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PubMed1996

Trends in the nutritional status of Salvadorian children: the post-war experience.

This article examines trends in the nutritional status of children in EI Salvador between 1988 and 1993 (before and after the signing of a peace accord that ended the civil war.) The data derive from two national surveys, each of which included measurements of the height and weight of children aged 3-59 months. The prevalence of low weight-for-age (< -2 SD) dropped from 15% in 1988 to 10.5% in 1993. The prevalence of low weight-for-height (< -2 SD) was minimal in both surveys: falling from 3.9% to 2.9%. The prevalence of low height-for-age (< -2 SD) fell from 28.1% to 22%. These declines in malnutrition indicators resulted from an upward shift in the distributions of weight and height of children, not from thinner lower tails of the distributions. The quality of anthropometric data appears to be high for both surveys: < 1% of surveyed children had heights or weights outside the expected range. This analysis demonstrates the value of repeated surveys of nutritional status.

Adult↗

PubMed2006

Patterns of injury associated with routine childhood falls.

OBJECTIVE: To identify the pattern of injuries associated with routine childhood falls. METHODS: Retrospective chart review of patients at most 12 years presenting to a children's hospital emergency department with complaint of a fall. Patients were classified into 3 age groups (<2, 2-4, and 5-12 years) and analyzed for the type of fall and diagnosis. RESULTS: Seven hundred eighty-seven patients were enrolled. Mean age was 5.7 years. Fifty-six percent were boys. The types of falls reported were categorized as a fall down steps, from patient's own height, from an object, and other. In all 3 groups, the most common fall was fall from an object (50%, 50%, and 48%, respectively). There were 91 (12%) patients in the younger-than-2-year-old age group and 235 (30%) in the 2- to 4-year-old age group. Both groups commonly fell from a bed/chair (35% and 25%, respectively). In the youngest group, the most frequent diagnosis was head injury (41%; odds ratio [OR], 5.0; 95% confidence interval [CI], 3.0-8.1). Children ages 5 to 12 years numbered 461 (58%) and most commonly fell from playground equipment (26%) sustaining a fracture (65%; OR, 3.1; 95% CI, 2.3-4.3). Of these, 77% were in the upper extremity (arm fracture; OR, 41; 95% CI, 22-79). CONCLUSIONS: In children who presented to a children's hospital emergency department with a fall, fall from an object was the most common type. Those younger than 2 years, most commonly fell from a bed/chair and sustained head injury. Children 5 to 12 years old were likely to fall from playground equipment and fracture their arm. These findings may be helpful to clinicians who evaluate routine childhood falls.

Accidental Falls↗

PubMed1999

Fatal occupational injuries among electric power company workers.

Surveillance data suggest high rates of electrocutions and fatal falls among workers in electric utility companies, who may be exposed to electric current, heights, flammable agents, and frequent motor vehicle travel. To characterize the occurrence of fatal injuries among electric utility workers, we studied workers in five electric power companies in the United States. A cohort of 127,129 men hired between 1950 and 1986 was followed through 1988. Injuries at work were identified through manual review of death certificates. The occurrence of occupational injuries was analyzed with directly adjusted rates and Poisson regression. The overall rate of fatal occupational injuries was 13.20 per 100,000 person-years (n = 192), with 76% due to electric current, homicide, and falls from heights. Deaths were concentrated in a few groups with elevated injury rates, notably linemen (rate ratio (RR) 3.33), electricians (RR 2.79), and painters (RR 3.27). Occupations requiring daily work on elevations or frequent, direct contact with energized electrical equipment experienced markedly higher rates of fatal injury from falls and electrocutions with rate ratios of 21.8 (95% confidence interval (CI) 11.4-41.5) and 16.7 (95% CI 6.6-42.6), respectively, independent of worker age and seniority. Although fatal injury rates in this industry have declined in recent decades, significant numbers of deaths still occur. Based on the premise that all injuries are preventable, a need for continued vigilance and efforts at prevention is indicated.

Accidental Falls↗

PubMed1976

Effects of oral versus intravenous nutrition on intestinal adaptation after small bowel resection in the dog.

