This thesis describes a multifocal approach on wrist related injuries following trauma, addressing its complexity in diagnosis and treatment strategies.
Background: Travelers can experience health problems while abroad. This descriptive study aimed to quantify the disease burden leading to hospital-based care, repatriation or death in Dutch... Show moreBackground: Travelers can experience health problems while abroad. This descriptive study aimed to quantify the disease burden leading to hospital-based care, repatriation or death in Dutch travelers during a stay in a foreign country, including Europe. Methods: Retrospective study of demographic and clinical data from three medical assistance centers (MACs) and the Dutch Ministry of Foreign Affairs on Dutch travelers receiving hospital-based care or who died abroad in the years 2010-2014. Diagnoses were coded according to the International Classification of Diseases (ICD) and classified using the Global Burden of Disease tool. Results: Data was available for 77,741 travelers' incidents: 75,385 medical consultations and 2,356 deaths. Four in five travelers received inpatient care, of which 36% concerned older travelers (65+) who had significantly longer hospital stays. Overall the top three diagnoses were: injuries (29%), infectious diseases (17%), and car-diovascular diseases (17%). Mental illness was reported in nearly 1.5% of the travelers. Incidence proportions were highest in South-Eastern Asia, with enteric infections as most common diagnosis. Injuries and communi-cable diseases occurred most often in South-Eastern Asia, while non-communicable diseases were mostly re-ported in South America. One in five travelers who consulted a physician was repatriated back home, mostly on a scheduled flight with or without medical escort. Cardiovascular diseases and injuries were the leading causes of death. Conclusions: Not only communicable diseases, but also injuries and chronic diseases (in particular cardiovascular diseases) frequently affected travelers' health while staying abroad and frequently necessitated hospital-based care. This should be addressed during the pre-travel counseling. Show less
BACKGROUND: Alpine sports are associated with risk of serious injuries. To gain insight into factors that may help reduce injury severity, accident characteristics and injury patterns were analyzed... Show moreBACKGROUND: Alpine sports are associated with risk of serious injuries. To gain insight into factors that may help reduce injury severity, accident characteristics and injury patterns were analyzed in a cohort of injured skiers and snowboarders.METHODS: All patients with Alpine sports-related injuries, reporting the injury to a leading medical assistance organization in the Netherlands in the period of 2013-2016, were contacted. Medical data were collected from the patients' files. Only ski and snowboard incidents were included. Injuries were classified according to the Abbreviated Injury Scale (AIS) and Injury Severity Scale (ISS). Data on the accident conditions, i.e. risk factors, were collected using retrospective patient-reported questionnaires. Risk factors for injuries with ISS >= 9 were analysed by multivariate modelling.RESULTS: Of the 1588 included patients, 421 patients filled out the questionnaire. Skiers (N.=1370) had more knee injuries (20.4% vs. 7.4%, P<0.001), femur fractures (5.3% vs. 0.5%, P=0.002) and lower leg fractures (27.5% vs. 11.5%, P<0.001) compared to snowboarders (N.=218). Skiers were also more seriously injured (ISS>9) (P=0.01). Injured snowboarders sustained more brain concussions (8.8% vs. 15.7%, P=0.003) and lower arm fractures (5.4% vs. 16.1%, P<0.001). Only `a higher skills level' was borderline significant for predicting serious injury (OR: 4.0 95% CI: 0.86-18.50; P=0.08). No additional risk factors were identified.CONCLUSIONS: Injury patterns after skiing and snowboarding accidents differ, injury severity differed not. Preventive measures should therefore aim to protect specific body parts depending on the type of Alpine sport. Experienced skiers and snowboarders may be more at risk for serious injuries. Show less
Deep venous thrombosis is a common disease. Already in 1856 it was suggested that immobilization could cause venous thrombosis. However, so far little research has shown whether exercise or... Show moreDeep venous thrombosis is a common disease. Already in 1856 it was suggested that immobilization could cause venous thrombosis. However, so far little research has shown whether exercise or ambulation could decrease the risk of venous thrombosis. We performed a historical review regarding the role of venous thrombosis risk in the change of the practices regarding ambulation after delivery. We could not find well-performed studies showing that early ambulation reduced venous thrombosis risk. Furthermore we performed two studies on the relation between participating in physical activity and venous thrombosis risk. In one case-control study in the Netherlands we showed that exercise decreases the risk of venous thrombosis. However, in a cohort study in elderly people from the USA, we showed that exercise seemed to increase this risk. A possible explanation for this difference might be due to an increased risk of injuries among elderly people as we showed that injuries increase the risk of venous thrombosis 5 fold. Furthermore we showed that for the very rare thrombosis of the arm, sports activities which highly involve the arm result in an increased risk. In summary, although immobilization seems to increase venous thrombosis risk, it is unclear whether mobilization or exercise decrease this risk. Show less
