Greater Risk Of Injury Research Articles

Ischemic liver injuries after hepatic artery embolization in patients with delayed postoperative hemorrhage following hepatobiliary pancreatic surgery

Many collateral pathways to the liver are dissected during hepatobiliary pancreatic surgery and, if the arterial bleeding is massive and a hematoma becomes larger, the adjacent portal vein can be compressed with impairment of the portal venous flow. To evaluate the frequency and severity of ischemic liver injuries after hepatic artery embolization in patients with delayed postoperative arterial hemorrhage after hepatobiliary pancreatic surgery. Eighteen patients undergoing proper or common hepatic artery embolization for delayed postoperative arterial hemorrhage after hepatobiliary pancreatic surgery achieved hemostasis. To evaluate the frequency and severity of ischemic liver injuries, the liver enzyme levels and CT findings before and after hepatic artery embolization were retrospectively compared and the clinical outcomes after hepatic artery embolization were analyzed. Angiographic findings were also analyzed to reveal any association with development of ischemic liver injuries after hepatic artery embolization. Ischemic liver injuries were observed in 15 (83%) of 18 patients undergoing hepatic artery embolization for postoperative hemorrhage. Injuries included hepatic infarction combined with abscess in one (5%) patient, hepatic infarction in 12 (67%) patients, and transient hepatic ischemia/dysfunction in two (11%). As for the extent of hepatic infarction, lobar infarction developed in two patients and subsegmental infarction in 11. One patient with right hepatic lobar infarction died of hepatic failure 11 days after hepatic artery embolization. In the other 14 patients with ischemic liver injuries, the elevated liver enzymes returned to baseline levels within two weeks. All of the four patients with portal vein stenosis, four patients with no hepatic arterial flow on post-embolization angiogram, and one patient with both had hepatic infarction after hepatic artery embolization. No ischemic liver injuries developed after hepatic artery embolization in three patients with no portal vein stenosis and bilobar hepatic arterial flow via the left hepatic artery aberrantly arising from the left gastric artery or from the common hepatic artery. Ischemic liver injuries can develop in most patients undergoing hepatic artery embolization for postoperative arterial hemorrhage after hepatobiliary pancreatic surgery; hepatic infarction appears to be the most frequent type of ischemic liver injury. Hepatic artery embolization for postoperative arterial hemorrhage after hepatobiliary pancreatic surgery may carry a great risk of ischemic liver injury if a patient has portal vein stenosis or no aberrant hepatic artery.

Drug-induced liver injury: a summary of recent advances

Introduction: The knowledge base of drug-induced liver injury (DILI) continues to grow each year as additional drugs are identified as hepatotoxins. There is still a need to improve our ability to predict and diagnose DILI in the preclinical and post-approval settings.Areas covered: This article presents the new and updated DILI registries for 2010, including the latest information on the causes and outcomes of non-acetaminophen DILI cases in the US Acute Liver Failure Study Group database. As DILI is still largely a diagnosis of exclusion, it is appropriate that causality assessment instruments are again the subject of considerable discussion.Expert opinion: DILI research remains extremely active including studies aimed at being better able to identify causative agents, utilize potential biomarkers, predict who is at greatest risk of injury and manage outcomes. With respect to identifying DILI risk factors at the genetic level, the field is rapidly approaching the day where ‘personalized medicine’ (based on pharmacogenomics) will become a reality. A large single-center series from India reminds us that geography can influence the drugs responsible for liver injury; however, Hy's law remains universal. As our DILI knowledge continues to grow, it remains essential to keep abreast of the important changes reported each year.

