Primary texting bans associated with lower traffic fatalities, study finds

Researchers at the University of Alabama at Birmingham School of Public Health examined the impact texting-while-driving laws have had on roadway crash-related fatalities, and the findings are published in the August issue of the American Journal of Public Health.Of drivers in the United States ages 18-64 years, 31 percent reported they had read or sent text or email messages while driving at least once in the 30 days prior, according to 2011 data from the Centers for Disease Control and Prevention. That same year, 3,331 people were killed in crashes involving a distracted driver, and an additional 387,000 people were injured.While completing her doctoral work in the Department of Health Care Organization and Policy, Alva O. Ferdinand, Dr.P.H., J.D., conducted a longitudinal panel study to examine within-state changes in roadway fatalities after the enactment of state texting-while-driving bans using roadway fatality data captured in the Fatality Analysis Reporting System between 2000 and 2010.”Very little is known about whether laws banning texting while driving have actually improved roadway safety,” Ferdinand said. “Further, given the considerable variation in the types of laws that states have passed and whom they ban from what, it was necessary to determine which types of laws are most beneficial in improving roadway safety.”Some states have banned all drivers from texting while driving, while others have banned only young drivers from this activity, Ferdinand says. Additionally, some states’ texting bans entail secondary enforcement, meaning an officer must have another reason to stop a vehicle, like speeding or running a red light, before citing a driver for texting while driving. Other states’ texting bans entail primary enforcement, meaning an officer does not have to have another reason for stopping a vehicle.”Our results indicated that primary texting bans were significantly associated with a 3 percent reduction in traffic fatalities among all age groups, which equates to an average of 19 deaths prevented per year in states with such bans,” Ferdinand said. “Primarily enforced texting laws that banned only young drivers from texting were the most effective at reducing deaths among the 15- to 21-year-old cohort, with an associated 11 percent reduction in traffic fatalities among this age group in states with such bans.”States with secondarily enforced restrictions did not see any significant reductions in traffic fatalities.”We were a little surprised to see that primarily enforced texting bans were not associated with significant reductions in fatalities among those ages 21 to 64, who are not considered to be young drivers,” Ferdinand said. “However, states with bans prohibiting the use of cellphones without hands-free technology altogether on all drivers saw significant reductions in fatalities among this particular age group. Thus, although texting-while-driving bans were most effective for reducing traffic-related fatalities among young individuals, handheld bans appear to be most effective for adults.”Ferdinand says these results could aid policymakers interested in improving roadway safety in that they indicate the types of laws that are most effective in reducing deaths among various age groups, as well as those in states with secondarily enforced texting bans advocating for stricter, primarily enforced texting bans.Ferdinand’s mentor, Nir Menachemi, Ph.D., professor in the Department of Health Care Organization and Policy, says it is a key responsibility of health policy researchers to generate high-quality evidence on the health impact of societal policies and laws.”Clearly, distracted driving is a growing problem affecting everyone on the roadways,” Menachemi said. “It is my hope that policymakers act upon our findings so that motor-vehicle deaths can be prevented.”Story Source:The above story is based on materials provided by University of Alabama at Birmingham. …

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New pathway discovered in blood vessel inflammation and disease

Sep. 4, 2013 — Case Western Reserve researchers have identified a genetic factor that blocks the blood vessel inflammation that can lead to heart attacks, strokes and other potentially life-threatening events.The breakthrough involving Kruppel-like factor (KLF) 15 is the latest in a string of discoveries from the laboratory of professor of medicine Mukesh K. Jain, MD, FAHA, that involves a remarkable genetic family. Kruppel-like factors appear to play prominent roles in everything from cardiac health and obesity to metabolism and childhood muscular dystrophy.School of Medicine instructor Yuan Lu, MD, a member of Jain’s team, led the study involving KLF-15 and its role in inflammation, which appears online this week in the Journal of Clinical Investigation. Lu and colleagues observed that KLF-15 blocks the function of a molecule called NF-kB, a dominant factor responsible for triggering inflammation.This finding reveals a new understanding of the origins of inflammation in vascular diseases, and may eventually lead to new, targeted treatment options.“It had been suspected that smooth muscle cells were related to inflammation, but it hadn’t been pinpointed and specifically linked to disease,” said Jain, Ellery Sedgwick Jr. Chair and director, Case Cardiovascular Research Institute at Case Western Reserve School of Medicine. Jain also is chief research officer for the Harrington Heart & Vascular Institute at University Hospitals Case Medical Center. “This work provides cogent evidence that smooth muscle cells can initiate inflammation and thereby promote the development of vascular disease.”Smooth muscle cells are only one of two major cell types within blood vessels walls. The other cell type, endothelium, has traditionally taken the blame for inflammation, but Jain’s study suggests that both cells are critically important in the development of vascular disease.The researchers learned that expression of this factor appeared mainly in smooth muscle cells and that levels were markedly reduced in atherosclerotic human blood vessels. To establish causality, the team generated genetically-modified mice where they deleted KLF-15 gene in smooth muscle cells.“We expected to see more proliferation of the smooth muscle cells as this is a common response of this cell type in disease,” Lu said, first author on the paper. …

