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Extreme bushfires are devastating and costly and are predicted to increase in frequency. This project investigated emergency responders’ (ER) compensable injury/disease costs associated with extreme bushfire periods compared with the general workforce. Workers’ compensation claims data for Victoria, Australia, were sourced for ER and controls (10% of the general workforce) from January 2005 to April 2021 (encompassing two extreme bushfires). Using generalised linear models, claims from ambulance officers, career firefighters, police, and controls were compared across extreme bushfires, other summers, and all other periods. In total, ER made 749/24,008 (3.1%) claims in extreme bushfire periods, compared to 1254/49,484 (2.5%) in the controls. The study group overall (including both ER and the general workforce control group) experienced significantly higher income compensation costs/claims during extreme bushfire periods, with a 31% increase. ER’ costs/claims were highest for mental illness, burns and cancer. After accounting for bushfire impacts on the general workforce, total claims costs were increased by 67% among firefighters in extreme bushfire periods, largely attributable to fatality payments (other non-medical expenses). These results highlight the need for targeted injury prevention for fatal and non-fatal injuries among ERs and measures that address the broader socio-economic impacts on ERs and the general workforce.

Background Antimicrobial stewardship programs (ASPs) are an internationally recognized strategy for reducing antimicrobial resistance while maintaining patient safety. ASP activities include the restriction of broad-spectrum antibiotics, the establishment of hospital guidelines based on antibiograms, and the promotion of appropriate antibiotic use. This study aimed to determine whether the implementation of antimicrobial stewardship practices improved the effects of a peri-procedure antibiotic prophylaxis prescribed by urologists for patients with spinal cord injury/disease (SCI/D) undergoing minor urological procedures at a tertiary care hospital. Methods This single-group, quasi-experiment study included adult patients with SCI/D who required minor urological procedures (cystoscopy, cytobotox, cystolitholapaxy, and urodynamic study) and who were hospitalized between 2012 and 2020. Results In total, 233 patients were included in each of the pre- and post-ASP implantation groups. There was a significant reduction in antibiotic use among patients who received a pre-procedure antimicrobial prophylaxis in the post- compared to the pre-implementation group (45.9% vs. 24.46%, p  < 0.0001), and there was a highly significant reduction in the post- compared to the pre-implementation group in the number who received a post-procedure prophylaxis (16.7% vs. 1.2%, p  < 0.0001). Conclusion ASP implementation is a highly effective strategy for reducing the use of peri-procedure antimicrobial prophylaxes in patients with SCI/D injuries undergoing minor urological procedures.

BackgroundDespite the efforts of contractors to identify and reduce any occupational risk that exists in subcontracted works, if the associated risks cannot be eliminated and reduced and subcontractors have to take risks, this situation can be called ‘risk transfer.’ The hypothesis of this study is that the contractor–subcontractor status of a company affects the risk of occupational injury or occupational disease. The inside subcontractor and outside subcontractor represent subcontractors located inside and outside the contractor workplace, respectively.MethodsThe dataset from the 9th Occupational Safety and Health Company Survey (OSHCS) with 5219 workplaces, which was conducted in South Korea, was used. After the exclusion of 45 workplaces with no reported employees, 5174 workplaces with a total of 1,072,583 employees were used for analysis. Poisson regression was applied with the contractor–subcontractor category as the independent variable and the number of both occupational injury and disease cases per workplace as the dependent variable. Poisson regression is an appropriate model for the count-data analysis of rare events that do not follow a normal distribution but rather follow a right-skewed distribution.ResultsCompared to the ‘contractor’ category, the ‘outside contractor’ reported the highest risk ratio, 1.66 (95% Confidence Interval, CI 1.09–2.41). The ‘inside contractor’ reported the second highest risk ratio, 1.39 (95% CI 1.07–1.78). In contrast, the ‘both contractor and subcontractor’ category reported a statistically significant decreased risk ratio of 0.69 (95% CI 0.57–0.84). The ‘neither contractor nor subcontractor’ category showed a statistically equivocal risk ratio of 0.91 (95% CI 0.76–1.07).ConclusionThis study confirmed the increased risk of occupational injuries and diseases for subcontractors, whether located inside or outside the contractor workplace (1.66-fold and 1.39-fold increased risk, respectively). Future individual-based epidemiologic studies such as case–control and cohort studies could provide more detailed information such as specific risk factors associated with subcontracted works and confounders according to industry classification.

