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1.  Predicting ICU admissions from attempted suicide presentations at an Emergency Department in Central Queensland 
The Australasian Medical Journal  2013;6(11):536-541.
Emergency medicine physicians and psychiatric staff face a challenging job in risk stratifying patients presenting with suicide attempts to predict which patients need intensive care unit admission, hospital admission or can be discharged with psychiatry follow up.
This study aims to analyse patients who were admitted to the intensive care unit or regular ward for suicide attempt, and the methods they employed in a rural Australian base hospital.
We conducted a retrospective analysis of patients who presented with suicide attempts to the Rockhampton Base Hospital Emergency Department, Queensland Australia from 1 September 2007 to 31 August 2009. Multivariate logistic regression was undertaken to identify risk factors for ICU and regular ward admission, and predictors of suicide method.
There were 570 patients presenting with suicide attempts, 74 of which were repeat suicide attempts. There was a 10- fold increase in the odds of intensive care unit or ICU admission (CI 1.45-81.9, p=0.02) for patients who presented with drug overdose. Increased age (OR=1.02, 95 per cent CI 1.00-1.03, p=0.05), drug overdose (OR=2.69, 95 per cent CI 1.37-5.29, p=0.004), and previous suicide attempt (OR=1.53, 95 per cent CI 1.03-2.28, p=0.03) were significantly correlated with hospital admission. Male patients (OR=2.76, 95 per cent CI 1.43-5.30, p=0.002) and Aboriginal patients (OR=3.38, 95 per cent CI 1.42-8.05, p=0.006) were more likely to choose hanging as a suicide method.
We identified drug overdose as a strong predictor of ICU admission, while age, drug overdose and history of previous suicide attempts predict hospital admission. We recommend reviewing physician practices, especially safe medication, in suicide risk patients. Our study also highlights the need for continued close collaboration by acute care and community mental health providers for quality improvement.
PMCID: PMC3858606  PMID: 24348869
Suicide, Attempted; Drug Overdose; Emergency Care; Intensive Care; Utilisation
2.  Enablers of and barriers to making healthy change during pregnancy in overweight and obese women 
The Australasian Medical Journal  2013;6(11):565-577.
High Body Mass Index (BMI) during pregnancy is associated with an increased risk of adverse health outcomes. Making healthy change during pregnancy is beneficial, especially for overweight and obese women.
The aim of this study was to explore the barriers and enablers identified by overweight and obese women that preclude and facilitate making healthy change during pregnancy.
We conducted a retrospective analysis of patients who presented with suicide attempts to the Rockhampton Base Hospital Emergency Department, Queensland Australia from 1 September 2007 to 31 August 2009. Multivariate logistic regression was undertaken to identify risk factors for ICU and regular ward admission, and predictors of suicide method.
The core concept of “being pregnant” indicated women consider this specific time as both a reason not to make healthy change as well as a motivation for change. Overweight and obese women cited the following barriers to making healthy change during pregnancy: physiological (e.g. pregnancy complications and tiredness); emotional (e.g. preference and mood); cognitive (e.g. lack knowledge); interpersonal (e.g. lack support); and environmental (e.g. availability of healthy choice). Similar enablers were identified by overweight and obese women: physiological (e.g. relief of pregnancy symptoms); emotional (e.g. approval and commitment); cognitive (e.g. knowledge and belief); interpersonal (e.g. family support); and environmental (e.g. help from others). More barriers than enablers were given, indicating that women were more sensitive to barriers than the enablers for making healthy change. Factors viewed by some women as barriers were viewed as enablers by others.
When designing interventions to promote healthy eating and physical activity during pregnancy, individually focused interventions must be implemented in conjunction with environmental-level interventions to facilitate behaviour change.
PMCID: PMC3858610  PMID: 24348873
Pregnancy; overweight; healthy change
3.  Serious head injury in sport. 
British Medical Journal  1980;281(6243):789-791.
