Injury-related Mortality Research Articles

Unplanned emergency department attendances due to home and leisure accidents in the elderly Portugal

Abstract Home and Leisure Accidents (HLA) have been identified as a relevant public health issue with individual, societal and economic consequences. So, common cause of injury-related morbidity and mortality, especially among older people. Evidence shows that most of HLA among the older ones are associated with identifiable and modifiable risk factors. However, more detailed information about the context and characteristics of such events is needed. This study aimed to characterize the occurrence of HLA in victims aged 65 and over related to hospital Emergency Department (ED) of the National Health Service in Portugal based on hospital records, through EVITA system. A descriptive analysis of the data was performed. Bivariate comparisons were performed using Pearson’s chi-square test with a significance level of 5%. In this analysis, the statistical program SPSS V.27 was used. During the 2022 year the older people aged 65 and over represented 25% of the total of attendances in the emergency department. In the 2022 year there were 70 452 HLA in people victims aged 65+, constituting 32% of hospital ED attendances by HLA (preliminary data). The results show that 65,9% of the attendances were amongst the age group of 75 years and beyond. More frequently reported in females (64,3%) than in males (35,6%), being these differences statistically significant (p < 0,01). The summer season for both age groups had higher proportion of HLA. In both age groups 65-74 years and 75 years and over most of HLA occurred at home (65,2%; 68,8%), followed by outdoor spaces (12,2%; 6,7%), public area (3,4%; 13,6%) and transport area (9,2%; 5,5%), these differences were statistically significant (p < 0,01). Regarding to the products/agents most involved in the HLA the “floor” was the leading category in age group 65-74 years (27,1%) and in the oldest 75 years and over (43,0%). Considering that globally HLA can be prevented, this information reinforces the importance of this problem and its magnitude. Key messages • The older people represented 25% of the total of attendances in the emergency department in the year in analysis. 13% of ED attendances occurred due to HLA. • The National Injury Surveillance System provides information that allows to know the characteristics and circumstances of HLA that occur in older people.

Trends in Acute Kidney Injury Related Deaths in the US from 1999 to 2020

Background Acute kidney injury requiring dialysis is linked to long-term care demands, higher hospital mortality, and increased healthcare expenses. We aim to assess nationwide trends and regional variations in acute kidney injury-related mortality in the US. Materials and Methods We used death certificates from the CDC WONDER database (1999-2020) to calculate age-adjusted mortality rates (AAMRs) and annual percent change (APC). The data were stratified by year, gender, race/ethnicity, and geographic region. Results From 1999 to 2020, there were a total of 4,599,652 deaths attributed to acute kidney injury. The AAMR for acute kidney injury-related deaths surged from 11.4 in 1999 to 20.1 in 2020. Men consistently exhibited higher AAMRs than women throughout the study period (overall AAMR in men: 20.1; women: 13.2). When examining average AAMRs by race/ethnicity, Black/African Americans recorded the highest rates at 21.9, followed by American Indian or Alaskan Native (16.4), Whites (15.6), Hispanics (14.5), and Asian/Pacific Islander (10.7). Significant regional disparities were observed, with the southern region reporting the highest AAMR (17.2) and non-metropolitan areas having higher AAMRs than metropolitan areas (18.3 vs. 15.6). States in the top 90th percentile for acute kidney injury deaths included Indiana, Kentucky and South Carolina, which had nearly double the AAMR compared to states like New York, Utah, and Vermont. Conclusion In the last two decades, the United States has experienced a troubling increase in acute kidney injury-related deaths, emphasizing the urgent need for targeted and equitable healthcare interventions to address persistent disparities in gender, race, geography, and urbanization.

