Geriatric falls: injury severity is high and disproportionate to mechanism.

OBJECTIVE: Falls are a well-known source of morbidity and mortality in the elderly. Fall-related injury severity in this group, however, is less clear, particularly as it relates to type of fall. Our purpose is to explore the relationship between mechanism of fall and both pattern and severity of injury in geriatric patients as compared with a younger cohort. METHODS: Our trauma registry was queried for all patients evaluated by the trauma service over a 412-year period (1994-1998). Two cohorts were formed on the basis of age greater than 65 or less than or equal to 65 years and compared as to mechanism, Injury Severity Score (ISS), Abbreviated Injury Scale score, and mortality. RESULTS: Over the study period, 1,512 patients were evaluated, 333 greater than 65 years and 1,179 less than or equal to 65 years of age. Falls were the injury mechanism in 48% of the older group and 7% of the younger group (p < 0.05). Falls in the older group constituted 65% of patients with ISS >15, with 32% of all falls resulting in serious injury (ISS >15). In contrast, falls in the younger group constituted only 11% of ISS >15 patients, with falls causing serious injury only 15% of the time (both p < 0.05). Notably, same-level falls resulted in serious injury 30% of the time in the older group versus 4% in the younger group (p < 0.05), and were responsible for an ISS >15 30-fold more in the older group (31% vs. <1%; p < 0.05). Abbreviated Injury Scale evaluation revealed more frequent head/neck (47% vs. 22%), chest (23% vs. 9%), and pelvic/extremity (27% vs. 15%) injuries in the older group for all falls (all p < 0.05). The mean ISS for same-level falls in the older group was twice that for the younger group (9.28 vs. 4.64, p < 0.05), whereas there was no difference in mean ISS between multilevel and same-level falls within the older group itself (10.12 vs. 9.28, p > 0.05). The fall-related death rate was higher in the older group (7% vs. 4%), with falls seven times more likely to be the cause of death compared with the younger group (55% vs. 7.5%) (both p < 0.05). Same-level falls as a cause of death was 10 times more common in the elderly (25% vs. 2.5%, p < 0.05). CONCLUSION: Falls among the elderly, including same-level falls, are a common source of both high injury severity and mortality, much more so than in younger patients. A different pattern of injury between older and younger fall patients also exists.

A portable x-ray fluorescence instrument for analyzing dust wipe samples for lead: evaluation with field samples.

Dust wipe samples collected in the field were tested by nondestructive X-ray fluorescence (XRF) followed by laboratory analysis with flame atomic absorption spectrophotometry (FAAS). Data were analyzed for precision and accuracy of measurement. Replicate samples with the XRF show high precision with an intraclass correlation coefficient (ICC) of 0.97 (P<0.0001) and an overall coefficient of variation of 11.6%. Paired comparison indicates no statistical difference (P=0.272) between XRF and FAAS analysis. Paired samples are highly correlated with an R(2) ranging between 0.89 for samples that contain paint chips and 0.93 for samples that do not contain paint chips. The ICC for absolute agreement between XRF and laboratory results was 0.95 (P<0.0001). The relative error over the concentration range of 25 to 14,200 microgram Pb is -12% (95% CI, -18 to -5). The XRF appears to be an excellent method for rapid on-site evaluation of dust wipes for clearance and risk assessment purposes, although there are indications of some confounding when paint chips are present.

Immunoperoxidase detection of CD10 in Precursor T-lymphoblastic lymphoma/leukemia: a clinicopathologic study of 24 cases.

CONTEXT: CD10 was originally reported in non-T-cell lymphoblastic lymphomas/leukemias. It has since been identified, however, in a minority of cases of T-lympho-blastic lymphoma/leukemia and other hematopoietic and nonhematopoietic entities. The usual method for the detection of CD10 previously required fresh tissue. A new antibody for CD10 (56C6) in paraffin embedded tissue sections, however, has recently become available. OBJECTIVE: To study the expression of CD10 in paraffin sections of T-lymphoblastic lymphoma/leukemia using monoclonal antibody 56C6. DESIGN: Twenty-four cases of T-lymphoblastic lymphoma/leukemia in various anatomic sites were studied. Immunohistochemical analysis with CD10 and a panel of other hematolymphoid antibodies was performed in all 24 cases. Gene rearrangement studies for the T-cell receptor by the polymerase chain reaction were performed in 18 of 24 cases. RESULTS: All cases were positive with at least 2 T-cell markers. In 15 (63%) of 24 cases CD10 was positive. T-cell receptor gene rearrangement was detected in 10 of 18 cases. CONCLUSIONS: Immunodetection of CD10 in T-lympho-blastic lymphoma/leukemia using monoclonal antibody 56C6 is common. This finding is useful in the evaluation of T-cell neoplasms.

