Home accidents in the province of Trento. Ten years of observations regarding admissions to the emergency and first aid department.

BACKGROUND: Home accidents, or domestic accidents, are accidents that occur inside a home or the adjacent areas (stairways, courtyards, gardens, attics, cellars, garages, etc.). In Italy, they are monitored through a number of surveillance systems including the PASSI system and the ISTAT (Italian Institute of Statistics) Multipurpose Survey on Households. Only the SINIACA system (Italian National Information Service on Domestic Accidents), managed by the Istituto Superiore di Sanità (National Institute for Health), provides health-related information regarding such events and their circumstances and consequences, based primarily on Accident & Emergency Departments' data. STUDY DESIGN: This is an observational study on the domestic accidents trends in the province of Trento, using data on Accident & Emergency Departments admissions, between 2009 and 2018, combined with mortality and hospital discharge data. METHODS: The authors extrapolated records regarding admissions for domestic accidents from the digital annual Accident & Emergency admissions archive. For the 2009-2018 period, they analysed: the trend over time, both overall and classified according to gender and age group; and the inflow rate/10,000 inhabitants, broken down according to gender, nationality (Italians and foreign nationals) and age group. The coverage of the additional SINIACA variables regarding the accident dynamic, contingent activity and place of the accident were also analysed. With regard to the case load for 2018, the authors analysed the site and type of the injuries, the level of severity, outcome and the services provided, comparing the 0-14 years and >65 years age groups. Trend significance was analysed using the Cochran-Armitage test for trend and the significance of the differences between the proportions was analysed using the Chi-squared test. We have also calculated the costs of the services provided, overall and by age group. RESULTS: During the study period, a total of 99,386 A&E admissions for domestic accidents were recorded, with an annual average of 9,938 admissions. Between 2009 and 2018, there was a statistically significant increase of 41%, which was due in part to better event recognition and recording. Females prevail over males, especially over the age of 75 years. Over time there is an increase in cases over the age of 65, due to the progressive ageing of the population. Considering the resident population alone, the A&E inflow rate rises from 147 admissions/10,000 inhabitants in 2009 to 197 admissions/10,000 inhabitants in 2018, with a 39.0% increase. Inflow is greater in the two extreme age groups: in 2018, in the 0-4 years age group, the inflow rate is 319 admissions/10,000 inhabitants and in the over 75 years class it rises to 481 admission/10,000 inhabitants, 1.6 and 2.4 times the mean inflow for home accidents in the province of Trento, respectively. Admissions are less amongst foreign nationals than amongst Italians. Generally speaking, the events were of a mild severity, with white triage codes accounting for 16% of cases and green triage codes for 73%. The degree of severity is higher amongst subjects aged over 65, as well as in women and Italian citizens.The level of recording of SINIACA variables increases over time, to reach 100% coverage in 2018. Falls are the most common dynamic in all age ranges; household chores, activities of daily living and DIY are the three most commonly observed activities. Home accidents most commonly occur in the areas adjacent to the home and the kitchen. In over 2/3 of cases, the injuries sustained were to the limbs and the head/face. Head/face injuries prevail in the youngest age group. Wounds, burns and head injuries are the most common types of injury sustained by children in the 0-14 years age group, whereas fractures and dislocations are typical of the older age groups. Diagnostic and care resource consumption is far higher amongst the elderly, which absorb 61% of the total costs of the cases treated in the year 2018. CONCLUSION: Accident & Emergency facilities provide a privileged observatory for the monitoring of domestic accidents in the population. By comparing our data with the ISTAT data, it can be estimated that 1 in 2 home accidents in the population resulted in an A&E admission. Admissions increase over time, particularly amongst the elderly and they are not higher amongst foreign nationals than amongst Italians. The inflow rate is higher in the extreme age ranges: 0-4 and >75 years; however, there are differences between the two in terms of type of injury, level of severity and outcome. It is essential for A&E admission data to be fully digitalised, and facility and staff sensitisation is also important in order to guarantee the availability of good-quality data. The completeness of A&E data and the possibility of obtaining case stratification based on social and demographic characteristics could make it possible, through a virtuous integration of services, to use these data for the implementation of prevention initiatives. These, if carried out effectively, could also contribute to contain healthcare costs.

Development of an effective communication strategy for the prevention of burns in children: the PRIUS project.

This study has developed a learning kit for the prevention of domestic burns in childhood. The main objective was to trial an educational package for children (nursery and primary classes), for the prevention of burns, to be implemented through education in schools. The educational kit comprises posters, information leaflets, comic books, and pre and post education evaluation materials for school children, parents and teachers. Recipients of the preliminary study were the students of nine schools in the eight Italian cities where Burn Centers are located. In order to reach the target groups of children, it was necessary to identify the most effective communication strategy to convey the burn prevention message. For nursery school children, it was not possible to use tools with written texts alone, as they were not yet literate. Moreover, even for older children, it was necessary to find an attractive tool to catch their attention and interest, promoting the understanding and memorization of lessons learned. The most suitable means was found to be comic strips, allowing the messages to be conveyed through images as well as words. A total of 370 children (195 from nurseries and 175 from primary schools) participated in the trial of the educational kit. Overall, for every environment represented in the evaluation table, the ability to recognize the dangers among both the pre-school and primary school children increased significantly after the training activity. In conclusion, the educational kit has been positively assessed.

