Childhood injuries due to falls from apartment balconies and windows.

BACKGROUND: Falls from balconies and windows are an important cause of childhood injury. This study investigated the circumstances around such falls and attempted to identify possible measures for their prevention. POPULATION: Children <15 years living in Dallas County, Texas. METHODS: Each child treated because of a fall from a building in 1997-99 had information about the injury collected, and a parent was contacted to obtain further information. For apartment related falls, an attempt was made to visit the apartment to measure windows and balcony rails. RESULTS: Ninety eight children were injured in falls from buildings during the three year period; 39 (40%) were admitted to hospital. Seventy five of the falls (77%) involved apartments, and most occurred around noon or evening meal times. Among apartment falls, 39 (52%) fell from windows, 34 (45%) from balconies, and two (3%) from unknown sites. For more than two thirds of balcony related falls, the child fell from between the balcony rails, all of which were spaced more than 4 inches (10 cm) apart. On-site measurement showed the rails were an average of 7.5 inches (19 cm) apart; all of these apartments were built before 1984. For more than two thirds of window related falls, the window was situated within 2 feet (61 cm) of the floor. CONCLUSIONS: Two factors are important in falls from apartment windows and balconies: balcony rails more than 4 inches (10 cm) apart, and windows positioned low to the floor. Current building codes do not apply to older apartments, where most of these falls occurred. Nevertheless, these factors may be amenable to environmental modifications that may prevent most of these falls.

Residential fire related deaths and injuries among children: fireplay, smoke alarms, and prevention.

BACKGROUND: The aim of the study was to describe the epidemiology of residential fire related deaths and injuries among children, and identify risk factors for these injuries through a linked dataset for the city of Dallas, Texas. METHODS: Data for all residential fires were linked with fire related injury data, using fire department records, ambulance transports, hospital admissions, and medical examiner records, for children 0-19 years of age. Causes of fires, including fireplay (children playing with fire or combustibles), arson and other causes, were determined by fire department investigation. RESULTS: From 1991-98, 76 children were injured in residential fires (39 deaths, 37 non-fatal). The highest rates occurred in the youngest children (<5 years) and in census tracts with lowest income. Fireplay accounted for 42% (32/76) of all injuries, 62% (15/24) of deaths in children 0-4 years, and 94% (13/14) of deaths from apartment and mobile home fires. Most of the fireplay related injuries (27/32, 84%) were from children playing with matches or lighters. Most started in a bedroom. Smoke alarms showed no protective efficacy in preventing deaths or injuries in fires started by fireplay or arson, but there was significant protective efficacy for a functional smoke alarm in fires started from all other causes (p<0.01). CONCLUSIONS: Residential fire related injuries among children in Dallas occurred predominantly in the youngest ages (<5 years) and in poor neighborhoods. Most of the deaths, especially those in apartments and mobile homes, resulted from fireplay. Smoke alarms appeared to offer no protection against death or injury in fireplay associated fires, possibly from the nature of the child's behavior in these fires, or from the placement of the smoke alarm. Prevention of childhood residential fire related deaths may require interventions to prevent fireplay in order to be successful.

Deaths and injuries from house fires.

BACKGROUND: We sought to define the factors associated with house fires and related injuries by analyzing the data from population-based surveillance. METHODS: For 1991 through 1997, we linked the following data for Dallas: records from the fire department of all house fires (excluding fires in apartments and mobile homes), records of patients transported by ambulance, hospital admissions, and reports from the medical examiner of fatal injuries. RESULTS: There were 223 injuries (91 fatal and 132 nonfatal) from 7190 house fires, for a rate of 5.2 injured persons per 100,000 population per year. Rates of injury related to house fires were highest among blacks (relative risk, 2.8; 95 percent confidence interval, 2.1 to 3.6) and in people 65 years of age or older (relative risk, 2.6; 95 percent confidence interval, 1.9 to 3.5). Census tracts with low median incomes had the highest rates of injury related to house fires (relative risk as compared with census tracts with high median incomes, 8.1; 95 percent confidence interval, 2.5 to 32.0). The rate of injuries was higher for fires that began in bedrooms or living areas (relative risk, 3.7); that were started by heating equipment, smoking, or children playing with fire (relative risk, 2.6); or that occurred in houses built before 1980 (relative risk, 6.6). Injuries occurred more often in houses without functioning smoke detectors (relative risk, 1.5; 95 percent confidence interval, 1.0 to 2.4). The prevalence of functioning smoke detectors was lowest in houses in the census tracts with the lowest median incomes (P<0.001). CONCLUSIONS: Rates of injuries related to house fires are highest in elderly, minority, and low-income populations and in houses without functioning smoke detectors. Efforts to prevent injuries and deaths from house fires should target these populations.

