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Biomedical subjects

D M Sosin

Publications and source records attributed to D M Sosin.

At least 19 recordsLinked to original sources
PubMed1996

Incidence of mild and moderate brain injury in the United States, 1991.

The 1991 National Health Interview Survey was analysed to describe the incidence of mild and moderate brain injury in the United States. Data were collected from 46 761 households and weighted to reflect all non-institutionalized civilians. The report of one or more occurrences of head injury resulting in loss of consciousness in the previous 12 months was the main outcome measure. Each year an estimated 1.5 million non-institutionalized US civilians sustain a non-fatal brain injury that does not result in institutionalization, a rate of 618 per 100,000 person-years. Motor vehicles were involved in 28% of the brain injuries, sports and physical activity were responsible for 20%, and assaults were responsible for 9%. Medical care was sought by 75% of those with brain injury; 14% were treated in clinics or offices, 35% were treated in emergency departments, and 25% were hospitalized. The risk of medically attended brain injury was highest among three subgroups: teens and young adults, males, and persons with low income who lived alone. The incidence of mild and moderate brain injury in the United States is substantial. The National Health Interview Survey is an important national source of current outpatient brain-injury data.

Accidents, Traffic↗
PubMed1996

Pediatric head injuries and deaths from bicycling in the United States.

OBJECTIVE: To estimate the potential benefit of increasing bicycle helmet use among children and adolescents in the United States. DESIGN: All bicycle-related deaths (Multiple Cause-of-Death Public Use Data Tapes, 1989 through 1992) and bicycle-related injuries treated in sampled emergency departments (National Electronic Injury Surveillance System, 1989 through 1993) were used to calculate traumatic brain injury-associated death and head injury rates per 1,000,000 US residents. Preventable injuries and deaths were estimated by calculating the population-attributable risk of head injury due to nonuse of bicycle helmets. PATIENTS: US residents aged 0 through 19 years who were injured or who died as a result of a bicycle crash. RESULTS: An average of 247 traumatic brain injury deaths and 140,000 head injuries among children and adolescents younger than 20 years were related to bicycle crashes each year in the United States. As many as 184 deaths and 116,000 head injuries might have been prevented annually if these riders had worn helmets. An additional 19,000 mouth and chin injuries were treated each year. The youngest age groups had the highest proportions of both head and mouth injuries. CONCLUSION: There continues to be a need to advocate for greater use of bicycle helmets, particularly among young children. Helmet design changes should be considered to prevent mouth injuries.

Adolescent↗
PubMed1995

The first reported outbreak of diarrheal illness associated with Cyclospora in the United States.

OBJECTIVE: To investigate and characterize the epidemiology of a diarrheal outbreak associated with a potentially new pathogen, Cyclospora species (previously referred to as Cyanobacteria [blue-green algae]-like bodies). DESIGN: Three retrospective cohort studies supported by laboratory studies, environmental investigation, and community surveillance. SETTING: A hospital in Chicago. PARTICIPANTS: Housestaff physicians and hospital administrative staff. MEASUREMENTS: Identification of clinical features associated with illness and potential risks for acquisition of infection. RESULTS: Illness was characterized by watery diarrhea, abdominal cramping, decreased appetite, and low-grade fever. Symptoms typically occurred in a distinctive cycle of remissions and exacerbations lasting up to several weeks. Stool cultures and examinations for known ova and parasites were negative. Microscopic examination of stool specimens from 11 ill persons showed many spherical bodies, 8 to 10 microns in diameter, that were identified as Cyclospora organisms. The organisms disappeared by 9 weeks after onset of illness in the 7 patients from whom follow-up specimens were obtained. Epidemiologic studies implicated tap water from a physicians' dormitory as the most likely source of the outbreak. Environmental investigation suggested that stagnant water in a storage tank may have contaminated the water supply after a pump failure. CONCLUSIONS: This is the first reported outbreak of diarrhea associated with Cyclospora in the United States. Cyclospora may be a human enteric pathogen able to produce bouts of acute and relapsing diarrhea, and it should be considered in assessments of patients with unexplained, prolonged diarrheal illness.

Adult↗
PubMed1995

Trends in death associated with traumatic brain injury, 1979 through 1992. Success and failure.

