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Objectives: Fatal falls cause more than 15,000 deaths per year in the United States. Despite this, the circumstances surrounding fatal falls in elderly adults are poorly understood. It is unknown whether these circumstances differ across ethnicities, although Hispanic American individuals are at reduced risk for fatal falls. This study sought to describe fatal falls in an urban, predominantly Hispanic, and white non-Hispanic community and to determine the association of demographics with the circumstances surrounding these falls (proximate factors)., Methods: The death certificates and medical examiners' reports for all 328 elderly individuals experiencing a fatal fall in Miami-Dade County, FL, from 2005 to 2007 were reviewed for demographic and proximate factors such as the preceding activity and fall location., Results: Fatal falls in elderly adults were experienced mostly by individuals living in the community (80%) and affected all demographic subgroups, although 80% occurred in individuals older than 74 years. Most fatal falls occurred at home (74%), indoors (75%), and during nonvigorous activities such as walking (58%) and these tended to affect the oldest elderly. In addition, a significant number of fatal falls occurred in public locations, outdoors, and during vigorous activity, with these falls tending to affect younger individuals living without family. Hispanic ethnicity was not associated with proximate factors., Conclusions: Fatal fall prevention is needed for elderly individuals living in the community and should target the oldest elderly adults living at home while helping to ensure that individuals who are living without family have the appropriate support. These data suggest that Hispanic individuals may benefit from prevention strategies developed in other populations.

Background: Hispanic ethnicity is associated with a reduced risk of fatal falls in the elderly despite lower socioeconomic standing. The factors responsible for this "Hispanic paradox" are unknown. We hypothesized that age and gender would modify this relationship and that the association would be accentuated in a community with prominent Hispanic culture., Materials and Methods: The number of fatal falls in a 3-year period in the United States (US) and in Miami-Dade County, Florida (MDC) were obtained through the CDC's WISQARS database and the Florida Office of Vital Statistics. US Census Bureau data were used to define the total at-risk populations by age group and gender. Age group- and gender-specific ratios of the risk of fatal fall in Hispanic to white non-Hispanic individuals were calculated., Results: In the US and MDC, Hispanic ethnicity was associated with a reduced risk of fatal fall across all age and gender subgroups. In the US, the risk reduction associated with Hispanic ethnicity grew from 11% and 23% in 65- to 74-year-old men and women, respectively, to 43% for both men and women over 84-years-old. This relationship was stronger in MDC than nationally in five of the six age and gender subgroups examined., Conclusions: Older individuals, women, and residents of communities with prominent Hispanic culture have the greatest reduction in fatal fall risk associated with Hispanic ethnicity., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Background: During the last 10 years, the number of motorcycle riders in the United States has risen sharply. The corresponding increase in fatalities observed during this time may be because of the increase in riders, or because the number of states that mandate universal helmet use has decreased. We examined the effect of the repeal of Florida's helmet law in July 2000 to test the hypothesis that the increase in fatalities observed after repeal resulted from an increase in the number of motorcycle riders., Methods: We identified all motorcycle fatalities (N = 197) in Miami-Dade county for a 3.5-year period before repeal (prelaw), and a similar period after repeal (postlaw), using police crash reports and medical examiner records. We compared the number of fatalities, frequency of helmet use in fatal crashes, and number of registered motorcycles in the two time periods., Results: There was a decrease in helmet use from 80% to 33%, and an increase in motorcycle fatalities after repeal: 72 to 125. However, repeal was also associated with a rise in annual motorcycle registrations from 17,270 to 39,043. Fatality rates adjusted for numbers of registered motorcycles did not change significantly; 11.6 deaths per 10,000 motorcycles prelaw, and 12.5 deaths postlaw., Conclusions: There was a significant rise in motorcycle fatalities after Florida's helmet law repeal, which appears to be associated with an increase in the number of motorcycle riders. Injury prevention efforts focusing on factors other than helmet use should be developed in light of continuing repeal of universal motorcycle helmet laws across the nation.

