Home Injuries Research Articles

Хирургическая тактика при закрытой дуоденальной травме

Relevance Among closed injuries of the abdominal cavity trauma duodenum (KDP) holds a special place due to the rare, large traumatic severe complications in 50-70% of operated patients. To date, there is a high mortality rate (30 to 60%) due to develop complications and failure at the seams or phlegmon - up to 100%. The purpose of the study The aim of the study was choice of the method of surgical treatment and analysis results of surgical treatment in patients with closed trauma of the KDP. Materials and methods The paper analyzes results of treatment 35 patients with a closed duodenal injury. The most common cause of damage KDP was closed to road traffic injury (17 pers. - 48.6%), resulting in katatravmy in 6 (17.1%) patients. In 5 (14.3%) patients injury was received in the workplace, in 1 - sports injury in 6 - home injury. Results and their discussion Depending on the timing of the victims to the hospital after the injury, the size of the defect duodenal wall, level of injury, associated injuries pancreatoduodenal zone defines the principles of surgical treatment for injuries of the duodenum. For the prevention and treatment of retroperitoneal phlegmon used 5% glucose solution ozonated, which reduced the number of complications from 52.3% in the control group to 33.3% - in the main group and reduced the risk of an adverse outcome, ie, reduce mortality C60% to 33.3%. Conclusion 1. The volume of surgery at closed duodenal injury must be selected individually, depending on the severity of the injury and status of victim. 2. In the postoperative period is mandatory drug suppression of secretion digestive tract and the appointment of broad-spectrum antibiotics against background of infusion-transfusion therapy. Key words Closed duodenal trauma, surgical technique, complications, mortality

Posttraumatic Epilepsy among Epileptic Children Seen in a Pediatric Neurology Clinic in Enugu, Nigeria-A Descriptive Study

Background: There is a wide variation in epidemiology and clinical profile of children with seizures following a head injury. Head injury can result from a variety of trauma to the head and remains a worldwide public health problem. Purpose: To determine the prevalence and characteristics of posttraumatic epilepsy among epileptic children seen in a pediatric neurology clinic in Enugu, Nigeria. Method: Records of epileptic patients who presented from January 2009 to January 2013 were reviewed. Data of those with history of head injury prior to onset of the seizure were documented. Statistical analysis was done using SPSS. Frequency and contingency table were derived and Chi2 test was used for associations. Result: Out of 1400 patients, who presented to the clinic, six hundred and eighty-two (48.7%) patients had epilepsy and fifty-nine of the epileptics (8.65%) had history of significant head injury before the onset of seizure. The peak incidence was in the preschool age (13-60 months). Falls from heights were the commonest mechanism of head injury. Mild, moderate and severe trauma was documented in 32, 19 and 8 patients respectively. Majority of patients with severe trauma fell from heights. There was however no statistically significant difference between the mechanism of head injury and degree of severity of trauma (p = 0.73). Complex partial seizure was the most common type. Seizure control was documented in 35 patients who were followed up for 18 months or more. Eighteen patients (51.43%) had good control. Conclusion: Head injury is a significant cause of epilepsy in this environment. Home injuries may have farreaching public health concern in our environment.

Risk for household safety hazards: Socioeconomic and sociodemographic factors

IntroductionMany unintentional injuries to young children occur in the home. The current study examines the relation between family socioeconomic and sociodemographic factors and risk factors for home injury. MethodsPresence of household hazards was examined in 80 families with toddler-aged children. Parental ability to identify household hazards in pictures was also assessed. ANOVAs and Pearson product–moment correlations examined the relationship between presence of household hazards, knowledge to identify hazards, and factors of yearly family income, parental age, parental education, parental marital status, child ethnicity, and the number of children living in the home. ResultsA greater number of hazards were found in the homes of both the lowest and highest income families, but poorer knowledge to identify household hazards was found only among parents of the lowest income families and younger parents. Across family socioeconomic status, parent knowledge of hazards was related to observed household hazards. ConclusionsThe relationship between family income and risk for injury is complex, and children of both lower and higher SES families may be at risk for injury. Practical applicationsWhile historically particular focus has been placed on risk for injury among children in low income families, injury prevention efforts should target reducing presence of household hazards in both high and low SES families.

