Injury Hazards Research Articles

Effects of WN1703 on Cardiovascular Function in Chronic Hyperuricemia Rats and Myocardial Injury Mechanism Exploration in H9C2 Cells.

Hyperuricemia, a prevalent condition, is typically preceded by disturbances in purine metabolism and is frequently associated with hyperlipidemia and other dysfunctions of metabolism. WN1703 demonstrated an inhibitory activity against xanthine oxidoreductase (XOR) that was comparable to febuxostat in our prior investigation. In this study, we assessed the cardiovascular safety of WN1703 in a chronic hyperuricemia rat model induced by potassium oxonate in combination with hypoxanthine. We investigated the changes in cardiovascular biomarkers in chronic hyperuricemia rats treated with febuxostat and WN1703, including creatine kinase (CK), CK-MB, B type natriuretic peptide (BNP), Corin protein (CRN), Neprilysin (NEP), myeloperoxidase (MPO), 8-hydroxy-2-deoxyguanosine (8-OHdG), tumor necrosis factor (TNF-α), interleukin-1β (IL-1β), and interleukin-8 (IL-8). Additionally, we validated the potential mechanism of cardiac injury induced by WN1703 in H9C2 cells, guided by cardiotoxicity predictions from the cardioToxCSM database and network pharmacology. We observed that excessively rapid urate-lowering, oxidative stress, and inflammation could disrupt myocardial functional homeostasis and increase the risk of cardiovascular injury in hyperuricemia rats, and WN1703 treatment effectively reduced the levels oxidative stress marker 8-OHdG and inflammatory factor TNF-α. Despite the absence of organic damage to the heart with prolonged treatment of febuxostat and WN1703, potential hazard of cardiovascular injury could be associated with the modulation of the TGFβ and RHO/ROCK signaling pathways by febuxostat and WN1703. This could offer new insights into the mechanisms underlying the adverse effects caused by XOR inhibitors.

Neck Range of Motion Prognostic Factors in Association to Shoulder and Elbow Injuries in Professional Baseball Pitchers

BackgroundAuthors have observed an association between cervical spine mobility and arm injury risk in baseball player; however, there is a need to assess the generalizability of cervical measurement data. Assessing the downstream of associations of cervical dysfunction on shoulder and elbow injuries can inform clinical interventions to help reduce future arm injuries. The purpose of this study was to assess the generalizability of neck range of motion measures as arm injury prognostic factors in professional baseball pitchers. MethodsA prospective cohort of professional baseball pitchers in one Major League Baseball Organization was performed. Pitchers underwent pre-season neck range of motion including cervical flexion, extension, rotation, lateral flexion, and the flexion-rotation test (CFRT) and were followed for the season. The outcome was the occurrence of shoulder or elbow injury. A Cox proportional hazards analysis was performed and reported as hazard ratios (HR) with 95% confidence intervals (95% CI). ResultsA total of 88 pitchers were included (Age: 24.2 (2.4); Left-Handed: 21 (23%); Fastball Velocity: 92.3 (1.8)), with 15,942 athlete exposure days collected over the season. Pitcher neck range of motion was assessed (Flexion: 64 (10); Extension: 69 (11); Difference in Lateral Flexion: -1 (7); Difference in Neck Rotation: -2 (9); Difference in CFRT: -1 (7)). A total of 20 arm injuries (Shoulder: 9 (10%); Elbow: 11 (13%); Combined Rate: 1.3 (95% CI: 0.7, 1.7) per 1000 exposure days) were suffered by pitchers during the season. For every degree increase in the difference in dominant (rotating to dominant shoulder) versus non-dominant (rotating to non-dominant shoulder) neck rotation, there was a four-fold increase in arm injury hazard (HR: 4.0 (95% CI: 1.1, 13.9), p = 0.031). No other neck measurements demonstrated prognostic value. ConclusionsA deficit in dominant versus non-dominant neck rotation was prognostic for pitching arm injury. However, the cervical rotation test did not have prognostic value in this sample. Further research is required to assess the generalizability and scalability of neck range of motion assessment in relation to baseball shoulder and elbow injuries across different competition levels.

