The global burden of injury: incidence, mortality, disability-adjusted life years and time trends from the Global Burden of Disease study 2013

A societal cost-benefit analysis of falls prevention in community-dwelling older people in the Netherlands

BACKGROUND

Aging populations face rising incidents of falls among older people, leading to increased healthcare costs. Preventive measures can reduce this burden and associated costs. However, implementing falls prevention interventions causes costs for society. In order to gain insight in the balance between investments and gains for society the Societal Cost Benefit Analysis (SCBA) methodology can be applied. We conducted a societal cost-benefit analysis (SCBA) of falls prevention interventions in the Netherlands in order to show the stepwise approach, data sources needed and analyses that characterize this method.

METHODS

We used SCBA to assess falls prevention interventions' costs and benefits for three stakeholders: private health insurance companies, the national government, and local government. We created five healthcare scenarios for falls prevention interventions, involving informal care, primary care, home care, social work, and an integral scenario. Our SCBA model considered all associated costs with case-finding, screening, and recruitment for each scenario, as well as multifactorial falls prevention programs' costs and benefits, such as reduced healthcare expenses and health gains (DALYs).

RESULTS

All scenarios lead to health gains, ranging from 90 averted DALYs in the informal care to 300 in the primary care scenario.The net benefits per 100,000 senior citizens of falls prevention programs range from €0.2- €5.6 million respectively for social care and home care scenario with benefit-cost ratios of respectively 1.1 and 2.5. Sensitivity analysis revealed that a lower age limit accompanied by a low initial fall risk for recruitment significantly influence the SCBA outcomes.

CONCLUSION

Structural implementation of evidence-based falls prevention can provide significant health benefits and net cost savings, supporting its implementation at the societal level. The SCBA offers guidance to policymakers on the optimal falls prevention programs for older people, reducing the disease burden of falls in the Netherlands.

Are we ready? Emergency unit capacity at selected district level hospitals in Lusaka Province, Zambia: Barriers and facilitators for improving trauma care: a mixed methods approach

The increasing burden of road traffic injuries (RTIs) has become a public health concern in Zambia for the last five years. Little is known about the capacity and determinants of emergency care at the point of first contact in a country without coordinated pre-hospital and emergency medical services (EMS). Evaluation of the in-hospital emergency trauma care for RTIs is critical. This study sought to assess the emergency care at the district level hospitals to effectively manage RTIs, using the WHO Hospital Emergency Assessment Tool (HEAT), and identify the barriers and facilitators. A mixed-methods approach was employed at ten facilities in Lusaka Province between May 2023 and September 2023. Quantitative data were collected using the WHO HEAT instrument on facility matrices, infrastructure and equipment, human resources, diagnostic and clinical services, and signal functions. Thirty-five interviews were conducted with emergency unit healthcare providers at these facilities to identify the barriers and facilitators to care. The WHO tool guided inductive and deductive thematic analysis. Emergency care services were available 24 hours a day, with a mean bed capacity of 4.7 for the ten (10) facilities sampled. Eight hospitals had a designated emergency unit and three had no triage area. Only four hospitals had a core emergency trauma team. The key barriers to care were shortage of equipment and consumables, a lack of skills and specialist services to perform signal functions, and inadequate ambulance services. However, supportive and committed leadership, team cohesiveness, interdepartmental collaboration, motivated staff, and skills transfer from seniors emerged as the facilitators to care. Lusaka Province is moderately prepared for the increasing number of emergency trauma cases. To strengthen emergency trauma care; capacity building for human resource in triage, resuscitation, and trauma interventions for the initial care is integral. Deliberate action through budgetary support for infrastructure development, emergency equipment procurement, increased ambulance service availability, and recruitment of skilled human resources is timely.

A reason to recover: A qualitative study of recovery after traumatic chest wall injury requiring intensive care admission

BACKGROUND

Patients surviving major traumatic injury involving the chest wall experience unpredictable recovery trajectories, typically extending over 12 months or more. While some recover well, others experience ongoing physical and mental health difficulties and reduced quality of life. A nuanced understanding of the meaning and process of recovery is needed to inform the development of interventions to enable patients to access the right help, at the right time. Hence, we examined the experience of recovery and the bio-psycho-social factors shaping recovery in the months after traumatic injury resulting in admission to intensive care.

METHODS

This qualitative inquiry was underpinned by philosophical pragmatism, an approach which promotes development of knowledge that can be applied to solve problems. Participants recruited from a tertiary hospital completed semi-structured interviews encompassing perceived recovery, health as reflected in the EQ-5D-5 L, and factors influencing recovery. Qualitative data were analysed using the framework approach enabling the team to focus on matters pertinent to participants while addressing research questions. EQ-5D-5 L data were analysed descriptively.

RESULTS

Fourteen participants including 13 men, aged 19 to 67 years were interviewed by telephone, video-conference or in-person four- to seven-months post-injury. Duration of interviews was, on average, 50 min. Participants understood recovery as a non-linear process with progress assessed against pre-injury 'normal'; some acknowledged the need to develop and adapt to a new 'normal'. Engagement in the recovery process ranged along a spectrum anchored by passivity and proactivity, with approach taken reflecting the participant's characteristic way of being, and investment in a 'reason to recover'. Recovery was a function of interlinked factors categorised as 'pre-injury life circumstances', 'recovery mindset', 'recovery behaviours' and 'recovery resources'. While EQ-5D-5 L scores indicated substantial impairment across domains, participants generally regarded themselves as recovering well 'given the circumstances'.

CONCLUSIONS

Findings highlight the need for care to be grounded in an appreciation of the 'person' of the patient because pre-injury circumstances inexorably shape approach to recovery, engagement in recovery behaviours and access to resources. The model of recovery developed in this study can guide clinicians undertaking the comprehensive assessment that is fundamental to provision of personalised care, and ongoing evaluation of recovery, potentially using patient-generated outcome measures.

Early-onset Parkinson's disease, regional and national burden, and its attributable risk factors in 204 countries and regions from 1990 to 2021: Results from the global burden of disease study 2021

BACKGROUND

Early-Onset Parkinson's Disease (EOPD), defined as diagnosis before age 40, accounts for 5-10 % of Parkinson's cases and is characterized by slower progression and severe motor and non-motor complications. Its global burden has risen significantly, particularly among younger populations, but comprehensive analyses of trends, disparities, and determinants remain scarce.

METHODS

EOPD burden was examined in 204 countries from 1990 to 2021 using Global Burden of Disease (GBD) 2021 data. Age-standardized rates (ASR) for incidence, mortality, and disability-adjusted life years (DALYs) were computed. Estimated annual percentage change (EAPC) was used to analyze temporal trends. Associations with the Socio-Demographic Index (SDI) were investigated, and projections were made for future trends up to 2035 using time-series models.

RESULTS

Global ASRs for incidence, mortality, and DALYs in 2021 were 0.333, 0.006, and 0.461 per 100,000 population, respectively. Incidence and DALYs increased from 1990 to 2021, while mortality fluctuated. Higher burdens were reported in high-SDI regions due to improved detection and longer survival, whereas low-SDI regions faced underdiagnosis and limited healthcare access. Projections suggest a continued rise in EOPD burden, particularly in the 35-39 age group, by 2035.

CONCLUSION

The increasing worldwide burden of EOPD, along with significant regional and socioeconomic inequalities, underscores the pressing necessity for prompt diagnosis, equitable healthcare access, and specific interventions to address this escalating public health issue.

Using a simulation-based approach to evaluate a contextually appropriate, non-internet dependent mobile navigation tool for emergency medical dispatch (EMD) of lay first responders (LFRs) in Sierra Leone: A multi-cohort feasibility trial

INTRODUCTION

Despite disproportionately bearing the global injury burden, low- and middle-income countries often lack emergency medical services(EMS). Equipping lay first responders(LFRs) with emergency medical dispatch(EMD) is a critical next step for formal EMS development. However, few context-appropriate mobile dispatch solutions are available for LFRs, and implementation feasibility and impact on response intervals are not well understood MATERIALS AND METHODS: A simulation-based feasibility trial assessed a novel EMD tool, previously used for shipping in resource-limited settings without formal addresses. Two cohorts of 10 non-EMD enabled LFRs trained in 2019 in Sierra Leone were recruited. 100 total simulations were launched in randomized order over 6 months(Cohort 1 distributed along 10 kms of highway(n = 50), Cohort 2 distributed across 24 square-kilometers of an urban setting(n = 50)). On-scene first aid skill performance was assessed under direct observation with a standardized patient actor using checklists. Participants were blinded to randomized dispatch timing/scenario to assess response intervals, replicating real-world conditions, and compared with two-sample t-tests. At six-month follow-up, participants were surveyed on tool ease-of-use and appropriateness, confidence, and ranked dispatch variable relative importance.

RESULTS

Median total response interval (initial notification to LFR arrival on scene) for Cohort 1 for linearly-plotted highway simulations was 6 mins 33 ss(IQR: 2m27 s; 10m48 s), while Cohort 2 for dispersed urban simulations was 6m41s(IQR:3m59 s;14m47 s) (p = 0.720). Median distance between simulated emergency and LFR at the time of notification acceptance=1.675 km(IQR:1.13 km;2.47 km) and 1.73 km(IQR:0.82 km;2.28 km). Mean completion percentage of all discrete first aid steps across all 10 simulation scenario types for Cohort 1 = 89.8 %(IQR: 80 %;100 %) and Cohort 2 = 94.9 %(IQR: 88.89 %;100 %) (p = 0.017). Mean confidence was 9.4/10(median=10) and 9.5/10(median=10)(p = 0.889). 75 % of LFRs (15/20) used the compass feature for navigation while 25 % used turn-by-turn directions (5/20). 70 % LFRs (14/20) reported no unexpected data costs. Emergency location was considered the most important dispatch variable factor, followed by nature/severity of injury.

DISCUSSION

A novel mobile navigation tool for EMD accurately dispatches LFRs to simulated emergency incidents across linear/dispersed settings without significant difference in response interval. Equipping LFRs with EMD tools may facilitate efficient dispatch in resource-limited settings to trauma while expanding emergency care access, meriting further study.

