Injuries In China Research Articles

The Burden of Injury in China, 1990-2017: Findings from the Global Burden of Disease Study 2017

The Burden of Injury in China, 1990-2017: Findings from the Global Burden of Disease Study 2017

Identification of anti-nociceptive constituents from the pollen of Typha angustifolia L. using effect-directed fractionation

The pollen of T. angustifolia, also known as Pu huang in Chinese, has been used for treatment of stranguria, hematuria, dysmenorrhea, metrorrhagia and injuries in China for a long time. Extensive efforts have been directed toward its phytochemical and biological aspects. However, little is known about its anti-nociceptive implication and material basis. This work presented the investigation of the anti-nociceptive effect of Typhae Pollen using an effect-directed fractionation strategy, thereby leading to identification of isorhamnetin-3-O-neohesperidin (1) and typhaneoside (2), together with other minor flavonoid glycoside congeners, as the main anti-nociceptive constituents. This work not only unveils the anti-nociceptive potential of Typhae Pollen, but also establishes a method to enrich and identify the anti-nociceptive constitutes of Typhae Pollen. Moreover, this work is a successful example of effect-directed fractionation strategy, which represents a powerful tool in TCM-based drug discovery and development.

Qualitative research investigating the mental health care service gap in Chinese burn injury patients

BackgroundPsychological disturbances are prevalent in people with burn injuries; however, psychological services are rarely accessiblepost-burn injury in China. The objective of this qualitative study was to explore and conceptualize the obstacles to delivering mental health care in burn injury patients.MethodsThe researchers used a grounded theory research approach to interview sixteen burn injury patients, five nurses, four rehabilitation therapists, five medical doctors, and eight caregivers regarding their experiences with current health care services and barriers.ResultsAn explorative model was generated from the data, and the relationships among the categories were identified. People’s beliefs, knowledge, socioeconomic status, cultural understanding of mental health, and social stigma appear to play key roles in the public health approach to post-burn health promotion and post-burn psychosocial interventions.ConclusionThe model proposed in our research highlights the need to focus on the underlying social, economic, and cultural determinants of mental health care. The underlying social determinants of the mental health care gap that is responsible for the ill-prepared health care must be addressed.

Effectiveness of an app-based intervention for unintentional injury among caregivers of preschoolers: protocol for a cluster randomized controlled trial

BackgroundEach year, over 15,000 preschoolers die from unintentional injuries in China. Many interventions proven to work in other nations have not been implemented nationwide in China. The rapid popularity of smartphones offers an opportunity to overcome this limitation and disseminate evidence-based interventions to the large population of China. This study aims to assess the effectiveness of an app-based intervention for caregivers of preschoolers to prevent unintentional injury among young Chinese children.MethodA single-blinded, 6-month, parallel-group cluster randomized controlled trial with 1:1 allocation ratio will be conducted in Changsha, China. In total, 2626 caregivers of preschoolers ages 3–6 years old who own a smartphone will be recruited from 20 preschools. Clusters will be randomized at the preschool level and allocated to either the control group (routine education plus app-based parenting education excluding unintentional injury prevention) or the intervention group (routine education plus app-based parenting education including unintentional injury prevention). The app-based injury prevention program was developed based on the Theory of Planned Behavior, the Haddon Matrix, the Mobile Learning framework, and a needs assessment. Data collection will be conducted at baseline, 3-month, and 6-month follow-up via app-based survey plus printed questionnaire survey. The primary outcome measure is unintentional injury incidence among preschoolers in the past 3 months. Secondary outcome measures include economic losses due to unintentional injury in the past 3 months, the Incremental Cost-Effectiveness Ratios (ICERs), and parent’s attitudes and behaviors concerning supervision to prevent preschooler unintentional injury in the past week. An intention-to-treat approach will be used to evaluate outcome measures. Chi-square tests will examine differences for outcome measures between groups at each time point and generalized estimation equations (GEE) will test the overall effectiveness of the app-based intervention. Missing outcome data will be imputed using the Expectation Maximization algorithm (EM).DiscussionThis trial will examine evidence concerning the effectiveness of an innovative app-based intervention for caregivers of Chinese preschoolers. If effective, the app-based intervention could offer an effective population-based intervention option to cost-effectively promote unintentional injury prevention in countries and regions where injury control is under-supported.Trial registrationChiCTR-IOR-17010438. Registered 15 January 2017.

