A qualitative exploration of the facility-based trauma care for Road Traffic Crash patients in Bangladesh: When only numbers do not tell the whole story

OBJECTIVE

Bangladesh is currently undergoing an epidemic of road traffic crashes (RTCs). In addition to morbidity and mortality, the economic loss from RTC as per cent of gross domestic product is comparatively higher than in countries with similar socioeconomic conditions. However, trauma care remained poorly developed as a specialty and service delivery mechanism. This study aimed to examine the current situation of in-hospital trauma care after RTCs to inform the design of a comprehensive service for Bangladesh.

DESIGN, SETTING AND PARTICIPANTS

This qualitative study attempted to elicit stakeholders' perceptions and experiences of managing RTCs through in-depth interviews and focus group discussions. Three districts and Dhaka city were selected based on the frequency of occurrence of RTCs. Fifteen in-depth interviews and 5 focus group discussions were conducted with 38 RTC patients, their relatives and community members in the catchment areas of 11 facilities managing trauma patients. Key informant interviews were conducted with 21 service providers and 17 key stakeholders/policy-makers.

RESULTS

Hospital-based trauma care was generally poor in primary and secondary-level facilities. There was no triage area or triage protocol in the emergency rooms, no trained staff for trauma care, no dedicated RTC patient register and scarce life-saving equipment. Only in Dhaka-based tertiary hospitals was trauma care prioritised. These hospitals follow Advanced Trauma Life Support guidelines and maintain an RTC logbook. Emergency diagnostic services were not always available in the hospitals. Most RTC patients were males; the female participants were additionally vulnerable to physical and mental trauma. Affected people avoided taking legal action considering it a lengthy, complicated and ultimately ineffective process.

CONCLUSION

The trauma care services currently available in the studied health facilities are very rudimentary and without the necessary human and financial resources. This needs urgent attention from policymakers, programmers and practitioners to reduce morbidity and mortality from the current epidemic of RTCs in Bangladesh.

Exploring the relationship between intimate partner violence during pregnancy and stillbirths

INTRODUCTION

The relationship between intimate partner violence (IPV) in pregnancy and stillbirths is poorly understood. We aimed to determine if there was any association between stillbirths and IPV during pregnancy.

METHODS

A community-based, matched, case-control study was conducted in 2014, nested within the Maternal and Newborn Health Registry of the Global Network for Women's and Children's Health Research in Pakistan. Using a WHO questionnaire, IPV in pregnancy was ascertained from 256 cases (women with stillbirths) and 539 controls (women with live births), individually matched on parity. Multivariable conditional logistic regression analysis assessed the association of IPV in pregnancy ending in stillbirths compared to those with live births.

RESULTS

The effect of physical and psychological IPV was modified by maternal age. Among women 25-34 years old with stillbirths, the odds of experiencing physical IPV in pregnancy were four times greater than those with live births, after controlling for confounders [odds ratio 4.1 (95% CI: 1.5, 11.2)]. A negative association was observed between psychological IPV in pregnancy and stillbirths among women younger than 25 years, and no association was observed between sexual IPV during pregnancy and stillbirths.

CONCLUSION

Study results show that women 25-34 years of age with stillbirths were four times more likely to experience physical IPV during pregnancy. Further studies replicating the effect modification of IPV by maternal age are warranted.

Enhancing a Willingness to Respond to Disasters and Public Health Emergencies Among Health Care Workers, Using mHealth Intervention: A Multidisciplinary Approach

Health care workers (HCWs) are increasingly faced with the continuous threat of confronting acute disasters, extreme weather-related events, and protracted public health emergencies. One of the major factors that determines emergency-department-based HCWs' willingness to respond during public health emergencies and disasters is self-efficacy. Despite increased public awareness of the threat of disasters and heightened possibility of future public health emergencies, the emphasis on preparing the health care workforce for such disasters is inadequate in low-and-middle-income countries (LMICs). Interventions for boosting self-efficacy and response willingness in public health emergencies and disasters have yet to be implemented or examined among emergency HCWs in LMICs. Mobile health (mHealth) technology seems to be a promising platform for such interventions, especially in a resource-constrained setting. This paper introduces an mHealth-focused project that demonstrates a model of multi-institutional and multidisciplinary collaboration for research and training to enhance disaster response willingness among emergency department workers in Pakistan.

The Role of Self-Efficacy and Risk Perception in the Willingness to Respond to Weather Disasters Among Emergency Medicine Health Care Workers in Pakistan

OBJECTIVE

Optimizing health care workers' (HCWs) willingness to respond (WTR) is critical in low-and-middle-income countries (LMICs) for proper health system functioning during extreme weather events. Pakistan frequently experiences weather-related disasters, but limited evidence is available to examine HCW willingness. Our study examined the association between WTR and behavioral factors among emergency department HCWs.

METHODS

A cross-sectional survey was conducted from August to September 2022 among HCWs from 2 hospitals in Karachi, Pakistan. Non-probability purposive sampling was used to recruit participants. A survey tool was informed by Witte's Extended Parallel Process Model (EPPM). Multivariate logistic regression analyses were performed to examine the association between WTR and attitudes/beliefs as well as EPPM profiles.

RESULTS

Twenty-nine percent of HCWs indicated a low WTR. HCWs using public transportation had a higher WTR. Perceived knowledge and skills, self-efficacy, and perceived impact of one's response showed positive associations with WTR if required. Perception that one's colleagues would report to work positively predicted WTR if asked. Consistent with the EPPM, HCWs with high efficacy and perceived threat were willing to respond to weather disasters.

CONCLUSIONS

Our findings highlight the need of strengthening WTR by promoting self-efficacy and enhancing accurate risk perception as a response motivator, among emergency department HCWs in Pakistan.

Child injuries in Lebanon: assessing mothers' injury prevention knowledge attitude and practices

BACKGROUND

Childhood injury is a neglected public health problem with a sizeable burden on children's well-being and their families. This study aims to describe the pattern and types of childhood injuries and to determine the level of mothers' Knowledge, Attitude, and Practices (KAP) towards childhood injury prevention in Lebanon. The study further examines the association between childhood injury occurrence and mothers' supervision.

METHODS

This cross-sectional study recruited mothers of children aged up to 10 years from multiple sites (i.e., a medical center, a private clinic, a healthcare facility, and a refugee camp clinic). Data were collected on mothers' KAP toward childhood injuries using self-administrated questionnaires. A summation score for KAP correct answers was calculated and descriptive and statistical analyses were performed to measure the association between the outcomes.

RESULTS

A total of 264 mothers were surveyed and injury data were collected on their 464 children. The prevalence of childhood injury was 20% in the past 12 months, mostly sustained by males (53.8%) and children aged 5-10 years (38.7%). The most common type of injury was fall (48.4%), followed by burns (%7.5), and sports injuries (7.5%). Hospitalized children were more likely to be males and older than 5 years (p < 0.001). More than one-third of the mothers demonstrated poor knowledge, while the majority showed poor practice (54.4%), and fair attitude (45.6%) towards child injury prevention. Children of working mothers have three times higher odds of sustaining injuries (OR: 2.95, 95% CI: 1.60;5.47) compared to those of non-working mothers, accounting for possible confounders (p = 0.001).

