Evaluation of the reasons for preferring root canal treatment in mature permanent teeth potentially indicated for pulp preservation: a clinical case/photo-based questionnaire study

BACKGROUND

With advances in pulp preservation procedures (PPP), indications for PPP extend to exposed pulp with symptoms in teeth with carious lesions. Scenario/text-based questionnaire studies report a high preference for PPP for exposed pulp with no pulpal symptoms. However, negative perceptions towards PPP for exposed pulp in carious teeth are prevalent among dentists. Identifying the differences in PPP preference rates in questionnaire studies and actual clinical situations is necessary to determine the current status of PPP. In this study, a clinical case/photo-based design was devised to overcome the limitations of scenario/text-based questionnaires. This study aimed to evaluate the reasons dentists prefer root canal treatment (RCT) in cases where PPP is potentially indicated.

METHODS

A questionnaire containing three cases of PPP with successful results was administered to dentists. The cases were selected to elicit comprehensive responses from the dentists. Clinical photos of the pulp exposure sites were presented to dentists without describing the tooth conditions, including the extent of pulp exposure and tooth decay, pulpal surface conditions, or restorability. The questions were focused on the reasons for selecting RCT in cases where was practiced. Questionnaire data were collected using Google e-forms. Chi-squared and Fisher's exact test (P < 0.05) were used for statistical analyses.

RESULTS

Pulpal diagnosis was not a dominant factor in treatment decision-making for pulp exposure during caries removal. Reasons for selecting RCT where PPP was potentially indicated included the event of pulp exposure itself and the dentists' desire to prevent post-PPP symptoms. Apart from symptomatic pulp, the tooth conditions influenced the establishment of pulpal diagnosis and selection of treatment modality. Moreover, the tooth condition and dentists' desire for good patient prognosis influenced the negative perceptions towards PPP.

CONCLUSIONS

Unfavourable tooth conditions, in association with a desire for preventing post-PPP symptoms, prevent dentists from attempting PPP for pulp exposed during caries removal with no/slight symptoms. Improving negative perceptions towards PPP through accumulation of data on the high success rates of PPP is a prerequisite for achieving widespread application of PPP.

Effectiveness and Safety of Recombinant Human Follicle-Stimulating Hormone (Follitrope™) in Inducing Controlled Ovarian Stimulation in Infertile Women in Real-World Practice: a Prospective Cohort Study

To evaluate the safety and effectiveness of recombinant human follicle-stimulating hormone (rhFSH [Follitrope™]) in infertile women undergoing in vitro fertilization (IVF). To identify predictors of ovarian response that induce optimal clinical outcomes. This multicenter prospective study enrolled infertile women who were scheduled to undergo IVF after ovarian stimulation with rhFSH (Follitrope™) following the gonadotropin-releasing hormone (GnRH) agonist or GnRH antagonist protocol. Predictive factors for ovarian response were identified in the GnRH antagonist group based on the number of oocytes retrieved. A total of 516 infertile women were enrolled, among whom 136 (except one who withdrew before administration) received rhFSH using the GnRH agonist protocol and 379 using the antagonist protocol. The mean number of oocytes retrieved was 13.4 in the GnRH agonist group and 13.6 in the GnRH antagonist group. The clinical pregnancy rates were 32.3% (30/93) and 39.9% (115/288) in the GnRH agonist and antagonist groups, respectively. The incidence of ovarian hyperstimulation syndrome was 1.8% and 3.4% in the GnRH agonist and antagonist groups, respectively. No other significant safety risks associated with rhFSH administration were identified. Body mass index, basal serum FSH and anti-Müllerian hormone levels, and antral follicle count were identified as predictors of ovarian response by multiple regression with backward elimination, and the final regression model accounted for 26.5% of the response variability. In real-world practice, rhFSH (Follitrope™) is safe and effective in inducing ovarian stimulation in infertile women. Patient characteristics identified as predictors can be considered to be highly related to optimal clinical outcomes.