Mise en place d’un système de surveillance épidémiologique de la mortalité par traumatisme chez les enfants de moins de 15 ans en France métropolitaine

In metropolitan France in 2009, trauma was the leading cause of death among children under 15 years of age: 459 deaths (source CépiDc), with 236 deaths by home and leisure injuries (HLI). These rough mortality data do not describe the circumstances of the trauma responsible for the death. The "Fatal home and leisure injury among children under 15 years old-MAC-15" feasibility study was set up in 2009 in France in the following regions: Île-de-France, Nord-Pas-de-Calais, and Provence-Alpes-Côte d'Azur. The main objective of the survey was to understand exactly how these accidents occurred and determine their risk factors. Its secondary objectives were to test the feasibility and analyze the possibility of extending and/or scaling up the monitoring of these deaths. Case reporting was made through death certificates, contacts with regional health agencies, and media surveillance. A detailed record was completed by the medical certifier. In 2009, 76 HLI-related deaths in under 15-year-old children were identified by the survey in the three regions. The victims were mostly boys. The most common cause of death was drowning, followed by suffocation, falls, and fires. The survey contributed to precisely determining the risk factors of HLIs in children and, most often, to identifying the cause responsible for the fatal accident. The feasibility conclusions of this survey are positive, data collection is effective and practicable, and its quality and exhaustiveness were demonstrated. Implementation of the "detailed analyses of the deaths by trauma among children under 15 years old" survey is proposed. This survey will be extended to all deaths by trauma among children in Metropolitan France.

Home modifications to reduce injuries from falls in the Home Injury Prevention Intervention (HIPI) study: a cluster-randomised controlled trial

Despite the considerable injury burden attributable to falls at home among the general population, few effective safety interventions have been identified. We tested the safety benefits of home modifications, including handrails for outside steps and internal stairs, grab rails for bathrooms, outside lighting, edging for outside steps, and slip-resistant surfacing for outside areas such as decks and porches. We did a single-blind, cluster-randomised controlled trial of households from the Taranaki region of New Zealand. To be eligible, participants had to live in an owner-occupied dwelling constructed before 1980 and at least one member of every household had to be in receipt of state benefits or subsidies. We randomly assigned households by electronic coin toss to either immediate home modifications (treatment group) or a 3-year wait before modifications (control group). Household members in the treatment group could not be masked to their assigned status because modifications were made to their homes. The primary outcome was the rate of falls at home per person per year that needed medical treatment, which we derived from administrative data for insurance claims. Coders who were unaware of the random allocation analysed text descriptions of injuries and coded injuries as all falls and injuries most likely to be affected by the home modifications tested. To account for clustering at the household level, we analysed all injuries from falls at home per person-year with a negative binomial generalised linear model with generalised estimating equations. Analysis was by intention to treat. This trial is registered with the Australian New Zealand Clinical Trials Registry, number ACTRN12609000779279. Of 842 households recruited, 436 (n=950 individual occupants) were randomly assigned to the treatment group and 406 (n=898 occupants) were allocated to the control group. After a median observation period of 1148 days (IQR 1085-1263), the crude rate of fall injuries per person per year was 0.061 in the treatment group and 0.072 in the control group (relative rate 0.86, 95% CI 0.66-1.12). The crude rate of injuries specific to the intervention per person per year was 0.018 in the treatment group and 0.028 in the control group (0.66, 0.43-1.00). A 26% reduction in the rate of injuries caused by falls at home per year exposed to the intervention was estimated in people allocated to the treatment group compared with those assigned to the control group, after adjustment for age, previous falls, sex, and ethnic origin (relative rate 0.74, 95% CI 0.58-0.94). Injuries specific to the home-modification intervention were cut by 39% per year exposed (0.61, 0.41-0.91). Our findings suggest that low-cost home modifications and repairs can be a means to reduce injury in the general population. Further research is needed to identify the effectiveness of particular modifications from the package tested. Health Research Council of New Zealand.

