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Background: Physical violence against women is a major public health problem in African countries; however, no studies have focused on factors associated with violent injuries to women in Africa.Objectives: A matched case-control study was conducted to investigate risk factors for injuries from physical violence against African women in The Gambia.Methods: Over a 12-month study period, study participants were recruited from emergency departments of eight government-managed health care facilities. Cases were female patients aged ≥ 15 years who had been violently injured. Matched by the health facility, date of injury, sex, and age, a control patient for each case was selected from those injured due to nonviolent mechanisms.Results: In total, 194 case-control pairs were recruited. Results of a conditional logistic regression showed that being a Fula (odds ratio [OR] 2.45; 95% confidence interval [CI] 1.06-5.66), living in an extended family compound (OR 3.07; 95% CI 1.22-7.72), having six or more female siblings (OR 3.10; 95% CI 1.38-6.97), having been raised by grandparents (OR 3.34; 95% CI 1.06-10.51), and having been verbally (OR 3.04; 95% CI 1.56-5.96) or physically abused (OR 3.36; 95% CI 1.34-8.39) in the past 12 months were significantly associated with injury from physical violence.Conclusion: Most risk factors identified for violent injury among African women are unique to the studied geography. Violence prevention programs, if designed based on these identified risk factors, may be more effective for this population. [ABSTRACT FROM AUTHOR]

Abstract: A longitudinal study was conducted to investigate the effects of injury type and discharge placement on mortality, falls, hospital admissions, and changes in activities of daily living (ADLs) over a 12-month period among older fallers. Of 762 community-dwelling people aged 65years or older who visited an emergency department (ED) of a general hospital in Taiwan due to a fall, 273 sustained a hip fracture, 157 had a vertebral fracture, 47 had a distal forearm fracture, 102 had a traumatic brain injury, and 183 had soft-tissue injuries. Results showed that, compared to patients with a soft-tissue injury, those with TBI had significantly higher risks of dying (rate ratio (RR)=3.59) and hospital admissions (RR=3.23) and better improvement in ADLs (1.93 points) at 6months post-injury, and those who sustained a hip fracture (4.26 and 4.41 points), a vertebral fracture (3.81 and 3.83 points), or a distal-forearm fracture (2.80 and 2.80 points) had significantly better improvement in ADLs at 6 and 12months post-injury. Patients discharged to a nursing home had a significantly increased risk of death (RR=2.08) and hospital admission (RR=2.05) than those returning to their usual residence during the first year post-injury. No significant differences in the occurrence of falls during the first post-injury year were found among patients with different injury types or between those with different discharge placements. In conclusion, among the five major fall injury types in older people, TBIs result in the highest risk of death and hospital admissions, while hip and vertebral fractures exhibited the largest improvement during the first year after injury. Additionally, nursing home care may be associated with increased risks of death and hospital admissions than home care. In addition to primary prevention of falls, further research to investigate mechanisms leading to TBIs during a fall is needed to facilitate effective secondary fall-prevention programs for older people. [Copyright &y& Elsevier]

Abstract: Lin M-R, Yu W-Y, Wang S-C. Examination of assumptions in using time tradeoff and standard gamble utilities in individuals with spinal cord injury. Objective: To examine how the time tradeoff (TTO) and standard gamble (SG) utilities perform at different lengths of life expectancy and across patient characteristics such as risk attitudes and injury severity in individuals with traumatic spinal cord injury (SCI). Design: Survey. Setting: Structured telephone interviews of patients after discharge from 4 teaching hospitals. Participants: Subjects (N=270) who had sustained SCI were block-randomized in groups of 4 to receive 1 of 2 questionnaire versions. One version asked about the TTO and SG at 2 life expectancies of 10 and 20 years, and the other at 20 and 30 years. Interventions: Not applicable. Main Outcome Measures: The TTO and SG were used to elicit preferences for patients with an SCI. Results: Patients with SCI who were younger and had more severe neurologic lesions, had higher intense risk-taking attitudes, and experienced depression had significantly lower TTO and SG scores than their counterparts. A longer life expectancy was also significantly associated with lower TTO scores. As the life expectancy increased, patients who had sustained SCI more recently (≤1y ago) were more willing to trade off life years for full health (ie, lower TTO scores). SG scores did not significantly vary according to different life expectancies. Conclusions: Among patients with SCI, there was a nonlinear relation between the TTO and life expectancy that violated the fundamental assumption of risk neutrality toward life years. Accordingly, TTO utilities elicited for different life expectancies should not be compared in quality-of-life assessments or used in cost-utility analyses. In contrast, SG utilities remained stable at different lengths of life expectancy in SCI patients. Moreover, certain patient characteristics such as age, time lapse since the injury, neurologic severity, risk attitudes, and depressive status can account for some TTO and SG variations among patients with SCI. [Copyright &y& Elsevier]