Subsequent musculoskeletal injury after concussion in National Football League players

ObjectiveTo assess whether National Football League (NFL) players diagnosed with a concussion have an increased risk of injury after return to football.MethodsA retrospective cohort study analysed the hazard of subsequent...

Stroke: Another Delayed Hazard of Traumatic Brain Injury, Even in Young Adults.

Stroke: Another Delayed Hazard of Traumatic Brain Injury, Even in Young Adults.

Child Home Safety in Hispanic and Rural Communities Along the Texas–Mexico Border: A Community Health Worker Intervention

Low-income children are among the most affected by unintentional injuries. Although these injuries are preventable, outreach to low-income families in Hispanic and rural communities can be challenging. Community Health Workers (CHWs) are effective partners in reaching these populations. This study sought to determine whether a CHW-led intervention would reduce common hazards that increase the risk of unintentional injuries in low-income rural Hispanic homes along the Texas–Mexico border. CHWs conducted home visits to assess for injury hazards and distribute safety devices to 47 families with children ages 0 to 5 in five low-income rural border communities. CHWs provided follow-up assessments and support 30 days later. Analyses examined changes in the proportion of hazards from visits 1 to 2, with relative risks estimating the impact of safety devices on hazard reduction. Findings showed a 26.2% reduction in the total number of common hazards present in homes from visit 1 to visit 2 ( p < .001). There was a 70% reduction in the overall risk of a hazard being present at visit 2, relative to visit 1 ( relative risk = 0.30, 95% CI [0.28, 0.33], p < .001). This study suggests that tailored CHW interventions can reduce home safety hazards. CHWs are well suited to inform hard-to-reach Hispanic and rural populations, addressing feelings of distrust and promoting acceptance of recommended environmental changes. More rigorous evaluations of this intervention strategy are needed.

Improving the industrial safety management system at enterprises with chemically hazardous sites

This study focuses on developing an industrial and occupational safety management system for enterprises that contain chemically hazardous sites. The methodology, based on an expert approach, enabled the authors to design the structure of the risk management system at such enterprises. It also facilitated the identification of clusters and their descriptors, along with their roles in evaluating the state of the safety management system. The proposed methodology features a flexible and universal structure, making it applicable for assessing industrial and occupational safety across different enterprises, taking into account the specific technological aspects of production processes. In this case study, the authors examined the accident rates, injury hazards, and health risks associated with chemically hazardous sites in enterprises located in the Republic of Kazakhstan. The findings of this study provide a methodological approach that industrial enterprises can use to evaluate the effectiveness of their safety management systems. This allows for the development of measures aimed at preventing chemical accidents and reducing their impacts.

Electrostatic charging of material webs in production machines and how to eliminate it

The elimination of electrostatic charges, especially on material webs is critical to preventing ignition hazards and personal injury hazards in industry. The use of discharge bars (called “ionizers”) is an important method for eliminating electrostatic charges.The possibility of electrostatic discharge in a production machine is real. The metrological detection of charges on material webs is also discussed and the special phenomenon of a super brush discharge is described. A useful arrangement for active ionizers is described and justified.

Index construction and real-time hazard assessment of rice sterile-type chilling injury process in Northeast China

Rice is a warm-temperature crop, and sterile-type chilling injuries may be induced by acute periods of low-temperature weather during the reproductive growth period. This study considered the daily mean and minimum temperatures in Northeast China from 1979 to 2018 as influencing factors to construct a process-based rice accumulated intensity index (PARII) and hazard assessment model based on known crop disaster periods, analyzed the spatiotemporal distribution characteristics of chilling injury during the rice growth period (booting and flowering stages), used solar-induced chlorophyll fluorescence (SIF) and yield fluctuation data to calculate the adaptability of the hazard assessment model, and selected two typical events of disaster processes to verify the proposed real-time hazard assessment model. The change in the cumulative intensity index of rice sterile-type chilling injury indicated an increasing trend in chilling injury in the rice booting stage . Based on the probability density static hazard and cumulative probability dynamics, the results of real-time hazard analysis showed that the chilling injury hazard area was significantly expanded compared with the sterile-type chilling injury during the booting and flowering periods. The hazard value was greater than 0.2 in central and southeastern Heilongjiang, and the static hazard index was significantly negatively correlated with SIF and fluctuating yield, which indicated the chilling injury impacted rice yield and physiology. Regional-scale hazard levels were assessed by daily real-time hazard evaluation to highlight spatial heterogeneity in crop stress and damage. The results of this study provide a scientific basis for real-time risk assessment and management of chilling injury in rice crops and may support future adaptation strategies for addressing risks associated with severe low-temperature events.