Considering that heart patients may be at higher risk for cardiac arrest, this study was conducted to evaluate the preparedness and willingness of cardiac patient family members to perform cardiopulmonary resuscitation (CPR). A cross-sectional survey of 100 family members of cardiac patients was conducted at a tertiary care emergency department over a 1.5-month period. Response rate was 95%. While 49% reported prior CPR training, only 7% trained within the past year. The majority received training (59%) because of a school or job requirement with only 8% trained because of 'concern for a family member.' The most frequent reasons for not being trained were 'never thought about it' or 'not interested' (57%). However, 49% of the untrained group did report an interest in future training. While 2% of respondents recalled a healthcare professional suggesting such training, 58% stated they would be influenced positively by such a recommendation. The most frequently reported barriers to performing CPR included fear of harming the patient or a lack of knowledge and skill to help. Despite a presumed higher risk for sudden cardiac death, most family members of cardiac patients do not maintain skills in basic CPR. Healthcare professionals may have the ability to significantly alter this concerning statistic through education and routine recommendations to patients' families.

Context: The majority of prior studies examining intimate partner abuse in the emergency department (ED) setting have been conducted in large, urban tertiary care settings and may not reflect the experiences of women seen at community hospital EDs, which treat the majority of ED patients in the United States., Objective: To determine the prevalence of intimate partner abuse among female patients presenting for treatment in community hospital EDs and describe their characteristics., Design: An anonymous survey conducted from 1995 through 1997 inquiring about physical, sexual, and emotional abuse., Setting: Eleven community EDs in Pennsylvania and California., Participants: All women aged 18 years or older who came to the ED during selected shifts., Main Outcome Measures: Reported acute trauma from abuse, past-year physical or sexual abuse, and lifetime physical or emotional abuse., Results: Surveys were completed by 3455 (74%) of 4641 women seen. The prevalence of reported abuse by an intimate partner was 2.2% (95% confidence interval [CI], 1.7%-2.7%) for acute trauma from abuse, 14.4% (95% CI, 13.2%-15.6%) for past-year physical or sexual abuse, and 36.9% (95% CI, 35.3%-38.6%) for lifetime emotional or physical abuse. California had significantly higher reported rates of past-year physical or sexual abuse (17% vs 12%, P<.001) and lifetime abuse (44% vs 31%, P<.001) than Pennsylvania. Logistic regression modeling identified 4 risk factors for reported physical, sexual, or acute trauma from abuse within the past year: age, 18 to 39 years (odds ratio [OR], 2.2; 95% CI, 1.7-3.0); monthly income less than $1000 (OR, 1.7; 95% CI, 1.3-2.1); children younger than 18 years living in the home (OR, 2.0; 95% CI, 1.5-2.6); and ending a relationship within the past year (OR, 7.0; 95% CI, 5.5-8.9)., Conclusion: If the prevalence of abuse in community hospitals throughout the United States is similar to the range of prevalence estimates found in this study, then heightened awareness of intimate partner abuse is warranted for patients presenting to the ED.

Objectives: To determine the prevalence of interpersonal physical violence (IPV) among Pennsylvania adults, to identify the personal characteristics of the victims, and to determine their health care use for resulting injuries., Methods: Population-based data describing physical violence were obtained through a statewide telephone survey of 3,620 Pennsylvania adults selected from households by random-digit dialing in 1994. The prevalence and 95% confidence interval (95% CI) of victimization from IPV along with ED or other medical care facility use for IPV-related injuries were computed by several personal characteristics. Logistic regression was used to compare victims of IPV and their levels of health care use., Results: The prevalence of reported victimization from IPV was 5.6% (95% CI = 4.9, 6.3). Significantly more victimization was reported by males, persons aged 18-29 years, those employed, and unmarried persons. The proportion of victims who reported to have gone to an ED or other medical care facility for IPV-related injury treatment was 12.9%. Significantly more persons with annual household incomes < $20,000 reported health care use for injuries resulting from IPV than did those with incomes of > or = $20,000 (OR = 3.98; 95% CI = 1.27, 12.48). Health care use for injuries was not found to be related to gender, age, race, employment, or marital status., Conclusions: This population-based study of health care use for IPV-related injuries found that victims of physical violence in Pennsylvania were not only young and unmarried men, but also employed. Health care use for resulting injuries was greater among persons with lower incomes.

