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These recommendations on the use of bicycle helmets are the first in a series of Injury-Control Recommendations that are designed for state and local health departments or other organizations for use in planning injury control programs. Each publication in the series of Injury-Control Recommendations will provide information for program planners to use when implementing injury control interventions. These guidelines were developed for state and local agencies and organizations that are planning programs to prevent head injuries among bicyclists through the use of bicycle helmets. The guidelines contain information on the magnitude and extent of the problem of bicycle-related head injuries and the potential impact of increased helmet use; the characteristics of helmets, including biomechanical characteristics, helmet standards, and performance in actual crash conditions; barriers that impede increased helmet use; and approaches to increasing the use of bicycle helmets within the community. In addition, bicycle helmet legislation and community educational campaigns are evaluated.
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BACKGROUND: From 1986 to 1987 the Carter Center of Emory University joined with the Centers for Disease Control (CDC) to develop a new, probability-based, adult health risk appraisal (HRA) instrument for the public domain. This new instrument is compared with the CDC HRA version to determine which is a more accurate predictor of mortality. METHODS: We compared predicted mortality risks from the CDC HRA and the Carter Center HRA with the observed mortality among 3135 smokers and never-smoking persons, aged 25 to 60, followed from 1959 to 1979 as part of the Tecumseh Community Health Study. RESULTS: When individuals were classified according to the difference between their actual age and risk age, for the CDC HRA, there was a progressively increasing risk of 10-year mortality as the difference increased. The Carter Center HRA did not show this trend. An analysis using relative operating characteristic curves showed that the mortality risk predictions for both programs were very similar for men and women. However, differences between actual age and risk age for the two programs were not similar for men or women, particularly older men. Therefore, actual age minus risk age for the CDC program was a more accurate predictor of 10-year mortality than was this difference for the Carter Center program. CONCLUSIONS: The results from both types of analyses suggest that the validity of risk ages obtained from the Carter Center version may not be sufficient to justify updating programs for those currently using the CDC instrument.
A Surgical Wound Infection (SWI) Task Force was convened by The Society for Hospital Epidemiology of America (SHEA) to evaluate how SWI surveillance should be done and to identify where more information is needed. The Task Force reached consensus in the following areas. The Centers for Disease Control (CDC) definitions of SWI should be used for routine surveillance because of their current widespread acceptance and reproducibility. The CDC definitions have been clarified in an accompanying article ("Report From the CDC"). Direct observation of wounds and traditional infection control surveillance techniques are acceptable methods of case finding for hospitalized patients. The optimal method for case finding postdischarge or after outpatient surgery is unknown at this time. SWI rates should be stratified by surgical wound class plus a measure of patient susceptibility to infection, such as the American Society of Anesthesiology (ASA) class, and duration of surgery. Surgeon-specific SWI rates should be calculated and reported to individual surgeons.
INTRODUCTION: The Centers for Disease Control and Prevention's Guidelines for School Health Programs to Prevent Tobacco Use and Addiction were developed, in part, to help state and local education agencies implement effective school-based tobacco control programs. This paper: (1) reports on school tobacco policies, one facet of a larger investigation conducted to examine the consistency between WV's school-based tobacco control policies and programs and the CDC Tobacco Guidelines and (2) describes the impact this investigation had on state policy in WV. METHODS: A content analysis was conducted on all (n = 55) county tobacco policies using a coding protocol developed by the authors. This protocol was designed to enable judgment about whether the county policies addressed particular elements specified in the CDC Tobacco Guidelines. Additionally, data about school-level policies, collected from a telephone survey of a sample of school principals (n = 421), are presented. Since the purpose of the needs assessment was to describe current practice, frequencies were computed for both the county and school-level analyses. RESULTS: Both county- and school-level tobacco policies were found lacking in many of the elements recommended in CDC's Tobacco Guidelines, particularly in the areas of enforcement procedures and access to cessation programs. CONCLUSIONS: Two major outcomes resulted from this needs assessment: (1) the WV State Board of Education's Tobacco Control Policy was revised to be more consistent with CDC's Tobacco Guidelines and (2) increased attention is now being focused on providing cessation options for WV schools.
BACKGROUND: The purpose of this report is to identify the most important research questions pertaining to the acute care of the injured patient using a Web-based Delphi technique to achieve expert opinion consensus. METHODS: Experts in trauma care from the United States and Canada (n =39) generated structured research questions and then ranked these questions in order of importance, using a Web-based survey for question generation, question ranking, and a Delphi technique of consensus. Guidelines for question construction and ranking specified that participants considered questions that fall within the interest and domain of the Centers for Disease Control (CDC)-National Center for Injury Prevention and Control (NCIPC). RESULTS: One hundred thirty-seven questions in 18 distinct categories of interest were initially generated. After two rounds of merging, collating, reassessing, and ranking by significance and importance, 25 research questions were deemed most important and significant in the care of the injured patient. Ten of these (40%) were considered to be appropriate issues for the CDC-NCIPC to address and fund, dealing with injury prevention strategies, trauma systems design and funding, the epidemiology of injury, and global outcome determinants. These 25 questions were also reviewed with consideration given to the most likely source of federal funding of investigations. CONCLUSION: This report identifies the areas of trauma care in which research efforts might best be directed. Fully 40% of the key research questions could be considered to fall under the interest and auspices of the CDC-NCIPC. The remaining questions cover a broad range of topics and likely funding sources, emphasizing the need for a coordinated oversight of research funding in trauma care.
Each year, poison control centers (PCCs) receive more than 25,000 calls related to workplace exposures to hazardous substances. Recent studies indicate that each caller may be a sentinel contact representing other exposed or ill workers. Although PCCs traditionally focus their follow-up efforts on the treatment of the index case alone, with minimal attention to the public health implications of other exposed or ill workers, PCCs could serve as a national surveillance system for occupational illnesses, a system with both passive and active attributes.