Search

The present study addressed the contentious discussions about the benefits and risks of nipple shield use. The objective was to explore self‐reported reasons for using a nipple shield and examine associations pertaining to the mother, the infant and duration of breastfeeding. Data were collected from 4815 Danish mothers (68%) who filled out a self‐administered questionnaire with open and closed question. Data were analyzed by content and statistical descriptive and multivariable analysis. Results showed that 22% of the mothers used nipple shields in the beginning and 7% used it the entire breastfeeding period. Primiparae used nipple shields more often than multiparae, and early breastfeeding problems as well as background factors like lower age, education and higher body mass index were associated with a higher likelihood of using nipple shields. Characteristics of infants associated with introducing nipple shields were lower‐ gestational age and birthweight. The use of nipple shields was furthermore found to be associated with a threefold increased risk of earlier cessation of exclusive breastfeeding: among primiparae odds ratio = 3.80 (confidence interval 2.61–5.53); among multiparae odds ratio = 3.33 (confidence interval 1.88–5.93). Mothers' own descriptions underlined how various early breastfeeding problems led to the use of nipple shields. Some mothers were helped through a difficult period; others described the use creating a kind of dependence. The results highlight how nipple shields may help breastfeeding mothers in the early period but is not necessarily a supportive solution to the inexperienced mother who needs extra support in the early process of learning to breastfeed. [ABSTRACT FROM AUTHOR]

Introduction: This study presents the prediction of driver yielding compliance and pedestrian tendencies to press pushbuttons at signalized mid-block Danish offset crosswalks., Method: It applies Bayesian Networks (BNs) analysis, which is basically a graphical non-functional form model, on observational survey data collected from five signalized crosswalks in Las Vegas, Nevada. The BNs structures were learnt from the data by the application of several score functions. By considering prediction accuracy and the Area under the Receiver Operating Characteristic (ROC) curves, the BN learnt using the Bayesian Information Criterion (BIC) score resulted as the best network structure, compared to the ones learnt using K2 and the Akaike Information Criterion (AIC). The BIC score-based structure was then used for parameter learning and probabilistic inference., Results: Results show that, when considering an individual scenario, the highest predicted yielding compliance (81%) is attained when pedestrians arrive at the crosswalk while the flashes are active, whereas the lowest predicted yielding compliance (23.4%) is observed when the pedestrians cross between the yield line and advanced pedestrian crosswalk sign. On the other hand, crossing within marked stripes, approaching the crosswalk from the near side of the pushbutton pole, inactive flashing lights, and being the first to arrive at the crosswalk result in relatively high-predicted probabilities of pedestrians pressing pushbutton. Furthermore, with a combination of scenarios, the maximum achievable predicted yielding probability is 87.5%, while that of pressing the button was 96.3%. Practical applications: Traffic engineers and planners may use these findings to improve the safety of crosswalk users., (Published by Elsevier Ltd.)

Objective: This study aims at evaluating the effectiveness of electronic stability control (ESC) on single-vehicle injury accidents while controlling for a number of confounders influencing the accident risk., Methods: Using police-registered injury accidents from 2004 to 2011 in Denmark with cars manufactured in the period 1998 to 2011 and the principle of induced exposure, 2 measures of the effectiveness of ESC were calculated: The crude odds ratio and the adjusted odds ratio, the latter by means of logistic regression. The logistic regression controlled for a number of confounding factors, of which the following were significant. For the driver: Age, gender, driving experience, valid driving license, and seat belt use. For the vehicle: Year of registration, weight, and ESC. For the accident surroundings: Visibility, light, and location. Finally, for the road: Speed limit, surface, and section characteristics., Results: The present study calculated the crude odds ratio for ESC-equipped cars of getting in a single-vehicle injury accident as 0.40 (95% confidence interval [CI], 0.34-0.47) and the adjusted odds ratio as 0.69 (95% CI, 0.54-0.88). No difference was found in the effectiveness of ESC across the injury severity categories (slight, severe, and fatal)., Conclusions: In line with previous results, this study concludes that ESC reduces the risk for single-vehicle injury accidents by 31% when controlling for various confounding factors related to the driver, the car, and the accident surroundings. Furthermore, it is concluded that it is important to control for human factors (at a minimum age and gender) in analyses where evaluations of this type are performed.

