HICN241 News Part 2/2 
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 HICN241 News Part 2/2

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    The ISRA demonstrated that among persons who were injured and used  safety
restraints injuries were less severe and cost less. Reduction of motor vehicle
crash injury and subsequent effects will require increased public awareness of
the benefits of correct and consistent safety-restraint use.  Methods to reach
this goal include:

-- Emphasis on the ability of safety restraints to reduce crash  injuries  and
associated hospital costs, disability, and death.

--  Instruction  of children about the importance of wearing safety restraints
to reduce the risk of severe injury in a crash so  that  safety-restraint  use
becomes routine before adolescence and early {*filter*}hood.

--  Education  of  persons  16-24  years  of age--who are at greatest risk for
traffic-related injury--about preventive behavior  (safety-restraint  use  and
{*filter*} avoidance) and traffic safety enforcement (compliance with speed limit
and {*filter*} consumption laws).

 Since 1975,  detailed mortality data have been collected on all motor vehicle
crash deaths by the National Highway Traffic Safety Administration  using  the
Fatal  Accident  Reporting System.  Data are limited on nonfatal motor vehicle
crash injuries,  such as those reported in the ISRA.  A comprehensive database
on  injuries  and disabilities will require integrated morbidity and mortality
data collection at the local, state, and federal levels (5). In addition, such
data linkage will require collaboration between public service  agencies,  the
medical community (e.g.,  physicians,  nurses,  coroners,  hospital staff, and
prehospital emergency medical-care staff), police,  highway and transportation
departments, and others.

References

1.  Committee on Injury Scaling, American Association for Automotive Medicine.
Abbreviated injury scale, 1985 revision. Arlington Heights, Illinois: American
Association for Automotive Medicine, 1985.

2.  Peterson TD.  Trauma prevention from the  use  of  seat  belts.  Iowa  Med
1987;(May):233-6.

3.   Office   of   Driver   Services,   Iowa   Department  of  Transportation.
Observational Safety Belt Usage Survey.  Des Moines, Iowa:  Iowa Department of
Transportation, 1987.

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Volume  2, Number 41                                      November  8, 1989

4.   Office   of   Driver   Services,   Iowa   Department  of  Transportation.
Observational Safety Belt Usage Survey.  Des Moines, Iowa:  Iowa Department of
Transportation, 1988.

5.  Committee  on  Trauma  Research,  Commission  of  Life Sciences,  National
Research  Council  and  the  Institute  of  Medicine.   Injury   in   America.
Washington, DC: National Academy Press, 1985.

Health InfoCom Network News                                             Page 11
Volume  2, Number 41                                      November  8, 1989

