Summary—In 1995 the American College of Sports Medicine and the Centers for Disease Control and Prevention published national guidelines on Physical Activity and Public Health The Committee on Exercise and Cardiac Rehabilitation of the American Heart Association endorsed and supported these recommendations The purpose of the present report is to update and clarify the 1995 recommendations on the types and amounts of physical activity needed by healthy adults to improve and maintain health Development of this document was by an expert panel of scientists, including physicians, epidemiologists, exercise scientists, and public health specialists This panel reviewed advances in pertinent physiologic, epidemiologic, and clinical scientific data, including primary research articles and reviews published since the original recommendation was issued in 1995 Issues considered by the panel included new scientific evidence relating physical activity to health, physical activity recommendations by various organizations in the interim, and communications issues Key points related to updating the physical activity recommendation were outlined and writing groups were formed A draft manuscript was prepared and circulated for review to the expert panel as well as to outside experts Comments were integrated into the final recommendation Primary Recommendation—To promote and maintain health, all healthy adults aged 18 to 65 yr need moderate-intensity aerobic (endurance) physical activity for a minimum of 30 min on five days each week or vigorous-intensity aerobic physical activity for a minimum of 20 min on three days each week [I (A)] Combinations of moderate- and vigorous-intensity activity can be performed to meet this recommendation [IIa (B)] For example, a person can meet the recommendation by walking briskly for 30 min twice during the week and then jogging for 20 min on two other days Moderate-intensity aerobic activity, which is generally equivalent to a brisk walk and noticeably accelerates the heart rate, can be accumulated toward the 30-min minimum by performing bouts each lasting 10 or more minutes [I (B)] Vigorous-intensity activity is exemplified by jogging, and causes rapid breathing and a substantial increase in heart rate In addition, every adult should perform activities that maintain or increase muscular strength and endurance a minimum of two days each week [IIa (A)] Because of the dose-response relation between physical activity and health, persons who wish to further improve their personal fitness, reduce their risk for chronic diseases and disabilities or prevent unhealthy weight gain may benefit by exceeding the minimum recommended amounts of physical activity [I (A)] (Circulation 2007;116:1081-1093)

/pdf/physical-activity-and-public-health-updated-recommendation-5ar650n64d.pdf

Physical Activity and Public Health Updated Recommendation for Adults From the American College of Sports Medicine and the American Heart Association

Summary: In 1995 the American College of Sports Medicine and the Centers for Disease Control and Prevention published national guidelines on Physical Activity and Public Health. The Committee on Exercise and Cardiac Rehabilitation of the American Heart Association endorsed and supported these recommendations. The purpose of the present report is to update and clarify the 1995 recommendations on the types and amounts of physical activity needed by healthy adults to improve and maintain health. Development of this document was by an expert panel of scientists, including physicians, epidemiologists, exercise scientists, and public health specialists. This panel reviewed advances in pertinent physiologic, epidemiologic, and clinical scientific data, including primary research articles and reviews published since the original recommendation was issued in 1995. Issues considered by the panel included new scientific evidence relating physical activity to health, physical activity recommendations by various organizations in the interim, and communications issues. Key points related to updating the physical activity recommendation were outlined and writing groups were formed. A draft manuscript was prepared and circulated for review to the expert panel as well as to outside experts. Comments were integrated into the final recommendation.

Primary Recommendation: To promote and maintain health, all healthy adults aged 18 to 65 yr need moderate-intensity aerobic (endurance) physical activity for a minimum of 30 min on five days each week or vigorous-intensity aerobic physical activity for a minimum of 20 min on three days each week. [I (A)] Combinations of moderate- and vigorous-intensity activity can be performed to meet this recommendation. [IIa (B)] For example, a person can meet the recommendation by walking briskly for 30 min twice during the week and then jogging for 20 min on two other days. Moderate-intensity aerobic activity, which is generally equivalent to a brisk walk and noticeably accelerates the heart rate, can be accumulated toward the 30-min minimum by performing bouts each lasting 10 or more minutes. [I (B)] Vigorous-intensity activity is exemplified by jogging, and causes rapid breathing and a substantial increase in heart rate. In addition, every adult should perform activities that maintain or increase muscular strength and endurance a minimum of two days each week. [IIa (A)] Because of the dose-response relation between physical activity and health, persons who wish to further improve their personal fitness, reduce their risk for chronic diseases and disabilities or prevent unhealthy weight gain may benefit by exceeding the minimum recommended amounts of physical activity. [I (A)]

Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association.

The American Society for Testing and Materials (ASTM) is an independent organization devoted to the development of standards.

