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Injuries remain the most important cause of loss of potential years of life before age 65 Road traffic injuries, selfinflicted injuries, falls, and interpersonal violence are the major sources of injuries Injuries affect mostly older women and young men, often causing long-term disability Although there has been a steady decline in motor vehicle accident deaths per miles driven, road traffic injuries remain the tenth leading cause of death and the ninth leading cause of the burden of disease Although seat belt use protects against serious injury and death in motor vehicle accidents, at least one-fourth of adults and onethird of teenagers do not use seat belts routinely Air bags are protective for adults but not for small children Each year in the United States, more than 500,000 people are nonfatally injured while riding bicycles The rate of helmet use by bicyclists and motorcyclists is significantly increased in states with helmet laws By the end of 2000, bicycle helmet use in 15 communities monitored by the CDC s National Center for Injury Prevention and Control had risen from 40% to 55%, exceeding the Healthy People 2000 goal Young men appear most likely to resist wearing helmets Clinicians should try to educate their patients about seat belts, safety helmets, the risks of using cellular telephones while driving, drinking and driving or using other intoxicants or long-acting benzodiazepines and then driving and the risks of having guns in the home Long-term alcohol abuse adversely affects outcome from trauma and increases the risk of readmission for new trauma Alcohol and illicit drug use are associated with an increased risk of violent death There is a causal link between alcohol intoxication and injury due to assault Harm reduction can be achieved through practical measures, such as using plastic glasses and bottles in licensed premises; controlling prices of drinks; and targeted policing based on police, accident, and emergency data Males aged 16 35 are at especially high risk for serious injury and death from accidents and violence, with blacks and Latinos at greatest risk For 16- and 17-year-old drivers, the risk of fatal crashes increases with the number of passengers Deaths from firearms have reached epidemic levels in the United States and will soon surpass the number of deaths from motor vehicle accidents Having a gun in the home increases the likelihood of homicide nearly threefold and of suicide fivefold In 2002, an estimated 877,000 individuals successfully committed suicide Educating physicians to recognize and treat depression as well as restricting access to lethal methods have been found to reduce suicide rates In elderly patients, the risk of hip fracture when falling can be reduced by as much as 80% by wearing hip protectors, but only about half of patients use them regularly Oral vitamin D supplementation with 700 800 IU/d appears to reduce the risk of hip and other nonvertebral fractures in.

both ambulatory and institutionalized elderly persons, but 400 IU/d is not sufficient for fracture prevention Finally, clinicians have a critical role in detection, prevention, and management of physical or sexual abuse in particular, routine assessment of women for risk of domestic violence In a trial, the 12-month prevalence of intimate partner violence ranged from 4% to 18% depending on the screening method, instrument, and health care setting Rates of current domestic violence on exit questionnaire were 21% in suburban emergency department and 26% in urban emergency department settings Inclusion of a single question about domestic violence in the medical history At any time, has a partner ever hit you, kicked you, or otherwise physically hurt you can increase identification of this common problem Another screen consists of three questions: (1) Have you ever been hit, kicked, punched, or otherwise hurt by someone within the past year If so, by whom (2) Do you feel safe in your current relationship (3) Is there a partner from a previous relationship who is making you feel unsafe now Women seem to prefer written, self-completed screening questionnaires to face-to-face questioning Alternatively, computer prompts to clinicians may serve as useful reminders to inquiry Assessment for abuse and offering of referrals to community resources creates potential to interrupt and prevent recurrence of domestic violence and associated trauma Physical and psychological abuse, exploitation, and neglect of older adults are serious underrecognized problems Clues to elder mistreatment include the patient s appearance, recurrent urgent-care visits, missed appointments, suspicious physical findings, and implausible explanations for injuries

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Bischoff-Ferrari HA et al Fracture prevention with vitamin D supplementation: a meta-analysis of randomized controlled trials JAMA 2005 May 11;293(18):2257 64 [PMID: 15886381] Collins KA Elder maltreatment: a review Arch Pathol Lab Med 2006 Sep;130(9):1290 6 [PMID: 16948513] Cusens B et al Prevention of alcohol-related assault and injury Hosp Med 2005 Jun;66(6):346 8 [PMID: 15974163] Jackson RD et al; Women s Health Initiative Investigators Calcium plus vitamin D supplementation and the risk of fractures N Engl J Med 2006 Feb 16;354(7):669 83 [PMID: 16481635] JAMA patient page Partner violence JAMA 2002 Aug 7;288 (5):662 [PMID: 12171057] MacMillan HL et al; McMaster Violence Against Women Research Group Approaches to screening for intimate partner violence in health care settings: a randomized trial JAMA 2006 Aug 2;296(5):530 6 [PMID: 16882959] Mann JJ et al Suicide prevention strategies: a systematic review JAMA 2005 Oct 26;294(16):2064 74 [PMID: 16249421] McClure R et al Population-based interventions for the prevention of fall-related injuries in older people Cochrane Database Syst Rev 2005;(1):CD004441 [PMID: 15674948] McFarlane JM et al Secondary prevention of intimate partner violence: a randomized controlled trial Nurs Res 2006 Jan Feb;55(1):52 61 [PMID: 16439929] Rhodes KV et al Lowering the threshold for discussions of domestic violence: a randomized controlled trial of computer screening Arch Intern Med 2006 May 22;166(10):1107 14 [PMID: 16717173]

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Herpes zoster frequently involves the ophthalmic division of the trigeminal nerve It presents with malaise, fever, headache, and periorbital burning and itching These symptoms may precede the eruption by a day or more The rash is initially vesicular, quickly becoming pustular and then crusting Involvement of the tip of the nose or the lid margins predicts involvement of the eye Ocular signs include conjunctivitis, keratitis, episcleritis, and anterior uveitis, often with elevated intraocular pressure Recurrent anterior segment inflammation, neurotrophic keratitis, and posterior subcapsular cataract are long-term complications Optic neuropathy, cranial nerve palsies, acute retinal necrosis, and cerebral angiitis are infrequent problems in the acute stage HIV infection is an important risk factor for herpes zoster ophthalmicus and increases the likelihood of complications High-dose oral acyclovir (800 mg five times a day), valacyclovir (1 g three times a day), or famciclovir (250 500 mg three times a day) started within 72 hours after the appearance of the rash reduces the incidence of ocular complications but not of postherpetic neuralgia Anterior uveitis requires treatment with topical corticosteroids and cycloplegics Neurotrophic keratitis is an important cause of long-term morbidity

Opstelten W et al Managing ophthalmic herpes zoster in primary care BMJ 2005 Jul 16;331(7509):147 51 [PMID: 16020856]

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