Protective and risk factors in amateur equestrians and description of injury patterns: A retrospective data analysis and a case - control survey

Background In Switzerland there are about 150,000 equestrians. Horse related injuries, including head and spinal injuries, are frequently treated at our level I trauma centre. Objectives To analyse injury patterns, protective factors, and risk factors related to horse riding, and to define groups of safer riders and those at greater risk Methods We present a retrospective and a case-control survey at conducted a tertiary trauma centre in Bern, Switzerland. Injured equestrians from July 2000 - June 2006 were retrospectively classified by injury pattern and neurological symptoms. Injured equestrians from July-December 2008 were prospectively collected using a questionnaire with 17 variables. The same questionnaire was applied in non-injured controls. Multiple logistic regression was performed, and combined risk factors were calculated using inference trees. Results Retrospective survey A total of 528 injuries occured in 365 patients. The injury pattern revealed as follows: extremities (32%: upper 17%, lower 15%), head (24%), spine (14%), thorax (9%), face (9%), pelvis (7%) and abdomen (2%). Two injuries were fatal. One case resulted in quadriplegia, one in paraplegia. Case-control survey 61 patients and 102 controls (patients: 72% female, 28% male; controls: 63% female, 37% male) were included. Falls were most frequent (65%), followed by horse kicks (19%) and horse bites (2%). Variables statistically significant for the controls were: Older age (p = 0.015), male gender (p = 0.04) and holding a diploma in horse riding (p = 0.004). Inference trees revealed typical groups less and more likely to suffer injury. Conclusions Experience with riding and having passed a diploma in horse riding seem to be protective factors. Educational levels and injury risk should be graded within an educational level-injury risk index

Historia de la ultima guerra, negociaciones, y conclusion de la paz : que contiene todo lo mas importante, acontecido en Italia, el Rhin, Polonia, y la mayor parte de las Cortes de Europa, desde el año de 1733 hasta el de 1736 : dedicada a la Reyna Nuestra Señora

Autor tomado de licencia y censuraTítulo original: Histoire de la dernière guerre et des négociations pour la paixSignaturas: [calderón]-2[calderón]4, A-Z4, 2A-2Y

Histoire de la guerre de sept ans, et des événemens depuis 1746, jusqu'à la Paix de Hubertsbourg en 1763

Vol. I (306 p.) -- Vol. II (356 p.

Intramuscular injections in newborns: analgesic treatment and sex-linked response

Aim: To compare the analgesic effect of 3 treatments to relieve the pain produced by intramuscular injections (IMI) in term newborns, and to assess sex-linked differences in their response to pain. Material and methods: We studied 62 babies. Each baby received antibiotic IMIs for clinical aims. During each IMI, one of the following analgesic treatments was utilized: oral 33% glucose (OG), sensorial saturation (SS), or topic anesthetic cream (TAC). SS is a validated analgesic method, based on the combination of three stimulations (tactile, acoustic and gustative). During the IMI, pain level was assessed with the use of the DAN scale, a validated neonatal pain scale. All babies who received 3 distinct analgesic procedures for 3 distinct IMIs were enrolled. Mean pain scores of the 3 analgesic treatment groups were compared. We then compared mean pain scores of females vs males in the whole cohort and within each treatment group. Results: The 95% Confidence Intervals of pain scores were: 5.6-6.5 for TAC, 1.4-2.3 for OG and 0.6-1.2 for SS: when treated with TAC, babies' pain scores were significantly higher than with OG or SS ( p <0.0001); when treated with OG, babies' pain scores were higher than SS (p = 0.001). Females' mean pain score was significantly higher than males' mean pain score: (95% CI: 2.9-4.1 vs 2.0-3.1; p=0.001). OG and SS produced significantly higher mean DAN scores in females than in males. Also in the TAC group females' mean DAN scores were higher than males, though this last difference was not statistically significant. Conclusion: This is the first study to show the effectiveness of non-pharmacologic analgesia in relieving IMI pain. It is also the first study to clearly show that the sex-differences in pain perception are present since birth

in: Damage Control Resuscitation

Airway care of the patient with life threatening haemorrhage presents many challenges during damage control resuscitation. The essential requirements are to maintain oxygenation at all stages of care and when necessary deliver general anaesthesia to facilitate invasive haemorrhage control procedures. In the remote, pre-hospital setting, providers must be able to assess the airway and intervene with a range of strategies to prevent hypoxaemia. These interventions may vary from basic airway opening manoeuvres to advanced techniques such as drug-assisted rapid sequence intubation. The initial delivery of these skills in remote settings will be the responsibility of whichever medical provider is present, and so their training, equipment and decision-making skills must reflect the challenges they will face. Rapid sequence intubation skills may not be widely available in remote environments and so providers must be equipped with alternative airway management strategies including cricothyrotomy and use of extraglottic airway devices. When invasive haemorrhage control procedures are required for patients with life threatening haemorrhage, rapid sequence intubation will need to be performed. This procedure carries significant risk in the presence of haemorrhagic shock. Providers must be aware of the hypotensive effects of induction agents and the adverse impact of positive pressure ventilation upon cardiac output in the presence of life threatening haemorrhage. The risks of intubation should be minimised with appropriate blood production administration and ventilation techniques as part of a coordinated damage control resuscitation strategy