
From <@VMS.DC.LSOFT.COM:owner-mednews@ASUVM.INRE.ASU.EDU>  Sun Sep 17 
11:40:26
1995
(LSMTP
for OpenVMS v0.1a) with SMTP id 63117E7E ; Sun, 17 Sep 1995 11:37:09 -
0400
release
1.8b)
          with NJE id 1633 for MEDNEWS@ASUVM.INRE.ASU.EDU; Sun, 17 Sep 
1995
          08:35:51 -0700
(LMail
          V1.2a/1.8a) with BSMTP id 6410; Sun, 17 Sep 1995 08:35:50 -
0700
SMTP
V2R3)
          with TCP; Sun, 17 Sep 95 08:35:46 MST
          (8.6.12/8.6.9) with UUCP id IAA19366 for 
mednews@asuvm.inre.asu.edu;
          Sun, 17 Sep 1995 08:07:48 -0700
          mednews@asuvm.inre.asu.edu
              <MEDNEWS@ASUVM.INRE.ASU.EDU>
Comments: To: asumednews@stat.com


HICNet Medical News Digest      Sun, 17 Sep 1995        Volume 08 : 
Issue 33

Today's Topics:

  [MMWR] Errata: Vol. 44, No. 32 "Human Granulocytic Ehrlichiosis...
  [MMWR]  Erratum: Vol. 44,
  [MMWR] Erratum: Vol. 43, No. 38 "Health Status of Displaced Persons...
  [MMWR Sep13] Measles Outbreak --- Guam, 1994
  [MMWR] Agricultural Auger-Related Injuries and Fatalities
  [MMWR] State-Specific Changes in Physical Inactivity Among Persons...

             +------------------------------------------------+
             !                                                !
             !              Health Info-Com Network           !
             !                Medical Newsletter              !
             +------------------------------------------------+
                        Editor: David Dodell, D.M.D.
   10250 North 92nd Street, Suite 210, Scottsdale, Arizona 85258-4599 
USA
                        Telephone +1 (602) 860-1121
                           FAX +1 (602) 451-1165
                         Internet: mednews@stat.com
                           Bitnet: ATW1H@ASUACAD

                                 Mosaic WWW
*Asia/Pacific:
 http://biomed.nus.sg/MEDNEWS/welcome.html
*Americas:
 http://outland.cardinal.com/hicn
*Europe:
 http://www.dmu.ac.uk/ln/MEDNEWS/

Compilation Copyright 1995 by David Dodell,  D.M.D.  All  rights  
Reserved.
License  is  hereby  granted  to republish on electronic media for which 
no
fees are charged,  so long as the text of this copyright notice and 
license
are attached intact to any and all republished portion or portions.

The Health Info-Com Network Newsletter is  distributed  biweekly.  
Articles
on  a medical nature are welcomed.  If you have an article,  please 
contact
the editor for information on how to submit it.  If you are  interested  
in
joining the automated distribution system, please contact the editor.

                             Associate Editors:

E. Loren Buhle, Jr. Ph.D. Dept. of Radiation Oncology, Univ of 
Pennsylvania

       Tom Whalen, M.D., Robert Wood Johnson Medical School at Camden

        Douglas B. Hanson, Ph.D., Forsyth Dental Center, Boston, MA

             Lawrence Lee Miller, B.S. Biological Sciences, UCI

            Dr K C Lun, National University Hospital, Singapore

             W. Scott Erdley, MS, RN, SUNY@UB School of Nursing

      Jack E. Cross, B.S Health Care Admin, 882 Medical Trng Grp, USAF

  Albert Shar, Ph.D. CIO, Associate Prof, Univ of Penn School of 
Medicine

 Stephen Cristol, M.D. MPH, Dept of Ophthalmology, Emory Univ, Atlanta, 
GA

                  Subscription Requests = mednews@stat.com
              anonymous ftp = vm1.nodak.edu; directory HICNEWS
               FAX Delivery = Contact Editor for information


----------------------------------------------------------------------

To: hicnews
Ehrlichiosis...

