Surfers risk eye injuries
AUSTRALIAN research has confirmed that surfing carries a small risk of severe ocular injuries. The prospective questionnaire-based study, published in the MJA, used data from 16 coastal and teaching hospitals in NSW, where ophthalmologists and ophthalmology trainees were asked to report the incidence and severity of surfboard-related eye injuries (SREIs). Between December 2010 and December 2011, 10 patients were recorded with SREIs and two of these injuries were categorised as severe (loss of vision or loss of the eye). The patients had a mean age of 35.4 years, eight were male and two were children. Patients frequently presented with a combination of ophthalmic injuries, with two globe ruptures, four fractured orbits, one case of fibreglass foreign bodies in the orbit, and six eyelid lacerations reported by the hospitals. “SREIs were caused by all sharp projections of the surfboard, including the nose, fins and tail”, the authors wrote. As the first prospective longitudinal assessment of SREIs in Australia, the authors said this study had “helped to describe and quantify the risk of SREIs”. They wrote that the use of protective eyewear and headgear by surfers needed to be encouraged, and recommended the modification of surfboards to include soft rubber tips to make the fins, nose and tail more flexible and less dangerous to a surfer’s eyes.
Ibuprofen best for fracture pain in children
A RANDOMISED controlled trial, published in CMAJ, has shown morphine taken orally and ibuprofen for postfracture pain in children each resulted in improved pain scores with no significant difference in analgesic efficacy. However, significantly more children taking morphine had adverse effects such as nausea, vomiting and drowsiness, which was experienced by more than a third, compared with 20.9% of those taking ibuprofen. The research included children aged 5–17 years who presented to the paediatric emergency department of a major Canadian hospital with a non-operative, radiographically evident extremity fracture. Exclusion criteria included known hypersensitivity to ibuprofen or morphine, and chronic use of non-steroidal anti-inflammatory drugs or opioids. The 183 children in the study were assigned to receive normal-release morphine (0.5 mg/kg, maximum 10 mg) or ibuprofen (10 mg/kg, maximum 600 mg) every 6 hours as needed for pain for 24 hours after discharge, with a maximum of four doses. The researchers wrote that both morphine and ibuprofen resulted in a decrease in pain scores at each dose, and the between-group difference in pre–post changes in pain scores was not significant. “Given that morphine was associated with significantly more adverse effects, we conclude that ibuprofen remains a safe and effective therapy for outpatient management of children’s fracture pain”, the researchers wrote. “We hope that our results will provide clinicians with a foundation for rational analgesic choices for children with fractures who are discharged from the emergency department.”

Questions about milk and fractures
A LARGE Swedish study has found that drinking more milk does not lower fracture risk in men and women and could instead be associated with a higher risk of death. The research, published in The BMJ, included one cohort of 61 433 women (aged 39–74 years at baseline, in 1987–1990) and another of 45 339 men (aged 45–79 years at baseline, in 1997) who completed food frequency questionnaires. Mean intake of milk at baseline was 240 g/day for women and 290 g/day for men. During a median 22 years of follow-up, 15 541 women died, with cardiovascular disease the underlying cause of death in 5278 and cancer in 3283 women. There were 17 252 women who had any type of fracture during follow-up, including 4259 who had a hip fracture. During a median 13 years of follow-up, 10 112 men died (4568 from cardiovascular causes and 2881 from cancer) and 5379 had any type of fracture, including 1166 men who had a hip fracture. In women the adjusted mortality hazard ratio (HR) for drinking three or more glasses of milk a day compared with less than one glass a day was 1.93. For every glass of milk, the adjusted HR of all-cause mortality was 1.15 in women and 1.03 in men. There was no reduction observed in fracture risk with higher milk consumption for any fracture (HR, 1.02) or for hip fracture (HR, 1.09). The corresponding adjusted HRs in men were 1.01 and 1.03. “Our results may question the validity of recommendations to consume high amounts of milk to prevent fragility fractures”, the authors wrote. However, they said the results should be interpreted cautiously and required independent replication before they could be used for dietary recommendations. An accompanying editorial said improving the evidence base for dietary recommendations “could have substantial benefits for everyone”.

Eczema‒fracture risk found
ADULTS with eczema have an increased risk of developing fractures and other injuries, according to a prospective questionnaire-based study published in JAMA Dermatology. Using data from the 2012 US National Health Interview Study, the authors analysed the incidence rates of fractures, bone or joint injuries (FBJIs) and other injury causing limitations in 34 500 adults aged 18–85 years with a history of eczema. They found the prevalence of eczema was 7.2% and the prevalence of any injury causing limitation was 2.0%. An FBJI was reported by 1.5% of adults and other injury causing limitation by 0.6%. The prevalence of injuries increased with age, peaked at ages 50‒69 years, and then decreased substantially in patients 70 years or older. The researchers found that adults with eczema and fatigue, daytime sleepiness or insomnia had higher rates of FBJI compared to adults with sleep symptoms and no eczema. Adults with both eczema and psychiatric and behavioural disorders (PBDs) also had higher rates of FBJI compared to those with eczema or PBDs alone. The authors found adults with eczema had higher odds of any injury (odds ratio [OR], 1.99), including FBJI (OR, 2.27) and other injury (OR, 1.92) causing limitation, compared with adults without eczema. These associations remained significant after controlling for the effects of comorbid atopic disease and psychiatric and behavioural disorders. “Taken together, these data suggest that adult eczema is a previously unrecognized risk factor for fracture and other injury, emphasizing the importance of developing safer and more effective clinical interventions for itch and sleep problems in eczema, as well as preventive measures for injury risk reduction in eczema”, the authors wrote.

More prescription opioid overdoses
MORE patients overdose on prescription opioids than on heroin or any other opioid type, according to a research letter published in JAMA Internal Medicine. The researchers analysed 135 971 visits to US emergency departments for opioid overdoses recorded in 2010. They found prescription opioids were involved in 67.8% of all overdoses, heroin in 16.1%, unspecified opioids in 13.4% and multiple opioid types in 2.7% of cases. The proportion of visits resulting in death was highest for overdoses involving multiple opioids and lowest for prescription opioids. The authors said that prescription opioid overdoses were more likely in urban areas and among women, and that several comorbidities were common among overdose patients, including chronic mental illness, and circulatory and respiratory diseases. The authors wrote that health care providers who prescribed opioid analgesics to patients with comorbidities should “do so with care and counsel all patients about the risk of overdose”. Acute benzodiazepine intoxication was recorded in 22.2% of all overdose patients, highlighting the need for cautious prescribing of opioids in conjunction with other sedating medications. The authors said their findings suggested that the costs associated with opioid overdose were significant and that strategies to reduce morbidity and mortality resulting from overdose were urgently needed, “including enhanced access to substance abuse treatment”.

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