Study protocol: process and outcome evaluation of the Walk with Ease program for fall prevention

BackgroundFalls are the leading cause of injury related morbidity and mortality in older adults. Primary and secondary prevention strategies that address modifiable risk factors are critically important to reduce the number of falls and fall related injuries. A number of evidence-based fall prevention programs are available, but few offer potential for broad dissemination and public health impact due to implementation barriers, such as a need for trained program leaders and clinicians.MethodsThe study will use a randomized controlled trial design to evaluate incorporating physical therapy exercises (primary prevention strategy) within an existing intervention called Walk with Ease. While Walk with Ease has an established evidence-base related to the management of arthritis pain and symptoms, the present study will determine the potential to also reduce falls and fall risk in community-dwelling older adults. The integrated process and outcome evaluation will determine the relative effectiveness of individually-prescribed exercises (compared to standardized exercises) as well as the potential of ‘habit training’ resources (relative to generic behavior prompts) to improve compliance with exercises in this population.DiscussionThe study, conducted through a local clinical-community partnership will advance both the science and practice of community-based fall prevention programming, while also informing implementation strategies needed to promote broader dissemination.Trial registrationClinicalTrials.gov, NCT05693025, Registered January 20, 2023, Updated March 1, 2023.

Preventability of injury-related morbidity & mortality at four hospitals in Cameroon: A systematic approach to trauma quality improvement.

Adverse events reviews are a fundamental component of trauma quality improvement (QI) that facilitate the correction of systemic issues in care. Although injury-related mortality in Cameroon is substantial, to our knowledge, opportunities for QI have not been formally assessed. Thus, a formal review of adverse events in Cameroonian trauma patients was implemented as a first step toward identifying targets for systems modification. A QI committee composed of multidisciplinary experts at four hospitals in Cameroon was formed to review adverse events including deaths among trauma patients from 2019 to 2021. Events were discussed at newly established morbidity and mortality conferences and committee meetings to identify contributing factors and overall preventability. During 50 meetings, 95 adverse events were reviewed, including 58 deaths (61%). Other adverse events were delays in diagnosis/treatment (22%) and surgical site infections (17%). Overall, 34 deaths (59%) were classified as preventable, 21% potentially preventable, and 21% not preventable. Over half (52%) of the 46 preventable or potentially preventable deaths occurred in the emergency department (ED); while brain injury (57%), respiratory failure (41%), and hemorrhage (39%) were the most frequent physiologic factors associated with mortality. Contributory factors identified include lack of a structured approach to patient management, absence of continuous training for personnel, and locally adapted protocols. Basic improvements in evaluation and management of life-threatening issues in the ED can significantly reduce the high rate of preventable trauma-related deaths across Cameroon. Formal trauma QI methods can be utilized in low-resource environments to determine mortality root causes and identify intervention targets.

Electrical Injuries in Nepal: An Analysis of Nepal Police Records

Electric shock is a major cause of injury-related mortality and morbidity. However, it remains a neglected issue in Nepal because mortality and morbidity data are unsystematic and many of them are even unknown. Realizing the need of a systematic study in this regard, I aim to present the available national status of electrical injuries using incidents recorded by Nepal Police from July 2014 to July 2019 for an analysis. The data, obtained in descriptive narratives include information on the injured person's age, sex, place of occurrence, month of occurrence, activity during the occurrence, and the number of casualties per incident. This article explores the issue in some detail to open up the avenues for further study. The findings that I mentioned above indicate a significant burden of electrical injuries in Nepal, potentially higher than reported due to limitations in the police data recording system. As the government regulates electricity distribution, it should also be accountable for preventing electric shock incidents and saving many lives.

Hospital level interventions to improve outcomes after injury in India, a LMIC.

