Functional outcomes of motor vehicle crash thoracic injuries in pediatric and adult occupants

Objective: Characterization of the severity of injury should account for both mortality and disability. The objective of this study was to develop a disability metric for thoracic injuries in motor vehicle crashes (MVCs) and compare the functional outcomes between the pediatric and adult populations.

Methods: Disability risk (DR) was quantified using Functional Independence Measure (FIM) scores within the National Trauma Data Bank for the most frequently occurring Abbreviated Injury Scale (AIS) 2–5 thoracic injuries. Occupants with thoracic injury were classified as disabled or not disabled based on the FIM scale, and comparisons were made between the following age groups: pediatric, adult, middle-aged, and older occupants (ages 7–18, 19–45, 46–65, and 66+, respectively). For each age group, DR was calculated by dividing the number of patients who were disabled and sustained a given injury by the number of patients who sustained a given injury. To account for the effect of higher severity co-injuries, a maximum AIS adjusted DR (DR_MAIS) was also calculated for each injury. DR and DR_MAIS could range from 0 to 100% disability risk.

Results: The mean DR_MAIS for MVC thoracic injuries was 20% for pediatric occupants, 22% for adults, 29% for middle-aged adults, and 43% for older adults. Older adults possessed higher DR_MAIS values for diaphragm laceration/rupture, heart laceration, hemo/pneumothorax, lung contusion/laceration, and rib and sternum fracture compared to the other age groups. The pediatric population possessed a higher DR_MAIS value for flail chest compared to the other age groups.

Conclusion: Older adults had significantly greater overall disability than each of the other age groups for thoracic injuries. The developed disability metrics are important in quantifying the significant burden of injuries and loss of quality life years. Such metrics can be used to better characterize severity of injury and further the understanding of age-related differences in injury outcomes, which can influence future age-specific modifications to AIS.     

Analysis of injury mechanism of the elderly and non-elderly groups in minor motor vehicle accidents

Abstract

Objective: The purpose of this study is to investigate the injury patterns of noncatastrophic accidents by individual age groups.

Methods: Data were collected from the Korean In-Depth Accident Study database based on actual accident investigation. The noncatastrophic criteria were classified according to U.S. experts from the Centers for Disease Control and Prevention’s recommendations for field triage guidelines of high-risk automobile crash criteria by vehicle intrusions more than 12 in. on occupant sites (including the roof) and more than 18 in. on any site. The Abbreviated Injury Scale (AIS) was used to determine injury patterns for each body region. Severely injured patients were classified as Maximum Abbreviated Injury Scale (MAIS) 3 or higher.

Results: In this study, the most significant injury regions were the head and neck, extremities, and thorax. In addition, the incidence of severe injury among elderly patients was nearly 1.6 times higher than that of non-elderly patients. According to age group, injured body regions among the elderly were the thorax, head and neck, and extremities, in that order. For the non-elderly groups, these were head and neck, extremities, and thorax. Severe injury rates were slightly different for the elderly group (head and neck, abdomen) and non-elderly group (thorax, head and neck).

Conclusions: In both age groups, the rate of severe injury is proportional to an increase in crush extent zone. Front airbag deployment may have a relatively significant relationship to severe injuries.     

岳阳楼景区周末游客构成及消费行为初探

周末是我国大多数旅游景区周期性出现的旅游小高峰期,但其研究未得到重视。在问卷调查的基础上,获得了岳阳楼景区周末游客构成的基础资料,并对游客消费行为进行了分析,就此提出岳阳楼景区经营管理的几点看法。     

Self-reported falls and fall-related injuries among persons aged>or=65 years--United States, 2006

PROBLEM: In 2005, 15,802 persons aged>or=65 years died from fall injuries. How many older adults seek outpatient treatment for minor or moderate fall injuries is unknown. METHOD: To estimate the percentage of older adults who fell during the preceding three months, the Centers for Disease Control and Prevention (CDC) analyzed data from two questions about falls included in the 2006 Behavioral Risk Factor Surveillance System (BRFSS) survey. RESULTS: Approximately 5.8 million (15.9%) persons aged>or=65 years reported falling at least once during the preceding three months, and 1.8 million (31.3%) of those who fell sustained an injury that resulted in a doctor visit or restricted activity for at least one day. DISCUSSION: This report presents the first national estimates of the number and proportion of persons reporting fall-related injuries associated with either doctor visits or restricted activity. SUMMARY: The prevalence of falls reinforces the need for broader use of scientifically proven fall-prevention interventions. IMPACT ON INDUSTRY: Falls and fall-related injuries represent an enormous burden to individuals, society, and to our health care system. Because the U.S. population is aging, this problem will increase unless we take preventive action by broadly implementing evidence-based fall prevention programs. Such programs could appreciably decrease the incidence and health care costs of fall injuries, as well as greatly improve the quality of life for older adults.     