Socio-cultural context of road safety in youth: a scoping review

Road traffic injuries (RTIs) are a leading cause of death globally, disproportionately affecting youth in low- and middle-income countries (LMICs). While behavioral factors significantly contribute to RTIs, the role of socio-cultural norms remains understudied. This scoping review examines 75 studies (2000-2020) to explore how social norms (descriptive, injunctive, subjective, and collective) and cultural factors influence road safety behaviors among young people. Findings reveal that norms shape behaviors such as risky driving, helmet/seatbelt use, and compliance with traffic laws, often moderated by cultural contexts like gender, media, and religion. Peer and familial influences emerged as both risk and protective factors, while collective norms in certain communities reinforced harmful practices like drunk driving. Gaps persist in understanding the interplay between culture and norms, particularly in LMICs. The review highlights the need for culturally tailored interventions and further research to address socio-cultural determinants of road safety.

The national and subnational burden of falls and its attributable risk factors among older adults in Iran from 1990 to 2021: findings from the global burden of disease study

BACKGROUND

Falls among older adults (individuals aged 60 and above) are a substantial health issue worldwide. This study aimed to analyze the burden of falls and its attributable risk factors among older adults at the national and subnational levels in Iran over 32 years.

METHODS

Using the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 data, we estimated the incidence, prevalence, death, and disability-adjusted life-years (DALYs) of falls and its attributable risk factors among older adults by sex, age groups, and socio-demographic index (SDI) in Iran and its provinces. We reported the estimates with their 95% uncertainty intervals (UIs). Rates were reported per 100,000 population.

RESULTS

In 2021 in Iran, the incidence rate of falls among older adults was 1674.0 (95% UI: 1454.9-1897.3), the prevalence rate was 11302.5 (10504.7-12095.7), the death rate was 16.9 (12.9-21.0), and the DALYs rate was 736.3 (647.6-825.4). In 2021, at the subnational level, Qazvin had the highest incidence, death, and DALYs rates for falls with values at 2329.5 (2008.8-2652.1), 24.2 (19.5-29.0), and 965.9 (856.2-1074.6), respectively, while Kohgiluyeh and Boyer-Ahmad had the highest falls prevalence rate at 16043.1 (14918.4-17149.0). In 2021, males had higher prevalence, death, and DALYs rates of falls compared to females, while females had a higher incidence rate. Among the age groups, the 90-94 age group had the highest rates of incidence, prevalence, death, and DALYs from falls. Low bone mineral density was the primary risk factor attributable to the burden of falls. There were significant positive associations between SDI and both the incidence and prevalence rates of falls. Conversely, a significant inverse association was found between SDI and the death rate.

CONCLUSIONS

From 1990 to 2021, the incidence rate of falls has increased significantly among older adults in Iran, necessitating urgent interventions. Implementing nationwide, cost-effective strategies such as exercise programs to improve strength and balance, home hazard modifications, medication reviews to reduce fall-related risks, and routine screening programs for osteoporosis and fall risk assessment can help protect and support older people, minimizing their risk of falls.

The burden of mental disorders and substance abuse in the Middle East and North Africa (MENA) region: findings from the Global Burden of Disease Study

BACKGROUND

Mental disorders pose significant morbidity and mortality risks globally. Despite this, research on mental health in the Middle East and North Africa (MENA) region is scarce, hindered by social stigmas and limited healthcare expenditure. This study, utilizing the Global Burden of Disease (GBD) database, aims to address this gap by examining the prevalence, incidence, and demographic patterns of mental disorders in MENA.

METHODS

This ecological study draws on the GBD data to assess the prevalence and burden of mental disorders and substance abuse across the MENA region from 1990 to 2019. Utilizing age-standardized rates of prevalence and Disability-Adjusted Life Years (DALYs), we examine the evolving burden of mental disorders, variations among MENA countries, and trends in associated risk factors by age and gender.

RESULTS

From 1990 to 2019, the MENA region witnessed varying trends in mental disorders. The age-standardized prevalence rate in 2019 was 14,938 per 100,000 individuals, experiencing a 2.1% decrease overall. However, all-age prevalence surged by 86.2%. Disorders like schizophrenia and depressive disorders exhibited substantial increases, contrasting with a 128.1% rise in substance use disorders. Temporal analysis revealed fluctuations in DALY trends, capturing the dynamic nature of mental health burdens over time. Risk factors, including bullying victimization and intimate partner violence, underwent shifts, reflecting changing contributors to mental health burden.

CONCLUSION(S)

Despite a decrease in age-standardized prevalence rates in 2019, the substantial all-age prevalence rise demands attention. Temporal analysis unraveled nuanced trends, emphasizing the complex interplay of sociocultural factors. The shifting prominence of risk factors underscores the dynamic nature of mental health burdens, necessitating region-specific interventions that address both prevalence patterns and contributing factors. Future research should delve into the specific sociocultural determinants influencing the observed trends, allowing for tailored interventions to mitigate the burden of mental health disorders in the MENA region.

Injury caseload, pattern and time of presentation to emergency services in Mozambique: A pragmatic, multicentre, observational study

BACKGROUND

Rapid population growth and urbanisation raise a critical need to better understand the burden of injuries in sub-Saharan Africa. We assessed the pattern of service demand for injuries at emergency department (ED) in urban areas of Mozambique.

METHODS

This prospective, multi-centric, observational study was conducted in EDs in southern (Maputo), central (Beira) and northern (Nampula) of Mozambique. We randomly selected 7809 cases (age ≥1 years) during the seasonally distinct months of April/2016-2017 and October/2017. Data on patients' demographics, nature of injury and clinical outcomes were collected.

RESULTS

Overall, 1881/7809 (26.2 %) emergency cases comprising 518 children (58.5 % male, aged 4.6 ± 2.5 years), 324 adolescents (64.8 % male, 14.7 ± 3.0 years) and 10,39 adults (60.8 % male, 34.5 ± 13.0 years) presented with injury. The arms, legs and head were most affected in both children (518 with 795 injuries) and adults (1039 with 1496 injuries). The diversity of injuries increased with older age. Injury cases predominantly presented during daylight hours (from 0900 to 1900) with age-differentials evident. There were proportionately more injury presentations in the hotter and wetter October than in colder and drier April. The most common mechanisms of injury were falls, physical violence and road traffic injuries. Overall, 9.1 % of injury cases were admitted to hospital and 0.2 % died.

CONCLUSIONS

Injuries corresponded to around one-quarter of all emergency admissions in urban Mozambique, and were predominantly caused by falls, physical violence, and road traffic injuries. Understanding distinctive variations in the pattern and timing of these presentations according to the age, location and season will assist in future planning for more efficient injury prevention and health care services in Mozambique.

Are the same parameters measured at admission and in the ICU comparable in their predictive values for complication and mortality in severely injured patients?

INTRODUCTION

Numerous studies have investigated variables that predict mortality and complications following severe trauma. These studies, however, mainly focus on admission values or a single variable. The aim of this study was to investigate the predictive quality of multiple routine clinical measurements (at admission and in the ICU).

METHODS

Retrospective cohort study of severely injured patients treated at one Level 1 academic trauma centre.

INCLUSION CRITERIA

severe injury (ISS ≥ 16 points), primary admission and complete data set. Exclusion criteria end-of-life treatment based on advanced directive, secondary transferred patients.

PRIMARY OUTCOME

mortality, pneumonia, sepsis. Routine clinical parameters were stratified based on measurement timepoint into Group TB (Trauma Bay, admission) and into Group intensive care unit (ICU, 72 h after admission). Prediction of complications and mortality were calculated using two prediction methods: adaptive boosting (AdaBoost, artificial intelligence, AI) and LASSO regression analysis.

RESULTS

Inclusion of 3668 cases. Overall mean age 45.5 ± 20 years, mean ISS 28.2 ± 15.1 points, incidence pneumonia 19.0%, sepsis 14.9%, death from haemorrhagic shock 4.1%, death from multiple organ failure 1.9%, overall mortality rate 26.8%. Highest predictive value for complications for Group TB include abbreviated injury scale (AIS), new injury severity score (NISS) and systemic Inflammatory Response Syndrome (SIRS) score. Highest predictive quality for complications for Group ICU include late lactate values, haematocrit, leukocytes, and CRP. Sensitivity and specificity of late prediction models using a 25% cutoff were 73.61% and 76.24%, respectively.

CONCLUSIONS

The predictive quality of routine clinical measurements strongly depends on the timepoint of the measurement. Upon admission, the injury severity and affected anatomical regions are more predictive, while during the ICU stay, laboratory parameters are better predictor of adverse outcomes. Therefore, the dynamics of pathophysiologic responses should be taken into consideration, especially during decision making of secondary definitive surgical interventions.

LEVEL OF EVIDENCE

III (retrospective cohort study).

Peer support experiences and needs across the continuum of trauma care: A qualitative study of traumatic injury survivor, caregiver, and provider perspectives

BACKGROUND

Traumatic injuries significantly impact individuals' physical and mental health and are a leading cause of disability worldwide. Trauma recovery is complex and entails patients interacting with multiple places of care before returning to the community. Despite trauma recovery being optimized when patients' psychosocial needs are addressed early on and throughout recovery, care remains overwhelmingly focused on physical and functional improvement. Peer support is a cost-effective way of providing emotionally and experientially-driven psychosocial support that complements usual patient care. Thus, we aimed to explore the experiences of trauma survivors, family caregivers, and healthcare providers (HCPs) with engaging in and facilitating peer support and to identify their priorities for a future peer support program.

METHODS

Qualitative descriptive approach. Trauma survivors, caregivers and HCPs were recruited from three major trauma centres in Ontario. We conducted one-one-one interviews with participants which were recorded and transcribed. Data was thematically analyzed by multiple analysts to reduce bias and enhance data reliability.

RESULTS

We interviewed n=16 trauma survivors, n=4 caregivers, and n=16 HCPs. We identified four themes: (1) "It's a major change": Navigating life after injury is challenging and characterized by uncertainty; "I just needed somebody just to talk to:" Peer support helps trauma survivors feel like they're not alone; (3) "You can learn off each other": Peer support is multi-faceted and facilitates recovery in ways that other supports cannot; and (4) "If other people say negative things…that makes things worse": Tensions exist between the benefits of peer support and the risk of unintended negative consequences. Overall, to meet trauma survivors' socialization needs and enhance the efficacy of interventions, it is recommended that peer support to be offered via a range of modalities.

CONCLUSIONS

Our study demonstrates that peer support is valued across stakeholders and has the potential to positively impact the psychosocial health of trauma survivors throughout recovery. Future development of a cross-continuum peer support program will consider how to connect peers early on after injury and sustain these relationships into community recovery.

