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OBJECTIVES: The increasing numbers of migrants and refugees to Europe include persons seeking asylum, many of whom will have experienced physical violence and torture. Here we describe the personal histories and clinical evidence of violence and torture among attendees at a public health specialist service in France.METHODS: Physicians in a multidisciplinary team conducted examinations to corroborate refugees' skin lesions and other signs of injury with self-reported histories of physical violence and torture to provide evidence for asylum applications.RESULTS: The 240 asylum seekers assessed between October 2016 and September 2018 were mostly male (89% (213/240)) with median age 29 years (IQR 26-34 years) and originating from north and west Africa. Consultations took place on average 15 months after arrival in France. In most cases (58%) the reason for seeking asylum was political persecution. Almost all attendees (94%) presented with scars. The most common mechanisms of injury were beatings (84%), burns (32%) and cuts/stab wounds (15%). Sexual violence was reported for 37% of women (10/27) and 4% of men (9/213). Police tended to use multiple methods for inflicting injuries, whereas the army and non-state actors mostly inflicted beatings. Sexual violation was most commonly reported for violence inflicted by family members or partners. Corroboration of lesions with patients' histories of physical violence and torture was affirmative in 93% (224/240) of cases.CONCLUSION: For this ethnically diverse group, a specialist service which can provide clinical corroboration of self-reported histories of physical violence and torture to support asylum applications is an essential minimum.

Background Emergency departments handle a large proportion of acute patients. In 2007, it was recommended centralizing the Danish healthcare system and establishing emergency departments as the main common entrance for emergency patients. Since this reorganization, few studies describing the emergency patient population in this new setting have been carried out and none describing diagnoses and mortality. Hence, we aimed to investigate diagnoses and 1- and 30-day mortality of patients in the emergency departments in the North Denmark Region during 2014–2016. Methods Population-based historic cohort study in the North Denmark Region (580,000 inhabitants) of patients with contact to emergency departments during 2014–2016. The study included patients who were referred by general practitioners (daytime and out-of-hours), by emergency medical services or who were self-referred. Primary diagnoses (ICD-10) were retrieved from the regional Patient Administrative System. For non-specific diagnoses (ICD-10 chapter ‘Symptoms and signs’ and ‘Other factors’), we searched the same hospital stay for a specific diagnosis and used this, if one was given. We performed descriptive analysis reporting distribution and frequency of diagnoses. Moreover, 1- and 30-day mortality rate estimates were performed using the Kaplan-Meier estimator. Results We included 290,590 patient contacts corresponding to 166 ED visits per 1000 inhabitants per year. The three most frequent ICD-10 chapters used were ‘Injuries and poisoning’ (38.3% n = 111,274), ‘Symptoms and signs’ (16.1% n = 46,852) and ‘Other factors’ (14.52% n = 42,195). Mortality at day 30 (95% confidence intervals) for these chapters were 0.86% (0.81–0.92), 3.95% (3.78–4.13) and 2.84% (2.69–3.00), respectively. The highest 30-day mortality were within chapters ‘Neoplasms’ (14.22% (12.07–16.72)), ‘Endocrine diseases’ (8.95% (8.21–9.75)) and ‘Respiratory diseases’ (8.44% (8.02–8.88)). Conclusions Patients in contact with the emergency department receive a wide range of diagnoses within all chapters of ICD-10, and one third of the diagnoses given are non-specific. Within the non-specific chapters, we found a 30-day mortality, surpassing several of the more organ specific ICD-10 chapters. Trial registration Observational study - no trial registration was performed. Electronic supplementary material The online version of this article (10.1186/s12913-018-3361-x) contains supplementary material, which is available to authorized users.