Of 1900 head injuries serious enough to be admitted to the neurosurgical unit in Glasgow over a five year period, 52 (2.7%) were due to "sport." Golf, horse-riding, and Association football were the sports most commonly linked with serious head injury. Golfing injuries were all compound depressed fractures, and all these patients made a good recovery; horse-riding produced more severe injuries, three of the eight patients being left with residual disability. Much attention has been directed to preventing repeated minor head injury in boxing, but this study emphasises the need for preventing both the primary head injury and secondary complications associated with other sports.
PMCID: PMC1714033  PMID: 7427450
4.  Children and bicycles: what is really happening? Studies of fatal and non-fatal bicycle injury. 
Injury Prevention  1995;1(2):86-91.
OBJECTIVES: The objectives of the study were to ascertain the causes of accidents, injuries, and deaths in children who ride bicycles. Fatality and injury rates were also studied in order to compare with other studies. METHODS: Two studies of children were undertaken in children aged less than 15 years. In the first (retrospective fatality study), children who died as a result of a bicycle incident during the period 1981-92 were reviewed. In the second (prospective injury study) data were obtained prospectively between April 1991 and June 1992 about children who were injured while riding a bicycle and treated at a public hospital in Brisbane. RESULTS: Study 1: fatality rates for boys were twice those for girls. The rate was highest for boys of 14 years in the metropolitan area at 6.23/100,000. All deaths involved vehicles, and the majority involved head injury or multiple injuries including head injury. Study 2: similar numbers of children were injured at onroad and off-road locations. Faculty riding was described by the rider or caregiver as the cause in 62.5% of cases. The most common time of injury was between 3 and 6 pm on both school and non-school days. Only 5.5% of all incidents involved a moving vehicle. CONCLUSIONS: Bicycle riding by children is a common cause of injury, particularly for boys. Equal numbers of injuries occurred on the road as at other locations. Faulty riding caused most accidents. Injury prevention for bicycle riders should involve not only compulsory wearing of helmets, but should also include education and training about safe riding habits, separation of motorised vehicles from bicycles, modified helmet design to incorporate facial protection, and improved handlebar design.
PMCID: PMC1067558  PMID: 9346002
5.  Ten years of major equestrian injury: are we addressing functional outcomes? 
Horseback riding is considered more dangerous than motorcycle riding, skiing, automobile racing, football and rugby. The integral role of rehabilitation therapy in the recovery of patients who have sustained a major horse-related injury is previously not described. The goals of this paper were to (1) define the incidence and pattern of severe equestrian trauma, (2) identify the current level of in-patient rehabilitation services, (3) describe functional outcomes for patients, and (4) discuss methods for increasing rehabilitation therapy in this unique population.
Methods and results
A retrospective review of the trauma registry at a level 1 center (1995–2005) was completed in conjunction with a patient survey outlining formal in-hospital therapy. Forty-nine percent of patients underwent in-patient rehabilitation therapy. Injuries predictive of receiving therapy included musculoskeletal and spinal cord trauma. Previous injury while horseback riding was predictive of not receiving therapy. The majority (55%) of respondents had chronic physical difficulties following their accident.
Rehabilitation therapy is significantly underutilized following severe equestrian trauma. Increased therapy services should target patients with brain, neck and skull injuries. Improvements in the initial provision, and follow-up of rehabilitation therapy could enhance functional outcomes in the treatment resistant Western equestrian population.
PMCID: PMC2653027  PMID: 19228424
6.  Equestrian injuries: a comparison of professional and amateur injuries in Berkshire. 
A retrospective study of horse riding injuries in Berkshire was undertaken over a one year period from November 1983. The information was obtained from the Ambulance Service, the Jockey Club and the St. John Ambulance Brigade. There was a total of 103 injured persons with no deaths. Information from the Jockey Club was compared with the other two groups, the former sustaining more limb injuries and the latter more head injuries. A questionnaire was sent to all 42 ambulance patients. Thirty-eight had radiographs taken, 16 of which showed a fracture. Forty-one were wearing some form of hard hat, but if a safety strap was available it was attached in 24 cases. The dangers of riding are highlighted and the importance of adequate protective clothing emphasised.