Abstract: Lin M-R, Chiu W-T, Chen Y-J, Yu W-Y, Huang S-J, Tsai M-D. Longitudinal changes in the health-related quality of life during the first year after traumatic brain injury. Objective: To track the health-related quality of life (HRQL) at discharge and at 6 and 12 months after a traumatic brain injury (TBI) and examine factors associated with changes in each HRQL domain. Design: Longitudinal cohort study. Setting: Using codes of the International Classification of Diseases, eligible participants who had a newly diagnosed TBI were identified from discharge records of 4 hospitals in northern Taiwan. Information on the HRQL and injury-related characteristics at the initial and 2 follow-up assessments was collected by extracting medical records and conducting telephone interviews. Participants: Subjects (N=158) participated in the initial assessment, and 147 and 146, respectively, completed the follow-up assessments at 6 and 12 months after injury. Interventions: Not applicable. Main Outcome Measure: The brief version of the World Health Organization Quality of Life (WHOQOL-BREF) with 4 domains of physical capacity, psychologic well being, social relationships, and environment. Results: Scores on all WHOQOL-BREF domains except social relationships greatly improved over the first 6 months and showed continued improvement at 12 months after injury. The domain scores of the WHOQOL-BREF at discharge were significantly associated with the preinjury HRQL level, marital status, alcohol consumption at the time of injury, Glasgow Outcome Scale (GOS) level, cognition, activities of daily living, social support, and depressive status. However, after adjusting for these baseline differences, only the GOS level and depressive status significantly influenced longitudinal changes in the psychologic and social domains over the 12-month period. Changes in the physical and environmental domains were not significantly associated with any characteristics of the study. Conclusions: During the first year after a TBI, the magnitude of HRQL recovery differed across different HRQL domains. Many factors may have significant associations with the initial domain scores of HRQL after TBI; however, only a few factors can significantly influence longitudinal changes in the HRQL. [Copyright &y& Elsevier]

Abstract: Lin M-R, Hwang H-F, Yu W-Y, Chen C-Y. A prospective study of factors influencing return to work after traumatic spinal cord injury in Taiwan. Objective: To examine comprehensively the effects of physical, psychologic, and sociologic characteristics on employment among persons after a traumatic spinal cord injury (SCI) in Taiwan. Design: A prospective study with follow-up telephone interviews over a 3-year period. Setting: To register people who had sustained an SCI, medical records of 4 hospitals were reviewed using codes of the International Classification of Diseases–9th Revision–Clinical Modifications from 806.0 to 806.9 and from 952.0 to 952.9. Participants: Subjects (N=219) employed at the time of injury. Interventions: Not applicable. Main Outcome Measures: Employment status after an SCI. Results: The employment rate was 32.9%. After controlling for other variables, education level (relative rate [RR]=4.01∼8.17), autonomy in transportation (RR=5.13), professional licensure (RR=1.86), and thrill and adventure-seeking trait (RR=1.12) were positively and significantly associated with employment, while subjects with more severe overall injury severity (RR=0.95), preinjury chronic conditions (RR=0.20), necessity for aids for daily living (RR=0.31), and depression (RR=0.38) were less likely to have been employed than their counterparts. Conclusions: In addition to education level and traditional physical factors, overall injury severity and psychologic factors such as thrill and adventure seeking and depression can also influence the return to work after an SCI. [Copyright &y& Elsevier]

Abstract: This study was designed to determine the incidence rate and risk factors of missed injuries in major trauma patients in the emergency department (ED). Hospital records of all 976 trauma patients visiting the ED and admitted to intensive care units (ICUs) of a medical center in Taiwan from 2006 to 2007 were reviewed. Missed injuries were defined as those not identified in the ED but recognized later in the ICUs. Clinically significant injuries were those with an Abbreviated Injury Scale of ≥2. In the 2-year period, there were 133 missed injuries in 118 patients in the ED, for a prevalence of 12.1%; 87 injuries were clinically significant in 78 patients, for a prevalence of 8.0%. The estimated incidence rate per 100 person-hours was 3.2 for missed injuries and 2.1 for clinically significant missed injuries. The most commonly involved body region of missed injuries was the head/neck, followed by the chest and extremities. Results of a Cox regression analysis showed that a younger age, more-severe injury, polytrauma, and the absence of soft-tissue injuries were significantly associated with missed injuries, while younger ages, more-severe injuries, and the presence of chest and pelvic injuries were also significantly associated with clinically significant missed injuries. In conclusion, a considerable number of injuries, particularly to the head/neck, may be undetected in the ED, while young people and patients with certain injury patterns such as severity levels, polytrauma, and the presence of a chest or pelvic injury are more likely to have missed injuries and/or clinically significant missed injuries. [Copyright &y& Elsevier]

