and an intraoral ulceration at the apex of the affected tooth. At 15 days, minimal signs of ecchymosis were observed, and the treatment was resumed. At 30 days after the accident, there was complete remission of the sequelae. The clinical, radiographic, and tomographic assessment after 1 month, 1 year, and 8 years showed favorable case evolution. During the 8-year follow-up, the patient maintained the systemic use of alendronate. It can be concluded that NaOCl extrusion is an accident that causes patients and clinicians to experience an unpleasant consequence. The radiographic working length should always be determined carefully. A successful outcome can be achieved in patients who take alendronate.

[Requirements for trauma rehabilitation centers : Post-acute rehabilitation (phase C) after severe trauma injury]

Severely injured patients need a qualified and seamless rehabilitation after the end of the acute treatment. This post-acute rehabilitation (phase C) places high demands on the rehabilitation facility in terms of personnel, material, organizational and spatial requirements.The working group on trauma rehabilitation of the German Society for Orthopedics and Traumatology e. V. (DGOU) and other experts have agreed on requirements for post-acute phase C rehabilitation for seriously injured people. These concern both the personnel and material requirements for a highly specialized orthopedic trauma surgery trauma rehabilitation as well as the demands on processes, organization and quality assurance.A seamless transition to the follow-up and further treatment of seriously injured people in the TraumaNetzwerk DGU® is ensured through a high level of qualification and the corresponding infrastructure of supraregional trauma rehabilitation centers. This also places new demands on the TraumaZentren DGU®. Only if these are met can the treatment and rehabilitation of seriously injured people be optimized.

The water incident database (WAID) 2012 to 2019: a systematic evaluation of the documenting of UK drownings

Background

Death by drowning is a leading cause of accidental death in the United Kingdom (UK) and worldwide. The World Health Organization (WHO) states that effective documentation of drowning is required to describe drowning frequency and to underpin effective drowning prevention intervention, thus improving the quality of data describing drowning frequency represents a key initiative. The water incident database (WAID) has been used to document UK fatal and non-fatal water-based incidents since 2009. WAID has not undergone a systematic evaluation of its data or data collection procedures to establish if the database meets the WHO requirements. The present study investigated the characteristics of UK fatal drowning incidents and audited current WAID data capture procedures.

Methods

Data for the fatal drowning cases recorded between 2012 and 2019 were reviewed. Descriptive data were generated 1) to describe fatal drownings in the UK’s WAID in this period; 2) a sub-set of drownings were audited i) for completeness of data entry and, based on source documents, ii) for quality of data entry; 3) these processes were used to make recommendations for onward revisions to WAID.

Results

A total of 5051 fatalities were recorded between 2012 and 2019. Drowning was most frequent amongst males aged 35 to 60 years (n = 1346), whilst suspected accidents and suicides accounted for 44 and 35% of fatalities. Suicide by drowning was at a peak in the most recent year of data analysed (i.e., 2019; 279 cases) highlighting an urgent need for targeted intervention. Audit part 2i) indicated that 16% of all fields were incomplete, thus indicating potential redundancy, duplication, or the need for onward review. Audit part 2ii) indicated high levels of agreement (80 ± 12%) between audited cases and the ‘true’ WAID entries.

Conclusions

This study confirms WAID as a rigorous, transparent and effective means of documenting UK drownings thereby meeting WHO requirements for data quality; yet future improvements are recommended. Such findings allow researchers and policy makers to use WAID to further investigate UK drowning with a view to improving public safety measures and drowning prevention interventions. Observations alongside several expert recommendations have informed a revised version of WAID.

The impact of the COVID-19 pandemic on patterns of attendance at emergency departments in two large London hospitals: an observational study

BACKGROUND

Hospitals in England have undergone considerable change to address the surge in demand imposed by the COVID-19 pandemic. The impact of this on emergency department (ED) attendances is unknown, especially for non-COVID-19 related emergencies.

METHODS

This analysis is an observational study of ED attendances at the Imperial College Healthcare NHS Trust (ICHNT). We calibrated auto-regressive integrated moving average time-series models of ED attendances using historic (2015-2019) data. Forecasted trends were compared to present year ICHNT data for the period between March 12, 2020 (when England implemented the first COVID-19 public health measure) and May 31, 2020. We compared ICHTN trends with publicly available regional and national data. Lastly, we compared hospital admissions made via the ED and in-hospital mortality at ICHNT during the present year to the historic 5-year average.