OBJECTIVE: The aim of this study was to investigate the role of the forensic clinical examination in the judicial assessment made by the Prosecution Service in cases of rape.METHODS: All cases of police-reported sexual assault in the county of Funen, Denmark in a six-year period were reviewed, and the retrospective data was collected. Cases in which a forensic clinical examination was performed were included.RESULTS: The Prosecution Service in the county of Funen received 348 police-reported rape cases and of these 184 cases were included. The Prosecution Service stated that the forensic clinical examination (FCE) was important for the decision-making process in approximately half of the cases. The Prosecution Service finding an FCE important due to the presence of relevant findings was significantly associated with the case going to trial, whereas importance due to absence of relevant findings was significantly associated with the cases not going to trial. The only single factor associated with a case going to court and a guilty verdict was an FCE of the alleged perpetrator. There were no crude associations between any other factors i.e. the type of assault, victim injuries or alcohol consumption. In a logistic regression model, however, it was significantly more likely (p CONCLUSION: The results of the first in-depth analysis of the overall importance of a forensic clinical examination in cases of rape and sexual assault shows that we need to continuously focus on the documentation of sexual assault, as documentation is part of the decision-making process at all stages of the judicial process.

In Geneva, examination of victims of sexual assault is performed by a gynecologist and a medical examiner. 48% of the victims file a complaint and we wanted to investigate the factors leading to file a complaint, those leading the Prosecutor to go to trial, and those influencing a conviction. Between 2006 and 2012, 676 victims of sexual assault were investigated (averaged age 26 year, mean 22). Information on injuries, perpetrators, and circumstances of the assault was collected and analyzed. The attacker being the ex-spouse or a friend and the presence of semen were factors leading to file a complaint. The assailant being a family member or ex-spouse and the presence of genital/anal lesions were factors influencing the Prosecutor. The presence of nongenital lesions, the assailant being known by the victim, influenced conviction. This study shows that the medical examiner plays a vital role in the investigation of cases of sexual assault.

BACKGROUND: How long one lives, how many years of life are spent in good and poor health, and how the population's state of health and leading causes of disability change over time all have implications for policy, planning, and provision of services. We comparatively assessed the patterns and trends of healthy life expectancy (HALE), which quantifies the number of years of life expected to be lived in good health, and the complementary measure of disability-adjusted life-years (DALYs), a composite measure of disease burden capturing both premature mortality and prevalence and severity of ill health, for 359 diseases and injuries for 195 countries and territories over the past 28 years.METHODS: We used data for age-specific mortality rates, years of life lost (YLLs) due to premature mortality, and years lived with disability (YLDs) from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 to calculate HALE and DALYs from 1990 to 2017. We calculated HALE using age-specific mortality rates and YLDs per capita for each location, age, sex, and year. We calculated DALYs for 359 causes as the sum of YLLs and YLDs. We assessed how observed HALE and DALYs differed by country and sex from expected trends based on Socio-demographic Index (SDI). We also analysed HALE by decomposing years of life gained into years spent in good health and in poor health, between 1990 and 2017, and extra years lived by females compared with males.FINDINGS: Globally, from 1990 to 2017, life expectancy at birth increased by 7·4 years (95% uncertainty interval 7·1-7·8), from 65·6 years (65·3-65·8) in 1990 to 73·0 years (72·7-73·3) in 2017. The increase in years of life varied from 5·1 years (5·0-5·3) in high SDI countries to 12·0 years (11·3-12·8) in low SDI countries. Of the additional years of life expected at birth, 26·3% (20·1-33·1) were expected to be spent in poor health in high SDI countries compared with 11·7% (8·8-15·1) in low-middle SDI countries. HALE at birth increased by 6·3 years (5·9-6·7), from 57·0 years (54·6-59·1) in 1990 to 63·3 years (60·5-65·7) in 2017. The increase varied from 3·8 years (3·4-4·1) in high SDI countries to 10·5 years (9·8-11·2) in low SDI countries. Even larger variations in HALE than these were observed between countries, ranging from 1·0 year (0·4-1·7) in Saint Vincent and the Grenadines (62·4 years [59·9-64·7] in 1990 to 63·5 years [60·9-65·8] in 2017) to 23·7 years (21·9-25·6) in Eritrea (30·7 years [28·9-32·2] in 1990 to 54·4 years [51·5-57·1] in 2017). In most countries, the increase in HALE was smaller than the increase in overall life expectancy, indicating more years lived in poor health. In 180 of 195 countries and territories, females were expected to live longer than males in 2017, with extra years lived varying from 1·4 years (0·6-2·3) in Algeria to 11·9 years (10·9-12·9) in Ukraine. Of the extra years gained, the proportion spent in poor health varied largely across countries, with less than 20% of additional years spent in poor health in Bosnia and Herzegovina, Burundi, and Slovakia, whereas in Bahrain all the extra years were spent in poor health. In 2017, the highest estimate of HALE at birth was in Singapore for both females (75·8 years [72·4-78·7]) and males (72·6 years [69·8-75·0]) and the lowest estimates were in Central African Republic (47·0 years [43·7-50·2] for females and 42·8 years [40·1-45·6] for males). Globally, in 2017, the five leading causes of DALYs were neonatal disorders, ischaemic heart disease, stroke, lower respiratory infections, and chronic obstructive pulmonary disease. Between 1990 and 2017, age-standardised DALY rates decreased by 41·3% (38·8-43·5) for communicable diseases and by 49·8% (47·9-51·6) for neonatal disorders. For non-communicable diseases, global DALYs increased by 40·1% (36·8-43·0), although age-standardised DALY rates decreased by 18·1% (16·0-20·2).INTERPRETATION: With increasing life expectancy in most countries, the question of whether the additional years of life gained are spent in good health or poor health has been increasingly relevant because of the potential policy implications, such as health-care provisions and extending retirement ages. In some locations, a large proportion of those additional years are spent in poor health. Large inequalities in HALE and disease burden exist across countries in different SDI quintiles and between sexes. The burden of disabling conditions has serious implications for health system planning and health-related expenditures. Despite the progress made in reducing the burden of communicable diseases and neonatal disorders in low SDI countries, the speed of this progress could be increased by scaling up proven interventions. The global trends among non-communicable diseases indicate that more effort is needed to maximise HALE, such as risk prevention and attention to upstream determinants of health.FUNDING: Bill & Melinda Gates Foundation.