Survey of early complications of primary skin graft and secondary skin graft (delayed) surgery after resection of burn waste in hospitalized burn patients.

Introduction:Burning is the second most common cause of home injuries in Iran that is often the cause of conflicts between children and young adults. Burning can lead to early and late complications that scar and contracture are the most common. Burn waste treatment is done by two methods: excision and then skin graft after the formation of granulation tissue; and excision and graft simultaneously that in this study, these two methods are compared.Methods:This was performed as a quasi-experimental analysis and retrospective study on all patients who were hospitalized for burn scar. All patients who have associated with weak eningimmune diseases such as diabetes, acquired immunodeficiency or congenital, taking steroids and patients undergoing chemotherapy etc. are excluded. The method of grafting in patients is primary graft procedure that was compared with patients who are treated using secondary graft. Data collected through review of patients’ hospital and clinic chart.Results:The mean burn percentage in the primary repair group was 14.4% and in the delayed repair group was 16.6%, respectively. The incidence of hematoma in both groups was zero. Skin necrosis and graft rejection and infection in the primary repair group was in 3.7% of patients and in the delayed repair group was in 1.2% of cases (P=0.5)Conclusion:Based on the findings of this study, no difference was observed between the two methods of excision and primary graft with delayed graft in the incidence of graft rejection. Due to the shorter treatment of primary graft and patient satisfaction and also according to the findings of this study excision and primary graft method seems appropriate method for treating old waste burning.

The Falsified Medicines Directive: How to secure your supply chain.

With new EU-wide legislation being introduced to protect patients from falsified medicines, how can the existing supply chain adapt and thrive in this new, safer environment? Falsified medicines, and supply chain security in general, are a global issue gaining great political and consumer attention.1 Although no formal study has been carried out on a global scale, it is known that the issue affects both developing and developed nations, across the entire spectrum of available drugs.2 According to the World Health Organisation, a variety of factors contribute to the problem. These include high drug prices, demand in excess of supply and, critically, a lack of appropriately enforced legislation. The rise in illegal online retail of pharmaceuticals has greatly augmented the threat of falsified medicines from outside of the legal supply chain,3 though they may also reach patients via the legal supply chain.4 When properly formulated and enforced, government legislation helps keep people safe in the realest terms. Consider Scotland’s recent lowering of the drink-driving limit, which resulted in an early 30% drop in the number of drivers found over the limit.5 Mandatory fitting and use of seatbelts in cars have saved untold thousands of lives across Europe and electrical safety laws have reduced accidents and injuries in homes and workplaces. When you consider that, in 2009, France’s inability to efficiently recall the diabetes drug, Mediator (Benfluorex; Servier Laboratories, Surenes, France) resulted in as many as 2,000 deaths,6 the same principles must apply to the pharmaceutical industry.

Characteristics and predictors of home injury hazards among toddlers in Wenzhou, China: a community-based cross-sectional study.

