Unintentional Causes Research Articles

The Clinical Audit of Bed Falls in General and Emergency Units Patients, in Golestan Hospital, September 2014 - March 2015

Background: Bed falling is the most common unintentional cause of injury in all age patients and is a major safety problem in health facilities. The main objective of this study was to evaluate the effectiveness of clinical audit to prevent patient falls in general and emergency units at Ahvaz’s Golestan hospital. Methods: The study population consisted of at-risk hospitalized patients in the general and emergency units over a six-month period. In accordance with the clinical audit cycle, the weak points were found, proper interventions were implemented based on the standard guidelines for bed falling, and then another audit was performed again to assess the effectiveness of our intervention. Results: Measuring the level of interventions before and after the clinical audit showed an increase in all study variables. The falling results revealed that these interventions reduced bed falling by more than 50%. Conclusions: The clinical audit for reducing bed falling incidents in the study units led to the improved patient safety and care according to the standards of care.

Zawał serca w przebiegu zatrucia tlenkiem węgla

Carbon monoxide (CO) poisoning is a common, unintentional cause of death. The clinical manifestation of intoxication is most often neurological and cardiovascular symptoms of hypoxia in both the brain and the heart. A case report of a 55-year-old patient with myocardial infarct in the course of CO poisoning was presented.

Characteristics and outcomes of acute pediatric blunt torso trauma based on injury intent

IntroductionBlunt trauma is a leading cause of pediatric morbidity. We compared injuries, interventions and outcomes of acute pediatric blunt torso trauma based on intent. MethodsWe analyzed de-identified data from a prospective, multi-center emergency department (ED)-based observational cohort of children under age eighteen. Injuries were classified based on intent (unintentional/inflicted). We compared demographic, physical and laboratory findings, ED disposition, hospitalization, need for surgery, 30-day mortality, and cause of death between groups using Chi-squared or Fisher's test for categorical variables, and Mann-Whitney test for non-normal continuous factors comparing median values and interquartile ranges (IQR). ResultsThere were 12,044 children who sustained blunt torso trauma: Inflicted=720 (6%); Unintentional=9563 (79.4%); Indeterminate=148 (1.2%); Missing=1613 (13.4%). Patients with unintentional torso injuries significantly differed from those with inflicted injuries in median age in years (IQR) [10 (5, 15) vs. 14 (8, 16); p-value<0.001], race, presence of pelvic fractures, hospitalization and need for non-abdominal surgery. Mortality rates did not differ based on intent. Further adjustment using binary, logistic regression revealed that the risk of pelvic fractures in the inflicted group was 96% less than the unintentional group (OR: 0.04; 95%CI: 0.01–0.26; p-value=0.001). ConclusionsChildren who sustain acute blunt torso trauma due to unintentional causes have a significantly higher risk of pelvic fractures and are more likely to be hospitalized compared to those with inflicted injuries.

Mortality from Unspecified Unintentional Injury among Individuals Aged 65 Years and Older by U.S. State, 1999-2013.

Introduction: Recent changes in unspecified unintentional injury mortality for the elderly by U.S. state remain unreported. This study aims to examine U.S. state variations in mortality from unspecified unintentional injury among Americans aged 65+, 1999–2013; Methods: Using mortality rates from the U.S. CDC’s Web-based Injury Statistics Query and Reporting System (WISQARS™), we examined unspecified unintentional injury mortality for older adults aged 65+ from 1999 to 2013 by state. Specifically, the proportion of unintentional injury deaths with unspecified external cause in the data was considered. Linear regression examined the statistical significance of changes in proportion of unspecified unintentional injury from 1999 to 2013; Results: Of the 36 U.S. states with stable mortality rates, over 8-fold differences were observed for both the mortality rates and the proportions of unspecified unintentional injury for Americans aged 65+ during 1999–2013. Twenty-nine of the 36 states showed reductions in the proportion of unspecified unintentional injury cause, with Oklahoma (−89%), Massachusetts (−86%) and Oregon (−81%) displaying the largest changes. As unspecified unintentional injury mortality decreased, mortality from falls in 28 states and poisoning in 3 states increased significantly. Mortality from suffocation in 15 states, motor vehicle traffic crashes in 12 states, and fire/burn in 8 states also decreased; Conclusions: The proportion of unintentional injuries among older adults with unspecified cause decreased significantly for many states in the United States from 1999 to 2013. The reduced proportion of unspecified injury has implications for research and practice. It should be considered in state-level trend analysis during 1999–2013. It also suggests comparisons between states for specific injury mortality should be conducted with caution, as large differences in unspecified injury mortality across states and over time could create bias for specified injury mortality comparisons.