Alcohol use is a major contributor to injuries, mortality and the burden of disease. This review updates knowledge on risk relations between dimensions of alcohol use and health outcomes to be used in global and national Comparative Risk Assessments (CRAs). Systematic review of reviews and meta-analyses on alcohol consumption and health outcomes attributable to alcohol use. For dimensions of exposure: volume of alcohol use, blood alcohol concentration and patterns of drinking, in particular heavy drinking occasions were studied. For liver cirrhosis, quality of alcohol was additionally considered. For all outcomes (mortality and/or morbidity): cause of death and disease/injury categories based on International Classification of Diseases (ICD) codes used in global CRAs; harm to others. In total, 255 reviews and meta-analyses were identified. Alcohol use was found to be linked causally to many disease and injury categories, with more than 40 ICD-10 three-digit categories being fully attributable to alcohol. Most partially attributable disease categories showed monotonic relationships with volume of alcohol use: the more alcohol consumed, the higher the risk of disease or death. Exceptions were ischaemic diseases and diabetes, with curvilinear relationships, and with beneficial effects of light to moderate drinking in people without heavy irregular drinking occasions. Biological pathways suggest an impact of heavy drinking occasions on additional diseases; however, the lack of medical epidemiological studies measuring this dimension of alcohol use precluded an in-depth analysis. For injuries, except suicide, blood alcohol concentration was the most important dimension of alcohol use. Alcohol use caused marked harm to others, which has not yet been researched sufficiently. Research since 2010 confirms the importance of alcohol use as a risk factor for disease and injuries; for some health outcomes, more than one dimension of use needs to be considered. Epidemiological studies should include measurement of heavy drinking occasions in line with biological knowledge.

