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30 July 2001
Heat-Related Deaths --- Los Angeles County, California, 1999--2000, and United States, 1979--1998
Sathyavagiswaran L, Fielding JE, Dassy D, and the CDC National Center for Environmental Health. MMWR 2001; 50(29): 623-626.
Full text available online: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5029a3.htm
These case reports illustrate some of the risks for hyperthermia. The primary risk factors include age (i.e., increasing age, except children aged <5 years who are at higher risk than older children), behavior (e.g., low fluid intake, excessive exercise, prolonged stay in nonair-conditioned places, and alcohol and/or drug use), chronic disease (e.g., cardiac or mental illness), prescription drugs (e.g., psychotropic medication), living conditions (e.g., low income, residence in urban areas, no access to air-conditioning, and social isolation), and prolonged outdoor activities (e.g., agricultural work and recreational running).
Heat-related illness can begin as sunburn and fatigue and progress to heat cramps, heat exhaustion, and heatstroke. The two most serious types of heat-related illness are heat exhaustion (heavy sweating, paleness, muscle cramps, tiredness or weakness, dizziness or headache, nausea or vomiting, and faintness) and heatstroke (oral temperature of >103.0 F [>39.4 C]; rapid, strong pulse; red, hot, and dry or sweaty skin; throbbing headache or dizziness; nausea; confusion; and unconsciousness). Untreated heat exhaustion can progress to heatstroke, a medical emergency that can develop in <24 hours. Even when treated, the death rate for heatstroke may be as high as 33%. Permanent neurologic damage occurs in up to 17% of survivors, and its likelihood increases with longer duration of heatstroke.
Trends and patterns of playground injuries in United States children and adolescents
Phelan KJ, Khoury J, Kalkwarf HJ, Lanphear BP. Ambulatory Pediatrics 2001; 1(4): 227-233.
Correspondence: Lieran J. Phelan, Division of General and Community Pediatrics, Children's Hospital Medical center, 3333 Burnet Ave., Cincinnati, OH 45229 USA (email: kj.phelan@chmcc.org)
The authors report on a study of the prevalence, trends, and severity of injuries attributable to playground falls relative to other common unintentional mechanisms that resulted in an emergency department (ED) visit in the United States. Data were from the emergency subset of the National Ambulatory Medical CAre Survey collected from 1992 to 1997 for persons < 20 years of age. There were 920,551 (95% CI: 540,803 to 1,300,299) ED visits over the 6-year study period by children and adolescents that were attributable to falls from playground equipment. The annual incidence of visits for playground injuries remained about constant over the course of the study. Injury visits for playground falls were twice as prevalent as pedestrian mechanisms, but they were less prevalent than visits for motor vehicle occupant- and bicycle-related injuries. A larger proportion of playground falls resulted in moderate-to-severe injury than did bicycle or motor vehicle occupant injuries. Children aged 5 to 9 years had the highest number of playground falls (p=0.0014). Playground falls were most likely to occur at school compared to home, public, and other locations (p= 0.0016).
The incidence of injury with the British Antarctic Survey, 1986-1995
Cattermole TJ. Int J Circumpolar Health 2001; 60(1): 72-81.
Trevor Cattermole, British Antarctic Survey Medical Unit, RGIT Ltd., Aberdeen, UK. (email: Trevor.Cattermole@ed.ac.uk)
Medical consultations recorded by the British Antarctic Survey between 1986-1995 were analyzed. A total of 3683 new consultations were recorded, an incidence of 2193.7/1000/year, with a significantly higher incidence on the bases compared to the ships. Injuries comprised 30.2% of consultations, an incidence of 661.7/1000 workers/year. The bases had a significantly higher incidence of injuries. Work accounted for 47.0% and recreation 30.6% of all injuries.
Updated Guidelines for Evaluating Public Health Surveillance Systems
Centers for Disease Control and Prevention. MMWR 2001; 50(RR13): 1-35.
Full text (pdf) available online: http://www.cdc.gov/mmwr/PDF/rr/rr5013.pdf
The purpose of evaluating public health surveillance systems is to ensure that problems of public health importance are being monitored efficiently and effectively. CDC's Guidelines for Evaluating Surveillance Systems are being updated to address the need for a) the integration of surveillance and health information systems, b) the establishment of data standards, c) the electronic exchange of health data, and d) changes in the objectives of public health surveillance to facilitate the response of public health to emerging health threats (e.g., new diseases). This report provides updated guidelines for evaluating surveillance systems based on CDC's Framework for Program Evaluation in Public Health, research and discussion of concerns related to public health surveillance systems, and comments received from the public health community. The guidelines in this report describe many tasks and related activities that can be applied to public health surveillance systems.
Alcohol use disorders and risk factor interactions for adolescent suicidal ideation and attempts
Kelly TM, Lynch KG, Donovan JE, Clark DB. Suicide Life Threat Behav 2001;31(2): 181-193.
Correspondence: Duncan B. Clark, Pittsburgh Adolescent Alcohol Research Center, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, PA 15213-2593, USA (email: clarkdb@msx.upmc.edu)
Four hundred eighty-two adolescents who were diagnosed with at least one mental disorder were studied to determine the predictors of suicidal ideation and suicide attempts. Major depression was predictive of suicidal ideation and suicide attempts for both genders. Chronic stress was found predictive of male suicidal ideation, while low self-esteem and high family dysfunction were found to be predictive of suicidal ideation in females. Statistical trends suggest that females with comorbid alcohol use/conduct disorder were approximately three times more likely to have attempted suicide than those with only one of these conditions. Clinicians working with adolescents should be aware that, while depression remains the number one clinical risk for suicidal behavior, risk factors for suicidal ideation may be different than those for attempted suicide and may vary by gender.
