Harmful Risk Factors Research Articles

Kerosene Oil Poisoning among Children in Rural Sri Lanka

Introduction Kerosene oil poisoning is one of common presentations to emergency departments among children in rural territories of developing countries. This study aimed to describe clinical manifestations, reasons for delayed presentations, harmful first aid practices, complications, and risk factors related to kerosene oil poisoning among children in rural Sri Lanka. Methods This multicenter study was conducted in North-Central province of Sri Lanka involving all in-patient children with acute kerosene oil poisoning. Data were collected over seven years from thirty-six hospitals in the province. Data collection was done by pretested, multistructured questionnaires and a qualitative study. Results Male children accounted for 189 (60.4%) while 283 (93%) children were below five years. The majority of parents belonged to farming community. Most children ingested kerosene oil in home kitchen. Mortality rate was 0.3%. Lack of transport facilities and financial resources were common reasons for delayed management. Hospital transfer rate was 65.5%. Thirty percent of caregivers practiced harmful first aid measures. Commonest complication was chemical pneumonitis. Strongest risk factors for kerosene oil poisoning were unsafe storage, inadequate supervision, and inadequate house space. Conclusions Effect of safe storage and community education in reducing the burden of kerosene oil poisoning should be evaluated. Since many risk factors interact to bring about the event of poisoning in a child, holistic approaches to community education in rural settings are recommended.

Effect of Gender on Outcomes After Cardiac Resynchronization Therapy in Patients With a Narrow QRS Complex: A Subgroup Analysis of the EchoCRT Trial.

In EchoCRT, a randomized controlled trial evaluating the effect of cardiac resynchronization therapy (CRT) in patients with a QRS duration of <130 ms and echocardiographic evidence of left ventricular dyssynchrony, the primary outcome (death from any cause or first hospitalization for worsening heart failure) occurred more frequently in the CRT-ON when compared with the control group. In this prespecified subgroup analysis, we evaluated the effect of sex on clinical outcome in EchoCRT. In EchoCRT, 585 (72%) of included patients were men. At baseline, male patients had a higher incidence of ischemic cardiomyopathy and longer QRS duration. On uni- and multivariable analysis, no significant interaction was observed regarding sex for the primary or any of the secondary end points. Numerically, a higher all-cause mortality was observed in male patients randomized to CRT-ON versus CRT-OFF on univariable analysis (hazard ratio, 1.83; 95% confidence interval, 1.08-3.12); however, no statistically significant interaction compared with females randomized to CRT-ON versus CRT-OFF was noted (hazard ratio, 0.99; P interaction, 0.56). There was no difference in the primary safety end point of system-related complications, including CRT system- and implantation-related events. The largest hazard for all-cause mortality in EchoCRT was observed in men randomized to CRT-ON; the comparison with women did not reach statistical significance, which may be because of the premature termination of the trial and the limited data. These results suggest that male sex may be a risk factor for harm by CRT in patients with narrow QRS width, an observation which deserves further investigation. URL: https://clinicaltrials.gov. Unique identifier: NCT00683696.