Background & objectives Trauma is one of the leading causes of disability and death, worldwide. Ninety per cent of trauma related mortality occurs in low- and middle-income countries (LMICs). Despite this, there is paucity of literature emanating from LMICs with studies that present and/or evaluate feasible interventions that can have a measurable impact on outcomes after injury, primarily mortality. The current article aims at developing such interventions key elements of implementation and measures of compliance and impact. Methods A literature review was conducted to evaluate the status of injury care among LMICs worldwide. Based on this review, interventions were identified/developed, that (i) were feasible to implement within the constraints of available resources; (ii) could be implemented within a two year timespan; and (iii) would improve outcomes primarily, mortality. These interventions were then discussed at a symposium of experts and stakeholders from around the world. Results The literature review identified gaps across the entire spectrum of injury care at all levels - primary, secondary and tertiary prevention. Additionally, lack of data systems capable of ensuring quality of care and driving performance improvement was identified. Utilizing the review as the basis and focusing on hospital level interventions, one policy intervention, five in-hospital interventions and one major research question were identified/developed that met the defined criteria. Interpretation & conclusions Gaps in trauma care in LMICs at every level and in data systems were identified. Feasible interventions that can be implemented within the resource constraints of LMICs in a reasonable timeframe and that can have a measurable impact on injury related mortality were developed and are presented.

Trends in injury-related mortality among residents of Jiangsu Province from 2012 to 2021: an age-period-cohort analysis.

We investigated the temporal trends and examined age-, period-, and cohort-specific effects of injury-related deaths among residents in Jiangsu to provide evidence for future injury prevention. This study included 406,936 injury deaths from the Jiangsu provincial population death registration system. The average annual percent change (AAPC) in age-standardized mortality rates (ASMRs) was analyzed using joinpoint regression. Age-period-cohort models were generated to explore the effects of age, period, and birth cohort effects on mortality risk. ASMRs for all injuries (AAPC = -2.3%), road traffic accidents (AAPC = -5.3%), suicide (AAPC = -3.8%), and drowning (AAPC = -3.9%) showed a downward trend during 2012-2021(all p < 0.05), while unintentional falls showed an upward trend (AAPC = 5.1%, p < 0.05). From 2012 to 2021, the age-standardized mortality rates (ASMRs) for four primary types of injuries consistently exhibited higher among males compared to females, with rural regions displaying higher ASMRs than urban areas. Trends in ASMRs for road traffic accidents, drowning, and unintentional falls by sex and urban/rural areas were consistent with overall trends. Significant age, cohort, and period effects were identified in the trends of injury-related deaths for both sexes in Jiangsu. The age effect showed that the highest age effect for injury-related deaths was for the ages of 85 years and above, except for suicide, which was for the ages 80-84 years. Between 2012 and 2021, the period effect on road traffic accidents declined, while that on accidental falls increased. Initially, the period effect on suicide decreased but then rose, peaking in 2012 with a Relative Risk (RR) of 1.11 (95% CI: 1.04-1.19). Similarly, the period effect on drowning initially declined before rising, with the highest effect observed in 2013, at an RR of 1.12 (95% CI: 1.07-1.19). The highest cohort effects for road traffic accidents were observed in the 1957-1961 group, for accidental falls in the 1952-1956 group, and for both drowning and suicide in the 1927-1931 group. The mortality rate of unintentional falls has been increasing. Older adults are at high risk for the four leading injuries. The improvements in mortality rates can be attributed to advancements in education, urbanization, and the promulgation and implementation of laws and policies.

Interventions to Prevent Falls in Older Adults: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force.