Correction: JAMA Pediatr. 2017;171(10):1019. doi:10.1001/jamapediatrics.2017.2732 Correction: JAMA Pediatr. 2017;171(6):602. DOI: 10.1001/jamapediatrics.2017.1667, IMPORTANCE Comprehensive and timely monitoring of disease burden in all age groups, including children and adolescents, is essential for improving population health. OBJECTIVE To quantify and describe levels and trends of mortality and nonfatal health outcomes among children and adolescents from 1990 to 2015 to provide a framework for policy discussion. EVIDENCE REVIEW Cause-specific mortality and nonfatal health outcomes were analyzed for 195 countries and territories by age group, sex, and year from 1990 to 2015 using standardized approaches for data processing and statistical modeling, with subsequent analysis of the findings to describe levels and trends across geography and time among children and adolescents 19 years or younger. A composite indicator of income, education, and fertility was developed (Socio-demographic Index [SDI]) for each geographic unit and year, which evaluates the historical association between SDI and health loss. FINDINGS Global child and adolescent mortality decreased from 14.18 million (95% uncertainty interval [UI], 14.09 million to 14.28 million) deaths in 1990 to 7.26 million (95% UI, 7.14 million to 7.39 million) deaths in 2015, but progress has been unevenly distributed. Countries with a lower SDI had a larger proportion of mortality burden (75%) in 2015 than was the case in 1990 (61%). Most deaths in 2015 occurred in South Asia and sub-Saharan Africa. Global trends were driven by reductions in mortality owing to infectious, nutritional, and neonatal disorders, which in the aggregate led to a relative increase in the importance of noncommunicable diseases and injuries in explaining global disease burden. The absolute burden of disability in children and adolescents increased 4.3%(95% UI, 3.1%-5.6%) from 1990 to 2015, with much of the increase owing to population growth and improved survival for children and adolescents to older ages. Other than infectious conditions, many top causes of disability are associated with long-term sequelae of conditions present at birth (eg, neonatal disorders, congenital birth defects, and hemoglobinopathies) and complications of a variety of infections and nutritional deficiencies. Anemia, developmental intellectual disability, hearing loss, epilepsy, and vision loss are important contributors to childhood disability that can arise from multiple causes. Maternal and reproductive health remains a key cause of disease burden in adolescent females, especially in lower-SDI countries. In low-SDI countries, mortality is the primary driver of health loss for children and adolescents, whereas disability predominates in higher-SDI locations; the specific pattern of epidemiological transition varies across diseases and injuries. CONCLUSIONS AND RELEVANCE Consistent international attention and investment have led to sustained improvements in causes of health loss among children and adolescents in many countries, although progress has been uneven. The persistence of infectious diseases in some countries, coupled with ongoing epidemiologic transition to injuries and noncommunicable diseases, require all countries to carefully evaluate and implement appropriate strategies to maximize the health of their children and adolescents and for the international community to carefully consider which elements of child and adolescent health should be monitored., The Institute for Health Metrics and Evaluation received funding from the Bill & Melinda Gates Foundation

INTRODUCTION: The epidemiology of children or adolescents admitted to a Scandinavian trauma centre is largely unknown. The aim of this paper was to describe the epidemiology and severity of potentially severely injured children and adolescents admitted to a university hospital trauma centre. METHODS: This was a descriptive study of all children and adolescents aged 0-17 admitted to the university level trauma centre at Odense University Hospital, Denmark in the 2002-2011 period. Data were extracted from the Southern Danish Trauma Register and from medical records. RESULTS: A total of 950 children and adolescents were included. The median age was 13 (range: 0-17) years. Boys accounted for 60.6% of the cases. Accidents accounted for 97.2%, violence 1.4% and self-inflicted injuries 0.4%. More than three fourths of the injuries occurred either in traffic or at home. The occurrence was greatest in the summer (34.0%), during weekends (48.9%) and in the hours between 12.00 and 20.00 (59.2%). Overall, 58.5% of the injuries were due to traffic. Of these injuries, 39.7% were injuries suffered by passengers in motor vehicles, 27.5% drivers/passengers of a scooter/MC, 21.8% bicyclists and 10.3% pedestrians. The median Injury Severity Score (ISS) and Abbreviated Injury Scale was 4 (range: 1-75) and 2 (range: 1-6), respectively. Head/face injuries accounted for 36.5% and injuries to the extremities for 30.9% of all injuries. A total of 153 (16.1%) suffered from severe injuries (ISS > 15). Overall, 49 (5.2%) died due to their injuries. CONCLUSIONS: Based on a local trauma register, we described the epidemiology and severity of potentially severely injured children and adolescents admitted to a university trauma centre.