89-04: Gender Effects of CRT in Patients with QRS Duration &lt;130 ms in EchoCRT

Purpose: Evaluation of the effect of gender on clinical outcome among patients with a QRS duration <130 ms and echocardiographic evidence of left ventricular dyssynchrony. This subanalysis was pre-specified in EchoCRT, a randomized controlled trial, in which the primary outcome (death from any cause or first hospitalization for worsening heart failure) occurred more frequently in the CRT compared with the control group. Methods: Eligible Patients with NYHA III, LVEF ≤35%, QRS duration <130 ms; LVEDD ≥55 mm, and echocardiographic evidence of left ventricular dyssynchrony, were implanted with a CRT-D device and randomized 1:1 to CRT on or off. The primary endpoint was the combination of death from any cause or first heart failure hospitalization. Results: 224/809 (27.7%) of patients were women. At baseline, female patients did not differ to males regarding age (57.5 ± 13.6 vs 58.2 ±12.4 yrs, p = 0.48), NYHA class III (95 vs 93%), LVEF (27.2 ±5.4 vs 26.9 ±5.6%, p = 0.48), prevalence of hypertension (66.1 vs 66.6%, p = 0.89), diabetes (42.8 vs 38.6%, p =0.27) or chronic kidney disease (9.95 vs 14. 78%, p= 0.074), and optimized medical therapy (>95%). However, females had a lower prevalence of ischemic cardiomyopathy (39.3 vs 58.9 %, p < 0.001) and shorter QRS duration (102.4 ± 12.9 vs 106.3 ± 12.7 ms, p< 0.001). On univariable analysis, all-cause mortality was increased in male patients randomized to CRT-ON vs. CRT-OFF (HR 1.83 (95% CI 1.08 - 3.12), p = 0.026 vs. HR 0.99 (95% CI 0.28 - 3.45), p = 0.98 for the females) (Figure). Cardiovascular mortality was increased 2.4-fold in male patients (HR 2.43 (95% CI 1.27 - 4.63), p = 0.007 vs. HR 0.97 (95% CI 0.24 - 3.93), p = 0.97 for the females). However, no statistically significant interaction compared to females randomized to CRT-ON vs. CRT-OFF was noted (p interaction = 0.56 all-cause mortality and p interaction = 0.37 cardiovascular mortality). Conclusions: The largest hazard for all-cause mortality in EchoCRT was observed in men randomized to CRT-ON; the comparison with women did not reach statistical significance, which may be due to the premature termination of the trial and limited data. These results suggest that male gender may be a risk factor for harm from CRT in patients with narrow QRS width, irrespective of the presence of mechanical dyssynchrony.

Construction Scheduling and Stability of the Resulting Schedules

Abstract The paper present the concept of stability assessing the of solutions which are construction schedules. Rank have been obtained through the use of task scheduling rules and the application of the KASS software. The aim of the work is the choice of the equivalent solution in terms of the total time of the project. The selected solution optimization task should be characterized by the highest resistance to harmful environmental risk factors. To asses the stability of schedule simulation technique was used.

Socioeconomic and sociodemographic factors related to allergic diseases in Korean adolescents based on the Seventh Korea Youth Risk Behavior Web-based Survey: a cross-sectional study.

BackgroundVarious international reports have shown that socioeconomic and sociodemographic variables are correlated with allergic diseases; however, little is known about how these variables affect Korean adolescents. This study was conducted to identify socioeconomic and sociodemographic risk factors for allergic diseases in Korean adolescents to provide information for preventing and managing such conditions.MethodsData from the 2011 Korea Youth Risk Behavior Web-based Survey (KYRBWS-VII) of 75,643 adolescents were used. An anonymously administered online survey was conducted to collect dependent variable information on perceived sexes, residence, family affluence (Family Affluence Scale; FAS), parental education levels, subjective academic achievement, obesity, drinking and smoking. The independent variables were asthma, allergic rhinitis and atopic dermatitis. Multivariate logistic regression was used to analyze the correlations between the dependent and independent variables.ResultsLow subjective academic achievement, obesity, drinking and smoking were risk factors for asthma. High FAS, parental bachelor’s degree and high subjective academic achievement were risk factors for allergic rhinitis. Finally, high FAS, maternal bachelor’s degree and high subjective academic achievement were risk factors for atopic dermatitis.ConclusionWe found that high socioeconomic status (SES) was a risk factor for allergic diseases in Korean adolescents. We propose that the greater access to medical services and immunization (e.g., hygiene hypothesis) afforded by high SES influenced the prevalence of allergic diseases. Thus, as the Korean economy develops further, the prevalence of allergic diseases is likely to increase. Controlling harmful behavioral risk factors, such as drinking and smoking, may help to prevent adolescent allergic diseases.

Typology of alcohol consumers in five Australian nighttime entertainment districts.

Understanding how types of alcohol consumers differ is important for public policy targeted at reducing adverse events. The aims of the present study were to identify typologies of alcohol consumers in Australian nighttime entertainment districts based on risk factors for harm and to examine variation between the identified groups in drinking setting and harms. Street-intercept surveys were conducted with 5556 alcohol consumers in and around licensed venues in five Australian cities between November 2011 and June 2012. Latent class analysis identified groups based on age and sex, and blood alcohol concentration, pre-drinking, energy drink use and illicit drug use during that night. Four classes were identified: general patron group (33%), young pre-drinker group (27%), intoxicated male pre-drinker group (31%) and intoxicated illicit drug male group (9%). The proportion of the general patron group interviewed decreased over the night, while the other groups increased (particularly in regional cities). As compared with the general patron group, the remaining three groups reported increased odds of being involved in aggression and any alcohol-related injuries in the past 3 months, with highest rates of harm amongst the intoxicated illicit drug male group. Alcohol consumers in nighttime entertainment districts are not a homogeneous group. One-third have a low likelihood of risky consumption practices; however, representation of this consumer class diminishes throughout the night. Elevated harms amongst groups characterised by certain risk factors (e.g. pre-drinking and illicit drug use) emphasise the importance of addressing these behaviours in public policy. [Peacock A, Norman T, Bruno B, Pennay, Droste N, Jenkinson R, Quinn B, Lubman DI, Miller P. Typology of alcohol consumers in five Australian nighttime entertainment districts. Drug Alcohol Rev 2016;35:539-548].

