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Journal of Addiction Medicine Jun 2024To prospectively assess rates of QT prolongation, arrhythmia, syncope, and sudden cardiac death (SCD) in a cohort of people with heroin dependence.
OBJECTIVES
To prospectively assess rates of QT prolongation, arrhythmia, syncope, and sudden cardiac death (SCD) in a cohort of people with heroin dependence.
METHODS
To estimate rates of QT prolongation, arrhythmia, and syncope, a subcohort (n = 130) from the Australian Treatment Outcomes Study, a prospective longitudinal cohort study of 615 people with heroin dependence, underwent medical history, venepuncture, and ECG at the 18- to 20-year follow-up.To estimate rates of SCD, probabilistic matching for the entire cohort was undertaken with the Australian Institute of Health and Welfare National Death Index. Deaths were classified into suicide, accidental overdose, trauma, unknown, and disease, which were then further subclassified by probability of SCD. SCD rate was the number of possible or probable SCDs divided by total patient years from the cohort.
RESULTS
From the subcohort, 4 participants (3%) met the criteria for QT prolongation; 3 were prescribed methadone. Seven participants (5%) reported history of arrhythmia, including 2 transferred from methadone to buprenorphine. Thirty participants (23%) reported a previous syncopal event-14 diagnosed as nonarrhythmic syncope and 13 not investigated. In the previous 12 months, 66 participants (51%) reported heroin use; 55 participants (42%) were prescribed methadone. No participant had QTc greater than 500 milliseconds.There were 3 possible SCDs, translating to an estimated SCD rate of 0.29 (CI: 0.05, 0.8) events per 1000 patient years. More cohort members died of overdose (n = 50), suicide (n = 11), and hepatitis C (n = 4).
CONCLUSIONS
Low rates of QT prolongation, arrhythmia, syncope, and SCD in the cohort despite high rates of heroin use and methadone treatment.
PubMed: 38941157
DOI: 10.1097/ADM.0000000000001317 -
PLOS Global Public Health 2024Road traffic accidents account for 1.35 million deaths and up to 50 million injuries each year globally, mostly among persons aged 5-29 years. The existing road safety...
Road traffic accidents account for 1.35 million deaths and up to 50 million injuries each year globally, mostly among persons aged 5-29 years. The existing road safety measures in Ghana are grossly inadequate, leading to occurrence of unprecedented Road Traffic Accidents (RTA). This study sought to document the epidemiological indices and determine the public health implications of Road Traffic Accidents and the socio-economic effect on lives of RTA victims in Ho and Hohoe Municipalities of the Volta Region in Ghana. A cross-sectional study was carried out among 198 road traffic accident victims who reported to three health facilities in the Volta Region of Ghana. The victims were interviewed using a structured questionnaire. Principal component analysis was done to categorize RTA victims into various economic status. The results show that out of the 198 road traffic accident victims who were interviewed, 50% were breadwinners of their families. Approximately 40% of the accident cases happened between 12 mid-day and 6 o'clock in the evening. Among the RTA cases recorded, 35% involved four-wheeler vehicles. Majority (88%) of those with injuries resulting from motorcycle accidents sustained a head injury; 70% of the respondents who sustained a disability from RTA were unable to perform activity of daily living (i.e. bathing, oral care, and toileting). The average cost of care on RTA victims from formal and informal health care facilities, at the time of this study, was GHC 902 (US$150) and GHC 724 (US$120) respectively. In conclusion, the increase in usage of motorcycles as a means of transport has contributed significantly to the incidence of RTAs in the Ho and Hohoe municipalities posing a public health concern. Majority of RTAs resulted in head injuries and other disabilities which affected their ability to perform activities of daily living and posed significant economic cost to victims and their families who are mostly already in lower wealth quintiles.
PubMed: 38935786
DOI: 10.1371/journal.pgph.0003238 -
Psychological Trauma : Theory,... Jun 2024War and forced migration expose refugees to trauma and ongoing stress, often contributing to long-term psychological consequences. Typically, trauma exposure is assessed...
