Cultural Adaptation of a Brief Motivational Intervention for Heavy Drinking Among Hispanics in a Medical Setting

Hispanics, particularly men of Mexican origin, are more likely to engage in heavy drinking and experience alcohol-related problems, but less likely to obtain treatment for alcohol problems than non-Hispanic men. Our previous research indicates that heavy-drinking Hispanics who received a brief motivational intervention (BMI) were significantly more likely than Hispanics receiving standard care to reduce subsequent alcohol use. Among Hispanics who drink heavily the BMI effectively reduced alcohol use but did not impact alcohol-related problems or treatment utilization. We hypothesized that an adapted BMI that integrates cultural values and addresses acculturative stress among Hispanics would be more effective. Methods/Design: We describe here the protocol for the design and implementation of a randomized (approximately 300 patients per condition) controlled trial evaluating the comparative effectiveness of a culturally adapted (CA) BMI in contrast to a non-adapted BMI (NA-BMI) in a community hospital setting among men of Mexican origin. Study participants will include men who were hospitalized due to an alcohol related injury or screened positive for heavy drinking. By accounting for risk and protective factors of heavy drinking among Hispanics, we hypothesize that CA-BMI will significantly decrease alcohol use and alcohol problems, and increase help-seeking and treatment utilization. Discussion: This is likely the first study to directly address alcohol related health disparities among non-treatment seekingmen of Mexican origin by comparing the benefits of a CA-BMI to a NA-BMI. This study stands to not only inform interventions used in medical settings to reduce alcohol-related health disparities, but may also help reduce the public health burden of heavy alcohol use in the United States.Patient Centered Outcomes Research Institute (PCORI) 1306-03852Center for Social Work Researc

Children have Higher incidence of Traumatic Brain Injury After ATV Crash Compared to Adults

This study is a retrospective cohort study on the risk of not wearing helmets the incidence of traumatic brain injury on persons who suffer an ATV crash, comparing adults to children

Teenage All-Terrain Vehicle Crashes: Helmet Non-compliance and Traumatic Brain Injury

Background: All-terrain vehicle (ATV) crashes are a source of childhood injury, especially traumatic brain injury (TBI). Children have differing influences on behavior at different ages; age-group assessment of safety practices is important in designing prevention programs. Helmet use is one of the proven injury prevention practices for ATV drivers. The primary objective was to identify which age groups had the highest odds for traumatic brain injury and exhibited lack of helmet wearing practices, to target a group for health prevention education. Methods: After IRB approval, a retrospective cohort study of medical records at a level one trauma center was completed for years 1998-2012. Variables included presence of TBI, helmet use, crash month, and age. Chi-square analysis was used for categorical variables. Cases categorized into age groups corresponding to school levels. SPSS version 25 was used for analysis. Results: 349 out of a total 750 were younger than 18 years. Cases/age group: 65 ages 0-10, 90 ages 11-13, 194 ages 14-18. Peak admission months were: 11-13-year-olds in September (15), August (11) and January (10); 14-18-year-olds in July (24). 190 had TBI, age categories: 27(41%) of 0-10 years, 51(56%) of 11-13 years, 112(57%) of 14-18 years. Comparing proportions in age groups of those with TBI, the 14-18-year-old group had the highest percentage at 58.9% (p, .068). 349 had helmet data, 17% used helmets. Eighteen (11%) persons out of the 163 with acute brain injury were wearing a helmet, 145 (89.0%) were unhelmeted (p=.004). Relative risk of unhelmeted patients for TBI was 1.6. Odds ratio for unhelmeted to have TBI compared to helmeted was 2.656, p, .004. Relative risk of TBI for unhelmeted compared to helmeted to have TBI in the 0-10, 11-13, 14-18 age groups respectively was 1.5 (p=0.47), 2.7 (p=.21), 1.75(p=.009). Conclusion: Overall odds ratio for unhelmeted children admitted after ATV crash was significantly higher than for helmeted crash victims. OR for TBI was significantly elevated in unhelmeted 14-18-year-old ATV crash victims admitted to the hospital, the largest age group category with the highest proportion of TBI. Since July had the highest incidence of TBI, the 14-18 year-old group should be targeted prior to July for a helmet-wearing ATV safety education intervention. Age group N (%) Helmet (%) Unhelmeted (%) TBI (%) OR of TBI/unhelmeted P (1.) 0-10 65 (18.6) 9 (16.4%) 46 (83.6%) 27 (41.5%) 2.0 0..48 11-13 90 (25.8) 12 (15.8%) 64 (84.2%) 51 (56.7%) 2.33 0.21 14-18 194 (55.6) 27 (17.6%) 126 (82.4%) 112 (57.7%) 3.17 .009 total 349 (100) 48 (13.8) 236 (67.6) 190 (54.4%) 2.656 .004