To study the influence of luminal nutrition on the structural and functional adaptive changes which are seen in the residual intestine after partial small bowel resection, quantitative histology, in vitro uptake of 14C l-leucine, mucosal enzyme activities, and in vivo absorption of glucose were studied before and 6 weeks after 50% proximal small bowel resection in 10 greyhound dogs, 5 of which were nourished exclusively by the intravenous route while 5 were pair-fed by mouth. In the orally fed jejunectomized dogs, the ileum became dialed with mucosal hyperplasia, the villus height increased from 796 +/- SEM 26 mum to 1102 +/- 28 mum (P less than 0.001), and there was a corresponding increase in glucose absorption in vivo (milligrams -centimeter of intestine -1min-1) from 5.3 +/- 1.2 to 10.1 +/-1.6. The increased absorption seems mainly caused by the dilation and villus hyperplasia, since there was no significant change in in vitro absorption and mucosal enzyme activity when expressed per unit weight of intestine. In the absence of exogenous luminal nutrition, the well nourished intravenously fed dogs showed no evidence of functional adaptation and a significant fall in mean ileal villus height from 823 +/-48 mum at the initial operation to 732 +/-57 mum 6 weeks after jejunectomy. These results provide the most direct evidence to date that luminal nutrition is essential for the development of intestinal adaptation after resection. They also suggest that luminal contents are necessary to maintain the structural and functional integrity of the normal small bowel.

Adaptation, Physiological↗

PubMedDate not supplied

Growth patterns of school-children in Bahrain.

The aim of this study is to assess physical growth of school children in Bahrain. Cross-sectional data on 1593 children (818 boys and 775 girls), aged 6.5 to 18.5 years were collected in 1986. Anthropometric measures included height, weight, mid-arm circumference, triceps, biceps, subscapular and suprailiac skinfold thickness. At all ages median (P50) heights and weights of Bahraini boys and girls are below the 50th percentiles of the North American reference standard (NCHS). Median heights of both Bahraini sexes falls between the 25th and 5th percentiles of the reference data. As for weight, the median of boys fluctuates between the 25th and 5th percentiles, while that of girls fluctuates between the 50th and 10th percentiles of the standard. When compared to the American standard, median triceps skinfold of Bahraini boys and girls falls between the 50th and 25th percentiles. The median arm circumference of both sexes is close to the 5th percentiles. In general, the skinfold measurements indicate a high subcutaneous fat store, suggesting a lack of muscle development. Health, genetic and other factors associated with growth patterns of Bahraini children are discussed.

Adipose Tissue↗

PubMed2004

Profile of children with head injuries treated at the trauma unit of Red Cross War Memorial Children's Hospital, 1991 - 2001.

OBJECTIVE: To describe the profile of childhood head injury patients treated in a trauma unit. DESIGN: A retrospective record-based study. SETTING: The trauma unit of the Red Cross War Memorial Children's Hospital. SUBJECTS: Children (under 13 years of age) presenting with head injuries between January 1991 and December 2001. RESULTS: Of the almost 94 000 records, more than one-third were children presenting with head injuries. Fifty-nine per cent were boys, with more than half the sample under 5 years of age. The majority of children presented with superficial lacerations and abrasions, mostly affecting the scalp and skull. Injuries were mainly caused by falls from a variety of heights, and traffic-related injuries. Almost two-thirds of traffic-related injuries involved children as pedestrians being struck by a motor vehicle. More than 60% of injuries occurred in or around the child's own home. CONCLUSIONS: Head injuries in children are a significant cause of morbidity. Prevention, especially in the home and on the streets, needs urgent attention.

Accidental Falls↗

PubMedDate not supplied

Birth to age 7 growth of children prenatally exposed to drugs: a prospective cohort study.

Prenatal exposure to cocaine, alcohol, and cigarettes has been linked to decreased birth weight and length. Unclear, however, is whether growth deficits persist into childhood. Women who were pregnant, African-American, not HIV-positive, and who delivered singleton infants were extensively screened throughout pregnancy for cocaine, alcohol, cigarette, and other illicit drug use. Of the approximately 1100 eligible subjects, 665 families were located at a 7-year postbirth follow-up and 540 participated. After appropriate control for potential confounders and prenatal exposures, prenatal exposure to cocaine, alcohol, and cigarettes each independently predicted birth weight and length. At age 7, prenatal cocaine exposure was significantly related to height deficits after accounting for other prenatal exposures and significant confounders. Children at age 7 exposed to cocaine in utero were up to 1 in. shorter and twice as likely to fall below the 10th percentile in height as the control children after accounting for other significant confounders including other prenatal exposures. Maternal age moderated the relation between prenatal exposures and child growth. Children born to women over 30 and exposed to cocaine were up to 2 in. shorter and four times more likely to have clinically significant height deficits at age 7. Children of older women and exposed to moderate-to-high levels of alcohol prenatally were up to 14 lb lighter and five times more likely to fall below the 10th percentile in weight. Similar growth restriction was not associated with prenatal exposures for children born to younger mothers. These outcomes add to the growing body of literature detailing long-term effects of prenatal drug exposure, suggesting differential effects for cocaine and alcohol, and indicating that maternal age may moderate these effects. Mechanisms for growth restriction and failure of catch-up under conditions of prenatal exposures are presented, suggesting further study of these developmental outcomes.

