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At least 937 records · Page 52Linked to original sources
PubMed2004

A comparison of injury criteria used in evaluating seats for whiplash protection.

A protocol has been proposed for testing seats for whiplash protection, however injury criteria have not yet been chosen. Assuming that whiplash symptoms arise from non-physiological motions of vertebral segments, we determined the ability of proposed criteria to predict peak individual vertebral displacements. Twenty-eight volunteers were subjected to rear impacts while seated in a car seat with head restraint, mounted onto a sled. Accelerometers were used to record head and torso accelerations. The volunteer data was used as a basis for testing post-mortem human specimens (PMHS). The seat was replaced by a platform onto which was mounted each of 11 cervico-thoracic spines. An instrumented headform was mounted to the upper end of the spine. The head restraint, head-to-restraint geometry, sled, and impact pulse remained the same. Head and T1 accelerations were measured and individual vertebral sagittal (XZ) plane rotations and translations were obtained from high speed video. Proposed injury criteria (NIC, Nkm, Nte, Nd) were tested for their ability to predict average, total, and peak intervertebral displacements. PMHS specimens had chest and head X (horizontal) and Z (vertical) linear accelerations similar to volunteers whose heads hit the head restraint. The best predictors were: Nd shear and peak intervertebral posterior translation (r(2) = 0.80), Nd extension and peak extension angle (r(2) = 0.70), and Nd distraction and peak distraction (r(2) = 0.51). Therefore consideration should be given to a displacement based injury criteria such as Nd in assessment of whiplash protection devices.

Acceleration↗
PubMed1999

Usefulness of pulsed-field gel electrophoresis in assessing nosocomial transmission of pertussis.

During a 2-week period, three infants with a cough lasting at least 8 days with whoops, were admitted to the pediatric unit; Bordetella pertussis was isolated from nasopharyngeal aspirates collected from the three infants. Approximately 1 week later, a nurse working on the same unit developed influenza-like symptoms followed by whooping cough; B pertussis was isolated. Isolates from the nurse and from one of the infants were shown to be indistinguishable by pulsed-field gel electrophoresis. These data demonstrate that B pertussis transmission to healthcare workers is possible and emphasize the need to use respiratory protection devices (Droplet Precautions) for healthcare workers having close contact with infected children.

Adult↗
PubMed1990

Occupational and environmental hygiene assessment of fumigations with methyl bromide.

Use of methyl bromide for pest control fumigation may result in adverse exposure to three populations: the actual fumigators; other workers not actually involved in the fumigation; and the general public in the vicinity. The risk of exposure of these three target populations in Switzerland was investigated. The methodology was a combination of occupational hygiene surveys, including a preliminary hazard analysis, with a comprehensive assessment of the safety and health systems in use based on the 'Management Oversight and Risk Tree' (MORT) method [Knox and Eicher, MORT User's Manual, Revision 2. DOE 76-45/4 (1983)]. The target populations most concerned depend on the type of fumigation. Fumigators risk severe accidental exposure although they usually wear personal protection devices. In soil and chamber fumigation, workers not involved in the fumigation may undergo high exposure (75-100 pm for 1 h), far greater than the usual time-weighted average and short-term occupational exposure limits (5-20 ppm range). Occupants of premises adjoining the fumigated buildings may also be exposed to significant concentrations (25-50 ppm for 0.1-2 h). Problems originate mainly from a lack of management controls, failure to apply an appropriate code of practice and the use of personnel who are not properly qualified and trained.

Air Pollutants↗
PubMed2000

CYP1A1 and GSTM1 polymorphisms affect urinary 1-hydroxypyrene levels after PAH exposure.

