Basic social resource needs screening in the gynecologic oncology clinic: a quality improvement initiative

BACKGROUND

Social determinants of health are known to contribute to disparities in health outcomes. Routine screening for basic social needs is not a part of standard care; however, the association of those needs with increased healthcare utilization and poor compliance with guideline-directed care is well established.

OBJECTIVE

In this study, we aimed to assess the prevalence of basic social resource needs identified through a quality improvement initiative in a gynecologic oncology outpatient clinic. In addition, we aimed to identify clinical and demographic factors associated with having basic social resource needs.

STUDY DESIGN

We performed a prospective cohort study of women presenting to a gynecologic oncology clinic at an urban academic institution who were screened for basic social resource needs as part of a quality improvement initiative from July 2017 to May 2018. The following 8 domains of resource needs were assessed: food insecurity, housing insecurity, utility needs, financial strain, transportation, childcare, household items, and difficulty reading hospital materials. Women with needs were referred to resources to address those needs. Demographic and clinical information were collected for each patient. The prevalence of needs and successful follow-up interventions were calculated. Patient factors independently associated with having at least 1 basic social resource need were identified using multivariable Poisson regression.

RESULTS

A total of 752 women were screened in the study period, of whom 274 (36%) reported 1 or more basic social resource need, with a median of 1 (range, 1-7) need. Financial strain was the most commonly reported need (171 of 752, 23%), followed by transportation (119 of 752, 16%), difficulty reading hospital materials (54 of 752, 7%), housing insecurity (31 of 752, 4%), food insecurity (28 of 752, 4%), household items (22 of 752, 3%), childcare (15 of 752, 2%), and utility needs (13 of 752, 2%). On multivariable analysis, independent factors associated with having at least 1 basic social resource need were being single, divorced or widowed, nonwhite race, current smoker, nonprivate insurance, and a history of anxiety or depression. A total of 36 of 274 (13%) women who screened positive requested assistance and were referred to resources to address those needs. Of the 36 women, 25 (69%) successfully accessed a resource or felt equipped to address their needs, 9 (25%) could not be reached despite repeated attempts, and 2 (6%) declined assistance.

CONCLUSION

Basic social resource needs are prevalent in women presenting to an urban academic gynecologic oncology clinic and can be identified and addressed through routine screening. To help mitigate ongoing disparities in this population, screening for and addressing basic social resource needs should be incorporated into routine comprehensive care in gynecologic oncology clinics.

Current management of household hazardous waste (HHW) in the Asian region

Background This review intends to explore the household hazardous waste (HHW) generation rates, HHW management, and people's awareness regarding HHW in Asian countries based on the economic levels using the available published articles. Methods This is a systematic review of the scientific literature based on several databases, namely Scopus, ProQuest, PubMed, Sage Journals, and Elsevier's Science Direct from 2008 to 2018. Results HHW generation rates in various Asian cities do not seem to be influenced by the countries' financial status, except for e-waste. The variety in HHW generation rates among Asian countries might be due to various reasons, which include differences in (1) sampling frame/locations; (2) sampling size; (3) study duration; (4) seasons; (5) study year; and (6) HHW definition/composition. Governmental intervention programs on HHW management have been implemented in some of the Asian countries, mostly in high and upper-middle income groups although misconducts are still found. There is a tendency for economically developed countries to ship their e-waste to less-developed countries, where the system relies heavily on the informal sectors where unsafe treatments are often discovered. Low level of awareness regarding HHW risks is mostly identified in the lower-middle income group. However, even though high and upper-middle income groups have a better awareness of HHW, many people do not entirely follow the recommended practices. Conclusion The lack of enforced regulation and proper treatment infrastructure may lead to HHW being mixed with general household waste, which is found in many Asian countries, despite their income levels. In addition, a good awareness of HHW does not guarantee proper handling of it.

Household biogas digesters or medium-large-scale biogas plants: a conflicting issue in rural China

There has been a conflicting issue in rural China that whether or not encouraging the development of medium-large-scale biogas plants (MLBPs) to reduce household biogas digesters (HBDs) will be better for China in the long run. In this study, we investigate the difference between HBD users and MLBP users and the factors that affect the biogas use of these two user types on the basis of a survey of 1125 households in four provinces in China. The results indicate that compared to HBD users, MLBP users have a higher ratio (29%) of biogas use, obtain a higher subsidy-to-cost ratio (25%), and present a more positive evaluation of biogas service (3%). For HBD users, installation years and service evaluation are significant predictors of biogas use. For MLBP users, in addition to installation years and service, the subsidy-to-cost ratio affects biogas use negatively, and the biogas price is a key constraint for biogas use. These results provide valuable insights into the future development of biogas energy in rural China and guidance for the development of biogas in similar countries worldwide.

Environmental characteristics and taxonomy of microscopic fungi isolated from washing machines

Washing machines (WMs) are convenient places for fungal colonization. This study is focused on fungal diversity of WMs, and investigates relationships between habits of WM users and colonising species. Housekeeping conditions and habits were assessed in Hungary with a questionnaire. Several fungal species were identified by microscopy and sequence analysis of diagnostic loci. Based on the results, 32 % of the sampled WMs were highly polluted with various species of fungi. Forty six percent of them were colonised also by opportunistically human pathogenic species. In total, 32 yeast and 39 filamentous fungal strains were isolated. Growth tests were conducted with five selected taxa (Cutaneotrichosporon dermatis, Cystobasidium slooffiae, Meyerozyma guilliermondii, Candida parapsilosis and the Fusarium oxysporum species complex (FOSC)) to ascertain their tolerance ranges. None of the examined isolates were able to grow >50 °C, 4.10 < pH < 10.88. FOSC could grow at high salinity. More species were detected in WMs operated in rooms without heating systems (p = 0.0025). The number of species was higher in WMs located in the kitchen than the ones kept in bathroom or in other rooms (p = 0.0205). WMs may serve as a reservoir of pathogenic fungi, the presence of which may depend on the usage of these devices.

Traditional cooking practices and preferences for stove features among women in rural Senegal: Informing improved cookstove design and interventions

Nearly half the world’s population burns solid fuel for cooking, heating, and lighting. The incomplete combustion of these fuels is associated with detrimental health and environmental effects. The design and distribution of improved cookstoves that increase combustion efficiency and reduce indoor air pollution are a global priority. However, promoting exclusive and sustainable use of the improved stoves has proved challenging. In 2012, we conducted a survey in a community in rural Senegal to describe stove ownership and preferences for different stove technologies. This report aims to describe local stove and fuel use, to identify household preferences related to stove features and function, and to elicit the community perceptions of cleaner-burning stove alternatives with a focus on liquid propane gas. Similar to many resource-limited settings, biomass fuel use was ubiquitous and multiple stoves were used, even when cleaner burning alternatives were available; less than 1% of households that owned a liquid propane stove used it as the primary cooking device. Despite nearly universal use of the traditional open fire (92% of households), women did not prefer this stove when presented with other options. Propane gas, solar, and improved cookstoves were all viewed as more desirable when compared to the traditional open fire, however first-hand experience and knowledge of these stoves was limited. The stove features of greatest value were, in order: large cooking capacity, minimal smoke production, and rapid heating. Despite the low desirability and smoke emisions from the traditional open fire, its pervasive use, even in the presence of alternative stove options, may be related to its ability to satisfy the practical needs of the surveyed cooks, namely large cooking capacity and rapid, intense heat generation. Our data suggest women in this community want alternative stove options that reduce smoke exposure, however currently available stoves, including liquid propane gas, do not address all of the cooks’ preferences.