BackgroundHome hazards are associated with toddlers receiving unintentional home injuries (UHI). These result in not only physical and psychological difficulties for children, but also economic losses and additional stress for their families. Few researchers pay attention to predictors of home hazards among toddlers in a systematic way. The purpose of this study is firstly to describe the characteristics of homes with hazards and secondly to explore the predicted relationship of children, parents and family factors to home hazards among toddlers aged 24–47 months in Wenzhou, China.MethodsA random cluster sampling was employed to select 366 parents having children aged 24 – 47 months from 13 kindergartens between March and April of 2012. Four instruments assessed home hazards, demographics, parent’s awareness of UHI, as well as family functioning.ResultsDescriptive statistics showed that the mean of home hazards was 12.29 (SD = 6.39). The nine kinds of home hazards that were identified in over 50% of households were: plastic bags (74.3%), coin buttons (69.1%), and toys with small components (66.7%) etc. Multivariate linear regression revealed that the predictors of home hazards were the child’s age, the child’s residential status and family functioning (b = .19, 2.02, - .07, p < .01, < .05 and < .01, respectively).ConclusionsThe results showed that a higher number of home hazards were significantly attributed to older toddlers, migrant toddlers and poorer family functioning. This result suggested that heath care providers should focus on the vulnerable family and help the parents assess home hazards. Further study is needed to find interventions on how to manage home hazards for toddlers in China.

Managing children's risk of injury in the home: Does parental teaching about home safety reduce young children's hazard interactions?

Past research confirms that parents extend much effort to teach their young children about safety, but little is known about this process. The present study examined mothers’ use of teaching as a strategy to manage young children's risk of home injury and how this impacts children's hazard interactions. Mothers of three-year-olds completed an in-home room-by-room interview in which they identified injury hazards that concern them, reported on use of teaching to manage risk of injury from these hazards, rated children's understanding of these safety issues and compliance with behavioral guidelines regarding these safety issues, and reported on children's recent interactions with these hazards. They also completed questionnaire measures of how difficult the child is to manage and the child's typical level of risk taking. Results revealed that children's understanding of safety impacted both their compliance and hazard interactions, moderating the impact of risk taking on compliance and also the impact of children's difficult-to-manage score on hazard interactions. These findings demonstrate that teaching strategies need to effectively enhance children's understanding of the safety issue in order to reduce children's risk of hazard interactions.

Epidemiology of injuries in metropolitan Tehran, Iran: a household survey

A household survey was conducted to determine the epidemiological characteristics of injuries among people living in Tehran, the mega capital of Iran. Using cluster random sampling in April 2007, survey was conducted seeking information about injuries occurred within families in past Persian year. All injury patterns and causes were classified according to ICD-10 and analysed using SPSS version 16. Out of 9173 household participants, 765 ones (8.3%) had injuries during the past Persian year, frequently open wounds and burns with a male to female ratio of 0.54 : 1. They occurred mostly due to ‘exposure to the inanimate mechanical forces’, followed by ‘contact with heat or hot substances’ and ‘falls’. The common locations were home, and then streets. Approximately 15% of injuries required medical attention and the incidence rate was 175.5 per 10,000 person–year with male to female ratio of 2.37 : 1. They were frequently fractures and open wounds and mostly associated with falls and transport accidents that had been transpired on streets or at workplace. This study evidences the high rate of injuries in Tehran city and prevention priorities should be given to traffic and home injuries.

Epidemiological risk analysis of home injuries in Italy (1999-2006).

Home injuries are an important public health issue in both developed and developing countries. This study focused on the Italian epidemiological framework between 1999 and 2006, using a nation-representative sample provided by the National Institute of Statistics. Every year, about 3,000,000 Italian residents reported at least one home injury, with an overall annual rate of 5.2/100 (95% CI 5.1–5.4); 3.2/100 (3.0–3.4) for males and 7.2/100 (6.9–7.4) for females. Poisson regression models were used for different age-specific populations (children, young/adults and older people), to evaluate the effects of socio-demographic, health/income satisfaction and housing variables. For children, non-applicable variables (including smoking and health satisfaction) were taken as those of the head of family, while housework time was taken the family mean time. Evidence of decreasing time trend in risk of home injury was found only among young/adults (p < 0.01). The following were risk factors: female gender (adjusted relative risk—RR 2.0 for older people and RR 1.9 for young/adults, p < 0.01); one additional hour of work at home (RR 1.009, p < 0.01 for young/adults and RR 1.016, p = 0.01 for children); smoking (RR 1.3, p < 0.01 for young/adults and p = 0.02 for children); health dissatisfaction (RR 1.3, p = 0.05 for children, RR 1.6 for young/adults and RR 1.7 for older people, p < 0.01); income dissatisfaction (RR 1.2, p < 0.01 for young/adults ); living alone (RR 1.5, p < 0.01 for young/adults and RR 1.2, p < 0.02 for the older people); having a garden (RR 1.1, p < 0.01 for young/adults ). Awareness of the need for safety at home could be boosted by information campaigns on the risk, and its social cost could be reduced by specific prevention schemes. Developing tools for assessing the risk at home and for removing the main hazards would be useful for both informative and prevention interventions.