Certain human biotransformation enzymes have been implicated in the formation and scavenging of the ultimate reactive metabolites, the diolepoxides, from polycyclic aromatic hydrocarbons (PAHs). In the present study, performed on aluminum smelter workers, we have analyzed airborne PAH, the pyrene metabolite 1-hydroxypyrene (1-OHP) in urine, and genotypes for biotransformation enzymes involved in PAH metabolism. The aim was to evaluate the correlation between external exposure and biomarkers of exposure and to investigate to what extent genetic polymorphism in metabolic enzymes can explain interindividual variation in urinary 1-OHP levels. DNA was prepared from blood samples from 98 potroom workers and 55 controls and altogether eight polymorphisms in the CYP1A1, mEH, GSTM1, GSTP1 and GSTT1 genes were analyzed. The 1-OHP excretion was found to correlate significantly (P </= 0.005) to the exposure. The interindividual difference in excretion of 1-OHP was vast (>100-fold) and univariate and multivariate regression analyses were used to find the variables that could determine differences in excretion. The variation could, to some degree, be explained by differences in exposure to airborne particulate-associated PAHs, the use of personal respiratory protection devices, smoking habits and genetic polymorphisms in the cytochrome P450 1A1, GSTM1 and GSTT1 enzymes. The part of the variance that could be explained by differences in biotransformation genotypes seemed to be of the same order of magnitude as the variance explained by differences in exposure. In the control group as well as in the occupationally exposed group, the highest 1-OHP levels were observed in individuals carrying the CYP1A1 Ile/Val genotype who were also of the GSTM1 null genotype. The results show that urinary 1-OHP is a sensitive indicator of recent human exposure to PAHs and that it may also to some extent reflect the interindividual variation in susceptibility to PAHs.

Aluminum↗
PubMed2005

Risk assessment of welders using analysis of eight metals by ICP-MS in blood and urine and DNA damage evaluation by the comet and micronucleus assays; influence of XRCC1 and XRCC3 polymorphisms.

The aims of the present study were to assess the occupational risk of welders using analysis of metals in biological fluids, DNA damage evaluation by complementary genotoxic endpoints and the incidence of polymorphisms in DNA repair genes. A biomonitoring study was conducted that included biometrology (blood and urinary concentrations of aluminium, cadmium, chromium, cobalt, lead, manganese, nickel, zinc by ICP-MS), comet and cytokinesis-block micronucleus assays in peripheral lymphocytes and genetic polymorphisms of XRCC1 (p.Arg399Gln) and XRCC3 (p.Thr241Met). This study included 60 male welders divided into two groups: group 1 working without any collective protection device and group 2 equipped with smoke extraction systems. A control group (n = 30) was also included in the study. Higher chromium, lead and nickel blood and urinary concentrations were detected in the two groups of welders compared to controls. Statistically differences between welders of group 1 and group 2 were found for blood concentration of cobalt and urinary concentrations of aluminium, chromium, lead and nickel. The alkaline comet assay revealed that welders had a significant increase of OTMchi2 distribution at the end of a work week compared to the beginning; a significant induction of DNA strand breaks at the end of the week was observed in 20 welders out of 30. The cytokinesis-block micronucleus assay showed that welders of group 1 had a higher frequency of chromosomal damage than controls. The XRCC1 variant allele coding Gln amino acid at position 399 was found to be associated with a higher number of DNA breaks as revealed by the comet assay. Increased metal concentrations in biological fluids, DNA breaks and chromosomal damage in lymphocytes emphasized the need to develop safety programmes for welders.

Adult↗
PubMed2006

A combined analysis of XRCC1, XRCC3, GSTM1 and GSTT1 polymorphisms and centromere content of micronuclei in welders.

The aims of the present study were to assess clastogenic and aneugenic properties of welding fumes using fluorescent in situ hybridization (FISH) with a human pancentromeric DNA probe. The involvement of genetic polymorphisms in DNA repair genes (p.Arg399Gln of XRCC1 and p.Thr241Met of XRCC3) and in detoxification genes (GSTM1 and GSTT1) on the centromere content of micronuclei (MN) was also evaluated. This study included 27 male welders working without any collective protection device and a control group (n = 30). The welders showed significantly higher levels of chromosome/genome damage compared to the controls. The frequencies of MN and centromere-positive MN (C+MN) per 1,000 binucleated cells were significantly higher in the exposed group than in the control group (7.1 per thousand +/- 3.7 versus 4.9 per thousand +/- 1.8; P = 0.012 and 3.5 per thousand +/- 1.8 versus 2.4 per thousand +/- 1.2; P = 0.018, respectively, Mann-Whitney U-test). The centromere-negative MN (C-MN) frequency was higher in the exposed subjects than in the controls (3.6 per thousand +/- 3.4 versus 2.5 per thousand +/- 1.4), but the Mann-Whitney U-test did not yield a significant result. In the total population, the GSTM1 and GSTT1 polymorphisms significantly affected the frequencies of C-MN and C+MN defined by FISH. GSTM1 positive subjects showed an increased C-MN frequency and GSTT1 null subjects showed an elevated C+MN frequency. When GSTM1 and GSTT1 genotypes were included in multiple regression analysis, the effect of the occupational exposure could better be demonstrated; both C+MN and C-MN were significantly increased in the welders. Our results suggest that the combined analysis of genetic polymorphisms and centromeres in MN may improve the sensitivity of the micronucleus assay in detecting genotoxic effects.

