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PubMed2005

Occupational injuries among construction workers treated in a major metropolitan emergency department in the United States.

OBJECTIVES: The aim of this study was to profile construction workers' injuries for more information about the causes of nonfatal construction worker injuries and identify injury trends for further investigations and prevention programs. METHODS: An injury-tracking program for emergency departments was established in 1990 to gather the data needed for the study. Profiles were obtained for 2916 construction workers' injuries that were identified on hospital registration forms at the George Washington University Emergency Department in Washington, DC, from November 1990 through October 1997. Laborers and construction workers who did not specify a trade were combined, and together they made up the largest group--29% of the injured workers. RESULTS: The leading cause of injury was contact with cutting or piercing objects-most often pieces of metal, razors, knives, power tools, and nails. Workers striking against objects or being struck by objects (including falling objects) accounted for the second-largest group of injuries, and the third leading injury circumstance was falling--either from a height or on the same level. Detailed injury statistics are presented by trade, showing patterns of injury that reflect tasks of these trades and which injuries predominated in each trade. Although many previous reports have described construction workers' injuries, very few have provided detailed data by trade. CONCLUSIONS: The details presented in this analysis allow for a better understanding of the injury circumstances and provide a starting point for injury prevention programs.

Accidents, Occupational↗

PubMedDate not supplied

[Clinical and computed tomographic comparisons of analysis of the condition in children with brain injury of 13-15 scores by the Glasgow Coma Scale on admission to hospital].

Clinical and computed tomographic comparisons were made in 590 children with mild brain injury (BI). The children admitted for BI of 13-15 scores assessed by the Glasgow coma scale (GCS) in the first hour after injury were examined. They all underwent brain computed tomography (CT), skull X-ray study, and neurological studies. Their history data were analyzed. 73% of the children were admitted within the first 12 hours following injury. Falling from the growth height was mainly responsible for BI (45.2%). The frequency of the CT signs of BI was 36.3%. Surgical treatment was required in 5.8% of the children; among them 4.4% and 1.4% were operated on for depressed fractures and intracranial hematomas, respectively. A relationship was found between the presence of the CT signs of BI and the GCS scores on admission. With 15 and 13 GCS scores, the positive CT pattern was detected in 16 and 70% of cases. Well-defined focal neurological symptoms and multiple vomiting (38 and 57%, respectively) are predictors of acute pathology on a CT scan. X-ray skull fracture increases the likelihood of CT pathology up to 62%. Consciousness disturbance of as high as 13-14 GCS score concurrent with noticeable neurological symptoms and skull fracture increases the probability of the positive CT pattern up to 93%. X-ray and CT studies did not reveal acute traumatic injuries when there were traces of skull injury in the presence of clear consciousness and in the absence of vomiting.

Adolescent↗

PubMed1989

[Experimental studies on properties of mouth protector: evaluation of various materials dynamic energy absorption test with electrical shock sensor].

During contact sports, mouth protectors are very effective in protecting teeth from traumatic forces, which are usually great enough to fracture teeth or at least to damage their supporting structures. In addition, they reduce the force transmitted through the temporomandibular joint to the base of the skull. Athletes select mouth protectors from various view points, that is, energy absorption, comfortable seating, retention, durability, speech facility, lack of taste, and cleanliness. In this study, the physical properties of various highly polymerized compound materials were investigated in an attempt to select a suitable material for use as a mouth protector and to develop a new relevant mechanical test. Dynamic energy absorption tests were performed by positioning a specimen on the board and allowing a 12.7 mm diameter steel ball to fall from a predetermined height and measuring by electrical shock sensor. The following results were obtained: 1. Materials such as Rabaron S 371 C, Exaflex, Flexicon and Sorbosene (soft type), indicated highest value of energy absorption rate. 2. As the thickness of inner materials increased the energy absorption rate also increased and the logarithmic decrement decreased.

Humans↗

PubMed1995

Fast-roping injuries among Army Rangers: a retrospective survey of an elite airborne battalion.

