Search

This article, part of a recently completed research project on safety belts, presents results on neck injuries. A total of 3927 injured front-seat occupants (drivers and passengers) involved in two-car crashes were studied. Among them, 725 sustained neck sprains (ICD-9 code 847.0); some of them may have sustained other injuries as well. The more serious injuries to the cervical spine were more prevalent among the unbelted occupants. Neck sprains were relatively more numerous among belted occupants compared with unbelted ones, with a relative risk estimate of 1.68. Similar results hold also for subsets of the data on different types of collisions; the relative risks ranged from 1.39 to 2.42. A log linear model was constructed for the odds ratio (neck sprain vs. no neck sprain) taking into account the following factors: (1) seatbelt use, (2) direction of impact, (3) authorized speed limit, and (4) vehicle weight. The resulting relative risk estimate (belted vs. unbelted) became 1.58. The results raise questions about seatbelts and their protection against neck sprains.

This paper presents: (i) an operational definition of risk exposure, (ii) a questionnaire developed to measure exposure, (iii) validity studies of estimates of the distance traveled and time spent driving for different permit holder categories, and (iv) a feasibility study for a telephone survey on exposure. Results show that long-distance truck drivers from one company studied estimated accurately their distance driven on the last worked day; Montreal Urban Community Transport Commission bus drivers estimated well their time behind the wheel; while a convenience sample of private car drivers (coworkers and friends) estimated well their previous week distance and time on the road. Phone surveys appear to be an efficient and cost-effective method for risk exposure data collection.

Objectives: This study was conducted to compare the influence of psychologic traits versus ischemia severity on the occurrence of angina during treadmill exercise., Background: Some studies suggest that angina is associated with certain psychologic traits, whereas others show an association with more severe ischemia. The relative influence of these two factors and the extent to which they interact are not known., Methods: Off-drug treadmill exercise testing and a battery of psychologic tests were performed on 122 patients with known coronary artery disease. Psychologic tests measured sensitivity to physical symptoms, denial and deception, type A behavior, anger, hostility, depression, marital adjustment and amount of external stress. Stepwise logistic regression was used to determine the independent association of psychologic traits, ischemic threshold and exercise tolerance with the occurrence of angina., Results: Angina during treadmill exercise was reported by 66 of 122 patients. On univariate testing, angina was positively associated with sensitivity to physical symptoms (p < 0.001), type A behavior (p = 0.021) and depression (p = 0.032) and was negatively associated with exercise tolerance (p < 0.001) and work load threshold for ischemia (p < 0.01). Multivariate analysis revealed independent and additive associations of angina with sensitivity to physical symptoms (p = 0.003), exercise capacity (p = 0.003) and work load threshold for ischemia (p = 0.018). Once these were included in a logistic model, depression and type A behavior were no longer significant. Other psychologic traits showed no association with angina., Conclusions: Sensitivity to physical symptoms, ischemic threshold and exercise tolerance are independently associated with angina, with sensitivity to physical symptoms having the stronger influence. The physiologic and psychologic mechanisms underlying symptom perception have an influence on angina that is independent of and additive to the severity of underlying ischemia.

In Canadian Provinces and in several states of the United States the minimal legal age to drive a motor vehicle is 16 years old and in some, it is 15. The excess mortality and morbidity registered by 15 to 24-year-old drivers is well known. Several studies have reported that accident rates decrease with experience, but the effect of the age of new drivers has not been well documented. The objective is to study injury accident rates in terms of the age and experience factors. The data sources are computer files of the Government Insurance Corporation (Société de l'assurance automobile du Québec), which covers all Quebec drivers. For each driver, the file contains birth date, sex, year and month of first license, involvement in accidents, and other parameters. The yearly rates (1970-1984) of new permits per age last birthday and sex show an increase over time, particularly for 16-year-old men. For the period 1979-1984, injury accident involvement rates were computed for all Quebec drivers by age, sex, and driving experience. An experienced driver has been defined as a person who has been licensed for at least one year. The results show, for experienced as well as inexperienced young men (16-18), a high injury accident rate that decreases with age. For women, the rates are much lower and decrease more gradually than for men. This study does not take into account the kilometers driven. Since young drivers (16-18) have the highest accident rates, the question of regulating access to first licensing for such drivers must be examined as a possible strategy for injury prevention.

Patients with New York Heart Association functional class II or III heart failure stabilized on furosemide therapy were entered into a randomized controlled trial comparing enalapril (n = 72) and digoxin (n = 73). End points were clinical outcome, treadmill exercise capacity and echocardiographic left ventricular dimensions. Improvement in clinical outcome was defined as a reduction of at least one functional class or withdrawal because of an adverse clinical event. After 4 weeks, 13 patients receiving enalapril showed improvement, 55 had no change and 9 manifested deterioration compared with 7, 49 and 17, respectively, in the digoxin group (p less than 0.01). After 14 weeks, 13 patients receiving enalapril showed improvement, 50 had no change and 9 manifested deterioration, compared with 14, 37 and 22, respectively, in the digoxin group (p less than 0.025). More patients in the digoxin group were withdrawn because of an adverse clinical event (p less than 0.05). Exercise time and percent fractional shortening improved in both groups (p less than 0.001 and less than 0.05, respectively), with no significant difference between groups (p greater than 0.50). Both rate-pressure product and subjectively evaluated exertion during submaximal exercise were reduced only in the enalapril group. Although the majority of patients in both groups did well, those receiving enalapril experienced fewer adverse clinical events and had less fatigue during submaximal exercise.

