Historical and projected fractures associated with mobility scooters presenting to U.S. emergency departments: 2004-2025.
Ontology highlight
ABSTRACT: Introduction
The proportion of mobility scooter users in the United States continues to rise. However, these devices impart a substantial yet underappreciated risk of serious injury - namely, fractures - on users.Methods
The purpose of this cross-sectional, retrospective study was to use the National Electronic Injury Surveillance System (NEISS) to quantify the national burden of these device-associated fractures between 2004 and 2017, analyzing in two-year intervals. We also projected estimates to 2025, and described the demographic characteristics of those injured.Results
We found that national estimates of device-associated fractures increased significantly between the 2004-2005 (N = 2583; C.I. 1851 - 3316) and 2016-2017 (N = 6553; C.I. 5026 - 8081) periods (p < 0.001). A linear regression model (R2 = 0.89; P = 0.002) was applied to project 9824 such fractures (C.I. 8273-11,328) in the 2024-2025 period. Injured patients were commonly over age 65 (63.5%; C.I. 57.7%-69.4%) and white (61.4%; C.I. 50.7% - 72.1). Fractures often occurred at home (28.6%; C.I. 22.0%-35.3%) or in public (26.0%; C.I. 21.1%-30.9%).Conclusion
Our study suggests that osteoarthritic patients relying on mobility scooters to manage pain during ambulation should be considered candidates for total joint replacement procedures. This may help minimize the growing economic and health burden of mobility scooter fractures.
SUBMITTER: Pirruccio K
PROVIDER: S-EPMC6441709 | biostudies-literature |
REPOSITORIES: biostudies-literature
Similar Datasets
Project description:BackgroundOnchocerciasis elimination through mass drug administration (MDA) is hampered by coendemicity of Loa loa, as people with high L. loa microfilariae (mf) density can develop serious adverse events (SAEs) after ivermectin treatment. We assessed the geographical overlap of onchocerciasis and loiasis prevalence and estimated the number of coinfected individuals at risk of post-ivermectin SAEs in West and Central Africa from 1995 to 2025.MethodsFocusing on regions with suspected loiasis transmission in 14 countries, we overlaid precontrol maps of loiasis and onchocerciasis prevalence to calculate precontrol prevalence of coinfection by 5 km2 × 5 km2 pixel, distinguishing different categories of L. loa mf intensity. Using statistical and mathematical models, we predicted prevalence of both infections and coinfection for 2015 and 2025, accounting for the impact of MDA with ivermectin.ResultsThe number of people infected with onchocerciasis was predicted to decline from almost 19 million in 1995 to 4 million in 2025. Of these, 137 000 people were estimated to also have L. loa hypermicrofilaremia (≥20 000 L. loa mf/mL) in 1995, declining to 31 000 in 2025. In 2025, 92.8% of coinfected cases with loiasis hypermicrofilaremia are predicted to live in hypoendemic areas currently not targeted for MDA.ConclusionsLoiasis coinfection is a major concern for onchocerciasis elimination in Africa. We predict that under current strategies, at least 31 000 coinfected people still require treatment for onchocerciasis in 2025 while being at risk of SAEs, justifying continued efforts in research and development for safer drugs and control strategies.
| S-EPMC7245158 | biostudies-literature
Project description:The data presented in this article are related to the research article entitled "Assessing climate change impacts on the reliability of rainwater harvesting systems" (Alamdari et al., 2018) [1]. This article evaluated the water supply and runoff capture reliability of rainwater harvesting (RWH) systems for locations across the U.S. for historical and projected climate conditions. Hypothetical RWH systems with varying storage volumes, rooftop catchment areas, irrigated areas, and indoor wSater demand based upon population from selected locations were simulated for historical (1971-1998) and projected (2041-2068) periods, the latter dataset was developed using dynamic downscaling of North American Regional Climate Change (CC) Assessment Program (NARCCAP). A computational model, the Rainwater Analysis and Simulation Program (RASP), was used to compute RWH performance with respect to the reliability of water supply and runoff capture. The reliability of water supply was defined as the proportion of demands that are met; and the reliability of runoff capture was defined as the amount stored and reused, but not spilled. A series of contour plots using the four design variables and the reliability metrics were developed for historical and projected conditions. Frequency analysis was also used to characterize the long-term behavior of rainfall and dry duration at each location. The full data set is made publicly available to enable critical or extended analysis of this work.
