Introduction Injury is responsible for nearly five million annual deaths worldwide, and nearly 90% of these deaths occur in low- and middle-income countries (LMICs). Reliable clinical data detailing ...the epidemiology of injury are necessary for improved care delivery, but they are lacking in these regions.
A retrospective review of the Service d'Aide Medicale Urgente (SAMU; Kigali, Rwanda) prehospital database for patients with traumatic injury-related conditions from December 2012 through November 2014 was conducted. Chi-squared analysis, binomial probability test, and student's t-test were used, where appropriate, to describe patient demographics, injury patterns, and temporal and geographic trends of injuries.
In the two-year period, 3,357 patients were managed by SAMU for traumatic injuries. Males were 76.5% of the study population, and the median age of all injured patients was 29 years (IQR=23-35). The most common causes of injury were road traffic crashes (RTCs; 73.4%), stabbings/cuts (11.1%), and falls (9.4%), and the most common anatomic regions injured were the head (55.7%), lower (45.0%) extremities, and upper (27.0%) extremities. Almost one-fourth of injured patients suffered a fracture (24.9%). The most common mechanism of injury for adults was motorcycle-related RTCs (61.4%), whereas children were more commonly injured as pedestrians (59.8%). Centrally located sectors within Kigali represented common areas for RTCs.
These data support the call for focused injury prevention strategies, some of which already are underway in Rwanda. Further research on care processes and clinical outcomes for injured patients may help identify avenues for improved care delivery. Enumah S , Scott JW , Maine R , Uwitonze E , Nyinawankusi JD , Riviello R , Byiringiro JC , Kabagema I , Jayaraman S . Rwanda's model prehospital emergency care service: a two-year review of patient demographics and injury patterns in Kigali. Prehosp Disaster Med. 2016;31(6):614-620.
Although experts recommend routine screening of hepatic transaminases (aspartate aminotransferase AST and alanine aminotransferase ALT) in cases of potential child physical abuse, this practice is ...highly variable. Our objective was to determine the sensitivity and specificity of routine transaminase testing in young children who underwent consultation for physical abuse.
This was a prospective, multicenter, observational study of all children younger than 60 months referred for subspecialty evaluation of possible physical abuse. The child abuse team at each center recommended screening transaminases routinely as standard of care for all cases with a reasonable concern for physical abuse. Sensitivity and specificity for transaminases and clinical examination findings to detect identified abdominal injuries were determined, and receiver operating characteristic analysis was undertaken.
Of 1676 consultations, 1272 (76%) patients underwent transaminase testing, and 54 (3.2% 95% confidence interval: 2.4-4.2) had identified abdominal injuries. Area under the curve for the highest level of either transaminase was 0.85. Using a threshold level of 80 IU/L for either AST or ALT yielded a sensitivity of 77% and a specificity of 82% (positive likelihood ratio: 4.3; negative likelihood ratio: 0.3). Of injuries with elevated transaminase levels, 14 (26%) were clinically occult, lacking abdominal bruising, tenderness, and distention. Several clinical findings used to predict abdominal injury had high specificity but low sensitivity.
In the population of children with concern for physical abuse, abdominal injury is an important cause of morbidity and mortality, but it is not so common as to warrant universal imaging. Abdominal imaging should be considered for potentially abused children when either the AST or ALT level is >80 IU/L or with abdominal bruising, distention, or tenderness.
Intrapartum care Vasanth Andrews; Abdul H Sultan; Ranee Thakar ...