Lead abatement training for underserved populations: lessons learned.

An environmental-justice (equity) grant program was used to make accessible an existing lead-training program to minority persons and residents of low-income communities. The purpose of the program was to enhance the knowledge base within the communities concerning lead hazards and intervention strategies and expand possibilities for employment in the lead abatement industry. Barriers to attendance were anticipated and addressed, and included transportation, meals, license application fees, reminders of course date and location, and day care. The program was evaluated through measures of recruitment rates, pre- and post-testing scores, and change in perception of confidence at pre-test, post-test, and at four-month follow-up. Fee-paying registrants over the same time period were used as a comparison group. First day attendance rates for individuals recruited into the equity-grant was 59 percent, of these 94 percent completed all days. Equity and fee-paying groups had similar scores on the pre-test (p = .209), while mean scores on the final exam differed significantly (p < .001) between the groups and were 77 percent and 85 percent, respectively. After adjusting for demographic and course type attended, perceptions of self-efficacy (benefit) and outcome-effectiveness (confidence) increased significantly from pre- to post-tests for both groups and remained at post-course levels at four months follow-up. Lessons learned include: (1) Lead abatement and other related activities can be successfully taught through traditional training methods; (2) A necessary element for delivery of educational services to minority groups is forming workable ties with local community groups, but eligibility requirements must be maintained; (3) Once barriers to first-day attendance are overcome, the information necessary to perform specific work skills can be taught; (4) Positive changes in belief are not dependent on minority status, income, or education levels; (5) Training and education increased confidence in ability to perform learned skills, and belief that there will be a beneficial outcome when performed for themselves, their families, and communities; and, (6) A consensus regarding applicability of regulations must be achieved among federal, state, and local communities.

Evaluation of four sampling methods for determining exposure of children to lead-contaminated household dust.

Childhood exposure to lead has been demonstrated to result in health effects and lead-contaminated household dust is a primary exposure source. There is a need to establish reliable methods for sampling surfaces to determine levels of lead contamination. Three vacuums (HVS3, GS80, and MVM) and one wipe method were evaluated for the collection of household floor dust under field sampling conditions within a Superfund site and demographically similar control area. Side-by-side floor samples were taken from three locations within 41 randomly selected households between August and September 1995: a child's bedroom, primary play area, and primary entrance. Analysis was performed to assess the relative collection performance of each sampler, spatial distribution of lead within a household, and correlation of lead loading with observed blood lead level, and to determine if discrete or composites samples were more predictive of blood lead levels. Approximately 90% of the floor surfaces were carpeted. The rank order of sampling methods from greatest to lowest collection efficiency was HVS3 > GS80 > wipe > MVM. The HVS3 had the highest level of precision (CV=0.05), with the GS80 and wipe precisions 0.48 and 0.053, respectively. Lead loadings for samples collected in bedrooms and living areas and composite samples using the HVS3 and wipe methods were significantly correlated with blood lead levels. Correlations between blood lead levels and composite samples were stronger for the HVS3 (R(2)=0.33, P=0.003) and wipe (R(2)=0.25, P=0.002) methods than the respective discrete samples. Regression analysis indicated that a blood lead level of 10 microgram/dl corresponds to a carpet wipe sample geometric mean of 68 microgram/ft(2). For ongoing public health purposes, such as screening and clearance testing, use of the wipe sampling method is the most appropriate. This investigation supports findings by others that the present HUD risk levels for lead in floor wipe samples may not be adequate for reducing children's blood lead levels below 10 microgram/dl.

Evidence of large particle allergen inhalation from contact with surfaces.

