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PubMed2005

Evaluation of a community-based handgun safe-storage campaign.

OBJECTIVE: Safe storage of firearms has been recommended as a means of preventing gun-related pediatric injuries, yet few interventions have led to significant improvements in storage practices. This study examined a multifaceted community education campaign to promote safe handgun storage and the campaign's impact on firearm locking and loading practices in households with children. METHODS: Beginning in 1997, a safe-storage campaign consisting of television and radio announcements, educational materials, billboards, and discount coupons for lock boxes was conducted in King County, Washington. The campaign evaluation used a quasi-experimental design and compared the intervention site with 9 control counties outside Washington State and west of the Mississippi River. Cross-sectional, random-digit-dial telephone surveys of handgun-owning households with children were conducted in all study counties both before the intervention in 1996 (n = 302) and again in 2001 (n = 255). The main analyses assessed whether greater improvements in household firearm-storage practices occurred between 1996 and 2001 in the intervention, compared with the control, counties. Primary outcomes were based on up to 3 handguns per household and included (1) all stored with trigger locks, lock boxes, or gun safes (formal locking devices), (2) all stored in lock boxes or gun safes, (3) any stored loaded, (4) any stored loaded without a formal locking device, and (5) any stored loaded and not in a lock box or gun safe. Data were also collected on up to 1 long gun per household; long-gun outcomes included (1) stored with a trigger lock or gun safe and (2) stored loaded. RESULTS: Overall, handguns and long guns were generally more likely to be stored locked and less likely to be loaded in 2001 compared with 1996, with these trends seeming to be more consistent in the intervention county. Even so, more than one quarter of households with children and handguns in 2001 failed to store all of their handguns with a formal locking device, and up to 8% continued to possess at least 1 loaded handgun that was not stored with a formal device. The majority of households that stored their handguns with formal devices used lock boxes or gun safes. Storage of handguns in lock boxes or gun safes became more common in both the intervention (adjusted odds ratio [aOR]: 1.71; 95% confidence interval [CI]: 1.03-2.84) and control households (aOR: 1.66; 95% CI: 1.01-2.72) between 1996 and 2001. None of the other measured changes reached statistical significance, such as storing any household handgun loaded (aOR: 0.71; 95% CI: 0.35-1.42 [intervention]; aOR: 1.08; 95% CI: 0.58-2.00 [control]) or keeping any household handgun loaded and not stored in a lock box or gun safe (aOR: 0.59; 95% CI: 0.22-1.55 [intervention]; aOR: 0.67; 95% CI: 0.30-1.49 [control]). Moreover, the intervention county did not experience significantly greater overall improvements in household storage practices for handguns or long guns than did control counties. CONCLUSIONS: In both the intervention and control counties, households were more likely to lock all handguns in 2001 compared with 1996. After accounting for temporal trends, this educational campaign, combined with economic incentives to purchase lock boxes, did not seem to significantly change safe storage practices in households with handguns and children. Even if the campaign did result in small improvements in firearm safe storage, simultaneous national and state-specific gun-safety activities or legislative efforts may have drawn increasing attention to gun-related issues in the control counties, thereby making it more difficult to identify effects of our specific handgun storage intervention.

Accident Prevention↗
PubMed2006

Safety belt use and the switch to primary enforcement, 1991-2003.

State seat belt laws have increased use rates and have reduced traffic fatalities, but tremendous variation exists in the laws. New Hampshire does not have a law, and 30 states have only secondary enforcement laws. Whereas primary enforcement allows an officer to issue a citation for any infraction, secondary enforcement permits a citation only if a motorist is stopped for another infraction first. We performed a cross-sectional time-series analysis of the impact of upgrading to primary enforcement on belt use rates for 47 states and the District of Columbia from 1991 to 2003. Our results suggest that states with secondary enforcement laws could increase belt use by 10 percentage points and improve public safety considerably by upgrading to primary enforcement.

Adolescent↗
PubMed2003

Mental disorder and serious violence: the victims.