Interaction effects between hypothermia and diabetes mellitus on survival outcomes after out-of-hospital cardiac arrest

ObjectivesMild therapeutic hypothermia (MTH) is the core hospital intervention to enhance neurological outcome after out-of-hospital cardiac arrest (OHCA). Diabetes mellitus (DM) has been known to be a harmful risk factor on survival after OHCA. This study aimed to investigate whether the effect of MTH on brain recovery after OHCA differed between patients with or without DM. MethodsWe used a Korean national OHCA database composed of hospital and ambulance data. We included adult OHCA patients who survived to admission with presumed cardiac etiology during the study period from 2009 to 2013. We excluded cases without hospital outcome data. The primary exposure was MTH, which included all kinds of cooling methods that had been initiated within 6h after return of spontaneous circulation. DM was coded positive when the patient had a clinical history diagnosed by a physician before an OHCA event. The endpoints were discharge with good neurological recovery (cerebral performance category 1 or 2) and survival to discharge. We compared outcomes between MTH vs. non-MTH groups using multivariable logistic regression with an interaction term between MTH and DM for calculating adjusted odds ratios (AORs) and 95% confidence intervals (CIs) after adjusting for potential confounders. ResultsAmong 9735 patients following OHCA survived to hospital admission with cardiac etiology, MTH was performed in 16.5%. History of DM was observed in 25.4% among MTH group and 27.4% in non-MTH group (p=0.09). MTH group showed better outcomes than non-MTH group; 23.6% vs. 15.7% for good neurological recovery (p<0.01). AOR (95% CI) of MTH for good neurological recovery for all study groups was 1.23 (1.03–1.47). In the interaction model, AOR (95% CI) of MTH for good neurological recovery was 1.40 (1.16–1.70) in patients without DM vs. 0.69 (0.46–1.04) in patients with DM. For survival to discharge, the effects of MTH were different in patients without DM (1.97 (1.70–2.29)) and patients with DM (1.23 (0.96–1.57)). ConclusionDM modified the effect of MTH on survival and neurological outcomes for OHCA survivors. MTH is significantly associated with good neurological recovery in patients without DM, but not in patients with DM.

Cytoarchitectural and functional abnormalities of the inferior colliculus in sudden unexplained perinatal death.

The inferior colliculus is a mesencephalic structure endowed with serotonergic fibers that plays an important role in the processing of acoustic information. The implication of the neuromodulator serotonin also in the aetiology of sudden unexplained fetal and infant death syndromes and the demonstration in these pathologies of developmental alterations of the superior olivary complex (SOC), a group of pontine nuclei likewise involved in hearing, prompted us to investigate whether the inferior colliculus may somehow contribute to the pathogenetic mechanism of unexplained perinatal death. Therefore, we performed in a wide set of fetuses and infants, aged from 33 gestational weeks to 7 postnatal months and died of both known and unknown cause, an in-depth anatomopathological analysis of the brainstem, particularly of the midbrain. Peculiar neuroanatomical and functional abnormalities of the inferior colliculus, such as hypoplasia/structural disarrangement and immunonegativity or poor positivity of serotonin, were exclusively found in sudden death victims, and not in controls. In addition, these alterations were frequently related to dysgenesis of connected structures, precisely the raphé nuclei and the superior olivary complex, and to nicotine absorption in pregnancy. We propose, on the basis of these results, the involvement of the inferior colliculus in more important functions than those related to hearing, as breathing and, more extensively, all the vital activities, and then in pathological conditions underlying a sudden death in vulnerable periods of the autonomic nervous system development, particularly associated to harmful risk factors as cigarette smoking.

