From the Feds
2000; Elsevier BV; Volume: 26; Issue: 6 Linguagem: Inglês
10.1067/men.2000.110196
ISSN1527-2966
Autores Tópico(s)Obesity, Physical Activity, Diet
ResumoFor some time, emergency nurse experiences have suggested that American babies seen in the emergency department are getting bigger. Those observations have now been confirmed. Department of Health and Human Services (DHHS) Secretary Donna E. Shalala recently announced the release of new Centers for Disease Control and Prevention (CDC) pediatric growth charts that are not only updated but that will now include a new assessment for body mass index (BMI). This key tool will help identify weight problems early in childhood. These growth charts are used by physicians, nurses, nutritionists, and parents to monitor children’s growth. Most parents are familiar with the original growth charts used by pediatric health care providers since 1977 and adopted by the World Health Organization (WHO) for international use since 1978. They are the most widely used tools to track growth and development in children and assist in signaling potential developmental problems. The charts consist of a series of curves called “percentiles” that illustrate the distribution in growth of children across the United States. The original charts were developed from data taken from a group of children born and raised in Yellow Springs, Ohio, in the 1930s. No baby was breast-fed for more than 3 months, and most were bottle- and breast-fed. Few, if any, were African American, Asian American, or Hispanic. Given the formulas of the day, their accuracy is certainly questionable, despite their widespread use for the past 25 years. CDC’s new charts are based on data gathered through the National Health and Nutrition Examination Survey, the only survey that collects data from actual physical examinations for a cross-section of Americans from all over the United States. The revised pediatric growth charts more accurately reflect the nation’s cultural and racial diversity and track children and young people through age 20 years. In addition, the infant growth charts show considerable improvement because new data and improved statistical procedures were used in the revision process. The National Health and Nutrition Examination Survey showed that in the past 2 decades, the number of overweight children and adolescents has doubled. The growth charts indicate that, in general, children are heavier today than in 1977, but height has remained virtually unchanged. The new BMI information offers health care providers, parents, and caregivers a new tool that can identify children who have the potential to become overweight. BMI can be helpful in identifying weight trends in children as young as 2 years old. BMI is the single number that evaluates an individual’s weight status in relation to height. It is also the most common method of tracking weight problems and obesity among adults. Health care professionals know that as early as age 2 years, children can demonstrate their propensity for future weight problems if they have a high ratio of body fat and a family history of weight problems. The new charts are published in the report “CDC Growth Charts: United States.” The gender-specific charts are organized into categories, including weight, height, and head circumference from birth to 36 months, as well as stature, weight, and BMI from 2 to 20 years of age. The report and the data will be available on the CDC Web site at www.cdc.gov/growthcharts . It will be interesting to observe what other references are revised as a result of the release of these new growth charts. Emergency departments using references for medications, equipment, and such procedures as resuscitation would be well advised to check these references, especially if they contain any language referring to “the average weight” of any age child, to evaluate the need for revision of these materials. Working women face high risk from job-related stress, musculoskeletal injuries, violence, and other hazards of the workplace, according to a new report issued by the National Institute for Occupational Safety and Health (NIOSH). NIOSH researchers described their findings in 2 articles and an editorial in a recent issue of the Journal of the American Medical Women’s Association. They provide an overview of relevant occupational health and safety hazards for the women who currently make up almost half of the general US workforce. It will come as no surprise to emergency nurses that a complex range of hazards were identified in the health care industry, including latex allergy, back injuries, needlestick injuries, stress, and exposure to potentially hazardous materials, to name a few. In health care, approximately 80% of the workforce is female. Increasingly, women are also moving into occupations once held exclusively by men, such as construction. In these industries, physiologic differences between women and men can actually create occupational hazards, as when women operate equipment designed for male workers of different and generally larger stature. Women are at disproportionately high risk for musculoskeletal injuries on the job; they experience 63% of all work-related repetitive motion injuries. Other hazards such as radiation, lead, and strenuous physical labor can have a negative effect on women’s reproductive health and pregnancy outcomes. Violence is also of special concern to female workers, because homicide is the leading cause of job-related death for women. Women are also at increased risk of nonfatal assault. The NIOSH article entitled “Working Women and Stress” also identified causes of stress specific to the female workforce, including the following: •Gender-specific work stress factors, such as sex discrimination and balancing work and family demands, may have an effect on women workers above and beyond the impact of general job stressors such as job overload and skill underutilization.