Helmets for preventing injury in motorcycle riders

Background: Motorcycle crash victims form a high proportion of those killed or injured in road traffic accidents. Injuries to the head, following motorcycle crashes, are a common cause of severe morbidity and mortality. It seems intuitive that helmets should protect against head injuries but it has been argued that motorcycle helmet use decreases rider vision and increases neck injuries. This review will collate the 'current available evidence on helmets and their impact on mortality, and head, face and neck injuries following motorcycle crashes.

Objectives: To quantify the effectiveness of wearing a motorcycle helmet in reducing mortality and head and neck injury following motorcycle crashes.

Search strategy: Databases including the Cochrane Injuries Group Specialised Register, Cochrane Central Register of Controlled Trials (The Cochrane Library issue 1,2003), MEDLINE (January 1966 to February 2003), EMBASE (January 1985 to February 2003), CINAHL (January 1982 to February 2003), IRRD (International Road Research Documentation), TRANSDOC, TRIS (Transport Research Information Service), ATRI (Australian Transport Index) (1976 to Feb 2003), Science Citation Index were searched for relevant articles. Web sites of traffic and road accident research bodies including government agencies were also searched. Reference lists from topic reviews, identified studies and bibliographies were examined for relevant articles.

Selection criteria: We considered for inclusion studies that investigated a population of motorcycle riders who had crashed, examining helmet use as an intervention and with outcomes that included one or more of the following: death, head, neck or facial injury. Studies included any that compared an intervention and control group and, therefore, included any randomised controlled trials, non-randomised controlled trials, cohort, case-control and cross-sectional studies. Ecological and case series studies were excluded.

Data collection and analysis: Two reviewers independently screened reference lists for eligible articles. Two reviewers independently assessed articles for inclusion criteria. Data were abstracted by two independent reviewers using a standard abstraction form.

Main results: Fifty-three observational studies were identified of varying quality. Despite methodological differences there was a remarkable consistency in results, particularly for mortality and head injury outcomes. Motorcycle helmets appear to reduce the risk of mortality although, due to heterogeneity in study design, an overall estimate of effect was not calculated. There was some evidence that the effect of helmets on mortality is modified by speed. Motorcycle helmets were found to reduce the risk of head injury and from five well-conducted studies the risk reduction is estimated to be 72% (OR 0.28, 95%CI 0.23,0.35). Insufficient evidence was found to estimate the effect of motorcycle helmets compared with no helmet on facial or neck injuries. However, studies of poorer quality suggest that helmets have no effect on the risk of neck injuries and are protective for facial injury. There was insufficient evidence to demonstrate whether differences in helmet type confer more or less advantage in injury reduction.

Conclusions: Motorcycle helmets reduce the risk of mortality and head injury in motorcycle riders who crash, although the former effect may be modified by other crash factors such as speed. Further well-conducted research is required to determine the effects of helmets and different helmet types on mortalIty, head, neck and facial injuries. However, the findings suggest that global efforts to reduce road traffic injuries may be facilitated by increasing helmet use by motorcyclists.

Substance use and its implications for the critical care nurses: a literature review

Background
Illicit drug use in Australia has been increasing and studies indicate that illicit drug users have a higher risk of accidents which may result in the user needing critical care. However, there is a significant gap in the literature specifically pertaining to the implications of drug use in critical care.

Aims
The primary objective was to examine the literature for the physiological effects of methylenedioxymethamphetamine (MDMA), cocaine and amphetamines in critically ill patients.

Methods
A comprehensive literature review was undertaken and a body systems framework was used to categorise the effects of these illicit drugs.

Results
The illicit substances addressed have potentially fatal and long-term side effects. For those users involved in accidents or trauma requiring intensive or critical care nursing, the mortality and co-morbidity risks are increased significantly. It is, therefore, important that nurses are able to recognise the specific physiological effects and possible complications that can occur with the use of each illicit drug.

Conclusion
Both nursing and medical staff need to have a thorough understanding of how illicit substances work and how they can affect the critical care patient and the care they are given.

Traffic fatalities: does income inequity create an externality?

