Fatal dog attacks, 1989-1994.

OBJECTIVES: To update data on fatal dog bites and see if past trends have continued. DESIGN: To merge data from vital records, the Humane Society of the United States, and searches of electronic news files. SETTING: United States. SUBJECTS: U.S. residents dying in the U.S. from 1989 through 1994 from dog bites. RESULTS: We identified 109 dog bite-related fatalities, of which 57% were less than 10 years of age. The death rate for neonates was two orders of magnitude higher than for adults and the rate for children one order of magnitude higher. Of classifiable deaths, 22% involved an unrestrained dog off the owner's property, 18% involved a restrained dog on the owner's property, and 59% involved an unrestrained dog on the owner's property. Eleven attacks involved a sleeping infant; 19 dogs involved in fatal attacks had a prior history of aggression; and 19 of 20 classifiable deaths involved an unneutered dog. Pit bulls, the most commonly reported breed, were involved in 24 deaths; the next most commonly reported breeds were rottweilers (16) and German shepherds (10). CONCLUSIONS: The dog bite problem should be reconceptualized as a largely preventable epidemic. Breed-specific approaches to the control of dog bites do not address the issue that many breeds are involved in the problem and that most of the factors contributing to dog bites are related to the level of responsibility exercised by dog owners. To prevent dog bite-related deaths and injuries, we recommend public education about responsible dog ownership and dog bite prevention, stronger animal control laws, better resources for enforcement of these laws, and better reporting of bites. Anticipatory guidance by pediatric health care providers should address dog bite prevention.

Fatal farm injuries among young children.

Death certificate data concerning farm-related injury deaths among children 0 to 9 years of age in Wisconsin and Illinois for the period of 1979 to 1985 were reviewed. Average annual farm-related injury death rates were 3.2 per 100,000 rural children in Wisconsin (62 deaths) and 1.5 per 100,000 in Illinois (32 deaths). Rates were three times higher among boys than girls. The occurrence of two harvest-related peaks and the absence of fatality in children less than 1 year of age suggest that presence of children on the farm when supervision is diminished is a key factor in farm-related fatalities. Moving machinery (tractors, wagons, and trucks) was the source of injury in approximately 55% of all deaths. Drowning accounted for 15% of all farm-related deaths. Two fatalities related to gravity box wagons could have easily been prevented with simple safety devices. These findings suggest a need for developing environmental interventions in farms. This will require the allocation of more resources to farm safety programs and a revision of current farm safety legislation.

Physical activity, functional limitations, and the risk of fall-related fractures in community-dwelling elderly.

This case-control study examines the association of vigorous and mild physical activity with fall-related fractures in a community-dwelling population age 65 and older in South Florida. Vigorous physical activity was defined as exercising, doing heavy housecleaning, or other hard labor three or more times per week in the month prior to the index date; mild physical activity was defined as the number of hours per day subjects reported spending on their feet. A case was any subject who sustained a fall-related fracture (ICD-9CM-800 through ICD-9CM-829) over a 21-month period (n = 471). Controls were at 10% random sample selected from the Health Care Financing Administration Medicare files (n = 712). The presence of any limitation in activities of daily living (ADL) significantly modified the effect of vigorous physical activity. Physically active subjects with no limitations (ADL = 0) were less likely to sustain a fall-related fracture than were inactive subjects with an adjusted odds ratio (aOR) of 0.6, (0.5-0.8 95% CI), and active subjects with any limitation (ADL > or = 1) had an aOR of 3.2 (1.1-9.8 95% CI). Limiting this analysis to 159 hip fracture cases produced similar results. Mild physical activity was not associated with fracture. These results suggest that vigorous physical activity is associated with a lower fracture risk among elderly persons who have no limitation in ADL and with a higher risk among those with any limitations.

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.

Fall injuries among the elderly. Community-based surveillance.