          Cost of Injury -- United States: A Report to Congress, 1989

    In   1987,   Congress   directed   the  National  Highway  Traffic  Safety
Administration and CDC to evaluate the cost of injury in the United States  in
terms   of   the  medical  resources  used  for  the  care,   treatment,   and
rehabilitation of injured persons;  life years lost* due to short-  and  long-
term  disability  and  premature death;  and pain and suffering of the injured
persons, their families, and their friends. This article summarizes the report
(Cost of Injury in the United States) submitted to Congress  in  October  1989
(1).
    The report estimates the lifetime economic cost for injuries that occurred
in  the United States in 1985.  This estimate reflects the incidence of injury
by patient age,  sex,  and major cause categories,  as well as indicators  for
injury severity,  i.e.,  death, hospitalization, medical attention outside the
hospital,  and restricted activity for greater than or equal  to  1  day.  The
lifetime  economic  cost  reflects  the  direct cost for medical treatment and
rehabilitation of patients injured in 1985 and the indirect  costs  associated
with  loss  of  earnings  due to short- and long-term disability and premature
death.
    Estimates of incidence and lifetime cost were based in part on  data  from
CDC's National Center for Health Statistics,  including the National Mortality
Detail File,  National Health Interview Survey,  National  Hospital  Discharge
Survey, National Medical Care Utilization and Expenditure Survey, and National
Nursing  Home  Survey.  Other  data  sources  included the National Council on
Compensation Insurance  Detailed  Claim  Information  Database,  Maryland  and
California  statewide  hospital discharge abstract data,  and information from
smaller studies.
    In 1985,  approximately 57 million persons  were  injured  in  the  United
States  at a lifetime cost to the nation of $157.6 billion.  {*filter*}s aged 25-44
years accounted for the greatest number of injuries and for 42% of  the  total
cost.  Injury to persons aged 15-24 years ranked second, accounting for 25% of
the total cost (Table 1).
    The greatest lifetime economic losses (in billions of dollars) were caused
by motor vehicles ($48.7); falls ($37.3); firearms ($14.4); poisonings ($8.5);
fire and burns ($3.8);  and drownings and near  drownings  ($2.5)  (Table  2).
Injuries  from  all  other  causes  (e.g.,  cutting  and piercing instruments,
railway and air transportation crashes,  suffocations,  and trauma from  blunt
objects) resulted in $42.4 billion in lifetime costs (Table 2).
    As  a  result  of  injuries  that  occurred in 1985,  155,665 persons died
(142,568 deaths in 1985 and 13,097 deaths in subsequent years).  An additional
2.3 million Americans were hospitalized for their injuries, while 54.4 million
were treated outside the hospital for injuries or required restricted activity
for greater than or equal to 1 day.
    Direct  personal  medical and nonmedical costs of care for injured persons
were $44.8 billion,  of which $24.5  billion  (55%)  was  for  hospital  care,
including  rehabilitation  and  the  cost of professional services provided to
hospitalized patients.  Physician visits outside of hospitals  ($6.5  billion)
and  nursing-home care ($2.5 billion) were the second and third highest direct
cost expenditures.
    In 1985, morbidity losses included 5.1 million productive life years**, or
9 life years lost per 100 injured persons.  These losses represented a cost of
$64.9  billion,  or  $1145  per injured person.  Injury fatalities resulted in
losses of 5.3 million life years and $47.9 billion.
    Private sources (e.g.,  private health insurance,  workers'  compensation,
uninsured  care)  paid  approximately  72% of the direct cost;  public sources

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Volume  2, Number 41                                      November  8, 1989

(federal, state, and local governments) accounted for 28%.  Medicare and other
public  sources  paid 72% of the direct costs for injured persons aged greater
than or equal to 65 years.  For injured  persons  aged  less  than  65  years,
however,  private  health  insurance  and  other private funds paid 85% of the
direct costs.

Reported by:  DP Rice, PhD, SR Kaufman, PhD, E McLoughlin,  ScD,  W Max,  PhD,
Institute  for  Health  and  Aging,  Univ  of  California,  San Francisco.  EJ
MacKenzie, PhD, GS Smith, PhD, DS Salkever, PhD, GV deLissovoy, PhD, AS Jones,
MPH, Injury Prevention Center,  Johns Hopkins Univ,  Baltimore,  Maryland.  TR
Miller,  PhD,  Urban Institute,  Washington,  DC.  LS Robertson,  PhD,  Nanlee
Research,  Branford,  Connecticut.  BM Faigin,  Office of Regulatory Analysis,
National   Highway   Traffic   Safety   Administration,   US   Department   of
Transportation.   Div  of  Injury  Epidemiology  and   Control,   Center   for
Environmental Health and Injury Control, CDC.

