Joseph E. Sniezek

Traumatic Brain Injury in the United States: A Public Health Perspective

Traumatic brain injury (TBI) is a leading cause of death and disability among persons in the United States. Each year, an estimated 1.5 million Americans sustain a TBI. As a result of these injuries, 50,000 people die, 230,000 people are hospitalized and survive, and an estimated 80,000-90,000 people experience the onset of long-term disability. Rates of TBI-related hospitalization have declined nearly 50% since 1980, a phenomenon that may be attributed, in part, to successes in injury prevention and also to changes in hospital admission practices that shift the care of persons with less severe TBI from inpatient to outpatient settings. The magnitude of TBI in the United States requires public health measures to prevent these injuries and to improve their consequences. State surveillance systems can provide reliable data on injury causes and risk factors, identify trends in TBI incidence, enable the development of cause-specific prevention strategies focused on populations at greatest risk, and monitor the effectiveness of such programs. State follow-up registries, built on surveillance systems, can provide more information regarding the frequency and nature of disabilities associated with TBI. This information can help states and communities to design, implement, and evaluate cost-effective programs for people living with TBI and for their families, addressing acute care, rehabilitation, and vocational, school, and community support.

Incidence of mild and moderate brain injury in the United States, 1991

The 1991 National Health Interview Survey was analysed to describe the incidence of mild and moderate brain injury in the United States. Data were collected from 46 761 households and weighted to reflect all non-institutionalized civilians. The report of one or more occurrences of head injury resulting in loss of consciousness in the previous 12 months was the main outcome measure. Each year an estimated 1.5 million non-institutionalized US civilians sustain a non-fatal brain injury that does not result in institutionalization, a rate of 618 per 100,000 person-years. Motor vehicles were involved in 28% of the brain injuries, sports and physical activity were responsible for 20%, and assaults were responsible for 9%. Medical care was sought by 75% of those with brain injury; 14% were treated in clinics or offices, 35% were treated in emergency departments, and 25% were hospitalized. The risk of medically attended brain injury was highest among three subgroups: teens and young adults, males, and persons with low income who lived alone. The incidence of mild and moderate brain injury in the United States is substantial. The National Health Interview Survey is an important national source of current outpatient brain-injury data.

The epidemiology of sports-related traumatic brain injuries in the United States: recent developments

We examined recent population-based data from the National Health Interview Survey, Consumer Product Safety Commission, and state-based traumatic brain injury (TBI) surveillance programs that provide estimates of the overall incidence of sports-related TBI in the United States. Available data indicate that sports-related TBI is an important public health problem because of the large number of people who incur these injuries each year (approximately 300,000), the generally young age of patients at the time of injury (with possible long-term disability), and the potential cumulative effects of repeated injuries. The importance of this problem Indicates the need for more effective prevention measures. The public health approach can guide efforts in injury prevention and control. The steps in this approach are (1) identifying the problem, (2) identifying risk factors, (3) developing and testing interventions, and (4) implementing programs and evaluating outcomes. Each of these steps requires adequate data. This article examines the limitations of current sports-related TBI data and suggests ways to improve data in order to develop more effective injury prevention strategies. The impact of sports-related TBI on the public indicates that this task deserves a high priority.

Surveillance of spinal cord injuries in Utah, USA

From 1989 through 1991, we conducted surveillance of spinal cord injury (SCI) among residents of Utah. We found an annual incidence rate of 4.3 per 100,000, with the highest rates occurring among males 15-24 years of age. Motor vehicles were the leading cause of injury, followed by falls, and sports and recreation. We also examined the accuracy and completeness of reporting in this surveillance system. We found the predictive value positive of SCI diagnoses reported in hospital discharge data to be only 61%. When we considered only patients who received acute hospital care in-state, we found that the sensitivity of hospital discharge data was 89%. These findings indicate serious problems in the reporting of spinal cord injury diagnoses in hospital discharge data and the need to verify case reports based on these data. There is also a need to study this problem in other jurisdictions to determine if overreporting is widespread.

Describing the Prevalence of Neural Tube Defects Worldwide: A Systematic Literature Review

Background Folate-sensitive neural tube defects (NTDs) are an important, preventable cause of morbidity and mortality worldwide. There is a need to describe the current global burden of NTDs and identify gaps in available NTD data. Methods and Findings We conducted a systematic review and searched multiple databases for NTD prevalence estimates and abstracted data from peer-reviewed literature, birth defects surveillance registries, and reports published between January 1990 and July 2014 that had greater than 5,000 births and were not solely based on mortality data. We classified countries according to World Health Organization (WHO) regions and World Bank income classifications. The initial search yielded 11,614 results; after systematic review we identified 160 full text manuscripts and reports that met the inclusion criteria. Data came from 75 countries. Coverage by WHO region varied in completeness (i.e., % of countries reporting) as follows: African (17%), Eastern Mediterranean (57%), European (49%), Americas (43%), South-East Asian (36%), and Western Pacific (33%). The reported NTD prevalence ranges and medians for each region were: African (5.2–75.4; 11.7 per 10,000 births), Eastern Mediterranean (2.1–124.1; 21.9 per 10,000 births), European (1.3–35.9; 9.0 per 10,000 births), Americas (3.3–27.9; 11.5 per 10,000 births), South-East Asian (1.9–66.2; 15.8 per 10,000 births), and Western Pacific (0.3–199.4; 6.9 per 10,000 births). The presence of a registry or surveillance system for NTDs increased with country income level: low income (0%), lower-middle income (25%), upper-middle income (70%), and high income (91%). Conclusions Many WHO member states (120/194) did not have any data on NTD prevalence. Where data are collected, prevalence estimates vary widely. These findings highlight the need for greater NTD surveillance efforts, especially in lower-income countries. NTDs are an important public health problem that can be prevented with folic acid supplementation and fortification of staple foods.

