Accidents and resulting injuries in premobile infants: data from the ALSPAC study.
(17/198)
BACKGROUND AND AIMS: Little is known about injuries resulting from accidents in premobile infants. We aimed to describe the pattern of minor accidents in infants and their resulting injuries. METHODS: The ALSPAC study collected data in successive postal questionnaires. At 6 months of age, parents were asked to describe any accident since birth. The type of fall, distance fallen, resulting injury, and help sought were independently coded. Burns were similarly coded. RESULTS: A total of 11 466 responses were available. In 2554 children, 3357 falls were reported; 53% fell from beds or settees and 12% fell from arms or while being carried. Only 14% reported visible injury, of which 56% were bruises; 97% of injuries specified involved the head. Only 21 falls (<1%) resulted in concussion or fracture. A burn or scald occurred in 172 cases (1.5%). The main causes of scalds were hot drinks and water, with contact burns caused by radiators, cookers, and hot food. CONCLUSIONS: Falls in young infants are common while burns are rare. Injuries from falls are infrequent, predominantly trivial, and almost entirely confined to the head. Falls from beds and settees did not result in skull fractures. Serious injury was the result of complex accidents. (+info)
Do electric patient beds reduce the risk of lower back disorders in nurses?
(18/198)
The aim of this study was to compare the probability estimates of lower back disorder (LBD) for a nurse performing a range of simulated patient care activities involving manual and electric patient beds. Studies of simulated patient care involving patient beds were undertaken using electrically powered and manually operated patient beds. The estimated probabilities of back injury, as calculated by the Lumbar Motion Monitor (LMM), between the two beds were compared statistically. A statistically significant reduction in LBD probability was observed in those functions that were completely achieved by the electrical mechanism. No significant difference in risk was observed in the patient care activities involving manipulating the patient in and around the bed that are more typical of 'heavy' orthopaedic nursing care in a busy acute ward environment. A potential for increased patient independence was observed during this trial. The LMM recorded no real risk reduction between situations involving electric or manual patient beds in those actions typically required of nurses in an acute orthopaedic ward caring for a disabled patient. (+info)
Insecticide-treated bed nets reduce plasma antibody levels and limit the repertoire of antibodies to Plasmodium falciparum variant surface antigens.
(19/198)
The use of insecticide-treated bed nets (ITN) has been documented to reduce malaria morbidity and mortality in areas with endemic malaria, but concerns have been raised that ITN usage could affect the acquisition of malaria immunity. Several lines of evidence have indicated that antibodies against variant surface antigens (VSA) are important in the development of naturally acquired immunity to Plasmodium falciparum malaria and may thus be good indicators of immune status. We have compared the levels of VSA antibodies in plasma from children who have used ITN for 4 years to levels in plasma from children from a nearby village not using ITN. A total of 97 plasma samples were analyzed using 13 different P. falciparum isolates. We found that the children using ITN had significantly lower VSA antibody levels and recognized a smaller proportion of the VSA expressed by the tested parasite isolates than children not using ITN. (+info)
Nurses' accuracy in estimating backrest elevation.
(20/198)
BACKGROUND: Positioning patients is a key component of nursing care and can affect their morbidity and mortality. The Centers for Disease Control and Prevention recommend that patients receiving mechanical ventilation have the head of the bed elevated 30 degrees to 45 degrees to prevent nosocomial pneumonia. However, use of higher backrest positions for critically ill patients is not common nursing practice. Backrest elevation may be affected by the accuracy of nurses' estimates of patients' positions. OBJECTIVES: To determine the difference between nurses' estimates of bed angles and measured bed angles and to describe the relationship between nurses' characteristics and the accuracy of their estimates. METHODS: A convenience sample of 67 nurses attending the 1999 American Association of Critical-Care Nurses National Teaching Institute and Critical Care Exposition in New Orleans, La. Each subject provided demographic information and estimated 3 bed angles. The angles were preselected by using a random number table. Summary statistics were used and were categorized according to the demographic information provided by participants. Estimated angles were correlated with measured angles, and accuracies in estimating angles were correlated with demographic characteristics. RESULTS: Nurses were accurate in estimating bed angles (correlation, 0.8488). Demographic information, including sex, age, years of practice, years of critical care practice, basic education, highest educational level, and present position had no relationship to accuracy. CONCLUSIONS: Nurses are able to estimate backrest elevation accurately. Other explanations are needed to understand why recommendations for backrest elevation are not used in practice. (+info)
Usefulness of a dispensary-based case-control study for assessing morbidity impact of a treated net programme.
(21/198)
BACKGROUND: Case-control studies have been proposed as an appropriate tool for health impact evaluation of insecticide-treated nets (ITN) programmes. METHODS: A dispensary-based case-control study was carried out in one village in Tanzania. Each case of fever and parasitaemia in a child under 5 years was paired with one community and one dispensary control without fever and parasitaemia. Cases and controls were compared with regard to ITN ownership and other factors assessed by a questionnaire. A cross-sectional survey of factors associated with parasitaemia, including ITN use, was carried out during the study. Dispensary attendance rates of the study children were calculated using passive case detection data. RESULTS: Cases and dispensary controls had higher dispensary attendance rates compared to community controls and children with nets attended more for most of the illness events. A comparison of cases and community controls showed a strong and statistically significant association between untreated net use and being a case (odds ratio [OR] = 2.1, 95% CI : 1.3-3.4). For those with ITN there was a smaller and weaker association between risk of being a case and ITN use (OR =1.4, 95% CI : 0.9-2.2). Comparison of cases and dispensary controls showed no association between untreated or treated nets and the risk of being a case (for treated nets OR = 0.9, 95% CI : 0.5-1.4 and for untreated nets OR = 1.2, 95% CI : 0.7-2.0). These results are contrary to those from the cross-sectional assessment, where children with ITN had a lower prevalence of parasitaemia than those with no nets (OR = 0.5, 95% CI : 0.3-0.9), and also contrary to other assessments of the health impact of ITN in this population. CONCLUSIONS: The positive association between mild malaria and net ownership is counter-intuitive and best explained by attendance bias, since children with nets attended more frequently for all curative and preventive services at the dispensary than those without nets. Dispensary-based case-control studies may not be appropriate for assessing impact of treated nets on clinical malaria, while cross-sectional surveys might represent an attractive alternative. (+info)
Bunk versus conventional beds: a comparative assessment of fall injury risk.