Editorial  Note:  In  1985  and  1988,  the National Academy of Sciences (NAS)
recommended as a high priority research on the  prevention  and  treatment  of
injuries  and the rehabilitation of injured persons (2,3).  Although injury is
the fourth leading cause of death in the United  States,  productivity  losses
are  greater  from  injury than from the three other leading causes of death--
heart disease, stroke, and cancer.  Injury causes 36 life years lost per death
compared  with  12  years  from heart disease and stroke combined and 16 years
from cancer.
    The large number of premature deaths and disabilities due  to  injury  and
the  accompanying  high  economic cost,  including public-sector expenditures,
emphasize the need to reduce the  burden  of  injury  in  the  United  States.
Implementation  of known injury-control interventions can substantially reduce
the incidence, severity, and accompanying cost of injury.
    The report to Congress  provides  recommendations  in  four  major  areas:
injury  prevention and control,  methods for collecting injury data,  types of
data needed,  and treatment  and  rehabilitation.  Data  needs  include  1)  a
national  coordinated  program of injury surveillance for rapid identification
and control of specific injuries;  2) longitudinal studies  to  determine  the
short-  and  long-term  consequences  of  injuries for individuals,  families,
friends, communities, and society; 3) improved and more timely data on cost of
injury; and 4) reliable data on occupational injuries (4).
    Single copies of Cost of Injury in the United States  are  available  from
the  Division  of  Injury  Epidemiology and Control,  Center for Environmental
Health and Injury Control, CDC, Mailstop F-36, Atlanta, GA 30333.

References

1.  Rice DP,  MacKenzie EJ,  Jones AS,  et al.  Cost of injury in  the  United
States:  a report to Congress.  San Francisco: Institute for Health and Aging,
University of California;  Injury Prevention Center, Johns Hopkins University,
1989.

2.  Committee  on  Trauma  Research,  Commission  on  Life Sciences,  National
Research Council,  Institute of Medicine.  Injury  in  America:  a  continuing
public health problem. Washington, DC: National Academy Press, 1985.

3.  Committee  to Review the Status and Progress of the Injury Control Program
at the Centers for Disease Control.  Injury control.  Washington, DC: National
Academy Press, 1988.

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Volume  2, Number 41                                      November  8, 1989

4.   National  Research  Council.  Counting  injuries  and  illnesses  in  the
workplace:  proposals for better systems.  Washington,  DC:  National  Academy
Press, 1987.

 *Based on number of years of life expectancy remaining at death (1).

 **Derived  from  the  number  of years lost from work by employed persons and
from performance of housekeeping services by those who perform them  as  their
major activity.

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Volume  2, Number 41                                      November  8, 1989

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                                  Dental News
:::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::

               Dental News from the American Dental Association

                          U.S. AIDS cases top l00,000

Since June l98l when  the  first  cases  of  AIDS  were  reported,  state  and
territorial  health  departments  have  reported greater than l00,000 cases of
AIDS and greater than 59,000 AIDS-related deaths to the  Centers  for  Disease
Control.
    AIDS is now a major cause of morbidity and mortality in children and young
{*filter*}s  in  the  U.S.,  ranking l5th among leading causes of death in l988 and
seventh among estimated years of potential life lost before age 65 in l987.
    Although {*filter*}/{*filter*} men still  account  for  most  reported  AIDS
cases,  I.V.  drug  users,  their sex partners and their children represent an
increasing proportion of all cases.  The proportion of AIDS cases among  women
also  has increased from 7 percent of cases reported before l985 to ll percent
of cases reported in the first six months of l989.
    The l00,000 AIDS cases reported in the U.S.  as of July l989 represent the
minimum  number  of  persons  with  severe human immunodeficiency virus (HIV)-
related  disease.   Because  of  the   combination   of   underdiagnosis   and
underreporting  of  AIDS  cases  and  severe  manifestations of HIV infection,
reported AIDS cases underestimate the number of persons severely  affected  by
HIV since l98l.
    The  number of AIDS cases are one indication of the larger epidemic of HIV
infection.  An estimated l-l.5 million persons are affected with  HIV  in  the
U.S.,  according  to  the  CDC.  A  study  of  {*filter*}/{*filter*}  men in San
Francisco suggests that 54 percent  of  infected  persons  will  develop  AIDS
within l0 years of infection and that up to 99 percent will eventually develop
AIDS.  AIDS research programs established