BACKGROUND: Governments wish to compare their performance in preventing serious injury. International comparisons based on hospital inpatient records are typically contaminated by variations in health services utilisation. To reduce these effects, a serious injury case definition has been proposed based on diagnoses with a high probability of inpatient admission (PrA). The aim of this paper was to identify diagnoses with estimated high PrA for selected developed countries.METHODS: The study population was injured persons of all ages who attended emergency department (ED) for their injury in regions of Canada, Denmark, Greece, Spain and the USA. International Classification of Diseases (ICD)-9 or ICD-10 4-digit/character injury diagnosis-specific ED attendance and inpatient admission counts were provided, based on a common protocol. Diagnosis-specific and region-specific PrAs with 95% CIs were calculated.RESULTS: The results confirmed that femoral fractures have high PrA across all countries studied. Strong evidence for high PrA also exists for fracture of base of skull with cerebral laceration and contusion; intracranial haemorrhage; open fracture of radius, ulna, tibia and fibula; pneumohaemothorax and injury to the liver and spleen. Slightly weaker evidence exists for cerebellar or brain stem laceration; closed fracture of the tibia and fibula; open and closed fracture of the ankle; haemothorax and injury to the heart and lung.CONCLUSIONS: Using a large study size, we identified injury diagnoses with high estimated PrAs. These diagnoses can be used as the basis for more valid international comparisons of life-threatening injury, based on hospital discharge data, for countries with well-developed healthcare and data collection systems.

Objective: to analyze the epidemiological profile and mortality associated with the Revised Trauma Score (RTS) in trauma victims treated at a university hospital. Methods: we conducted a descriptive, cross-sectional study of trauma protocols (prospectively collected) from December 2013 to February 2014, including trauma victims admitted in the emergency room of the Cajuru University Hospital. We set up three groups: (G1) penetrating trauma to the abdomen and chest, (G2) blunt trauma to the abdomen and chest, and (G3) traumatic brain injury. The variables we analyzed were: gender, age, day of week, mechanism of injury, type of transportation, RTS, hospitalization time and mortality. Results: we analyzed 200 patients, with a mean age of 36.42 ± 17.63 years, and 73.5% were male. The mean age was significantly lower in G1 than in the other groups (p

BACKGROUND: The epidemiological profile and trends of road traffic injuries (RTIs) in Peru have not been well-defined, though this is a necessary step to address this significant public health problem in Peru. The objective of this study was to determine trends of incidence, mortality, and fatality of RTIs in Peru during 1973-2008, as well as their relationship to population trends such as economic growth. METHODS AND FINDINGS: Secondary aggregated databases were used to estimate incidence, mortality and fatality rate ratios (IRRs) of RTIs. These estimates were standardized to age groups and sex of the 2008 Peruvian population. Negative binomial regression and cubic spline curves were used for multivariable analysis. During the 35-year period there were 952,668 road traffic victims, injured or killed. The adjusted yearly incidence of RTIs increased by 3.59 (95% CI 2.43-5.31) on average. We did not observe any significant trends in the yearly mortality rate. The total adjusted yearly fatality rate decreased by 0.26 (95% CI 0.15-0.43), while among adults the fatality rate increased by 1.25 (95% CI 1.09-1.43). Models fitted with splines suggest that the incidence follows a bimodal curve and closely followed trends in the gross domestic product (GDP) per capita. CONCLUSIONS: The significant increasing incidence of RTIs in Peru affirms their growing threat to public health. A substantial improvement of information systems for RTIs is needed to create a more accurate epidemiologic profile of RTIs in Peru. This approach can be of use in other similar low and middle-income settings to inform about the local challenges posed by RTIs. Language: en