Classification of domestic burning smell using covariance k- nearest neighbour algorithm for early fire detection application

Fire is one of the most common hazards in households. It is the fifth leading unintentional cause of injury and death, behind motor vehicle crashes, falls, poisoning by solids or liquids, and drowning. It also ranks as the first cause of death for children under the age of 15 at home. Roughly, 80 percent of all fire deaths occur in places where people sleep, such as in homes, dormitories, barracks, or hotels. 74% of the deaths result from fires in homes with no smoke alarms or no working smoke alarms while surveys report that 96% of all homes have at least one smoke alarm. Nearly all home and other building fires are preventable. No fire is inevitable. Determination of burning smell is important because it can help in early fire detection and prevention. This preliminary study discusses the development of a fire sensing system that is not only capable of detecting fire in its early stage but also of classifying the fire based on the smell of the smoke in the environment. A domestic burning smell classification system for early fire detection application has been proposed using new covariance k-nearest neighbour (Ck-NN) algorithm. The experiments were performed on recorded smell samples from combustion of ten different commonly available domestic odour sources, including candle, joss sticks, air freshener, mosquito coil, newspaper, card board, plastic materials, Styrofoam and wood. All the experiments were done in a test chamber with humidity and temperature sensors. Portable Electronic Nose (PEN3) from AirSense Analytics is used as the measurement device. The smell source is placed 0.3m from the PEN3 and the time-series signal is measured for two minutes. The odour metrics consist of 66000 odour samples are modelled using Ck-NN algorithm. It is found that the average mean classification accuracy for the model is 99.63%.

Childhood Mishaps and Its Cognizance among Nepalese Mothers of Parsa District for Its Prevention, Small Cross-sectional Study

Several studies have shown that there several unintentional causes for the unwanted childhood accidents. In addition, Nepal demographic health survey via West University of England revealed at 2006 A.D, 11% death casualties of under- five aged children are due to unintentional injuries 1. This particular study is extremely useful to health care planner, provider and researcher to have grand design to be produced by government of Nepal, such that; there shall be minimal rate of casualties of deceased children due to accidents. This study is descriptive cross sectional study carried out in Parsa district of Nepal where the respondents were mother to assess their awareness of cause of childhood accidents and its prevention. Computer software SPSS is use to scrupulous analysis of study where the chi-square test is used with 95% level of confidence (p=0.05). Poisoning 96% cases is the cause of childhood accident unintentionally, followed by 94% foreign body aspiration, 85% flame burn. Unsupervised children are more prone to injury than supervised children. Finally and foremost the crucial correlation of parents level of awareness with childhood are as follows; inadequate level of knowledge have higher percentage of accident (58%), followed by moderately adequate (32%) and adequate (10%). This study though done on small scale on small part of Parsa district can play key role to the policy to have vigilantive and supervision power to see the loopholes that need to be detected and dealing in curative manner.

Educating Children on Water Safety for Drowning Prevention

Drowning is accepted as one of the most leading causes of unintentional injuries and a leading unintentional cause of injury-related deaths in many countries as well as in Turkey. We conducted a water safety education programme among secondary school children aged between 10 and 14 years to test an active measure. Children were trained about seven subjects from American Red Cross Longfellow’s WHALE Tales program and on lifeline throw (LT). Pre- and post-tests were used to collect data which was used for statistical analyses. Results showed a significant increase in knowledge (32 %) and in LT (476.2 %) (p < 0.05). Among sub-groups’ of independent variables except “city” and “gender”, no significant differences were found. An active approach for drowning prevention was tested by this study and according to our findings; we conclude that such a water safety education programme can help increasing knowledge and safe lifesaving skills of children.