OBJECTIVE: To report updated national trends in traumatic brain injury deaths from 1979 through 1992. DESIGN: Retrospective analysis of Multiple Cause-of-Death Public Use Data Tapes from the National Center for Health Statistics. All deaths associated with traumatic brain injury were identified, the underlying causes of death were categorized, and the annual rates were calculated per 100,000 US residents. PATIENTS: Residents of the United States who died with traumatic brain injury from 1979 through 1992. RESULTS: An average of 52,000 US residents die each year with traumatic brain injuries. The brain injury-associated death rate declined 22% from 24.6 per 100,000 US residents in 1979 to 19.3 per 100,000 US residents in 1992. Firearm-related rates increased 13% from 1984 through 1992, undermining a 25% decline in motor vehicle-related rates for the same period. Firearms surpassed motor vehicles as the largest single cause of death associated with traumatic brain injury in 1990. CONCLUSIONS: These data highlight the success of efforts to prevent traumatic brain injury due to motor vehicles and failure to prevent such injuries due to firearms. The increasing importance of penetrating injury has important implications for research, treatment, and prevention of traumatic brain injury in the United States.

Accidental Falls↗
PubMed1995

Fighting as a marker for multiple problem behaviors in adolescents.

PURPOSE: Behaviors that put adolescents at risk frequently occur together. To help identify high-risk adolescents, we analyzed a national, self-reported behavior survey of high school students to assess the suitability of fighting as a marker for students with multiple problem behaviors. METHODS: A cross-sectional cluster survey of 11,631 U.S. high school students in 1990 was used to compare the prevalence of recent problem behaviors among all students and those who fight. RESULTS: One (8%) of every 12 students was in a fight during the 30 days before the survey. Reported problem behaviors were prevalent among fighters: during the previous 12 months, 24% attempted suicide; during the previous 30 days, 26% carried a firearm, 13% used cocaine, and 39% drove a motor vehicle while intoxicated; during the previous 3 months 41% had two or more sex partners; and 45% had sexual intercourse and did not use a condom the last time they had sex. Of all students, fighters accounted for 22% of those who reported attempting suicide, 49% carrying a firearm, 46% using cocaine, 18% driving while intoxicated, 25% having sex with multiple partners, and 11% not using condoms. Three or more of these six problem behaviors were reported by 26% of the fighters. The problem behaviors were all positively correlated, and the first principal component accounted for 35% of the total variation among the individual variables.

Adolescent↗
PubMed1995

The role of heightened surveillance in an outbreak of Escherichia coli O157.H7.

After instituting laboratory screening for Escherichia coli O157.H7, a Connecticut hospital isolated the organism from four persons in September 1993. As a result, an outbreak of E. coli O157.H7 associated with a country club was detected. The club had served hamburger from the same shipment at two picnics. Attendees of two picnics were interviewed, stool cultures were obtained from symptomatic persons, and the remaining hamburger was cultured. Twenty (22%) of 89 persons who ate hamburger became ill, compared with 1 of 60 who did not eat hamburger (relative risk = 13.5, 95% confidence interval 3.2-56.3). Among persons who ate hamburgers, illness was strongly associated with eating hamburger that was not thoroughly cooked (P < 0.001). All 20 samples from 5 remaining boxes of patties yielded E. coli O157.H7. Isolates from hamburger and case-patients were indistinguishable by pulsed-field gel electrophoresis. Heightened surveillance can rapidly identify outbreaks and may mitigate their impact. However, continued review of food safety issues is necessary if E. coli O157.H7 outbreaks are to be prevented.

Adolescent↗
PubMed1994

Household-acquisition of measles and illness severity in an urban community in the United States.

Studies from developing countries suggest that persons with household-acquired (HA) measles are at greater risk of severe illness than persons with community-acquired (CA) infection. Reported measles cases occurring among Milwaukee residents from May 1989 to June 1990 were used to assess whether household-acquisition was a risk factor for severe measles in the United States. A case was classified as HA if onset of rash occurred 7-18 days after onset of rash in another case in the same household. Hospitalization rates were similar for 128 patients with HA measles (27%) and for 1004 patients with CA measles (26%). Multiple logistic regression was used to evaluate the association between hospitalization and household-acquisition after controlling for socioeconomic status, measles vaccination history, age, race, and date of onset of rash. Patients with HA measles were no more likely to be hospitalized than patients with CA measles (odds ratio 0.9, 95% confidence interval 0.6, 1.5). HA measles cases were not more severe than CA measles cases during this urban outbreak in the United States.

Adolescent↗
PubMed1994

Boilerbaisse: an outbreak of methemoglobinemia in New Jersey in 1992.