Adult↗

PubMed1999

Combined use of growth hormone and gonadotropin-releasing hormone analogues in precocious puberty: theoretic and practical considerations.

The rationale underlying the use of gonadotropin-releasing hormone analogues (GnRHa) to treat patients with central precocious puberty is reviewed. GnRHa are now considered the treatment of choice for patients with central precocious puberty, but the adult heights that these patients attain often fall short of what would be expected according to their genetic potential. This has led to investigations of whether adding growth hormone to GnRHa therapy can improve adult height. The results of recent combination trials are presented and analyzed.

Body Height↗

PubMed1990

Relationship of the morbidity of under-fives to anthropometric measurements and community health intervention.

In a 3-year prospective morbidity study in seven villages of northeast Thailand the health of preschool children was assessed every alternate week by questioning the mothers. The nutritional status was determined by weight-for-age, weight-for-height and height-for-age every third month. In four villages active measures were undertaken to improve the health and nutritional status of the children. A child had an average of 2.5 illness episodes and was ill 14.1 days per year. More than 80% of all illness episodes could be accounted to ill-defined infections such as fever and cough with only 5.2% accountable to diarrhoea. A marked decline in the rate of illness episodes was observed in communities where cooperation was good. Weight-for-height is a better indicator for determining children at risk of falling ill than weight-for-age and height-for-age. The duration of illness episodes was not related to the nutritional status.

Body Height↗

PubMed2000

Incomplete ventricular septal rupture following blunt chest trauma.

Nonpenetrating cardiac trauma should be considered in the diagnosis of electrocardiographic changes after road traffic accidents. Transesophageal echocardiography is the most useful noninvasive technique for the diagnosis of cardiac trauma. This paper reports the case of a patient with traumatic contusion of the ventricular septum following a fall from a 20 m height onto the roof of a car.

Adult↗

PubMed2003

Evaluation and management of osteoporosis following hospitalization for low-impact fracture.

OBJECTIVE: To evaluate the pattern of osteoporosis evaluation and management in postmenopausal women who present with low-impact (minimal trauma) fracture. DESIGN: Retrospective chart review of patients admitted with a fracture in the absence of trauma or bone disease. Telephone follow-up survey was conducted at 12 months after discharge to collect information on physician visits, pharmacological therapies for osteoporosis, functional status, and subsequent fractures. PATIENTS/PARTICIPANTS: Postmenopausal women admitted to a hospital in St. Paul, Minnesota between June 1996 and December 1997 for low-impact fractures were identified. Low-impact fracture was defined as a fracture occurring spontaneously or from a fall no greater than standing height. Retrospective review of 301 patient medical records was conducted to obtain data on pre-admission risk factors for osteoporosis and/or fracture, and osteoporosis-related evaluation and management during the course of hospitalization. Follow-up 1 year after the incident fracture was obtained on 227 patients. MEASUREMENTS AND MAIN RESULTS: Two hundred twenty-seven women were included in the study. Osteoporosis was documented in the medical record in 26% (59/227) of the patients at hospital discharge. Within 12 months of hospital discharge, 9.6% (22/227) had a bone mineral density test, and 26.4% (60/227) were prescribed osteoporosis treatment. Of those who were prescribed osteoporosis treatment, 86.6% (52/60) remained on therapy for 1 year. Nineteen women suffered an additional fracture. Compared to women without a prior fracture, women with at least 1 fracture prior to admission were more likely to have osteoporosis diagnosed and to receive osteoporosis-related medications. CONCLUSION: Despite guidelines that recommend osteoporosis evaluation in adults experiencing a low-trauma fracture, we report that postmenopausal women hospitalized for low-impact fracture were not sufficiently evaluated or treated for osteoporosis during or after their hospital stay. There are substantial opportunities for improvement of care in this high-risk population to prevent subsequent fractures.