Public health interventions for arthritis: expanding the toolbox of evidence-based interventions.

BACKGROUND Since 1999, the Centers for Disease Control and Preventions (CDC) Arthritis Program has worked to improve the quality of life for people with arthritis, in part by funding state health departments to disseminate physical activity (PA) and self-management education (SME) interventions. Initially, only one SME and two PA interventions were considered evidence-based and appropriate for people with arthritis. The purposes of this article are to describe the processes and criteria used to screen new or existing intervention programs and report the results of that screening, including an updated list of recommended intervention programs. METHODS A series of three sets of screening criteria was created in consultation with subject matter experts: arthritis appropriateness, adequacy of the evidence base, and implementability as a public health intervention. Screening interventions were categorized as Recommended, Promising Practices, Watch List, Future Possibility, or Unlikely to Meet criteria based on how well the intervention met the screening criteria. RESULTS A total of 15 packaged PA interventions and six SME interventions were screened. Three PA and three SME interventions met all three sets of criteria and were added to the list of recommended public health interventions for use by CDC-funded state arthritis programs. An additional two SME interventions are developing the infrastructure for public health dissemination and were categorized as Promising Practices, and six PA interventions have evaluations underway and are on the Watch List. CONCLUSIONS The CDC Arthritis Program identified arthritis-appropriate interventions that can be used effectively and efficiently in public health settings to improve the quality of life of people with arthritis. The screening criteria used offer a guide to intervention developers on necessary characteristics of interventions for use in public health settings. The expanded menu of interventions is beneficial to clinical care and public health professionals and, ultimately, to people with arthritis.

Observations from the CDC: Women and Arthritis: Burden, Impact, and Prevention Programs

OBJECTIVES To characterize the public health burden and impact of arthritis among women, document the growing interest in addressing arthritis as a public health problem, and review new national (Centers for Disease Control and Prevention [CDC]) and state arthritis programs. RESULTS Arthritis and other rheumatic diseases are a major public health problem, affecting nearly 27 million women in 1997 and accounting for 23.9 million ambulatory medical care visits and 451,000 hospitalizations among women in that year. Arthritis is also the leading cause of disability and is associated with considerable functional limitations. The 1999 National Arthritis Action Plan: A Public Health Strategy prompted first-time congressional funding to the CDC to monitor the burden of arthritis and to establish state arthritis prevention programs through cooperative agreements. The CDCs Arthritis Program also used this funding to build the public health science base, develop national health communications campaigns, foster partnerships, and initiate health systems change. CONCLUSIONS Arthritis in general and selected types, such as rheumatoid arthritis, systemic lupus erythmatosus (SLE), and fibromyalgia, disproportionately affect women. The CDC, state health departments, and their partners are working toward improving the quality of life for women affected by arthritis. Effective, evidence-based interventions, such as self-management education and physical activity programs, are currently available and can reduce pain, improve function, and delay disability, but they remain underused. Future research should focus on improving earlier diagnosis and increasing access to effective interventions.

Characteristics and behaviors of mothers who have a child with fetal alcohol syndrome.

Fetal alcohol syndrome (FAS) is a leading cause of birth defects and developmental disabilities. The objective of this study was to identify the characteristics and behaviors of mothers of children with FAS in the United States using population-based data from the FAS Surveillance Network (FASSNet). FASSNet used a multiple source methodology that identified FAS cases through passive reporting and active review of records from hospitals, specialty clinics, private physicians, early intervention programs, Medicaid, birth certificates and other vital records, birth defects surveillance programs, and hospital discharge data. The surveillance included children born during January 1, 1995-December 31, 1997. In the four states included in our analysis - Arizona, New York, Alaska, and Colorado - there were 257 confirmed cases and 96 probable cases for a total of 353 FAS cases. Compared to all mothers in the states where surveillance occurred, mothers of children with FAS were significantly more likely to be older, American Indians/Alaska Natives, Black, not Hispanic, unmarried, unemployed, and without prenatal care, to smoke during pregnancy, to have a lower educational level, and to have more live born children. A significant proportion of mothers (9-29%) had another child with suspected alcohol effects. Compared to all US mothers, they were also significantly more likely to be on public assistance, to be on Medicaid at their childs birth, to have received treatment for alcohol abuse, to have confirmed alcoholism, to have used marijuana or cocaine during pregnancy, to have their baby screen positive for alcohol or drugs at birth, to have had an induced abortion, to have had a history of mental illness, to have been involved in binge drinking during pregnancy, and to have drunk heavily (7 days/week) during pregnancy. These findings suggest that it is possible to identify women who are at high risk of having a child with FAS and target these women for interventions.

RISK FACTORS AND MECHANISMS OF OCCURRENCE IN MOTOR VEHICLE RELATED SPINAL CORD INJURIES: UTAH

The purpose of this paper is to describe the incidence, risk factors, and crash factors of motor-vehicle-related spinal cord injuries in Utah. The Utah Department of Health established a statewide registry of spinal cord injuries (SCIs) occurring in 1989-1991, analyzing data from hospital medical records and police reports. Forty-nine percent of all SCIs involved motor vehicles, including injuries arising from motor vehicle collisions with bicyclists and pedestrians. Adolescent and young adult males were at highest risk of injury. Among occupants of automobiles and trucks with SCI, 70% were involved in a vehicle rollover, while 39% were ejected from the vehicle. Only 25% reported using seatbelts. SCIs were much more likely to be associated with rollover compared with other types of motor vehicle-occupant injuries. These findings suggest areas in which SCI prevention programs and research should be focused.

Screening for Excessive Alcohol Use and Brief Counseling of Adults — 17 States and the District of Columbia, 2014

Excessive and/or risky alcohol use* resulted in