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Biomedical subjects

J J Sacks

Publications and source records attributed to J J Sacks.

At least 73 records · Page 4Linked to original sources
PubMed1990

Playground hazards in Atlanta child care centers.

We identified 684 playground hazards in 66 child care centers despite regulations mandating that the grounds be hazard-free. Of 21 centers with less than or equal to 5 hazards, 42.9 percent reported a playground-related injury in the previous year; of 25 centers with 6-11 hazards, 52.0 percent reported a playground-related injury; and of 20 centers with greater than or equal to 12 hazards, 60.0 percent reported a playground-related injury. Climbing equipment greater than or equal to 6 feet tall generally had inadequate impact-absorbing undersurfacing and had over twice the rate of fall injuries as climbing equipment less than 6 feet.

Child Day Care Centers↗
PubMed1989

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↗
PubMed1989

Dog bite-related fatalities from 1979 through 1988.

By combining data from the National Center for Health Statistics and computerized searching of news stories, we identified 157 dog bite-related fatalities that occurred in the United States from 1979 through 1988. Of the 157 deaths, 70% occurred among children who were less than 10 years of age. The death rate for neonates was almost 370 times that of adults who were 30 to 49 years of age. Pit bull breeds were involved in 42 (41.6%) of 101 deaths where dog breed was reported, almost three times more than German shepherds, the next most commonly reported breed. The proportion of deaths attributable to pit bulls increased from 20% in 1979 and 1980 to 62% in 1987 and 1988. Pit bull attacks were almost twice as likely to be caused by strays as attacks by other breeds. Extrapolated estimates suggest 183 to 204 dog bite-related fatalities from 1979 through 1988. To prevent such deaths, we recommend stronger animal control laws, public education regarding dog bites, and more responsible dog ownership. Parents and physicians should be aware that infants left alone with a dog may be at risk of death.

Adolescent↗
PubMed1989

Deaths from residential fires among older people, United States, 1984.

Deaths from fires are the fifth leading cause of injury death among people aged 65 years or older. To describe the epidemiology of deaths from residential fires among older people, we analyzed mortality data for 1984 collected by the National Center for Health Statistics. Although older people represented only 12% of the U.S. population in 1984, they accounted for 29% (1,278) of that year's 4,466 residential fire deaths. Conflagrations accounted for 78% of older people's deaths from residential fires; clothing ignitions and other fires accounted for 11% each. Residential fire death rates increased with advancing age. Older black people had death rates 4.6 times the death rates of older white people. Older males had higher death rates than older females. Host, environmental, and behavioral risk factors for residential fire deaths among older people and potential strategies for intervention are discussed. Unless intervention strategies are focused on older people, the residential fire death toll in the U.S. may actually grow as the population of older people increases from 12% of the population in 1984 to about 21% of the population in 2030.

Accidents, Home↗
PubMed1988

A nurse-associated epidemic of cardiac arrests in an intensive care unit.

Review of 2219 admissions to an intensive care unit at a large urban hospital from 1983 to 1985 revealed an epidemic of cardiac arrests during the evening shift from January 1984 to March 1985. Of the 88 evening-shift cardiac arrests during this time, one specific nurse (Nurse 14) was the care giver for 57 (65%). Eight of ten epidemic-period patients who experienced shift-specific circadian recurrences of cardiac arrests were patients of Nurse 14. No therapeutic intervention and no other health care provider was as strongly associated with evening-shift cardiac arrests as was Nurse 14. Multiple logistic regression analysis demonstrated that when risk of cardiac arrest was adjusted for age, sex, severity of illness, and postoperative status, patients of Nurse 14 were 47.5 times more likely to experience arrest than were other nurses' patients. An expert determined that, compared with other nurses, the cardiac arrests among Nurse 14's patients were more likely to be consistent with unexplained hyperkalemia, to be unexpected in timing, and to be inconsistent with the clinical course. The epidemic ceased when Nurse 14 left employment at the intensive care unit in March 1985. Epidemiologic surveillance of adverse outcomes in health care settings is recommended.

Data Interpretation, Statistical↗
PubMed1988

A cluster of unexplained deaths in a nursing home in Florida.

In the two-week period November 13-27, 1984, 12 patients died in a 54-bed nursing home in Florida; based on previous mortality patterns, 2.5 deaths would have been expected for the whole month. There was no similar increase in deaths in November 1984 and no comparable monthly death rate for any of 69 nursing homes in the same county from 1976-84. Comparison of the 12 deaths in November with 28 deaths that occurred during the previous 10 months and with 31 surviving patients who were continuously present in the nursing home between November 12-28, 1984 revealed that the patients who died in November were more likely to have had onset of the terminal event during the night shift, had a recent visitor, and had an admitting diagnosis of organic brain syndrome. The abrupt increase in the death rate for November 1984 was not associated with a measurable change in population characteristics, an outbreak of infectious disease, or changes in procedures or the environment. Reviews of employee schedules revealed a consistent and strong association between the duty times of two nurses and the onsets of the terminal episode and the times of patient deaths. Continuing epidemiologic surveillance of adverse outcomes in nursing homes is recommended.