Incidence, Distribution, and Cost of Lawn-Mower Injuries in the United States, 2006-2013

OBJECTIVES

Characterization of the epidemiology and cost of lawn-mower injuries is potentially useful to inform injury prevention and health policy efforts. We examined the incidence, distribution, types and severity, and emergency department (ED) and hospitalization charges of lawn-mower injuries among all age groups across the United States.

METHODS

This retrospective, cross-sectional study used nationally representative, population-based (all-payer) data from the US Nationwide Emergency Department Sample for lawn-mower-related ED visits and hospitalizations from January 1, 2006, through December 31, 2013. Lawn-mower injuries were identified by using International Classification of Diseases, Ninth Revision, Clinical Modification code E920 (accidents caused by a powered lawn mower). We analyzed data on demographic characteristics, age, geographic distribution, type of injury, injury severity, and hospital charges.

RESULTS

We calculated a weighted estimate of 51 151 lawn-mower injuries during the 8-year study period. The most common types of injuries were lacerations (n = 23 907, 46.7%), fractures (n = 11 433, 22.4%), and amputations (n = 11 013, 21.5%). The most common injury locations were wrist or hand (n = 33 477, 65.4%) and foot or toe (n = 10 122, 19.8%). Mean ED charges were $2482 per patient, and mean inpatient charges were $36 987 per patient. The most common procedures performed were wound irrigation or debridement (n = 1436, 29.9%) and amputation (n = 1230, 25.6%).

CONCLUSIONS

Lawn-mower injuries occurred at a constant rate during the study period. Changes to nationwide industry safety standards are needed to reduce the frequency and severity of these preventable injuries.

Comfort, Energy Efficiency and Adoption of Personal Cooling Systems in Warm Environments: A Field Experimental Study

It is well known that personal cooling improves thermal comfort and save energy. This study aims to: (1) compare different personal cooling systems and (2) understand what influences users' willingness to adopt them. A series of experiments on several types of personal cooling systems, which included physical measurements, questionnaires and feedback, was conducted in a real office environment. The obtained results showed that personal cooling improved comfort of participants in warm environments. Then an improved index was proposed and used to compare different types of personal cooling systems in terms of comfort and energy efficiency simultaneously. According to the improved index, desk fans were highly energy-efficient, while the hybrid personal cooling (the combination of radiant cooling desk and desk fan) consumed more energy but showed advantages of extending the comfortable temperature range. Moreover, if personal cooling was free, most participants were willing to adopt it and the effectiveness was the main factor influencing their willingness, whereas if participants had to pay, they probably refused to adopt it due to the cost and the availability of conventional air conditioners. Thus, providing effective and free personal cooling systems should be regarded as a better way for its wider application.

After 10 years, how do changes in asset ownership affect the Indicador Econômico Nacional?

OBJECTIVE

Our main objective was to analyse how the evolution of household assets ownership affected the Indicador Econômico Nacional (IEN - National Wealth index) and to point out the most stable assets and which lost importance more quickly.

METHODS

We analysed the trend of the ownership of each IEN variable and the distribution of the households' scores. We calculated the correlation coefficients of each variable separately with the IEN score and the household income. We also evaluated how the changes of the score distribution over time affected the validity of the published reference cut-points. We used data from consortium surveys conducted every two years from 2002 to 2014 in the city of Pelotas, Brazil.

RESULTS

An increase in the educational level of household heads and in the ownership of all IEN assets, except radio and telephone, was observed in the study period. In general, the correlation of the assets with the IEN scores decreased over time. There was an increase in the score, with a consequent increase in the quintiles cut-points, but the distance between these cut-points had no significant variation. Thus, the reference cut-points for Pelotas, quickly became outdated.

CONCLUSIONS

Some assets showed greatly reduction on its importance for the indicator, and the reference cut-points became obsolete very quickly. It is essential for a standardized wealth (or asset) index with research purposes to be updated frequently, especially the cut-points of reference distribution.

OBJETIVO

Analisar como a evolução temporal da posse de bens domésticos afetou o Indicador Econômico Nacional e como essas mudanças afetaram o poder discriminatório do indicador.

MÉTODOS

Analisou-se a evolução temporal da posse de cada uma das variáveis do Indicador Econômico Nacional, bem como da distribuição do escore dos domicílios. Utilizamos dados de inquéritos populacionais realizados bienalmente no município de Pelotas, RS, de 2002 a 2014. Foi calculado o coeficiente de correlação de cada variável isoladamente com o escore do Indicador Econômico Nacional e com a renda familiar. Avaliamos também como a variação da distribuição do escore ao longo do tempo afetou a validade da utilização dos pontos de corte de referência publicados.

RESULTADOS

Houve aumento da escolaridade dos chefes das famílias e da posse de todos os bens, exceto rádio e linha telefônica no período. A correlação dos bens com o Indicador Econômico Nacional reduziu com o tempo. O escore aumentou, com consequente incremento nos pontos de corte dos quintis, mas a distância entre os pontos não teve variação importante. Assim, os pontos de corte de referência publicados para Pelotas rapidamente ficaram desatualizados.

CONCLUSÕES

Alguns bens perderam a capacidade discriminatória e os pontos de corte ficaram obsoletos rapidamente. É essencial um indicador de bens padronizado para uso em pesquisa, que seja atualizado com frequência, em especial os pontos de corte da distribuição de referência.

Disassembly properties and material characterisation of household small waste electric and electronic equipment

This paper is focused on characterising small waste electric and electronic equipment, specifically small household appliances, from two different points of views: disassembly properties and material identification. The sample for this characterisation was obtained from a selective collection campaign organised in Castellón de la Plana (Spain). A total amount of 833.7kg (749 units) of small waste electric and electronic equipment was collected, of which 23.3% by weight and 22.4% by units belonged to the subcategory household equipment. This subcategory, composed of appliances such as vacuum cleaners, toasters, sandwich makers, hand blenders, juicers, coffee makers, hairdryers, scales, irons and heaters, was first disassembled in order to analyse different aspects of the disassembly process for each equipment type: type of joints, ease of identification of materials, ease of access to joints for extracting components, ease of separation of components from the whole, uniformity of tools needed for the disassembly process and possibility of reassembly after disassembly. Results show that the most common joints used in these equipment types are snap-fits and screws, although some permanent joints have also been identified. Next, the material composition of each component of each appliance belonging to each equipment type was identified visually and with additional mechanical trials and testing. It can be observed that plastic and electric/electronic components are present in all the equipment types analysed and are also the material fractions that appear with higher percentages in the material composition: 41.1wt% and 39.1wt% for the plastic fraction and electric/electronic components, respectively. The most common plastics are: polypropylene (PP), acrylonitrile butadiene styrene (ABS) and polycarbonate (PC), while the most common electric/electronic components are: cable, plug and printed circuit boards. Results also show that disassembly properties and material characterisation vary widely from one equipment type to another.

Potential reuse of small household waste electrical and electronic equipment: Methodology and case study

This study proposes a general methodology for assessing and estimating the potential reuse of small waste electrical and electronic equipment (sWEEE), focusing on devices classified as domestic appliances. Specific tests for visual inspection, function and safety have been defined for ten different types of household appliances (vacuum cleaner, iron, microwave, toaster, sandwich maker, hand blender, juicer, boiler, heater and hair dryer). After applying the tests, reuse protocols have been defined in the form of easy-to-apply checklists for each of the ten types of appliance evaluated. This methodology could be useful for reuse enterprises, since there is a lack of specific protocols, adapted to each type of appliance, to test its potential of reuse. After applying the methodology, electrical and electronic appliances (used or waste) can be segregated into three categories: the appliance works properly and can be classified as direct reuse (items can be used by a second consumer without prior repair operations), the appliance requires a later evaluation of its potential refurbishment and repair (restoration of products to working order, although with possible loss of quality) or the appliance needs to be finally discarded from the reuse process and goes directly to a recycling process. Results after applying the methodology to a sample of 87.7kg (96 units) show that 30.2% of the appliances have no potential for reuse and should be diverted for recycling, while 67.7% require a subsequent evaluation of their potential refurbishment and repair, and only 2.1% of them could be directly reused with minor cleaning operations. This study represents a first approach to the "preparation for reuse" strategy that the European Directive related to Waste Electrical and Electronic Equipment encourages to be applied. However, more research needs to be done as an extension of this study, mainly related to the identification of the feasibility of repair or refurbishment operations.