Inductive 3D numerical modelling of the tibia bone using MRI to examine von Mises stress and overall deformation

Abstract As the main load bearer throughout the gait cycle, the tibia is a crucial bone in the lower leg that distributes ground reaction forces with each stride. Comprehending the distribution of stress inside the tibia is essential for both avoiding fractures and developing efficient methods of redistributing load to promote healing and biomechanical correction. The study examined the stress, strain, and deformation encountered by the tibia over a 7-s walking cycle using an ANSYS workbench software, using tibia bone under a period of force applied to the boundary condition at intervals of 0.2 s. The tibia encounters stress levels varying from 0 to 1,400 N, exhibiting a regular pattern that aligns with the loading attributes often associated with traditional walking. The research conducted in this study identified the occurrence of maximum stress levels, measuring 25.45 MPa. Additionally, related peak elastic strains and deformations were observed, measuring 2.19 × 10−3 and 2.43 mm, respectively. The patterns that have been seen indicate that there is an initial contact of the foot with the ground, followed by the bearing of weight and subsequently the toe-off. These observed patterns closely resemble the natural motion of the foot during the act of walking. Temporal fluctuations in elastic strain through the tibia throughout a gait cycle reveal that the strain is mostly cantered at the medial surface of the tibia. Additional investigation into the elastic properties and overall deformations of the tibia yielded valuable observations on prospective areas of interest within the bone’s structure. These findings are of utmost importance for biomechanical assessments and the identification of potential injury hazards in subsequent research endeavours.

On the thermal impact during drilling operations in guided dental surgery: An experimental and numerical investigation

In recent years, a major development in dental implantology has been the introduction of patient-specific 3D-printed surgical guides. The utilization of dental guides offers advantages such as enhanced accuracy in locating the implant sites, greater simplicity, and reliability in performing bone drilling operations. However, it is important to note that the presence of such guides may contribute to a rise in cutting temperature, hence increasing the potential hazards of thermal injury to the patient's bone. The aim of this study is to examine the drilling temperature evolution in two distinct methods for 3D-printed surgical dental guides, one utilizing an internal metal bushing system and the other using external metal reducers. Cutting tests are done on synthetic polyurethane bone jaw models using a lab-scale automated Computer Numeric Control (CNC) machine to find out the temperature reached by different drilling techniques and compare them to traditional free cutting configurations. Thermal imaging and thermocouples, as well as the development of numerical simulations using finite element modeling, are used for the aim. The temperature of the tools' shanks experienced an average rise of 2.4 °C and 4.8 °C, but the tooltips exhibited an average increase of around 17 °C and 24 °C during traditional and guided dental surgery, respectively. This finding provides confirmation that both guided technologies have the capability to maintain temperatures below the critical limit for potential harm to bone and tissue. Numerical models were employed to validate and corroborate the findings, which exhibited identical outcomes when applied to genuine bone samples with distinct thermal characteristics.

Early Detection of hyperemia with Magnetic Resonance Fluid Attenuation Inversion Recovery Imaging after Superficial Temporal Artery to Middle Cerebral Artery Anastomosis.