CONCLUSION

Childhood injuries represent a major health problem in Lebanon. Findings from this study showed that mothers are less knowledgeable and unprepared to prevent their children from getting injured. Educational programs are much needed to address the gap in the mothers' KAP toward child injury prevention. Further studies are recommended to understand the cultural context and examine its key determinants to identify effective strategies and develop tailored interventions for preventing childhood injuries.

The impact of community medical camps on medical students and graduates' education

Objectives

To investigate the impact of volunteering at community medical camps on medical students' and graduates' clinical and soft skills, knowledge of community health, and future career goals.

METHODS

The cross-sectional pilot study was conducted at the Aga Khan University Hospital, Karachi from July to October 2020, and comprised medical students or trainees who had attended at least one medical camp in a community-based setting organised by any of the two non-governmental organisations who collaborated in the study. Responses were obtained through a self-reported online survey from the participants. Data was analyzed using SPSS 25.

RESULTS

Of the 52 subjects, there were 25(48.9%) males and 27(51.9%) females with overall mean age 25.4±3.8 years. Majority of the participants 35(67.3%) had attended a private first-tier medical school while 17(32.7%) had attended other local medical schools. Overall, 40(76.9%) subjects reported improved community knowledge, , 44(84.6%) had experiential learning and confidence in outpatient management, and 49(94%) had improved soft skills. Besides, 21(40.4%) participants agreed to have been influenced to pursue a career in primary care, and 25(48.1%) reported a direct impact on their choice of career specialty. Compared to males, females reported improved awareness and alertness (p=0.016), increased confidence approaching communities (p=0.032), and increased compassion towards patient care (p=0.047).

CONCLUSIONS

Community-based medical camps had an overall positive impact on volunteering medical students.

Masking Behaviors in the Absence of Local Mandate-An Observational Study from Hillsborough County, Florida

The purpose of this study was to understand the predictors of masking-especially age, race/ethnicity and gender-in Hillsborough County Florida, a region without mask mandates. Masking and social distancing behaviors of individuals were observed in Hillsborough County during one-week intervals in July 2021, August 2021 and Late September-early October 2021. Demographic and behavioral observations were recorded and logistic regression was utilized to determine the odds ratio of wearing a mask amongst various groups. Overall, masking ranged from 36.80% to 48.64%, peaking during the second observation period. Masking rates were highest amongst people of color, women and seniors. Establishments posting mask-negative language, such as "masks NOT required," saw a 46% decrease in the odds of masking compared to establishments without mask-related signage (thereby defaulting to no mandate). Understanding who engaged in masking and social distancing behaviors will provide local public health officials with a deeper understanding of the effectiveness of previously used strategies, which can be leveraged in future surges of COVID-19 and other emergencies to create maximum impact. Lessons learned regarding policy implementation and understanding patterns of uptake of health guidelines are important for the continuous improvement of public health practice.

Fat Embolism Syndrome and in-Hospital Mortality Rates According to Patient Age: A Large Nationwide Retrospective Study

Introduction

Fat embolism syndrome (FES) is a rare life-threatening condition that can develop after traumatic orthopedic injuries. Controversy remains concerning the epidemiology in the elderly population. Therefore, this study aims to report FES related to in-hospital mortality stratified by age.

Methods

A retrospective trauma cohort study was conducted using data from the National Trauma Data Bank (NTDB) from 2007 to 2014. All FES cases were included in the study with the diagnosis of FES (ICD9 958.1). Death on arrival cases were excluded. Patients were stratified by age cohort: less than 40 (G1), 40–64 (G2), and greater than 65 (G3) years of age. The primary outcome evaluated was in-hospital mortality. Multivariable regression models were performed to adjust for potential confounders.

Results

Between 2007 and 2014, 451 people from a total of 5,836,499 trauma patients in the NTDB met the inclusion criteria. The incidence rate was 8 out of 100,000. The inpatient mortality rate was 11.8% for all subjects with the highest mortality rate of 17.6% in patients over 65. Multivariable analyses demonstrated that age greater than 65 years was an independent predictor of mortality (aOR 24.16, 95% CI 3.73, 156.59, p=0.001), despite higher incidence and injury severity of FES among patients less than 40. No significant association with length of hospital stay, length of intensive unit care, or length of ventilation use was found between the groups. Subgroup analysis of the elderly population also showed a higher mortality rate for FES in femoral neck fracture patients (18%) than other femoral fractures (14%).

Conclusion

In this retrospective cohort analysis, old age (≥ 65 years) was found to be an independent risk factor for in-hospital mortality among fat embolism syndrome patients. Elderly patients specifically with femoral neck fractures should be monitored for the development of FES.

Association of masking policies with mask adherence and distancing during the SARS-COV-2 pandemic

BACKGROUND

Quantification of the impact of local masking policies may help guide future policy interventions to reduce SARS-COV-2 disease transmission. This study's objective was to identify factors associated with adherence to masking and social distancing guidelines.

METHODS

Faculty from 16 U.S. colleges and universities trained 231 students in systematic direct observation. They assessed correct mask use and distancing in public settings in 126 US cities from September 2020 through August 2021.

RESULTS

Of 109,999 individuals observed in 126 US cities, 48% wore masks correctly with highest adherence among females, teens and seniors and lowest among non-Hispanic whites, those in vigorous physical activity, and in larger groups (P < .0001). Having a local mask mandate increased the odds of wearing a mask by nearly 3-fold (OR = 2.99, P = .0003) compared to no recommendation. People observed in non-commercial areas were least likely to wear masks. Correct mask use was greatest in December 2020 and remained high until June 2021 (P < .0001). Masking policy requirements were not associated with distancing.

DISCUSSION

The strong association between mask mandates and correct mask use suggests that public policy has a powerful influence on individual behavior.

CONCLUSIONS

Mask mandates should be considered in future pandemics to increase adherence.

Factors associated with the severity of road traffic injuries from emergency department based surveillance system in two Mexican cities

Background

Limited data from low- and middle-income countries (LMICs) on the severity of road traffic injuries (RTIs) and their relation to different variables of interest are routinely obtained. Knowledge on this subject relies on evidence from high-income countries, which might not be the same as in LMICs. This information is greatly needed to advance and inform local and regional efforts towards the United Nations’ Decade of Action and the Sustainable Development Goals.

Methods

From May 2012 to November 2014, a RTI surveillance system was implemented in two referral hospitals in two Mexican cities, León and Guadalajara, with the objective of exploring the relationship between Injury Severity Score (ISS) and different sociodemographic characteristics of the injured as well as different variables related to the event and the environment. All individuals suffering RTIs who visited the Emergency Rooms (ER) were included after granting informed consent. A Zero-Truncated Negative Binomial Model was employed to explore the statistical association between ISS and variables of interest.