Aged↗

PubMed1999

Diffuse axonal injury in a rugby player.

Sections of the cerebrum, cerebellum, and brain stem of a rugby player who died 15 hours after being tackled were stained using an immunoperoxidase technique to detect beta-amyloid protein. The sections of the pons showed axonal spheroids in the base, and those of the cerebellum showed axonal spheroids in deep white matter. The findings demonstrated axonal injury following a fall from the victim's height in a team sporting event.

Adult↗

PubMed2003

Effects of magnesium administration on brain edema and blood-brain barrier breakdown after experimental traumatic brain injury in rats.

In this study, we examined the effects of magnesium sulfate administration on brain edema and blood-brain barrier breakdown after experimental traumatic brain injury in rats. Seventy-one adult male Sprague-Dawley rats were anesthetized, and experimental closed head trauma was induced by allowing a 450-g weight to fall from a 2-m height onto a metallic disk fixed to the intact skull. Sixty-eight surviving rats were randomly assigned to receive an intraperitoneal bolus of either 750 micromol/kg magnesium sulfate (group 4; n = 30) or 1 mL of saline (group 2; n = 30) 30 minutes after induction of traumatic brain injury; 39 nontraumatized animals received saline (group 1; n = 21) or magnesium sulfate (group 3; n = 18) with an identical protocol of administration. Brain water content and brain tissue specific gravity, as indicators of brain edema, were measured 24 hours after traumatic brain injury. Blood-brain barrier integrity was evaluated quantitatively 24 hours after injury by spectrophotometric assay of Evans blue dye extravasations. In the magnesium-treated injured group, brain water content was significantly reduced (left hemisphere: group 2, 83.2 +/- 0.8; group 4, 78.4 +/- 0.7 [P <.05]; right hemisphere: group 2, 83.1 +/- 0.7; group 4, 78.4 +/- 0.5. [P <.05]) and brain tissue specific gravity was significantly increased (left hemisphere: group 2, 1.0391 +/- 0.0008; group 4, 1.0437 +/- 0.001 [P <.05]; right hemisphere, group 2, 1.0384 +/- 0.001; group 4, 1.0442 +/- 0.005 [P <.05]) compared with the saline-treated injured group. Evans blue dye content in the brain tissue was significantly decreased in the magnesium-treated injured group (left hemisphere: group 2, 0.0204 +/- 0.03; group 4, 0.0013 +/- 0.0002 [P <.05]; right hemisphere: group 2, 0.0064 +/- 0.0009; group 4, 0.0013 +/- 0.0003 [P <.05]) compared with the saline-treated injured group. The findings of the present study support that beneficial effects of magnesium sulfate exist after severe traumatic brain injury in rats. These results also indicate that a blood-brain barrier permeability defect occurs after this model of diffuse traumatic brain injury, and magnesium seems to attenuate this defect.

Animals↗

PubMed2003

An intervention to promote appropriate management of allergies in a heavy manufacturing workforce: evaluating health and productivity outcomes.

This work presents the evaluation of a first-of-its-kind intervention to improve the management of allergies among workers in a largely blue-collar industrial setting. This intervention implemented eight educational strategies focusing on appropriate medication use in the context of a controlled, nonrandomized, pre-post quasi-experimental study design. Program implementation occurred during summer 2001, with change assessed by means of measures of health and productivity, developed from employee surveys timed to occur at the height of the spring and fall allergy seasons, and measures of contemporaneous adverse events developed from administrative databases. Evidence of improvement was found at one experimental site but not at the other experimental sites or the control site. Tests using exploratory and confirmatory analyses were conducted of two hypotheses linking the gains of this site's allergy group to 1) intervention process changes and 2) changes in allergy severity caused by seasonality. Neither hypothesis is found to fully account for the explained variation between sites. Similar pre-post productivity gains for other disease groups at this site relative to the other sites suggest that the inclusion of other unmeasured variables would improve explanation; e.g., the responses of employees with chronic disease to notably challenging labor negotiations at this site. The implications for promoting behavioral change in the management of the impact of disease on productivity are explored.

Allergens↗

PubMed1974

Blood levels and management of lithium treatment.

