Introduction:For children ages 1–14, 21.6% of drowning cases involve swimming, wading, or playing in natural bodies of water, such as rivers and lakes. Personal flotation devices (PFDs) are believed to be an effective prevention measure. We measure compliance with city and county ordinances, publicized but not actively enforced, requiring that PFDs be worn by children accessing public bodies of water in Sacramento County, California.Methods:During June–August 2010, volunteers conducted 79 observation sessions at three popular local river beaches where PFDs were available for use at no cost. They recorded personal characteristics and PFD use for 1,727 children in or very near the water and believed to be 0–13 years of age (the age covered by the ordinances). We used logistic regression to quantify differences in use by subject characteristics and study site.Results:The prevalence of PFD use was 29.9% overall, with large and significant differences by age: < 1, 55.6%; 1–4, 37.6%; 5–10, 29.4%; 10–13, 14.6%; P < 0.0001. Usage did not vary significantly by sex or race/ethnicity, and was somewhat higher at one study site (33.1%) than at the others (25.9% and 27.3%), P = 0.009.Conclusion:The combination of a statutory requirement and a cost-elimination strategy was associated with moderate rates of PFD use that were highest among young children.
The management of duodenal laceration (DL) is controversial. We sought to determine the influence of damage control (DC) on the use of decompression/diversion/exclusion (DDE) techniques and the risk of duodenal-related complications (DRC). We conducted a retrospective review of all patients with full-thickness DL surviving more than 72 hours in the years 1989 to 2009. Forty-one patients with a median duodenal organ injury scale of 3 and a mean abdominal trauma index (ATI) of 45 ± 24 underwent laparotomy. Twenty-five patients (61%) were treated with DC and 16 (39%) with fascial closure (FC). Although the ATI of the patients treated with DC was greater than the ATI of the patients treated with FC (56 ± 23 vs 28 ± 17, P < 0.001), DRCs were equivalent (two vs three, nonsignificant). Twenty-one patients were treated in the first decade and 20 in the second decade. Between the first and second decades, there were trends toward an increased use of DC (52 to 70%, nonsignificant) and a decreased use of DDE (52 to 35%, nonsignificant) with a significant reduction in DRC (5 vs 0, P = 0.04). Among the 18 patients (44%) who underwent DDE procedures there were 2 DRCs (11%) related to DDE. Among the 23 patients who did not have DDE, there were three DRCs (13%), including two obstructions, one partial and one complete. When DC is used after DL, DDE may be unnecessary. Diversion is recommended, however, when the duodenum is at risk for obstruction after primary repair.
A cross-sectional medical survey was conducted among 63 Nicaraguan aviation mechanics exposed to organophosphate and other toxic pesticides. Thirty-one (49 percent) reported having been acutely poisoned on the job. Also, seven of 14 novice mechanics, with less than one year on the job, reported that they had been poisoned. Thirty-eight (61 percent) had cholinesterase levels below the lower limit of normal, including three workers with levels less than 20 percent of the lower limit of normal. Risk factors for low cholinesterase included recent hire and recent poisoning. Workers
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