Do the risks and consequences of hospitalized fall injuries among older adults in California vary by type of fall?

BACKGROUND: Research on fall injuries in older persons generally does not examine different types of falls separately. (The main types are same level, from one level to another, and on or from stairs and steps.) There is no a priori reason to believe that various types of falls have similar demographic risk factors and consequences. Therefore, we examined patterns in types of falls, place of falls, and consequences of fall injuries as Californians move through their later decades. METHODS: We analyzed all computerized patient discharge records for all adults 20 years and over hospitalized with a fall as the principal external cause of injury in California nonfederal acute care hospitals, from 1995 through 1997 (N = 242,166). Older-adult age groups were compared with all younger adults. Place of fall, hospital charges, and disposition at discharge were analyzed by type of fall. RESULTS: The three main types of fall injury increase with age, but each type shows variation by age and sex. Women have the highest rates for the main types but not for the less common types. Hospitalized falls vary by place of fall. Mean hospital charges ($17,086) vary by type of fall, with falls from one level to another having the largest mean hospital charge ($19,632). Disposition at discharge does not vary by type of fall. CONCLUSIONS: We found significant variation in demographic factors, place of fall, and mean hospital charges for falling by type of fall, suggesting that future research should focus on individual types of falls rather than on aggregated falls.

Firearm-related injury surveillance in California.

CONTEXT: Although firearms are the leading cause of injury death in California, no staff resources were devoted to surveillance of firearm-related injuries until 1995, when The California Wellness Foundation funded the Firearm Injury Surveillance Program (FISP). OBJECTIVE: To develop and evaluate surveillance of serious firearm-related injuries and risk factors. DESIGN: Passive surveillance using several data sources: death records, homicide data, hospital discharge data, and Behavioral Risk Factor Surveys. To evaluate FISP, we follow the Centers for Disease Control and Prevention's Guidelines for Evaluating Surveillance Systems. SETTING: State of California. PARTICIPANTS: California Department of Health Services, Epidemiology and Prevention for Injury Control Branch. MAIN OUTCOME MEASURES: Deaths and hospitalizations resulting from firearm-related injuries and presence and storage of firearms in the home. We evaluated FISP's utility, simplicity, flexibility, acceptability, representativeness, and timeliness. RESULTS: Firearm-related injuries were the leading cause of death among children as young as 13 or 14 years of age. In 1994, more than 13,000 California residents died or were hospitalized as a result of firearm-related injuries. Except among whites, most of these serious firearm-related injuries were from assaults. The predominance of handguns as murder weapons increased with time and was more marked among younger and racial/ethnic minority victims. FISP provides data needed for setting policy and preventing firearm-related injuries. The system is acceptable and represents the serious firearm-related injury problem well, but lacks flexibility, timeliness, and detail. CONCLUSIONS: Despite the limitations inherent in passive surveillance, FISP serves many of our surveillance needs well.

Swimming pool drownings and near-drownings among California preschoolers.

OBJECTIVE: To describe a significant but poorly understood public health problem, the authors compiled data on swimming pool drownings and near-drownings requiring hospitalization for California children ages 1 to 4. METHODS: Data from death certificates were used to analyze swimming pool drownings, and hospital discharge data were used to analyze near-drownings. RESULTS: Among California preschoolers in 1993, pool immersion incidents were the leading cause of injury death and the eighth leading cause of injuries leading to hospitalization. Rates per 100,000 population were 3.2 for fatalities and 11.2 for nonfatal incidents, with a fatality-to-case ratio of 1:3.5. Total charges for initial hospital stays (excluding physicians' fees) were $5.2 million for 1227 hospital days. CONCLUSIONS: Swimming pools remain a serious hazard for young children. Primary prevention continues to be an important public health goal. Public health officials should support the adoption of laws designed to protect children from drowning and near-drownings.

Activities associated with drownings in Imperial County, CA, 1980-90: implications for prevention.

Statewide surveillance in California determined that the highest drowning rate from 1980 through 1989 was for the rural, desert county of Imperial (21.9 drownings per 100,000 population). To identify activities associated with drowning in this county, the authors abstracted data from the county sheriff-coroner's reports. From 1980 through 1990, there were 317 unintentional drownings; 85 percent occurred in irrigation canals. The activity prior to drowning was known for 262 persons (83 percent), and the most common activity was illegal entry into the United States. Overall, 140 persons (53 percent) were illegal entrants. Ninety-three percent of illegal entrants drowned in the All American Canal; the monthly drowning rate increased as the monthly average water velocity in the canal increased (r = 0.36; P < 0.001). Forty-eight persons (18 percent) drowned while riding in or on a land vehicle (automobile, pick-up truck, motorcycle, dune buggy, or tractor), the second most common activity associated with drowning. Seventy percent of the 23 drivers had an alcohol concentration of 100 milligrams per deciliter or more, California's limit for intoxication. To reduce drownings in Imperial County, prevention strategies should target persons engaged in at-risk activities near bodies of water. These strategies should include the identification and use of effective canal safety devices.

