Injury patterns in cyclists attending an accident and emergency department: a comparison of helmet wearers and non-wearers.

OBJECTIVES--To study circumstances of bicycle accidents and nature of injuries sustained and to determine effect of safety helmets on pattern of injuries. DESIGN--Prospective study of patients with cycle related injuries. SETTING--Accident and emergency department of teaching hospital. SUBJECTS--1040 patients with complete data presenting to the department in one year with cycle related injuries, of whom 114 had worn cycle helmets when accident occurred. MAIN OUTCOME MEASURES--Type of accident and nature and distribution of injuries among patients with and without safety helmets. RESULTS--There were no significant differences between the two groups with respect to type of accident or nature and distribution of injuries other than those to the head. Head injury was sustained by 4/114 (4%) of helmet wearers compared with 100/928 (11%) of non-wearers (P = 0.023). Significantly more children wore helmets (50/309 (16%)) than did adults (64/731 (9%)) (P < 0.001). The incidence of head injuries sustained in accidents involving motor vehicles (52/288 (18%)) was significantly higher than in those not involving motor vehicles (52/754 (7%)) (chi 2 = 28.9, P < 0.0001). Multiple logistic regression analysis of probability of sustaining a head injury showed that only two variables were significant: helmet use and involvement of a motor vehicle. Mutually adjusted odds ratios showed a risk factor of 2.95 (95% confidence interval 1.95 to 4.47, P < 0.0001) for accidents involving a motor vehicle and a protective factor of 3.25 (1.17 to 9.06, P = 0.024) for wearing a helmet. CONCLUSION--The findings suggest an increased risk of sustaining head injury in a bicycle accident when a motor vehicle is involved and confirm protective effect of helmet wearing for any bicycle accident.     

The influence of airbag and restraining devices on the patterns of facial trauma in motor vehicle collisions

According to the National Highway Traffic Safety Administration (1990), there were more than 3 million motor vehicle collisions severe enough to lead to significant injury or fatality. Airbags may prevent brain and facial injury caused by these accidents. To date, however, no study has focused primarily on the correlation between facial injuries and the use of airbags and restraining devices. A retrospective analysis was performed on motor vehicle collision data submitted to the Pennsylvania Trauma Outcome Study database from 1990 through 1995. Criteria for submission to the database included admission to the intensive care unit, death during hospitalization, hospitalization for >72 hours, or transfer to or from the receiving hospital. There were 15,450 patients who sustained facial trauma (identified by ICD-9 codes) and were analyzed for patterns of injury and the presence or absence of protective devices. Protective devices were categorized into four groups: airbag alone, airbag with seatbelt, seatbelt or car seat without airbag, and no restraining devices. Statistical analysis was performed using chi-squared test of association. For contingency tables with small expected frequencies, Fisher's exact test was used. There were 9408 male and 6042 female subjects, with a mean age of 38 years (range, 3 to 98 years). There were 11,672 drivers and 3778 passengers. Airbags were deployed in 429 instances. In 276 of these cases, additional restraint was provided with a seatbelt. Airbags were not deployed in 4866 cases when a seatbelt or a car seat was used. In 10,155 cases, no restraining device was employed. There was significantly more facial trauma in patients without protective devices (p < 0.001). Drivers sustained significantly fewer facial fractures when airbags were used, either alone or in combination with a seatbelt (p < 0.001); however, there was no difference in the number of facial lacerations. Among passengers, airbags provided protection from lacerations (p < 0.001) but had no impact on the incidence of facial fractures. In collisions in which airbags were deployed, the use of a seatbelt provided no additional protection from facial fractures or lacerations. In summary, the use of any protective device decreased the incidence of facial fractures and lacerations sustained in motor vehicle collisions (p < 0.001). Airbags provided the best protection of all currently available devices.     

Non-fatal injuries sustained by back seat passengers.