RESULTS

ED attendances at ICHNT decreased by 35% during the period after the first lockdown was imposed on March 12, 2020 and before May 31, 2020, reflecting broader trends seen for ED attendances across all England regions, which fell by approximately 50% for the same time frame. For ICHNT, the decrease in attendances was mainly amongst those aged < 65 years and those arriving by their own means (e.g. personal or public transport) and not correlated with any of the spatial dependencies analysed such as increasing distance from postcode of residence to the hospital. Emergency admissions of patients without COVID-19 after March 12, 2020 fell by 48%; we did not observe a significant change to the crude mortality risk in patients without COVID-19 (RR 1.13, 95%CI 0.94-1.37, p = 0.19).

CONCLUSIONS

Our study findings reflect broader trends seen across England and give an indication how emergency healthcare seeking has drastically changed. At ICHNT, we find that a larger proportion arrived by ambulance and that hospitalisation outcomes of patients without COVID-19 did not differ from previous years. The extent to which these findings relate to ED avoidance behaviours compared to having sought alternative emergency health services outside of hospital remains unknown. National analyses and strategies to streamline emergency services in England going forward are urgently needed.

Impact of COVID-19 on Public Transportation and Road Safety in Bangladesh

Due to the spread of COVID-19, global measures such as lockdown and limits on public transit, entertainment, the closure of all educational institutions, and religious practices have been imposed in early 2020. During and after the COVID-19 disease outbreak, the first target ought to be safer road travel and zero fatalities. This paper general overviews the effects of the government's COVID-19 control measures on Bangladesh's transportation system and road safety during the period March 2020-2021. Secondary data sources, newspaper articles, WHO, Worldometer, Institute of Epidemiology, Disease Control and Research (IEDCR) websites, and relevant research papers were used to compile this article. The various restriction policies would have a negative impact on the transportation sector's finances, exacerbating the economic crisis that public transportation and airline operators in Bangladesh are experiencing. This study found that restricting mobility reduces road traffic deaths and injuries by a small amount, but that accidents continue to occur during the lockdown period in Bangladesh.

Comprehensive analysis and investigation of accident/occupational disease responsibility rates: A case study for accidental CO poisoning

One of the major problems of courts and insurance companies is the lack of a proper technique to determine the rate of responsibility of the parties involved in the accident. The aim of this study was to determine the Accident/Occupational Diseases Responsibility Rates (AOD RR) for complex events. Accordingly, a case study of a complex accident of carbon monoxide (CO) poisoning was selected and Occupational Accident Tree Analysis (OATA) and Occupational Accident Component Analysis (OACA) techniques, which were solely used to investigate occupational accidents, were used with the new names Accident/Occupational Disease Tree Analysis (AOD TA) and Accident/Occupational Disease Component Analysis (AOD CA) to evaluate their applicability to investigate non-occupational accidents and occupational diseases. For this purpose, causes of CO penetration to victims' room was assessed using gas tracking methods. Finally, Fuzzy Accident/Occupational Disease Tree/Component Analysis (FAOD TA and FAOD CA) techniques were developed and used for determining AOD RR in fuzzy environment. The results showed that the AOD RR obtained by AOD TA and AOD CA based on the average of experts' personal opinions and consensus between experts, and AOD TA and AOD CA in a fuzzy environment were close to each other, with the power terminal and the power cable crossing route being the main routes of transmission and penetration of CO to the victims' room. Also, the owner, contractor, tenant, and serviceman were responsible for the CO poisoning of victims. It can be concluded that any hole, crack, or fission in the building can result in CO penetration to the individuals' living rooms, and gas tracking in early winter, especially in older buildings, plays a very significant role in preventing residents' poisoning. Further, due to the uncertainty of AOD TA and AOD CA techniques, it is recommended to use FAOD TA and FAOD CA techniques for increasing the accuracy of the results. This will enhance the court and insurance companies' trust in the opinions of accident investigation experts, decrease delays in the proceedings, and prevent any violation of the individual rights.