Abstract: The study was to examine the effects of Sanguis draconis ethanol extract (SDEE) on streptozotocin (STZ)- and cytokine-induced β-cell damage. In vitro, SDEE did not cause cytotoxicity below 200μg/ml, and can prevent STZ (5mM)-induced cell death and apoptosis below 100μg/ml on RIN-m5F cells. SDEE inhibits IL-1β/IFN-γ-stimulated NO, TNF-α release, and iNOS expression. Furthermore, SDEE suppressed the IL-1β/IFN-γ- or STZ-induced p65 expression of NF-κB, which is associated with inhibition of IκB-α degradation. In vivo, treatment of ICR mice with STZ (100mg/kg, i.p. single injection) resulted in hyperglycemia and hypoinsulinemia, which was further evidenced by blood glucose and plasma insulin. The diabetogenic effects of STZ were completely prevented when mice were orally administered with SDEE for 3 weeks, however, the blood glucose and plasma insulin showed no significant change after SDEE administration alone. In addition, SDEE also can inhibit STZ-induced iNOS protein expression, pancreatic injury and lipid peroxidation. In conclusions, the molecular mechanism by which SDEE inhibits iNOS gene expression appears to involve the inhibition of NF-κB activation. These results suggest the possible therapeutic value of S. draconis and could be potentially developed into a novel drug for preventing the progression of diabetes mellitus. [Copyright &y& Elsevier]

Abstract: Brazilin, the main constituent of Caesalpinia sappan L., is a natural red pigment that has been reported to possess anti-inflammatory properties. This study aimed to identify a novel anti-inflammatory mechanism of brazilin. We found that brazilin did not cause cytotoxicity below 300μM, and activated heme oxygenase-1 (HO-1) protein synthesis in a concentration-dependent manner at 10–300μM in RAW264.7 macrophages without affecting mRNA transcription of HO-1. Additionally, brazilin increased bilirubin production and HO-1 activity in RAW264.7 macrophages. In lipopolysaccharide (LPS)-stimulated macrophages, brazilin suppressed the release of nitric oxide (NO), prostaglandin E2 (PGE2), interleukin (IL)-1β and tumor necrosis factor-α (TNF-α), and reduced the expression of inducible nitric oxide synthase (iNOS). A specific inhibitor of HO-1, Zn(II) protoporphyrin IX, blocked the suppression of NO production, cytokines release and iNOS expression by brazilin. These results suggest that brazilin possesses anti-inflammatory actions in macrophages and works through a novel mechanism involving the action of HO-1. [Copyright &y& Elsevier]

Abstract: Background: Bicycle-related head injury is an important public health issue. A paucity of statistical data on bicycle accidents exists in Taiwan. The purpose of this study was to report the characteristics of bicycle-related head injuries among school-aged children in Taipei, Taiwan. Methods: Between 2001 and 2002, basic patient information of those with bicycle-related head injuries was collected from the Trauma Data Registry in 5 hospitals of the Taipei area. Telephone interviews were conducted to collect specific information surrounding bicycle accidents. Results: Of 324 patients with bicycle-related head injuries, 90 (27.8%) had severe head injuries. Boys compared with girls had a higher proportion of severe head injuries (34.1% vs 23.4%; P = .048). Children aged 5 to 9 years had a higher proportion of severe head injuries compared with ages 10 to 14 years (65.2% vs 6.4%; P = .043). Bicycles without reflectors had a higher proportion of severe head injuries compared to bicycles with reflectors (69.0% vs 5.7%; P = .004). Bicyclists carrying goods (such as backpacks or weighted toward the road) and speeding were associated with severe head injury (P < .05). Collisions with vehicles of a larger size resulted in a higher rate of severe head injury compared with collisions with pedestrians (76.9% vs 3.6%; P = .043). Conclusions: For children whose main mode of transport is bicycles, the enforcement of helmet legislation, educational programs in bicycling safety and equipment, and improving the infrastructure for bicycling in urban areas are needed in Taiwan to reduce potentially debilitating or life-threatening injuries. [Copyright &y& Elsevier]