Head injury deaths: the enormity of firearms.
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Centers for Disease Control and Prevention, U.S.↗
Biomedical subjects
D M Sosin
Publications and source records attributed to D M Sosin.
Motorcycle helmet-use laws and head injury prevention.
OBJECTIVE: To rebut criticism of a previous study of motorcycle helmet-use laws through reanalysis with improved measures of exposure, stratification for regional differences in crash risk, and addressing of total motorcycle-related mortality and the grounds for targeting motorcyclists for helmet-use laws. DESIGN: Death certificate-based correlational study of motorcycle-related deaths and motorcycle helmet-use laws. POPULATION STUDIED: United States resident deaths from 1979 through 1986. RESULTS: Regardless of the denominator used (resident population, motorcycle registrations, or motorcycle crashes), states with full helmet-use laws had consistently lower head injury-associated death rates than states without such laws, even when stratified by region. Total motorcycle-related mortality, however, was similar between law groups. On a registration or crash basis, motorcyclists who died in crashes had a fivefold to sixfold higher risk of head injury than those who died using any other type of motor vehicle. CONCLUSION: Full helmet-use laws were consistently associated with lower rates of head injury-associated death. While disagreement remains on the acceptability of the legislative approach, the scientific basis for motorcycle helmet-use laws as a head injury prevention tool appears sound.
Accidents, Traffic↗
Causes of nonfatal injuries in the United States, 1986.
During the 1986 National Health Interview Survey (NHIS), data on injuries resulting in a doctor visit or restricted activity for at least a half day were collected and assigned E-codes. Based on 603 injuries, the estimated number of nonfatal injuries for civilian, noninstitutionalized U.S. residents in 1986 was 60,212,000. The most frequent cause of injury was a fall (11,547,000), followed by motor vehicle traffic crashes (4,361,000) and adverse effects of drugs and biologics (3,363,000). While cause-specific detail was limited by small numbers of injuries in the sample, the NHIS can provide a valuable snapshot of the causes of nonfatal injuries.
Humans↗
Conclusions on cancer and low socioeconomic status questioned.
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Adult↗
Bicycle-associated head injuries and deaths in the United States from 1984 through 1988. How many are preventable?
OBJECTIVE: To estimate the potential benefits from more widespread bicycle safety helmet use. DESIGN: Review of death certificates and emergency department injury data for 1984 through 1988. Categorization of deaths and injuries as related to bicycling and head injury. Using relative risks of 3.85 and 6.67 derived from a case-control study and varying helmet usage from 10% to 100%, population attributable risk was calculated to estimate preventable deaths and injuries. SETTING: Entire United States. MAIN OUTCOME MEASURES: Numbers of US residents coded as dying from bicycle-related head injuries, numbers of persons presenting to emergency departments for bicycle-related head injuries, and numbers of attributable bicycle-related deaths and head injuries. MAIN RESULTS: From 1984 through 1988, bicycling accounted for 2985 head injury deaths (62% of all bicycling deaths) and 905,752 head injuries (32% of persons with bicycling injuries treated at an emergency department). Forty-one percent of head injury deaths and 76% of head injuries occurred among children less than 15 years of age. Universal use of helmets by all bicyclists could have prevented as many as 2500 deaths and 757,000 head injuries, ie, one death every day and one head injury every 4 minutes. CONCLUSIONS: Effective community-based education programs and legislated approaches for increasing bicycle safety helmet usage have been developed and await only the resources and commitment to reduce these unnecessary deaths and injuries.
Adolescent↗
Shigellosis in Kentucky, 1986 through 1989.
A marked increase in the number of cases of shigellosis was reported in Kentucky in 1988. To examine reasons for this increase, we reviewed the 389 cases of shigellosis reported from 1986 through 1989. Ninety-three percent (285/305) of cases due to known species were due to Shigella sonnei. Sixty-two percent (243/389) of cases occurred in children less than 10 years of age. The annual incidence for blacks (6.8 cases per 100,000) was nearly four times that for whites (1.8 per 100,000). The increased number of cases in 1988 was due to outbreaks in five areas of the state, which accounted for 85% (200/234) of the cases. Three of the five outbreaks involved day-care centers. The primary mode of transmission appeared to be person-to-person; there was no evidence of a common source of infection from food or water. To prevent future outbreaks, cases of shigellosis need to be reported promptly to ensure appropriate investigation and control by local health departments.
Adolescent↗
The epidemiology of Lyme disease in Kentucky, 1985-1990.
Lyme Disease has become the most common vector-borne disease in the United States. To assess the extent of the disease in Kentucky, all case reports were reviewed for 1985-1990. A total of 51 cases met the current case definition. Epidemiologic features were similar to those reported nationally. Although the recognized tick vectors for Lyme Disease have still not been identified in Kentucky, physicians should educate their patients on the risk of Lyme Disease and measures to prevent tick bites. Reporting cases of Lyme Disease will continue to be important so that trends in the disease's occurrence in Kentucky can be monitored.