Estimating the proportion of homes with functioning smoke alarms: a comparison of telephone survey and household survey results.

OBJECTIVES: This study determined the proportion of homes with functioning smoke alarms in a low-income area experiencing a high rate of residential fire-related injuries. METHODS: An on-site survey of households was conducted to confirm the results of a telephone survey. RESULTS: In the telephone survey, 71% of households reported having functioning smoke alarms. In the household survey, 66% of households reported having functioning alarms; however, when the alarms were tested, the percentage dropped to 49%. CONCLUSIONS: Telephone surveys may overestimate the presence of functioning smoke alarms in some populations. Thus, the use of telephone surveys to establish baseline measures could significantly affect the evaluation of smoke-alarm giveaway programs.

Comparison of community based smoke detector distribution methods in an urban community.

OBJECTIVES: Various methods of soliciting participation for a large smoke detector giveaway program were tested to determine the most effective method of distributing smoke detectors to a high risk urban population. SETTING: The target area was a 24 square mile (62 km2) section on the south side of Oklahoma City where 16% (73,301) of the city's population resided in 16% (34,845) of the dwellings (excluding apartments). Of the 66 persons in Oklahoma City who were injured in residential fires from September 1987 to April 1990, 45% (30) were in the target area. Of the target area injuries, 47% resulted from fires started by children playing with fire (fireplay). METHODS: The number of homes without detectors was estimated by telephone survey. Four different methods of soliciting participants were used, including notifying residents by mail; placing flyers on the doors of every habitable residence; and displaying flyers at public places (grocery stores, convenience stores, restaurants, etc). Each of these methods alerted residents that free smoke detectors were available at specific fire stations. The fourth method was distributing detectors door-to-door (canvassing). RESULTS: The canvassing method resulted in significantly more smoke detectors being distributed to homes without detectors (107%) than any of the three other methods (18%) (p < 0.00001). The canvassing method distributed detectors to 31% of the total target homes, compared with 5% with the other methods (p < 0.00001). Canvassing also resulted in the lowest estimated cost per detector distributed ($1.96) (all other methods, $3.95), and in the largest number distributed per volunteer hour (5.9 v 3.1 detectors per hour by other methods). CONCLUSIONS: Distributing smoke detectors directly to homes (canvassing) was the most effective and cost efficient method to reach high risk urban residents.

Surveillance and prevention of residential-fire injuries.

BACKGROUND: The majority of severe and fatal burn injuries result from residential fires. We studied the effectiveness of a smoke-alarm-giveaway program in the prevention of burn injuries in an area with a high rate of such injuries. METHODS: We collected data on burn injuries in Oklahoma City from September 1987 through April 1990. The target area for the intervention was an area of 24 square miles (62 km2) with the highest rate of injuries related to residential fires in the city. We distributed smoke alarms door to door in the target area and then surveyed alarm use and function in a sample of the homes that had received an alarm. We also calculated the rates of fire injury per 100,000 population and per 100 fires for both the target area and the rest of the city before and after the smoke-alarm giveaway. RESULTS: Before the intervention the rate of burn injuries per 100,000 population was 4.2 times higher in the target area than in the rest of Oklahoma City. An initial survey indicated that 11,881 of the 34,945 homes in the target area (34 percent) did not have smoke alarms. A total of 10,100 smoke alarms were distributed to 9291 homes; 45 percent were functioning four years later. The annualized fire-injury rates declined by 80 percent in the target area during the four years after the intervention (from 15.3 to 3.1 per 100,000 population), as compared with a small increase in the rest of the city (from 3.6 to 3.9 per 100,000 population). There was also a 74 percent decline in the target area in the injury rate per 100 fires (from 5.0 to 1.3; rate ratio, 0.3; 95 percent confidence interval, 0.1 to 0.6), as compared with a small increase in the rest of the city. CONCLUSIONS: A targeted intervention involving a smoke-alarm-giveaway program can reduce the incidence of injuries from residential fires.

