Evaluating the effectiveness of rapid SARS-CoV-2 genome sequencing in supporting infection control teams: the COG-UK hospital-onset COVID-19 infection study

IntroductionViral sequencing of SARS-CoV-2 has been used for outbreak investigation, but there is limited evidence supporting routine use for infection prevention and control (IPC) within hospital settings. MethodsWe conducted a prospective non-randomised trial of sequencing at 14 acute UK hospital trusts. Sites each had a 4-week baseline data-collection period, followed by intervention periods comprising 8 weeks of rapid (<48h) and 4 weeks of longer-turnaround (5-10 day) sequencing using a sequence reporting tool (SRT). Data were collected on all hospital onset COVID-19 infections (HOCIs; detected [≥]48h from admission). The impact of the sequencing intervention on IPC knowledge and actions, and on incidence of probable/definite hospital-acquired infections (HAIs) was evaluated. ResultsA total of 2170 HOCI cases were recorded from October 2020-April 2021, with sequence reports returned for 650/1320 (49.2%) during intervention phases. We did not detect a statistically significant change in weekly incidence of HAIs in longer-turnaround (IRR 1.60, 95%CI 0.85-3.01; P=0.14) or rapid (0.85, 0.48-1.50; P=0.54) intervention phases compared to baseline phase. However, IPC practice was changed in 7.8% and 7.4% of all HOCI cases in rapid and longer-turnaround phases, respectively, and 17.2% and 11.6% of cases where the report was returned. In a per-protocol sensitivity analysis there was an impact on IPC actions in 20.7% of HOCI cases when the SRT report was returned within 5 days. ConclusionWhile we did not demonstrate a direct impact of sequencing on the incidence of nosocomial transmission, our results suggest that sequencing can inform IPC response to HOCIs, particularly when returned within 5 days.

Presentation and surgical management of a gossypiboma presenting with small bowel obstruction.

Gossypiboma is a cotton-based foreign body retained within the human body following a surgical procedure. Transmural migration of intra-abdominal gossypiboma into the small bowel is rare; however, it can present with life-threatening complications. We report a case of a 28-year-old male who presented with small bowel obstruction due to gossypiboma, 11 years after the initial surgical procedure. Due to the size of the retained surgical swab, 40 cm × 40 cm, an open surgical approach was preferred. Following removal of the retained swab and bowel reconstruction, the patient was followed in clinic and discharged without complications. Staff education and adherence to operating room record-keeping protocols can prevent gossypiboma. To the best of our knowledge such a long interval between the initial surgery and presentation of gossypiboma that large has not been previously reported in the literature.

Non-operative meningiomas: long-term follow-up of 136 patients.

BACKGROUND: Improving access to neuroradiology investigations has led to an increased rate of diagnosis of incidental meningiomas. METHOD: A cohort of 136 incidental meningioma patients collected by a single neurosurgeon in a single neurosurgical centre is retrospectively analysed between 2002 and 2016. Demographic data, imaging and clinical features are presented. The radiological factors associated with meningiomas progression are also presented. RESULTS: The mean age at diagnosis was 65 (range, 33-94) years. Univariate analysis showed oedema was most strongly correlated with progression (p = 0.010) followed by hyperintensity in T2-weighted (T2W) MRI (p = 0.029) and in Flair-T2W MRI (p = 0.017). Isointensity in Flair-T2W MRI (0.004) was most strongly correlated with non-progression of the meningioma followed by calcification (p = 0.007), older age (p = 0.087), hypointensity in Flair-T2W MRI (p = 0.014) sequences and in T2W MRI (p = 0.096). In multivariate analysis, the strongest radiological factor predictive of progression was peritumoural oedema (p = 0.016) and that of non-progression was calcification (p = 0.002). At the end of the median follow-up (FU) of 43 (range, 4-150) months, 109 (80%) patients remained clinically stable, 13 (10%) became symptomatic and 14 (10%) showed clinical and radiological progression. CONCLUSIONS: One hundred and nine (80%) patients remained stable at the end of FU. Peritumoural oedema was predictive of meningiomas progression. Further prospective study is needed to identify the combination of factors which can predict the meningioma progression for an early surgery or early discharge.

Association of Comorbid and Metabolic Factors with Optimal Control of Type 2 Diabetes Mellitus.