Falls are a leading cause of fatal and nonfatal injuries among the elderly in the United States. Despite the importance of fall injuries, epidemiological studies of falls among the elderly have identified neither their causes nor the methods to prevent them. Therefore, we established a community-based surveillance system in Miami Beach, Florida, as part of a study to assess falls among the elderly. A total of 1,827 fall injury events occurred in this community between July 1985 and June 1986. More than 85% (1,567) of the persons who fell and received care were seen in an emergency room. The remaining cases were identified from one of the three other sources used: fire rescue reports, inpatient medical records, or medical examiner reports. Most falls (97%) were coded as accidental (E880-E888). More than 100 people sought medical assistance for a fall each month. The time of the injury was known for 68% (1,244) of the people who fell. Seventy-four percent of these falls (921) occurred during daylight hours. Fifty-four percent of the falls (986) occurred in and around the home, and 38% of these had a particular area of the home recorded: 42% occurred in the bedroom, 34% in the bathroom, 9% in the kitchen, 5% on the stairs, 4% in the living room, and the remaining 6% in other areas. This surveillance system will help us use the study to clarify the causes of falls in the elderly and identify and evaluate appropriate prevention efforts. It will also help others in designing and implementing other injury surveillance systems.

Alcohol as a risk factor for fall injury events among elderly persons living in the community.

OBJECTIVE: To determine if alcohol use is a risk factor for fall injury events among community-dwelling older persons. DESIGN: Case-control study. SETTING: South Miami Beach, Florida. PARTICIPANTS: 320 persons 65 or older who sought treatment at six area hospitals for injuries resulting from falls; 609 controls, matched for sex and age, selected randomly from Health Care Financing Administration (Medicare) files. MAIN INDEPENDENT VARIABLES: Self-reported current alcohol use. RESULTS: No association was found between fall injury events and average weekly alcohol use. CONCLUSIONS: Further efforts at reducing injuries to older persons from falls should concentrate on other modifiable risk factors, including adequate treatment of underlying medical conditions, reducing inappropriate psychotropic medication use, and installing safety devices in the home.

Home environmental hazards and the risk of fall injury events among community-dwelling older persons. Study to Assess Falls Among the Elderly (SAFE) Group.

OBJECTIVE: To determine if home environmental hazards increase the risk of fall injury events among community-dwelling older persons. DESIGN: Population-based case-control study. SETTING: South Miami Beach, Florida. PARTICIPANTS: 270 persons aged 65 years and older who sought treatment at six area hospitals for injuries resulting from falls within the dwelling unit and 691 controls, frequency matched for sex and age, selected randomly from Health Care Financing Administration (Medicare) files. MAIN INDEPENDENT VARIABLES: The home environment of each person, assessed directly by interviewers using a standardized instrument. RESULTS: Environmental hazards were present in nearly all dwelling units. After adjusting for important confounding factors, most of these hazards were not associated with an increased risk of fall injury events among most older persons. Increasing numbers of tripping hazards, or total hazards in the dwelling unit, did not increase the risk of fall injury events, nor was there an increasing trend in risk. CONCLUSIONS: Current fall-prevention strategies of finding and changing all environmental hazards in all community-dwelling older persons' homes may have less potential effect than previously thought. The usefulness of grab bars, however, appears to warrant further evaluation.

Chronic medical conditions and risk of fall injury events at home in older adults.

OBJECTIVE: To evaluate the association between selected chronic medical conditions (CMCs) and fall injury events at home among community-dwelling older persons. DESIGN: Population-based case-control study. SETTING: The general community. PARTICIPANTS: Persons aged 65 and older living at home, excluding those using a wheelchair; 467 cases and 691 control subjects were studied. MEASUREMENTS: The main independent variables were self-reported histories of 10 CMCs: diabetes, high blood pressure, anemia, heart attack, Parkinson's disease, stroke, emphysema, cancer (other than skin), cataracts, and glaucoma. RESULTS: The final multivariate model included variables for age, sex, body mass, dependency in activities of daily living, current exercise (three or more times per week), mental status scores, and three CMCs. Persons with a history of stroke or anemia had an increased risk of a fall injury event: for stroke the adjusted odds ratio (aOR) equalled 1.7 (95% confidence interval (CI), 1.0-3.0); for anemia the aOR equalled 1.5 (95% CI, 1.0-2.2). Those with a history of high blood pressure had decreased risk (aOR = .7, 95% CI 0.5-0.9). CONCLUSIONS: Persons 65 and older with a self-reported history of anemia or stroke are at increased risk of a fall injury event in the home, whereas those with a self-reported history of high blood pressure are at decreased risk.

Associations of demographic, functional, and behavioral characteristics with activity-related fear of falling among older adults transitioning to frailty.

