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During the past half century, traumatic injuries have emerged as a pre-em­ inent public health challenge. Injury is the leading cause of hospitalization and death in persons younger than 45 years of age; results in more years of potential life lost than cancer or heart disease; and is second only to respiratory conditions as a reason for contact with physicians (3). One third of all nonfatal injuries and one sixth of all injury fatalities among adults aged 20 to 64 occur on the job (3). The public health response to a broad spectrum of occupational health and safety problems has embraced three traditional applications of epide­ miology: surveillance; etiologic research (i.e. studies to identify risk factors); and evaluation of the effect of interventions. With the increased recognition of injury as a serious public health problem, it is logical that efforts to prevent and control occupational injury should rely on the same epidemio­ logical approach used to attack other public health problems (9, 13). In industry and government, the role of surveillance in identifying the most important occupational injury problems, targeting high-risk popUlations, and monitoring trends has been recognized for a long time (16, 26, 28, 48). The application of epidemiological methods to the study of the etiology of occupational injury is far less common. This review is intended to summarize etiologic studies of occupational injuries, identify their methodological strengths and limitations, point out needs for methodological improvement in such studies, and suggest a

–Techniques for mass marking of otoliths of hatchery-reared American shad Alosa sapidissima with tetracycline (TC) antibiotics were refined to include multiple marks produced by immersion of fry or by feeding TC compounds to fingerlings. Single, double, triple, or quadruple marks were produced in fry by immersion in 200 mg tetracycline or oxytetracycline/L for 6 h at 4-d intervals. Single, double, and triple marks were produced in fingerlings by feeding 88 g of tetracycline/kg of food for three consecutive days, at 5- or 7-d intervals. Unique combinations of marks produced by immersion in or feeding of TC compounds can be used to evaluate the success of hatchery releases and to refine hatchery effort to maximize returns.

Data on occupational injury fatalities in Alaska for the period 1980-85 were complied from workers' compensation claims and death certificates. These data yielded 422 unique cases for the 6-year period, for an average annual fatality rate of 36.3 per 100,000 workers. This rate is 5 times higher than the Bureau of Labor Statistics estimate of 7.6 per 100,000 for the United States during the same period. The four industries with the highest fatality rates were the same for Alaska as for the nation (agriculture-forestry-fishing, construction, mining, and transportation-communication-public utilities). The leading causes of occupational fatalities in Alaska, however, were considerably different than for the United States as a whole. Nationally, motor vehicles and industrial equipment accidents are the leading causes of death. In Alaska, the leading causes of occupational injury mortality are aircraft crashes and drowning. These findings highlight the benefit of local surveillance in planning prevention strategies.

This paper discusses characteristics of occupational traumatic deaths, caused by helicopters, during 1980-1985. Death certificate data are used to describe demographic characteristics and causes of death. Information from National Transportation Safety Board (NTSB) investigations is used to describe pilot experience and environmental circumstances surrounding the incident. During 1980-1985, 374 worker deaths involving helicopters were identified in the National Traumatic Occupational Fatality (NTOF) database. The majority of deaths resulted from trauma to body organs (including the brain). According to NTSB investigations, 59% of crashes in this study were attributed to pilot error, compared to 16.5% from mechanical failure of the helicopter. Thirty percent of deaths were related to military use of helicopters. While death due to occupational exposure to helicopters is not common, some workers (e.g., helicopter pilots) appear to be at especially high risk. This group should be studied further to develop better strategies for their protection.

The National Traumatic Occupational Fatality surveillance project was designed to gather demographic, employment, and injury information from death certificates for all deaths due to injuries at work in the United States. Approximately 7000 workers have died each year during the 6-year period from 1980 through 1985: 94% were men, and 6% were women. Unintentional injuries caused the deaths of 83% of the men and 50% of the women. Eleven percent of the men and 39% of the women died from homicide. While the greatest number of deaths occurred in the group aged 20 through 34 years, fatality rates were highest among those aged 70 years and older. Expressed as deaths per 100,000 workers, annual fatality rates for black workers (7.7) were slightly higher than for white workers (6.5). The four industrial groups with the highest fatality rates were mining (31.9); transportation, communication, and public utilities (25.4); construction (24.0); and agriculture, forestry, and fishing (20.7). From 1980 through 1985 the annual traumatic occupational fatality rate fell 23%.