Aged↗
PubMed1986

Transmission of measles in medical settings. 1980 through 1984.

For the five-year period 1980 through 1984, a total of 241 persons with measles in 30 states were identified as probably having acquired their infection in a medical facility. The proportion of all measles cases acquired in medical settings increased from 0.7% for 1980 through 1982 to 2.9% for 1983 and 1984. Seventy-six percent of cases were found in patients or visitors, and 24% in personnel at the medical facility where transmission occurred. The highest proportion of cases occurred in children less than 5 years of age (54.3%), followed by persons 25 to 29 years of age (14.7%). Of spread (50.0%) and patient-to-staff spread (36.7%) were most common. Medical personnel rarely transmitted disease to others. More attention needs to be given to methods of preventing spread of measles in medical facilities, such as isolation precautions, postexposure prohylaxis of potential contacts (vaccination or immune globulin), and ensuring that medical personnel are immune to measles.

Adult↗
PubMed1986

An outbreak and review of cave-associated histoplasmosis capsulati.

Three male college students from Florida developed acute onsets of fever, chills, shortness of breath, and cough within one day of each other, and all were eventually hospitalized for four to 29 days. All chest x-ray films showed diffuse reticulonodularities in both lung fields. Laboratory studies confirmed the diagnosis of histoplasmosis. The three students had been 'spelunking' (cave exploring) 6 to 7 days before their onset of symptoms. One of four soil samples collected in the caves was positive for Histoplasma capsulatum by the indirect mouse inoculation procedure. Of three investigators who entered the implicated caves, two developed acute febrile illness within 15-21 days. One investigator was hospitalized for 18 days with a confirmed diagnosis of histoplasmosis. Investigation identified an additional case (the person had entered the caves 6 months before this episode), but was not reported to health authorities. Spelunkers should be aware of the potential risk of histoplasmosis and how to avoid infection. Physicians should be cognizant of cave-associated histoplasmosis, inquire about spelunking in persons who develop febrile respiratory illnesses with diffuse nodularities on chest x-ray films, and report such cases to their health department. A review of 42 reported outbreaks of cave-associated histoplasmosis and the approach to environmental control of infected caves are included.

Adult↗
PubMed1986

Cluster of abortion deaths at a single facility.

This report describes a cluster of four abortion-related deaths at a single facility from 1979 to 1983. The deaths followed curettage abortions at eight to 18 weeks' gestation. One death was attributed to a prolapsed mitral valve, and one was attributed to spontaneous ventricular fibrillation. Two deaths, which occurred within three weeks of each other, were caused by hemorrhage from uterine perforation. The person who allegedly performed the last two abortions was not licensed to practice medicine, nor was he under the supervision of a licensed physician. The estimated death-to-case rate at this facility (57 per 100,000 abortions) is significantly higher than the national rate (1.2 per 100,000 abortions, P less than .001). To prevent such situations, prompt treatment of abortion complications and community-based surveillance of serious morbidity should be performed.

Abortion, Illegal↗
PubMed1986

Epidemic campylobacteriosis associated with a community water supply.

In May 1983, an estimated 865 cases of epidemic gastrointestinal disease occurred in Greenville, Florida. Surveillance of pharmacy sales of antidiarrheal medicines suggested that the outbreak was confined to Greenville and its immediate vicinity. Surveys demonstrated that the gastrointestinal illness attack rates inside and outside the city limits were 56 per cent (72/128) and 9 per cent (7/77), respectively (relative risk (RR) = 6.2); consumption of city water was associated with illness (RR = 12); and as water consumption increased, the attack rate also increased (p less than 0.001). Four adults were hospitalized and one outbreak-related case of Guillain-Barre' syndrome was identified. Campylobacter jejuni was isolated from specimens from 11 ill persons; serologic studies showed the development of Campylobacter-specific antibodies. Fecal coliforms were found in water samples, but Campylobacter was not recovered from water. The city water plant, a deep well system, had numerous deficiencies including an unlicensed operator, a failure of chlorination, and open-top treatment towers. Birds were observed perching on the open-top treatment tower. Of 38 birds trapped seven weeks later, 37 per cent harbored C. jejuni; however, plasmid and serotyping studies showed that strains were not the same as the common strain from ill persons. This outbreak suggests that water systems that are unprotected from contact with birds may become contaminated and a source of outbreaks of human campylobacteriosis.

Adult↗