Falls are the most common cause of injury-related morbidity and mortality in older adults. To systematically review evidence on the effectiveness and harms of fall prevention interventions in community-dwelling older adults. MEDLINE, Cumulative Index for Nursing and Allied Health Literature, and Cochrane Central Register of Controlled Clinical Trials for relevant English-language literature published between January 1, 2016, and May 8, 2023, with ongoing surveillance through March 22, 2024. Randomized clinical trials of interventions to prevent falls in community-dwelling adults 65 years or older. Critical appraisal and data abstraction by 2 independent reviewers. Random-effects meta-analyses with Knapp-Hartung adjustment. Falls, injurious falls, fall-related fractures, hospitalizations or emergency department visits, people with 1 or more falls, people with injurious falls, people with fall-related fractures, and harms. Eighty-three fair- to good-quality randomized clinical trials (n = 48 839) examined the effectiveness of 6 fall prevention interventions in older adults. This article focuses on the 2 most studied intervention types: multifactorial (28 studies; n = 27 784) and exercise (37 studies; n = 16 117) interventions. Multifactorial interventions were associated with a statistically significant reduction in falls (incidence rate ratio [IRR], 0.84 [95% CI, 0.74-0.95]) but not a statistically significant reduction in individual risk of 1 or more falls (relative risk [RR], 0.96 [95% CI, 0.91-1.02]), injurious falls (IRR, 0.92 [95% CI, 0.84-1.01]), fall-related fractures (IRR, 1.01 [95% CI, 0.81-1.26]), individual risk of injurious falls (RR, 0.92 [95% CI, 0.83-1.02]), or individual risk of fall-related fractures (RR, 0.86 [95% CI, 0.60-1.24]). Exercise interventions were associated with statistically significant reductions in falls (IRR, 0.85 [95% CI, 0.75-0.96]), individual risk of 1 or more falls (RR, 0.92 [95% CI, 0.87-0.98]), and injurious falls (IRR, 0.84 [95% CI, 0.74-0.95]) but not individual risk of injurious falls (RR, 0.90 [95% CI, 0.79-1.02]). Harms associated with multifactorial and exercise interventions were not well reported and were generally rare, minor musculoskeletal symptoms associated with exercise. Multifactorial and exercise interventions were associated with reduced falls in multiple good-quality trials. Exercise demonstrated the most consistent statistically significant benefit across multiple fall-related outcomes.

Global estimates on the reports of vaccine-associated myocarditis and pericarditis from 1969 to 2023: Findings with critical reanalysis from the WHO pharmacovigilance database.

Due to the limitation of previous studies examining adverse reports of myocarditis and pericarditis associated with vaccines other than the COVID-19 vaccine, there are challenges in establishing a comprehensive understanding of vaccine safety on a global scale. Hence, the objective of this study was to examine the worldwide burden of vaccine-associated pericarditis and myocarditis and the vaccines associated with these indications. This study utilized the World Health Organization international pharmacovigilance database, from which records of vaccine-associated pericarditis and myocarditis between 1969 and 2023 were extracted (over 130 million reports). We calculated global reporting counts, reported odds ratios (RORs), and information components (ICs) to discern the association between 19 vaccines and the occurrence of pericarditis and myocarditis across 156 countries and territories. We identified 49 096 reports (male, n = 30 013) of vaccine-associated pericarditis and myocarditis among 73 590 reports of all-cause pericarditis and myocarditis. There has been a significant increase in reports of vaccine-related cardiac adverse events over time, with a noteworthy surge observed after 2020, attributed to cases of pericarditis associated with COVID-19 mRNA vaccines. Smallpox vaccines were associated with most pericarditis and myocarditis reports (ROR: 73.68 [95% CI, 67.79-80.10]; IC [IC0.25]: 6.05 [5.91]), followed by COVID-19 mRNA vaccine (37.77 [37.00-38.56]; 3.07 [3.05]), anthrax vaccine (25.54 [22.37-29.16]; 4.58 [4.35]), typhoid vaccine (6.17 [5.16-7.38]; 2.59 [2.29]), encephalitis vaccine (2.00 [1.48-2.71]; 0.99 [0.47]), influenza vaccine (1.87 [1.71-2.04]; 0.90 [0.75]), and Ad5-vectored COVID-19 vaccine (1.40 [1.34-1.46]; 0.46 [0.39]). Concerning age and sex-specific risks, reports of vaccine-associated pericarditis and myocarditis were more prevalent among males and in older age groups. The age group between 12 and 17 years exhibited significant sex disproportion. Most of these adverse events had a short time to onset (median time: 1 day) and fatality rate was 0.44%. Our analysis of global data revealed an increase in pericarditis and myocarditis reports associated with vaccines, particularly live vaccines like smallpox and anthrax, notably in young males. While these adverse events are generally rare and mild, caution is warranted, especially for healthcare workers, due to potential myocardial injury-related in-hospital mortality. Further study with validated reporting is crucial to enhance accuracy in evaluating the correlation between vaccines and cardiac conditions for preventive measures.