Results

3024 individuals participated in the study: 2185 (72.3%) patients from León and 839 patients (27.7%) from Guadalajara. Being male, in the 20–59 age-group, having less schooling, events occurring in Guadalajara, on Sundays, at night, and arriving at ER via public/private ambulance were all associated with an increased log count of ISS. Found a significant interaction effect (p-value< 0.05) between type of road user and alcohol intake six hours before the accident on severity of the injury (ISS). The use of illicit drugs, cellphones and safety devices during the event showed no association to ISS.

Conclusions

Our study contributes to the statistical analysis of ISS obtained through RTI hospital surveillance systems. Findings might facilitate the development and evaluation of focused interventions to reduce RTIs in vulnerable users, to enhance ER services and prehospital care, and to reduce drink driving.

Direct Healthcare Costs of Moderate and Severe Work-Related Injuries: Estimates from the National Trauma Center of Qatar

Work-related injuries (WRIs) are recognized as a leading cause of admission to the national trauma center of Qatar. A retrospective analysis of trauma registry data and electronic medical records was conducted on a cohort of all WRI patients who were admitted to the Hamad Trauma Center (HTC), in Doha, Qatar, between 2011 and 2017. A total of 3757 WRI patients were treated at the HTC over the 7-year study period. The overall cost for treatment was 124,671,431 USD (18 million USD per year), with a median cost of 19,071 USD. There was a strong positive correlation between the overall cost and hospital-stay cost (r² = 0.949, p = 0.00001) and between the overall cost and procedure cost (r² = 0.852, p = 0.00001). Motor vehicle crash (MVC) victims who wore seatbelts had significantly lower injury severity, hospital stay and median total costs. A comparison of patients by quartiles of the costs incurred showed that the proportions of MVC victims, pedestrian injuries and mortality were significantly higher in the fourth quartile when compared to other quartiles (p < 0.05). These findings suggest that investments in the primary prevention of work-related injuries from falls and MVCs, through proven interventions, should be priorities for occupational safety and health in Qatar.

The Important Role for Physicians as Advocates for Firearm and Road Traffic Injury Prevention

The purpose of this article is to discuss the important role for physicians in advocating for the prevention of road traffic and firearm injuries. Physicians have shown to be effective advocates for a variety of injuries, and this needs to continue and be enhanced for these injury categories. Road traffic and firearm injuries are among the leading causes of death across the lifespan. The influence and credibility of physicians enhance the messages they provide in advocacy efforts. It is important that physicians educate and counsel patients in a variety of healthcare settings along with joining advocacy efforts of professional associations. Recommendations are provided for advocacy components related to these injuries. Also, it is very important that physicians receive training in medical school and/or residency about injuries and how to successfully advocate for evidence-based injury prevention strategies.

Antioxidant potential and α-glucosidase inhibitory activity of onion (Allium cepa L.) peel and bulb extracts

Allium cepa L. is a commonly consumed vegetable that belongs to the Amaryllidaceae family and contains nutrients and antioxidants in ample amounts. In spite of the valuable food applications of onion bulb, its peel and outer fleshy layers are generally regarded as waste and exploration of their nutritional and therapeutic potential is still in progress with a very slow progression rate. The present study was designed with the purpose of doing a comparative analysis of the antioxidant potential of two parts of Allium cepa, i.g., bulb (edible part) and outer fleshy layers and dry peels (inedible part). Moreover, the inhibitory effect of the onion bulb and peel extracts on rat intestinal α-glucosidase and pancreatic α-amylase of porcine was also evaluated. The antioxidant potential of onion peel and bulb extracts were evaluated using 2,2-diphenyl- 1-picryl hydrazyl (DPPH), ferric-reducing antioxidant power assay (FRAP), 2,2'-azino-bis- 3-ethylbenzothiazoline-6-sulfonic acid (ABTS) radical scavenging assay, H2O2 radical scavenging activity and Fe2+ chelating activity. Total flavonoids and phenolic content of ethanolic extract of onion peel were significantly greater as compared to that of onion bulb. Ethanolic extract of onion peel also presented better antioxidant and free-radical scavenging activity as compared to the ethanolic extract of bulb, while the aqueous extract of bulb presented weakest antioxidative potential. Onion peel extract's α-glucosidase inhibition potential was also correlated with their phenolic and flavonoid contents. The current findings presented onion peel as a possible source of antioxidative agents and phenolic compounds that might be beneficial against development of various common chronic diseases that might have an association with oxidative stress. Besides, outer dry layers and fleshy peels of onion exhibited higher phenolic content and antioxidant activities, compared to the inner bulb. The information obtained by the present study can be useful in promoting the use of vegetable parts other than the edible mesocarp for several future food applications, rather than these being wasted.

Delays in emergency department intervention for patients with traumatic brain injury in Uganda

Background

In Sub-Saharan African countries, the incidence of traumatic brain injury (TBI) is estimated to be many folds higher than the global average and outcome is hugely impacted by access to healthcare services and quality of care. We conducted an analysis of the TBI registry data to determine the disparities and delays in treatment for patients presenting at a tertiary care hospital in Uganda and to identify factors predictive of delayed treatment initiation.

Methods

The study was conducted at the Mulago National Referral Hospital, Kampala. The study included all patients presenting to the emergency department (ED) with suspected or documented TBI. Early treatment was defined as first intervention within 4 hours of ED presentation-a cut-off determined using sensitivity analysis to injury severity. Descriptive statistics were generated and Pearson's χ² test was used to assess the sample distribution between treatment time categories. Univariable and multivariable logistic regression models with <0.05 level of significance were used to derive the associations between patient characteristics and early intervention for TBI.

Results

Of 3944 patients, only 4.6% (n=182) received an intervention for TBI management within 1 hour of ED presentation, whereas 17.4% of patients (n=708) received some treatment within 4 hours of presentation. 19% of those with one or more serious injuries and 18% of those with moderate to severe head injury received care within 4 hours of arrival. Factors independently associated with early treatment included young age, severe head injury, and no known pre-existing conditions, whereas older or female patients had significantly less odds of receiving early treatment.

Discussion

With the increasing number of patients with TBI, ensuring early and appropriate management must be a priority for Ugandan hospitals. Delay in initiation of treatment may impact survival and functional outcome. Gender-related and age-related disparities in care should receive attention and targeted interventions.

Level of evidence

Prognostic and epidemiological study; level II evidence.

Trauma Center Outcomes After Transition From Level 2 to Level 1: A National Trauma Data Bank Analysis

BACKGROUND

Previous US-based studies have shown that a trauma center designation of level 1 is associated with improved patient outcomes. However, most studies are cross-sectional, focus on volume-related issues and are direct comparisons between levels. This study investigates the change in patient characteristics when individual trauma centers transition from level 2 to level 1 and whether the patients have similar outcomes during the initial period of the transition.

