Risk Factors for Road Traffic Injuries among Different Road Users in the Gambia.

We identified risk factors for road traffic injuries among road users who received treatment at two major trauma hospitals in urban Gambia. The study includes pedestrians, bicyclists, motorcyclists, and drivers/passengers of cars and trucks. We examined distributions of injury by age, gender, collision vehicle types and vehicle category, and driver and environment factors. Two hundred and fifty-four patients were included in the study. Two-thirds were male and one-third female. Two-thirds (67%) of road traffic injuries involved pedestrians, bicyclists, and motorcyclists; and these were more common during weekdays (74%) than weekends. Nearly half (47%) of road traffic injuries involved pedestrians. One-third (34%) of injured patients were students (mean age of students was less than 14 years), more than half (51%) of whom were injured on the roadway as pedestrians. Head/skull injuries were common. Concussion/brain injuries were 3.5 times higher among pedestrians, bicyclists, and motorcyclists than vehicle occupants. Crashes involving pedestrians were more likely to involve young people (<25 years; aOR 6.36, 95% CI: 3.32-12.17) and involve being struck by a motor car (aOR 3.95, 95% CI: 2.09-7.47). Pedestrians contribute the largest proportion of hospitalizations in the Gambia. Young pedestrians are at particularly high risk. Prevention efforts should focus on not only vehicle and driver factors, but also protecting pedestrians, bicyclists, and motorcyclists.

Injury factors associated with discharge status from emergency room at two major trauma hospitals in The Gambia, Africa.

INTRODUCTION: Injuries are the leading cause of disability across all ages and gender. In this study, we identified predictors of discharge status and disability at discharge among patients who seek emergency room treatment. MATERIALS AND METHODS: The study was conducted in two major trauma hospitals in urban Gambia. 1905 patients participated in the study. 74.9% were males, and 25.1% were females. The study includes injured patients from all mechanisms. However, patients' records without age, gender, injury mechanism, and deposition from the emergency room were considered incomplete and excluded. We examined distributions of injury by age, gender, mechanism, place of occurrence, intent, primary body part injured, and primary nature of injury. We identified demographic and injury characteristics associated with hospital admission (compared to emergency department discharge) and discharge disability (any level of disability compared with none). RESULTS: The leading mechanisms of injury were road traffic (26.1%), struck by objects (22.1%), cut/pierce (19.2%), falls (19.2%), and burns (5.4%). Injuries most commonly occurred in the home (36.7%) and on the road (33.2%). For those aged 19-44, the proportion of injuries due to assault was higher for females (35.9%) than males (29.7%). Males had increased odds for admission (aOR=1.48 95% CI=1.15-1.91) and for disability (aOR=1.45; 95% CI=1.06-1.99). Increased odds for admission were found for brain injuries, fractures, large system injuries, and musculoskeletal injuries when compared with soft tissue injuries. The highest odds for any level of discharge disability were found for brain injuries, fractures, injuries from falls, burns, and road traffic. CONCLUSIONS: Epidemiology of injuries in The Gambia is similar to other low-income countries. However, the magnitude of cases and issues uncovered highlights the need for a formal registry.

Nonfatal tractor-related injuries presenting to a state trauma system.

PURPOSE: To identify tractor-related injuries using data from a statewide trauma system, to characterize the mechanisms of nonfatal tractor-related injury, and to determine which injuries are associated with higher severity injury. METHODS: A retrospective observational study was conducted using the Iowa State Trauma Registry to identify cases of nonfatal tractor-related injuries over an 11-year period from 2002 to 2012. Frequency of injury was reported by age, sex, severity, and nature. Injuries were classified by mechanism and a polytomous regression model was used to predict injury severity adjusting for sex and age. RESULTS: Five-hundred thirteen nonfatal tractor-related injuries were identified with 18% classified as severe. Injuries were most frequent among males and among those ≥45years of age. Rollovers were the most frequent mechanism of both total (25%) and severe injury (38%), although the frequency of injury mechanism varied by age. Falls were the next most frequent mechanism of injury (20%) but resulted in fewer high-severity injuries. Collision (adjOR=1.89, 95% CI=1.01-3.51), rollover (adjOR=2.03, 95% CI=1.21-3.40), and run over/rolled on (adjOR=2.06, 95% CI=1.17-3.62) injuries were significantly associated with higher injury severity. Advanced age was also a significant predictor of higher severity injury (adjOR=1.82, 95% CI=1.06-3.12). SUMMARY: Mechanisms of nonfatal tractor-related injuries are heterogeneous, differ by age, and are associated with varying level of severity. PRACTICAL APPLICATIONS: This work shows the burden of nonfatal tractor injuries on a rural state trauma system. These findings also demonstrate the heterogeneous nature of nonfatal tractor injuries and underscore the need for a multi-level approaches to injury prevention.

Smoke alarms by type and battery life in rural households: a randomized controlled trial.