Of 2,275 cases of non-fatal injuries sustained by all categories of road users 185 were inflicted on back seat passengers. Twenty-six such passengers sustained severe and 66 moderately severe injuries. Only two patients (aged 18 months and 3 years) wore any form of restraint. Back seat passengers may be injured by impact with the rear of the front seat or other objects in the rear compartment; by objects in the front compartment; or by being thrown out of the car completely. An adequate restraint system, such as the lap-and-diagnoal type of seat belt, would reduce the incidence and severity of injuries.     

Influence of restraining devices on patterns of pediatric facial trauma in motor vehicle collisions

In the Commonwealth of Pennsylvania, it is required that all children under the age of 4 years be restrained by an infant seat or car seat appropriate for their age and weight. Furthermore, all individuals riding in the front seat must be restrained by a seatbelt. This study examined the relationship between patterns of facial injuries and the use of restraining devices in the pediatric population. A retrospective analysis was performed on motor vehicle collision data submitted to the Pennsylvania Trauma Outcome Study database from 1990 through 1995. Criteria for submission included trauma patients who were admitted to the Intensive Care Unit, those who died during hospitalization, those who were hospitalized for more than 72 hours, or those who were transferred in or out of the receiving hospital. A subset of 412 pediatric patients, 15 years of age or younger, was analyzed for patterns of facial injury and the presence or absence of restraining devices. Restraining devices were categorized as a car seat or a seatbelt. Statistical analysis was performed using chi-square and Fisher's exact tests. Of the 412 pediatric patients, only 17 children were restrained with a car seat and 121 were wearing a seatbelt. A total of 30 children sustained facial fractures, and 50 children suffered facial lacerations. There was a statistically significant increase in the incidence of facial fractures with increasing age of the child (p < 0.001). Of children with facial fractures, 70 percent of those 5 to 12 years old and 90 percent of those 13 to 15 years old were unrestrained (p = 0.166). In conclusion, despite legislation mandating the use of restraints, a large proportion of children involved in motor vehicle collisions were unrestrained. Furthermore, there seems to be a direct relationship between the age of a child and the incidence of facial fractures sustained in motor vehicle collisions.     

Morbidity and mortality of car occupants: comparative survey over 24 months.

The severity of injuries sustained by 2577 car occupants in road traffic accidents in the catchment area of one district accident service during February 1982 to January 1984 inclusive was assessed using the injury severity score system. In the first 12 months the mean injury severity score for front seat occupants injured in a road traffic accident was 4.94 and in the second 12 month period, after the implementation of the seat belt law, the mean injury severity score of all injured front seat occupants was 2.80. These figures indicated a reduction in injury severity of front seat occupants of 53.4% on the previous 12 month figures. The severity of injury sustained by unbelted front seat occupants and back seat passengers showed no significant change over the two years. The number of front seat occupants killed or sustaining serious injuries (injury severity score greater than 12) showed a reduction of 54% in the 12 months beginning February 1983. Front seat occupants requiring admission for injuries sustained showed a decline of 42% in the 12 months after the introduction of the seat belt law, and deaths among front seat occupants fell by 27% compared with the previous 12 months. After the implementation of seat belt legislation those front seat occupants killed or sustaining serious injuries included a significantly higher proportion of victims who were not wearing their seat belts or showed positive evidence of alcohol intake at the time of the accident. This series suggests that the incidence of serious injury or deaths among front seat occupants of cars has decreased substantially since the seat belt law became effective on 31 January 1983.     

卡车与卡车前部碰撞驾驶员与前排乘车人损伤特征的研究

目的：研究道路交通事故卡车与卡车前部碰撞驾乘人员损伤特征,分析比较驾乘人员的损伤及损伤分布特点。方法：应用统计学方法对2001年-2010年昆明地区卡车与卡车200例前部碰撞人员损伤的法医学鉴定资料进行系统分析性研究。结果：1.驾驶员易发生损伤的部位是下肢、头颈部,其次为胸、腹部损伤。驾驶员易发生右下肢的损伤及骨折。驾驶员易发生颅骨骨折和肋骨骨折。2.前排乘车人员易发生损伤的部位是上肢、头颈部,其次为下肢,而胸腹部损伤较少见。前排乘车人员易发生上肢的损伤及双侧尺桡骨的骨折。前排乘车人员左侧头颈部受伤的几率大于驾驶员的相对部位。前排乘车人员易发生右肱骨骨折。结论：1.与前排乘车人相比,驾驶员易造成胸部、腹部及盆部、右侧下肢的损伤及右股骨胫腓骨的骨折,发生双侧上肢的体表损伤及尺桡骨骨折均明显少。在身体体表出现胸部、腹部及盆部多部位连续的损伤,有助于提高认定卡车驾驶员的准确性。2.与驾驶员相比,前排乘车人易形成左侧头颈部的损伤,上肢双侧尺桡骨骨折,右侧肱骨的骨折。当损伤位于身体左侧头颈部且有右侧肱骨的骨折,有助于提高认定卡车前排乘车人的准确性。     