Effect of Rural Trauma Team Development on the Outcomes of Motorcycle Accident-Related Injuries (Motor Registry Project): Protocol for a Multicenter Cluster Randomized Controlled Trial.

Injury is a global health concern, and injury-related mortality disproportionately impacts low- and middle-income countries (LMICs). Compelling evidence from observational studies in high-income countries shows that trauma education programs, such as the Rural Trauma Team Development Course (RTTDC), increase clinician knowledge of injury care. There is a dearth of such evidence from controlled clinical trials to demonstrate the effect of the RTTDC on process and patient outcomes in LMICs. This multicenter cluster randomized controlled clinical trial aims to examine the impact of the RTTDC on process and patient outcomes associated with motorcycle accident-related injuries in an African low-resource setting. This is a 2-arm, parallel, multi-period, cluster randomized, controlled, clinical trial in Uganda, where rural trauma team development training is not routinely conducted. We will recruit regional referral hospitals and include patients with motorcycle accident-related injuries, interns, medical trainees, and road traffic law enforcement professionals. The intervention group (RTTDC) and control group (standard care) will include 3 hospitals each. The primary outcomes will be the interval from the accident to hospital admission and the interval from the referral decision to hospital discharge. The secondary outcomes will be all-cause mortality and morbidity associated with neurological and orthopedic injuries at 90 days after injury. All outcomes will be measured as final values. We will compare baseline characteristics and outcomes at both individual and cluster levels between the intervention and control groups. We will use mixed effects regression models to report any absolute or relative differences along with 95% CIs. We will perform subgroup analyses to evaluate and control confounding due to injury mechanisms and injury severity. We will establish a motorcycle trauma outcome (MOTOR) registry in consultation with community traffic police. The trial was approved on August 27, 2019. The actual recruitment of the first patient participant began on September 01, 2019. The last follow-up was on August 27, 2023. Posttrial care, including linkage to clinical, social support, and referral services, is to be completed by November 27, 2023. Data analyses will be performed in Spring 2024, and the results are expected to be published in Autumn 2024. This trial will unveil how a locally contextualized rural trauma team development program impacts organizational efficiency in a continent challenged with limited infrastructure and human resources. Moreover, this trial will uncover how rural trauma team coordination impacts clinical outcomes, such as mortality and morbidity associated with neurological and orthopedic injuries, which are the key targets for strengthening trauma systems in LMICs where prehospital care is in the early stage. Our results could inform the design, implementation, and scalability of future rural trauma teams and trauma education programs in LMICs. Pan African Clinical Trials Registry (PACTR202308851460352); https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=25763. DERR1-10.2196/55297.

The Age- And Sex- Specific Burden of Transport Injuries in India Over a Decade From 2010-2019: A Systematic Analysis from Global Burden of Diseases 2019

Background: In India, transport injuries persist as leading preventable causes of mortality and morbidity for a large number of people, including children, young adults and elderly people. The objective is to estimate the transport injury-related mortality and morbidity in India over the past decade from 2010-2019. Methodology: By using the Global Burden of Diseases, Injuries, and Risk Factors 2019 Study (GBD), we analysed mortality, Disability-Adjusted Life-Years (DALYs), Years Lived in Disability (YLDs), Years of Life Lost (YLL), prevalence rate (per 100K) attributed to transport injuries for all ages, in India. Burden is reported in absolute numbers and percentage changes over a decade period from 2010 to 2019; stratified by sex ratio, and age groups, with 95% confidence intervals (CIs). Results: Transport injuries had accounted for 235,444 deaths (2.51%) in 2019; and 231,177 deaths (2.68%) in 2010. Transport injuries are the leading cause of death among people aged 15-49 years with more than 50% of burden in India. Death-rate due to transport had declined from 18.77 to 16.93 per 100,000 populations over a decade (2010-2019). Conclusions: Over a decade, progress made in the burden of transport injuries was limited and the burden had started to rise after achieving some success till 2016. India needs to sustain and improve the progress made in order to achieve UN goals for 2030.