American Society for Testing and Materials

2014 AHA/ACC Guideline for the Management of Patients With Non–ST-Elevation Acute Coronary Syndromes A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines

/pdf/traumatic-brain-injury-in-the-united-states-emergency-35y7u89u11.pdf

Traumatic brain injury in the United States; emergency department visits, hospitalizations, and deaths

ContextAdverse drug events are common and often preventable causes of medical injuries. However, timely, nationally representative information on outpatient adverse drug events is limited.ObjectiveTo describe the frequency and characteristics of adverse drug events that lead to emergency department visits in the United States.Design, Setting, and ParticipantsActive surveillance from January 1, 2004, through December 31, 2005, through the National Electronic Injury Surveillance System–Cooperative Adverse Drug Event Surveillance project.Main Outcome MeasuresNational estimates of the numbers, population rates, and severity (measured by hospitalization) of individuals with adverse drug events treated in emergency departments.ResultsOver the 2-year study period, 21 298 adverse drug event cases were reported, producing weighted annual estimates of 701 547 individuals (95% confidence interval [CI], 509 642-893 452) or 2.4 individuals per 1000 population (95% CI, 1.7-3.0) treated in emergency departments. Of these cases, 3487 individuals required hospitalization (annual estimate, 117 318 [16.7%]; 95% CI, 13.1%-20.3%). Adverse drug events accounted for 2.5% (95% CI, 2.0%-3.1%) of estimated emergency department visits for all unintentional injuries and 6.7% (95% CI, 4.7%-8.7%) of those leading to hospitalization and accounted for 0.6% of estimated emergency department visits for all causes. Individuals aged 65 years or older were more likely than younger individuals to sustain adverse drug events (annual estimate, 4.9 vs 2.0 per 1000; rate ratio [RR], 2.4; 95% CI, 1.8-3.0) and more likely to require hospitalization (annual estimate, 1.6 vs 0.23 per 1000; RR, 6.8; 95% CI, 4.3-9.2). Drugs for which regular outpatient monitoring is used to prevent acute toxicity accounted for 41.5% of estimated hospitalizations overall (1381 cases; 95% CI, 30.9%-52.1%) and 54.4% of estimated hospitalizations among individuals aged 65 years or older (829 cases; 95% CI, 45.0%-63.7%).ConclusionsAdverse drug events among outpatients that lead to emergency department visits are an important cause of morbidity in the United States, particularly among individuals aged 65 years or older. Ongoing, population-based surveillance can help monitor these events and target prevention strategies.

https://jamanetwork.com/journals/jama/articlepdf/203690/JOC60142.pdf

National surveillance of emergency department visits for outpatient adverse drug events.

Objective: To characterize sports and recreation related (SR) injury episodes in the US population. SR activities are growing in popularity suggesting the need for increased awareness of SR injuries as a public health concern for physically active persons of all ages in the US population. 

Setting: The National Health Interview Survey (NHIS) is a face-to-face household survey conducted yearly by the National Center for Health Statistics, part of the Centers for Disease Control and Prevention. Demographic and health data are collected from a nationally representative sample of the civilian, non-institutionalized population residing in the US. 

Methods: Medically attended injury events reported in the 1997–99 Injury Section of the NHIS were categorized according to the associated sport or recreational activity using a classification scheme based on the International Classification of External Causes of Injury system. Episodes where the injured person received any type of medical attention (that is, medical advice or treatment) from any health care provider were used to report the incidence, severity, and nature of SR injuries sustained by US citizens. 

Results: Annually, an estimated seven million Americans received medical attention for SR injuries (25.9 injury episodes per 1000 population). For 5–24 year olds, this national estimate was about 42% higher than estimates based on SR injuries seen only in emergency departments over a similar time frame. The highest average annual SR injury episode rates were for children ages 5–14 years (59.3 per 1000 persons) and persons aged 15–24 years (56.4 per 1000 persons). The SR injury episode rate for males was more than twice the rate for females. The age adjusted injury rate for whites was 1.5 times higher than for blacks (28.8 v 19.0 per 1000 population). Basketball was the most frequently mentioned SR activity when the injury episode occurred, with a rate of about four injury events per 1000 population. Strains and sprains accounted for 31% of injury episodes. An estimated 1.1 million SR episode related injuries involve the head or neck region, of which 17% were internal head injuries. The most common mechanisms of injury were struck by/against (34%), fall (28%), and overexertion (13%). 

Conclusion: As physical activity continues to be promoted as part of a healthy lifestyle, SR injuries are becoming an important public health concern for both children and adults. Prevention efforts aimed at reducing SR injuries through targeting high risk activities, places of occurrence, activity, risk behaviors, and use of protective devices need to go beyond focusing on children and also consider physically active adults.