BACKGROUND: Media representation of violence by people with mental disorder tends toward images of random, serious violence to strangers. Studies of general psychiatric patients do not support this representation, but include few cases of serious or homicidal violence. This study describes the relationship of mentally disordered offenders to victims of an attack that was serious enough to result in the offender's detention in a high-security hospital. Hypotheses tested were that perpetrators of stranger violence would be more likely than those targeting people they know to be male, nonwhite, and younger and have a violence history and less likely to have psychotic features. METHOD: A clinical register and record study of all patients with an index offense of interpersonal violence who were resident in English high-security hospitals Jan. 1, 1993, to June 30, 1993, was conducted. RESULTS: Among 887 men and 88 women, 33% had attacked strangers. After adjustment for the high proportion of men in this male-dominated population, men were still more likely than women to have attacked strangers. There was no independent association between stranger victimization and perpetrator's age, ethnic group, or violence history. Stranger victimization was, however, more likely to have been committed by those with personality disorder than those with psychosis. The most serious violence and homicide were more likely to be against intimates than strangers. CONCLUSION: Among patients selected for high risk to the public, high rates of stranger victimization would be expected. The rates appeared, however, only slightly higher than in other reported patient samples and lower than in an untreated sample. The safety of people close to such patients urgently needs improvement.

Adult↗
PubMed1993

Protocol for the Multicenter Acute Stroke Trial--thrombolysis study.

The rationale for the Multicenter Acute Stroke Trial (MAST) is presented in a companion article appearing in this issue. Acute ischaemic stroke is the third major cause of death in developed countries, and a major cause of disability. Despite a very poor prognosis, no treatment has demonstrated an efficacy in lowering the mortality and disability resulting from stroke events. Thrombolysis has been proven to reduce mortality in myocardial infarction, and it has been shown able to induce recanalisation when administered to acute stroke patients. A recent meta analysis of small-sized studies suggests that thrombolysis could offer some benefit to stroke patients, by reducing the mortality and severe invalidity by 56%; these results need to be confirmed in adequately designed and sized studies.

Brain Ischemia↗
PubMed2000

[Clinical utilization of magnetic resonance imaging for patients with cochlear implants].

To date, MR imaging is absolutely contraindicated in cochlear-implanted patients. The aim of this study is to document the potential value of MR imaging in such patients, without injurious or side effects and without technical device failure. After in vitro experimental testing, 25 cochlear implanted patients underwent MRI. Radiological evaluation was also possible. The use of 1-Tesla fast spin echo sequences minimised artifacts. All cochlear implants are still in working order; no changes in fitting data or a reduction in speech understanding were observed. MR helped to avoid other invasive medical procedures.

Austria↗
PubMed2003

[A cross-sectional survey on injection safety in health facilities in Wulong county, Chongqing city].

OBJECTIVE: To provide evidence for intervention measures on safe injection through a survey on the safety of injection in the health facilities in Wulong county, Chongqing city, China. METHODS: An investigation on injection safety was conducted among health care providers with a uniform questionnaire. RESULTS: Glass syringes which were not appropriately sterilized was found in 52.2% (12/23) of the health facilities. Injection practices were not correct in 31.4% (11/35) of the health facilities. Used disposable syringes were discarded directly without any disposal in 63.6% (21/33) of the health facilities. At least one of the unsafe injection practices mentioned above existed in 77.1% (27/35) of the health facilities. CONCLUSIONS: The main unsafe factors in the practice of injection are included: the practice to change needle but not syringe in penicillin allergic test and the injuries caused by used disposable syringes in medical staff. The important measures to improve injection safety were to train the medical staff on the knowledge about safe injection and the risks caused by unsafe injection, and to equip the health facilities with safe tools to destroy the used disposable syringes.

Adult↗
PubMed2003

Are hot tubs safe for people with treated hypertension?

BACKGROUND: People with hypertension are commonly warned to check with a physician before using a hot tub, but there is little literature on which to base this advice. We compared symptoms, heart rate, and systolic and diastolic blood pressure in response to 10 minutes of hot-tub immersion in a group of patients with treated hypertension and in a control group normotensive subjects. METHODS: We recruited 21 patients (18 men and 3 women aged 43-76 years) with stable, treated hypertension and 23 control subjects (14 men and 9 women aged 19-83 years) without hypertension. They were studied, in mid-afternoon, at a public facility. Systolic and diastolic blood pressure and heart rate were measured at baseline, during immersion in a hot tub at 40 degrees C and for 10 minutes after immersion. We asked each subject to report any symptoms. RESULTS: None of the subjects reported dizziness, chest pain or palpitations. During immersion, systolic blood pressure fell in both groups, from a mean (and standard deviation [SD]) of 144 (17) mm Hg to 122 (18) mm Hg in the hypertensive group (p < 0.05) and from 130 (14) mm Hg to 110 (17) mm Hg in the control group (p < 0.05). It returned toward baseline within 10 minutes after the subjects left the hot tub. Diastolic blood pressure also fell, whereas heart rate was increased in both groups. The hypertensive group showed a slightly lower maximal increase in heart rate than the normotensive group (5 [SD 5] v. 13 [SD 10] beats/minute, p < 0.05). INTERPRETATION: Immersion in a hot tub for 10 minutes lowers blood pressure in subjects with treated hypertension, but no more than in normotensive control subjects. Spending 10 minutes in a hot tub should be safe for most treated hypertensive patients.