Estimates of home and leisure injuries treated in emergency departments in the adult population living in metropolitan France: a model-assisted approach

BackgroundHome and leisure injuries (HLIs) are currently a major public health concern, because of their frequency, associated consequences, and considerable medical costs. As in many other countries in Europe, in France the population coverage of the surveillance system of HLIs is low. In this study, a model-assisted approach is developed to estimate the incidence rates of HLIs in adults treated in emergency departments (EDs) in metropolitan France between 2004 and 2008.MethodsUsing a sample of the hospitals participating in the French ED-based surveillance system, a generalized linear mixed model was applied, which describes the relationship between the numbers of ED visits for HLIs and the sex and age of the patients on the basis of the number of injury-related stays recorded by the hospitals. Statistics on hospital stays were provided by the French hospital discharge databases in the participating hospitals. The same statistics were available at the national level, which made it possible to extrapolate national incidence estimates.ResultsOver the 2004–2008 period, the estimated incidence rate of HLIs age-standardized on the European population aged 15 years and over was 48.7 per 1,000 person-years (95% confidence interval: 39.4-58.0), and displayed little variability over time. This rate corresponded to an average of 2.5 million emergency hospital visits each year due to an HLI in people aged over 15 in France.ConclusionsThe method made it possible to use medico-administrative datasets available nationwide to provide informative estimates despite the small number of participating EDs. The consequences and costs generated by hospital emergency visits can sometimes be onerous, and these estimated rates confirm the scale of the problem and the need to continue investing in preventive actions.

Global Childhood Unintentional Injury Study: Multisite Surveillance Data

We aimed to analyze the epidemiology of childhood unintentional injuries presenting to hospitals in 5 select sites in low- and middle-income countries (LMICs) (Bangladesh, Colombia, Egypt, Malaysia, and Pakistan). We collected standardized data from children ages 0 to 12 years at participating emergency departments (EDs) in 2007. Statistical analyses were conducted to compare the characteristics of these injuries and to explore the determinants of injury outcomes. Among 2686 injured children, falls (50.4%) and road traffic injuries (16.4%) were the most common, affecting boys more often (64.7%). Home injuries were more common among younger children (average 5.41 vs 7.06 years) and girls (38.2% vs 31.7%). Following an ED visit, 24% of injured children were admitted to the hospital, and 6 died. Injury outcomes were associated with risk factors, such as age and sex, to varying extents. Standardized ED surveillance revealed unintentional injuries are a threat to child health. The majority of events took place inside the home, challenging traditional concepts of children's safety and underscoring the need for intensified context-appropriate injury prevention.