BJOG : an international journal of obstetrics and gynaecology,
02/2006, Volume:
113, Issue:
2
Journal Article
Peer reviewed
To establish the true prevalence of clinically recognisable and occult obstetric anal sphincter injuries (OASIS). Prospective interventional study. Busy district general hospital. Two hundred and ...fifty-four women having their first vaginal delivery over a 12-month period were invited. Two hundred and forty-one (95%) participated and 208 (86%) attended follow up. Women had a clinical examination at delivery by the accoucheur and repeated by an experienced research fellow immediately after delivery. All identified OASIS were verified and repaired by the duty specialist registrar or consultant. Endoanal ultrasound was performed immediately postpartum prior to suturing and repeated seven weeks later. Prevalence of recognised and occult anal sphincter injuries. Fifty-nine (24.5%) women sustained OASIS. The prevalence of OASIS increased significantly from 11% to 24.5% when women were re-examined. Of these, 30 occurred in deliveries by midwives who missed 26 (87%) and 29 following deliveries by doctors who missed 8 (28%) injuries. All clinically apparent OASIS were also identified on endoanal ultrasound. In addition, three (1.2%) women had an occult anal sphincter injury. Two of these occult sphincter injuries were isolated to the internal anal sphincter (IAS) and would not usually be clinically detectable. OASIS occur more frequently than previously reported. Many remain undiagnosed and are subsequently classified as occult when identified on anal endosonography. Genuine occult injuries are rare. Training in perineal anatomy and recognition of OASIS needs to be enhanced in order to increase detection of OASIS and minimise the risk of consequent anal incontinence.
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Background:
Rotator cuff injuries are a leading cause of shoulder disability among adults. Surgical intervention is a common treatment modality; however, conservative management has been described ...for the treatment of rotator cuff tears. As the cost of health care increases, the industry has shifted to optimizing patient outcomes, reducing readmissions, and reducing expenditure. In 2010, the American Academy of Orthopaedic Surgeons created clinical practice guidelines (CPGs) to guide the management of rotator cuff injuries. Since their publication, there have been several randomized controlled trials assessing the management of rotator cuff injuries.
Purpose:
To quantitatively describe changes in the management of full-thickness rotator cuff tears over time with regard to the publication of the CPGs and prospective clinical trials.
Study Design:
Cohort study; Level of evidence, 3.
Methods:
Included in the study were Humana-insured patients in the PearlDiver database with the diagnosis of a full-thickness rotator cuff tear from 2010 to 2015. Patients undergoing rotator cuff repair (CPT-29827, CPT-23410, CPT-23412, CPT-23420) and patients undergoing nonoperative management in the queried years were identified. The incidence of physical therapy (PT), nonsteroidal anti-inflammatory drugs (NSAIDs), and corticosteroid injections was assessed.
Results:
In 2015, patients with full-thickness rotator cuff tears were less likely to receive a corticosteroid injection (16.5% vs 23.9%, respectively; odds ratio OR, 0.6; P < .001) or undergo PT (7.8% vs 12.1%, respectively; OR, 0.6; P < .001) before rotator cuff repair in comparison with 2010. Additionally, patients were no more likely to be prescribed NSAIDs before rotator cuff repair in 2015 in comparison with 2010 (OR, 1.0; P = .6). Patients with full-thickness rotator cuff tears were less likely to undergo acromioplasty in 2015 in comparison with 2010 (48.2% vs 76.9%, respectively; OR, 0.4; P < .001); however, the rate of concomitant biceps tenodesis slightly increased (14.8% vs 14.6%, respectively; OR, 1.1; P = .01).
Conclusion:
From 2010 to 2015, there were changes in the management of full-thickness rotator cuff tears, including decreased preoperative utilization of corticosteroid injections and PT as well as a decrease in concomitant acromioplasty, and the rate of biceps tenodesis slightly increased. As CPGs and prospective investigations continue to proliferate, management practices of patients with full-thickness rotator cuff tears continue to evolve.
