Mitchell, Williamson and Olivier's (2010) study estimated drowning
rates for the Australian state of New South Wales (NSW) in 2005 based on
resident population person-time exposure to swimming. The authors state
(p. 261) that "failure to adjust injury rates for exposure to a hazard
necessarily results in poor estimates of risk", and based on their
findings, conclude (p. 264) drowning mortality rates to be "more than 200...
Mitchell, Williamson and Olivier's (2010) study estimated drowning
rates for the Australian state of New South Wales (NSW) in 2005 based on
resident population person-time exposure to swimming. The authors state
(p. 261) that "failure to adjust injury rates for exposure to a hazard
necessarily results in poor estimates of risk", and based on their
findings, conclude (p. 264) drowning mortality rates to be "more than 200
times higher than equivalent exposure-adjusted rates for road traffic
fatalities." This fact is cited in the Royal Life Saving Society's 2010
National Drowning Report (Royal Life Saving, 2010, p. 3).
However, comparison data detailed below suggest the reported time-
exposure drowning rate presents a gross overestimation of swimming risk.
This is due to deficiencies in reported numerator data and denominator
estimates.
The majority of unintentional drowning death cases included in the
reported numerator would be unlikely to come from the population
denominator (swimmers). This is a key principle for calculating population
rates (Robertson, 2007). Australia-wide unintentional drowning deaths
reported for July 2004 to June 2005 identified 97 (37.5%) of 259 victims
engaged in a swimming / leisure activity (Royal Life Saving, 2005). In the
following 12 month period (2005-2006) this figure was 54 (20.4%) of 265
unintentional drownings (Royal Life Saving, 2006). NSW drowning mortality
data, as a subset of national data, would be expected to follow a similar
pattern. Mitchell et al. (2010) did not report the numerator frequency for
drowning deaths.
Mitchell et al. (2010) report a rate of 90,000 drowning deaths per 10
million hours of swimming in NSW for 2005 (p. 264). The rate indicates
that for every thousand hours of swimming at a NSW public pool, river,
beach or other location, nine swimmers will drown. But Sydney's Bondi
beach alone caters to thousands of bathers most days during summer--yet
drowning remains a relatively rare, and not daily, event. Drowning
protection at this beach, given the risk of swimming indicated by the
reported rate, may be explained by regular surf lifesaver patrols. Even
so, the NSW population, which numbers many millions concentrated in
coastal areas experiencing a mild to warm climate, will likely spend
numerous hours swimming in unpatrolled locations.
The reported rate of 90,000 drowning deaths per 10 million hours of
swimming must be questioned given that the annual frequency of drowning
among swimmers in NSW is probably well below one-hundred. Fortunately, a
check of this rate is readily available using swimming participation data
reported by the Australian Bureau of Statistics (2007) for 2005-2006.
These data were collected using a method and time period consistent with
exposure data relied upon by Mitchell et al. (2010).
In the previous 12 months for Australia (2005-2006), 1,447,300
persons aged 15 and over residing in private dwellings (9% of the national
population) were estimated to have participated in organised (13%) or
unorganised (87%) swimming. (The swimming participation rate for NSW was
estimated by the Australian Bureau of Statistics (ABS) to be marginally
higher at 10 percent of the population or 556,400 persons.) For national
swimmer estimates in the 12 months prior to sample interview, 1.1 million
(76%) reported swimming 53 times or more, 186,300 (13%) 27 to 52 times,
89,500 (6%) 13 to 26 times, and 71,500 (5%) 12 or less times. This
estimate equates to a minimum of 64,565,100 swimming episodes in Australia
by residents for the 12 month period.
Based on minimum participation frequencies reported by the ABS, I
have estimated person-time exposure and drowning rates (using a numerator
of 80 drowning deaths while swimming--the average over a five year period
to 2006 [Royal Life Saving, 2006]) for mean bathing-time exposures per
swimming episode of 30 minutes. The calculation was based on conservative
estimates (lowest swimming frequency by frequency group) and ignores what
is likely to be millions of bathing hours undertaken by international
visitors to Australia (note that drownings of international tourists were
included in numerator data). This produced a rate of 24.8 drownings per 10
million hours of swimming. (Note: Mean swimming episodes at 15 minutes
yielded a rate of 49.6 and at 60 minutes 12.4, per 10 million hours of
swimming.)