This is a review of the literature dealing with exposure to the risk of traffic accidents. We present the principal definitions of this concept, the different measures of risk exposure, indicators of the risk of traffic accidents, and the advantages and disadvantages of the methods used for the collection of data. The validity of the measure of exposure to risk is analyzed as well. We conclude that while distance travelled is the principal measure of exposure to risk accepted by the research community, it is necessary to use a composite measure which also takes into account the risk associated with the driver.

Driving ability is controlled by specific regulations. Therefore disabled individuals or those with certain chronic diseases may be affected by these regulations. These latter are based on assumption that the existence and the nature of certain diseases may cause particular hazard; and this could be prevented by introducing certain driving regulations. This hypothesis has not been tested properly, considering the proposed and suspected risk factors. Diabetes mellitus is a good example of the interested medical condition in this field. Review of the literature do not provide adequate information to allow us to conclude whether the insulin treated diabetic person is at higher risk to develop traffic accident, compared with non diabetic individual; and there is no definite explanation whether hypoglycaemia play a causative role in the etiology of traffic accident among insulin treated diabetics. Perhaps the lack of knowledge in this field is due to use of non-standardized methodologies and small sample size studies which make the comparisons difficult. The existing regulations in different countries are based on empirical knowledge and common sense. This often leads to conflictual situations and apparently discriminatory decisions regarding diabetics. Further comparative and prospective studies are needed.

We have cloned a repetitive EcoRI fragment from the human genome which displays weak homologies with the Drosophila melanogaster transposable P-element. This cloned DNA appeared not to be a mobile element but, instead, a divergent member of human satellite II or III DNAs. We present here the first complete nucleotide sequence of a 1.797 kilobase pair (kb) satellite-like DNA. Moreover, this EcoRI satellite monomer contains a unique sequence of 49 basepairs (bp) that is devoid of the satellite consensus repeat 5'TTCCA3'. Southern hybridization analysis revealed that the cloned insert is closely related to a highly repetitive 1.8 kb KpnI family of tandemly organized satellite DNAs. Thus, the relationships among these satellite DNA families appear to be complex and may be a factor in their copy number, position and spatial organization.

We present the results of a questionnaire completed by 526 victims of accidents involving three- and four-wheeled all-terrain vehicles. All victims were treated at the emergency departments of 10 regional hospitals in Quebec. In 70% of cases, the vehicles overturned. Two thirds of victims were injured in accidents without collision, typically involving overturns on level ground or hills. We suggest accident reconstruction research as a means of identifying engineering solutions as one element in an injury control approach.

The antiarrhythmic efficacy of timolol maleate was assessed in 94 patients with acute myocardial infarction. No significant differences were noted between early treatment with timolol and placebo in the mean and peak hourly ventricular premature complex rates, ventricular premature complex couplets, or runs. However, compared to the placebo treatment, there was a significant (p less than 0.001) 66% reduction in the relative fraction of early-cycle ventricular premature complexes 7 to 9 days after initiation of timolol therapy and a more prolonged significant (p less than 0.001) 73% reduction in the fraction of early-cycle supraventricular complexes throughout the 28-day timolol and placebo comparison period. The frequency distribution of QRS duration was significantly different between the placebo- and timolol-treated patients, with the mean duration 8 msec longer in the placebo-treated patients (p = 0.008). Adverse effects from early administration of timolol did not differ from those in the placebo-treated patients.

During a seven-month survey from May to November 1985, 624 victims injured from three- or four-wheeled all-terrain vehicles (ATVs) were observed in the emergency rooms of 10 regional hospitals in Quebec. A total of 1,100 injuries were identified, including 3 fatal and 104 serious to critical injuries (AIS greater than or equal to 3). These injuries were to the lower limb (29%), the upper limb (28%), the head, neck, and face (26%), and the thorax, abdomen, and pelvis (18%). Close to one-half (45%) of the victims were 19 years old and less; 54% reported wearing helmets. Ten percent of the victims were hospitalized for an average period of 8 days. In 70% of the cases, the vehicle overturned: half of these vehicles turned on the side, 27% toward the back, and 19% flipped forward. Two-thirds of persons injured were involved in accidents in which no external objects were hit by the vehicle; these accidents typically involved vehicle overturns, both on hills and on level ground. Ninety-five percent of the vehicles were in good mechanical condition. The use of these vehicles presents a danger whether used by a child or an adult, by an experienced or an inexperienced rider. The average user may not be aware that three- and four-wheel ATVs demand considerable skill and caution. We suggest the use of accident reconstruction studies for possible engineering solutions.