Injuries from paintball game related activities in the United States, 1997-2001.

OBJECTIVE: To quantify and characterize injuries resulting from paintball game related activities among persons >/=7 years in the United States. SETTING: Hospitals included in the National Electronic Injury Surveillance System (NEISS); these are composed of a stratified probability sample of all hospitals in the United States with emergency departments. METHODS: Using NEISS, non-fatal injury data for paintball game related injury cases from 1997-2001 were obtained from emergency department records. Participation estimates used to calculate injury rates were obtained from a yearly survey funded by the National Sporting Goods Association. RESULTS: An estimated 11 998 persons >/=7 years with paintball game related injuries were treated in emergency departments from 1997-2001, with an annual average rate of 4.5 per 10 000 participants (95% confidence interval 3.3 to 5.7). The paintball game related injury rate was highest for 18-24 year olds (4.9 per 10 000 participants) and most injuries (94.0%) occurred among males. Almost 60% of all injured persons >/=7 years were treated for paintball pellet wounds of which most were to the eye. While 76.9% of injured persons ages 7-17 years were treated for paintball pellet wounds, almost 40% of those >/=18 years were treated for injuries resulting from overexertion or a fall. Lower extremity injuries were also common (23.0%), mostly from overexertion. Most injured persons (95.5%) were treated and released. CONCLUSIONS: As paintball games become more popular, efforts are needed to increase training, enforce rules, and educate participants about how to stay safe, such as wearing protective eye gear, when engaged in paintball games at home, in a public area, or in a sports field.

Sports and recreation related injury episodes in the US population, 1997-99.

OBJECTIVE: To characterize sports and recreation related (SR) injury episodes in the US population. SR activities are growing in popularity suggesting the need for increased awareness of SR injuries as a public health concern for physically active persons of all ages in the US population. SETTING: The National Health Interview Survey (NHIS) is a face-to-face household survey conducted yearly by the National Center for Health Statistics, part of the Centers for Disease Control and Prevention. Demographic and health data are collected from a nationally representative sample of the civilian, non-institutionalized population residing in the US. METHODS: Medically attended injury events reported in the 1997-99 Injury Section of the NHIS were categorized according to the associated sport or recreational activity using a classification scheme based on the International Classification of External Causes of Injury system. Episodes where the injured person received any type of medical attention (that is, medical advice or treatment) from any health care provider were used to report the incidence, severity, and nature of SR injuries sustained by US citizens. RESULTS: Annually, an estimated seven million Americans received medical attention for SR injuries (25.9 injury episodes per 1000 population). For 5-24 year olds, this national estimate was about 42% higher than estimates based on SR injuries seen only in emergency departments over a similar time frame. The highest average annual SR injury episode rates were for children ages 5-14 years (59.3 per 1000 persons) and persons aged 15-24 years (56.4 per 1000 persons). The SR injury episode rate for males was more than twice the rate for females. The age adjusted injury rate for whites was 1.5 times higher than for blacks (28.8 v 19.0 per 1000 population). Basketball was the most frequently mentioned SR activity when the injury episode occurred, with a rate of about four injury events per 1000 population. Strains and sprains accounted for 31% of injury episodes. An estimated 1.1 million SR episode related injuries involve the head or neck region, of which 17% were internal head injuries. The most common mechanisms of injury were struck by/against (34%), fall (28%), and overexertion (13%). CONCLUSION: As physical activity continues to be promoted as part of a healthy lifestyle, SR injuries are becoming an important public health concern for both children and adults. Prevention efforts aimed at reducing SR injuries through targeting high risk activities, places of occurrence, activity, risk behaviors, and use of protective devices need to go beyond focusing on children and also consider physically active adults.

Personal watercraft-related injuries. A growing public health concern.

CONTEXT: An increase in the recreational use of personal watercraft (PWC) raises concern about an increase in associated injuries on a national level. OBJECTIVE: To estimate the relative frequency, types of injury, and demographic features of persons injured while using PWC in the United States. DESIGN: Case series. SETTING: Emergency department (ED) visits to hospitals participating a national probability sample. PARTICIPANTS: All persons treated for PWC-related injury from January 1,1990, through December 31, 1995. RESULTS: An estimated 32954 persons (95% confidence interval [CI], 22919-42989) with PWC-related injuries were treated in US hospital EDs, of which 3.5% were hospitalized. Personal watercraft-related injuries have increased significantly from an estimated 2860 in 1990 to more than 12000 in 1995. During this period, the number of PWC in operation increased 3-fold from approximately 241500 in 1990 to an estimated 760000 in 1995. The most prevalent diagnoses were lacerations, contusions, and fractures. MAIN OUTCOME MEASURES: The estimated number and percentage of patients treated in EDs for PWC-related injuries, by year, age, sex, and the number and rate per 1000 of PWC in operation by year. CONCLUSIONS: Since 1990, there has been at least a 4-fold increase in injuries associated with an increase in the recreational use of PWC. The rate of ED-treated injuries related to PWC was about 8.5 times higher (95% CI, 8.2-8.8; 1992 data) than the rate of those from motorboats. Specific training and adult supervision is recommended for minors using PWC. Furthermore, medical practitioners should encourage personal flotation device use and other protection for their patients who are known water enthusiasts.

