The influence of meteorological factors on the occurrence of trauma and motor vehicle collisions in Tokyo.

BACKGROUND: Previous studies have suggested a possible association between meteorological factors and the occurrence of trauma, but with conflicting results. This study investigated the relation of the occurrence of trauma with meteorological factors, including barometric pressure, ambient temperature, relative humidity and rainfall. METHODS: Hourly data were collected on traumatic injuries through ambulance transport records of the Tokyo Fire Department from 1 January to 31 December 2005. Hourly meteorological data for Tokyo were also collected from the Japan Meteorological Agency during the same period. A time-series analysis was performed using an autoregressive integrated moving average (ARIMA) model to control for autocorrelations in time-series data. RESULTS: Of a total of 643,849 patients who were transported to hospitals by ambulance, there were 226,339 trauma patients, including 94,916 patients from motor vehicle collisions (42% of all trauma patients). Based on the ARIMA model, higher temperature (p<0.001), greater rainfall (p<0.05) and holidays (p<0.001) were significantly associated with the occurrence of trauma. These factors were also significantly associated with the occurrence of motor vehicle collisions. Barometric pressure and humidity were not associated with the occurrence of trauma. CONCLUSIONS: This population-based study shows that, in addition to high temperature, rainfall and holidays are associated with the occurrence of trauma including motor vehicle collisions.

Managing ankle injuries in the emergency department.

We review the anatomy and physiology of the ankle joint with attention to the structures most likely to be injured. We discuss the epidemiology of ankle injuries and their physical and radiographic evaluation, including the Ottawa Ankle Rules. Treatment, consultation, and pitfalls are followed by more specific discussions of tendonitis, Achilles tendon injury, tendonous subluxations, tarsal tunnel syndrome, sonovial impingement, and injury to the os trigonum. The references provide a guide for further reading.

Depression and aging too often do mix.

Depression in elderly persons is prevalent, often undiagnosed, and usually untreated. Because there is no reliable diagnostic test, careful clinical evaluation is essential. With aggressive antidepressant treatment, the overall long-term outcome in elderly patients is optimistic. In this article, Dr Birrer discusses the scope of the problem, important diagnostic considerations, and the current recommended treatments in this population.

Lyme carditis: a rare presentation in an unexpected setting.

A case is reported of a 27-year-old man who presented to an inner city trauma center after he had experienced several seizure-like episodes. He was diagnosed with Lyme carditis and required 6 weeks of treatment with intravenous ceftriaxone for complete resolution of his symptoms. The case is discussed along with a review of the literature.

Accessing the scientific literature. The reality of virtual scholarship.

The age-honored practice of plowing through the Index Medicus in a good medical library to meander through citations for treasured finds is an anachronism. Today, clinicians have the astonishing capacity to bring to bear existing knowledge almost effortlessly. Virtual scholarship makes available up-to-date medical citations and their abstracts. There can be access around the clock on any topic in the office, at the bedside, or from home. Computerized searches of the medical literature promote directed continuing education and may enhance clinical care of patients.

Prevention and care of diabetic foot ulcers.

The foot is frequently overlooked in the management of diabetic patients. Failure to control diabetic foot ulcers at an early stage can lead to life-threatening infection or amputation. Preventive care should emphasize patient education, glycemic control, careful daily foot hygiene and appropriate footwear. Early management of a diabetic foot ulcer should include culture-directed antibiotic therapy when there is evidence of infection, moist dressings and adjustment of footwear or casting to avoid pressure on the wound site. All patients with foot ulcers should be evaluated for evidence of foot ischemia. Surgical intervention to debride infected tissue and bone or to revascularize ischemic tissue can aid in ulcer healing. Serious infection or severe ischemia, unfortunately, often necessitates amputation.

Obese children should be screened for hypercholesterolemia.