Interrelationships of brain, cranial base and mandible.

The purpose of this study is to evaluate the neural and masticatory growth factors that contribute to the development of the cranial base. Cephalometric and submentovertex (SMV) radiographs of 66 adult human skulls, of Caucasian (India) origin and unknown gender were used in this study. Results indicate that the cranial base, posterior to the foramen caecum, develops in response to brain growth. The part anterior to the foramen caecum develops in response to the mandible. Our findings indicate that: 1. the glabella instead of the nasion should be considered as the most anterior point of the cranial base. Mandibular dimensions (the height and the length) have a better correlation with CG than CN. 2. Instead of a single parameter, sella-nasion (SN), two parameters, the foramen caecum-glabella (CG) and the foramen caecum-sella (CS) should be considered. In cephalometry the more stable line CS, rather than SN, can be used for registration of successive radiographs; 3. The typical mandibular retrognathia, and/or the decrease in the posterior height (ascending ramus) of a Class II malocclusion could be explained by their positive correlation with SB (sella-basion) and the negative correlation with angle GSB.

Proposed cephalometric diagnosis for osteogenic obstructive sleep apnea (OSA): the mandibular/pharyngeal ratio.

The purpose of this laboratory study is to devise a simple, diagnostic test to assess possible osteological deficiency as a probable cause of OSA. Modern day skulls of fifty males and forty eight females of Tuscan origin and an additional seventy-five skulls, from India, with their cephalograms were used for this study. Mandibular length and antero-posterior dimension of the nasopharynx--pharyngeal tubercle (PhT) to posterior nasal spine (PNS)--were measured on the Tuscan skulls. The nasopharynx was similarly measured on the Indian skulls and readings multiplied by 1.14, the magnification factor of the cephalometric apparatus used. The PhT-PNS distance was then plotted on the cephalogram of Indian skulls with point PhT at the basiocciput. The possible presence of an osteogenic etiology of OSA can be determined by comparison of the mandibular/pharyngeal ratio obtained from the skull cephalograms to that of the individual patient.

Locations of fatal work injuries in the United States: 1980 to 1985.

Surveillance of injury at work is beset with problems of method and definition. As a result, national agencies have widely varying estimates of the number of fatal work injuries in the United States. One plausible method for identifying fatal work injuries is to use the Place of Injury variable, which is entered on all US death certificates but is not encoded by the National Center for Health Statistics. To use this method, one would assume that work injuries largely occur at "typical work sites," ie, places coded as industrial, farm, and mine and quarry. Data to test this method were derived from the National Traumatic Occupational Fatality data base maintained by the National Institute for Occupational Safety and Health. Analysis of this data base showed that work-related fatal injuries mostly occur in places where many non-work-related injuries also occur. Only about one third of fatal work injuries took place at locations coded as industrial, farm, and mine and quarry. As a method for identifying fatal work injuries, the Place of Injury variable appears to have little value.

Hospitalized fall injuries and race in California.

OBJECTIVE: To compare risks for falls and their consequences among four major race/ethnic groups in California. METHODS: Cases are 104,902 hospital discharges of California residents with a same level fall injury as the principal external cause of injury. Included are all discharges for a first hospitalization for a given injury in any California non-federal hospital from 1995-97. Analysis includes crude and age standardized rates to describe risks, diagnoses, and consequences. RESULTS: Rates per 100 000 for same level hospitalized fall injuries for whites (161) are distinctively higher than for blacks (64), Hispanics (43), and Asian/Pacific Islanders (35). Whites are more likely to have a fracture diagnosis and to be discharged to long term care rather than home, suggesting a poorer outcome or greater severity. Same level falls absorb a large proportion of hospital resources directed to the treatment of injuries. CONCLUSIONS: In a four way comparison among race/ethnic groups, whites are distinguished by their high incidence, rates of fracture, and unfavorable discharge status. Prevention, particularly aimed at whites, has potential to improve health and save treatment resources.

Safety belts and public health. The role of medical practitioners.

Medical practitioners have helped the public become aware of the importance of health-promoting life-style changes such as getting more exercise and abstaining from smoking. They can likewise help their patients protect themselves from the threat of automobile crash injury. Safety belt use remains too low, and increased use offers unusual potential for averting death and disability. Various characteristics associated with a failure to use safety belts can be used to help identify patients at high risk of traffic injury. These include male sex, persons who are ethnic minorities, young people, poor people, those with low educational levels, and persons with negative attitudes to seat belt use. Various methods and resources are available to help practitioners provide appropriate safety belt advice to patients, although the specific resources available vary from place to place. At a minimum, patients need to be told that a proper use of occupant protection can at least double the chances of avoiding death or severe injury in an automobile crash.

Respiratory impairment and symptoms as predictors of early retirement with disability in US underground coal miners.

