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SPLINTERS & FRAGMENTS

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Pharmacies across the US are removing ipecac from their shelves in the wake of revised guidelines. The American Academy of Pediatrics has reversed its recommendation from 1989 to keep ipecac in the home. The new policy statement urges families to consult a local poison control center as the first step and to dispose of any ipecac on hand. But these new guidelines are more stringent than what the American Association of Poison Control Centers currently recommends. Out-of-hospital guidelines are still being debated among poison centers. See www.aapcc.org. (

and Bond GR. Home syrup of ipecac use does not reduce emergency department use or improve outcome.

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New Year’s Eve came and went a while ago. Did you notice whether your bottle of champagne warned the opener to angle the cork away from their eyes? In Hungary, no such warning label appears on the bottles. A comparison of data from three national eye injury registries found that champagne bottle corks were responsible for 71% of eye injuries caused by bottles containing pressurized drinks in Hungary. In Mexico, there were none due to this cause, and in the US, 20% were caused by champagne corks. Although most eyes improved, more than a quarter of patients remained legally blind following the event. The authors plan to request labels in Hungary. (

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The Hong Kong health department traced a patient’s mercury exposure to a skin cream used for “whitening” purchased from a street vendor. Public warnings were made about this cosmetic which contained high levels of mercury (ranging from 7000 to 21 000 ppm), and a telephone hotline was set up. In a study of 314 cream users, 65% had raised mercury in their blood and urine, despite most patients being asymptomatic. Even very minimal usage of the product caused increased blood concentrations, showing that mercury can be readily absorbed dermally. (

China has the highest rate of burns due to liquid alcohol in the world, in part because stoves using this fuel are very popular and widely used during the winter. An analysis of 169 flame burns from alcohol stoves found that one quarter were to children, two thirds to adults, and 13% to the elderly. Many of the burns occurred in restaurants and often to waitresses. The authors estimate that 10 000 such injuries occur each year and recommend increased warnings, the promotion of safer ignition fuels, redesign of the chafing-dish stove, and increased safety measures in restaurants and hotels. (

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A community disaster occurred in Nigeria in 2001 when 58 families sustained explosion burns using kerosene that had been contaminated with petrol. An investigation found that the kerosene had been contaminated at a local fuel depot, but most of the incidents occurred while people tried to refuel hurricane lanterns that were already lit, frequently during power outages. House fires also resulted, with additional burns sustained because of delayed escapes due to burglar bars and other barriers. This article describes the burns and circumstances related to 94 injuries and calls for an intense public awareness campaign on the dangers of refueling lighted lanterns. (

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Although road traffic injuries are a leading cause of death and disability in developing nations, many governments and donors do not invest in preventing these events. These authors examined road safety efforts in two of the poorest countries in the world, Pakistan and Uganda, and conclude that their public spending on road safety amounts to about 1% of their public spending on health overall. World Health Day 2004 focuses on road safety but without increased investments in road design, traffic police, traffic signals, vehicle inspections, and pre-hospital care of the injured, the disparities between developed nations and poor countries will continue to prevail. (

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The past decade has seen an increase in the use of safety surfacing on playgrounds in the developed world. A brief paper examines five years of data on head injuries and fractures occurring on playgrounds and concludes that while head injuries have virtually been eliminated with the use of proper surfacing, arm fractures have remained unchanged. Most were to the upper arm and were the results of falls onto surfaces. The authors challenge us to further improve playgrounds to reduce these all-too-common injuries. (

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Preventing head injuries in sport is an ongoing concern as well. Two related articles examine how to improve the performance and the acceptance of protective headgear among Australian rules football players. The researchers found that a small increase in the thickness of the foam would lead to significant improvements in how the headgear absorbs impact energy. On the other hand, a survey of players showed resistance to wearing headgear far beyond their objection to mouthguards. The reasons for not using either device were similar: uncomfortable. But although three quarters wore mouthguards, only 2% wore headgear. The authors note that 67% said they would be motivated to wear the protective equipment if they had an injury. Such an attitude presents a challenge for injury prevention practitioners: should we focus our efforts on the already injured? (

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