BACKGROUND: To establish a more accurate relationship between dust mite allergen on surfaces such as bedding with respiratory uptake, an exposure method is needed which correlates exposure of allergen on surfaces with respiratory dose. OBJECTIVES: Assess if aerodynamically large allergen particles (> 10 microm), similar in nature to dust mite allergen, is inhaled into the nose from direct head-and-hand contact with allergen contaminated surfaces. METHODS: Short ragweed pollen (20-microm diameter) was used as a surrogate for dust mite allergen exposure because of its similar aerodynamic and physiologic properties. Pillows and a section of linoleum (followed by a hand press) were embedded with 99MTechnetium labeled pollen. Particles on the linoleum were transferred to the sampler after a hand press to the surface. Simulated human exposure was performed by surface-sampling particles, at a capture velocity of the nose, onto a filter. Human evaluation of hand transfer to the nose or direct inhalation from a pillow was performed with three subjects. Percentage respiratory uptake and deposition location was determined by gamma camera imaging. RESULTS: Simulated respiratory uptake of pollen by hand-to-nose transfer and directly off pillows was 20% and 1.4%, respectively. Human subject respiratory uptake by hand-to-nose transfer and directly off pillows was 6.6% and 1.5%, respectively. Most of the regional activity was found immediately in the nasal vestibule with 13% to 39% of the total activity localized in the pharyngeal region. CONCLUSIONS: Aerodynamically large allergen particles (pollen) are inhaled and deposited into the anterior nose and pharyngeal areas of the respiratory tract from direct contact with allergen-containing surfaces.

A soiling system for evaluation of house dust, allergens, and lead retention on carpets and other surfaces.

Artificial soiling of carpeted or other floor surfaces has several important applications in human exposure assessment and textile research including evaluation of textile properties, sampling devices, and cleaning regimens. A method was developed and validated to deposit uniform and reproducible known quantities of house dust, allergens, and leaded dust on carpets. The soiling apparatus consisted of a 100 cm x 60 cm inclined steel track and a plastic cylinder, with a series of staggered holes, that contains a known volume of reference house dust. After deposition, the dust is embedded by dragging a steel rod over the carpet surface. Deposition tests were performed with bulk house dust, sodium chloride, and house dust with reference quantities of dust mite allergen and lead. The apparatus deposited equivalent (arithmetic mean) amounts of dust, sodium chloride, and dust mite allergen on the front and back halves of test carpets. The introduction of inert fumed silica to the reference sample aided in dispersal of dust over test surfaces. Little to no variation in mean deposition was found within or between 4 days of testing. Using a grid containing weighing boats under the apparatus, spatial deposition was found to vary across a 92 x 46 cm surface by 13 percent. The apparatus deposited reproducible mean quantities of bulk dust on test surfaces from 7 g/m2 to 28 g/m2 with a coefficient of variation ranging from 4-6 percent. The apparatus could be altered to deliver smaller or larger amounts of dust.

Source contribution of lead in house dust from a lead mining waste superfund site.

The relative contribution to household dust of lead particles from a mining waste superfund site and lead-based paint is investigated. Automated individual particle analysis (IPA) based on scanning electron microscopy (SEM) and X-ray energy spectroscopy (EDX) is used to develop a classification algorithm for determining lead particle source contribution in household dust vacuum bags. On a volume basis the proportion derived from the mining waste is found to be 26%, the proportion derived from a paint source is 16%, and the proportion from soil is 37%. In 15% of the lead particles identified a specific originating source could not be determined. Using a weighting method accounting for the lead concentration per particle rather than volume the contributions were similar for mining waste and paint, 21% and 23%, respectively, but the soil contribution was reduced to 8%, and the source for 29% of the lead could not be identified. These results suggested that the contribution of waste piles to the lead present in household dust is at least as important a source as paint. There is evidence to suggest that a large percentage of lead in the soil also originated from the waste piles and the overall contribution, therefore, of the waste piles may be greater than the contribution from paint.

Pollen and fungal spores indoor and outdoor of mobile homes.

