Estimates of motor vehicle seat belt effectiveness and use: implications for occupant crash protection

Estimates of the effectiveness of seat belts, when used, in reducing motor vehicle occupant deaths vary widely. A recently publicized claim by one analyst that seat belts reduce vehicle occupant deaths 70-80 per cent is based on studies found to contain fundamental systematic error. Deaths occur only 50 per cent less often to belted compared to nonbelted vehicle occupants in crashes, according to previously unanalyzed data from three U.S. states during recent years. New belt systems would be about 60 per cent effective with 100 per cent use. But surveys of observed belt use in 1975 U.S. cars indicate that two-thirds of drivers were not using belts. Prospects for widespread adoption and enforcement of belt use laws in the U.S. are not encouraging. Substantial reductions in fatal and other injuries would result from the adoption of requirements mandating automatic (passive) protection for front seat occupants in crashes with forward decelerations.     

Patterns of injury in belted and unbelted individuals presenting to a trauma center after motor vehicle crash: seat belt syndrome revisited

STUDY OBJECTIVE: Investigators have described a "seat belt syndrome" consisting variously of injuries to the lumbar or cervical spine, abdominal contents, or all 3. In this study we sought to identify these and any other patterns of injury associated with seat belt use in patients who presented to a trauma center after a motor vehicle crash. METHODS: The charts of all patients involved in motor vehicle crashes who presented as trauma alerts to the study institution between January 1, 1991, and December 31, 1993, were retrospectively reviewed for data regarding belt use and 35 specific injuries in 7 body regions. We calculated the positive likelihood ratio of injury between belted and unbelted patients, along with 95% confidence intervals. RESULTS: We identified 1,124 patients involved in motor vehicle crashes. Of these subjects, 376 were belted and 544 unbelted; in 204 belt status was unknown. Belted patients were more likely to have sustained sternal fracture than were unbelted patients (4% versus .7%; positive likelihood ratio, 1.97; 95% confidence interval, 1.09 to 3.29) but were less likely to have sustained head injury (30.6% versus 46.0%; positive likelihood ratio, .67; 95% confidence interval, .53 to .83). We noted no statistically significant differences in the rates of other specific injuries, including cervical and lumbar fractures and the need for abdominal surgery. CONCLUSION: Severe injuries of all types occur in both belted and unbelted individuals involved in motor vehicle crashes who present to a typical trauma center. With the exception of sternal fractures, injuries previously associated with the seat belt syndrome occurred in similar proportions of belted and unbelted patients. Head injuries were less frequent. Seat belt use cannot serve as a discriminator for specific injury. A diligent search of all body regions is indicated in both belted and unbelted patients.     

Psychiatric morbidity following motor vehicle accidents: a review of methodological issues

Motor vehicle accidents (MVAs), even those of a nonserious nature, appear to increase the risk of severe psychiatric morbidity in survivors. The present review examines the evidence indicating the levels of psychiatric morbidity in MVA survivors. Although no consistent profile has emerged, the most commonly reported symptoms are depression, anxiety, irritability, driving phobia, anger, sleep disturbances, and headache, with rates of posttraumatic stress disorder (PTSD) across studies of 0% to 100%. Variability in the type and severity of psychiatric outcomes may be due, in part, to methodological inadequacies in many studies, particularly the use of biased population samples, inclusion of subjects exposed to varied types of accidents, an absence of a clear definition of PTSD, a reliance on clinical judgment rather than the use of objective psychometric measures, the failure to include ratings of injury severity, and the absence of assessments for past exposure to traumatic events or preexisting posttraumatic reactions. The most important concern relates to the use of nonrepresentative samples, usually patients referred for medicolegal assessment in whom issues of compensation are of central importance. Gender and age differences distinguish the compensation group from the general population of MVA survivors, who therefore may also differ in the vulnerability to posttraumatic morbidity. It is argued that more systematic research on unselected subject samples is critical to establish epidemiological data on the true nature and extent of psychiatric morbidity following MVAs.     

Acute and chronic distress and posstraumatic stress disorder as a function of responsibility for serious motor vehicle accidents.