Injuries sustained after falls from bridges across the United States-Mexico border at El Paso Traumatismos por caídas desde puentes que atraviesan la frontera entre México y los Estados Unidos en El Paso

OBJECTIVE: To compare demographics and motivations for falls from bridges at the United States-Mexico border and in El Paso County, Texas, and to analyze injuries and injury patterns to support intentionality and to provide treatment recommendations. METHODS: A retrospective observational review was conducted of hospital admissions to a trauma center after falls from bridges from 1995 to 2009. Statistical methods used were chi-square testing, T-test for means comparison, univariate correlations, and regression analysis. RESULTS: Of the 97 evaluated patients, 81.4% fell from U.S.-Mexico border bridges, including one patient who fell from a railway bridge; 74.7% of those falling from border bridges had a non-U.S. address, contrasting with 22.2% of those who fell within the United States. Falls over the border were associated with more immigration-related motivations and fewer suicide attempts. Injuries included lower extremities in 76 (78.4%) and thoracolumbar spine in 27 (27.8%) patients; 16 patients with a thoracolumbar spine fracture (59.3%) also had a lower extremity injury. Mean hospital length of stay was 7.2 days. Mean injury severity score was 8.45 (range 1-43). Age, injury severity score, and pelvic fracture increased the hospital length of stay. CONCLUSIONS: Patients fell while emigrating-immigrating based on residence and motivating factors. A dyad of lower extremity and thoracolumbar spine injuries coincided in 59.3% of those with a thoracolumbar spine injury; thoracolumbar spine imaging of patients evaluated after falls from bridges is recommended. Proposed prevention strategies include posting signs on bridges and installing catch-net safety barriers.OBJETIVO: Comparar la información demográfica y las motivaciones relacionadas con las caídas desde puentes que atraviesan la frontera entre México y los Estados Unidos en el condado de El Paso, Texas; analizar las lesiones y los patrones de lesiones que avalan la intencionalidad; y proporcionar recomendaciones terapéuticas. MÉTODOS: Se llevó a cabo un examen retrospectivo observacional de las internaciones en un centro traumatológico debidas a caídas desde puentes que tuvieron lugar entre 1995 y el 2009. Los métodos estadísticos usados fueron la prueba de ji al cuadrado, la prueba T de comparación de medias, correlaciones de una sola variable y el análisis de regresión. RESULTADOS: De los 97 pacientes evaluados, 81,4% cayeron desde puentes ubicados en la frontera México-Estados Unidos, incluido un paciente que cayó desde un puente ferroviario; 74,7% de las personas que cayeron desde puentes fronterizos tenían un domicilio no residente, en comparación con 22,2% en las personas que cayeron desde puentes ubicados en el interior de los Estados Unidos. Las caídas desde los puentes fronterizos estaban asociadas con más motivaciones relacionadas con la inmigración y con menos intentos de suicidio. Las lesiones afectaban las extremidades inferiores en 76 pacientes (78,4%) y la columna vertebral toracolumbar en 27 (27,8%); 16 pacientes con fractura de la columna toracolumbar (59,3%) también presentaban lesión de las extremidades inferiores. La duración media de la hospitalización fue 7,2 días. La puntuación media de gravedad de la lesión fue 8,45 (rango 1 a 43). Una mayor edad, una puntuación alta en la escala de gravedad de la lesión y la fractura pelviana aumentaron la duración de la hospitalización. CONCLUSIONES: Los pacientes cayeron durante un intento de emigración o inmigración relacionado con la residencia y otros factores motivadores. En 59,3% de los pacientes con lesión de la columna vertebral toracolumbar esta coexistía con lesión de las extremidades inferiores; al evaluar a pacientes con lesiones por caídas desde puentes se recomienda efectuar estudios de imágenes de la columna vertebral toracolumbar. Las estrategias de prevención propuestas comprenden la colocación de señales en los puentes y la instalación de redes de seguridad