PMCID: PMC1478592  PMID: 3580723
7.  Randomised Controlled Trial to determine the appropriate time to initiate peritoneal dialysis after insertion of catheter to minimise complications (Timely PD study) 
BMC Nephrology  2010;11:11.
The most appropriate time to initiate dialysis after surgical insertion of Tenckhoff catheters is not clear in the literature. There is the possibility of peritoneal dialysis (PD) complications such as leakage and infection if dialysis is started too soon after insertion. However, much morbidity and expense could be saved by reducing dependency on haemodialysis (HD) by earlier initiation of PD post catheter insertion. Previous studies are observational and mostly compare immediate with delayed use. The primary objective is to determine the safest and shortest time interval between surgical placement of a Tenckhoff catheter and starting PD.
This is a randomised controlled trial of patients who will start PD after insertion of Tenckhoff catheter at Royal Brisbane and Women's Hospital (RBWH) or Rockhampton Base Hospital (RBH) who meet the inclusion criteria. Patients will be stratified by site and diabetic status. The patients will be randomised to one of three treatment groups. Group 1 will start PD one week after Tenckhoff catheter insertion, group 2 at two weeks and group 3 at four weeks. Nurses and physicians will be blinded to the randomised allocation. The primary end point is the complication rate (leaks and infection) after initiation of PD.
The study will determine the most appropriate time to initiate PD after placement of a Tenckhoff catheter.
Trial Registration
PMCID: PMC2898765  PMID: 20565984
8.  Bicycle-related injuries: a survey in a pediatric emergency department. 
The number of bicycle-related injuries has risen significantly with the increased popularity of bicycle riding in Canada. The risk of injury is highest among children. To assess the magnitude of the problem and to identify the contributing factors we used a questionnaire, injury reports and patient charts to survey bicycle-related injuries among children brought to the emergency department of the Children's Hospital of Eastern Ontario, Ottawa, between May 1 and Sept. 30, 1988. The questionnaire was completed for 517 (91%) of the 568 children; 70% were boys, and the mean age was 9.4 years. Only 2% of the patients had been wearing a helmet at the time of injury, although 13% claimed to own one for cycling. Over 60% of the accidents were attributable to carelessness or poor bicycle control; mechanical failure and environmental hazards were minor factors. Over 80% of the injuries occurred within a kilometre of the child's home. Of the 97 children admitted to hospital 49% had head and skull injuries and 40% had limb fractures. Bicycle-related injuries represented 14.8% of all nonwinter (Apr. 1 to Oct. 31) trauma admissions among children 5 years or older. Our results further document bicycle-related injuries as an important childhood problem and underscore the need for improved safety measures.
PMCID: PMC1452120  PMID: 2364332
9.  Equestrian injuries--a one year prospective study. 
A one year prospective study of equestrian injuries was carried out in an area where horse riding is a popular pursuit. 115 persons suffered injury--eighty females and thirty-five males of whom sixty were under fifteen years of age. No fatalities were recorded and there were 0.2 injuries per 100 rides. Most injuries were minor and to the musculo-skeletal system. Visceral and cerebral injuries were not common but the former were life threatening in all cases. It is concluded that young riders should be supervised.
PMCID: PMC1859746  PMID: 465903
10.  Characteristics and effects of nurse dosing over-rides on computer-based intensive insulin therapy protocol performance 
To determine characteristics and effects of nurse dosing over-rides of a clinical decision support system (CDSS) for intensive insulin therapy (IIT) in critical care units.
Retrospective analysis of patient database records and ethnographic study of nurses using IIT CDSS.
The authors determined the frequency, direction—greater than recommended (GTR) and less than recommended (LTR)— and magnitude of over-rides, and then compared recommended and over-ride doses' blood glucose (BG) variability and insulin resistance, two measures of IIT CDSS associated with mortality. The authors hypothesized that rates of hypoglycemia and hyperglycemia would be greater for recommended than over-ride doses. Finally, the authors observed and interviewed nurse users.