Association of coffee drinking with all-cause and cause-specific mortality in over 190,000 individuals: data from two prospective studies

We examined the association of coffee drinking with all-cause and cause-specific mortality in a pooled analysis of two Korean prospective cohort studies: The Korea National Health and Nutrition Examination Survey and the Korean Genome and Epidemiology Study. We included 192,222 participants, and a total of 6057 deaths were documented. Cox proportional hazards model was used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs), and the HRs were combined using a random-effects model. Coffee drinking was associated with a lower risk of all-cause mortality [HR (95% CI) = 0.84 (0.77-0.92), for ≥3 cups/day of coffee drinking versus non-drinkers; p for trend = 0.004]. We observed the potential benefit of coffee drinking for mortality due to cardiovascular disease, respiratory disease, and diabetes, but not for cancer mortality. Overall, we found that moderate coffee drinking was associated with a lower risk of death in population-based cohort analysis of Korean adults.

Association of Habitual Coffee Consumption and HECTD4 Polymorphism with Risk of Prediabetes and Type 2 Diabetes (P18-071-19)

Objectives

Epidemiological studies suggested the evidence that coffee consumption decreased risk of type 2 diabetes. Recently, Japanese genome-wide association studies (GWAS) of coffee consumption has identified rs2074356 (G > A) at 12q24.12–13 in HECTD4. This study aims to examine the associations of habitual coffee consumption with prediabetes and type 2 diabetes, and whether this association is modified by rs2074356 variant in Korean adults.

Methods

A total of 4010 participants (1890 men and 2120 women) who had genetic information from Korea Association REsource (KARE) study were included. Habitual coffee consumption was assessed through a food frequency questionnaire and categorized into five categories (non-consumers, <1 cup/day and ≥1 cups/day of black coffee, and <1 cup/day and ≥1 cups/day of sugared coffee). Incident prediabetes or type 2 diabetes were defined according to the self-report of physician-diagnosis, oral glucose tolerance test (OGTT) or hemoglobin A1c (HbA1c) test. Multivariable logistic regression models were used to calculate odds ratio (OR)s and 95% confidence interval (CI)s.

Results

A total of 2916 participants (72.7%) have developed prediabetes during a follow-up of 15 years. We found that black coffee consumption lowered risk of prediabetes and type 2 diabetes combined among men and women combined (OR = 0.63; 95% CI = 0.44–0.91 for ≥1 cups/day black coffee vs. non-consumers). When we separated men and women, compared with non-consumers, ORs (95% CIs) for ≥1 cups/day of black coffee were 0.50 (0.27–0.93) among men and 0.72 (0.45–1.14) among women and ORs (95% CIs) for ≥1 cups/day of sugared coffee were 1.41 (0.91–2.18) among men and 1.12 (0.80–1.58) among women. We observed a suggestive difference by rs2074356 (GG vs. AG + AA). Compared with non-consumers, participants with AG + AA genotypes consumed ≥ 1 cups/day of black coffee had a 60% lower risk of prediabetes and type 2 diabetes combined (95% CI 0.20–0.78), but we found a weaker association among those with GG genotype (OR = 0.81; 95% CI = 0.51–1.28).

Conclusions

We observed an inverse association between black coffee consumption and prediabetes and type 2 diabetes combined in Korean population. This association was more pronounced among carriers of minor allele of HECTD4 rs2074356 (AG/AA).

Funding Sources

None.

The Prevalence of Cardiovascular Disease Risk Factors: An Age-matched Analysis from FiLWHEL (2014–2016), NNS (2008), KNHANES (2013–2015) and NHANES (2013–2016) Data (P18-088-19)

Objectives

Cardiovascular disease (CVD) is accountable for major cause of deaths among women worldwide. We aimed to assess the prevalence of CVD risk factors among Filipino women in Korea, Filipino women in the Philippines, Korean women in Korea and US women in the US.