Screening only those with a positive family history misses many children with hypercholesterolemia. This study investigated whether sensitivity improved by adding obesity as a criterion when screening children for cholesterol. During a two-year period screenings were conducted on 506 inner-city subjects aged 5-19. Demographic, clinical, and dietary information was also recorded. Mean age of participants was 11 +/- 4 years; 52 percent were female, 53 percent black, 39 percent Hispanic, and 8 percent other. Mean cholesterol level was 4.14 mmol/l (160 mg/dl). In multivariate analysis obesity was an independent risk factor for hypercholesterolemia, F = 13.14, p < 0.001. The sensitivity of obesity as a screening tool for hypercholesterolemia was better than that for positive family history (42 vs. 24 percent, respectively). Combining the two improved the sensitivity to 49 percent. The authors recommend expanding the indications for screening children to include obesity, in addition to positive family history of hypercholesterolemia or premature cardiovascular disease.

Orbital emphysema: how common, how significant?

STUDY OBJECTIVE: To describe the natural history of orbital emphysema and its management in the emergency setting. DESIGN: Retrospective medical record review. SETTING: Inner-city integrated hospital system (four divisions) including one Level I trauma center. PARTICIPANTS: All cases of orbital floor fracture and orbital emphysema from January 1, 1988, to December 31, 1993. RESULTS: The average patient was aged 33 years, and the male-to-female ratio was 7 to 1. Trauma was the underlying etiology in all patients. Seventy-four percent of patients required hospitalization, and 43% developed significant complications. Eighty-three percent were managed with antibiotics. Orbital emphysema was identified on conventional radiographs in 65% of cases. CONCLUSION: Identification of orbital emphysema in the ED should prompt a careful search for associated injury. Consultation should be sought in the presence of orbital or ocular injury. Antibiotic prophylaxis is not necessary for clean wounds.

Immediate Diagnosis of Ankle Trauma.

In brief Traumatic Injuries to the ankle vary greatly in severity, from minor contusions to displaced intra-articular fractures. A systematic approach to their evaluation can lead to more accurate diagnoses and help simplify treatment options. Primary care physicians can successfully manage most sports-related ankle trauma, but knowing when to obtain orthopedic consultation is equally important.

Self-mutilation: three cases and a review of the literature.

The self-mutilating patient is an unusual psychiatric presentation in the emergency department (ED). Nonetheless, serious underlying psychiatric pathology and drug abuse are important background risk factors. A careful stepwise approach in the ED is essential, although the prognosis, follow-up, and eventual rehabilitation are poor.

An urban primary school health program.

This paper summarizes the results of the first three years of an integrated on-site school health demonstration project based on the family practice model of delivering primary health care. An inner city public elementary school was chosen as the study location. Of the 712 study participants, 98% were black or Hispanic. Prior to implementation of the demonstration project, the Health Guarded Index for the study population was computed to be 58%. Among study participants, this index rose to 79% during the first year of the project and eventually reached 95% during the third year of the project. The absentee rates among study participants relative to nonparticipants decreased to 8.7% during the first year of the project and by 36.2% during the third year of the project. The substantial increase in the Health Guarded Index indicates that, among study participants, preventable defects, such as lack of immunizations, dental care, screening for common problems, and follow-up had been largely corrected. The substantial decline in absenteeism among study participants clearly shows the effectiveness of the demonstration project in promoting good health by decreasing morbidity and/or decreasing recovery time. Overall, the results of the three-year demonstration project reported here show that a carefully designed, well-coordinated school health program based on a family practice model can have a substantially favorable impact on the health of participating children.

Radon: counseling patients about risk.

Exposure to radon and its decay products has increased as the United States has changed from an outdoor society to a largely indoor society. Radon, which is found primarily in the soil, enters houses and buildings through cracks, holes and pipes in foundation walls and floors. Although radon is suspected of being a significant cause of lung cancer, comparisons with other risk factors cannot yet be made. Radon levels in the home can be measured with commercially available kits. Guidelines for reducing the amount of radon in a home are provided by the U.S. Environmental Protection Agency.