              Errata: Vol. 44, No. 32
     In the article, "Human Granulocytic Ehrlichiosis--New York,
1995," references 4,5, and 3 at the end of the second and third
sentences of the Editorial Note on page 594 should be renumbered
(3,4) and (5), respectively; however, the numbers were attributed
to the correct references in the list on the following page.
     The fourth and new fifth sentences of the first paragraph of
the Editorial Note should read: "E. chaffeensis has most commonly
been identified in the Lone Star tick (Amblyomma americanum) (6)."
HGE patients reported having been bitten by "deer ticks" and "wood
ticks" (possibly I. scapularis and Dermacentor variabilis,
respectively) (2)." The new reference 6 is: Anderson BE, Sims KG,
Olson JG, et al. Amblyomma americanum: a potential vector of human
ehrlichiosis. Am J Trop Med Hyg 1993;49:239-44.


------------------------------

To: hicnews

            Erratum: Vol. 44, No. 34
     In the article "Hypertension Among Mexican Americans--United
States, 1982-1984 and 1988-1991," the last sentence on page 635
should read: "Analysis of characteristics of persons with
hypertension included awareness (being told by a health
professional of having hypertension), treatment (taking
antihypertension medication),and control (taking antihypertension
medication and having blood pressure less than 140/90 mm/Hg)."


------------------------------

To: hicnews
Persons...

              Erratum: Vol. 43, No. 38
     On page 702 of the article "Health Status of Displaced Persons
Following Civil War--Burundi, December 1993-January 1994," in the
"Reported by:" section, S Nkurikiye should be listed first, and the
affiliation of JS Kidasi should be U.S. Agency for International
Development.