Predictors for return to work after physical injury in China: A one-year review.

Several studies have explored the factors influencing patients' return to work (RTW) status. However, only few studies have tried to explore the predictors for RTW in subpopulations in terms of different levels of disability, particularly in the Chinese population. This study describes the trends in patient's RTW and explores the predictors associated with RTW for patients with work-related injury in Mainland China. A total of 457 patients with different types of injury were followed up for one year. Patients were stratified into three groups according to the grade of disability as follows: mild, moderate, and severe. Variables affecting RTW were then compared between the three groups, and multiple logistic regression was performed to identify the predictors for RTW. The RTW rates during the study period were significantly different among the three groups. RTW tended to increase rapidly during the early stage, but the increase plateaued during the later stage. For the mild disability group, educational level, expectation to RTW, and other types of injury (e.g., spinal cord injury, traumatic brain injury, and burn) were significant predictors for RTW. White-collar work and better employer satisfaction were positive predictors for RTW for the moderate group. Meanwhile, no significant predictor for RTW was determined for the severe disability group. RTW tended to increase rapidly during the early stage, but the increase plateaued during the later stage. The predictors for RTW also varied among the patients with different levels of disability. These predictors may help vocational rehabilitation service providers provide more accurate intervention.

A social change perspective on injury prevention in China

IntroductionChina has undergone massive social change over the past four decades. Since national estimates became available in 1987, the overall fatal injury rate has decreased. This paper investigates targeted interventions...

PDB41 - Influence Factors and Economic Burden of Antidiabetics-Injection-Related Needle-Stick Injuries in China

Needle-stick Injury (NSI) is one of the most common occupational injuries among healthcare professionals. In view of the large size of diabetes population in China, the burden of antidiabetics-injections-related NSI is significant. Thus, we identified the influence factors and economic burden of antidiabetics-injections-related NSI among nurses in China. A cross-sectional national survey on antidiabetics-injection-related NSI among nurses in 31 provinces of China was performed with online questionnaire, aiming to analyze the NSI influence factors of antidiabetics injection. A model was constructed to estimate economic burden of antidiabetics-injection-related NSI in China. The model’s cost components included: testing for infection in the injured nurses and the patient on whom the needles had been used, post-exposure prophylaxis(PEP), and treatment for chronic blood-born viral infections. Both univariate analysis and multivariate analysis indicated that the influence factors of antidiabetics-injection-related NSI included level of hospital, hospital departments, numbers of beds in the department, job titles, total weekly insulin injection times, the way to unscrew needles (with/without tools), the ratio of pen and needles usage in the practice, qualifications, working experience and mental health (with/without anxiety or depression). Three scenarios were created to estimate the economic burden: 1) PEP cost, infection rates and treatment costs of the infections were all abstracted from literature; 2) infection rates were from the survey while the rest from literature; 3) all factors from the survey. The economic burden in the three scenarios were ¥2422.45, ¥2910.21 and ¥2927.54, respectively. This analysis indicated broad-spectrum factors ranging from hospital administration to clinical practice can influence the incidence of antidiabetics-injection-related NSI. Hospital-administrators and decision-makers should raise awareness, improve education, and adapt new technology to reduce NSI due to its considerable economic, psychological, and societal burden.

Pharmacoeconomics of three Therapeutic Schemes for Anti-tuberculosis Therapy Induced Liver Injury in China.