Eigh{*filter*}  AIDS  treatment research programs based in the communities where the
impact of  the  AIDS  epidemic  is  severe,  will  be  established,  the  U.S.
Department of Health and Human Services announced.
    The  new  Community Programs for Clinical Research on AIDS will receive $9
million from the National Institute of Allergy and  Infectious  Diseases.  The
programs  will  enlist  many  community-based physicians and their patients in
studies of AIDS {*filter*} and will serve many people who, until now, have not been
included  in  clinical  trials  of  promising  experimental  AIDS   therapies,
including blacks, HIspanics, women and IV drug users.
    Doctors  in private practice,  community hospitals and at large inner-city
hospitals will be involved.
    Until now, federally-funded clinical trials of experimental AIDS therapies
have been conducted by investigators at the National Institutes of  Health  or
at 46 university-based research hospitals.  Safer transfusions predicted

The  odds  of  getting  an  AIDS  infection from a {*filter*} transfusion were l in
28,000 two years ago,  and the risk is dropping more than 30 percent  a  year.
This  results  from fewer AIDS carriers donating {*filter*},  an American Red Cross
study reported in the New England Journal of Medicine found.
    The {*filter*} supply is probably safer now than it has ever  been,  the  study
concludes.  But  another  report in the journal warns that some people at high
risk still donate {*filter*}, despite appeals to refrain.

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Volume  2, Number 41                                      November  8, 1989

    A third study reported that more than 95 percent  of  people  who  receive
AIDS-tainted  transfusions  become  infected,  and  half  of them develop AIDS
within seven years.
    The research shows that in general women are safer donors  than  men.  The
riskiest  {*filter*}  is  from  men  making donations for the first time,  and some
people still give simply to learn whether they are infected.
    Based on data from  l7  million  Red  Cross  donations,  the  organization
estimated  that  in  l987 l3l units of AIDS-contaminated {*filter*} were transfused
throughout the U.S.  despite screening efforts.  They estimate that the number
of infectious units fell to 87 in l988.
    Only l4 clear-cut cases of transfusion-associated AIDS have been  reported
to  the  U.S.  Centers for Disease Control since widespread screening of {*filter*}
began in l985.
    The Red Cross said one way of further reducing the  already-slim  risk  of
AIDS-infected  {*filter*}  is  to  recruit  and  keep female donors.  Another is to
emphasize frequent donations by already tested donors rather  than  attracting
new donors.

                            Cigarette smoking down

Both  the  average  smoking  rate among Americans and cigarette production are
declining this year -- for the l6th consecutive year,  according to  the  U.S.
Agriculture Department.
    Cigarette  use  per  person  may  drop  from  last year's average of 3,096
cigarettes, or fewer than l55 packs of 20 each,  a 3.5 percent reduction,  the
report predicted.
    Total  production  is  expected  to  drop  from  last  year's  695 billion
cigarettes due to higher prices, health concerns and smoking restrictions, the
department's Economic Research Service noted in its report.
    The decline in consumption  has  followed  increased  warnings  about  the
dangers  of  smoking.  Public  health  officials have described smoking as the
most common cause of preventable death in the U.S.,  killing more than 300,000
Americans  a  year  from  lung  cancer,  emphysema,  heart  attacks  and other
diseases.

                       Successful fluoridation campaigns

Aided by efforts of the ADA,  the following cities  have  enacted  legislation
relating to water fluoridation.

                                  Phoenix, AZ

The  Phoenix  City  Council  passed  a  fluoridation  resolution  in  favor of
adjusting the natural fluoride level of the city's water supply to an  optimum
level.  The  water  supply  serves  a  population of approximately one million
people residing  in  Phoenix  and  sections  of  Scottsdale  and  Mesa.  These
residents,  many  of  whom  supported the efforts of the "Arizona Citizens for
Better Dental Health Coalition," are expected to reap the dental  benefits  of
water fluoridation by the summer of l990.
    Phoenix  is  the 42nd city,  out of the 50 largest cities in the U.S.,  to
enact fluoridation legislation.  As a result of  the  Phoenix  City  Council's
decision,  several  other  Arizona  communities (Peoria and Chandler) are also
considering  fluoridation.   Glendale's  City  Council  voted  unanimously  to
fluoridate their water system, serving a population of l40,000.  Broken Arrow,
OK  The  citizens  of  Broken Arrow voted 68 percent in favor of fluoridation,