Integrating peer support across the continuum of trauma care: Trauma survivor, caregiver and healthcare provider perspectives and recommendations

BACKGROUND

Recovery from a traumatic injury is a complex process that precipitates difficulties and isolation for survivors. Peers can provide valuable psychosocial support rooted in lived experience. The savings associated with peer support largely outweigh the costs. Despite this, research has yet to explore the ideal components of a cross-continuum peer support program or the factors that might impact its delivery.

OBJECTIVES

Understand the barriers/facilitators to integrating peer support across the continuum of care; and (2) Identify recommendations for the design and delivery of a cross-continuum peer support program.

METHODS

Qualitative descriptive approach. Interviews were conducted with trauma survivors (n = 16), caregivers (n = 4), and healthcare providers (HCPs) (n = 16). We employed an inductive thematic analysis to identify barriers and facilitators. We also conducted a deductive analysis using a framework for peer support interventions in physical medicine and rehabilitation to identify what should be included in a cross-continuum peer support program.

RESULTS

Barriers and facilitators included: (1) individual-level issues, (2) the physical and social environment, (3) clinical practice considerations, (4) finance and resourcing, and (5) organization/system issues. Peer support programming should be introduced early in recovery and continue into community living. Peer support programming should be offered flexibly (virtually or in-person) and provide: (1) education, (2) empowerment; and (3) social support. Participants agreed that a person with lived experience should be trained and centrally involved.

CONCLUSIONS

When designing peer support programming, we must consider who would benefit from support, what support should consist of, and ideal timing and mode of support delivery.

Global burden of drowning and risk factors across 204 countries from 1990 to 2021

Drowning is a major global public health issue with marked variations in incidence, mortality, and disability-adjusted life years (DALYs) across regions, age groups, and sexes. Although previous studies have examined global trends in drowning, few have comprehensively analyzed regional and national disparities while addressing potential reporting biases and confounding factors. Data from the Global Burden of Disease (GBD) Study 2021, focusing on drowning-related incidence, death rates, and DALYs, and examined trends from 1990 to 2021 across various regions and countries. The study used age-standardized rates to assess trends and risk factors associated with drowning. In 2021, there were 856.1 thousand drowning cases globally, leading to 274.2 thousand deaths and 15.7 million DALYs. Age-standardized rates showed significant reductions since 1990: incidence decreased by 51.5% to 11.1, deaths by 60.9% to 3.6, and DALYs by 67.3% to 211.9. Solomon Islands, Belarus, and Ukraine had the highest incidence rates, while Nauru, Central African Republic, and Marshall Islands reported the highest death and DALYs rates. DALYs rates were highest in children aged 0-5 years and declined with age. A negative correlation was observed between SDI and DALYs rates. Key risk factors included occupational injuries (13.2%), high temperature (4.6%), and alcohol use (1.7%), while low temperature had a negative contribution (-10.6%). Despite reductions, drowning remains a major public health issue, especially in low-SDI countries. Targeted interventions addressing Occupational injuries, High temperature and Alcohol use are essential to further reduce drowning-related morbidity and mortality.

Global, regional, and national burdens of fracture in children and adolescents from 1990 to 2019

BACKGROUND

Fractures in children and adolescents(FCA) represent a significant public health concern.This underlines the essential need for comprehensive research into the global burden of disease related to FCA.

OBJECTIVE

To examine the trajectories of fracture rates and disability-adjusted life years (DALYs) in children and adolescents, as well as to identify contributing risk factors for fracture-associated DALYs between 1990 and 2019.

METHODS

This cross-sectional analysis utilized data from the Global Burden of Diseases 2019 (GBD 2019) study. It included individuals with Fracture of Childhood Age (FCA) ranging from 5 to 14 years.

RESULTS

In 2019, there were 33,646,042 incident cases of FCA were reported worldwide. South Asia exhibited the highest number of new cases (8,270,826) and DALYs (190,124 life years) in 2019, accounting for approximately one-fourth of the global data. From 1990 to 2019, the age-standardized incidence slight decreased by 21.19% and DALYs decreased by 28.99% globally. Fractures involving the radius and/r ulna (19.88%) rank as the top most prevalent FCA. Panel models analysis has pinpointed growth in adjusted national income (coefficient B 3.50, p-value 0.02) and per capita adjusted national income (coefficient B 3.48, p-value 0.03) as significant predictors of the worldwide DALYs associated with FCA.

CONCLUSION

From 1990 to 2019, the burden of FCA exhibited a notable downward trend. However, in low SDI regions such as South Asia, the burden remains substantial. It was found that national income is a risk factor for FCA-associated DALYs, highlighting the need for policies and resources directed towards FCA alongside economic development.

Evaluation of the Patient-Specific Functional Scale for monitoring paediatric injury patients at a zonal referral hospital in Northern Tanzania

BACKGROUND

Injuries are a major cause of morbidity and mortality among paediatric populations in low- and middle-income countries (LMICs). The Patient-Specific Functional Scale (PSFS) is a commonly used tool to assess functional recovery. This study aims to evaluate the psychometric properties of the PSFS for monitoring paediatric injury patients at a zonal referral hospital in Northern Tanzania.

METHODS

This retrospective cohort study used data from the Kilimanjaro Christian Medical Centre paediatric injury registry (November 2020 to June 2024) and included patients under 18 years treated for injuries at a zonal referral hospital in Northern Tanzania. Key outcomes were in-hospital mortality and injury-related morbidity, assessed using the PSFS and Glasgow Outcome Scale Extended Paediatric (GOS-E Ped). The PSFS's reliability was tested with Cronbach's alpha, its smallest meaningful change was calculated and its correlation with GOS-E Ped was analysed using Spearman's rank.

RESULTS

Among 1000 paediatric injury patients, the mortality rate was 6.6%. PSFS mean scores improved from 4.3 at discharge to 6.5 at 2 weeks and 9.0 at 3 months post hospital discharge. The PSFS showed good reliability (Cronbach's alpha: 0.90). A moderate negative correlation was found between PSFS and GOS-E Ped at 3 months (Spearman's ρ: -0.74). The minimally clinically important difference was 2.7, with a sensitivity of 0.73, specificity of 0.72 and an area under the curve of 0.83.

CONCLUSION

The PSFS was found to be a valid, reliable and responsive tool for assessing functional changes in paediatric injury patients, demonstrating strong internal consistency. The findings support its use to measure morbidity in this population.

Examining the burden of mental disorders in Jordan: an ecological study over three decades

BACKGROUND

Mental disorders are a major public health issue, causing 4.9% of global disability-adjusted life years (DALYs). In Jordan, factors like regional conflicts, economic changes, and population growth contribute to this burden. This study examines the trends and risk factors of mental disorders in Jordan from 1990 to 2021 using Global Burden of Disease (GBD) data.

METHODS

We analyzed prevalence, deaths, and DALYs of mental disorders from the GBD 2021 dataset, reporting both all-age numbers and age-standardized rates. Key risk factors, including behavioral risks, bullying, childhood sexual abuse, and substance use, were assessed.

RESULTS

Mental disorder cases in Jordan rose by 279.8%, from 514,234 in 1990 to 1,953,087 in 2021. Anxiety and depression were the most common in 2021. All-age DALYs increased by 649.6%, while age-standardized DALY rates showed a slight 4.3% rise. Females had higher mental disorder prevalence and DALY rates, while males had higher substance use disorder rates. Behavioral risks, bullying, and childhood sexual abuse were major contributors.

CONCLUSION

The burden of mental disorders in Jordan has grown significantly over three decades. Limited resources, stigma, and regional instability worsen the issue. Policies focusing on stigma reduction, mental health integration, and prevention are essential.

Predicting the Need for Tertiary Trauma Care Using a Multivariable Model: A 4-Year Retrospective Cohort Study

Introduction

Delays in accessing an appropriate level of care can lead to significant morbidity or even mortality of trauma patients. This study aimed to develop a simplified prehospital predictive model to determine the need for tertiary care trauma centers (TTC), enabling timely and appropriate transport decisions by emergency medical service (EMS) teams.

Methods

This is a retrospective cohort study conducted at the emergency department (ED) of Ramathibodi Hospital between January 2020 and April 2024. Prehospital trauma patients aged ≥15 years who were transported by EMS were included in the study. Patients were divided into two groups with and without the need for TTC, and the independent predictive factors of the need for TTC were explored using multivariable regression analysis.

Results

The study included 440 trauma patients, with 31.1% requiring TTC. The predictors of the need for TTC included age (coefficient (Coef.) -0.003; 95% confidence interval (CI): -0.018 to 0.012; P=0.693), traffic mechanism (Coef. 0.848; 95%CI: 0.150 to 1.546; P=0.017), respiratory rate (Coef. 0.044; 95%CI: -0.037 to 1.124; P=0.285), heart rate (Coef. -0.004; 95%CI: -0.020 to 0.012; P=0.610), and Glasgow Coma Scale (Coef. -0.312; 95%CI: -0.451 to -0.173; P<0.001). The predictive model categorized patients into low, moderate, and high-risk groups. Patients who were categorized in the high-risk group showed a positive likelihood ratio (LHR+) of 14.88 for requiring TTC. The model achieved an area under the receiver operating characteristic curve (AuROC) of 73%, indicating the good discriminative ability of this prediction model.

Conclusions

The predictive model classifies trauma patients into three risk groups based on five prognostic variables, which are able to predict the likelihood of requiring TTC. Internal validation has verified its high level of accuracy in trauma triage.

[Clinical signs of thermal skin burns in the acute phase in black-skinned patients. Results of a prospective study of 214 burn victims]

In the literature, we do not find any published study on the clinical signs of thermal skin burns in the acute phase in black-skinned patients. The present study, which fills this gap, reports for the very first time the results of clinical observations in 214 black-skinned burn victims. This was a prospective study that collected the clinical signs of burns in the acute phase. This study included all burn patients with black skin who consulted in the acute phase without initial local treatment and whose burn was less than 4hours old. It covered a period of 13 years, from January 1st, 2011 to December 31st, 2023. Males (54.6%) and children aged 5 years and under were the most affected (46.3%). Boiling liquids were the most common causative agent (67.4%). Burns of 20% or more of the body surface area represented the largest proportion (39.1%) followed by those between 10 and 19% (35.5%). All 214 patients included in the study had at least one first-degree burn and there were several associated degrees. Second-degree burns, as a whole, were also among the most encountered, i.e. 89.1% of cases. In our burn patients with black skin, we observed some clinical differences in the assessment of burn depth with the description reported in the literature. The erythema described in first-degree burns on "white" skin was reflected in the burned patient with black skin by a dark, darker or grayish appearance of the skin; and the dermis for second- and third-degree burns appeared whiter in patients with black skin compared to patients with "white skin". The semiology of thermal skin burns in the acute phase should be revisited and adapted to the patient's skin color.