Mutagenicity and Pollutant Emission Factors of Solid-Fuel Cookstoves: Comparison with Other Combustion Sources

BACKGROUND

Emissions from solid fuels used for cooking cause ~4 million premature deaths per year. Advanced solid-fuel cookstoves are a potential solution, but they should be assessed by appropriate performance indicators, including biological effects.

OBJECTIVE

We evaluated two categories of solid-fuel cookstoves for eight pollutant and four mutagenicity emission factors, correlated the mutagenicity emission factors, and compared them to those of other combustion emissions.

METHODS

We burned red oak in a 3-stone fire (TSF), a natural-draft stove (NDS), and a forced-draft stove (FDS), and we combusted propane as a liquified petroleum gas control fuel. We determined emission factors based on useful energy (megajoules delivered, MJd) for carbon monoxide, nitrogen oxides (NOx), black carbon, methane, total hydrocarbons, 32 polycyclic aromatic hydrocarbons, PM2.5, levoglucosan (a wood-smoke marker), and mutagenicity in Salmonella.

RESULTS

With the exception of NOx, the emission factors per MJd were highly correlated (r ≥ 0.97); the correlation for NOx with the other emission factors was 0.58-0.76. Excluding NOx, the NDS and FDS reduced the emission factors an average of 68 and 92%, respectively, relative to the TSF. Nevertheless, the mutagenicity emission factor based on fuel energy used (MJthermal) for the most efficient stove (FDS) was between those of a large diesel bus engine and a small diesel generator.

CONCLUSIONS

Both mutagenicity and pollutant emission factors may be informative for characterizing cookstove performance. However, mutagenicity emission factors may be especially useful for characterizing potential health effects and should be evaluated in relation to health outcomes in future research. An FDS operated as intended by the manufacturer is safer than a TSF, but without adequate ventilation, it will still result in poor indoor air quality.

CITATION

Mutlu E, Warren SH, Ebersviller SM, Kooter IM, Schmid JE, Dye JA, Linak WP, Gilmour MI, Jetter JJ, Higuchi M, DeMarini DM. 2016. Mutagenicity and pollutant emission factors of solid-fuel cookstoves: comparison with other combustion sources. Environ Health Perspect 124:974-982; http://dx.doi.org/10.1289/ehp.1509852.

Bed Bugs: Prevalence in Low-Income Communities, Resident's Reactions, and Implementation of a Low-Cost Inspection Protocol

We examined bed bug prevalence in 2,372 low-income apartments within 43 buildings in four New Jersey cities using a combination of resident interviews, brief visual inspections, and monitoring with Climbup Insect Interceptors. Infestation rates ranged from 3.8 to 29.5% among the buildings, with an overall infestation rate of 12.3%. Within each apartment, the bed area trapped significantly more bed bugs per trap than the sofa (or upholstered chair) area. African American residents had a proportionally higher number of bed bug infestations than white residents. Women were more likely to report bed bug bite symptoms than men. Only 68% of the residents who experienced bed bug infestations reported symptoms after being bitten (n = 475). Among those with self-reported symptoms (n = 319), the frequency of the reported symptoms was: pain 90%, itchiness 20%, welts 13%, and insomnia 8%. Fifty-nine percent of the residents (n = 539) who experienced bed bug infestations applied insecticides to control bed bugs. Climbup interceptors detected 89 ± 1% and brief visual inspections detected 72 ± 3% of the infestations. Only two out of 291 infestations were not detected by brief visual inspection or interceptors. Assuming US$50 per hour labor rate, the average per apartment cost for the building-wide bed bug monitoring protocol was US$12 per apartment. Forty-nine percent of the infestations detected by the protocol were in apartments whose residents were unaware of the bed bug activity.

[Control of Aedes aegypti breeding sites with the program Recicla por tu bienestar in Merida, Mexico]

OBJECTIVES

To determine the importance of Ae. aegypti breeding-sites in Merida;to evaluate the impact of Recicla por tu bienestar (RxB, a recycling program) on the reduction of breeding sites and the perception of participants.

MATERIALS AND METHODS

The relative importance for pupae production of the different types of breeding-sites was determined. Pre-and post-RxB entomological surveys were performed in participant neighborhoods to evaluate the impact on total containers and positive breeding-sites. A survey on the perception of participating people about dengue prevention and control and RxB was applied.

RESULTS

Buckets/pots and "small diverse items" were the most important breeding-sites. RxB had a significant impact in the reduction of total containers (IRR = 0.74), positive containers (IRR = 0.33) and the risk of a house being positive for Ae. aegypti (OR = 0.41). All the interviewed participants referred RxB as needed and most consider it useful.

CONCLUSIONS

RxB should be considered as a good practice for the dengue vector control.

The impact of Local Authorities' interventions on household waste collection: a case study approach using time series modelling

At a local Government level there have been many interventions and changes made to household waste collection services to meet new regulatory requirements. These changes include separate collection of recyclable and organic materials. This paper has used a time series model to quantify the success of interventions introduced by a LA. The case study was a medium sized UK LA, Charnwood Borough Council (CBC), the research analyses monthly data of quantities of recyclates, garden waste for composting and residual waste for landfill disposal. The time series model was validated with a five year data set and used to measure the impacts of the various changes to identify which intervention was the most successful, while controlling for season and number of working days. The results show the interventions analysed both had abrupt and permanent positive impacts on the yield of recyclable materials, and a corresponding negative impact on the residual waste. The model could be added to the National data base to help LAs to compare interventions and to understand which schemes encourage householder participation and improve recycling performance.

Municipal-level covariates of health status in Brazil: a proposed method for data interpolation

OBJECTIVE

To propose a method for the interpolation of yearly local-level covariates of health status that is suitable for panel data analysis of the effect of health services.

METHODS

The proposed method distributes the yearly rate of growth of covariates at the regional level (e.g., state) from household survey data, and applies it to interpolate yearly data at the local level (e.g., municipality) between two consecutive census surveys. The method was applied to municipal-level socioeconomic covariates of health status in Brazil for every year between 2001 and 2009. The data was tested on a previously validated analysis of the effects of the Family Health Program on post-neonatal infant mortality in Brazil.

RESULTS

A total of 895 628 values were generated for 20 socioeconomic predictors of health status. Valid data were obtained for 5 057 municipalities in the Northeast, Southeast, South, and Center-West regions of Brazil, from 2001 to 2009, covering 98.89% of the municipalities in these regions and 90.87% of municipalities in the country. A supplemental annex includes the interpolated data from 2001 to 2009, plus the 2000 and 2010 census data, for all 5 057 municipalities. An application on a fixed-effect regression model suggested that, compared to linear interpolation, the proposed method reduced multi-collinearity and improved the precision of the estimates of the effects of health services.

CONCLUSIONS

The advantages of the proposed interpolation method suggest that it is a feasible solution for panel data analysis of health services at the local level in Brazil and other countries.