Objective: To determine population-based firearm-related morbidity and mortality for Allegheny County, PA (population = 1.3 million), for the year 1994., Methods: Fatalities were identified from a review of death certificates. To identify nonfatal cases, an active surveillance was conducted at all 24 acute care EDs in the county. The ED surveillance used 2 existing sources of case identification from each hospital to minimize undercount., Results: Firearms were the leading cause of injury death to county residents, accounting for 155 deaths. The crude mortality rate from firearms was 11.7/100,000. Black males aged 15-19 years were most at risk for a firearm fatality (293/100,000). There were 514 nonfatal firearm injuries, producing a case fatality rate of 23%. The highest age-specific rate for nonfatal firearm-related injuries treated in the county EDs was observed for black males aged 15-19 years (2,245/100,000), which is 58 times higher than the firearm-related injury rate for the entire county population (38.7/100,000)., Conclusion: Firearm-related injury and death are a significant public health problem in Allegheny County. Although the crude mortality rate from firearms in the county is lower than the reported national rate, the observed rate for nonfatal injuries in the black youth of this community is the highest firearm injury incidence rate ever reported. Local surveillance of firearm-related injuries, including nonfatal events, is needed to more accurately demonstrate the magnitude of this problem.

With data from the Center for Disease Control's Behavioral Risk Factor Surveillance System, we estimated the prevalence of homes with inadequate smoke detector protection from residential fires in Pennsylvania and identified the characteristics of these homes in an effort to identify useful prevention strategies for Pennsylvania and other regions with similar characteristics. Homes with inadequate smoke detector protection from residential fires were defined on three levels. Eight percent (95% CL = 6.8, 8.6) of homes lacked any installed smoke detectors, 14% (95% CL = 12.8, 15) lacked smoke detectors installed on the same floor where they slept, and 28% (95% CL = 26.6, 29.6) were found to engage in unsafe smoke detector practices. The strong predictors of unsafe smoke detector practices determined from logistic regression included black, non-Hispanic homes (OR = 1.53), homes with annual household income of less than +20,000 (OR = 1.29), and those with no children younger than 5 years old (OR = 1.55). These findings should assist policy makers in planning residential fire prevention programs for Pennsylvania, which has yet to meet the Healthy People 2000 objective regarding fire prevention.

Objective: To determine the household prevalence of firearms in Pennsylvania, and describe the storage practices for these weapons., Design: A statewide telephone survey of 3,620 Pennsylvania adults selected from households by random digit dialing in 1994., Main Outcome Measures: Firearm ownership and storage practices were computed by household characteristics using logistic regression., Results: The prevalence of firearm ownership was 37% (95% confidence interval = 35.4 to 38.6). Ownership of firearms was significantly higher for white residents, households with annual income of $20,000 or more, those in rural counties, and those with children and adolescents. Of the households with firearms, 23% contained a single firearm, the majority of which were handguns (40%) or rifles (40%); 76% had two or more firearms, with 57% reporting one handgun or more and 83% reporting one rifle or more. Storage of firearms in 72% of households involved two or more of these barriers: (1) taken apart; (2) trigger lock applied; (3) kept in a locked place; (4) unloaded; (5) no other ammunition; (6) locked ammunition; 6% stored at least one of their firearms with none of these barriers. The strongest predictor of storing a firearm with fewer than two protective barriers was households with no children or adolescents., Conclusions: Firearms are present in a large number of Pennsylvania homes. Many of these homes also contain children. To reduce the potential risks of firearms, optimal methods of storage of firearms in the home need to be determined.

Study Objective: To evaluate existing emergency department logbooks as a source of population-based data on firearm-related injuries., Methods: We examined the logbooks of the 24 acute care and specialty-hospital EDs in Allegheny County, Pennsylvania, to determine the number and type of data variables each contained and the completeness of reporting of each variable for selected firearm-related cases. The amount of missing data for certain variables was determined and the cause for the missing data described., Results: Logbooks from 18 of the 24 eligible hospitals were reviewed. We identified 785 cases of firearm-related injury recorded between January 1, 1992, and December 31, 1993. Of the variables we selected for analysis, only date (100%), chief complaint or diagnosis (100%), name (98%), and time of admission (97%) were consistently documented. In 37% of cases the patient's county of residence could not be determined. Similarly incomplete data were found for body part injured (31%), race (28%), age (26%), sex (22%), and mode of arrival (21%). The factor most responsible for the high percentage of incomplete data was the considerable variation in the data elements contained in the different hospitals' logbooks., Conclusion: Missing data resulting from inconsistencies in the variables contained in different EDs' logbooks and errors of omission prevent ED logbooks, in their current state, from providing population-based data for surveillance of firearm-related injury. Standardization of such variables in ED logbooks would yield a more useful source of information for injury and disease surveillance. In lieu of standardized logbooks, multiple sources of data are necessary to establish a more comprehensive and useful system of surveillance of firearm-related injury.