Cette étude a permis de mettre au point un kit d'apprentissage pour la prévention des brûlures domestiques chez les enfants. L'objectif principal était d'expérimenter un ensemble éducatif pour enfants (crèches et écoles primaires), pour la prévention des brûlures, à mettre en oeuvre à travers des actions d'éducation dans les écoles. Le kit éducatif est composé de posters, de brochures d'information, de bandes dessinées, et d'un matériel d'évaluation pré et post enseignements, pour enfants, parents et enseignants. Cette'étude préliminaire a rassemblé les élèves de 9 écoles, appartenant aux 8 villes des Centres de grands brûles en Italie. Concernant l'éducation des enfants, il était nécessaire d'identifier la stratégie de communication la plus efficace pour leur transmettre les messages de prévention. Pour les élèves de maternelle, il n'a pas été possible d'utiliser des outils avec textes, puisqu'ils n'étaient pas encore capables de lire et écrire; en outre, même pour les enfants plus âgés, il était nécessaire de trouver un outil attrayant pour attirer leur attention et susciter leur intérêt, promouvoir la compréhension et la mémorisation des leçons apprises. La bande dessinée a été jugée l'outil le plus approprié (langage complexe qui utilise l'outil verbal et les codes iconiques).Au total, 195 enfants de maternelle et 175 d'écoles primaires ont participé à l'évaluation du kit pédagogique. Nos résultats démontrent que, pour chaque environnement représenté dans le tableau d'évaluation, la capacité à reconnaître les dangers a augmenté d'une manière significative après la formation aussi bien dans le groupe des élèves de maternelle que dans celui des élèves d'écoles primaires. En conclusion, le kit pédagogique a été évalué positivement.

Qualitative analysis of emergency department reports applied to a pilot project for the prevention of pediatric burns.

Accidents and burns are a major problem in Italy and in industrialized countries, due to the consequences they have on health, especially in children aged 0-4 years. In Italy, about 400 people die each year from burns, with over 70% of these occurring in the home. In the European Union, burns are one of the top five causes of death from accidents, accounting for 3% of all deaths from accidents and violence in those age groups. One percent of all deaths in children are due to burns. In this paper, we illustrate the results of qualitative analysis, conducted according to the methodology of content analysis, on narratives included in the anamnesis of clinical papers at the ED in 738 cases of burns in children (0-14 years) observed in a sample of Emergency Departments in the years 2005-2009. The results of content analysis show that the most frequent mechanism that leads to burns is contact with hot liquids and heating surfaces. Much of preventive action should be directed at controlling the child. The accidental event descriptions for the younger age group (0-4 years) reveal an unequivocal responsibility of the parents. The qualitative analysis of narratives was carried out to produce scientific evidence to identify the more frequent and severe burn accidents for specific target/age groups and to establish specific preventive measures. The study of qualitative analysis of burns observed at the ED was introductory to the pilot project PRIUS (Preventing burns among school-aged children). The objective of PRIUS is to increase awareness of the risks of burns in children and adults through a learning path tailored towards their prevention, and the promotion of appropriate standards of personal safe behaviour and first aid actions.

Les accidents et les brûlures représentent en Italie et dans les pays industrialisés, un problème majeur de santé publique, en particulier chez les enfants entre 0 et 4 ans. En Italie, environ 400 personnes meurent chaque année de brûlures, dont 70% sont survenues au domicile. Dans l'Union Européenne, les brûlures (3% des causes de mort violente ou accidentelle), entrent dans le groupe des cinq causes les plus fréquentes de décès dans cette tranche d'âge. Dans cet article, nous présentons les résultats de l'analyse qualitative, réalisée selon la méthodologie de l'analyse de contenu, des dossiers d'entrée aux urgences de 738 cas de brûlures chez les enfants (0-14 ans) survenues entre 2005 et 2009, dans un échantillon représentatif de la population italienne. L'analyse de contenu montre que les causes les plus fréquentes qui conduisent aux brûlures dans les groupes d'âge étudiés sont représentées par le contact avec des liquides chauds et les surfaces de chauffage. Donc, une grande partie des actions préventives doit être élaborée en direction de la surveillance de l'enfant. L'étude de l'événement accidentel, pour ce groupe d'âge (0-4 ans), révèle une responsabilité sans équivoque des parents. L'analyse qualitative des récits a aidé à produire les preuves scientifiques des circonstances de survenue des brûlures graves et étendues chez des enfants petits, afin préconiser des mesures spécifiques de prévention. Notre étude est une étude d'analyse qualitative réalisée avant de proposer le projet pilote Prius (Prévention des accidents et des brûlures chez les enfants d'âge scolaire). L'objectif de Prius est d'accroître la sensibilisation aux risques de brûlures chez les enfants et les adultes à travers un parcours d'apprentissage adapté à leur prévention et la promotion de protocoles appropriés de comportement et de premiers secours.

