The epidemiology of injuries to bicycle riders

Over half a million injuries related to bicycle crashes were seen in U.S. hospital emergency rooms in 1982. The data reviewed show a strong link between bicycle/motor vehicle collisions, head injury, and serious morbidity and mortality.

A home injury prevention program for children

Most injuries to children under age five occur in the home. This article recounts the experience of an injury prevention project in developing and implementing an approach combining educational, regulatory, and technologic methods to reduce home injuries.

An approach to the epidemiology of childhood injuries

Injury epidemiology is summarized and important concepts such as injury versus accident, the agent-host-environment model, level of severity, morbidity versus mortality, and definitions of rates are considered. The authors suggest steps needed to improve the understanding of injury epidemiology and to remove barriers to the acceptance of injury prevention as a recognized field of study and clinical practice.

The incidence of injuries among 87,000 Massachusetts children and adolescents: results of the 1980-81 Statewide Childhood Injury Prevention Program Surveillance System

This study describes the incidence of fatal and nonfatal injuries occurring in 87,022 Massachusetts children and adolescents during a one-year period. A surveillance system for injuries at 23 hospitals captured 93 per cent of all discharges for ages 0-19 in the 14 communities under study. Sample data were collected on emergency room visits, hospital admissions, and deaths for all but a few causes of unintentional injuries. The overall incidence was 2,239 per 10,000. The true incidence rates are probably higher than those reported. The ratio of emergency room visits to admissions to deaths was 1,300 to 45 to 1. Injury rates varied considerably by age, sex, cause, and level of severity. Age-specific injury rates were lowest for infants and elementary school age children and highest for toddlers and adolescents. The overall ratio of male to female injury rates was 1.66 to 1. Injuries from falls, sports, and cutting and piercing instruments had a high incidence and low severity. Injuries from motor vehicles, burns, and drownings had lower incidence, but greater severity. Results provide evidence that both morbidity and mortality must be considered when determining priorities for injury prevention. Current prevention efforts must be expanded to target injuries of higher incidence and within the adolescent population.

Needs assessment under the Maternal and Child Health Services Block Grant: Massachusetts

The Massachusetts maternal and child health (MCH) agency has developed a needs assessment process which includes four components: a statistical measure of need based on indirect, proxy health and social indicators; clinical standards for services to be provided; an advisory process which guides decision making and involves constituency groups; and a management system for implementing funds distribution, namely open competitive bidding in response to a Request for Proposals. In Fiscal Years 1982 and 1983, the process was applied statewide in the distribution of primary prenatal (MIC) and pediatric (C&Y) care services and lead poisoning prevention projects. Both processes resulted in clearer definitions of services to be provided under contract to the state as well as redistribution of funds to serve localities that had previously received no resources. Although the needs assessment process does not provide a direct measure of unmet need in a complex system of private and public services, it can be used to advocate for increased MCH funding and guide the distribution of new MCH service dollars.

Dosimetry of computerized tomography in the evaluation of hip dysplasia

The usefulness of computerized tomography (CT) in the assessment of hip dysplasia has recently been given attention in the literature and concern regarding radiation dose has been raised. This study was undertaken to measure the radiation dose, both in and out of plaster, for plain films, arthrography, tomography, and CT. A method is suggested to reduce dosage by 80% without compromising diagnostic information. Our experience with 25 scans of patients aged 4 months to 39 years is presented.

Measles control in Yaounde: justification of a one dose, nine month minimum age vaccination policy in tropical Africa

For tropical countries the World Health Organisation recommends a single dose of measles vaccine, administered at a minimum age of 9 months. In some African nations, however, up to 26% of all reported measles occurs before the age of 9 months, and many African nations have been reluctant to follow the WHO recommendation. In 1974 the Ministry of Health of the United Republic of Cameroon made several changes in the existing measles control strategy, including increasing the minimum age for measles vaccination from 6 to 9 months. Surveillance of measles in Yaounde, the capital city, during the five years after the increase in age at vaccination did not reveal a need to return to the minimum age of 6 months. In fact, by 1979, with measles vaccination coverage among children 12-23 months of age at 40%, there had been a 44% decrease in reported measles among children of all ages, including a 64% decrease in the measles attack rate among children under the age of 9 months. These observations support the one dose, 9 month minimum age measles vaccination policy in tropical Africa.