(22/198)
OBJECTIVE: To depict the magnitude and spectrum of childhood injuries attributable to falls from bunk beds in comparison with conventional beds and to outline sociodemographic risk factors and injury characteristics. STUDY DESIGN: Case-control investigation. SETTING: Accident and emergency departments of four hospitals in Greece, namely a teaching children's hospital and a trauma hospital in Greater Athens and the two district hospitals in the Magnesia county and the Corfu island. PATIENTS: During the three year period 1996-98, 1881 children (0-14 years) presenting with bed fall injuries were recorded by the Emergency Department Injury Surveillance System (EDISS). Out of these, 197 children with falls from bunk beds served as cases and 1684 children with falls from conventional beds served as controls. RESULTS: From the analysis and a nationwide extrapolation, it was calculated that each year about 5000 children in Greece (total population 10 million) seek medical attendance at an emergency department for a bed injury, corresponding to an estimated incidence of about 3 per 1000 children years. Out of bed fall injuries, 10.5% are from bunk beds, 10.4% from cribs, 3.1% from cots, and 76.0% from other conventional beds. Falls from the bed ladder accounted for 8% of all bunk bed injuries. Boys are at higher risk for falls from beds but there is no evidence that the proportion is different depending on the type of bed used. Relatively few falls from bunk beds are recorded outside the crowded apartments of Greater Athens or among migrant children. The increased relative risk of injuries from bunk bed falls during the sleeping hours indicates the higher risk of injury after a fall from a bunk rather than a conventional bed. Injuries from bunk bed falls are generally more serious than those from conventional bed falls (overrepresentation of brain injuries, fractures, multiple injuries, and injuries requiring hospitalisation). Overall, it can be estimated that almost half of the sleep related bunk bed injuries are easily preventable. CONCLUSIONS: Falls from bunk beds represent a non-negligible childhood injury risk. A sizeable fraction can be avoided with simple design modifications of the product, such as use of side rails in the upper bed or removal of the bed ladder when not in use. (+info)
Reliability of two behavioral tools to assess pain in preterm neonates.
(23/198)
CONTEXT: One of the main difficulties in adequately treating the pain of neonatal patients is the scarcity of validated pain evaluation methods for this population. OBJECTIVE: To analyze the reliability of two behavioral pain scales in neonates. TYPE OF STUDY: Cross-sectional. SETTING: University hospital neonatal intensive care unit. PARTICIPANTS: 22 preterm neonates were studied, with gestational age of 34 +/- 2 weeks, birth weight of 1804 +/- 584 g, 68% female, 30 +/- 12 hours of life, and 30% intubated. PROCEDURES: Two neonatologists (A and B) observed the patients at the bedside and on video films for 10 minutes. The Neonatal Facial Coding System and the Clinical Scoring System were scored at 1, 5, and 10 minutes. The final score was the median of the three values for each observer and scale. A and B were blinded to each other. Video assessments were made three months after bedside evaluations. MAIN MEASUREMENTS: End scores were compared between the observers using the intraclass correlation coefficient and bias analysis (paired t test and signal test). RESULTS: For the Neonatal Facial Coding System, at the bedside and on video, A and B showed a significant correlation of scores (intraclass correlation score: 0.62), without bias between them (t test and signal test: p > 0.05). For the Clinical Scoring System bedside assessment, A and B showed correlation of scores (intraclass correlation score: 0.55), but bias was also detected between them: A scored on average two points higher than B (paired t test and signal test: p < 0.05). For the Clinical Scoring System video assessment, A and B did not show correlation of scores (intraclass correlation score: 0.25), and bias was also detected between them (paired t-test and signal test: p < 0.05). CONCLUSION: The results strengthen the reliability of the Neonatal Facial Coding System for bedside pain assessment in preterm neonates. (+info)
Comparison of a long spinal board and vacuum mattress for spinal immobilisation.
(24/198)
OBJECTIVES: This study was designed to compare the stability and comfort afforded by the long spinal board (backboard) and the vacuum mattress. METHODS: Nine volunteers wearing standardised clothing and rigid neck collars were secured on to a backboard and vacuum mattress using a standard strapping arrangement. An operating department table was used to tilt the volunteers from 45 degrees head up to 45 degrees head down, and additionally 45 degrees laterally. Movements of the head, sternum, and pubic symphysis (pelvis) from a fixed position were then recorded. The comfort level during the procedure was assessed using a 10 point numerical rating scale (NRS) where 1=no pain and 10=worst pain imaginable. RESULTS: The mean body movements in the head up position (23.3 v 6.66 mm), head down (40.89 v 8.33mm), and lateral tilt (18.33 v 4.26mm) were significantly greater on the backboard than on the vacuum mattress (p<0.01 for all planes of movement). Using the NRS the vacuum mattress (mean score=1.88) was significantly more comfortable than the backboard (mean score=5.22) (p<0.01). CONCLUSIONS: In the measured planes the vacuum mattress provides significantly superior stability and comfort than a backboard. (+info)