Rakes and Pains

Leave raking injuries behind with these safety tips

Press Release From AAOS

Autumn leaves look beautiful on trees, but less so once they fall. That is because leaves on the ground mean it is time to start raking. This outdoor task is often more physically demanding than people realize, so the American Academy of Orthopaedic Surgeons (AAOS) recommends that people take precautions when raking.

Even though raking does not utilize power tools or sharp blades, it can still cause injuries. According to 2006 U.S. Consumer Products Safety Commission statistics, more than 76,000 people were treated in hospital emergency rooms, doctors’ offices, clinics and other medical settings for injuries related to non-powered garden tools, including rakes.

"Many people consider raking just another chore, but it requires a lot more reaching, bending and lifting than most odd jobs," says Daryll C. Dykes, MD, PhD, orthopaedic surgeon and spokesperson for the Academy. "Raking should be treated like any other vigorous exercise. People should pay close attention to their arms and backs, being careful not to reach or stretch too far."

The Academy offers the following recommendations to prevent injuries while raking:

• With any physical activity, it is important to warm up your muscles for at least 10 minutes with light exercise and stretching, especially when it is cold outside. You should also stretch your muscles after raking to relieve tension and prevent soreness.
  
  
• Use a rake that feels comfortable for your height and strength. Wear gloves or use rakes with padded handles to help prevent blisters.
  
  
• Avoid using old rakes that have gotten rusty or that have loose or broken parts.
  
  
• Do not let a hat or scarf block your vision. Watch out for large rocks, low branches, tree stumps and uneven surfaces.
  
  
• Try to vary your movements, alternating your leg and arm positions often. When picking up leaves, bend at the knees, not the waist.
  
  
• Exercise care walking on wet leaves, which can be very slippery. Avoid falls by wearing shoes or boots with slip-resistant soles.
  
  
• Avoid overfilling leaf bags, especially if the leaves are wet. You should be able to carry bags comfortably, so make sure they aren’t too heavy or large.
  
  
• Do not throw the leaves over your shoulder or to the side. This requires a twisting motion that places undue stress on your back.

For more information on exercise- and sports-related injury prevention, visit:
http://www.orthoinfo.org/category.cfm?topcategory=Injury%20Prevention

2007 America’s Health Rankings Show a Decline in the Overall Health of the Nation

The following is a press release from American Public Health Association.

Analysis shows Vermont, Minnesota and Hawaii are nation’s healthiest states; Mississippi and Louisiana rank as least-healthy states

WASHINGTON, D.C. – November 5, 2007 – The overall health of the nation declined over the past year, despite progress made in several key health indicators, according to a report launched today by United Health Foundation, the American Public Health Association (APHA) and Partnership for Prevention. The 18th annual edition of America's Health Rankings: A Call to Action for People & Their Communities measures the overall healthiness of states and the nation using a comprehensive and longitudinal set of related health determinants and health outcomes. The report indicates that the overall health of the nation declined by a rate of 0.3 percent since last year.

While this report, and others, show there have been modest gains in reducing the rates of cancer and cardiovascular mortality, these improvements continue to be dwarfed by increasing obesity, increasing numbers of uninsured people, children in poverty and the persistence of risky health behaviors, such as tobacco use and violent crime -- all of which have a significant impact on the overall healthiness of the nation.

"Even though specific mortality rates have improved, this report shows there are still many people who, through unhealthy personal behaviors, adverse community environments and difficult access to care, are vulnerable to a future life of poor health -- which is essentially preventable," said Reed Tuckson, M.D., member of the board of United Health Foundation. "The consequence of this reality manifests itself in a poor quality of life, people living with chronic disease, compromised productivity and significant escalation in the costs associated with managing chronic illness."

This lack of progress is in sharp contrast to the nation's average annual improvement of 1.5 percent between 1990 and 2000. In fact, since 2000, there has been a virtual stagnation in health improvement. The failure to demonstrate progress is particularly worrisome given that the U.S. continues to trail other nations in important health indicators such as infant mortality and healthy life expectancy.

Once again, this year's report provides a ranking of the healthiness of each state. Vermont surpassed Minnesota as the healthiest state in the nation this year, with Minnesota (2), Hawaii (3), New Hampshire (4) and Connecticut (5) rounding out the top five.

