AIDS in a surgeon.
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Acquired Immunodeficiency Syndrome↗
Biomedical subjects
J J Sacks
Publications and source records attributed to J J Sacks.
Utilization of case definitions and laboratory reporting in the surveillance of notifiable communicable diseases in the United States.
In 1984, questionnaires were sent to the chief epidemiologist in all 50 states, Puerto Rico, and Washington, DC, with a 100 per cent response rate. There were substantial variations in case definitions of reportable diseases, criteria for counting as a case, and sources of surveillance. Laboratory reporting of any notifiable condition is mandated by 54 per cent of jurisdictions. These differences in ascertainment and case-counting practices constitute potential sources of error in national surveillance data on communicable diseases.
Attitude of Health Personnel↗
Rocky Mountain spotted fever acquired in Florida, 1973-83.
From 1973 to 1983, 49 Florida residents were reported with confirmed Rocky Mountain spotted fever (RMSF), 25 of whom were considered to have had Florida-acquired disease. Although there was no history of tick exposure for six of these 25 persons, all had contact with dogs or outdoor activities during the incubation period. The tick vectors of RMSF are widely distributed throughout Florida. We conclude that RMSF, although rare in Florida, can be acquired in the state.
Adolescent↗
Epidemiology of a tuberculosis outbreak in a South Carolina junior high school.
A 13-year-old, female, seventh-grade student (the index patient) was found to have smear-positive, cavitary, pulmonary tuberculosis. Epidemiologic and contact investigation, involving skin testing over 900 people, revealed a 40 per cent tuberculin reactor rate for persons in the junior high school she attended compared to a 2 per cent rate for control schools. Repeat skin testing of initial non-reactors identified an additional 3 per cent of infected school children. School teachers showed a seven-fold increase in the prevalence of positive skin-test reactions following the outbreak. Tuberculin-reactor rates for seventh graders were substantially higher than for eighth graders. The more classes shared with the index patient, the higher the probability of being a reactor. Among students who shared no classes with the index patient, the highest rates of tuberculin reactions were found for those who had entered a classroom immediately after the index patient had left it. Evidence of transmission on the school bus and in the church choir was also suggested. Six secondary cases (three pulmonary) resulted from the outbreak. Identical phage types from the index and secondary patients suggest who had left school during the term proved useful in determining when transmission began. The index case was found to be a missed contact of a previously identified case of tuberculosis. Since household contacts are at high risk for developing active disease, there is a need for meticulous and complete investigation and preventive therapy for all such persons, especially children.
Adolescent↗
Concurrent infection in families of patients with acute toxoplasmosis.
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Acute Disease↗
Employee rubella screening programs in Arizona hospitals.
One year after voluntary guidelines on rubella screening of hospital employees were issued by the Arizona Department of Health, a survey of 68 members of the Arizona Hospital Association was conducted, with an 81% response. Some form of employee rubella screening was present in only 49% of responding hospitals. Of the screening hospitals, 70% of programs had a mandatory aspect for selected employees. Administrative logistics, cost, problems encountered, and the quality and coverage of the program varied substantially among the different hospitals. Fewer than half of the screening hospitals had programs for physicians, students, or volunteers. Verbal histories of immunization or serological tests, although notoriously unreliable, were accepted by 14% of the screening hospitals. Half of the nonscreening hospitals plan to implement programs in the future. Reasons given for not establishing rubella screening programs include cost, no pediatric or obstetric service, liability issues, high turnover, and no previous case of rubella in an employee. Three hospitals (all screening) reported they had had a case of rubella in an employee. The data suggest slow partial compliance with recommendations for rubella screening in hospitals.
Adolescent↗
Toxoplasmosis infection associated with eating undercooked venison.
Toxoplasmosis infection was documented in one Alabama and two South Carolina deer hunters in 1980. All three cases were acutely ill and required hospitalization. Physical findings included fever, leukopenia, and abnormal liver function tests. Two of the three patients showed infiltrates on chest x-ray. All three hunters had recently consumed raw or nearly raw venison and lacked other known risk factors for toxoplasmosis such as cat contact or eating other undercooked meats. In a serosurvey and questionnaire of 62 wildlife workers who regularly handled deer viscera, an association between seropositivity to Toxoplasma gondii and a history of eating raw or rare venison was found (p less than 0.05), but no significant association was found between seropositivity and any other risk factors. Eating inadequately cooked venison may represent an important vehicle of human toxoplasmosis infection.
Acute Disease↗
Tick testing as a method of controlling Rocky Mountain spotted fever.