OBJECTIVES: To determine, in a cohort of older individuals transitioning to frailty (defined by Speechley and Tinetti, 1991) who have previously fallen, whether there are significant associations between demographic, functional, and behavioral characteristics and activity-related fear of falling, using both the Falls Efficacy Scale (FES) and the Activities-Specific Balance Confidence Scale (ABC). DESIGN: Baseline cross-sectional analysis in a prospective cohort intervention study. SETTING: Twenty independent senior living facilities in Atlanta. PARTICIPANTS: Seventeen male and 270 female subjects (n = 287), age 70 and older (mean +/- standard deviation, 80.9 +/- 6.2), with Mini-Mental State Examination score > or = 24, transitioning to frailty, ambulatory (with or without assistive device), medically stable, and having fallen in the past year. MEASUREMENTS: Activity-related fear of falling was evaluated with the FES and ABC Scale. Because of the comparable data derived from each scale, associations with functional measures-related analyses were expressed using the latter. Depression was measured by Center for Epidemiological Studies Depression Scale. Functional measurements included timed 360 degrees turn, functional reach test, timed 10-meter walk test, single limb stands, picking up an object, and three chair stands. RESULTS: No statistically significant association was found between activity-related fear of falling and age. For the proposed activities, about half (ABC, 48.1%; FES, 50.1%) of the subjects were concerned about falling or showed lack of confidence in controlling their balance. A statistically significant inverse correlation was found between FES and ABC (r = -0.65; P < .001). African-American subjects showed more activity-related fear of falling than did Caucasians (odds ratio (OR): 2.7 for ABC; 2.1 for FES). Fearful individuals were more likely to be depressed and more likely to report the use of a walking aid than were nonfearful individuals. Fear of falling was significantly correlated to all of the functional measurements (P < .05). In a multivariable logistic regression model, depression, using a walking-aid, slow gait speed, and being an African-American were directly related to being more fearful of falling. CONCLUSIONS: Activity-related fear of falling was present in almost half of this sample of older adults transitioning to frailty. The significant association of activity-related fear of falling with demographic, functional, and behavioral characteristics emphasizes the need for multidimensional intervention strategies to lessen activity-related fear of falling in this population.

Epidemiology of childhood poisonings leading to hospitalization in the United States, 1979-1983.

Since 1979 unintentional childhood poisonings have accounted for about 75 deaths annually in the United States, and for each death thousands of ingestions are reported to poison control centers. Little is known about childhood ingestions that lead to hospitalization. To address this issue, we analyzed National Hospital Discharge Survey data from the National Center for Health Statistics for 1979-1983. For these years, an estimated 108,280 children from birth to 9 years of age were hospitalized because of unintentional poisonings. Overall, the annual rate for hospitalization because of childhood poisoning was 65.1 per 100,000 children aged 0-9 years. Hospitalization rates for poisoning were highest for children aged 1 and 2 years (216.2 and 184.3 per 100,000, respectively) and lowest for those aged 5-9 years (11.3 per 100,000). Rates for children less than 1 year old and for those 3-4 years old were moderate. Children of other races had higher hospitalization rates for poisoning than did white children (124.2 per 100,000 compared with 51.9 per 100,000). White male patients were hospitalized more frequently than white female patients, but this sex difference did not occur in children of other races. Rates were consistently highest for children in the Northeast and South and lowest for children in the West. From 1979 to 1983, the length of a hospital stay for childhood poisoning declined by 26 percent. Our results provide new information on childhood poisonings requiring hospitalization.

Incidence of hip fractures, United States, 1970-83.

Hip fractures are a major cause of morbidity and mortality in the United States. Twenty to 40% of persons who fracture their hips die within 6 months of the injury, and many survivors need long-term care. To assess the public health impact of hip fractures in the United States, we analyzed sample-based data from the National Hospital Discharge Survey, National Center for Health Statistics, for the United States for the period 1970-83. For these years, an estimated annual average of 197,000 persons 45 years of age or older was hospitalized for hip fractures. The age-, race-, and sex-adjusted hospitalization rates for hip fractures rose from 28.9 per 10,000 persons in 1970 to 30.9 per 10,000 in 1983 (P less than .01). Hospitalization rates rose exponentially by successive 10-year age groups, with persons 85 years of age or older having the highest rate (251.4 per 10,000). For each age group, women had hospitalization rates twice those of men, and whites had hospitalization rates twice those of other races. Never-married and divorced persons had higher hospitalization rates than currently married persons. The percentage of mortality before discharge from hospital fell from 11% in 1970 to 6% in 1983, with most of the decrease occurring among persons 75 years of age or older. The age-adjusted mean length of hospital stay declined 24%, from 23.9 days in 1970 to 18.2 days in 1983.(ABSTRACT TRUNCATED AT 250 WORDS)

Epidemic of gynecomastia among illegal Haitian entrants.