The data also notes that Mississippi ranks as the least healthy state, with Louisiana (49), Arkansas (48), Oklahoma (47) and Tennessee (46) completing the bottom five. The publishers of the report note that every state – no matter its ranking – has its own set of unique challenges to confront and successes on which to build and from which other states can learn.

A National Health Analysis

This year the report analyzes a comprehensive set of 20 related health measures, such as smoking, binge drinking, violent crime, infectious disease, high school graduation, health status and several measures of mortality. The analysis of this comprehensive set of factors allows for a more complete and holistic view of the health of the nation than only death-related statistics. The following is a snapshot of the national findings:

• Since the first report in 1990, America’s Health Rankings, using a consistent set of measures, has shown an 18.4 percent improvement in the nation's overall health. This national success can be attributed mostly to:

1. The reduction of several health determinants, such as infectious diseases, smoking, infant mortality, cardiovascular deaths and violent crime.
2. Fewer children living in poverty.
3. More ninth graders graduating high school within four years now than in 1990.

• Over the last six years, however, the nation’s health has virtually stagnated. Several reasons for the stagnation are obesity, a growing number of uninsured and persistent lack of progress in key health measures such as tobacco use, violent crime and children in poverty. Within the national environment, some states have addressed key health issues and improved, however others have not and are declining.
  
  
• Obesity has increased from 11.6 percent of the population in 1990 to more than 25 percent today. More than 55 million Americans are obese and as a result are at significant risk for other diseases, such as heart disease, diabetes, stroke, and cancer.
  
  
• According to the U.S. Census Bureau, the number of Americans who are uninsured has increased from 13.4 percent in 1990 to 15.8 percent of the population today. Up .5 percent from last year, an alarming 47 million Americans are living without health insurance. Tragically, more than nine million of the uninsured are children. According to the Institute of Medicine (IOM), people without health insurance are sicker and die sooner. IOM attributes 18,000 deaths per year to people under age 65 due to lack of insurance coverage.
  

The United States Compared to Other Nations

This year's report also looks at the U.S. compared to other nations. According to the 2007 Commonwealth Fund findings, the U.S. spends twice as much on health care than Australia, Canada, Germany, New Zealand and the United Kingdom. Despite this expenditure of health care assets, the U.S. continues to fall behind in several important indicators of health. For example:

• Although the U.S. can now celebrate its highest life expectancy in history (77.9 years), 43 other countries still have life expectancies that are higher than the U.S., including Japan, Sweden, France, Canada, Italy and Australia. In fact, a baby born today in Japan has a life expectancy of 82.0 years and a baby born in the U.S. has a life expectancy of 77.9 years. If we look at a broader measure and compare healthy life expectancy – that is number of years of active, healthy life expected at birth – a baby girl in Japan can expect 78 years whereas a girl born in the U.S. can expect only 71 years of healthy life at birth. Once again, U.S. citizens continue to demonstrate unacceptably high burdens of illness.

"The health of the American people is not just about length of life, but it is also about quality of life," said John Clymer, president of Partnership for Prevention. "We must look to each other, but also to these other nations as examples to aid us in our efforts to improve health."

State-by-State Analysis

Several states exhibited noteworthy gains in overall health improvement. For example:

• South Carolina had the highest overall health improvement with a 6.3 percent increase. Montana followed with a 4.6 percent increase, and Maryland and New Mexico both had a 4.5 percent increase in health status.
  
  
• Vermont moved to the top of the list of healthiest states after a steady climb in the rankings for the past seven years. This is notable because it demonstrates that progress can be made. Vermont has made significant progress in several key areas:

1. The prevalence of smoking declined from 21.5 percent in 2001 to 18.0 percent in 2007.
2. Children in poverty declined from 16.1 percent in 2001 to 8.9 percent of persons under age 18 in 2007.
3. In 2001, Vermont ranked only 29th in prenatal care – now it ranks 2nd.

• Nebraska’s return to the top ten (it last appeared in the top ten in 1992). Nebraska notes a continued improvement in high school graduation rates – now the highest in the U.S. Nebraska also has experienced reductions in the last few years in the occupational fatality rate and violent crime.
  
  
• After four years in the bottom ten, Georgia moved up to 40th place. Georgia has experienced a decline in the infectious disease rate, number of poor physical health days and prevalence of smoking.

Health Disparities among Populations

Given that America’s Health Rankings™ is specifically intended to provide opportunities for focused analysis and action to meet high priority local problems, documenting disparities in health status between populations has been, and continues to be, a major feature of the report. Once again, state-specific concerns are noted and national trends also are documented.

