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Hygieia
  1. Michael Muir
  1. mmuirbmjgroup.com

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    SEATBELT COMPLIANCE

    Seatbelt compliance in Japanese women decreases when they become pregnant, bucking the world trend for increased seatbelt use in pregnancy. Prompted by the fact that pregnant women are exempt from seatbelt legislation in Japan, researchers decided to examine the factors that influenced seatbelt use in pregnancy. They not only found that compliance was low compared with use before pregnancy, but also that those who used their cars most were least likely to wear a seatbelt. Furthermore, only one in five of the sample realised the importance of wearing a seatbelt during pregnancy, leading the authors to suggest increased traffic safety education and revision of the legislation that exempts pregnant women from wearing seatbelts. (

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    INJURIES IN AMERICAN CHILDREN

    Injury is the leading cause of death for American children under 15 years old, but these deaths are known to represent just a fraction of the number of children injured: for every paediatric injury death, there are about 1000 non-fatal injuries requiring emergency treatment. Researchers in Atlanta decided to analyse the causes of fatal and non-fatal injury in US children and found that motor vehicle crashes, suffocation, and drowning were the most common cause of fatal injury, while falls and being struck by (or against) were most responsible for non-fatal injury. The authors recommend the development of appropriate preventative measures to permit adequate protection of this vulnerable group. (

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    MEN DOMINATE STATIN TRIALS

    Clinical trials of cardiovascular medicine have been described as un-inclusive because women, older people, and ethnic minorities tend to be under represented. Researchers from the UK decided to test this statement by examining almost 50 randomised controlled trials published between 1990 and 2001. They found that some trials excluded women completely, many reported female cardiovascular event data only superficially, and only two distinguished between the sexes when reporting adverse events. Most trials set an upper age limit, the median being 70, and only a small percentage reported the ethnic minority proportion in their samples. (

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    NOVEL APPROACH TO MULTIPLE INJURY ANALYSIS

    A new systematic approach for summarising multiple injury diagnosis data into patient injury profiles has been developed. Using the International Classification of Diseases, injury diagnosis codes are classified using a modification of the Barell body region (by nature of injury diagnosis matrix) then grouped by body region, nature of injury, or both. Profiles are then created using matrix units to describe the patient’s injury combinations, which permits not only the study of injuries (the function of most current approaches) but also the analysis of individual patients. (

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    PROGNOSIS AND OUTCOME IN CHD

    Despite clear improvements in survival over an eight year period, the prognosis remains poor for patients newly admitted with heart failure in Leicestershire, UK. Researchers analysed data on over 12 000 patients newly hospitalised for heart failure between 1993 and 2001. They found that the prognosis was particularly poor for men, who had a 14%–17% higher risk of death, older people—an increase of 43%–45% in risk of death for each decade was observed—and patients with concomitant acute myocardial infarction. Rate of hospitilisation increased by 63% from the start of the study but did not increase after 1998. (

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    SOCIOECONOMIC POSITION AND INJURY

    The relation between socioeconomic position and non-fatal injury varies by age group and cause according to a large population based study from Wales. Researchers grouped each emergency hospital discharge from 1997 to 1999 into one of five deprivation groups before examining the cause and analysing the results. The relation between position and cause is demonstrated by the finding that people from deprived areas are more likely to sustain injury from an assault, while children from more deprived areas had a higher chance of being hospitalised because of self harm, although intentionality was not measured. The authors suggest we bear the findings in mind when either developing or monitoring public health initiatives, particularly those that are area based. (

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    COMBINING DATA INCREASES ACCURACY

    Concerned by evidence that GPs under-report clinical events while patients over-report (and the subsequent implications for the reliability of long term follow up studies that rely on patient recall) researchers from the UK examined the accuracy of such reports on hospital admissions during follow up care for cardiac bypass surgery. After comparing patient and GP completed questionnaires with their hospital information system, the authors found that patients and GPs are not sensitive or specific sources of information when consulted separately, but that requesting data from both parties regularly is not only sensitive and specific, but also practicable and inexpensive. (

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    NEW KNEES NEARLY NEEDED

    There are many causes of knee pain, with playing football (as Hygieia has experienced) one of the many identified risk factors, particularly for cartilage injury. It may come as little surprise therefore to learn that a high prevalence of knee symptoms exist among men of working age in the UK. Sudden onset of symptoms is experienced in 70% of cases and hospital referral is influenced to some extent by patient’s occupation. The authors also found that work entailing regular kneeling or squatting carries a higher risk of knee pain, and recommend that preventative strategies are developed to soften the impact of knee disorders on society. (

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    DEPRIVATION PREDICTS POOR OUTCOMES AGAIN

    Coronary artery bypass graft (CABG) patients from deprived areas are younger, have more clinical risk factors, and experience more postoperative complications than their more affluent counterparts. Over 3500 CABG patients at a UK hospital were analysed and grouped into one of five deprivation categories, then compared against the incidence of postoperative complication and 30 day mortality. Patients from less affluent areas had greater body mass index and were more likely to smoke at the time of surgery, while socioeconomic deprivation was independently associated with postoperative myocardial infarction, stroke, and death. (

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