Impact of diabetes on crash risks of truck-permit holders and commercial drivers.
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OBJECTIVE: The U.S. and some Canadian government agencies have waived commercial license restrictions for some insulin-using diabetic drivers. However, the U.S. Federal Highway Administration is no longer giving waivers. Scientific evidence to support such regulations has been sparse. This article presents detailed analyses of crash risks for users and nonusers of insulin among diabetic truck-permit holders in Quebec, Canada. RESEARCH DESIGN AND METHODS: Diabetic truck-permit holders were group-matched by age to a random sample of healthy permit holders. Data on permits, medical conditions, and crashes involving 13,453 permit holder-years in 1987-1990 were extracted from the files of the public insurer for automobile injuries in Quebec. Additional health status data were obtained from the provincial public health insurer. A telephone survey was conducted to collect data on driving patterns and exposure. Risk ratios were estimated using negative binomial regression models. RESULTS: Risk ratios for crashes vary by category of diabetes. Permit holders for single-unit trucks (STs) who are diabetic without complications and not using insulin have an increased crash risk of 1.68 when compared with healthy permit holders of the same permit class. When controlling for risk exposure, commercial drivers with an ST permit and the same diabetic condition have an increased risk of 1.76. Insulin use is not associated with higher crash risk. CONCLUSIONS: The increased crash risk for the group with uncomplicated diabetes not using insulin is a new finding. The lack of consistent increases in crash risks among diabetic commercial drivers with complications or who use insulin may be a "healthy worker effect" masking the real risk, because these licensees have a lower participation rate as professional drivers. (+info)
Socioeconomic status and injury mortality: individual and neighbourhood determinants.
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STUDY OBJECTIVE: This study examined both individual and neighbourhood correlates of injury mortality to better understand the contribution of socioeconomic status to cause specific injury mortality. Of particular interest was whether neighbourhood effects remained after adjusting for individual demographic characteristics and socioeconomic status. DESIGN: Census tract data (measuring small area socioeconomic status, racial concentration, residential stability, urbanisation, and family structure) was merged with the National Health Interview Survey (NHIS) and a file that links the respondents to subsequent follow up of vital status and cause of death data. Cox proportional hazards models were specified to determine individual and neighbourhood effects on homicide, suicide, motor vehicle deaths, and other external causes. Variances are adjusted for the clustered sample design of the NHIS. SETTING: United States, 1987-1994, with follow up to the end of 1995. PARTICIPANTS: From a sample of 472 364 persons ages 18-64, there were 1195 injury related deaths over the follow up period. MAIN RESULTS: Individual level effects were generally robust to the inclusion of neighbourhood level variables in the models. Neighbourhood characteristics had independent effects on the outcome even after adjustment for individual variability. For example, there was approximately a twofold increased risk of homicide associated with living in a neighborhood characterised by low socioeconomic status, after adjusting for individual demographic and socioeconomic characteristics. CONCLUSIONS: Social inequalities in injury mortality exist for both persons and places. Policies or interventions aimed at preventing or controlling injuries should take into account not only the socioeconomic characteristics of people but also of the places in which they live. (+info)
Economic development and traffic accident mortality in the industrialized world, 1962-1990.
(67/2587)
BACKGROUND: We examined the association between prosperity and traffic accident mortality in the industrialized world in a long-term perspective. METHODS: We calculated traffic accident mortality, traffic mobility and the fatal injury rate of 21 industrialized countries from 1962 until 1990. We used mortality and population data of the World Health Organization (WHO), and figures on motor vehicle ownership of the International Road Federation (IRF). We examined cross-sectional and longitudinal associations of these traffic-related variables with the prosperity level per country, derived from data of the Organization for Economic Cooperation and Development (OECD). RESULTS: We found a reversal from a positive relation between prosperity and traffic accident mortality in the 1960s to a negative association currently. At a certain level of prosperity, the growth rate of traffic mobility decelerates and the fatal injury rate continues to decline at a similar rate to earlier phases. CONCLUSIONS: In a long-term perspective, the relation between prosperity and traffic accident mortality appears to be non-linear: economic development first leads to a growing number of traffic-related deaths, but later becomes protective. Prosperity growth is not only associated with growing numbers of motor vehicles in the population, but also seems to stimulate adaptation mechanisms, such as improvements in the traffic infrastructure and trauma care. (+info)
Effects of recent 0.08% legal blood alcohol limits on fatal crash involvement.