Arterial injuries of the forearm account for an important fraction of peripheral vascular injuries. Early diagnosis and treatment are important for both function and viability of the extremity. Arterial injuries of the forearm mostly occur as a result of glass or knife cuts and gunshot wounds and the presence of accompanying injuries may facilitate the diagnosis. However, in this case (50-year-old male patient), a piece of nail behaved like a high-energy particle and injured the radial artery without any accompanying lesion. Detection of normal pulses in the radial and ulnar arteries delayed the diagnosis and treatment. This case report aimed to address difficulties in establishing the diagnosis of isolated radial artery injuries., Önkoldaki arter yaralanmaları, periferik vasküler travmaların önemli bir kısmını oluşturur. Erken tanı ve tedavi gerek el fonksiyonları açısından, gerekse ekstremitenin yaşamı açısından çok önemlidir. Önkolda arter yaralanmaları sıklıkla cam, bıçak ve ateşli silahlarla meydana gelmektedir ve bu yaralanmalarla birlikte ek yaralanmaların olması tanıyı kolaylaştırır. Fakat, sunduğumuz olguda (50 yaşında erkek hasta) küçük bir çivi parçası yüksek enerjili cisim gibi davranıp başka bir hasar vermeden radial arteri yaralamış; ulnar ve radial arter nabızlarının normal bulunması tanı ve tedaviyi geciktirmiştir. Bu yazıda, tedavisi basit olan yaralanmanın tanısının konmasındaki sorunlar gündeme getirildi.

Objectives: This epidemiological study was designed to evaluate the factors affecting the incidence of fractures in children, to assess our treatment methods, and to make suggestions for preventing accident-induced fractures in children.Methods: A total of 240 fractures of 223 patients were investigated. Patients were administered a standard questionnaire to collect sociodemographic data and assess childhood fractures. At the end of a year, all data were analyzed using SPSS statistics package.Results: Of the study group, 152 patients were males (68.2%) and 71 patients were females (31.8%). Mean age was 8.4±4.1 years. The incidence of fractures tended to increase with age. The season and month of the year that the fractures mostly occurred were spring and May, respectively. Streets were the most common environment of fracture occurrences. Falling from height played a significant role in the mechanism of fractures. The majority of cases (63.7%) sought emergency treatment in the first 24 hours. Fractures were most frequently seen in the upper extremities. Only 4.5% of patients were referred to other hospitals due to hospital shortcomings.Conclusion: Education of parents and programs concerning accident prevention implemented either locally or nationwide will be beneficial in preventing child accidents and injuries., Amaç: Çocukluk çağında görülen kırıkları epidemiyolojik olarak değerlendirerek, kırık insidansı üzerinde etkisi olan faktörleri ortaya koymak, kırıklara uyguladığımız tedavi şekillerini vurgulamak ve çocukluk çağında kırıkların ortaya çıkmasını önleyecek programlar geliştirmek.Çalışma planı: Toplam 223 olguya ait 240 kırık incelendi. Çocukluk çağı kırıklarını değerlendirmek ve sosyodemografik verileri elde etmek için hazırlanan bir form her olgu için dolduruldu. Bir yıllık süre sonunda toplanan veriler SPSS paket programı ile bilgisayarda irdelendi.Sonuçlar: Çalışma grubunun 152’si erkek (%68.2), 71’i kız (% 31.8) idi (ort. yaş 8.4±4.1). Kırık insidansı yaş arttıkça artma eğilimi göstermekteydi. Kırıkların mevsim olarak ilkbaharda, ay olarak mayıs ayında daha sık ortaya çıktığı saptandı. Kırıkların sokak ortamında daha sık ortaya çıktığı, yüksekten düşmelerin etyolojide önemli rol oynadığı, olguların %63.7’sinin ilk 24 saat içinde hastaneye başvurdukları belirlendi. Kırıkların en sık üst ekstremite lokalizasyonlu olduğu ve yalnızca %4.5’inin hastane koşullarının yetersizliği nedeniyle başka hastanelere sevk edildiği belirlendi. Çıkarımlar: Ebeveynlerin eğitimi, yerel veya ulusal kampanyalarla çocuk kazalarını önlemeye yönelik programların uygulanması çocuk kazalarının ve yaralanmalarının önlenmesinde faydalı olabilecektir.