Cerebral hyperperfusion syndrome (CHS) manifests as a collection of symptoms brought on by heightened focal cerebral blood flow (CBF), afflicting nearly 30% of patients who have undergone superficial temporal artery (STA)-middle cerebral artery (MCA) anastomosis. The aim of this study was to investigate whether the amalgamation of magnetic resonance imaging (MRI) fluid-attenuated inversion recovery (FLAIR) and apparent diffusion coefficient (ADC) imaging via MRI can discern cerebral hyperemia after STA-MCA anastomosis surgery. A retrospective study was performed of patients who underwent STA-MCA anastomosis due to Moyamoya disease or atherosclerotic steno-occlusive disease. A protocol aimed at preventing CHS was instituted, leveraging the use of MRI FLAIR. Patients underwent MRI diffusion with FLAIR imaging 24 hours after STA-MCA anastomosis. A high signal on FLAIR images signified the presence of hyperemia at the bypass site, triggering a protocol of hyperemia care. All patients underwent hemodynamic evaluations, including perfusion MRI, single-photon emission computed tomography (SPECT), and digital subtraction angiography, both before and after the surgery. If a high signal intensity is observed on MRI FLAIR within 24 hours of the surgery, a repeat MRI is performed to confirm the presence of hyperemia. Patients with confirmed hyperemia are managed according to a protocol aimed at preventing further progression. Out of a total of 162 patients, 24 individuals (comprising 16 women and 8 men) exhibited hyperemia on their MRI FLAIR scans following the procedure. SPECT was conducted on 23 patients, and 11 of them yielded positive results. All 24 patients underwent perfusion MRI, but nine of them showed no significant findings. Among the patients, 10 displayed elevations in both CBF and cerebral blood volume (CBV), three only showed elevation in CBF, and two only showed elevation in CBV. Follow-up MRI FLAIR scans conducted 6 months later on these patients revealed complete normalization of the previously observed high signal intensity, with no evidence of ischemic injury. The study determined that the use of MRI FLAIR and ADC mapping is a competent means of early detection of hyperemia after STA-MCA anastomosis surgery. The protocol established can be adopted by other neurosurgical institutions to enhance patient outcomes and mitigate the hazard of permanent cerebral injury caused by cerebral hyperemia.

Increase in Trauma Leading to Psychological Injury Among Canadian Homelessness Services Workers During the COVID-19 Pandemic.

This study examined the traumatic psychological impact of the pandemic on frontline workers in homelessness services. Staff from homelessness serving organizations completed pre- and mid-COVID pandemic surveys measuring traumatic stress symptoms (PTSS), burnout, and job-related traumatic experiences. The mid-pandemic survey was expanded to seven Canadian cities to determine prevalence of workplace PTSS nationally. In the comparison group, baseline rates of PTSS (41%) rose to 47.3% ( n = 164), while 75% reported low-moderate levels of burnout both times. Nationwide, PYSS was 51% ( n = 574). Case managers working at remotely had greater levels of PTSS. COVID-19 exacerbated risk of psychological workplace injury from traumatic stress; however, burnout did not increase significantly, indicating the primary dynamic as anxiety and emotional exhaustion associated with ubiquitous trauma induced by COVID-19. Working remotely increased the hazards of psychological workplace injury.

CHASE (Children’s Housing Assessment for a Safe Environment): a protocol for the inspection and modification of injury risks in children’s homes

BackgroundDecades of research and practice experience have led to an extensive body of evidence about effective home safety modifications. However, the benefits of safety modifications have not reached all segments of society. Poor quality housing in low-income neighborhoods, along with limited access to safety products and injury prevention information, can be significant barriers to child safety.MethodsThis is a longitudinal study of 300 low-income families in Baltimore City and Baltimore County with children under 7 years of age who are referred from existing Green & Healthy Homes Initiative (GHHI) home visiting programs. Three home visits will be completed to assess home injury hazards using a previously developed tool, the Children’s Housing Assessment for a Safe Environment (CHASE), and provide a Scope of Work that includes home modifications specific to the identified home injury hazards. An Assessor will also provide do-it-yourself education materials and injury prevention supplies to assist residents in completing the modifications. If the parent or caregiver is unable to complete the home modifications, a professional Housing Intervention Services team will complete the home modifications necessary to prevent injury in the home. This study will involve both quantitative and qualitative data analysis methods. Paired and regression analyses will be conducted to examine the maintenance of modifications and the variables associated with positive outcomes. A thematic analysis of staff and participant interviews will be used to identify perceived barriers and facilitators of successful program implementation.DiscussionBetter data on residential injuries of children and an improvement in the overall surveillance of home injuries are necessitated. This study will set a strong foundation for a larger future study of health and cost effectiveness outcomes and will advance our understanding of the feasibility, costs, and potential benefits of addressing and preventing home injuries to children.