BACKGROUND
War and forced migration expose refugees to trauma and ongoing stress, often contributing to long-term psychological consequences. Typically, trauma exposure is assessed cumulatively; yet, trauma type may better predict psychological outcomes. This study examined the differential impact of cumulative trauma and trauma subtypes (victimization, death threat, accidental/injury) on postmigration trajectories of posttraumatic stress and anxiety in refugees.
METHOD
Seventy-seven Syrian (88.3%) and Iraqi (9.1%) adult refugees self-reported prior trauma exposure and psychological symptoms at time of arrival in the United States and 2 years post. Linear mixed-effects modeling was performed to assess for associations between trauma variables and symptom trajectories. Models using cumulative trauma as a predictor were compared to models including the three trauma subtype variables as predictors, using pseudo-² values to compare variance explained between the two methods of trauma measurement.
RESULTS
Linear mixed-effects modeling indicated that prior exposure to victimization predicted progressively worsening posttraumatic stress disorder (PTSD) symptoms over time postmigration ( = .97, = .45, = 2.14, = .036). Cumulative trauma also predicted increasing PTSD symptoms ( = .124, = .06, = 2.09, = .041), but explained less variance than victimization (9% vs. 18.1%). Direct effects of cumulative trauma ( = .009) and victimization ( = .002) on anxiety severity emerged; however, anxiety symptoms did not change over time depending on prior trauma exposure. Accidents/injuries and death threats did not predict PTSD or anxiety.
CONCLUSIONS
These findings can be leveraged toward focused identification of those at highest risk for progressive illness postmigration, thus providing empirical guidance for allocation of interventions and resources for refugees. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
PubMed: 38934942
DOI: 10.1037/tra0001698 -
Sensors (Basel, Switzerland) Jun 2024The aim of the study is to compare the head displacement of the KPSIT C50 dummy during a frontal collision at a speed of 20 km/h, along with the change in the angle of...
The aim of the study is to compare the head displacement of the KPSIT C50 dummy during a frontal collision at a speed of 20 km/h, along with the change in the angle of the car seat backrest. Passenger car manufacturers recommend setting the backrest angle of the car seat between 100 and 125 degrees. It should be noted that the driver's position is of great importance in the event of a collision injury. In the event of a rear-end collision, the position of the headrest of the car seat is an element that affects the degree of the driver's injuries. In extreme cases, incorrect positioning of the headrest, even at low speed, can lead to serious injuries to the cervical spine and even death. The article is part of a large-scale study on low-speed crash testing. The research problem concerned the influence of the seat backrest angle on the head displacement during a low-speed collision. The article compares the displacement of the head of the KPSIT C50 dummy during a series of crash tests, where the angle of the car seat backrest was changed. On the basis of the research, it was found that the optimal angle of the car seat backrest is 110 degrees. In addition, a preliminary analysis of the displacements of the dummy's head showed a high risk of whiplash injury in people sitting in a fully reclined seat.
Topics: Humans; Accidents, Traffic; Head; Male; Automobiles; Manikins; Automobile Driving; Equipment Design
PubMed: 38931652
DOI: 10.3390/s24123868 -
Sensors (Basel, Switzerland) Jun 2024Driving while drowsy poses significant risks, including reduced cognitive function and the potential for accidents, which can lead to severe consequences such as trauma,...
Driving while drowsy poses significant risks, including reduced cognitive function and the potential for accidents, which can lead to severe consequences such as trauma, economic losses, injuries, or death. The use of artificial intelligence can enable effective detection of driver drowsiness, helping to prevent accidents and enhance driver performance. This research aims to address the crucial need for real-time and accurate drowsiness detection to mitigate the impact of fatigue-related accidents. Leveraging ultra-wideband radar data collected over five minutes, the dataset was segmented into one-minute chunks and transformed into grayscale images. Spatial features are retrieved from the images using a two-dimensional Convolutional Neural Network. Following that, these features were used to train and test multiple machine learning classifiers. The ensemble classifier RF-XGB-SVM, which combines Random Forest, XGBoost, and Support Vector Machine using a hard voting criterion, performed admirably with an accuracy of 96.6%. Additionally, the proposed approach was validated with a robust k-fold score of 97% and a standard deviation of 0.018, demonstrating significant results. The dataset is augmented using Generative Adversarial Networks, resulting in improved accuracies for all models. Among them, the RF-XGB-SVM model outperformed the rest with an accuracy score of 99.58%.
