Falls and their consequences are a major health problem in the older population, increasing their immobility, morbidity and mortality. This thesis focuses on older people living in geriatric care settings, frail older people who are most prone to suffer falls. The aim was to study predisposing and precipitating factors associated with falls in older people with or without cognitive impairment. In a cross-sectional study with a one-year prospective follow-up for falls 63% of the 83 residents suffered 163 falls and 65% of the fallers fell more than once. The antidepressants selective serotonine reuptake inhibitors (SSRIs), impaired vision and being unable to use stairs independently were the factors most strongly associated with sustaining falls. Acute diseases were judged to have precipitated 32 % of the falls and drug side effects 9%. In another cross-sectional study with a one-year follow-up for falls, including 199 residents, previous falls and treatment with antidepressants (mainly SSRIs) were found to be the most important predisposing factor for falls. Acute disease was judged to be the precipitating factor alone or in combination, in 39% of the falls, medical drugs in 8%, external factors such as obstacles in 8% and other conditions both related to the individual and the environment, such as misinterpretation, misuse of roller walkers or mistakes made by the staff were judged to have precipitated 17% of the falls. In a population-based cross-sectional study including 3604 residents in geriatric care settings more than 8% sustained a fall at least once during the preceding week. A history of falls, the ability to get up from a chair, the need for a helper when walking, pain, cognitive impairment, use of neuroleptics and use of antidepressants were all associated with falls in multivariate analyses. In the subgroup of people with cognitive impairment (2008 residents) more than 9% had sustained a fall at least once during the preceding week. As for the whole population, being able to get up from a chair, previous falls, needing a helper when walking with the addition of hyperactive symptoms were the factors independently associated with falls. In a study with a one-year prospective follow up for falls, including 439 residents in residential care facilities, 63% sustained 1354 falls, corresponding to an incidence rate of 3.5 falls / person year. Thirty-three percent of the falls and 37% of the injurious falls occurred during the night (9pm-6am). There were significantly higher fall rates in the evening and in January, April, May, November and December. There were no associations between fall rates and any of the weather parameters studied. In conclusion falls and fall-related injuries in older people in geriatric care settings are common. Both predisposing and precipitating factors contribute to the risk of falling. Addressing precipitating factors for falls seems to be important in an individualised preventive strategy among older people in geriatric care settings.

This thesis represents the first anthropological perspective to be offered on the nature of the Klondike Gold Rush population. In order to better understand the experience of the average gold rusher, morbidity and mortality patterns are examined for the residents of the Yukon Territory following the discovery of gold in the region (1898-1904). Infectious diseases such as measles, pneumonia, smallpox and typhoid fever are the primary focus of this study, however local factors such as the severe climate and the seclusion of the gold fields from the outside world also offers an interesting opportunity to examine the consequences of leading a particularly harsh and physically demanding lifestyle in an inhospitable environment. / October 2008

The overall goal of my research was to advance our understanding of the potential for novel compliant flooring systems to reduce the risk for fall-related injuries in older adults, including fall-related traumatic brain injury (TBI). This entailed an assessment of how these floors affect the competing demands of fall-related TBI – impact severity attenuation in concert with minimal concomitant impairments to balance control and postural stability. Two studies are included as part of this thesis. The first study used a mechanical drop tower to assess the effects of four traditional flooring systems and six novel compliant flooring conditions on the impact dynamics of a surrogate headform during the impact phase of simulated ‘worst- case’ head impacts. The second study entailed an assessment of the effect of two traditional and three novel compliant floors on the initial phase of the compensatory balance reactions of older adult men and women living in a residential-care facility environment following an externally induced perturbation using a tether-release paradigm. Overall, this thesis demonstrates that novel compliant floors substantially attenuate the forces and accelerations applied to the head during simulated worst- case impacts when compared to traditional flooring surfaces such as vinyl and carpet with underpadding. These benefits are achieved without compromising indices of balance control, supported by the finding that parameters characterizing early compensatory balance reactions were unaffected by the novel compliant floors tested. This work supports the introduction of pilot installations of novel compliant flooring systems into environments with high incidences of falls to test their effectiveness at reducing fall-related injuries in clinical settings.

