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PubMed2001

American Academy of Pediatrics: Falls from heights: windows, roofs, and balconies.

Falls of all kinds represent an important cause of child injury and death. In the United States, approximately 140 deaths from falls occur annually in children younger than 15 years. Three million children require emergency department care for fall-related injuries. This policy statement examines the epidemiology of falls from heights and recommends preventive strategies for pediatricians and other child health care professionals. Such strategies involve parent counseling, community programs, building code changes, legislation, and environmental modification, such as the installation of window guards and balcony railings.

Accidental Falls↗
PubMed1997

Childhood burn injuries related to gasoline can home storage.

OBJECTIVE: To examine the risks associated with home storage of gasoline and to outline prevention strategies to avoid further injury and death. DESIGN: Case series. PATIENTS AND OTHER PARTICIPANTS: Twenty-five patients less than 6 years old were selected for study (3 by presentation to a tertiary care Children's Hospital Emergency Department, and 22 from the National Electronic Injury Surveillance System Data during the same calendar year). MAIN OUTCOME MEASURES: Data collected included child's age; burn injury, either percent body surface area or minor, moderate, or major burn classification; mortality; circumstances related to ignition of gasoline, such as behaviors, and if can was opened or closed; and flame source. RESULTS: Boys were involved in 95% of cases. Mean age was 2.7 years. The source of ignition was a pilot light in 100% of cases. Forty-four percent of patients died. Only vapors were ignited in 56% of cases. The gasoline can was described as closed in 64% of cases. CONCLUSION: Gasoline is dangerous. The rectangular red metal gasoline can is not safe either. National building codes and can specifications are needed to prevent serious injury and deaths among young children.

Burns↗
PubMed2000

Effects of pool-fencing ordinances and other factors on childhood drowning in Los Angeles County, 1990-1995.

OBJECTIVES: This study estimated the effects of local pool-fencing ordinances and other factors on the rate of childhood drowning in Los Angeles County, California. METHODS: Stage 1 was a retrospective dynamic cohort study of all drownings among children younger than 10 years that occurred in residential swimming pools in Los Angeles County between 1990 and 1995. Stage 2 was a matched case-control study that compared pools in which childhood drownings occurred (cases) with randomly selected pools in which drownings did not occur (controls). RESULTS: The drowning rate was relatively high among toddlers (aged 1-4 years), boys, and African Americans and in areas with a high density of residential swimming pools. Pool-fencing ordinances were not associated with a reduced overall rate of childhood drowning. CONCLUSIONS: Local ordinances enacted in Los Angeles County before 1996 do not appear to have been effective in reducing the rate of childhood drowning in residential pools. Possible reasons for this ineffectiveness are insufficient building codes for isolating pools from homes, inadequate enforcement of the ordinances, and inadequate operation or maintenance of fencing equipment by pool owners.

Age Distribution↗
PubMedDate not supplied

The case of the high-risk safety product.

After several days of meetings, J.F. Winchester, president of MDC Industries, felt no closer to a decision. MDC, a manufacturer of wall and ceiling panels, was considering whether to exercise an option to buy a new and safer wallboard technology. The product was being touted as revolutionary, but, Winchester wondered, could MDC afford to carry the flag? According to its inventor, Robert Goerner, Smoke-Safe would be a vast improvement over standard safety-rated wallboard. With almost the same flame-retardant properties, Smoke-Safe had the advantage of giving off almost no fumes or smoke in fire tests. And, Winchester knew, most fire-related deaths are from smoke, not flames. Indeed, the numbers were grimly persuasive: 82% of fire-related injuries involving standard panels were caused by smoke inhalation. What's more, Smoke-Safe would cost about the same to manufacture as MDC's current wallboard. But MDC had several other good options for spending the $5 million Goerner was asking; building plastics was only one of its profit centers. And the prospect of launching a campaign to change building codes in order to market Smoke-Safe, which could spark a fight with competitors, was daunting. Since its current wallboard gave MDC only 18% of the wallboard market, many industry insiders speculated whether MDC had the market clout to influence major cities to revise their codes. Six experts in marketing, law, and ethics advise MDC Industries on how it can balance ethical and business imperatives in making its decision.

Consumer Product Safety↗
PubMed1992

Atlanta's Grady renovating for the future.

Grady Memorial Hospital in Atlanta has opened a new emergency-care center, designed around a fast-track system. It's only part of a massive $318 million renovation affecting nearly every department in the public hospital. When the project is completed in 1995, it will allow Grady to meet building codes, increase its total number of beds to 1,024 and eliminate duplicative services.

