JOURNAL OF INJURY & VIOLENCE RESEARCH
Year:2021 | Volume:13 | Issue:1|Papers Count:10

Background: The research was done to evaluate the value of the visual evoked potentials test in the assessment of visual pathways function in cases with head trauma and minimal findings on routine testing. Materials and Methods: A prospective case series evaluating use of visual evoked potentials testing in patients with a history of head trauma and suffering from visual symptoms with no significant clinical and neuroimaging findings, referred for further work up. Results: Thirty-four patients with a history of head trauma and subsequent visual complaints were included. 27 cases (79. 4%) were male and 7 cases (20. 6%) were female. The mean elapsed time after the trauma was 47. 6 weeks (range: 3. 5 to 320 weeks). Twenty-five cases had unilateral and 9 cases had bilateral visual complaints. History of coma with mean duration of 12 days was present in 4 cases. The best-corrected visual acuity was less than 1 Log MAR (legally blind) in 21 eyes. In 4 eyes (12%) the relative afferent papillary defect test was positive. Mild to moderate optic disc pallor was present bilaterally in 4 cases and unilaterally in 3 cases. Hemorrhagic patches were reported on MRI in 2 cases; no other cases had pathologic MRI findings. In unilateral cases, there was a statistically significant difference between the involved eye-sided lobe and the sound eye-sided lobe implicit time and amplitude. In patients with bilateral complaints, by testing each eye, the VEP amplitudes of both eyes showed significant differences with the International Society for Clinical Electrophysiology of Vision standards, whereas the implicit times showed not-statistically significant differences. Conclusion: The visual evoked potentials test shows not only additional diagnostic value, not seen on routine clinical and neuroimaging testing, but also rather a high validity in tracing visual disability in traumatic brain injury.

Background: Use of checklist in evaluation of trauma patients has been a critical component of improving the care process and reducing medical errors and increasing patient's quality of life. We aim to assess the impact of the modified World Health Organization Trauma Care Checklist (WHO TCC) on the management of pain, complications, mortality and patient satisfaction in trauma patients. Methods: This was a randomized control trial (RTC). Trauma patients referred to the trauma center and met the eligibility criteria were randomly assigned into three study groups. Group 1 were patients who received trauma care without using the WHO checklist, and only by the standard of care. Group 2 were patients who received trauma care according to the WHO's checklist, and group 3 were patients received trauma care according to the WHO's modified checklist. We used independent t-test and chi-square tests to assess the association between the study variables with checklist groups. The significance level of tests was set for p-value less than 0. 05. Results: We observed patients’ level of pain, Injury Severity Score (ISS), Glasgow Coma Criterion (GCS) and patient satisfaction significantly improved across the checklist groups, but more so in the modified checklist group (P less than 0. 001). Similarly, findings reveal significant relationships between all clinical characteristics of the patients and checklist groups, except for a CT Scan of the spinal cord. We were unable to establish any significant associations between the checklist groups and the majority of the selected trauma care process measures, except for missed injury (p = 0. 001). Conclusions: Both the WHO TCC and the WHO modified checklist, in the initial assessment and during the treatment and care processes, enhance patients’ clinical outcomes. However, patients in the modified checklist compared to WHO TCC reported a higher level of satisfaction. Implications and future directions are discussed.

Background: Road traffic injuries (RTIs) pose a disproportionate public health burden in the low and middle-income countries (LMICs) like Uganda, with 85% of all the fatalities and 90% of all disability-adjusted life years lost reported worldwide. Of all RTIs which are recorded in Uganda, 50% of cases happen in Kampala — the capital city of Uganda and the nearby cities. Identifying the RTI prone-areas and their associated risk factors can help to inform road safety and prevention measures aimed at reducing RTIs, particularly in emerging cities such as Kampala. Methods: This study was based on a retrospective cross-sectional design to analyze a five year (2011 – 2015) traffic crash data of the Uganda Police Force. Results: Accordingly, 60 RTI prone-areas were identified to exist across the Kampala. They were ranked as low and high risk areas; 41 and 19, respectively and with the majority of the latter based in the main city center. The bivariate analysis showed a significant association between identified prone-areas and population flow (OR: 4. 89, P– value: 0. 01) and traffic flow time (OR: 9. 06, P– value: 0. 01). On the other hand, the multivariate regression analysis only showed traffic flow time as the significant predictor (OR: 6. 27, P– value: 0. 02) at identified RTI prone-areas. Conclusions: The measures devised to mitigate RTI in an emerging city like Kampala should study thoroughly the patterns of traffic and population flow to help to optimize the use of available resources for effective road safety planning, injury prevention and sustainable transport systems.