Adult↗
PubMed2000

Epidemiology of injuries: current trends and future challenges.

For the above challenges to be met, it will be important for the field of injury epidemiology to move from the largely descriptive studies that have predominated in the literature to the application of more rigorous analytical methods for defining the underlying casual patterns of injury. Studies focusing on the descriptive epidemiology of injury have and will continue to serve the field well, perhaps even more so than in other fields, since the proximal etiology of injuries (i.e., acute exposure to physical agents such as mechanical energy) is well known. However, major new advances in the prevention of injuries will continue to require a more analytical approach to understanding the complex array of factors that influence the incidence, severity, and outcomes of injury. At the same time, it will be important for investigators in this field to conduct rigorous evaluations of new interventions to better inform the establishment of programs and policies. These evaluations must include assessments of both the effectiveness and the costs of the intervention. For example, in a recently published systematic review of 10 different strategies for preventing motor vehicle injuries, 54,708 papers and reports were identified in the literature but only 161 met the initial screening criteria for inclusion in the published review (44). Of these, a much smaller number were randomized controlled trials or well executed controlled time series trials. Major advancements in the prevention and control of injuries will continue to rely on effective collaborations between epidemiologists and scientists from other disciplines, including the behavioral sciences, sociology, criminology, law, engineering, and biomechanics. Only through truly collaborative efforts across these disciplines will we be able to establish a foundation for cost-effective interventions. For example, understanding the principles of injury mechanics and the physical and physiologic responses of the human body to the impact of injury is fundamental to the study of injury causation (6). While significant advances have been made in this regard, more work needs to be done. The biomechanics of head injury are still not well understood, yet head injuries account for nearly 50 percent of all injury deaths and remain the leading cause of both injury death and disability among children and young adults. Animal and human cadaver research combined with rapidly evolving techniques of computerized modeling will continue to play a critical role in increasing our understanding of injury mechanisms. At the same time, the development of effective interventions is dependent on a better understanding of the role of behavior in injury causation and prevention (45). We know, for example, that the use of personal protective devices such as seat belts, car seats, and bicycle helmets reduces injury risk and that these behaviors can be influenced through educational, behavioral, and legislative strategies (46-49). Interventions addressing individuals at risk can be enhanced by additional research into risk perception, risk-taking, and behavioral responses to safety improvements. However, behavioral strategies may also be used effectively with key decision-makers who design and manufacture products and who pass and implement laws that affect the injury risk of entire populations; more research is needed to understand and influence the process of behavior change in these groups (50). The importance of injury as a major public health problem worldwide was highlighted in the seminal report "The Global Burden of Disease" (25). Worldwide, injuries account for approximately one in eight deaths among males and one in 14 deaths among females (51). Motor vehicle injuries alone constitute the ninth leading cause of disease burden as measured by the number of associated disability-adjusted life years (25). By the year 2020, motor vehicle injuries are projected to increase in rank to third. (ABSTRACT TRUNCATED)

Cause of Death↗
PubMedDate not supplied

A refined angioplasty and stenting technique may offer an alternative to carotid endarterectomy.

Strokes are the third leading cause of death in the United States. Carotid artery occlusive disease accounts for about 20% to 30% of all strokes. Carotid endarterectomy has been the traditional standard treatment for patients with significant carotid artery disease. However, surgical therapy is associated with significant complications. Carotid angioplasty and stenting offers an attractive alternative to surgery. There have been significant advances in this field including the use of embolic protection devices. In this article, we review the current literature addressing the role of endovascular interventions in the management of patients with significant carotid stenosis.

Angioplasty, Balloon↗
PubMed2004

Prevalence and patterns of foot injuries following motorcycle trauma.