STUDY DESIGN

We performed a retrospective cohort study that analyzed hospital and patient records included in the National Trauma Data Bank from 2007 to 2016. Patient characteristics were compared before and after their hospitals transitioned their trauma level. Mortality; complications including acute kidney injury, acute respiratory distress syndrome, cardiac arrest with CPR, deep surgical site infection, deep vein thrombosis, extremity compartment syndrome, surgical site infection, osteomyelitis, pulmonary embolism, and so on; ICU admission; ventilation use; unplanned returns to the OR; unplanned ICU transfers; unplanned intubations; and lengths of stay were obtained following propensity score matching, comparing posttransition years with the last pretransition year.

RESULTS

Sixteen trauma centers transitioned from level 2 to level 1 between 2007 and 2016. One was excluded due to missing data. After transition, patient characteristics showed differences in the distribution of race, comorbidities, insurance status, injury severity scores, injury mechanisms, and injury type. After propensity score matching, patients treated in a trauma center after transition from level 2 to 1 required significantly fewer ICU admissions and had lower complication rates. However, significantly more unplanned intubations, unplanned returns to the OR, unplanned ICU transfers, ventilation use, surgical site infections, pneumonia, and urinary tract infections and higher mortality were reported after the transition.

CONCLUSIONS

Trauma centers that transitioned from level 2 to level 1 had lower overall complications, with fewer patients requiring ICU admission. However, higher mortality and more surgical site infections, pneumonia, urinary tract infections, unplanned intubations, and unplanned ICU transfers were reported after the transition. These findings may have significant implications in the planning of trauma systems for administrators and healthcare leaders.

Benzimidazole Derivative Ameliorates Opioid-Mediated Tolerance during Anticancer- Induced Neuropathic Pain in Mice

BACKGROUND

Cancer is known to be the second significant cause of death worldwide. Chemotherapeutic agents such as platinum-based compounds are frequently used single-handedly or accompanied by additional chemotherapies to treat cancer patients. Chemotherapy-induced peripheral painful neuropathy is seen in around 40% of patients who are treated with platinum-based compounds, including cisplatin. This not only decreases the quality of life of patients but also patients' compliance with cisplatin.

OBJECTIVES

Nalbuphine, an opioid, is frequently used to treat acute and chronic pain, coupled with cisplatin in cancer patients. However, long term use of nalbuphine induces tolerance to its analgesic effects. We employed the same strategy to induce tolerance in mice.

METHODS

Here, we investigated analgesic effects of 2-[(pyrrolidin-1-yl) methyl]-1H-benzimidazole (BNZ), a benzimidazole derivative, on nalbuphine-induced tolerance during cisplatin-induced neuropathic pain using hot plate test, tail-flick tests and von Frey filament in mouse models. Furthermore, we investigated the effects of BNZ on the expression of Tumor Necrosis Factor-alpha (TNF-α) in the spinal cord.

RESULTS

The results showed that BNZ reduced tolerance to analgesic effects of nalbuphine and TNF-α expression in mice.

CONCLUSION

BNZ could be a potential drug candidate for the management of nalbuphine-induced tolerance in cisplatin-induced neuropathic pain.

Occupational Safety and Work-Related Injury Control Efforts in Qatar: Lessons Learned from a Rapidly Developing Economy

Work-related injury (WRI) control is an integral part of occupational safety. In rapidly developing Gulf countries such as Qatar with a predominantly expatriate workforce, WRI control is a complex issue often seen in conjunction with the implementation of labour laws and labour rights. We aimed to implement a public health approach to facilitate efforts to achieve long-term WRI control in Qatar. A range of initiatives helped to gain visibility and momentum for this important public health problem, including identifying and engaging with key stakeholders, workers’ surveys, steps to establish a unified injury database, and the implementation of a WRI identification tool in the electronic medical records. A contemporaneous improved enforcement of existent occupational safety regulations through heightened worksite inspections and efforts to improve living conditions for migrant workers also took place. WRIs are not only a Qatar-specific problem; the same issues are faced by neighbouring Gulf countries and other rapidly developing economies with large expatriate worker populations. These strategies are also useful starting points for similar countries interested in nurturing a safe, healthy and productive workforce.

Paper Versus Digital Data Collection Methods for Road Safety Observations: Comparative Efficiency Analysis of Cost, Timeliness, Reliability, and Results

BACKGROUND

Roadside observational studies play a fundamental role in designing evidence-informed strategies to address the pressing global health problem of road traffic injuries. Paper-based data collection has been the standard method for such studies, although digital methods are gaining popularity in all types of primary data collection.

OBJECTIVE

This study aims to understand the reliability, productivity, and efficiency of paper vs digital data collection based on three different road user behaviors: helmet use, seatbelt use, and speeding. It also aims to understand the cost and time efficiency of each method and to evaluate potential trade-offs among reliability, productivity, and efficiency.

METHODS

A total of 150 observational sessions were conducted simultaneously for each risk factor in Mumbai, India, across two rounds of data collection. We matched the simultaneous digital and paper observation periods by date, time, and location, and compared the reliability by subgroups and the productivity using Pearson correlations (r). We also conducted logistic regressions separately by method to understand how similar results of inferential analyses would be. The time to complete an observation and the time to obtain a complete dataset were also compared, as were the total costs in US dollars for fieldwork, data entry, management, and cleaning.

RESULTS

Productivity was higher in paper than digital methods in each round for each risk factor. However, the sample sizes across both methods provided a precision of 0.7 percentage points or smaller. The gap between digital and paper data collection productivity narrowed across rounds, with correlations improving from r=0.27-0.49 to 0.89-0.96. Reliability in risk factor proportions was between 0.61 and 0.99, improving between the two rounds for each risk factor. The results of the logistic regressions were also largely comparable between the two methods. Differences in regression results were largely attributable to small sample sizes in some variable levels or random error in variables where the prevalence of the outcome was similar among variable levels. Although data collectors were able to complete an observation using paper more quickly, the digital dataset was available approximately 9 days sooner. Although fixed costs were higher for digital data collection, variable costs were much lower, resulting in a 7.73% (US $3011/38,947) lower overall cost.

CONCLUSIONS

Our study did not face trade-offs among time efficiency, cost efficiency, statistical reliability, and descriptive comparability when deciding between digital and paper, as digital data collection proved equivalent or superior on these domains in the context of our project. As trade-offs among cost, timeliness, and comparability-and the relative importance of each-could be unique to every data collection project, researchers should carefully consider the questionnaire complexity, target sample size, implementation plan, cost and logistical constraints, and geographical contexts when making the decision between digital and paper.

