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All accidental carbon monoxide poisoning should be preventable. Yet despite intervention efforts including promotion of inexpensive home carbon monoxide detectors, annual inspection of home gas and oil appliances, and general awareness campaigns, in 2002 there were 18 fatalities, 36 inpatient admissions, 351 emergency department visits and 117 poison center calls attributed to acute carbon monoxide exposure. The first step to help better focus public health interventions is adequate information on occurrences. The Wisconsin Environmental Public Health Tracking program identified and evaluated potential data sources for inclusion in a surveillance system for monitoring unintentional carbon monoxide poisonings. Criteria to evaluate the utility of the existing data systems were developed and included the number of new cases identified from that source, the circumstantial detail provided, timeliness of data availability, confidence that an actual exposure occurred, and the resources required to retrieve and summarize the data. Five candidate datasets were evaluated: emergency department visits, hospital inpatient stays, death certificates, Wisconsin Poison Center records, and newspaper reports. It was found that although there was some overlap between cases reported in the different datasets, each source provided unique cases. The sources also differed in the resources required for utilizing the data and the amount of circumstantial information provided. Based on the evaluation of the different sources, it was concluded that newspaper reports should not be included, but the other 4 data sources would each contribute substantially to establishing a comprehensive surveillance system for accidental carbon monoxide poisoning.

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Pediatricians can reduce exposures to environmental hazards but most have little training in environmental health. To assess whether Wisconsin pediatricians perceive a relative lack of self-efficacy for common environmental exposures and diseases of environmental origin, we assessed their attitudes and beliefs about the role of the environment in children's health. A 4-page survey was sent to the membership of the Wisconsin Chapter of the American Academy of Pediatrics. We obtained a 35.4% response rate after 1 follow-up mailing. Respondents agreed that the role of the environment in children's health is significant (mean 4.28 +/- .78 on 1-5 Likert scale). They expressed high confidence in dealing with lead exposure (means 4.22-4.27 +/- 1.01-1.09), but confidence in their skills for pesticide, mercury, and mold was much lower (means 2.49-3.09 +/- 1.06-1.26; P<.001). Of those surveyed, 88.6% would refer patients to a clinic "where pediatricians could refer patients for clinical evaluation and treatment of their environmental health concerns." These findings indicate that Wisconsin pediatricians agree that children are suffering preventable illnesses of environmental origin, but feel ill equipped to educate families about many common exposures. Significant demand exists for centers that can evaluate environmental health concerns, as well as for educational opportunities.

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STUDY OBJECTIVES: We characterize the use of analgesics among children of different race and ethnicity who had isolated long bone fractures that were treated in emergency departments (EDs) across the United States. METHODS: According to ED survey data from the National Hospital Ambulatory Medical Care Survey for 1992 through 1998, patients younger than 19 years and visiting EDs with isolated long bone fractures were identified by International Classification of Diseases, Ninth Revision codes. Analgesic-prescribing rates were examined for children of different racial and ethnic groups. Multivariate logistic regression was used to determine the independent effect of race and ethnicity on analgesic use and on opioid use while other potential confounders were controlled. RESULTS: One thousand thirty records representing approximately 3.9 million children were identified. Seven hundred ninety-two records were of non-Hispanic white patients, 111 were of black patients, and 127 were of Hispanic white patients. No significant difference was noted among the different racial and ethnic groups for receipt of analgesic medications or of opioid analgesic medications. Children with long bone fractures who visited the ED in the South (adjusted odds ratio [OR] 1.91; 95% confidence interval [CI] 1.19 to 3.09) and the West (adjusted OR 1.78; 95% CI 1.07 to 2.96) received opioid analgesic medications more often than children in the Northeast. Children in the South also received any analgesics more often (adjusted OR 1.61; 95% CI 1.01 to 2.56). CONCLUSION: No difference in analgesic prescription or opioid analgesic prescription was found between black and Hispanic children compared with non-Hispanic white children with long bone fractures in EDs. There are, however, previously unreported regional differences in analgesic administration.

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