OBJECTIVES: To determine the prevalence and patterns of foot injuries following motorcycle trauma. DESIGN: Prospective. SETTING: Yorkshire Region Trauma Units (Level 1 trauma centers with trauma research). PATIENTS: Individuals injured in motorcycle road traffic accidents between January 1993 and December 1999. OUTCOME MEASUREMENTS: Patient demographics, protective devices (helmet) use, Injury Severity Score (ISS), Glasgow Coma Scale (GCS), clinical details, therapeutic interventions, resuscitation requirements, duration of hospital stay, mortality, and type of foot injuries sustained. RESULTS: The parent population of 1239 contained 53 (4.3%) foot-injured motorcyclists (49 men) with a mean age of 31.7 years (range 18-79 years). Fifty-two were drivers and one was a rear-seat passenger. Mean ISS was 6.9 (range 4-33), significantly lower than the parent population mean of 34.98 (range 9-75) (P = 0.001). Mean GCS was 14.7 (range 13-15). The motorcyclists' injuries included 26 metatarsal fractures (49.1%), 14 talar fractures (26.4%), 7 os calcis fractures (13.2%), and 6 toe fractures (11.3%). Associated foot injuries included three partial foot amputations, four Lisfranc dislocations, three cases of foot compartment syndrome (two crush injuries with no fracture, one open fourth metatarsal fracture with associated Lisfranc dislocation). Forty-six motorcyclists had more than one foot injury. Associated injuries included 22 ankle fractures (41.5%), 15 tibial fractures (28.3%), 6 femoral fractures (11.3%), 5 pelvic ring fractures (9.4%), 23 upper limb injuries (43.4%), and 3 cases of chest trauma (5.7%). No one sustained abdominal trauma or head injury compared with the parent population. All patients required operative stabilization of foot fractures, including their associated injuries. Mean hospital stay was 10.9 days (range 1-35 days). In the parent population, there were 71 deaths (6.0%), whereas there was only 1 death (1.9%) in the foot-injured group (with fractures including open book pelvic, T6-8, unilateral open femur, tibial, ankle, and metatarsal) with an ISS 33, who died of multiorgan dysfunction syndrome. At final follow-up, all patients underwent radiologic and clinical assessment of foot injuries. Forty-three patients returned to their previous occupation and level of mobility. Ten of the more significantly injured patients had to modify their occupation from manual to sedentary-type jobs due to their foot injuries. We noted a pattern of complex ipsilateral foot and limb injury in nine patients, which we postulate was due to the actual mechanism of contact with the road surface. CONCLUSION: Motorcycle accidents continue to be a source of severe injury, especially to the foot. The most common foot injury is a metatarsal fracture; however, there must be a high index of suspicion for associated injuries. Although these injuries are associated with a low mortality rate, they require prompt assessment and treatment to limit long-term morbidity and disability. The difference in foot injury pattern and mortality between the parent population and our series, among other factors, potentially may be influenced by the actual mechanism of contact with the road surface and the modifying action of the foot during the accident.

Accidents, Traffic↗
PubMed1984

Severe thoracic and abdominal injuries associated with lap-harness seatbelts.

We report an unusual constellation of severe thoracic and abdominal injuries in a passenger restrained by a lap-harness seat belt during a high-speed automobile accident. This combination of injuries, which appears to have not previously been described, emphasizes the causative relationship of this protective device.

Abdominal Injuries↗
PubMed2002

Carotid angioplasty and stent placement: a prospective analysis of perioperative complications and impact of intravenously administered abciximab.