•Discriminatory barriers to financial and career advancement have been linked to more frequent physical and psychological symptoms and more frequent visits to the doctor. The article identified the most effective way of reducing work stress as organizational change in the workplace. This information holds true for female and male workers alike. Workplaces that actively discourage sexual discrimination and harassment and promote family-friendly policies appear to foster worker loyalty and attachment regardless of gender. Effective organizational changes for reducing job stress among female workers included expanding promotion and career ladders, introducing family support programs and policies, and enforcing policies against sex discrimination and harassment. Any workplace, including hospitals and emergency departments, might find ideas for improving their employee programs and policies in this report. Further information on job-related stress appears in a NIOSH document entitled “Stress At Work,” DHHS (NIOSH) publication No. 99-101. For copies of these documents or for other information on the health and safety of working women, call the toll-free NIOSH information number, (800)356-4674, or visit the NIOSH Web site at www.cdc.gov/niosh . The first in a new class of antibacterial drugs to treat serious infections resistant to other antibiotics has been approved by the Food and Drug Administration (FDA). Zyvox (linezolid) may offer new hope to the health care professionals currently faced with the formidable task of isolating patients and containing infections like vancomycin-resistant Enterococcus faecium (VREF) and methicillin-resistant Staphylococcus aureus (MRSA). Zyvox was developed by Pharmacia and Upjohn, based in Kalamazoo, Mich, which will market the drug in the United States. Zyvox is used to treat infections, including bloodstream infections associated with VREF. Zyvox has also been approved for the treatment of pneumonia acquired in the hospital and complicated skin infections, including those resulting from MRSA; pneumonia acquired in the community; and uncomplicated skin and skin structure infections. Infections resulting from VREF and MRSA are a particular problem in hospital patients and in people with compromised immunity, such as people with AIDS or cancer. Since the first case of VREF was reported in 1989, the incidence of VREF infections, as well as MRSA infections, has increased dramatically. The burden of treating and caring for patients with these resistant organisms has been significant, and the health care system stands to reduce the drain on its resources by the advent of this new drug. It is the first in a new class of synthetic drugs, the oxazolidinone class, and it is also the first drug in more than 40 years to be introduced into the US market for treatment of MRSA infections. The most frequently reported adverse effects attributed to Zyvox in clinical studies were headache, nausea, diarrhea, and vomiting. The most significant laboratory test change was a decrease in platelet counts. Zyvox may interact with other drugs, including over-the-counter cold remedies that contain pseudoephedrine or phenylpropanolamine, causing an increase in blood pressure. Therapy with Zyvox is expected to first take place mainly in hospitals or other institutional settings. Doctors have been advised to consider alternative drug therapies before prescribing Zyvox to outpatients because of concerns about inappropriate use of antibiotics leading to an increase in resistant organisms. The Nationwide Inpatient Sample—the AHRQ database used to develop the report—contains approximately 7 million records, making it one of the largest publicly available databases for research and policy analysis and the only one that provides information on total hospital charges for all patients, regardless of their type of insurance or other payment source. According to the report, based on 1997 data, the number one cause of hospital admission through the emergency department was pneumonia. Half of the other top 10 conditions for the admission of ED patients involved cardiac conditions. Other leading causes for admission were stroke, chronic obstructive pulmonary disease, asthma, and septicemia. More than half of all hospital patients had at least one other illness, or comorbidity, in addition to the illness for which they were admitted. Comorbidities can make treatment more expensive and lengthen hospital stays. High blood pressure was the most common comorbidity. The leading comorbidities among adolescents and adults up to age 44 years included drug abuse, psychoses, and depression. Alcohol abuse was the leading secondary condition in patients ages 18 to 64 years. Medicare and Medicaid were billed for more than half of all hospital stays, whereas private health insurance was charged for approximately 37% of stays. Roughly 5% of stays involved uninsured patients. Patients with no health insurance accounted for approximately 23% of all hospital admissions for substance-related mental disorders and nearly 20% of those for alcohol-related mental disorders. The report also provided statistics on the age and gender of hospitalized patients, in-hospital mortality, patients who leave against medical advice, and types of locations to which patients are discharged. This report provides a snapshot of the status of hospital use and the continued need for emergency services. It comes as no surprise that such a large proportion of patients are admitted through the emergency department. However, it is striking to realize that such a high percentage of relatively young patients are admitted with existing problems with substance abuse and psychological conditions. Also significant is the large amount of public support to treat these disorders and for other conditions requiring hospital admission. More study is required to determine whether these