------------------------------

To: hicnews

                  Measles Outbreak -- Guam, 1994

     One of the largest outbreaks of measles in the United States
and its territories since 1992 occurred in Guam during 1994. From
February 8 through June 25, 1994, a total of 280 suspected,
probable, or confirmed cases of measles were reported to the Guam
Department of Public Health and Social Services (GDPH). Of these
cases, 228 were considered confirmed, including 47 serologically
confirmed cases (Figure 1). This report summarizes findings from
the investigation of these 228 cases.
     The index case occurred in an 8-month-old child who developed
a rash on February 7, 1994. This case could not be
epidemiologically linked to a previous measles outbreak in Guam (22
cases) that occurred during October 20-December 26, 1993; that
outbreak was initiated by an imported case from the Republic of
Palau. In addition, genetic sequencing of viral isolates indicated
that viruses that had circulated in Palau and in Guam were
different. The outbreak peaked in April, when 104 cases were
reported.
     The incidence of confirmed cases was 17 per 10,000 population.
Patients ranged in age from 2 months to 57 years (median: 16
months), and 70% of cases occurred among preschool-aged children.
The age-specific incidence was highest for children aged less than
1 year (318.0 per 10,000 population), and was higher for children
aged 1-4 years (57.9) and 10-19 years (20.1) than for children aged
5-9 years (7.8) and persons aged greater than or equal to 20 years
(4.8).
     Of the 228 cases, 133 (58%) occurred among patients who were
Chamorros (an ethnic group native to Guam), 45 (20%) occurred among
persons from the Chuuk State of the Federated States of Micronesia
(FSM), and 29 (13%) among Filipinos. The highest ethnicity-specific
attack rate was among persons from FSM (91 per 10,000 population).
The incidence among U.S. military personnel and dependents was
three per 10,000 population.
     Of the 138 (61%) patients aged greater than or equal to 12
months, measles vaccination history was known for 84 (61%). A
history of receipt of at least one dose of measles-containing
vaccine (MCV) was reported for 52 (62%) persons, and 14 (17%) had
documentation of measles vaccination on or after their first
birthday and at least 14 days before rash onset. Appropriate
vaccination was documented for 7% of those aged 1-4 years and 25%
of those aged 5-19 years. No cases were reported among persons who
had received two doses of MCV.
     Twenty-three (10%) patients were hospitalized, and three died
(case-fatality rate=1.3%). The three fatal cases occurred among
patients aged 9 months, 17 months, and 22 years who were immigrants
or children of immigrants from the Chuuk State, FSM. The
hospitalization rate was highest among children aged less than 6
months (four [22%] of 18).
     Outbreak-control measures focused on vaccinating
preschool-aged children and immigrants. Routine vaccination clinic
hours were extended, and outreach clinics were provided in shopping
centers, villages, and housing areas with large immigrant
populations. On April 8, GDPH lowered the age for measles
vaccination from 12 months to 6 months. In May, GDPH implemented a
mass vaccination campaign and encouraged families to take all
children aged 6 months-5 years to vaccination clinics for measles
vaccination, regardless of previous vaccination history; children
with documentation of two doses of MCV after age 12 months were not
revaccinated. During March-June, approximately 12,000 doses of MCV
were administered, 4000 of which were given to children aged less
than 5 years. This was the first measles vaccination for 70% of the
children who participated in the campaign. The campaign is
estimated to have increased measles vaccination coverage among
children aged less than 5 years to approximately 74%.
     Other outbreak-control efforts included improving passive
surveillance by providing outbreak information to health-care
providers and active surveillance through periodic phone calls to
the civilian hospital and private clinics, instituting triage and
isolation for patients with rash illness in medical settings,
exclusion of persons with cases from day care centers and schools
and vaccination of their contacts, and disseminating public
education messages about measles and measles vaccination.
     Since June 25, when two cases imported from the Philippines
were reported, no additional cases are known to have occurred.
Reported by: K Cruz, MPH, E Dolor, MD, K Leonhardt, MD, L Duenas,
MPH, A Mathew, MD, R Wilson, MS, L Espaldon, MD, R Haddock, DVM,
Territorial Epidemiologist, Guam Dept of Public Health and Social
Svcs; A Cabanero, MD, Guam Memorial Hospital Authority. Measles
Virus Section, Respiratory and Enteric Viruses Br, Div of Viral and
Rickettsial Diseases, National Center for Infectious Diseases;
National Immunization Program, CDC.
Editorial Note: The mass vaccination campaign in Guam appeared to
be an effective strategy for controlling measles outbreaks among
island populations. Although the campaign was initiated late in the
course of the outbreak, the decline of the outbreak may have been
accelerated by efforts to encourage all preschool-aged children to
receive a dose of MCV, regardless of prior receipt of one dose of
vaccine. Most of the preschool-aged children who participated in
the campaign received their first dose of MCV during the campaign;
among children who had already received a dose, the campaign also
effectively lowered the age at which many children received a
second dose of vaccine.*
     Lowering the age for primary vaccination also was an important
control strategy in Guam because the risk was highest among
infants. Many of these infants lacked maternal antibody because
they had been born to mothers who had received a maximum of one
dose of measles vaccine and who had not had natural measles
infection (e.g., children of immigrant mothers from islands where
previous outbreaks occurred greater than 20 years ago) (1,2). The
Advisory Committee on Immunization Practices (ACIP) recommends that
measles vaccine be administered at age 6 months if exposure of
children aged less than 1 year is likely (3). Children vaccinated
before age 12 months should be revaccinated after their first
birthday and should be given another dose of MCV before entering
school.
     The outbreak in Guam was especially a consequence of the large
number of unvaccinated, preschool-aged children. A retrospective
survey in 1991 of the vaccination records of children entering
school for the first time documented that only 55% of children on
Guam had received a dose of MCV by age 2 years. Audits of records
from public and private clinics in 1993 and 1994 indicated that
coverage among 2-year-old children with one dose of MCV ranged from
53% to 90% depending on the site.
     Reasons for higher morbidity and mortality in the Chuukese
population than in other ethnic groups are unclear. Possible
explanations include low levels of immunity because of low
vaccination coverage levels; the lower likelihood of exposure to
measles (the last outbreak in Chuuk was in 1968); limited access to
health care; and large family size, resulting in increased exposure
to measles.
     Other factors associated with increased risk for measles
importation and transmission on islands such as Guam include
tourism and the high mobility of the local population. These
factors underscore the importance of the need to achieve and
maintain high vaccination coverage levels. Approaches to
maintaining high vaccination coverage levels among preschool-aged
children should include establishing walk-in service to provide
vaccinations on a routine basis, extending clinic hours, offering
door-to-door vaccination in areas with hard-to-reach populations
(e.g., immigrants), educating providers and parents about
contraindications to vaccinations, and taking advantage of all
opportunities to vaccinate children during health-care visits, as
is recommended in the United States. Optimal levels of immunity may
be achieved in school children through the establishment and
enforcement of requirements for receipt of two doses of vaccine.
References
1. Jenks PJ, Caul EO, Roome APCH. Maternally derived measles
immunity in children of naturally infected and vaccinated mothers.
Epidemiol Infect 1988;101:473-6.
2. Lennon J, Black FL. Maternally derived measles immunity in era
of vaccine-protected mothers. J Pediatr 1986;108:671-6.
3. CDC. Measles prevention: supplementary statement. MMWR
1989;38:11-4.