Is chronic feeding of low dose alcohol hepatotoxic or genotoxic?: A time course study in mice

Chronic intake of alcohol is known to be the third most harmful risk factor for some serious diseases including cancer. Though chronic abuse of alcohol in high dose is reported to cause progressive damage and organ failure mainly affecting liver, whether the same in a low dose can produce any hepatotoxic or genotoxic effect is not precisely known. Therefore, in this study, effects of chronic feeding of low dose alcohol were critically assessed at both genotoxic and hepatotoxic levels in a mammalian model—mice. Mice were chronically fed 0.6 ml of 0.85 M ethanol daily for 7 days onward through 120 days and sacrificed at six fixation intervals, namely at 7, 15, 30, 60, 90 and 120 days. Cytogenetical endpoints like chromosome aberrations, micronuclei, mitotic index from bone marrow cells and sperm head abnormality from epididymis of males were studied and for assessment of genotoxicity and several toxicity markers like acid and alkaline phosphatases, alanine and aspartate amino transferases, lipid peroxidation, reduced glutathione, glutathione reductase, succinate dehydrogenase and catalase were analyzed for assessment of hepatotoxicity. Additionally, liver histology, lymphocyte viability and hepatic cell viability were also studied. In this study, although chronic consumption of the low dose of alcohol did not produce significant changes in parameters like histology, percentages of hepatic cell and lymphocyte viability but certain clastogenic changes were observed at longer intervals (60 day onward). Thus, overall results suggested possible generation of hepatotoxicity and oxidative stress in chronically fed low alcohol consumption group, which could also increase cancer risk.

Dementia, walking outdoors and getting lost: incidence, risk factors and consequences from dementia-related police missing-person reports

Objectives: To estimate incidence, identify consequences and potential risk factors for harm in people with dementia who got lost in one UK policing region.Methods: In a retrospective observational study, data were extracted from missing-person records over a four-year period in one UK policing region (population of 2.1 million).Results: Two hundred and eighty-one incidents of getting lost were identified. Incidence of getting lost was estimated at 0.5% of the regional dementia population. Fifty-nine percent of reports came from domestic settings, 29% from care homes/hospitals, and 12% on excursions from home. Five percent (n = 15) sustained significant harm, including two deaths. Average age was 78 years (SD 8.3). Harm was associated with older age (mean difference 6.16 years, CI 1.86 to 10.46, p = 0.005, t = 2.82), length of time missing (Mdn time 2.48 hours; IQR 0.97 to 9.45, p = 0.02), and season (9% winter, 2% summer, p = 0.006). The length of time missing increased with delays in reporting to police (r = 0.15, p = 0.018), getting lost at night (Mdn time 1.70 hours, IQR 0.52–3.32, p = 0.028), driving themselves (Mdn time 2.45 hours, IQR 0.42–2.00, p = 0.001), and using public transport (Mdn 1.78 hours, IQR 1.07–3.92, p = 0.001).Conclusion: Incidence in this study suggests getting lost is a low-frequency event for people with dementia but for a small minority, the risks are considerable. Exploratory analyses suggest individual and environmental factors increase the risk of harm. Suitable methods need to be developed to replicate these findings in larger prospective samples. A focus on the predictors of harm may aid development of assessment protocols to ensure intervention is proportionate.

Global research on smoking and pregnancy-a scientometric and gender analysis.

The exposure to tobacco smoke during pregnancy is considered to be amongst the most harmful avoidable risk factors. In this scientometric and gender study scientific data on smoking and pregnancy was analyzed using a variety of objective scientometric methods like the number of scientific contributions, the number of citations and the modified h-index in combination with gender-specific investigations. Covering a time period from 1900 to 2012, publishing activities of 27,955 authors, institutions and countries, reception within the international scientific community and its reactions were analyzed and interpreted. Out of 10,043 publications the highest number of scientific works were published in the USA (35.5%), followed by the UK (9.9%) and Canada (5.3%). These nations also achieve the highest modified h-indices of 128, 79 and 62 and the highest citation rates of 41.4%, 8.6% and 5.3%, respectively. Out of 12,596 scientists 6,935 are female (55.1%), however they account for no more than 49.7% of publications (12,470) and 42.8% of citations (172,733). The highest percentage of female experts about smoking and pregnancy is found in Australasia (60.7%), while the lowest is found in Asia (41.9%). The findings of the study indicate an increase in gender equality as well as in quantity and quality of international scientific research about smoking and pregnancy in the future.