Evaluation of the Hemochron 8000 Rx/Dx system for heparin management.

The Hemochron Rx/Dx uses an ACT and a heparin response tube to calculate the heparin dose to identify heparin sensitive/resistant patients. We evaluated the Rx/Dx system in 37 patients to determine if the ACT after the predicted heparin loading dose was adequate to initiate CPB. The mean heparin dose calculated by the Rx/Dx was 31,700 IU +/- 8,700 IU (370 IU/kg) with a mean post ACT of 463 +/- 124 sec. Our standard heparin dose (400 IU/kg) would have given an additional 2,800 IU over the Rx/Dx. Four patients (6.5%) were predicted to be heparin sensitive and all four achieved an ACT over 450 sec. Twenty-one patients (56.8%) were predicted to be resistant and yet failed to raise the ACT over 450 sec in 17 (81.0%). Twelve patients (32.4%) were predicted to have a normal heparin response, and four (33.3%) did not achieve an ACT over 450 sec. In all, 21 patients (56.8%) did not achieve an ACT greater than 450 sec. Each institution should evaluate their heparin loading dose and the resultant ACT. In this study, we found the number of times the Rx/Dx system did not raise the ACT over 450 sec too great to justify the additional expense.

The mediastinal parathyroid.

Of 573 patients explored for primary hyperparathyroidism (PHP), parathyroid tissue was found in the mediastinum in 64 (11.2%). Age, sex, symptoms, gland mass, and pathologic diagnoses did not differ significantly from those of all PHP patients. Mean preoperative serum calcium values were higher for patients with mediastinal parathyroid tissue than for all patients with PHP, although median serum calcium values were similar in both groups. Mediastinal parathyroid glands numbered 68, of which 55 (81%) were enlarged, and 13 were normal size. One-third (36%) of patients with mediastinal parathyroid tissue underwent more than one exploration for PHP. However, 43 (63%) of 68 mediastinal glands were found on first exploration of the neck. Sternotomy was carried out in 21 (3.6%) of the 573 patients with PHP but showed mediastinal pathology in only 15 cases, being unsuccessful in 29 per cent. Of the six failed sternotomies, four patients were cured by simultaneous or subsequent neck exploration and resection, and two remain hypercalcemic. "Culprit" parathyroid glands are those typically enlarged and histologically abnormal glands that are credited with causing PHP in a given patient. Of 60 patients whose mediastinal glands were culprits, 48 (80%) were retrieved on initial or subsequent neck exploration. Localizing studies were used in all reoperative patients, and results are evaluated in detail. If neither CT scan nor angiogram localized the gland preoperatively, then sternotomy was always negative.

A model-based approach to the imputation of missing data: home injury incidences.

Missing or incomplete data cases are a problem in all types of statistical analyses. In disease surveillance, this problem inhibits determining the actual incidence of a disease event and monitoring the disease occurrence. Several statistical techniques have been developed to impute values for incomplete data cases. We present a model-based approach to the imputation of missing data elements as applied to determining the incidence of home injury deaths.

Marital status and the risk of suicide.

No recent United States study has previously calculated national suicide rates by marital status for specific age, race, and sex categories in order to better identify high-risk groups for suicide. We used national vital statistics and census data to calculate marital-status-specific rates. Results show that for each marital status group, by age and sex, married persons have the lowest suicide rates and young widowed males have exceptionally high rates.

The emergence of youth suicide: an epidemiologic analysis and public health perspective.