Background: According to official statistics in Iran, there were 17000 fatalities in road traffic crashes in 2018 that 25% of all crash fatalities belong to pedestrians. In most of the researches related to pedestrians’ safety, one aspect of the traffic crash (e. g. the injury or crash severity) is almost considered for the investigation. In order to perform a complete study of the crash, accident size can be utilized which involves different aspects of the crash. Accident size is described in terms of the number of fatalities and injured individuals and the number of damaged and involved vehicles in a crash. Method: According to the fact that accident size has multiple indicators and it is not measured directly, traditional methodologies cannot be applied. So, in the present study the effective factors on the accident size of pedestrian crashes are investigated through structural equation modeling. For the purpose of this study, 3718 pedestrian-involved crash data occurred in Isfahan province is used for the modeling. The independent variables are weather conditions, road surface conditions, time, horizontal and vertical alignments, road type and location, driver’ s gender and age, vehicle type, pedestrian’ s age, gender and clothing color. Results: The results indicated that highways, the pedestrians’ invisibility, female and old-aged pedestrians, heavy vehicles, old-aged and female drivers are related to the increase of the accident size in pedestrian crashes. These results denote that the mentioned variables are associated with the higher number of injuries, fatalities, the higher number of involved and damaged vehicles in a crash. Conclusion: Present study shows the importance of considering safety improvement measures in highways, educating the people in the society about the traffic safety, the separation of pedestrian and motor vehicle traffic flow and considering the old people in policies and programs for mitigating the accident size.

Background: After cardiac arrest, the possibility of death or irreversible complications will highly increase in the absence of cardiac resuscitation within 4 to 6 minutes. Accordingly, measuring the pre-hospital services time intervals is important for better management of emergency medical services delivery. The purpose of this study then was to investigate pre-hospital time intervals for patients with heart attack in Arak city, based on locations and time variables. Methods: This is a retrospective descriptive cross-sectional study, which was conducted at the Arak Emergency Medical Services (EMS) during 2017-2018. Data were analyzed by SPSS version 13. Results: The total number of heart attack patients registered in Arak emergency medical services was 2, 659 of which 51% of patients were males. Six percent of patients were under 25 and about 49 percent were between 46 and 65 years old. The average of activation, response, on-scene, transportation, recovery and total time intervals were 3: 30, 7: 56, 15: 15, 13: 34, 11: 07, 12: 11, and 41: 25, respectively. In the city area, the shortest and longest average response time intervals were in spring and winter, respectively. In out of the city area, the shortest average response time interval was in summer and the longest one in autumn. The shortest and the longest average response time intervals in the city area were in June and March, respectively, and in out of the city area, the shortest average response time interval was in June and the longest one in April. Conclusion: The shorter response and delivery time interval compared to the other studies may indicate improvement in the provision of EMS. Special attention should be paid to the facilities and equipment of vehicles during cold seasons to be in the shortest possible time. Also, training and informing the staff more about the code of cardiac patients along with general public education can help improve these intervals.

Background: Over 95% of unintentional injury-related childhood deaths globally occur in low-and middle-income countries, such as Uganda. Risks for injury in settings like rural Uganda are vastly understudied despite differing patterns of child injury risk. The present study investigated the prevalence and type of hazards in children’ s environments in rural Uganda, as well as the relationship between hazard exposure and parent attitudes and perceptions regarding unintentional injury. Methods: Our sample included 152 primary caregivers in Eastern Rural Uganda who had children in either 1st or 6th grade. All parents/guardians completed caregiver surveys following verbal instructions. Surveys assessed demographic information, child hazard exposure, and parent beliefs regarding child injury. Results: Almost all parents (98. 5%) reported daily exposure for their children to at least one of the hazards assessed. Caregiver's perceived likelihood of child injury was positively related to hazard exposure (r =. 21, p less than. 05). This relationship remained significant when controlling for family demographics, child grade level, and child injury history (F (7, 126) = 2. 25, p less than. 05). Conclusions: Our results suggest that Ugandan parents are aware of the risks of children’ s exposure to hazards, but may lack the tools to address it. Development of injury prevention interventions focusing on behavioral change techniques may help reduce childhood injury and injury-related deaths in Uganda.

Background: The aim of this study was to identify the characteristics of suicidal ideation (SI), suicidal plan (SP), and suicide attempt (SA) in patients who had survived suicide attempts. Methods: In a one-year cross-sectional design in Khorasan Razavi province, all suicide attempters who were referred to urban and rural health care centers, hospital’ s emergency rooms and agreed to participate in the study were included. The previous twelve-month SI, SP and lifelong SA (prior to the current suicide attempt) were obtained. Results: The mean age of 856 included individuals was 24. 2± 8. 3 years. The majority (652, 76. 4%) were females. Half of them were first-time suicide attempters. The mean age of first SI was 22± 7. 7; SP 22± 7. 9; and SA 22. 2± 8 years. The twelve-month prevalence of SI and SP prior to the current suicide attempt was 30% and 26. 7%, respectively. Males, unlettered, wedded, and employees were significantly older at their first time SI, SP, and SA (all p less than 0. 001). SI (25, 44. 6%), SP(25, 47. 2%) and SA(34, 75. 6%) were more prevalent in widow/divorced individuals(all p-values less than 0. 02). SI (OR=53. 4, CI95%=33. 6-85) increased the risk of SP, and SP(OR=6. 7, CI95%=4. 5-9. 9) increased the risk of SA. Conclusion: SI seems to be a more important predictor of suicide compared to SP, however, the fact that a significant number of attempters had not any previous detectable suicidal ideation or plan, indicates particular clinical considerations. We need to have some presuppositions about the factors leading to unplanned and unthoughtful suicide attempts.