Capture-recapture methods were employed to determine the most accurate and efficient approaches to monitor adolescent injuries. Multiple sources were used to ascertain cases of adolescent injuries that occurred between September 1 and December 31, 1991, in a single school district in metropolitan Pittsburgh, Pennsylvania. Eliminating the duplicate cases between the sources revealed 144 verified injuries; 127 (88.2%) were identified by student monthly recalls, 33 (22.9%) by daily attendance records, 58 (40.3%) by medical excuses, and 72 (50.0%) by a 4-month student recall. Capture-recapture analyses were undertaken to assess potential dependencies between the sources, to estimate the degree of underascertainment in the population, and to evaluate the efficiency of the individual sources and the combinations between them. It was estimated that 91% of the cases in the population were ascertained when all four methods of case finding were utilized. Furthermore, the analysis indicated that accurate injury estimates could be achieved using combinations of only two or three of the sources. An analysis of the efficiency of the methods of ascertainment revealed a trade-off between effort (the number of hours needed to identify cases) and the precision (coefficient of variation) of the injury estimates. Capture-recapture analysis not only provided an approach to evaluate and adjust for undercount but also offered a formal means to evaluate the most efficient combination of the sources to maximize completeness while minimizing effort. The use of these techniques has the potential to evaluate and improve injury surveillance as well as other disease monitoring systems.

The reproducibility and validity of a past year physical activity questionnaire was determined in a sample of 100 adolescents aged 15-18 years, randomly selected from a population-based cohort. Subjects completed four 7-day recalls of activity approximately 3 months apart. The average of the four 7-day recalls of activity was utilized as the "gold standard" against which the past year questionnaire was compared to evaluate validity. The questionnaire was also validated against objective measures, such as physical fitness and body mass index. Interscholastic team rosters were utilized to directly validate the reporting of specific activities. One-month and one-year test-retest reproducibility of the questionnaire were determined. For different measures of activity, the Spearman correlations between the questionnaire and the average of the 7-day recalls ranged from 0.55 to 0.67 in males and 0.73 to 0.83 in females, all significant at p < 0.01. In general, although there was no association between the past year activity questionnaire results and objective measures, there was a significant, albeit weak association between the physical activity questionnaire and time to complete a 1-mile (1.61-km) run (r = -0.47) in females. Subjects reported participating in specific interscholastic sports with an accuracy of 100%, 86%, and 95% for the fall, winter, and spring sports, respectively. Test-retest reproducibility was higher over one month (r = 0.79) than over one year (r = 0.66). These data provide evidence that the questionnaire yields a reasonable estimate of past year or "habitual" physical activity in adolescents.

Because noninstitutionalized senior citizens comprise over 95% of the population 65 years of age and older, their health needs are a major concern. Data regarding infections in this population including the epidemiology, morbidity, and mortality are lacking. The authors recruited a study population of 417 free-living persons, all 65 years of age or older, from two neighborhoods in Pittsburgh, Pennsylvania. After the collection of self-reported baseline information from these persons, they were monitored for all clinical infections for 2 years, beginning July 1986 and through June 1988, using clinic visits, hospitalizations, or phone calls when needed. The baseline information showed the study population of 417 persons to be comparable with a neighborhood comparison group and with established populations for epidemiologic studies of the elderly in three other states. The 24 months of infection surveillance yielded 494 diagnosed infections in 224 or 54% of the subjects. Respiratory infections were most frequent with 259 or 52% of the total, followed by genitourinary infections with 24%, skin infections with 18%, gastrointestinal infections with 4%, and other types of infection with 2%. By comparing 22 self-reported baseline conditions with the occurrence of infection, 10 historic factors were univariately significant for infection. Of these 10 factors, only history of a lung problem (relative risk = 1.7, 95% confidence interval (CI) 1.1-2.9) and history of difficulty controlling urination (relative risk = 2.7, 95% CI 1.3-4.9) were statistically significant in multivariate analysis. To our knowledge, this study represents the first prospective data on infections in the noninstitutionalized elderly. The data demonstrate the wide variety of infections that occurred in this population and suggest that persons with a history of any one of several medical problems were possibly at greater risk for infection.