Substantial differences between the person time-exposure rate
reported by Mitchell et al. (2010) and that listed above (respectively,
90,000 drowning deaths in NSW compared with 25 drowning deaths in
Australia, per 10 million hours of swimming) are unlikely to be explained
by differences in water exposure or drowning patterns between NSW and
other Australian states and territories. Perhaps Mitchell et al. applied
sample exposure data in the denominator without extrapolation to the
population?
In comparison with reported traffic mortality time-exposure rates,
the time-exposure rate of drowning mortality for persons exposed to
swimming in Australia appears higher. But rather than being 200 times
higher as reported in the study, it's more likely to be a factor below 10.
Mitchell et al. (2010) rightly state (p. 264) that "In terms of
policy development, under- or overestimation of the true risk of injury
can lead to poor identification of priorities for developing injury
prevention policies and interventions, and inadequate resource
allocation." The reported rates emphasize the need for precision so as not
to perpetuate these challenges to injury problems including drowning.
A spreadsheet with supporting data is available on request.
References cited:
Australian Bureau of Statistics (2007). Participation in Sports and
Physical Recreation, 2005-06 (cat. no. 4177.0). Canberra: ABS.
Mitchell, R. J., Williamson, A. M., & Olivier, J. (2010).
Estimates of drowning morbidity and mortality adjusted for exposure to
risk. Injury Prevention, 16(4), 261-266.
Robertson, L. S. (2007). Injury Epidemiology: Research and Control
Strategies (3rd ed.). New York: Oxford University Press.
Royal Life Saving (2005). The National Drowning Report 2005. Sydney:
Royal Life Saving Society.
Royal Life Saving (2006). The National Drowning Report 2006. Sydney:
Royal Life Saving Society.
Royal Life Saving (2010). The National Drowning Reports 2010. Sydney:
Royal Life Saving Society.
The investigators did not meaningfully compare Relative Bicycling
Risk and Relative Traffic Danger for individual pairs. Such a comparison
of their data demonstrates that the Apparent Cycle Track Effect was
increased Danger to bicyclists at two cycle tracks, Neutrality at two
cycle tracks, and increased Safety at two cycle tracks. This contrasts
with the investigators' claim that the six cycle tracks had a combined 28%
l...
The investigators did not meaningfully compare Relative Bicycling
Risk and Relative Traffic Danger for individual pairs. Such a comparison
of their data demonstrates that the Apparent Cycle Track Effect was
increased Danger to bicyclists at two cycle tracks, Neutrality at two
cycle tracks, and increased Safety at two cycle tracks. This contrasts
with the investigators' claim that the six cycle tracks had a combined 28%
lower injury rate than their eight reference streets.
But are the two cycle tracks that are apparently safer in actuality
safer for bicycling than their reference streets? Examination reveals that
this is false safety.
The investigators assumed, without testing or providing supporting
evidence, that Motor Vehicle Occupant injury counts are a surrogate for
traffic danger a bicyclist might face on a given street apart from any
treatment. Examination of the street characters of Berri and reference
Saint Denis show that MVO injuries are not a suitable surrogate for this
pairing. I conclude that after adjustment for its reference street being
inherently more dangerous for bicyclists, the Apparent Cycle Track Effect
of Safety for Berri is instead Unknown.
The Apparent Cycle Track Effect of Safety for Christophe Colomb can
be explained by an artificially low Relative Bicycling Risk compared to
reference Saint Hubert, and an artificially high Relative Traffic Danger
compared to reference Christoph Colomb non-cycle track section. After
adjustments I conclude the Christophe Colomb cycle track has Neutrality
with both its reference streets.
The reference streets in pairs 1, 3, and 6 are engineered to be more
dangerous with the presence of "faux Door Zone Bike Lanes." Simple re-
striping to eliminate this hazard and alert bicyclists to the extent of
the door zone, and signage to empower them to use a full traffic lane
could reduce bicyclist risk on these streets. This would make the cycle
tracks comparatively more dangerous.
For my full critique, see:
http://bicyclingmatters.wordpress.com/critiques/montreal-cycle-tracks/
Lusk et al's paper (1) indicates an important subtext regarding
travel. Governments wish to make personal mobility as widely available as
possible; this inevitably entails promotion of the private automobile,
which can provide convenient and comfortable travel for the widest range
of individuals, including those for whom disability would otherwise pose
severe limitations in participating in society. However, there is a...