BACKGROUND: Type 2 diabetes mellitus (T2DM) is a poorly controlled epidemic worldwide that demands active research into mitigation of the factors that are associated with poor control. AIMS: The study was to determine the factors associated with suboptimal glycemic control. MATERIALS AND METHODS: Electronic medical records of 263 adult patients with T2DM in our suburban internal medicine office were reviewed. Patients were divided into two groups: Group 1 [optimal diabetes control with glycosylated hemoglobin (HbA1c) of 7% or less] and Group 2 (suboptimal diabetes control with HbA1c greater than 7%). The influence of factors such as age, gender, race, social history, comorbid conditions, gestational diabetes, family history of diabetes, diabetes management, statin use, aspirin use, angiotensin convertase enzyme inhibitor (ACE-I) or angiotensin receptor blocker (ARB) use, body mass index (BMI), blood pressures, lipid profile, and urine microalbumin level were analyzed in the two groups. RESULTS: In the suboptimal diabetes control group (N = 119), the majority (86.6%) of the patients were 41-80 years old. Factors associated with the suboptimal control were male gender [odds ratio (OR) 2.6, 95% confidence interval (CI), 1.579-4.321], Asian ethnicity (OR 1.4, 95% CI, 0.683-3.008), history of peripheral arterial disease (PAD; OR 3.9, 95% CI, 1.017-14.543), history of congestive heart failure (CHF; OR 3.9, 95% CI, 1.017-14.543), elevated triglycerides (OR 1.004, 95% CI, 1.000-1.007), and elevated urine microalbumin level of 30 mg/24 h or above (OR 4.5, 95% CI, 2.446-8.380). Patients with suboptimal diabetes control had a 3.8 times greater odds (95% CI, 1.493-6.885) of receiving the insulin and oral hypoglycemic agent together. CONCLUSIONS: In adult patients with T2DM, male gender, Asian ethnicity, CHF, PAD, management with insulin along with oral hypoglycemic agents, hypertriglyceridemia, and microalbuminuria were associated with suboptimal control.

Stakeholder perceptions and operational barriers in the training and distribution of take-home naloxone within prisons in England.

BACKGROUND: The aim of the study was to assess potential barriers and challenges to the implementation of take-home naloxone (THN) across ten prisons in one region of England. METHODS: Qualitative interviews deploying a grounded theory approach were utilised over a 12- to 18-month period that included an on-going structured dialogue with strategic and operational prison staff from the ten prisons and other key stakeholders (n = 17). Prisoner perceptions were addressed through four purposive focus groups belonging to different establishments (n = 26). Document analysis also included report minutes and access to management information and local performance reports. The data were thematically interpreted using visual mapping techniques. RESULTS: The distribution and implementation of THN in a prison setting was characterised by significant barriers and challenges. As a result, four main themes were identified: a wide range of negative and confused perceptions of THN amongst prison staff and prisoners; inherent difficulties with the identification and engagement of eligible prisoners; the need to focus on individual prison processes to enhance the effective distribution of THN; and the need for senior prison staff engagement. CONCLUSIONS: The distribution of THN within a custodial setting requires consideration of a number of important factors which are discussed.

Prevalence of Sexual Violence Against Women in 23 States and Two U.S. Territories, BRFSS 2005.

Sexual violence (SV) is a significant public health problem. Using data from the 2005 Behavioral Risk Factor Surveillance System (BRFSS), this article provides state-specific 12-month SV prevalence data for women residing in 23 states and two territories. Overall, more than 500,000 women in the participating states experienced completed or attempted nonconsensual sex in the 12-month period prior to the survey. The collection of state-level data using consistent, uniform, and behaviorally specific SV definitions enables states to evaluate the magnitude of the problem within their state and informs the development and evaluation of state-level SV programs, policies, and prevention efforts.

Older adult pedestrian injuries in the United States: causes and contributing circumstances.

As the US population ages, more older adults will face transportation and mobility challenges. This study examines the characteristics and contributing circumstances of nonfatal older adult pedestrian injuries. Data were obtained from the National Electronic Injury Surveillance System-All Injury Programme (NEISS-AIP) for the years 2001 through 2006. Cases included persons aged 65 years and older who were nonfatally injured on a public roadway. The results indicated that on average, an estimated 52,482 older adults were treated in emergency departments each year for nonfatal pedestrian injuries. Falling and being hit by a motor vehicle were the leading mechanisms of injury, resulting in 77.5% and 15.0% of older adult pedestrian injuries, respectively. More than 9000 older pedestrian fall-related injuries each year involved a kerb. It is concluded that the growth in the older adult population could add to the overall burden of these nonfatal pedestrian injuries. Making transportation and mobility improvements, including environmental modifications, is important for preventing these injuries.