Epidemiology of traumatic spinal cord injury and acute hospitalization and rehabilitation charges for spinal cord injuries in Oklahoma, 1988-1990.

Few injuries result in more profound and long-term disability than traumatic spinal cord injury. This study describes the demographic and epidemiologic characteristics of traumatic spinal cord injury among Oklahoma residents reported to the statewide, population-based surveillance system in 1988-1990; initial acute hospital and rehabilitation charges for 1989 are also included. There was a reported incidence rate of 40 per million population. Based on a reporting sensitivity of 77%, the "true" incidence of spinal cord injury was estimated to be 51 per million population. Motor vehicle crashes accounted for 48% of injuries. Males aged 15-29 years and blacks were at highest risk of injury. Among blacks, the injury rate due to violence was seven times that for whites or Native Americans. Alcohol/drug use was a contributing factor in 39% of injuries and was highest among males aged 20-29 years (58%), Native Americans (57%), and victims of motor vehicle crashes (48%) or violence (51%). The combined initial charges for persons receiving both acute and rehabilitative care ranged from $9,790 to $666,510, with a median of $53,410 per patient; for complete quadriplegia, the combined median charge was $88,585. Despite its low incidence, hospitalization and rehabilitation charges for spinal cord injury in 1989 caused an economic burden of an estimated $8.4 million. While the charges presented were only a small portion of the total costs of spinal cord injury, they further substantiate the need for prevention efforts targeting these debilitating, often permanent injuries. These efforts should target young males and blacks, and should focus on preventing injuries associated with motor vehicle crashes, violence, and alcohol/drug use.

Invasive pneumococcal disease in central Oklahoma: emergence of high-level penicillin resistance and multiple antibiotic resistance. Pneumococcus Study Group.

Relatively penicillin-resistant pneumococci have caused 10% of invasive pneumococcal disease in central Oklahoma during the last decade, but almost no high-level penicillin or other antibiotic resistance has been described. This study evaluated antibiotic susceptibility and serotype distribution in invasive pneumococcal disease in the Oklahoma City metropolitan area (1990 population 848,000). A total of 144 cases of invasive infection was collected in 1 year (17 with meningitis, 120 with other bacteremic infections, and 7 with other invasive infections), for a rate of 16.9/100,000 (95% confidence interval [CI], 14.0-19.5). For the population aged > or = 60, invasive pneumococcal disease rates were higher among nursing home residents (352/100,000) than among nonresidents (25.6/100,000; relative risk, 13.7; 95% CI, 7.7-24.7). Antibiotic-resistant organisms caused 19.4% of the cases: relative penicillin resistance, 7.6%; high-level penicillin resistance, 1.4% (2 cases), and 11% resistance to erythromycin, trimethoprim-sulfamethoxazole, or both, with 5% sharing both resistances plus a MIC of penicillin of 0.06 microgram/mL.

Day care attendance and other risk factors for invasive Haemophilus influenzae type b disease.