| S-EPMC5996225 | biostudies-literature
Project description:Increased heat-related mortality is projected to be among the major impacts of climate change on human health, and the United States urban Northeast region is likely to be particularly vulnerable. In support of regional adaptation planning, quantitative information is needed on potential future health responses at the urban and regional scales. Here, we present future projections of heat-related mortality in Boston, New York and Philadelphia utilizing downscaled next-generation climate models and Representative Concentration Pathways (RCPs) developed in support of the Intergovernmental Panel on Climate Change (IPCC)'s Fifth Assessment Report (AR5). Our analyses reveal that heat-related mortality rates per 100,000 of population during the baseline period between 1985 and 2006 were highest in Philadelphia followed by New York City and Boston. However, projected heat-related mortality rates in the 2020s, 2050s and 2080s were highest in New York City followed by Philadelphia and Boston. This study may be of value in developing strategies for reducing the future impacts of heat and building climate change resilience in the urban Northeast region.
| S-EPMC3881138 | biostudies-literature
Project description:Based on the projected need for a larger oncology care workforce, we estimated the patient care visits and care activities that Board Certified oncology pharmacists (BCOPs) could contribute to oncology care from 2020-2025. Using projected counts for BCOPs through 2025, we estimated that 2.9-4.1 million 30-min BCOP patient visits were possible at 50% workforce capacity. BCOPs' clinical activities overlapped strongly with those of nurse practitioners (NPs) and physician assistants (PAs) in patient education and treatment management. BCOPs could help reduce provider stress and burnout concerns by spreading these activities across a broader set of providers. BCOPs were more active than NPs and PAs in clinical trials research. Recent advances in immunotherapy, pharmacogenetics, pharmacogenomics, and oral oncolytic agents make the medication-focused training of OPs particularly useful to care teams. Comparison also showed that BCOPs were less active in providing follow-up visits and prescribing. Fulfilling the projected BCOP numbers through 2025 will require continued growth in Postgraduate Year 2 (PGY2) oncology pharmacy resident programs and on-the-job training programs. Our review of the trends in cancer incidence, mortality, and survivorship suggest a sustained need for the activities of BCOPs and other oncology care providers.
| S-EPMC7151692 | biostudies-literature
Project description:ObjectivesTo estimate the proportion of visits to U.S. emergency departments (EDs) in which a diagnosis of elder abuse is reached using two nationally representative datasets.DesignRetrospective cross-sectional analysis.SettingU.S. ED visits recorded in the 2012 Nationwide Emergency Department Sample (NEDS) or the 2011 National Hospital Ambulatory Medical Care Survey (NHAMCS).ParticipantsAll ED visits of individuals aged 60 and older.MeasurementsThe primary outcome was elder abuse defined according to International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes. The proportion of visits with elder abuse was estimated using survey weights. Odds ratios (ORs) were calculated to identify demographic characteristics and common ED diagnoses associated with elder abuse.ResultsIn 2012, NEDS contained information on 6,723,667 ED visits of older adults, representing an estimated 29,056,673 ED visits. Elder abuse was diagnosed in an estimated 3,846 visits, corresponding to a weighted diagnosis period prevalence of elder abuse in U.S. EDs of 0.013% (95% confidence interval (CI) = 0.012-0.015%). Neglect and physical abuse were the most common types diagnosed, accounting for 32.9% and 32.2% of cases, respectively. Multivariable analysis showed greater weighted odds of elder abuse diagnosis in women (odds ratio (OR) = 1.95, 95% CI = 1.68-2.26) and individuals with contusions (OR = 2.91, 95% CI = 2.36-3.57), urinary tract infection (OR = 2.21, 95% CI = 1.84-2.65), and septicemia (OR = 1.92, 95% CI = 1.44-2.55). In the 2011 NHAMCS dataset, no cases of elder abuse were recorded for the 5,965 older adult ED visits.ConclusionThe proportion of U.S. ED visits by older adults receiving a diagnosis of elder abuse is at least two orders of magnitude lower than the estimated prevalence in the population. Efforts to improve the identification of elder abuse in EDs may be warranted.
