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The number of school-associated deaths appears to be higher than originally estimated. Researchers used newspaper clipping services and online newspaper databases to identify 105 deaths of elementary and secondary school students that occurred at 101 schools in 25 states between July, 1992 and June, 1994. Additional data were provided by local police, medical examiners and school officials. Twenty of the deaths (19%) were suicides. Forty-three percent occurred during an activity sponsored by the school. However, only 29% occurred inside the school building, indicating that metal detectors and security cameras may have little effect on reducing student violence. Sixty percent of the deaths occurred in urban schools and 77% involved firearms. Most of the firearms used were handguns and many were automatic or semiautomatic. One-third of the incidents involved personal disputes and 31% were gang-related. Most of the victims were younger than 20, 83% were male and almost half were non-Hispanic blacks. Twenty-one percent had a criminal background., Objectives. - To conduct the first nationwide investigation of violent deaths associated with schools in the United States, to quantify the risk of school-associated violent death, and to identify epidemiologic features of these deaths. Design. - Descriptive case series. Setting. - United States, July 1, 1992, through June 30, 1994. Methods. - School-associated violent deaths were identified by study collaborators and through 2 online news databases. Police reports, medical examiners' records, and interviews with police and school officials provided detailed information about each case. Results. - In a 2-year period, 105 school-associated violent deaths were identified. The estimated incidence of school-associated violent death was 0.09 per 100 000 student-years. Students in secondary schools, students of minority racial and ethnic backgrounds, and students in urban school districts had higher levels of risk. The deaths occurred in communities of all sizes in 25 different states. Homicide was the predominant cause of death (n=85 [80.90%]), and firearms were responsible for a majority (n=81 [77.1%]) of the deaths. Most victims were students (n=76 [72.4%]). Both victims and offenders tended to be young (median ages, 16 and 17 years, respectively) and male (82.90% and 95.60%, respectively). Approximately equal numbers of deaths occurred inside school buildings (n=31 [29.5%]), outdoors but on school property (n=37 [35.2%]), and at off-campus locations while the victim was in transit to or from school (n=37 [35.21%]). Equal numbers of deaths occurred during classes or other school activities (n=46 [43.80%]) and before or after official school activities (n=46 [43.8%]). Conclusions. - School-associated violent deaths were more common than previously estimated. The epidemiologic features of these deaths were similar to those of homicides and suicides that occur elsewhere. A comprehensive approach that addresses violent injury and death among young people at school and elsewhere in the community is suggested.

Background: The use of preventive measures, including effective chemoprophylaxis, is essential for protection against malaria among travelers. However, data have shown that travelers and medical advisors are confused by the lack of uniform recommendations and numerous prophylactic regimens of varying effectiveness that are used. Methods: To assess the use and type of preventive measures against malaria, we conducted a cross-sectional study in 1997 among travelers departing from the Nairobi and Mombasa airports in Kenya with European destinations. Results: Seventy-five percent of the travelers studied were residents of Europe and 25% were residents of North America; all stayed less than 1 year, and visited malarious areas. Most travelers, 97.1%, were aware of the risk and 91.3% sought pretravel medical advice. Although 95.4% used chemoprophylaxis and/or antimosquito measures, only 61.7% used both regular chemoprophylaxis and two or more antimosquito measures. Compliance with chemoprophylaxis was lowest amongst those who used a drug with a daily, as opposed to, a weekly dosing schedule, stayed more than 1 month, attributed an adverse health event to the chemoprophylaxis, and were less than 40 years of age. Among US travelers, 94.6% of those taking chemoprophylaxis were taking an effective regimen, that is, mefloquine or doxycycline. Only 1.9% used a suboptimal drug regimen, such as chloroquine/proguanil. Among European travelers, 69% used mefloquine or doxycycline, and 25% used chloroquine/proguanil. Notably, 45.3% of travelers from the UK used chloroquine/proguanil. Adverse events were noted by 19.7% of mefloquine users and 16.4% of travelers taking chloroquine/proguanil. Neuropsychologic adverse events were reported by 7.8% of users of mefloquine and 1.9% of those taking chloroquine/proguanil. The adverse events, however, had a lesser impact on compliance than frequent dosing schedule. Conclusions: Health information should be targeted to travelers who are... [ABSTRACT FROM AUTHOR]