Efficiency↗
PubMedDate not supplied

Project planning in the diagnostic imaging department.

Certain common steps in the planning process are necessary to ensure the success of any construction project in a diagnostic imaging department. Determining the need for the project, analyzing requirements for equipment, space and personnel, and budgeting for the project are necessary steps. They are followed by scheduling and designing the various aspects of the project. Engineering the construction phase and implementation with follow-up are the last steps. Determining whether a proposed project is necessary is the essential first step. Doing a cost-benefit analysis and determining if the return on the investment will be positive are important for a project's success. Good planning and communication with key staff members of the healthcare institution and the members of the design and construction team will help ensure successful implementation of any project. The role of the facility engineer is often critical in the early planning stages of a project to determine what utilities may be needed, any need for plumbing or electric work, power sources, building code requirements, the need for medical gasses and suction and so forth. Analysis of a potential project's equipment, space and personnel needs is also critical. Gathering the necessary information from various sources within the healthcare institution is essential. The steps for scheduling and designing an entire project should include finalizing the design and developing a schedule for its implementation. Keeping accurate minutes and documenting action items from all project meetings can serve to protect the budget. By following the steps outlined, budgeting time efficiently and delegating some tasks to others, the radiology administrator can continue to perform tasks involved in the day-to-day management of a radiology department.

Budgets↗
PubMed1989

Cost reductions from a smoking policy.

The health of its workforce is of paramount importance to a business. The loss of even one key person to heart and lung disease can have a detrimental effect on organizational efficiency. Provided strides similar to those made in the last five years continue, perhaps within the next five years major employers will have all work areas smoke free. In large cities considerable help in implementing a nonsmoking policy is available to employers. Individual companies need to consider the merits of each type of program and then decide which best fits the organization. Compared with a nonsmoker, the average employed smoker in the United States 1. Takes approximately 50% more sick leave 2. Uses the health care system at least 50% more 3. Suffers over twice the mortality rate during working years 4. Spends 6% of working hours smoking 5. Causes indoor work facilities to expend six times the capital and operating outlays to maintain air circulation rates that meet building code specifications 6. Imposes a much greater maintenance burden for cleaning, repairing, repainting and replacing furnishings and equipment 7. Imposes unnecessary costly liability on employers for damages sustained by co-workers who are forced to work in a smoky environment 8. Exacts a high price in employee morale because of the irritation and discomfort suffered by fellow workers.

Cost Control↗
PubMedDate not supplied

Biomaterials and biomechanics of oral and maxillofacial implants: current status and future developments.

Research in biomaterials and biomechanics has fueled a large part of the significant revolution associated with osseointegrated implants. Additional key areas that may become even more important--such as guided tissue regeneration, growth factors, and tissue engineering--could not be included in this review because of space limitations. All of this work will no doubt continue unabated; indeed, it is probably even accelerating as more clinical applications are found for implant technology and related therapies. An excellent overall summary of oral biology and dental implants recently appeared in a dedicated issue of Advances in Dental Research. Many advances have been made in the understanding of events at the interface between bone and implants and in developing methods for controlling these events. However, several important questions still remain. What is the relationship between tissue structure, matrix composition, and biomechanical properties of the interface? Do surface modifications alter the interfacial tissue structure and composition and the rate at which it forms? If surface modifications change the initial interface structure and composition, are these changes retained? Do surface modifications enhance biomechanical properties of the interface? As current understanding of the bone-implant interface progresses, so will development of proactive implants that can help promote desired outcomes. However, in the midst of the excitement born out of this activity, it is necessary to remember that the needs of the patient must remain paramount. It is also worth noting another as-yet unsatisfied need. With all of the new developments, continuing education of clinicians in the expert use of all of these research advances is needed. For example, in the area of biomechanical treatment planning, there are still no well-accepted biomaterials/biomechanics "building codes" that can be passed on to clinicians. Also, there are no readily available treatment-planning tools that clinicians can use to explore "what-if" scenarios and other design calculations of the sort done in modern engineering. No doubt such approaches could be developed based on materials already in the literature, but unfortunately much of what is done now by clinicians remains empirical. A worthwhile task for the future is to find ways to more effectively deliver products of research into the hands of clinicians.

Biocompatible Materials↗
PubMed2000

Injuries as a public health problem in sub-Saharan Africa: epidemiology and prospects for control.