Responsible for 20 million severe injuries and/or deaths annually, few epidemics receive less attention than traffic accidents. Going beyond confirming an inverted U-shaped relationship between mean income and fatalities, we show theoretically that income inequality can positively affect fatalities in two ways. Each operates through heterogeneity between road users, and while the direct effect can be expected to evaporate with rising income, the indirect effect may prove to be an externality in that the relationship remains regardless of the level of income. Our model is supported by evidence from 79 countries between 1970 and 2000.

Another look at the culture-quality-performance link

Quality improvement is usually driven by quality, safety and risk agendas leading to a focus on measurements of the outputs of care; outputs such as fewer complaints, fewer accidents and adverse events. An oft-neglected theme is the impact of the quality improvement initiative within the organisation itself. This paper presents the findings of the first stage of an evaluation that has examined the changes which have occurred within organisations since participating in a quality improvement initiative. These findings indicate that engaging with a quality improvement program can change the nature of social interactions within the organisation. In this way, quality improvement programs can impact on organisational culture, particularly in relation to organisational learning. Thus, this paper argues that successful engagement with a quality improvement program can enhance organisational learning, and, in turn, build organisational capacity.

The spatial pattern of natural selection when selection depends upon experience

Apostatic (frequency‐ or density‐dependent) selection, aposematic signals, and mate choice behavior generally require that the mean prey or potential mate density m value be high enough (above a threshold T) to result in sufficient encounter rates for the searcher to learn or retain the association between conspicuous signals and prey unprofitability, to forage apostatically, or to choose among mates. This assumes that all searchers experience , which implicitly assumes an even dispersion of targets among searcher territories. Uneven dispersion generates new phenomena. If , then only territories with local density x values that are greater than T favor experience‐based behavior, leading to spatially variable frequency‐ or density‐dependent selection intensity. As aggregation increases, the increase in percentage of targets in favorable territories ( ) is greater than the increase in the percentage of territories that are favorable. The relationship is reversed when . In both cases, because as few as 10% of the territories can contain 80% of the targets, only a few territory holders may account for most of the selection on most of the target population; accidents of experience in only a few searchers can have unexpectedly large effects on the target population. This also provides an explanation for high searcher behavior variation (personalities) : individuals from favorable territories will behave differently in behavioral experiments than those from unfavorable territories, at least with respect to similar kinds of targets. These effects will generate spatial heterogeneity in natural and sexual selection in what are otherwise uniform environments.

Examination of the "all hazards" approach to disaster management as applied to field disaster management and pre-hospital care in Australia