| S-EPMC5258672 | biostudies-literature
Project description:Lysinuric protein intolerance (LPI) is a rare autosomal recessive inborn error of metabolism caused by mutations in SLC7A7, which encodes a component of the dibasic amino acid transporter found in intestinal and renal tubular cells. Patients typically present with vomiting, diarrhea, irritability, failure to thrive, and symptomatic hyperammonemia after protein-rich meals. Long-term complications may include pulmonary alveolar proteinosis, renal disease, and osteoporosis. We present a 5-year-old male who was followed in our skeletal dysplasia clinic for 3 years for multiple fractures, idiopathic osteoporosis, and short stature in the absence of typical features of LPI. Whole exome sequencing performed to determine the etiology of the osteoporosis and speech delay identified a nonsense mutation in SLC7A7. Chromosome microarray analysis identified a deletion involving the second allele of the same gene, and biochemical analysis supported the diagnosis of LPI. Our patient's atypical presentation underscores the importance of maintaining a high index of suspicion for LPI in patients with unexplained fractures and idiopathic osteoporosis, even in the absence of clinical symptoms of hyperammonemia after protein rich meals or other systemic features of classical LPI. This case further demonstrates the utility of whole exome sequencing in diagnosis of unusual presentations of rare disorders for which early intervention may modify the clinical course.
| S-EPMC4235665 | biostudies-literature
Project description:The Ngorongoro Crater is an intact caldera with an area of approximately 310 km2 located within the Ngorongoro Conservation Area (NCA) in northern Tanzania. It is known for the abundance and diversity of its wildlife and is a UNESCO World Heritage Site and an International Biosphere Reserve. Long term records (1963-2012) on herbivore populations, vegetation and rainfall made it possible to analyze historic and project future herbivore population dynamics. NCA was established as a multiple use area in 1959. In 1974 there was a perturbation in that resident Maasai and their livestock were removed from the Ngorongoro Crater. Thus, their pasture management that was a combination of livestock grazing and fire was also removed and 'burning' stopped being a regular occurrence until it was resumed in 2001 by NCA management. The Maasai pasture management would have selected for shorter grasses and more palatable species. Vegetation mapping in 1966-1967 recorded predominately short grasslands. Subsequent vegetation mapping in the crater in 1995 determined that the grassland structure had changed such that mid and tall grasses were dominant. After removal of the Maasai pastoralists from the Ngorongoro Crater in 1974, there were significant changes in population trends for some herbivore species. Buffalo, elephant and ostrich numbers increased significantly during 1974-2012. The zebra population was stable from 1963 to 2012 whereas population numbers of five species declined substantially between 1974 and 2012 relative to their peak numbers during 1974-1976. Grant's and Thomson's gazelles, eland, kongoni, and waterbuck (wet season only) declined significantly in the Crater in both seasons after 1974. In addition, some herbivore species were consistently more abundant inside the Crater during the wet than the dry season. This pattern was most evident for the large herbivore species requiring bulk forage, i.e., buffalo, eland, and elephant. Even with a change in grassland structure, total herbivore biomass remained relatively stable from 1963 to 2012, implying that the crater has a stable carrying capacity. Analyses of rainfall indicated that there was a persistent cycle of 4.83 years for the annual component. Herbivore population size was correlated with rainfall in both the wet and dry seasons. The relationships established between the time series of historic animal counts in the wet and dry seasons and lagged wet and dry season rainfall series were used to forecast the likely future trajectories of the wet and dry season population size for each species under three alternative climate change scenarios.
| S-EPMC7064247 | biostudies-literature
Project description:ObjectiveTo determine the prevalence of fever phobia among caregivers of children presenting to New Zealand EDs.MethodsA cross-sectional survey was administered to caregivers of children <5 years of age presenting to three New Zealand EDs. We defined fever phobia as caregivers having a high level of concern regarding fever or having incorrect beliefs regarding the consequences of fever.ResultsA total of 502 caregivers completed the survey. Fever phobia was present in 365 (74.3% [95% confidence interval, CI 70.3-78.0%]) respondents, with 242 (49.3% [95% CI 44.9-53.7%]) caregivers reporting a high level of concern regarding fever, and 288 (61.8% [95% CI 57.3-66.1%]) caregivers reporting at least one incorrect belief regarding the consequences of fever. Majority of caregivers (n = 383, 87.6% [95% CI 84.2-90.4%]) knew the correct dosing interval for paracetamol, compared to less than half of caregivers (n = 179, 42.5% [95% CI 37.9-47.3%]) for ibuprofen. Caregivers reported non-evidence-based fever management practices such as sponging, always giving paracetamol and/or ibuprofen for fever, and waking children from sleep to give antipyretics. Over one-third of caregivers identified ED doctors (n = 195, 40.2% [95% CI 34.7-43.2%]) and ED nurses (n = 173, 35.7% [95% CI 31.5-40.0%]) as sources of information regarding fever management. A higher level of education was associated with fever phobia (odds ratio 1.68 [95% CI 1.04-2.72], P = 0.04).ConclusionsFever phobia is prevalent among caregivers of children presenting to New Zealand EDs. Opportunistic caregiver education in the ED in conjunction with public health strategies are needed to dispel undue fears and misconceptions about fever.