admissions are either directly or indirectly a result of unresolved or unsuccessful treatment of substance abuse and psychological conditions, or simply an unavoidable consequence of their existence. Copies of “Hospitalization in the United States, 1997, HCUP Fact Book No. 1” (AHRQ publication No. 00-0031) are available without charge from the AHRQ Publications Clearinghouse, PO Box 8547, Silver Spring, MD 20907, phone (800)358-9295. Users can preview data through the Healthcare Cost and Utilization Project (HCUPnet), an interactive software tool on AHRQ’s Web site, at www.ahrq.gov/data/hcup/hcupnet.htm . At its National Congress on Childhood Emergencies, Emergency Medical Services for Children (EMSC) announced the establishment of a nationwide program to encourage schools to incorporate Basic Emergency Lifesaving Skills (BELS) training into their current health education curricula. BELS provides students with a developmental approach for teaching essential interventions known to stabilize an injured or ill person’s health condition until the arrival of an adult, EMS professional, or other responsible person. Basic emergency lifesaving skills are introduced, acquired, and reinforced according to the students’ ages and developmental levels. BELS was developed with help from more than 25 national organizations and medical institutions. Every year, more than 31 million persons between the ages of 1 and 17 years visit the emergency department because of illness or injury. Many of these incidents occur in the home while a parent is away at work, in a school where a nurse is not available, or on the playground when an adult is not present. Other children or adolescents often become involved in these incidents while walking home from school, playing on the schoolyard, or while babysitting, and may be the first person available to render care prior to the arrival of EMS personnel. BELS instills students with a sense of social responsibility and allows them to gain confidence in responding to sudden and often frightening events. It also teaches them to recognize the need for emergency assistance and how to obtain it. Emergency nurses would be natural messengers for the delivery of BELS, and the curricula are easily adaptable for any youth audience. “The BELS Framework” is available through the EMSC National Clearinghouse. To obtain a printed copy, call the Clearinghouse at (703)902-1203, or send an E-mail request to [email protected] and ask for product 848. “The BELS Framework” is also available as a free downloadable .pdf document from the EMSC Web site at www.ems-c.org . Once on the site, click on “Products and Resources” and then “downloadable files.” US Transportation Secretary Rodney E. Slater and Meharry Medical College have convened a blue ribbon panel to identify strategies to increase seat belt use within the African American community. Although seat belt use among African Americans has increased, it is still consistently lower than the national average. Seat belt use among African Americans is 4 percentage points lower than the national average, an improvement from the 10 percentage point gap that existed in 1996. One hundred percent use by African Americans would save as many as 1300 lives per year and prevent 26,000 injuries at a cost savings of nearly $2.6 billion. Black male teens are at particular risk; although they travel fewer miles than their white counterparts, they are 2 to 3 times more likely to die in a motor vehicle crash. The Department of Transportation’s (DOT’s) partner in this effort is Meharry Medical College. Meharry is a 130-year-old historically Black college and university with renowned credibility in the African American community. In July 1999, Meharry Medical College released a report entitled “Achieving a Credible Health and Safety Approach to Increasing Seat Belt Use Among African Americans.” The report confirmed the need for definitive action to reduce the disproportionately high incidence of traffic-related injuries among African Americans. The Blue Ribbon Panel to Increase Seat Belt Use Among African Americans includes an array of distinguished members from the medical, academic, legal, business, athletic, law enforcement, and activist communities. The panel will have come to consensus on directions and strategies for increasing seat belt use during 4 meetings and will complete its recommendations by the end of the year 2000. These recommendations will be made available to the public in early 2001. The National Highway Traffic Safety Administration (NHTSA), along with Ford Motor Company and Inova Fairfax Hospital’s Regional Trauma Center in Falls Church, Va, have announced a partnership to reduce injuries and deaths from motor vehicle crashes. The partnership will establish the ninth Crash Injury Research and Engineering Network (CIREN) center in the United States. CIREN is a unique collaboration of clinicians and engineers in academia, industry, and government. Multidisciplinary teams combine data from crash scenes, trauma centers, and vehicle wreckage to learn more about the real-world dynamics of car crashes, injuries, and treatments to improve processes and outcomes. The CIREN network returns traffic engineering to its roots. Years ago, when safety engineering was in its infancy, crash dummies had not yet been developed. By necessity, safety engineers investigated real-world crashes, worked with physicians, observed autopsies, and studied real people, not dummies. With the advent of more and more sophisticated instrumentation, engineers grew to depend on this simulated source of data. The current generation of automotive engineers may know more about crash dummies than they do about real people. The CIREN network seeks to reverse this trend. Much can be gained from this approach. By identifying real injuries as they occur, motor vehicle designs can be altered to improve crash avoidance and occupant