In South Carolina, 1974-1980, only two matches were found between 536 Rocky Mountain spotted fever (RMSF) cases and 965 individuals who submitted ticks that tested rickettsial antigen positive. In neither case did the positive test prevent RMSF. Tick rickettsial positivity rates varied inversely with human RMSF attack rates in different geographic areas. A physician survey established it as unlikely that RMSF occurred in positive tick submitters (PTS), and that although not recommended, 34 per cent of asymptomatic PTS received prophylactic treatment. Only 18 per cent of positive ticks were engorged. Tick testing appears ineffective in preventing RMSF.
Child↗
Toxoplasmosis infection associated with raw goat's milk.
In October 1978, a large family cluster of acute toxoplasmosis was identified in northern California. Indirect fluorescent IgM antibody tests showed that ten of 24 members of an extended family had serological evidence of acute Toxoplasma infection. The index case had retinochoroiditis; the other nine persons had asymptomatic infections. All ten seropositive persons had recently consumed raw goat's milk from the family herd as compared with no consumption of raw milk by the 14 persons with negative results. No dietary item or other risk factors were as strongly associated with positive serological test results as raw milk consumption. Although ingestion of soil-transmitted oocysts could not be ruled out unequivocally as the source of infection, the data suggest that drinking raw milk from infected goats might be another possible vehicle for the transmission of toxoplasmosis.
Adolescent↗
Reliability of the health hazard appraisal.
As part of a controlled clinical trial of Health Hazard Appraisal's (HHA) efficacy in stimulating risk reduction, the reliability of the HHA questionnaire was evaluated. Of 203 subjects, only 30 (15%) had no contradictions when comparing the responses of the follow-up with baseline questionnaire. Overall, there was an average of 1.6 contradictions per subject. Failure to control for reliability may account for apparent reduction of risk reported in previous studies of HHA.
Adult↗
Reported bicycle helmet use among adults in the United States.
This study estimates bicycle helmet use among adults in the United States, examines factors associated with helmet use among adult bicyclists in 1994, and examines other safety-related practices. A telephone survey of 5238 randomly dialed households in the United States was conducted. The participants were randomly selected adult (aged > or = 18 years) respondents, and the main outcome measure was bicycle riding and helmet use in the last 30 days. We estimate that 20.2% of adults reported riding a bicycle in the 30 days preceding their interview. Of the bicyclists, 18.3% report they always wear their helmet when bicycling. Persons between the ages of 18 and 24 years had the highest proportion of bicycle riders for any adult age group (31.3%) but reported using helmets less than any other adult age group (5.1%). In univariate and multivariate analyses, age older than 24 years, female sex, higher educational level, and living in the west or northeast region of the country were associated with helmet use among adults. Helmet users were also more likely than nonusers to report a higher prevalence of other safety behaviors (ie, always wearing a safety belt, having a smoke detector in the house, and having a fire escape plan). Further efforts to increase the wearing of bicycle helmets by adults are necessary to meet the year 2000 objective of 50% helmet use. Adults should be targeted for increased helmet promotion efforts, especially those between the ages of 18 and 24 years. Increasing consistent use of helmets among adults may also help increase consistent use of helmets among children through role modeling.
Adult↗
Nonfatal physical violence, United States, 1994.
OBJECTIVES: Most surveillance and research efforts focus on severe violence, especially on homicides. Because less extreme forms of violence may be precursors to more extreme forms, the authors analyzed data from a national survey to describe the extent of nonfatal physical violence in the US. METHODS: The authors generated weighted national estimates from responses to a random-digit-dialed telephone survey. Respondents were asked if they had been "hit, slapped, pushed, or kicked by another person or hit with an object or weapon" in the preceding 12 months. Respondents were also asked how many times such incidents had occurred and, for the last such episode, their relationship with the perpetrator, whether they had been injured, and, if so, whether they had sought medical treatment. RESULTS: The authors estimate that approximately 15 million people, or 8% of the US adult population, experienced nonfatal physical violence, as defined for this study, during a 12-month period. Male gender, the 18-24-year-old age group, never having been married, being out of work or a student, and heavy drinking were associated with a higher likelihood of being assaulted. An estimated 75% of assaults were by a known person and 26% by a stranger. Women were more likely than men to be assaulted by current or former intimate partners; men were more likely than women to be assaulted by strangers. An estimated 18% of incidents resulted in injuries, and an estimated 7% required medical attention. CONCLUSIONS: Nonfatal physical violence is fairly common in the US and may lead to more than one million medical encounters each year.
Adolescent↗
Measuring community bicycle helmet use among children.
Bicycling is a popular recreational activity and a principal mode of transportation for children in the United States, yet about 300 children die and 430,000 are injured annually. Wearing a bicycle helmet is an important countermeasure, since it reduces the risk of serious brain injury by up to 85%. The Centers for Disease Control and Prevention (CDC) have funded state health departments to conduct bicycle helmet programs, and their effectiveness has been evaluated by monitoring community bicycle helmet use. Although it would appear that measuring bicycle helmet use is easy, it is actually neither simple nor straightforward. The authors describe what they have learned about assessing helmet use and what methods have been most useful. They also detail several key practical decisions that define the current CDC position regarding helmet use assessment. Although important enough in their own right, the lessons learned in the CDC's bicycle helmet evaluation may serve as a model for evaluating other injury prevention and public health programs.