A study was conducted in an area of hepatitis B hyperendemicity to determin whether contact with infective bodily secretions or contaminated environmental surfaces could be involved in the transmission of the hepatitis B virus. Hepatitis B surface antigen was detected in gingival swab, saliva, and impetiginous lesion exudate samples from children. Hepatitis B surface antigen also was found in swab samples of surfaces frequently touched or placed in the mouth. In the absence of classical exposure to infectious blood or blood products, these findings suggested that, in a crowded home environment, saliva and cutaneous exudates containing hepatitis B virus may play a role in the transmission of hepatitis B.

Botulism outbreaks shown to be due to type A and type B toxin occurred in Alaska, a region previously known for only type E botulism. The outbreak due to type A toxin involved three people, two of whom died. The outbreak due to type B toxin involved nine people, none of whom died. Both outbreaks were in Inuit villages, and native foods were incriminated. The occurrence of these outbreaks strongly suggests that Clostridium botulinum, types A and B are indigenous to Alaska. The outbreaks underscore the need for initial treatment of patients with antitoxin that is trivalent (ABE), even in Arctic regions.

Myopia is common in Western populations but is considered rare in nonindustrialized population groups. However, studies in undeveloped areas of the Arctic and sub-Arctic have demonstrated increased rates of myopia among young Inuit adults indigenous to the region. We examined the refractive status of Yupik Eskimos, a group that had not previously been evaluated. Our subjects were young adults born between November 1960 and December 1962 to persons living in 10 villages in southwestern Alaska. The refractive status was obtained for 92% of these persons. The prevalence of myopia (refractive error -0.50 D or greater) was 68%, a rate among the highest reported for a general population anywhere in the world. The young women were significantly more myopic than the young men (mean refractive errors -1.91 and -1.36 D respectively). Astigmatism and myopia were positively correlated (r = 0.20, p less than 0.01). The etiology of myopia in this population is under study.

Nasopharyngeal carcinoma (NPC) has been reported to occur in Alsaka Natives (Eskimos, Indians, and Aleuts) at a rate greater than 15 times the rate for U.S. whites. At least 3 cases of NPC have occurred in close relatives of a Northern Alaskan Eskimo family. All 3 patients had poorly differentiated tumors and have died. Blood groups, HLA antigens, and antibodies to Epstein-Barr virus (EBV) were studied in the family members. EBV titers were elevated in the 1 NPC patient tested and in 1 of 15 other family members tested. All family members studied except 1 were of blood group A, Rh-positive, and HLA types AW24, CW3, CW40/A2, CW2 and B27. This was the first report of more than 2 cases of NPC in a single family in the United States.

The goal of detecting iron deficiency in children is to identify those whose Hb concentration will rise in response to treatment with iron. In a controlled treatment trial conducted among Eskimo children, we examined the effectiveness of various measures of iron nutrition in predicting a response to iron therapy (>1.0 g/dl rise in Hb). A response was seen in 43�. and an additional 26% had an intermediate response (0.5 to 1.0 g/dl rise). When individual Hb values were expressed as SD scores of the Hb distribution of a reference population, a marked skew toward low scores was seen before treatment. After treatment, the distribution became more Gaussian, indicating that iron deficiency had been the major cause of anemia. Serum fernitin, transferrin saturation, and free erythrocyte protoporphyrin levels moved toward normal with treatment, however, none of the tests used was very effective in distinguishing individuals who would have a response to Hb from those who would not (sensitivities: 63 to 42%. specificities: 45 to 6 1%). Laboratory measures of iron nutrition were far more helpful in depicting the iron status of the population than they were in distinguishing iron-responsive from nonnesponsive individuals. Am. J. C/in. Nuir. 34: 2158-2168, 1981.