Fast-roping is a modified rappelling technique used by civilian and military special operations forces that frequently produces injuries. Highly classified until recently, fast-roping is poorly understood from a medical perspective. This paper presents a brief description of fast-roping and a retrospective survey of the types of fast-roping injuries sustained in a U.S. Army Ranger battalion. Injuries are similar to parachute landing fall injuries, but show a greater propensity for ankle injuries (30% of all injuries). The mechanisms of injury include landing injuries after a controlled descent and falls from a great height when an individual loses control of the rope.

Adolescent↗

PubMed1998

Relation between image-based assessment of distal radius trabecular structure and compressive strength.

OBJECTIVE: To investigate the degree to which an image-based assessment of trabecular bone structure can predict bone strength. METHODS: Transaxial high-resolution magnetic resonance imaging (MRI) images and peripheral quantitative computed tomography (pQCT) images were obtained for a set of 9 isolated radii. Trabecular bone was segmented from fat, and indices relating to the connectivity of the bone network and the size of the marrow space were derived. Bone mineral density was also assessed in each radius by means of dual-energy x-ray absorptiometry and pQCT. Each bone was subjected to a mechanical load consistent with a fall from a standing height, and measures of density and trabecular structure were compared to the compressive load. RESULTS: In the 9 bones tested, measures of bone mineral density explained approximately 50% of the variability with load (0.52 < r2 < 0.57, p < 0.03), and indices relating to the size of the marrow spaces explained an additional 25% to 30% of the variance. This held true whether the indices quantifying the marrow space were derived from the MRI images (r2 = 0.70, p = 0.03) or the pQCT images (r2 = 0.82, p = 0.006). CONCLUSION: Our findings suggest that image-based assessments of trabecular bone structure relate to bone strength in vitro.

Absorptiometry, Photon↗

PubMed2005

Pediatric window falls: not just a problem for children in high rises.

BACKGROUND: Window falls are a frequent cause of injury (15/100,000) among Chicago preschool children. In Boston and New York, public health efforts have successfully decreased window fall injuries. Local data are needed to develop appropriate interventions for Chicago. OBJECTIVE: To describe the housing characteristics and types of injuries among children who fell from windows treated in a Chicago pediatric trauma center. METHODS: Children treated in a pediatric trauma center for injuries related to window falls between 1995 and 2002 were identified retrospectively. We reviewed family demographics, the circumstances of the fall, and types of injuries. Site visits were performed to determine the height and type of building and type of window where the fall took place. RESULTS: The authors reviewed 90 cases; 55 were male. The median age was 2 years. Ninety eight percent of falls were reported to be from the third floor or lower. Site visits (n=77) showed that 96% of the buildings were four storeys or lower. The median length of hospital stay was two days (range 0--24 days). The most common injuries were head trauma and extremity fractures. Three patients died, and an additional three patients were discharged to rehabilitation centers. CONCLUSIONS: Some window falls result in serious injury. In Chicago, most falls were from modest heights (2nd/3rd floor windows) in buildings of four or fewer storeys, rather than from "high rises". Strategies to prevent window falls should be directed to the owners and occupants of this type of housing.

Accidental Falls↗

PubMed1996

Korotkoff Sounds.

We were interested in the historical perspective that Arabidze et al. [1] brought to the subject of Korotkoff's auscultatory method of measuring blood pressure. The original description by the Reverend Stephen Hales performing the very first blood pressure measurement (which was actually published in 1733) does not make reference to a column of water as the authors suggest [2]. Hales wrote: 'Then untying the Ligature on the Artery, the Blood rose in the Tube eight Feet three Inches.'. He goes on to state that, 'When it was at its full Height, it would rise and fall at and after each Pulse two, three, or four Inches, and sometimes it would fall twelve or fourteen Inches, and have there for a time the same vibrations up and down at and after each Pulse, as it had, when it was at its full Height; to which it would rise again, after forty or fifty Pulses'. We believe this fall of '12 or 14 in' to have been the first description of blood pressure variability, which has wrongly been attributed to respirations by subsequent authors [3]. The mare's pulse rate was described to be about 50 beats per minute; therefore an unanaesthetized horse would not be likely to have a respiration rate of once per minute. One further important point of error concerning the Korotkoff sounds is their reproducibility. We have demonstrated recently that phase IV is reproduced or identified poorly, both in adults and even during pregnancy, when it has been recommended to be used in favour of phase V. We have also demonstrated that phase I (systolic blood pressure) is perceived to be significantly clearer than phase V [4].

