Ediriweera B. R. Desapriya

Deterrent to Healthy Lifestyles in Our Communities

bral blood flow and increased cerebral fractional oxygen extraction induced by the hypocapnia.5 As mentioned in our discussion, the mechanisms that underlie the association of severe IVH with hypocapnia and marked fluctuations in PaCO2 need to be determined in future studies, although decreases in cerebral blood flow induced by hypocapnia and ischemia-reperfusion resulting from marked fluctuations in PaCO2 may possibly be involved. Alternatively, hypercapnia, hypocapnia, and the fluctuations in PaCO2 could be effects, rather than the causes, of severe IVH, by either fluctuations in respiratory drive or changes in carbon dioxide production caused by intracranial pathology.

Injury prevention in child death review: child pedestrian fatalities

Objective This article describes the epidemiology of child pedestrian fatalities in British Columbia using data generated by the provinces Child Death Review Unit, to demonstrate the unique capacity of child death review to provide an ecological understanding of child mortality and catalyse evidence based, multi-level prevention strategies. Methods All child pedestrian fatalities in British Columbia from 1 January 1 2003 to 31 December 2008 were reviewed. Data on demographics, circumstance of injury, and risk factors related to the child, driver, vehicle, and physical environment were extracted. Frequency of sociodemographic variables and modifiable risk factors were calculated, followed by statistical comparisons against the general population for Aboriginal ancestry, gender, ethnicity, income assistance and driver violations using z and t tests. Results Analysis of child pedestrian fatalities (n=33) found a significant overrepresentation of Aboriginal children (p=0.06), males (p<0.01), and children within low income families (p<0.01). The majority of incidents occurred in residential areas (51.5%), with a speed limit of 50 kph or higher (85.7%). Risky pedestrian behaviour was a factor in 56.7% of cases, and 33% of children under 10 years of age were not under active supervision. Drivers had significantly more driving violations than the comparison population (p<0.01). Conclusion Child pedestrian fatalities are highly preventable through the modification of behavioural, social, and environmental risk factors. This paper illustrates the ability of child death review to generate an ecological understanding of injury epidemiology not otherwise available and advance policy and programme interventions designed to reduce preventable child mortality.

Vision improvement and reduction in falls after expedited cataract surgery Systematic review and metaanalysis

PURPOSE: To quantify the benefits of expedited cataract surgery in improving visual acuity and reducing fall‐related injuries in the older population. SETTING: Developmental Neurosciences and Child Health: Neurons to Neighbourhoods, Vancouver, British Columbia, Canada. METHODS: A systematic review of the literature was conducted. Studies were included if expedited cataract surgery was presented as a measure to enhance vision and to reduce injury. Published and unpublished studies with any type of study design were included. Studies were identified from 12 databases including Medline (1950 to 2008) and Embase (1980 to 2008). The metaanalysis was specific to randomized controlled trials (RCTs). RESULTS: The review comprised 737 participants. Sufficient data for the metaanalysis were available to evaluate the impact of expedited cataract surgery on improved visual acuity and a reduced fall rate. Twenty‐two publications that included RCTs and prospective cohort studies met the inclusion criteria. Three studies evaluated visual acuity after expedited routine cataract surgery and routine cataract surgery. The pooled estimate showed that expedited cataract surgery increased visual acuity by more than 7 times (odds ratio [OR], 7.22; 95% confidence interval [CI], 3.16‐16.55; P<.0001). Pooling of data from 2 RCTs of 535 participants showed a nonsignificant reduction in the incidence of falls after expedited cataract surgery (OR, 0.81; 95% CI, 0.55‐1.17). CONCLUSIONS: Accumulating evidence indicates that expedited cataract surgery is effective in significantly enhancing vision but is inconclusive in preventing falls. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.

Social and Health Factors Associated with Physical Activity among Kuwaiti College Students.

Our aim was to explore the social and health factors that are associated with the level of physical activity among Kuwaiti college students. A random sample of 787 students (48% males and 52% females) was chosen and weight and height were measured to obtain body mass index (BMI, kg/m2). Associated social and health factors were obtained using a questionnaire. Those reporting being physically inactive numbered 354 and the remaining 433 were active. Obesity among males was 13% and was 10.5% among females. The social and health factors that were found to be significantly associated with physical activity among the students were gender (P < .001), marital status (P < .05), BMI category (obese or nonobese) (P < .05), last dental and health checkup (P < .01), desiring a higher degree (P < .001), and countries preferred for visiting (P < .01). Males significantly exceeded females in the practice of physical activity. In conclusion, behavioural modifications, intervention studies, and health education touting the benefits of being physically active should be instituted to increase the practice of sports and other physical activities in order to control and decrease obesity-related morbidity and mortality.