OBJECTIVE: To determine the frequency of perioperative complications since the introduction of abciximab, we prospectively evaluated our experience in a consecutive series of patients undergoing carotid angioplasty and stent placement (CAS). CAS has been introduced recently for treatment of carotid artery stenosis. A major limitation to this modality is the risk of perioperative thromboembolic and ischemic events. To reduce the risk of ischemic complications, abciximab, a platelet glycoprotein IIb/IIIa receptor inhibitor, has been introduced as adjunctive treatment for high-risk patients. METHODS: Each patient was evaluated by a neurologist before, immediately after, and 24 hours after CAS for identification and classification of new neurological deficits. Bleeding events or other complications during hospitalization were recorded. Bleeding complications were classified as major (hemoglobin decrease,g5 g/dl), minor (hemoglobin decrease, 3-5 g/dl), or insignificant. Abciximab was administered intravenously as a single bolus (0.25 mg/kg) and then via infusion (10 microg/min) for 12 hours as an adjunct to CAS in patients considered to be at high risk for thromboembolic events owing to recent ischemic symptoms and/or complex lesion morphology. RESULTS: Intravenously administered abciximab was used in 37 patients (mean age, 70 yr; 21 patients were men) as an adjunct to high-risk CAS. Thirty-three other patients underwent CAS performed with standard intraprocedural heparinization (mean age, 69 yr; 17 patients were men). Minor ischemic strokes were observed in 1 of 37 abciximab-treated patients and in 4 of 33 heparin-treated patients. No major ischemic strokes were observed in either group. Transient neurological deficits were observed in nine patients in the abciximab-treated group and in one patient in the heparin-treated group. Transient neurological deficits in abciximab-treated patients were mainly related to hemodynamic factors (associated with balloon inflation in two patients and with hypotension in another two patients) or occurred after completion of infusion (in three patients). Minor bleeding complications were observed in three patients who received abciximab and in four patients who received standard heparinization. Major bleeding complications were observed in four patients from each group. Two patients who received abciximab developed intracerebral hemorrhages; one hemorrhage was fatal. CONCLUSION: The frequency of ischemic stroke in high-risk patients (3%) with the use of intravenously administered abciximab was lower, but not significantly so, than rates observed in lower-risk patients (12%), although the benefit was lost because of the high rate of intracranial hemorrhages (5%). Further efforts are required to determine appropriate selection criteria for use of intravenously administered abciximab and the effect of other strategies that involve distal protection devices.

Abciximab↗
PubMed1978

Glenn A. Fry Award Lecture--1977. The ocular effects of ultraviolet radiation.

The author reviews the previous known effects of UV radiation on the eye together with results obtained on human and animal eyes in his laboratory during the past 11 years. Damage to the cornea and lens is assessed, classified, and discussed. Methods of calculating safe UV exposures and establishing characteristics of protective devices are presented.

Animals↗
PubMed1993

Diabetic wound healing and limb salvage in an outpatient wound care program.

Healing wounds and preventing amputations in diabetic patients is a challenge. Baptist Hospital in Nashville, Tennessee, developed an outpatient Wound Care Center program to treat patients with chronic wounds. This comprehensive program includes wound assessment, vascular studies, revascularization, antibiotic therapy, wound debridement, a topical growth factor solution of platelet-derived wound healing factors, protection devices, and patient education. A retrospective study of wound healing and limb salvage was conducted on 54 diabetic patients with 86 wounds. Average previous wound duration was 8 months. Amputation had previously been recommended for 15 limbs. Healing occurred in 88% of the wounds in an average of 15.8 weeks. Ninety-three percent of the limbs for which amputation had been recommended were salvaged. Healing efficacy and amputation reduction have been demonstrated in this program.

Administration, Topical↗
PubMed1993

Childhood sexual abuse, depression, and family dysfunction in adult obese patients: a case control study.

One hundred significantly overweight patients sequentially applying to a very low calorie diet (VLCD) program were interviewed to learn how the onset of obesity correlated with other life events. By comparison with a control group of 100 always-slender adults, the obese applicants were found to be different at a highly significant level in the prevalence of childhood sexual abuse, nonsexual childhood abuse, early parental loss, parental alcoholism, chronic depression, and marital family dysfunction in their own adult lives. The obese patients commonly reported using obesity as a sexually protective device; many reported overeating to cope with emotional distress. Inquiry into depression, past sexual abuse, and past or present dysfunctional family life should be added to the current medical evaluation of all obese patients. The resultant findings are likely to be relevant to their treatment, whether for obesity or for other medical conditions.

Adult↗
PubMedDate not supplied

A radiologic survey of various configurations of the lumbar spine.