Disertacijoje aprašomas metodas, sukurtas vertinti ypatingųjų poveikių statiniams keliamą riziką. Darbe pateikti trys šio metodo taikymo pavyzdžiai. Disertaciją sudaro įvadas, penki skyriai, išvados, literatūros šaltiniai, autoriaus publikacijų sąrašas ir penki priedai. Pirmajame skyriuje apžvelgiama mokslinė literatūra, kurioje tiriami rizikos vertinimo metodai ir aptariama jų taikymo konstrukcijoms skaičiuoti galimybė. Pateikiama trumpa ypatingųjų poveikių klasifikacija bei konstrukcijų, kurias jie gali paveikti, pažeidžiamumo modeliavimas. Antrajame skyriuje aprašomas metodas, sukurtas ypatingųju poveikių keliamų konstrukcijų pažaidų tikimybėms vertinti. Metodas derina statybinių konstrukcijų patikimumo teorijos ir Bajeso statistinės teorijos priemones. Jis gali būti taikomas tiek projektuojant konstrukcijas, tiek vertinant pramoninių objektų riziką. Trečiajame skyriuje aprašoma, kaip taikyti siūlomą metodą vertinant medinėms konstrukcijoms keliamą gaisro riziką. Ta rizika išreiškiama gaisro pažeistos konstrukcijos suirimo tikimybe, kuri yra vertinama apriorine ir aposteriorine tankio funkcijomis, skaiciuojamomis Bajeso statistinės teorijos priemonėmis. Šiame skyriuje nagrinėjama medinė gaisro veikiama pramoninio pastato stogo konstrukcijos sija. Gaisro poveikis modeliuojamas maža statistine gaisro charakteristikų imtimi. Ketvirtajame skyriuje pateiktas siūlomo metodo taikymas projektuojant sprogimo veikiamą apsauginį barjerą. Atsižvelgiama i barjero elementų mechaninio... [toliau žr. visą tekstą] / The dissertation presents a method developed for assessing the risk to constructed facilities posed by accidental actions. The proposed method is applied to the analysis of structures subjected to accidental actions induced by fire, explosion and extreme wind. The dissertation consists of introduction, five chapters, conclusions, lists of references and papers published by the author of the dissertation, as well as five annexes. Chapter 1 presents a review of published work on the assessment of risk to structures and non-structural property posed by accidental actions. The review covers general aspects of risk assessment and application of risk analysis tools to the analysis and design of structures. The core of the review is an application of Bayesian methods, which prevail in the field of risk assessment, to a risk-based structural analysis. Chapter 2 proposes a method developed for the assessment of damage to structures from accidental actions. This method combines structural analysis with Bayesian handling of information related to accidental actions and response of structures to these actions. The method allows to estimate probabilities of the damage to structures caused by accidental actions. Chapter 3 deals with an application of the proposed method to the estimation of fire risk to structures. It is shown how to apply this method to the estimation of failure probability of a timber beam damaged by fire in an industrial building. This chapter shows how to handle... [to full text]

This thesis represents the first anthropological perspective to be offered on the nature of the Klondike Gold Rush population. In order to better understand the experience of the average gold rusher, morbidity and mortality patterns are examined for the residents of the Yukon Territory following the discovery of gold in the region (1898-1904). Infectious diseases such as measles, pneumonia, smallpox and typhoid fever are the primary focus of this study, however local factors such as the severe climate and the seclusion of the gold fields from the outside world also offers an interesting opportunity to examine the consequences of leading a particularly harsh and physically demanding lifestyle in an inhospitable environment.

