Journal Search

Journal Search - December 2003


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Paul Worley1
-, Editor-in-Chief


* Jennifer Richmond


1 Rural and Remote Health


19 December 2003 Volume 3 Issue 4


RECEIVED: 16 December 2003

ACCEPTED: 19 December 2003


Worley P.  Journal Search - December 2003. Rural and Remote Health 2003; 3: 260. Available: www.rrh.org.au/journal/article/260


© Paul Worley 2003 A licence to publish this material has been given to Deakin University, deakin.edu.au

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In December, Journal Search brings Rural and Remote Health users a collection of holiday abstracts from recent MEDLINE-listed articles. This month's title key words included: alcohol, alpine, irukandji syndrome, jellyfish, MVA, road, rural, ski, snake bite.

full article:

Zhongguo Zhong Xi Yi Jie He Za Zhi 2003; 23: 590-2 [In Chinese]
[Clinical observation on treatment of snake bite induced disseminated intravascular coagulation by qinwen baidu decoction]
Miao YN, Chen MC, Huang Z
Emergency Department, Zhongshan Municipal TCM Hospital, Guangdong 528400. zschenmc@21cn.com

OBJECTIVE: To observe the effect of Qinwen Baidu Decoction (QBD) in treating snake bite induced dissseminated intravascular coagulation (DIC). METHODS: Forty-six patients were randomly divided into the control group (n = 16) and the treated group (n = 30). They were all treated with the conventional therapy, including application of anti-snake venom serum and supplement of blood agglutination factors. For the treated group, QBD was administered additionally. The efficacy of treatment, chief indexes for DIC (platelet, fibrinogen and prothrombin time) and their recovery time, etc. were observed. RESULTS: The total effective rate of the treated group was 93.33%, which was higher than that of the control group (56.35%), and the recovery time of chief DIC indexes in the treated group was significantly shorter than that in the control group respectively (P < 0.01). CONCLUSION: QBD shows obvious effects of shortening therapeutic course and enhancing efficacy in treating snake bite induced DIC.

Presse Med 2003; 32: 1131-7 [In French]
[Aggravation of snake bite in France and their treatment]
de Haro L
Centre Antipoison, Hopital Salvator, 249 bd Sainte Marguerite, 13274 Marseille

VIPERS AT THE ORIGIN OF ENVENOMING: Out of the 4 species of vipers found in France, only two can be responsible for severe envenoming: the aspic viper (Vipera aspis) and the addetr (Vipera berus). CLINICAL GRADING: Since 1992, a grading table published by the Institut Pasteur in Paris helps to assess the severity of the clinical and biological picture. A grade 2 (extensive oedema +/- accompanied by moderate general signs) or notably a grade 3 (giant oedema + severe general signs + biological signs) implies the administration of an antivenom. ANTIVENOM VIPERFAV: Available on the market since 2000, is administered in intravenous infusion, the only route effective. Tolerance to the treatment is good and clinical improvement is rapid after administration of 1 to 4 infusions of antivenom. When confronted with life-threatening envenoming, there is no strong argument to justify the non-use of an antivenom. VIPERINE ENVENOMING: Among the grass snakes, the viperine snake of Montpellier is the only species that is actually venomous. The fangs are posterior in the buccal cavity of the snake, which does not usually permit it to inject its venom in humans. In exceptional circumstances (finger placed in the throat), envenoming has been observed with, in this case, essentially neurological clinical signs: involvement of the cranial nerves, drowsiness. There is no specific treatment for these extremely rare accidents.