Two hundred and ninety-five of 373 (79%) children with reported cases of invasive Haemophilus influenzae type b (Hib) occurring in the state of Oklahoma from January 1, 1986, through December 31, 1987, were matched according to birth date with two controls each. Conditional logistic regression was used to assess the independent roles of day care attendance, number of young children in the home, crowding, passive smoking, maternal education, household income, and race in Hib disease. Statistically significant odds ratios (ORs) were found for day care attendance (OR = 2.9), the presence of two or more children in the home under 6 years of age (OR = 2.4), crowding (ratio of number of people in the home to number of bedrooms > or = 2) (OR = 2.0), and exposure to cigarette smoking in the home (OR = 1.4). Household income was independently associated with Hib disease. African Americans were at increased risk even after adjustment for income and crowding (OR = 4.1). Although there were no important differences in risk for other factors by type of Hib disease, there was a large and statistically significant difference in risk for day care attendance between meningitis (adjusted OR = 5.1, 95% confidence interval (CI) 3.1-8.2) and other types of Hib disease (combining nonmeningitis cases, adjusted OR = 1.6, 95% CI 0.9-2.7). Increasing numbers of hours per week of day care attendance and children per room were associated with increasing risk of Hib meningitis in a dose-response pattern. The highest day care ORs for meningitis were observed in the youngest (< 6 months) and oldest (> or = 24 months) children. The adjusted OR for exposure to breast feeding was 0.5 (95% CI 0.3-0.8). A protective effect for Hib polysaccharide vaccination among children aged > or = 18 months was suggested but did not reach statistical significance (OR = 0.4, 95% CI 0.2-1.1).

Community-wide outbreak of hepatitis A among an Indian population in Oklahoma.

Between September 1983 and September 1984, 118 cases of hepatitis A were reported from Caddo County, Oklahoma. No common source was identified, and the epidemic curve suggested person-to-person transmission. In July 1984, enhanced control measures were implemented; these consisted of improvements in surveillance, standardization of case investigation, an expanded, although targeted, use of immune globulin, and a public awareness campaign. Control measures resulted in a decrease in the delay between onset of symptoms and case report (from 12 days to 4 days), an increase in the percentage of patients with confirmed cases interviewed (from 77% to 100%), an increase in the percentage of patients reporting contact with a previous case (from 39% to 72%), and an increase in the average number of household-like contacts per case (from seven to 27). Within two incubation periods of the implementation of enhanced controls, the outbreak ended. These data indicate that community-wide outbreaks of hepatitis A can be stopped with an intensive epidemiologic approach, coupled with the expanded and targeted use of immune globulin.

Epidemiology and clinical characteristics of tularemia in Oklahoma, 1979 to 1985.

We studied the clinical and epidemiologic characteristics of tularemia in 165 Oklahomans from 1979 to 1985. The ulceroglandular form of the disease was most common (60%), followed by typhoidal (18%), glandular (15%), oropharyngeal (7%), and oculoglandular (1%) forms. The male-female ratio was 3.7:1, and the highest rates of disease were found in the age groups 5 to 14, 35 to 44, and 55 to 74. Ticks were most frequently implicated as the source of infection (84/154 [55%]), followed by rabbits, (58/154 [38%]). Seventy percent of the patients were hospitalized, and four (2.5%) died. The annual number of patients who reported that rabbits were their probable source of exposure to Francisella tularensis and the estimated number of rabbits harvested (ie, killed by hunters) for the year correlated closely with the total number of cases reported from year to year.

Epidemiologic characteristics of human tularemia in the southwest-central states, 1981-1987.

From 1981 through 1987, a total of 1,041 cases of tularemia in humans were reported in Arkansas, Kansas, Louisiana, Missouri, Oklahoma, and Texas; this represents 60% of the cases reported in the United States during this same time period. The state of Arkansas reported the highest total (420 cases). Annual incidence rates per one million population ranged from 36.3 in Arkansas to less than 5.0 in Kansas, Louisiana, and Texas. Epidemiologic data were available for 1,026 cases. The majority of cases were white (88%) and male (75%). May, June, and July were the months of onset of symptoms for 52% of the cases. For the cases with known exposure history, 63% reported an attached tick and 23% had exposure to rabbits. Other animals associated with human infection were squirrels, cats, and raccoons. The case-fatality ratio was 2%. Public health efforts to prevent human tularemia cases in the six southwest-central states should focus on reducing exposure to ticks.

Alcohol and fatal injuries in Oklahoma.