Methods

We randomly selected a sample of 504 women from each study using a 1:1 age-matching analysis. Age range from 20–57 years old. We analyzed anthropometry, blood pressure and biomarkers data from the Filipino Women's Health and Diet Study (FiLWHEL), the Philippine National Nutrition Survey (NNS), Korean National Health and Nutrition Examination Survey (KNHANES) and the US National Health and Nutrition Examination Survey (NHANES). We used the American Heart Association/National Heart, Lung, and Blood Institute (AHA/NHLBI) criteria to categorize blood lipids. We assessed the prevalence of CVD risk factors using proportions, means and standard deviations.

Results

We found that high BMI (≥25 kg/m²) and high waist circumference (WC: ≥85 cm) were prevalent in NHANES (65.6%, mean BMI = 29.48 ± 8.18 and 70.8%, mean WC = 96.16 ± 18.19, respectively) than in FiLWHEL (30.9%, 26.4% respectively), NNS (29.0%, 23.9% respectively) and KNHANES (19.8%, 12.0% respectively), p-value = <.0001. NHANES also exhibited higher prevalence for high cholesterol (≥200 mg/dL), high triglyceride (≥150 mg/dL) and high glucose (≥110 mg/dL) with 32.3%, 25.4% and 10.8% respectively. However, compared with NHANES (28.3%) and KNHANES (21.6%), NNS and FiLWHEL had higher prevalence of pre-hypertension and hypertension combined (47.6% and 43.8%, respectively), p-value = < .0001. Also, high prevalence of low HDL-c (<50 mg/dL) was striking in NNS (39.84 ± 5.75) than in FiLWHEL (58.19 ± 14.06), NHANES (57.44 ± 16.76) and KNHANES (56.97 ± 11.35).

Conclusions

Our study suggest that the prevalence of risk factors for cardiovascular disease were different across Filipino women in Korea and in the Philippines, Korean women and US women.

Funding Sources

Handok Pharmaceutical Co., Ltd.

Comparison of a Food Frequency Questionnaire with 24 Hour Recalls in Assessing Coffee Consumption: The Health Examinees (HEXA) Study (P18-075-19)

Objectives

Most cohort studies have used a food frequency questionnaire (FFQ) to evaluate coffee consumption as it assesses habitual dietary patterns, whereas some studies use the 24 hour recalls as it elicits in-depth description of foods and the amount eaten. The aim of this study was to compare FFQs and 24 hour recalls to assess the consumption of various types of coffee.

Methods

We included a total of 25,904 participants from the Health Examinees (HEXA) Study of the Korean Genome and Epidemiologic Study (KoGES), where individuals were aged 40 years or older. Each participant completed both one FFQ and two 24 hour recalls one month apart, which included coffee consumption and the use of sugar and powdered creamers in coffee. We classified coffee consumption whether they drink more than one cup a day or not. We categorized types of coffee as “black coffee”, “coffee with sugar”, “coffee with powder creamer”, “coffee with sugar and powdered creamer” and “combinations of four types of coffee”. We compared the types of coffee they consumed through FFQs and 24 hour recalls.

Results

Among those who marked “black coffee” on their FFQ, 51.90% reported to drink “black coffee”, 2.70% reported “coffee with sugar”, 10.81% said “coffee with sugar and powdered creamer” and 20.97% reported they did not drink coffee in 24 hour recalls. 13.63% reported that they drink the rest combinations of four types of coffee in 24 hour recalls. Whereas among those who marked “coffee with sugar” on their FFQ, 33.49% said “coffee with sugar”, 12.44% said “black coffee” and 12.91% reported to drink “coffee with sugar and powdered creamer” in 24 hour recalls. Among those who marked “coffee with sugar and powdered creamer” on their FFQ, 53.49% said “coffee with sugar and powdered creamer” in 24 hour recalls. Those who reported drinking “coffee with powder creamer” on their FFQ, however, only 9.18% marked “coffee with powder creamer”, 28.5% marked “coffee with sugar and powdered creamer” in 24 hour recalls. Finally, 19.32% marked drinking any four types of coffee on their FFQs, but reported not drinking coffee in 24 hour recalls.

Conclusions

We found discrepancies between FFQs and 24 hour recalls in the types of coffee consumed. Such limitations should be considered when using 24 hour recalls data to examine the effect of coffee consumption on disease development.