Bicycling↗
Self-reported swimming ability in US adults, 1994.
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Adolescent↗
Household survey of child-safe packaging for medications.
In an investigation of the prevalence of safety packaging of medications, 131 randomly selected Minneapolis and St. Paul households with children were surveyed in 1985. Of the 1,953 oral medications in these households (mean was 14.9 per home), 43.3 percent did not have safety packaging. Over-the-counter medications were less likely to have safety packaging than prescription medications (over-the-counter 53.1 percent, prescription 25 percent). This high prevalence of medications without safety packaging in households with children could increase the risk of childhood poisoning. Strategies to reduce this potential risk are discussed.
Child, Preschool↗
The epidemiology of injuries in Atlanta day-care centers.
From June 1987 through May 1988, we collected reports of injuries among 5300 children who attended 71 day-care centers in Atlanta, Ga. One hundred forty-three injuries severe enough for the child to require medical or dental care were reported, including 63 lacerations (44.1%), 23 fractures (16.1%), 5 crush injuries (3.5%), 4 dislocations (2.8%), 2 human bites (1.4%), and 2 concussions (1.4%). The head was the site of 98 (68.5%) injuries. Peak hours for injuries were 11 AM and 4 PM, the peak day was Monday, and the peak season was summer. After adjustment for hours and dates of attendance, the rate was 1.77 injuries per 100,000 child-hours in day care; among preschool-aged children, infants had the lowest rate (0.77) and 2-year-old children had the highest rate (2.26). Almost 47% of injuries occurred on the playground; falls were involved in 70% of such injuries. Because 33% of all injuries resulted from falls on the playground, impact-absorbing playground surfaces may be a possible intervention to reduce injuries.
Accidental Falls↗
The cost effectiveness of three programs to increase use of bicycle helmets among children.
Each year in the United States, 280 children die from bicycle crashes and 144,000 are treated for head injuries from bicycling. Although bicycle helmets reduce the risk of head injury by 85 percent, few children wear them. To help guide the choice of strategy to promote helmet use among children ages 5 to 16 years, the cost effectiveness of legislative, communitywide, and school-based approaches was assessed. A societal perspective was used, only direct costs were included, and a 4-year period after program startup was examined. National age-specific injury rates and an attributable risk model were used to estimate the expected number of bicycle-related head injuries and deaths in localities with and without a program. The percentage of children who wore helmets increased from 4 to 47 in the legislative program, from 5 to 33 in the community program, and from 2 to 8 in the school program. Two programs had similar cost effectiveness ratios per head injury avoided. The legislative program had a $36,643 cost and the community-based one, $37,732, while the school-based program had a cost of $144,498 per head injury avoided. The community program obtained its 33 percent usage gradually over the 4 years, while the legislative program resulted in an immediate increase in usage, thus, considering program characteristics and overall results, the legislative program appears to be the most cost-effective. The cost of helmets was the most influential factor on the cost-effectiveness ratio. The year 2000 health objectives call for use of helmets by 50 percent of bicyclists. Since helmet use in all these programs is less than 50 percent, new or combinations of approaches may be required to achieve the objective.
Adolescent↗
Bicycle helmet use by adults: the impact of companionship.
Most of the nearly 1,000 fatal bicycle-related injuries annually could be prevented if riders used safety helmets. Helmet use by adult bicyclists has received relatively little attention because educational campaigns to promote helmet use generally focus on children. Helmet use by adult and child bicyclists at 120 suburban and rural sites in three Maryland counties was observed on two Saturdays in 1990-91 during an evaluation of the impact of a mandatory helmet law. Concordance or discordance of helmet use within various groups of bicyclists--adults only, adults with children, and children only--was recorded. Helmet use among 2,068 adult bicyclists was 49 percent, 51 percent, and 74 percent in the three counties. In two counties combined, 52 percent (365 of 706) of solo adult bicyclists wore helmets compared with only 5 percent (5 of 94) of solo child bicyclists (P < .001). Helmet use or nonuse was concordant among 87 percent of 277 adult-adult pairs, 94 percent of 50 child-child pairs, and 91 percent of 32 adult-child pairs of bicyclists observed. Concordance rates of helmet use or nonuse were similarly high among pairs of adult bicyclists of the same or mixed sexes. These data are consistent with the concept that both adults and children tend to adopt the helmet-wearing behaviors of their companions. Public health efforts focused on adults should encourage helmet use by adult bicyclists both to prevent head injuries and to provide a role model for children.
Adolescent↗