Trends in violent deaths among young people 10-24 years old, in Switzerland, 1969-1997.

PURPOSE: To assess violent death rates and trends between 1969 and 1997 among young people aged 10-24 years old in Switzerland. METHODS: Total causes of death, all external causes of injuries, traffic injuries, suicides and overdoses were retrieved from the databank of the Swiss Federal Statistical Office (SFSO), using the eighth and tenth revisions of the International Classification of Diseases (ICD). Mortality rates per 100,000 individuals were computed by gender and by age (10-14, 15-19, 20-24) using census records as denominators. RESULTS: In 1995-1997, violent deaths represented the primary cause of fatalities among young people. Rates of violent death were much higher among males than among females, with a ratio of 3.5:1 in 1995-1997 and also became increasingly elevated from the age range of 10-14 to 20-24 years (1.9:1-4.4:1). In 1995-1997, violent deaths accounted for 66% (n = 1221) of all fatalities among young people. Among violent deaths, 36% were due to traffic injuries, 13% to other types of injuries, 32% to suicide, 15% to overdoses, 3% to homicides and 1% to undetermined intent. Between 1969 and 1997, rates of traffic injuries decreased in both genders and in the three age groups considered, while rates of suicide remained stable and rates of overdoses stabilised during the nineties after a sharp increase during the eighties. CONCLUSION: Although violent deaths in Switzerland have become significantly less frequent over the last 30 years, they still represent the single greatest cause of fatalities among young people and, as such, constitute a major public health challenge.

Behaviour evaluation for risk-taking adolescents (BERTA): an easy to use and assess instrument to detect adolescent risky behaviours in a clinical setting.

To create an instrument to be used in an outpatient clinic to detect adolescents prone to risk-taking behaviours. Based on previous research, five identified variables (relationship with parents and teachers, liking going to school, average grades, and level of religiosity) were used to create a screening tool to detect at least one of ten risky behaviours (tobacco, alcohol, cannabis and other illegal drugs use; sexual intercourse and sexual risky behaviour; driving while intoxicated, riding with an intoxicated driver, not always using a seat belt, and not always using a helmet). The instrument was tested using the Barcelona Adolescent Health Survey 1993. A Receiver Operating Characteristics curve was used to find the best cut-off point between high and low risk score. Odds ratios and 95% confidence intervals were calculated to detect at least one risky behaviour and for each individual behaviour. In order to assess its predictive value, the analysis was repeated using the Barcelona Adolescent Health Survey 1999. In both cases, analyses were conducted for the whole sample and for younger and older adolescents. Adolescents with a high-risk score were more likely to take at least one risky behaviour both when the whole sample was analysed and by age groups. With very few exceptions, the Behaviour Evaluation for Risk-Taking Adolescents showed significant odds ratios for each individual variable. CONCLUSION: The Behaviour Evaluation for Risk-Taking Adolescents has shown its potential as an easy to use instrument to screen for risk-taking behaviours. Future research must aim towards assessing this instrument's predictive value in the clinical setting and it's application to other populations.

Cannabis et conduite automobile [Cannabis and automobile driving]

Cannabis use has increased considerably during the last 15 years. One of the major problems dealing with cannabis use is driving under the influence of drugs. With the exception of ethyl alcohol, the majority of the epidemiological studies have shown that cannabis is the most frequently detected substance in people suspected of driving under the influence of drugs. Experimental studies are therefore needed to assess cannabis effects on driving capability. Many studies indicate that cannabis impairs psychomotor performance. This impairment becomes obvious when high doses of cannabis are taken, when ethyl alcohol or other drugs are simultaneously ingested, or when sustained attention is needed. Moreover, cannabis effects are qualitatively different from those observed after ethyl alcohol consumption. In forensic practice, cannabis impairment of driving performance must be related to cannabinoids blood concentrations. To facilitate the interpretation of cannabinoids blood levels, several models were set up recently. These models must be further improved in order to fit in with all circumstances of cannabis use.