Journal Article↗

PubMed1992

Height prognosis of children with true precocious puberty and growth hormone deficiency: effect of combination therapy with gonadotropin releasing hormone agonist and growth hormone.

We evaluated height prognosis and therapeutic efficacy of long-term, combination therapy with gonadotropin releasing-hormone agonist and growth hormone (GH) in five children (three girls) with coexistent precocious puberty and GH deficiency. Their clinical characteristics and growth response were compared with those of 12 girls with idiopathic true precocious puberty and eight prepubertal GH-deficient children (one girl). Precocious GH-deficient subjects were older than the precocious GH-sufficient children (9.5 +/- 1.8 years vs 6.5 +/- 1.3 years; mean +/- SD), but bone ages were comparable (12 +/- 3.7 years vs 10 +/- 0.9 years); their chronologic age was similar to that of the prepubertal GH-deficient children (9.6 +/- 2.1 years), but bone age was significantly more advanced (6.9 +/- 2.3 years). The mean height velocity of the prepubertal GH-deficient children (3.8 +/- 1.5 cm/yr) was lower than that of the precocious GH-deficient subjects (6.7 +/- 1.6 cm/yr) and the precocious GH-sufficient children (9.5 +/- 2.9 cm/yr). Baseline adult height prediction z scores were significantly lower in the precocious GH-deficient children (-3.7 +/- 1.0) than in either the precocious GH-sufficient children (-2.2 +/- 1.0) or the prepubertal GH-deficient subjects (-1.5 +/- 0.8). During therapy with gonadotropin releasing-hormone agonist, growth rates slowed to an average of 3.7 cm/yr in the precocious GH-deficient children but increased after the addition of GH to 7.4 cm during the first year of combination therapy. After 2 to 3 years of combination therapy, height predictions increased an average of 10 cm, compared with an increase of 2.8 cm in the precocious GH-sufficient group treated with gonadotropin releasing-hormone agonist alone. We conclude that combination treatment with gonadotropin releasing-hormone agonist and GH improves the height prognosis of children with coexistent true precocious puberty and GH deficiency, but falls short of achieving normal adult height potential.

Age Determination by Skeleton↗

PubMed1993

Self-reported height and weight and prevalence of obesity. Study in a Spanish population.

The objective of this investigation was to evaluate the usefulness of self-reported measures of height and weight under the hypothesis that they under-estimate the prevalence of obesity. A cross-sectional study was carried out on a random sample of the adult population of the province of León, Spain. The study involved 572 participants (262 men and 310 women). All participants were interviewed and questioned about socio-cultural characteristics plus their weight and height. All respondents were later weighted and measured for height using standard methods. A Quetelet or body mass index (BMI) > or = 30 kg/m2 was used as the index for obesity. Many people were unaware of their weight and/or height. Self-reported BMI could not be calculated in 40 men (15%) and 107 women participants (35%). This occurrence was more frequent in women than in men (chi 2 = 3.98; P < 0.05). The prevalence of obesity, based on measured weight and height, was 1.8 times that from self-reported values in men and 2.5 times that from self-reported values in women. If we consider only the measured values for those individuals who supplied self-reported heights and weights, these prevalences fall to 1.7 and 1.6 times those from self-reported values respectively. In addition, the difference between measured and self-reported height increase with age. All these differences are statistically significant. We believe that the use of self-reported values of weight and height in epidemiological studies should be avoided in an elderly population. These measurements could, however, be used on a younger population.

Adult↗

PubMed1984

Diffuse axonal injury in head injuries caused by a fall.

82 cases of diffuse axonal injury were found at necropsy in 635 patients with fatal nonmissile head injuries. 13 of these injuries were attributable to falls, and in all the patients fell from a considerable height. Diffuse axonal injury was not found in those with head injuries caused by a simple fall--ie, a fall from not more than the person's own height--but there was a statistically significant association between the presence of diffuse axonal injury and falls from a considerable height. These results indicate that diffuse axonal injury rarely, if ever, occurs as a result of a fall unless the patient has fallen some distance.