Effectiveness of cataract surgery in reducing driving-related difficulties: a systematic review and meta-analysis.

Objectives: To assess the effects of cataract surgery in improving vision and driving performance while reducing driving-related difficulties. Design: Systematic review and meta-analysis. Data sources: Twelve electronic databases were searched from the date of inception of each database to May 2007. Other sources of potentially relevant information were also identified and examined. Review methods: Eligible study designs included randomized controlled trials (RCT), non-RCT, quasi-experimental, case-control, controlled-before-and-after, and cohort studies that examined driving-related indicators in patients undergoing cataract surgery. Main outcome measures: The outcome measures included any type of driving-related indicator. A secondary outcome measure was motor vehicle (MV) crash involvement. Results: Seven studies were included in the review and five in the meta-analysis. The overall pooled odds ratio (OR) was 0.12 (95% CI 0.10 to 0.16). Results suggest that the risk of driving-related difficulties was reduced by 88% following cataract surgery. Conclusions: Cataract surgery is associated with an 88% reduction in the risk of driving-related difficulties. This supports the efficacy of cataract surgery to improve driving in older people, as well as positive implications for a reduction in MV crashes, overall traffic safety, and individual well-being.

Impact of lowering the legal blood alcohol concentration limit to 0.03 on male, female and teenage drivers involved alcohol-related crashes in Japan

In June of 2002, a revision to part of the Road Traffic Act drastically increased the penalties for drinking and driving offences in Japan. Most notably, the legal blood alcohol concentration (BAC) limit for driving was lowered from 0.05 mg/ml to 0.03 mg/ml. The rationale for the new lower BAC limit was predicated on the assumption that drinking drivers will comply with the new, lower limit by reducing the amount of alcohol they consume prior to driving, thereby lowering their risk of crash involvement. This, in turn, would lead to fewer alcohol-related crashes. A key limitation of previous lower BAC evaluation research in determining the effectiveness of lower legal BAC limit policies is the assumption of population homogeneity in responding to the laws. The present analysis is unique in this perspective and focuses on the evaluation of the impact of BAC limit reduction on different segments of the population. The chief objective of this research is to quantify the extent to which lowering the legal limit of BAC has reduced male, female and teenager involvement in motor vehicle crashes in Japan since 2002. Most notably, the introduction of reduced BAC limit legislation resulted in a statistically significant decrease in the number of alcohol-impaired drivers on the road in Japan, indicating responsiveness to the legal change among adults and teenagers. In addition, this preliminary assessment appears to indicate that the implementation of 0.03 BAC laws and other associated activities are associated with statistically significant reductions in alcohol-involved motor vehicle crashes. In comparison, the rates of total crashes showed no statistically significant decline nor increase in the period following the introduction of the BAC law, indicating that the lower BAC limit only had an effect on alcohol-related crashes in Japan. The evidence suggests that the lower BAC legal limit and perceived risk of detection are the two most important factors resulting in a sustained change in drinking and driving behaviour in Japan. It is recommended that future research and resources in other countries be focused on these factors as determinants to reduced alcohol-related crashes.

Do Light Truck Vehicles (LTV) Impose Greater Risk of Pedestrian Injury Than Passenger Cars? A Meta-analysis and Systematic Review

Objective: Pedestrian crashes present a growing challenge for public health trauma and road safety researchers around the world. They are associated with substantial morbidity, mortality, and cost, yet there is an international lack of published work on the topic, especially when compared with vehicle occupant safety studies. Our review attempts to quantify the risk of fatal injury among vulnerable road users. The specific objective of this systematic review and meta-analysis is to quantify and compare the impact of light truck vehicles (LTVs) versus conventional cars on pedestrian fatal injury. Methods: A protocol was developed using methods of the Cochrane Collaboration. We conducted a search for the studies in bibliographic databases that included ATI (Australian Transport Index); Cochrane Injuries Group Specialized Register; EMBASE; ERIC; MEDLINE; National Research Register; PsycINFO; Road Res (ARRB); SIGLE; Science (and Social Science) Citation Index; TRANSPORT (NTIS, TRIS, TRANSDOC, IRRD). Web sites of traffic and road accident research bodies, government agencies, and injury prevention organizations were searched for grey literature. Reference lists from selected papers or topic reviews were scanned for potentially relevant papers. Results: Our initial search identified 878 potentially eligible studies. After thorough review by three of the researchers a total of 12 studies were included in the systematic review, 11 of which were included in the meta-analysis. The overall pooled odds ratio for the risk of fatal injury in pedestrian collisions with LTVs compared to conventional cars was odds ratio 1.54, 95 percent confidence interval 1.15–1.93, p = 0.001. Thus, the risk for pedestrians of sustaining fatal injury is 50 percent greater in collisions with LTVs than in collisions with conventional cars. Conclusions: Our systematic review and meta-analysis suggests that LTVs pose a greater risk of pedestrian injury death compared to conventional cars. These findings have important implications for the automotive industry and the safety of vulnerable road users.