Funding Sources

None.

Transformation of Cortex-wide Emergent Properties during Motor Learning

Learning involves a transformation of brain-wide operation dynamics. However, our understanding of learning-related changes in macroscopic dynamics is limited. Here, we monitored cortex-wide activity of the mouse brain using wide-field calcium imaging while the mouse learned a motor task over weeks. Over learning, the sequential activity across cortical modules became temporally more compressed, and its trial-by-trial variability decreased. Moreover, a new flow of activity emerged during learning, originating from premotor cortex (M2), and M2 became predictive of the activity of many other modules. Inactivation experiments showed that M2 is critical for the post-learning dynamics in the cortex-wide activity. Furthermore, two-photon calcium imaging revealed that M2 ensemble activity also showed earlier activity onset and reduced variability with learning, which was accompanied by changes in the activity-movement relationship. These results reveal newly emergent properties of macroscopic cortical dynamics during motor learning and highlight the importance of M2 in controlling learned movements.

Clinical outcomes of patients with advanced hepatocellular carcinoma treated with sorafenib: a retrospective study of routine clinical practice in multi-institutions

Background

Sorafenib is an orally administered multikinase inhibitor with antiangiogenic and antiproliferative properties. The results of large clinical trials demonstrate that sorafenib prolongs survival and the time to progression of patients with advanced hepatocellular carcinoma (HCC). The aim of the present study was to determine the outcomes of such patients who were routinely treated with sorafenib at multi-institutions in Korea, in contrast to formal clinical trials.

Methods

Between August 2007 and March 2012, patients with advanced HCC in seven referral medical centers in Daejeon-Chungcheong Province of Korea were retrospectively enrolled to evaluate treatment response, survival, and tolerability following administration of sorafenib. The treatment response was assessed in accordance with the Response Evaluation Criteria in Solid Tumor 1.1 guidelines.

Results

Among 116 patients, 66 (57%) had undergone treatment for HCC, and 77 (66%) were accompanied with Child-Pugh A cirrhosis. The median duration of sorafenib treatment was 67 days (range 14–452 days). Median overall survival and median time to progression were 141 days and 90 days, respectively. Complete response, partial response, and stable disease were achieved for 0%, 2%, and 29% of patients, respectively. Overall median survival, but not the median time to progression, was significantly shorter for patients with Child-Pugh B cirrhosis compared with those with Child-Pugh A cirrhosis (64 days vs 168 days, P = 0.004). Child-Pugh B cirrhosis (P = 0.024) and a high level of serum alpha-fetoprotein (P = 0.039) were independent risk factors for poor overall survival. Thirty-nine (34%) patients experienced grade 3/4 adverse events such as hand-foot skin reactions and diarrhea that required dose adjustment.

Conclusions

The clinical outcomes of sorafenib-treated patients with advanced HCC were comparable to those reported by formal clinical trial conducted in the Asia-Pacific region. Underlying hepatic dysfunction was the most important risk factor for shorter survival.

[Occupational morbidity in Kazakhstan]

The main principle of the whole health care system in Kazakhstan is joint responsibility of state, employer and employee for the health state. Coordination of occupational therapeutic service is maintained by National Center of Industrial hygiene and occupational diseases. The country appears to have registered 6919 patients with "occupational disease" diagnosis, with new 500-600 cases register annually. Occupational diseases should be revealed at early stages, when the patients remain at their workplaces, and rehabilitation measures should be performed.

Long-term treatment outcomes of clevudine in antiviral-naive patients with chronic hepatitis B

AIM: To evaluate the treatment outcomes of clevudine compared with entecavir in antiviral-naive patients with chronic hepatitis B (CHB).

METHODS: We retrospectively analyzed the clinical data of CHB patients treated with clevudine 30 mg/d and compared their clinical outcomes with patients treated with entecavir 0.5 mg/d. The biochemical response, as assessed by serum alanine aminotransferase (ALT) activity, virologic response, as assessed by serum hepatitis B virus DNA (HBV DNA) titer, serologic response, as assessed by hepatitis B e antigen (HBeAg) status, and virologic breakthrough with genotypic mutations were assessed.

