Hospitalizations for dog bite injuries.
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Animals↗
Biomedical subjects
J J Sacks
Publications and source records attributed to J J Sacks.
Injury among cavers: results of a preliminary national survey.
BACKGROUND: To estimate the frequency of and risk factors for caving-associated injuries. METHODS: A standardized questionnaire covering demographics, caving exposure, and injury history was distributed to all members of the National Speleological Society by inclusion in the monthly newsletter. RESULTS: Of 9,532 members sent a questionnaire, 301 responded (3.2%). Respondents had an average of 18 years of caving experience, and 37% had sustained one or more injuries while caving. Hypothermia was the most frequent injury, followed by fractures, animal bites, and concussions. The rate of injury was about 1 per 1,990 hours in a cave. Injury rates for females were about twice those of males; older persons and those with more than 5 years of caving experience seemed to have lower injury rates. CONCLUSIONS: Many caving injuries appear potentially preventable. Proper technique for safe climbing should be a part of exploration training. There is a need for proper belaying or rappelling for even short ascents or descents. Helmet use should be stressed, as should adequate protection from hypothermia.
Adult↗
Fatal residential fires: who dies and who survives?
CONTEXT: The United States has one of the highest fire fatality rates in the developed world, and three quarters of these deaths are in residential fires. OBJECTIVE: To compare characteristics of those who die and those who survive in the same residential fire. DESIGN: Data on fatal residential fires were collected from the medical examiner and interviews with local fire officials. SETTING: North Carolina. SUBJECTS: Persons in residential fires with at least 1 fatality in a 1-year period. MAIN OUTCOME MEASURE: Dying vs surviving a fatal residential fire that occurred with more than 1 person at home. RESULTS: Of the 190 decedents, 124 (65%) were male, 78 (41%) were home alone, and 69 (53%) of 130 adults who had blood alcohol measured were intoxicated (blood alcohol content >22 mmol/L [100 mg/dL]). Of the 254 persons present during fires in which more than 1 person was at home, 112 died. Individuals more likely to die (high-vulnerability group) were younger than 5 years or 64 years or older, had a physical or cognitive disability, or were impaired by alcohol or other drugs (risk of death for group, odds ratio [OR], 4.01; 95% confidence interval [CI], 2.29-7.03). The presence of an adult with no physical or cognitive disabilities who was unimpaired by alcohol or other drugs (a potential rescuer) reduced the risk of death in the high-vulnerability group (OR, 0.49; 95% CI, 0.24-0.99) but not the low-vulnerability group. Overall, a functioning smoke detector lowered the risk of death (OR, 0.39; 95% CI, 0.18-0.83). CONCLUSIONS: Smoke detectors were equally effective in both low- and high-vulnerability populations. The high-vulnerability group was more likely to survive if, in addition to a smoke detector, a potential rescuer was present. Further research should seek to identify prompts that facilitate speedy egress from a burning structure and that can be incorporated into residential fire alarm systems.
Adolescent↗
Evaluation of three smoke detector promotion programs.
CONTEXT: Seventy percent of U.S. residential fire deaths occur in homes without a working smoke detector. To help prevent residential fire deaths, many programs have distributed or installed detectors in unprotected homes. Because persons receiving a detector may not install it and because detector batteries require annual replacement, the enduring effectiveness of these programs may be questioned. OBJECTIVE: We evaluated the long-term functional status of smoke detectors distributed to high-risk households in eight areas of Minnesota, Cherokee County (North Carolina), and Oklahoma City (Oklahoma). DESIGN: Cross-sectional. SETTING: Home visits were made to check the detectors that were distributed 3 to 4 years earlier. PARTICIPANTS: Randomly selected households from the three detector promotion programs. MAIN OUT-COME MEASURE: At least one working smoke detector. RESULTS: Participation rates ranged from 72% to 82%. The percentage of evaluation households with at least one working detector ranged from 58% in Oklahoma to 73% in North Carolina. In 76% of households with nonworking detectors, the batteries were either missing or disconnected. When batteries in nonworking detectors were replaced, 83% of the detectors regained function. CONCLUSIONS: Future programs should consider distributing detectors that do not require annual battery changes or find effective ways to ensure that batteries are routinely replaced. Programs should also provide each household with the number of detectors needed to meet the most current recommended standard of the National Fire Protection Agency. The evaluation's participation rates support the practicality of unannounced home visits to evaluate home injury prevention programs in high-risk groups.