The Application of Fuzzy Comprehensive Evaluation Method in Mine

Mine is a high-risk industry and the security will have a direct impact on its reputation, economic and employees survival. In recent years, frequent coal mine accidents have caused enormous social and economic losses. Conducted scientifically and systematically, safety can eliminate harmful risk factors, reduce the occurrence of the accident and improve the security of enterprise management level. So, it is especially important to safety evaluation for the coal industry. There are many risk factors in the production process of coal mine and the factors analysis is the premise of safety evaluation. Researchers evaluated the safety status of mine by fuzzy comprehensive evaluation measure. The study was discussed on the main five factors, including personnel of condition, environmental factors, security management, coal comprehensive conditions and emergency rescue system. Establishing eighteen single factor index layer and getting the index weight values by fuzzy analytic hierarchy. Using the expert evaluation method for the 18 single factors and drawing their membership vector. Finally, combing the evaluation index and weights, it can get a general level to a coal mine in Heilongjiang by fuzzy comprehensive evaluation. Finally, analyzing the practical of this method and give some advises to these analysis results.

Cardiovascular Risk for Workers in Big, Infrastructure Projects

For many years the Florentine area has been involved in carrying out big, infrastructure projects. These projects are very complex and the workforce employed to construct them, coming from all parts of Italy and also from abroad, are represented by workers with a high level of specialization, exposed to several and harmful risk factors. The majority live far from their family for long periods of time, mainly in base camps far from residential areas, sometimes isolated, without the possibility of dedicating their free time to social, cultural, sport and/or recreational activities. The objective of our study is to evaluate in this category of workers which working risk factors and styles of life represent a major risk factor for arterial hypertension which, in turn, significantly increases cardiovascular risk. A significant majority of workers carry out mansions of carpenter/soldered and of machine/excavator driver, in charge of dirt handling. The sample also includes numerous miners and drivers. The workers' average age is 45 years old and a high working seniority. Arterial hypertension is present in 139 subjects, equaling to 54% of the sample. The distribution of frequency of arterial hypertension is greater in the class of drivers, followed by the class of site managers and construction machines/excavator drivers. It is believed that the risk factors to which the workers studied are exposed, constitute elements that facilitate the onset of a state of arterial hypertension; among these, the stress correlated to a task which requires, lengthened attention and concentration, resulted as being the most important factor.

Dry up and survive: the role of antioxidant defences in anhydrobiotic organisms

Although the evolution of life has turned oxygen into a vital chemical for aerobic organisms, this element can also have deleterious effects on living systems through the production of oxidative stress. This is a process resulting from an imbalance between the excessive production of Reactive Oxygen Species (ROS) and the limited action of antioxidant defences. It is a particularly harmful health risk factor, involved in the development of several chronic human pathologies and believed to play a major role in the ageing process. Consequently aerobic metabolism needs a stringent control of ROS. Water too is essential for life, but some organisms widespread throughout nature have the ability to survive complete desiccation by entering an anhydrobiotic state. The loss of water induces changes in metabolism, cell membrane organization, and molecular composition. In the anhydrobiotic state, high temperatures, high humidity, light exposure, and high oxygen partial pressure negatively affect organism survival and directly influence the time required to reactivate the metabolism after a period of desiccation. These abiotic factors induce damages that are accumulated in proportion to the time spent in the desiccated state, potentially leading to organism death. Oxidative stress seems to be one of the most deleterious damages due to water depletion, therefore anhydrobiosis also needs a stringent control of ROS production. Anhydrobiotic organisms seem to apply two main strategies to cope with the danger of oxygen toxicity, namely an increased efficiency of antioxidant defences and a metabolic control of both energy-production and energy-consuming processes. Experimental studies provide evidence that antioxidant defences such as ROS scavenging enzymes ( e.g. peroxidases, catalases, superoxide dismutase, glutathione peroxidases) and other molecules ( e.g. glutathione, carotenoids, vitamins C and E) represent a key group of molecules required for desiccation tolerance in anhydrobiotic organisms. The action of these molecules emphasises the need for redox balancing in anhydrobiotic organisms including tardigrades and chironomid larvae.