Cad Saude Publica 2003 ; 19: 7-16. Epub 2003 Apr 01 [Review. In Portuguese]
[Snake bite epidemiology in the last 100 years in Brazil: a review]
Bochner R, Struchiner CJ.Centro de Informa o Cientifica e Tecnologica, Fundacao Oswaldo Cruz, Rio de Janeiro, RJ, 21045-900, Brasil. rosany@cict.fiocruz.br

We review 30 studies on snake bites in Brazil, published from 1901 to 2000, and conclude that epidemiological analyses conducted in the last 100 years are based on the same variables already identified by Vital Brazil in his pioneering report, i.e., characteristics of the individuals prone to snake bites, the bites themselves, and treatment. The original epidemiological profile was also maintained over the years and indicates that such accidents are more frequent among male farm workers in the 15-49-year age bracket, affecting mainly the lower limbs, and caused by snakes from genus Bothrops.

Full text available at Scielo

Accid Emerg Nurs 2003; 11: 106-11. [Review]
Snake bite in Australia: first aid and envenomation management
Stewart CJ
Emergency Nursing and Critical Care Nursing, Department of Nursing and Midwifery RMIT University Bundoora, PO Box 71, Bundoora 3083, Melbourne, Australia. carmel.stewart@rmit.edu.au

Australia is inhabited by a large variety of snakes, including some of the most poisonous in the world. Sightings are regular, and the incidence of snake bite is estimated to be several thousand a year. A bite does not necessarily result in envenomation occurring, however there are at least 300 snakebites a year requiring treatment of envenomation, with between 1 and 4 fatalities every year. The incidence of fatalities from snake bite has increased over recent years. The explanation for this is unclear, but possible reasons include the urban sprawl, and a delay in application of appropriate first aid and definitive treatment for envenomation. Emergency nurses in particular should be aware of the first aid techniques appropriate for Australian snake bite, as well as the recognition and management of envenomation. This article will outline the steps required and rationale for applying first aid techniques considered to be effective in retarding spread and circulation of snake venom. It will also discuss the manifestations that indicate systemic envenomation, and management considered to be responsible for reducing the incidence of death from snake envenomation in Australia.

Full text available at Elsevier, Science Direct

Acta Anaesthesiol Scand 2003; 47: 226-9
Exotic snake bite: a challenge for the Scandinavian anesthesiologist?
Chew MS, Guttormsen AB, Metzsch C, Jahr J
Department of Anesthesia and Intensive Care, Lund University Hospital, Lund, Sweden

BACKGROUND: Venomous snake bites are uncommon in the Scandinavian countries. Envenomation from exotic snakes do however occur, mostly amongst snake handlers. This case report documents the effects and treatment for envenomation from Hoplocephalus bungaroides, or the Broad-Headed snake, native to eastern and southern Australia. Snakes of the genus Hoplocephalus have previously been described as of 'lesser medical importance' because of their rarity. METHODS: This case report describes the signs, symptoms and management of systemic envenomation in a previously healthy man. RESULTS: The patient developed signs of severe coagulopathy less than an hour after envenomation. There was also biochemical evidence of rhabdomyolysis, and cardiotoxicity. At no time did the patient develop respiratory insufficiency, neurotoxicity or renal failure. The patient was initially managed with i.v. crystalloids, plasma, corticosteroids and antifibrinolytics and by observation in the intensive care unit (ICU). Coagulopathy resolved after causal treatment with monovalent Tiger snake antivenom. CONCLUSION: The patient made good progress and was well on discharge from the ICU 26 h postenvenomation. Copyright Acta Anaesthesiologica Scandinavica 47 (2003)

Mayo Clin Proc 2003; 78: 1557-60
Acute myocardial infarction in a professional diver after jellyfish sting
Salam AM, Albinali HA, Gehani AA, Al Suwaidi J
Department of Cardiology and Cardiovascular Surgery, Hamad Medical Corporation, Doha, Sate of Qatar

To our knowledge, acute myocardial infarction after jellyfish envenomation has not been reported previously. We describe a previously healthy 45-year-old male diver who had an acute inferior myocardial infarction with right ventricular involvement after a jellyfish sting on his left forearm while diving in the Gulf Sea. The patient had a normal controlled ascent after the incident. He had no risk factors for coronary artery disease, and cardiac catheterization revealed normal coronary arteries. Acute myocardial infarction should be considered in patients who experience chest pain or have hemodynamic compromise after jellyfish envenomation.