A rapid market survey on the availability of car seats in Qatar: Implications for child passenger safety

Introduction: Despite the high income level in Arabian Gulf countries, people in the region need to improve their use of child restraint systems (CRSs) to reduce the incidence of preventable injuries to child automobile passengers. Anecdotal reports have attributed the resistance to using CRSs to the expense and unavailability of the systems, prompting car seat giveaway programs. Previous studies have not assessed the adoption of CRS. This study reports the results of a rapid market survey (RMS) to understand the availability, characteristics, and affordability of CRSs in Qatar and recommend future child restraint policies and legislation. Methods: The RMS identified all retail outlets that sell CRSs in Qatar and collected standard data on each restraint system: brand, model number, age/weight limits, compliance with standards, availability, and language of the owner's manual. A previously utilized metric for child safety devices was used to measure affordability. Results: The RMS showed a sufficient number (83) and variety (five types) of car seat models at 15 retail outlets, selling at a wide price range of $14–$1,399. All the car seats complied with the European standard. Only 2% showed a manufacturing or expiry date. A user manual was available for 71% of the seats and in different languages, but only 28% appeared in Arabic. The median CRS price was equivalent to the wages for less than one day of work. Conclusion: The RMS demonstrates the availability, variety, and affordability of CRSs in Qatar. Unavailability and expense cannot be cited as barriers to use CRS, and the market is prepared for legislation requiring car seats for children in Qatar. Areas for improvement include requiring user manuals for all seats, especially in Arabic; requiring that all car seats comply with globally accepted safety standards, especially for expiry/manufacturing dates, given the harsh local climate; and encouraging further varieties of CRSs in the local market.

Paper Versus Digital Data Collection for Road Safety Risk Factors: Reliability Comparative Analysis From Three Cities in Low- and Middle-Income Countries

Background

Rapid advances in mobile technologies and applications and the continued growth in digital network coverage have the potential to transform data collection in low- and middle-income countries. A common perception is that digital data collection (DDC) is faster and quickly adaptable.

Objective

The objective of this study was to test whether DDC is faster and more adaptable in a roadside environment. We conducted a reliability study comparing digital versus paper data collection in 3 cities in Ghana, Vietnam, and Indonesia observing road safety risk factors in real time.

Methods

Roadside observation of helmet use among motorcycle passengers, seat belt use among 4-wheeler passengers, and speeding was conducted in Accra, Ghana; Ho Chi Minh City (HCMC), Vietnam; and Bandung, Indonesia. Two independent data collection teams were deployed to the same sites on the same dates and times, one using a paper-based data collection tool and the other using a digital tool. All research assistants were trained on paper-based data collection and DDC. A head-to-head analysis was conducted to compare the volume of observations, as well as the prevalence of each risk factor. Correlations (r) for continuous variables and kappa for categorical variables are reported with their level of statistical significance.

Results

In Accra, there were 119 observation periods (90-min each) identical by date, time, and location during the helmet and seat belt use risk factor data collection and 118 identical periods observing speeding prevalence. In Bandung, there were 150 observation periods common to digital and paper data collection methods, whereas in HCMC, there were 77 matching observation periods for helmet use, 82 for seat belt use, and 84 for speeding. Data collectors using paper tools were more productive than their DDC counterparts during the study. The highest mean volume per session was recorded for speeding, with Bandung recording over 1000 vehicles on paper (paper: mean 1092 [SD 435]; digital: mean 807 [SD 261]); whereas the lowest volume per session was from HCMC for seat belts (paper: mean 52 [SD 28]; digital: mean 62 [SD 30]). Accra and Bandung showed good-to-high correlation for all 3 risk factors (r=0.52 to 0.96), with higher reliability in speeding and helmet use over seat belt use; HCMC showed high reliability for speeding (r=0.99) but lower reliability for helmet and seat belt use (r=0.08 to 0.32). The reported prevalence of risk factors was comparable in all cities regardless of the data collection method.

Conclusions

DDC was convenient and reliable during roadside observational data collection. There was some site-related variability in implementing DDC methods, and generally the productivity was higher using the more familiar paper-based method. Even with low correlations between digital and paper data collection methods, the overall reported population prevalence was similar for all risk factors.

Causes and outcomes of traumatic brain injuries in Uganda: analysis from a pilot hospital registry

Background

Traumatic brain injury (TBI) is an important cause of morbidity and mortality in low/middle-income countries. The objective was to assess causes and outcomes of unintentional and intentional TBI among patients presenting to a tertiary care hospital in Uganda.

Methods

This study was conducted at Mulago National Referral Hospital, Kampala, Uganda, for 15 months in 2016–2017. Patients of all ages, males and females, presenting to the emergency department with suspected or documented TBI were enrolled. Patient demographics, TBI causes and outcomes were recorded. The outcome of interest was unintentional and intentional TBI.

Results

Intent was known for 3749 patients, of these 69.7% were unintentional TBI and 30.3% were intentional TBI. The average age of patients in both groups was similar (28±14 years) with over 70% of patients between 19 and 45 years age group. About 80% were males in both groups. The main causes of unintentional TBI were road traffic injuries (RTI) (88.9%) and falls (11.1%). Pedestrians (42.1%) and motorcycle drivers (28.1%) were the most common road users. Among patients with unintentional TBI, about 43.6% were admitted, 34.0% were sent home. There were 73 deaths: 63 were patients with RTI and 10 had a fall. Although assault (97.1%) was the main cause of intentional TBI, those patients with self-harm were likely to be in severe Glasgow Coma Scale range (39.4%) compared with victims of assault (14.2%). Among patients with intentional TBI, 42.6% were admitted and 37.1% were sent home. There were 30 deaths: 29 were assault victims and 1 of self-harm.

Discussion

Unintentional TBI caused by RTI and intentional TBI caused by assault are common among young males attending Mulago Hospital in Kampala.

Level of evidence

Prospective observational study, level III.

Global Surgery: Could systems thinking be the key to success?

Surgery and anaesthesia care is progressively making its way into the Global Public Health arena, which was d omi na ted by ma ter nal an d c hild h e al th an d communicable diseases in low-and middle-income countries (LMICs). Global Surgery (GS) could potentially make an impact on survival and quality of life in all age groups for a variety of disease conditions. After success in highlighting knowledge, policy and advocacy gaps, Global Surgery is transitioning from problem identification to designing and implementing solutions. A shared vision will lay out priorities to achieve the common goal of providing safe and affordable surgical and anaesthesia care in under-developed and developing countries. A systematic thinking approach could amplify the impact of such efforts by highlighting the bigger picture, enabling Global Surgery leaders in such countries to build multidisciplinary coalitions and utilise crosslevel interactions between Global Surgery and other initiatives.

Secreted frizzled-related protein 2 (SFRP2) expression promotes lesion proliferation via canonical WNT signaling and indicates lesion borders in extraovarian endometriosis

STUDY QUESTION

What is the role of SFRP2 in endometriosis?

SUMMARY ANSWER

SFRP2 acts as a canonical WNT/CTNNB1 signaling agonist in endometriosis, regulating endometriosis lesion growth and indicating endometriosis lesion borders together with CTNNB1 (also known as beta catenin).

WHAT IS KNOWN ALREADY

Endometriosis is a common, chronic disease that affects women of reproductive age, causing pain and infertility, and has significant economic impact on national health systems. Despite extensive research, the pathogenesis of endometriosis is poorly understood, and targeted medical treatments are lacking. WNT signaling is dysregulated in various human diseases, but its role in extraovarian endometriosis has not been fully elucidated.