Injuries are common and on increase in most developing countries, including sub-Saharan Africa. A large proportion of the injuries are caused by road traffic accidents, falls, burns, assaults, bites, stings and other animal-related injuries, poisonings, drownings/near-drownings and suicide. Globally, injuries are responsible for about five per cent of the total mortality, and the overall global annual costs were estimated in the late 1980s at around 500 billion US dollars. The burden and pattern of injuries in Africa and other developing areas are poorly known and not well studied. The incidence is on the increase, partly due to rapid growth of motorised transport and to expansion of industrial production without adequate safety precautions. This is a review of data on various kinds of injuries in developing countries with a focus on sub-Saharan Africa. A computerised search of the relevant literature published between 1985 and 1998 was conducted and a manual search of journals publishing texts on health in low-income countries and in tropical environments was also done. A few studies on injury prevention policy and on research related to injury epidemiology and prevention have also been identified and included. It is concluded that in a relatively typical East African area with a total mortality rate of 1,300/100,000/year, injuries are likely to cause around 100 of these deaths. The corresponding total rate of significant injuries is estimated at 40,000/100,000/year with a breakdown as tabulated below. [table: see text] Although a few surveys and other investigations of injuries have been conducted over the years, injury epidemiology and control remain under-researched and relatively neglected subject areas. Much needs to be done. Collection and analysis of injury data need to be standardised, for example regarding age groups, gender disaggregation and severity. Injuries and accidents should be subdivided in at least road traffic injury, fall, burn, assault, poisoning, drowning, suicide, homicide and others, and details regarding time and place, victim and main cause should be noted. Morbidity survey field staff should be informed that injuries are part of the illness concept and that questions should be asked accordingly. Details regarding the circumstances surrounding different injuries must be known to those who develop preventive programmes. Injury is a public health problem affecting some people more than others. Our ordinary environment--the home, the work-site, the street or road--represents various kinds of risk, and some of these are difficult to eliminate. Not only do we have to accept much of our environment with its existing houses, equipment, vehicles, transport systems, energy supply, toxic substances etcetera, many also suffer from various inherited or acquired conditions that increase the risk. We therefore need to develop safer and more "forgiving" living environments where ordinary people can live and move around safely. Injury control activities may focus on different categories of injury. Road safety measures often include information and education campaigns, improved driver training, road design and maintenance, regular vehicle safety checks, separation of pedestrians from vehicle traffic, speed limits, safety belt, air-bag and helmet use, special training and control of public service vehicle drivers, bicycle lane separation, road lighting, reflectorised materials on clothing, review of the road traffic related legislation and law enforcement, and emergency medical services improvement. Domestic injuries can be prevented for example with window guards, child barriers at stairs, smoke detectors, clothes and furniture in less flammable materials, replacement of open stoves, stabilising of open lamps, fire-fighting equipment and practice, child-proof poison packaging and storage, safe disposal of toxic waste, home safety education of parents, and strict building code enforcement. Occupational injuries can largely be prevented if well adapted to the work environment. Research is required in several areas. An improved facility-based injury recording and reporting system needs to be developed and tested. There is need to combine data collection methods, such as interview surveys, hospital records, police records, focus group discussions and key informant interviews. The outcome of emergency medical care and of different forms of transport and referral needs to be determined. Different combinations of preventive interventions needs to be evaluated. This review is intended as guidance for those who need a broad overview of the subject of injury occurrence and prevention in Africa, for example in preparation for the development of injury control programmes or to help identify issues requiring further research in this field.

Adolescent↗
PubMedDate not supplied

Political advocacy and research both needed to address federal-provincial gaps in service: Manitoba First Nations Personal Care Homes.

BACKGROUND: First Nation residents within Personal Care Homes (PCHs) are the most vulnerable segment of First Nations society and are in need of continuing care. Recent conditions imposed through unilateral decision-making by the federal government are placing the existence and continued operations of PCHs in jeopardy. METHODS: This article documents the current state of First Nation PCHs in Manitoba. In January 2003, the federal Minister of Indian and Northern Affairs Canada (INAC) announced conditions with which First Nation PCHs must comply or face closure. For instance, none of the PCHs were licensed in accordance with provincial legislation. Such provincial licensing would enable them to access provincial funding. However, provinces are wary of licensing on-reserve PCHs, and First Nations are reluctant to come under provincial health authority. First Nations continue to press for recognition of their own jurisdiction to set standards which emphasize their own culturally-based responsibilities and rights. RESULTS: As of October 2003, on-reserve PCHs have undergone infrastructure assessments to determine upgrades required to meet provincial building codes and standards in preparation for licensing. The First Nations plan to develop their own standards and licensing. Conditional licensing would ensure that PCHs continued to operate while renovations are made and funding allocations worked out. CONCLUSIONS: PCHs are a critical component in the spectrum of health care offered in First Nations communities. The imposition of conditions on the continued provision of federal funding to on-reserve PCHs is seen by First Nations as a restriction of the accessibility of culturally appropriate care for the most vulnerable segment of the First Nations population.