Oral mucosal lesions in denture wearers

doi:10.1111/j.1741‐2358.2009.00289.x
Oral mucosal lesions in denture wearers Objective: To determine the prevalence of oral mucosal lesions (OMLs) and denture‐related mucosal lesions (DMLs) in denture wearers and to co‐relate the prevalence with age, gender, type of denture and any systemic conditions. Materials and methods: Dental records of 380 denture wearers were retrospectively reviewed for OMLs and DMLs. Results: We found 45% of the denture wearers had DMLs and 60.8% had OMLs not related to denture wearing. Although the prevalence of DMLs was higher in complete denture wearers than in partial denture wearers (49% vs. 42.2%), this difference was not significant. The most common DMLs were traumatic ulcer (19.5%) and denture‐induced stomatitis (18.1%). When analysed by type, traumatic ulcer, denture hyperplasia, frictional keratosis and candidiasis were more common in complete denture wearers, whereas denture‐induced stomatitis was more common in partial denture wearers. Frictional keratosis was more common in men than in women. The prevalence of OMLs not related to denture wearing was higher in complete denture wearers than in partial denture wearers, and the most common OML was fissured tongue (27.6%). No association between DMLs and systemic conditions or xerostomic drugs was noted. Conclusion: No differences in the prevalence of DMLs in association with denture type were found. The prevalence of OMLs not related to denture wearing was higher in complete denture wearers than in partial denture wearers. This difference was affected by age, and the data were similar to the findings observed in the elderly.     

Mixed feelings of children and adolescents with unilateral congenital below elbow deficiency: an online focus group study

The existing literature is inconsistent about the psychosocial functioning of children and adolescents with Unilateral Congenital Below Elbow Deficiency (UCBED). The objective of this qualitative study was to explore the psychosocial functioning of children and adolescents with UCBED in terms of their feelings about the deficiency and what helps them to cope with those feelings. Additionally, the perspectives of prosthesis wearers and non-wearers were compared, as were the perspectives of children, adolescents, parents and health professionals. Online focus group interviews were carried out with 42 children and adolescents (aged 8-12, 13-16 and 17-20), 16 parents and 19 health professionals. Questions were asked about psychosocial functioning, activities, participation, prosthetic use or non-use, and rehabilitation care. This study concerned remarks about psychosocial functioning. Children and adolescents with UCBED had mixed feelings about their deficiency. Both negative and positive feelings were often felt simultaneously and mainly depended on the way people in the children's environment reacted to the deficiency. People staring affected the children negatively, while support from others helped them to cope with the deficiency. Wearing a prosthesis and peer-to-peer contact were also helpful. Non-wearers tended to be more resilient than prosthesis wearers. Wearers wore their prosthesis for cosmetic reasons and to prevent them from negative reactions from the environment. We recommend that rehabilitation teams make parents aware of their great influence on the psychosocial functioning of their child with UCBED, to adjust or extend the currently available psychosocial help, and to encourage peer-to-peer contact.     

Pediatric and Youth Traffic-Collision Injuries in Al Ain,United Arab Emirates: A Prospective Study

Aim

To study the mechanism of road traffic collisions (RTC), use of safety devices, and outcome of hospitalized pediatric and youth RTC injured patients so as to give recommendations regarding prevention of pediatric RTC injuries.