Sexual and reproductive health of persons aged 10-24 years - United States, 2002-2007.

This report presents data for 2002-2007 concerning the sexual and reproductive health of persons aged 10-24 years in the United States. Data were compiled from the National Vital Statistics System and multiple surveys and surveillance systems that monitor sexual and reproductive health outcomes into a single reference report that makes this information more easily accessible to policy makers, researchers, and program providers who are working to improve the reproductive health of young persons in the United States. The report addresses three primary topics: 1) current levels of risk behavior and health outcomes; 2) disparities by sex, age, race/ethnicity, and geographic residence; and 3) trends over time. The data presented in this report indicate that many young persons in the United States engage in sexual risk behavior and experience negative reproductive health outcomes. In 2004, approximately 745,000 pregnancies occurred among U.S. females aged <20 years. In 2006, approximately 22,000 adolescents and young adults aged 10-24 years in 33 states were living with human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS), and approximately 1 million adolescents and young adults aged 10-24 years were reported to have chlamydia, gonorrhea, or syphilis. One-quarter of females aged 15-19 years and 45% of those aged 20-24 years had evidence of infection with human papillomavirus during 2003-2004, and approximately 105,000 females aged 10--24 years visited a hospital emergency department (ED) for a nonfatal sexual assault injury during 2004-2006. Although risks tend to increase with age, persons in the youngest age group (youths aged 10--14 years) also are affected. For example, among persons aged 10-14 years, 16,000 females became pregnant in 2004, nearly 18,000 males and females were reported to have sexually transmitted diseases (STDs) in 2006, and 27,500 females visited a hospital ED because of a nonfatal sexual assault injury during 2004-2006. Noticeable disparities exist in the sexual and reproductive health of young persons in the United States. For example, pregnancy rates for female Hispanic and non-Hispanic black adolescents aged 15-19 years are much higher (132.8 and 128.0 per 1,000 population) than their non-Hispanic white peers (45.2 per 1,000 population). Non-Hispanic black young persons are more likely to be affected by AIDS: for example, black female adolescents aged 15-19 years were more likely to be living with AIDS (49.6 per 100,000 population) than Hispanic (12.2 per 100,000 population), American Indian/Alaska Native (2.6 per 100,000 population), non-Hispanic white (2.5 per 100,000 population) and Asian/Pacific Islander (1.3 per 100,000 population) adolescents. In 2006, among young persons aged 10-24 years, rates for chlamydia, gonorrhea, and syphilis were highest among non-Hispanic blacks for all age groups. The southern states tend to have the highest rates of negative sexual and reproductive health outcomes, including early pregnancy and STDs. Although the majority of negative outcomes have been declining for the past decade, the most recent data suggest that progress might be slowing, and certain negative sexual health outcomes are increasing. For example, birth rates among adolescents aged 15-19 years decreased annually during 1991-2005 but increased during 2005-2007, from 40.5 live births per 1,000 females in 2005 to 42.5 in 2007 (preliminary data). The annual rate of AIDS diagnoses reported among males aged 15-19 years has nearly doubled in the past 10 years, from 1.3 cases per 100,000 population in 1997 to 2.5 cases in 2006. Similarly, after decreasing for >20 years, gonorrhea infection rates among adolescents and young adults have leveled off or had modest fluctuations (e.g., rates among males aged 15-19 years ranged from 285.7 cases per 100,000 population in 2002 to 250.2 cases per 100,000 population in 2004 and then increased to 275.4 cases per 100,000 population in 2006), and rates for syphilis have been increasing (e.g., rates among females aged 15-19 years increased from 1.5 cases per 100,000 population in 2004 to 2.2 cases per 100,000 population in 2006) after a significant decrease during 1997-2005.

A randomized controlled trial to prevent noncontact anterior cruciate ligament injury in female collegiate soccer players.