To evaluate the pharmacoeconomics of three therapeutic schemes in treating anti-tuberluosis therapy -induced liver injury (anti-TB DILI).MethodsIn the construction of a decision tree model, the efficacy and safety parameters came from the results of the randomized, controlled trial conducted here, the effect parameters were derived from expert advice, and the cost parameters, such as usage specification, number, and unit price, came from literature, expert advice, and so on.ResultsThe cost-effectiveness analysis (CEA) based on the effect degrees showed that bicyclol had the best effect (4.63562). The incremental cost-effectiveness ratio (ICER) (206.03270) of bicyclol was the lowest. The cost-effectiveness ratio of silibinin was the lowest (68.59987). The CEA based on the complete normalization rate showed that bicyclol had the highest complete normalization rate (83.562%), the lowest cost-effectiveness ratio (4.63627), and the smallest ICER (4.63504). Sensitivity analyses proved the robustness of the results.ConclusionsBicyclol is the most cost-effective therapy and the preferred choice for treating anti-TB DILI.

Antipsychotic Drugs and Liver Injury.

SummaryIn October 2015, the drug-induced liver diseases group of the Chinese Society of Hepatology drafted and published the first Diagnosis and Treatment Guidelines on Drug-induced Liver Injury in China, giving suggestions on the diagnosis and treatment of drug-induced liver injury (DILI). As a psychiatrist, I have found that in clinical practice both typical and new antipsychotic drugs can induce liver injury to varying degrees. Therefore, it is necessary to quickly and accurately determine the cause of liver injury and the type and severity of injury and establish a solution. This article reviewed relevant literature including the common pathogenesis and clinical manifestations of drug-induced liver injury caused by antipsychotic drugs, laboratory tests, diagnostic criteria and classification, and clinical management strategies. This paper also includes a summary and a perspective on liver injury caused by antipsychotic drugs.

Prevention and treatment of electrical burn injury: much progresses achieved yet further efforts still needed

Electrical burn injury is very common, including electrical contact burn, electrical arc burn, and lightning burn, etc. Electrical burn patients account for 0.04 to 5 percent of all burn victims in the developed countries, while it hit up to 27 percent in the developing countries, much more than the global average of 4.5 percent. Historical and recent data have shown that the electrical burn injuries in China, either for the case number, the proportion of burn patients in hospital, or the population incidence per year, are much higher than those of the developed countries and the global average. Before the 1960s, conservative treatment or skin grafts after repeated debridements were used for electrical burns, resulting in high rates of amputation and severe deformity. In the 1960s, transplantation of flaps after debridement in early stage were used for repairing wrist electrical burn wounds, breaking through the traditional conservative methods. In the 1980s, local, distant and island pedicled skin or myocutaneous flaps were widely used for early stage repair of electrical burn wounds. In recent years, along with the increasing experience of evaluating the blood vessel injuries and the development of microsurgical techniques, free flaps have been more and more used to cover the deep wounds of electrical burns in early stage, leading to much better effects and shorter length of hospital stay. With the persistent efforts of the burn specialists in the last decades, great improvements have been made for the treatment of electrical burn injuries in China. Future study on decoding the full mechanism of electrical burn injury, exploring new methods to save the injured but not yet necrotic tissue, are still needed to improve the treatment and reduce amputation and deformity of electrical burn injury.

On the Improvement of the Identification Procedure of the Occupational Injury in China

The identification procedure of the occupational injury in China is so complicated that it impedes the preconceived effect of the occupational injury insurance severely. This thesis collected 2774 judicial documents of Chinese courts from the Pkulaw database. On the foundation of the present system of the identification procedure and the analysis of the judicial documents, it’s found that both the time cost and the evidences in the cases of the occupational injury are not reasonable. We should simplify the procedure to improve Chinese occupational injury insurance system. On one hand, we should cancel the identification as the pre-procedure of the application of industrial injury insurance. On the other hand, the injured worker should be allowed to file an incidental civil action in the administrative suit.