Methods

All RTC injured children and youth (0–19-year-olds) who were admitted to Al Ain City’s two major trauma centers or who died after arrival to these centers were prospectively studied from April 2006 to October 2007. Demography of patients, road-user and vehicle types, crash mechanism, usage of safety devices, injured body regions, injury severity, Revised Trauma Score, Glasgow Coma Scale, intensive care unit admissions, hospital stay and mortality were analyzed.

Results

245 patients were studied, 69% were vehicle occupants, 15% pedestrians, 9% motorcyclists and 5% bicyclists. 79% were males and 67% UAE citizens. The most common mechanism of RTC was rollover of vehicle (37%) followed by front impact collision (32%). 32 (13%) of vehicle occupants were ejected from car. 63% of ejected occupants and 70% of motorcyclists sustained head injuries. Only 2% (3/170) vehicle passengers used seatbelts and 13% (3/23) motorcyclists a helmet.

Conclusions

Male drivers and UAE nationals were at high risk of RTC as drivers and as motorcyclists. Ejection rate was high because safety restraint use was extremely low in our community. More education and law enforcement focusing especially on car/booster seat use is needed.     

Seat-belt Injuries

The drivers and passengers of two cars which collided head-on all wore lap and diagonal seat-belts. Three of the four suffered ruptured viscera and two incurred flexion-compression fractures of the neck.A victim of a traffic accident who was wearing a seat-belt and who has superficial bruising or pain presents a difficult diagnostic problem. Visceral injury should be suspected in such cases.     

Helmet use improves outcomes after motorcycle accidents.

To determine the effects of motorcycle helmet use on the outcome of patients admitted to a Level I trauma center, we studied patient outcomes and demographic and epidemiologic variables of 474 patients injured in motorcycle collisions and treated at such a center over a 45-month period. Of those involved in a motorcycle collision, 50% were not wearing a helmet, 23% were wearing a helmet, and in 27% helmet use was unknown. Those who were wearing a helmet had fewer and less severe head and facial injuries, required fewer days on a ventilator, and sustained no serious neck injuries; fewer patients who wore helmets were discharged with disability, and hospital charges were lower. These data support the need for both increased public education regarding helmet use and mandatory helmet use legislation.     

The masseteric jaw-jerk reflex in older dentate subjects and edentulous denture wearers

The aim of the present study was to investigate any variations in the jaw-jerk reflex in edentulous subjects wearing complete dentures, compared to an age and sex-matched dentate group. The reflex was elicited by chin taps in 22 older dentate subjects with mean age 61.3 years and in 22 denture wearers with mean age 63.1 years. Surface electromyographic recordings were obtained from the masseter muscle of the preferred chewing side during mandibular rest and at moderate clenching (40% of the individual maximum clenching masseteric EMG activity). A jaw-jerk reflex was recorded in all subjects at least once, and its occurrence during clenching was reduced compared to rest. The occurrence of the reflex was however increased in the denture wearers in both experimental conditions, while minor differences were observed in the values for latency, duration and amplitude between the two dental status groups. These results suggest that under the present experimental conditions the periodontal ligament receptors might inhibit reflex activity. Multiple sensory interactions are expected in denture wearing. However a particular source of sensory feedback is provided by the stimulation of mucosal receptors from the acrylic denture base. Since the occurrence of the jaw-jerk at clench in the denture wearers was also reduced compared to the rest experiments, a potential inhibitory effect of the mucosal receptors can be speculated. According to the findings in the present study the loss of teeth and the rehabilitation with complete dentures do not severely disrupt the reflex activity investigated.     

Effectiveness of bicycle helmets in preventing head injury in children: case-control study.