Home Injuries among Young Children in Malaysia: A Population Based Study

Background: Home injury among children is a public health concern. This study aimed to assess the prevalence rate and risk factors of home injury among children less than seven years old in Malaysia. Methods:Secondary data from National Health and Morbidity Survey 2006 was used. It was a cross sectional study using a stratified two stage sampling technique. The data was analysed using SPSS version 19. Descriptive and multiple logistic regressions were used in the analysis. All tests were two tailed with significance as p<0.05. Odds ratio (OR) along with 95% confidence interval (C.I) were derived where appropriate. Results:Among 8017 children aged less than seven years, 994 (11.4%) experienced some kind of home injury within the past one year. Among those who were injured, the higher prevalence was reported among boys; 13.1% (95% CI: 12.00-14.20), rural dwellers; 12.4% (95% CI: 11.20-13.80), children aged 0-4 years old 11.8% (95% CI: 10.90-12.80), Indians; 14.7% (95% CI: 11.80-18.20) and children from high family incomes. Multiple logistic regression analysis revealed that boys (aOR=1.424, p<0.001), rural dwellers (aOR=1.243, p=0.015), children from ethnic Indians (aOR=1.949, p<0.001), others ethnics (aOR=1.865, p<0.001) and Malays (aOR=1.427, p=0.007) were more likely to sustain a home injury. Children from high (aOR=1.607, p=0.006) and medium (aOR=1.255, p=0.016) family income were also significantly associated to sustain home injury after adjusting all other predictors. As a result from home injury, about 11.6% (95% CI: 9.7-13.8) were unable to perform activities whilst 4.8% (95% CI: 3.7-6.3) of them had been admitted to the hospital. Conclusion:Home injury among children is still a health problem which should not be taken lightly. Educational and interventional programs need to be implemented accordingly in order to help Malaysians understand the importance of making a safe home environment for children thus preventing home injuries.

Injury-Related Profiles among School-Aged Children in Cameroon: Analysis Based on the “First Survey—Health Young People”

Aims: Establish profiles of young “at risk” of injuries, first, on an overall point of view and, secondly, for some types of injuries (sport, home, road traffic, school and work injuries). Methods: We have taken nearly 50 variables into consideration: 17 variables for construction of the socioeconomic status, 9 variables for the investigation of symptoms, 11 concerning drugs, 5 for healthy habits, 3 for investigating the violence behavior, 4 concerning the school, 3 for subjective health and finally 3 for social network. We have used the principal component analysis, the multiple correspondence analysis and the weighted-frequency score for reducing the number of them. After these reductions, 15 variables were available for analyses. The relationship between injuries and investigated factors was assessed using the Pearson’s chi-square test. We also calculated odds ratio (OR) with their 95% confidence intervals (95%CI) to estimate the strengths of the associations. To further assess these relationships but also for taking into account the potentials confounding effects of some variables, logistic regression model and multinomial logistic regression model were applied. Results: The whole injury prevalence was equal to 45.6% and among the injured, the proportion of the several types was equal to 33.8% for sport injuries, 32.2% for home injuries, 16.6% for traffic injuries, 11.6% for school injuries and 5.7% for work injuries. We can say that, in light of the variables studied, the “at risk” profile for having reported an injury is being a boy, being younger, having drug experiences, with the violent profile, and declaring several symptoms. There are no consistent and marked deviations in this study from the findings obtained in previous studies. Conclusion: Analyzing injuries in general is interesting but for preventing them it is important to know in which activities children and students are engaged when they are injured.

Mother’s Education and her Knowledge about Home Accident Prevention among Preschool Children in Rural Area in Sharkia Governorate