*The second dose of measles vaccine is routinely recommended at
entry to primary or secondary school but may be given at earlier
ages provided it is administered at least 30 days after the first
dose, and both doses are given after age 12 months.



------------------------------

To: hicnews

    Agricultural Auger-Related Injuries and Fatalities --
                   Minnesota, 1992-1994

     Agriculture remains one of the most hazardous industries in
the United States: in 1992, approximately 37 fatalities occurred
per 100,000 agricultural workers and an estimated 140,000 disabling
injuries to farm workers (1). Recent surveillance for agricultural
injuries and fatalities in Minnesota has helped characterize
problems associated with the use of one type of implement--agricultural 
augers
(large, corkscrew-like devices used to move dry
materials [e.g., grains, animal feeds, and granular fertilizers]).
This report presents surveillance findings for auger-related
injuries during 1992-1994, summarizes the investigations of four
selected auger-related injuries that occurred in the state, and
provides recommendations to prevent injuries to farmers who use
these devices.
     Since 1992, the Minnesota Department of Health has collected
surveillance data about agricultural injuries and fatalities
through three programs sponsored by CDC's National Institute for
Occupational Safety and Health (NIOSH): the Fatality Assessment and
Control Evaluation Program (FACE), which conducts on-site
investigations of selected categories of occupational fatalities
(e.g., falls and machinery-related and logging-related deaths); the
Sentinel Event Notification System for Occupational Risks (SENSOR),
which conducts surveillance for occupational amputation injuries;
and the Occupational Health Nurses in Agricultural Communities
Program (OHNAC), which identifies and investigates farm-related
injuries and illnesses.* Case ascertainment employs a combination
of surveillance methods, including reviews of medical records,
articles from newspaper clipping services, death certificates,
hospital records, and Minnesota Occupational Safety and Health
Administration (M-OSHA) program records. In addition, the Minnesota
Extension Service independently records agricultural injuries and
deaths reported by extension agents and newspaper clipping
services.
Surveillance for Auger-Related Injuries
     During 1992-1994, augers were associated with two fatal and 25
nonfatal injuries in Minnesota. From 1993** through 1994, FACE
received reports of two auger-related deaths, and SENSOR was
notified of seven auger-related amputations. During 1992-1994,
OHNAC was notified of 18 auger-related injuries, of which six (33%)
were among children aged less than 18 years; three of these
resulted in amputations.
     During 1984-1994, the Minnesota Extension Service received
reports of 14 auger-related deaths, which were attributed to
entanglement or crushing (eight) and electrocution (six). Although
cases reported to OHNAC and SENSOR were not duplicated, duplication
of fatalities reported to the Extension Service and to FACE could
not be excluded.
Case Reports
     Incident 1. On April 14, 1992, a 13-year-old boy was cleaning
inside an oxygen-limiting silo while a sweep auger was in
operation. The unguarded auger swept slowly around the silo floor,
pivoting about a central axis. As the boy stepped over the moving
equipment, the hem of his pants caught in the auger, and his leg
was traumatically amputated below the knee as it became entangled.
He required multiple surgical procedures and had been hospitalized
for 2-1/2 months at the time of the OHNAC interview.
     Incident 2. On January 16, 1993, a 70-year-old farm laborer
was cleaning a grain auger that had been shut off, but the
machine's electric power supply had not been disconnected (the
controls for switching the auger on and off were located in a
different building). The auger was inadvertently activated by a
co-worker, and the laborer's left hand was traumatically amputated
above the wrist. He was subsequently hospitalized and had not
resumed work at the time of the SENSOR interview 2 months later.
     Incident 3. On January 8, 1994, a 21-year-old farm laborer was