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Volume  2, Number 41                                      November  8, 1989

largely due to the perseverance of the fluoridation committee of the  Oklahoma
Dental  Association  and  the Tulsa Dental Society.  Broken Arrow relinquished
its status as the largest non-fluoridated city  in  Oklahoma.  Aspen,  CO  The
citizens  of  Aspen voted 77 percent in favor of maintaining fluoride in their
water system,  thanks in part to efforts of  the  pro-fluoridation  committee,
headed by two dentists.

                           Dental students satisfied

Today's  dental students are more satisfied with their education than students
30 years ago,  according to a  report  in  the  September  Journal  of  Dental
Education.
    Dental students who graduated in spring l989 were asked the same questions
as dental students who graduated in l959.  Compared with their counterparts 30
years ago, the l989 seniors: o found the dental curriculum more intellectually
challenging;  o  experienced slightly more pressure while in dental school;  o
studied harder;  o were more  satisfied  with  their  dental  education,  when
compared  with  their  undergraduate  education;  o in greater numbers,  rated
aspects of their dental  education  as  "excellent";  o  in  smaller  numbers,
identified  aspects  of  their  education  as  "needing  improvement";  and  o
generally believed they had a better  understanding  of  selected  aspects  of
dentistry.

                           Treatment for xerostomia

Pilocarpine,  a  drug used in prescription eye drops,  is a safe and effective
treatment for xerostomia,  according to results  of  clinical  trials  at  the
National Institute of Dental Research (NIDR).
    In the six-month clinical trial,  pilocarpine taken orally three times per
day in 5 mg capsules measurably increased salivary secretions in 20 of the  3l
xerostomia  patients  studied.  Subjective  improvement in their condition was
reported by 27 of the participants.  Side  effects  from  the  medicaton  were
minimal  and  included increased sweating,  flushing of the skin and increased
urination.
    Pilocarpine is an alkaloid extracted from  the  South  American  jaborandi
plant.  Its  effects  have  been recognized for over l00 years and it has long
been used in prescription eye drops to contract pupils.
    According to the study,  pilocarpine  is  more  beneficial  to  xerostomia
patients  than  artificial  saliva products because it actually stimulates the
salivary glands.  Consequently,  it can only be used with  patients  who  have
some salivary gland function.

                          Year 2000 health objectives

More  than  300  national  organizations  and  state  and  territorial  health
departments formed a consortium to develop national health objectives for  the
year 2000.
    A draft of the publication Promoting Health/Preventing Disease:  Year 2000
Objectives for the Nation proposes  five  specific,  measurable  goals  in  21
priority areas to achieve by the year 2000:

1.  Reduce  infant mortality to no more than seven deaths per l000 live births
(baseline: l0.4 per l000 in l986).

2.  Increase life expectancy to at least 78 years  (baseline:  74.9  years  in

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Volume  2, Number 41                                      November  8, 1989

l987).

3.  Reduce  disability caused by chronic conditions to a prevalence of no more
than 6 percent of all persons (age-adjusted baseline: 8.9 percent).

4.  Increase years of  healthy  life  to  at  least  65  years  (baseline:  an
estimated 60 years in l987).

5.   Decrease   disparity  in  life  expectancy  between  white  and  minority
populations to no more than 4 years (baseline: 5.8 years in l987).

    The draft  contains  339  objectives  characterized  by  l)  an  increased
emphasis  on  prevention of disability and morbidity,  2) greater attention to
improvements in the health status of  specific  groups  at  highest  risk  for
premature  death,  disease and disability,  and 3) inclusion of more screening
interventions to detect asymptomatic diseases and conditions early  enough  to
prevent early death or disability.

Health InfoCom Network News                                             Page 18

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