Biomechanical studies that involve normal, injured or stabilized human spines are sometimes difficult to perform on large samples due to limited access to cadaveric human spines and biological ...variability. Finite element models alleviate these limitations due to the possibility of reusing the same model, whereas cadaveric spines can be damaged during testing, or have their mechanicals behaviour modified by fatigue, permanent deformation or structural failure. Finite element models need to be validated with experimental data to make sure that they represent the complex mechanical and physiological behaviour of normal, injured and stabilized spinal segments. The purpose of this study is to characterize the mechanical response of thoracolumbar spine segments with an analytical approach drawn from experimental measurements. A total of 24 normal and fresh cadaveric thoracolumbar spine segments (T11-L3), aged between 53 and 91 years, were tested in pure flexion/extension, lateral bending and axial torsion using a specific experimental setup. Measurements of global and intervertebral angle variations were performed using three-dimensional mark tracking methods. Load/angle curves for each loading were fitted by a logarithmic approach with two coefficients. The coefficients for the functions describing the response of the spinal segments are given and constitute predictive models from experimental data. This work provides data corridors of human thoracolumbar spine motion segments subjected to pure bending in the three physiological planes. These data could be very useful to validate finite element models of the human spine.
Introduction Low levels of pre-accession physical fitness and activity are risk factors for stress fractures and other overuse musculoskeletal injuries among military trainees. One dimension in the ...Tailored Adaptive Personality Assessment System (TAPAS), a non-cognitive personality test given to Army applicants, specifically assesses propensity to engage in physical activity. This dimension may serve as a surrogate measure for activity or fitness. The study examines the associations between TAPAS dimension scores and risk of musculoskeletal injuries. Methods Fifteen TAPAS dimension scores for 15,082 U.S. Army trainees entering military service in 2010 were provided by the U.S. Army Research Institute for Social and Behavioral Sciences. During 2013–2015, the associations between TAPAS dimension scores (as a continuous variable) and injuries in the first 6 months of service were evaluated using logistic regression, with the measure of association being the OR. Results The TAPAS physical conditioning dimension was associated with musculoskeletal injuries and stress fractures among both men (musculoskeletal injury, OR=0.83, 95% CI=0.79, 0.86; stress fracture, OR=0.68, 95% CI=0.57, 0.80) and women (musculoskeletal injury, OR=0.77, 95% CI=0.70, 0.85; stress fracture, OR=0.60, 95% CI=0.43, 082). No other dimensions were both significantly and consistently associated with either injury. Conclusions The TAPAS physical conditioning dimension is a strong predictor of musculoskeletal injury and stress fracture among male and female U.S. Army trainees, and may serve as a pre-accession screen for self-reported physical activity.
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The article is devoted to the analysis of the practical application of regulations part 2 clause 1085 of the Civil code of the Russian Federation, which contains one of the fundamental rules on the ...definition of lost earnings in compensation for harm caused to health. The content and legal value of the specified norms of the civil legislation is defined. Based on the analysis of legal practice of courts of general jurisdiction of various instances the authors come to the conclusion that the benefits the courts will also include disability benefits paid to the victim as a result of bodily injury in case of failure of the latter to work. It is established that courts very often, formulating positive decisions on satisfaction of requirements on recovery of the lost earnings in the period of temporary disability, in general do not investigate such circumstance as existence or absence of the disability benefit paid to the victim in connection with the harm caused to the last to health. The article defends the point of view, according to which this approach to the understanding and application of part 2 clause 1085 of the Civil code of the Russian Federation is not correct and contradicts the fundamental principles of civil liability. The authors believe that it is necessary to proceed from the fact that the funds of the social insurance Fund of the Russian Federation for the payment of disability benefits to the victim are accumulated at the expense of deductions that are carried out by the employer of the injured person. In fact, the employer bears the costs in the form of insurance contributions to the social insurance fund in cases where his employee will be harmed, resulting in disability. The authors insist that it is necessary to allow the employer of the injured person to recover from the tortfeasor or of the person obliged to answer for damages, the