Postoperative nausea and vomiting in facial fracture patients : a randomized and controlled trial on the effect of dexamethasone

Non peer reviewe

Assault-related facial fractures : does the injury mechanism matter?

This study clarified the injury characteristics and occurrence of associated injuries in patients with assault-related facial fractures. Data from 840 assault-related facial fracture patients were included; demographic factors, facial fracture type, associated injuries, alcohol use, and injury mechanisms were recorded. Assault mechanisms most often included combinations of different mechanisms (57.5%) and resulted in the victim falling (50.1%). The perpetrator was most commonly a stranger (52.5%) and acted alone (57.7%). A total of 123 patients (14.6%) had associated injuries, with the most common being traumatic brain injury. Associated injuries occurred most frequently in patients with combined fractures of the facial thirds (24.2%) and upper third fractures (42.9%). The most significant differentiating factors for associated injuries were the number of perpetrators, falling, the use of an offensive weapon, and if the events of the assault remained unknown. In adjusted logistic regression analyses, statistically significant associations with associated injuries were found for age (odds ratio (OR) 1.05, 95% confidence interval (CI) 1.03-1.07; P < 0.001), falling due to the assault (OR 2.87, 95% CI 1.49-5.50; P = 0.002), and upper third facial fractures (OR 6.93, 95% CI 2.06-23.33; P = 0.002). A single punch also caused severe injuries and should therefore not be overlooked, as this can be as dangerous as other assault mechanisms.Peer reviewe

Midlife Cardiovascular Status and Old Age Physical Functioning Trajectories in Older Businessmen

Peer reviewe

Maternal satisfaction with joint and sole child physical placement arrangements following separation in Wisconsin and Finland

Families (and sometimes courts) make important decisions regarding child physical custody arrangements post-separation, and shared parenting arrangements are increasingly common in most developed countries. Shared arrangements may be differentially associated with parental satisfaction, and these associations may vary across countries. Using data from surveys of separated mothers in Wisconsin and Finland, the present study explores this possibility and is guided by three aims: (a) to identify child and family characteristics associated with sole and shared child placements 6 or more years after separation; (b) to estimate associations of children's post-separation placements with maternal satisfaction with placements and expense sharing; (c) to examine whether the relationship between post-separation placement and maternal satisfaction varies by mothers' earnings and the quality of parents' relationships. We find that Finnish mothers with shared placement are more satisfied with their placement than are their counterparts with sole placement, while we find the inverse is true for Wisconsin mothers. Moreover, parental satisfaction with shared placement, overall and relative to sole placement, varies greatly depending on the quality of a mother's relationship with the other parent; and differences in relationship quality in Wisconsin and Finland may help explain the difference in satisfaction with shared placement in the two locations. In both Finland and Wisconsin, we find mothers with shared placement are more satisfied with the way expenses are shared between parents than are mothers with sole placement. Associations between placement and satisfaction are robust to extensive controls for child and maternal characteristics.</p

Midlife Cardiovascular Status and Old Age Physical Functioning Trajectories in Older Businessmen

OBJECTIVES: The associations between cardiovascular disease (CVD) risk and later physical functioning have been observed, but only a few studies with follow-up into old age are available. We investigated the association between cardiovascular status in midlife and physical functioning trajectories in old age. DESIGN: Prospective cohort study. SETTING: Helsinki Businessmen Study. PARTICIPANTS: We studied white men born between 1919 and 1934 in the Helsinki Businessmen Study (HBS, initial n = 3490). MEASUREMENTS: Three CVD status groups were formed based on clinical measurements carried out in 1974: signs of CVD (diagnosed clinically or with changes in ECG, chronic disease present or used medication, n = 563); healthy and low CVD risk (n = 593) and high CVD risk (n = 1222). Of them, 1560 men had data on physical functioning from at least one of four data collection waves between 2000-2010. Ten questions from the RAND-36 (SF-36) survey were used to construct physical functioning trajectories with latent class growth mixture models. Mortality was accounted for in competing risk models. RESULTS: A five-class solution provided the optimal number of trajectories: “intact,” “high stable,” “high and declining,” “intermediate and declining,” and “consistently low” functioning. Compared with low CVD risk, high CVD risk in midlife decreased the risk of being classified into the intact (fully adjusted β = −3.98; standard error = 2.0; P =.046) relative to the consistently low physical functioning trajectory. Compared with low CVD risk, those with signs of CVD were less likely to follow the intact, high stable, or high and declining relative to the consistently low trajectory (all P CONCLUSION: Among businessmen, a more favorable CVD profile in midlife was associated with better development of physical functioning in old age.</p

Pharmacological Preconditioning with Diazoxide in the Experimental Hypothermic Circulatory Arrest Model

Background: Hypothermic circulatory arrest includes a remarkable risk for neurological injury. Diazoxide, a mitochondrial adenosine triphosphate-dependent potassium ion (K+ATP) channel opener, is known to have cardioprotective effects. We assessed its efficacy in preventing ischemic injury in a clinically relevant animal model.Methods: Eighteen piglets were randomized into a diazoxide group (n = 9) and a control group (n = 9). Animals underwent 60 minutes of hypothermic circulatory arrest at 18 degrees C. Diazoxide (5 mg/kg + 10 mL NaOH + 40 mL NaCl) was infused during the cooling phase. Metabolic and hemodynamic data were collected throughout the experiment. After 24-hour follow-up, whole brain, heart, and kidney biopsy specimens were collected for analysis.Results: Cerebellar Cytochrome-C and caspase-3 activation was higher in the control group (P = .02 and P = .016, respectively). Antioxidant activity tended to be higher in the diazoxide group (P = .099). Throughout the experiment, the oxygen consumption ratio was higher in the control animals (P-g = .04), as were the lactate levels (P-g = .02). Cardiac function tended to be better in diazoxide-treated animals.Conclusion: Diazoxide might confer neuroprotective effect as implied by the immunohistochemical analysis of the brain. Additionally, the circulatory effects of diazoxide were beneficial, supporting its neuroprotective effect

Population change in breeding boreal waterbirds in a 25-year perspective : What characterises winners and losers?