Kinematics, kinetics, and electromyogram of ankle during drop landing: A comparison between dominant and non-dominant limb

The biomechanical difference between the dominant and non-dominant limb has seldom been studied during double-leg landing. The objective of this study was to evaluate the effectiveness of limb laterality on the ankle kinematics, kinetics and electromyogram (EMG) during drop landing. Sixteen healthy adults were recruited and dropped individually from platforms with three different heights (0.32 m, 0.52 m, and 0.72 m). The ground reaction force, ankle joint kinematics, and surface EMG of tibialis anterior (TA) and lateral gastrocnemius (LG) were measured in both lower extremities. Two-way analysis of variance was used to analyze the effects of laterality and dropping height. The peak angular velocities in dorsiflexion and abduction were significantly higher in the dominant ankle, whereas the pre- and post-landing EMG amplitudes of the TA were significantly higher in the non-dominant limb. Compared with the dominant side, the non-dominant ankle has a more effective protective mechanism in that excessive joint motion is restrained by greater ankle flexor activity. Compared with the non-dominant side, the dominant ankle joint is in greater injury risk during drop landing, and data measured in the dominant limb may produce more conservative conclusions for injury protection or prediction.

Is Noncontact ACL Injury Associated with the Posterior Tibial and Meniscal Slope?

The risk of noncontact ACL injury reportedly is increased in patients with a greater posterior tibial slope (PTS), but clinical data are inconsistent. It is unclear whether the medial and lateral PTSs have a different impact on this connection. It also is unknown whether the meniscal slope (MS) is associated with ACL injury. Using MRI, we compared the medial and lateral PTSs and MSs separately in 55 matched pairs of patients with isolated noncontact ACL injuries and a control group. Neither the PTS nor the relative difference between the medial and lateral PTSs differed between groups. In contrast, the lateral MS was greater with ACL injuries: 2.0° versus -2.7° in males with and without ACL injury and 1.7° versus -0.9 in females. Uninjured females had a greater PTS than males: 4.9° versus 3.0° in females and males medially, respectively; 5.7° versus 4.0° lateral. There is no obvious link between the medial or lateral PTSs and ACL injury, and there is no obvious link between the relative difference in the medial and lateral PTSs and noncontact ACL injury. However, a greater lateral MS may indicate a greater risk of injury. The PTS can differ between the genders but the average difference is small. Level II, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.

Biomechanical properties of the triceps surae muscle–tendon unit in young and postmenopausal women

BackgroundInsufficient and excessive stiffness may increase the risk of soft tissue and bone injuries, respectively, while the resonance frequency seems to be related with energy expenditure and stiffness. With aging and menopause muscle weakness, physical fragility and mobility limitations are also expected. Therefore this study addresses the differences of biomechanical properties of the triceps surae muscle–tendon unit between young and postmenopausal women. Methods39 young and 37 postmenopausal women participated. The biomechanical properties of the triceps surae muscle–tendon unit were assessed in vivo using a free oscillation technique involving 30% of the maximal voluntary isometric contraction load. FindingsThe postmenopausal women in this study show significant higher values in the damped natural frequency of oscillation (young 3.84Hz vs. postmenopausal 4.68Hz, P<0.001), muscle–tendon unit stiffness (young 16,446N/m vs. postmenopausal 23,229N/m, P<0.001), and muscle–tendon unit stiffness normalized by mass (young 286.3N/m vs. postmenopausal 325.1N/m, P<0.05). The postmenopausal study group shows significant lower values in the damping ratio (young 0.190 vs. postmenopausal 0.150, P<0.01) than young women. InterpretationThe postmenopausal subjects may not be able to take advantage of resonance as the young subjects, or, the relationship between these frequencies is adjusted according to the musculoskeletal characteristics of each group. The decrease in damping properties and the increase in muscle–tendon unit stiffness suggest that postmenopausal women might be at a greater risk of injury.

Perception is reality

Nurses and aides are among the occupational subgroups with the highest injury rates and workdays lost to illness and injury in North America. Many studies have shown that these incidents frequently happen during provision of patient care. Moreover, health care workplaces are a source of numerous safety risks that contribute to worker injuries. These findings identify health care as a high-risk occupation for employee injury or illness. The purpose of this study was to examine the relationships among patient care, employee safety perceptions, and employee stress. Using the National Institute for Occupational Safety and Health Model of Job Stress and Health as a foundation, we developed and tested a conceptual workplace safety climate-stress model that explicates how caring for high-risk patients is a safety stressor that has negative outcomes for health care providers, including poor workplace safety perceptions and increasing stress levels. We introduced the concept of "high-risk patients" and define them as those who put providers at greater risk for injury or illness. Using a nonexperimental survey design, we examined patient types and safety perceptions of health care providers (nurses, aides, and allied health) in an acute care hospital. Health care providers who care for high-risk patients more frequently have poor safety climate perceptions and higher stress levels. Safety climate was found to mediate the relationship between high-risk patients and stress. These findings bring insight into actions health care organizations can pursue to improve health care provider well-being. Recognizing that different patients present different risks and pursuing staffing, training, and equipment to minimize employee risk of injury will help reduce the staggering injury rates experienced by these employees. Moreover, minimizing employee stress over poor workplace safety is achievable through comprehensive workplace safety climate programs that include supervisor, management, and organizational commitment to safety enhancement.