                                                                                                                 

using an auger to unload a silo. While attempting to step over the
machine, he stepped on a metal shield that covered the bottom of
the auger. The shield broke, and he fell into the auger, sustaining
a traumatic below-the-knee amputation. He subsequently was
hospitalized and had not resumed work at the time of the SENSOR
interview 3 months later.
     Incident 4. On June 22, 1994, a 46-year-old farmer died after
becoming entangled in an unshielded auger system that was being
used to move feed down the length of a feed bunk in a cattle feed
lot. While the system was in operation, the farmer entered the feed
bunk, and his leg became entangled when he either slipped or
attempted to step over the auger. The electric motor driving the
system stopped after the fuse blew. Although he freed himself from
the auger and climbed out of the feed bunk, he died a short
distance from the feed lot as a result of massive hemorrhage. This
incident was unwitnessed, and data were compiled by FACE
investigators based on a review of sheriff's reports and
photographs of the incident site.
Reported by: DJ Boyle, DVM, DL Parker, MD, C Lexau, MPH, G Wahl,
MS, Minnesota Dept of Health; J Shutske, PhD, Biosystems and
Agricultural Engineering Dept, Univ of Minnesota, St. Paul. Div of
Safety Research, and Div of Surveillance, Hazard Evaluations, and
Field Studies, National Institute for Occupational Safety and
Health, CDC.
Editorial Note: An agricultural auger consists of a continuous
corkscrew blade attached to a long metal shaft and a round metal
tube into which the blade is inserted. The metal tube contains the
material as it is moved from the intake at one end of the auger to
the discharge at the other end and protects the operator from
contact with the rotating blade.*** Augers vary in size, generally
ranging from 4 to 15 inches in diameter and from several feet to
100 feet or more in length (2). An auger can be independent and
movable or it can be integrated with another piece of machinery or
a grain storage system (e.g., as a fixed component of a combine,
grain dryer, grain wagon, storage bin system, or silo unloader). In
addition, augers can be self-powered (by an electric motor or a
gasoline- or diesel-fueled engine) or driven by power transferred
from a second piece of equipment through a power take-off shaft
(PTO) or a series of gears, chains, belts, and/or pulleys.
Auger-related injuries result from 1) contact with the exposed
auger blade; 2) entanglement in a belt drive or PTO conveying power
to the blade; 3) electrocution when an auger contacts overhead
power lines (e.g., while it is being moved or positioned in an
upright configuration); or 4) contact with a spinning crank, which
is used to position the auger (3).
     Although auger-related injuries are preventable, they remain
a public health concern among farmers. On a per-hour-of-use basis,
augers are one of the most dangerous types of farming equipment
(4); severe injuries have resulted from entanglement and
electrocution (2). The occupational injury surveillance and
investigation data from Minnesota underscore the risks augers pose
for both disabling and fatal injuries among farmers. In particular,
the Minnesota data emphasize the risk for traumatic amputation
resulting from entanglement of extremeties.
     NIOSH recommends the following precautions to substantially
reduce the risks for hazards related to auger use:
      1. Barriers (e.g., fences) should be used to prevent persons
not involved in the operation of an auger from entering the area
adjacent to the auger.
      2. Children aged less than 18 years should not operate augers
and should not enter the area near an auger.****
      3. Before starting an auger, the operator should ensure that
all protective shields, as supplied by the manufacturer, are in
place and in good condition. The federal OSHA standard for safety
of farm equipment requires placement of guards on augers consistent
with their designed use (5).
      4. Before service or repair, power should be shut off and the
auger power source "locked-out" and "tagged." (Locking out prevents
power from being restored while maintenance is in progress, and
tagging the switch indicates that power is disabled and the
reason).
      5. To prevent entanglement, persons wearing loose clothing or
jewelry or persons with long, untied hair should not operate
augers.
      6. Workers should not step or jump on or over an auger while
it is in operation.
      7. Grain augers always should be lowered to a horizontal
position before being moved from one location to another. Workers
always should observe the presence and location of power lines
before raising an auger into position.
      8. Whenever possible, operators should ensure good footing
while working around augers. Portable augers should be placed on
dry, level ground or a gravel pad. Spilled grain should be removed
between loads, after the equipment has been turned off.
      9. Operators should never use their hands or feet to redirect
the flow of grain or other materials into the auger.
     10. All farm workers and auger operators should be educated
about safe operating procedures and hazards associated with augers.
     11. Augers should be clearly labeled as posing a hazard for
entanglement and subsequent serious injury.
References
1. National Safety Council. Accident facts. Chicago: National
Safety Council, 1993.
2. NIOSH. Preventing grain auger electrocutions. Cincinnati, Ohio:
US Department of Health and Human Services, Public Health Service,
CDC, 1986; DHHS publication no. (NIOSH)86-119.
3. Linn R. Auger and elevator accident victim rescue. Bozeman,
Montana: Montana State University, Montguide Cooperative Extension
Service, February 1987.
4. Aherin RA, Schultz L. Safe storage and handling of grain. St.
Paul, Minnesota: Minnesota Extension Service Bulletin, 1981;
publication no. AG-FO-568.
5. Office of the Federal Register. Code of federal regulations:
occupational safety and health standards. Subpart D: safety for
agricultural equipment. Washington, DC: Office of the Federal
Register, National Archives and Records Administration, 1994. (29
CFR section 1928.57[b]).