Understanding drivers of variation and trends in biodiversity change is a general scientific challenge, but also crucial for conservation and management. Previous research shows that patterns of increase and decrease are not always consistent at different spatial scales, calling for approaches combining the latter. We here explore the idea that functional traits of species may help explaining divergent population trends. Complementing a previous community level study, we here analyse data about breeding waterbirds on 58 wetlands in boreal Fennoscandia, covering gradients in latitude as well as trophic status. We used linear mixed models to address how change in local abundance over 25 years in 25 waterbird species are associated with life history traits, diet, distribution, breeding phenology, and habitat affinity. Mean abundance increased in 10 species from 1990/1991 to 2016, whereas it decreased in 15 species. Local population increases were associated with species that are early breeders and have small clutches, an affinity for luxurious wetlands, an herbivorous diet, and a wide breeding range rather than a southern distribution. Local decreases, by contrast, were associated with species having large clutches and invertivorous diet, as well as being late breeders and less confined to luxurious wetlands. The three species occurring on the highest number of wetlands all decreased in mean abundance. The fact that early breeders have done better than late fits well with previous research about adaptability to climate change, that is, response to earlier springs. We found only limited support for the idea that life history traits are good predictors of wetland level population change. Instead, diet turned out to be a strong candidate for an important driver of population change, as supported by a general decrease of invertivores and a concomitant increase of large herbivores. In a wider perspective, future research needs to address whether population growth of large-bodied aquatic herbivores affects abundance of co-occurring invertivorous species, and if so, if this is due to habitat alteration, or to interference or exploitative competition.Peer reviewe

Established Risk Factors Account for Most of the Racial Differences in Cardiovascular Disease Mortality

BACKGROUND: Cardiovascular disease (CVD) mortality varies across racial and ethnic groups in the U.S., and the extent that known risk factors can explain the differences has not been extensively explored. METHODS: We examined the risk of dying from acute myocardial infarction (AMI) and other heart disease (OHD) among 139,406 African-American (AA), Native Hawaiian (NH), Japanese-American (JA), Latino and White men and women initially free from cardiovascular disease followed prospectively between 1993–1996 and 2003 in the Multiethnic Cohort Study (MEC). During this period, 946 deaths from AMI and 2,323 deaths from OHD were observed. Relative risks of AMI and OHD mortality were calculated accounting for established CVD risk factors: body mass index (BMI), hypertension, diabetes, smoking, alcohol consumption, amount of vigorous physical activity, educational level, diet and, for women, type and age at menopause and hormone replacement therapy (HRT) use. RESULTS: Established CVD risk factors explained much of the observed racial and ethnic differences in risk of AMI and OHD mortality. After adjustment, NH men and women had greater risks of OHD than Whites (69% excess, P<0.001 and 62% excess, P = 0.003, respectively), and AA women had greater risks of AMI (48% excess, P = 0.01) and OHD (35% excess, P = 0.007). JA men had lower risks of AMI (51% deficit, P<0.001) and OHD (27% deficit, P = 0.001), as did JA women (AMI, 37% deficit, P = 0.03; OHD, 40% deficit, P = 0.001). Latinos had underlying lower risk of AMI death (26% deficit in men and 35% in women, P = 0.03). CONCLUSION: Known risk factors explain the majority of racial and ethnic differences in mortality due to AMI and OHD. The unexplained excess in NH and AA and the deficits in JA suggest the presence of unmeasured determinants for cardiovascular mortality that are distributed unequally across these populations

Review on the validity of self-report to assess work-related diseases

Self-report is an efficient and accepted means of assessing population characteristics, risk factors, and diseases. Little is known on the validity of self-reported work-related illness as an indicator of the presence of a work-related disease. This study reviews the evidence on (1) the validity of workers' self-reported illness and (2) on the validity of workers' self-assessed work relatedness of an illness. A systematic literature search was conducted in four databases (Medline, Embase, PsycINFO and OSH-Update). Two reviewers independently performed the article selection and data extraction. The methodological quality of the studies was evaluated, levels of agreement and predictive values were rated against predefined criteria, and sources of heterogeneity were explored. In 32 studies, workers' self-reports of health conditions were compared with the "reference standard" of expert opinion. We found that agreement was mainly low to moderate. Self-assessed work relatedness of a health condition was examined in only four studies, showing low-to-moderate agreement with expert assessment. The health condition, type of questionnaire, and the case definitions for both self-report and reference standards influence the results of validation studies. Workers' self-reported illness may provide valuable information on the presence of disease, although the generalizability of the findings is limited primarily to musculoskeletal and skin disorders. For case finding in a population at risk, e.g., an active workers' health surveillance program, a sensitive symptom questionnaire with a follow-up by a medical examination may be the best choice. Evidence on the validity of self-assessed work relatedness of a health condition is scarce. Adding well-developed questions to a specific medical diagnosis exploring the relationship between symptoms and work may be a good strateg