Adolescent↗
Head injury--associated deaths from motorcycle crashes. Relationship to helmet-use laws.
A review of US mortality data from 1979 to 1986 identified 15,194 deaths and nearly 600,000 years of potential life lost before age 65 years that were associated with head injuries from motorcycle crashes. White males from 15 to 34 years of age accounted for 69% of the deaths. The rate of motorcycle-related deaths associated with head injury declined modestly between 1979 and 1986 (19% using rates based on resident population and 8% based on motorcycle registrations). Population-based rates adjusted for age, sex, and race in states with partial or no motorcycle helmet-use laws were almost twice those in states with comprehensive helmet-use laws. Two states that weakened their helmet-use laws from comprehensive to partial during the study period had increases in motorcycle-related head injury death rates (184% and 73%), and one state that strengthened its law from partial to comprehensive had a decline in its death rate (44%). Head injury death rates based on motorcycle registrations were also lowest in states with comprehensive helmet-use laws. Since helmets reduce the severity of nonfatal head injuries in addition to lowering the rate of fatal injuries, we urge the adoption and enforcement of comprehensive motorcycle helmet-use legislation.
Accidents, Traffic↗
Head injury-associated deaths in the United States from 1979 to 1986.
Review of US mortality data from 1979 to 1986 identified 315,328 deaths associated with head injury, which represented 2% of all deaths, 26% of injury deaths, and an annualized head injury-associated death rate of 16.9 per 100,000 residents. Motor vehicles (57%), firearms (14%), and falls (12%) were the most frequent causes. Death rates peaked at 15 to 24 years of age and at 75 years or older, with the younger group most affected by motor vehicles (77%) and the older group by falls (43%). Although blacks and whites had similar death rates overall, age- and cause-specific rates varied considerably. The rate of head injury-associated death for males was three times that of females. Rates for head injury-associated death plateaued after declining in the early 1980s. Physicians can play an important role in primary prevention of head injury through careful prescribing of medications, patient counseling, and advocacy of proved interventions such as motor vehicle-occupant restraints. use, we observed 9827 children riding bicycles at sites in high-, middle-, and
Accidental Falls↗
Vaccine-preventable diseases on college campuses: the emergence of mumps.
Because of the adverse health impact of vaccine-preventable diseases, particularly measles and rubella, on college campuses, the American College Health Association (ACHA) Committee on Immunization and the House of Delegates issued position statements in 1983 and 1984 stating that colleges and universities should institute prematriculation immunity requirements. Since then, many colleges have implemented requirements and some states have passed comprehensive college laws requiring proof of immunity at the time of matriculation. No college rubella outbreaks have been reported to the Centers for Disease Control (CDC) since 1985. Measles outbreaks, however, have continued to be reported. In 1986-1987, 315 college measles cases were reported from 15 states, comprising over 3% of the total cases reported to CDC. Thirty-six percent of college measles cases could have been prevented through full implementation of prematriculation immunity requirements. Outbreaks of mumps were reported among students attending 16 colleges and universities in 3 states where active surveillance was undertaken during the 1986-1987 academic year. These mumps outbreaks, the first reported in colleges since vaccine licensure in 1967, were responsible for considerable health impact and disruption of activities. The outbreaks paralleled the increase in mumps reported nationally, which was largely a result of illness among unvaccinated adolescents and young adults not previously exposed to mumps. A lack of routine mumps vaccination in the past has allowed accumulation of susceptible unvaccinated persons in middle schools, high schools, and colleges. Outbreaks are likely to occur in those colleges that draw students who attended primary and secondary school in states without comprehensive laws requiring mumps vaccination.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
Changing epidemiology of mumps and its impact on university campuses.
The reported incidence of mumps has declined dramatically since licensure of the live attenuated mumps vaccine in the United States in 1967, particularly in young children. Because administration of the vaccine was not widely practiced during the first decade it was available, there is now a cohort of teenagers and young adults who are relatively underimmunized. Reported mumps cases in this cohort increased substantially during 1986 to 1987. Mumps outbreaks at three Illinois universities, from which 123 clinical cases were reported between September 1986 and May 1987, were investigated. Meningeal involvement was reported in 17% of case-patients, orchitis occurred in 19% of 64 men, 6% of patients were hospitalized, and direct health care costs were estimated at $264 per case and more than $32,000 for the three outbreaks combined. The risk of mumps illness was greater for students less than 20 years of age (relative risk [RR] = 2.1, 95% confidence interval [CI] = 1.4, 3.1); students residing in dormitories (RR = 2.7, 95% CI = 1.6, 4.6); and out-of-state students (RR = 1.8, 95% CI = 1.0, 3.0). Because the available data suggest that mumps in college-aged persons is due chiefly to a failure to vaccinate susceptible persons, colleges and universities should become one major focus of mumps prevention activities to reduce susceptibility in this high-risk population.
Adolescent↗
The Will Rogers phenomenon. Stage migration and new diagnostic techniques as a source of misleading statistics for survival in cancer.