Diversity of containers and buildings infested with Aedes aegypti in Puerto Iguazú, Argentina

Aedes aegypti is the main domestic vector of the dengue virus. Control measures to prevent dengue transmission focus on the treatment and elimination of this vector's oviposition sites. There is limited biological information on Ae. aegypti in Argentina. The aim of this study was to characterize Ae. aegypti oviposition sites in the city of Puerto Iguazú, Argentina. We surveyed an area covering nine neighborhoods in 2005. We identified 191 premises as positive for Ae. aegypti, giving a general house index of 9.6%. Premises classified as residential and vacant lots presented the highest number of infested premises, with 9% and 22% respectively. The total number of surveyed containers was 29,600. The overall container index (CI) was 1.1. The most frequently infested containers were water tanks (CI = 37). These preliminary results suggest that vacant lots and water tanks provide suitable breeding areas and environmental conditions, improving the chances of Ae. aegypti survival in Puerto Iguazú.

Mercury risk from fluorescent lamps in China: current status and future perspective

Energy-efficient lighting is one of the key measures for addressing electric power shortages and climate change mitigation, and fluorescent lamps are expected to dominate the lighting market in China over the next several years. This review presents an overview on the emissions and risk of mercury from fluorescent lamps during production and disposal, and discusses measures for reducing the mercury risk through solid waste management and source reduction. Fluorescent lamps produced in China used to contain relatively large amounts of mercury (up to 40 mg per lamp) due to the prevalence of liquid mercury dosing, which also released significant amounts of mercury to the environment. Upgrade of the mercury dosing technologies and manufacturing facilities had significantly reduced the mercury contents in fluorescent lamps, with most of them containing less than 10 or 5mg per lamp now. Occupational hygiene studies showed that mercury emissions occurred during fluorescent lamp production, particularly in the facilities using liquid mercury dosing, which polluted the environmental media at and surrounding the production sites and posed chronic health risk to the workers by causing neuropsychological and motor impairments. It is estimated that spent fluorescent lamps account for approximately 20% of mercury input in the MSW in China. Even though recycling of fluorescent lamps presents an important opportunity to capture the mercury they contain, it is difficult and not cost-effective at reducing the mercury risk under the broader context of mercury pollution control in China. In light of the significant mercury emissions associated with electricity generation in China, we propose that reduction of mercury emissions and risk associated with fluorescent lamps should be achieved primarily through lowering their mercury contents by the manufacturers while recycling programs should focus on elemental mercury-containing waste products instead of fluorescent lamps to recapture mercury from the waste stream cost-effectively.

Usage monitoring of electrical devices in a smart home

Profiling the usage of electrical devices within a smart home can be used as a method for determining an occupant's activities of daily living. A nonintrusive load monitoring system monitors the electrical consumption at a single electrical source (e.g., main electric utility service entry) and the operating schedules of individual devices are determined by disaggregating the composite electrical consumption waveforms. An electrical device's load signature plays a key role in nonintrusive load monitoring systems. A load signature is the unique electrical behaviour of an individual device when it is in operation. This paper proposes a feature-based model, using the real power and reactive power as features for describing the load signatures of individual devices. Experimental results for single device recognition for 7 devices show that the proposed approach can achieve 100% classification accuracy with discriminant analysis using Mahalanobis distances.

Characterization of particle emission from household electrical appliances

The release of ultra-fine particles from equipment of daily use is currently a topic of high public concern. The present study reports on the measurement of 12 household appliances such as toasters, grills, and hair dryers in an emission test chamber regarding the release of particles between 5.6 and 560 nm. The devices were new at the time experiments started and had never been used for their original purpose. For instance, toasters and sandwich-makers were tested without the presence of food or residues from prior usage. During the experiments the devices released aerosols with count mean diameters mainly below 100 nm. Within the operating phase high quantities of 10 nm particles are released which form larger particles by agglomeration. The origin of the particles can be attributed to the heated surfaces but cleaning these surfaces only had a minor influence on the emission strength. The released particles are evaporated in a thermodenuder between 150 °C and 200 °C. These findings indicate the particles to be formed from semi-volatile organic compounds. However, the compounds are not located on the heated surfaces and are not released as supersaturated vapor because emission is continuous over the operating phase of the device. Furthermore, the contribution of oxygen to the formation process can be neglected because the emission can also be detected in a nitrogen atmosphere. However, the presence of additional organic compounds in the surrounding air was found to be influencing the growth of the particles within the operating phase. All in all the tested household appliances were strong particle emission sources even when there was no contact with food or clothing.

Pesticides on household surfaces may influence dietary intake of children

The physical and chemical environment influences children's exposures to pesticides in and around the home. Children's activities, which increase their potential for exposure especially during eating, have been captured in the Children's Dietary Intake Model (CDIM). In addition to the chemical exposure associated with the food itself, this model incorporates excess dietary exposures due to handling of food during consumption. To stochastically evaluate CDIM, distributions of measured, and in some cases estimated, model factors were determined from measurements of permethrin, chlorpyrifos, and diazinon derived from assembled databases and laboratory experiments. Using the distributions of these factors, Monte Carlo simulations were performed to obtain distributions of total dietary intake of pesticides. To target the sources of pesticide contamination that were influencing total dietary intake, each factor was evaluated. We found pesticide surface concentration to be highly influential. By excluding surface concentration, we were also able to determine the influence of the other factors based on the F-statistic. Transfer efficiencies, followed by pesticide residue in consumed foods and amount of food consumed, were the next most influential factors within the model. With these distributions for model inputs, CDIM has the potential to more accurately predict total dietary intake of a contaminant by a child.

Remanufacturing and energy savings

Remanufactured products that can substitute for new products are generally claimed to save energy. These claims are made from studies that look mainly at the differences in materials production and manufacturing. However, when the use phase is included, the situation can change radically. In this Article, 25 case studies for eight different product categories were studied, including: (1) furniture, (2) clothing, (3) computers, (4) electric motors, (5) tires, (6) appliances, (7) engines, and (8) toner cartridges. For most of these products, the use phase energy dominates that for materials production and manufacturing combined. As a result, small changes in use phase efficiency can overwhelm the claimed savings from materials production and manufacturing. These use phase energy changes are primarily due to efficiency improvements in new products, and efficiency degradation in remanufactured products. For those products with no, or an unchanging, use phase energy requirement, remanufacturing can save energy. For the 25 cases, we found that 8 cases clearly saved energy, 6 did not, and 11 were too close to call. In some cases, we could examine how the energy savings potential of remanufacturing has changed over time. Specifically, during times of significant improvements in energy efficiency, remanufacturing would often not save energy. A general design trend seems to be to add power to a previously unpowered product, and then to improve on the energy efficiency of the product over time. These trends tend to undermine the energy savings potential of remanufacturing.

An analysis of household waste management policy using system dynamics modelling

This paper analyses the Flemish household waste management policy. Based on historical data from the period 1991-2006, literature reviews and interviews, both mathematical and descriptive relationships are derived that describe Flemish waste collection, reuse, recycling and disposal behaviour. This provides insights into how gross domestic product (GDP), population and selective collection behaviour have influenced household waste production and collection over time. These relationships are used to model the dynamic relationships underlying household waste management in Flanders by using a system dynamics (SD) modelling approach. Where most SD models in literature are conceptual and descriptive, in the present study a real-life case with both correlational and descriptive relationships was modelled for Flanders, a European region with an outstanding waste management track record. This model was used to evaluate the current Flemish household waste management policy based on the principles of the waste hierarchy, also referred as the Lansink ranking. The results show that Flemish household waste targets up to 2015 can be achieved by the current waste policy measures. It also shows the sensitivity of some key policy parameters such as prevention and reuse. Given the general nature of the model and its limited data requirements, the authors believe that the approach implemented in this model can also assist waste policy makers in other regions or countries to meet their policy targets by simulating the effect of their current and potential household waste policy measures.