The Incidence of Upper Extremity Injuries in Canadian Endoscopy Nurses

Work-related musculoskeletal injuries occur at an epidemic rate in Canada. Many thousands of workers are temporarily or permanently removed from the workforce annually because of this type of injury. Workers who are most susceptible to this type of injury are those who perform physical, repetitive work involving sustained activity in awkward positions and cramped environments. Workers in the healthcare sector experience one of the highest rates of this type of injury annually. Injury prevention programs are being developed and instituted by government agencies and employers in an attempt to reduce the frequency of occurrence of this type of injury. In spite of attempts to prevent these injuries, musculoskeletal injuries of the upper extremity, neck, and back continue to occur in healthcare workers including nurses. Endoscopy nurses experience upper extremity injuries at work. The purpose of this study was to explore whether the occurrence of upper extremity injuries is common in this population of nurses and to identify factors that may be associated with these injuries. Results reveal that for this sample of Canadian nurses, older endoscopy nurses are at greater risk of injury. Nurses with injuries tended to self-prescribe treatment of their injuries. They also took anti-inflammatory medications and painkillers for their symptoms and saw their doctors for their conditions. Physiotherapist involvement was not common. Thirty-two percent of the endoscopy nurses in this study missed work because of upper extremity pain. Considering the number of nurses working in Canada, this percentage suggests a significant number of sick days, indicating a cause for concern, exploration, and further prevention measures.

Are skilled players at greater risk of injury in female youth football?

BackgroundKnowledge of skill-related risk factors for injury in football is limited.ObjectiveTo investigate whether there is an association between football skills and risk of injury in football.Study DesignProspective cohort study of...

Work disability prevention in rural healthcare workers

Approximately 20% of healthcare workers in high-income countries such as Australia, Canada and the USA work in rural areas. Healthcare workers are known to be vulnerable to occupational injury and poor work disability outcomes; given their rural-urban distribution, it is possible to compare work disability prevention in rural and urban areas. However, little attention has been paid to work disability prevention issues specific to rural workers, including rural healthcare workers. A comprehensive review of the literature was conducted to identify rural-urban differences in work disability outcomes (defined as the incidence of occupational injury and the duration of associated work absence), as well as risk factors for poor work disability outcomes in rural healthcare workers. The databases MEDLINE, CINAHL, and EMBASE were searched, as were relevant research centers and government agencies, to identify all quantitative and qualitative English-language studies published between 1 January 2000 and 6 October 2009 that discussed occupational injury, work absence duration, work disability management, or risk factors for poor work disability outcomes, for rural workers specifically, or in comparison with urban workers. To ensure inclusion of studies of healthcare workers as a distinct group among other sector-specific groups, a broad search for literature related to all industrial sectors was conducted. Of 860 references identified, 5 discussed work disability outcomes and 25 discussed known risk factors. Known risk factors were defined as factors firmly established to be associated with poor work disability outcomes in the general worker population based on systematic reviews, well-established conceptual models of work disability prevention, and public health literature. Although somewhat conflicting, the evidence suggests that rural healthcare workers experience higher rates of occupational injury compared with urban healthcare workers, within occupational categories. Rural workers also appear to be more vulnerable to prolonged work absence although the data are limited. No studies directly compared risk factors for work disability prevention outcomes between rural and urban healthcare workers. However, potential risk factors were identified at the level of the environment, worker, job, organization, worker compensation system and healthcare access. Important methodological limitations were noted, including unclear definitions of rurality, inadequate methods of urban-rural comparisons such as comparing samples from different countries, and a paucity of studies applying longitudinal or multivariate designs. There is a notable lack of evidence about work disability prevention issues for healthcare workers in rural areas. Available evidence supports the hypothesis that rural healthcare workers are vulnerable to occupational injury, and suggests they are vulnerable to prolonged work absence. They may be particularly vulnerable to poor work disability prevention outcomes due to complex patient needs in the context of risk factors such as heavy workloads, long hours, heavy on-call demands, high stress levels, limited support and workplace violence. Additional vulnerability may occur because their work conditions are managed in distant urban administrative centers, and due to barriers in their own healthcare access. Although rural healthcare workers seem generally at greater risk of injury, one study suggests that urban emergency medical service workers experience a high vulnerability to injury that may outweigh the effects of rurality. Additional research is needed to document rural-urban disparities in work disability outcomes and to identify associated sources and risk factors. Other issues to address are access to and quality of healthcare for rural healthcare workers, streamlining the compensation system, the unique needs of Aboriginal healthcare workers, and the management of prolonged work absence. Finally, occupational injury and work absence duration programs should be tailored to meet the needs of rural workers.

