Journal of Injury and Violence Research
Volume:4 Issue: 2, Jul 2012

Hip fracture is a common cause of long hospital stay in the elderly. Approximately one third of these patients die within the first year. As a consequence geriatric and orthopedic collaboration (orthogeriatrics) has been organized in different ways. The aim of this study is to evaluate the efficiency of a multidisciplinary geriatric in-hospital intervention on patient outcome. A total of 495 elderly hip fracture patients consecutively admitted to orthopedic surgery, were followed. Data were based on medical records. The intervention group (n=233) was compared to a historical cohort group (n=262) receiving traditional orthopedic treatment. Intervention program was based on initial physical and mental screening and evaluation, geriatric-focused care, and early discharge planning. The intervention was provided by a multidisciplinary geriatric team. After discharge, follow-up home-visits by a physiotherapist were performed, except for patients discharged to nursing homes, due to a 24-hour staff and easy access to the GP. Median length of stay was reduced from 15 to 13 days. More patients began treatment with calcium/vitamin-D and bisphosphonate (p=sig). There was no difference in hemoglobin variation between the time of admission and three to six months post admission, and no difference in three-month readmissions (odds ratio (OR) = 1.09 [95%CI: 0.71;1.67]). Discharge destination was unchanged (OR=0.93 [95%CI: 0.52; 1.65]). In-hospital mortality was 8% in the intervention group vs. 6% (p=0.48), in the control group. Three-month mortality was 16% in the intervention group vs. 15% (p=0.39), in the control group. In the intervention group, residents from nursing homes had a higher three-month mortality (OR=2.37 [95% CI: 0.99; 5.67]), and the risk of new fractures within two years decreased from 9.5% to 7.7%, though not statistically significant. Our study indicates that co-management of hip fracture patients by orthopedic surgeons and geriatricians may be associated with a reduction in length of hospital stay without negatively affecting major patient outcomes. The concept should be further developed particularly among the frail elderly.

Two recent studies reported a curvilinear (U-shaped) between elderly suicide rates and educational attainment measured by the United Nation’s Education Index. A study examining the curvilinear (U-shaped) relationship between elderly suicide rates and the individual components of the Education Index (adult literacy rate, percentage of children of relevant age group enrolled in primary schools and percentage of children of relevant age group enrolled for secondary schools) and one other measure of educational attainment (youth literacy rate) was undertaken to partial out the effects of the individual components of Education Index on elderly suicides. A cross-national study examining the relationship between elderly suicide rates (Y-axis) and different measures of educational attainment (X-axis) was undertaken using data from the World Health Organization and the United Nations data banks using Curve estimation regression models. The relationship between elderly suicide rates with the adult literacy rate, the percentage of children of relevant age group enrolled for secondary schools and the youth literacy rate was curvilinear (U-shaped curve). This relationship was absent with the percentage of children of relevant age group enrolled in primary schools. Given the cross-sectional study design, a causal relationship between elderly suicide rates and measures of educational attainment, including the adult literacy rate, the percentage of children of relevant age group enrolled for secondary schools and the youth literacy rate, cannot be assumed. However, the findings suggest that future studies of elderly suicide rates and educational attainment should focus on the adult literacy rate, the percentage of children of relevant age group enrolled for secondary schools and the youth literacy rate as measures of educational attainment.