Accidents↗

PubMed2004

Characteristics of fallers who fracture at the foot, distal forearm, proximal humerus, pelvis, and shaft of the tibia/fibula compared with fallers who do not fracture.

This case-control study examined the relation of circumstances of falls and characteristics of fallers with risk of fractures at five sites among persons 45 years of age or older from five Kaiser Permanente Medical Centers in Northern California from 1996 to 2001. Included were distal forearm (n = 1,016), foot (n = 574), proximal humerus (n = 467), pelvis (n = 150), and shaft of the tibia/fibula (n = 141) cases who fell at the time of their fracture, and controls (n = 512) who reported falling in the year before the interview but did not fracture. Interviewers collected information by using a standardized questionnaire. Medium-/high-heeled shoes and shoes with a narrow heel increased the risk of all fractures, and slip-on shoes (adjusted odds ratio = 2.3, 95% confidence interval: 1.4, 4.0) and sandals (adjusted odds ratio = 3.1, 95% confidence interval: 1.5, 6.3) increased the risk of foot fractures. Falling from more than a standing height increased the risk of all fractures by two- to fivefold, while breaking the fall was associated with lower risks of all fractures except the distal forearm. Physical activity and hormone therapy were associated with lower risks of most fractures. These results suggest ways in which risks of fractures in older persons can be reduced.

Accidental Falls↗

PubMed2001

Fat content of the diet among preschool children in southwest Britain: II. relationship with growth, blood lipids, and iron status.

OBJECTIVE: In most countries, it is recommended that adults restrict fat intake to 30% to 35% of energy to reduce the risk of coronary heart disease and certain cancers. However, the appropriate level of fat in the diet of children is hotly debated. It has been generally accepted that fat intake by children under 2 years of age should not be limited because of fears that nutrient intakes and thus growth and iron status might be compromised. However, there is very little longitudinal information on the relationship between fat intake and growth in representative populations of free-living children under 2 years old. The objective of this study was to investigate the relationship between fat intake as a percentage of energy, and nutrient adequacy, growth, blood lipids, and iron status in 18- and 43-month-old children. DESIGN: This study forms part of the Avon Longitudinal Study of Parents and Children (ALSPAC)-a geographically-based cohort study in southwest England. A randomly selected subsample of the ALSPAC cohort attended research clinics approximately every 6 months from birth, at which a variety of anthropometric and other measurements were made. Dietary intakes at 18 and 43 months were assessed using a 3-day unweighed food record. A capillary blood sample was taken at 18 months for measurement of hemoglobin and ferritin levels. Nonfasting venous blood samples were taken at 31 and 43 months and analyzed for total and high-density lipoprotein cholesterol. The children were divided into quartiles of fat intake as a percentage of energy (QFI). QFI groups were compared for the number of children reaching recommended nutrient intakes, and for anthropometry, measures of iron status, and blood lipid levels. PARTICIPANTS: Nine hundred fifty-one children at 18 months and 805 children at 43 months. RESULTS: The mean (standard deviation) percentages of energy from fat in each quartile at 18 months were 31.2 (2.8), 36.1 (0.9), 39.1 (0.8), and 43.1 (2.2), corresponding to a fat intake in grams of 37.3 (8.1), 44.3 (8.1), 50.4 (10.2), and 55.4 (12.7). The number of children failing to reach recommended intake levels for zinc and vitamin A fell with increasing fat intake, while the number of children consuming less than the recommendations for iron and vitamin C rose at both ages. Despite this, there was no association between fat intake at 18 months and mean height or body mass index (BMI) at either 18 or 31 months. Fat intake at 43 months was also unassociated with concurrent or subsequent height or BMI. There was also no significant increase in the number of children falling below the tenth percentile for height or BMI as QFI fell. Mean ferritin levels at 18 months fell in both sexes as QFI increased. Total cholesterol levels at 31 months were significantly associated with QFI at 18 months, and rose from 3.99 mmol/l in the lowest QFI in boys, to 4.31 mmol/l in the highest QFI. QFI at 43 months was unassociated with cholesterol levels. CONCLUSIONS: These data do not suggest that fat intakes are an important determinant of growth in these children, even before the age of 2 years, or that children at the bottom of the range of fat intakes are experiencing delayed growth. On the other hand, there is also no evidence in this study that children on higher fat intakes are at a greater risk of becoming obese. In contrast to a number of US studies, we have not found children on lower fat intakes to have lower iron intakes-indeed higher fat intakes were associated with a greater chance of consuming less than the recommended intake of iron and with lower ferritin levels. The association of higher fat intakes with higher total cholesterol levels among boys is of concern, as there is evidence that the process of atherosclerosis begins during the preschool years.