Child pedestrian injuries and urban change

BackgroundThe health impacts of rapid changes in urban environments due to economic growth and/or retraction are not widely known. This study looks at the effects of urban change on the...

Pediatric Obesity in Motor Vehicle Collisions

This article discusses the consequences of childhood obesity as it relates to motor vehicle collisions (MVCs) and injuries sustained therein. The authors note that there is no question that child age- and weight-appropriate restraints are effective in reducing fatal or serious injuries to children in MVCs. In adults there appears to be a linear decrease in seatbelt use with increasing body mass index, suggesting that seatbelts may not be large enough to accommodate larger sizes or are simply too uncomfortable for overweight adults to use regularly. Research on this topic has found correlations with obesity and degree of injury in adults. However, there is not much research in the literature that addresses the potential risks for injury of improperly-restrained obese children in a MVC. The authors briefly comment on some of the studies, noting that children may move directly from child car seats to adult seatbelts, without interim use of a booster seat, putting them at greater risk of injury. The authors conclude with a set of three questions for future research to address: are obese children at greater risk for serious injury in a MVC compared with their non-obese counterparts; injury severity, length of hospital stay, mental health, and residual disability in MVC-injured obese children compared with non-obese children; and whether obese children are at greater risk for post-traumatic stress syndrome.

Building rural motor vehicle safety capacity through community sports

Introduction/objectivePersons living in rural areas are at great risk of motor vehicle injury, as are children ages 4–7 years when prematurely graduated to seat belts designed for adults. Social marketing,...

Preventing injury in children and adolescents

Injury is a leading cause of death among children and adolescents and accounts for around 16% of the world’s burden of disease reflecting the disproportionate burden of injuries among young people and added years of life lived with disability. It is the poorest children in every country in the world that are at greatest risk of injury and the majority of deaths due to child injury occur in low-income and middle-income countries. The majority of injuries can be prevented or at least controlled and the costs of prevention are much lower than the costs of the consequences of injuries. But injury prevention requires good quality data monitoring and surveillance systems. This article provides an overview of child and adolescent injuries and their risk factors including socioeconomic inequality. Drawing on an original UK case study of data, it illustrates the crucial lack of data and injury surveillance systems to inform prevention.

Modelo conceptual para identificar factores relevantes en la seguridad de los niños en los autobuses escolares

Prepare a conceptual model that facilitates understanding of the relationships between the variables that lead children to adopt postures in school transportation vehicles that increase injuries in traffic accidents. For identification of the variables, direct information on school transportation was collected through focus groups, with bus aides and bus drivers, on-board filming during the transport of children, and recording of the dimensions of components in different types of school buses. The information collected was analyzed using the Atlas.ti v6 software and the construction of a model through deduction. Important relationships were found between adoption of potentially hazardous postures by children during transport to and from school and the seat and seat belt dimensions, the characteristics of the transportation service, and the role of bus aides. In order to adopt coherent interventions in school transportation safety, it is necessary to consider not only the technical aspects of the vehicle or posture that are controlled in crash tests but the specific variables of the activities that lead children to adopt postures that put them at greater risk of injury.