Accident Prevention↗
Injury rates from walking, gardening, weightlifting, outdoor bicycling, and aerobics.
PURPOSE: The objective of this survey was to estimate the frequency of injuries associated with five commonly performed moderately intense activities: walking for exercise, gardening and yard work, weightlifting, aerobic dance, and outdoor bicycling. METHODS: National estimates were derived from weighted responses of over 5,000 individuals contacted between April 28 and September 18, 1994, via random-digit dialing of U.S. residential telephone numbers. Self-reported participation in these five activities in the late spring and summer of 1994 was common, ranging from an estimated 14.5 +/- 1.2% of the population for aerobics (nearly 30 million people) to 73.0 +/- 1.5% for walking (about 138 million people). RESULTS: Among participants, the activity-specific 30-d prevalence of injury ranged from 0.9 +- 0.5% for outdoor bicycle riding to 2.4 +- 1.3% for weightlifting. The estimated number in the 30 d of people injured in the 30 d before their interview ranged from 330,000 for outdoor bicycle riding to 2.1 million for gardening or yard work. Incidence rates for injury causing reduced participation in activity were 1.1 +/- 0.5x100 participantsx30 d for walking, 1.1 +/- 0.4 for gardening, and 3.3 +/- 1.9 for weightlifting. During walking and gardening, men and women were equally likely to be injured, but younger people (18-44 yr) were more likely to be injured than older people (45 + yr). Injury rates were low, yet large numbers of people were injured because participation rates were high. Most injuries were minor, but injuries may reduce participation in these otherwise beneficial activities. CONCLUSIONS: Additional studies to confirm the magnitude of the problem, to identify modifiable risk factors, and to recommend methods to reduce the frequency of such injuries are needed.
Adolescent↗
Childhood drownings and fencing of outdoor pools in the United States, 1994.
OBJECTIVES: To determine the prevalence of proper fencing around outdoor swimming pools among US households and to describe this fencing in relation to demographic and other household factors. To estimate the number of drownings among children <5 years of age that might be prevented by having proper fencing around all residential pools in the United States. METHODS: A 1994, randomly dialed national telephone survey contacted 5238 adults who reported demographic information and household characteristics including whether the household had an outdoor swimming pool and the fencing around the pool. Data were weighted to obtain national estimates and percentages. The number of preventable drownings was estimated with a population-attributable risk equation. RESULTS: Approximately 18.5 million American households owned or had access to an outdoor swimming pool in 1994, and 76% (13.9 million) of them appeared to have had adequate fencing. Adequate fencing was associated with household income and type of home. We estimate that 19% of pool-related drownings among children <5 years of age in 1994 (88 drownings) might have been prevented if all residential pools in the United States were properly fenced. CONCLUSIONS: Adequate pool fencing prevents a child from having access to a swimming pool if a responsible adult is not present and has been promoted as a method to prevent drowning. Our research suggests that even if all residential pools in the United States were properly fenced, most drownings among children <5 years of age would not be prevented. Thus, additional strategies to prevent drowning will be needed.
Accident Prevention↗
Exposure to and compliance with pediatric injury prevention counseling--United States, 1994.