Violence has reached epidemic proportions in the United States with particularly serious health implications for school-age children and adolescents. Schools that experience the daily threat of potential student violence have their primary mission of education eroded at great cost to students. This article reviews the problem of violence in public schools and summarizes existing knowledge on school violence prevention. Violence prevention programs that use educational, regulatory, technological, or combined approaches are reviewed. Recommendations are presented addressing both policy and program needs related to control of violence in public schools. School health professionals should be active participants in violence prevention efforts. A critical need exists to carefully evaluate any planned prevention program so future efforts can be built on methods proven successful.

Objective: To examine the patterns of socioeconomic status and injury morbidity in adolescents., Design: Prospective cohort study., Setting: Metropolitan school district in Allegheny County, Pennsylvania., Participants: There were 1245 students (89%) recruited from 1400 aged 12 to 16 years., Interventions: None., Measures and Results: Baseline variables of socioeconomic status used for this analysis included township of residence (from the 1990 census data ranked by the percentage of households below the poverty level) and employment status of the parents (student self-report). Life-table analysis revealed no differential risk of injury by socioeconomic status. Similar results were found when stratified by gender, race, injury type (sport vs nonsport), and injury place (school vs home)., Conclusions: The results indicate that in this cohort of adolescents, socioeconomic status does not seem to be a contributing risk factor for injury.

Physical activity epidemiological studies provide one of many types of research evidence that are necessary to assess the importance of physical activity to health. Available epidemiological evidence, when coupled with relevant experimental and clinical research, suggests that physical activity has the potential to favourably influence the development and progression of a variety of chronic diseases and conditions that are a burden to public health. The evidence is only beginning to emerge for elderly populations, however, thereby highlighting an important void in our scientific knowledge. Attempting to increase the level of physical activity of elderly people raises three important issues. First, improving adherence to a physically active life-style requires assistance of behavioural scientists, either through direct intervention, or through research that can help the elderly identify and overcome impediments to physical activity. Second, many elderly people have diseases that can limit their physical ability, but exercise scientists can assist by prescribing exercise that is both efficacious and safe given the level of limitation. Third, the number of injuries may increase with increased physical activity in elderly persons. Epidemiologists and exercise scientists working in the area of injury control can determine which activities are safe at specific levels of physical ability and function. To quote one of the originators of exercise physiology, Per Olaf Astrand (1992), 'As a consequence of diminished exercise tolerance, a large and increasing number of elderly people will be living below, at, or just above "thresholds" of physical ability, needing only a minor intercurrent illness to render them completely dependent'. Physical activity can help to push back that 'threshold of physical ability' and thereby improve physical functioning. As physical function improves, there is a propensity to perform even greater amounts of physical activity that may be essential to the quality and perhaps quantity of life for an elderly person.

Prevention of head and spinal cord injuries is defined as a reduction in the incidence of these disabilities. Accurate incidence data are fundamental to any prevention program. The current approaches toward determining incidence rates for head and spinal cord injuries are summarized. Previous research has focused on passive surveillance systems and population-based registries. An alternative system for monitoring the incidence of head injuries is discussed that uses a surveillance methodology called capture-recapture. This method employs multiple population-based sources to identify cases and uses the cases that overlap between the sources to estimate the degree of undercount in the population. This estimate in turn is used to produce an ascertainment-corrected incidence estimate. Through the use of methods such as capture-recapture, accurate monitoring of the incidence of head and spinal injuries across developing and developed countries is indeed feasible.

A cohort of 1245 adolescents, 12-16 yr old and participating in a prospective study of risk factors for injury, were surveyed annually to assess past year leisure physical activity. This report describes the development and reproducibility of the questionnaire and provides the descriptive epidemiology of leisure physical activity in adolescents. The questionnaire was self-administered twice, a year apart, and had a 1 yr test-retest rank order correlation of 0.55. The past year estimate of leisure activity was also shown to be related to fitness (rho = -0.37), which was defined as the time needed to complete a 1-mile run. Males reported significantly more activity than females (P < 0.05) and whites reported more activity than nonwhites (P < 0.05). However, socioeconomic status was not found to be a determinant of activity levels in either males or females. In females, a negative association between activity and age was found (P < 0.05); however, this association was not evident in males. In summary, an activity questionnaire has been developed and was shown to be both reproducible and feasible. Therefore, it was used to examine habitual leisure physical activity patterns of adolescents.