Gynecomastia may occur as a normal physiologic development at certain ages or as a result of a variety of pathological conditions. An outbreak of gynecomastia was investigated at two processing centers of the Immigration and Naturalization Service (INS) between December 2, 1981, and May 14, 1982. At the Fort Allen Service Processing Center, Puerto Rico, gynecomastia was initially detected in 77 of 540 Haitian male entrants (14 percent) and in only 6 of 186 male employees of the center (3 percent) who were 18-50 years old; the difference in prevalence was statistically significant. At the Krome North Service Processing Center in Miami, Fla., gynecomastia was initially detected in 52 of 512 Haitian males 18-50 years old (10 percent). Two case-control studies did not demonstrate an association between gynecomastia and a number of factors that might have been related to an exogenous estrogen or to a substance with an estrogenic effect. Estrogen or estrogen-like substances were not found in food, water, or environmental samples. When the populations were rescreened several months later, 76 of the persons with gynecomastia detected in the first screening had had total or partial remission. Persons with remission had arrived earlier--a mean of 21.6 days for those at Fort Allen and 36.7 for those at Krome--than did those with newly detected gynecomastia and those with continuing cases. The difference in arrival dates was significant (P less than .005 for Fort Allen and P less than .001 for Krome). These results, in view of nutritional deprivation in Haiti, suggest that these cases may have been an outbreak of refeeding gynecomastia.

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.

Water recreation-related spinal injuries: risk factors in natural bodies of water.

Spinal cord injuries are a major public health problem, and costs to society may total $6.2 billion per year. Using a case-control design, we investigated risk factors for spinal injury in male Wisconsin residents who sustained their injuries during water recreational activity. Compared with the controls, the people who sustained spinal injury were more likely to have entered the water from a pier or dock; to have dived into water; and to have used alcohol. Injury prevention programs for water recreation enthusiasts should address the topics of the hazards of combining alcohol with these activities, how to enter natural bodies of water safely, and safe water levels for diving.

A standardized instrument to assess hazards for falls in the home of older persons.

Hazards in the home are implicated in up to half of all falls among older persons. Yet, the instruments used to identify these hazards usually have been unstandardized, have lacked specific definitions of hazards, and have not been evaluated. Therefore, in 1988, as part of the Study to Assess Falls among the Elderly, in Miami Beach, Florida, the authors evaluated the reliability of a standardized instrument used for assessing the training of evaluators and assessing home environments. Based on up to 176 observations for each potential hazard, the interviewers' assessment of hazards such as throw rugs, tripping hazards, light switch hazards, and hazardous bath surfaces had good overall reliability (kappa = 0.65-0.92). Their assessment of grab-bars and hazardous furniture was unreliable (kappa = 0.18-0.35). Variations in the reliability reflect the difficulty in creating definitions that are simple to be understood and used, yet detailed enough to produce sensitive and specific survey items. Investigators studying falls among older persons should use standardized definitions to train evaluators and assess environmental hazards.

Injuries as an adverse reaction to clinically used laser devices.

Since the first use of lasers in ophthalmology in the early 1960s, applications for the medical laser have been found in many medical specialties. Despite their increasing usefulness, lasers have been reported to induce injuries. Few studies have tried to quantify the number of injuries caused by the clinical use of lasers. To address this issue, we surveyed physicians at the 5th Annual Meeting of the American Society for Laser Medicine and Surgery, May 1985. Forty-two of the 226 physicians attending the meeting responded to the questionnaire about their experience with lasers in their practice. An average of 25 laser procedures per month were performed by the responding physicians, and 61.9% of them reported at least one complication. Of the complications reported in the survey, 33 occurred within the last 12 months for an overall rate of 2.7 incidents per 1,000 procedures performed. The most common complications reported were burns and scarring; however, bowel perforation and pneumothorax were among the more serious. The mean number of reported complications varied by the length and type of training in the use of the laser, with the lowest number of complications reported by respondents who had taken a training course lasting longer than 7 days within the last year. Our findings show that both minor and life-threatening injury can be caused by the clinical use of medical lasers. Evaluation of the adverse effects of any medical technology, such as lasers, is needed to help guide recommendations for its safe use.