Recurrent anterior dislocation of the hip: case report with arthrographic findings

A case of recurrent post-traumatic anterior dislocation of the hip in a 27-year-old woman is presented. Radiographs document this rare abnormality in the acute stage. Post-reduction arthrography demonstrates an anterior pseudobursa resulting from capsular tear.

Pediatric nursing homes. Implications of the Massachusetts experience for residential care of multiply handicapped children

Pediatric nursing homes were established in Massachusetts in 1971, in response to the crisis created by the deinstitutionalization of children with multiple severe handicaps for whom care in the community was unrealistic. Although these residential beds provided short-term relief for the system, failure both to plan for the improved long-term survival of the children and to develop alternative community services for those whose functional and medical status changed has left fundamental problems unresolved. A review of the 421 residents of pediatric nursing homes since 1972 shows that most have been bedridden and nonverbal, requiring provision of basic care: feeding, dressing, maintaining hygiene, and sensory and motor stimulation. Three quarters of the residents were severely or profoundly retarded and had seizures. About 4 per cent died each year, and another 5 per cent were discharged; few beds were available for new admissions. Low standards of care and financial disincentives have resulted in less than optimal educational and rehabilitative services. Other states are facing similar problems, which can be resolved only through better funding and coordination of the relevant state agencies.

The epidemiology and control of measles in Yaoundé, Cameroun, 1968-1975

Surveillance data on measles in Yaoundé during the 8 years from 1968-1975 have been reviewed. Measles epidemics occurred in every year except 1969-1970, the period of the attach phase of the Smallpox Eradication and Measles Control Programme. Subsequent biennial mass measles immunisation campaigns and maintenance measles immunisation at the child health centre failed to interrupt epidemic transmission. 70-80% of cases were under 24 months of age. Annual outbreaks occurred during the first half of each year, but smaller numbers of cases continued throughout the year. The outbreaks came to an end despite 32-41% of 6 through 36 month old children remaining susceptible. The seasonality of measles was not simply related to the annual rainfall pattern. Rather it is hypothesised that measles seasonality depends on the movement of young children with their mothers during the annual agricultural cycles. Measles immunisation programmes must be adapted to local epidemiological and cultural conditions in order to interrupt transmission.

Injections and paralytic poliomyelitis in tropical Africa

A case-control study was conducted in Yaoundé, United Republic of Cameroon, to evaluate the hypothesis that intramuscular inoculations predisposed young children to paralysis if they were later exposed to poliomyelitis virus. Thirty-three cases with lower motor neuron disease and 66 neighbourhood controls were studied. Poliovirus was isolated from 39% of the paralytic cases but from only 18% of the comparison group. Controls were more likely to have had serological evidence of previous exposure to all three poliovirus types while most of the paralytic cases had been exposed to a poliovirus for the first time. Two-thirds of the paralytic cases but only 11% of the comparison group had been ill, visited a medical facility, and received multiple injections, primarily with quinine and penicillin, in the month prior to the onset of poliomyelitis. There was a strong temporal relationship between these injections and the onset of paralysis. The increased relative risks (15 and 32, respectively) of paralysis associated with inoculations in the two weeks immediately prior to onset of disease were felt to represent the treatment of symptoms related to poliomyelitis. However, the increased relative risks (13 and 27, respectively) three and four weeks prior to onset were felt to be consistent with the hypothesis that intramuscular injections provoked paralysis. Overestimation of this measure of the effect because of bias in the control group is discussed.

Non-A, non-B hepatitis among participants in a plasmapheresis stimulation program

Non-A, non-B hepatitis was transmitted to seven of nine participants in a red blood cell-stimulation program following transfusion of blood from one asymptomatic donor. Five of the seven patients had clinical as well as biochemical evidence of infection, and three of these five were icteric. Incubation periods for the clinical cases ranged from 28 to 50 days, and duration of illness was from two to eight weeks. None of the seven patients showed serologic evidence of acute infection or reinfection with hepatitis A virus, hepatitis B virus, cytomegalovirus, or Epstein-Barr virus. Viremia persisted in the donor for at least 34 days, since non-A, non-B hepatitis was transmitted to program participants during that period.