A 1960-62 study of southwestern Alaskan Eskimos documented an infant mortality rate--102.6 deaths per 1,000 live births--that was four times greater than that of U.S. whites. In 1980-81, 20 years after the original study, a similar cohort was identified in this population so that changes in infant mortality and other birth characteristics could be examined. Average birth weight and the amount of prenatal care received by the mothers increased from 1960 to 1980. Birth weight and prenatal visits were positively correlated. Results of the followup also revealed a 1980-81 infant mortality rate--17.1 deaths per 1,000 live births--that was less than a fifth of the 1960-62 rate and no longer significantly different from the national rate. Major changes associated with the decrease in mortality during the first 28 days of life (neonatal mortality) were a significant increase in the proportion of infants born in hospitals and an associated decrease in the number of deaths of infants weighing less than 2,500 grams at birth. The reduction in mortality during the rest of the first year of life was related to a decrease in deaths due to infectious diseases, particularly measles and pertussis. Changes in infant mortality reflect the increased availability of health care in this region, improved immunization programs, and the establishment of the Bethel Prematernal Home in Bethel, AK.

In 1973, epidemiologic and serologic data related to hepatitis B infection were collected from the residents of two remote Alaskan Eskimo villages located in an area of high hepatitis incidence. A total of 418 sera were tested by solid-phase radioimmunoassay for heaptitis B surface antigen (HBsAg) and antibody to that antigen (anti-HBs). The overall infection prevalence of 54.8% in the two villages included a 13.9% prevalence of HBsAg and a 40.9% prevalence of anti-HBs. Families containing an individual with HBsAg had significantly higher infection prevalence than those without an antigen carrier. Larger households had higher proportions of infected members than smaller households. The data suggest that efficient transmission of hepatitis B virus occurs within the household setting in these villages by other than classically established parenteral routes.

The records of Alaskan Native patients with gallbladder and extrahepatic bile duct cancers diagnosed during 1970--79 were reviewed. Of 34 cases identified, the primary cancer was in the gallbladder in 29, resulting in age-adjusted incidence rates for gallbladder cancer of 4.4 for males and 17.6 for females. On the basis of calculations applying cancer incidence rates for U.S. whites to the Alaska Native population, a greater than expected number of both Eskimo and Indian patients were diagnosed. A 5-year review of cholecystectomies indicated that nonmalignant gallbladder disease was also elevated in both Indians and Eskimos.

Six cases of hepatitis B-associated vasculitis occurred during a four-year period in Eskimos living in southwest Alaska, an area hyperendemic for hepatitis B. All showed positive results in tests for hepatitis B surface antigen (HBsAg), and all five patients tested for hepatitis B e antigen (HBeAg) showed positive values. Two patients died of the disease. Of three who recovered, two had positive values for HBsAg and HBeAg when tested two years later. In the villages of four patients, the prevalence of hepatitis B virus (HBV) infection ranged from 18.2% to 73.1%. Serological evidence of HBsAg was found in 22% and antibody to HBsAg (anti-HBs) in 30% of close relatives of the patients. Two patients had no previous serological evidence of infection with HBV, indicating that vasculitis followed recent infection. The results provide epidemiologic evidence of the clinical association between HBV infection and vasculitis.

Serum levels of alpha-fetoprotein (AFP) may be raised for up to 2 years before clinical presentation of primary hepatocellular carcinoma (PHC). A group of people judged to be at high risk of PHC because of long-term serological positivity for hepatitis B surface antigen, ethnicity, location of residence, and a strong family history of PHC were screened for increasing levels of AFP. After 1 1/2 years of twice-yearly screening, one of them, a 19-year-old Eskimo man, had a raised AFP level, which continued to rise rapidly over the next 3 months, although the patient remained symptomless and ultrasonography, 99mTc-scan, and computerised tomography of the liver were negative. Hepatic angiography suggested a small tumour in the periphery of the right lobe of the liver, but at laparotomy the right lobe was normal. Instead a tumour was found in the lateral tip of the left lobe. The tumour, a PHC, was resected surgically, and the patient has been well in the 11 months since his operation. His serum AFP level returned to normal 2 weeks after the operation and has remained normal.

An analysis of the levels of DDT and DDE in the blood of some Alaskan Eskimo children and in the fat of some local marine mammals taken for food suggests that the children's pesticide burdin is only modestly lower than that of other American children. Authors suggest that some other food source, perhaps packaged food, supplies a portion of the dietary chlorohydrocarbon pesticide.