A five-year prospective study of 1,394 United States underground coal miners was undertaken to study the effects of respiratory impairment on the rate of early retirement with disability (ERD). Using a logistic regression analysis, ERD was found to be related to reported persistent phlegm after adjustment was made for other respiratory symptoms, respiratory function measurements, cigarette smoking, and some demographic characteristics. No prediction of ERD occurred for spirometrically determined measures of respiratory function. The data thus give limited support to the hypothesis that early retirement with disability in underground coal miners can be predicted prospectively by measures of respiratory symptoms.

Respiratory predictors of disability days: a five year prospective study of U.S. coal miners.

A 5-year prospective analysis tests the hypothesis that coal miners who have impaired respiratory health also experience greater numbers of disability days due to occupational injury. Occupational and respiratory health information collected for the period 1977 through 1981 by the National Institute for Occupational Safety and Health (NIOSH) on 1,118 U.S. underground coal miners was linked to coal miner injury records collected under a mandatory reporting system by the Mine Safety and Health Administration (MSHA). Respiratory impairment, based on spirometric measures, and a questionnaire measure of chronic bronchitis symptoms, after adjustment for cigarette smoking and total years of underground mining, did not provide statistically significant prediction of average disability days. In addition, respiratory impairment did not predict the number of episodes of occupational injuries resulting in days lost from work.

Fatal hand tool injuries in construction.

Past research on occupational hand tool injuries has generally focused on nonfatal injuries. Most such injuries occur at the point where energy is transferred to the material being worked, eg, at the edge of a saw blade or the point of a drill. Assuming that hand tool injuries that are fatal will differ from nonfatal injuries, 62 Occupation Safety and Health Administration reports were analyzed. Four patterns emerged when the type of contact with energy was used to classify incidents. Fatal injuries occurred when (1) contact was made with energy that supplies power to the hand tool, (2) energy normally transferred to the material being worked is transferred to the worker, (3) workers or materials fall, and (4) potential energy is encountered in the work environment. Analysis showed that almost all such injuries could be prevented by application of existing safe work practices.

Respiratory health as a predictor of questionnaire return in a sample of United States underground coalminers.

A logistic model was used to analyse questionnaire return in a postal survey of 311 coalminers who had left their place of employment between 1977 and 1982. Three measures of respiratory health, obstruction, restriction, and presence of chronic bronchitis symptoms, were included in the model as predictors together with the possibly confounding factors of age, education, and marital and smoking status. Age was positively associated with questionnaire return (p less than 0.001). Speed of return, and whether the return was in response to a prompt, were not predicted by either the respiratory health measures or any of the other possibly confounding variables.

Physician drug use: availability or occupational stress?

The research examines the nature and frequency of reported drug use in a sample of health professionals and considers occupational stress as a possible explanation for the high rate of drug use among physicians. Anonymous questionnaires, eliciting drug use frequency and occupational stress, were sent to physicians and dentists practicing in West Virginia. Physicians report greater drug use than dentists, even though dentists also have legal access to prescription drugs. Among physicians there is a significant positive relationship between occupational stress and the use of selected drugs. This finding lends tentative support to the hypothesis that drug use among physicians is not primarily a function of drug availability.

Hospitalizations for near drowning in California: incidence and costs.

California hospital discharge data for 1991 were examined to describe persons hospitalized for near drownings (i.e., a submersion incident for which the victim was admitted to a hospital). Among residents with near-drowning injuries, there were 865 discharges, regardless of outcome (rate = 2.8/100,000); 785 persons survived the hospitalization, and 80 (9%) did not. Swimming pools were the most common submersion site (62%). Highest rates per 100,000 were found among males (3.6), Blacks (3.6), and children 1 through 5 years old (18.4). Charges for the initial hospitalization (excluding physicians' fees) amounted to $11.4 million. The state government's share of these charges was $5.4 million, with Medi-Cal expected to pay $4.1 million. Blacks, males, Medi-Cal recipients, and young children are most at risk and should be targeted for prevention programs.

Population-based analysis of 10,766 hospitalizations for mandibular fractures in California, 1991 to 1993.

BACKGROUND: This study describes mandibular fracture incidence, causes, and consequences in a large population. METHODS: California hospital discharge data from 1991 to 1993 were examined to describe causes, lengths of stay, and hospital charges for patients hospitalized for mandibular fractures. Rates were calculated per 100,000 population. RESULTS: There were 10,766 discharges with mandibular fracture as principal diagnosis or as diagnoses two through five on the discharge record (rate=11.5). Of these, 2,694 had mandibular fracture as the only diagnosis (principal diagnosis). For all 10,766 cases, assaults were responsible for more than half (54.0%) of all admissions for mandibular fracture. The highest rates were found among males (18.7), blacks (43.0), and adults aged 16 to 20 (26.5). Charges for the initial hospitalization (excluding physician's fees) for the 2,694 cases with only a diagnosis of mandibular fracture were used to estimate mean charges ($8,740). The total extrapolated 1993 inflation-adjusted hospital charges for mandibular fractures were $34 million per year. Most patients' bills were submitted to government payers, such as Medicaid. CONCLUSION: Treatment of mandibular fractures represents a considerable cost to public-supported programs as well as to patients.