| S-EPMC9291848 | biostudies-literature
Project description:Cost-effective heat mitigation strategies are imperative for maintaining milk production and dairy farm profitability in the U.S. with projected climate change. This study investigated the cost-effectiveness of four heat abatement strategies, including Minimal (open barn or shading), Moderate (forced ventilation), High (fans and misting), and Intense (air conditioning). Heat stress and subsequent impacts on milk production per cow were predicted across nine climatic regions in the U.S. for early (2015 to 2034), mid (2045 to 2064) and late (2081 to 2100) 21st century, using downscaled climate projections. Heat abatements were used to adjust predicted milk production losses and illustrate the potential to reduce milk production losses due to heat stress. Economic analysis included a cost-benefit ratio calculation associated with the implementation of each heat abatement. Results showed that milk production losses were expected to accelerate across the U.S. at a mean rate of 174±7 kg/cow/decade, with the fastest rate in the Southeast region. Relative to Minimal heat abatement, Moderate, High, and Intense heat abatements increased annual milk production per cow by 3%, 4%, and 6% during early-21st century, 3%, 6%, and 11% during mid-21st century, and 3%, 8%, and 21% during late-21st century, respectively. The cost effectiveness of different heat abatement strategies generally increased with subsequently stronger heat abatements. In mid- and late-21st century, mean annual net values of High and Intense heat stress abatement implementation approached -$30 to $190 /cow and -$20 to $590 /cow, respectively, with the largest net annual benefit in late-21st century under Intense abatement. Findings from the study demonstrate the value of using downscaled climate projections to shed light on local and regional strategies to abate heat stress on cattle and mitigate potential milk production losses due to climate change.
| S-EPMC6438606 | biostudies-literature
Project description:With anti-retroviral treatment (ART) scale-up set to continue over the next few years it is of key importance that manufacturers and planners in low- and middle-income countries (LMICs) hardest hit by the HIV/AIDS pandemic are able to anticipate and respond to future changes to treatment regimens, generics pipeline and demand, in order to secure continued access to all ARV medicines required. We did a forecast analysis, using secondary WHO and UNAIDS data sources, to estimate the number of people living with HIV (PLHIV) and the market share and demand for a range of new and existing ARV drugs in LMICs up to 2025. UNAIDS estimates 24.7 million person-years of ART in 2020 and 28.5 million person-years of ART in 2025 (24.3 million on first-line treatment, 3.5 million on second-line treatment, and 0.6 million on third-line treatment). Our analysis showed that TAF and DTG will be major players in the ART regimen by 2025, with 8 million and 15 million patients using these ARVs respectively. However, as safety and efficacy of dolutegravir (DTG) and tenofovir alafenamide (TAF) during pregnancy and among TB/HIV co-infected patients using rifampicin is still under debate, and ART scale-up is predicted to increase considerably, there also remains a clear need for continuous supplies of existing ARVs including TDF and EFV, which 16 million and 10 million patients-respectively-are predicted to be using in 2025. It will be important to ensure that the existing capacities of generics manufacturers, which are geared towards ARVs of higher doses (such as TDF 300mg and EFV 600mg), will not be adversely impacted due to the introduction of lower dose ARVs such as TAF 25mg and DTG 50mg. With increased access to viral load testing, more patients would be using protease inhibitors containing regimens in second-line, with 1 million patients on LPV/r and 2.3 million on ATV/r by 2025. However, it will remain important to continue monitoring the evolution of ARV market in LMICs to guarantee the availability of these medicines.
| S-EPMC5063297 | biostudies-literature