Many compounds in Chinese medicine formulae, including Danhong injection (DHI) formulae, are capable of stimulating angiogenesis and promoting vascular repair, but their chemical basis and action mechanisms remain poorly defined. The aim of this study is to determine the minimal native chemical composition of DHI for the pro-angiogenesis activity and to evaluate its contribution from local endothelial cells (ECs) and bone marrow-derived endothelial progenitor cells (EPCs). Our study demonstrated that the action of DHI in accelerating the recovery of hindlimb blood flow in a ischemic rat model was attributable to its local CXCR4-mediated pro-angiogenesis activity in mature endothelial cells, as well as to its ability to promote the proliferation, migration, adhesion, and angiogenesis of EPCs via integrated activation of SDF-1α/CXCR4, VEGF/KDR, and eNOS/MMP-9 signal pathways. Combination experiments narrowed down the angiogenic activity into a few components in DHI. Reconstitution experiment defined that a combination of tanshinol, protocatechuic aldehyde, salvianolic acid B, and salvianolic acid C in their native proportion was necessary and sufficient for DHI’s angiogenic activity. Compared with the full DHI, the minimal reconstituted four active principles had the same effects in promoting tube formation in vitro , improving perfusion and recovery of ischemic limb, and enhancing angiogenesis in ischemic mice post-hindlimb ischemia in vivo .

Individuals with spinal cord injury/disorder (SCI/D) are at high risk for developing secondary osteoporosis. Bone loss after neurologic injury is multifactorial and is dependent on the time from and extent of neurologic injury. Most bone loss occurs in the first year after complete motor paralysis, and fractures occur most commonly in the distal femur and proximal tibia (paraplegic fracture). The 2019 International Society for Clinical Densitometry Position Statement in SCI establishes that dual-energy X-ray absorptiometry (DXA) can be used to both diagnose osteoporosis and predict lower extremity fracture risk in individuals with SCI/D. Pharmacologic treatments used in primary osteoporosis have mixed results when used for SCI/D-related osteoporosis. Ambulation, standing, and electrical stimulation may be helpful at increasing bone mineral density (BMD) in individuals with SCI/D but do not necessarily correlate with fracture risk reduction. Clinicians caring for individuals with spinal cord–related paralysis must maintain a high index of suspicion for fragility fractures and consider referral for surgical evaluation and management.

Objective: To demonstrate properties of the International Classification of the External Cause of Injury (ICECI) as a tool for use in injury prevention research. Methods: The Childhood Injury Prevention Study (CHIPS) is a prospective longitudinal follow up study of a cohort of 871 children 5–12 years of age, with a nested case crossover component. The ICECI is the latest tool in the International Classification of Diseases (ICD) family and has been designed to improve the precision of coding injury events. The details of all injury events recorded in the study, as well as all measured injury related exposures, were coded using the ICECI. This paper reports a substudy on the utility and practicability of using the ICECI in the CHIPS to record exposures. Interrater reliability was quantified for a sample of injured participants using the Kappa statistic to measure concordance between codes independently coded by two research staff. Results: There were 767 diaries collected at baseline and event details from 563 injuries and exposure details from injury crossover periods. There were no event, location, or activity details which could not be coded using the ICECI. Kappa statistics for concordance between raters within each of the dimensions ranged from 0.31 to 0.93 for the injury events and 0.94 and 0.97 for activity and location in the control periods. Discussion: This study represents the first detailed account of the properties of the ICECI revealed by its use in a primary analytic epidemiological study of injury prevention. The results of this study provide considerable support for the ICECI and its further use.