RESULTS: Two-hundred and fifty-four patients [clevudine (n = 118) vs entecavir (n = 136)] were enrolled. In clevudine-treated patients, the cumulative rates of serum ALT normalization were 83.9% at week 48 and 91.5% at week 96 (80.9% and 91.2% in the entecavir group, respectively), the mean titer changes in serum HBV DNA were -6.03 and -6.55 log₁₀ copies/mL (-6.35 and -6.86 log₁₀ copies/mL, respectively, in the entecavir group), and the cumulative non-detection rates of serum HBV DNA were 72.6% and 83.1% (74.4% and 83.8%, respectively, in the entecavir group). These results were similar to those of entecavir-treated patients. The cumulative rates of HBeAg seroconversion were 21.8% at week 48 and 25.0% at week 96 in patients treated with clevudine, which was similar to patients treated with entecavir (22.8% and 27.7%, respectively). The virologic breakthrough in the clevudine group occurred in 9 (7.6%) patients at weeks 48 and 15 (12.7%) patients at week 96, which primarily corresponded to genotypic mutations of rtM204I and/or rtL180M. There was no virologic breakthrough in the entecavir group.

CONCLUSION: In antiviral-naive CHB patients, long-term treatment outcomes of clevudine were not inferior to those of entecavir, except for virologic breakthrough.

Efficacy of initial treatment with clevudine in naive patients with chronic hepatitis B

BACKGROUND/AIMS

Clevudine, a pyrimidine nucleoside analogue, has potent antiviral effects in patients with chronic viral hepatitis B (CHB). We report the efficacy of initial treatment with clevudine in naïve patients with CHB living in Daejeon and Chungcheong Province, South Korea.

METHODS

One hundred five adults with CHB were administered 30 mg of clevudine per day for an average of 51 weeks. We evaluated viral markers and liver biochemistry retrospectively every 3 months.

RESULTS

Alanine aminotransferase (ALT), aspartate aminotransferase (AST), and hepatitis B virus (HBV) DNA before the treatment were 184 ± 188 IU/L, 150 ± 138 IU/L, and 7.1 ± 1.2 log copies/mL, respectively. Undetectable rates (< 60 IU/mL) of DNA were 36.2%, 68.9%, 83.6%, 76.2%, and 75.8% at 12, 24, 36, 48, and 60 weeks, respectively. Seroconversion rates were 9.1%, 13.6%, 24.6%, 26.5%, and 26.1% and ALT normalization rates were 64.5%, 78.1%, 87.9%, 90.0% at 12, 24, 36, and 48 weeks, respectively. Six patients (5.7%) had a viral breakthrough.

CONCLUSIONS

Clevudine is a useful drug in the initial treatment of patients with CHB, with a potent antiviral effect and low incidence of viral breakthrough.

Up-regulation of heme oxygenase-1 expression through CaMKII-ERK1/2-Nrf2 signaling mediates the anti-inflammatory effect of bisdemethoxycurcumin in LPS-stimulated macrophages

We have identified a novel anti-inflammatory signaling pathway that leads to the expression of heme oxygenase-1 (HO-1) in response to bisdemethoxycurcumin (BDMC), an analog of curcumin. Treatment with BDMC suppressed inducible nitric oxide synthase expression and nitric oxide (NO) production by down-regulating NF-kappaB activity in lipopolysaccharide (LPS)-stimulated RAW264.7 macrophages. These effects were reversed by blocking HO-1 activity or expression. The signaling pathway involved in BDMC-mediated HO-1 induction included Ca(2+)/calmodulin-dependent protein kinase II (CaMKII) and extracellular signal-regulated kinase 1/2 (ERK1/2). BDMC induced phosphorylation of ERK1/2 in a CaMKII-dependent manner. Pretreatment with the mitogen-activated protein kinase kinase 1/2 (MEK1/2) inhibitor, U0126, inhibited CaMKII-induced stimulation of HO-1 promoter activity, suggesting that ERK1/2 is a downstream mediator of CaMKII in BDMC signaling to HO-1 expression. Furthermore, the CaMKII-ERK1/2 cascade targets the transcription factor, NF-E2-related factor-2 (Nrf2). Finally, inhibition of the Ca(2+)-CaMKII-ERK1/2-linked cascade attenuated significantly suppression by BDMC of LPS-induced iNOS expression and subsequent NO production. Collectively, our findings identify a Ca(2+)/calmodulin-CaMKII-ERK1/2-Nrf2 cascade as a novel anti-inflammatory pathway mediating BDMC signaling to HO-1 expression in macrophages.