Age Distribution↗

PubMed1997

Hip fractures. Epidemiology, risk factors, falls, energy absorption, hip protectors, and prevention.

The present review summarizes the pathogenic mechanisms leading to hip fracture based on epidemiological, experimental, and controlled studies. The estimated lifetime risk of hip fracture is about 14% in postmenopausal women and 6% in men. The incidence of hip fractures increases exponentially with aging, but the time-trend in increasing age-specific incidence may not be a universal phenomenon. Postmenopausal women suffering earlier non-hip fractures have an increased risk of later hip fracture. The relative risk being highest within the first years following the fracture. Nursing home residents have a high risk of hip fracture (annual rate of 5-6%), and the incidence of falls is about 1,500 falls/1,000 persons/year. Most hip fractures are a result of a direct trauma against the hip. The incidence of falls on the hip among nursing home residents is about 290 falls/1,000 persons/year and about 24% of these impacts lead to hip fracture. The force acting on the hip may reach 3.7 kN in falls on the hip from standing height, which means that only susceptible subjects will sustain a hip fracture in such falls. The effective load acting on the hip is 35% of the body weight in unprotected falls on the hip. Women with hip fractures have a lower body weight compared with controls, and they may also have less soft tissue covering the hip even when adjusted for body mass index, indicating a more android body habitus. Experimental studies show that the passive energy absorption in soft tissue covering the hip may influence the risk of hip fracture, and being an important determinant for the development of hip fracture, maybe more important than bone strength. External hip protectors were developed and tested in an open randomised nursing home study. The rate of hip fractures was reduced by 50%, corresponding to 9 out of 247 residents saved from sustaining a hip fracture. The review points to the essentials of the development of hip fracture, which constitutes; risk of fall, type of fall, type of impact, energy absorption, and lastly bone strength, which is the ultimate and last permissive factor in the cascade leading to hip fracture. Risk estimation and prevention of hip fractures may prove realistic when these issues are taken into consideration.

Absorption↗

PubMed1989

The relation between height, armspan and forced expiratory volume in elderly women.

Loss of height occurs with ageing. This could distort the relation between height and forced expiratory volume in 1s (FEV1) as age increases. Armspan, which approximates to height at maturity, does not fall with age and might, therefore, be a better linear variable to compare with age and spirometric volumes in older people. We studied the relation between age, height, armspan and FEV1 in 150 women aged 60-91 years. The mean value of span minus height was 4.7 cm (range -5 to +17). Standardized FEV1 (SD) in 5-year age bands between 60 and 80+ fell as follows: 1.79(0.52)1, 1.62(0.49)1, 1.38(0.41)1, 1.32(0.44)1, 1.15(0.48)1. When re-standardized using armspan, the values were: 1.76(0.48)1, 1.59(0.53)1, 1.37(0.46)1, 1.29(0.47)1, 1.11(0.54)1. The differences between the two standardized values in each age band were not significant. It was concluded that span measurements offer no advantage over height measurements in cross-sectional population studies of lung volume in old age. However, in subjects who cannot have their height measured, or who are known to have lost a substantial amount of height, armspan is a reasonable substitute measure of body size from which to calculate predicted FEV1 values.

Aged↗

PubMed2004

Effect of milking pipeline height on machine milking efficiency and milk quality in sheep.