An analysis of escalator-related injuries in metro stations in China, 2013–2015

In order to reduce the probability and severity of escalator-related injuries and enhance the safety of passengers, this study analyzed 950 escalator-related injuries in Guangzhou metro stations to identify the characteristics and the risk factors associated with escalator-related injuries in China. The data extracted from Management Information System of Guangzhou Metro covers the site and time of the accident, age and gender of the victims, escalator condition and injury information. The results from the statistical analysis indicated that the majority of the escalator-related injuries was caused by failing to stand firm (287 cases, 30.2%), passengers carrying out other tasks (214 cases, 22.5%), not holding the handrail (168 cases, 17.7%) and unhealthy passengers (18 cases, 9.3%). Age was associated with all factors except for need for an ambulance and the distribution law of these factors differed with age groups. Elderly passengers (aged 66 years and above) accounted for the highest proportion of all injuries (49.1%), and failing to stand firm (18.63%) was the main cause of escalator-related injuries of elderly passengers. The most common mechanism of injury for all age groups was a fall, accounting for (51.0%) injuries. Proportion of injuries caused by a fall increased with age, whereas injuries attributed to entrapment decreased. Female passengers (65.9%) were more likely to be involved escalator-related injuries than male passengers (34.1%), while male passengers were more likely to have accidents caused by unhealthy physical condition than female passengers. These results based on the analysis of current accident data can be used to help metro operation corporation develop effective injury prevention measures and document the need for continued improvement of escalator safety in metro stations.

Disease burden on road injury in the Chinese population, in 1990 and 2013

Objective: To explore the disease burden of road injuries in China. Methods: The results of Global Burden of Disease 2013 including death rate, disability-adjusted of life years (DALY), years of life lost due to premature mortality (YLL), years lived with disability (YLD), were used to describe the burden caused by road injuries in 2013 and the trends from 1990 to 2013, in China. Results: In 2013, there were 313 676 deaths caused by traffic accidents in China. Death rate, rates on DALY, YLL and YLD were 22.52 per 100 000, 1 076.54 per 100 000, 971.21 per 100 000 and 105.34 per 100 000, respectively. Rates on deaths, YLL and YLD appeared higher in males, pedestrians than in females and other types of road travelers. Burden of injuries caused by traffic accidents was seen higher in those aged 15 to 49-year-old. From 1990 to 2013, the overall death rate on road injuries increased by 0.54 per 100 000 in China, with an increase of 2.34 per 100 000 and 0.81 per 100 000, respectively in males and pedestrians. The rates on DALY, YLL and YLD decreased by 164.21 per 100 000, 115.06 per 100 000 and 49.06 per 100 000, respectively. Conclusions: During the past 20 years, achievements had been made on road injury prevention and control, with the decrease of disease burden caused by road accidents. Males, young adults and pedestrians should be called for more attention to prevent road injuries.

Renal replacement therapy practices for patients with acute kidney injury in China.

Recent data indicate AKI is very common among hospitalized Chinese patients and continuous renal replacement therapy (CRRT) is increasingly offered for treatment. However, only anecdotal information regarding CRRT’s use in relation to other modalities and the specific manner in which it is prescribed exists currently. This report summarizes the results of a comprehensive physician survey designed to characterize contemporary dialytic management of AKI patients in China, especially with respect to the utilization of CRRT. The survey queried both nephrologists and critical care physicians across a wide spectrum of hospitals about factors influencing initial RRT modality selection, especially patient clinical characteristics and willingness to receive RRT, treatment location, and institutional capabilities. For patients initially treated with CRRT, data related to indication, timing of treatment initiation, dose, anticoagulation technique, and duration of therapy were also collected. Among AKI patients considered RRT candidates, the survey indicated 15.1% (95% CI, 12.3%-17.9%) did not actually receive dialysis at Chinese hospitals. The finding was largely attributed to prohibitively high therapy costs in the view of patients or their families. The survey confirmed the dichotomy in RRT delivery in China, occurring both in the nephrology department (with nephrologists responsible) and the intensive care unit (with critical care physicians responsible). For all patients who were offered and received RRT, the survey participants reported 63.9% (56.4%-71.3%) were treated initially with CRRT and 24.8% (19.2%-30.3%) with intermittent hemodialysis (HD) (P<0.001). The mean percentage of patients considered hemodynamically unstable at RRT initiation was 36.2% (31.3%-41.1%), although this figure was two-fold higher in patients treated initially with CRRT (43.1%; 35.8%-50.4%) in comparison to those initially treated with HD (22.4%; 16.4%-28.4%)(P<0.001). An overwhelming majority of intensive care patients were treated initially with CRRT (86.6%; 79.8–93.4%) while it was the initial modality in only 44.6% (33.5–55.7%) of patients treated in a nephrology department (P<0.001). Approximately 70% of respondents overall reported prescribing a CRRT dose in the range of 20–30 mL/kg/hr while approximately 20% of prescriptions fell above this range. Daily prescribed therapy duration demonstrated a marked divergence from values reported in the literature and standard clinical practice. Overall, the most common average prescribed value (50% of respondents) fell in the 10–20 hr range, with only 18% in the 20–24 hr range. Moreover, 32% of respondents reported an average prescribed value of less than 10 hrs per day. While the percentages for the 10–20 hrs range were essentially the same for nephrology and ICU programs, a daily duration of less than 10 hrs was much more common in nephrology programs (48.0%; 38.3%-57.9%) versus ICU programs (16%; 10.0%-24.6%)(P<0.001). Our analysis demonstrates both similarities and differences between RRT practices for AKI in China and those in the developed world. While some differences are driven by non-medical factors, future studies should explore these issues further as Chinese RRT practices are harmonized with those in the rest of the world.