STUDY DESIGN, SIZE, DURATION

We evaluated the significance of WNT signaling, and especially secreted frizzled-related protein 2 (SFRP2), in extraovarian endometriosis, including peritoneal and deep lesions. The study design was based on a cohort of clinical samples collected by laparoscopy or curettage and questionnaire data from healthy controls and endometriosis patients.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Global gene expression analysis in human endometrium (n = 104) and endometriosis (n = 177) specimens from 47 healthy controls and 103 endometriosis patients was followed by bioinformatics and supportive qPCR analyses. Immunohistochemistry, Western blotting, primary cell culture and siRNA knockdown approaches were used to validate the findings.

MAIN RESULTS AND THE ROLE OF CHANCE

Among the 220 WNT signaling and CTNNB1 target genes analysed, 184 genes showed differential expression in extraovarian endometriosis (P < 0.05) compared with endometrium tissue, including SFRP2 and CTNNB1. Menstrual cycle-dependent regulation of WNT genes observed in the endometrium was lost in endometriosis lesions, as shown by hierarchical clustering. Immunohistochemical analysis indicated that SFRP2 and CTNNB1 are novel endometriosis lesion border markers, complementing immunostaining for the known marker CD10 (also known as MME). SFRP2 and CTNNB1 localized similarly in both the epithelium and stroma of extraovarian endometriosis tissue, and interestingly, both also indicated an additional distant lesion border, suggesting that WNT signaling is altered in the endometriosis stroma beyond the primary border indicated by the known marker CD10. SFRP2 expression was positively associated with pain symptoms experienced by patients (P < 0.05), and functional loss of SFRP2 in extraovarian endometriosis primary cell cultures resulted in decreased cell proliferation (P < 0.05) associated with reduced CTNNB1 protein expression (P = 0.05).

LIMITATIONS REASONS FOR CAUTION

SFRP2 and CTNNB1 improved extraovarian endometriosis lesion border detection in a relatively small cohort (n = 20), although larger studies with different endometriosis subtypes in variable cycle phases and under hormonal medication are required.

WIDER IMPLICATIONS OF THE FINDINGS

The highly expressed SFRP2 and CTNNB1 improve endometriosis lesion border detection, which can have clinical implications for better visualization of endometriosis lesions over CD10. Furthermore, SFRP2 acts as a canonical WNT/CTNNB1 signaling agonist in endometriosis and positively regulates endometriosis lesion growth, suggesting that the WNT pathway may be an important therapeutic target for endometriosis.

STUDY FUNDING/COMPETING INTEREST(S)

This study was funded by the Academy of Finland and by Tekes: Finnish Funding Agency for Innovation. The authors have no conflict of interest to declare.

Determinants of emergency department disposition of patients with traumatic brain injury in Uganda: results from a registry

Background

Traumatic brain injuries (TBIs) are a common cause of emergency department (ED) visits and hospital admissions in Kampala, Uganda. The objective of this study was to assess determinants of ED discharge disposition based on patient demographic and injury characteristics. Four ED outcomes were considered: discharge home, hospital admission, death, and others.

Methods

This prospective study was conducted at Mulago National Referral Hospital, Kampala, Uganda, from May 2016 to July 2017. Patients of all age groups presenting with TBI were included. Patient demographics, external causes of injury, TBI characteristics, and disposition from EDs were noted. Injury severity was estimated using the Glasgow Coma Scale (GCS), Kampala Trauma Score (KTS), and the Revised Trauma Score (RTS). A multinomial logistic regression model was used to estimate conditional ORs of hospital admission, death, and other dispositions compared with the reference category “discharged home”.

Results

A total of 3944 patients were included in the study with a male versus female ratio of 5.5:1 and a mean age of 28.5 years (SD=14.2). Patients had closed head injuries in 62.9% of cases. The leading causes of TBIs were road traffic crashes (58.8%) and intentional injuries (28.7%). There was no significant difference between the four discharge categories with respect to age, sex, mode of arrival, cause of TBI, place of injury, type of head injury, transport time, and RTS (p>0.05). There were statistically significant differences between the four discharge categories for a number of serious injuries, GCS on arrival, change in GCS, and KTS. In a multinomial logistic regression model, change in GCS, area of residence, number of serious injuries, and KTS were significant predictors of ED disposition.

Discussion

This study provides evidence that ED disposition of patients with TBI is differentially affected by injury characteristics and is largely dependent on injury severity and change in GCS during ED stay.

Level of evidence

Level II.

Performance of injury severity measures in trauma research: a literature review and validation analysis of studies from low-income and middle-income countries

INTRODUCTION

Characterisation of injury severity is an important pillar of scientific research to measure and compare the outcomes. Although majority of injury severity measures were developed in high-income countries, many have been studied in low-income and middle-income countries (LMICs). We conducted this study to identify and characterise all injury severity measures, describe how widely and frequently they are used in trauma research from LMICs, and summarise the evidence on their performance based on empirical and theoretical validation​ analysis.

METHODS

First, a list of injury measures was identified through PubMed search. Subsequently, a systematic search of PubMed, Global Health and EMBASE was undertaken on LMIC trauma literature published from January 2006 to June 2016, in order to assess the application and performance of injury severity measures to predict in-hospital mortality. Studies that applied one or more global injury severity measure(s) on all types of injuries were included, with the exception of war injuries and isolated organ injuries.

RESULTS

Over a span of 40 years, more than 55 injury severity measures were developed. Out of 3862 non-duplicate citations, 597 studies from 54 LMICs were listed as eligible studies. Full-text review revealed 37 studies describing performance of injury severity measures for outcome prediction. Twenty-five articles from 13 LMICs assessed the validity of at least one injury severity measure for in-hospital mortality. Injury severity score was the most commonly validated measure in LMICs, with a wide range of performance (area under the receiver operating characteristic curve (AUROC) between 0.9 and 0.65). Trauma and Injury Severity Score validation studies reported AUROC between 0.80 and 0.98.

CONCLUSION

Empirical studies from LMICs frequently use injury severity measures, however, no single injury severity measure has shown a consistent result in all settings or populations and thus warrants validation studies for the diversity of LMIC population.

Assessment of pre-hospital emergency medical services in low-income settings using a health systems approach

Emergency medical services (EMS) is defined as the system that organizes all aspects of care provided to patients in the pre-hospital or out-of-hospital environment. Hence, EMS is a critical component of the health systems and is necessary to improve outcomes of injuries and other time-sensitive illnesses. Still there exists a substantial need for evidence to improve our understanding of the capacity of such systems as well as their strengths, weaknesses, and priority areas for improvement in low-resource environments. The aim was to develop a tool for assessment of the pre-hospital EMS system using the World Health Organization (WHO) health system framework. Relevant literature search and expert consultation helped identify variables describing system capacity, outputs, and goals of pre-hospital EMS. Those were organized according to the health systems framework, and a multipronged approach is proposed for data collection including use of qualitative and quantitative methods with triangulation of information from important stakeholders, direct observation, and policy document review. The resultant information is expected to provide a holistic picture of the pre-hospital emergency medical services and develop key recommendations for PEMS systems strengthening.