BACKGROUND: Although the use of smoke alarms is widely recommended, little guidance is available on the types of alarms and batteries that function best. This study examined smoke alarm and battery function 12 months after installation in rural residential households. METHODS: An RCT, involving the installation of either a photoelectric or ionizing smoke alarm with either a lithium or carbon-zinc battery, was conducted in 643 rural Iowa households in July 2003. The functionality of each installed smoke alarm was tested 12 months later. Generalized estimating equations were used to model the effects of alarm type and battery type on alarm function and false alarms 12 months after installation. RESULTS: Of 643 study homes, 98.8% had at least one functioning alarm, and 81.5% had all alarms functioning 12 months after installation. No difference was observed in alarm function between photoelectric alarms and ionizing alarms 12 months after installation (OR=1.30, 95% CI=0.88, 1.92). However, photoelectric alarms had significantly lower odds of false alarms than ionizing alarms. Alarms with lithium batteries had 91% higher odds of functioning than those with carbon-zinc batteries. The main reasons for nonfunctioning included a missing battery (30.7%); a missing alarm (28%); and a disconnected battery (11.3%). CONCLUSIONS: Although lithium batteries and photoelectric alarms are more expensive than their counterparts, the financial investment might be worthwhile in terms of overall performance.

A prospective analysis of trash, brush, and grass burning behaviors.

Burn injuries sustained during residential trash, brush, and grass burning cause significant morbidity and mortality in rural areas. To further prevention efforts, we surveyed individuals who incurred injuries from residential burning. Thirty-six individuals injured while burning trash, brush, or grass from June 2003 through September 2005 were asked to respond to a self-administered written survey. Injury related questions revealed that the majority of those injured were burning brush (21 of 35, 60.0%) in an open space (19 of 35, 54.2%) with the addition of accelerants (27 of 36, 75%). Survey questions regarding usual burning practices revealed almost two-thirds burned either brush or a mixture of brush and trash (23 of 36, 63.9%). Eighty percent of those who were injured desired to change their behavior (25 of 35, 80%). Approximately two-thirds would consider asking for help with burning if it were provided (22 of 34, 64.7%). Our survey shows that acceptable alternatives to burning varied depending on the material that was burned. As the majority of respondents usually burned brush or a mixture of brush and trash, an acceptable trash removal system should also include brush pickup. As residential burning continues presently, injury prevention efforts are essential and should focus on the misuse of gasoline, uniform safety standards for gasoline cans, and dissemination of safe burning practices.

Transdifferentiation of the retina into pigmented cells in ocular retardation mice defines a new function of the homeodomain gene Chx10.

The homeodomain transcription factor Chx10 is one of the earliest markers of the developing retina. It is required for retinal progenitor cell proliferation as well as formation of bipolar cells, a type of retinal interneuron. or(J) (ocular retardation) mice, which are Chx10 null mutants, are microphthalmic and show expanded and abnormal peripheral structures, including the ciliary body. We show here, in a mixed genetic background, the progressive appearance of pigmented cells in the neural retina, concomitant with loss of expression of retinal markers. Fate mapping analysis using a multifunctional Chx10 BAC reporter mouse revealed this process to be direct transdifferentiation of retinal cells into pigmented cells. Microarray and in situ hybridization analyses revealed a complex program underlying the transdifferentiation. This program involved the expansion of expression of genes normally found only in the periphery into central regions of the eye. These genes included a transcription factor controlling pigmentation, Mitf, and the related factor Tfec (Tcfec -- Mouse Genome Informatics), which can activate a melanogenic gene expression program. Misexpression of Chx10 in the developing retinal pigmented epithelium (RPE) caused downregulation of Mitf, Tfec, and associated pigment markers, leading to a nonpigmented RPE. These data link Chx10 and Mitf to maintenance of the neural retina and RPE fates respectively. Further, they suggest a new role for Chx10 in maintenance of compartment boundaries in the peripheral retina.

A role for ligand-gated ion channels in rod photoreceptor development.

Neurotransmitter receptors are central to communication at synapses. Many components of the machinery for neurotransmission are present prior to synapse formation, suggesting a developmental role. Here, evidence is presented that signaling through glycine receptor alpha2 (GlyRalpha2) and GABA(A) receptors plays a role in photoreceptor development in the vertebrate retina. The signaling is likely mediated by taurine, which is present at high levels throughout the developing central nervous system (CNS). Taurine potentiates the production of rod photoreceptors, and this induction is inhibited by strychnine, an antagonist of glycine receptors, and bicuculline, an antagonist of GABA receptors. Gain-of-function experiments showed that signaling through GlyRalpha2 induced exit from mitosis and an increase in rod photoreceptors. Furthermore, targeted knockdown of GlyRalpha2 decreased the number of photoreceptors while increasing the number of other retinal cell types. These data support a previously undescribed role for these ligand-gated ion channels during the early stages of CNS development.

The Hispanic MMPI-A across five countries.

The Hispanic MMPI-A was developed for use with Spanish-speaking adolescents living in the United States. In order to sample its potential usefulness in other countries, the test was administered to 385 Spanish-speaking adolescents in Colombia, Mexico, Peru, Spain, and the United States. The results showed a high degree of similarity across the five countries on the basic content and supplementary scales. Most scales were within 1/2 standard deviation of the U.S. Hispanic mean, and no scale elevations were greater than T = 65. Slight differences (T = 55-60) were obtained on scale F for males and scales F, Hs, Mf (Peru and Colombia), Pa, and Sc for females. This study would suggest that the Hispanic MMPI-A, with its established norms, is appropriate for adaptation in Spanish-speaking countries other than the United States. Further studies with the Hispanic MMPI-A are recommended to determine its effectiveness in clinical assessment in Spanish-speaking countries.