Factors associated with overweight and obesity among Kuwaiti elementary male school children aged 6-10 years

Background. Childhood obesity is becoming a global epidemic which may result in increased morbidity and mortality during young adulthood. Objectives. To identify factors associated with overweight and that of obesity among Kuwaiti elementary male school children aged 6–10 years. Methods. Weights and heights of 662 students at a randomly selected school were collected to obtain body mass index (BMI). Results. The prevalence of overweight and obesity among the students were 20.2% and 16.8%, respectively. There were a variety of factors associated with overweight and obesity; however, having one or more obese brother, an unemployed father, or a high (>11) number of persons living at home was significantly associated with higher risk of overweight and obesity. Increased age and school level as well as having a chronic disease were associated with the risk of overweight. Conclusion. Health education programs for families should be implemented to help control overweight and obesity in Kuwaiti children.

Reduction in Fatalities, Ambulance Calls, and Hospital Admissions for Road Trauma After Implementation of New Traffic Laws

OBJECTIVES We evaluated the public health benefits of traffic laws targeting speeding and drunk drivers (British Columbia, Canada, September 2010). METHODS We studied fatal crashes and ambulance dispatches and hospital admissions for road trauma, using interrupted time series with multiple nonequivalent comparison series. We determined estimates of effect using linear regression models incorporating an autoregressive integrated moving average error term. We used neighboring jurisdictions (Alberta, Saskatchewan, Washington State) as external controls. RESULTS In the 2 years after implementation of the new laws, significant decreases occurred in fatal crashes (21.0%; 95% confidence interval [CI]=15.3, 26.4) and in hospital admissions (8.0%; 95% CI=0.6, 14.9) and ambulance calls (7.2%; 95% CI=1.1, 13.0) for road trauma. We found a very large reduction in alcohol-related fatal crashes (52.0%; 95% CI=34.5, 69.5), and the benefits of the new laws are likely primarily the result of a reduction in drinking and driving. CONCLUSIONS These findings suggest that laws calling for immediate sanctions for dangerous drivers can reduce road trauma and should be supported.

Severity of alcohol-related motor vehicle crashes in British Columbia: case - control study

The objective of the present study was to compare the injury severity and vehicle damage severity rates of alcohol-related crashes with rates of non-alcohol-related crashes in British Columbia (BC). Injury severity rates and vehicle damage severity rates were taken from 2002 Insurance Corporation of British Columbia traffic collision data. The data were computed in order to compare the differences in injury severity and vehicle damage severity rates of alcohol-related vs. non-alcohol-related motor vehicle crashes. Case – control methods were used in this study to analyse the risk of alcohol-related crashes compared to non-alcohol-related crashes in BC. Odds ratios (OR) and 95% CI were calculated to estimate relative risks. In the case – control analysis, the risk of fatal collision was increased for those drinking and driving compared with those driving sober (OR 4.70; 95% CI 3.15 – 7.01). Risk of injury collision was increased for those drinking and driving compared with those driving sober (OR 1.32; 95% CI 1.19 – 1.37). Importantly, the risk of vehicle damage severity was increased for those drinking and driving compared with those driving sober (write-off vehicle OR 4.24; 95% CI 3.70 – 4.86, severely damaged vehicles OR 1.98; 95% CI 1.77 – 2.21). The study reinforces existing literature to suggest that current evidence is sufficient to show an increased risk of injury and fatality to drivers and occupants in alcohol-related crashes. This paper not only emphasizes this well-known relationship, but also such consequences as increased vehicle damage severity. The connection between drinking and severity of motor vehicle crashes is popularly believed and has now received substantial scientific support. There is strong justification for injury prevention experts and policy-makers to step up motor vehicle crash injury prevention advocacy by implementing evidence-based policies to reduce rates of alcohol-impaired driving in the province of BC. Most unintentional injuries in BC are related to motor vehicle crashes. Significant improvements can be made in these statistics by: increasing the use of occupant protection (safety belt and child restraint seats); reducing alcohol-related injuries through multiple strategies including corrections in the physical environment, extensive enforcement of drinking and driving laws and health promotion/education.