High accidental death rates in the former Soviet republics (FSR) and its profound fluctuation over the past decades have attracted considerable interest. The research evidences emphasize binge drinking pattern as a potentially important contributor to accident mortality crisis in FSR. In line with this evidence we assume that higher level of alcohol consumption in con­junction with binge drinking pattern results in close aggregate-level association between alcohol psychoses and accidental death rates in the former Soviet Slavic republic Belarus. Trends in alcohol psychoses rate (as a proxy for alcohol consumption) from 1979 to 2007 were analyzed employing a distributed lag analysis in order to asses bivariate relation­ship between the two time series. According to the Bureau of Forensic Medicine autopsy reports the number of deaths due to accidents and injuries increased by 52.5% (from 62.3 to 95.0 per 100.000 of resi­dents), and fatal alcohol poisoning rate increased by 108.6% (from 12.8 to 26.7 per 100.000 of residents) in Belarus between 1979 and 2007. Alcohol in blood was found in 50.1% victims of deaths from accidents and injuries for the whole period, with the minimum figure 40% in 1986 and maximum 58.2% in 2005. The outcome of distributed lags analysis indicated statisti­cally significant association between the number of alcohol psychoses cases and the number BAC-positive deaths from accidents at zero lag. The outcome of this study supports previous findings suggesting that alcohol and deaths from accidents are closely connected in a culture with prevailing intoxication-oriented drinking pattern, and add to growing body of evidence that a substantial proportion of acci­dental deaths in Belarus are due to effects of binge drinking.

Road traffic injuries (RTIs) constitute 45% of injury mortality in Egypt; 75% of these injuries are pedestrians related. Traditionally, research on road traffic safety has focused on the traffic environment and the vehicles. However, little attention has been given to road risky behaviors and perceptions of road safety by pedestrians as risk factors associated with high pedestrian injury rates. This study aimed to examine the relationship between road risk- perception, specific road behaviors, and self-reported pedestrian injuries among university students in Cairo, Egypt. A cross sectional survey was conducted among university students aged 18 to 24 years old at Ain Shams University in Cairo. Questions covered socio-demographic variables, injury episodes, road behaviors, road risk-perceptions, attitudes towards injury prevention, and road safety education. The survey was completed by 1,324 students. Two hundred ninety (21.9%) of the participants suffered from pedestrian injury during the past 6 months; of these, 28.9% were admitted to hospital or clinic as a result of the injury, 39.3% were unable to go to university or leave home because of the injury for a period ranging from one day up to one week. Participants were more likely to suffer from pedestrian injury when they did not always "look both ways to cross the road", whereas always “waiting for a green light” was protective. Students who "perceived it safe to cross the road from any point" or "did not perceive it to be safer to cross at a zebra crossing" were less likely to "look both ways" before crossing the road. Similarly, there was a positive association between road safety education and participants’ road crossing behaviors. Inappropriate youth's road behaviors were significantly associated with pedestrian injury. There was also a positive association between road risk perception and road behaviors. This suggests that a behavioral approach together with modification of the traffic environment (such as provision of crossing signals) might be effective in preventing the occurrence of pedestrian injury.

Many preadolescents and adolescents have been reported to take part in forced asphyxiation as a means of creating a feeling of being high without taking drugs. This activity goes by different names, including the Choking Game, Blackout, and Space Monkey. The limited epidemiological data suggest that about 6-11% of adolescents report having engaged in this behavior. This study surveyed a predominantly Caucasian cohort of parents regarding their knowledge of the choking game and its associated risks, as well as their attitudes toward possible prevention efforts. Three quarters of parents responding reported being familiar with the choking game but considerably fewer (20%) reported having talked to their children about this activity. Ninety-six percent of parents reported knowing that unintentional death was a potential risk and ninety percent believe information about this activity should be included in school health curricula. Parents of adolescents in the United States appear to be quite knowledgeable about the Choking Game and its potential risks and are overwhelmingly supportive of prevention measures. The parents surveyed understood the importance of preventing children from engaging in the Choking Game, but may need specific help in how to talk to their children about it. Further work is needed to confirm that the proportion of parents identified as aware of this risk taking behavior is consistent across other populations and to urgently identify effective prevention efforts that can be integrated into existing health curricula.