РИСК-ОРИЕНТИРОВАННЫЙ ПОДХОД В УПРАВЛЕНИИ МЕДИЦИНСКИМ ОБОРУДОВАНИЕМ В ОКАЗАНИИ

Introduction. The use of equipment in the provision of medical care is associated with risks of harm to health and life with the likelihood of adverse events, for this reason, a risk-based approach is a prerequisite in modern realities. The goal is to identify the risks of operating medical equipment (MO) in a cardiac surgery clinic. Material and methods. The Research Institute for Complex Problems of Cardiovascular Diseases (NII KPSSZ) used the technique of failure cause and effect analysis (FMEA) to identify risks. By the number of points of the generalized quantitative characteristic of the risk of non-compliance (priority risk number - RPR), all risks are divided into levels: low, medium, high and catastrophic. The obtained data were systematized in the "Risk Passport", including: the definition of risk, its indicator, indicator, level, source. The cause and consequences of the risk, as well as measures to manage them are indicated. The whole process is formalized within the framework of the Quality Manual and documented QMS procedures. Results. Indicators of the equipment of the Ministry of Defense and the performance of the engineering service of the Research Institute of the KPSS for the period from 2012 to 2022 indicate a high load on the management system of the Ministry of Defense, in particular, an increase in the number of units of the Ministry of Defense (from 976 units to 2520 units, the average annual (chain) growth rate was 13%), carried out Maintenance (from 555 to 2361) and repair of the Ministry of Defense (335-897). In the process, 8 risks were identified, including two high levels (purchase of low-quality spare parts, consumables and improper operation of the MO). The consequences of high risks include: violations in the operation of medical equipment, reduction of service life, deterioration of performance, downtime, unscheduled maintenance, repairs and the risk of obtaining erroneous diagnostic results, injury hazard for personnel and patients. Consequence management includes: compliance with the procedure for acceptance of consumables and spare parts, organization of claims work, timely repairs, internal investigation of cases of violations. The medium level of risk includes “improper maintenance of the MO by the outsourcer’s personnel”, the consequences of which may also be a decrease in the resource and deterioration in performance, downtime for repairs. Measures to manage the causes of this risk were the development of technical specifications for the conclusion of a contract with qualification requirements. The low level of risk includes: delay in the procedure for preparing documents for write-off, the reasons for which are the short deadlines for completing the task, the limited horizontal links with related services, difficulties in identifying by the departments allowing the write-off; violation of the requirements for the terms of delivery of MO (the reason is the violation by the supplier of the manufacturer's requirements for the conditions of storage and transportation, violation of the delivery time); lack of conditions for launching a new MO (the reason is non-compliance with the procedure for organizing the purchase of equipment); MOs requiring verification may not be included in the lists, and some of the already verified equipment may mistakenly be included in the lists of verified measuring instruments (the reason is errors made in the preparation and approval of statements according to F3.5-15, F3.5-17); refusal of the CMS to verify the MO due to a malfunction or incompleteness (the reason is a violation of the procedure for preparing equipment for verification of the measuring instruments) - the control measure is the introduction of a pre-verification control of the technical condition. Conclusion. A risk-based approach when working with MO allows medical organizations to prevent, identify and prevent risks that pose a threat to the life and health of both patients and staff, to minimize the consequences of their occurrence by improving approaches to the implementation of medical activities.

Injury hazard assessment in schools: Findings from a pilot study in Karachi, Pakistan

IntroductionInjuries are a major public health concern and one of the leading causes of death and disability worldwide. Childhood injuries contribute to a major proportion of this burden. ObjectiveTo identify injury hazards within school premises and playgrounds in Karachi, Pakistan. MethodsThis observational cross-sectional study took place in 107 public and private schools of Karachi, Pakistan using a self-structured standard injury risk assessment tool. This tool was developed after an extensive literature review, expert consultation, and field visits to a few local schools. Data related to school demographics, administrative data and injury hazards within the school boundaries were collected in schools offering education from nursery to secondary grades (through 10th grade, matriculation). Descriptive analysis were calculated. ResultsOut of 107 schools, only 12 were recording school-related injuries. A quarter (25%) of schools had some type of disaster drill exercises and built-in fire exits. Fire alarms were placed in 10 schools (9%), all of which were private. In 16 schools (15%), students had access to rooftop doors. There were multiple injury hazards in the school playgrounds. More than half of the schools had hazardous playground surfaces, such as slippery, concrete and uneven ground. Over 80% of schools were not supervising the children during playtime and did not have a separate play area for children under 6 years old. In 38 schools (22%), there were multiple injury hazards in the play rides, such as broken equipment, rusted parts, and sharp edges. Moreover, nine schools (7%) had loose nuts, bolts, edges, belts, steps, or rails in their play rides. Inside, almost a quarter (24%, n = 76) of schools did not have proper insulation of electric wires. Protruded metal nails, which could be high risk for prick and cut injuries, were observed in 20% of the observed furniture. ConclusionIn conclusion, there are multiple injury hazards in the private and public schools of Karachi, Pakistan.