protection. Greater insight has already been gained into injuries that are caused by safety devices themselves, including lap and shoulder restraints and air bags. We have greater understanding about how real-world crashes compare with the outcomes predicted during controlled crash test research. We also have improved understanding of how crashes affect infants and children. In addition, much more is being learned about survivors—people who may not have lived if the crash had occurred a decade or more ago. NHTSA already directs 8 other CIREN centers throughout the United States. The other 8 CIREN centers are the R Adams Cowley Shock Trauma Center in Baltimore, Md; the University of Medicine and Dentistry at the New Jersey Medical School in Newark; Children’s National Medical Center in Washington, DC; Lehman Injury Research Center at the University of Miami School of Medicine in Miami, Fla; the University of Michigan Medical Center in Ann Arbor; Harborview Injury Prevention Center in Seattle, Wash; the San Diego County Trauma System in San Diego, Calif; and the University of Alabama at Birmingham. Each of these centers chooses a particular type of injury or a particular type of crash as the focus for its studies. Once completed, studies and data from these CIREN centers are published for review by the medical community, design engineers, and the public. Besides the obvious implications to improve car design, the CIREN data have potential for health care professionals, particularly those in EMS. These data have been used to train hospital, law enforcement, and emergency response personnel to identify injuries that may not be readily apparent and transport patients to facilities for appropriate and timely care. It is also used to increase the index of suspicion associated with particular types of crashes. Emergency nurses are familiar with collective injury syndromes such as Waddell’s triad. The CIREN network has the potential to identify other such injury “sets” and improve care by reducing the time between identification and definitive treatment. Research findings and other information on CIREN are readily accessible on the Internet at www.nhtsa.dot.gov/include/bio_and_trauma/ciren-final.htm . The Consumer Product Safety Commission (CPSC) recently announced new safety standards for window guards that will help protect children from window falls. The industry standards, developed at the urging of CPSC, ensure that guards are strong enough to prevent falls and that guards in single-family homes and lower floors of apartment buildings can be opened easily for escape in the event of a fire. CPSC estimates that about 12 children, 10 years old or younger, die each year as a result of falls from windows, and more than 4000 are treated in hospital emergency departments for injuries related to falls from windows. CPSC knows of 120 deaths of children resulting from falls from windows since 1990. Most of the deaths and injuries involve children younger than 5 years. Window guards screw into the side of a window frame and have bars no more than 4 inches apart. They are sold in different sizes for various sized windows and adjust for width. Consumers can also purchase window stops that can be added to the window frame to prevent the window from opening more than 4 inches. Window guards are priced between $10 and $30, and window stops cost about $2 each. CPSC guidelines for preventing window falls are as follows:•Install window guards to prevent children from falling out of windows. For windows on the 6th floor and below, install window guards that adults and older children can open easily in case of fire.•Guards should be installed in children’s bedrooms, parents’ bedrooms, and other rooms where young children spend time.•Install window stops that permit windows to open no more than 4 inches.•Never depend on screens to keep children from falling out of windows.•Whenever possible, open windows from the top, not the bottom.•Keep furniture away from windows to discourage children from climbing near windows.•Consumers should check for guards that have bars no more than 4 inches apart. CPSC has long been known for its work in making children’s sleepwear safer. To prevent burn injuries, CPSC recently required new labels on children’s sleepwear that urge parents to make sure that their children’s sleepwear is either flame-resistant or snug-fitting. CPSC is requiring hanging tags and permanent labels on snug-fitting children’s sleepwear made of cotton or cotton blends to remind consumers that because the garment is not flame-resistant, it must fit snugly for safety. Loose-fitting T-shirts and other loose fitting clothing made of cotton or cotton blends should not be used for children’s sleepwear. These garments can catch fire easily and burn rapidly, and each year they are associated with approximately 300 burn injuries to children that are treated in the emergency department. Children are at most risk from burn injuries that result from playing with fire (eg, matches, lighters, candles, and burners on stoves) just before bedtime and just before waking in the morning. Flame-resistant garments are made from inherently flame-resistant fabrics or are treated with flame retardants and do not continue to burn when removed from a small flame. Snug-fitting sleepwear is made of stretchy cotton or cotton blends that fit closely against the child’s body. Snug-fitting sleepwear is less likely than loose T-shirts to come in contact with flame and does not ignite easily or burn as rapidly because there is little air under the garment to feed the fire. CPSC sets national safety standards for children’s sleepwear flammability. Under federal safety rules, garments sold as children’s sleepwear for sizes larger than 9 months must be either flame-resistant or snug-fitting. For more information, visit the CPSC Web site at www.cpsc.gov .
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