Towards an internet civil defence against bioterrorism

Approaches towards the public-health prevention of bioterrorism are too little, and too late. New information-based approaches could yield better homeland protection. An internet civil defence is presented where millions of eyes could help to identify suspected cases of bioterrorism, with the internet used to report, confirm, and prevent outbreaks.     

Attitudes towards CPR training and performance in family members of patients with heart disease

Considering that heart patients may be at higher risk for cardiac arrest, this study was conducted to evaluate the preparedness and willingness of cardiac patient family members to perform cardiopulmonary resuscitation (CPR). A cross-sectional survey of 100 family members of cardiac patients was conducted at a tertiary care emergency department over a 1.5-month period. Response rate was 95%. While 49% reported prior CPR training, only 7% trained within the past year. The majority received training (59%) because of a school or job requirement with only 8% trained because of 'concern for a family member.' The most frequent reasons for not being trained were 'never thought about it' or 'not interested' (57%). However, 49% of the untrained group did report an interest in future training. While 2% of respondents recalled a healthcare professional suggesting such training, 58% stated they would be influenced positively by such a recommendation. The most frequently reported barriers to performing CPR included fear of harming the patient or a lack of knowledge and skill to help. Despite a presumed higher risk for sudden cardiac death, most family members of cardiac patients do not maintain skills in basic CPR. Healthcare professionals may have the ability to significantly alter this concerning statistic through education and routine recommendations to patients' families.     

High density lipoprotein cholesterol concentrations in physically active and sedentary spinal cord injured patients

Individuals with traumatic spinal cord injury (SCI) are extremely inactive yet little is known about the long-term consequences of chronic inactivity. Current research investigated the concentrations of high density lipoprotein cholesterol (HDLc) and its subfractions HDL2 and HDL3 in 66 extremely sedentary SCI admissions to a rehabilitation center. High density lipoprotein cholesterol is a primary risk factor for cardiovascular disease with decreased levels associated with increased cardiovascular risk. The concentrations of HDLc observed in the SCI sedentary population were compared with 22 olympic caliber wheelchair athletes (SCI athletes) and 126 able-bodied controls. Total HDLc, HDL2, and HDL3 was significantly lower in the male SCI sedentary population (34.2 mg/dl, 8.9 mg/dl, 25.3 mg/dl) than the male SCI athletes (42.7 mg/dl, 13.9 mg/dl, 28.8 mg/dl) or male able-bodied control populations (47.1mg/dl, 11.3mg/dl, 35.8 mg/dl). A similar pattern emerged for the female subjects. The reduction in HDLc seen in the SCI sedentary would predict over a 60% increased risk of heart attack compared to nondisabled controls. The primary difference between the two SCI groups was the level of physical activity, suggesting that this may be an important parameter for elevating total HDLc and HDL2, and presumably decreasing the risk for coronary heart disease. Therefore, physical activity positively affects total HDL and the supposedly antiatherogenic subfraction HDL2 in the SCI patient.     

A Population-based Study of Fatal and Nonfatal Firearm-related Injuries

Objective: To determine population-based firearm-related morbidity and mortality for Allegheny County, PA (population = 1.3 million), for the year 1994.
Methods: Fatalities were identified from a review of death certificates. To identify nonfatal cases, an active surveillance was conducted at all 24 acute care EDs in the county. The ED surveillance used 2 existing sources of case identification from each hospital to minimize undercount.
Results: Firearms were the leading cause of injury death to county residents, accounting for 155 deaths. The crude mortality rate from firearms was 11.7/100,000. Black males aged 15–19 years were most at risk for a firearm fatality (293/100,000). There were 514 nonfatal firearm injuries, producing a case fatality rate of 23%. The highest age-specific rate for nonfatal firearm-related injuries treated in the county EDs was observed for black males aged 15–19 years (2,245/100,000), which is 58 times higher than the firearm-related injury rate for the entire county population (38.7/100,000).
Conclusion: Firearm-related injury and death are a significant public health problem in Allegheny County. Although the crude mortality rate from firearms in the county is lower than the reported national rate, the observed rate for nonfatal injuries in the black youth of this community is the highest firearm injury incidence rate ever reported. Local surveillance of firearm-related injuries, including nonfatal events, is needed to more accurately demonstrate the magnitude of this problem.     

Loss of motion after anterior cruciate ligament reconstruction.

We did a retrospective review and follow-up examination to investigate the incidence, risk factors, and outcome of patients who developed loss of motion after arthroscopic anterior cruciate ligament reconstruction. Two hundred forty-four patients with a minimum followup of 1 year were reviewed. Loss of motion (defined as a loss of extension of more than 10 degrees or flexion of less than 125 degrees) was identified in 27 patients for an overall incidence of 11.1%. Factors associated with loss of motion included acute reconstruction (less than 1 month from initial injury), male sex, and concomitant medial collateral ligament repair or posterior oblique ligament reefing or both. Twenty-one patients required surgery to regain their motion; three patients required a second procedure. Twenty-one of 27 patients with loss of motion underwent a detailed followup and were compared with 24 randomly chosen controls who had a normal range of motion after anterior cruciate ligament reconstruction. At followup, patients who experienced loss of motion had a significant decrease in noninvolved to involved knee extension and flexion compared to the control patients. There was no difference between our patients and the controls regarding patellofemoral problems, anterior knee laxity, and functional strength. Sixty-seven percent of patients with loss of motion had a good or excellent result in comparison to 80% of the controls.     