The evolution of safety-adjusted transportation efficiency for the road system in China

Traffic accident is a grievous problem that costs more than one million lives worldwide every year, but remains understudied in transportation efficiency literature. This paper develops safety-adjusted transportation efficiency to account for the negative outcomes in transportation including accidents, fatalities, injuries and property loss. We model the transportation efficiency under the data envelopment analysis (DEA) framework by treating the accident-related negative outcomes as undesirable outputs. Two DEA models, based on radial and non-radial structures respectively, are proposed for panel data. We apply the methods to 31 provinces in China over a 20-year horizon 1998-2017. We find that the evolution of China's overall safety-adjusted transportation efficiency follows a U-shaped path: It deteriorated between 1998 and 2002, steadily improved from 2002 to 2012, and stabilized during 2012-2017. The majority of the provinces improved their safety-adjusted transportation efficiency from 1998 to 2017, except for one province that maintained the status quo and three provinces that experienced a decline in performance. Improvement analysis is carried out to identify gaps in accident-related factors that each province should close to attain best-practice. Further, we find strong evidence of unconditional β-convergence and σ-convergence in safety-adjusted transportation efficiency, indicating that the provinces with low initial efficiency generally grew more rapidly and the dispersion of provincial efficiency levels diminished. The main findings are substantially different from the regular transportation efficiency analysis that does not consider the accident-related undesirable factors. The safety-adjusted transportation efficiency can convey important information that the regular transportation efficiency fails to capture.

Manner of death associated with multiple tattoos

A prospective study was undertaken of 150 medicolegal cases where five or more tattoos were identified in anatomically separate areas. All cases were the subject of full police and coronial investigations with examination by forensic pathologists. There were 120 males and 30 females (M:F = 4:1) with an age range of 22-86 years (mean = 48.1 years). 78 cases were found where deaths were due to natural diseases (52%) (age range 27-82 years; mean 55.3 years; M:F = 4.2:1). 72 cases (48%) were found where deaths were classified as unnatural - 23 drug/alcohol related, 37 suicides, 12 accidents and 0 homicides (age range 20-66 years; mean 39.8 years; M:F = 3.8:1). This distribution was not shown to be statistically different to a control group of 100 non-tattooed individuals where there were 56 natural and 44 unnatural deaths (p = 0.3). Thus, although certain types of tattoos may be associated with an increased number of unnatural deaths in a medicolegal environment, the actual number of tattoos appears to have minimal effect.

Prevalence of bone fractures among children and adolescents with attention-deficit/hyperactivity disorder: a systematic review and meta-analysis

Background

Attention-deficit/hyperactivity disorder (ADHD) is a significant neurodevelopment disorder among children and adolescents, with 5 % prevalence. Bone fractures account for 25 % of accidents and injuries among all children and adolescents. Considering the characteristics of inattention, hyperactivity, and impulsivity in children with ADHD, it is critical to examine bone fractures among these children. The objective of our meta-analysis was to determine the prevalence of bone fractures among children and adolescents with ADHD.

Methods

We completed a systematic review and meta-analysis using an electronic search of the following databases: CINAHL, EMBASE, PsycINFO, PubMed, and Scopus. The search terms used were: “attention deficit hyperactivity disorder OR attention deficit disorder” and “bone fracture*.” We included studies examining patients 18 years or younger who were diagnosed with ADHD and tracked (prospectively or retrospectively) for five or more years. Effect size (es), using a random effects model, was calculated. We registered the review protocol with PROSPERO (CRD42019119527).

Results

From 445 records retrieved, 31 full text articles were reviewed and 5 articles met inclusion criteria for meta-analysis. The summary es revealed the prevalence of bone fractures among children and adolescents with ADHD to be 4.83 % (95 % CI: 3.07–6.58 %). The location of bone fractures, using a subset of data, showed a distribution of 69.62 %, 22.85 %, and 7.53 % in the upper limbs, lower limbs, and other anatomical regions, respectively. Another subset of studies revealed a 2.55-fold increase in the prevalence of fractures among the children with ADHD compared to their counterparts.

Conclusions

Awareness of these findings is critical to physicians, parents, and policy makers to create safe environments and provide supports in order to optimize the health and safety of children and adolescents with ADHD.

E-scooter accidents: A rising cause of kidney injury

INTRODUCTION

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

CASE REPORTS

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

DISCUSSION

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

CONCLUSION

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

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

BACKGROUND

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

AIMS

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

METHODS

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

RESULTS

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

CONCLUSIONS

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