Switzerland, the country with the highest health expenditure per capita, is lacking data on trauma care and system planning. Recently, 12 trauma centres were designated to be reassessed through a future national trauma registry by 2015. Lausanne University Hospital launched the first Swiss trauma registry in 2008, which contains the largest database on trauma activity nationwide. Prospective analysis of data from consecutively admitted shock room patients from 1 January 2008 to 31 December 2012. Shock room admission is based on physiology and mechanism of injury, assessed by prehospital physicians. Management follows a surgeon-led multidisciplinary approach. Injuries are coded by Association for the Advancement of Automotive Medicine (AAAM) certified coders. Over the 5 years, 1,599 trauma patients were admitted, predominantly males with a median age of 41.4 years and median injury severity score (ISS) of 13. Rate of ISS >15 was 42%. Principal mechanisms of injury were road traffic (40.4%) and falls (34.4%), with 91.5% blunt trauma. Principal patterns were brain (64.4%), chest (59.8%) and extremity/pelvic girdle (52.9%) injuries. Severe (abbreviated injury scale [AIS] score ≥ 3) orthopaedic injuries, defined as extremity and spine injuries together, accounted for 67.1%. Overall, 29.1% underwent immediate intervention, mainly by orthopaedics (27.3%), neurosurgeons (26.3 %) and visceral surgeons (13.9%); 43.8% underwent a surgical intervention within the first 24 hours and 59.1% during their hospitalisation. In-hospital mortality for patients with ISS >15 was 26.2%. This is the first 5-year report on trauma in Switzerland. Trauma workload was similar to other European countries. Despite high levels of healthcare, mortality exceeds published rates by >50%. Regardless of the importance of a multidisciplinary approach, trauma remains a surgical disease and needs dedicated surgical resources.

Background: Clinically evident neurologic injury of the involved limb after total shoulder arthroplasty is not uncommon, but the subclinical prevalence is unknown. The purposes of this prospective study were to determine the subclinical prevalence of neurologic lesions after reverse shoulder arthroplasty and anatomic shoulder arthroplasty, and to evaluate the correlation of neurologic injury to postoperative lengthening of the arm. Methods: All patients undergoing either a reverse or an anatomic shoulder arthroplasty were included during the period studied. This study focused on the clinical, radiographic, and preoperative and postoperative electromyographic evaluation, with measurement of arm lengthening in patients who had reverse shoulder arthroplasty according to a previously validated protocol. Results: Between November 2007 and February 2009, forty-one patients (forty-two shoulders) underwent reverse shoulder arthroplasty (nineteen shoulders) or anatomic primary shoulder arthroplasty (twenty-three shoulders). The two groups were similar with respect to sex distribution, preoperative neurologic lesions, and Constant score. Electromyography performed at a mean of 3.6 weeks postoperatively in the reverse shoulder arthroplasty group showed subclinical electromyographic changes in nine shoulders, involving mainly the axillary nerve; eight resolved in less than six months. In the anatomic shoulder arthroplasty group, a brachial plexus lesion was evident in one shoulder. The prevalence of acute postoperative nerve injury was significantly more frequent in the reverse shoulder arthroplasty group (p = 0.002), with a 10.9 times higher risk (95% confidence interval, 1.5 to 78.5). Mean lengthening (and standard deviation) of the arm after reverse shoulder arthroplasty was 2.7 ± 1.8 cm (range, 0 to 5.9 cm) compared with the normal, contralateral side. Conclusions: The occurrence of peripheral neurologic lesions following reverse shoulder arthroplasty is relatively common, but usually transient. Arm lengthening with a reverse shoulder arthroplasty may be responsible for these nerve injuries.

Length of travel appears to be associated with health risks. GeoSentinel Surveillance Network data for 4,039 long-term travelers (trip duration >6 months) seen after travel during June 1, 1996, through December 31, 2008, were compared with data for 24,807 short-term travelers (trip duration 1 month, eosinophilia, cutaneous leishmaniasis, schistosomiasis, and Entamoeba histolytica diarrhea. Areas of concern for long-term travelers were vector-borne diseases, contact-transmitted diseases, and psychological problems. Our results can help prioritize screening for and diagnosis of illness in long-term travelers and provide evidence-based pretravel advice.