Aged↗
PubMed1987

Radon in homes. Council on Scientific Affairs.

Radon 222 and its radioactive decay products can enter buildings and, through inhalation, expose the inhabitants' pulmonary tissues to ionizing radiation. Studies of radon levels in the United States indicate that variations of 100-fold or greater exist among private dwellings. In one region, 55% of homes had levels exceeding 4 pCi/L (0.15 Bq/L), which is the guidance level recommended by the US Environmental Protection Agency. Ventilation and tightness of construction are important determinants of radon levels. In some instances, fans or heat exchangers can reduce excessive concentrations, but in others more elaborate remedial measures may be required. Physicians may obtain information about radon through Environmental Protection Agency regional offices and state radiation control programs. The risk of radiogenic cancer is believed to increase with exposure to ionizing radiation. According to some estimates, concentrations of radon decay products in US homes could be responsible for several thousand cases of lung cancer per year. Studies of radon levels in representative buildings and guidelines are needed to ensure safe, effective, and cost-effective countermeasures. Architects, contractors, designers, building code administrators, health physicists, and biomedical investigators can help with solutions.

Air Pollutants↗
PubMed1994

Indoor air quality medicolegal issues.

The regulatory and legal communities have begun only recently to address the medicolegal issues surrounding indoor air quality. No single governmental agency is responsible for indoor air quality issues. The focus of the federal government's indoor air quality programs is on the gathering and dissemination of information rather than on the regulation of indoor air pollution. State and local regulatory controls vary but may include antismoking ordinances, building codes, and contractor certification programs. Numerous lawsuits involving various parties and legal theories have been filed on the basis of illness allegedly related to indoor air quality. Further regulatory and legal review of indoor air problems will likely occur in the near future, particularly as a result of the characterization of environmental tobacco smoke as a class A carcinogen.

Air Pollution, Indoor↗
PubMed1997

Earthquakes: health outcomes and implications in Lebanon.

Earthquakes remain damaging to human life and property. Recent reports point out that there is 50% chance to have a damaging earthquake in the next 50 years in Lebanon. Major health outcomes of earthquakes include physical injuries, cardiovascular effects and psychological reactions. Physical injuries are correlated with entrapment, higher number of floors in buildings and behavior at time of impact. Cardiovascular effects of earthquakes are either immediate or delayed. Immediate cardiovascular effects are exemplified by increased coronary death while delayed effects are reflected by the increase in coronary risk factors such as serum triglycerides and heart rate. The severity of PTSD decreases as the distance from the epicenter of the earthquake increases. Preventive measures such as implementation of safety building codes, medical emergency readiness and public education should be carried out in areas threatened by earthquakes. Also special mental health programs should be executed following an earthquake.

Cardiovascular Diseases↗
PubMed1985

Building permanent memory codes: codification and repetition effects in word identification.

The studies presented in this article investigate the memory processes that underlie two phenomena in threshold identification: word superiority over pseudowords and the repetition effect (a prior presentation of an item facilitates later identification of that item). Codification (i.e., the development of a single memory code that can be triggered even by fragmented input information) explains the faster and more accurate identification of words than pseudowords. Our studies trace the development and retention of such codes for repeated pseudowords and examine the growth and loss of the repetition effect for both pseudowords and words. After approximately five prior occurrences, words and pseudowords are identified equally accurately in two types of threshold identification tasks, suggesting codification has been completed for pseudowords. Although the initial word advantage disappears, the accuracy of identification still increases with repetitions. The facilitation caused by repetition is not affected much by spacing within a session, but drops from one day to the next, and after a delay of one year has disappeared (new and old words were identified equally well). These results suggest an episodic basis for the repetition effect. Most important, after one year, performance is equal for old pseudowords and new and old words: all these levels are superior to that for new pseudowords, suggesting that the learned codes for pseudowords are as strong and permanent as the codes for words. A model of identification is presented in which feedback from codes and episodic images in memory facilitates letter processing. An instantiation of the model accounts for the major features of the data.

Attention↗