Pediatr Emerg Care 2003; 19: 84-86
Severe dyspnea due to jellyfish envenomation
Armoni M, Ohali M, Hay E

During the summer, jellyfish stings are the most common envenomation situations encountered by humans in the marine environment. The more people swim, scuba dive, or snorkel, the more necessary it is to know what should be done immediately, how life can be saved, how to prevent early and late complications, and how to facilitate convalescence in the event of jellyfish envenomation. We describe an atypical case of a 14-year-old boy with severe dyspnea due to upper airway obstruction caused by a jellyfish sting to the face and outline a practical approach to the treatment of jellyfish stings.

Med J Aust 2003; 178: 34-7 [Review]
Jellyfish envenoming syndromes: unknown toxic mechanisms and unproven therapies
Bailey PM, Little M, Jelinek GA, Wilce JA
Department of Biochemistry, University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia. pbailey@iinet.net.au

Interest in envenoming syndromes caused by Australian jellyfish has been intense since the deaths in early 2002 of two tourists in Queensland, attributed to the Irukandji syndrome. We review current knowledge of these envenoming syndromes, mechanisms of venom action and therapy, focusing on the deadly box jellyfish, Chironex fleckeri, and the array of jellyfish thought to cause the Irukandji syndrome. Current understanding of jellyfish venom activity is very limited, and many treatments are unproven and based on anecdote.

Full text available at MJA online

Ann Emerg Med 2003; 42: 763-6
Irukandji-like syndrome in South Florida divers
Grady JD, Burnett JW

Irukandji syndrome is a constellation of delayed severe local and systemic symptoms occurring after a Carukia barnesi box jellyfish sting involving any exposed skin. These cases are limited to Australia, the habitat of that animal. Numerous other cases of an Irukandji-like syndrome after other small Carybdeid genus envenomations have been reported elsewhere in the world. There have yet been no reports of Irukandji-like syndrome occurring in continental US coastal waters. We describe 3 cases of marine envenomation causing such a symptom complex in US military combat divers off Key West, FL. It is unclear what species caused the injuries, but a member of the Carybdeid genus seems most likely.

J Adolesc 2003; 26: 741-51
Associations among sexual attraction status, school belonging, and alcohol and marijuana use in rural high school students
Rostosky SS, Owens GP, Zimmerman RS, Riggle ED
Department of Educational and Counseling Psychology, University of Kentucky, 245 Dickey Hall, 40506, Lexington, KY, USA

Analysis of data collected from 1725 9th graders from 25 rural high schools revealed that students reporting same-sex attraction or uncertainty about their attraction status also reported significantly lower GPAs, lower school belonging, and higher marijuana and alcohol use. Regression analyses confirmed that beyond the effects of GPA and biological sex, sexual minority attraction status was negatively associated with school belonging. Further, while higher school belonging significantly decreased the odds of alcohol and marijuana use, sexual attraction status did not significantly contribute to the model. Post-hoc analyses indicated that sexual minority students systematically reported that they perceived less privacy in completing the survey, lending support to the notion that these adolescents may feel less trusting of their school environments. These findings are discussed in light of the need for interventions to address the developmental challenges of sexual minority students.

J Rural Health 2003; 19: 497-505
Rural and small-town attitudes about alcohol use during pregnancy: a community and provider sample
Logan TK, Walker R, Nagle L, Lewis J, Wiesenhahn D
Center on Drug and Alcohol Research, University of Kentucky, 1151 Red Mile Road, Suite 1-A, Lexington, KY 40504-2645, USA. tklogan@uky.edu