Lusk et al's paper (1) indicates an important subtext regarding
travel. Governments wish to make personal mobility as widely available as
possible; this inevitably entails promotion of the private automobile,
which can provide convenient and comfortable travel for the widest range
of individuals, including those for whom disability would otherwise pose
severe limitations in participating in society. However, there is a
competing agenda concerning congestion, sustainability, pollution and
health, along with the risk posed by automobiles for vulnerable road-users
such as pedestrians and cyclists.
Authorities must strike a balance. In the case of the US, the balance
generally favours the automobile: the insistence that cyclists be treated
as "operators of vehicles" (2) underlines that assertion. Canada may be
more bicycle-orientated. Lusk et al demonstrate that in Montreal
segregated cycle tracks can entail fewer casualties than matched common-
user roads: the consequent reduction in perceived and objective risk can
sussessfully act to promote cycling.
0However, poorly designed and policed facilities may render the
situation for cyclists worse than if the US model is followed. This is
arguably the case in Northern Ireland. Cycle lanes at the side of roads
are provided. Despite official prohibition, motor-vehicles frequently park
or straddle cycle lanes before undertaking manoeuvres: junctions are
particularly problematic regarding rights-of-way. Finally, cycle lanes are
often well short of any meaningful journey. The official stance is that:
"Use of cycle lanes is not compulsory and will depend on your experience
and skills" (3). So cyclists are free to use other traffic lanes - but
motorists seem unaware of this and often evince hostility towards cyclists
exercising this freedom. The cyclist is uncomfortable on any part of the
road - hardly a recipe for the development of mass cycle-commuting.
Segregated paths are also provided. These are in fact shared with
pedestrians. Pedestrians no doubt provide better fellow travellers for
cyclists than do automobiles, but the two groups are nevertheless
incompatible regarding speed: cycling through groups of pedestrians or
walking through streams of cyclists is not comfortable. Curiously, this is
recognised regarding sidewalks, which are solely for pedestrians: cycling
and driving are officially outlawed (3).
The above issues may reflect anomalous conceptualisations of risk.
Northern Ireland again provides a useful example. The political conflict
("the Troubles") was always perceived to be particularly dangerous - for
more so than the roads - as reflected in provision of manpower and
resources. In fact, Northern Irish roads were objectively much riskier.
Throughout the worst of the Troubles in the 1970s and 1980s, the objective
risks of politically-motivated death and injury were about 50% and 12%
respectively those for the roads (4). It is perhaps not surprising that
strategies for promoting cycling are often ineffectual. With obvious
exceptions such as the Netherlands, Denmark and - perhaps - Montreal, this
unfortunately may apply in many jurisdictions.
Perhaps the seemingly inexorable increases in fuel cost may achieve
real change: personal economics may win where conceptualisations of risk
have failed.
References
1. Lusk A C, Furth P G, Morency P, et al. Risk of injury for
bicycling on cycle tracks versus in the street. Inj Prev doi:
10.1136/ip.2010.028696.
2. Forrester J. Effective cycling. Cambridge: MIT Press, 1984.
3. The Highway Code: AA Publishing, 2008.
4. Reinhardt-Rutland A H. Roadside speed-cameras: arguments for
covert siting. Police J 2001; 74: 312-315.
The major problem in enforcing the zero BAC limit is ensuring that
the province or territory enacts accompanying legislation authorizing the
police to demand a breath sample from drivers subject to this limit. There
has been no problem with drivers testing positive with exceedingly small
amounts of alcohol in their breath samples, because of natural processes
or diet. Presumably, the machines have thresholds to eliminate...
The major problem in enforcing the zero BAC limit is ensuring that
the province or territory enacts accompanying legislation authorizing the
police to demand a breath sample from drivers subject to this limit. There
has been no problem with drivers testing positive with exceedingly small
amounts of alcohol in their breath samples, because of natural processes
or diet. Presumably, the machines have thresholds to eliminate this
problem.
How easy is it to enforce zero limit in the face of possiblity of
physicigical sources of alcohol and uses of other dietry and household
sources of alcohol? There might be a lot or few false positive cases as a
result. Is there anything of in the scientific evidence base?