The limited value of plasma measurements in the management of treatment with lithium is discussed in the light of the mechanisms of its therapeutic actions and toxic effects.The plasma level of lithium usually rises twofold or threefold in the three to five hours after ingestion of each dose of delayed-release tablets and then gradually falls. The precise shape and height of the lithium curve depend on gastric emptying, which can be slowed with propantheline or speeded with metoclopramide. Depressed or demented patients may be irregular in taking their tablets and variable in food intake. Both the time of the blood test and this behaviour must be considered before changing the prescribed dose of lithium salt because of a laboratory result. A lithium tolerance curve may be a safer guide to treatment than single measures.Mild intermittent thirst is a common early side effect, and severe persistent thirst with polyuria is an uncommon later effect of daily intakes of at least 1,500 mg lithium carbonate. This diabetes insipidus is reversible, non-progressive, unrelated to plasma level, and distinct in attack from lithium-induced hypothyroidism, which may occur at low dosage but is also usually of late onset and reversible or treatable with thyroxine while lithium is continued. Obesity is another occasional effect of large doses. These side effects and the antimanic and prophylactic effects may have different mechanisms.

Administration, Oral↗

PubMed1992

Experimental blunt injury to the larynx.

This article deals with the fracture line distribution and severity of laryngeal trauma. Laryngeal trauma was experimentally inflicted on 100 human laryngeal specimens with the impact of a 2.0-kg weight falling by gravity from a height of 100 cm. According to the previous pilot experiment and clinical experiences, the author classified the severity of fracture into four grades. The results showed no significant sex difference in the severity of fracture with reference to age distribution, especially severe injury in older age groups. The pattern of fracture lines of the laryngeal cartilage was observed and traced in four selected locations, including the thyroid notch, central zone of the thyroid cartilage, cricothyroid region, and cricoid. The distributions of fracture lines are illustrated. The experiment is described in detail.

Adolescent↗

PubMed1980

Patterns of change in mature Angus cow weight and fatness during the year.

Postcalving cow weight and subcutaneous fatness change patterns were described for 80 mature spring-calving Angus cows. The cows grazed either high (regularly clipped fescue-legume) or low (fescue clipped once) quality pastures. Forage consumption was estimated continuously by an internal (acid detergent lignin)-external (Cr2O3) indicator technique. Milk production (calf-suckle technique) was estimated seven times during lactation. Wither height was measured during the fall after the period of intensive measurment. Angus cows grazing high quality pasture lost an average of 36 kg postcalving, whereas those grazing low quality pasture lost an average of 22 kilograms. Minimum weights were observed about April 1, prior to the season of large pasture quality differences in digestibility of consumed forage. Taller cows, when allowed increased nutrient density during midlactation (high versus low quality), responded by increasing (P < .05) fatness at a more rapid rate than less tall cows. For cows grazing high quality pasture, weight change was independent of level of milk production. Cows grazing low quality pasture and giving relatively large amounts of milk maintained less weight and fat during the middle and last part of lactation than did those giving smaller amounts of milk. Shapes of the curves depicting change in weight and fatness were closely related (P < .01) to digestible dry matter intake. Cows apparently consumed forage in such a manner that they became more alike in both weight and fatness as the grazing season progressed.

Adipose Tissue↗

PubMed1994

A new model of diffuse brain injury in rats. Part I: Pathophysiology and biomechanics.

This report describes the development of an experimental head injury model capable of producing diffuse brain injury in the rodent. A total of 161 anesthetized adult rats were injured utilizing a simple weight-drop device consisting of a segmented brass weight free-falling through a Plexiglas guide tube. Skull fracture was prevented by cementing a small stainless-steel disc on the calvaria. Two groups of rats were tested: Group 1, consisting of 54 rats, to establish fracture threshold; and Group 2, consisting of 107 animals, to determine the primary cause of death at severe injury levels. Data from Group 1 animals showed that a 450-gm weight falling from a 2-m height (0.9 kg-m) resulted in a mortality rate of 44% with a low incidence (12.5%) of skull fracture. Impact was followed by apnea, convulsions, and moderate hypertension. The surviving rats developed decortication flexion deformity of the forelimbs, with behavioral depression and loss of muscle tone. Data from Group 2 animals suggested that the cause of death was due to central respiratory depression; the mortality rate decreased markedly in animals mechanically ventilated during the impact. Analysis of mathematical models showed that this mass-height combination resulted in a brain acceleration of 900 G and a brain compression gradient of 0.28 mm. It is concluded that this simple model is capable of producing a graded brain injury in the rodent without a massive hypertensive surge or excessive brain-stem damage.

Animals↗