Disasters, emergencies, incidents, and major incidents - they all come back to the same thing regardless of what they are called. The common denominator is that there is loss of life, injury to people and animals and damage and destruction of property. The management of such events relies on four phases: 1. Prevention 2. Preparation 3. Response 4. Recovery Each of these phases is managed in a different way and often by different teams. Here, concentration has been given to phases 2 and 3, with particular emphasis on phase 3, Response. The words used to describe such events are often related to legislation. The terminology is detailed later. However, whatever the description, whenever prevention is not possible, or fails, then the need is to respond. Response is always better when the responders are prepared. Training is a major part of response preparation and this book is designed to assist those in the health industry who need to be ready when something happens. One of the training packages for responders is the Major Incident Medical Management and Support (MIMMS) Course and this work was designed to supplement the manual prepared by Hodgetts and Macway-Jones(87) in the UK. Included is what the health services responder, who may be sent to an event in which the main concern is trauma, should know. Concentration is on the initial response and does not deal in any detail with hospital reaction, the public health aspects, or the mental health support that provides psychological help to victims and responders, and which are also essential parts of disaster management. People, in times of disaster, have always been quick to offer assistance. It is now well recognised however, that the 'enthusiastic amateur', whilst being a well meaning volunteer, isn't always what is needed. All too often such people have made things worse and have sometimes ended up as victims themselves. There is a place now for volunteers and there probably always will be. The big difference is that these people must be well informed, well trained and well practiced if they are to be effective. Fortunately such people and organisations do exist. Without the work of the St John Ambulance, the State Emergency Service, the Rural Fire Service the Red Cross and the Volunteer Rescue Association, to mention only a few, our response to disasters would be far less effective. There is a strong history of individuals being available to help the community in times of crisis. Mostly these people were volunteers but there has also always been the need for a core of professional support. In the recent past, professional support mechanisms have been developed from lessons learned, particularly to situations that need a rapid and well organised response. As lessons are learned from an analysis of events, philosophy and methods have changed. Our present system is not perfect and perhaps never will be. The need for an 'all-hazards approach' makes detailed planning very difficult and so there will probably always be criticisms about the way an event was handled. Hindsight is a wonderful thing, provided we learn from it. That means that this text is certainly not the 'last word' and revisions as we learn from experience will be inevitable. Because the author works primarily in New South Wales, many of the explanations and examples are specific to that state. In Australia disaster response is a State, rather than a Commonwealth, responsibility and consequently, and inevitably, there are differences in management between the states and territories within Australia. With the influence of Emergency Management Australia, these differences are being reduced. This means that across state and territory boundaries, assistance is common and interstate teams can be deployed and assimilated into the response rapidly, safely, effectively and with minimum explanation. This text sets out to increase the understanding of what is required, what is in place and how the processes of response are managed. By way of introduction and background, examples are given of those situations that have occurred, or could happen. Man Made Disasters has been divided into two distinct sections. Those which are related to structures or transport and those related directly to people. The first section, Chapter 3, includes: • Transport accidents involving land, rail, sea or air vehicles. • Collapse of buildings for reasons other than earthquakes or storms. • Industrial accidents, including the release of hazardous substances and nuclear events. A second section dealing with the consequences of the direct actions of people is separated as Chapter 4, entitled 'People Disasters'. Included are: • Crowd incidents involving sports and entertainment venues. • Terrorism From Chapter 4 on, the emphasis is on the Response phase and deals with organisation and response techniques in detail. Finally there is a section on terminology and abbreviations. An appendix details a typical disaster pack content. War, the greatest of all man made disasters is not considered in this text.

Traffic fatalities and public sector corruption

Traffic accidents result in 1 million deaths annually worldwide, though the burden is disproportionately felt in poorer countries. Typically, fatality rates from disease and accidents fall as countries develop. Traffic deaths, however, regularly increase with income, at least up to a threshold level, before declining. While we confirm this by analyzing 1,356 country-year observations between 1982 and 2000, our purpose is to consider the role played by public sector corruption in determining traffic fatalities. We find that such corruption, independent of income, plays a significant role in the epidemics of traffic fatalities that are common in relatively poor countries.

Modelling the public health consequences of cannabis use in Australia

Aims: To detail and validate a simulation model that describes the dynamics of cannabis use, including its probable causal relationships with schizophrenia, road traffic accidents (RTA) and heroin/poly-drug use (HPU).

Methods: A Markov model with 17 health-states was constructed. Annual cycles were used to simulate the initiation of cannabis use, progression in use, reduction and complete remission. The probabilities of transition between health-states were derived from observational data. Following 10-year-old Australian children for 90 years, the model estimated age-specific prevalence for cannabis use. By applying the relative risks according to the extent of cannabis use, the age-specific prevalence of schizophrenia and HPU, and the annual RTA incidence and fatality rate were also estimated. Predictive validity of the model was tested by comparing modelled outputs with data from other credible sources. Sensitivity and scenario analyses were conducted to evaluate technical validity and face validity.

Results: The estimated cannabis use prevalence in individuals aged 10-65 years was 12.2% which comprised 27.4% weekly and 18.0% daily users. The modelled prevalence and age profile were comparable to the reported cross-sectional data. The model also provided good approximations to the prevalence of schizophrenia (Modelled: 4.75/1,000 persons vs Observed: 4.6/1,000 persons), HPU (3.2/1,000 vs 3.1/1,000) and the RTA fatality rate (8.1 per 100,000 vs 8.2 per 100,000). Sensitivity analyses and scenario analysis provided expected and explainable trends.