BACKGROUND: Because injuries are the leading cause of death in children, injury prevention counseling is recommended as part of routine pediatric care. Increasing such counseling is a national health objective. Estimating the proportion of US children who receive such counseling and assessing their compliance with safety recommendations may help improve counseling efforts. METHODS: Respondents to a 1994 random digit-dial telephone survey of the US population were asked about receipt of age-appropriate injury prevention counseling at a medical visit and related safety practices for a randomly selected child 0 to 14 years of age in the household (N = 1596). RESULTS: Receiving any injury prevention counseling was reported for 39.3% of children 0 to 14 years old who had a medical visit in the past year and was more common among children who were younger, lived in urban areas, and lived in poverty. In general, receiving counseling was associated with safer behaviors. Counseling about ipecac was reported for 17.2% of children 0 to 6 years old; having ipecac in the home was more likely for those counseled (73.4% vs 32.0%). Counseling about posting the poison control number was reported for 24.9% of children 0 to 6 years old; posting this number was more common among those counseled (79.3% vs 52.6%). Counseling about bicycle helmets was reported for 18.6% of children 5 to 14 years old; a report of always wearing a helmet was more common among those counseled (43.9% vs 19.1%). Counseling about car seats and safety belts was reported for 25.4% of children 0 to 14 years old; a report of always using occupant restraints was more common among those counseled (89.0% vs 78.2%). CONCLUSIONS: Injury prevention counseling is associated with reported preventive safety practices among US children, but a relatively small proportion of households with young children report receiving such counseling. Health care providers should increase efforts to provide injury prevention counseling. counseling, wounds and injuries, child, accident prevention.
Accident Prevention↗
Evaluation of a statewide bicycle helmet law via multiple measures of helmet use.
OBJECTIVES: To evaluate an Oregon law requiring bicyclists younger than 16 year to wear a helmet and to compare methods of measuring helmet use. DESIGN: Four prelaw and postlaw statewide helmet use surveys: (1) statewide observations, (2) middle school observations, (3) classroom self-report surveys, and (4) a statewide adult telephone survey. SETTING: Oregon. SUBJECTS: Statewide observations, 3313 child bicyclists at 13 sites; middle school observations, 995 child bicyclists at 33 randomly selected middle schools; classroom self-report surveys, fourth, sixth, and eighth graders in 448 classrooms (ie, 8955 students) before the law was effected and 456 classrooms (ie, 9811 students) after the law was effected in 66 randomly selected schools; and statewide telephone survey, 1219 randomly called parents of 1437 children younger than 16 years. MAIN OUTCOME MEASURES: Prelaw and postlaw helmet use and ownership and knowledge and opinion about the law. RESULTS: Observed helmet use among youth was 24.5% before the law was effected and 49.3% after the law was effected. School-observed use increased from 20.4% to 56.1%. Classroom survey self-reported "always" use of helmets increased from 14.7% to 39.4%; reported use on the day of the survey increased from 25.8% to 76.0%. Telephone survey-reported "always" helmet use increased from 36.8% to 65.7%. Younger children and girls were more likely to use helmets. Most students (ie, 87.8%) and parents (ie, 95.4%) knew about the law; however, only 42.6% of children thought the law was a good idea. CONCLUSIONS: We conclude that (1) the law increased helmet use; (2) although use estimates differ, all helmet surveys showed similar degrees of prelaw and postlaw change; and (3) half of child bicyclists are still not wearing helmets, indicating a need for additional promotion of helmet wearing. Laws seem to be an effective way to increase helmet use.
Adolescent↗
Estimating intruder-related firearm retrievals in U.S. households, 1994.
To estimate the frequency of firearm retrieval because of a known or presumed intruder, the authors analyzed data from a 1994 national random digit dialing telephone survey (n = 5,238 interviews). Three mutually exclusive definitions of firearm retrieval were constructed: (1) retrieved a firearm because there might be an intruder, (2) retrieved a firearm and saw an intruder, and (3) retrieved a firearm, saw an intruder, and believed the intruder was frightened away by the gun. Of 1,678 (34%) households with firearms, 105 (6%) retrieved a firearm in the previous 12 months because of an intruder. National projections based on these self-reports reveal an estimated 1,896,842 (95% CI [confidence interval] = 1,480,647-2,313,035) incidents in which a firearm was retrieved, but no intruder was seen; 503,481 (95% CI = 305,093-701,870) incidents occurred in which an intruder was seen, and 497,646 (95% CI = 266,060-729,231) incidents occurred in which the intruder was seen and reportedly scared away by the firearm. Estimates of the protective use of firearms are sensitive to the definitions used. Researchers should carefully consider both how these events are defined and the study methods used.
Adult↗
Effect of a state law on reported bicycle helmet ownership and use.