Preventing Gun Injuries in Children

Firearms are involved in the injury and death of a large number of children each year from both intentional and unintentional causes. Gun ownership in homes with children is common, and pediatricians should incorporate evidence-based means to discuss firearms and protect children from gun-related injuries and violence. Safe storage of guns, including unloaded guns locked and stored separately from ammunition, can decrease risks to children, and effective tools are available that pediatricians can use in clinical settings to help decrease children’s access to firearms. Furthermore, several community-based interventions led by pediatricians have effectively reduced firearm-related injury risks to children. Educational programs that focus on children’s behavior around guns have not proven effective.

Preventing Gun Injuries in Children

Firearms are involved in the injury and death of a large number of children each year from both intentional and unintentional causes. Gun ownership in homes with children is common, and pediatricians should incorporate evidence-based means to discuss firearms and protect children from gun-related injuries and violence. Safe storage of guns, including unloaded guns locked and stored separately from ammunition, can decrease risks to children, and effective tools are available that pediatricians can use in clinical settings to help decrease children's access to firearms. Furthermore, several community-based interventions led by pediatricians have effectively reduced firearm-related injury risks to children. Educational programs that focus on children's behavior around guns have not proven effective.

Morbidity and mortality associated with injuries: results of the Global Burden of Disease study in Brazil, 2008.

The aim of this study was to estimate the global burden of disease from external causes in 2008 in Brazil, based on DALYs (disability-adjusted life years). YLLs (years of life lost) were estimated according to the method proposed by Murray & Lopez (1996). Meanwhile, the method for estimating YLDs (years lived with disability) included methodological adjustments taking the Brazilian reality into account. The study showed a total of 195 DALYs per 100 thousand inhabitants, of which 19 DALYs were related to external causes. Among YLLs, 48% were from unintentional causes and 52% from intentional causes. Among YLDs, unintentional causes predominated, with 95%. The share of YLLs in DALYs was 90%. The cause with the highest proportion of YLLs was "homicide and violence" (43%), followed by "road traffic accidents" (31%). Falls accounted for the highest share of YLDs (36%). The sex ratio (male-to-female) was 4.8 for DALYs, and the predominant age bracket was 15-29 years. Since external causes are avoidable, the study provides potentially useful information for policymakers in public security and health.

A standardised mortuary-based injury surveillance system: lessons learned from the Ibadan Nigerian trial

This study explored the challenges in establishing a mortuary-based injury surveillance system in a resource-constrained setting of Ibadan, Nigeria. To quantify and detail fatal injuries, in September 2010 to February 2011, a prospective data collection utilised the World Health Organization–Monash draft surveillance system. Findings were compared with other low- and middle-income settings, and surveillance system attributes were assessed. The leading injury mechanism among all age groups was transport related, with 45.6% being vulnerable road users, consistent with comparable settings. Fire-related injury was the second unintentional cause in the Ibadan pilot, unlike Global Burden of Disease estimates for Nigeria, Mauritius and Mexico, where drowning was the second cause. Positive system attributes included timeliness, data field completeness, specificity, flexibility and sensitivity. Despite apparent under-reporting of eligible deaths and questionable representativeness, this study illustrates potential for mortuary data to inform injury prevention policies and programmes in resource-constrained settings.