Standard incidence ratios for cancers that occurred during 1969--73 among Alaskan Natives (Indians and Eskimo-Aleuts) were reported. Although data suggested that the overall rate of cancer in this population was close to that of U.S. whites, differences existed for certain cancer sites. Thus increased risks in Alaskan Natives were observed for nasopharyngeal, salivary gland, kidney, and gallbladder and liver cancers. Conversely, decreased risks were found for cancers of the lung, larynx, bladder, prostate gland, breast, and corpus uterus and for melanoma and lymphoma.

Preliminary results of a cancer incidence survey among Alaskan Natives, 1974-78, indicated that patterns continue to differ from those of U.S. whites. Significantly high risks were found for cancers of the nasopharynx and liver in men, and cancers of the nasopharynx, gallbladder, cervix, and kidney in women. In men, significantly low risks were found for cancers of the prostate and bladder, leukemia, and lymphoma, and in women for cancers of the breast and uterus (excluding cervix), and lymphoma. Results are also given separately for Eskimo-Aleuts and Indians. Compared with Indians, Eskimo-Aleuts had higher risks for nasopharyngeal and liver cancers and lower risks for prostate and breast cancers.

The epidemiology of streptococcal disease affecting 706 Alaskan Eskimo children was investigated by analysis of data on throat cultures obtained during a long-term surveillance program begun in 1971. A binary variable multiple-regression model was used to study the association between streptococcal colonization of these children and six potential risk factors: age, sex, number of children in household, region, health-aide rating, and colonization rate for each child the previous year. Factors found to be significantly associated with streptococcal colonization included age, past colonization, competence of local health-aide in providing care, and health-care region. Age varied most in the standardized colonization ratio (percentage of corresponding adjusted rate to overall crude colonization rate), ranging from 122 percent for children 3--6 years old to 67 percent for children 13--18 years old. The number of children in over-crowded homes and a child's sex were not apparently important. The method of analysis can be used to provide health-care planners with a simple means of identifying potentially important areas of concern for planning effective and economical health-care strategy.

In 1981, a hepatitis B vaccine demonstration project was initiated among Yupik Eskimos of southwest Alaska to demonstrate that, under field conditions, the vaccine was safe, immunogenic, and efficacious. Laboratory tests for serologic markers of hepatitis B virus infection (HBsAg, anti-HBs, and anti-HBc) performed on sera collected in May 1981 from 3,988 residents of 17 remote Eskimo villages revealed that 2,645 (66.3%) had no evidence of hepatitis B virus infection. Because of a limited supply of vaccine, specific criteria for selection were used so that those at highest risk of infection would be immunized first. In November 1981, the first dose of vaccine was administered to 1,693 carefully selected individuals. The second dose was administered to 1,678 (99.1%) of those who received the first dose, and the final dose was administered to 1,630 persons (96.3%). Serologic follow-up showed the vaccine to be safe (0.4% experienced minor adverse reactions) and immunogenic (97.4% developed antibody). Vaccine-induced antibody levels were significantly higher for persons less than 30 years of age (p less than 0.001) and for females (p less than 0.001). Vaccine recipients were also protected from hepatitis B virus infection (p = 0.002). This public health measure proved to be feasible and effective in this remote arctic population despite difficult conditions for delivery and administration of this temperature-sensitive vaccine. This strategy for immunization is now being applied on a larger scale in Alaska as part of a program for the primary prevention of this infection and its sequelae.

The motto of the Public Health Service (PHS) is "Service with Distinction." An example of how that motto was earned can be seen in the work of the professionals of the Marine Hospital Service (as PHS was then known) in a smallpox epidemic on the Texas border in 1895. Barely 2 years after Congress had given the U.S. Surgeon General the authority to intervene and prevent the spread of contagious diseases from one State to another, Surgeon General Walter Wyman, MD, stepped in. In response to a request from the Texas State Health Officer, Wyman sent a team of officers to assist the State and prevent the spread of smallpox. At that time the Surgeon General was head of the Marine Hospital Service, which became the Public Health Service in 1912. In a period of slightly more than 2 months, the epidemic was contained in the population of 411 refugees. Sixty people had died at the camp, 51 from smallpox. Although that fatality rate would be incredibly high by current standards, it was low under the circumstances. Milton Rosenau, MD, was a key to the containment of the disease and the humanitarian treatment of the survivors, a group of black Americans who had fled from Mexico after having been lured there with the promise of land that would be their own. Rosenau would later become the head of the Hygienic Laboratory, precursor of the National Institutes of Health.