Unintentional injury remains the leading cause of morbidity and mortality among children worldwide. The aim of this study was to describe the mother's education and her knowledge in relation to home accidents prevention in rural area in Sharkia Governorate. Study design, a cross-sectional descriptive study design was adopted in this study. The sample size was 150 mothers from Kafr Mohsen village, this number was drawn by a systematic random by visiting every 5 house in the village, those mother's were inter-viewed in their homes through home visits. Structured interview sheet was developed based on relevant literature ,it contained the following data: A) The first included socio-demographic characteristics of the families as mother's age, educational level, occupation, family size and number of children .B) The second included mother knowledge towards home accidents among children and its occurrence, types and mother's knowledge regarding causes of home accidents. C) The third included mother's practice or first aid measures she followed towards her child in case of exposure to any type of home accidents. The study result indicated that, the mean age of the mothers was (34.1±9.6) years. Regarding educational level, 33.3% had completed university education, while 25.3% of them were illiterate. Occupational status showed that more than one half of the studied mothers (58%) didn't work, while 14% worked as health care personnel. 61.3% were of middle socio economic status. More than half of the injured children (59.3%) were aged 3years or less, over half of them (58.7%) were males. The majority of the mothers (84.7%) reported that the child had suffered an injury at home. Cut/wound represented the highest percentage of home injury (37.3%) followed by fall (29.3%), burn (12%), animal bite (3.3%) then poisoning (1.3%). The study revealed that the majority of mothers (80%) heard of the term of first aid and the main source of their knowledge was from radio and television (24%) then doctors and nurses (15.3%) , part of curriculum nearly(14%) and the lowest source was from books (6.7%). More than half of the studied mothers (55.3%) did not have any knowledge about the causes of home accidents. the relation between mother's age and her knowledge regarding causes of home accidents was proved to be statistically non significant (p>0.05). mother's knowledge regarding causes of home accidents increased with increasing educational level. The relation was proved to be statistically significant (p<0.001).The conclusion of this study revealed that, well educated mothers will use the proper first aid. So there is need for parent's educational programs especially mothers with preschool children about home accidents and how to manage.

The feasibility of using a parenting programme for the prevention of unintentional home injuries in the under-fives: a cluster randomised controlled trial

Unintentional injury is the leading cause of preventable death of children over the age of 1 year in the UK and a major cause of attendance at emergency departments. Children having one injury are at increased risk of further injuries. Parenting programmes can reduce injuries in preschool children if delivered in the home and on a one-to-one basis. It is not known if group-based programmes delivered outside the home are effective. To develop (1) a parenting programme to prevent recurrent unintentional home injuries in preschool children and (2) a tool for parents to report unintentional home injuries occurring to their preschool children. To assess the feasibility of delivering and evaluating the parenting programme through a cluster randomised controlled trial, specifically to (1) assess methods for the recruitment and retention of parents; (2) determine the training, equipment and facilities needed for the delivery of the programme; (3) establish appropriate primary and secondary outcome measures and methods for their collection; (4) determine how 'normal care' in a comparison arm should be defined; and (5) determine the resource utilisation and costing data that would need to be collected for the cost-effectiveness component of a future trial; and (6) produce estimates of effect sizes to inform sample size estimation for a main trial. Feasibility multicentre, cluster, randomised, unblinded trial. Eight children's centres in Bristol and Nottingham, UK. Ninety-six parents of preschool children who had sustained an unintentional injury requiring medical attention in the previous 12 months. The First-aid Advice and Safety Training (FAST) parent programme, comprising parenting support and skills combined with first aid and home safety advice. Parent-reported medically attended injuries in the index child and any preschool siblings sustained during a 6-month period of observation. An 8-week parenting programme was produced, designed with participant-friendly, incrementally progressive content. A slimline, month-to-a-view injury calendar, spiral bound and suitable for hanging on a wall, was designed for parents to record injuries occurring to their preschool children during the 6-month period of observed time. Fifty-one parents were recruited (40 meeting eligibility criteria plus 11 following 'open invite' to participate); 15 parents completed the FAST parent programme and 49 provided data at baseline and during follow-up. Completion of the programme was significantly greater for participants using the 'open invite' approach (85%) than for those recruited using the original eligibility criteria (31%). Prototype resource use checklists, unit costs and total costs were developed for phases 0, 1 and 2 of the study for use in a future trial. This feasibility study has developed an innovative injury prevention intervention and a tool to record parent-reported injuries in preschool children. It was not feasible to recruit parents of children who had sustained a recent injury, or to ask health visitor teams to identify potential participants and to deliver the programme. A trial should target all families attending children's centres in disadvantaged areas. The intervention could be delivered by a health professional supported by a member of the children's centre team in a community setting. Current Controlled Trials ISRCTN03605270. This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 18, No. 3. See the NIHR Journals Library website for further project information.