This paper reports an investigation to determine whether or not human spine configurations can be categorized into types by which one could predict the possibility of disablement at one specific level more than another. Configurations of the lumbar spine, the shape of the lower two lumbar discs, the anterior and posterior heights of discs, the sizes of the transverse processes of L4-5, the presence or absence of rudimentery ribs, and the presence of transitional vertebrae were studied in roentgenograms of 554 subjects. They concluded that the probable criteria for development of L4-5 degeneration were 1) high intercrestal line passing through the upper half of L4, 2) long transverse process on L5, 3) rudimentary rib, and 4) transitional vertebra. Criteria for development of L5-S1 degeneration were 1) intercrestal line passing through the body of L5, 2) short transverse process on L5, 3) no rudimentary rib, 4) no transitional vertebrae. A high intercrestal line and long transverse process probably act as antitorsional devices protecting the L5-S1 disc; hence the likelihood of degeneration at L4-5 is increased.

Adult↗
PubMed1997

The effects of padded surfaces on the risk for cervical spine injury.

STUDY DESIGN: This is an in vitro study comparing cervical spine injuries produced in rigid head impacts and in padded head impacts. OBJECTIVES: To test the hypothesis that deformable impact surfaces pose a greater risk for cervical spine injury than rigid surfaces using a cadaver-based model that includes the effects of the head and torso masses. SUMMARY OF BACKGROUND DATA: It is widely assumed that energy-absorbing devices that protect the head from injury also reduce the risk for neck injury. However, this has not been demonstrated in any experimental or epidemiologic study. On the contrary, some studies have shown that padded surfaces have no effect on neck injury risk, and others have suggested that they can increase risk. METHODS: Experiments were performed on 18 cadaveric cervical spines to test 6 combinations of impact angle and impact surface padding. The impact surface was oriented at -15 degrees (posterior impact), 0 degree (vertex impact), or +15 degrees (anterior impact). The impact surface was either a 3-mm sheet of lubricated Teflon or 5 cm of polyurethane foam. RESULTS: Impacts onto padded surfaces produced significantly larger neck impulses (P = 0.00023) and a significantly greater frequency of cervical spine injuries than rigid impacts (P = 0.0375). The impact angle was also correlated with injury risk (P < 0.00001). CONCLUSIONS: These experiments suggest that highly deformable, padded contact surfaces should be used carefully in environments where there is the risk for cervical spine injury. The results also suggest that the orientation of the head, neck, and torso relative to the impact surface is of equal if not greater importance in neck injury risk.

Adult↗
PubMed2006

Treatment of aortocoronary graft lesions with graft-stents.

OBJECTIVE: Previous controlled trials do not indicate a superiority of the polytetrafluoroethylene membrane-covered stent graft compared with a conventional stent with respect to acute results, restenosis, or clinical event rates. We evaluated the outcome of stenting aortocoronary bypass grafts with polytetrafluoroethylene-covered stent. METHODS: The study included 64 patients who had 73 saphenous graft-stent implants. Clinical follow-up was obtained for a median of 6.2 months (1-9 months) for 54 patients. RESULTS: The mean age of the grafts was 9.2+/-6 years (2-14 years). Procedural success was achieved in 72 of 73 lesions (98.6%). One patient having an anterior Q-wave myocardial infarction died on the second day of procedure. Four patients (6.2%) sustained distal embolization and no reflow. No reflow was overcome after intracoronary administration of nitroglycerine and verapamil in two cases. At follow-up, stable angina pectoris had developed in 10 patients (18%), unstable angina pectoris in two patients (3.7%), acute myocardial infarction in two patients (3.7%), and cardiac death in one patient (1.8%). A total of 45 patients had a coronary angiogram at 6 months of follow-up or earlier, and restenosis at the target site was detected in eight of 53 lesions (15%). CONCLUSIONS: Saphenous graft lesions can be managed successfully with polytetrafluoroethylene-covered stents with acceptable long-term clinical outcome. Further and larger studies are needed to compare conventional stents, polytetrafluoroethylene-covered stents, drug eluting stents, and additional benefit of distal protection devices in these subgroups.

Aged↗
PubMed2003

Paragliding accidents--the spine is at risk. A study from a Swiss Trauma Centre.

In recent decades, paragliding-like other fashionable activities-has become a part of lifestyle and outdoor activities. The introduction of protective devices has helped to reduce the risk of severe injuries. However, it seems that the spine remains the paraglider's 'Achilles heel'. Better education, training, and the introduction of innovative back protectors are required to reduce the frequency and severity of paragliding injuries.

Accidental Falls↗