Suicide rates traditionally increased with ageing. There is a paucity of studies examining factors associated with age-associated trends in suicide rates. The relationship between suicide rates and ageing was examined by ascertaining suicide rates in the seven age-bands 16-24 years to 75+ years from the World Health Organization for 97 countries. The relationship between socio-economic status, income inequality, healthcare expenditure, child mortality rates and life expectancy and countries with an increase, a decline and no change in suicide rates with ageing was examined using data from the United Nations. In males and females there was a decline in 5 and 10 countries, an increase in 33 and 37 countries and no change in 59 and 50 countries respectively in suicide rates with ageing. Age-associated trends in suicide rates were significantly associated with socio-economic status (males) or income inequality (females), per capita expenditure in healthcare, the proportion of gross-national domestic product spent on healthcare, child mortality rates and life expectancy. The current study, of factors associated with age-associated trends in suicide rates, confirmed a previously developed five sequential stage model to explain the relationship between elderly suicide rates and socio-economic status and income inequality, quality and quantity of healthcare services, child mortality rates and life expectancy.

Violence is a major public health problem. Both clinical and population based studies shows that violence against men and women has physical and psychological health consequences. However, elsewhere and in Sweden little is known of the effect of individual socioeconomic position (SEP) on the relation between violence and health outcomes. This study aimed to assess the effect of individual SEP on the relation between violence and three health outcomes (general health, pain and anxiety) among women in Stockholm County. The study used data from the Stockholm Public Health Survey, a cross-sectional survey carried out in 2006 for the Stockholm County Council by Statistic Sweden. 34 704 respondents answered the survey, the response rate was sixty one percent. Analyses were carried out using descriptive statistics and logistic regression analysis in SPSS v.17.0. Individual SEP increased the odds of reporting poor health outcomes among victimized women in Stockholm County. Regarding self-reported health women in low-SEP who reported victimization in the past twelve months had odds of 2,36 (95% CI 1.48-3.77) for the age group 18-29 years and 3.78 (95% CI 2.53-5.64) for the age group 30-44 years compared with women in high-SEP and non-victim. For pain the odds was 2,41 (95% CI 1,56-3,73) for the age group 18-29 years and 2,98 (95% CI 1,99-4,46) for women aged 30-44 years. Regarding anxiety the age group 18-29 years had odds of 2,53 (95% CI 1,58-4,03) and for the age group 30-44 years had odds of 3,87 (95% CI 2,55-5,87). Results showed that individual SEP (measured by occupation) matters to the relationship between violence and health outcomes such as general self-reported health, pain and anxiety. Women in lower SEP who experienced victimization in the past twelve months had increased odds of reporting poorer self-rated health, pain and anxiety compared to those in higher SEP with no experience of victimization. However, further exploration of the relationship between poverty, individual SEP is needed using other Swedish population samples.

Ventricular Septal Defect (VSD) after blunt chest trauma is a very rare traumatic affection. We report here a case of blunt chest injury-related VSD and pseudoaneurysm. A 30-year old male truck driver was referred from a trauma center to our hospital seven days after a blunt chest trauma and rib fracture. The patient had severe pulmonary edema and echocardiography showed large VSD. Several mechanisms are involved in the pathogenesis of this affection including an acute compression of the heart muscle between the sternum and the spine, leading to excessive changes in the intrathoracic and most likely the intracardiac pressure after blunt chest injury. Traumatical patients with the same symptoms may be at risk of sudden death. Therefore, a high grade of suspicion is mandatory even without solid evidence of myocardial damage on the initial evaluation. In continue some hidden angles of this case was discussed. Given the prognostic implications of traumatic VSD with associated pseudoaneurysm, its detection has critical value for preventing its clinical sequelae.

The cost in human lives and injuries due to road traffic crashes are in the millions. Among the developing countries Iran bears a disproportionate burden of this cost. In March 8, 2012, the 1st International Road Safety Congress was held at the Razavi Neuroscience Center in Razavi Hospital, Iran to facilitate interaction among experts in the field for developing, establishing, and maintaining road safety initiatives and practices. Twenty-five scientists from around the world participated in this congress; alongside many local clinicians and scientists. Presentations include topics ranging from global road safety actions, children and road safety, as well as road safety research, infrastructure/management, and education. Suggestions were made in ways to share proposed road safety actions with relevant Ministries in Transportation, Health, Education, and Communication.