No abstract

This study evaluated factors affecting the severity of bite site necrosis and systemic symptoms resulting from envenomation among patients bitten by Malayan pit vipers (Calloselasma rhodostoma) in Thailand. We studied 145 victims prospectively. An additional 80 medical records were obtained for a retrospective study. Collected data included gender of the victims, anatomic locations of bites, where attacks took place, and predisposing factors and how they might have affected the clinical course. Most patients presented with minimal to moderate symptoms. Only eight patients required surgical wound debridement. None required amputation. However, 27 subjects developed permanently swollen limbs, presumably because of lymphatic or vascular injury. Significant coagulopathies were common (52.48%), and the only two deaths were attributable to intracranial hemorrhage. The improved clinical outcomes in the prospective and retrospective groups, compared with older series, might have been attributable to better public education, improved road infrastructure, and more health care facilities. Less reliance on nonprofessional healers and fewer applications of tourniquets also might have influenced clinical outcomes. Malayan pit viper antivenin, manufactured in Thailand, appears to be effective in reversing dangerous coagulopathies.

Chronic conditions and lifestyle behaviors have a detrimental influence on the quality of life for seniors because of physical disability and emotional concerns. This study aimed to assess the influence of chronic illness, smoking, and alcohol use on quality of life among Thai seniors. A cross-sectional study was conducted in three communities, selected purposively from the North, Northeast, and Central regions, and 1278 senior participants were recruited. Binary logistic regression was used to predict the influence of factors on quality of life with adjusted covariates. Most participants were aged 60–70 years and married, earned 500–1,000 Baht/month (US $17–$35), had one chronic illness, and were nonsmokers and nondrinkers. Surprisingly, there appeared to be no link between chronic conditions and quality of life. Current drinkers were more likely to have a high quality of life, with Odds Ratios of 2.16 for men and 2.73 for women. Seniors of both genders who were current drinkers were more likely to accept death and dying and this improved their quality of life. Social participation in alcohol consumption may encourage seniors to share their concerns about death and dying and eventually accept this as a foundation of life.

This study evaluated factors affecting the severity of bite site necrosis and systemic symptoms resulting from envenomation among patients bitten by Thai cobras (Naja kaouthia) in Thailand. We studied 45 victims prospectively. An additional 40 medical records were obtained for a retrospective study. Collected data included gender of the victims, anatomic locations of bites, where attacks took place, and predisposing factors and how they might have affected the clinical course. Most patients were asymptomatic or mildly symptomatic. Neurotoxic symptoms and respiratory failure developed in 31.11% and 12.50% in the prospective and retrospective groups, respectively. Only one patient died, from the effects of prolonged respiratory failure. There was some degree of tissue necrosis at the bite site for almost all victims. One victim required amputation of a digit in the retrospective study, and 33.60% of the prospective group and 20% of the retrospective group required minor surgical debridement. Snakebites in Thailand are still a public health problem, although rapid urbanization has decreased the number of victims because of degradation of the snake's habitat.

Purpose Violence directed at ambulance paramedics has attracted increasing public attention because of its major negative impact on the physical and psychological well-being of victims and productivity of organisations. The purpose of this paper is to explore the prevalence of violent incidents, contributing factors, burnout and post-traumatic symptoms among paramedics. Design/methodology/approach A cross-sectional survey was distributed in two ambulance services in Tasmania and South Australia, with self-administered instruments completed online. In total, 48 respondents completed questionnaires. Findings There were no significant differences between sites in timing of violent incidents, consequences of traumatic events or organisation provision. Surprisingly, over 90 per cent of paramedics had not been pushed, slapped, beaten, scratched or spat on in the previous month. There was a statistically significant difference between genders for being yelled at or verbally abused (p=0.02). When considering burnout, female paramedics showed significantly higher levels of emotional exhaustion t(37)=–2.32, p=0.02 and lower levels of career satisfaction than their male counterparts, t(37)=3.32, p=0.00. Originality/value Although prevalence rates of violent incidents seemed lower than expected, policy interventions to encourage female paramedics to display their professional identities and steps to enhance well-being and safety while on duty should be considered.