   *FACE, SENSOR, and OHNAC are cooperative agreements between
NIOSH and various state health departments and are intended to
develop models for state-based occupational health surveillance and
intervention. FACE was developed to more accurately identify and
evaluate work-related fatalities; 14 states currently have FACE
programs. Fourteen states have been awarded SENSOR cooperative
agreements to develop systems for surveillance of 12 occupational
conditions. OHNAC is a national surveillance system that has placed
public health nurses in 10 states. Surveillance data compiled by
these programs ultimately are used to reduce work-related injury
and illness.
  **Both FACE and SENSOR in Minnesota were initiated in 1993.
 ***An auger also may consist of only an exposed spiral corkscrew.
A "sweep" auger, referred to in incident 1, is typically an exposed
auger used to move material such as grain to a central discharge
point inside a large storage structure. A sweep auger usually
extends from the center of a round structure to its outside wall,
is powered by a drive system that contacts the bin or silo wall,
and slowly rotates (i.e., sweeps) around a pivot point at the
center of the structure. The auger rests directly in the grain (or
similar material), and the excess grain alongside the auger acts to
confine the grain that is in contact with the auger.
****Federal child labor laws prohibit employees aged less than 16
years from operating hazardous equipment (including agricultural
augers). However, family members working on family farms are exempt
from these provisions.


------------------------------

To: hicnews
Persons...

State-Specific Changes in Physical Inactivity Among Persons Aged
Greater Than or Equal to 65 Years -- United States, 1987-1992