BACKGROUND: On October 20, 1992, > 40 children from one elementary school visited the school nurse due to the acute onset of blue lips and hands, vomiting, and headache during and after the school lunch periods. Forty-nine children were seen by physicians that day and 14 were hospitalized. Laboratory analysis revealed methemoglobinemia in many of the children. All recovered in 36 hours. OBJECTIVE: A case-control study was supplemented by environmental and laboratory investigations to determine the outbreak source. METHODS: Cases were selected based on the laboratory diagnosis of methemoglobinemia (methemoglobin level > 2%). Children whose methemoglobin levels were missing or < 2% were excluded from analysis. Controls were obtained by selecting every third name from a school roster. The parents of 29 students who met the case definition and 52 controls were interviewed. RESULTS: All 29 cases and 33% (17/52) of the controls ate soup during the school lunch (odds ratio undefined, lower 95% confidence limit 16.1). Two pots of soup were prepared from ready-to-serve cans, which were diluted with water and enriched with a commercially prepared flavor enhancer. The school's boiler, dormant during the previous 5 months, was restarted on the morning of the outbreak. The boiler also served as a tankless hot water heater. Laboratory analysis of the soup identified abnormally high quantities of nitrite (459 ppm) and sodium metaborate, major components of the boiler water treatment solution. Undiluted soup from the same lot had 2.0 ppm nitrites; the flavor enhancer had 2.2 ppm nitrites. Nitrites were present in the hot potable water system (4 to 10 ppm) and absent in the cold potable water system. CONCLUSIONS: This outbreak of methemoglobinemia due to nitrite poisoning was traced to soup contaminated by nitrites in a boiler additive. Nitrites are ubiquitous and potentially hazardous inorganic ions. Extreme caution should be used when the possibility for toxic human exposure to nitrites exists.

Case-Control Studies↗
PubMed1993

Tuberculosis in a correctional facility.

BACKGROUND: After the identification of five suspected cases of tuberculosis (TB) in a Nassau County (New York) jail during a 3-week period, an epidemiologic investigation was begun to document the number of cases of TB infection and disease associated with the jail, the characteristics of current or former inmates with TB disease, and the factors contributing to TB transmission in the jail. METHODS: The county TB register was matched against the inmate files of the jail. Medical records from hospitals, the health department, and the jail were then reviewed. All inmates in the jail were skin tested during a mass screening. RESULTS: From January 1, 1988, through March 16, 1990, of 205 TB cases in the county, 49 (24%) were associated with the jail. Forty of the cases occurred among current or former inmates, one in a corrections officer, and eight among community contacts of inmates. The 40 inmates with TB were predominantly nonwhite (75%), unmarried (80%) men (90%), with a median age of 32 years. Twenty-three (58%) had a history of injecting drug use, and 14 (35%) were known to be seropositive for the human immunodeficiency virus. Thirty (75%) of the inmates had culture-confirmed pulmonary TB. Five (29%) of 17 Mycobacterium tuberculosis isolates had the same phage type and DNA fingerprint, which was consistent with transmission of infection within the jail. The mass screening revealed that 374 (20%) of 1855 inmates were tuberculin positive. CONCLUSIONS: Without an effective program of TB control, jails can act as reservoirs of disease for inmates and staff, and for the community into which the inmates are released.

Adult↗
PubMed1993

Sensitivity of multiple-cause mortality data for surveillance of deaths associated with head or neck injuries.

PROBLEM/CONDITION: Multiple-cause mortality data was assessed as a source of information for surveillance of deaths associated with head or neck injuries. REPORTING PERIOD COVERED: 1985-1986 DESCRIPTION OF SYSTEM: Data on causes of death were abstracted from death certificates in New Mexico and coded according to criteria of the International Classification of Diseases, Ninth Revision (ICD-9). Deaths with an external cause-of-death (E) code as the underlying cause of death and one or more head or neck injury nature-of-condition (N) codes as contributing causes of death were considered head or neck injury deaths. These data were compared with data for head or neck injury deaths obtained from computerized records from the New Mexico Office of the Medical Investigator (OMI). Data for alcohol or drug use were abstracted from both systems. RESULTS: Of the 699 head or neck injury deaths coded by the New Mexico OMI system in 1985-1986, 536 were identified as head or neck injury deaths in multiple-cause mortality data (sensitivity = 76.7%). Firearms were the leading cause of head or neck injury deaths, followed by motor vehicles. Multiple-cause mortality data contained alcohol codes for only 3.7% of OMI records with blood alcohol concentrations > or = 0.10 mg/dL and contained drug codes for none of the OMI records with positive toxicology tests for drugs. INTERPRETATION: The sensitivity of multiple-cause mortality data was relatively high for surveillance of head and neck injury deaths.(ABSTRACT TRUNCATED AT 250 WORDS)

Accidental Falls↗
PubMed1993

Surface-specific fall injury rates on Utah school playgrounds.