Electric bicycle-related injuries presenting to a provincial hospital in China: A retrospective study.

The use of electric bicycles (EBs) in China is growing. In the present study, we aimed to characterize the pattern and outcomes of EB-related injuries presenting to a major general hospital in China.This was a retrospective review of EB-related injuries presenting to Zhejiang Provincial People's Hospital from 2008 to 2011. Cases were identified from medical records according to diagnosis codes. Data captured included demographics, injury characteristics, and outcomes.A total of 3156 cases were reviewed in the present study. There were 1460 cases of traffic accidents, of which 482 cases were EB-related (32.7%). In addition, most of EB-related cases (44.6%) belonged to the 41- to 60-year-old age group. Median injury severity score was 10. Moreover, 34.9% underwent surgery and 24.7% were admitted to intensive care unit. The median hospitalization cost was 14,269 USD. Fracture (56.5%) was the most frequently diagnosed injury type, and head was the most commonly injured body region (31.1%).EB-related injuries have become a major health concern, making up a sizeable proportion of injuries presenting to the emergency department. Therefore, it is necessary to establish injury prevention and strategies for EB road safety. Implementation of policy such as compulsory helmet use, as well as popularization of EB road safety education should be considered to improve the current situation of EB-related injuries in China.

Hepatitis E Virus–Associated Neurological Injury in China

Hepatitis E Virus–Associated Neurological Injury in China

Epidemiology and management of splenic injury: An analysis of a Chinese military registry.

In China, there have been few meta-analyses of the epidemiology and management of splenic injury. Due to the success of Chinese military hospitals in the domestic treatment of splenic injury, the present study conducted a systematic review of such cases, identifying a high occurrence rate of splenic trauma, as well as a number of strategies of managing splenic injury in China. Data were collected from sixteen Chinese military hospitals between July 2000 and March 2009, and retrospectively reviewed. It was observed that between July 2000 and March 2009 a total of 7,807 patients (84.32% male and 15.68% female) with splenic injury were admitted to hospital. The mean duration of hospital stay was 17.9±18.6 days and the gender distribution of splenic injury over the successive years did not differ significantly (P>0.05, c=0.034). However, there was a significant difference in the gender distribution of splenic injury patients in different months (P<0.05, c=0.063). In addition, admission numbers for splenic injury were highest in September, October and November. It was also found that splenic injury may occur at all ages, though patients of working age (20-50 years), which comprises 85.59% of patients, the highest proportion of all recorded cases. Associations between mortality rate and each management strategy were as follows: Operative management, 0.11% and non-operative management, 0.15%. Furthermore, multivariate analysis demonstrated that transfusion, New Injury Severity Score and management strategies were all correlated with mortality rate. Thus, despite a lack of data for inpatients from civilian hospitals, the present study has, in part, identified the epidemiology and management strategies of splenic injury in China. These findings may supplement those from previous analyses of splenic injury in other countries and regions.