Topics: Humans; Radar; Artificial Intelligence; Neural Networks, Computer; Automobile Driving; Support Vector Machine; Algorithms; Machine Learning
PubMed: 38931541
DOI: 10.3390/s24123754 -
International Journal of Environmental... May 2024Although seatbelt use is known to reduce motor vehicle occupant crash injury and death, rear-seated adult occupants are less likely to use restraints. This study...
Although seatbelt use is known to reduce motor vehicle occupant crash injury and death, rear-seated adult occupants are less likely to use restraints. This study examines risk and protective factors associated with injury severity in front- and rear-seated adults involved in a motor vehicle crash in New York State. The Crash Outcome Data Evaluation System (CODES) (2016-2017) was used to examine injury severity in front- and rear-seated occupants aged 18 years or older ( = 958,704) involved in a motor vehicle crash. CODES uses probabilistic linkage of New York State hospitalization, emergency department, and police and motorist crash reports. Multivariable logistic regression models with MI analyze employed SAS 9.4. Odds ratios are reported as OR with 95% CI. The mortality rate was approximately 1.5 times higher for rear-seated than front-seated occupants (136.60 vs. 92.45 per 100,000), with rear-seated occupants more frequently unrestrained than front-seated occupants (15.28% vs. 1.70%, < 0.0001). In adjusted analyses that did not include restraint status, serious injury/death was higher in rear-seated compared to front-seated occupants (OR:1.272, 1.146-1.412), but lower once restraint use was added (OR: 0.851, 0.771-0.939). Unrestrained rear-seated occupants exhibited higher serious injury/death than restrained front-seated occupants. Unrestrained teens aged 18-19 years old exhibit mortality per 100,000 occupants that is more similar to that of the oldest two age groups than to other young and middle-aged adults. Speeding, a drinking driver, and older vehicles were among the independent predictors of serious injury/death. Unrestrained rear-seated adult occupants exhibit higher severe injury/death than restrained front-seated occupants. When restrained, rear-seated occupants are less likely to be seriously injured than restrained front-seated occupants.
Topics: Humans; Accidents, Traffic; Adult; Middle Aged; New York; Female; Male; Young Adult; Aged; Adolescent; Wounds and Injuries; Risk Factors; Protective Factors; Aged, 80 and over; Seat Belts
PubMed: 38928910
DOI: 10.3390/ijerph21060663 -
Emergency Medicine Clinics of North... Aug 2024Drowning is responsible for considerable morbidity and mortality worldwide, and it is estimated that 90% of drownings are preventable. Drowning is defined as "the... (Review)
Review
Drowning is responsible for considerable morbidity and mortality worldwide, and it is estimated that 90% of drownings are preventable. Drowning is defined as "the process of experiencing respiratory impairment from submersion/immersion in liquid." Emergency providers should focus on airway management and rapid delivery of oxygen to interrupt the drowning process and improve patient outcomes. Patients with minimal or no symptoms do not require any specific diagnostic workup, aside from physical examination and 4 to 6 hours of observation prior to discharge. Patients with more severe symptoms may present with rales and foamy secretions, and should be managed with high-concentration oxygen and positive airway pressure.
Topics: Humans; Drowning; Near Drowning; Emergency Service, Hospital
PubMed: 38925773
DOI: 10.1016/j.emc.2024.02.014 -
Annals of the Academy of Medicine,... Sep 2023
Topics: Humans; Male; Drowning; Female; Adult; Singapore; Adolescent; Young Adult; Hospitalization; Retrospective Studies; Middle Aged; Child
PubMed: 38920197
DOI: 10.47102/annals-acadmedsg.2022385 -
Frontiers in Public Health 2024We investigated the temporal trends and examined age-, period-, and cohort-specific effects of injury-related deaths among residents in Jiangsu to provide evidence for...
OBJECTIVE
We investigated the temporal trends and examined age-, period-, and cohort-specific effects of injury-related deaths among residents in Jiangsu to provide evidence for future injury prevention.