Clinical Epidemiology of Trauma Patients: A Retrospective Analysis of 3705 Consecutive Patients Treated at a Level I Trauma Center

BACKGROUND

Trauma is a leading cause of morbidity and mortality globally, particularly in low- and middle-income (LMIC) countries like India, where road traffic injuries (RTIs) dominate. Despite advancements in medical technology, trauma care remains underdeveloped due to resource limitations, inadequate pre-hospital care, and poor compliance with safety measures. This study aimed to analyze the clinical-epidemiological profile of trauma patients and develop strategies for effective trauma prevention and management.

METHODS

A retrospective review of 3,705 trauma patients admitted to a level I trauma center between July 2018 and June 2024 was conducted. Data on demographics, injury mechanisms, triage priority, treatment outcomes, and resource utilization were analyzed. Patients were managed following Advanced Trauma Life Support (ATLS) protocols, with multidisciplinary care and trauma registry utilization.

RESULTS

RTIs accounted for 67.3% of cases, with two-wheeler accidents being the most common (84.7%). Males comprised 78.3% of patients, with a mean age of 37.5 years. Alcohol intoxication was present in 41.9% of cases. Head injuries (1663/3705; 44.9%) and polytrauma (719/3705; 19.5%) were prevalent, with a mortality rate of 4.0%. ICU admission was required for 58.4% (n=2165) of patients, and of these, 992 (45.8%) needed mechanical ventilation. Of the 2,111 two-wheeler-related accidents, only 33% (696) wore helmets and of the 201 four-wheeler accidents, seatbelts were worn by only 41% (n=83). Low compliance with helmet and seatbelt use exacerbated injury severity.

CONCLUSION

The study emphasizes the critical need for tighter enforcement of seatbelt and helmet regulations, improved pre-hospital care systems, and improved road safety measures. To lower trauma-related morbidity and mortality in India, it is essential to build trauma registries, strengthen the infrastructure for trauma care, and put evidence-based policies into place.

Composition design and performance analysis of binary and ternary Mg-Zn-Ti alloys for biomedical implants

Magnesium-based implants are highly valued in the biomedical field for biocompatibility and biodegradability, though their inherent low strength in body fluids is a limitation. This study addresses this by alloying magnesium with zinc and titanium to enhance its properties. Mechanical alloying was used to synthesize binary (Mg-Zn, Mg-Ti) and ternary (Mg-Zn-Ti) alloys, which were then compacted and sintered. The alloy powders, composed of 10 wt% Zn and 5 wt% Ti, were milled at 360 rpm for 10 h. Microstructural analysis revealed uniformly dispersed particles, with SEM confirming spherical and fine particles alongside laminates. XRD identified intermetallic compound formation. The ternary alloy demonstrated superior micro-hardness and Young's modulus similar to human bone, making it particularly promising for biomedical applications. Incorporating zinc and titanium into the magnesium matrix resulted in a ternary alloy that outperformed its binary counterparts.

Immediate Implant Therapy with Full-Digital Workflow to Replace a Central Incisor

Background: Replacing a maxillary central incisor and immediately placing an implant represents a clinical challenge. Methods: This case report demonstrates a full digital workflow to achieve a predictable implant placement and esthetically pleasing restoration for a 35-year-old male patient who suffered a horizontal root fracture after a sports accident. The patient's treatment included digital implant planning, minimally traumatic tooth extraction, computer-guided implant placement, soft tissue augmentation, and a provisional restoration to contour the augmented gingival tissues. The process began with cone beam computed tomography (CBCT) evaluation and patient consultation on treatment options, with the patient opting for implant therapy. Using a 3D-printed surgical guide, the implant was placed precisely, and a soft tissue graft was used to enhance the gingival architecture and volume. A provisional restoration was designed to support the emergence profile and condition the peri implant soft tissues. A final digital impression was made, and a screw-retained all-ceramic crown was fabricated uneventfully after healing. Results: This digital approach allowed accurate planning and allowed the efficient execution of a technique-sensitive procedure such as immediate implant placement, thus providing an esthetic and functional solution while minimizing treatment time. Conclusions: The case highlights that immediate implant therapy in the esthetic zone requires meticulous planning and execution, and that incorporating advanced digital tools and techniques is required to achieve favorable clinical outcomes.

Using the ADAPT guidance to culturally adapt a brief intervention to reduce alcohol use among injury patients in Tanzania

Harmful alcohol use is a leading risk factor for injury-related death and disability in low- and middle-income countries (LMICs). Brief negotiational interventions (BNIs) in emergency departments (EDs) effectively reduce alcohol intake and re-injury rates. However, most BNIs are developed in high-income countries, with limited evidence of their effectiveness in LMICs. To address this gap, we culturally adapted a BNI for alcohol-related injury patients at Kilimanjaro Christian Medical Centre (KCMC), a tertiary hospital in Tanzania. Our study followed the ADAPT guidance to culturally adapt an existing high-income country BNI for use in the KCMC, a tertiary hospital in Tanzania. The adaptation included: 1) a systematic review of effective alcohol harm reduction interventions in similar settings; 2) consultations with local and international healthcare professionals experienced in counseling and substance abuse treatment; 3) group discussions to refine goals and finalize adaptations. The adapted BNI protocol and assessment scales ensured intervention fidelity. At KCMC, 30% of injury patients screened positive for alcohol use disorder (AUD), with a five-fold increased risk of injury, primarily from road traffic accidents and violence. A systematic review highlighted limited data on patient-level interventions in low-resource settings. Our adapted BNI, 'Punguza Pombe Kwa Afya Yako (PPKAY)', based on the FRAMES model, showed high feasibility and acceptability, with 84% of interventions achieving ≥80% adherence and 98% patient satisfaction. PPKAY is the first culturally adapted alcohol BNI for injury patients in an African ED. Our study demonstrates our approach to adapting substance use interventions for use in low resource settings and shows that cultural adaptation of alcohol use interventions is feasible, beneficial and empowering for our team. Our study lays a framework and method for other low resourced settings to integrate cultural adaptation into the implementation of a BNI in low resource EDs.

Demographics, management and outcomes of major trauma in older patients at an Irish trauma unit

BACKGROUND

Major trauma data in the developed world trends towards increased rates of lower energy mechanism in an older cohort. This study examines how the mechanism of trauma, injury pattern and outcomes differ between a younger and older cohorts in an Irish trauma unit.

METHODS

In this retrospective study, all entries to the Trauma Audit and Research Network (TARN) database from Tallaght University Hospital, between January 1st 2016 and 31st December 2021, were interrogated. Differences between injury severity, 30-day mortality, and hospital length of stay in younger and older patients were also examined.

RESULTS

Older patients (≥ 65 years) had a similar severity of injury to younger patients (< 65 years); however, they had longer stays in hospital (18.8 versus 9.5 days, p < 0.001). Older patients (≥ 65 years) were more likely to have head (16.1% versus 11.3%, p < 0.05) and cervical spine (21.4% versus 11.2%, p < 0.05) injuries as their primary injury compared with younger patients. Older patients (≥ 65 years) are less likely to have limb (33.3% versus 45.6%, p < 0.05). Fall from a height less than 2 m was more likely to be the mechanism of injury in the older cohort compared with the younger cohort (77.3% versus 36.3%, p < 0.05).

CONCLUSION

This study highlights the increased mortality and morbidity experienced by older trauma patients compared with a younger cohort. The findings support the development of "silver trauma" care pathways and directing resources to meet the needs of older trauma patients and optimize clinical outcomes.

Age- and sex-specific incidence rates and future projections for hip fractures in Zimbabwe

INTRODUCTION

Population ageing in Africa is increasing healthcare demands. Hip fractures require multidisciplinary care and are considered an indicator condition for age-related health services. We aimed to estimate current hip fracture incidence in Zimbabwe, compare rates against other regional estimates and estimate future fracture numbers.

METHODS

All hip fracture cases in adults aged ≥40 years, presenting to any hospital in Harare over 2 years, were identified. From this, age- and sex-specific hip fracture incidence rates per 100 000 person-years were estimated using 2022 Zimbabwean Census data and compared with South African and Botswanan estimates. Furthermore, using the United Nations population projections, future hip fracture numbers were estimated to 2052 for Zimbabwe.

RESULTS

In 2022, 1 83 312 women and 1 79 212 men aged ≥40 years were living in Harare (14.9% of the city's population). Over 2 years 243 hip fracture cases, 133 (54.7%) female, mean (SD) age 71.2 (15.9) years, were identified. Most presented to public hospitals (202 [83.1%]) and were fragility hip fractures (211 [86.8%]); high-impact trauma (eg, traffic accidents) was more common in younger men. Presentation delays of >2 weeks were common (37.4%). Incidence rates for adults aged ≥40 years in Harare (observed) and Zimbabwe (estimated) were 33.5 and 53.8/100 000 person-years, respectively. Over age 50, rates increased with age, with the highest rates seen in women aged ≥85 years (704/100 000 person-years). Age-standardised hip fracture incidence rates are broadly comparable between Zimbabwe, Botswana and Black South Africans in those aged 40-69 years; thereafter, rates in Zimbabwean women and men exceed those in Botswana and South Africa. Across Zimbabwe, the number of hip fractures occurring annually is expected to increase more than 2.5-fold from 1709 in 2022 to 4414 by 2052.

CONCLUSION

In Zimbabwe, most hip fractures in adults ≥50 years are fragility fractures, consistent with age-associated osteoporosis; incidence rates exceed those previously reported regionally. Demands on already challenged healthcare systems will increase.

The trend of suicide and self-harm in the Chinese population from 2018 to 2022 based on ambulance medical emergency cases: a retrospective study

Objective

This study investigates the trends of suicide and self-harm in Nanjing, China, through 4 years of data collection, aiming to provide valuable information for developing effective suicide prevention strategies.

Methods

This descriptive study analyzed Nanjing Emergency Medical Center (NEMC) ambulance records from Nanjing (2018-2022) to investigate suicide and self-harm events. Out of 689,305 records, 4,261 cases were included after exclusions. The study categorized incidents into 4,103 suicide events and 158 self-harm cases. Descriptive statistics and content analysis were conducted to identify characteristics and themes related to these events, with age groups defined according to American Medical Association standards.

