Agricultural Injury Surveillance Using a Regional Trauma Registry.

BACKGROUND: The burden of traumatic injury among workers in agriculture is substantial. Surveillance can inform injury prevention efforts to reduce farmworkers' risk. We posited that the regional trauma registry can provide surveillance for agricultural injury requiring trauma-center care. METHODS: The Northeast Texas regional trauma registry was queried for patients injured in agricultural settings during 2016-2019 occurring in the 23,580 square mile study area subdivided into 219 US Census Zip Code Tract Area (ZCTA). Population at risk was estimated from the 2017 Census of Agriculture. Kuldorff's SaTScan identified case hot spots. A multivariable, geographically weighted regression model was fit for cases/1000 workers. RESULTS: In total, 273 cases occurred, (mean 68 cases per year [95% confidence interval 55.1-80.9]) among 96 ZCTA. The mean injury rate was 3.9 (95% confidence interval 3.4-4.3) cases per 1000 farmworkers. Animals and farm machinery were the most common injury mechanisms, 52.0% and 20.9%, respectively. Trauma ZCTA demonstrated more farms (median 170 versus 95.5, P < 0.001), greater farm acreage (53,900 acres versus 32,800, P = 0.004), and higher median total product sales ($6.5 million versus $3.9 million, P < 0.001). Six hot spots were identified with relative risks from 2.85 to 5.31. The multivariable model of cases/1000 workers demonstrated significant associations with workers per ZCTA (a mean ß-coefficient of 0.004 with P values <0.05 in 145 of 219 [66.5%] ZCTA) and percent rural population (ß = -6.62, P values <0.05 in 76.1% of ZCTA). CONCLUSIONS: Regional trauma registry data, combined with census data and spatial analyses, can identify actionable geographic areas of high agriculture-related injury risk.

Efficacy of anticoagulants and platelet inhibitors in cancer-induced thrombosis.

The efficacy of anticoagulants, low-molecular-weight heparins (LMWHs), the antiplatelet glycoprotein IIb/IIIa antagonist, or combinations on cancer-activated thrombosis was determined using thromboelastography. The LMWHs tinzaparin and enoxaparin (0.179, 1.79, 17.9 microg) were incubated in human citrated whole blood (n = 4) and then activated by calcium chloride (11 mmol/l) or Colo205 (cell count 10). Concentrations of 9.9, 17.9 and 179 microg glycoprotein IIb/IIIa antagonist, XV454, and combinations with each LMWH were carried out and activated under the same conditions. The experiment was repeated with tissue factor substituting for the Colo205 to induce platelet/fibrin clot formation. Parameters tested in the thrombelastography analysis included clotting time, rate of clot formation due to fibrin formation, clot kinetics, and clot strength related to platelet count (maximum amplitude). Tinzaparin (1.79 microg), enoxaparin (1.79 microg), and XV454 (17.9 microg) significantly reduced the angle by 64, 26 and 27%, respectively, in cancer-induced clotting. Significant reductions in the maximum amplitude occurred in tinzaparin 1.79 microg (31%), enoxaparin 1.79 microg (11%), and XV454 17.9 microg (59%). An overall antithrombotic additive effect occurred when each LMWH (1.79 microg) was combined with XV454 (17.9 microg). The results between cancer-activated and tissue factor-activated blood were similar. The study concludes that an additive effect is present between LMWHs and a glycoprotein IIb/IIIa antagonist in reducing cancer-mediated thrombosis.