Trends and disparities in deaths among young persons in the US during the COVID-19 pandemic

PurposeTo examine changes in death rates by demographic group and by the leading causes of death in U.S. persons 1 to 24 years of age during the COVID-19 pandemic. MethodsA retrospective cross-sectional study using mortality data from the National Vital Statistics System from April 2017 to March 2023. Pre-pandemic death rates were compared with death rates during the pandemic overall, by race/ethnicity, age, sex, and cause group. ResultsAge-adjusted death rates in young persons 1–24 years of age increased by 14.3% during the pandemic. Injury-related causes accounted for 78.2% of the increase, driven mainly by increases in homicides and unintentional injuries related to drug overdose, firearms, and motor-vehicle traffic crashes. Non-Hispanic Black and Hispanic teens and young adults experienced the largest increases in deaths overall and across the leading causes of death. ConclusionsDuring the COVID-19 pandemic, injury-related causes accounted for the majority of the increases in deaths in children and young adults, driven mainly by firearms, drug overdoses, and motor vehicle traffic crashes. Findings highlight the importance of understanding the drivers of these marked increases in injury-related mortality and the need for injury prevention efforts among children even in the context of an infectious disease pandemic.

Association of ethnicity with unintentional injury-related hospitalisation and mortality among older people residing in two regions of Aotearoa New Zealand.

To characterise unintentional injury-related hospitalisation and mortality amongst older adults (aged 50+ years) in the Lakes and Bay of Plenty District Health Boards of Aotearoa New Zealand and to examine whether hospitalisation patterns differed by ethnicity. This observational study analysed unintentional injury-related hospitalisations and deaths among older adults between 2014 and 2018. Routinely collected national data sets were used to calculate annualised, age-standardised injury rates. The independent variable of interest was ethnicity (Māori or non-Māori). There were 11,834 unintentional injury-related hospitalisations in the study period (n = 1444 for Māori). Overall, there was no significant difference in the age-standardised hospitalisation rate between Māori and non-Māori (Standardised Rate Ratio [SRR] = 0.96 [95% CI 0.90, 1.02]). Falls were the most common mechanism of injury among Māori and non-Māori overall (50% and 71%) and relative risks of falls increased with age. Non-Māori were 57% less likely to be hospitalised for unintentional poisoning than Māori (SRR = 0.43, [0.34, 0.59]). The mechanisms of injury, and variation in unintentional injury-related hospitalisation rates between Māori and non-Māori, change throughout older age, and incidence increase0073 with age. Falls cause significant injury-related hospitalisations for older Māori and responsive injury prevention and rehabilitation efforts are warranted to achieve equitable health outcomes.

Falls and Alzheimer Disease.

Falls are the leading cause of injury, disability, and injury-related mortality in the older adult population. Older adults with Alzheimer disease (AD) are over twice as likely to experience a fall compared to cognitively normal older adults. Intrinsic and extrinsic fall risk factors may influence falls during symptomatic AD; intrinsic factors include changes in cognition and impaired functional mobility, and extrinsic factors include polypharmacy and environmental fall hazards. Despite many known fall risk factors, the high prevalence of falls, and the presence of effective fall prevention interventions for older adults without cognitive impairment, effective fall prevention interventions for older adults with AD to date are limited and inconclusive. Falls may precede AD-related cognitive impairment during the preclinical phase of AD, though a narrow understanding of fall risk factors and fall prevention interventions for older adults with preclinical AD limits clinical treatment of falls among cognitively normal older adults with preclinical AD. This mini review explores fall risk factors in symptomatic AD, evidence for effective fall prevention interventions in symptomatic AD, and preclinical AD as an avenue for future falls research, including recommendations for future research directions to improve our understanding of falls and fall risk during preclinical AD. Early detection and tailored interventions to address these functional changes are needed to reduce the risk of falls for those at risk for developing AD. Concerted efforts should be dedicated to understanding falls to inform precision fall prevention strategies for this population.

