129 research outputs found
Social Environmental Factors Related to Resuming Driving after Brain Injury : A Multicenter Retrospective Cohort Study.
Many patients resume driving after brain injury regardless of their ability to drive safely. Predictors for resuming driving in terms of actual resumption status and environmental factors are unclear. We evaluated the reasons for resuming driving after brain injury and examined whether social environmental factors are useful predictors of resuming driving. This retrospective cohort study was based on a multicenter questionnaire survey at least 18 months after discharge of brain injury patients with rehabilitation. A total of 206 brain injury patients (cerebrovascular disease and traumatic brain injury) were included in the study, which was conducted according to the International Classification of Functioning (ICF) items using log-binominal regression analysis, evaluating social environmental factors as associated factors of resuming driving after brain injury. Social environmental factors, inadequate public transport (risk ratio (RR), 1.38), and no alternative driver (RR, 1.53) were included as significant independent associated factors. We found that models using ICF categories were effective for investigating factors associated with resuming driving in patients after brain injury and significant association between resuming driving and social environmental factors. Therefore, social environmental factors should be considered when predicting driving resumption in patients after brain injury, which may lead to better counseling and environmental adjustment
外傷性窒息により死亡した自転車乗員の一剖検例
We report an autopsy case of fatal traumatic asphyxia in a bicyclist. A 15-year-old female bicyclist fell from her bike after collision with the rear end of a truck that was backing up. Her body was pinned between the ground and a spare tire attached to the bottom of the truck. Autopsy revealed congestion of the head, face, neck, upper anterior aspect of the chest, and bilateral arms, and many petechial hemorrhages in the oral mucosa and bilateral palpebral conjunctivae. Internal examination revealed hemorrhage of the intercostal muscles with a rib fracture, mild liver laceration, and pelvic fracture resulting from compression of the thoracoabdominal region, and the findings of acute death. The cause of death was diagnosed as traumatic asphyxia. Known mechanisms of traumatic asphyxia in motor vehicle collisions include crushing of pedestrians or ejected occupants by the vehicle and crushing of occupants by intrusion into the passenger compartment; traumatic asphyxia resulting from vehicle collision involving in a bicyclist has not been reported. The present case indicates that forensic pathologists should consider the possibility of traumatic asphyxia when investigating vehicle collision deaths, especially in bicyclists.外傷性窒息により死亡した自転車乗員の剖検事例を報告する.症例は15歳の女子,自転車に乗車し空き地を走行中,空き地に駐車するため後進する大型トラックの後部と衝突した.死者は自転車から転落し,地面と大型トラックの底面に取り付けられたスペアタイヤの間に挟まれ死亡した.翌日司法解剖が施行された.外表所見では,頭部,顔面,頚部,胸部上前面,両上肢にうっ血と,左右眼瞼結膜下及び口腔粘膜下に多数の溢血点を認めた.内景所見では,急死の所見,左第2から第5肋骨及び右第5から第7肋骨の骨折,軽度の肝挫傷,胸腹部圧迫による骨盤骨折を認め,死因は外傷性窒息と診断した.自動車衝突事故における外傷性窒息では,歩行者や車外放出された乗員の車両底面による圧迫,車両の陥凹に伴う乗員の圧迫などが知られているが,自転車乗員の車両衝突事故による外傷性窒息は報告されていない.本事例は,自転車乗員の衝突事故死例を経験した際に,外傷性窒息の可能性を検討すべきことを示唆している
The Value of Interleukin-6 among Several Inflammatory Markers as a Predictor of Respiratory Failure in COVID-19 Patients.
Patients with coronavirus disease 2019 (COVID-19) develop severe respiratory failure within a short period during the clinical course. It is essential to predict respiratory deterioration in the short term. We investigated the use of inflammatory markers to predict respiratory distress within three days from their analysis in COVID-19 patients. This retrospective observational study included 81 patients admitted with COVID-19. Patients were divided into two groups according to whether the maximum fraction of inspired oxygen (FiO2) for three days from the blood marker measurements was ≥0.4 (high FiO2 group; HFG) or <0.4 (low FiO2 group; LFG). Interleukin-6 (IL-6), C-reactive protein (CRP), lactate dehydrogenase (LDH), white blood cell, D-dimer, and creatinine levels were compared between the two groups. The levels of all markers were significantly higher in HFG patients. Areas under the receiver operating characteristic curve of IL-6, CRP, and LDH had high values of 0.85, 0.82, and 0.81, respectively. The odds ratio of IL-6 which was crude and adjusted for dexamethasone administration initiated before laboratory measurement, showed the high value of 29.1 (5.6–295.6) and 53.9 (4.5–3242.8), respectively. IL-6 can be used as a reliable marker for predicting respiratory illness within three days after assessment
Risk Factors for Collisions and Near-Miss Incidents Caused by Drowsy Bus Drivers.
Serious accidents have been caused by drowsy bus drivers and have necessitated an examination of the risk factors involved. A questionnaire survey among employees of a bus company was conducted in Ibaraki Prefecture, Japan in September 2014. Respondents were asked to report details of their work and life over the preceding month. The 301 valid responses by bus drivers (295 men and 6 women) with a mean age of 51.6 years (range: 24-73 years) were used for analysis. Univariable logistic regression showed that factors affecting the incidence of collisions and near-miss incidents by drowsy drivers were continued driving when feeling sick, reporting a physical condition, number of sleep hours, time spent with family, working hours, and nutritional balance. According to a multiple regression analysis, continued driving when feeling sick (odds ratio: 3.421, 95% confidence interval: 1.618-7.231) was the only significant risk for the event. Managers should encourage drivers to voluntarily report poor health and should provide opportunities to stop driving if drivers experience physical discomfort or sleepiness. To improve road safety, educational measures are required for both drivers and managers to prevent driving under poor health conditions, although the decision to stop driving depends on drivers\u27 subjective judgment
Education for appropriate seatbelt use required for early-phase pregnant women drivers.