OBJECTIVE--To examine the risk of injury to the head and the effect of wearing helmets in bicycle accidents among children. DESIGN--Case-control study by questionnaire completed by the children and their carers. SETTING--Two large children''s hospitals in Brisbane, Australia. SUBJECT--445 children presenting with bicycle related injuries during 15 April 1991 to 30 June 1992. The cases comprised 102 children who had sustained injury to the upper head including the skull, forehead and scalp or loss of consciousness. The controls were 278 cyclists presenting with injuries other than to the head or face. A further 65 children with injuries to the face were considered as an extra comparison group. MAIN OUTCOME MEASURES--Cause and type of injury, wearing of helmet. RESULTS--Most children (230) were injured after losing control and falling from their bicycle. Only 31 had contact with another moving vehicle. Children with head injury were significantly more likely to have made contact with a moving vehicle than control children (19 (19%) v 12 (4%), P < 0.001). Head injuries were more likely to occur on paved surfaces than on grass, gravel, or dirt. Wearing a helmet reduced the risk of head injury by 63% (95% confidence interval 34% to 80%) and of loss of consciousness by 86% (62% to 95%). CONCLUSIONS--The risk of head injury in bicycle accidents is reduced among children wearing a helmet. Current helmet design maximises protection in the type of accident most commonly occurring in this study. Legislation enforcing helmet use among children should be considered.     

Eye injuries in squash: a preventable disease.

As more Canadians are taking up squash the incidence of eye injuries is increasing dramatically. Over 2-1/2 years, 23 cases from one urban practice were examined. Almost half of the group required inhospital treatment. Five patients sustained a permanent decrease in vision; these cases involved three corneal scars, one cataract and one macular cyst. Patients wearing glasses or hard contact lenses appear to be more susceptible to serious eye injury. Experience does not appear to reduce the likelihood of eye injuries; the patients in this study had played squash for 5.6 years on the average. Consequently the medical profession must take the lead by encouraging squash players to use protective equipment now available to reduce the incidence of these injuries that pose so much personal hazard.     

Complete denture hygiene and nocturnal wearing habits among patients attending the Prosthodontic Department in a Dental University in Brazil

Gerodontology 2010; doi: 10.1111/j.1741‐2358.2010.00369.x Complete denture hygiene and nocturnal wearing habits among patients attending the Prosthodontic Department in a Dental University in Brazil Objective: The aim of this study was to evaluate the overnight wearing and cleaning habits of complete denture wearers. Background: Successful complete denture treatment can be achieved when the patients are motivated and aware of appropriate denture wear and hygiene. Materials and methods: A sample of 224 complete denture wearers (162 women) aged 37–89 years was studied. Inclusion criteria comprised edentulous subjects who had received their new complete dentures between 2000 and 2005 in the Dental Clinic of the Araçatuba and Araraquara Dental School, São Paulo State University. Ethical approval was sought and granted. Subjects were interviewed using questions related to overnight denture wearing and denture cleaning habits. Possible statistical relationships among some of items were analysed by the chi‐square test at 5% significance level. Results: Of the patients, 55.8% removed their dentures during the overnight period and 88% did this every day. Among them, 66.4% removed both dentures. Most of the patients used brushing with toothpaste (105 patients – 46.87%) as a cleaning method. More than a half of the subjects (63.4%) showed biofilm and calculus on their dentures. Conclusion: The patients need instructions and motivation concerning denture hygienic and denture removal overnight.     

Injuries to occupants in cargo areas of pickup trucks.

Transporting passengers in the cargo area of pickup trucks is a public health safety issue in the United States. Our study compared crashes involving passengers in the cargo area with those involving passengers in the cab. We obtained data for all injury events of pickup occupants for 1990 from the California Highway Patrol. A total of 702 traffic reports coded as having passengers riding in pickup truck beds involved 1,685 passengers in the cargo area and 865 in the cab. Significantly more events involving passengers in the cargo area occurred in summer in rural areas and were noncollisions than did events with only cab passengers. Crashes with passengers in the cargo area resulted in death in 5% of passengers. Of the drivers, 81% were male and 22% were younger than 20 years. Among the 1,685 passengers in the cargo area, 65% were male, 36% were younger than 15 years, and 30% were ages 15 to 19 years. Passengers in the cargo area were more frequently ejected and more seriously injured than their counterparts in the cab. Legislation to restrict travel in truck beds and the design of restraints for this area are some measures that may reduce the risk of injury.     