Economic Burden of Trauma-Related Injuries in Iran in 2019.

Trauma-related injuries are the leading cause of death and disability in the active population, with devastating economic, health, and social consequences for nations. TThis study aimed to assess the economic burden of injuries in Iran. In this study, the economic impact of trauma in Iran in 2019 was estimated using a prevalence-based approach. The prevalence was estimated based on available statistics in Iran and the GBD website. Direct medical expenditures were calculated using a top-down approach. The cost of lost production due to injuries and premature death was also estimated using the DALY value. Microsoft Excel 2019 and Stata software version 13.0 were used for the analysis. In Iran, approximately 16,500,000 individuals were estimated to have sustained injuries in a single year. The average direct medical expenses for each trauma patient were around $226. Fractures contributed to 39% of the financial impact of trauma. The overall economic burden of trauma in Iran was calculated to be $10,214,403,423. Approximately 66% of this economic burden was attributed to lost productivity and premature death resulting from trauma, while direct medical costs made up 34%. The economic burden of trauma in Iran is expected to significantly rise in the future. It may be necessary to enhance awareness of injury-related mortality and disability, improve therapies, and expand evidence-based interventions to reduce the economic impact of injuries.

Trends in Traumatic Brain Injury Mortality in the US

This cohort study characterizes US trends in traumatic brain injury–related mortality by age, sex, and race and ethnicity.

Fluctuating risk of acute kidney injury-related mortality for four weeks after exposure to air pollution: A multi-country time-series study in 6 countries

BackgroundRecent studies have reported that air pollution is related to kidney diseases. However, the global evidence on the risk of death from acute kidney injury (AKI) owing to air pollution is limited. Therefore, we investigated the association between short-term exposure to air pollution—particulate matter ≤ 2.5 μm (PM2.5), ozone (O3), and nitrogen dioxide (NO2)—and AKI-related mortality using a multi-country dataset. MethodsThis study included 41,379 AKI-related deaths in 136 locations in six countries during 1987–2018. A novel case time-series design was applied to each air pollutant during 0–28 lag days to estimate the association between air pollution and AKI-related deaths. Moreover, we calculated AKI deaths attributable to non-compliance with the World Health Organization (WHO) air quality guidelines. ResultsThe relative risks (95% confidence interval) of AKI-related deaths are 1.052 (1.003, 1.103), 1.022 (0.994, 1.050), and 1.022 (0.982, 1.063) for 5, 10, and 10 µg/m3 increase in lag 0–28 days of PM2.5, warm-season O3, and NO2, respectively. The lag-distributed association showed that the risk appeared immediately on the day of exposure to air pollution, gradually decreased, and then increased again reaching the peak approximately 20 days after exposure to PM2.5 and O3. We also found that 1.9%, 6.3%, and 5.2% of AKI deaths were attributed to PM2.5, warm-season O3, and NO2 concentrations above the WHO guidelines. ConclusionsThis study provides evidence that public health policies to reduce air pollution may alleviate the burden of death from AKI and suggests the need to investigate the several pathways between air pollution and AKI death.

Mortality, cancer incidence, and disability among professional drivers in Slovenia.

Literature data about all-cause and cause-specific mortality among professional drivers are inconsistent. Most studies report lower all-cause and higher cause-specific mortality. Higher cause-specific mortality is most often the result of malignant and circulatory diseases. The aim of our retrospective cohort study was to get a better insight into the mortality, cancer incidence, and occupational disability of the entire professional driver population in Slovenia (N=8,231) from 1997 to 2016 through standardised mortality ratio (SMR), standardised proportional mortality ratio (SPMR), standardised cancer incidence ratio (SIR), and standardised disability ratio (SDR). Total mortality was significantly lower than that of the general working population (SMR=0.49; 95 % CI=0.44-0.55). When SPMR was calculated, however, the risk of all-cause mortality increased to 1 (SPMR=1.00; 95 % CI=0.89-1.12), of cancer-related mortality to 1.13 (95 % CI=0.94-1.35), and of injury-related mortality to 1.25 (95 % CI=0.97-1.59). Cancer incidence was lower than in the general male working population for all types of cancer (SIR=0.66; 95 % CI=0.59-0.72), lung cancer included (SIR=0.56; 95 % CI=0.41-0.73). Occupational all-cause and cause-specific disability were also lower than in the rest of the working population. Even though all types of cancer and injuries were established among professional drivers in Slovenia, no major risk stand out. However, our findings may have been skewed by the healthy worker effect.