BACKGROUND: Allergenic diseases triggered by aeroallergens extract a health cost in quality of life and in economic impact. People generally spend 90% to 95% of their time indoors, so understanding the environmental factors that affect the presence of aeroallergens indoors are important in understanding health impact and potential intervention methods. OBJECTIVE: Describe the relationship of indoor airborne pollen and fungal spores in occupied mobile homes with outdoor concentrations and other environmental factors within geographically diverse areas of Texas. METHODS: Airborne pollen and fungal spores were collected during the daytime with RotoRod samplers indoor and outdoor of mobile homes in Houston and El Paso, Texas. Samples were counted simultaneously with a dual eyepiece microscope and identified morphologically and through staining techniques. RESULTS: Geometric mean concentrations (counts/m3) indoors and outdoors for pollen, respectively, were Houston 7.1 and 196.4; and El Paso 17.5 and 71.5. Geometric mean concentrations (counts/m3) indoors and outdoors for spore, respectively, were Houston 98.5 and 196.4; and El Paso 36.9 and 71.5. Indoor to outdoor ratios (I/O) for pollen and fungal spores were found to be higher on average than has been previously reported. Modeling of predictive factors in Houston demonstrate that 62% and 41% of indoor levels of pollen and fungal spores, respectively, can be explained by their corresponding outdoor levels. These data suggest that the many factors associated with individual exposure to airborne pollen and fungal spores indoors are under the control of the occupant, and may additionally be influenced by the physical characteristics of mobile homes, in particular the high surface area to volume ratio and restricted flow patterns.

Relationship between lead mining and blood lead levels in children.

The authors studied blood lead levels of 226 randomly selected children, aged 6-92 mo, who lived in either a lead-mining area or a nonmining area, and 69 controls. The authors sought to determine to what extent mining activities contributed to blood lead levels in the children. The mean blood lead levels in the study and control groups were 6.52 microg/dl and 3.43 microg/dl, respectively. The corresponding proportions of children with elevated blood lead levels were 17% and 3%. Soil and dust lead levels were up to 10 times higher in the study than the control group. Elevated blood lead levels appeared to result from exposure to both lead-mining waste and lead-based paint. Mining waste was the cause of the higher prevalence of elevated blood lead levels in these children.

An alternative explanation for the apparent elevated relative mortality and morbidity risks associated with exposure to environmental tobacco smoke.

Insofar as industrial and other blue collar workers are more likely to bring home toxic materials on their person, and also are more likely to smoke than those in other occupations, members of a household are more likely to be subject to paraoccupational exposure and belong to lower socioeconomic strata if the household contains a smoker than if the household does not contain a smoker. Thus observed differences in risk of mortality or morbidity ascribed to ETS on the basis of a comparison of households with and without smokers may be partly or entirely due to differences in paraoccupational exposure and socioeconomic strata. Similarly, differences in mortality and morbidity ascribed to paraoccupational exposure may be partly or entirely due to differences in ETS exposure that are also related to social class and to types of occupation. Unfortunately, there are no data now in existence that could help determine separately the effects of these major confounded variables. There exists, then, a situation in which two explanations are advanced for respiratory diseases among members of a household, each based on similar study populations but focused on different major risk variables: ETS on the one hand, socioeconomic status and paraoccupational exposure on the other. Properly focused investigations need to be initiated.

Problems associated with establishing a clinic for the elderly.

Actual use of a newly established geriatric clinic in a low-cost housing unit was appreciably below projected numbers, even though cost and transportation were removed as barriers to care. In a survey of building occupants, 20% were unaware of the clinic's existence. More than 90% of the occupants did not know clinic hours but a third could identify clinic staff. About half of the occupants had used the clinic, often for minor services. The major reason for lack of use of the clinic was an established pattern of receiving medical care which occupants were reluctant to risk or abandon. Needs must be appropriately assessed before service programs are designed for the elderly. Assumptions may at times be incorrect. A thorough understanding of needs and existing methods of meeting them leads to more appropriately designed programs.

Health effects of chlorophenol wood preservatives on sawmill workers.

At the request of the International Woodworkers of America, Local 1-85, woodworkers in two Port Alberni, British Columbia, sawmills were surveyed for health complaints possibly associated with chlorophenol exposure. On the basis of their exposure to anti-sapstain, workers were divided into low/moderate and high exposure groups. Health status was determined through a questionnaire that included lists of symptoms associated with exposure to chlorophenates and their contaminants. Extensive differences were found between exposure groups, especially in terms of the prevalence and extensiveness of symptoms related to dermatological, upper and general respiratory, and neurological structures and functions. Significant elevations of a wide range of other symptom complaints directly related to chemical exposure were also found. While improved spray control operations and the use of personal protective equipment will decrease injury among workers, they cannot be expected to decrease the hazards of chlorophenol exposure to an acceptable level. The only effective means of eliminating worker and public health risks attendant with these chemical exposures is to implement an alternative means of anti-sapstain treatment and to seek an end to the use of chlorophenol for this purpose.