We found that a cohort of patients with lung cancer first treated in 1977 had higher six-month survival rates for the total group and for subgroups in each of the three main TNM stages (tumor, nodes, and metastases) than a cohort treated between 1953 and 1964 at the same institutions. The more recent cohort, however, had undergone many new diagnostic imaging procedures. According to the "old" diagnostic data for both cohorts, the recent cohort had a prognostically favorable "zero-time shift." In addition, by demonstrating metastases that had formerly been silent and unidentified, the new technological data resulted in a stage migration. Many patients who previously would have been classified in a "good" stage were assigned to a "bad" stage. Because the prognosis of those who migrated, although worse than that for other members of the good-stage group, was better than that for other members of the bad-stage group, survival rates rose in each group without any change in individual outcomes. When classified according to symptom stages that would be unaltered by changes in diagnostic techniques, the two cohorts had similar survival rates.
Female↗
Capillarity and blood flow of transplanted skeletal muscles of cats.
After transplantation, skeletal muscle fibers and the microvasculature degenerate and then regenerate. The structural and functional characteristics of autografted muscle change with time and ultimately stabilize. Capillarity, blood flow, or fatigability was measured in control (total n = 22) and in autografted (total n = 42) extensor digitorum longus muscles of cats. From 10 to 180 days after transplantation, the capillaries per square millimeter in peripheral areas of autografts averaged 65% of control, and from 180 to 518 days, 45% of control. Resting blood flow in autografts increased eventually from total ischemia at the time of transplantation to values 400% of control. After 400 days, resting blood flow returned to control values. The blood flow of autografts increased in response to twitch stimulation, reaching maximal value (24.4 +/- 1.4 ml . 100 g-1 . min-1) at 1 twitch . s-1 . The maximal blood flow of autografts was comparable to the submaximal blood flow at 1 twitch . s-2 of controls and was 30% of the maximal flow of controls obtained at 4 twitches . s-1. The maximal blood flow in autografts did not increase from 80 to 460 days. When stimulated with repetitive twitches, autografts fatigued more rapidly than controls.
Action Potentials↗
An outbreak of furunculosis among high school athletes.
Furuncles (boils) are common among teenagers; however, few outbreaks have been documented. We investigated an outbreak of furuncles that occurred among male athletes of a Kentucky high school during the 1986 to 1987 school year. The overall attack rate was 25% (31/124). The risk of developing a furuncle increased two to three times in those who had skin injury. Athletes who sustained abrasions more than twice per week (P less than 0.01), who had a cut that required bandaging (P = 0.01), or had an unspecified injury causing a missed practice or game (P = 0.04) were at increased risk. The risk of developing furunculosis did not appear to be related to contact with formites, but rather, to contact with furuncles. Although athletes shared common areas (showers, locker rooms, practice areas, the attack rates for varsity football (36%) and varsity basketball (33%) were four times greater than for nonvarsity teams (P less than 0.01). Players who had a friend with a furuncle were more than twice as likely to also have had a furuncle (P less than 0.01). Exposure to furuncles appeared to increase the risk of furunculosis independently of reported skin injury. Control and prevention should, therefore, focus on both reducing skin injury and reducing exposure to furuncles, rather than attempting to sterilize inanimate objects.
Disease Outbreaks↗
An outbreak of cryptosporidiosis from fresh-pressed apple cider.
BACKGROUND: Recent waterborne outbreaks have established Cryptosporidium as an emerging enteric pathogen, but foodborne transmission has rarely been reported. In October 1993, an outbreak of cryptosporidiosis occurred among students and staff attending a 1-day school agricultural fair in central Maine. DESIGN: Environmental/laboratory investigation and cohort study. PARTICIPANTS: Attendees of the fair and their household members. MAIN OUTCOME MEASURES: Clinical or laboratory-confirmed cryptosporidiosis. Clinical cryptosporidiosis was defined as 3 days of either diarrhea (three loose stools in a 24-hour period) or vomiting. RESULTS: Surveys were completed for 611 (81%) of the estimated 759 fair attendees. Among attendees who completed the survey, there were 160 (26%) primary cases. Cryptosporidium oocysts were detected in the stools of 50 (89%) of 56 primary and secondary case patients tested. The median incubation period was 6 days (range, 10 hours to 13 days); the median duration of illness was 6 days (range, 1 to 16 days). Eighty-four percent of primary case patients had diarrhea and 82% had vomiting. Persons drinking apple cider that was hand pressed in the afternoon were at increased risk for cryptosporidiosis (154 [54%] of 284 exposed vs six [2%] of 292 unexposed; relative risk, 26; 95% confidence interval, 12 to 59). Cryptosporidium oocysts were detected in the apple cider, on the cider press, and in the stool specimen of a calf on the farm that supplied the apples. The secondary household transmission rate was 15% (53/353). CONCLUSIONS: This is the first large cryptosporidiosis outbreak in which foodborne transmission has been documented. It underscores the need for agricultural producers to take measures to avoid contamination of foodstuffs with infectious agents common to the farm environment.
Agriculture↗