In this study on the effects of attributions of responsibility for traumatic events, stress, coping, and symptoms of posttraumatic stress disorder (PTSD) were measured, including intrusive thoughts among 130 victims of serious motor vehicle accidents (MVAs) 14-21 days and 3, 6, and 12 months after their accident. MVA victims and 43 control participants were categorized by accident and attribution of responsibility for their accidents (self-responsible, other-responsible, and control). Although initially all MVA victims reported higher levels of intrusive thoughts and were more likely to meet criteria for PTSD diagnoses, only other-responsible participants continued to demonstrate increased distress 6 and 12 months postaccident. Self-responsible participants used more self-blame coping than other-responsible participants, although within the self-responsible group, use of self-blame was associated with more distress. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Traumatic brain injury and posttraumatic stress disorder: a preliminary investigation of neuropsychological test results in PTSD secondary to motor vehicle accidents

In the present investigation involvement of endothelial-derived reactive oxygen species (ROS) and their interaction with nitric oxide (NO), during norepinephrine (NE)-induced contraction of rat aortic rings was studied. NE (1x10(-10) M to 1x10(-5) M) caused concentration-dependent contractio n of the endothelium intact aortic rings. In the presence of hydroxyl radical scavengers, histidine (1x10(-3) M), mannitol (3x10(-3) M), dimethyl sulfoxide (50x10(-3) M) or thiourea (1x10(-3) m), superoxide dismutase (superoxide radical scavenger, SOD 10 or 100 U ml-1) or catalase (hydrogen peroxide inactivator 3, 10, or 100 U ml-1) the concentration-response curve of NE was shifted towards the right. Interestingly, in NG-nitro-l-arginine methyl ester (L-NAME) (1x10(-5) M, a NO synthase inhibitor) pretreated rings, NE-induced contractions were not inhibited by SOD or extracellular hydroxyl radical scavengers (mannitol and histidine). However, in these rings NE-induced contractions were found to be attenuated by endogenous hydroxyl radical scavengers (thiourea and DMSO) or catalase. In the endothelium denuded rings no significant effect of these scavengers on NE-induced contractions was observed. These results thus indicate the involvement of endothelium-derived hydrogen peroxide, superoxide and hydroxyl radicals in the NE-induced contractions. In addition, endothelial NO interacts with the ROS generated during rat aortic ring contractions.     

Latex sensitization in general pediatric surgical patients: a call for increased screening of patients

BACKGROUND/PURPOSE: Latex sensitization is a well-documented occurrence in children with myelodysplastic and urologic anomalies. The incidence of latex allergy in general pediatric surgical patients, however, has not been previously addressed. The purpose of this study was to examine the risk of perioperative latex reactions in a general pediatric surgical practice over a 1-year period. METHODS: This study examined the occurrence of latex sensitization using two methods. First, the preoperative anesthesia records of patients that have undergone surgery from October 1995 through September 1996 at Mott Children's Hospital were reviewed retrospectively. Second, all patients who had intraoperative anaphylaxis attributable to latex sensitization, including those from three additional hospitals, were evaluated. RESULTS: During a 12-month period, 1,523 pediatric general surgical operations were performed at the C.S. Mott Children's Hospital. Of these, only 11 operations on five patients were performed under latex precautions. All of these patients had a preoperative diagnosis of latex sensitivity. During the same period, intraoperative anaphylactic reactions caused by latex allergy occurred in two of the general surgical patients (0.13%) at the C.S. Mott Hospital. Four additional cases are also reported from other study hospitals. None of these patients were suspected, based on current screening methods, of having a latex allergy before their surgery. CONCLUSIONS: Latex allergy is a potentially life-threatening condition in the pediatric general surgical population. Further study is needed to develop criteria to preoperatively identify patients at risk for latex sensitization.     

The psychiatric review of symptoms: a screening tool for family physicians

The psychiatric review of symptoms is a useful screening tool for identifying patients who have psychiatric disorders. The approach begins with a mnemonic encompassing the major psychiatric disorders: depression, personality disorders, substance abuse disorders, anxiety disorders, somatization disorder, eating disorders, cognitive disorders and psychotic disorders. For each category, an initial screening question is used, with a positive response leading to more detailed diagnostic questions. Useful interviewing techniques include transitioning from one subject to another rather than abruptly changing subjects, normalization (phrasing a question to convey to the patient that such behavior is normal or understandable) and symptom assumption (phrasing a question to imply that it is assumed the patient has engaged in such behavior). The psychiatric review of symptoms is both rapid and thorough, and can be readily incorporated into the standard history and physical examination.     

Age and individual differences in prospective memory during a "Virtual Week": The roles of working memory, vigilance, task regularity, and cue focality.