GUIDES: Assessment for Prevention of Child Maltreatment in Primary Care

OPEN ACCESSMay 23, 2013GUIDES: Assessment for Prevention of Child Maltreatment in Primary Care Rachel Boykan, MD, Leslie Quinn, MD, Catherine Messina Rachel Boykan, MD Stony Brook University School of Medicine Google Scholar More articles by this author , Leslie Quinn, MD Stony Brook University School of Medicine Google Scholar More articles by this author , Catherine Messina Stony Brook University Google Scholar More articles by this author https://doi.org/10.15766/mep_2374-8265.9429 SectionsAbout ToolsDownload Citations ShareFacebookTwitterEmail Abstract Introduction: Child abuse is a significant problem in the US; approximately 700,000 children per year are victims of child maltreatment. Risk factors for child abuse are well defined and multifactorial and include those that are parent-related, child-related, and environmental. Pediatricians do not commonly screen for these risk factors in the primary care setting. This may be due to a perceived lack of time, discomfort in speaking about sensitive issues, and mistrust of the system, among other reasons. While several interventions to address risk for child abuse have been developed and published, most are systems-focused, involving social workers, nurses, physicians, and other health care workers. The GUIDES method educates pediatric residents on known risk factors for child abuse and establishes an easy-to-use method for addressing these risk factors in the clinical setting, specifically at well-child visits of children from birth to age 10. Methods: Similar to the HEADS mnemonic, GUIDES is a mnemonic that stands for Growth, Underlying medical history, Injury/prevention, Development, Economics, and Social/family history. Using this mnemonic, one may structure questions to maximize obtaining information regarding well-established risk factors for childhood harm/injury. In a 1-hour self-directed PowerPoint tutorial, the learner is educated on risk factors for child maltreatment and an easy-to-learn method for screening for these risk factors in the primary care setting. It is expected that the learner will apply this method in his/her primary care setting. Repeated application of the material can serve to reinforce knowledge and skills. Results: In an initial pilot study, residents' self-assessments and use of this tool in their continuity care clinics were tracked for a period of 6 months by telephone survey of parents of children seen for well-child care visits. A comparison of residents' pre/post surveys (n = 24) using the McNemar test revealed a trend towards improvement in addressing questions in domains such as growth, behavior, and development. Residents asked about discipline more frequently postintervention. However, in other areas of questioning (economic and psychosocial), residents showed no improvement. Discussion: Based on these preliminary data, we conclude that this brief intervention may improve residents' ability to address known risk factors for childhood harm. The lack of improvement in residents' self-report in more sensitive domains (economic and psychosocial) may reflect the need for more in-depth intervention and/or longitudinal practice. Educational Objectives By the end of this tutorial, learners will be able to: Utilize the GUIDES mnemonic to structure questions and define strategies for addressing risk factors for childhood harm/injury in the primary care setting.Identify well-established risk factors for childhood harm/injury.Understand how to utilize GUIDES in the primary care setting. Sign up for the latest publications from MedEdPORTAL Add your email below FILES INCLUDEDReferencesRelatedDetails FILES INCLUDED Included in this publication: GUIDES Instructor's Guide.doc GUIDES- card (front and back).pptx GUIDES.pptx PEDIATRIC RESIDENT QUESTIONNAIRE for GUIDES follow-up.doc PEDIATRIC RESIDENT QUESTIONNAIRE for GUIDES pre-module.doc To view all publication components, extract (i.e., unzip) them from the downloaded .zip file. Download editor’s noteThis publication may contain technology or a display format that is no longer in use. CitationBoykan R, Quinn L, Messina C. GUIDES: Assessment for Prevention of Child Maltreatment in Primary Care. MedEdPORTAL. 2013;9:9429. https://doi.org/10.15766/mep_2374-8265.9429 Copyright & Permissions© 2013 Boykan et al. This is an open-access article publication under the terms of the Creative Commons Attribution-No Derivatives license.KeywordsGUIDESChild MaltreatmentRisk Factors Disclosures None to report. Funding/Support None to report. Loading ...