METHODS
This study included 406,936 injury deaths from the Jiangsu provincial population death registration system. The average annual percent change (AAPC) in age-standardized mortality rates (ASMRs) was analyzed using joinpoint regression. Age-period-cohort models were generated to explore the effects of age, period, and birth cohort effects on mortality risk.
RESULTS
ASMRs for all injuries (AAPC = -2.3%), road traffic accidents (AAPC = -5.3%), suicide (AAPC = -3.8%), and drowning (AAPC = -3.9%) showed a downward trend during 2012-2021(all < 0.05), while unintentional falls showed an upward trend (AAPC = 5.1%, < 0.05). From 2012 to 2021, the age-standardized mortality rates (ASMRs) for four primary types of injuries consistently exhibited higher among males compared to females, with rural regions displaying higher ASMRs than urban areas. Trends in ASMRs for road traffic accidents, drowning, and unintentional falls by sex and urban/rural areas were consistent with overall trends. Significant age, cohort, and period effects were identified in the trends of injury-related deaths for both sexes in Jiangsu. The age effect showed that the highest age effect for injury-related deaths was for the ages of 85 years and above, except for suicide, which was for the ages 80-84 years. Between 2012 and 2021, the period effect on road traffic accidents declined, while that on accidental falls increased. Initially, the period effect on suicide decreased but then rose, peaking in 2012 with a Relative Risk (RR) of 1.11 (95% : 1.04-1.19). Similarly, the period effect on drowning initially declined before rising, with the highest effect observed in 2013, at an RR of 1.12 (95% : 1.07-1.19). The highest cohort effects for road traffic accidents were observed in the 1957-1961 group, for accidental falls in the 1952-1956 group, and for both drowning and suicide in the 1927-1931 group.
CONCLUSION
The mortality rate of unintentional falls has been increasing. Older adults are at high risk for the four leading injuries. The improvements in mortality rates can be attributed to advancements in education, urbanization, and the promulgation and implementation of laws and policies.
Topics: Humans; Male; Female; China; Middle Aged; Adult; Aged; Adolescent; Child; Child, Preschool; Accidents, Traffic; Young Adult; Wounds and Injuries; Infant; Cohort Studies; Aged, 80 and over; Suicide; Drowning; Accidental Falls; Infant, Newborn; Mortality; Rural Population; Age Factors; Cause of Death
PubMed: 38919918
DOI: 10.3389/fpubh.2024.1373238 -
Zeitschrift Fur Rheumatologie Jun 2024This study aimed to evaluate standardized mortality ratios (SMRs) for both all-cause and cause-specific mortality in patients with rheumatoid arthritis (RA).
OBJECTIVE
This study aimed to evaluate standardized mortality ratios (SMRs) for both all-cause and cause-specific mortality in patients with rheumatoid arthritis (RA).
METHODS
We conducted an extensive search across the Medline, Embase, and Cochrane databases to identify studies investigating SMRs for all-cause and/or cause-specific mortality in individuals with RA compared to the general population. Subsequently, we performed a comprehensive meta-analysis, examining SMRs across various categories, including all-cause, sex-specific, ethnicity-specific, and cause-specific SMRs in RA patients.
RESULTS
Seventeen studies involving 486,098 patients with RA and 63,988 deaths met the inclusion criteria. Patients with RA had a 1.522-fold increase in all-cause SMR (SMR 1.522, 95% CI 1.340-1.704, p < 0.001) compared to the general population. Stratification by ethnicity revealed that the all-cause SMR was 1.575 (95% CI 1.207-1.943) in Caucasians and 1.355 (95% CI 1.140-1.569) in Asians. The gender-specific meta-analysis revealed elevated SMR in both women and men. RA patients exhibited an increased risk of mortality attributed to cardiovascular disease (CVD), respiratory disease, infection, and cerebrovascular accidents (CVA). However, no significant increase in SMR was observed for mortality due to malignancy.
CONCLUSION
This meta-analysis study highlights a 1.522-fold increase in SMR in patients with RA compared to that in the general population, irrespective of sex or region. Additionally, a notable increase in mortality associated with specific causes, including CVD, respiratory disease, infection, and CVA, underscores the critical need for targeted interventions to manage these heightened risks in patients with RA.
PubMed: 38918258
DOI: 10.1007/s00393-024-01538-3