Injuries associated with the use of riding mowers in the United States, 2002-2007

CONTEXT

To examine injuries among patients treated in an emergency department (ED) related to the use of a riding lawn mower.

DESIGN AND SETTING

Data were obtained from the National Electronic Injury Surveillance System for the years 2002-2007. National estimates of ED visits for injuries associated with the use of a riding lawn mower were analyzed. Narrative text entries were categorized to provide a detailed record of the circumstances precipitating the injury. Average annual rates were calculated and logistic regression analyses were employed to determine risk estimates for patient disposition and demographic characteristics related to ED visits for injuries associated with riding mowers.

RESULTS

From 2002 through 2007, there were an estimated 66,341 ED visits for injuries related to the use of riding lawnmowers in the U.S., with an average annual rate of 6.0 ED visits per 100,000 males, and 1.6 ED visits per 100,000 females. Older adults had higher rates of ED visits for injuries (7.2/100,000) than younger age groups. The most common injuries involved contusions (24%); sprains/strains (22%) and fractures (17%). The majority of patients (90%) were treated and released the same day. Results of logistic regression analyses revealed that older adults were more likely to be hospitalized when compared to younger age groups; and incidents involving rollovers [OR=5.45 (95% CI=3.22-9.23)] and being run over [6.01 (95% CI 3.23-11.17)] were more likely to result in hospitalization when compared to all other circumstances of injury.

CONCLUSIONS

Riding mowers present injury patterns and circumstances that are different than those reported for push mowers. Circumstances related to injuries and age groups affected were varied, making prevention of riding mower injuries challenging. APPLICATION/IMPACT: Findings support the need to increase awareness and/or change the design of riding mowers with respect to risk of rollover injuries.

Particulate matter and gaseous pollutants in residences in Antwerp, Belgium

This comprehensive study, a first in Flanders, Belgium, aimed at characterizing the residential indoor air quality of subgroups that took part in the European Community Respiratory Health Survey (ECRHS I-1991 and ECHRS II-1996) questionnaire-based asthma and related illnesses studies. This pilot study aimed at the evaluation of particulate matter and various inorganic gaseous compounds in residences in Antwerp. In addition personal exposure to the gaseous compounds of one individual per residence was assessed. The main objective was to obtain some base-line pollutant levels and compare these with studies performed in other cities, to estimate the indoor air quality in residences in Antwerp. Correlations between the various pollutant levels, indoor:outdoor ratios and the micro-environments of each residence were investigated. This paper presents results on indoor and ambient PM(1), PM(2.5) and PM(10) mass concentrations, its elemental composition in terms of K, Ca, Ti, V, Cr, Mn, Fe, Ni, Cu, Zn, Br, Pb, Al, Si, S and Cl and the water-soluble ionic concentrations in terms of SO(4)(2-), NO(3)(2-), Cl(-), NH(4)(+) K(+), Ca(2+). In addition, indoor, ambient and personal exposure levels of the gases NO2, SO2, and O3 were determined. Elevated indoor:outdoor ratios were found for NO2 in residences containing gas stoves. In smoker's houses increased PM concentrations of 58 and 43% were found for the fine and coarse fractions respectively. Contrary to the fact that all I/O ratios of the registered elements in each individual house were significantly correlated to each other, no correlation could be established between the I/O ratios of the different houses, thus indicating a unique micro-environment for each residence. Linear relationships between the particulate matter elemental composition, SO2 and O3 levels indoors and outdoors could be established. No linear relationships between indoor and outdoor NO2 and particulate mass concentrations were found.

Estimation of secular trends in adult height, and childhood socioeconomic circumstances in three Eastern European populations

The objective of these analyses was to estimate the strength and direction of secular trends in adult height and childhood socioeconomic circumstances in eight towns in three Eastern European countries in the mid-20th century, and to assess the extent to which childhood conditions might explain the height differences. We used cross-sectional data from the baseline survey of the Health, Alcohol and Psychosocial factors in Eastern Europe (HAPIEE) study, conducted in 2002-2005. The study examined 24,012 men and women born between 1933 and 1957, randomly selected from the general populations of Novosibirsk (Russia), Krakow (Poland) and six towns of the Czech Republic. To allow for age-related height loss we estimated maximum attained height. Parental education and household item ownership at age 10 were used as markers of childhood socioeconomic conditions. In all 5-year birth cohorts, Novosibirsk men and women were shortest. There were positive and statistically significant secular trends in childhood conditions and in maximum adult height. Adjustment for childhood conditions explained about one third of the trend in height. There appeared to be a small reduction in height of persons born during the Second World War which was, however, only significant in Novosibirsk. These results suggest that secular trends in height mirror, but are not wholly explained by, trends in socioeconomic circumstances in early life.

Lawnmower injuries in children

OBJECTIVE

Power lawnmowers can pose significant danger of injury to both the operator and the bystander, from direct contact with the rotary blades or missile injury. Our objective was to review our experience with paediatric lawnmower-associated trauma, and the safety recommendations available to operators of power lawnmowers.

METHODS

The patient cohort comprised paediatric (<16 years of age) patients treated for lawnmower-associated trauma, by the plastic surgery service, between 1996 and 2003. These patients were identified retrospectively. Age at the time of injury, location and extent of bony and soft tissue injuries sustained, treatment instituted and clinical outcome were recorded. Brochures and instruction manuals of six lawnmower manufacturers were reviewed, and safety recommendations noted.

RESULTS

Fifteen patients were identified. The majority of injuries occurred from direct contact with the rotary blades (93%); the remaining child sustained a burn injury. Fourteen children (93%) required operative intervention. Seven patients (46%) sustained injuries resulting in amputation, two of whom had major limb amputations. All children, except the burns patient, underwent wound debridement and received antibiotic therapy. Reconstructive methods ranged from primary closure to free tissue transfer. Many patients required multiple procedures. In all instruction manuals, instructions to keep children and pets indoors or out of the yard when mowing were found.

CONCLUSIONS

Lawnmower injuries can be devastating, particularly in children. Many victims have lasting deformities as a result of their injuries. Awareness of and stringent adherence to safety precautions during use of power lawnmowers can prevent many of these accidents.

Presentation and management of aural foreign bodies in two Australian emergency departments

OBJECTIVE

To survey and compare the type and management of foreign bodies found in adult and paediatric ears presenting to an Australian otorhinolaryngology and a general ED.

METHODS

Retrospective case study with data collated from two centres. Chart reviews of a total of 330 patients presenting with aural foreign bodies to the ED of the Royal Victorian Eye and Ear Hospital and the ED of The Bendigo Hospital, both situated in the state of Victoria, Australia, were surveyed for patient demographics, foreign body description and referral and removal pattern.

RESULTS

Two hundred and seventeen adults and 113 children were included in the study. The most common foreign bodies in children were beads, cotton tips, insects and paper, and in adults cotton tips, insects, cotton wool and silicone ear plugs. Flying insects were far more common in the Australian population than cockroaches found in surveys in other countries. Children were significantly more likely to have initially been seen by their Local Medical Officer than adults (P < 0.001) and to require a general anaesthetic for removal of the object(s) (P < 0.001). Adults were more likely to have associated otitis externa at the time of presentation (P < 0.05).

CONCLUSIONS

Aural foreign bodies are a frequent presentation to the ED. Recognition of patients requiring early specialist referral is important. Adults present with a different profile of aural foreign objects to children and require different management. The use of cotton tips or cotton wool in the external ear canal and silicone ear plugs should be discouraged.