Prevalence of drink driving and speeding in China: a time series analysis from two cities

ObjectivesTo confront the public health challenge imposed by road traffic injuries in China. Study designA consortium of international partners designed and implemented targeted interventions, such as social media campaigns, advocacy for legislative change and law enforcement training, to reduce the percentage of drink driving and speeding in two Chinese cities, Dalian and Suzhou, from 2010 to 2014. MethodsTime series models were developed to detect changes in the prevalence of drink driving and speeding using data collected through four years of observational studies. ResultsThis analysis, based on 15 rounds of data, shows that from May 2011 to November 2014, the percentage of vehicles driving above the speed limit decreased from 31.8% (95% confidence interval [CI]: 29.2–34.5) to 7.4% (95% CI: 7.0–7.9) in Dalian and from 13.5% (95% CI: 11.7–15.5) to 6.9% (95% CI: 6.4–7.4) in Suzhou. Drink driving decreased from 1.7% (95% CI: 1.1–2.4) in January 2011 to 0.5% (95% CI: 0.2–0.9) in November 2014 in Dalian and from 6.4% (95% CI: 5.4–7.4) to 0.5% (95% CI: 0.1–2.4) in Suzhou during approximately the same period. Time series models confirmed declining trends in both risk factors in both cities (P-value: 0.06 for speeding prevalence in Suzhou; all other P-values are below 0.05). Disaggregated by vehicle type, saloon cars and SUVs were more likely to exceed the posted speed limit than other types of vehicles in both cities. The speeding rate was higher where the posted speed limit is lower. In Dalian, more drivers were driving above the posted speed limit on weekdays than on weekends (11.4% vs 6.8%); Suzhou had a similar pattern, but the difference was smaller (14.0% vs 12.2%). ConclusionDespite the challenge in accurately attributing the observed changes to one programme, the substantial reduction in the prevalence of the two risk factors suggests that through coordinated actions, internationally recognized best practices in road safety may be effective in improving road traffic safety in China.

People with Spinal Cord Injury in China.

People with Spinal Cord Injury in China.

Isolation and bioactivity evaluation of the chemical constituents from Bridelia balansae Tutcher

From our in vitro high throughput screening study of around 3000 plant extracts, the dichloromethane fraction of the roots of Bridelia balansae Tutcher (Phyllanthaceae) showed potential anticancer activity, with an IC50 value at 0.8 µg/mL against HCT116 colon cancer cell. B. balansae has been used as a folk medicine to treat cataclasis and traumatic injury in China. There is no prior report of the bioactivity of the chemical constituents from B. balansae. To identify the potential anticancer lead molecules, the plant materials of B. balansae were recollected and extracted with methanol. Bioassay-directed fractionation of the extract led to the isolation of 16 compounds. Among them, four (1 – 4) showed cancer cell killing activity against HCT116 cell line with the IC50 values at 20 nM, 33.5, 20.0 and 16.3µM, respectively (Table 1). Compounds 1 and 5 are new ones. Compound 1, an α-peltatin, demonstrated the most significant cytotoxic activity among all the isolates. It was evaluated against a panel of cancer cell lines (A375, HCT116, HT29 and A549) and showed highest cytotoxicity against HCT116 and the melanoma A375 cell lines, with the IC50 values at 20 nM and 7 nM, respectively. Compound 1 is a retro-lactone analogue of podophylotoxin (the carbonyl carbon located at C-11 in 1 but at C-12 in podophylotoxin). In our study, compound 1 showed much higher cancer cell killing activity than etoposide (an FDA approved anticancer drug) in two cell lines (HCT116 and A375) (Table 1). Previous study [1] showed that etoposide has much higher activity than the 4-hydroxyl analogue (6) of compound 1, indicating the presence of the hydroxyl group at C-4 significantly reduced cancer cell killing activity for a retro-podophylotoxin compound. The in vitro cancer cell killing potency of this retro-podophylotoxin compound provides basements for further structure-activity relationship (SAR) and in vivo studies.