CONTEXT: While there has been considerable research on prenatal alcohol use, there have been limited studies focused on women in rural and small-town environments. PURPOSE: This 2-part study examines gender differences in attitudes and perceived barriers to intervention in large community sample of persons living in rural and small-town environments in Kentucky (n = 3,346). The study also examines rural/small-town prenatal service providers' perceptions of barriers to assessment and intervention with pregnant substance abusers (n = 138). METHODS: Surveys were administered to a convenience sample of employees and customers from 16 rural and small-town community outlets. There were 1503 males (45%) and 1843 females (55%) ranging in age from under 18 years old to over 66 years old. Surveys also were mailed to prenatal providers in county health departments of the 13-county study area, with 138 of 149 responding. FINDINGS: Overall results of the community sample suggest that neither males nor females were knowledgeable about the harmful effects of alcohol use during pregnancy. Results also indicate substantial gender differences in alcohol attitudes, knowledge, and perceived barriers. Further, prenatal care providers identified several barriers in assessment and treatment of pregnant women with alcohol use problems in rural and small-town communities, including lack of knowledge and comfort with assessment as well as a lack of available and accessible treatment for referrals.

Arch Psychiatr Nurs 2003; 17: 33-41
Vulnerability to alcohol and other drug disorders in rural women
Boyd MR
College of Nursing, University of South Carolina, Columbia, SC 29208, USA

Alcohol and other drug disorders (AOD) are a growing problem among women, with estimates as high as 11 million U.S. women affected. This article is a report of the results from 2 studies investigating risk factors for AOD disorders in rural women. Samples of the 2 studies were combined for a total of 267 women. Analyses focused on victimization as a vulnerability factor for AOD disorders in rural women. Comorbid Axis I mental disorders and nursing implications are discussed.

Behav Res Ther 2003; 41: 1105-12
Posttraumatic stress disorder and psychosocial functioning within two samples of MVA survivors
Kuhn E, Blanchard EB, Hickling EJ
Center for Stress and Anxiety Disorders, 1535 Western Avenue, University at Albany, State University of New York, Albany 12203, USA. ek2110@albany.edu

To examine criterion F variables of PTSD, the psychosocial functioning of two samples of motor vehicle accident (MVA) survivors was investigated. Within each sample, comparisons between MVA survivors with and without PTSD were conducted on four psychosocial functioning indices at three time points. In addition, the relationships between specific PTSD symptom clusters and psychosocial functioning indices were examined. The study revealed that, in general, MVA survivors with PTSD evidenced poorer psychosocial functioning than did survivors without PTSD. The emotional numbing symptoms of PTSD emerged as the most consistent predictors of the psychosocial functioning indices. The implications of these findings to the comprehensive treatment of PTSD are discussed.

Chin J Traumatol 2003; 6: 355-8
The analysis of epidemiological characteristics of road traffic crashes in a mountain city in western China
Zhou JH, Zhao XC, Wang ZG, Zhu PF, Jian HG, Liu DW, Zhou JL, Liu L
The Institute for Traffic Medicine, Research Institute of Surgery, Third Military Medical University, Chongqing 400042, China

OBJECTIVE: To study the epidemiological characteristics and preventive methods of road traffic crashes in a mountain city in western China through sampling investigation of traffic crashes in different regions of Chongqing city in recent years. METHODS: Two police teams of traffic management in downtown, two teams in suburb, one team in county and one freeway team were randomly selected, and road traffic crashes between 1988 and 1997 were investigated and analyzed. RESULTS: A total of 13121 road traffic crashes with 6201 crashes with casualties were analyzed. The incidence of crashes was higher in May, June and July, and on Friday and Wednesday and at 8:00-12:00 and 14:00-18:00 within a day. Casualties were 44.0% in pedestrians and 42.5% in passengers of total casualties. The deaths and severe injuries in pedestrians were 59.1% of total deaths and 56.4% of total severe injuries. The age of drivers and passengers were mainly at 18-30 years, followed by 31-40 years. People over 60 years old accounted for 24.1% of total pedestrian casualty. Head injury was the most common reason for deaths. The main reasons for these crashes were improper driving and violating traffic laws. Violating traffic laws by pedestrian was one of the main reasons for pedestrian casualty. CONCLUSIONS: The crashes are related to the characteristics of geography, climate, society activity of people, and the sense of traffic safety, the basic traffic construction and management in Chongqing. The traffic casualty of pedestrian is a big problem in Chongqing. To prevent and decrease road traffic injuries effective methods should be worked out and propaganda on traffic safety and traffic management should be strengthened according to different characteristics of different regions. To strengthen the first aid and treatment of cranium-brain injury and chest-back injury is also helpful in decreasing traffic deaths.