Reading the article, The effects of provincial bicycle helmet
legislation on helmet use and bicycle ridership in Canada (ref 1), it
appears the conclusions reached were ill considered and unreliable for a
number of reasons.
The article concludes that helmet legislation is not associated with
changes in ridership. This statement is somewhat misleading. Fig 3 in the
article shows trends of recreational bicycle u...
Reading the article, The effects of provincial bicycle helmet
legislation on helmet use and bicycle ridership in Canada (ref 1), it
appears the conclusions reached were ill considered and unreliable for a
number of reasons.
The article concludes that helmet legislation is not associated with
changes in ridership. This statement is somewhat misleading. Fig 3 in the
article shows trends of recreational bicycle use and the mean number of
times cycled in Alberta and Prince Edward Island. Alberta youth data 2001
shows approximately 58% use bikes, 30 times a year, a combined product of
17.4 may indicate the level of cycling activity. In 2007, 58% also used
bicycles but only 16 times per year, indicating a product of 9.28 and
suggesting a reduced level of cycling activity by 47%. For PEI by similar
calculation, in 2001, 73% x 38 = 27.7 and in 2007, 66% by 39 = 25.74,
reduced cycling 8%. The articles does not provide data on the helmet
wearing rates in either Alberta of PEI and therefore it lacks essential
data to make reliable judgements, except possibly to say youth cycling has
been discouraged. No information is provided on enforcement levels for
helmet use, police data on fines for example, whereas in Victoria,
Australia they issued more than 19000 fines in the first 12 months of
their helmet law.
Fig 2 shows a wearing rate of 32.9% for youth in Saskatchewan and it
is of interest because the head injury rate quoted by Macpherson et al
2002 (ref 2) was 9.78 for children 5-19 years in Saskatchewan, compared to
an average for provinces with helmet legislation of 9.96. Ontario is
similar with a low head injury rate but the wearing rate from before
legislation to after was similar at about 46% (ref 3). Both results
indicates helmets may have little bearing on the head injury rates and
other aspects could be involved, taking more care when cycling for
example.
The article mentions national response rates of 84.7%, 80.7%, and
78.9%, respectively, indicating a reduction and could this reflect people
who may cycle less due to having a legal requirement not responding?
People may also be less inclined to admit not wearing a helmet and thus
breaking the law, so is the telephone survey process a reliable guide
compared with road surveys for example.
The article contains no data on the accident rates, enforcement rates
or head injury rate changes but advocates helmet legislation. It refers to
a meta-analysis of five case control studies of cyclists seen in emergency
departments found that helmets significantly reduced the risk of head,
brain, and severe brain injuries by 63- 88% among cyclists of all ages.
However, the 5 reports included in the meta -analysis were primarily
comparing cyclists who had chosen to wear helmets and research suggests
the accident rates and injury rates can change for various types of
cyclists significantly.
The article mentions, bicycling is among the top five physical
activities practiced by Canadians; however, benefits to physical health
and to the environment must be considered in light of the risks of injury.
Between 1994 and 2004, 44 577 hospitalisations occurred due to cycling
incidents in Canada, representing 2% of all hospitalised injuries. The
health benefit of cycling are not discussed in detail that would have
helped to promote a balanced view, e.g. In 2001, deaths in Canada (ref 4)
due to all circulatory disease were approximately 60,000 compared to 63
from cycling. Type 2 diabetes is one of the fastest growing diseases in
Canada with more than 60,000 new cases yearly (ref 5). Per million
population, approximately two cyclist deaths occur annually compared with
2000 from circulatory diseases. Exercise helps to avoid depression and
annually about 3665 individuals commit suicide, including a youth category
of approximately 500 (ref 6). Exercise also helps to avoid stroke leading
to brain damage. During 2003/04, 26,676 patients were admitted for
ischaemic stroke (ref 7). Physical inactivity, high blood pressure,
obesity and diabetes continue to contribute to heart disease and stroke in
Canada and cycling helps to avoid all these problems. Dr Hillman from the
UK's Policy Studies Institute calculated the life years gained by cycling
outweigh life years lost in accidents by a factor of 20 to 1(ref 8).
The UK's National Children's Bureau (NCB) provided a detailed review
(ref 9) of cycling and helmets in 2005 stating the case for helmets is far
from sound, the benefits of helmets need further investigation before even
a policy supporting promotion can be unequivocally supported,. the strong
claims of injury reduction made by helmet proponents have not been borne
out for fatalities (which this paper argues is the most methodologically
sound test of effectiveness) in real-life settings with large populations.