Young (ages 18–22 years) and older (ages 61–87 years) adults (N = 106) played the Virtual Week board game, which involves simulating common prospective memory (PM) tasks of everyday life (e.g., taking medication), and performed working memory (WM) and vigilance tasks. The Virtual Week game includes regular (repeated) and irregular (nonrepeated) PM tasks with cues that are either more or less focal to other ongoing activities. Age differences in PM were reduced for repeated tasks, and performance improved over the course of the week, suggesting retrieval was more spontaneous or habitual. Correlations with WM within each age group were reduced for PM tasks that had more regular or focal cues. WM (but not vigilance) ability was a strong predictor of irregular PM tasks with less focal cues. Taken together, these results support the hypothesis that habitual and focally cued PM tasks are less demanding of attentional resources (specifically, WM), whereas tasks that are more demanding of controlled attentional processes produce larger age differences, which may be attributable to individual differences in WM. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

"The questionable value of a master's degree for a PhD-pursuing student": Comment.

Responds to R. J. Howell and M. L. Murdock's (see record 1973-05428-001) negative evaluation of the master's degree from non-PhD-granting institutions. The success is described of a master's program designed to prepare students for doctoral work elsewhere. Data from one year show that all of the master's program graduates who applied for further study were accepted and that 80% were accepted into schools classified in the top-rated category used by Howell and Murdock. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The "Wallstent": a new stent for the treatment of urethral strictures

Morphine or morphine-6-glucuronide either alone or in combination with morphine-3-glucuronide was administered intrathecally to rats. Antinociceptive effects were evaluated with the tail flick and the hot plate tests. Motor function was tested using the rotarod test. Estimated ED50 from the dose-response curves for morphine and morphine-6-glucuronide showed about a 30 times more potent antinociceptive effect of morphine-6-glucuronide compared with morphine. Morphine-3-glucuronide had no antinociceptive effect. Simultaneous administration of morphine-3-glucuronide 5.0 micrograms did not show any significant effect on antinociception induced by morphine 1.0 microgram or morphine-6-glucuronide 0.05 microgram.     

The "cyclic" regimen of low-dose doxycycline for adult periodontitis: a preliminary study

Specially-formulated low-dose doxycycline (LDD) regimens have been found to reduce collagenase activity in the gingival tissues and crevicular fluid (GCF) of adult periodontitis subjects in short-term studies. In the current, double-blind, placebo-controlled study, adult periodontitis patients were administered for 6 months a "cyclical" regimen of either LDD or placebo capsules; and various clinical parameters of periodontal disease severity, and both collagenase activity and degradation of the serum protein, alpha 1-PI, in the GCF were measured at different time periods. No significant differences between the LDD- and placebo-treated groups were observed for plaque index and gingival index. However, attachment levels, probing depth, and GCF collagenase activity and alpha 1-PI degradation were all beneficially and significantly (P < 0.05) affected by the drug regimen. We propose: 1) that LDD inhibits tissue destruction in the absence of either antimicrobial or significant anti-inflammatory efficacy; and 2) that long-term LDD could be a useful adjunct to instrumentation therapy in the management of the adult periodontitis patient.     

The role of catecholamines in cocaine toxicity: a model for cocaine "sudden death"

Sudden death associated with cocaine abuse is preceded by a state of agitated delirium. We postulated that release of catecholamines associated with this stress enhanced toxicity from cocaine. Thus we investigated the effect of catecholamine infusion [(epinephrine (7.25 ugml-1), norepinephrine (4.4 ugml-1) and dopamine (8.0 ugml-1), infused at 6 ml h-1] on the toxicity from concomitant infusion of cocaine (1 mg-kg-1 min-1). Two groups of rats were studied in order to isolate distinct toxicity endpoints: convulsions and respiratory arrest in conscious, and, circulatory arrest in anesthetized and ventilated rats. Catecholamines were administered at either full or 1/2 strength to establish a dose response effect on cocaine toxicity. Catecholamine infusion in a dose dependent fashion provoked earlier convulsions and respiratory arrest in conscious rats and circulatory arrest in anesthetized and ventilated rats. Despite lower cocaine cumulative dose administration, rats receiving catecholamines had similar plasma cocaine concentrations at the onset of convulsions and respiratory arrest compared to those with cocaine infusion alone. The data suggest that catecholamines enhance the convulsive, respiratory and circulatory toxicity of cocaine by a pharmacokinetic interaction.     

The "Telefono Rosso": a service for the prevention of birth defects and for the evaluation of teratogenic risk

The "Telefono Rosso" ("Red telephone") is a specialized service for preconceptional counselling and teratogenic risk evaluation. In both cases the choice of telephone communication allows to reach a wide basin of users with personalized information. The service finds one of its main reasons in the marked disinformation which exists in this field and in the wrong risk perception shown by a high proportion of users. In addition to serving the community to prevent birth defects and to prevent some induced abortions, the "Telefono Rosso" represents a unique opportunity to add to the current body of knowledge by documenting the outcomes of pregnancies exposed to a variety of agents. In this respect the "Telefono Rosso" may be considered an additional source of post-marketing surveillance.     