Adult↗
PubMed1992

Early amniocentesis.

Early amniocentesis (EA) refers to any genetic amniocentesis performed prior to 15 weeks, 0 days' gestation. Because of technical problems, most practitioners stopped doing amniocenteses prior to 15 weeks' gestation in the late 1970s. The development of ultrasound-monitored needle insertion has allowed improved success and safety of sampling at earlier gestations, and improvements in laboratory techniques have allowed a high degree of success in culturing and processing low-volume samples. We present information on 1,805 early amniocenteses, of which 35% were performed prior to 14 weeks, 0 days' gestation. Our data indicate that with operator experience the success rate of the procedure can be similar to that seen with routine amniocentesis and that laboratory experience is not different from that with routine amniocentesis (RA) as measured by culture success, time to completion and accuracy. Pregnancy outcome, as measured by the gestational age at delivery, mode of delivery, birth weight and Apgar score, is indistinguishable between RA and EA patients. Although a randomized study is needed to accurately evaluate the fetal loss rate, the rate of birth defects and incidence of neonatal complications associated with EA procedures and examination of the crude rates for the above three parameters show that they compare favorably to the rates reported for patients who have undergone chorionic villus sampling or RA.

Abortion, Spontaneous↗
PubMed2004

Adherence to physical activity in young people with type 1 diabetes.

Regular physical activity plays a key role in the management of children and adolescents with Type 1 diabetes mellitus but it is not considered as a treatment for diabetes. Aim of this study was to investigate time spent exercising, adherence to the programme for a safe exercise and ability of young people with diabetes to take appropriate measures to reduce potential risks. Ninety one Type 1 diabetes mellitus young people (aged from 10 to 18 years, duration of diabetes longer than 6 months) without associated chronic diseases were randomly enrolled in the study. Age, sex, weight, height, BMI, duration of disease, mean HbA1c value over preceding 6 months have been collected. The time weekly spent for physical activity, the type of exercise usually performed, the measures taken to reduce exercise risks have been collected by a structured questionnaire. BMI was 21.6+/-3.05 in the boys and 21.3+/-3.63 in the girls. All patients spent exercising 438+/-221 minutes/week. Boys exercised 71 minutes longer than girls in competitive sports. Children exercising less than 60 minutes weekly showed a mean HbA1c level (8,9+/-05%) higher than that found in children exercising 120-360 minutes (8,3+/-0.4 %; p=0.002) or 360-480 minutes (8,0+/-0.6 %; p< 0.01) weekly. Children attending a competitive sport (at least 360 min per week) had a better glycemic control (HbA1c=7,39+/-0.6 %; p=0.03) than other active peers. Fifty percent of patients reported to monitor blood glucose levels during exercise; 32 % changed insulin dose according to blood glucose levels; 60 % usually added carbohydrate-based foods before (35%), during (15%) or after (10%) exercise. Hypoglycemic episodes (37.7%) were reported more frequently than hyperglycemic ones (p=0.024), but only twelve percent of them were symptomatic and appeared 30 minutes to 2 hours after the end of exercise. These results must encourage health care professionals to review regularly the ability of their patients in managing physical activity and to check their adherence to the program for a safe exercise.

Adolescent↗
PubMed2005

[Rationale, characteristics and study design of PREAMI (Perindopril and Remodelling in the Elderly with Acute Myocardial Infraction)].