• Disparities continue to exist in measures such as premature death (premature death measures the loss of life before age 75 in a population). The premature death rate for Blacks is almost 1.5 times than the rate for Whites.
  
  
• Disparities also are growing between the Hispanic and non-Hispanic populations.
  
  
• According to the National Healthcare Disparities Report, Hispanics receive poorer quality care than non-Hispanics and data indicates that this trend is getting worse, not better.
  
  
• In terms of preventive care, the Hispanic population has the lowest percentage of people accessing regular dental care and colon cancer screenings – two key indicators of a population’s ability to stay healthy.

"Eliminating disparities in health requires a greater emphasis and focus on the root causes of poor access to care; differential access to quality medical care; and the social determinates that lead to unhealthy living conditions," said Georges C. Benjamin, M.D., FACP, FACEP (E), executive director of APHA. "Eliminating these disparities is a mechanism to improve the overall health status of the nation and advance our health rankings as compared to the rest of the world."

To view the entire report, please visit www.americashealthrankings.org or www.unitedhealthfoundation.org.

30-minute CPR Classes Just As Effective As Multi-hour Courses

UT Southwestern Medical Center researchers have found that a user-friendly, 30-minute, video-based cardiopulmonary resuscitation training session is just as effective as the traditional three- to four-hour course in teaching basic life-saving techniques to laypersons. In addition, at six months after the training — a critical point for CPR skill retention — those who took the shorter course performed CPR and used an automated external defibrillator (AED) just as well or better than those who take the traditional training.

These findings, published in the August issue of the journal Resuscitation, are the first to evaluate and document the effectiveness of long-term retention of the new 30-minute CPR-AED training.

“The results of this formal investigation should not only facilitate more widespread training and frequent re-training in CPR techniques, but it also diminishes some of the inefficiencies and labor-intensity inherent in traditional CPR training,” said Dr. Paul Pepe, chief of emergency medicine at UT Southwestern.

	Dr. Lynn Roppolo (right), assistant professor of emergency medicine, and Dr. Ahamed Idris, professor of emergency medicine, were part of a group of researchers who have found that a user-friendly, 30-minute, video-based cardiopulmonary resuscitation training session is as effective as the traditional three- to four-hour course in teaching basic life-saving techniques to the public.

Traditional CPR courses last half a day, as six to eight people take turns practicing their skills on a shared manikin. The remainder of the time is spent listening to instruction, leaving little time for skills practice, the researchers report.

“Using individualized kits, the trainees can focus on uninterrupted skills practice and develop muscle memory from more intensive, focused and reiterative practice,” said Dr. Pepe.

The shorter course is much more convenient and easily accessible, said Dr. Lynn Roppolo, assistant professor of emergency medicine and lead author of the study.

“Individuals practice while they learn, allowing more time to perform and retain the critical hands-on skills required to provide more effective CPR,” Dr. Roppolo said. “All of these factors will likely translate into more people knowing what to do — and doing it right — whenever CPR is needed. As a result, hopefully, many more lives will be saved in years to come.”

For the study, volunteers recruited in Fort Worth were selected randomly to take either the 30-minute course or a traditional three-hour session.

The short course consisted of a 23-minute digital video disc program, developed by the American Heart Association, which covers basic adult CPR skills, including recognition of signs of life, calling for help, opening the airway, rescue breaths and chest compressions.

As two dozen or more students watched the video in each session simultaneously, they practiced the CPR techniques almost continuously for nearly 20 minutes on their own personal mini-manikin, supervised by a “facilitator” who generally only needed to answer an occasional question from the trainees once the DVD was started.

Also included was a three-minute discussion and demonstration on the recognition of and best procedures for choking, as well as a five-minute demonstration of the use of an AED.

In the traditional course, students attended a three-hour session consisting of lectures supplemented by related video-based instruction, practice of basic CPR skills, choking procedures and instruction and hands-on practice in the use of an AED. During this course, there was one certified instructor for every six to eight students during the skills practice.

After their respective training, the students from both groups were tested using a life-sized manikin, which was connected to a laptop computer that objectively measured parameters such as the rate and depth of ventilations and chest compressions.

In addition to the computer measurements, overall CPR performance and AED use were videotaped and later judged as being appropriate by CPR training experts, who graded each study participant without knowing whether the he or she had taken the half-hour course or the traditional training.