amount paid to the victim of disability benefits as a result of recent injury. Статья посвящена анализу практики применения положений части 2 статьи 1085 Гражданского кодекса Российской Федерации, в которых содержится одно из основополагающих правил об определении утраченного заработка при возмещении вреда, причиненного здоровью. Определяется содержание и правовое значение указанных норм гражданского законодательства. На основе анализа сложившейся судебной практики судов общей юрисдикции различных инстанций авторы приходят к выводу, что к числу пособий суды относят также пособие по нетрудоспособности, выплачиваемое потерпевшему в результате причинения вреда здоровью в случае невозможности последним осуществлять трудовую деятельность. Установлено, что суды очень часто, формулируя положительные решения об удовлетворении требований о взыскании утраченного заработка в период временной нетрудоспособности, вообще не исследуют такое обстоятельство, как наличие или отсутствие выплаченного потерпевшему пособия по нетрудоспособности в связи с причиненным последнему вреда здоровью. В статье отстаивается точка зрения, согласно которой указанный подход к пониманию и применению части 2 статьи 1085 Гражданского кодекса Российской Федерации не является верным и противоречит основополагающим принципам наступления гражданско-правовой ответственности. Авторы полагают, что необходимо исходить из того, что средства Фонда социального страхования Российской Федерации для выплаты потерпевшему пособия по нетрудоспособности, накапливаются за счет отчислений, которые проводятся работодателем потерпевшего лица. Фактически, работодатель несет расходы в виде страховых отчислений в Фонд социального страхования в случаях, когда его работнику будет причинен вред здоровью, повлекший за собой утрату трудоспособности. Авторы настаивают на том, что необходимо дать возможность работодателю потерпевшего лица взыскать с причинителя вреда или лица, обязанного отвечать за вред, размер выплаченного потерпевшему пособия по нетрудоспособности ввиду причиненного последнему вреда здоровью.
Objective
The association between occlusal contact and orofacial pain remains unclear. The aim of this study was to detect occlusal contact tightness by using a new method and to compare differences ...between patients and asymptomatic controls.
Methods
Fifteen female patients with orofacial myalgia and fifteen age- and sex-matched asymptomatic controls were enrolled. Occlusal contacts were recorded by making bite imprints. The numbers, sizes, and distributions of the contacts were detected by making photos of bite imprints after biting. The Mann-Whitney U test and ANOVA were used for statistical analysis.
Results
In myalgia patients, impact contacts at the molar regions were more frequent, larger in number and area size, and were distributed more on guiding cusps, compared with impact contacts in asymptomatic controls.
Conclusion
Our new method revealed more prevalent and more severe impact contacts in orofacial myalgia patients, compared with asymptomatic controls.
L'etude des coureurs a pied de competition s'avere particulierement propice pour analyser les liens entre le social et le biologique, en ce qu'elle conduit a reflechir a ce qui determine les ...capacites corporelles d'un individu. Dans cette optique, trois pistes sont explorees : la premiere s'interesse a la maniere par laquelle le social determine les corps dans leur materialite meme ; la deuxieme met l'accent sur le faconnement social des categories de perception et montre que la fatigue ressentie par un athlete s'inscrit a l'interface entre des manifestations physiologiques et un encodage symbolique de ces dernieres ; la troisieme fait ressortir que, loin d'etre reductibles a la mise en jeu de capacites physiques "pures", la performance procede d'une interaction qui determine ce dont un coureur est capable. Consideres dans leur ensemble, ces trois developpements visent a rendre compte de ce que le social fait a des potentialites physiologiques dont il n'y a pas lieu de penser qu'elles puissent etre, a elles seules, au principe de differences interindividuelles en matiere de possibles corporels.//The French alienist Bénédict Augustin Morel built a theoretical frame of interpretation of mental illness, the degeneration theory, which became the scientific ideology dominating the understanding of the causes of madness, for several decades. Assuming that the success met by this theory lies in the conceptual solutions and in the practical perspectives it proposes to solve the crisis affecting the French psychiatry at that point in time, this paper investigates two main lines of research. First, it attempts to understand to what extent his theory renews the approach of madness and why it is received in the medical field as a leading contribution to psychiatry. Then, it takes an interest in Morel as producing agent and aims at identifying the social properties attached to his person, liable to confer a medical authority upon him such as his discourse may be recognized as a major scientific work. web URL: https://www.cairn.info/resume.php?ID_ARTICLE=RESS_541_0201 Reprinted by permission of DROZ
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