5.1% (9075) of 179 452 IIT CDSS doses were over-rides. 83.4% of over-ride doses were LTR, and 45.5% of these were ≥50% lower than recommended. In contrast, 78.9% of GTR doses were ≤25% higher than recommended. When recommended doses were administered, the rate of hypoglycemia was higher than the rate for GTR (p=0.257) and LTR (p=0.033) doses. When recommended doses were administered, the rate of hyperglycemia was lower than the rate for GTR (p=0.003) and LTR (p<0.001) doses. Estimates of patients' insulin requirements were higher for LTR doses than recommended and GTR doses. Nurses reported trusting IIT CDSS overall but appeared concerned about recommendations when administering LTR doses.
When over-riding IIT CDSS recommendations, nurses overwhelmingly administered LTR doses, which emphasized prevention of hypoglycemia but interfered with hyperglycemia control, especially when BG was >150 mg/dl. Nurses appeared to consider the amount of a recommended insulin dose, not a patient's trend of insulin resistance, when administering LTR doses overall. Over-rides affected IIT CDSS protocol performance.
PMCID: PMC3078667  PMID: 21402737
Health-information exchange; qualitative/ethnographic field study; system implementation and management issues; surveys and needs analysis; social/organizational study; improving the education and skills training of health professionals; machine learning; clinical decision support system; intensive insulin therapy; nurse protocol; critical care; intensive care unit; over-ride
11.  Injuries associated with recreational horse riding and changes over the last 20 years: a review 
JRSM Short Reports  2013;4(5):2042533313476688.
To assess the incidence and distribution of recreational equestrian injuries seen in the Kent and Sussex region and review the available literature on this subject.
This is a retrospective case series with historical controls.
Kent and Sussex region, England.
Main outcome measurement
Injuries related to horses in the recreational setting.
Subjects were selected from our acute injury database. Notes of all patients presenting with horse riding-related injuries between January and December 2010 were reviewed. Skeletal injuries were confirmed using our Picture Archiving and Communications Systems (PACS) system. Data were tabulated and grouped using Microsoft Excel software. Statistics were calculated using Graph Pad software.
During the study period, 155 patients presented with a total of 199 injuries related to horses, accounting for 0.3% of all presentations; 69% were soft tissue injuries. The most commonly affected areas were the extremities (77 patients, 49.7%) followed by injuries to the head (38 patients, 24.5%) and trunk (36 patients, 23.2%). Seventeen patients (11%) were admitted. Patients presenting with head injuries suffered significantly more injuries compared to other groups (1.65 compared to 1.4 injuries, p < 0.0002).
A larger number of persons were riding for a longer period of the year compared to previous studies in the United Kingdom. There was also a shift in the patterns of injury seen in this population over the last two to three decades.
PMCID: PMC3681230  PMID: 23772313
12.  Spine fractures caused by horse riding 
European Spine Journal  2006;15(4):465-471.
Study Design: Retrospective study and review of literature. Objectives: Study of demographic data concerning spinal fractures caused by horse riding, classification of fractures according to the AO and Load Sharing classifications, evaluation of mid-term radiological results and long-term functional results. Methods: A review of medical reports and radiological examinations of patients presented to our hospital with horse riding-related spine fractures over a 13-year period; long-term functional follow-up is performed using the Roland Morris Disability Questionnaire (RMDQ-24). Results: Thirty-six spine fractures were found in 32 patients. Male to female ratio is 1:7. Average age is 33.7 years (8–58 years). The majority of the fractures (78%) are seen at the thoracolumbar junction Th11–L2. All but two patients have AO type A fractures. The average Load Sharing Classification score is 4.9 (range 3–9). Neurological examinations show ASIA/Frankel E status for all patients. Surgical treatment is performed on ten patients. Mean follow-up for radiological data is 15 months (range 3–63). Functional follow-up times range from 1 to 13 years with an average follow-up of 7.3 years. Mean RMDQ-24 score for all patients is 5.5 (range: 0–19), with significantly different scores for the non-operative and surgical group: 4.6 vs 8.1. Twenty-two percent of the patients have permanent occupational disabilities and there is a significant correlation between occupational disability and RMDQ-24 scores. Conclusions: Not only are short-term effects of spine fractures caused by horse riding substantial but these injuries can also lead to long-term disabilities.
