Sayed Subzwari

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.

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 Published and unpublished studies with any type of study design were included.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.

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.

Infant injuries from child restraint safety seat misuse at British Columbia Children's Hospital.

Background: Child restraint safety seats (CRS) are used to prevent injuries or deaths among child passengers involved in a motor vehicle crash. When used outside of a motor vehicle, CRS use could potentially place an infant at risk of injury. The objective of the current study was to describe the proportion of CRS misuse injuries among infants <12 months old and associated factors presenting to the British Columbia (BC) Children’s Hospital Emergency Department over 5 years (1997–2002).

Conventional vision screening tests and older driver motor vehicle crash prevention

Statistically significant motor vehicle collision data and vision test result correlations have been reported, raising global safety concerns. The authors discuss and make recommendations concerning currently available vision screening test effectiveness and a conventional vision screening test alternative in regard to older drivers.

Does Obesity Increase the Risk of Injury or Mortality in Motor Vehicle Crashes? A Systematic Review and Meta-Analysis

The objective of this review was to assess the risk of obesity in injuries and fatalities resulting from motor vehicle crash (MVC), as compared with individuals with a normal-range body mass index. A systematic review of the literature was conducted yielding 824 potential studies. Nine of these studies met our inclusion criteria. Meta-analyses examining obesity as a risk factor for various injury types and risk of fatality were conducted using data from these studies. Obesity was associated with higher fatality risk (odds ratio [OR] = 1.89, 95% confidence interval [CI] = 1.51-2.37, P = .0001; pooled estimate from 6 studies), and increased risk of lower extremity fractures (OR = 1.39, 95% CI = 1.18-1.65, P = .0001; pooled estimate from 2 studies). No significant differences were observed when considering abdominal injuries or pelvic fractures. Interestingly, for head injuries obesity was a protective factor (OR = 0.67, 95% CI = 0.46-0.97, P = .0001; pooled data from 3 studies). Evidence strongly supports the association of obesity with higher fatality and fractures of the lower extremities in MVCs. Contrary to our hypothesis, 3 studies showed that obesity was a protective factor in reducing head injuries. Furthermore, the review shows that obesity was not a risk factor of MVC-related pelvic fractures and abdominal injuries.

Injury-related mortality and indigenous people

576 www.thelancet.com Vol 368 August 12, 2006 data on HIV/AIDS in these communities because ethnic breakdown is rarely collected, and in many countries is even illegal owing to fear of discrimination. The diffi culties in improving the health of Roma communities derive also from basic obstructions such as language and cultural barriers. Nevertheless, bridging health services and communities with the aid of sustainable long-term projects and national and international networking and the empowerment of Roma communities represent the only opportunities to fi ght the spread of HIV among this marginalised population.

Prevention of baby-walker-related injury

www.thelancet.com Vol 373 February 14, 2009 545 simply be scaled up” is perplexing. There is ample evidence of successful communication and behaviourchange campaigns—eg, Thailand’s “100% condom” and Uganda’s “zerograzing” campaigns. More recently, Swaziland scaled up a boldly successful campaign to address multiple and concurrent partnerships. It certainly was not our intention to promote “non-participatory, noncon sultative interventions”. Although urging that “knowing your epidemic” should be a primarily scientifi c endeavour, we also repeatedly emphasised the “need to address imme diate risk settings as well as social norms.” Finally, the assertion that a “revitalised HIV prevention movement needs to move beyond... whether any specifi c intervention is more important than the other” is problematic. Eff ective public health must be grounded in evidence and prioritise what is most eff ective. Although the general notion of “comprehensive pre vention” is appealing, the specifi c elements of the mix are essential. The assumption that merely combining diff erent strategies—whose individual eff ectiveness is often “insuffi ciently proven”—will some how result in a sub stantial population-level eff ect is dubious. As with HIV treatment regimens, prevention elements should be combined, but their combined eff ectiveness must be demonstrated. Trials of standard combination prevention approaches in Africa have thus far been unsuccessful (and, in one, HIV incidence was higher in the experimental group). Like treatment, prevention must be deployed with scientifi c rigour.