BACKGROUND: Neuromuscular and proprioceptive training programs can decrease noncontact anterior cruciate ligament injuries; however, they may be difficult to implement within an entire team or the community at large. HYPOTHESIS: A simple on-field alternative warm-up program can reduce noncontact ACL injuries. STUDY DESIGN: Randomized controlled trial (clustered); Level of evidence, 1. METHODS: Participating National Collegiate Athletic Association Division I women's soccer teams were assigned randomly to intervention or control groups. Intervention teams were asked to perform the program 3 times per week during the fall 2002 season. All teams reported athletes' participation in games and practices and any knee injuries. Injury rates were calculated based on athlete exposures, expressed as rate per 1000 athlete exposures. A z statistic was used for rate ratio comparisons. RESULTS: Sixty-one teams with 1435 athletes completed the study (852 control athletes; 583 intervention). The overall anterior cruciate ligament injury rate among intervention athletes was 1.7 times less than in control athletes (0.199 vs 0.340; P = .198; 41% decrease). Noncontact anterior cruciate ligament injury rate among intervention athletes was 3.3 times less than in control athletes (0.057 vs 0.189; P = .066; 70% decrease). No anterior cruciate ligament injuries occurred among intervention athletes during practice versus 6 among control athletes (P = .014). Game-related noncontact anterior cruciate ligament injury rates in intervention athletes were reduced by more than half (0.233 vs 0.564; P = .218). Intervention athletes with a history of anterior cruciate ligament injury were significantly less likely to suffer another anterior cruciate ligament injury compared with control athletes with a similar history (P = .046 for noncontact injuries). CONCLUSION: This program, which focuses on neuromuscular control, appears to reduce the risk of anterior cruciate ligament injuries in collegiate female soccer players, especially those with a history of anterior cruciate ligament injury.

Chronic disease and health risk behaviors associated with intimate partner violence-18 U.S. states/territories, 2005.

PURPOSE: Few studies have examined the association between intimate partner violence (IPV) and health outcomes for both women and men. The current study examined this relationship for women and men as part of a large cross-sectional public-health survey that collected information on a range of health behaviors and health risks. METHODS: In 2005, over 70,000 respondents in 16 states and 2 territories were administered the first-ever IPV module within the Behavioral Risk Factor Surveillance System (BRFSS). The BRFSS, sponsored by the Centers for Disease Control and Prevention, is an annual random-digit-dialed telephone survey. Lifetime IPV was assessed by four questions that asked about threatened, attempted, or completed physical violence, as well as unwanted sex. RESULTS: Women and men who reported IPV victimization during their lifetime were more likely to report joint disease, current asthma, activity limitations, HIV risk factors, current smoking, heavy/binge drinking, and not having had a checkup with a doctor in the past year. CONCLUSIONS: Experiencing IPV is associated with a number of adverse health outcomes and behaviors. There remains a need for the development of assessment opportunities and secondary intervention strategies to reduce the risk of negative health behaviors and long-term health problems associated with IPV victimization.

Prevalence and risk factors of intimate partner violence in eighteen U.S. states/territories, 2005.

BACKGROUND: Intimate partner violence (IPV) has been shown to have serious health consequences for both women and men, including poor general health, depressive symptoms, substance use, and elevated rates of chronic disease. Aside from crime surveys, there have been no large-scale IPV prevalence studies since the 1996 National Violence Against Women Survey. The lack of regular, ongoing surveillance, using uniform definitions and survey methods across states has hindered efforts to track IPV. In addition, the lack of state-specific data has hampered efforts at designing and evaluating localized IPV prevention programs. METHODS: In 2005, over 70,000 respondents were administered the first-ever IPV module within the Behavioral Risk Factor Surveillance System (BRFSS). The BRFSS is a Centers for Disease Control and Prevention-sponsored annual random-digit-dialed telephone survey, providing surveillance of health behaviors and health risks among the non-institutionalized adult population of the United States and several U.S. territories. RESULTS: Approximately 1 in 4 women and 1 in 7 men reported some form of lifetime IPV victimization. Women evidenced significantly higher lifetime and 12-month IPV prevalence, and were more likely to report IPV-related injury than men. IPV prevalence also varied by state of residence, race/ethnicity, age, income, and education. CONCLUSIONS: State-level data can assist state health officials and policy planners to better understand how many people have experienced IPV in their state. Such information provides a foundation on which to build prevention efforts directed toward this pervasive public health problem.