(page 46).
The case for helmets is not conclusive because several reports
contain details which raise serious doubts whether helmet wearing improves
safety overall. Data from Canada also indicates that the accident rate can
increase by wearing a helmet.
My report, Evaluating bicycle helmet use and legislation in Canada (ref 3)
shows why helmet legislation and helmet promotion is not justified and it
is important to fully consider all of the evidence. Additional information
is provided in an assessment of the USA and their state bicycle helmet
laws (ref 10).
Jessica Dennis, Beth Potter, Tim Ramsay, Ryan Zarychanski.
The effects of provincial bicycle helmet legislation on helmet use and
bicycle ridership in Canada.
Inj Prev 2010 16: 219-224 originally published online June 29, 2010
2 Macpherson AK, To TM, Macarthur C, et al. Impact of mandatory
helmet legislation on bicycle-related head injuries in children: a
population-based study. Pediatrics 2000;110:e60.
3 Clarke CF, Evaluating bicycle helmet use and legislation in Canada
http://www.cycle-helmets.com/canada-helmet-assessment.doc
4 Health indicators, January 2005, Statistics Canada , Catalogue no.
82-221, Vol 2005 No1.
5 Health Canada, It's Your Health, Type 2 Diabetes http://www.hc-
sc.gc.ca/iyh-vsv/diseases-maladies/diabete_e.html accessed 17.02.2008
6 Kutcher SP, Szumilas M, Youth suicide prevention, CanMedAssocJ, 29
Jan ,178,(3) 2008
7 Medical News Today, Weekend Hospital Admission Increases Fatality
Risk Of Stroke, http://www.medicalnewstoday.com/articles/64884.php ,
accessed 18.02.2008
8 Hillman M, CYCLE HELMETS the case for and against Policy studies
Institute, London 1993
9 Gill T, Cycling and Children and Young People, A review, National
Children's Bureau, 2005. http://www.cycle-
helmets.com/cyclingreport_timgill.pdf
10 Health and safety assessment of state bicycle helmets laws in the
USA
http://www.ctcyorkshirehumber.org.uk/USA_helmet_laws.pdf
The story of seatbelts has ever been one of success - at least for
government bodies and the motor industry. However, seatbelts have an
unfortunate side effect owing to the dissipation of the kinetic and
vestibular discomfort associated with acceleration and deceleration: in
effect, faster and more erratic driving is encouraged.
Moreover, any savings in casualties among motor vehicle occupants
must be weighed...
The story of seatbelts has ever been one of success - at least for
government bodies and the motor industry. However, seatbelts have an
unfortunate side effect owing to the dissipation of the kinetic and
vestibular discomfort associated with acceleration and deceleration: in
effect, faster and more erratic driving is encouraged.
Moreover, any savings in casualties among motor vehicle occupants
must be weighed against the obvious failure of seatbelts to assist
vulnerable road-users such as pedestrians and cyclists - and hence public-
transport users, since walking and cycling are generally the most
practible modes for accessing public transport. The official attitude to
this issue - at least in the UK - has often been one of oversight, even if
the value of walking and cycling are recognised. The limited provision of
paths for the (sometimes) exclusive use of these vulnerable groups is
hardly compensation.
There is plenty of evidence to show that speeds on urban and suburban
streets - when the density of traffic permits - have steadily increased
[1], an issue for which seatbelt use cannot be absolved. Indeed, the link
between seatbelt use and increased speed was recognised by at least one
state: German seatbelt-fitted buses were permitted higher speeds than
buses without seatbelts [2].
So, happy-with-reservations 50th birthday...
References
[1] UK Department for Transport (2008). Road Safety Compliance
Consultation. London: TSO.
Jeffrey et al's [1] evidence of a serious underestimation of road
injuries is worrying for the year-by-year comparisons that are taken as
evidence for the state of road safety. The UK figures for death and
serious injury are reported to have followed a downward trend for forty
years or so, which has generally been taken as evidence - if no more than
implicitly - that a culture of safety on the roads i...