Double-bundle transtibial posterior cruciate ligament reconstruction with a tendon-patellar bone-semitendinosus tendon autograft: clinical results with a minimum of 2 years' follow-up.

PURPOSE: The purpose of this study was to evaluate the clinical and subjective outcomes after arthroscopic-assisted double-bundle posterior cruciate ligament (PCL) reconstruction. METHODS: A series of 15 patients with grade III isolated chronic PCL tears underwent double-bundle PCL reconstruction. Of these patients, 8 (53%) had simultaneous fractures. The mean time from accident to surgery was 10.8 months (range, 8 to 15 months). The mean age at the time of surgery was 28.2 years (range, 17 to 43 years). All of the patients reported knee insecurity during activities of daily living or light sporting activities, with associated anterior knee pain in 5 patients. Preoperatively, posterolateral or posteromedial corner injuries were ruled out through accurate clinical examination. The knees were assessed before surgery and at a mean follow-up of 3.2 years (range, 2 to 5 years) with a physical examination, 4 different rating scales, and stress radiographs obtained with a Telos device (Telos, Marburg, Germany). RESULTS: Postoperative physical examination revealed a reduction of the posterior drawer and tibial step-off in all cases, although the posterior laxity was not completely normalized. Nevertheless, the patients were subjectively better after surgery. The subjective International Knee Documentation Committee score was significantly ameliorated. With regard to the objective International Knee Documentation Committee score, 6 knees (40%) were graded as abnormal because of posterior displacement of 6 mm or greater on follow-up stress radiographs with the Telos device. On the Lysholm knee scoring scale, the score was excellent in 13% of patients and good in 87%. The mean score on the Hospital for Special Surgery knee ligament rating scale was 85.8. The Tegner activity score showed an amelioration after surgery, but no patient resumed his or her preinjury level of activities. The postoperative stress radiographs revealed an improvement in posterior instability of 50% or more in all but 3 knees (20%). CONCLUSIONS: Our technique of double-bundle PCL reconstruction produced a significant reduction in knee symptoms and allowed the patients to return to moderate or strenuous activity, although the posterior tibial translation was not completely normalized and our results appear to be no better than the results of single-bundle PCL reconstruction. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

The modern holy shroud.

Testimonies disclosed that a 44-year-old pedestrian was struck head-on by a truck while she was roaming on the motorway; at the time of collision, the truck was travelling at a speed of about 90 km/h. In the second phase of the collision, the pedestrian was projected about 100 m before her body was run over by the truck and then by a car. The autopsy revealed extensive mutilations, making it impossible to verify the testimonies of witnesses to the collision as regards the pedestrian's position at the moment of the first impact. However, the reports produced by the technical expert and the forensic pathologist were able to confirm the testimonies, based on an impact zone on the front panel of the cab of the truck, where part of the pedestrian's face was reproduced like a "modern holy shroud".

Diabète et conduite: réflexions et atelier pratique [Diabetes and driving: thoughts and educational perspectives].

In Switzerland over 200'000 people with diagnosed diabetes drive a car. Their physicians endorse many roles: usual medical care as well as informing properly about driving recommandations and handling the legal issues behing the licensing procedure. Ability to drive can be impaired in three ways: hypogylcemia, diabetes complications and hyperglycemia. Hypoglycemia is the main risk factor of vehicle accident for diabetic drivers and frequent while driving. However few accidents are reported due to hypoglycemia. Swiss medical guidelines about diabetes and driving mention the requested conditions, but practically how should we do? We sought to answear by creating a specific educationnal program focused on hypoglycemia management. Building patient knowledges through experiences is the main goal of the course diabetes and driving.

Spiral CT aortography: an efficient technique for the diagnosis of traumatic aortic injury.