6.0 Supporting patients on therapy

6.0 Supporting patients on therapy

Quality assurance and training procedures for computer‐aided detection and diagnosis systems in clinical usea)

Computer-aided detection/diagnosis (CAD) is increasingly used for decision support by clinicians for detection and interpretation of diseases. However, there are no quality assurance (QA) requirements for CAD in clinical use at present. QA of CAD is important so that end users can be made aware of changes in CAD performance both due to intentional or unintentional causes. In addition, end-user training is critical to prevent improper use of CAD, which could potentially result in lower overall clinical performance. Research on QA of CAD and user training are limited to date. The purpose of this paper is to bring attention to these issues, inform the readers of the opinions of the members of the American Association of Physicists in Medicine (AAPM) CAD subcommittee, and thus stimulate further discussion in the CAD community on these topics. The recommendations in this paper are intended to be work items for AAPM task groups that will be formed to address QA and user training issues on CAD in the future. The work items may serve as a framework for the discussion and eventual design of detailed QA and training procedures for physicists and users of CAD. Some of the recommendations are considered by the subcommittee to be reasonably easy and practical and can be implemented immediately by the end users; others are considered to be "best practice" approaches, which may require significant effort, additional tools, and proper training to implement. The eventual standardization of the requirements of QA procedures for CAD will have to be determined through consensus from members of the CAD community, and user training may require support of professional societies. It is expected that high-quality CAD and proper use of CAD could allow these systems to achieve their true potential, thus benefiting both the patients and the clinicians, and may bring about more widespread clinical use of CAD for many other diseases and applications. It is hoped that the awareness of the need for appropriate CAD QA and user training will stimulate new ideas and approaches for implementing such procedures efficiently and effectively as well as funding opportunities to fulfill such critical efforts.

Unintentional injury mortality -The role of criminal offending. A Swedish longitudinal population based study

The aim was to investigate life course criminality in relation to unintentional injury mortality and other causes of death among 49,398 male Swedish conscripts aged 18–20 years in 1969/70 and a follow-up through 35 years. All subjects completed two questionnaires at the time of conscription concerning family, social, behavioural risk factors including alcohol and drug use. The impacts of committed crimes, alcohol and drug use and other risk factors were estimated using proportional hazard ratios (HRs) from Cox regression analyses. Many adolescent offences entailed a nearly six-fold higher injury mortality risk (HR = 5.64) and a four-fold higher risk (HR = 3.93) for all other causes vs. no convictions. In multivariate analyses, adolescent criminality was still found to be significantly associated with time to unintentional injury mortality, while criminality limited to adulthood had a moderately higher risk for all other causes of deaths. Individuals with both adolescence and adult criminality showed elevated mortality from especially unintentional injury (HR = 5.06), with the hazards remaining elevated, even after adjustment for other behavioural risk factors. Men with behavioural risk factors including alcohol and/or drug misuse in combination with frequent criminality seem to be a vulnerable group of both unintentional and other causes of deaths.

Case analyses of all children’s drowning deaths occurring in Sweden 1998–2007

The goal of this research project was to explore circumstances surrounding each drowning death occurring to children and adolescents ages 0-17 in Sweden during the years 1998-2007. Records from the National Board of Forensic Medicine (NBFM) and other sources were analysed. We collected information on children's personal characteristics (sex, age, ethnic background, weight, height, physical condition, and pre-existing health conditions) and the circumstances of deaths (time and place of occurrence, type of drowning, resuscitation efforts and medical care given, for example). We also collected information on prevention factors: the physical environment, adult supervision, whether or not the child could swim, and if the child was using a personal flotation device at the time of death. Our analysis showed that 109 children had drowned in Sweden during the study period - of this group, 96 had died from unintentional causes. Children from immigrant backgrounds, particularly with families coming from the Middle East and Iran, were inordinately represented in the group of victims who had died from unintentional drowning deaths. Other risk factors included: coming from a single parent-headed family, alcohol use by older victims and a lack of ability to swim. Prevention efforts to prevent drowning in the future should focus on preventing alcohol use by young bathers; better fencing around swimming sites; improved coverage of swimming lessons to all children in Sweden, especially children from immigrant families; more education on drowning risks for single parents; and better awareness by adults on the need for constant supervision of children and adolescents in and near water.

Does Intentional or Unintentional Contact in Youth Ice Hockey Result in More Injuries?