Epidemiology of lawn-mower-related injuries to children in the United States, 1990-2004

OBJECTIVE

Our objective for this study was to describe the epidemiology of lawn mower-related injuries among children in the United States.

METHODS

A retrospective analysis was conducted of data from children who were 20 years and younger in the National Electronic Injury Surveillance System of the United States Consumer Product Safety Commission for 1990-2004.

RESULTS

There were an estimated 140700 lawn mower-related injuries to children who were 20 years and younger and treated in hospital emergency departments in the United States during the 15-year period of 1990-2004. This yielded an average of 9400 injuries annually, or 11.1 injuries per 100000 US children per year. The mean age was 10.7 (SD: 6.0) years, and 78% were boys. The leading type of lawn mower-related injury sustained by patients was a laceration (41.2%), followed by soft tissue injury (21.4%), burn (15.5%), and fracture (10.3%). The most common body region injured was the hand/finger (34.6%), followed by lower extremity (18.9%) and foot/toe (17.7%). The eyeball/face and upper extremity accounted for 10.6% and 7.4% of injuries, respectively. Burns accounted for 34.5% of injuries to the hand/finger compared with 5.5% to other body regions. Ninety-seven percent of amputation injuries occurred to the foot/toe (49.5%) and hand/finger (47.5%) compared with 3% of amputations to other body regions. Burns accounted for 41.8% of injuries among children who were < or = 5 years of age compared with 6.5% of injuries to children who were older than 5 years. Foreign body injuries accounted for 4.8% of injuries among children who were > or = 12 years of age compared with 1.6% of injuries to children who were younger than 12 years. Amputations (31.9%), lacerations (28.8%), and fractures (26.0%) accounted for almost 87% of injuries among children who were admitted or transferred to another hospital. In contrast, lacerations (42.3%), soft tissue injuries (23.3%), and burns (16.9%) predominated among children who were treated and released to home from the emergency department. Children with amputations were more likely to be admitted than children with other types of injury.

CONCLUSIONS

Injuries related to lawn mowers are an important cause of pediatric morbidity. The relative consistency of the number of lawn mower-related injuries to children during the 15-year study period is evidence that current prevention strategies are inadequate. Passive protection that is provided by safer product design is the strategy with the highest likelihood of success in preventing these ongoing injuries. The lawn mower voluntary safety standard American National Standards Institute/Outdoor Power Equipment Institute B71.1-2003 should be revised to include more rigorous performance provisions regarding prevention of penetration of feet and toes under the mower and into the path of the blades, shielding of hot mower parts from access by young children, and equipping all ride-on lawn mowers with a no-mow-in-reverse default feature with location of its override switch behind the seating position of the ride-on mower operator. By locating the no-mow-in-reverse override switch behind the ride-on mower operator, the operator would be required to look behind the mower before mowing in reverse.

Lawnmower Injuries in the United States: 1996 to 2004

STUDY OBJECTIVE

We update the epidemiology of lawnmower injuries, together with leading mechanisms of lawnmower injury in the United States, for the entire age range by using nationally representative data.

METHODS

Data were obtained from the National Hospital Discharge Survey 1996-2003 and the National Electronic Injury Surveillance System 1996-2004.

RESULTS

Individuals in the 60- to 69-year age group had the highest push mower injury incidence in 2004, whereas those in the 70 years and older age group had the highest riding mower injury incidence. Children younger than 15 years also had a substantial injury incidence. Individuals in the 15- to 19-year age group had the highest rate of hospitalizations caused by lawnmower injuries from 1996 through 2003, with 0.72 per 100,000 person-years (95% confidence interval 0.07 to 1.36). Debris from under the mower hitting a body part or entering the eye was the most common mechanism for lawnmower injury. The second most common mechanism of injury was nonspecific pain onset after the ordinary operation of the mower. Fracture of 1 or more phalanges of the foot was the most common diagnosis among lawnmower injury hospitalizations, with 34.4%, followed by traumatic amputation of the toe, with 32.4%. There is an increasing trend of lawnmower injuries in the United States during the last 9 years.

CONCLUSION

Lawnmower injuries increase with age, with peaks in persons older than 59 years. Given the high incidence of projectile-related injuries, improved protective apparel and eyewear could lower the rate of injury for all age groups. The increasing trend of lawnmower injuries in the United States suggests that more must be done to prevent lawnmower injuries.

Improvement in household stoves and risk of chronic obstructive pulmonary disease in Xuanwei, China: retrospective cohort study

OBJECTIVE

To test whether improvement in household coal stoves affected the incidence of chronic obstructive pulmonary disease (COPD) in Xuanwei County, China.

DESIGN

Retrospective cohort study (follow-up 1976-92) comparing incidence of COPD between groups with and without chimneys.

PARTICIPANTS

20,453 people born into homes with unvented coal stoves;16,606 (81.2%) subsequently changed to stoves with chimneys.

INTERVENTION

Installation of a chimney in households in which unvented stoves had been used previously.

RESULTS

Installation of a chimney was associated with distinct reduction in the incidence of COPD. Compared with people who did not have chimneys, the Cox-modelled risk ratio (relative risk) was 0.58 (95% confidence interval 0.49 to 0.70, P < 0.001) in men and 0.75 (0.62 to 0.92, P = 0.005) in women. Modelled risk ratios were robust to different Cox model specifications. Relative risks decreased with time since stove improvement. In both sexes, the reduction in risk became unequivocal about 10 years after stove improvement.

CONCLUSIONS

In Xuanwei, incidence of COPD decreased markedly after household coal stoves were improved.

Witnessed and unwitnessed esophageal foreign bodies in children

OBJECTIVE

The purpose of this study was to describe the clinical presentation of children with either an unwitnessed or witnessed esophageal foreign body.

METHODS

Retrospective chart review was performed. Patients were identified using ICD-9 code for esophageal foreign body. Clinical data and management techniques, along with complications were abstracted.

RESULTS

For the 5-year period of review, 255 patients were identified with an esophageal foreign body. 214 children had a witnessed ingestion. The mean age of the unwitnessed ingestion group was 2.3 years, compared to 4.6 years for a witnessed ingestion. In both groups, males and females were distributed equally and the most common ingested object was a coin. Bivariate, unadjusted analysis revealed that history of wheeze (OR, 4.35) and fever (OR, 11.15) had the largest association with patients who had an unwitnessed ingestion. Multivariate analysis indicated that any physical findings of wheeze, rhonchi, stridor, or retractions were associated significantly with a diagnosis of an unwitnessed foreign body. Children less than 2 years of age and with a documented fever are also predictive of an unwitnessed ingestion. Eleven children (4.3%) with esophageal abnormalities were also noted to have foreign bodies.

CONCLUSIONS

Children who present to the emergency department two years old and younger, who have a documented fever and with respiratory findings should be considered at risk for having a retained esophageal foreign body. Children with esophageal abnormalities may also be at risk for retained esophageal foreign bodies.

Do partners with children know about firearms in their home? Evidence of a gender gap and implications for practitioners

OBJECTIVE

The gender gap describing the apparent differences in male and female reports of firearm-ownership and -storage habits has never been evaluated among individuals who live in the same household. Thus, the objective of this study was to examine the level of agreement on household firearms and storage practices among cohabiting partners.

METHODS

Data for this investigation came from follow-up telephone interviews of participants who underwent a randomized, controlled trial to test the effect of home-safety counseling, including firearm safety, on behavior change. Baseline interviews were conducted at a level 1 pediatric emergency department in North Carolina with adults who took a child or adolescent who was under his or her care to a pediatric emergency department. Follow-up interviews were conducted via telephone at 18 months after intervention with participants who reported household firearms at baseline. Participants then were asked whether their partners could be contacted for a separate telephone interview. The measured outcomes were number and type of household firearms and firearm-storage practices. The strength of agreement between partners' reported firearm-ownership and -storage practices was measured with the kappa statistic.