The objective of this study was to assess the efficiency of spiral CT (SCT) aortography for diagnosing acute aortic lesions in blunt thoracic trauma patients. Between October 1992 and June 1997, 487 SCT scans of the chest were performed on blunt thoracic trauma patients. To assess aortic injury, the following SCT criteria were considered: hemomediastinum, peri-aortic hematoma, irregular aspect of the aortic wall, aortic pseudodiverticulum, intimal flap and traumatic dissection. Aortic injury was diagnosed on 14 SCT examinations (2.9 %), five of the patients having had an additional digital aortography that confirmed the aortic trauma. Twelve subjects underwent surgical repair of the thoracic aorta, which in all but one case confirmed the aortic injury. Two patients died before surgery from severe brain lesions. The aortic blunt lesions were confirmed at autopsy. According to the follow-up of the other 473 patients, we are aware of no false-negative SCT examination. Our limited series shows a sensitivity of 100 % and specificity of 99.8 % of SCT aortography in the diagnosis of aortic injury. It is concluded that SCT aortagraphy is an accurate diagnostic method for the assessment of aortic injury in blunt thoracic trauma patients.

Trends in motor vehicle crash mortality in Europe, 1980-2007.

Recent trends (1980-2007) in mortality from road traffic crashes in European countries, and, for comparative purposes, in the USA and Japan were reviewed. Data came from the World Health Organisation database. Age-standardised rates, at all ages and at 15-24, 25-64, >=65 years, were computed. Joinpoint regression analyses to evaluate significant changes in trends were performed. In the European Union as a whole rates declined from 20.2 in 1987 to 13.5/100,000 in 2007 in men, and from 6.3 to 3.7/100,000 in women; European Union rates remained lower than USA, but higher than Japanese ones. In 2007, the highest male rates were in Lithuania (36.7/100,000), the Russian Federation (35.2), Ukraine (29.8), and Latvia (28.5), and the lowest ones in the Netherlands (6.2) and Sweden (6.9); the highest female rates were in the Russian Federation (11.3), Lithuania (9.7), Belarus, Latvia, and Ukraine (around 8), and the lowest ones in Switzerland (1.7), the UK, and Nordic countries (around 2). Mortality from motor vehicle crashes declined in northern and western European countries and - though to a lesser extent - in southern European countries, too. Mortality trends were also favourable in the Czech Republic and Poland since the mid 1990's, whereas they were still upwards in Romania and the Russian Federation. No trend was observed in Hungary and Ukraine. Trends were consistent in various age groups considered. Thus, additional urgent and integrated intervention is required to prevent avoidable deaths from motor vehicle crashes, particularly in selected central and eastern European countries.

Management of major accidents with on-site 144 dispatcher

Introduction: An excellent coordination between firefighters, policemen and medical rescue is the key to success in the management of major accidents. In order to improve and assist the medical teams engaged on site, the Swiss "medical command and control system" for rescue operations is based on a binomial set up involving one head emergency doctor and one head rescue paramedic, both trained in disaster medicine. We have recently experimented an innovative on-site "medical command and control system", based on the binomial team, supported by a dedicated 144 dispatcher. Methods: A major road traffic accident took place on the highway between Lausanne and Vevey on April 9th 2008. We have retrospectively collected all data concerning the victims as well as the logistics and dedicated structures, reported by the 144, the Hospitals, the Authority of the State and the Police and Fire Departments. Results: The 72-car pileup caused one death and 26 slightly injured patients. The management on the accident site was organized around a tripartite system, gathering together the medical command and control team with the police and fire departments. On the medical side, 16 ambulances, 2 medical response teams (SMUR), the Rega crew and the medical command and control team were dispatched by the 144. On that occasion an advanced medical command car equipped with communication devices and staffed with a 144 dispatcher was also engaged, allowing efficient medical regulation directly from the site. Discussion: The specific skills of one doctor and one paramedic both trained for disaster's management proved to be perfectly complementary. The presence of a dispatcher on site with a medical command car also proved to be useful, improving orders transmission from the medical command team to all other on- and off-site partners. It relieved the need of repeated back-and-forth communication with the 144, allowing both paramedic and doctor to focus on strategy and tactics rather than communication and logistics.