https://injuryprevention.bmj.com/content/injuryprev/9/2/117.full.pdf

Sports and recreation related injury episodes in the US population, 1997–99

https://stacks.cdc.gov/view/cdc/37255/cdc_37255_DS1.pdf

Firearm injuries in the United States

PROBLEM/CONDITION: Each year in the United States, an estimated one in six residents requires medical treatment for an injury, and an estimated one in 10 residents visits a hospital emergency department (ED) for treatment of a nonfatal injury. This report summarizes national data on fatal and nonfatal injuries in the United States for 2001, by age; sex; mechanism, intent, and type of injury; and other selected characteristics. REPORTING PERIOD COVERED: January-December 2001. DESCRIPTION OF SYSTEM: Description of the System: Fatal injury data are derived from CDC's National Vital Statistics System (NVSS) and include information obtained from official death certificates throughout the United States. Nonfatal injury data, other than gunshot injuries, are from the National Electronic Injury Surveillance System All Injury Program (NEISS-AIP), a national stratified probability sample of 66 U.S. hospital EDs. Nonfatal firearm and BB/pellet gunshot injury data are from CDC's Firearm Injury Surveillance Study, being conducted by using the National Electronic Injury Surveillance System (NEISS), a national stratified probability sample of 100 U.S. hospital EDs. RESULTS: In 2001, approximately 157,078 persons in the United States (age-adjusted injury death rate: 54.9/100,000 population; 95% confidence interval [CI] = 54.6-55.2/100,000) died from an injury, and an estimated 29,721,821 persons with nonfatal injuries (age-adjusted nonfatal injury rate: 10404.3/100,000; 95% CI = 10074.9-10733.7/ 100,000) were treated in U.S. hospital EDs. The overall injury-related case-fatality rate (CFR) was 0.53%, but CFRs varied substantially by age (rates for older persons were higher than rates for younger persons); sex (rates were higher for males than females); intent (rates were higher for self-harm-related than for assault and unintentional injuries); and mechanism (rates were highest for drowning, suffocation/inhalation, and firearm-related injury). Overall, fatal and nonfatal injury rates were higher for males than females and disproportionately affected younger and older persons. For fatal injuries, 101,537 (64.6%) were unintentional, and 51,326 (32.7%) were violence-related, including homicides, legal intervention, and suicide. For nonfatal injuries, 27,551,362 (92.7%) were unintentional, and 2,155,912 (7.3%) were violence-related, including assaults, legal intervention, and self-harm. Overall, the leading cause of fatal injury was unintentional motor-vehicle-occupant injuries. The leading cause of nonfatal injury was unintentional falls; however, leading causes vary substantially by sex and age. For nonfatal injuries, the majority of injured persons were treated in hospital EDs for lacerations (25.8%), strains/sprains (20.2%), and contusions/abrasions (18.3%); the majority of injuries were to the head/neck region (29.5%) and the extremities (47.9%). Overall, 5.5% of those treated for nonfatal injuries in hospital EDs were hospitalized or transferred to another facility for specialized care. INTERPRETATION: This report provides the first summary report of fatal and nonfatal injuries that combines death data from NVSS and nonfatal injury data from NEISS-AIP. These data indicate that mortality and morbidity associated with injuries affect all segments of the population, although the leading external causes of injuries vary substantially by age and sex of injured persons. Injury prevention efforts should include consideration of the substantial differences in fatal and nonfatal injury rates, CFRs, and the leading causes of unintentional and violence-related injuries, in regard to the sex and age of injured persons.

/pdf/surveillance-for-fatal-and-nonfatal-injuries-united-states-4xbqb9m181.pdf

Surveillance for fatal and nonfatal injuries--United States, 2001.

Objective. —To describe the magnitude and characteristics of nonfatal firearm-related injuries treated in hospital emergency departments in the United States and to compare nonfatal injury rates with firearm-related fatality rates. Design. —Data were obtained from medical records for all firearm-related injury cases identified using the National Electronic Injury Surveillance System (NEISS) from June 1, 1992, through May 31, 1993. Setting. —NEISS comprises 91 hospitals that are a stratified probability sample of all hospitals in the United States and its territories that have at least six beds and provide 24-hour emergency service. Main Outcome Measures. —Numbers and population rates for nonfatal and fatal firearm-related injuries. Results. —An estimated 99 025 (95% confidence interval [CI], 56 325 to 141 725) persons (or 38.6 per 100000 population; 95% CI, 22.0 to 55.2) were treated for nonfatal firearm-related injuries in US hospital emergency departments during the study period. The rate of nonfatal firearm-related injuries treated was 2.6 (95% CI, 1.5 to 3.7) times the national rate of fatal firearm-related injuries for 1992. Conclusions. —Nonfatal firearm-related injuries contribute substantially to the overall public health burden of firearm-related injuries. NEISS can be useful to monitor the number of nonfatal firearm-related injuries in the United States. A national surveillance system is needed to provide uniform data on firearm-related injury morbidity and mortality for use in research and prevention efforts. ( JAMA . 1995;273:1749-1754)

Joseph L. Annest

Papers

National surveillance of emergency department visits for outpatient adverse drug events.

Sports and recreation related injury episodes in the US population, 1997–99

Firearm injuries in the United States

Surveillance for fatal and nonfatal injuries--United States, 2001.

National estimates of nonfatal firearm-related injuries. Beyond the tip of the iceberg.