Conclusions: The validated model provides a valuable tool to assess the likely effectiveness and cost-effectiveness of interventions designed to affect patterns of cannabis use. It can be updated as new data becomes available and/or applied to other countries.

Simulation of Mg sheet press cell materials

Major characteristics of Magnesium alloy are low density (= 1.8 g/cm³) and excellent recyclability; therefore Mg is considered as one of low environmental loading materials. The low-density materials, such as Mg, are suitable for the transportation system to reduce the emission of Co2, save energy resource and increase the safety for accidents like corrosions. In the place, cellular materials like aluminum foams are also low-density materials and can be controlled the stress-strain relation. Combination of Mg alloy and cellular materials, that is Mg cell, is one of the most excellent materials for transportation system, because of its ultra low density. safeties, and recycle ability. To make the Mg cellular materials. there are some problems to solve. One is how to make them uniformly to supply them as same perfonnance materials. One is how to make them inexpensively. Most of cellular materials are very expensive because of there are many processes or special fabrication system to make them. To solve these problems. we investigated the press cell materials. The press cell material consists sheets pressed as cell shape and wall. Therefore, it is very easy to make cellular materials and control validation of the performance of each foam materials. In this paper, we simulated compression tests of this new type of Mg alloy cellular materials under dynamic loading to investigate the relation between the compression speed and the compression behavior to show the shock absorbing capability of this new foam material. It is very important to understand their mechanical properties relatcd with cell shapes and wall to be applied widely.

Fall risk management intervention : a feasibility and validation study

A fall risk management intervention was undertaken by staff caring for older people in nursing homes. Its acceptability and usefulness was tested. 'High risk times' and 'at risk' individuals were found, thereby identfying times when staff should be vigilant, and specific residents to be targeted with fall prevention strategies.

Acute farm injury

Using the 'integrative framework', based on the health promoting PRECEDE framework and Haddon's injury prevention strategies, as suggested by Gielen, a theoretical model for general practitioner involvement in the prevention of farm injury was developed. A listing of potential roles in farm injury prevention for general practitioners was produced.

Accident avoidance importance for building demolition

Building demolition, as compared to building construction is always carried out as quickly and cheaply as possible. The nature of limited time and resources of the demolition project sometimes translate into poor work planning and safety precautions. In recent years, demolition work has become more complicated due to the high diversity of building types and there are various demolition techniques and strategies. It is important to have a clear understanding of the type of building to be demolished, the method to be used and risks involved to ensure proper work planning. Using historical data on demolition related accidents; this paper discusses the classification of injuries and causes of the accidents. To conclude, strategies for better understanding of demolition work and good practices of site safety are recommended.

Review of rural and regional alcohol research in Australia

INTRODUCTION: Alcohol is the most commonly used drug within Australia. Recently, there have been indications that there is a greater incidence of high-risk drinking within rural populations as compared with their urban counterparts. High-risk drinking is associated with numerous conditions, such as diabetes, heart attack and cancer, as well as acute harms such as assault, suicide and road accidents. The objective of this article is to review the current research and relevant data pertaining to alcohol use and alcohol-related harms within rural Australia. METHODS: This paper is a systematic review of 16 databases, including PubMed, PsycINFO and Google Scholar. RESULTS: Overall, 18 studies describing alcohol consumption or alcohol-related harms were found. Approximately half of these studies were large-scale national population surveys, which were therefore limited in their representativeness of specific regional and rural towns. Most studies examining alcohol consumption used self-report data collection, meaning that interpretation of results needs to be tentative. There is a consistent pattern of higher rates of alcohol consumption and consequent harm within regional and rural Australia than in urban areas. CONCLUSIONS: There is emerging research examining alcohol consumption and alcohol-related harms within regional and rural Australia. All studies show that these populations experience disproportionate harm because of alcohol consumption. The causes and mechanism for this have not been investigated, and a program of research is required to understand how and why rural populations experience disproportionate levels of alcohol-related harm and ultimately, what interventions will be most effective in reducing alcohol-related harms.