Results

The study highlights drug poisoning as the leading method, accounting for 63.56% of the 4,103 suicide events. It notes significant trends by age, gender, and season, with males showing higher rates of self-harm. The study emphasizes the need for targeted prevention strategies, particularly focusing on drug-related suicides among adults and adolescents, as well as the prevalence of various self-harming behaviors.

Conclusion

To reduce self-harm and suicide, interventions must be strengthened for women, who experience higher rates. Key strategies include regulating pesticides and psychotropic drugs, increasing access to mental health resources, and launching community awareness campaigns. Additionally, training healthcare providers and promoting family education can enhance support for women facing mental health challenges.

Compliance and associated factors of personal protective equipment among sanitary workers in selected public hospitals, Eastern Ethiopia: A cross-sectional study design

Background

Adherence to the proper use of protective personal equipment (PPE) in health care facilities including public hospitals is challenging among sanitation workers(SWs) across the world in general and in developing countries in particular. Despite the emphasis inline up on various policies and guidelines for PPE use implementation, inconsistent use of PPE, disobedience to PPE regulations, negligence, ignorance, discomfort, and lacking infection prevention and control (IPC) practice have been identified as main associated factors. All these and other factors contributing for the non-compliance of PPE practice among SWs within the hospitals in nations with limited resources such as Ethiopia, as well as study regions. Thus, such non-adherence or improper application of PPE is a major concern, and ultimately the consequences of unworthy PPE use has had an influence on the health and safety of sanitary workers.

Objective

The aim of this study was to assess compliance and associated factors of personal protective equipment among sanitary workers in selected public hospitals, eastern Ethiopia.

Methods

A cross-sectional research design used with mixed of quantitative and qualitative data. Surveys were conducted on 809 hospital sanitary workers from May-to-August, 2023. Face-to-face interview was conducted for the quantitative data. Sixteen Key Informant interviews were participated. Field observation also conducted. Epi Data version 3.1 was used for data import, while Stata version 17 MP was used for analysis. Multilevel binary and multivariable regression were for the crude odds ratio and adjusted odds ratio. Variables were analyzed at four levels: Model-0, Model-1, Model-2, and Model-3 for outcome, individual level, hospital level, and individual and hospital levels, respectively. Of these, only model 3 was reported for the interpretation. The cut-point of p-value for crude odds ratio and adjusted odds ratio at model 3 were 0.20 and 0.05, respectively, with a 95% confidence interval reported.

Result

Out of 809 sanitary workers, 729 (90.11%) of them were responded. The prevalence of compliance and noncompliance with protective personal equipment practice among sanitary workers were 46.78(95% CI: 43.11%-50.47%) and 53.22% (95% CI: 50.19%-57.11%), respectively. Multivariable multilevel analysis of model 3 shows that the overall variation for compliance of protective personal equipment practice between sanitary workers from hospitals to hospitals was 26.66%. The model also found that those had daily supervision (AOR = 13.71, 3.18-59.11), good infection prevention and control practice (AOR = 11.34, 1.97-65.24), and perceived less severity of protective personal equipment (AOR = 1.46, 0.85-2.59) were more likely to increase protective personal equipment practice.

Conclusion

The study concluded that improper personal protective equipment practices among sanitary workers were caused by a shortage, discomfortable, wearing carelessly and negligence, felt less advantaged, and cues to action, and had worse self-efficacy. The study advised that maintaining a sufficient supply of protective personal equipment, increasing awareness of protective personal equipment utilization, and providing daily supervision are all necessary to improve the level of protective personal equipment compliance within the selected hospitals.

Urban-rural disparities in fatal and non-fatal paediatric injuries after trauma - A national retrospective cohort study

INTRODUCTION

Paediatric trauma is a leading cause of death, with correlations between trauma outcomes and geographical locations. Certain rural regions of Norway face a higher risk of trauma-related fatalities compared to the nationwide population. Among adults, the risk of both fatal and non-fatal injuries rises with increased rurality. The study aimed to investigate whether there is an increased risk of fatal and non-fatal injuries for children in rural areas across the entire country, as well as any changes over two decades.

MATERIALS AND METHODS

We conducted a retrospective cohort study of fatal and non-fatal paediatric injuries by accessing two national registries for all trauma-related patients under the age of 18. All cases were stratified into six groups according to level of centrality based on a national index used as a proxy for rurality. For inter-group comparison, urban-rural disparities were evaluated using Pearson`s Chi-square test, linear regression, and relative risk (RR).

RESULT

1,059 paediatric deaths were included in the study period from 2002 to 2021. The mortality rate increased linearly with increased rurality (r = 0.985, p < .001). The overall mortality risk was 2.4 times higher in the most rural group compared to the most urban (RR = 2.37, 95 %CI 1.78 - 3.14, p < .001). Most deaths occurred pre-hospital (73 %), the total number of fatalities was highest in the age group 16 to 17 (42 %), and transport-related injury (32 %) was the most common cause of death. The relative risk of non-fatal injury was significantly higher for all centrality groups compared to most urban, and the highest rate was seen in sub-rural areas (RR = 1.39, 95 %CI 1.37 - 1.42, p < .001).

CONCLUSION

The mortality rate increased linearly across all levels of centrality, and the relative risk was 2.4 times higher in the most rural population compared to the most urban population. To effectively target primary prevention and enhance trauma care for paediatric patients in rural areas, a deeper epidemiological understanding and more comprehensive studies are essential.

Assessment of the HIV Enhanced Access Testing in the Emergency Department (HEATED) program in Nairobi, Kenya: a quasi-experimental prospective study

BACKGROUND

Persons seeking emergency injury care are often from higher-risk and underserved key populations (KPs) and priority populations (PPs) for HIV programming. While facility-based HIV Testing Services (HTS) in Kenya are effective, emergency department (ED) delivery is limited, despite the potential to reach underserved persons.

METHODS

This quasi-experimental prospective study evaluated implementation of the HIV Enhanced Access Testing in Emergency Departments (HEATED) at Kenyatta National Hospital ED in Nairobi, Kenya. The HEATED program was designed as a multi-component intervention employing setting appropriate strategies for HIV care sensitization and integration, task shifting, resource reorganization, linkage advocacy, skills development and education to promote ED-HTS with a focus on higher-risk persons. KPs included sex workers, gay men, men who have sex with men, transgender persons and persons who inject drugs. PPs included young persons (18-24 years), victims of interpersonal violence, persons with hazardous alcohol use and persons never HIV tested. Data were obtained from systems-level records, enrolled injured patient participants and healthcare providers. Systems and patient-level data were collected during a pre-implementation period (6 March - 16 April 2023) and post-implementation (period 1, 1 May - 26 June 2023). Additional, systems-level data were collected during a second post-implementation (period 2, 27 June - 20 August 2023). HTS data were evaluated as facility-based HIV testing (completed in the ED) and distribution of HIV self-tests independently, and aggregated as ED-HTS. Evaluation analyses were completed across reach, effectiveness, adoption, implementation and maintenance framework domains.

RESULTS

All 151 clinical staff were reached through trainings and sensitizations on the HEATED program. Systems-level ED-HTS among all presenting patients increased from 16.7% pre-implementation to 23.0% post-implementation periods 1 and 2 (RR = 1.31, 95% CI: 1.21-1.43; p < 0.001). Among 605 enrolled patient participants, facilities-based HTS increased from 5.7% pre-implementation to 62.3% post-implementation period 1 (RR = 11.2, 95%CI: 6.9-18.1; p < 0.001). There were 440 (72.7%) patient participants identified as KPs (5.6%) and/or PPs (65.3%). For enrolled KPs/PPs, facilities-based HTS increased from 4.6% pre-implementation to 72.3% post-implementation period 1 (RR = 13.8, 95%CI: 5.5-28.7, p < 0.001). Systems and participant level data demonstrated successful adoption and implementation of the HEATED program. Through 16 wk post-implementation a significant increase in ED-HTS delivery was maintained as compared to pre-implementation.

CONCLUSIONS

The HEATED program increased overall ED-HTS and augmented delivery to KPs/PPs, suggesting that broader implementation could improve HIV services for underserved persons already in contact with health systems.

Cross-cultural adaptation, content validity, and reliability of the Amharic version of the modified John-Hopkins fall risk assessment scale among older adults who attend home health care services

Background

The modified John-Hopkins fall risk assessment tool (mJH-FRAT) is a comprehensive and multi-factor fall risk assessment tool used to screen and grade older adult's fall risk levels in home health care services. This can help to identify risky individuals early, establish prevention protocols, and reduce the occurrence of injury. Nevertheless, there is a dearth of contextually valid and reliable fall risk assessment tools among this population in the study area. The aim of this study is therefore to cross-culturally adapt and assess the content validity and reliability of the modified John-Hopkins fall risk assessment tool among older adults following home health care in Ethiopia.

Method

The English version of the mJH-FRAT underwent cross-cultural adaptation into Amharic. The final Amharic version was subjected to face validity and then content validity was computed. This community-based study was conducted from November 2023 to May 2024 with a total of 150 participants selected through convenience sampling. Data collection occurred through face-to-face interviews. Epi-Info 7 and Statistical Package for the Social Sciences software version 25 facilitated data entry and analysis, respectively. Reliability was assessed by employing intra-rater and inter-rater reliability using Cohen's kappa.

Result

The CVI based on the item level of all the items was between 0.8 and 1. The S-CVI based on average for domains such as general condition and clinical condition was 0.925 and 1, respectively, and the S-CVI (average) of the scale was 0.96. The S-CVI based on the universal agreement value for the overall 8 items was 0.75. The kappa statistic coefficient value was between 0.79 and 1. The intra-rater reliability and inter-rater reliability were 0.94 and 0.93, respectively.

Conclusion

The rigorous adaptation process, face and content validity, and reliability analyses demonstrated that the Amharic mJH-FRAT is a content valid and reliable tool for assessing the fall risk level in this population. Clinicians and researchers can utilize this tool for the advancement of both clinical practice and research work on this group of people in Ethiopia.

Injury epidemiology and emergency department length of stay in trauma hospital in Addis Ababa, Ethiopia

BACKGROUND

Injuries are a major cause of health problems in low- and middle-income countries than in high-income nations. This study aimed to describe injuries and identify factors associated with the emergency department (ED) length of stay (LoS).

METHODS

This study was conducted at the Addis Ababa Burn, Emergency, and Trauma (AaBET) hospital in Addis Ababa, Ethiopia. All injured patients who visited the ED between April 1, 2021, and March 30, 2022, were included in the study. Data were collected through a retrospective medical record review. Descriptive statistics were used to present the data and a multivariable binary logistic regression model was used to assess factors associated with LoS in the ED.