[Efficacy of initial treatment with peginterferon alpha-2a versus peginterferon alpha-2b in combination with ribavirin in naive chronic hepatitis C patients living in Daejeon and Chungcheong Province in Korea: a comparative study]

BACKGROUNDS/AIMS

Peginterferon alpha-2a or -2b is the standard treatment regimen in chronic hepatitis C. However, there have been few comparative studies of the efficacies of these two types of peginterferon. We evaluated their efficacies in combination with ribavirin as a initial treatment for chronic hepatitis C.

METHODS

Ninety-seven patients were treated with peginterferon alpha-2a (180 microg/week, n=48) or peginterferon alpha-2b (1.5 microg/kg/week, n=49) plus ribavirin (800 mg/day for 24 weeks in genotype non-1 or 1,000-1,200 mg/day for 48 weeks in genotype 1). Virologic responses including the early virologic response (EVR), end-of-treatment response (ETR), sustained virologic response (SVR), and adverse effects were analyzed retrospectively.

RESULTS

The virologic response rates did not differ significantly between peginterferon alpha-2a and -2b: 89.6% and 89.7% for EVR, 79.2% and 79.5% for ETR, 72.9% and 73.5% for SVR, respectively. Analysis of the virologic responses according to genotype also revealed no significant differences in SVR between peginterferon alpha-2a and -2b (59.3% vs. 59.7% for genotype 1 and 90.5% vs. 83.3% for genotype non-1, respectively), or in adverse effects including flu-like symptom, rash, itching, neutropenia, and thrombocytopenia.

CONCLUSIONS

We found no significant differences in therapeutic efficacies and adverse effects between the alpha-2a and -2b types of peginterferon as the initial treatment regimen in naive chronic hepatitis C patients.

Acute drug-induced hepatitis caused by albendazole

Albendazole binds to parasite's tubulin inhibiting its glucose absorption. Its common adverse effects are nausea, vomiting, constipation, thirst, dizziness, headache, hair loss and pruritus. Although mainly metabolized in the liver, abnormal liver function tests were a rare adverse effect during clinical trials and we found no literature about albendazole-induced hepatitis requiring admission. This patient had a previous history of albendazole ingestion in 2002 resulting in increase of liver function tests. And in 2005, the episode repeated. We evaluated the patient for viral hepatitis, alcoholic liver disease, and autoimmune hepatitis, but no other cause of hepatic injury could be found. Liver biopsy showed periportal steatosis and periportal necrosis. The initial abnormal liver function test improved only with supportive care. These findings and the Roussel Uclaf Causality Assessment Method of the Council for International Organizations of Medical Sciences (RUCAM/CIOMS) score of 9 are compatible with drug-induced hepatitis so we report the case of this patient with a review of the literature.

[A randomized, prospective, comparative, multicenter study of rabeprazole and ranitidine in the treatment of reflux esophagitis]

BACKGROUND/AIMS

This study was done to evaluate the efficacy of rabeprazole (proton-pump-inhibitor) and ranitidine (H(2)-receptor antagonist) in the symptom relief and treatment of erosive esophagitis diagnosed by endoscopy.

METHODS

A total of 110 patients with typical gastroesophageal reflux disease (GERD) symptoms were enrolled in this multicenter study. They were randomized into rabeprazole group (53 patients) and ranitidine group (57 patients) respectively. The patients in rabeprazole group were given 10 mg of rabeprazole and ranitidine group received 300 mg of ranitidine before breakfast and dinner for 8 weeks. After the end of treatment, we evaluated the endoscopic healing rate of reflux esophagitis and symptomatic improvement.