Work related injuries in Qatar: a framework for prevention and control

Work related injuries (WRIs) are a growing public health concern that remains under-recognized, inadequately addressed and largely unmeasured in low and middle-income countries (LMIC’s). However, even in high-income countries, such as those in Gulf Cooperating Council (GCC) like Qatar, there are challenges in assuring the health and safety of its labor population. Countries in the GCC have been rapidly developing as a result of the economic boom from the petrochemical industry during the early seventies. Economic prosperity has propelled the migration of workers from less developed countries to make up for the human resource deficiency to develop its infrastructure, service and hospitality industries. Although these countries have gradually made huge gains in health, economy and human development index, including improvements in life expectancy, education, and standard of living, there remains a high incidence of work-related injuries especially in jobs in the construction and petrochemical sector. Currently, there is scarcity of literature on work-related injuries, especially empirical studies documenting the burden, characteristics and risk factors of work injuries and the work injured population, which includes large numbers of migrant workers in many GCC countries. This paper will focus on the current understanding of WRIs in those countries and identify the gaps in current approaches to workplace injury prevention, outlining current status of WRI prevention efforts in Qatar, and propose a framework of concerted action by multi-sectoral engagement.

Traumatic brain injury in Uganda: exploring the use of a hospital based registry for measuring burden and outcomes

Objective

Lack of data on traumatic brain injuries (TBI) hinders the appreciation of the true magnitude of the TBI burden. This paper describes a scientific approach for hospital based systematic data collection in a low-income country. The registry is based on the evaluation framework for injury surveillance systems which comprises a four-step approach: (1) identifying characteristics that assess a surveillance system, (2) review of the identified variables based on adopted specific, measurable, assignable, realistic, and time-related criteria, (3) assessment of the proposed variables and system characteristics by an expert panel, and (4) development and application of a rating system.

Results

The electronic hospital-based TBI registry is designed through a collaborative approach to capture comprehensive, yet context specific, information on each TBI case, from the time of injury until death or discharge from the hospital. It includes patients’ demographics, pre-hospital and hospital assessment and care, TBI causes, injury severity, and patient outcomes. The registry in Uganda will open the opportunity to replicate the process in other similar context and contribute to a better understanding of TBI in these settings, and feed into the global agenda of reducing deaths and disabilities from TBI in low-and middle-income countries.

Electronic supplementary material

The online version of this article (10.1186/s13104-018-3419-1) contains supplementary material, which is available to authorized users.

Childhood injuries in Oman: retrospective review of a multicentre trauma registry data

OBJECTIVES

Injuries are among the top causes of hospital-based mortality for adults in Oman. However, little is known about the distribution and risk of injuries among children. This paper describes the epidemiology and risk factors for childhood injuries (0-15 years of age), in two hospitals of Oman.

METHODS

Data were collected between November 2014 and April 2015 at Khoula and Nizwa Hospitals. All patients between 0 and 15 years with a diagnosis of injury/trauma admitted to the hospital, and those who had trauma team activation in the emergency department were included in the analysis. Descriptive and multivariable Poisson regression analyses were conducted to generate sociodemographic risk factor profiles associated with the need for surgical management of injuries.

RESULTS

Out of 795 cases, 59% were under 5 years of age; 67% were males. Around 50% injuries were fall related, followed by exposure to inanimate mechanical forces and transport injuries. Burn injuries were more prevalent in females than males. Three-fourths of all injuries occurred in private residences. Almost 92% injuries were minor (Injury Severity Score <9). Of children with all types of injuries, 303 (40.9%) received surgical treatment. Patients suffering from head injuries (RR 8.8: 95% CI 4.9 to 15.3) or being involved in a burn injury (RR 1.5: 95% CI 0.3 to 7.5) were at increased risk of undergoing surgical treatment.

CONCLUSION

In this study, >30% of injury admissions were children 0-15 years of age. The high incidence of falls, home injuries and burns highlight the need for age-targeted interventions and injury control programmes. Although infrequent, transport injuries and head injuries put children in need of surgical management and prolonged hospital care.

Adolescent and Young Adult Injuries in Developing Economies: A Comparative Analysis from Oman and Kenya

BACKGROUND

Adolescence is a distinct period of rapid and dramatic biological, cognitive, psychological, and social development. The burden of injuries among young people (aged 10-24) is both substantial and maldistributed across regions and levels of economic development.

OBJECTIVES

Our objective was to compare sociodemographic correlates of injury cause, intentionality, and mortality between Kenya and Oman, 2 countries with different levels of economic development and position in the demographic and epidemiologic transitions.

METHODS

Data on 566 patients in Oman and 5859 in Kenya between 10 and 24 years old were extracted from 2 separate multicenter trauma registries. Multivariable log binomial and Poisson regressions were used to evaluate social and demographic factors associated with injury cause, intentionality, and mortality. Literature on adolescent development was used to parameterize variables, and Akaike information criteria were used in the final model selections.

FINDINGS

The trauma registry data indicated a substantial burden of adolescent and young adult injury in both Oman and Kenya, particularly among males. The data indicated significant differences between countries (P < .001) in age category, gender distributions, level of education, occupation, cause of injury, and place where injury occurred. Consistent with other literature, road traffic injuries emerged as the most common type of injury as well as the most severe and fatal, with interpersonal violence also resulting in severe injury across contexts. Both road traffic injuries and interpersonal violence were more common among older adolescents and young adults. Education and being in school were protective against injury, after controlling for gender, age category, occupation, and country.

CONCLUSIONS

A rising burden of injuries among young people has been documented in every region of the world, irrespective on income status or level of development. Cost-effective injury control measures targeting this age group exist, including involvement in educational, vocational, and other prosocial activities; environmental alterations; and road safety measures.

Exploring injury severity measures and in-hospital mortality: A multi-hospital study in Kenya

INTRODUCTION

Low- and middle-income countries (LMICs) have a disproportionately high burden of injuries. Most injury severity measures were developed in high-income settings and there have been limited studies on their application and validity in low-resource settings. In this study, we compared the performance of seven injury severity measures: estimated Injury Severity Score (eISS), Glasgow Coma Score (GCS), Mechanism, GCS, Age, Pressure score (MGAP), GCS, Age, Pressure score (GAP), Revised Trauma Score (RTS), Trauma and Injury Severity Score (TRISS) and Kampala Trauma Score (KTS), in predicting in-hospital mortality in a multi-hospital cohort of adult patients in Kenya.

METHODS

This study was performed using data from trauma registries implemented in four public hospitals in Kenya. Estimated ISS, MGAP, GAP, RTS, TRISS and KTS were computed according to algorithms described in the literature. All seven measures were compared for discrimination by computing area under curve (AUC) for the receiver operating characteristics (ROC), model fit information using Akaike information criterion (AIC), and model calibration curves. Sensitivity analysis was conducted to include all trauma patients during the study period who had missing information on any of the injury severity measure(s) through multiple imputations.