     Regular physical activity can provide important health
benefits, even when such activities are initiated later in life
(1,2). Despite these benefits, most older persons in the United
States have sedentary lifestyles (3). One of the national health
objectives for the year 2000 is to reduce to 22% the proportion of
adults aged greater than or equal to 65 years who engage in no
leisure-time physical activity (objective 1.5a) (4). This report
uses data from CDC's Behavioral Risk Factor Surveillance System
(BRFSS) to summarize state-specific trends during 1987-1992 in the
prevalence of physical inactivity during leisure time among persons
aged greater than or equal to 65 years and projects state-specific
prevalences for 1997.
     The BRFSS is a population-based, random-digit-dialed telephone
survey of the noninstitutionalized U.S. population. Data were
available for 83,858 persons aged greater than or equal to 65 years
residing in 49 states and the District of Columbia who participated
in the BRFSS during 1987-1992. Of the 50 reporting areas, 32 states
and the District of Columbia collected information about physical
activity for the entire study period. Respondents were asked
specific questions about physical activity, including the type,
frequency, and duration of the two leisure-time physical activities
in which they participated most frequently during the preceding
month. Persons who reported engaging in no physical activity during
leisure time were categorized as inactive. Confidence intervals and
prevalence estimates were calculated using SUDAAN (5).
     For the 33 reporting areas that participated in the BRFSS each
year during 1987-1992, the median prevalence of no reported
leisure-time physical activity among persons aged greater than or
equal to 65 years declined from 43.2% in 1987 to 38.5% in 1992.
Consistent decreases (i.e., a decrease from the previous year in at
least 4 years) occurred in three states (Maryland, New Mexico, and
New York) and the District of Columbia; no state reported
consistent increases (i.e., an increase over the previous year in
at least 4 years) in physical inactivity (Table 1). The largest
overall declines in prevalence of inactivity over the 6-year period
were reported from Rhode Island (21.5%), Massachusetts (15.0%),
Ohio (14.1%), New Mexico (12.7%) and Maryland (10.1%). The largest
overall increases in prevalence were reported from Montana (7.2%),
West Virginia (4.3%), Maine (3.9%), and Georgia (2.9%).
     Two methods, a state-specific method and an aggregate method,
were used to project the prevalence of physical inactivity in 1997.
The analysis using the state-specific method was limited to data
from the 33 reporting areas that collected physical activity
information from 1987 through 1992. For each of these reporting
areas, the 5-year change (i.e., the 1992 value minus the 1987
value) in the percentage of respondents participating in no
leisure-time physical activity was added to that state's 1992 value
to project the 1997 prevalence. The analysis using the aggregate
method employed the median 5-year change in the prevalence of no
leisure-time physical activity during 1987-1992 from the 33 areas
reporting throughout the interval. The median 5-year change was
then added to the 1992 prevalence for each of the 49 participating
states and the District of Columbia to project the 1997 prevalence.
     The projected median prevalence of no leisure-time physical
activity for 1997 was 35.9% based on the state-specific method and
37.1% based on the aggregate method. Using the state-specific
method, three states (Massachusetts, Rhode Island, and Minnesota)
are projected in 1997 to meet the year 2000 objective to reduce
physical inactivity. Using the aggregate method, the lowest
projected prevalence is 24.8% for Washington, followed by 25.3% for
Colorado.
Reported by the following BRFSS coordinators: J Durham, Alabama; P
Owen, Alaska; B Bender, Arizona; J Senner, PhD, Arkansas; B Davis,
PhD, California; M Leff, MSPH, Colorado; M Adams, MPH, Connecticut;
F Breukelman, Delaware; C Mitchell, District of Columbia; D
McTague, MS, Florida; E Pledger, MPA, Georgia; F Newfield, MPH,
Hawaii; C Johnson, MPH, Idaho; B Steiner, MS, Illinois; N Costello,
MPA, Indiana; P Busick, Iowa; M Perry, Kansas; K Bramblett,
Kentucky; D Hargrove-Roberson, MSW, Louisiana; D Maines, Maine; A
Weinstein, MA, Maryland; R Lederman, MPH, Massachusetts; H McGee,
MPH, Michigan; N Salem, PhD, Minnesota; E Jones, MS, Mississippi;
J Jackson-Thompson, PhD, Missouri; P Smith, Montana; S Huffman,
Nebraska; E DeJan, Nevada; K Zaso, MPH, New Hampshire; G
Boeselager, MS, New Jersey; P Jaramillo, MPA, New Mexico; C
Maylahn, MPH, New York; G Lengerich, VMD, North Carolina; D Young,
MS, North Dakota; E Capwell, PhD, Ohio; N Hann, MPH, Oklahoma; J
Grant-Worley, MS, Oregon; L Mann, Pennsylvania; J Hesser, PhD,
Rhode Island; J Ferguson, DrPH, South Carolina; B Miller, South
Dakota; D Ridings, Tennessee; R Diamond, MPH, Texas; R Giles, Utah;
R McIntyre, PhD, Vermont; S Carswell, MA, Virginia; K Holm, MPH,
Washington; F King, West Virginia; E Cautley, MS, Wisconsin.