First, to test whether current injury is more closely related to acute intake than to usual consumption patterns, and second, to test whether repeated injury is more closely related to general consumption patterns than to acute intake.Screening of alcohol consumption of 7,872 patients enrolling between January 1, 2003 and June 30, 2004 in an emergency department (ED) in Lausanne, Switzerland. General consumption patterns were measured as usual volume (in drinks per week) and binge drinking (5+ drinks for men; 4+ drinks for women) at least once monthly. Acute intake was measured through number of drinks in the 24-hour period prior to attending the ED. Separate logistic regression models of current injury and repeated injury on alcohol consumption patterns were estimated.Acute intake and binge drinking dominated the association with current injury, while general consumption patterns were predictive of repeated alcohol-related injury.Acute intake is associated with current injury in a dose-response relationship and with binge drinking. Because acute intake can be found among moderate volume drinkers as well as among chronic heavy drinkers, for current injury usual volume adds little predictive value over the effects of acute intake. Repeated injuries occur more often among chronic heavy drinkers, and thus general consumption patterns are more closely associated with injury "recidivism" than with acute intake. A screening question assessing prior injury may be a useful tool in the ED for distinguishing between chronic heavy drinkers and usually moderate drinkers with heavy drinking episodes, and thus prove helpful when creating preventive efforts tailored to different types of drinker.

to analyze the epidemiological profile and mortality associated with the Revised Trauma Score (RTS) in trauma victims treated at a university hospital.we conducted a descriptive, cross-sectional study of trauma protocols (prospectively collected) from December 2013 to February 2014, including trauma victims admitted in the emergency room of the Cajuru University Hospital. We set up three groups: (G1) penetrating trauma to the abdomen and chest, (G2) blunt trauma to the abdomen and chest, and (G3) traumatic brain injury. The variables we analyzed were: gender, age, day of week, mechanism of injury, type of transportation, RTS, hospitalization time and mortality.we analyzed 200 patients, with a mean age of 36.42 ± 17.63 years, and 73.5% were male. The mean age was significantly lower in G1 than in the other groups (p0.001). Most (40%) of the visits occurred on weekends and the most common pre-hospital transport service (58%) was the SIATE (Emergency Trauma Care Integrated Service). The hospital stay was significantly higher in G1 compared with the other groups (p0.01). Regarding mortality, there were 12%, 1.35% and 3.95% of deaths in G1, G2 and G3, respectively. The median RTS among the deaths was 5.49, 7.84 and 1.16, respectively, for the three groups.the majority of patients were young men. RTS was effective in predicting mortality in traumatic brain injury, however failing to predict it in patients suffering from blunt and penetrating trauma.analisar o perfil epidemiológico e a mortalidade associada ao escore de trauma revisado (RTS) em vítimas de trauma atendidas em um hospital universitário.estudo transversal descritivo de protocolos de trauma (coletados prospectivamente) de dezembro de 2013 a fevereiro de 2014, incluindo vítimas de trauma admitidas na sala de emergência do Hospital Universitário Cajuru. Três grupos foram criados: (G1) trauma penetrante em abdome e tórax, (G2) trauma contuso em abdome e tórax, e (G3) trauma cranioencefálico. As variáveis analisadas foram: sexo, idade, dia da semana, mecanismo de trauma, tipo de transporte, RTS, tempo de internamento e mortalidade.analisou-se 200 pacientes, com média de idade de 36,42 ± 17,63 anos, sendo 73,5% do sexo masculino. A média de idade no G1 foi significativamente menor do que nos demais grupos (p0,001). A maioria (40%) dos atendimentos ocorreu nos finais de semana e o serviço de transporte pré-hospitalar mais frequente (58%) foi o SIATE (Serviço Integrado de Atendimento ao Trauma em Emergência). O tempo de internamento foi significativamente maior no G1, em comparação aos demais grupos (p0,01). Quanto à mortalidade, houve 12%, 1,35% e 3,95% de óbitos nos grupos G1, G2 e G3, respectivamente. A mediana do RTS entre os óbitos foi 5,49, 7,84 e 1,16, respectivamente, para os três grupos.a maioria dos pacientes eram homens jovens. O RTS mostrou-se efetivo na predição de mortalidade no trauma cranioencefálico, entretanto falhou ao analisar pacientes vítimas de trauma contuso e penetrante.