Jährlich erleiden allein in Deutschland über 62 000 Personen eine schwere Verletzung nach einem Verkehrsunfall. Neben den persönlichen Verletzungsfolgen für die Patienten sind auch die volkswirtschaftlichen Kosten dabei nicht unerheblich. Die Summe der entstehenden Behandlungskosten wird durch das Statistische Bundesamt mit über 13,5 Milliarden Euro jährlich angegeben. Hinzu kommen weitere Aufwendungen, die sich durch Erwerbsminderung als Folge der Verletzungen ergeben. Durch Tod und Invalidität ergibt sich schließlich ein volkswirtschaftlicher Gesamtschaden von 41 Milliarden Euro jährlich (Statistisches Bundesamt 2012). Auch die häufig mit den Verletzungen einhergehende akzidentelle Hypothermie hat auf den innerklinischen Behandlungsverlauf einen entscheidenden Einfluss und stellt einen unabhängigen Mortalitätsfaktor dar (Lier et al. 2007; Tryba und Leban 1996). Dabei ist die Hypothermie Teil der „Lethal Triad“, die das gleichzeitige Auftreten einer Koagulopathie, einer Azidose und einer Hypothermie beschreibt und zu einer gesteigerten Letalität führt (Kashuk et al. 1982). Nach einer Studie von Helm et al. (Helm et al. 1995b) ist mit 49,6% jeder zweite Traumapatient hypotherm bei Einlieferung in den Schockraum des aufnehmenden Krankenhauses. Dabei ist der Schweregrad der Hypothermie unabhängig von Außentemperatur- und Witterungseinflüssen. Ziel muss daher sein, die akzidentelle Hypothermie zu verhindern oder zumindest eine frühzeitige Wiedererwärmung einzuleiten. Zur Durchführung einer Patientenerwärmung in der präklinischen Phase gibt es bisher jedoch neben der passiven Erwärmung mit Decken o.ä. nur wenige Ansätze. Eine in der Literatur beschriebene Möglichkeit der aktiven Wärmetherapie ist der Einsatz eines Halogenstrahlers, wie er von den Feuerwehren und Hilfsorganisationen als Lichtquelle mitgeführt wird. Dabei soll die Strahlungswärme (Radiation) die Körpertemperatur des Patienten stabilisieren. Eine weitere Möglichkeit stellt der in vielen innerklinischen Studien beschriebene Einsatz von konvektiven Luftwärmern dar, die erfolgreich im innerklinischen Intensiv- und Operationsalltag Anwendung finden. Dieses stellt jedoch an Einsatzstellen bisher eine Rarität dar. Zu beiden Methoden fehlen bisher Studien über die Wirksamkeit unter präklinischen Bedingungen. Dieses sollte mit dieser Arbeit untersucht werden. Dazu führten wir eine Studie an 30 gesunden Probanden bei einer standardisierten Umgebungstemperatur von 3°C durch. Die Probanden mussten jeweils zwei Versuchsteile durchlaufen, wobei sich die ersten 21 Minuten jeweils identisch gliederten. In dieser Zeit saßen die Studienteilnehmer bekleidet mit T-Shirt, Shorts, Strümpfen, Schuhen und Unterwäsche auf einem Fahrzeugsitz und waren schutzlos der Umgebungs-temperatur ausgesetzt. Diese Zeit sollte dem Zeitverzug im präklinischen Rettungswesen zwischen Unfallzeitpunkt und Beginn der Hilfsmaßnahmen entsprechen. Danach erfolgte dann für weitere 39 Minuten die Erwärmung mittels Halogenstrahler bzw. konvektivem Luftwärmer. Bei der Erwärmung mit dem konvektiven Luftwärmer diente eine Kunststofffolie, mit der der Proband eingehüllt wurde, als Wärmedecke, Als konvektiver Luftwärmer wurde das Gerät „Polarn 4000“ der Firma Eberspächer ausgewählt, da dieses für den präklinischen Einsatz vorgesehen ist. Während des Versuchszeitraumes wurde neben der Überwachung von Herz-frequenz, Blutdruck und Sauerstoffsättigung die Körpertemperatur an verschiedenen festgelegten Messpunkten in drei-minütlichem Abstand gemessen.Als Ergebnis konnte festgestellt werden, dass die Erwärmung mittels konvektivem Luftwärmer hoch effektiv und signifikant besser ist, als die mit einem Halogenstrahler. Bei der Erwärmung mittels Halogenstrahler konnte keine Stabilisierung und kein Anstieg der Körpertemperatur beobachtet werden. Prinzipiell ist der Einsatz eines konvektiven Luftwärmern unter präklinischen Bedingungen auch mit einfachsten Mitteln möglich. Ein Kritikpunkt muss jedoch die hohe Temperatur der erzeugten Warmluft sein. Hier sollte durch den Hersteller eine Temperaturregelung nachgebessert werden, um Verbrennungen der Patienten zu vermeiden. Bis dahin kann diese Methode in der jetzigen Form nicht allgemein empfohlen werden.

This thesis represents the first anthropological perspective to be offered on the nature of the Klondike Gold Rush population. In order to better understand the experience of the average gold rusher, morbidity and mortality patterns are examined for the residents of the Yukon Territory following the discovery of gold in the region (1898-1904). Infectious diseases such as measles, pneumonia, smallpox and typhoid fever are the primary focus of this study, however local factors such as the severe climate and the seclusion of the gold fields from the outside world also offers an interesting opportunity to examine the consequences of leading a particularly harsh and physically demanding lifestyle in an inhospitable environment.