Alcohol-related harm among university students in Hanoi, Vietnam

Introduction and Aim: This study examines the prevalence of and risk factors for alcohol-related harm and types of harm among medical students from Hanoi Medical University (Vietnam). Risk factors include aspects of drinking patterns and relevant socio-demographic variables.Study Design and Methods: A cross-sectional study involving 1st to 6th year students (N=1216; response rate 96.5%). Of these, 210 students from each academic year were randomly selected from a sampling frame covering all students from each academic year. Data were collected using a questionnaire distributed in class by researchers. Drinkers completed 23 questions on alcohol-related harm categorized into: 1) ‘negative influence on daily activities’; 2) ‘social conflict’; 3) ‘loss of control, acute consequences, and withdrawal’; 4) ‘mental health conditions’; and 5) ‘physical and medical health problems’. Logistic and Poisson regression models were used to identify the predictors of alcohol-related harm and the amount of harm, respectively.Results: The prevalence of alcohol use associated with at least one or more of the five types of harm was higher in men (81.8%) than in women (60.4%). In female and male students, the most common harm category was ‘loss of control, acute consequences, and withdrawal’ (51.8 and 75.6%, respectively), followed by ‘negative influence on daily activities’ (29.4 and 55.8%, respectively). Age, living away from home, and average number of standard drinks per occasion among male drinkers, and age and frequency of drinking per week among female drinkers were associated with alcohol-related harm.Conclusions: These data suggest that alcohol-related harm represents a serious public health problem among young educated individuals in Vietnam. The risk factors indicate that prevention should be aimed at aspects of drinking patterns and specific subpopulations defined by gender, age, and (for men only) type of living situation.

Harmful risk factors in the work of a nurse

Introduction. Nurses are exposed to harmful and troublesome factors, as they come in contact with all sorts of dangers every day. Aim. The aim of this paper was to assess the degree of exposure of hospital nurses to harmful and troublesome factors, and to examine a relationship between selected non-measurable characteristics. Material and methods. The study was conducted among 115 randomly selected respondents employed in hospital wards of the Independent State Health Care Centre in Sieradz in April 2011. The authors of the study used a survey questionnaire. The chi-square independence test was applied to determine the dependence. The strength of this relation, if statistically significant, was examined with the C-Pearson’s contingency coefficient. Results. The respondents are aware of adverse effects of biological, physical, chemical and biopsychosocial factors. Less than 50% of the respondents are overstrained due to shift work. One hundred-and-eleven respondents from the studied group assessed their work as burdensome. They blamed physical and mental overstrain, a shortage of medical personnel and great demands for that situation. The statistical analysis showed a relationship between an increased occurrence of factors negatively affecting the osteo-articular system in the workplace and the shift work system, the shift work system of nurses and a general feeling of excessive strain, inconvenience of work and presence of factors overstraining the osteo-articular system. In the first case, the strength of this relationship was moderate, it was strong in the second case and weak in the third one. However, no correlation was observed between the occurrence of mental and physical ailments at nurses and aggression at work. Conclusions. Bearing in mind the harmful character of the studied factors we should deepen knowledge in this sphere and apply prophylaxis. Moreover, employees should be made aware of effects of a proper kind of relaxation after work and the importance of measures to prevent infections.

Low level of alcohol drinking among two generations of non-Western immigrants in Oslo: a multi-ethnic comparison

BackgroundAlcohol drinking is a risk factor for harm and disease. A low level of drinking among non-Western immigrants may lead to less alcohol-related harm and disease. The first aim of this study was to describe frequency of drinking in two generations of immigrants in Oslo, contrasting the result to drinking frequency among ethnic Norwegians. The second aim was to study how frequency of drinking among adult immigrants was associated with social interaction with their own countrymen and ethnic Norwegians, acculturation, age, gender, socioeconomic factors and the Muslim faith.MethodThe Oslo Health Study (HUBRO) was conducted during the period 2000 to 2002 and consisted of three separate surveys: a youth study (15-16-year-olds, a total of 7343 respondents, response rate 88.3%); adult cohorts from 30 to 75 years old (18,770 respondents, response rate 46%); the five largest immigrant groups in Oslo (aged 20–60 years, a total of 3019 respondents, response rate 39.7%). Based on these three surveys, studies of frequency of drinking in the previous year (four categories) were conducted among 15-16-year-olds and their parents’ generation, 30-60-year-old Iranians, Pakistanis, Turks and ethnic Norwegians. A structural equation model with drinking frequency as outcome was established for the adult immigrants.ResultsAdults and youth of ethnic Norwegian background reported more frequent alcohol use than immigrants with backgrounds from Iran, Turkey and Pakistan. Iranians reported a higher drinking frequency than Turks and Pakistanis. In the structural equation model high drinking frequency was associated with high host culture competence and social interaction, while high own culture competence was associated with low drinking frequency. Adult first-generation immigrants with a longer stay in Norway, those of a higher age, and females drank alcohol less frequently, while those with a higher level of education and work participation drank more frequently. Muslim immigrants reported a significantly lower drinking frequency than non-Muslims, although this did not apply to Iranians.ConclusionsThe existence and growth in Western societies of immigrant groups with low-level alcohol consumption contributed to a lower level of consumption at the population level. This may imply reduced drinking and alcohol-related harm and disease even among ethnic Norwegians.