Immediately after taking the class, there were no significant differences in CPR performance between the students who took the three-hour course as compared to those who took the 30-minute course.

After six months, however, trainees who took the 30-minute course called 9-1-1 and provided adequate ventilation more frequently than those who took the longer course. Also, both at the initial and six-month follow-up test, the students who took the traditional course took 30 percent longer to assess for signs of life, and they took significantly more time to pause between chest compressions to perform ventilations.

In grading AED use immediately after the courses, the trainees who took the 30-minute course placed the AED pads and delivered a shock correctly in 98 percent of the cases, compared to 92 percent of those who took the longer course. Moreover, at the critical six-month follow-up, 93 percent of those in the half-hour course still operated the AED well and 93 percent were still judged to be performing chest compressions adequately.

“The results of this investigation were very compelling. This study suggests that hands-on practice is not necessary to learn how to operate an AED, a device that directly provides the rescuer with vocal instructions once it is turned on,” said Dr. Roppolo. “Thus, training tools that utilize cognitive modes, such as the Internet and DVD demonstrations, may be just as effective.”

Other UT Southwestern researchers contributing to the study included Dr. Ahamed Idris, professor of emergency medicine, and Dr. Ronna Miller, assistant professor of emergency medicine.

The research was supported by the American Heart Association, the Laerdal Medical Corp., and Phillips Medical Systems and American Airlines.

FDA Clears First Respirators for Use in Public Health Medical Emergencies

The U.S. Food and Drug Administration (FDA) today cleared for marketing the first respirators that can help reduce the user's exposure to airborne germs during a public health medical emergency, such as an influenza pandemic.

These two filtering facepiece respirators, manufactured by St. Paul, Minn.-based 3M Company (and called the 3M Respirator 8612F and 8670F), will be available to the general public without a prescription.

The devices are also certified as N95 filtering facepiece respirators by the National Institute for Occupational Safety and Health (NIOSH). NIOSH certifies respirators for use in occupational settings in accordance with an appropriate respiratory protection program.

An N95 filtering facepiece respirator is a type of face mask that fits tightly over the nose and mouth. It is made of fibrous material that is designed to filter out at least 95 percent of very small airborne particles. The filter and a proper fit determine the effectiveness of the product.

"While the exact nature and concentration of the biological agent or germ may not be known in a public health medical emergency, we believe that minimizing exposure will help reduce risk," said Daniel Schultz, M.D., director, FDA's Center for Devices and Radiological Health. "These respirators are only one part of a combination of approaches that can be used to help reduce the spread of infection between individuals during such events."

Many companies make N95 respirators for workplaces, including health care settings. However, the 3M respirators are the first devices to receive FDA clearance for use by the public during public health medical emergencies to reduce exposure to airborne germs.

Under Occupational Safety and Health Administration and other occupational health regulations, respirators used in the workplace must be individually selected for each worker and tested to ensure a proper fit. This kind of fit testing is not generally employed outside the workplace now and would probably not be feasible during a public health medical emergency.

FDA is requiring those who want to market respirators for use during public health medical emergencies to assure that they are certified by NIOSH to provide adequate filtration without hampering people's ability to breathe. In addition, companies must conduct fit assessment testing, conduct biocompatibility testing to reduce the chance for allergic skin reaction, and provide instructions that will enable wearers to achieve a protective fit and use the devices properly.

3M evaluated fit characteristics in healthy adults to determine that a user could achieve a protective fit following the instructions on the label. They measured how many airborne test particles were able to get inside the respirator through small leaks between the edges of the respirator and the wearer's face. While individual results varied, all participants tested achieved some reduction in exposure to airborne test particles.

The 3M respirators are sized for adults and may not form a proper fit on children. Anything that comes between the respirator and the face, such as facial hair, may interfere with its fit. Persons with pre-existing heart or lung disease or other health conditions may have difficulty breathing through a respirator. The devices are for single use. Wearers should not wash, disinfect, reuse or share their respirator with others. The respirators should be discarded after use.

FDA will soon issue a guidance document outlining its regulatory approach to this new type of device.

Inhaling particles is just one route of exposure to disease-causing organisms. Others include touching contaminated surfaces and coming into close contact with those who have infectious diseases. A total approach to personal protection includes hand hygiene, cough etiquette and other protection practices such as avoiding crowded settings.