A programme of multiple-antigen childhood immunization in Yaoundé, Cameroon: first-year evaluation, 1975-1976

The Yaoundé multiple-antigen childhood immunization programme began in November 1975, making it one of the first expanded programmes on immunization operational in Africa. During the first 9 months, more than 22 000 children were immunized against poliomyelitis, measles, tuberculosis, smallpox, whooping cough, tetanus, and diphtheria. Evaluation of the programme showed the following rates of immunization coverage in the target population; 30% for DPT (one dose or more), 27% for poliomyelitis (one dose or more), 27% for BCG, 33% for measles, and 20% for smallpox. Eighty per cent of children received the correct vaccines for their age and vaccination status. Seroconversion to measles vaccine was 89% in those over 12 months of age but only 50% in those between 6 and 11 months of age. The major factor in low immunization coverage was felt to be inadequate publicity. The cost of the programme was estimated to be US $10 920. The cost of immunizing a child completely was estimated at US $1.90. Some logistic problems encountered during this initial year of operation are discussed.

Clinical and laboratory evaluation of epidemic keratoconjunctivitis due to adenovirus types 8 and 19

During a community outbreak of epidemic keratoconjunctivitis due to adenovirus types 8 and 19, we compared the clinical and laboratory characteristics of the two viruses. Much of the disease was mild and the keratoconjunctivitis associated with adenovirus type 8 was indistinguishable clinically from that associated with adenovirus type 19. Adenovirus type 8 was isolated only from the conjunctival sac, whereas adenovirus type 19 was frequently cultured from the nose, throat, and conjunctiva. The two adenovirus types were never isolated from the same individual. In a prospective study of ten individuals exposed to known cases, adenovirus type 19 was isolated from two without clinical disease.

Failure to vaccinate children against measles during the second year of life. An analysis of immunization practices in two Tennessee county health departments

In many Tennessee counties, children under the care of health departments have low measles vaccination levels. An immunization survey and a health department record audit of 2-year-olds were undertaken in two counties to determine the reasons for this situation. The results indicated that faulty clinic procedures played a large part in the failure to vaccinate against measles. Nearly half of the unvaccinated 2-year-olds with health department records had been present in the health department clinic at the appropriate age for measles vaccination; the remainder had dropped out of the well-child program before their first birthday. Emphasis on tuberculin skin testing and delay in the administration of the basic series of DTP immunizations correlated with the failure to vaccinate against measles. For more than half of the children who attended the clinic after their first birthday, no reason was recorded for the failure to vaccinate them against measles. Improved clinic procedures could bring measles vaccination levels within the acceptable range. These procedures would include new methods for correcting immunization delinquency, simultaneous tuberculin skin testing and measles vaccination of children without a history of tuberculosis exposure, emphasis on vaccinating at-risk groups, and more convenient vaccination clinic hours.

The pediatric internship as a teaching technique: a comparison of learning experiences in five hospitals

Five interns joined in a collaborative study to assess their learning experiences during the internship year. A 3 times 5-inch data form was completed for each patient for whom the intern was responsible. Information was gathered on demongraphic characteristics of the patient, the teaching that involved this patient, and what skills were acquired. Nearly 30% of the patients were under 1 year of age; 55% were boys. More than one half of the contacts were in an outpatient or emergency department. Over 80% of the patients had not been seen before; continuity patients made up less than 9% of the contacts. Well-child care was the largest care category (19%), followed by respiratory problems (15%) and injuries (9%). About 40% of the contacts involved a teaching input, mainly from residents, attending physicians, and faculty. Care skills most frequently acquired were physical examination (49%), reading (15%), and interviewing (11%). Cross-tabulations showed that most learning was reported for inpatients, for patients with rare diseases, and when some teaching was involved.

Epidemic keratoconjunctivitis: a community outbreak of mixed adenovirus type 8 and type 19 infection

During the fall and winter of 1973, 145 cases of epidemic keratoconjunctivitis were diagnosed in Nashville, Tennessee. Of the 74 cases studied virologically and/or serologically, 62% were caused by adenovirus type 8, and 28% were caused by adenovirus 19. Whereas adenovirus type 8 was isolated only from conjunctival scrapings, adenovirus type 19 was isolated from nose and throat swabs as well as from conjunctivae. The two viruses produced clinically indistinguishable eye disease and household secondary attack rates that were not statistically different. Regardless of etiology, the secondary attack rate in households was significantly higher among the contacts of those patients who had severe disease for greater than 28 days than among the contacts of patients who had milder disease of shorter duration.