OBJECTIVE: : To determine whether boys' ice hockey programs have higher injury rates from intentional body contact or from unintentional contact and whether allowing body checking increases the rate of injuries. DESIGN: : Cohort study over 5 seasons. Many of the participants played for more than one season. SETTING: : Youth ice hockey programs during the years 2002-2007 in Ontario, Canada. PARTICIPANTS: : The study included between 2594 and 2730 boys aged 4-18 years in each season, for a total of 13 292 player-years. ASSESSMENT OF RISK FACTORS: : Player time was estimated from the trainers' reports of the number of games and practices during the season for each team, with the assumption that all players attended practices and participated in one-third of each game. Risk factors included team age group (5 groups), level of play (house league, select, and representative [rep]), games versus practices, and whether checking was permitted. House league teams were not permitted to body check, but checking was allowed in select teams from 11 years (peewee), and rep teams from 9 years. MAIN OUTCOME MEASURES: : The main outcome measures were rates of injury in relation to unintentional contact, intentional contact, and body checking and across age group, level of play and games and practices. Injuries were reported by the team trainers using the Hockey Canada injury report form, which included a physician's statement of the diagnosis and information on the cause of injury. Intentional contact (body checks) included contact with an opposing player in games, with a team member during practices, and illegal contacts, such as cross-checking or slashing. Unintentional contacts were collisions between same-team players during games, collisions with the boards, falling on the ice, or being hit by the puck. Time missed because of injury was recorded. Injury data were checked by phone calls to 22 families and found to be reliable. An injury required missing ≥1 day of activity. MAIN RESULTS: : The total number of injuries for the 5 seasons was 247 (range per season, 40-60). Overall, unintentional collision injuries accounted for 66% (95% confidence interval [CI] 60%-72%) of injuries (house/select leagues, 69.3% and rep leagues, 60.8% of unintentional contact injuries). Greater numbers of serious injuries (concussions, contusions, sprains/strains, fractures, and dislocations) occurred in unintentional collisions than in intentional collisions (P for each category, 0.20). Including all levels of play, in comparisons with peewee (age 11-12 years), younger boys (7-10 years) had a lower rate of injuries from all causes (P ≤ 0.011) and older boys (13-18 years) tended to have a higher rate of injuries from intentional causes (P ≤ 0.058) but not unintentional causes. The rates of injuries in games increased with age and league level (top rate per 1000 hours of play, bantam rep, 10.64), but rates of injuries in practices were low and relatively stable (range, 0.00-0.82/1000 hours of play). In divisions that allowed body checking versus those that did not, RR for injuries from intentional contact was 3.95 (95% CI, 0.80-19.50), from unintentional contact, 3.27 (95% CI, 1.07-10.00), and including all injuries, 3.75 (95% CI, 1.51-9.34). CONCLUSIONS: : More injuries and more serious injuries in boys' ice hockey occurred from unintentional collisions than from intentional contact. In divisions where body checking was allowed, almost 4 times as many injuries occurred from both intentional and unintentional contacts. Language: en

Research and Theory Towards a National Injury Costing System?:Lessons from a Public-Private Injury Costing Pilot Study in South Africa

South Africa has extremely high incidence rates of fatal and non-fatal injuries due to interpersonal violence, pedestrian&ndash;motor vehicle collisions, burns, falls and other unintentional causes. While the actual cost associated with these injuries remains relatively unknown, the estimated direct cost of the medical treatment, rehabilitation and administration of these victims may run into billions of rands. This public&ndash;private injury costing pilot study (hereafter the study) was conducted at a tertiary public health facility in Johannesburg, South Africa (hereafter the public facility). The study attempted to facilitate further costing capacity through skills transfers from personnel at a sentinel private health facility in Johannesburg (hereafter the private hospital) to selected personnel within the identified public facility, and through the determination of the partial baseline direct medical cost of the treatment of gun shot wounds, pedestrian&ndash;motor vehicle collision injuries, falls and burns at the public facility. Both the capacity building component and the actual study were complicated by a number of obstacles, including limited personnel, poor costing and billing capacity, underdeveloped billing documentation and recording procedures, and limited levels of investment in the general practice of injury costing in the public health sector itself. This article examines the practical challenges facing further attempts to describe the cost of injuries in South Africa. It concludes with several critical reflections on concerns associated with an uncritical pursuit of the roll-out of a national injury costing system, which may have a negative impact on service delivery to the very populations that encounter injuries as a public health sector priority.