The overall goal of my research was to advance our understanding of the potential for novel compliant flooring systems to reduce the risk for fall-related injuries in older adults, including fall-related traumatic brain injury (TBI). This entailed an assessment of how these floors affect the competing demands of fall-related TBI – impact severity attenuation in concert with minimal concomitant impairments to balance control and postural stability. Two studies are included as part of this thesis. The first study used a mechanical drop tower to assess the effects of four traditional flooring systems and six novel compliant flooring conditions on the impact dynamics of a surrogate headform during the impact phase of simulated ‘worst- case’ head impacts. The second study entailed an assessment of the effect of two traditional and three novel compliant floors on the initial phase of the compensatory balance reactions of older adult men and women living in a residential-care facility environment following an externally induced perturbation using a tether-release paradigm. Overall, this thesis demonstrates that novel compliant floors substantially attenuate the forces and accelerations applied to the head during simulated worst- case impacts when compared to traditional flooring surfaces such as vinyl and carpet with underpadding. These benefits are achieved without compromising indices of balance control, supported by the finding that parameters characterizing early compensatory balance reactions were unaffected by the novel compliant floors tested. This work supports the introduction of pilot installations of novel compliant flooring systems into environments with high incidences of falls to test their effectiveness at reducing fall-related injuries in clinical settings.

The production and processing of various chemicals and raw materials all around the world currently exceeds hundreds of millions of tonnes a year and is constantly growing. In addition, the spectre of produced materials is increasing, including relatively toxic compounds. It is absolutely clear that such production volumes lead to a risk of accidents with the leakage of chemical toxicants, and {--} depending on the toxicity of the relevant substances {--} these accidents represent a serious threat for human health, animals and the environment.Disasters involving chemicals drew public attention already in the 20th century, when ways were sought to guarantee the safety of production, storage and transportation of hazardous materials. This is also an essential prerequisite for the occurrence of an accident involving the leakage of chemical toxicants {--} the presence of such toxicants in the production, processing, storage or transportation.Whether during wars or in peacetime, there are situations when large numbers of people can be exposed to the effects of a wide spectre of hazardous chemical substances (NCHL). These situations include military operations, campaigns by the integrated rescue system (IZS), industrial accidents or acts of terror. In developed industrial countries, the capacities used for the production, storage, processing and transportation of NCHL are usually localized in urban industrial zones. The high concentrations of these hazardous chemical substances within these zones represent a potential health risk for the people nearby. Chemical safety is a challenge and a must. I find this issue attractive and therefore decided to analyse, in my thesis, the causes of mass chemical intoxication and their consequences on the affected population. The objective of this diploma thesis is to compare the forms of protection and liquidation of the consequences of such accidents and try to find, structure and unify the recommendations regarding the solution of emergencies associated with mass chemical intoxications. Another objective was to verify the hypothesis that regulations and existing procedures regarding the solution of emergencies associated with mass chemical intoxications do not correspond with today{\crq}s standards and the on-going development of chemical noxious agents.