Jeffrey et al's [1] evidence of a serious underestimation of road
injuries is worrying for the year-by-year comparisons that are taken as
evidence for the state of road safety. The UK figures for death and
serious injury are reported to have followed a downward trend for forty
years or so, which has generally been taken as evidence - if no more than
implicitly - that a culture of safety on the roads is steadily developing
[2]. However, Jeffrey et al's study raises the issue of just how much
change there has been in the standards of recording casualties over the
years. It follows also that the proposing of explanations for the reported
changes must be guarded.
Even overlooking this last point, the safety-culture argument is
itself unconvincing. We well know that there are persistent problems
concerning, for example, speeding, drink-driving and "jumping" level
crossings, along with more recent issues of drugs and mobile-phone use.
Regarding speeding, it is estimated that 50% of drivers exceed the limit
on urban and suburban roads [3].
Alternative factors to explain the falling casualties include the
following: (a) NHS spending on trauma care, by which the consequences of a
given level of trauma are less serious than previously; (b) increasing
cases of road congestion, which lowers speed and the incidence of
overtaking, and hence the severity of crashes; (c) the avoidance of the
road by vulnerable road users [4]. This last issue is coupled with the
high rates of reported pedestrian casualties in Britain [3]; evidence from
Scotland suggests that children in the lowest socio-economic classes are
particularly at risk [5]. In the light of Jeffrey et al's evidence that
casualties among cyclists have been most affected by underestimation, with
pedestrians also notable in this regard, vulnerable road-users seem to be
getting a worse deal than the official figures suggest. Furthermore, there
are the health issues of a society that has become inactive through its
heavy dependence on cars.
If walking and cycling are really to be developed to the level that
applies for example in the Netherlands and Denmark - and bearing in mind
the importance of walking and cycling for accessing public transport -
there is much work to be done in Scotland, and by extrapolation across the
UK as a whole.
References
1. Jeffrey S, Stone D H, Blamey A, et al. An evaluation of police
reporting of road casualties. Injury Prevention 2009; 15: 13-18.
2. Donneley R R (2008). Scottish road strategy: Consultation
document. Edinburgh: The Scottish Government.
3. Department for Transport (2008). Road safety compliance
consultation. London: TSO.
4. Reinhardt-Rutland A H, Thomson J, Foot H, Elliott M (2008).
Response to the Scottish Government consultation: Scottish road safety
strategy. Leicester: British Psychology Society.
5. White D, Raeside R, Barker D (2000). Road accidents and children
living disadvantaged areas. Edinburgh: The Scottish Government.
As noted in the recently released WHO and UNICEF World Report on
Child Injury Prevention, globally, road traffic injuries (RTI) are the
leading cause of death among 10-19 year-olds with more than 260,000
children dying from RTIs each year. (1) In addition, an estimated 10
million more children are non-fatally injured. Africa has the world's
highest RTI mortality rate at 28.3 per 100,000 (2), yet relatively few
resources...
As noted in the recently released WHO and UNICEF World Report on
Child Injury Prevention, globally, road traffic injuries (RTI) are the
leading cause of death among 10-19 year-olds with more than 260,000
children dying from RTIs each year. (1) In addition, an estimated 10
million more children are non-fatally injured. Africa has the world's
highest RTI mortality rate at 28.3 per 100,000 (2), yet relatively few
resources and attention are given to the prevention of RTI in Africa; the
dearth of information regarding the impact and cost-effectiveness of
injury-prevention interventions on the continent is staggering.
Amend.org is a non-governmental organization that focuses on road
traffic safety for children in sub-Saharan Africa. Programs include media
outreach, the distribution of reflective material to school children, and
the teaching of road traffic safety courses in primary schools. The
results of pre- and post-program evaluative tests in five sample primary
schools in Ghana showed improved levels of student understanding of road
safety strategies. This education initiative, called Be Seen, Be Safe, has
been introduced to over 30,000 school children in Ghana and plans are
underway to introduce it in Tanzania in the coming months. An additional
program included a seminar on RTI issues conducted for the media in the
Ghanaian capital, Accra. Journalists and editors from 28 newspapers,
representing approximately half of the country's newspapers attended.
Comparison of newspaper articles on road traffic safety collected three
weeks prior to the workshop compared with six weeks after the workshop
showed an increase of 20% for numbers of commentaries and informational
stories relating to RTIs. Clearly, the need for greater public education
and awareness was recognized by the journalists and editors.