Efecto del desarrollo económico en la mortalidad relacionada con el transporte, entre diferentes tipos de usuarios de las vías: un estudio transversal internacional / Effect of economic development on the fatality rate from motor vehicle accidents among various types of users of public thoroughfares: an international cross study

Introducción: La relación entre el estado de desarrollo económico de un país y su tasa de mortalidad por colisiones de vehículos de motor (CVM) no ha sido definida para los diferentes tipos de usuarios de las vías. Métodos: Este artículo presenta un análisis de regresión transversal con datos recientes de mortalidad en 44 países, utilizando datos de certificados de defunción provenientes de la Organización Mundial de la Salud. Resultados: Para cinco tipos de usuarios de las vías, la mortalidad por CVM es expresada como muertes por 100.000 habitantes, y muertes por 1.000 vehículos de motor. El desarrollo económico es medido como el Producto Interno Bruto (PIB) per cápita en dólares de Estados Unidos, y como vehículos de motor por 1.000 habitantes. Los resultados mostraron que la mortalidad total por CVM en los países con bajos ingresos presentó un pico a un PIB alrededor de US $2.000 per cápita, y cerca de 100 vehículos por 1.000 habitantes. Conclusiones: La mortalidad total disminuyó con el incremento del ingreso nacional alrededor de US $24.000. La mayoría de los cambios en la mortalidad por CVM asociados con el desarrollo económico fueron explicados por cambios en las tasas de usuarios no motorizados, especialmente de peatones. Las tasas totales de CVM fueron más bajas cuando la exposición de los peatones fue menor o porque hubo pocos vehículos de motor o peatones; y fueron más altas durante un periodo crítico de transición hacia transporte motorizado, cuando gran cantidad de peatones y otros usuarios vulnerables compitieron por el uso de las vías con vehículos de motor.

Associations between sociodemographics and safety belt use in states with and without primary enforcement laws.

OBJECTIVES: secondary enforcement laws (police may issue a safety belt citation only if the vehicle has been stopped for another reason). METHODS: We analyzed 2002 Behavioral Risk Factor Surveillance System data from 50 states and the District of Columbia. We performed multivariable, log-linear regression analyses to assess the effect of sociodemographic characteristics and safety belt laws on safety belt use. Analyses were stratified by the type of enforcement permitted by state laws. RESULTS: Reported safety belt use was higher in states that had primary versus secondary enforcement laws, both overall and for each sociodemographic characteristic examined. Safety belt use was 85% in states that had primary enforcement laws and 74% in states that had secondary enforcement laws. Cross-sectional data suggested that primary enforcement laws may have the greatest effect on sociodemographic groups that reported lower levels of safety belt use. CONCLUSIONS: Primary enforcement laws are an effective population-based strategy for reducing disparities in safety belt use and may, therefore, reduce disparities in crash-related injuries and fatalities.

Economic development's effect on road transport-related mortality among different types of road users: a cross-sectional international study.

The relationship between a country's stage of economic development and its motor vehicle crash (MVC) mortality rate is not defined for different road users. This paper presents a cross-sectional regression analysis of recent national mortality in 44 countries using death certificate data provided by the World Health Organization. For five types of road users, MVC mortality is expressed as deaths per 100,000 people and per 1000 motor vehicles. Economic development is measured as gross national income (GNI) per capita in U.S. dollars and as motor vehicles per 1000 people. Results showed overall MVC mortality peaked among low-income countries at about US$ 2000 GNI per capita and at about 100 motor vehicles per 1000 people. Overall mortality declined at higher national incomes up to about US$ 24,000. Most changes in MVC mortality associated with economic development were explained by changes in rates among nonmotorized travelers, especially pedestrians. Overall MVC rates were lowest when pedestrian exposure was low because there were few motor vehicles or few pedestrians, and were highest during a critical transition to motorized travel, when many pedestrians and other vulnerable road users vied for use of the roadways with many motor vehicles.

Opioid analgesics and rates of fatal drug poisoning in the United States.