Statistics Br, and Cardiovascular Health Studies Br, Div of Chronic
Disease Control and Community Intervention, National Center for
Chronic Disease Prevention and Health Promotion, CDC.
Editorial Note: The findings in this report indicate that in 19
(58%) of the 33 states for which complete data were available, the
prevalence of physical inactivity among persons aged greater than
or equal to 65 years declined moderately during 1987-1992. This
analysis extends findings from a previous analysis of BRFSS data
for 1986-1990 (6). However, based on analysis of the data for 1987-1992 
by the
state-specific and aggregate trends methods, the median
prevalence in 1997 is projected to be approximately 36%-37%; if the
decline continues at the projected rate, it will be insufficient to
achieve the year 2000 objective.
     Factors that may be associated with variations among the
states in physical inactivity include differences in the age
distribution of persons aged greater than or equal to 65 years,
perceptions among both health-care providers and the public about
the benefits and need for physical activity in older adults,
variations in climate, and differences in community-level resources
for physical activity (e.g., state funding of facilities and
programs to promote physical activity). Community efforts have
targeted barriers to participation in physical activity for older
adults (e.g., lack of access to age-appropriate activities) by
providing transportation to safe and accessible facilities, such as
local malls to attend walking programs or to senior centers for
low-impact stretching and exercise programs in conjunction with
congregate meals.
     The findings in this report are subject to at least three
limitations. First, because BRFSS data are self-reported, activity
levels cannot be validated; however, the categorization of only
those persons who report no leisure-time activities as inactive
probably reduced the degree of misclassification. Second, some
respondents may have been active for other reasons (e.g.,
occupation or housework) but were misclassified as inactive. Third,
the sensitivity of questions to ascertain leisure-time physical
activity may vary in relation to the age of respondents.
     The health benefits of regular physical activity for persons
aged greater than or equal to 65 years include reducing the risks
for coronary heart disease and noninsulin-dependent diabetes,
preventing osteoporosis, promoting weight loss and weight
maintenance, preserving functional capacity, and fostering
psychologic well-being (1,2). In 1993, CDC and the American College
of Sports Medicine recommended that all adults in the United States
participate in greater than or equal to 30 minutes of
moderate-intensity physical activity on most, if not all, days of
the week (7). Persons who report no leisure-time physical activity
are the target population with the greatest potential gain in
health benefits as they increase their level of activity (8).
Although increases in longevity are diminished compared with
younger persons, older adults who begin to participate in regular
physical activity can decrease their risks for death and disability
and improve their quality of life (9).
References
1. Caspersen CJ, Kriska AM, Dearwater SR. Physical activity
epidemiology as applied to elderly populations. Bailleres Clin
Rheumatol 1994;8:7-27.
2. Elward K, Larson EB. Benefits of exercise for older adults. Clin
Geriatr Med 1992;8:35-50.
3. Siegel PZ, Brackbill RM, Frazier EL, et al. Behavioral risk
factor surveillance,1986-1990. In: CDC surveillance summaries
(December). MMWR 1991;40(no. SS-4).
4. Public Health Service. Healthy people 2000: national health
promotion and disease prevention objectives. Washington DC: US
Department of Health and Human Services, Public Health Service,
1991; DHHS publication no. (PHS)91-50213.
5. Shah BV, Barnwell BG, Hunt PN, LaVange LM. SUDAAN user's manual
release 5.50. Research Triangle Park, North Carolina: Research
Triangle Institute, 1991.
6. Caspersen CJ, Merrit RK. Physical activity trends among 26
states, 1986-1990. Med Sci Sports Exerc 1995;27:713-20.
7. Pate RR, Pratt M, Blair SN, et al. Physical activity and public
health: a recommendation from the Centers for Disease Control and
Prevention and the American College of Sports Medicine. JAMA
1995;273:402-7.
8. Paffenbarger RS Jr, Hyde RT, Wing AL, Lee I-M, Jung DL, Kampert
JB. The association of changes in physical-activity level and other
lifestyle characteristics with mortality among men. N Engl J Med
1993;328:538-45.
9. Paffenbarger RS Jr, Hyde RT, Wing AL, Lee I-M, Kampert JB. Some
interrelations of physical activity, physiological fitness, health,
and longevity. In: Bopuchard C, Shepard RJ, Stephens T, eds.
Physical activity, fitness, and health. Champaign, Illinois: Human
Kinetics Publishers, 1994.


------------------------------

End of HICNet Medical News Digest V08 Issue #33
***********************************************


---
Editor, HICNet Medical Newsletter
Internet: david@stat.com                 FAX: +1 (602) 451-6135

                                                      