Full text available at Tydata

Health Policy 2003; 66: 147-58
Long-term follow-up and consequences for severe road traffic injuries-treatment costs and health impairment in Sweden in the 1960s and the 1990s
Maraste P, Persson U, Berntman M
Department of Technology and Society, Lund Institute of Technology, Lund University, Lund, Sweden

The purpose of this study is to provide information from two prospective long-term follow-ups for severe road traffic injuries in Sweden. The long-term consequences, in terms of loss of health and costs of care, are presented for severe injuries in Sweden in the early 1990s and are compared with information on injury severity and health care utilisation 25 years ago. The follow-up in the 1990s show that, 1 year after the accident 38% of the non-fatal adults were suffering of some functional disability, pain and distress. Adults suffering from long-term loss of health decreased to 23% on average 3.7 years after the accident. The average health care cost was estimated to SEK46200 (in 1995 prices), and the average in-patient care was 10 days. However, when also including subsequent expected life-long care for three severely injured patients, the average incidence-based health care cost was estimated to SEK100300. In the 4-5 year follow-up 25 years ago, severe traffic injuries were treated on average 21 days in hospital and 38% of the adults were still suffering from long-term physical effects. Conclusions to be drawn are that treatment in hospital of severe traffic injuries has shortened by half and long-term consequences have not been worsened. Our results indicate that long-term effects do not cause as serious loss of health nowadays as they did 25 years ago.

Arthroscopy 2003; 19: 194-202 [Review]
A review of ski injuries resulting in combined injury to the anterior cruciate ligament and medial collateral ligaments
Pressman A, Johnson DH
Sports Medicine Clinic, Carleton University, Ottawa, Ontario, Canada

Alpine skiing is a global winter recreational sport with 15 million participants in the United States alone, and an overall injury rate of 2.5 per 1,000 ski person-days. Isolated injury to the anterior cruciate ligament (ACL) or the medial collateral ligament (MCL) is common among ski injuries; however, combined injury to these structures is rare. Controversy in the management of ACL instability following alpine ski injury is diminishing with improvements in the techniques of intra-articular cruciate reconstruction. However, the management of the combined ACL-MCL injury remains something of an enigma. Evidence exists to support both surgical and nonsurgical management strategies for the medial structures, but little consensus exists for the timing of the repair. This paper highlights the mechanisms of ski injuries that can result in combined injury to the ACL and MCL. The anatomy and biomechanics of the medial complex as it relates both to stability and operative repair are reviewed, and literature on the techniques and indications used for MCL repair in the setting of a combined injury is presented. On the basis of this review, we believe that an injury to the MCL does not need to be repaired if the ACL is reconstructed after a combined injury.

Resuscitation 2003; 58: 159-69
First aid knowledge of alpine mountaineers
Kuepper T, Wermelskirchen D, Beeker T, Reisten O, Waanders R
Department for Aerospace Medicine, Technical University of Aachen, Aachen, Germany. kuepper@crm.de