Trends of fall-related and other fatal injuries in older adults in Finland between 1998 and 2020.

The number of falls and fall-related injuries will likely increase as the number of older adults expands. Increases in total deaths due to falls have been observed over Europe. Less is known about other injuries leading to death. We analyzed open data from Statistics Finland's register on the causes of death of those aged ≥65 collected between 1998 and 2020 yielding a total of 32150 deaths due to injury using Poisson regression and distributional comparisons chi-squared tests. The most common injuries leading to death among people aged ≥65 in Finland were fall related. There has been an increase in the absolute number of fall-related and other injuries, but when adjusting for person-years in population, a significant decrease can be observed. The crude rates of deaths from fall-related injuries among males annually increased 1.1-4.4% from 1998 to 2020, while the changes in rates among females ranged between -2% and 1.6%. The crude rates of other injuries ranged between -0.5% to +3.8%. Recently (2018-20), nearly 40% of the cases in males and 25% of cases in females were not fall related but comprised other types of injury mechanisms such as traffic, poisoning and drowning. Strengthening the implementation of preventive strategies is essential to prevent injuries. To reduce injury-related mortality and disability, improvement of acute and post-acute care for injured older patients is warranted.

Acute Kidney Injury in Neonates: A Single-Center Experience

Background: Neonatal intensive care unit infants frequently experience acute kidney damage. Estimates of the prevalence of acute kidney vary depending on the definitions used. In Iraq, studies addressing the prevalence and risk factors of acute kidney injury in this age group are scarce, none of which has implicated the KDIGO diagnostic and staging criteria. Objectives: To describe the prevalence, demographics, risk factors, etiology, and staging of acute kidney injury using KDIGO criteria in the Neonatal intensive care unit and correlate these findings with patient outcomes. Methods: A retrospective study was conducted in the Neonatal Intensive Care Unit/ CWTH/ Medical City Complex/ Baghdad during the period from the 1st of August 2019 to the 15th of January 2020. All neonates diagnosed with acute kidney injury according to KDIGO –classification 2012 and admitted to the neonatal intensive care unit were included in this study. Demographics, clinical staging, and investigations were retrieved from patients' notes. Results: The prevalence of acute kidney damage was 7.2%. The mean gestational age of the patients was 36.8 ± 2.9 weeks, 58% of them were full-term, with a male-to-female ratio of 1.40:1. Stage I patients represented 35.1%, 43.2% were stage 2, and 21.6% had severe stage 3. Acute kidney injury-related mortality was 35.1%. The term female sex, high birth weight, and age younger than seven days at diagnosis predicted a bad prognosis. Vaginally delivered, stage III acute kidney injury-KDIGO, and peritoneal dialysis patients had the worst outcomes. Asphyxia was a major cause of acute kidney injury (P=0.001). High blood urea (P=0.01), low PH (P=0.009), low HCO3 (P=0.001), low WBC count (P=0.001), and low platelet count (0.001) were associated with unfavorable outcomes. Conclusions: The prevalence of acute kidney injury, according to KIDGO diagnostic and staging criteria, is 7.1%. Asphyxia, female gender, and vaginal deliveries are variables associated with poor prognosis in addition to advanced illness stage and laboratory indicators. Received: Dec. 2022 Accepted: Jun 2023 Published: Oct.2023