The Unique Developmental Considerations of Youth-Related Work Injuries

Adolescents and young adults experience higher risks of occupational injuries and fatalities compared to adult workers. Consequently, understanding the risk and protective factors for young workers through a developmental lens is all the more compelling. This study describes the developmental processes of adolescence using a bioecological framework. It describes how factors such as neuromaturation, pubertal development, physical growth, and social contexts may place youth at greater risk of injury and other negative outcomes in the work environment. While the emphasis of the paper is on the developmental processes specific to adolescence, this is discussed in the larger contexts of macro forces such as policies, schools, and families. Implications of developmental factors on work-based practices and policies are also discussed.

Variation of the Chorda Tympani in the Infratemporal Fossa

The chorda tympani is a branch of the facial nerve returning taste sensation from the tongue's anterior two‐thirds and conveying secretory parasympathetics to the submandibular ganglion. While it is well known to be at risk of injury as it traverses the facial canal, its anatomical potential for injury in the infratemporal fossa remains largely unexplored. Damage to the chorda tympani has been reported during dental procedures requiring inferior alveolar nerve block. The exact mechanism of injury is unknown, although several possibilities exist, including direct trauma during injection and possible neurotoxic effects of the anesthetic. We examined variation in the chorda tympani in the infratemporal fossa to assess whether particular morphological variants might be at greater risk of injury during routine dental anesthesia. Variation of the chorda tympani and lingual, mylohyoid, and inferior alveolar nerves were examined. Discrete traits and metrics of the distance the chorda tympani traverses from the petrotympanic fissure to its union with the lingual nerve were recorded for 26 cadavers. On average, the chorda tympani extends 50.6% of the lingual nerve's length in the infratemporal fossa. Few individuals exhibit a chorda tympani extending more than 66% (n=2) or less than 33% (n=1) of this distance. Variants are discussed in light of their potential for injury during routine dental procedures.

Salicylic Acid Ingestion Leading to Esophageal Stricture

Accidental ingestion of caustic substances (acid and alkali) occurs more frequently in children than in adults. The subsequent injury varies from minimal to severe, with perforation and even death as potential complications. Several factors have been shown to mediate the severity of injury, including the pH, concentration and physical state of the ingested substance, tissue contact time, and quantity (volume) of the ingested material. Liquids with a pH of less than 2 (acidic) or a pH of greater than 12 (alkali) are considered to be extremely corrosive and hold the greatest risk for injury. Esophageal injury after caustic ingestion is endoscopically graded with a score of 0 for no injury to IIIb for significant circumferential injury with ulcers and necrosis. Ingestion of either a strong alkali or acid has been documented to result in esophageal necrosis and ulcers (grade IIIb). Alkali ingestions occur more frequently because of their presence in daily life (detergents, degreasers) and therefore have more reports of injury. Despite more than 8200 documented cases of topical salicylic acid ingestions annually in US children younger than 19 years, there are no reported cases of salicylic acid resulting in gastrointestinal pathology. We report 2 cases of salicylic acid ingestion resulting in esophageal strictures. Both patients had more significant injury than anticipated given their initial clinical presentations. Given our recent experience, we recommend close follow-up and evaluation for strictures in patients with exposure to salicylic acid.

COMMENTARY: Time for a Paradigm Shift in Conceptualizing Risk Factors in Sports Injury Research