Road safety hazards for children while commuting to school: Findings from a pilot study in Karachi, Pakistan

IntroductionRoad traffic injuries are a leading cause of mortality and morbidity among children. Travelling to and from school is a major risk exposure for children around the globe. ObjectiveThe purpose of this study was to assess road traffic injury hazards for school children during dropp-off or picked-up times. MethodsThis observational cross-sectional study included 94 public and private schools in Karachi, Pakistan. A structured observational tool was used to collect data on school demographics, the road traffic environment, infrastructure, injury hazards in vehicles used by school children, and child pedestrian injury risk and road use behaviors. ResultsA total of 860 observations of school children, drivers of vehicles transporting children, schools, and vehicles were recorded. Most schools (n = 83, 88%) did not have designated parking spaces around the school; only one public school had a parking area. Only one private school had a zebra crossing around the school premises. Very few schools (n = 13, 14%), mostly private (n = 12) had pedestrian sidewalks. Only 35 (18%) adult motorcyclists, out of 199, were wearing a helmet, and eight (6%), out of 145, car passengers were wearing seatbelts. Compressed natural gas (CNG) cylinders were installed in 83 (35%), out of 235, observed vehicles. The remaining 152 (65%) did not have CNG cylinders or they were not visible to our data collectors. In 55 (23%) observations, bus passengers stepped off the bus in the middle of the road. Most pedestrians (n = 266, 99.5%) did not use a Zebra crossing. More than a quarter (n = 74, 28%) of pedestrians looked left and right before crossing the road. ConclusionWhile traveling to school, either by walking or taking vehicular trips, children face many road traffic injury hazards in Karachi. Pedestrians and passengers exhibited risky behaviors while using roads. Further initiatives are advised from a public health viewpoint aiming at minimizing transport-related hazards.

Biochemical enzymes effects of analgesics treatment on post operative patients

Albeit 60 years have passed since it opened up on the restorative market, analgesics measurements in patients with liver illness stays a questionable subject. Fulminant hepatic disappointment has been a proven and factual result of analgesics over portion since its presentation, while short and long haul use have both been related with height of liver transaminases, a proxy marker for intense liver injury. From these reports it has been expected that analgesics use ought to be confined or the measurement decreased in patients with persistent liver sickness. We survey the elements that have been suspected to build hazard of hepatocellular injury from analgesics and the pharmacokinetic changes in various pathologies of persistent liver illness which might influence this gamble. We propose that unintentional under-dosing might bring about focuses excessively low to empower viability. Explicit examination to further develop the proof base for endorsing analgesics in patients with various an etiologies of constant liver sickness is required.. Results communicated that the study just with discoveries communicated that the patients which are not related with contamination but rather they impacted disease (498 numbers and 33.2%) for lesser rate and numbers when contrasted and disease related sicknesses (802 Numbers and 53.5%). The various degrees of SGOT results demonstrated after the medications taken pain+ tachyarrthymia (2.5 ± 0.4↑) patients levels of SGOT were fundamentally expanded contrasted with before drugs taken torment embraced patients. The various levels SGPT results made sense of for ensuing to the medications taken torment + aggravation ( 1.65 ± 0.003↓ ) patients levels of SGPT were widely diminished when contrasted with sooner than drugs taken torment. A more sensible manual for help the shriveling youngster expected by clear notification high philological hindrances with social and extreme contrasts. Additionally course expected to help the youngster and other gathering patients gone through chemotherapy radiation for therapy post operatively.