RESULTS

After 8 weeks of treatment, rabeprazole group showed significantly higher complete endoscopic cure rate than ranitidine group (86.8% [46/53] vs. 57.9% [33/57], p=0.001) and higher symptomatic improvement of heartburn (91.2% [31/34] vs. 76.2% [32/42], p=0.085), especially in the first 7 days (76.7% vs. 45.3%, p=0.008). Also, rabeprazole group showed significantly higher improvement of regurgitation symptom than ranitidine group (100% [35/35] vs. 83% [39/47], p=0.009). Both group showed no differences in the improvement of chest pain and globus sensation. All the adverse events (rabeprazole group 4 events vs. ranitidine group 3 events) were mild and there was no abnormality in laboratory test.

CONCLUSIONS

In patients with GERD, rabeprazole 10 mg b.i.d. is superior to ranitidine 300 mg b.i.d. in healing of reflux esophagitis and resolving typical GERD symptoms. Rabeprazole is an effective and well-tolerated drug for GERD treatment.

Firearm-related injury surveillance in California

CONTEXT

Although firearms are the leading cause of injury death in California, no staff resources were devoted to surveillance of firearm-related injuries until 1995, when The California Wellness Foundation funded the Firearm Injury Surveillance Program (FISP).

OBJECTIVE

To develop and evaluate surveillance of serious firearm-related injuries and risk factors.

DESIGN

Passive surveillance using several data sources: death records, homicide data, hospital discharge data, and Behavioral Risk Factor Surveys. To evaluate FISP, we follow the Centers for Disease Control and Prevention's Guidelines for Evaluating Surveillance Systems.

SETTING

State of California.

PARTICIPANTS

California Department of Health Services, Epidemiology and Prevention for Injury Control Branch.

MAIN OUTCOME MEASURES

Deaths and hospitalizations resulting from firearm-related injuries and presence and storage of firearms in the home. We evaluated FISP's utility, simplicity, flexibility, acceptability, representativeness, and timeliness.

RESULTS

Firearm-related injuries were the leading cause of death among children as young as 13 or 14 years of age. In 1994, more than 13,000 California residents died or were hospitalized as a result of firearm-related injuries. Except among whites, most of these serious firearm-related injuries were from assaults. The predominance of handguns as murder weapons increased with time and was more marked among younger and racial/ethnic minority victims. FISP provides data needed for setting policy and preventing firearm-related injuries. The system is acceptable and represents the serious firearm-related injury problem well, but lacks flexibility, timeliness, and detail.

CONCLUSIONS

Despite the limitations inherent in passive surveillance, FISP serves many of our surveillance needs well.

Does sharing the cost of a bicycle helmet help promote helmet use?

OBJECTIVE

To determine whether asking for a $5.00 donation for bicycle helmets, compared with distribution free of charge, would affect helmet use among children receiving helmets and an educational intervention from public health clinics.

SETTING

Six public health clinic sites in King County, Washington.

METHODS

Six participating clinic sites were randomly assigned to either free helmet distribution or to a $5.00 suggested donation for the helmets, stratified by whether a helmet law was in place. Three sites were assigned to each arm. Children who were between 6 and 12 years of age and who reported riding bicycles, but having no bicycle helmets, were eligible. Clinicians distributed helmets and delivered an educational intervention to 506 eligible children, or siblings of children seen at the clinic between March and July 1993. Parents were contacted after helmet distribution to ascertain helmet use.

RESULTS

82% of children whose parents were asked for a copayment and 77% of children who received free helmets were reported to wear their helmets every time they rode their bicycles (p=0.20). The adjusted odds ratio for the association between copayment compared with free helmets and helmet use was 1.66 (95% confidence interval 0.94 to 2.92).

CONCLUSIONS

Helmet use was not significantly different among children whose parents were asked for a small copayment, compared with those who received helmets free. Use of copayments can increase helmet use by increasing the number of helmets given to low income children.