An evolved anti-jamming adaptive beamforming network

Interference in wireless networks is undesirable, whether it is due to unintentional or malicious causes. Adaptive beamforming is a spatial filtering technique that can prevent jammers from disrupting wireless networks. This paper presents an evolvable hardware (EH) application in which an evolutionary algorithm (EA) is used to configure an adaptive beamformer to achieve two goals: (1) steering nulls towards jamming signals and (2) directing gain in the direction of the desired signal. This is the first demonstration of an EA-configured adaptive beamformer to counter a jamming system. Simulation results show that the EA is able to thwart up to three jamming signals. The results suggest that EH is a promising approach towards wireless network security.

Towards a National Injury Costing System?:Lessons from a Public-Private Injury Costing Pilot Study in South Africa

South Africa has extremely high incidence rates of fatal and non-fatal injuries due to interpersonal violence, pedestrian–motor vehicle collisions, burns, falls and other unintentional causes. Whilethe actual cost associated with these injuries remains relatively unknown, the estimated direct cost of the medical treatment, rehabilitation and administration of these victims may run into billionsof rands. This public–private injury costing pilot study (hereafter the study) was conducted at a tertiary public health facility in Johannesburg, South Africa (hereafter the public facility). The studyattempted to facilitate further costing capacity through skills transfers from personnel at a sentinel private health facility in Johannesburg (hereafter the private hospital) to selected personnel withinthe identified public facility, and through the determination of the partial baseline direct medical cost of the treatment of gun shot wounds, pedestrian–motor vehicle collision injuries, falls and burns at the public facility. Both the capacity building component and the actual study werecomplicated by a number of obstacles, including limited personnel, poor costing and billing capacity, underdeveloped billing documentation and recording procedures, and limited levels of investment in the general practice of injury costing in the public health sector itself. This articleexamines the practical challenges facing further attempts to describe the cost of injuries in South Africa. It concludes with several critical reflections on concerns associated with an uncritical pursuit of the roll-out of a national injury costing system, which may have a negative impact on service delivery to the very populations that encounter injuries as a public health sector priority.

Recent Declines in Australian Male Suicide are Real, not Artefactual

The aim of the present study was to clarify the extent to which the recorded marked decline in young male suicide (20-34 years) in Australia since 1998 is attributable to misclassification of cause of death information. Secular trends in young male suicide rates were investigated for the period 1976-2005. Suicide rates in the period after the peak of the epidemic in this age group (1998) were re-calculated based on published estimates of under-enumeration of suicide data, and misclassification of likely suicide cases to other unintentional and undetermined external causes. Two misclassification scenarios were used to revise young male suicide rates from 1998: previously reported estimates of 9% under-enumeration due to misclassification of unintentional causes of death, and 17% under-enumeration due to misclassification of open cases in addition to unintentional causes of death. All-cause mortality was also examined. Recorded male suicide in the 20-34 year age group increased over the study period, peaking in 1998 at 39 per 100,000, before declining sharply in the period 1999-2005 by 44% to 22 per 100,000 in 2005. Following adjustment for misallocation under the first scenario, suicide rates declined 38% to 24 per 100,000, and under the second scenario declined 33% to 26 per 100,000. Revised suicide rates were not materially different from recorded suicide rates based on 95% confidence intervals over this period. All-cause mortality declined from 1999 due to reductions in suicide and other causes. The recent marked decline in young male suicide in Australia is real. The effects of misallocation of likely suicide cases to other causes did not substantially affect population trends in suicide rates in the period after 1998. There is still a need to account in detail for why young male suicide has declined so substantially during the period after 1998.