Assessment of physical activity in inactive populations

The ability to index activity objectively in disabled or impaired activity populations is critical for our understanding of the long-term health consequences of reduced activity. The current research employed the large-scale integrated activity monitor as an objective measure of free living daily activity in 28 subjects with traumatic spinal cord injury. All the spinal cord-injured subjects wore the monitors for 2 d while in-patients at a rehabilitation center. The results indicated that the instruments can accurately index individual physical activity levels in this population, which has drastically reduced activity. Furthermore, group differences in activity were discriminated where paraplegic activity (mean, 32.0 counts X h-1) was significantly greater than quadriplegic activity (mean, 15.1 counts X h-1) (P less than 0.01) despite the markedly low activity levels. The results thus indicate that activity sensors can index individual activity levels at the very low end of the activity spectrum.     

A Primer on School Violence Prevention

ABSTRACT: Violence has reached epidemic proportions in the United States with particularly serious health implications for school-age children and adolescents. Schools that experience the daily threat of potential student violence have their primary mission of education eroded at great cost to students. This article reviews the problem of violence in public schools and summarizes existing knowledge on school violence prevention. Violence prevention programs that use educational, regulatory, technological, or combined approaches are reviewed. Recommendations are presented addressing both policy and program needs related to control of violence in public schools. School health professionals should be active participants in violence prevention efforts. A critical need exists to carefully evaluate any planned prevention program so future efforts can be built on methods proven successful.     

Intimate partner violence screening and intervention: data from eleven Pennsylvania and California community hospital emergency departments.

OBJECTIVE: To provide clinical practice recommendations for screening and interventions for intimate partner violence (IPV) in ED settings. SETTING: Eleven mid-sized community-level hospital emergency departments (20,000 to 40,000 admissions annually) in Pennsylvania and California. PARTICIPANTS: All women (4641) aged 18 years or older who came to the emergency department during 309 selected shifts. METHODS: An anonymous survey inquiring about physical, sexual, and emotional IPV was conducted from 1995 through 1997. In addition, medical records were abstracted for every woman (18 years and older) seen in the 11 participating emergency departments during the study period. RESULTS: The vast majority of both abused and nonabused women supported routine screening for IPV; however, fewer than 25% of women said they were asked about IPV by ED staff. ED screening rates for IPV were higher among women who came to the emergency department because of acute trauma from abuse (39%) than for women who reported that they had been abused within the past year (13%). The prevalence of past year and lifetime IPV was significantly higher when the questionnaire was self-administered than when it was administered by a nurse. More than a third of women who had recently been abused and 76% of women who acknowledged experiencing physical or sexual IPV within the past year reported that they did not come to the emergency department for treatment of an injury. Although the majority of women (76% to 90%) agreed with the concept of health care providers reporting IPV to the police, women abused recently were significantly less likely to support this practice. CONCLUSION: The study provides evidence supporting standard protocols for routine screening for IPV among women who come to emergency departments and chart prompts for both screening and interventions. These actions are acceptable to the majority of both abused and nonabused women seen in the emergency department and should be considered in systematic repeated training of health care professionals in emergency departments. This information is important for health care providers who are seeking to improve their identification of and care for abused women.     

Prevalence of Intimate Partner Abuse in Women Treated at Community Hospital Emergency Departments

Context.— The majority of prior studies examining intimate partner abuse in the emergency department (ED) setting have been conducted in large, urban tertiary care settings and may not reflect the experiences of women seen at community hospital EDs, which treat the majority of ED patients in the United States. Objective.— To determine the prevalence of intimate partner abuse among female patients presenting for treatment in community hospital EDs and describe their characteristics. Design.— An anonymous survey conducted from 1995 through 1997 inquiring about physical, sexual, and emotional abuse. Setting.— Eleven community EDs in Pennsylvania and California. Participants.— All women aged 18 years or older who came to the ED during selected shifts. Main Outcome Measures.— Reported acute trauma from abuse, past-year physical or sexual abuse, and lifetime physical or emotional abuse. Results.— Surveys were completed by 3455 (74%) of 4641 women seen. The prevalence of reported abuse by an intimate partner was 2.2% (95% confidence interval [CI], 1.7%-2.7%) for acute trauma from abuse, 14.4% (95% CI, 13.2%-15.6%) for past-year physical or sexual abuse, and 36.9% (95% CI, 35.3%-38.6%) for lifetime emotional or physical abuse. California had significantly higher reported rates of past-year physical or sexual abuse (17% vs 12%, P<.001) and lifetime abuse (44% vs 31%, P<.001) than Pennsylvania. Logistic regression modeling identified 4 risk factors for reported physical, sexual, or acute trauma from abuse within the past year: age, 18 to 39 years (odds ratio [OR], 2.2; 95% CI, 1.7-3.0); monthly income less than $1000 (OR, 1.7; 95% CI, 1.3-2.1); children younger than 18 years living in the home (OR, 2.0; 95% CI, 1.5-2.6); and ending a relationship within the past year (OR, 7.0; 95% CI, 5.5-8.9). Conclusion.— If the prevalence of abuse in community hospitals throughout the United States is similar to the range of prevalence estimates found in this study, then heightened awareness of intimate partner abuse is warranted for patients presenting to the ED.