Framing home injury: opportunities and barriers to regulating for safer rental housing in Aotearoa/New Zealand

Like many countries in the OECD, Aotearoa NZ does not comprehensively regulate or enforce the safety of rental housing, despite evidence that the significant scale of home injury can be reduced through cost-effective home modifications. We examine the framing of home injury in media, political, and organisational discourse to identify barriers to creating and enforcing laws for safer rental homes. We find progress in addressing safety via rental housing regulations is stymied, in part, by institutional arrangements that favour the framing of home injury as a product of individual behaviour and culpability rather than environmental risk, and the prioritisation of education and awareness-raising over regulatory and systemic interventions framed politically, as overreaching ‘nanny state’ policies. We propose opportunities to address the incidence of injury and inequities in outcomes and argue that effective regulation and enforcement will address the inherent power inequities in the rental sector between owner and occupier, which can influence the presence of injury hazards.

760 Building Cold Injury Prevention and Control Strategies with People Who are Experiencing Homelessness

Abstract Introduction The incidence of hypothermia and frostbite is increasing given larger numbers of people experiencing homelessness (PEH) across the country. Cold injuries create functional deficits that compound comorbidities of people who already experience disproportionate disability burdens. We collaborated with PEH to identify modifiable cold injury hazards, understand prevention knowledge and first aid techniques, and develop prevention strategies. Methods We conducted 12 interviews with PEH with and without lived experience of cold injury. Interviews covered domains of risk factors/hazards, utility of existing educational materials, novel strategies, and acceptable stakeholders for dissemination. Interviews were transcribed and coded by two analysts using both deductive and inductive approaches. Results Participants varied in the type (e.g., street, encampment, shelter) and chronicity of homelessness. Six themes emerged: i) PEH are engaged in prevention, ii) there is a need for improved awareness around synergistic risks (e.g., rain, nicotine or amphetamine use, diabetes), iii) existing materials are not sufficiently contextually specific, iv) a narrowly focused prevention and dissemination strategy will not suffice, v) prevention strategies need to be framed within the realities of living homeless, and vi) respect and kindness are integral to successful uptake (Table 1). Conclusions Insightful perspectives shared by PEH provided key strategies for cold injury prevention. Prevention strategies must fit into the reality of homelessness, be respectfully delivered, and need to be a collective community effort where voices of PEH are valued. Applicability of Research to Practice Themes and specific perspectives uncovered by this study can help clinicians, community service providers, and public health practitioners develop cold injury prevention strategies alongside people with lived experience of homelessness.

Association of first anti-seizure medication choice with injuries in older adults with newly diagnosed epilepsy

BackgroundEpilepsy incidence increases exponentially in older adults, who are also at higher risk of adverse drug effects. Anti-seizure medications (ASM) may be associated with sedation and injuries, but discontinuation can result in seizures. We sought to determine whether there was an association between prescribing non-guideline concordant ASM and subsequent injury as this could inform care models. MethodsRetrospective cohort study of adults 50 years or older with newly-diagnosed epilepsy in 2015–16, sampled from the MarketScan Databases. The outcome of interest was injury within 1-year of ASM prescription (e.g., burns, falls) and the exposure of interest was ASM category (recommended vs. not recommended by clinical guidelines). Descriptive statistics characterized covariates and a multivariable Cox-regression model was built to examine the association between ASM category and subsequent injury. Results5,931 people with newly diagnosed epilepsy were prescribed an ASM within 1-year. The three most common ASMs were: levetiracetam (62.86%), gabapentin (11.73%), and phenytoin (4.45%). Multivariable Cox-regression found that medication category was not associated with injury; however, older age (adjusted hazard ratio (AHR) 1.01/year), history of prior injury (AHR 1.77), traumatic brain injury (AHR 1.55) and ASM polypharmacy (AHR 1.32) were associated with increased hazard of injury. ConclusionsMost older adults appear to be getting appropriate first prescriptions for epilepsy. However, a substantial proportion still receives medication that guidelines suggest avoiding. In addition, we show that ASM polypharmacy is associated with an increased hazard of injury within 1- year. Efforts to improve prescribing in older adults with epilepsy should consider how to reduce. both polypharmacy and exposure to medications that guidelines recommend avoiding.