OBJECTIVE: To determine whether the variability in rate of sale of prescription opioid analgesics is related to the variability in rates of drug poisoning mortality among states in the United States in 2002. METHODS: Drug poisoning deaths were defined as unintentional deaths or those of undetermined intent whose underlying cause was coded to "narcotics" (X42) or "other and unspecified" drugs (X44) in the National Vital Statistics System. Per capita sales of ten opioid analgesics from the Drug Enforcement Administration and combined sales in morphine equivalents were correlated with drug poisoning mortality rates by state using multivariate linear regression. Regression coefficients between mortality rates and sales rates were adjusted for race (percent white, percent black) and age (percent aged 24 years or younger, and percent aged 65 years and older). RESULTS: There was over a ten-fold variability in sales of some opioid analgesics. Combined sales ranged 3.7-fold, from 218 mg per person in South Dakota to 798 mg per person in Maine. Drug poisoning mortality varied 7.9-fold, from 1.6/100,000 in Iowa to 12.4/100,000 in New Mexico. Drug poisoning mortality correlated most strongly with non-OxyContin oxycodone (r=0.73, p<0.0001), total oxycodone (r=0.68, p<0.0001), and total methadone (r=0.66, p<0.0001) in the multivariate analysis. A scatterplot demonstrated a linear relationship between total opioid analgesic sales and drug poisoning mortality. CONCLUSIONS: The extent of opioid analgesics use varies widely in the United States. Variation in the availability of opioid analgesics is related to the spatial distribution of drug poisoning mortality by state.

The reengineering of a software system for glaucoma analysis.

Glaucoma is a destructive eye disease that causes blindness in individuals displaying little or no symptoms. There is no cure as yet though there are treatments that can arrest its effects or slow its development. The earlier the disease is detected, the more likely the treatment will be successful; however early detection of the disease can be difficult. This highlights the importance of ophthalmologists having access to tools that can assist in accurately diagnosing glaucoma and other retinal diseases as early as possible. The stereo optic disc analyser (SODA) software package is a tool intended to be used by ophthalmologists, to aid in the accurate detection of retinal diseases. SODA will use stereoscopy and three-dimensional image analysis to assist in accurately detecting changes in the retina, caused by diseases such as glaucoma. This paper will focus on the reengineering and redesign of the SODA software package to overcome the shortcomings inherent in its prototype implementation and develop a package that can be commercialised. Software Engineering principles and the software development lifecycle, along with principles of object-orientation and usability, have been used to establish a framework for SODA, improve its accuracy, enhance its usability and to redevelop the product into an implementation that can later be commercialised.

Non-work-related finger amputations in the United States, 2001-2002.

STUDY OBJECTIVE: We characterize non-work-related finger amputations treated in US hospital emergency departments (EDs) and discuss implications for injury-prevention programs. METHODS: Finger amputation data from 2001 and 2002 were obtained from the National Electronic Injury Surveillance System All Injury Program (a nationally representative sample of 66 US hospital EDs). National estimates are based on weighted data for 948 cases for finger amputations (including partial and complete) that occurred during non-work-related activities (ie, nonoccupational) activities. RESULTS: An estimate of 30,673 (95% confidence interval [CI] 24,877 to 36,469) persons with non-work-related amputations were treated in US hospital EDs annually. Of these persons, 27,886 (90.9%; 95% CI 22,707 to 33,065) had amputations involving 1 or more fingers; 19.1% were hospitalized or transferred for specialized trauma care. Male patients were treated for finger amputations at 3 times the rate of female patients. The rate of persons treated for finger amputations was highest for children younger than 5 years (18.8 per 100,000 population; 95% CI 12.3 to 25.2 per 100,000 population), followed by adults aged 55 to 64 years (14.9 per 100,000 population; 95% CI 9.6 to 20.1 per 100,000 population). For children aged 4 years and younger, 72.9% were injured in incidents involving doors, and for adults aged 55 years or older, 47.2% were injured in incidents involving power tools. CONCLUSION: National estimates of finger amputations among US residents indicate that young children and older adults are at greatest risk. Parents or other responsible adults should be aware of the risk of small children's fingers around doorways, and adults should take safety precautions when using power tools.

Strategies to increase smoke alarm use in high-risk households.