Certified athletic trainers are positioned to play an integral role in sport-related, recreation-related, and exercise-related injury research and prevention efforts. The Centers for Disease Control and Prevention1 have specifically identified certified athletic trainers and their potential to contribute to this important area of research in their recently published Injury Research Agenda for 2009–2018. From a public health perspective, identifying factors associated with injury is one of the initial steps in the injury prevention process. The ultimate goal of this line of research is to identify populations that are at greatest risk for subsequent injury and to develop effective screening and intervention strategies to reduce the incidence and burden of injury. Therefore, the manner in which risk factors are conceptualized in initial research has significant bearing on the development of subsequent screening and intervention strategies. In the current issue of the Journal of Athletic Training, Reinking et al2 examined the factors associated with exerciserelated leg pain in high school cross-country athletes. After a discussion of modifiable and nonmodifiable risk factors, the authors conceptualized risk factors for exertional leg pain as intrinsic (within the body) or extrinsic (outside the body) factors; sports injury researchers have traditionally conceptualized risk factors associated with injury in this manner.3–5 This study provides an opportunity to discuss how risk factors are conceptualized in the context of sports injury research. The seminal work by sports injury researchers such as van Mechelen et al3 and Meeuwisse5 provided a theoretic framework for sports injury research, and although these models have evolved since they were first described,6–9 they have consistently characterized risk factors for injury as intrinsic factors and extrinsic factors. It is important to consider that injuries often result from the complex interaction of multiple factors3,7,10 in a dynamically changing environment,6 but the characterization of risk factors as intrinsic or extrinsic limits the clinical importance and usefulness of results in relation to future injury screening and prevention efforts. More importantly, characterizing risk factors in this manner provides limited insight into whether something can be done to intervene and mitigate the contributing influence of any given factor or combination of factors with regard to subsequent injury.11 Injury epidemiologists and public health professionals, on the other hand, use a different approach to conceptualizing risk factors for disease or injury by focusing on those risk factors that are modifiable and those that are nonmodifiable. Conceptualizing risk factors as modifiable and nonmodifiable is important from a clinical and injury prevention perspective, because modifiable risk factors are amenable to intervention.11 Researchers12,13 of chronic diseases, such as cardiovascular disease, hypertension, and type 2 diabetes, have conceptualized risk factors as modifiable and nonmodifiable. Some of these risk factors include physical activity, diet, smoking, and obesity, to name a few. Subsequent intervention efforts have been developed and evaluated to address these factors, with various degrees of success. Conceptualizing risk factors as modifiable and nonmodifiable aligns with the ‘‘Translating Research into Injury Prevention Practice (TRIPP)’’ framework described by Finch,9 which applies a public health approach to sports injury prevention. Clinicians and injury researchers are most interested in modifiable risk factors associated with injury because they provide the vector for developing injury prevention interventions. Although nonmodifiable risk factors may not be useful as targets for intervention, they are particularly important in identifying populations that are at greatest risk for injury, so that injury prevention strategies can be directed to those with the most pressing need. This information can be used to develop risk profiles for specific injuries, to screen athletes to identify those at greatest risk for injury, and to guide injury prevention interventions that target modifiable risk factors. This information can also be used to develop interventions and social marketing campaigns that are culturally and ecologically appropriate for the populations at greatest risk for injury.14 When only nonmodifiable risk factors associated with injury are known, this information can be used to counsel athletes and parents about potential risks during the preparticipation screening process, so they can make informed decisions about participation. Recently, researchers have conceptualized risk factors as modifiable and nonmodifiable in the sports medicine literature. Emerging research10,15–17 into the risk factors associated with anterior cruciate ligament (ACL) injuries is one of the best examples in the sports medicine literature of how the conceptualization of risk factors has evolved. Early work15 in this area conceptualized risk factors as intrinsic and extrinsic, while recognizing the importance of focusing on factors that are modifiable. Subsequent consensus statements10,16 on the risk factors for ACL

Quality Improves With Use of AE Tools

Quality Improves With Use of AE Tools

On the Biomechanics of Vaginal Birth and Common Sequelae

Approximately 11% of U.S. women undergo surgery for pelvic floor dysfunction, including genital organ prolapse and urinary and fecal incontinence. The major risk factor for developing these conditions is giving vaginal birth. Vaginal birth is a remarkable event about which little is known from a biomechanical perspective. We first review the functional anatomy of the female pelvic floor, the normal loads acting on the pelvic floor in activities of daily living, and the functional capacity of the pelvic floor muscles. Computer models show that the stretch ratio in the pelvic floor muscles can reach an extraordinary 3.26 by the end of the second stage of labor. Magnetic resonance images provide evidence that show that the pelvic floor regions experiencing the most stretch are at the greatest risk for injury, especially in forceps deliveries. A conceptual model suggests how these injuries may lead to the most common form of pelvic organ prolapse, a cystocele.