Road transport barriers encountered by people with travel difficulties in Japan
Tokuda K. IATSS Research 2001; 25(1): 12-22.
Full text available online: http://wwwsoc.nii.ac.jp/iatss/
This study examines in detail specific barriers encountered by pedestrians with disabilities -- wheelchair users and the visually impaired in particular. These barriers include vehicles parked on sidewalks or upon textured paving surfaces for the visually impaired, bicycles ridden on sidewalks, bicycles left on sidewalks, uneven sidewalks, obstacles on sidewalks, steep slopes, improperly laid textured paving surfaces, crosswalk request buttons that have been set in inappropriate locations, and other issues. Numerous photographs are included.
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Can Owning a Gun Really Triple the Owner's Chances of Being Murdered? The Anatomy of an Implausible Causal Mechanism
Kleck GD. Homicide Studies, 2001; 5(1): 64-77.
Correspondence: Gary Kleck. School of Criminology, 306-Hecht House MC-1127, Florida State University, Tallahassee, FL 32306 USA (email: gkleck@mailer.fsu.edu).
Using a case-control design comparing homicide victims with matched nonvictims, Kellermann et al. (1993) concluded that keeping a gun in one's home increased the risk of being murdered by a factor of 2.7. The authors' underlying assumption was that a significant elevation in homicide risk derived from the risk of being murdered with a gun kept in the victim's home. This article shows that homicides are rarely committed with guns belonging to members of the victim's home and that such killings could be responsible for no more than a 2.4% increase in the relative risk of being murdered. Guns in one's own home have little to do with homicide risk. Scholars need to attend more closely to the mechanisms by which an alleged causal effect is supposed to operate and to consider their plausibility before concluding that an association reflects a causal effect.
A Comparison of Supplementary Homicide Reports and National Vital Statistics System Homicide Estimates for U.S. Counties
Wiersema B, Loftin C, McDowell D. Homicide Studies, 2000; 4(4): 317-340.
Correspondence: Brian Wiersema, Violence Research Group, Department of Criminology and Criminal Justice, University of Maryland, College Park, Maryland 20742-8235 USA (email: brian.wiersema@umail.umd.edu).
This article examines agreement between homicide estimates from the Supplementary Homicide Report (SHR) and the National Vital Statistics System (NVSS) at the county level for 1980 to 1988. NVSS and SHR estimates exactly agree in 22% of the counties (68% if agreement is defined as no more than a difference of four homicides), but in some cases, they differ substantially. Although the NVSS generally exceeds the SHR, the pattern is not uniform: 28% of the counties report more SHR homicides than NVSS homicides. Differences between estimates from the two systems are related to population size. Large-population counties often have substantial differences in homicide counts, but the deflating effect of dividing by population yields small rate differences. In contrast, dividing by population magnifies differences in small-population counties and produces discrepancies in the rates that are not present in the counts. The NVSS and SHR differ somewhat in their definition of cases, and other disagreements result from ambiguities in or failures to follow data collection procedures within each system.
Homicide and Nativity: A Look at Victimization and Offending in Los Angeles County
Sorenson SB, Lew V. Homicide Studies, 2000; 4(2): 162-184.
Correspondence: Susan B. Sorenson, University of California, School of Public Health 21-245B CHS, 650 South C. E. Young Drive, Los Angeles, CA 90095-1772, USA (email: sorenson@ucla.edu).
Immigration has been associated with crime. Whether immigrants are more involved than native-born persons in violent crime, in general, and in homicide, in particular, is less clear. We addressed the latter question by examining the 9,442 homicides from 1990 to 1994 in Los Angeles County. To avoid attributing to nativity the risk associated with age, gender, and ethnicity, population structure differences of the two groups were taken into account. Immigrants are at slightly higher risk of becoming a homicide victim than native-born persons. Offense rates are difficult to interpret because in 42.3% of the homicides, no suspect was identified; using data from known suspects, U.S.-born persons are 1.29 times more likely than foreign-born persons to commit homicide. The nature of the homicides of immigrants and by immigrants are, with some exceptions, substantially similar to the homicides of and by natives. More and better data are needed to inform policy. -
Handgun sales, beer sales, and youth homicide, California, 1972-1993.
Sorenson SB, Berk RA. J Public Health Policy 2001; 22(2):182-197.
Correspondence: Susan B. Sorenson, University of California, School of Public Health 21-245B CHS, 650 South C. E. Young Drive, Los Angeles, CA 90095-1772, USA (email: sorenson@ucla.edu).
Whether regulating access to firearms and alcohol will reduce violent injuries is an important policy question. Empirical answers are difficult to obtain because only observational data are available. The present study estimated the association of firearm sales and alcohol sales with subsequent homicides, after adjusting statistically for potential confounders (e.g., unemployment rates) using California data from 1972 through 1993. Handgun sales and beer sales were lagged one year and used to explain variation in the homicides of Californians (e.g., 1990 sales were used to explain 1991 homicides). Differences across population groups were investigated, with a focus on 15- to 34-year-olds, the highest risk age group. Even when taking potential confounders in the base population into account, beer sales and handgun sales generally are associated positively one year later with homicide, particularly among young men. Reducing beer sales may reduce homicides. And, although they represent a small fraction of existing firearms, regulating the number of handguns sold may reduce the number of homicides.
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