RESULTS

A total of 16,548 patients were included in the study. Complete data analysis included 14,762 (90.2%) patients for the seven injury severity measures. TRISS (complete case AUC: 0.889, 95% CI: 0.866-0.907) and KTS (complete case AUC: 0.873, 95% CI: 0.852-0.892) demonstrated similarly better discrimination measured by AUC on in-hospital deaths overall in both complete case analysis and multiple imputations. Estimated ISS had lower AUC (0.764, 95% CI: 0.736-0.787) than some injury severity measures. Calibration plots showed eISS and RTS had lower calibration than models from other injury severity measures.

CONCLUSIONS

This multi-hospital study in Kenya found statistical significant higher performance of KTS and TRISS than other injury severity measures. The KTS, is however, an easier score to compute as compared to the TRISS and has stable good performance across several hospital settings and robust to missing values. It is therefore a practical and robust option for use in low-resource settings, and is applicable to settings similar to Kenya.

Epidemiology and outcomes of injuries in Kenya: A multisite surveillance study

BACKGROUND

Injury is a leading cause of disability and death worldwide, accounting for over 5 million deaths each year. The injury burden is higher in low- and middle-income countries where more than 90% of injury-related deaths occur. Despite this burden, the use of prospective trauma registries to describe injury epidemiology and outcomes is limited in low- and middle-income countries. Kenya lacks robust data to describe injury epidemiology and care. The objective of this study was to investigate the epidemiology and outcomes of injuries at 4 referral hospitals in Kenya using hospital-based trauma registries.

METHODS

From January 2014 to May 2015, all injured patients presenting to the casualty departments of Kenyatta National, Thika Level 5, Machakos Level 5, and Meru Level 5 Hospitals were enrolled prospectively. Data collected included demographic characteristics, type of prehospital care received, prehospital time, injury pattern, and outcomes.

RESULTS

A total of 14,237 patients were enrolled in our study. Patients were predominantly male (76.1%) and young (mean age 28 years). The most common mechanisms of injury were road traffic injuries (36.8%), falls (26.4%), and being struck/hit by a person or object (20.1%). Burn was the most common mechanism of injury in the age category under 5 years. Body regions commonly injured were lower extremity (35.1%), upper extremity (33.4%), and head (26.0%). The overall mortality rate was 2.4%. Significant predictors of mortality from multivariate analysis were Glasgow Coma Scale ≤12, estimated injury severity score ≥9, burns, and gunshot injuries.

CONCLUSION

Hospital-based trauma registries can be important sources of data to study the epidemiology of injuries in low- and middle-income countries. Data from such trauma registries can highlight key needs and be used to design public health interventions and quality-of-care improvement programs.

Trauma care in Oman: A call for action

Many Arab countries have undergone the epidemiologic transition of diseases with increasing economic development and a proportionately decreasing prevalence of communicable diseases. With this transition, injuries have emerged as a major cause of mortality and morbidity in the Gulf Cooperation Council countries in addition to diseases of affluence. Injuries are the number one cause of years of life lost and disability-adjusted life-years in the Sultanate of Oman. The burden of injuries, which affects mostly young Omani males, has a unique geographic distribution that is in contrast to the trauma care capabilities of the country. The concentration of health care resources in the northern part of the country makes it difficult for the majority of Omanis who live elsewhere to access high-quality and time-sensitive care. A broader multisectorial national injury prevention strategy should be evidence based and must strengthen human resources, service delivery, and information systems to improve care of the injured and loss of life. This paper provides a unique overview of the Omani health system with the goal of examining its trauma care capabilities and injury control policies.

Vitamin E protects rat mesenchymal stem cells against hydrogen peroxide-induced oxidative stress in vitro and improves their therapeutic potential in surgically-induced rat model of osteoarthritis

OBJECTIVE

Oxidative stress is a major obstacle against cartilage repair in osteoarthritis (OA). Anti-oxidant agents can play a vital role in addressing this issue. We evaluated the effect of Vitamin E preconditioning in improving the potential of mesenchymal stem cells (MSCs) to confer resistance against oxidative stress prevailing during OA.

METHODS

Vitamin E pretreated MSCs were exposed to oxidative stress in vitro by hydrogen peroxide (H₂O₂) and also implanted in surgically-induced rat model of OA. Analysis was done in terms of cell proliferation, apoptosis, cytotoxicity, chondrogenesis and repair of cartilage tissue.

RESULTS

Vitamin E pretreatment enabled MSCs to counteract H₂O₂-induced oxidative stress in vitro. Proliferative markers, proliferating cell nuclear antigen (PCNA) and Ki67 were up-regulated, along with the increase in the viability of MSCs. Expression of transforming growth factor-beta (TGFβ) was also increased. Reduction of apoptosis, expression of vascular endothelial growth factor (VEGF) and caspase 3 (Casp3) genes, and lactate dehydrogenase (LDH) release were also observed. Transplantation of Vitamin E pretreated MSCs resulted in increased proteoglycan contents of cartilage matrix. Increased expression of chondrogenic markers, Aggrecan (Acan) and collagen type-II alpha (Col2a1) accompanied by decreased expression of collagen type-I alpha (Col1a1) resulted in increased differentiation index that signifies the formation of hyaline cartilage. Further, there was an increased expression of PCNA and TGFβ genes along with a decreased expression of Casp3 and VEGF genes with increased histological score.

CONCLUSION

Taken together results of this study demonstrated that Vitamin E pretreated MSCs have an improved ability to impede the progression of OA and thus increased potential to treat OA.

Development of an mHealth trauma registry in the Middle East using an implementation science framework

BACKGROUND

Trauma registries (TRs) play a vital role in the assessment of trauma care, but are often underutilized in countries with a high burden of injuries.

OBJECTIVES

We investigated whether information and communications technology (ICT) such as mobile health (mHealth) could enable the design of a tablet-based application for healthcare professionals. This would be used to inform trauma care and acquire surveillance data for injury control and prevention in Oman. This paper focuses on documenting the implementation process in a healthcare setting.

METHODS

The study was conducted using an ICT implementation framework consisting of multistep assessment, development and pilot testing of an electronic tablet-based TR. The pilot study was conducted at two large hospitals in Oman, followed by detailed evaluation of the process, system and impact of implementation.

RESULTS

The registry was designed to provide comprehensive information on each trauma case from the location of injury until hospital discharge, with variables organized to cover 11 domains of demographic and clinical information. The pilot study demonstrated that the registry was user friendly and reliable, and the implementation framework was useful in planning for the Omani hospital setting. Data collection by trained and dedicated nurses proved to be more feasible, efficient and reliable than real-time data entry by care providers.

CONCLUSIONS

The initial results show the promising potential of a user-friendly, comprehensive electronic TR through the use of mHealth tools. The pilot test in two hospitals indicates that the registry can be used to create a multicenter trauma database.