A Systematic Review of Family-Based Interventions Targeting Alcohol Misuse and Their Potential to Reduce Alcohol-Related Harm in Indigenous Communities

Alcohol misuse is a major risk factor for harm in indigenous communities. The indigenous family unit is often the setting for, and is most adversely affected by, alcohol-related harm. Therefore, family-based alcohol interventions offer great potential to reduce alcohol-related harm in indigenous communities. This systematic review aims to identify peer-reviewed published evaluations of family-based alcohol interventions, critique the methodological quality of those studies, describe their intervention characteristics, and identify which interventions appear most promising to reduce alcohol-related harm in indigenous communities. Eleven electronic databases were searched. The reference lists of reviews of family-based approaches focused on alcohol interventions were hand-searched for additional relevant studies not identified by the electronic database search. Initially, 1,369 studies were identified, of which 21% (n = 142) were classified as intervention studies. Nineteen intervention studies were family-based alcohol interventions. Eleven of these studies included family members in the treatment of problem drinkers, and eight studies specifically targeted family members of problem drinkers. Methodological quality of studies varied, particularly in relation to study design, including confounding variables in the analyses, and follow-up rates. The evidence for the effectiveness of family-based alcohol interventions is less than optimal, although the reviewed studies did show improved outcomes. Given the important role of family in indigenous communities, there is merit in exploring family-based approaches to reduce alcohol-related harms. Tailored family-based approaches should be developed that include direct consultation with targeted indigenous communities.

Evaluation and referral for child maltreatment in pediatric poisoning victims

ObjectiveAlthough the majority of poisonings in young children are due to exploratory ingestions and might be prevented through improved caregiver supervision, the circumstances that warrant evaluation for suspected maltreatment and referral to Child Protective Services (CPS) are unclear.Therefore the objective of this study was to determine the percentage and characteristics of young poisoning victims who were evaluated for child maltreatment by the hospital team (social work and/or child protection team) and/or referred to CPS. MethodsRetrospective study of poisoning victims<6 years old seen at an urban children's hospital from 2006 to 2008. Logistic regression was performed to evaluate the associations between the outcomes (evaluation for maltreatment by hospital team and/or referral to CPS) and predictor variables (demographics and circumstances, type and severity of poisoning). ResultsAmong 928 poisonings, 41% were from household products, 20% from over-the-counter drugs, 7% from prescription narcotics/sedatives, 29% from other prescription drugs, and ≤1% each from ethanol, illicit drugs, or other substances. Most children were asymptomatic (69%) or stable (28%); 3% were critically ill. Only 13% were evaluated by the hospital team and 4% were referred to CPS. Demographic characteristics were not associated with referral to CPS. Higher clinical severity was associated with increased referral (p<0.001). Compared to poisonings with over-the-counter drugs, referrals were more likely for poisonings with ethanol and prescription narcotics/sedatives, but not other prescription drugs or household products (p<0.001). All illicit drug poisonings and 44% of ethanol poisonings were referred. The majority of referrals to CPS were for concerns for illicit drugs, poor supervision or multiple forms of maltreatment; 6% were secondary to concerns for intentional poisoning. ConclusionsEvaluations and referrals to CPS for maltreatment are uncommon in young poisoning victims. Referrals occurred consistently for illicit drugs but not ethanol. Although referrals were more likely for higher severity poisonings, it is unclear if the severity of poisoning is associated with the level of supervisory neglect or a marker of ongoing risk to the child. These findings suggest the need to identify risk factors for ongoing harm and the development of clinical guidelines used to determine which poisoning victims should be referred to Child Protective Services.