"Silk purses into sow's ears: The decline of psychological testing and a suggestion for its redemption": Comment.

Comments on D. Bersoff's (see record 1974-10145-001) article on psychological testing, noting that Bersoff appears to exhibit a significant lack of familiarity with the fundamental principles of psychodynamic psychological testing. Bersoff's views about contextual factors in testing, what IQ tests reveal, and what it is about people that psychologists wish to measure are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The development of international emergency medicine: a role for U.S. emergency physicians and organizations. SAEM International Interest Group

There is a rapidly growing interest in emergency medicine (EM) and emergency out-of-hospital care throughout the world. In most countries, the specialty of EM is either nonexistent or in an early stage of development. Many countries have recognized the need for, and value of, establishing a quality emergency health care system and are striving to create the specialty. These systems do not have to be high tech and expense but can focus on providing appropriate emergency training to physicians and other health care workers. Rather than repeatedly "reinventing the wheel" with the start of each new emergency care system, the preexisting knowledge base of EM can be shared with these countries. Since the United States has an advanced emergency health care system and the longest history of recognizing EM as a distinct medical specialty, lessons learned in the United States may benefit other countries. In order to provide appropriate advice to countries in the early phase of emergency health care development, careful assessment of national resources, governmental structure, population demographics, culture, and health care needs is necessary. This paper lists specific recommendations for EM organizations and physicians seeking to assist the development of the specialty of EM internationally.     

The "Z" osteotomy versus the Kalish osteotomy for the correction of hallux abducto valgus deformities: a retrospective analysis

A retrospective analysis of hallux abducto valgus surgery performed between 1990 and 1995 where the "Z" osteotomy and Kalish osteotomy were utilized was performed. Objective and subjective data were collected to determine the effectiveness of the Z osteotomy versus the Kalish osteotomy. Twenty cases of hallux abducto valgus where the Z osteotomy was utilized were evaluated on the basis of intermetatarsal angle correction and alleviation of preoperative symptoms. The same evaluation was performed on 21 cases where the Kalish osteotomy was utilized. There did not appear to be an appreciable difference in intermetatarsal angle correction between the two osteotomies; however, the Kalish osteotomy did alleviate preoperative symptoms to a greater degree compared with the Z osteotomy.     

The use of artificial neural networks methodology in the assessment of "vulnerability" to heroin use among army corps soldiers: a preliminary study of 170 cases inside the Military Hospital of Legal Medicine of Verona

This article describes a preliminary study of screening/diagnostic instruments for prediction for large-scale application in the military field at the Neuropsychiatric Department of the Military Hospital of Legal Medicine of Verona and for the prevention of self-destructive behaviors, particularly through the use of drugs. 170 subjects divided into three subsamples were examined. The first subsample was characterized by a strong tendency towards normalcy, the second by a strong tendency towards pathology, and the third by a great variety of expressions of psychological and social problems, which were not necessarily related to drug use. These subjects were administered a questionnaire designed according to Squashing Theory principles (Buscema, 1994a). Answers were processed by an Artificial Neural Network created by Semeion in Rome (Buscema, 1996) and were compared with a standard clinical psychiatric assessment report and with the results of psychodiagnostic tests. Results document ANNs' remarkable ability to recognize subjects with declared, in exordium and "at risk" pathological behaviors. Blind results on learning and trial samples show a very high predictive capacity (over 90%). A comparison with the examined subjects' clinical report and the results of the first follow-up also document very high agreements. The broad variation of answers obtained in the third subsample allows further methodological reflections on the contribution of Artificial Neural Networks and Squashing Theory to the study of deviance, for both sociologists and clinicians, and not only for those in the field of drug addiction.     

The "common cause hypothesis" of cognitive aging: Evidence for not only a common factor but also specific associations of age with vision and grip strength in a cross-sectional analysis.

A prominent hypothesis in cognitive aging is the existence of a common factor that is responsible for age-related deterioration in cognitive and noncognitive processes. A multiple indicators, multiple causes model was used to examine the nature of this common factor and its relationship to age, gender, and the apolipoprotien E (APOE) genotype. The common factor was modeled by using 10 indicator variables with 374 participants aged between 77.4 and 98.7 years. A latent factor was identified, with all indicators except blood pressure loading significantly. This factor could be established in 2 age strata within the sample. After controlling for the effects of gender, APOE, and level of education, direct effects of age were seen on visual functioning and grip strength. APOE was significantly associated with memory but not with the common factor. The findings suggest that a number of specific processes may operate concurrently with the common cause factor. (PsycINFO Database Record (c) 2010 APA, all rights reserved)