Angiotensin-converting enzyme (ACE) inhibitors reduce mortality and morbidity in patients with heart failure and/or left ventricular systolic dysfunction and in patients with acute myocardial infarction (AMI), especially those with heart failure and/or evidence of left ventricular systolic dysfunction. ACE-inhibitors prevent cardiac events in patients at high cardiovascular risk and/or with documented coronary artery disease. There is a lack of data on the role of ACE-inhibitors in the elderly population with AMI and preserved left ventricular function. Nevertheless, the issue is of primary importance, considering the median age of patients with AMI and heart failure, the high risk of death, heart failure and left ventricular remodeling in the elderly, and the progressive aging of the general population. The multicenter and international (109 centers from five European countries), double-blind, randomized, parallel PREAMI (Perindopril and Remodelling in the Elderly with Acute Myocardial Infarction) trial evaluated the effects of the ACE-inhibitor perindopril in the elderly (aged > or =65 years) with AMI and preserved or mildly depressed left ventricular systolic function (ejection fraction > 40%). The combined primary endpoint was death, hospitalization for heart failure, and left ventricular remodeling (considered as an increase in left ventricular end-diastolic volume > or = 8%). Secondary endpoints included: each single primary endpoint, cardiovascular death, hospitalization for reinfarction or angina, and revascularization. The study involved 1252 patients, with an average age of 73 years, and AMI, treated with recommended usual therapy (antithrombotic drugs, beta-blockers, ACE-inhibitors). After 11 +/- 4 days from AMI, patients were randomized to receive either perindopril (4 mg/day for the first month and 8 mg/day for the remaining 11 months) or placebo, in addition to the recommended conventional therapy. Clinical assessment was performed at fixed times and included two-dimensional echocardiography (to evaluate left ventricular remodeling), Holter electrocardiographic monitoring (to assess heart rate variability and arrhythmias), and blood sampling (for safety evaluation). This review provides details on the background, rationale and study design of PREAMI.

Age Factors↗
PubMed1990

Fetal blood sampling from the intrahepatic vein: analysis of safety and clinical experience with 214 procedures.

Transabdominal fetal blood sampling under ultrasonic guidance was performed at the intrahepatic vein on 214 occasions in 177 fetuses. In 72 cases, an intravascular transfusion was also attempted at the same site. In 91.1% of the samplings, more than 1 mL of pure fetal blood was obtained, and in 89.9% of transfusions, fetal hematocrit or platelet concentration was raised to a satisfactory level. Fetal bradycardia and intraperitoneal bleeding occurred in 2.3% of the cases. Among fetuses at low risk, there was only one intrauterine death, which occurred 3 weeks after the procedure, and one spontaneous abortion in a patient with twin pregnancy. In fetuses with Rh/Kell alloimmunization or perinatal alloimmune thrombocytopenia, the survival rate was 86%. Four liver enzymes were assayed in the blood of 13 fetuses that underwent transfusions at the intrahepatic vein and 13 controls in whom the site of sampling was the umbilical vein at the placental cord insertion. No differences were found between the groups at the subsequent transfusion 2-5 weeks later. The intrahepatic vein is an alternate site of sampling/transfusion when access is difficult or failure occurs at the placental cord insertion. This approach minimizes the risks of fetal blood loss, fetomaternal hemorrhage, arterial vasospasm, and cord tamponade.

Blood Specimen Collection↗
PubMed1989

Mood elevating effect of fluoxetine in a diagnostically homogeneous inpatient population with major depressive disorder.

According to severity of depressive symptomatology 14 inpatients with major depressive disorder (RDC) were assigned to 2 groups of 7 patients each with 6 of them receiving fluoxetine 60-80 mg/day and 1 receiving placebo in each group in a double-blind manner. After the treatment period of 35 days clinical improvement as assessed by standardized rating scales was more pronounced in the moderately depressed patients. There were no substantial side-effects in the 2 groups. These findings corroborate previous results from outpatient studies in more heterogeneous patient samples demonstrating safety and antidepressive efficacy of fluoxetine.

Adult↗
PubMed1987

Chorionic villus sampling: counseling your patient.

Chorionic villus sampling is a technique for prenatal genetic screening that has been widely publicized by the print and television media. Although not yet commonly available, women may seek additional information about the procedure from nurse practitioners. This article discusses the women for whom this procedure is most appropriate, the procedure's accuracy, sampling techniques, safety records and the procedure's accessibility and cost. The NP's role in counseling and anticipatory guidance is also discussed.

Chorionic Villi↗