In 2002 - 2009 Danish forces suffered a mortality rate of 0.09% in Iraq and 0.38% in Afghanistan, and a morbidity rate of 0.30% in Iraq and 1.01% in Afghanistan, as a result of weapons effects. In Afghanistan the survival rate is 97.0% for Danish wounded who were alive on arrival at UK R3 Hospital. British data from Afghanistan are compared to the Danish figures and there is no significant difference. We found an increase in injuries and deaths caused by mines/IEDs from 33% in 2006 to 72.7% in 2009 of all weapon effects causes. The more offensive war fighting posture of the Danish forces in Afghanistan has resulted in greater numbers of casualties. The study also indicates that the great majority of fatalities occur almost immediately at the point of injury. Most of the wounded survive, and a large of number of them are only lightly injured with a partial incapacity level of less than five percent. Haemostatic's and active employment of tourniquets, improved first aid training and training of medics, better evacuation methods including optimised in-flight diagnostics and treatment (including blood transfusion) by Medical Emergency Response Teams, Damage Control Surgery as well as access to quicker diagnostic methods have increased survivability.

Introduction: Before the new temporary ice rink in Esbjerg was built, opponents feared that it would disproportionately increase the number of traumas needing medical care at the hospital. The reason for this concern was that it was built with ramps., Material and Methods: During the winter of 2004 an estimated 30,000 people visited the two ice rinks in Esbjerg. The temporary rink had ramps, whereas the permanent rink had no ramps. A total of 104 persons were injured and needed treatment at the emergency room of orthopaedic surgery. They all received a questionnaire in order to obtain information about a) whether the accident took place on one or the other ice rink, and b) how frequently safety equipment was used., Results: The answers from the questionnaire were used along with information obtained from the emergency room journals. We wanted to establish if accidents on the temporary ice rink were more serious or if the proportion of injuries was higher compared to accidents on the permanent ice rink., Discussion: There was no significant difference in the number of injuries or in the severity of the traumas resulting from skating on the temporary ice rink compared with the permanent rink. Only 4% used safety equipment., Conclusion: Having ramps on the ice rink produced no significant increase in the proportion of injuries, nor did it produce more severe traumas. Safety equipment protecting hand and wrist would probably decrease the number of soft tissue injuries presented at hospital.

On 1st March 1994, a passenger train with a speed of 85 km/h ran into the rear end of a stopped passenger train north of Aarhus, Denmark. No fatalities occurred. Questionnaires were sent to passengers and crew and 113 of 128 (88%) answered. In the stopped train 32% (9/28) of the sitting passengers compared with 12% (9/76) in the moving train had symptons corresponding to a whiplash lesion. Only the chairs in the moving train had head rests which might explain the observed difference. In the rest section of the moving train with all seats facing the same direction 81% (13/16) of the sitting passengers had face injuries compared to 13% (8/60) in the rest of the train. The higher incidence in the rest section was caused by folding tables at the back of the seats. Serious thoraco-abdominal injuries were only seen in one patient despite the fact that 37 passengers were thrown againsts tables between the seats in the second class section of the moving train. The tables were fragile and usually gave way. In conclusion, carriage interior has a major influence on personal injuries at railway accidents.

At the University Hospital of Odense DK an increasing number of roller skating injuries has been observed, and a total of 283 injuries were registered in 1996. They all received a questionnaire in order to obtain information about: The differences between users of conventional and in-line roller skaters in pattern of injury, to what extent safety gear was used and occurrence of "splint-top" fractures. Eighty-seven percent were returned. It showed that "in-liners" and conventional roller skaters showed no statistical differences in pattern of injury. Accidents occurred at low speed. Twenty-nine percent used protective gear. There was a significantly lower rate of injuries to the hand and wrist when wrist guards were used. Splint-top fractures were not observed. Increasing experience seems to lower the incidence of fractures. An increase in the use of protective gear seems to occur following an injury.

Rising popularity of roller-skates in recent years has resulted in increasing numbers of accidents involving roller-skates. The subject of our study was a consecutive number of patients who were treated at the casualty departments of Svendborg and Middelfart hospitals, Denmark, between July 1997 and June 1998. A total number of 169 patients representing 179 injuries were registered. A high incidence of injuries was found among children of school age. Protective equipment was used, in 31% (n = 52) of cases, which shows an increase compared to previous studies in Denmark (1). Injuries of the distal antebrachium, wrist and metacarpals account for 45% of all injuries. Wrist guards protect the area but do not completely eliminate the risk of fractures and injuries. A larger usage of protective equipment will probably result in a decrease in the number of injuries, and therefore information about protective measures is essential.

Rollerskating is an activity that has become increasingly popular over the past several years among children and adults in Denmark. During a 7-month period in 1997, 300 in-line skaters and 107 roller skaters were treated in the Emergency Department, Esbjerg County Hospital. Of these, 60.4% had minor injuries (sprains, bruises, lacerations) and 39.6% fractures. There was no statistical significant difference in the types of injury between skater groups. The most common serious injury was fracture of the wrist, which occurred in both skater groups (25%, n=102). Almost all of the fractures of the wrist and elbow occurred among skaters who did not wear wrist or elbow guards Only 20% of the skaters used protective equipment. In-line skaters used protective equipment more often than did roller skaters. Of all accidents, 69% occurred on public roads (street and sidewalk).