As the evidence mounts about the major public health epidemic
resulting from RTIs, especially in Africa and other developing countries,
promising efforts such as those undertaken by Amend.org must be encouraged
and expanded. However, we urge that all programs be developed in
collaboration with local stakeholders and undergo rigorous evaluation to
assure their effectiveness.
1 In: Peden M, Oyegbite K, Ozanne-Smith J, et al, eds. World report
on child injury prevention. 2008.
http://www.who.int/violence_injury_prevention/child/injury/world_report/en/index.html.
(accessed Jan 8, 2009).
2. In: Peden, M; Scurfield, R; Sleet, D; Mohan, D; Hyder, AA. World
report on road traffic injury prevention. Geneva: World Health
Organization; 2004. Available:
http://www.who.int/violence_injury_prevention/publications/road_traffic/world_report/en/.
(accessed Jan 8, 2009).
Several analyses of the results of bibliographic databases have shown
that--for several health fields and subjects--the number of databases
searched influences the number of papers found. Library and information
scientists seem to use certain methods and outcomes in their analyses. I
am curious whether this study used the same methods and measures.
Mitchell, Williamson and Olivier's (2010) study estimated drowning rates for the Australian state of New South Wales (NSW) in 2005 based on resident population person-time exposure to swimming. The authors state (p. 261) that "failure to adjust injury rates for exposure to a hazard necessarily results in poor estimates of risk", and based on their findings, conclude (p. 264) drowning mortality rates to be "more than 200...
The investigators did not meaningfully compare Relative Bicycling Risk and Relative Traffic Danger for individual pairs. Such a comparison of their data demonstrates that the Apparent Cycle Track Effect was increased Danger to bicyclists at two cycle tracks, Neutrality at two cycle tracks, and increased Safety at two cycle tracks. This contrasts with the investigators' claim that the six cycle tracks had a combined 28% l...
Lusk et al's paper (1) indicates an important subtext regarding travel. Governments wish to make personal mobility as widely available as possible; this inevitably entails promotion of the private automobile, which can provide convenient and comfortable travel for the widest range of individuals, including those for whom disability would otherwise pose severe limitations in participating in society. However, there is a...
The major problem in enforcing the zero BAC limit is ensuring that the province or territory enacts accompanying legislation authorizing the police to demand a breath sample from drivers subject to this limit. There has been no problem with drivers testing positive with exceedingly small amounts of alcohol in their breath samples, because of natural processes or diet. Presumably, the machines have thresholds to eliminate...
How easy is it to enforce zero limit in the face of possiblity of physicigical sources of alcohol and uses of other dietry and household sources of alcohol? There might be a lot or few false positive cases as a result. Is there anything of in the scientific evidence base?
Conflict of Interest:
None declared
Reading the article, The effects of provincial bicycle helmet legislation on helmet use and bicycle ridership in Canada (ref 1), it appears the conclusions reached were ill considered and unreliable for a number of reasons.
The article concludes that helmet legislation is not associated with changes in ridership. This statement is somewhat misleading. Fig 3 in the article shows trends of recreational bicycle u...
The story of seatbelts has ever been one of success - at least for government bodies and the motor industry. However, seatbelts have an unfortunate side effect owing to the dissipation of the kinetic and vestibular discomfort associated with acceleration and deceleration: in effect, faster and more erratic driving is encouraged.
Moreover, any savings in casualties among motor vehicle occupants must be weighed...
Dear Editor
Jeffrey et al's [1] evidence of a serious underestimation of road injuries is worrying for the year-by-year comparisons that are taken as evidence for the state of road safety. The UK figures for death and serious injury are reported to have followed a downward trend for forty years or so, which has generally been taken as evidence - if no more than implicitly - that a culture of safety on the roads i...
As noted in the recently released WHO and UNICEF World Report on Child Injury Prevention, globally, road traffic injuries (RTI) are the leading cause of death among 10-19 year-olds with more than 260,000 children dying from RTIs each year. (1) In addition, an estimated 10 million more children are non-fatally injured. Africa has the world's highest RTI mortality rate at 28.3 per 100,000 (2), yet relatively few resources...
Several analyses of the results of bibliographic databases have shown that--for several health fields and subjects--the number of databases searched influences the number of papers found. Library and information scientists seem to use certain methods and outcomes in their analyses. I am curious whether this study used the same methods and measures.
Pages