A 3-year project was undertaken to evaluate two methods of promoting residential smoke alarm installation and maintenance in high risk households across the U.S. Five states (Arkansas, Maine, Maryland, Massachusetts, and North Carolina) participated. The two strategies under study were direct installation of smoke alarms and distribution of a voucher for free smoke alarms. The target population included occupants of high-risk households without working smoke alarms who were approached as part of a door-to-door canvassing program. Fire Safety education was provided to both groups. A follow up assessment conducted 6-12 months post intervention assessed the presence and functional status of smoke alarms in each of the two groups. Demographic and fire safety data were also collected at baseline and follow up for each group. 4,455 households were enrolled in the study [Installation Group: 2,206 (49.5%), Voucher Group: 2,249 (50.5%)]. Baseline characteristics of the groups within each state were comparable. Follow up data was obtained on 1,583 installation group households and 1,545 voucher group households. At follow up, 1,421 (89.8%) households in the installation group had working smoke alarms, compared with 997 (65%) households in the voucher group, Odds Ratio 4.82 (95% CI=3.97, 5.85) (p <.0001). On average, 47% of all households enrolled in the voucher group did not redeem their vouchers (range 26-63%). Direct installation of alarms by program staff resulted in working smoke alarms in 90% of households receiving the direct installation intervention. Only 65% of voucher households had functioning alarms at follow up, largely due to failure to redeem vouchers.

Surveillance for fatal and nonfatal injuries--United States, 2001.

PROBLEM/CONDITION: Each year in the United States, an estimated one in six residents requires medical treatment for an injury, and an estimated one in 10 residents visits a hospital emergency department (ED) for treatment of a nonfatal injury. This report summarizes national data on fatal and nonfatal injuries in the United States for 2001, by age; sex; mechanism, intent, and type of injury; and other selected characteristics. REPORTING PERIOD COVERED: January-December 2001. DESCRIPTION OF THE SYSTEM: Fatal injury data are derived from CDC's National Vital Statistics System (NVSS) and include information obtained from official death certificates throughout the United States. Nonfatal injury data, other than gunshot injuries, are from the National Electronic Injury Surveillance System All Injury Program (NEISS-AIP), a national stratified probability sample of 66 U.S. hospital EDs. Nonfatal firearm and BB/pellet gunshot injury data are from CDC's Firearm Injury Surveillance Study, being conducted by using the National Electronic Injury Surveillance System (NEISS), a national stratified probability sample of 100 U.S. hospital EDs. RESULTS: In 2001, approximately 157,078 persons in the United States (age-adjusted injury death rate: 54.9/100,000 population; 95% confidence interval [CI] = 54.6-55.2/100,000) died from an injury, and an estimated 29,721,821 persons with nonfatal injuries (age-adjusted nonfatal injury rate: 10404.3/100,000; 95% CI = 10074.9-10733.7/ 100,000) were treated in U.S. hospital EDs. The overall injury-related case-fatality rate (CFR) was 0.53%, but CFRs varied substantially by age (rates for older persons were higher than rates for younger persons); sex (rates were higher for males than females); intent (rates were higher for self-harm-related than for assault and unintentional injuries); and mechanism (rates were highest for drowning, suffocation/inhalation, and firearm-related injury). Overall, fatal and nonfatal injury rates were higher for males than females and disproportionately affected younger and older persons. For fatal injuries, 101,537 (64.6%) were unintentional, and 51,326 (32.7%) were violence-related, including homicides, legal intervention, and suicide. For nonfatal injuries, 27,551,362 (92.7%) were unintentional, and 2,155,912 (7.3%) were violence-related, including assaults, legal intervention, and self-harm. Overall, the leading cause of fatal injury was unintentional motor-vehicle-occupant injuries. The leading cause of nonfatal injury was unintentional falls; however, leading causes vary substantially by sex and age. For nonfatal injuries, the majority of injured persons were treated in hospital EDs for lacerations (25.8%), strains/sprains (20.2%), and contusions/abrasions (18.3%); the majority of injuries were to the head/neck region (29.5%) and the extremities (47.9%). Overall, 5.5% of those treated for nonfatal injuries in hospital EDs were hospitalized or transferred to another facility for specialized care. INTERPRETATION: This report provides the first summary report of fatal and nonfatal injuries that combines death data from NVSS and nonfatal injury data from NEISS-AIP. These data indicate that mortality and morbidity associated with injuries affect all segments of the population, although the leading external causes of injuries vary substantially by age and sex of injured persons. Injury prevention efforts should include consideration of the substantial differences in fatal and nonfatal injury rates, CFRs, and the leading causes of unintentional and violence-related injuries, in regard to the sex and age of injured persons.