The study describes the mechanisms of percutaneous blood exposure (PCE) among Danish doctors and discusses rational strategies for prevention. Data were obtained as part of a nation-wide survey of occupational blood exposure. The most recent percutaneous or mucocutaneous exposure within the previous three months was described. Of 9375 doctors, 6005 (64%) participated. A total of 971 PCE were described. Inattentiveness contributed to 30.5%. Use of fingers rather than instruments was a contributing cause of 36.9% of 483 PCE on suture needles. Common concomitant causes in such cases (n = 199) were poor space in (30.2%) or view of (18.6%) the operation field. Of 689 PCE in surgical specialties, 17.4% were inflicted by colleagues. Up to 53.3% of PCE on hollow-bore needles could be attributed to unsafe routines only. In conclusion, education in safer working routines are needed in all specialties. Introduction of safer devices should have a high priority in surgical specialties, and should be considered in non-surgical specialties too.

In a nation-wide survey among Danish doctors, the compliance and reasons for non-compliance with universal precautions (UP) and the associated circumstances of mucocutaneous blood exposure (MCE) were studied. Of 9384 questionnaires, 6256 (67%) were returned and 6005 were eligible for analysis. Only 35% complied with the basic principles of UP. Compliance with protective barrier use in surgical versus non-surgical specialties was: Gloves 63.0% and 23.4%, masks 55.2% and 17.6% and protective eyewear 11.5% and 4.0% respectively. Common given reasons for non-compliance were: "Interferes with working skills", "forget", "wear spectacles", "not available", "too much trouble to get" or "gloves do not fit". Of 741 MCE described in detail, an estimated 84-98% were potentially preventable if appropriate barriers had been worn. More than half of MCE were preventable by two interventions only: Compulsory use of protective eyewear during operations and of gloves during insertion of peripheral i.v.-catheters. In conclusion compliance with UP is unacceptably low and the majority of MCE were potentially preventable if appropriate barriers had been worn.

The cascade of events leading to hip fracture is: a fall, protective responses, impact to the hip, local energy absorption and bone strength. A fall from standing height on the hip corresponds to a force of about 3500 N and the bone strength of the proximal femur in elderly women and men ranges between 2000 to 6000 N. Efficient hip protective systems have been developed and may be a significant factor in the prevention of hip fractures among the elderly with propensity to fall and osteoporosis. Theoretically, more than 90 per cent of all hip fractures can be prevented, and a substantial reduction in the rate of hip fractures can be obtained, when systematic intervention programs are initiated among nursing home residents. Prevention of hip fractures among home dwellers may be a greater challenge, although preliminary results seem promising. Improvement in design has made the protectors more compliant and may facilitate the aim of preventing hip fractures.

The incidence of Garden 1 + 2 and Garden 3 + 4 cervical hip fractures was studied in Copenhagen. The total incidence was 1.32 fractures per 1,000 inhabitants per year. A decrease in incidence in the oldest patients was found in the Garden 1 + 2 group.

Most hip fractures seem to be related to trauma near the hip, so a controlled trial was conducted to investigate the effect of external hip protectors on the prevention of such fractures in residents of a nursing home. Ten of 28 wards of the nursing home were randomized to receive external hip protectors; thus 167 women and 80 men were given protectors and 277 women and 141 men no protectors. A fall register was set up for two treatment wards (45 residents) and two control wards (76 residents). There were eight hip and 15 non-hip fractures in the hip protector group and 31 hip and 27 non-hip fractures in the control group. The relative risk of hip fractures among women and men in the intervention group was 0.44 (95% CL 0.21-0.94). None of the 8 residents in the intervention group who had a hip fracture was wearing the device at the time of the fracture. 154 falls were registered and 20% of these falls produced a direct impact to the hip. In 25 falls direct impact to the hip was sustained at a time when hip protectors were not being worn, and six fractures were produced. The study indicates that external hip protectors can prevent hip fractures in nursing-home residents.

In order to evaluate the use and handling of acrylic bone cement, questionnaire were presented to all Danish orthopaedic departments in 1987 and again in 1992. Marked improvements in the environmental safety precautions for handling of bone cement had taken place during the 5-year period. In 1992, the intraoperative handling and use of bone cement is thus generally considered safe. Further improvements are still to be advocated in some departments. The exposure to methylmethacrylate monomer (MMA) vapour during the cementation procedures should be eliminated by local punctual field suction or change to a bone cement with a lower content of monomer (MMA/n-decylmethacrylate/isobornylmethylacrylate bone cement). Unnecessary manual contact with the cement should be avoided, and if contact is necessary, special protective gloves (butyl rubber gloves or 4H-gloves) should be used in addition to ordinary surgical gloves.