Considerable numbers of pregnant women do not understand the correct way to use seatbelts; thus, they are inappropriately restrained when wearing seatbelts. To improve appropriate seatbelt wearing by pregnant women vehicle passengers, we examined their use by pregnant women drivers and the independent factors influencing appropriate use. We undertook a cross-sectional survey of 1,000 pregnant women in Shiga Prefecture, Japan. Among 774 returned questionnaires, we analysed those of 680 pregnant women who always wore a seatbelt. The mean participant age was 31.4 ± 5.0 years and mean gestational age 26.2 ± 8.2 weeks; 97.7% of subjects always wore a seatbelt; 86.9% wore a seatbelt correctly and 13.1% incorrectly. Multivariate analysis indicated that receiving information about correct seatbelt use (odds ratio, 2.25; P < 0.005) and gestational age (odds ratio, 1.06; P < 0.001) were significant independent factors for correct seatbelt use. Providing information about correct seatbelt use during the early term is required for pregnant women to protect both the mother and fetus
Simple, Frequent Indicator for Personal Identification-Postmortem and Antemortem Abdominal Computed Tomography Findings of a Charred Body.
Postmortem personal identification in forensic science is performed using various methods. However, severely burnt bodies are hard to identify using odontological or skeletal features because of carbonization, and sometimes DNA profiling is impracticable because of the unavailability of the relatives. We present a case of a burn victim found after a house fire. Personal identification was attempted, but the body was heavily charred to the bones and the use of physical appearance was impracticable. There were no known relatives or personal belongings of the deceased for comparison of DNA typing. We obtained a series of abdominal computed tomography (CT) scans taken antemortem and found bilateral multiple renal cysts, left renal artery calcification, and a big right inguinal hernia, which matched the deceased\u27s postmortem CT findings and autopsy findings. To date, studies of identification by CT have acted for a rise in precision, but they require complicated calculation or high graphical methods. Calcification of the arteries or renal cysts seen in our case are very common lesions present in many adults with abundant variation; thus, they may be helpful as simple indicators for identification
Factors influencing the length of the emergency room and hospital stay in non-fatal bicycle accidents: A retrospective analysis.
Purpose:Lengthy hospitalization places a burden on patients and healthcare resources. However, the factors affecting the length of hospital stay (LHoS) and length of emergency room stay (LERS) in non-fatal bicycle accidents are currently unclear. We investigated these factors to inform efforts to minimize hospitalization.Methods:We performed a retrospective analysis of data from non-fatal injured bicyclists admitted to the Emergency and Critical Care Center at Kyoto Medical Center between January 2012 and December 2016. We measured LHoS, LERS, mechanism of injury, head injury prevalence, polytrauma, operations performed, injury severity score (ISS), abbreviated injury scale (AIS) score, maximum AIS score, and trauma and injury severity score probability of survival. We conducted multiple regression analysis to determine predictors of LHoS and LERS.Results:Within the study period, 82 victims met the inclusion and exclusion criteria and were included. Mean age was (46.0 ± 24.7) years. Overall mean LHoS was (16.8 ± 25.2) days, mean LERS was (10.6 ± 14.7) days, median ISS was 9 (interquartile range (IQR): 3-16), median maximum AIS was 3 (IQR: 1-4), and median trauma and injury severity score probability of survival was 98.0% (IQR: 95.5%-99.6%). Age, maximum AIS, ISS, and prevalence of surgery were significantly greater in long LHoS and LERS groups compared with short LHoS and LERS group (p < 0.05). Performance of surgery independently explained LHoS (p = 0.0003) and ISS independently explained LERS (p = 0.0009).Conclusions:Surgery was associated with long hospital stays and ISS was associated with long emergency room stays. To improve the quality life of the bicyclists, preventive measures for reducing injury severity or avoiding injuries needing operation are required
Factors Influencing Fatalities or Severe Injuries to Pedestrians Lying on the Road in Japan: Nationwide Police Database Study.
To help reduce the number of pedestrians lying on the road suffering fatal or severe injuries as a result of vehicle collisions, we investigated the influencing factors. We conducted an analysis of the records of the Institute for Traffic Accident Research and Data Analysis Japan between 2012 and 2018; we found that 2452 pedestrians lying on the road were involved in collisions (797 fatalities, 784 severely injured, 871 mildly injured). Multivariate logistic regression analysis identified the following as major factors that positively influenced the fatalities: head or neck injuries (odds ratio [OR], 90.221); trunk injuries (OR, 71.040); trucks as offending vehicle (OR, 2.741); collision velocity of 10–20 km/h (OR, 31.794), 20–30 km/h (OR, 2.982), 30–40 km/h (OR, 8.394), 40–50 km/h (OR, 16.831), and >50 km/h (OR, 18.639); and hit-and-run cases (OR, 1.967). The following had a positive influence on severe injuries: trunk injuries (OR, 4.060); collision velocity of 10–20 km/h (OR, 2.540), 20–30 km/h (OR, 3.700), 30–40 km/h (OR, 5.297), 40–50 km/h (OR, 5.719), and ≥50 km/h (OR, 5.244); and hit-and-run cases (OR, 2.628). Decreasing the collision velocity, avoiding collisions to the head and neck or trunk, and preventing hit-and-run cases would be effective in reducing fatal or severe injuries to pedestrians lying on the road
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