PMCID: PMC3489311  PMID: 16408237
Sports medicine; Spinal fractures; Horses; Review
13.  Orthopaedic health status of horses from 8 riding schools - a pilot study 
Orthopaedic injury is the most common reason for lameness and wastage in sport and leisure horses. Studies on racehorses have shown differences in injury risk between trainers and training strategies. The aim was to study between riding school variation in orthopaedic health status by clinical examination and horses age, and control for change of examiner, in schools with previous high (n = 4) and low (n = 4) insurance utilisation.
Horses (n = 99) at 8 riding schools were examined for conformation, movement in all gaits, standing flexion tests and palpation by two veterinary surgeons (in some schools only one). Indexes of findings were created for total health, movements, limbs, conformation and back palpation.
Logistic regression analyses showed that findings increased with age (walk, trot, canter, conformation left hind limb, palpation fore limbs, hooves and flexion tests) or decreased with age (conformation right fore limb). Significant differences in findings were found between riding schools and examiner for seven and eight criteria each (partly overlapping). Increasing indexes were significantly associated with one examiner (total health, movements, back palpation), increasing age (total health, movements) or more time at the school (limbs). The back palpation index was highest at 5 < 8 years since acquisition.
The age distribution differed markedly between riding schools and age affected several types of findings. This, combined with the two opposite groups of insurance use, shows that schools with low insurance utilisation had previously been able to "avoid" using the insurance, maybe even on similar types of cases if these were more promptly/differently handled indicating differential coverage of disease data in the insurance database. The examiner effect was clearly demonstrated. For some findings, the amount of clinical observations differed by school, even when examiner and age was adjusted for. Most findings were of minor importance, including slight movement irregularities. Orthopaedic status varies between riding schools. We hypothesize that this is associated with management factors that warrant further study.
PMCID: PMC2939618  PMID: 20727185
14.  Effect of Horseback Riding Simulation Machine Training on Trunk Balance and Gait of Chronic Stroke Patients 
[Purpose] The purpose of this study was to assess the effect of horseback riding simulation machine training on trunk balance and gait of patients with chronic stroke. [Subjects and Methods] The subjects were 20 patients hospitalized for treatment after being diagnosed with stroke. Horseback riding simulation training was provided for 30 minutes, 5 times a week, for 6 weeks. Trunk balance was assessed using the Trunk Impairment Scale (TIS) and a balance measuring device (Biorescue, RM ingenierie, France), and gait ability was measured using the Functional Gait Assessment (FGA) and a gait analyzer (GAITRite, CIR system Inc., USA). [Results] There were significant changes in movement area, distance and velocity of body sway as measured by the TIS and the balance measuring device, and in gait velocity, cadence, stride length and double limb support as measured by the FGA and gait analyzer. [Conclusion] Horseback riding simulation training improved the trunk balance and gait of chronic stroke patients. This present study provides preliminary objective data for future research, and useful clinical information for physical therapists using horseback riding simulation machines as a treatment modality for patients with chronic stroke.