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OBJECTIVES: This study assessed whether states that lowered legal blood alcohol limits from 0.10% to 0.08% in 1993 and 1994 experienced post-law reductions in alcohol related fatal crashes. METHODS: Six states that adopted 0.08% as the legal blood alcohol limit in 1993 and 1994 were paired with six nearby states that retained a 0.10% legal standard. Within each pair, comparisons were made for the maximum equal available number of pre-law and post-law years. RESULTS: States adopting 0.08% laws experienced a 6% greater post-law decline in the proportion of drivers in fatal crashes with blood alcohol levels at 0.10% or higher and a 5% greater decline in the proportion of fatal crashes that were alcohol related at 0.10% or higher. CONCLUSIONS: If all states adopted the 0.08% legal blood alcohol level, 400-500 fewer traffic fatalities would occur annually. (+info)
Very old drivers: findings from a population cohort of people aged 84 and over.
(69/2587)
BACKGROUND: Increases in longevity will involve a significant increase among the number of drivers in the very old, who are at greater risk of being involved in road accidents. Data are thus needed from studies of older populations to characterize those still driving, the reasons for giving up and to help formulate appropriate policies for dealing with the problems faced and created by an increase in older drivers. METHODS: A driving questionnaire was administered to surviving members of a cohort comprising a representative sample of individuals aged >/=84, the Cambridge City over 75 Cohort. Out of 546 survivors 404 completed the driving questionnaire at the 9-year follow-up. In addition, subjects were assessed, at baseline and at each follow-up, for cognitive performance using the Mini-Mental State Examination (MMSE) and for physical impairment using the Instrumental of Activities in Daily Living (IADL) scale. RESULTS: Of the sample, 37% had driven in the past, and 8.4% were still driving, the majority regularly. The drivers tended to be younger (mean age 86.6 years), men (71%) and to be married (67.7%). Although physical disability and cognitive impairment are common in this age group, current drivers had few physical limitations on their daily activities and were not impaired on MMSE. None of the current drivers had visual impairment and 22.6% had hearing loss. Of those who had given up driving, 48.5% had given up at the age of >/=80. The commonest reasons for giving up driving were health problems (28.6%), and loss of confidence (17.9%). One-third reported giving up driving on advice. CONCLUSION: A process of self-selection takes place among older drivers. People over the age of 84 who are still driving have generally high levels of physical fitness and mental functioning, although some have some sensory loss. Given the likely increase in the number of older drivers over the next decades, safety will be improved most by strategies aimed at the entire driving population with older drivers in mind, rather than relying on costly screening programmes to identify the relatively small numbers of impaired older people who continue to drive. (+info)
Cross-national comparison of injury mortality: Los Angeles County, California and Mexico City, Mexico.
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BACKGROUND: Cross-national comparisons of injury mortality can suggest possible causal explanations for injuries across different countries and cultures. This study identifies differences in injury mortality between Los Angeles (LA) County, California and Mexico City DF, Mexico. METHODS: Using LA County and Mexico City death certificate data for 1994 and 1995, injury deaths were classified according to the International Classification of Diseases Ninth Revision-Clinical Modification external cause of injury codes. Crude, gender-, and age-adjusted annual fatality rates were calculated and comparisons were made between the two regions. RESULTS: Overall and age-adjusted injury death rates were higher for Mexico City than for LA County. Injury death rates were found to be higher for young adults in LA County and for elderly residents of Mexico City. Death rates for motor vehicle crashes, falls, and undetermined causes were higher in Mexico City, and relatively high rates of poisoning, homicide, and suicide were found for LA County. Motor vehicle crash and fall death rates in Mexico City increased beginning at about age 55, while homicide death rates were dramatically higher among young adults in LA County. The largest proportion of motor vehicle crash deaths was to motor vehicle occupants in LA County and to pedestrians in Mexico City. CONCLUSIONS: These findings illustrate the importance of primary injury prevention in countries having underdeveloped trauma care systems and should aid in setting priorities for future work. The high frequency of pedestrian fatalities in Mexico City may be related to migration of rural populations, differing vehicle characteristics and traffic patterns, and lack of safety knowledge. Mexico City's higher rate of fall-related deaths may be due to concurrent morbidity from chronic conditions, high-risk environments, and delay in seeking medical treatment. (+info)
Anabolic steroid accelerated multicompartment syndrome following trauma.
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The case is reported of a 23 year old male body builder who was involved in a road traffic accident after taking anabolic steroids. The resulting trauma caused a severe life threatening acute multicompartment syndrome resulting in the need for urgent multiple fasciotomies. (+info)
Patch reconstruction of hemidiaphragm agenesis by the polypropylene mesh prosthesis.
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We present a case of a middle-aged woman with right hemidiaphragm agenesis, which became evident after a blunt injury. Ultrasound, X-ray, and computed tomography confirmed the diagnosis, and the diaphragmatic congenital defect was closed by insertion of a polypropylene mesh prosthesis. (+info)