RESULTS

Seventy-six partner-respondent pairs completed the study (62% response rate). Most initial respondents were white (89%), female (76%), and college graduates (52%); the median age was 37. There were no same-gender partners, and 91% reported that they were spouses. There was not perfect agreement among male and female partners with regard to the presence of household firearms. More men (80%) reported the presence of household firearms than did women (72%; kappa = .64). The discordance between partner pairs regarding the number of household firearms and type was poor to fair (kappa = .35 and .34, respectively). Although similar proportions of men and women reported storing any household firearms loaded (10%) and storing all household firearms locked up (63% men and 62% women), the kappa values demonstrated only moderate agreement (kappa = .56-.60). Most men (88%) and women (83%) reported that firearm storage was the husband's responsibility; 82% of men compared with 17% of women reported that they personally owned all of the firearms.

CONCLUSIONS

A gender gap does exist in the reporting of firearm ownership with regard to the number and type of firearms owned. There are also differences in reported firearm-storage practices, which are likely related to the finding that men were reported to be the primary owner of firearms in most households as well as the person more commonly responsible for firearm storage. Firearm-safety counseling should include male partners in the history-taking process to improve knowledge about the presence and storage patterns of household firearms.

Evaluation of a community-based handgun safe-storage campaign

OBJECTIVE

Safe storage of firearms has been recommended as a means of preventing gun-related pediatric injuries, yet few interventions have led to significant improvements in storage practices. This study examined a multifaceted community education campaign to promote safe handgun storage and the campaign's impact on firearm locking and loading practices in households with children.

METHODS

Beginning in 1997, a safe-storage campaign consisting of television and radio announcements, educational materials, billboards, and discount coupons for lock boxes was conducted in King County, Washington. The campaign evaluation used a quasi-experimental design and compared the intervention site with 9 control counties outside Washington State and west of the Mississippi River. Cross-sectional, random-digit-dial telephone surveys of handgun-owning households with children were conducted in all study counties both before the intervention in 1996 (n = 302) and again in 2001 (n = 255). The main analyses assessed whether greater improvements in household firearm-storage practices occurred between 1996 and 2001 in the intervention, compared with the control, counties. Primary outcomes were based on up to 3 handguns per household and included (1) all stored with trigger locks, lock boxes, or gun safes (formal locking devices), (2) all stored in lock boxes or gun safes, (3) any stored loaded, (4) any stored loaded without a formal locking device, and (5) any stored loaded and not in a lock box or gun safe. Data were also collected on up to 1 long gun per household; long-gun outcomes included (1) stored with a trigger lock or gun safe and (2) stored loaded.

RESULTS

Overall, handguns and long guns were generally more likely to be stored locked and less likely to be loaded in 2001 compared with 1996, with these trends seeming to be more consistent in the intervention county. Even so, more than one quarter of households with children and handguns in 2001 failed to store all of their handguns with a formal locking device, and up to 8% continued to possess at least 1 loaded handgun that was not stored with a formal device. The majority of households that stored their handguns with formal devices used lock boxes or gun safes. Storage of handguns in lock boxes or gun safes became more common in both the intervention (adjusted odds ratio [aOR]: 1.71; 95% confidence interval [CI]: 1.03-2.84) and control households (aOR: 1.66; 95% CI: 1.01-2.72) between 1996 and 2001. None of the other measured changes reached statistical significance, such as storing any household handgun loaded (aOR: 0.71; 95% CI: 0.35-1.42 [intervention]; aOR: 1.08; 95% CI: 0.58-2.00 [control]) or keeping any household handgun loaded and not stored in a lock box or gun safe (aOR: 0.59; 95% CI: 0.22-1.55 [intervention]; aOR: 0.67; 95% CI: 0.30-1.49 [control]). Moreover, the intervention county did not experience significantly greater overall improvements in household storage practices for handguns or long guns than did control counties.

CONCLUSIONS

In both the intervention and control counties, households were more likely to lock all handguns in 2001 compared with 1996. After accounting for temporal trends, this educational campaign, combined with economic incentives to purchase lock boxes, did not seem to significantly change safe storage practices in households with handguns and children. Even if the campaign did result in small improvements in firearm safe storage, simultaneous national and state-specific gun-safety activities or legislative efforts may have drawn increasing attention to gun-related issues in the control counties, thereby making it more difficult to identify effects of our specific handgun storage intervention.

Frequency of food items among households in a low socioeconomic area of Karachi

OBJECTIVE

To describe the frequency of certain food items among families in a low socioeconomic area of Karachi and their association with socioeconomic variables.

METHOD

A cross sectional survey of houses selected through random sampling using a pre-tested structured questionnaire.

RESULTS

A total of 294 houses were surveyed, 23% households consumed meat almost daily, 55% consumed vegetables almost daily.

CONCLUSION

The survey showed that the consumption of food items in our study population is less as compared to what is recommended.

Power lawnmower injuries

Power lawnmowers are among the most ubiquitous household tools, yet they pose significant danger to operator and bystanders. Despite of the United States Consumer Products Safety Commission's push to have safety standards established for walk-behind mowers in 1982 and for ride-on mowers in 1986, by 2000 approximately 80,000 injuries nationwide were estimated to be associated with power mowers. Large numbers of these injuries are thought to be preventable, especially those to individuals younger than 14 years. Orthopaedic surgeons treat a significant number of the injuries associated with mower use including lacerations, amputations, fractures, infections, and skin defects. Therefore, the orthopaedic community has a stake in the prevention and outcome of these injuries. To date, changes in mower design have seemed to be more successful than user education programs in decreasing the numbers of these injuries. Involving orthopaedists in safety education programs to help prevent injuries associated with power mower use may be one method of increasing user knowledge and preventing injury.

Studying "exposure" to firearms: household ownership v access

BACKGROUND

Firearm ownership has often been used to measure access to weapons. However, persons who own a firearm may not have access to it and conversely, persons who do not own a firearm may be able to access one quickly.

OBJECTIVES

To examine whether using firearm ownership is a reasonable proxy for access by describing the demographic characteristics associated with ownership and access.

METHODS

Data are from the 1994 Injury Control and Risk Survey, a national, random digit dial survey. Information about household firearm ownership and ready access to a loaded firearm were collected and weighted to provide national estimates. Adjusted odds ratios for three separate models were calculated using logistic regression.

RESULTS

A total of 1353 (27.9%) respondents reported both having a firearm in the household and ready access to one. An additional 313 respondents (8.1%) reported having a firearm, but were not able to access these weapons. Another 421 respondents (7.2%) did not have a firearm in or around their home, yet reported being able to retrieve and fire one within 10 minutes. Based on the logistic regression findings, the demographic characteristics of this latter group are quite different from those who report ownership. Those who do not have a firearm, but report ready access to one, are more likely to be ethnic minorities, single, and living in attached homes.

CONCLUSIONS

Asking only about the presence of a firearm in a household may miss some respondents with ready access to a loaded firearm. More importantly, those who do not own a firearm, but report ready access to one, appear to be qualitatively different from those who report ownership. Caution should be exercised when using measures of ownership as a proxy for access.

Risks in product use: observations compared to accident statistics

This paper addresses two observational studies, of the use of a blender and a chip pan, and a study of the accident statistics regarding these two types of products. The aim is to understand risk in product use and the process of risk perception as displayed by product users. Consideration is given to the way information from both observational studies and accident statistics can support design in order to improve the safety of product users.

