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Splinters & Fragments

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A railway accident in a remote area of Pakistan resulted in 122 injured patients. Triage was conducted on three levels: at the site, at the primary health center, and at the tertiary referral center. This article compares the results of the three triage processes. Only one death resulted after the triage processes were begun. The authors point out that although “triage in a disaster is neither perfect nor democratic”, it is “a practical solution to deal with mass casualties, especially when resources are limited”. (

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An extensive body of literature exists on fall prevention and intervention, but there is no clear message on how best to prevent falls in older adults. A recent study conducted a systematic review and meta-analyses of 40 trials, looking at outcomes of falling at least once during follow up and at the monthly rate of falling. The authors conclude that the most effective intervention was a multifaceted risk assessment and management program. Exercise programs were also effective, but there was no evidence for the independent effectiveness of education or environmental modification alone. (

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Suicide is another injury risk to older adults. This study assessed whether the availability of guns is related to the presence of suicidal or depressive symptoms among primary care patients age 65 and over. Patients were also asked about the quantity and frequency of alcohol consumption. Almost 28% of patients screened had some type of firearm in their homes, and almost 20% had handguns. Patients with depression were not more or less likely to own guns; the authors discuss interventions to increase safe storage and reduce the availability of firearms to elders with significant distress or alcohol use. (

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Although firearm suicides outnumber firearm homicides in the United States, much more awareness and effort has focused on reducing homicides. A firearm injury reporting system for counties around three cities collected individual level data on guns, decedents and their environments for a five year period. Almost twice as many firearm suicides as homicides were recorded. Information was linked to census tract data and neighbourhood level predictors were analyzed. Homicides tended to occur outside the home, and be associated with busy nighttime neighborhood activity, while suicides displayed the opposite pattern. The authors note that suicides, while more frequent, attract less notice. We need to better identify neighborhoods and individuals at risk of both kinds of deaths. (

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One more report on suicide: the Centers for Disease Control released an analysis of 10 years of data on suicide methods among young people. Although the overall suicide rate declined, there was a marked increase in the rate of suffocation suicides, particularly among 10–14 year olds. Suicides by firearm declined during the period but firearms still remained the most common method among 15–19 year olds. Restricting access to lethal means is more difficult with suffocation deaths; the editors suggest that population based prevention efforts must also focus on the underlying reasons for suicide attempts. (

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Many studies have compared injuries between motorcyclists with and without helmets. In Singapore, where helmet use is mandated for drivers and passengers, and strictly enforced, most traffic deaths and injuries still occur to motorcyclists. This study examined the kinds of injuries that helmeted cyclists sustained compared with other motor vehicle injuries. Motorcyclists had fewer head injuries but when they did occur, they tended to be more severe, as were the chest injuries that cyclists sustained. Cyclists sustained a much lower proportion of severe abdominal injuries than did other drivers and passengers. (

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Gem polishing is an industry that produces frequent minor injuries to its workers; in one city in India, 10% of these workers are children. A survey was conducted among child workers, asking those who had been injured about the circumstances, how the injury was treated, and the use of protective devices to prevent injuries. Injuries were more common among children under age 14, those who worked more than six hours a day, and those having worked in the industry for less than two years. The children cared for their wounds poorly, frequently failing to wash their hands or apply appropriate medications. (

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A study of child workers in the United States, aged 10–14, focused on injuries sustained during summer jobs. Middle school students were surveyed about their summer jobs, most of which were informal, such as in family businesses or delivering papers. Eighteen percent reported being injured at work, and one quarter of those reported that the injury resulted in their missing more than three days of activities. Fewer than half of the students had received any kind of safety training. (

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An analysis of poisoning deaths in 11 states describes an overall increase in unintentional and undetermined death rates averaging 145% while suicide poison rates declined. Although there are a number of data problems, including non-specific T code categories and the use of two revisions of the ICD during the analysis period, drug overdose deaths appear to be a substantial part of the increase in poison deaths. The editors comment that preventing these deaths is challenging and will need to involve addiction specialists, law enforcement, and physicians, as well as public health professionals. (

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Have you read—or published—an interesting article recently? Please send the citation, and copy if possible, to the editor of Splinters & Fragments: Anara Guard, 44 King Street, Auburndale MA 02466, USA (fax 1 617 437 9394; email guardwilliamsrcn.com or Anarajointogether.org).

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