PMCID: PMC3927036  PMID: 24567670
Horseback riding simulation machine training; Trunk balance; Gait
15.  Hazards of horse-riding as a popular sport. 
The increasing incidence of horse-riding accidents, which are often severe in nature, prompted a pilot study of a questionnaire designed to elucidate the cause of such accidents. It was hoped that, on a larger scale, the information gleaned would highlight possible preventative measures which might improve the safety of an important recreational pursuit enjoyed by young and old from many walks of life. A retrospective study of riders sustaining serious spinal injuries admitted to Stoke Mandeville Hospital was compared with riders sustaining minor but significant injuries as the accidents came to the attention of the authors. The detailed analysis paid particular attention to the setting and to the experience and task of horse and rider. It was found that 70% of the 20 accidents could be thought attributable to the behaviour of the horse at the time, and seven of these were in the spinal injuries group. Rider error was a significant contribution in seven cases, and in two instances the rider was under instruction at the time. There was also inadequate experience of the rider in seven cases, of which five were thought to show inadequate supervision. The limited number of cases studied precludes significant observations, but, as the majority of accidents seemed preventable, a larger study has been initiated in collaboration with the British Horse Society.
PMCID: PMC1478823  PMID: 1751891
16.  Sport accidents in childhood. 
Injuries among children during sporting activities are common. This study is a one year study including children between five and fourteen years of age who sustained their injuries during sporting activities and were treated at Trondheim Regional and University Hospital. Sport accidents account for 27 per cent of all childhood accidents in this age group. Fifty-three per cent of the injured were boys, and 47 per cent were girls. The boys sustained more severe injuries than the girls. Soccer caused the greatest number of injuries. Horse riding and alpine skiing were the cause of the most severe injuries. A more widespread use of protective guards, better technique and body control, better coaching and not allowing the younger children to take part in technically advanced sporting activities might reduce the number and the severity of the sport injuries in children.
PMCID: PMC1478768  PMID: 2350666
17.  Lawnmower injuries in children. 
Canadian Medical Association Journal  1977;116(10):1151-1153.
Over an 8-year period 31 children in the Winnipeg area were admitted to hospital with lawnmower injuries. The accidents were always preventable and were caused by patient or parent carelessness. The wounds were severe, often resulting in amputation of a portion of an extremity. Infection was common; prophylaxis with a broad-spectrum antibiotic and human antitetanus globulin is recommended. Radiography, débridement of the wound with thorough exploration under general anesthesia, and defatting and reapplication of degloved skin should be done initially, then the wound should be reinspected and redressed at 2 to 3 days, and finally closed or skin grafted at 6 to 8 days. Children must be educated about the dangers of lawnmowers and prevented from riding on tractor mowers. The grass catcher should be used and the path cleared of missiles. Hand controls should be mounted on the mower's handle and the blade should be kept sharp so that the machine's speed can be reduced.
PMCID: PMC1879474  PMID: 16692
18.  Impact of Helmet Use in Traumatic Brain Injuries Associated with Recreational Vehicles 
Objective. To study the impact of helmet use on outcomes after recreational vehicle accidents. Methods. This is an observational cohort of adult and pediatric patients who sustained a TBI while riding a recreational vehicle. Recreational vehicles included bicycles, motorcycles, and all-terrain vehicles (ATVs), as well as a category for other vehicles such as skateboards and scooters. Results. Lack of helmet use was significantly associated with having a more severe traumatic brain injury and being admitted to the hospital. Similarly, 25% of those who did wearing a helmet were admitted to the ICU versus 36% of those who did not (P = 0.0489). The hospital length of stay was significantly greater for patients who did not use helmets. Conclusion. Lack of helmet use is significantly correlated with abnormal neuroimaging and admission to the hospital and ICU; these data support a call for action to implement more widespread injury prevention and helmet safety education and advocacy.
PMCID: PMC3800611  PMID: 24205441
19.  Causes of horse-related injuries in a rural western community. 
Canadian Family Physician  1996;42:1103-1109.
OBJECTIVE: To determine the causes of horse-related injuries in a rural western community. DESIGN: Prospective identification of persons with horse-related injuries and retrospective interviews with patients or witnesses to determine causes. SETTING: A small rural community in Alberta where the western style of riding predominates. PATIENTS: All patients presenting to two family medicine clinics or to the Sundre General Hospital emergency department. MAIN OUTCOME MEASURES: Factors contributing to the injury as recalled by patients or witnesses, and characteristics of the persons, horses, and injuries. RESULTS: Two thirds of the 150 injuries were caused primarily by horses and one third primarily by patients risk taking or inattention. The most common horse behaviour that caused injuries was "spooking," but several other behaviours also were identified as primary causes. The injuries were varied and relatively severe. Only one person was wearing a helmet. CONCLUSIONS: Horse-related injuries often are caused by characteristic horse behaviours.