RESULTS

A total of 6991 (86.8%) injured patients were studied out of 8055 patients who visited the ED. The majority of the patients were male, 5184 (74.2%), and aged between 18-44 years, 4368 (62.4%). The most common mechanism of injury was road traffic accidents, 2693 (38.5%), followed by falls, 1523 (21.8%). The most commonly reported injured body parts were the head (2179, 31.2%). Of the total injured patients, 101 (1.8%) died. The LoS in the ED was greater than 24 hours for 24.4% (95% CI: 23.3-25.5) of the injured patients, with a mean duration of 2.51 (SD = 5.18) days. Factors significantly associated with a prolonged LoS (>24 hours) in the ED included being residing in outside Addis Ababa in Oromia [AOR: 1.61, 95% CI (1.38-1.88)], Amhara [AOR: 1.56, 95% CI (1.14-2.14)] and other [AOR: 3.93, 95% CI (2.73-5.64)], male [AOR: 1.30, 95% CI (1.09-1.54)], aged 60 years or older [AOR: 1.38, 95% CI (1.03-1.85)]; sustaining injuries from road traffic accident [AOR: 2.43, 95% CI (1.19-4.94)], being triaged to orange [AOR: 3.03, 95% CI (2.40-3.83)] and red zones [AOR:3.37, 95% CI (2.65-4.28)]; having fracture injuries [AOR: 1.95, (1.34-2.83)]; and experiencing contusions and crushing injuries [AOR: 2.63 (1.57-4.42)].

CONCLUSIONS

Injuries are the major share of cases among ED patients at AaBET hospital. Patients were staying in the ED for longer than the recommended 24 hours by the Ethiopian health system. Intervention measures focusing on injury prevention are necessary to reduce the patient burden on the hospital and strengthen the hospital's capacity to reduce prolonged LoS.

From curriculum to clinic: a qualitative study of junior doctors' perceptions of global health and sustainable development

INTRODUCTION

The role of global health and sustainable development in medical education is often debated. However, research regarding medical doctors' views on the application of their global health knowledge in the clinical setting remains scarce. This study aimed to explore junior doctors' perceptions of global health and sustainable development, the education they have received on these issues and the relevance of this knowledge in their current and future work.

METHODS

This was a qualitative study based on individual interviews conducted between May and June 2022. 16 junior doctors, in mandatory clinical training after completing medical school, were purposively sampled from five Swedish hospitals. Transcripts were analysed using qualitative content analysis.

RESULTS

Three themes were identified. The first theme (1) 'medical doctors have a role in the transition to a sustainable society', shows that sustainable development is increasingly perceived as relevant for junior doctors' clinical work. The second theme (2) 'global health and sustainable development teaching is inconsistent and somewhat outdated', highlights that there is an assumption that global health and sustainable development can be self-taught. A discrepancy between what is being taught in medical school and the clinical reality is also recognised. This causes challenges in applying global health interest and knowledge in the clinical setting, which is described in the third theme (3) 'application of global health and sustainable development is difficult'. This theme also highlights opportunities for continued engagement, with the perceived benefit of becoming a more versatile doctor.

CONCLUSION

This study emphasises the need for conceptual clarity regarding global health in medical education and raises the need for clarification regarding the level of responsibility for integrating sustainable practices in Swedish healthcare settings.

Comparison of deep learning approaches to estimate injury severity from the International Classification of Diseases codes

OBJECTIVE

The injury severity classification based on the Abbreviated Injury Scale (AIS) provides information that allows for standardized comparisons for injury research. However, the majority of injury data is captured using the International Classification of Diseases (ICD), which lacks injury severity information. It has been shown that the encoder-decoder-based neural machine translation (NMT) model is more accurate than other methods for determining injury severity from ICD codes. The objectives of this project were to determine if feed-forward neural networks (FFNN) perform as well as NMT and to determine if direct estimation of injury severity is more accurate than using AIS codes as an intermediary (indirect method).

METHODS

Patient data from the National Trauma Data Bank were used to develop and test the four models (NMT/Indirect, NMT/Direct, FFNN/Indirect, FFNN/Direct). There were 2,031,793 cases from 2017-2018 used to train and 1,091,792 cases from 2019 were used for testing. The primary outcome of interest was the percent of cases with the correct binary classification of Injury Severity Score (ISS) ≥16, using ISS values recorded in NTDB for benchmarking. The secondary outcome was the percent of predicted ISS exactly matching the recorded ISS.

RESULTS

The results show that indirect estimation through first converting to AIS using an NMT was the most accurate in predicting ISS ≥ 16 (94.0%), followed by direct estimation with FFNN (93.4%), direct estimation with NMT (93.1%), and then indirect estimation with FFNN (93.1%), with statistically significant differences in pairwise comparison. The rankings were the same when evaluating models based on exactly matches of ISS. Training times were similar for all models (range 11-14 h), but testing was much faster for FFNN models (GPU: 1-2 min) compared to the NMT models (GPU: 69-82 min).

CONCLUSIONS

The most accurate method for obtaining injury severity from ICD was NMT using AIS codes as an intermediary (indirect method), although all methods performed well. The indirect NMT model was the most resource intensive in terms of processing time. The optimal approach for researchers will be based on their needs and the computing resources available.

Comparative Assessment of the Burden of Injury in Sub-Saharan Africa: An Analysis of Estimates From Global Burden of Disease 2021 Study

Objectives Surgical care for traumatic injuries remains a major concern to public health in sub-Saharan Africa. The 2030 Agenda for Sustainable Development recognizes rising inequalities in global health. The objectives of this study were to compare the Global Burden of Disease (GBD) 2021 estimates on injury mortality and disability across sub-Saharan sub-regions by cause-of-injury category. Methods We performed a secondary database descriptive study using the GBD 2021 results on injuries in the four sub-Saharan regions. The age-standardized rates of disability-adjusted life years (DALYs) in the sub-regions were assessed over a 10-year duration between 2012 and 2021. Results In 2021, the overall burden of injury is estimated to have affected over 42 million people in sub-Saharan Africa. Although 16 percent of this number is in Nigeria, population data suggests that southern sub-Saharan Africa records 104 deaths per 100,000 from injuries [95% uncertainty interval (UI): 96 to 113] which is twice as high compared to western sub-Saharan Africa (50 injury deaths per 100,000; 95% UI 37 to 61). Within the 10-year duration of this study, the injury DALY rates were twice as high in the Southern regions, compared to the Eastern and Western regions. Transport injuries, interpersonal violence, and drowning contributed the most to the burden of injury in sub-Saharan Africa. There is an overall decline in injury-related mortality rates and DALY rates in the region however there is a rise in the rate of police conflicts and executions. Conclusions Although these figures are highest globally, gradual improvements in the 10-year duration of this study were identified but these were slow-paced due to rising rates of police conflicts and executions in sub-Saharan Africa. Overall targeted interventions in communities and regional policy-making efforts are essential tools to create a safer region for the teeming young populace in sub-Saharan Africa.

Trauma care and its financing around the world

ABSTRACT

Worldwide, one billion people sustain trauma, and 5 million people will die every year from their injuries. Countries must build trauma systems to effectively address this high-burden disease, but efforts are often challenged by financial constraints. Understanding mechanisms for trauma funding internationally can help to identify opportunities to address the burden of injuries. Trauma leaders from around the world contributed summaries around how trauma is managed across their respective continents. These were aggregated to create a comparison of worldwide trauma systems of care. The burden of injuries is high across the world's inhabited continents, but trauma systems remain underfunded worldwide and, as a result, are overall underdeveloped and do not rise to the levels required given the burden of disease. Some countries in Africa and Asia have invested in financing mechanisms such as road accident funds or trauma-specific funding. In Latin America, active surgeon involvement in accident prevention advocacy has made meaningful impact. All continents show progress in trauma system maturation. This article describes how different regions of the world organize and commit to trauma care financially. Overall, while trauma tends to be underfunded, there is evidence of change in many regions and good examples of what can happen when a country invests in building trauma systems.

LEVEL OF EVIDENCE

Expert Opinions; Level VII.

Global burden of fracture of sternum and/or ribs: An analysis of 204 countries and territories between 1990 and 2019

BACKGROUND

Sternum and rib fractures represent a significant global health concern, contributing to morbidity and disability on a worldwide scale. However, there is a notable lack of recent epidemiological data detailing the global and regional burden of these fractures.

METHODS

We undertook a systematic analysis of the prevalence of sternum and rib fractures at the global, regional, and national levels in 2019, while also examining time trends spanning from 1990 to 2019. To achieve this, we extracted data from the Global Burden of Disease Study 2019, enabling us to determine incidence, prevalence, years lived with disability (YLDs), and their corresponding age-standardized rates.

RESULTS

In 2019, there were 4.1 million incident cases and 2 million prevalent cases of sternum and rib fractures worldwide. These figures represent increases of 43.7 % and 64.1 %, respectively, since 1990. YLDs also exhibited a notable increase, rising by 62.4 % to reach 190,834 cases. However, since 1990, their equivalent age-standardized rates, which ranged from 5.5 % to 7.1 %, have decreased. Notably, China had the greatest incidence (1.2 million cases), prevalence (573,000 cases), and number of YLDs (55,400 cases), all in 2019. The greatest age-standardized incidence rate (143/100,000) and age-standardized prevalence rate (65/100,000) were both recorded in Greenland in the same year. It's critical to emphasize that men experience these fractures at considerably higher rates than women. Around 70 % of incident instances included unintentional injuries worldwide and across all regions. High-socioeconomic regions had the highest rates of incidence, prevalence, and YLDs, albeit these rates have declined by 6.4 % to 7.1 % since 1990, whereas low-middle and low-income areas have had rises.

CONCLUSIONS

This study, which spans the years 1990 to 2019, provides a thorough and current assessment of the global burden attributed to sternum and rib fractures. In terms of nations, regions, sociodemographic index (SDI) levels, age groups, genders, and reasons, it reveals significant variances and trends. The knowledge obtained from this study can be extremely useful in formulating health policy, allocating resources, and developing methods to prevent these injuries.