Background: Over 90% of morbidity and mortality associated with traumatic brain injury (TBI) occurs in low-and middle-income countries. Lack of reliable, high-quality data regarding TBI prevention and care hinders the ability to reduce TBI burden. We sought to identify current TBI data collection practices and capacity in Georgia, focusing on pre-hospital, hospital, and rehabilitation treatment. Methods: The eight level I and two level II Trauma Hospitals in Georgia with the highest number of TBI admissions in 2017 were selected for study. A semi-structured survey about various aspects of TBI care was designed and semi-structured interviews of healthcare providers treating TBI patients (e. g. neurologists, neurosurgeons) were conducted based on this survey. Results: Pre-hospital triage protocols were not routinely used to match patient treatment needs with hospital capacity. All hospitals provided specialist care for TBI 24 hours/day. MRI was available at only three (30%) centers, and in-hospital rehabilitation units were available in only one (10%). No center used a defined protocol for treating TBI patients and no national protocol exists. Conclusion: Even among the largest, most highly specialized hospitals in Georgia, TBI care varies in terms of diagnostic and treatment protocols. While TBI specialists are available, diagnostic equipment often is not. Gaps in pre-hospital coordination and access to rehabilitation services exist and provide areas of focus for future investment in reducing TBI burden.

Background: NCDs require an ongoing management for optimal outcomes, which is challenging in emergency settings, because natural disasters increase the risk of acute NCD exacerbations and lead to health systems’ inability to respond. This study aims to develop a protocol for a systematic review on non-communicable diseases in natural disaster settings. Methods: This systematic review protocol is submitted to the International Prospective Register of Systematic Reviews (Registration No. CRD42020164032). The electronic databases to be used in this study include: Medline, Scopus, Web of Science, Clinical Key, CINAHL, EBSCO, Ovid, EMBASE, ProQuest, Google Scholar, Cochrane Library (Cochrane database of systematic reviews; Cochrane central Register of controlled Trials). Records from 1997 to 2019 are subject to this investigation. Three independent researchers will review the titles, abstracts, and full texts of articles eligible for inclusion, and if not matched, they will be reviewed by a final fourth reviewer. The proposed systematic review will be reported in accordance with the reporting guideline provided in the Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA) statement. We select studies based on: PICOs (Participants, Interventions, Comparators, and Outcomes). Results: This systematic review identifies any impacts of natural disasters on patients with NCDs in three stages i. e. before, during and in the aftermath of natural disasters. Conclusion: A comprehensive response to NCD management in natural disasters is an important but neglected aspect of non-communicable disease control and humanitarian response, which can significantly reduce the potential risk of morbidity and mortality associated with natural disasters.

Background: There is a vast amount of literature on the effects of driver education. However, the evidence has become somewhat fragmented, making it challenging to understand driver education's effectiveness for improving road safety. The current study aimed to provide the efficacy of pre-LDE and post-LDE interventions aimed at improving the safety of drivers (includes crashes, injuries, or secondary outcomes). Methods: The following online databases were searched up to the 21st of February 2020: Web of Science (WOS), Scopus, PubMed, Cochrane library, and other relevant databases. Systematic reviews (SR) and meta-analyses were selected to investigate the efficacy of driving education in reducing crashes, injuries, or secondary outcomes. Two investigators independently conducted the data extraction and used the assessment of multiple systematic reviews (AMSTAR) tool to conduct a quality assessment of each SR identified. Results: Out of the 229 potential articles, seven SRs were eligible for the current overview of systematic reviews and meta-analyses. This overview showed that pre-and post-license education by people of all ages led to improvements in secondary outcomes, such as performance, self-perceived driving abilities, behind-the-wheel driving performance, and even a small decrease in traffic offenses. However, education was not effective in reducing crashes or injuries, either at the individual or community level. Conclusion: There was no evidence that driver education is an effective approach to reducing crashes or injuries. This negative result might be due to ineffective teaching methods. To improve road safety, it appears necessary to change the method or content of driving education since the current approaches to driving education do not reduce traffic crashes or injuries.