PMCID: PMC2146496  PMID: 8704486
20.  Isolation of the Mycobacterium avium-M. intracellulare-M. scrofulaceum complex from tank water in Queensland, Australia. 
Disease-associated serotypes of Mycobacterium intracellulare and M. avium have been isolated from 32 of 141 rainwater tanks situated in the basin of the Fitzroy River and its tributaries in central Queensland, 7 of 32 tanks situated in the hinterland of the coastal city of Rockhampton, and 2 of 32 tanks sampled repetitively in the southeastern Queensland city of Toowoomba. M. gordonae was also isolated from 23 of the river basin tanks, from 9 in the Rockhampton hinterland, and from 5 in the city of Toowoomba. One half of these isolates came from tanks which also yielded M. intracellulare. Mycobacteria of the M. terrae-M. triviale-M. nonchromogenicum complex were found in 7 tanks, usually in conjunction with M. intracellulare. The humans who consume the contaminated tank water are free of symptoms but have not been medically examined. It is suggested that mycobacteria adhering to dust particles disturbed by mechanical cultivation may be the source of contamination.
PMCID: PMC291282  PMID: 7356321
21.  Acute injuries from mountain biking. 
Western Journal of Medicine  1993;159(2):145-148.
We questioned members of 2 southern California off-road bicycling organizations about injuries associated with the use of all-terrain bicycles. Cyclists were asked about riding and safety habits, the kind(s) of injury sustained with their most recent accident and whether they sought medical treatment, and the circumstances of the accident. Of 459 mailed surveys, 268 (58.4%) were returned. Respondents (82.8% of whom were male) ranged in age from 14 to 68 years. Of these, 225 (84%) had been injured while riding all-terrain bicycles, 51% in the past year. Although most injuries were characterized as minor, 26% required professional medical care, and 4.4% of those injured were admitted to hospital. Extremity injuries--abrasions, lacerations, contusions--occurred in 201 (90%) cyclists with 27 (12%) sustaining a fracture or dislocation. High levels of helmet use (88%) may explain the low occurrence of head and neck trauma (12%). Frequent riding and riding on paved terrain were associated with increased severity of injury, although most accidents--197 (87.6%)--occurred off paved roads. These results suggest that, compared with regular bicyclists, all-terrain cyclists have more, but not necessarily more severe, injuries. Clinicians and emergency medical personnel should be aware that the increasing popularity of off-road cycling may change the frequency and nature of bicycling injuries.
PMCID: PMC1022220  PMID: 8212679
22.  Perineal Bull Gore with Urinary Bladder Perforation and Pneumoperitoneum 
Animal related injuries are frequently reported in India and other countries, where bulls are used for sporting events as well as in places where farming and livestock rearing is practised. The presentation is, many times, atypical and misleading as well.
They have unique mechanics of injury. The patterns of the injury are reviewed. An intra-peritoneal urinary bladder injury which is caused by a perineal bull gore with a pneumoperitoneum is unusual and it has not been reported in the literature which was reviewed. We are reporting a successfully treated 25 years old male patient from the slopes of the southern district of Manipur, India, who had presented 40 hours after he was injured. The identification and prompt exploration, keeping in mind the mechanics of bull goring, helps the surgeons to adequately deal such atypical injuries, for optimal outcomes.
PMCID: PMC3681065  PMID: 23814738
Bull gore; Perineum; Urinary bladder perforation; Pneumoperitoneum; India
23.  Injuries at the BMX Cycling European Championship, 1989. 
At the BMX Cycling European Championship in 1989 with 976 participants of both sexes, aged between six and 40 years, all injuries were registered. A total of 6.3% of the participants sustained injuries (1.6% per individual start), 52.5% required medical attendance and 3.3% necessitated hospital admission. Women were injured twice as frequently as men. Most injuries, 72.1%, were minor, 6.6% were fractures with 75% of the fractures affecting the upper limbs. BMX bicycle riding has the high injury risk of 1190 injuries per 1000 competition hours.