生活空间重构旅游者的乡村游憩影响因素与路径——一个模糊集的定性比较分析

旅游者是乡村旅游发展中的核心要素,但当前研究缺乏从城乡空间转换中的人地关系变迁角度对旅游者进行的思考。以经历城乡生活空间重构的旅游者为研究对象,运用分析多变量交互作用的模糊集定性比较分析方法,探索旅游者乡村游憩影响因素的复杂路径。研究发现:地方情感、怀旧情感、主观规范、知觉行为控制、态度、愿望（欲望）、旅游目的地知名度形成的128种组合中,其中有8个充分性条件构型特定组合路径能够影响乡村旅游者游憩行为;单项中地方情感、怀旧情感、知觉行为控制的一致性相对较高,但都不能构成旅游者乡村游憩影响因素的必要条件;8条旅游者乡村游憩行为影响因素路径条件组合的总体覆盖率约为0.918919,总体一致性约为1,均达到了0.9的阈值标准。其中,地方情感和怀旧情感特性是最关键的影响因素;旅游者具有地方情感、怀旧情感特征时,其他影响因素都可能在“特定情境”下发挥作用。据此提出了生活空间重构旅游者的乡村游憩影响路径模型,揭示了“乡村情感—游憩意向路径”“计划行为—游憩意向路径”“游憩愿望路径”和“情感行为综合路径”四类影响路径的作用机制。旅游从业者可以据此寻找与旅游者游憩最匹配的产品开发解决方案。     

周庄旅游者的结构特征及利益追求

旅游客源市场由不同结构特征的旅游者组成,其利益追求各不相同,对此加以分析,可以制定正确的营销策略,提供科学依据.以周庄为案例,采用随机抽样问卷调查法,分别对周庄旅游者的性别结构、年龄结构、文化结构、家庭收入水平结构和职业结构进行了分析.结果显示,周庄旅游者以男性游客为主体,25～44岁的中青年游客占大多数;文化程度以大专及以上层次为主,职业构成比较分散,企事业管理人员居多;家庭月收入水平高于全国平均水平.对旅游者的利益追求进行了初步的探讨,并结合游客结构特征和利益追求的分析结果,提出了周庄未来旅游产品的营销策略.     

室内环境与高龄者血压的关联性——以大连市供暖季为例

对中国大连市供暖季住宅室内环境与高龄者血压的关联性进行了调查研究，具体包括住宅热湿环境（温度、相对湿度）、化学污染（CO₂、CO、甲醛和TVOC）、物理污染（PM_2.5）和生物污染（附着真菌）与高龄者血压的关联性.研究表明，城市和农村住宅供热方式不同是导致住宅室内热环境舒适度差异的主要原因.在大连农村，处于室外的厕所与室内形成的大温差使得农村高龄者患心血管疾病的诱发风险比城市更高.城市高龄者的平均血压比农村低且波动小.城市住宅室内温湿度与血压均存在关联（P<0.01），农村室内温湿度对血压的影响程度不如城市明显.另外，室内空气质量参数并未发现与血压存在显著关联.     

天津市老年人PM2.5个体暴露化学组分特征

分别于2011年6月13日—7月2日(夏季)和11月30日—12月12日(冬季),采用颗粒物个体暴露采样器对天津市某社区101名老年人(平均年龄67岁)的PM_2.5个体暴露水平进行监测,以探讨PM_2.5个体暴露化学组分的特征. 结果表明,天津市老年人夏、冬季PM_2.5个体暴露浓度分别为(124.2±75.2)和(170.8±126.6)μg/m3. 斯皮尔曼相关分析表明,Si、NH₄+和NO₃-的暴露浓度均与PM_2.5暴露浓度显著相关(P<0.01),R(相关系数)分别为0.61、0.55和0.46. 富集因子分析表明,Cd、Zn和Pb 3种元素高度富集,受人为源的影响强烈. SO₄2-是水溶性离子中含量最高的组分,其次是NO₃-和NH₄+,在夏、冬季这3种离子暴露浓度之和分别占PM_2.5暴露浓度的34.3%和40.6%. OC是老年人PM_2.5个体暴露的主要成分之一,夏、冬季OC暴露浓度分别占PM_2.5暴露浓度的19.3%和27.4%. 老年人PM_2.5个体暴露化学组分浓度受气象因素、室内源和室外源的共同影响,季节变化明显. 冬季Al、Si、K、Ca和Fe的暴露浓度高于夏季,但大部分微量金属元素(V、Cr、Mn、Ni、Cu、Zn、As、Sb和Pb)的冬季暴露浓度却低于夏季. 方差分析表明,冬季SO₄2-、NO₃-、NH₄+、OC和EC的暴露浓度显著高于夏季(P<0.05).      

探讨老年患者的心里压力及对策

目的:探讨老年患者的压力及心理护理.方法:对我院2010年元月至2011年12月收治298例老年患者,采用问卷调查和观察法,了解老年患者的心理压力,采取心理护理收到良好的效果.结果:298例中,配合治疗的199例痊愈,42例好转,8例无效;欠配合治疗的2例痊愈,6例好转,41例无效.结论:针对老年患者的压力,做好心理护理是我们义不容辞的责任,我们不仅要有精通的医学知识和丰富的心理学知识,还要有一颗爱心,这样才能做好老年心理护理,才能适应现代医学发展的需要.表2,参5.