This experiment studied the effect of milking pipeline height (mid- vs. low-level milking system) on milking efficiency and milk composition. The experiment was of 8 wk duration: 2 wk preexperimental period and 6 wk experimental, in crossover design (2 x 2). Ewes were milked in a 2 x 12 milking parlor with 2 milking pipelines set at a milking vacuum of 36 kPa with a pulsation rate of 180 cycle/min and ratio of 50%. Height of the milkline had no effect on yield of milk at the time of milking, yield after stripping, milk composition, SCC, and number of teatcup fall-offs. Nor did milkline height have any effect on milk lipolysis or on the distribution of fatty acids. The level of free fatty acids was higher in evening than in morning milk (60.5 vs. 25.6 mg/L). Likewise, the increase in the degree of lipolysis between the receiver (40.4 mg/L) and the refrigeration tank (45.8 mg/L) underlines the importance of the milk delivery line design. The parameters (time and flow rate) that define the first peak in the milk emission kinetics were statistically different between lines, so care must be taken when comparing milk emission curves from both types of pipeline.

Animals↗

PubMed1984

[The electrical discharge of Torpedo marmorata under normal conditions and during hypoxia and anoxia. I].

The electric discharge of Torpedo M. can be considered as an index of the metabolic activity of the electric lobe of C.N.S. In groups of 10 Torpedoes the electric charge was measured: the mechanical stimulus was obtained by the falling of different weights from a determinate height. The experiment was then repeated in conditions of hypoxia: a fall of the electric discharge values was observed. The experiment was also carried out considering the time: after 14 hours the condition of anoxia occurred.

Animals↗

PubMed1996

Secular trends in the growth of children aged 0-6 years in a rural Nigerian community.

Cross-sectional anthropometric measurements were taken between 1987 and 1990 in 673 children aged 0-6 years in Imesi Ile village, Nigeria. The height and weight curves obtained fall behind corresponding growth curves in the same community three decades previously. Mid-upper arm circumference values indicated moderate to severe malnutrition in 25.8% of children aged 1-5 years. The heights of 67.1% and weights of 59.7% of the children fell below the third percentile of a Nigerian equivalent of an international reference population standard. Possible reasons for deterioration of the nutritional status of children in the community include the prevailing adverse socio-economic conditions, changes in child rearing practices over the years, persistence of unsatisfactory living conditions and failure to sustain the implementation of innovative programmes previously introduced into the community. It is suggested that present programmes aimed at promoting the health of rural communities should be reviewed to improve sustainability and should be backed up by measures to improve socio-economic and living conditions.

Anthropometry↗

PubMed1998

Influence of diurnal blood pressure variations on target organ abnormalities in adolescents with mild essential hypertension.

As hypertensive target-organ damage has been associated with diminished diurnal blood pressure (BP) variation in adults, we compared diurnal BP patterns of hypertensive adolescents with left ventricular hypertrophy with normotensive and hypertensive adolescents with normal left ventricular mass. In addition, the frequency of microalbuminuria (Malb), hyperfiltration, and reduced renal functional reserve (RFR) was evaluated in adolescents with normal BP and untreated borderline and mild essential hypertension. Thirty-three normotensive (NT) adolescents, 14.5+/-2.1 years (mean +/- SD), and 29 untreated borderline and mildly hypertensive (HT) adolescents, 14.6+/-2.4 years, wore the SpaceLabs 90207 ambulatory BP monitor for 24 h. Left ventricular mass was measured by M-mode echocardiography and then indexed (LVMI) to the cube of height. Creatinine clearance (Clcr) and urine Malb was measured on 24 h collection and RFR by change in creatinine clearance after an oral protein load. Diurnal BP change was expressed as the absolute and percent day-night BP fall and cusum derived plot height (CPH) and circadian alteration magnitude (CDCAM). Groups were compared using analysis of covariance with adjustments for race, gender, and body mass index. All NT and 19 HT subjects (HT-1) had normal LVMI at 22.2+/-5.3 and 25.8+/-3.8 g/m3, respectively. Ten HT (HT-2) had increased LVMI of 36.9+/-5.2 g/m3. No significant difference was found for absolute or percent day-night BP fall or CDCAM between groups. Nocturnal systolic BP was correlated most closely with LVMI (r = 0.41, p = .001). Clcr, Malb, and RFR did not differ between the groups. In conclusion, adolescents with borderline and mild essential hypertension and left ventricular hypertrophy have similar levels of diurnal BP fall, urine Malb excretion, and RFR compared to normotensive and hypertensive adolescents with normal left ventricular mass.

Adolescent↗