During the three-year period 1987-1989, 80 persons were registered with lesions following accidents with chain saws. The information in the casualty department records was supplemented by an interview questionnaire. Sale of chain saws increased from the middle of the nineteen eighties although no appreciable increase in the number of accidents was registered. One of the reasons for this may be the legislation concerning safety equipment which was introduced in the middle of the nineteen eighties. Further efforts are still required to reduce the number of accidents. On the basis of the results of the investigation, the following suggestions are made: 1. Written information about personal protective equipment should be issued to every purchaser of a chain saw. 2. An informative campaign about the correct use of the chain saw and the personal protective equipment. 3. Compulsory issue of personal protective equipment in connection with hire of a chain saw. 4. Safety gloves should be included in the safety requirements.

A total of 110 accidents in slaughterhouse workers treated in the casualty department of Sønderborg Hospital during a period of one year was analysed as regards the nature of the injury, the mechanism of injury, employment of prophylactic measures, employment and the loss of income in connection with the sick leave involved. Cuts and stab lesions caused by ordinary knives constituted 72.7% and 93.7% of these were situated on the hands and forearms. Employment of prophylactic measures was not identical in the various working processes. Thus, all of the persons employed with filleting employed prophylactic equipment. In this group, the majority of injuries were on knife-hand but there were also many injuries to the protected hand. In the remainder of the production, employment of prophylactic measures was much less and the injuries here were localized electively to the hand not holding the knife. It is concluded that employment of safety knives in filleting is capable of reducing the number of injuries to the knife-hand while increased employment of five-fingered metal-net gloves and arm protectors is recommended in the remainder of the production.

The increasing popularity of skateboards and rollerskates has resulted in an increased number of contacts with the casualty department in Denmark after accidents. As part of the Danish share in the EHLASS project (European Home and Leisure Surveillance System), 120,000 consecutive contacts with the casualty departments were reviewed. Out of these 516 were due to accidents with skateboards and rollerskates (181/335). A total of 194 of these injuries (38%) were fractures and 80% of these were in the upper limbs. Twenty fractures required reposition under general anaesthesia and two required osteosynthesis. Nine patients were admitted for observation for concussion. One patient had sustained rupture of the spleen and splenectomy was necessary. A total of 44 patients were admitted. None of the 516 patients had employed protective equipment on the injured region. Considerable reduction in the number of injuries could probably be produced by employment of suitable protective equipment.

The purpose of the study was to analyse the effect of knuckle protection on the type and incidence of injuries in traditional karate contests. Knuckle protection was mandatory at the Danish karate championships 1983 and 1986 (290 matches, 0.26 injuries per match), and prohibited at the championships 1984 and 1985 (620 matches, 0.25 injuries per match). Head injuries were more common in the tournaments where fist pads were used. The incidences of transitory psychomotor disturbances following blows to the head were comparable. The severity of head injuries, however, decreased; minor head injuries dominated when fist pads were used (66%, compared with 44% without fist pads, p less than 0.01) and there were fewer lacerations and fractures. Injuries to the fingers or hands were also fewer--1.3% compared with 11% without protection (p less than 0.01). The use of fist pads reduced considerably the number of injuries requiring treatment (from 42% to 16%, p less than 0.01). In conclusion; fist pads offer some protection against injuries, especially to the hands, but additional measures are needed.

In both Germany and Denmark bills have been passed, that mopedists and motorcyclists should wear crash helmets in traffic. In an effort to elucidate the practical life-saving effect of such measures, this investigation has been performed in The Institute of Forensic Medicine, University of Aarhus, Denmark. Within the period 1959-1973 in all 188 mopedists killed in traffic accidents were submitted to medico-legal examination at the institute. All documents, including the police reports, photographs, the detailed autopsy-reports and medical case records were scrutinized in order to elucidate whether a crash helmet had been used during the accident, and if not, whether such use would have been life-saving. In 4 cases only, a crash helmet was used. Of the 188 moped drivers 54.2% died of scull-brain injuries, 33% of other injuries, while 12.8% died of combined scull-brain and other injuries. Following a thorough consideration of the circumstances and findings in each case, the authors in a retrospective judgment concluded, that 51% of the killed moped drivers probably should have survived the accident if they had worn an appropriate crash helmet. A further 8.5% might have survived. The authors admit that their material was selected and the results could hardly be considered indicative for the traffic in general, but are indicative of a tendency.