International journal of environmental research and public health
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Int J Environ Res Public Health · Nov 2018
Comparative StudyRisk Factors Contributing to Higher Mortality Rates in Elderly Patients with Acute Traumatic Subdural Hematoma Sustained in a Fall: A Cross-Sectional Analysis Using Registered Trauma Data.
We aimed to explore the risk factors that contribute to the mortality of elderly trauma patients with acute subdural hematoma (SDH) resulting from a fall. Mortality rates of the elderly were compared to those of young adults. ⋯ In this study, we identified that pre-existing CAD, ESRD, hematoma volume, ISS, and coagulopathy were significant independent risk factors for mortality in patients with acute traumatic SDH. These results suggest that death following acute SDH is influenced both by the extent of neurological damage and the overall health of the patient at the time of injury.
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Int J Environ Res Public Health · Oct 2018
The Reverse Shock Index Multiplied by Glasgow Coma Scale Score (rSIG) and Prediction of Mortality Outcome in Adult Trauma Patients: A Cross-Sectional Analysis Based on Registered Trauma Data.
The reverse shock index (rSI) multiplied by Glasgow Coma Scale (GCS) score (rSIG), calculated by multiplying the GCS score with systolic blood pressure (SBP)/hear rate (HR), was proposed to be a reliable triage tool for identifying risk of in-hospital mortality in trauma patients. This study was designed to externally validate the accuracy of the rSIG in the prediction of mortality in our cohort of trauma patients, in comparison with those that were predicted by the Revised Trauma Score (RTS), shock index (SI), and Trauma and Injury Severity Score (TRISS). Adult trauma patients aged ≥20 years who were admitted to the hospital from 1 January 2009 to 31 December 2017, were included in this study. ⋯ In addition, SI had the significantly worse predictive accuracy than all of the other three models in all trauma patients (AUC 0.57), and the patients with (AUC 0.53) or without (AUC 0.63) head injury. This study revealed that rSIG had a significantly higher predictive accuracy of mortality than SI in all of the studied population but a lower predictive accuracy of mortality than RTS in all adult trauma patients and in adult patients with isolated head injury. In addition, in the adult patients without head injury, rSIG had a similar performance as RTS to the predictive risk of mortality of the patients.
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Int J Environ Res Public Health · Oct 2018
ReviewClimate Change Adaptation through the Water-Energy-Food Nexus in Southern Africa.
Climate change is a complex and cross-cutting problem that needs an integrated and transformative systems approach to respond to the challenge. Current sectoral approaches to climate change adaptation initiatives often create imbalances and retard sustainable development. Regional and international literature on climate change adaptation opportunities and challenges applicable to southern Africa from a water-energy-food (WEF) nexus perspective was reviewed. ⋯ In this regard, a well-coordinated and integrated WEF nexus approach offers opportunities to build resilient systems, harmonise interventions, and mitigate trade-offs and hence improve sustainability. This would be achieved through greater resource mobilisation and coordination, policy convergence across sectors, and targeting nexus points in the landscape. The WEF nexus approach has potential to increase the resilience of marginalised communities in southern Africa by contributing towards attaining the Sustainable Development Goals (SDGs 1, 2, 3, 6, 7, and 13).
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Int J Environ Res Public Health · Oct 2018
Haze Attitudes and the Willingness to Pay for Haze Improvement: Evidence from Four Cities in Shandong Province, China.
Given the health and welfare impacts of haze, haze reduction governance challenges Chinese policy-makers. Surprisingly, there have been no studies of the differences in the public's willingness to pay (WTP) for haze governance within a province. Yet haze reduction policies are implemented at the provincial level. Based on the contingent valuation method, data on WTP for haze governance across four industrial cities in Shandong province were collected using a questionnaire survey. ⋯ City-specific differences in WTP may caution against "one size fits all" policies. The study indicates that the government may need to target policies to specific cities and the characteristics of residents in those cities by age, education, and income groups and residents' subjective evaluation of the government and the haze problem and those responsible for pollution.
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Int J Environ Res Public Health · Oct 2018
Significance of Blood Transfusion Units in Determining the Probability of Mortality among Elderly Trauma Patients Based on the Geriatric Trauma Outcome Scoring System: A Cross-Sectional Analysis Based on Trauma Registered Data.
Background: For elderly trauma patients, a prognostic tool called the Geriatric Trauma Outcome Score (GTOS), where GTOS = (age) + (ISS × 2.5) + (22 if any packed red blood cells (pRBCs) were transfused within 24 h after admission), was developed for predicting mortality. In such calculation, a score of 22 was added in the calculation of GTOS regardless of the transfused units of blood. This study aimed to assess the effect of transfused blood units on the mortality outcomes of the elderly trauma patients who received blood transfusion (BT). ⋯ The patients who received BT ≥ 8 U and 10 U had a 2.1-fold (AOR, 2.1; 95% CI, 1.09⁻3.96; p < 0.001) and 4.4-fold (AOR, 4.4; 95% CI, 2.04⁻9.48; p < 0.001) adjusted odds of mortality than those who received BT < 8 U and <10 U, respectively. Conclusions: This study revealed that the units of BT did matter in determining the probability of mortality. For those who received more units of blood, the mortality may be underestimated according to the GTOS.