OBJECTIVE: To evaluate the effect of a state law on reported bicycle helmet ownership and use. DESIGN: Multistage cluster random-digit-dialing telephone survey. SETTING: Georgia, June through November 1993. PARTICIPANTS: Adults who reported the behavior of bicyclists 4 through 15 years old. INTERVENTION: State law mandating helmet use after July 1, 1993, for all bicyclists aged younger than 16 years. MAIN OUTCOME MEASURES: Bicycle helmet ownership and use. RESULTS: Reported helmet ownership increased from 39% before the law took effect to 57% afterward (+ 46%, P = .06). Reported use increased from 33% before to 52% afterward (+ 58%, P < .05). About 7% of riders changed from "never-wearing" to "always-wearing" behavior. After the law took effect, in those households in which the law was known, 69% of riders owned and 64% used a helmet. By comparison, in those households in which the law was not known, only 30% owned and 25% used a helmet (P < .01). Reported ownership and use were 93% concordant, inversely related to rider age, and directly related to household income. Multivariable analysis indicated that race was an effect modifier of reported helmet ownership and use. In black riders, knowledge of the law appeared to be highly associated with both reported helmet ownership and use but was not significant in white riders. In white riders, though age and income were significantly associated with reported helmet ownership and use. CONCLUSIONS: This law appeared important in increasing reported helmet ownership and use, particularly in black riders. Since knowledge of the law was associated with increased ownership and use, additional publicity about the law might further increase helmet use. Because most riders who owned helmets used them, give-away programs targeting areas of low ownership may also increase use.
Adolescent↗
Dog bites: how big a problem?
OBJECTIVE: To estimate the magnitude of the dog bite problem in the US. METHODS: Data on dog bites were gathered as part of a 1994 national telephone survey of 5,238 randomly dialed households. Data were weighted to provide national estimates. RESULTS: The weighted total number of dog bites was 4,494,083 (estimated incidence = 18/1,000 population); of these, 756,701 persons sustained bites necessitating medical attention (incidence rate = 3/1,000). Children had 3.2 times higher medically attended bite rates than adults (6.4/1,000 children v 2/1,000 adults). CONCLUSIONS: More attention and research needs to be devoted to the prevention of dog bites. Potential prevention strategies include: educational programs on canine behavior, especially directed at children; laws for regulating dangerous or vicious dogs; enhanced animal control programs; and educational programs regarding responsible dog ownership and training. Unfortunately, the relative or absolute effectiveness of any of these strategies has not been assessed. Continuing surveillance for dog bites will be needed if we are to better understand how to reduce the incidence of dog bites and evaluate prevention efforts.
Accident Prevention↗
Bicycle helmet use among American children, 1994.
OBJECTIVE: To estimate ownership and use of bicycle helmets among children in the US in 1994. METHODS: As part of a 1994 national telephone survey of 5,238 randomly dialed households, adult respondents reported data on bicycle helmet ownership and helmet use among 1,645 child bicyclists. Data were weighted to provide national estimates. RESULTS: It is estimated that 72.7% of children 5-14 year olds ride bicycles, that is, 27.7 million child bicyclists. Of the bicyclists, 50.2% have a helmet and 25.0% reportedly always wore their helmet when cycling. Reported helmet ownership and use increased with income and educational level and decreased with age. Among regions of the US, those with the highest proportion of states with helmet use laws in 1994 also had the highest proportion of helmet use among children. Among child bicyclists who had been seen by a health care provider in the preceding 12 months, 43.9% of those counseled to wear a bicycle helmet were reported to comply compared with 19.1% of those seen by a provider but not so counseled (p < 0.001). CONCLUSIONS: To meet the year 2000 objective of 50% of bicyclists wearing helmets, use among American children will have to double. Concerted and increased efforts to promote the wearing of bicycle helmets are necessary.
Adolescent↗
Fatal dog attacks, 1989-1994.