Demography and Clinical Consequences of Trauma-Related Amputations in the Emergency Department Short

Objective: Total or subtotal traumatic extremity amputations constitute a considerable portion of trauma-related emergency department admissions. In this study, we aimed to establish the patients’ age group, educational level and occupational group in which trauma-related extremity amputations are more frequently performed. Material and Methods: Cases presenting to our Emergency Department between August 2006 and August 2008, in whom traumatic extremity amputations were performed were prospectively studied. The data that were recorded on a study form, which included age, sex, educational level, occupation, mechanism of the trauma and hospitalization duration, underwent evaluation. Results: The data of 309 subjects were evaluated in this study. The mean age of the patients was 29±17.9, with 18.1% of the subjects being female and 81.9% being of male gender. 41.1% of the cases were laborers, 23.6% were self-employed in various fields, and 9.4% were farmers. With respect to the method of trauma in the majority of the amputations, industrial injuries accounted for 65.7%, finger jamming (door-related) accounted for 17.2%, and home injuries accounted for 8.7%. Finger amputation was identified in 93.4%, toe amputation in 4.4%, and “others” in 2.2%. Conclusion: Traumatic amputation concerns particularly children, youths, and people of low educational level with an active work life. The most frequently affected body parts are the fingers. (JAEM 2013; 12: 205-10)

Insomnia and accidents: cross‐sectional study (EQUINOX) on sleep‐related home, work and car accidents in 5293 subjects with insomnia from 10 countries

The link between sleepiness and the risk of motor vehicle accidents is well known, but little is understood regarding the risk of home, work and car accidents of subjects with insomnia. An international cross-sectional survey was conducted across 10 countries in a population of subjects with sleep disturbances. Primary care physicians administered a questionnaire that included assessment of sociodemographic characteristics, sleep disturbance and accidents (motor vehicle, work and home) related to sleep problems to each subject. Insomnia was defined using the International Classification of Sleep Disorders (ICSD-10) criteria. A total of 5293 subjects were included in the study, of whom 20.9% reported having had at least one home accident within the past 12months, 10.1% at least one work accident, 9% reported having fallen asleep while driving at least once and 4.1% reported having had at least one car accident related to their sleepiness. All types of accident were reported more commonly by subjects living in urban compared to other residential areas. Car accidents were reported more commonly by employed subjects, whereas home injuries were reported more frequently by the unemployed. Car accidents were reported more frequently by males than by females, whereas home accidents were reported more commonly by females. Patients with insomnia have high rates of home accidents, car accidents and work accidents related to sleep disturbances independently of any adverse effects of hypnotic treatments. Reduced total sleep time may be one factor explaining the high risk of accidents in individuals who complain of insomnia.

Guns, Case Management, and Return to Work

Marcy Tigerman, MS, CRC, CDMS, CCM, CLCP, CBIS received her MS in Rehabilitation Counseling from the University of Arizona. She has been a Vocational Rehabilitation counselor and disability case manager for 30 years, specializing in workers' compensation and traumatic brain injury. In 1981, she went to work for the State Compensation Fund of Arizona, now known as SCF Arizona. Retiring from SCF in 2007, Ms. Tigerman now provides Clinical Coordination and community reentry services for Rehab Without Walls, as part of their Home and Community Brain Injury treatment program. She also provides case management services for a variety of referral sources and offers expert opinions regarding pre- and postearning capacity in personal injury case. She holds certifications in Life Care Planning, Disability Management Services, and Case Management and is a certified rehabilitation counselor and certified brain injury specialist. Address correspondence to Marcy Tigerman, MS, CRC, CDMS, CCM, CLCP, CBIS ([email protected]). The author reports no conflicts of interest.