Predictive power of the eTBI score for 30 day outcome in elderly patients with traumatic brain Injury

Traumatic brain injury (TBI) is a common problem in elderly individuals, with significant morbidity and mortality. The elderly Traumatic Brain Injury (eTBI) score, a novel tool for predicting outcomes in elderly patients with TBI, has shown promising results in previous studies. This study aimed to validate the eTBI score in a larger cohort of elderly patients with TBI in the Middle East. We conducted a retrospective study on 337 TBI patients with a mean age of 73.04 ± 8.73, admitted to a tertiary care hospital between March 2021 and November 2022. Within 30 days of admission, the patients' conditions, including mortality and entering a vegetative state, were evaluated. The study population was split into three groups based on eTBI score: low, medium, and high risk; then patients were divided into two subgroups based on their Glasgow Outcome Scale (GOS ≤ 2, GOS > 2) in 30 days from hospital admission. Poor outcomes (mortality and entering a vegetative state) occurred in 24.3% of the study population. Within 30 days of hospital admission, 88% of low-risk patients experienced some degree of improvement, while 100% of high-risk patients died or fell into a vegetative state. In the medium-risk group, there was a significant correlation between unresponsive pupil (P = 0.006), initial GCS score (P = 0.003), need for a ventilator device (P = 0.015), need for surgical treatment (P = 0.031) and poor outcomes. Despite having a low sensitivity (21% vs. 57%), the eTBI score performed well in terms of accuracy (81% vs. 88%), specificity (100 vs. 98%), positive predictive value (100% vs. 90%), and negative predictive value (80% vs. 88%) for both eTBI ≤ 0 and eTBI ≤ 3 thresholds. The eTBI score is a reliable tool for predicting outcomes in elderly patients with TBI. This scoring system has a positive predictive value of 100% in the eTBI ≤ 0 group, which shows that 100% of the patients who are predicted by the eTBI score to have a poor outcome will indeed have a poor outcome. Patients in the high-risk group should be closely monitored and provided with intensive care, while those in the low-risk group can be reassured about their prognosis. The eTBI score can also be used in conjunction with other clinical factors to inform treatment decisions for patients in the medium-risk group.

Unmet needs to admission in physical and rehabilitation inpatient department in Low and Middle Income Countries in 2023

BACKGROUND

Determining the needs to access to rehabilitation structures is essential for developing effective improvement strategies. The objective of this study was to determine the percentage of unmet needs to admission to rehabilitation and their associated factors.

METHODS

It is a cross sectional study in the inpatient rehabilitation department Sahloul Hospital of Sousse, tertiary care center including all requests to admission. Patient demographics, diagnoses, admission decisions, and post-decision outcomes were collected for each request.

RESULTS

Of 329 admission requests, 316 were eligible. The mean patient age was 45 years, with a male-to-female ratio of 0.84. Most requests originated from the hospital's outpatient department, neurology, and orthopedics. Among all requests, 40.5% were not admitted. Non-neurological diagnoses and patient residency were associated with non-admission. Patients with non-neurological conditions and those residing outside the city had twice the risk of non-admission. At one month, 63% of non-admitted patients experienced functional decline, and 18% were lost to follow-up.

CONCLUSION

Unmet needs to admission in rehabilitation structures is high due to lack of beds. This is leading of inequity of access to such important phase of care more. This study highlighted throwing the example of physical and rehabilitation department the gap of needs and the capacity of inpatient rehabilitation facilities. Healthcare policies should prioritize increasing rehabilitation bed availability in all regions of the country.

Impact of advanced trauma life support training on 30-day mortality in severely injured patients at a Kenyan tertiary center: a retrospective matched case-control study

INTRODUCTION

Trauma is a leading cause of mortality worldwide, particularly in low and middle-income countries (LMICs) like Kenya. This study evaluates the impact of Advanced Trauma Life Support (ATLS) training on 30-day mortality outcomes in severely injured patients at a tertiary care center in Kenya.

METHODS

A retrospective matched case-control study was conducted at Aga Khan University Hospital, Nairobi. The study included adult patients (≥ 18 years) with polytrauma (Injury Severity Score [ISS] > 15) from 2011 to 2022. Propensity score matching was used to pair 81 post-ATLS cases with 81 pre-ATLS controls based on age and ISS. Data analysis was performed using R Statistical language (version 4.3.0).

RESULTS

The 30-day mortality rate decreased significantly from 17% (95% CI: 9.4-27.4%) pre-ATLS to 6% (95% CI: 2.0-13.5%) post-ATLS (p = 0.028). No significant differences were found in baseline characteristics between the two groups. Road traffic accidents were the primary cause of trauma in both groups (72% pre-ATLS vs. 78% post-ATLS).

CONCLUSION

ATLS training significantly reduced 30-day mortality in severely injured patients, demonstrating its effectiveness even in resource-limited settings. Further prospective randomized studies are recommended to confirm these findings and evaluate long-term outcomes.

Consensus recommendations for acute trauma care & outcomes in LMICs from the transdisciplinary research, advocacy & implementation network for trauma in India

Background & objectives Injuries profoundly impact global health, with substantial deaths and disabilities, especially in low- and middle-income countries (LMICs). This paper presents strategic consensus from the Transdisciplinary Research, Advocacy, and Implementation Network for Trauma in India (TRAIN Trauma India) symposium, advocating for enhanced, system-level trauma care to address this challenge. Methods Five working groups conducted separate literature reviews on pre-hospital trauma care, in-hospital trauma resuscitation and training, trauma systems, trauma registries, and India's Towards Improving Trauma Care Outcomes (TITCO) registry. Using a Delphi approach, the TRAIN Trauma India Symposium generated consensus statements and recommendations for interventions to streamline trauma care and reduce preventable trauma mortality in India and LMICs. Experts prioritized interventions based on cost and difficulty. Results An expert panel agreed on four pre-hospital consensus statements, eight hospital resuscitation consensus statements, six system-level consensus statements, and six trauma registry consensus statements. The expert panel recommended six pre-hospital interventions, four hospital resuscitation interventions, nine system-level interventions, and seven trauma registry interventions applicable to the Indian context. Of these, 14 interventions were ranked as low cost/low difficulty, five high cost/low difficulty, five low cost/high difficulty, and three high cost/high difficulty. Interpretation & conclusions This consensus underscores the urgent need for integrated and efficient trauma systems to reduce preventable mortality, emphasizing the importance of comprehensive care that includes community engagement and robust pre-hospital and acute hospital trauma care pathways. It highlights the critical role of inclusive, system-wide approaches, from enhancing pre-hospital care and in-hospital resuscitation to implementing effective trauma registries to improve outcomes and streamline care across contexts.

Global trends and outcomes of nerve transfers for treatment of adult brachial plexus injuries

The presentation, management and outcomes of brachial plexus injuries are likely to be subject to regional differences across the globe. A comprehensive literature search was performed to identify relevant articles related to spinal accessory to suprascapular, intercostal to musculocutaneous, and ulnar and/or median nerve fascicle to biceps and/or brachialis motor branch nerve transfers for treatment of brachial plexus injuries. A total of 6007 individual brachial plexus injuries were described with a mean follow-up of 38 months. The specific indication for accessory to suprascapular and intercostal to musculocutaneous transfers were considerably different among regions (e.g. upper plexus vs. pan-plexal), while uniform for fascicular transfer for elbow flexion (e.g. upper plexus +/- C7). Similarly, functional recovery was highly variable for accessory to suprascapular and intercostal to musculocutaneous transfers, while British Medical Research Council grade ≥3 strength after fascicular transfer for elbow flexion was frequently obtained. Overall, differences in outcomes seem to be inherent to the specific transfer being utilized.Level of evidence: III.

Pattern of burden cancer breast and relationshipin to human development index in Iran 2009 to 2019: an observational study based on the Global Burden of Diseases

OBJECTIVE

Breast cancer is one of the most common cancers in women worldwide. This study aims is to investigate the burden of breast cancer in Iran and its relationship with the Human Development Index (HDI) during 2009 to 2019.

STUDY DESIGN

The present study is an observational study in Iran during the years 2009 to 2019. Data related to the incidence, mortality, Years of Life with Disability (YLD), Years of Life Lost (YLL) and Disability-Adjusted Life-Years (DALY) of breast cancer in Iran were extracted from the Global Burden of Disease 2019 (GBD-2019) website. Correlation tests are used to check the relationship between these indicators and the human development index.

RESULTS

The highest incidence rate of breast cancer in 2019 is related to the provinces of Gilan (29 per 100,000) and Tehran (28.55 per 100,000) and the highest rate of death from breast cancer is related to the provinces of Gilan (10.71 per 100,000). and Semnan (9.97 in 100,000). The results showed that there is a positive and significant correlation between DALY (r = 0.626, P < 0.0001), YLL (r = 0.611, P < 0.0001) and, YLD (r = 0.773, P < 0.0001) breast cancer with HDI index. There is a positive and significant correlation between the incidence (r = 0.794, P < 0.0001) and mortality (r = 0.503, P = 0.003) of breast cancer with the HDI index.

CONCLUSIONS

Considering that a positive correlation was observed between the incidence and burden of breast cancer and the human development index in the country, it is suggested to implement preventive measures such as public education programs to reduce the incidence and burden of breast cancer and the necessity of screening programs in areas with low human development index. It confirms the diagnosis of disease cases.

Identifying and prioritising barriers to injury care in Northern Malawi, results of a multifacility multidisciplinary health facility staff survey

INTRODUCTION

The burden of injuries globally and in Malawi is substantial. Optimising both access to, and quality of, care in health systems requires attention. We aimed to establish how health facility staff in Karonga, Malawi, perceive barriers to seeking (delay 1), reaching (delay 2) and receiving (delay 3) injury care.

METHOD

We conducted a cross-sectional survey of health facility staff who treat patients with injuries in all health facilities serving the Karonga Demographic Surveillance Site population. The primary outcome was participant perceptions of the importance of delays 1 to 3 following injury. Secondary outcomes were the barriers within each of these delays considered most important and which were considered the most important across all delays stages.

RESULTS

228 staff completed the survey: 36.8% (84/228) were female and 61.4% (140/228) reported being involved in caring for an injured person at least weekly. Delay 3 was most frequently considered the most important delay 35.1% (80/228), with 19.3% (44/228) and 16.6% (38/228) reporting delays 1 and 2 as the most important respectively; 28.9% (66/228) of respondents either did not know or answer. For delay 1 the barrier, "the perceived financial costs associated with seeking care are too great", was considered most important. For delay 2, the barrier "lack of timely affordable emergency transport (formal or informal)" was considered most important. For delay 3, the barrier, "lack of reliably available necessary physical resources (infrastructure, equipment and consumable material)" was considered most important. When considering the most important overall barrier across all delays, the delay 3 barrier, "lack of reliably available necessary physical resources" received the most nominations (41.7% [95/228]).