OBJECTIVES: To update data on fatal dog bites and see if past trends have continued. DESIGN: To merge data from vital records, the Humane Society of the United States, and searches of electronic news files. SETTING: United States. SUBJECTS: U.S. residents dying in the U.S. from 1989 through 1994 from dog bites. RESULTS: We identified 109 dog bite-related fatalities, of which 57% were less than 10 years of age. The death rate for neonates was two orders of magnitude higher than for adults and the rate for children one order of magnitude higher. Of classifiable deaths, 22% involved an unrestrained dog off the owner's property, 18% involved a restrained dog on the owner's property, and 59% involved an unrestrained dog on the owner's property. Eleven attacks involved a sleeping infant; 19 dogs involved in fatal attacks had a prior history of aggression; and 19 of 20 classifiable deaths involved an unneutered dog. Pit bulls, the most commonly reported breed, were involved in 24 deaths; the next most commonly reported breeds were rottweilers (16) and German shepherds (10). CONCLUSIONS: The dog bite problem should be reconceptualized as a largely preventable epidemic. Breed-specific approaches to the control of dog bites do not address the issue that many breeds are involved in the problem and that most of the factors contributing to dog bites are related to the level of responsibility exercised by dog owners. To prevent dog bite-related deaths and injuries, we recommend public education about responsible dog ownership and dog bite prevention, stronger animal control laws, better resources for enforcement of these laws, and better reporting of bites. Anticipatory guidance by pediatric health care providers should address dog bite prevention.
Adolescent↗
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↗
Injuries from falls on playgrounds. Effects of day care center regulation and enforcement.
OBJECTIVES: To measure the incidence of playground fall injuries among children attending licensed US day care centers and to evaluate how injury incidence varies with center characteristics and with the regulatory and enforcement climate in which centers operate. DESIGN: Telephone surveys of directors of day care centers and enforcement agencies and review of written day care regulations. SETTING: Probability sample of licensed day care centers in 50 states and the District of Columbia. PARTICIPANTS: Children attending day care centers with playgrounds. MAIN OUTCOME MEASURES: Medically attended playground fall injuries. RESULTS: Among the 1740 day care centers studied, a weighted total of 89.2 injuries occurred during the 2-month study period (0.25/100,000 child-hours in day care). The most important risk factor for injury was height of the tallest piece of climbing equipment on the playground in both bivariate (P = .01) and multivariate (P = .02) analyses. Neither regulations addressing playground safety or playground surfaces nor enforcement patterns were associated with lower injury rates. CONCLUSIONS: Additional effort is needed to develop and evaluate regulations and enforcement that reduce injury risks for children while minimizing burden on day care centers. In the meantime, limiting climbing equipment heights may reduce playground injury rates.
Accidental Falls↗
The perceived needs of child care center directors in preventing injuries and infectious diseases.
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Child Day Care Centers↗
Guns in the home, homicide, and suicide.
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Family Characteristics↗
Geographic patterns of fatal abuse or neglect in children younger than 5 years old, United States, 1979 to 1988.
OBJECTIVE: To examine geographic patterns of fatal child abuse or neglect (CAN) among children younger than 5 years old. DESIGN: A death certificate-based model to estimate the occurrence of fatal CAN. SETTING: United States, 1979 to 1988. PARTICIPANTS: The population of children younger than 5 years old. INTERVENTIONS: None. MAIN RESULTS: We estimate that from 868 to 1815 deaths annually occur among children younger than 5 years old from CAN. The lower figure is the estimate of confirmed CAN, and the higher is the estimate of the sum of confirmed, probable, and possible CAN. Death rates were highest in the South and West, intermediate in the North Central, and lowest in the Northeast. A threefold difference was noted between rates in the lowest- and highest-ranking states (ie, Connecticut, 2.9 to 5.2 per 100,000, and Nevada, 6.7 to 15.4 per 100,000, respectively). When the 39 largest metropolitan areas were ranked, a similar variation between the lowest and the highest was observed (ie, Boston, Mass, 2.7 to 5.5 per 100,000, and Phoenix, Ariz, 6.6 to 15.5 per 100,000, respectively). CONCLUSION: Understanding the sizable geographic variation in CAN deaths rates could lead to effective interventions. If the US fatality rate were reduced to that of Connecticut, between 434 and 908 fewer CAN deaths might occur annually.
Cause of Death↗