Contribution of alcohol to deaths in road traffic accidents in Tayside 1982-6

In Britain the precise number and relative proportions of deaths among drivers, passengers, and pedestrians in road traffic accidents related to alcohol are not known. These data were obtained in Tayside by cross matching police accident records with blood alcohol concentrations at necropsy. Of 71 alcohol-related deaths 30 were the drivers (or motorcyclists) themselves, nine were their passengers, 23 were pedestrians with raised blood alcohol concentrations, and nine were innocent victims.The high blood alcohol concentrations of the intoxicated drivers, passengers, and pedestrians, which may point to alcoholism, suggest that publicity campaigns will be of little value in reducing the number of deaths in road traffic accidents related to alcohol. The time at which these accidents occurred was related to licensing hours, and this should be taken into account when considering changes in licensing laws.     

Activation of CD38 by interleukin-8 signaling regulates intracellular Ca2+ level and motility of lymphokine-activated killer cells

CD38 is an ADP-ribosyl cyclase, producing a potent Ca(2+) mobilizer cyclic ADP-ribose (cADPR). In this study, we have investigated a role of CD38 and its regulation through interleukin-8 (IL8) signaling in lymphokine-activated killer (LAK) cells. Incubation of LAK cells with IL8 resulted in an increase of cellular cADPR level and a rapid rise of intracellular Ca(2+) concentration ([Ca(2+)](i)), which was sustained for a long period of time (>10 min). Preincubation of an antagonistic cADPR analog, 8-Br-cADPR (8-bromo-cyclic adenosine diphosphate ribose), abolished the sustained Ca(2+) signal only but not the initial Ca(2+) rise. An inositol 1,4,5-trisphosphate (IP(3)) receptor antagonist blocked both Ca(2+) signals. Interestingly, the sustained Ca(2+) rise was not observed in the absence of extracellular Ca(2+). Functional CD38-null (CD38(-)) LAK cells showed the initial rapid increase of [Ca(2+)](i) but not the sustained Ca(2+) rise in response to IL8 treatment. An increase of cellular cADPR level by cGMP analog, 8-pCPT-cGMP (8-(4-chlorophenylthio)-guanosine-3',5'-cyclic monophosphate), but not cAMP analog or phorbol 12-myristate 13-acetate was observed. IL8 treatment resulted in the increase of cGMP level that was inhibited by the IP(3) receptor blocker but not a protein kinase C inhibitor. cGMP-mediated Ca(2+) rise was blocked by 8-Br-cADPR. In addition, IL8-mediated LAK cell migration was inhibited by 8-Br-cADPR and a protein kinase G inhibitor. Consistent with these observations, IL8-induced migration of CD38(-) LAK cells was not observed. However, direct application of cADPR or 8-pCPT-cGMP stimulated migration of CD38(-) cells. These results demonstrate that CD38 is stimulated by sequential activation of IL8 receptor, IP(3)-mediated Ca(2+) rise, and cGMP/protein kinase G and that CD38 plays an essential role in IL8-induced migration of LAK cells.     

Predisposing conditions for Candida spp. carriage in the oral cavity of denture wearers and individuals with natural teeth

Candida species are a normal commensal present in a large percentage of healthy individuals. Denture wearers are predisposed to the development of candidosis and to the presence of Candida spp. The presence of the yeast, even in healthy subjects, should be considered more carefully. We investigated the prevalence of Candida spp. in 112 denture wearers and 103 individuals with natural teeth, patients from the clinic of total prosthesis of the Dental School of the Federal University of Minas Gerais, Brazil, and from the School of Pharmacy and Dentistry of Alfenas, Brazil. Factors like gender, age over 60 years, low education, and xerostomia were directly associated with the presence of Candida yeasts at a significance level of 5% (p > 0.05). However, the major predisposing factor for the carrier state was wearing dentures (p = 0.001). Candida isolates were identified using morphological and biochemical profiles. Seventy-one isolates were identified as C. albicans (65.1%), 15 as C. glabrata (13.7%), 8 as C. parapsilosis (7.3%), 3 as C. krusei (2.7%), and 12 as C. tropicalis (11.0%). Susceptibility testing to fluconazole and itraconazole was also performed with the strains obtained. Both drugs showed a strong inhibition against most oral isolates.