In 1993, the levels of copper (Cu) in much of Nebraska's drinking water exceeded the U.S. Environmental Protection Agency's (EPA) action level of 1.3 mg/L. To determine the association of copper with gastrointestinal (GI) illness in August 1994 the authors interviewed persons living in households with 1993 Cu levels > 3 mg/L (51 households), 2-3 mg/L (54 households), and < 1.3 mg/L (43 households). Cases were defined as persons who had experienced the rapid onset of vomiting or nausea with abdominal pain during the preceding two weeks. To validate their exposure index, the authors immediately resampled drinking water in the households of 25 cases and 27 controls matched for age. Reassessment in December 1994 of the exposure and case status of the original cohort showed no association between copper in drinking water in 1993 and case status in 1994. The risk of GI illness seemed no greater with Cu > 3 mg/L (RR = 1.03; 95% CI = 0.43, 2.49) or 2-3 mg/L (RR = 0.50; 95% CI = 0.18, 1.41) than with Cu < 1.3 mg/L. The 1993 Cu concentrations could not be reproduced in August 1994; resampling in December 1994 again showed no association between GI illness and Cu exposure (RR > 1.3-2.9 mg/L, < or = 1.3 mg/L = 0.25, 95% CI = 0.10, 0.64, and RR > or = 3.0 mg/L, < or = 1.3 mg/L = 0.36, 95% CI = 0.09, 1.49).

On October 12, 1992, the metropolitan area of Cairo, Egypt and surrounding villages in the Nile Valley sustained the effects of a moderate earthquake of magnitude MB 5.9 (MS 5.2). To identify mortality- or injury-prevention strategies for communities at risk, we investigated deaths and injuries that were associated with the event and modeled the time that patients spent in the hospital because of earthquake-related injuries. Populations in areas closest to the epicenter experienced increased death and injury rates (4.6 deaths per 100,000 and 80.6 injuries per 100,000) compared to those located further from the epicenter (0.8 deaths per 100,000 and 23.7 injuries per 100,000). The distribution of earthquake-related admissions in one hospital peaked within 36 hours after the earthquake. A general linear model predicted that older people were hospitalized longer than younger people and people with fractures to the trunk were hospitalized longer than those with injuries at other anatomical sites (p = 0.008). While recognizing that other characteristics are also important, we recommend that emergency managers consider proximity to the epicenter when planning response operations, and that health officials focus on ensuring appropriate medical care for older people and for people who have suffered severe injuries to the trunk.