To assess the usefulness of medical examiner data in describing the relationship between alcohol use and fatal injuries, 1978-84 data from the Office of the Chief Medical Examiner (ME), State of Oklahoma, was examined. In each year in the study period, approximately 1,500 deaths resulted from unintentional injuries (UI) and 800 deaths resulted from intentional injuries (i.e., suicides and homicides). For persons who died on the same day they were injured, testing for blood alcohol ranged from 90% of homicide victims, to 73% of suicide victims and to 66% of UI victims. Alcohol was associated with 52% of homicides, 49% of UI and 40% of suicides. Alcohol was detected most often in samples from Hispanic men and from Native Americans of both sexes. This study suggests that state public health agencies and researchers should consider the use of ME data for epidemiologic information on the relationship between alcohol and injury-related mortality and for surveillance of these problems.

Security measures for AIDS and HIV.

This study describes the measures being taken by AIDS surveillance offices across the country to ensure the security of information regarding patients with AIDS and HIV infection. Security measures were evaluated according to the cumulative number of AIDS cases reported, whether partner notification services were provided, and whether HIV seropositive reporting by name was also required. This study showed that public health departments have taken extra steps to ensure the security of AIDS and HIV data.

Syphilis, human immunodeficiency virus infection, and targeting prevention.

To examine the interaction between syphilis and human immunodeficiency virus-type 1 (HIV-1) infection in Oklahoma, we conducted an unlinked HIV seroprevalence survey using serum specimens submitted to the Oklahoma State Department of Health for serologic test for syphilis. Of specimens with positive results from fluorescent treponemal antibody absorption test (FTA-ABS), 6.3% were HIV-1 seropositive compared to 0.8% of those that had negative results from FTA-ABS. Among specimens positive for syphilis, HIV-1 seropositivity was found almost exclusively among those from persons 20 to 39 years of age and more often among those from men than those from women (9.9% vs 1.3%). Of syphilis-positive specimens from 20- to 39-year-old men, 17.6% were HIV-1 seropositive. In Oklahoma, an area with a relatively low overall prevalence of HIV-1 infection, targeting prevention efforts to young adults who test positive for syphilis should be an efficient way to reach some persons at high risk for HIV-1 infection.

Bacteremic disease due to Haemophilus influenzae capsular type f in adults: report of five cases and review.

Five cases of bacteremic infections due to Haemophilus influenzae type f in adults are described, and previous reports of type f disease in nonpediatric patients are reviewed. Respiratory tract infections were most common in our series (two cases of pneumonia, one of epiglottitis, and one of nosocomial septicemia probably resulting from aspiration pneumonitis). All of these patients had factors predisposing them to respiratory tract infections, e.g., neurologic disease, congestive heart failure, or cigarette smoking. A fifth patient, who was bacteremic without an apparent primary focus, had dysgammaglobulinemia. Six episodes of bacteremia occurred in five patients; 11 of 13 cultures of blood obtained before parenteral antibiotic therapy were positive. All isolates were biotype I and susceptible to ampicillin. Antibiotic therapy was curative in cases of proved respiratory tract infection but failed in the setting of nosocomial septicemia, perhaps because of delayed initiation. The brevity of antibiotic treatment of the cryptogenic bacteremia permitted infection of a prosthetic vascular graft and recurrent bacteremia. Graft removal and repeated antibiotic therapy were curative.

Epidemiologic and clinical characteristics of persons with serologic evidence of E. canis infection.

The results of a serosurvey of Oklahomans for the presence of antibody to Ehrlichia canis is reported. Paired serum specimens, from patients lacking the serologic criteria for diagnosis of Rocky Mountain spotted fever (RMSF), were tested. A four-fold increase in E. canis-IFA antibody was found in 16/144 (11 percent) of these paired serum samples. Patients with serologic evidence of E. canis infection had a mean age of 34 years, 69 percent were male, and 63 percent lived in a town less than 10,000 population. Signs and symptoms included: fever 94 percent, headache 94 percent, fatigue 94 percent, anorexia 81 percent, nausea 60 percent, and rash 44 percent. When compared to control patients, whose sera were submitted for RMSF testing but did not meet serologic criteria for RMSF or E. canis, case-patients were more likely to have had leukopenia (OR = 4.9, 95 percent Cl = 1.2, 19.0) and tick exposure (OR = 9.5, 95 percent Cl = 1.4, 62.7). The results suggest E. canis, or a closely related agent, is a cause of human illness. Ticks are probable vector.