In this epidemiologic analysis, we examine death certificate data to identify significant patterns and trends in suicide in the United States. Although the overall suicide rate did not change from 1950 to 1980, fundamental and important changes did occur: suicide rates among older persons decreased and rates among younger persons increased markedly. Suicide rates have increased most dramatically among young white men aged 15 to 24. From 1950 to 1980, rates among white males aged 15 to 19 increased by 305%; among white males aged 20 to 24, by 196%. The percentage of suicides in which firearms were used has also increased markedly, most dramatically in young men and women. These fundamental changes in the pattern of suicide in the United States have critical implications for how the mental health and public health communities approach the problem. Suicide has traditionally been considered a mental health problem, and our approach to prevention was based on a portrait of the typical suicidal individual as an older, depressed, white male. The basic prevention strategy involved detection and treatment of depression. If, as some recent research suggests, most young persons at high risk for suicide are not depressed, the whole approach to prevention must be reexamined. There is an urgent need to reexamine and advance our understanding of what causes suicide. Who are the persons at greatest risk, and what can be done to prevent these deaths? Although increased use of drugs and alcohol has been proposed as a possible cause of the increase in suicides, it is only one hypothesis among others that must be examined. The significance of mental illness, suicide clusters and contagion, and the availability of firearms need further study as possible risk factors for youth suicide. Suicide represents the second leading cause of death among young persons aged 15 to 24. A problem of this magnitude should be given high priority by the public health community in planning and implementing research and interventions.

Pneumococcal vaccination practices among private physicians.

It is estimated that less than 10 percent of patients thought to be at high risk of invasive pneumococcal diseases have received 14-valent pneumococcal polysaccharide vaccine. To determine if any of these groups are more likely to be vaccinated than others, 893 private, primary-care physicians were surveyed nationwide. Although there was general agreement that the vaccine is indicated for the high-risk groups, patients with cardiorespiratory diseases were the only ones usually immunized by more than half of the survey respondents. The discrepancy between attitudes and practices could not be attributed to any specific factor.

Waterborne giardiasis: a communitywide outbreak of disease and a high rate of asymptomatic infection.

A communitywide outbreak of gastrointestinal illness due to Giardia lamblia infection occurred in the city of Berlin, New Hampshire, during April and May 1977. The clinical, epidemiologic, and laboratory aspects of this outbreak are described here. In 213 predominantly symptomatic cases of G. lamblia infection diagnosed at a local hospital laboratory in a 6-week period, illness was characterized by prolonged diarrhea (median duration 10 days) and 13% of symptomatic infections required hospitalization. Treatment with either quinacrine or metronidazole was generally followed by symptomatic improvement. A communitywide survey of the city residents revealed that the majority (76%) of G. lamblia infections occurring during the epidemic period were asymptomatic and ran a self-limited course without treatment. No significant secondary, person-to-person spread occurred and no enteric pathogens other than G. lamblia were implicated. Water was epidemiologically implicated as the most likely source of infection with Giardia cysts being demonstrated in samples of treated water as well as raw source water. Evidence supported the occurrence of two simultaneous outbreaks in this city which is supplied by two largely independent water supply systems. Inspection of the two water treatment facilities revealed several defects which permitted untreated (raw) water to mix with treated water. Human or beaver could have been responsible for contaminating source water with Giardia in this outbreak. A marked reduction in both clinical and subclinical giardiasis was apparent two months after onset of the outbreak, apparently as a result of measures applied to interrupt waterborne transmission of Giardia.

Orosomucoid content of pleural and peritoneal effusions.

22 nonneoplastic, noninflammatory effusions (cirrhosis and congestive heart failure), 12 non-neoplastic inflammatory effusions (tuberculosis, lupus erythematosus, rheumatoid arthritis, and idiopathic pleuropericarditis), and 58 neoplastic effusions (cancer of lung, breast, ovary, and pancreas, and lymphoma) were analyzed by radial immunodiffusion for orosomucoid concentration. The average concentration +/-SE was 35+/-4, 65+/-17, and 130+/-13 mg/100 ml in the three types of effusion, respectively. By gel filtration and ion exchange chromatography, orosomucoid was isolated from 12 nonmalignant and 14 malignant fluids. The orosomucoid preparations reacted as single components in acrylamide gel electrophoresis at pH 9.0, and in immunodiffusion and immunoelectrophoresis against antisera to human serum and to human plasma orosomucoid. In radial immunodiffusion, the slope of the line relating concentration to the square of the diameter of the precipitate area was identical for orosomucoid isolated from normal human plasma and from nonneoplastic effusions, but was subnormal for orosomucoid isolated from neoplastic fluids. All orosomucoid preparations had normal amino acid composition. Orosomucoid from the nonmalignant effusions had normal carbohydrate content. 11 of 14 samples of orosomucoid isolated from neoplastic fluids had abnormalities in carbohydrate composition, consisting of subnormal content of sialic acid (11 of 14), hexose (10 of 14), and hexosamine (3 of 14), and abnormally high content of hexosamine (4 of 14). Discriminant analysis showed that concentration of orosomucoid distinguished between neoplastic and nonneoplastic noninflammatory effusions more effectively than concentration of total protein, albumin, alpha(1), alpha(2), beta, or gamma-globulin.