Vehicle year and the risk of car crash injury

OBJECTIVE: To quantify the association between vehicle age and risk of car crash injury. DESIGN AND SETTING: Data from a population based case-control study conducted in the Auckland region in 1998/99 was used to examine the adjusted risk of car crash injury or death due to vehicle age, after controlling for a range of known confounders. Cases were all cars involved in crashes in which at least one occupant was hospitalized or killed anywhere in the Auckland region, and controls were randomly selected cars on Auckland roads. The drivers of the 571 case vehicles and 588 control vehicles completed a structured interview. MAIN OUTCOME MEASURE: Hospitalisation or death of a vehicle occupant due to car crash injury. RESULTS: Vehicles constructed before 1984 had significantly greater chance of being involved in an injury crash than those constructed after 1994 (odds ratio 2.88, 95% confidence interval (CI) 1.20 to 6.91), after adjustment for potential confounders. There was also a trend for increasing crash risk with each one year increase in vehicle age after adjustment for potential confounders (odds ratio 1.05, 95% CI 0.99 to 1.11; p = 0.09). CONCLUSION: This study quantifies the increased risk of car crash injury associated with older vehicle year and confirms this as an important public health issue.     

广州、南宁市汽车安全带佩戴状况调查

目的 调查广州、南宁市汽车安全带佩戴情况。方法 采用随机抽样的方法，按照3种不同类型的道路选取观察点，在4个不同时间段对目标车辆进行观察。结果 司机安全带正确佩戴率南宁市（63．8％）高于广州市（49．3％），而不正确佩戴率广州市（22．9％）高于南宁市（8．1％）；乘客安全带佩戴率广州市高于南宁市，包括正确佩戴率和不正确佩戴率；安全带佩戴率受道路类型、时间、性别和车型等的影响，正确佩戴率高速路高于其他道路、白天高于晚上、女性高于男性、小型汽车高于其他车型，不正确佩戴率工作151高于周末。结论 广州市男性出租车司机安全带不正确佩戴率高；两地区周末和晚上佩戴安全带率较低，应加大执法力度；加强宣传教育，提高司乘人员佩戴安全带的意识。     

Randomized study on the efficacy of cognitive-behavioral therapy for insomnia secondary to breast cancer, part I: Sleep and psychological effects.

PURPOSE: Chronic insomnia is highly prevalent in cancer patients. Cognitive-behavioral therapy (CBT) is considered the treatment of choice for chronic primary insomnia. However, no randomized controlled study has been conducted on its efficacy for insomnia secondary to cancer. Using a randomized controlled design, this study conducted among breast cancer survivors evaluated the effect of CBT on sleep, assessed both subjectively and objectively, and on hypnotic medication use, psychological distress, and quality of life. PATIENTS AND METHODS: Fifty-seven women with insomnia caused or aggravated by breast cancer were randomly assigned to CBT (n = 27) or a waiting-list control condition (n = 30). The treatment consisted of eight weekly sessions administered in a group and combined the use of stimulus control, sleep restriction, cognitive therapy, sleep hygiene, and fatigue management. Follow-up evaluations were carried out 3, 6, and 12 months after the treatment. RESULTS: Participants who received the insomnia treatment had significantly better subjective sleep indices (daily sleep diary, Insomnia Severity Index), a lower frequency of medicated nights, lower levels of depression and anxiety, and greater global quality of life at post-treatment compared with participants of the control group after their waiting period. Results were more equivocal on polysomnographic indices. Therapeutic effects were well maintained up to 12 months after the intervention and generally were clinically significant. CONCLUSION: This study supports the efficacy of CBT for insomnia secondary to breast cancer.     

Randomized study on the efficacy of cognitive-behavioral therapy for insomnia secondary to breast cancer, part II: Immunologic effects.

PURPOSE: Cross-sectional studies suggest that clinical insomnia is associated with immune downregulation. However, there is a definite need for experimental studies on this question. The goal of this randomized controlled study was to assess the effect of an 8-week cognitive-behavioral therapy (CBT) for chronic insomnia on immune functioning of breast cancer survivors. Previous analyses of this study showed that CBT was associated with improved sleep and quality of life, and reduced psychological distress. PATIENTS AND METHODS: Fifty-seven women with chronic insomnia secondary to breast cancer were randomly assigned to CBT (n = 27) or to a waiting-list control condition (WLC; n = 30). Peripheral-blood samples were taken at baseline and post-treatment (and postwaiting for WLC patients), as well as at 3-, 6-, and 12-month follow-up for immune measures, including enumeration of blood cell counts (ie, WBCs, monocytes, lymphocytes, CD3+, CD4+, CD8+, and CD16+/CD56+) and cytokine production (ie, interleukin-1-beta [IL-1beta] and interferon gamma [IFN-gamma]). RESULTS: Patients treated with CBT had higher secretion of IFN-gamma and lower increase of lymphocytes at post-treatment compared with control patients. Pooled data from both treated groups indicated significantly increased levels of IFN-gamma and IL-1beta from pre- to post-treatment. In addition, significant changes in WBCs, lymphocytes, and IFN-gamma were found at follow-up compared with post-treatment. CONCLUSION: This study provides some support to the hypothesis of a causal relationship between clinical insomnia and immune functioning. Future studies are needed to investigate the clinical impact of such immune alterations.     

Cholera: Lessons from Haiti and Beyond

Cholera is an acute, severe diarrheal disease caused by Vibrio cholerae that affects millions of people each year. Without prompt rehydration, death can occur within hours of the onset of symptoms. In October 2010, cholera emerged in Haiti, and the resulting large epidemic continues today. As of August 29, 2011, more than 439,000 cases have been reported in Haiti, with over 6,200 deaths. This review covers important features of epidemiology, pathogenesis, treatment and prevention of cholera, with a focus on the ongoing epidemic in Haiti.     

First Nation Elders’ perspectives on healthy ageing in NSW,Australia

Objectives : Healthy ageing has been unattainable for many of Australia’s First Nation people, driven by an earlier onset of chronic disease when compared to the general Australian population. Our objective was to examine the perspectives of Australian First Nation people about healthy ageing. Methods : We used a conversational method to gather knowledge from older First Nation people from established communities in New South Wales, Australia. Discussions were audio recorded and transcribed and analysed using an Indigenous research standpoint methodology. Eight yarning circles were held in six locations with 76 participants aged 45 years and over. Results : Key issues around healthy ageing were identified; particularly, what the impact of chronic disease means to individuals. Study participants reported that healthy ageing is essential to continue to share knowledge of their history and culture. Conclusion : This article highlights the need for culturally appropriate healthy ageing programs addressing issues related to chronic disease among First Nation communities. Implications for public health : Research into what constitutes healthy ageing for older First Nation people is necessary for the development of culturally appropriate chronic disease interventions.