Hot surface temperatures of domestic appliances

BACKGROUND

Domestic appliances are burning people. In the European Union, accidents requiring hospital treatment due to burns from hot objects account for between 0 and 1% of all such accidents. Young children are particularly at risk. These reported accidents requiring hospital treatment are also likely to be a small proportion of the total number of burns from hot objects.

RESEARCH METHOD

There is a lack of hard evidence about the level of accidents, typical consumer expectation and use, and on the state of the art of appliances. Results of technical laboratory tests carried out on products are used to demonstrate the state of the art and also show how consumer expectations could be changing. Results of a survey into accidents, based on a written questionnaire following telephone contact, provide information on non-hospital cases.

RESULTS

Results of tests on products show that there are significant differences in the temperatures of touchable surfaces, even in products of the same type. Typically, these differences are due to variations in design and/or materials of construction. Some products are hot enough to burn skin. Accident research indicates that non-hospital medical practices are treating burn injuries, which are therefore not being included into the current accident statistics.

CONCLUSIONS

For products with the same function, some types of design or materials of construction are safer, with lower surface temperatures. Many product standards have no or unnecessarily high limits on surface temperatures. Many standards do not address the realities of who is using their products, for what purpose or where they are located. Some standards use unreasonable general limitations and exclusions that allow products with higher surface temperatures than they should have. Many standards rely on the experience factor for avoiding injury that is no longer valid, with the increased availability of safer products of the same type. A major field of work ahead is to carry out more surveys and in-depth studies of non-fatal accidents and injuries.

Reliability of proxy-reported and self-reported household appliance use

Exposure assessment presents a major challenge for studies evaluating the association between household exposure to electric and magnetic fields and adverse health outcomes, especially the reliance on proxy respondents when study subjects themselves have died. We evaluated the reliability of proxy- and self-reported household appliance exposure. We recruited 92 healthy couples through either random-digit dialing or newspaper advertisements. Trained interviewers administered questionnaires to each member of a couple independently to assess the reliability of proxy-reported household appliance use. Eighty-five couples completed a second interview 2 months later to assess the reliability of self-reported appliance use. Reliability of proxy-reported appliance exposure was good when we inquired about having any exposure to each of the eight indicator appliances during the past year (range of kappa coefficients = 0.63-0.85; median = 0.76) but was lower with increased time to recall or increased detail. Reliability of self respondents reporting 2 months apart was excellent (range of kappa coefficients = 0.75-0.94; median = 0.87) for having any exposure to the eight indicator appliances during the past year, but reliability was again lower with increased detail. When we used self reports at the first interview as the standard, little systematic over- or underreporting occurred for proxy respondents or for self respondents reporting 2 months later. Because this study did not include cases of specific disease, these findings of no systematic differences in reporting do not refer to case or control status. In summary, reliability of self respondents' reports of appliance use is very good for recent time periods and good for broad aspects of exposure in distant time periods. Proxy respondents can provide information regarding broad aspects of appliance exposure in the past year, but detailed aspects of exposure or exposure in more distant time periods is not reliable.

Kerosene stove as a cause of burns admitted to the Ain Shams burn unit

Kerosene stoves are in widespread use for cooking and warming water in underprivileged areas in Cairo. These stoves are dangerous and lack safety measures; they are often a cause of fire incidents and burn injuries. During the period from May 1995 to December 1996 the number of patients who presented to the burn unit of Ain Shams University, Cairo, Egypt was 759, of whom 304 (40%) sustained the injury as a consequence of kerosene stove fires. Efforts to inform the public about the danger of these stoves are recommended to minimize the incidence, morbidity, mortality and cost of this relatively common and preventable type of injury.

Effects function simulation of residential appliance field exposures

This paper demonstrates the application of effects function analysis to residential magnetic field exposure, focusing on appliance sources and mitigation choices. Residential field exposure time series were synthesized by using a sample of background household field measurements, a model of average daily appliance use, and a small sample of EMDEX data of field exposure from 12 household strength window, sudden field changes) were simulated by using the synthesized time series data for different exposure situations, such as high and low levels of appliance use, simple avoidance, and use of a set of hypothetical "low field" appliances (50% lower fields). In particular, field exposure from the use of bedside clocks and electric blankets was examined. Results demonstrate that the choice of effects function is critical for the ranks of field sources and exposure reduction choices. For the effects function of average field strength with or without a threshold, exposure from background fields dominated exposure from all appliances except for bedside clocks and electric blankets. In the case of the field strength window effects function, the dominant field sources changed with the width of the window. For the effects function based on rapid field changes, appliance use was the major source of exposure. Because of the small sample of our data set and other simplifications, specific results should be viewed as illustrative.

Use of unvented residential heating appliances--United States, 1988-1994

Many heating appliances rely on combustion of carbon-based fuels and therefore are potential sources of health-threatening indoor air pollution. Most combustion heating appliances are vented to the outside of buildings to facilitate removal of the products of combustion, which include carbon monoxide (CO), carbon dioxide, nitrogen dioxide, and water vapor. However, some combustion heating devices may be unvented (e.g., kerosene- and propane-fueled space heaters, some gas-fueled log sets, and cooking devices used improperly for heating), and the use of such unvented devices in closed settings may be associated with risks for exposure to toxic gases and other emissions. This report presents an analysis of data from the Third National Health and Nutrition Examination Survey (NHANES III) to estimate the number and regional distribution of adults using unvented residential heating appliances and stoves or ovens misused as heating devices in the United States during 1988-1994. The findings indicate that the percentage of adults using these devices was higher in the South, among low-income groups, among blacks, and among rural residents, and underscore the need for public education about the health risks associated with exposure to elevated levels of combustion by-products. NHANES III collected data from approximately 20,000 adults about household characteristics, including the prevalence of various types of residential heating appliances, the use of unvented combustion space heaters, and use of stoves or ovens specifically for heating during the previous year. NHANES weights were used to obtain national estimates based on these responses. Because responses by race/ethnicity other than for whites and blacks were too small for reliable estimates, responses from all others were combined.

The effects of housing on the health of preterm infants

Using a prospective study based on cases and controls selected from a geographical population, we have investigated the effects of housing on the health of very preterm infants (< or = 32 weeks' gestation) during the first year of life. Information on health morbidity of the 117 preterm and 226 term babies was collected using a parent-held record, and housing data by a validated self-completion questionnaire. The most common health problems in the first year-upper (UR) and lower (LR) respiratory tract infection, otitis media (OM) and diarrhoea and vomiting (DV)-were all more frequent in the preterm group, There were no significant differences in the housing conditions to which preterm and control infants were exposed. Relative risks (RR) and 95% confidence intervals (CI) associated with each housing factor were calculated for preterm and control infants separately. Significant (P < 0.05) interaction effects were found for overcrowding and gas cooking. Overcrowding was associated with an increased incidence of LR [RR = 1.53; CI 0.96-2.42] and DV [RR = 1.57; CI 0.92-2.67] in the preterm, but with a decreased incidence of LR [RR = 0.28; CI 0.04-1.86] and DV [RR = 0.85; CI 0.30-2.38] in the term controls. The use of gas ovens was found to be associated in preterm infants with an increase in LR [RR = 1.48; CI 0.96-2.28] and DV [RR = 2.24; CI 1.28-3.93] but the controls did not show this effect for LR [RR = 0.67; CI 0.40-1.09] or DV [RR = 0.93; CI 0.56-1.56]. These associations are robust-even after allowing for confounding social factors-but causality has not been proved. This work suggests that preterm infants may be vulnerable to specific adverse housing factors, and further studies are now indicated to clarify potential mechanisms and interactive effects behind these associations.