OBJECTIVE: The study evaluates the knowledge of first aid in mountaineerers who climb routes of moderate difficulty in the western Alps. Additionally the mountaineer's ability to assess their own knowledge was investigated. An analysis of the mountain accidents in the same area showed the real need for knowledge. DESIGN: An investigation of a cohort of mountaineers who reached Margherita Hut (4559 m, Monte Rosa; n=283; 17 questions with five answers each (11 themes)). RESULTS: Knowledge in general is poor. Best results were obtained in relation to cardiac emergencies, altitude sickness, and hypovolaemic shock, and worst resulted with hypothermia, traumatic injuries, treatment of pain and management of emergencies. Although traumatic injuries represent about 50% of mountain accidents in the region, there was a general lack of basic knowledge on this subject. Self-assessment of the individuals level of knowledge and their need for further education was inadequate. Differences between sex, age, nationality, mountaineering professional experience (medical education) are discussed. CONCLUSION: First aid education of mountaineers must be improved. Adequate education should take into account the specific demands of alpine emergencies.

Sports Med. 2002; 32: 785-93
Alpine ski injuries and their prevention
Koehle MS, Lloyd-Smith R, Taunton JE
Allan McGavin Sports Medicine Centre, University of British Columbia, Vancouver, British Columbia, Canada. mskoehle@interchange.ubc.ca

Alpine skiing is a popular sport with significant risk of injury. Since the 1970s, injury rates have dropped from approximately 5 to 8 per 1000 skier-days to about 2 to 3 per 1000 skier-days. The nature of the injuries has also been transformed over the same period. Lower leg injuries are becoming less common while the incidence of knee sprains and upper extremity injuries is becoming more common. Much of this change can be attributed to advancements in binding technology, which effectively reduces lower leg injury, but does not adequately address the issue of knee sprains. Along with design, binding adjustment and maintenance are important preventative factors. Poorly adjusted bindings have been correlated with increased injury rates. Upper extremity injuries constitute approximately one-third of skiing injuries, with ulnar collateral ligament sprains and shoulder injuries being the most common. Strategies to prevent these include proper poling technique and avoidance of non-detachable ski pole retention devices. Spinal injuries in skiers have been traditionally much less common than in snowboarders, but this disparity is likely to diminish with the recent trend of incorporating snowboarding moves into skiing. Strategies to help reduce these injuries include promoting the development of terrain parks and focussing on proper technique during such moves. Head injuries have been increasing in incidence over recent decades and account for more than half of skiing-related deaths. The issue of ski helmets remains controversial while evidence for their efficacy remains under debate. There is no evidence to demonstrate that traditional ski instruction reduces injury frequency. More specific programmes focussed on injury prevention techniques are effective. The question of pre-season conditioning to prevent injuries needs further research to demonstrate efficacy.

Eur Urol 2002; 42: 297-300
Blunt renal trauma in children: 26 years clinical experience in an alpine region
Radmayr C, Oswald J, Muller E, Holtl L, Bartsch G
Department of Urology, University of Innsbruck, A-6020, Anichstr. 35, Innsbruck, Austria christian.radmayr@uibk.ac.at

OBJECTIVES: From 1975 to 2001, 254 children aged younger than 17 were transferred to our department for renal trauma. We performed a retrospective study to assess causality and kind of the trauma, diagnostic procedures and therapeutic consequences, respectively. METHODS: The 254 children at a mean age of 10.56 years (+/-3.8) ranging from 2 to 17 years were treated for kidney trauma. Among these, 166 presented with a grade I trauma according to the kidney injury scale of the American Association for the Surgery of Trauma without any other accompanying injuries and 88 had a grade II-V lesion, respectively. Diagnostic evaluation included various standard lab tests such as urinalysis and routine blood parameters, ultrasound, IVP and/or CT. RESULTS: Most of the traumatic injuries resulted from skiing accidents. However, 18 children had a severe polytrauma with laceration of other vital organs. Most of the renal injuries could be treated conservatively. Surgical treatment options included immediate exploration, reconstruction, partial resection, or even nephrectomy. No child died. CONCLUSIONS: Due to leisure time activities in our region, skiing accidents often result in isolated laceration of the kidney. About one third presented with a severe kidney trauma, and approximately 20% of all affected children required surgical therapy. However, most of the injured kidneys could be preserved and only four nephrectomies had to be performed.