Made available in DSpace on 2015-07-22T20:49:28Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-05-27 / Este estudo observacional do tipo seccional teve por objetivos: investigar a prevalência de quedas acidentais em idosos freqüentadores de centro de convivência para idosos (CCI) e a influência de variáveis a ela associadas (faixa etária, sexo, estado civil, escolaridade, renda familiar/pessoa, aposentadoria, inserção no mercado de trabalho, estado cognitivo, tempo de registro e atividades praticadas no CCI e, nível de atividade física); estimar o nível de atividade física (NAF) desses idosos analisando as mesmas variáveis anteriores bem como a possível associação com quedas acidentais; e analisar as possíveis associações entre NAF e os fatores e/ou conseqüências relacionados à mais recente queda (número, período e local das quedas, ocorrência de fratura ou ferimento, procura por atendimento médico e medo de cair). Uma amostra de 350 idosos de três CCI da cidade de Cuiabá (Estado de Mato Grosso, Brasil) responderam ao Mini-Exame do Estado Mental – MEEM, e ao Questionário Internacional de Atividades Físicas - IPAQ versão curta. O Questionário de Caracterização de Quedas somente foi respondido pelos idosos que sofreram queda. Foram utilizadas para a análise de dados estatística descritiva, regressão logística binária e regressão logística ordinal pelo Modelo de Odds Proporcional (MOP), considerando o valor de p<0,05, em uma sub-amostra de 291 idosos. Cerca de 40% dos idosos disseram ter caído nos últimos 12 meses anteriores ao inquérito; dos que sofreram queda, 45,3% afirmaram ter sofrido duas ou mais quedas. O modelo preditivo de quedas foi composto das variáveis: sexo feminino (OR= 5,12; IC= 2,48–10,56), faixa etária de 75 a 79 anos (OR=3,0; IC= 1,20–7,47), estado civil separado (OR=4,09; IC= 1,27–13,22), e ser pensionista (OR=2,82; IC= 1,20–6,64). Quanto ao NAF, 38,1% dos voluntários foram classificados no nível “alto”, 49,8% no nível “moderado” e 12,1% no nível “baixo”. Os resultados do MOP para NAF indicaram que idosos mais velhos têm menos chance de estar no NAF alto (OR=0,78: IC=0,96-2,92) do que idosos nas faixas etárias mais jovens. Da mesma forma, idosos que não trabalham (OR=0,38: IC=0,22–0,67) e aqueles com baixo índice cognitivo (OR=0,31; IC=0,31-0,38) têm menos chance de estar no NAF alto em oposição aos outros níveis. Quanto à última queda relatada, verificou-se que 46,2% dos idosos caíram à tarde, 9,4% das quedas ocasionaram fratura, 70,9% dos casos resultaram em algum tipo de ferimento e não houve conseqüências em 23,9% das quedas. Foi verificado que 54,7% dos idosos caíram fora de casa, 61,5% não procuraram atendimento médico e 43,6% relataram muito medo de cair. Em relação às variáveis referentes à última queda, o resultado do MOP pelo NAF revelou que idosos que não sofreram ferimentos têm mais chances de se encontrar no NAF alto (OR=8,19: IC= 1,00–66,74). Os resultados indicam que a condição civil, o recebimento de benefício previdenciário, o sexo e a idade foram preditores de quedas. Além disso, o nível de atividade física dos idosos não mostrou qualquer associação com a ocorrência de quedas acidentais. / The aims of this observational, cross-sectional study were: i) investigate the prevalence of accidental falls in Senior Citizen Centers (SCC) users and the influence of factors associated with these falls such as age group, sex, civil status, level of education, family/person income, retirement, labor market participation, cognitive status, registration period and activities carried out at SCC, and level of physical activity; ii) estimate the level of physical activity in this elderly population relating to the variables described above as well as the possible association with accidental falls; and iii) analyze the association among level of physical activity and related-factors and/or consequences on the most recent fall (number, daytime and fall location, fracture or injury occurrence, search for medical services and fear of falling). The sample included 350 Senior Citizens from three different SCC from Cuiabá City (Mato Grosso State, Brazil) that answered the Mini-mental State Examination–MMSE and the International Physical Activity Questionnaire-IPAQ short version. The Characterization of Falls Questionnaire was answered only by those elderly who had fallen. Descriptive Statistic, Binary Logistic Regression and Ordinal Logistic Regression by Proportional Odds Model (POM) were used for data analyses (p<0.05) from a 291 elderly sub-sample. About 40% of the elderly suffered falls in the last year. From this group, 45.3% declared to have fallen two or more times in the same period. The predictive model of falls was comprised by the following variables: female gender (OR= 5.12; IC= 2.48–10.56), 75-79 years old age group (OR=3.0; IC= 1.20–7.47), divorced marital status (OR=4.09; IC= 1.27–13.22), and to be pensioner (OR=2.82; IC= 1.20–6.64). Analyzing the level of physical activity (LPA), 38.1% of voluntaries were classified as high level, 49.8% as moderate level and 12.1% as low level. The results of POM indicated that the oldest group showed lower chance to be classified as high LPA (OR=0.78: IC=0.96-2.92) than elderly younger groups. Seniors that do not have a job (OR=0.38: IC=0.22–0.67) and those with low cognitive status (OR=0.31; IC=0.31-0.38) had little possibility to be in high LPA in opposition to the other levels. Regarding to the last fall reported, it was verified that 46.2% occurred in the afternoon, 9.4% resulted in fractures, 70.9% resulted in some sort of injury and 23.9% did not result in any impairments. It was also verified that 54.7% of the elderly suffered outdoor falls, 61.5% did not seek any medical attention and 43.6% related being very afraid of falling. In relation to the variables concerning to the last fall reported, results from MOP by NAF revealed that elderly that did not suffered injuries were more likely to be in high LPA (OR=8.19: IC= 1.00–66.74). Our results indicate that civil status, social security benefit receiving, sex and age were predictors to falls. Moreover, level of physical activity did not show any association with accidental falls occurrence. / TEDE / BV UNIFESP: Teses e dissertações