The purpose of this study was to estimate surface-specific rates of fall injuries on school playgrounds. Playground injuries related to falls from climbing equipment and the surfaces involved were identified from injury reports for 1988 to 1990 from 157 Utah elementary schools. Enrollment data and playground inspections were used to estimate student-years spent over each surface. The fall injury rates per 10,000 student-years were asphalt, 44; grass, 12; mats, 16; gravel, 15; and sand, 7. These data did not show that impact-absorbing surfaces reduce fall injuries on playgrounds better than grass. Improved field studies are needed to guide policy decisions for playground surfacing.

Accidental Falls↗
PubMed1993

Exposure to environmental tobacco smoke among Missouri children.

Childhood exposure to environmental tobacco smoke (ETS) increases the risk of lower respiratory infections (e.g., bronchitis and pneumonia), exacerbates childhood asthma, and increases the prevalence of fluid in the middle ear. Using self-reported telephone survey data, we examined the attitudes and practices of Missouri residents related to ETS exposure of children. Ninety-five percent of all respondents believed that ETS exposure is harmful to children and the percentage was similar for households with children (96%) and without children (94%). ETS was present in 42% of households and the percentage was similar for households with children (41%) and without children (44%). Childhood exposure to ETS remains a problem in Missouri, despite widespread awareness of the hazards. More active intervention is needed to reduce ETS exposure in the home.

Adult↗
PubMed1992

Motorcycle helmet-use laws and head injury prevention.

OBJECTIVE: To rebut criticism of a previous study of motorcycle helmet-use laws through reanalysis with improved measures of exposure, stratification for regional differences in crash risk, and addressing of total motorcycle-related mortality and the grounds for targeting motorcyclists for helmet-use laws. DESIGN: Death certificate-based correlational study of motorcycle-related deaths and motorcycle helmet-use laws. POPULATION STUDIED: United States resident deaths from 1979 through 1986. RESULTS: Regardless of the denominator used (resident population, motorcycle registrations, or motorcycle crashes), states with full helmet-use laws had consistently lower head injury-associated death rates than states without such laws, even when stratified by region. Total motorcycle-related mortality, however, was similar between law groups. On a registration or crash basis, motorcyclists who died in crashes had a fivefold to sixfold higher risk of head injury than those who died using any other type of motor vehicle. CONCLUSION: Full helmet-use laws were consistently associated with lower rates of head injury-associated death. While disagreement remains on the acceptability of the legislative approach, the scientific basis for motorcycle helmet-use laws as a head injury prevention tool appears sound.

Accidents, Traffic↗
PubMed1992

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.

Humans↗
PubMed1991

Bicycle-associated head injuries and deaths in the United States from 1984 through 1988. How many are preventable?

OBJECTIVE: To estimate the potential benefits from more widespread bicycle safety helmet use. DESIGN: Review of death certificates and emergency department injury data for 1984 through 1988. Categorization of deaths and injuries as related to bicycling and head injury. Using relative risks of 3.85 and 6.67 derived from a case-control study and varying helmet usage from 10% to 100%, population attributable risk was calculated to estimate preventable deaths and injuries. SETTING: Entire United States. MAIN OUTCOME MEASURES: Numbers of US residents coded as dying from bicycle-related head injuries, numbers of persons presenting to emergency departments for bicycle-related head injuries, and numbers of attributable bicycle-related deaths and head injuries. MAIN RESULTS: From 1984 through 1988, bicycling accounted for 2985 head injury deaths (62% of all bicycling deaths) and 905,752 head injuries (32% of persons with bicycling injuries treated at an emergency department). Forty-one percent of head injury deaths and 76% of head injuries occurred among children less than 15 years of age. Universal use of helmets by all bicyclists could have prevented as many as 2500 deaths and 757,000 head injuries, ie, one death every day and one head injury every 4 minutes. CONCLUSIONS: Effective community-based education programs and legislated approaches for increasing bicycle safety helmet usage have been developed and await only the resources and commitment to reduce these unnecessary deaths and injuries.

Adolescent↗