PMCID: PMC1478891  PMID: 2097028
24.  Design and validation of a self-administered test to assess bullying (bull-M) in high school Mexicans: a pilot study 
BMC Public Health  2013;13:334.
Bullying (Bull) is a public health problem worldwide, and Mexico is not exempt. However, its epidemiology and early detection in our country is limited, in part, by the lack of validated tests to ensure the respondents’ anonymity. The aim of this study was to validate a self-administered test (Bull-M) for assessing Bull among high-school Mexicans.
Experts and school teachers from highly violent areas of Ciudad Juarez (Chihuahua, México), reported common Bull behaviors. Then, a 10-item test was developed based on twelve of these behaviors; the students’ and peers’ participation in Bull acts and in some somatic consequences in Bull victims with a 5-point Likert frequency scale. Validation criteria were: content (CV, judges); reliability [Cronbach’s alpha (CA), test-retest (spearman correlation, rs)]; construct [principal component (PCA), confirmatory factor (CFA), goodness-of-fit (GF) analysis]; and convergent (Bull-M vs. Bull-S test) validity.
Bull-M showed good reliability (CA = 0.75, rs = 0.91; p < 0.001). Two factors were identified (PCA) and confirmed (CFA): “bullying me (victim)” and “bullying others (aggressor)”. GF indices were: Root mean square error of approximation (0.031), GF index (0.97), and normalized fit index (0.92). Bull-M was as good as Bull-S for measuring Bull prevalence.
Bull-M has a good reliability and convergent validity and a bi-modal factor structure for detecting Bull victims and aggressors; however, its external validity and sensitivity should be analyzed on a wider and different population.
PMCID: PMC3671223  PMID: 23577755
School violence; Bullying; Mexico; Validation
25.  Correlates of pedometer use: Results from a community-based physical activity intervention trial (10,000 Steps Rockhampton) 
Pedometers have become common place in physical activity promotion, yet little information exists on who is using them. The multi-strategy, community-based 10,000 Steps Rockhampton physical activity intervention trial provided an opportunity to examine correlates of pedometer use at the population level.
Pedometer use was promoted across all intervention strategies including: local media, pedometer loan schemes through general practice, other health professionals and libraries, direct mail posted to dog owners, walking trail signage, and workplace competitions. Data on pedometer use were collected during the 2-year follow-up telephone interviews from random population samples in Rockhampton, Australia, and a matched comparison community (Mackay). Logistic regression analyses were used to determine the independent influence of interpersonal characteristics and program exposure variables on pedometer use.
Data from 2478 participants indicated that 18.1% of Rockhampton and 5.6% of Mackay participants used a pedometer in the previous 18-months. Rockhampton pedometer users (n = 222) were more likely to be female (OR = 1.59, 95% CI: 1.11, 2.23), aged 45 or older (OR = 1.69, 95% CI: 1.16, 2.46) and to have higher levels of education (university degree OR = 4.23, 95% CI: 1.86, 9.6). Respondents with a BMI > 30 were more likely to report using a pedometer (OR = 1.68, 95% CI: 1.11, 2.54) than those in the healthy weight range. Compared with those in full-time paid work, respondents in 'home duties' were significantly less likely to report pedometer use (OR = 0.18, 95% CI: 0.06, 0.53). Exposure to individual program components, in particular seeing 10,000 Steps street signage and walking trails or visiting the website, was also significantly associated with greater pedometer use.
Pedometer use varies between population subgroups, and alternate strategies need to be investigated to engage men, people with lower levels of education and those in full-time 'home duties', when using pedometers in community-based physical activity promotion initiatives.
PMCID: PMC1950707  PMID: 17655770

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