Serious injury from sport and recreation is a leading cause of morbidity and mortality in the United States. Historically, occurrences of diseases with substantial public health impact have been monitored via surveillance systems in order to obtain information concerning the frequency with which the diseases occur. Surveillance leads to efforts that identify risk factors, and eventually, control measures to reduce the incidence of disease. Currently, the surveillance of sports injury represents only limited coverage in the U.S. It is important to begin discussions regarding approaches toward the development of surveillance of these injuries. Methods based upon the communicable disease surveillance model could potentially be used to monitor serious sports injuries. One method of surveillance, using the statistical approach of capture-mark-recapture, is presented as an example by which a national system of surveillance of serious sports injury could be established.

We assessed the prevalence of low back pain (LBP) in a cohort of 1242 adolescents (aged 11 through 17) currently participating in a 4-year prospective study of medically treated injuries. Overall, 30.4% of the adolescents reported LBP. The impact of LBP in adolescents was considerable, with one third resulting in restricted activity and 7.3% seeking medical attention. Life-table analysis demonstrated that by age 15, the prevalence of LBP increased to 36%. There were few differences by gender or race. These results suggest that LBP in adolescents is a serious public health problem.

Individuals with traumatic spinal cord injury (SCI) represent a population with extreme inactivity. The purpose of the current research was to investigate the metabolic differences between extremely inactive disabled individuals (SCI sedentary group), active disabled individuals (SCI athletes), and able-bodied individuals. Fasting morning blood samples were obtained for the determination of high density lipoprotein cholesterol (HDLc) subfractions, glucose, and insulin. The sedentary SCI group was comprised of 77 consecutive male admissions to a rehabilitation center. The 17 SCI athletes were recruited prior to competition at the annual National Wheelchair Games. Total HDLc and both its subfractions were significantly lower (P less than 0.01) in the male SCI sedentary population than in the SCI athletes or able-bodied controls. HDL2 was significantly elevated (P less than 0.01) in the SCI athlete compared to the SCI sedentary group (42.7 vs 34.1 mg X dl-1) and was similar to the control population (46.1 mg X dl-1). Glucose levels were similar in the two SCI groups but were both significantly lower (P less than 0.05) than in the able-bodied controls. These data suggest that the extreme inactivity observed in disabled populations is associated with lower HDLc concentrations and presumably an increase in coronary heart disease risk if these values were to persist over time. Additionally, it appears that physical activity is associated with increases in total HDLc, primarily through the HDL2 subfraction. Glucose and insulin were similar for both SCI groups despite the marked difference in activity levels, suggesting that these parameters may not be associated with activity.

The ability to index activity objectively in disabled or impaired activity populations is critical for our understanding of the long-term health consequences of reduced activity. The current research employed the large-scale integrated activity monitor as an objective measure of free living daily activity in 28 subjects with traumatic spinal cord injury. All the spinal cord-injured subjects wore the monitors for 2 d while in-patients at a rehabilitation center. The results indicated that the instruments can accurately index individual physical activity levels in this population, which has drastically reduced activity. Furthermore, group differences in activity were discriminated where paraplegic activity (mean, 32.0 counts X h-1) was significantly greater than quadriplegic activity (mean, 15.1 counts X h-1) (P less than 0.01) despite the markedly low activity levels. The results thus indicate that activity sensors can index individual activity levels at the very low end of the activity spectrum.

To assess the relation of echocardiographic left ventricular (LV) mass to reported physical activity, 2 groups of subjects with widely different physical activity levels were evaluated: 50 men with spinal cord injuries and 166 apparently healthy, active men. Multivariate analysis revealed that reported physical activity was a significant independent predictor of LV mass index (LV mass/body surface area) in both injured patients and healthy, active subjects after controlling for age and blood pressure. The relation between LV mass index and physical activity (linear regression) was similar for both groups; LV mass index = 0.00321 (physical activity) + 82.8 and LV mass index = 0.00335 (physical activity) +88.4 for patients and healthy active subjects, respectively. These results suggest that physical activity as assessed by self-report is associated with echocardiographically detectable differences in LV mass in groups with widely divergent physical activity levels. In addition, for each of these groups 1,000 kcal/week of physical activity apparently results in a change of approximately 3 g/m2 in LV mass index. This information may have practical use for correction of LV mass for the effects of physical activity.