Hepatitis C virus infection prevalence and liver dysfunction in a cohort of B-cell non-Hodgkin's lymphoma patients treated with immunochemotherapy.

Several studies have reported a higher prevalence of hepatitis C virus (HCV) infection in patients with B-cell non-Hodgkin's lymphoma (NHL) than in the general population. Treatment for NHL includes the use of chemotherapeutic agents such as cytotoxic drugs, corticosteroids, and rituximab, which can be immunosuppressive and hepatotoxic. While reactivation of hepatitis B virus (HBV) when undergoing immunosuppressive therapy for haematological malignancies is a well-documented complication, data on HCV reactivation or liver function impairment after chemotherapy for NHL are controversial. From January 2006 to December 2009, 207 consecutive NHL patients treated with chemotherapy without rituximab (CHOP) or with rituximab (R-CHOP) were observed; screening for HCV infection and baseline liver function tests were performed in all patients. The prevalence of HCV infection was 9.2%. This prevalence is higher than that observed in the general population in Italy (3%). Among the HCV-infected subjects, the incidence of hepatitis flares was 26.3% vs 2.1% among the HCV-uninfected individuals. Although less frequent and less severe than in HBV-infected subjects, liver dysfunction can occur as a consequence of rituximab-containing regimens in HCV-infected patients with NHL. In the cases considered in this study, no patient treated with chemotherapy without rituximab developed hepatitis flares. The frequency and the severity of this complication vary in different reports. Therefore, we recommend the assessment of liver function and the screening of all patients with NHL for HCV infection before starting chemotherapy; we also recommend monitoring of liver function tests and HCV-RNA serum levels during treatment.

Monitoring caustic injuries from emergency department databases using automatic keyword recognition software.

In Italy the European Union Injury Database reports the involvement of chemical products in 0.9% of home and leisure accidents. The Emergency Department registry on domestic accidents in Italy and the Poison Control Centres record that 90% of cases of exposure to toxic substances occur in the home. It is not rare for the effects of chemical agents to be observed in hospitals, with a high potential risk of damage - the rate of this cause of hospital admission is double the domestic injury average. The aim of this study was to monitor the effects of injuries caused by caustic agents in Italy using automatic free-text recognition in Emergency Department medical databases. We created a Stata software program to automatically identify caustic or corrosive injury cases using an agent-specific list of keywords. We focused attention on the procedure's sensitivity and specificity. Ten hospitals in six regions of Italy participated in the study. The program identified 112 cases of injury by caustic or corrosive agents. Checking the cases by quality controls (based on manual reading of ED reports), we assessed 99 cases as true positive, i.e. 88.4% of the patients were automatically recognized by the software as being affected by caustic substances (99% CI: 80.6%- 96.2%), that is to say 0.59% (99% CI: 0.45%-0.76%) of the whole sample of home injuries, a value almost three times as high as that expected (p < 0.0001) from European codified information. False positives were 11.6% of the recognized cases (99% CI: 5.1%- 21.5%). Our automatic procedure for caustic agent identification proved to have excellent product recognition capacity with an acceptable level of excess sensitivity. Contrary to our a priori hypothesis, the automatic recognition system provided a level of identification of agents possessing caustic effects that was significantly much greater than was predictable on the basis of the values from current codifications reported in the European Database.

Systematic review: Endoscopic dilatation in Crohn's disease.

BACKGROUND: Endoscopic dilatation for Crohn's disease has been evaluated only in some small and heterogeneous studies. AIM: To evaluate any association between the main clinical variables and endoscopic variables and the efficacy and safety of endoscopic dilatation in Crohn's disease. METHODS: A Medline search regarding pneumatic dilatation in Crohn's disease was performed. Several technical and clinical variables were extracted from each study to build up a descriptive, pool-data analysis. Data on individual patients were extracted from suitable studies to create a simulated population upon which a multivariate statistical analysis was performed. RESULTS: Thirteen studies enrolling 347 Crohn's disease patients were reviewed. Endoscopic dilatation was mainly applied to postsurgical strictures, being technically successful in 86% of the cases. Long-term clinical efficacy was achieved in 58% of the patients. Mean follow-up was as long as 33 months, corresponding to 800 patient years of follow-up. Major complication rate was 2%, being higher than 10% in two series. At multivariate analysis, a stricture length < or = 4 cm was associated with a surgery-free outcome (OR: 4.01; 95% CI: 1.16-13.8; P < 0.028). CONCLUSIONS: Endoscopic dilatation is an effective and safe treatment for short strictures caused by Crohn's disease, impacting substantially on the natural history of these patients.