Cecal bascule after spinal cord injury: A case series report

Introduction: Cecal bascule is a rare cause of intestinal obstruction associated with upward and anterior folding of the ascending colon. We report three patients who presented with spinal cord injury complicated with a cecal bascule. Diagnosis and management of cecal bascule is discussed. Presentation of cases: Patient 1: 59-year-old male sustained a traumatic brain injury and cervical spinal cord injury after a motorcycle crash. He had abdominal distension and the diagnosis of cecal bascule was made. Cecopexy was performed. Patient 2: 51-year-old male sustained an unstable C7 vertebral fracture with a cord contusion and quadriplegia after a diving incident. After an unsuccessful medical management of the colonic distension, the patient was taken for a laparotomy and cecal bascule was found. A cecostomy and a cecopexy were performed. Patient 3: 63-year-old male was transferred after a fall. He had diffuse degenerative changes in the thoracic and lumbar spine. He was found to have a perforated cecal bascule. He had a right hemicolectomy with an ileocolic anastomosis. Discussion: We suggest the possibility of spinal cord injury being a risk factor for cecal bascule. Currently, right hemicolectomy is recommended for the treatment of cecal bascule. Cecopexy is also acceptable treatment option for a case in which the patient will be undergoing an operation with an insertion of hardware. Conclusion: The diagnosis of cecal bascule should be considered for trauma patients with cecal distention without delay in order to prevent disastrous complications

Hepatic “BOLSA” a novel method of perihepatic wrapping for hepatic hemorrhage “BOLSA”

Introduction: Severe traumatic liver hemorrhage quickly leads to exsanguination. Perihepatic packing is frequently used in damage control surgery. This method can be unsuccessful and accompanied by complications. Vicryl mesh wraps have been described in the treatment of liver hemorrhage. In this report, we describe an enhanced technique of hepatic wrapping in a case of hepatic bleeding after liver biopsy in a coagulopathic patient. The technique is called the hepatic “BOLSA” (Bag on Liver Supporting Anti-Hemorrhage). Presentation of case: A 59 year old male presented in the recovery room after liver biopsy of a mass, followed by angio-embolization of the hepatic mass 9 h earlier. The patient was acidotic, coagulopathic, and demonstrated intra-abdominal hypertension. Computed tomography demonstrated perihepatic fluid. The patient continued hemorrhaging despite attempts to correct coagulopathy by transfusion. Multiple operating room visits were required where a combination of packing and hemostatic agents could not stop hepatic venous parenchymal hemorrhage. Mesh wrap consisting of Vicryl and PDS suture were used to create the “BOLSA” to achieve hemostasis. Discussion: Perihepatic packing compromises pulmonary excursion, elevates intra-abdominal pressure, is a risk factor for sepsis, and requires an additional trip to the operating room for removal. The use of Vicryl mesh wrap obviates these complications. Previously described mesh wraps require anchoring. The self-supporting structure of the BOLSA simplifies construction and application. Conclusion: The BOLSA is an effective tool in treatment of severe liver hemorrhage in coagulopathic patients. It is the modern simplification of hepatic wrapping and the solution to the side effects of perihepatic packing

Trauma patients warrant upper and lower extremity venous duplex ultrasound surveillance

Background: Due to the high incidence of thromboembolic events (deep venous thrombosis [DVT] and pulmonary embolus [PE]) after injury, many trauma centers perform lower extremity surveillance duplex ultrasounds. We hypothesize that trauma patients are at a higher risk of upper extremity DVTs (UEDVTs) than lower extremity DVTs (LEDVTs), and therefore, all extremities should be evaluated. Materials and Methods: A retrospective chart and trauma registry review of Intensive Care Unit trauma patients with upper and LEDVTs detected on surveillance duplex ultrasound from January 2010 to December 2014 was carried out. Variables reviewed were age, gender, injury severity score, injury mechanism, clot location, day of clot detection, presence of central venous pressure catheter, presence of inferior vena cava filter, mechanical ventilation, and fracture. Results: A total of 136 patients had a DVT in a 5-year period: upper - 71 (52.2%), lower - 61 (44.9%), both upper and lower - 4 (2.9%). Overall, 75 (55.2%) patients had a UEDVT. Upper DVT vein: Brachial (62), axillary (26), subclavian (11), and internal jugular (10). Lower DVT vein: femoral (58), popliteal (14), below knee (4), and iliac (2). 10.3% had a PE: UEDVT - 5 (6.7%) and LEDVT - 9 (14.8%) P = 0.159. Conclusions: The majority of the DVTs in the study were in the upper extremities. For trauma centers that aggressively screen the lower extremities with venous duplex ultrasound, surveillance to include the upper extremities is warranted