CONCLUSIONS

Given the awareness of health facility staff of the issues facing their patients, these findings should assist in informing health system planning.

Associated Factors of Trauma Severity and Mortality in Pediatric Patients Admitted to Intensive Care Unit; a 10-Year Retrospective Study

Introduction

Trauma is a significant global public health concern and the leading cause of morbidity and mortality in children. This study aimed to assess the independent predictors of trauma severity as well as mortality in pediatric patients admitted to the intensive care unit (ICU).

Methods

In this cross-sectional study, following the STROBE checklist, we retrospectively analyzed the clinical and baseline characteristics of pediatric patients with trauma injuries admitted to the ICU of Children's Hospital of Zhejiang University School of Medicine, China, over a decade.

Results

951 pediatric patients with a mean age of 4.79 ± 3.24 years (60.78% Boys) were studied (mortality rate 8.41%). Significant associations were observed between ISS and place of residence (p = 0.021), location of the injury (p = 0.010), year of injury (p <0.001), and injury mechanism (p <0.001). The two independent factors of trauma severity were the year of injury (β = 0.47; 95%CI: 0.28 - 0.65) and injury mechanism (β = -0.60; 95%CI: -0.88 - -0.31). Significant differences were observed between survived and non-survived regarding age (p <0.001), ISS score (p <0.001), time elapsed from injury to ICU (p <0.001), duration of mechanical ventilation (p <0.001), GCS score (p <0.001), and the proportion of patients requiring mechanical ventilation (p <0.001 ). The results of multivariate analysis indicated that age (OR = 0.805; 95%CI: 0.70 - 0.914; p = 0.001) and GCS score at ICU admission (OR = 0.629; 95%CI: 0.53 - 0.735; p < 0.001) acted as protective factors, whereas mechanical ventilation in the ICU (OR = 7.834; 95%CI: 1.766 - 34.757; p = 0.007) and ISS score at ICU admission (OR = 1.088; 95%CI: 1.047 - 1.130; p < 0.001) served as risk factors for mortality.

Conclusion

Automobile-related injuries represent the leading cause of trauma in children, with escalating severity scores year over year among pediatric patients admitted to the ICU with trauma injuries. Based on the findings the independent predictors of mortality of pediatric trauma patients admitted to the ICU were age, GCS score at ICU admission; mechanical ventilation in the ICU, and ISS score at ICU admission. Also, the year of injury and injury mechanism were independent predictors of trauma severity.

Comparing NEWS2, TRISS, and RTS in predicting mortality rate in trauma patients based on prehospital data set: a diagnostic study

BACKGROUND

In the recent years, National Early Warning Score2 (NEWS2) is utilized to predict early on, the worsening of clinical status in patients. To this date the predictive accuracy of National Early Warning Score (NEWS2), Revised Trauma Score (RTS), and Trauma and injury severity score (TRISS) regarding the trauma patients' mortality rate have not been compared. Therefore, the objective of this study is comparing NEWS2, TRISS, and RTS in predicting mortality rate in trauma patients based on prehospital data set.

METHODS

This cross-sectional retrospective diagnostic study performed on 6905 trauma patients, of which 4191 were found eligible, referred to the largest trauma center in southern Iran, Shiraz, during 2022-2023 based on their prehospital data set in order to compare the prognostic power of NEWS2, RTS, and TRISS in predicting in-hospital mortality rate. Patients are divided into deceased and survived groups. Demographic data, vital signs, and GCS were obtained from the patients and scoring systems were calculated and compared between the two groups. TRISS and ISS are calculated with in-hospital data set; others are based on prehospital data set.

RESULTS

A total of 129 patients have deceased. Age, cause of injury, length of hospital stay, SBP, RR, HR, temperature, SpO2, and GCS were associated with mortality (p-value < 0.001). TRISS and RTS had the highest sensitivity and specificity respectively (77.52, CI 95% [69.3-84.4] and 93.99, CI 95% [93.2-94.7]). TRISS had the highest area under the ROC curve (0.934) followed by NEWS2 (0.879), GCS (0.815), RTS (0.812), and ISS (0.774). TRISS and NEWS were superior to RTS, GCS, and ISS (p-value < 0.0001).

CONCLUSION

This novel study compares the accuracy of NEWS2, TRISS, and RTS scoring systems in predicting mortality rate based on prehospital data. The findings suggest that all the scoring systems can predict mortality, with TRISS being the most accurate of them, followed by NEWS2. Considering the time consumption and ease of use, NEWS2 seems to be accurate and quick in predicting mortality based on prehospital data set.

Unifying Public Health Surveillance: A Scoping Review of Global Use of the Youth Risk Behavior Survey

PURPOSE

The Youth Risk Behavior Survey (YRBS) is a well-established surveillance tool designed to document the health risk behaviors of youth. However, there is limited insight into the use of the survey outside of the United States. The aim of this scoping review was to assess the global presence and utilization of the YRBS.

METHODS

A structured electronic search of all publication years (through February 2020) was conducted to identify articles in PubMed and EBSCOhost. The search identified 128 articles that used the YRBS beyond the United States.

RESULTS

More than one-third of all countries, territories, and dependencies were represented in the articles, with the greatest use among upper-middle and high-income economies and those in the East Asia and Pacific geographic region. Priority health-risk behaviors identified were alcohol and other drug use (51%), tobacco use (48%), and unintentional and intentional injuries (44%). The articles predominantly suggested that the survey data be used to influence programs, policies, and practices (57%).

DISCUSSION

The development and proliferation of surveillance systems has allowed for important contributions to public health. Extensive use of the YRBS is notable; however, greater efforts are needed to support more systematic and collaborative approaches for evaluating youth behaviors around the world.

Post-discharge 6-Month Functional Recovery of Traumatic Brain Injury Survivors with Unfavorable Functional Status at Discharge: A Registry-Based Cohort Study

BACKGROUND

Traumatic brain injury (TBI) is a major cause of physical disabilities worldwide. Herein, we aimed to investigate the factors contributing to post-discharge recovery in patients who were discharged with an unfavorable outcome.

METHODS

We collected data on the characteristics of patients, with a focus on those who survived TBI but had an unfavorable outcome at discharge as measured by Glasgow Outcome Scale Extended (GOSE) categories 2, 3, and 4. Post-discharge recovery was defined as achieving a favorable functional status at 6 months (GOSE of 5 or more) with a minimum 2-point increase in GOSE.

RESULTS

Of 4011 TBI patients in our registry, 797 had an unfavorable discharge functional status. In severe TBI, 51% achieved recovery, while in mild to moderate TBI, 57% achieved recovery after 6 months. Older patients and those with shorter intensive care unit length of stay were more likely to experience post-discharge recovery in both mild to moderate and severe TBI groups. The presence of skull base fracture was also associated with post-discharge recovery in severe TBI patients. Lastly, we show that, after adjustment for potential confounders, GOSE at discharge is associated with post-discharge recovery in both mild to moderate and severe TBI patients.

CONCLUSIONS

This study found that the majority of patients discharged with an unfavorable functional status were able to achieve a favorable outcome within 6 months. The novel post-discharge recovery in TBI patients might be a useful tool for illuminating the factors associated with a significant improvement after discharge.

Population-attributable fraction of psychiatric and physical disorders for suicide among older adults in Taiwan

BACKGROUND

This study aimed to estimate the population-attributable fraction (PAF) of psychiatric and physical disorders for suicide among older adults, focusing on sex- and age-specific factors.

METHODS

Data from Taiwan's National Health Insurance Research Data and National Death Registry included 9136 cases of suicide in individuals aged 65+, with 89,439 matched controls. Physical and psychiatric disorders were identified through diagnostic records. Conditional logistic regression assessed risk factors, and PAF was calculated using disorder prevalence and adjusted odds ratios.

RESULTS

Major suicide risk factors among older adults were depressive disorders, anxiety disorders, and sleep disorders. Physical disorders like hypertension, peptic ulcers, and cancer also showed significant PAF values. The combined PAF of physical disorders equaled that of psychiatric disorders. Psychiatric disorders had a greater impact on women and the youngest-old adults, while physical disorders had a higher contribution among men, middle-old adults, and oldest-old adults.

LIMITATIONS

Relying solely on claim data to identify psychiatric and physical disorders may underestimate their prevalence and associations with suicide due to unrecorded cases of individuals not seeking help and the absence of key risk factors like social isolation and family support.

CONCLUSIONS

This study identifies preventable or treatable risk factors for older adult suicide, emphasizing the need to target specific psychiatric and physical disorders in suicide prevention efforts while taking into account sex- and age-specific considerations. It also underscores the importance of establishing social welfare support systems to address the unique challenges older adults face.

Health-related quality of life among inpatients suffering from Traumatic brain injury in an urban setting in Vietnam

BACKGROUND

Traumatic brain injury (TBI) is a leading cause of mortality and morbidity globally. This study aimed to measure the health-related quality of life (HRQOL) of TBI patients in Vietnam and evaluate the associated factors.

METHODS

A longitudinal study was conducted in Thai Binh, Vietnam, from February to September 2020. The EuroQol-5 Dimensions-5 Levels (EQ-5D-5L) and EQ-Visual Analog Scale (EQ-VAS) were used to measure HRQOL. Socio-demographic characteristics, including age, gender, education level, employment status, marital status, and income, as well as clinical characteristics such as injury severity, cause of injury, comorbidities, and functional status, were collected through patient interviews and medical records. Multivariate Tobit regression analysis was performed to identify variables associated with HRQOL.

RESULTS

The study included 212 TBI patients. The mean scores of the VAS and EQ-5D-5L scales were 82.4/100 (SD = 14.49) and 0.9/1.0 (SD = 0.2), respectively, indicating a relatively high HRQOL. However, certain factors significantly impacted HRQOL. Unemployed patients and those with depression or higher injury severity, as measured by the Injury Severity Score (ISS), had notably lower HRQOL scores. Poor sleep quality and severe functional impairments also adversely affected HRQOL, whereas patients discharged for a longer period had slightly better HRQOL scores.

CONCLUSION

This study highlights that while HRQOL is relatively high among TBI patients, mental health disorders, injury severity, and functional impairments are key factors negatively impacting their quality of life. High HRQOL was defined by mean scores on the VAS and EQ-5D-5L scales, with higher scores indicating better quality of life. Home-based interventions addressing these issues could improve HRQOL for TBI patients.