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Bipolar disorder takes different path in patients who binge eat, study suggests

July 25, 2013 — Bipolar disorder evolves differently in patients who also binge eat, a study by Mayo Clinic, the Lindner Center of HOPE and the University of Minnesota found. Binge eating and obesity often are present among bipolar patients, but the mood disorder appears to take a different path in those who binge eat than it does in obese bipolar patients who do not, the researchers discovered.The findings are published online in the Journal of Affective Disorders.Up to 4 percent of Americans have some form of bipolar illness, and of those, just under 10 percent also have binge eating disorder — a higher rate of binge eating than seen in the general population, says co-author Mark Frye, M.D., a psychiatrist and chair of the Department of Psychiatry/Psychology at Mayo Clinic in Rochester. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) update released this spring recognizes binge eating disorder as a distinct condition, he noted.Bipolar patients who binge eat are more likely to have other mental health issues such as suicidal thoughts, psychosis, anxiety disorders and substance abuse, the study found. People with bipolar disorder who are obese but do not binge eat are more likely to have serious physical problems such as arthritis, diabetes, high blood pressure and heart disease.It was more common for women than men with bipolar disorder to binge eat or to be obese, the study showed.”The illness is more complicated, and then by definition how you would conceptualize how best to individualize treatment is more complicated,” Dr. Frye says. “It really underscores the importance of trying to stabilize mood, because we know when people are symptomatic of their bipolar illness their binge frequency is likely to increase. We want to work with treatments that can be helpful but not have weight gain as a significant side effect.”The researchers used the Mayo Clinic Bipolar Biobank, a collaborative effort by Mayo Clinic, the Lindner Center of HOPE, University of Minnesota and Mayo Clinic Health System. More research is planned to see whether there is a genetic link to binge eating disorder in bipolar disease.”Patients with bipolar disorder and binge eating disorder appear to represent a more severely ill population of bipolar patients. Identification of this subgroup of patients will help determine the underlying causes of bipolar disorder and lead to more effective and personalized treatments,” says co-author Susan McElroy, M.D., chief research officer at the Lindner Center of HOPE.The study was funded by the Marriott family. Co-authors also include Scott Crow, M.D., University of Minnesota Medical School; Nicole Mori of the Lindner Center of HOPE; and Joanna Biernacka, Ph.D., Stacey Winham, Ph.D., Jennifer Geske, Alfredo Cuellar Barboza, M.D., Mikel Prieto, M.D., Mohit Chauhan, M.D., and Lisa Seymour of Mayo Clinic.

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Strong pregnancy outcomes for survivors of childhood cancer

July 13, 2013 — Although women who survived childhood cancer face an increased risk of infertility, nearly two-thirds of those who tried unsuccessfully to become pregnant for at least a year eventually conceived, according to clinical researchers at Dana-Farber/Boston Children’s Cancer and Blood Disorders Center and Brigham and Women’s Hospital. This is comparable to the rate of eventual pregnancy among all clinically infertile women.”Most women think that if they had cancer as a child, then they’ll never have children. It turns out that many of them can get pregnant. It just might be a little harder,” said senior author Lisa Diller, MD, chief medical officer of Dana-Farber/Boston Children’s and medical director of the David B. Perini, Jr. Quality of Life Clinic at Dana-Farber Cancer Institute.The paper, published July 13 in Lancet Oncology, is the first large-scale study of female childhood cancer survivors that examines outcomes for those who experienced infertility, as defined by the typical clinical definition of infertility (attempting to conceive for a year or more without success).Overall, 15.9 percent of women who survived childhood cancer were affected by infertility, with 12.9 percent trying to conceive for at least one year without success. The remainder of survivors included in the infertile group had ovarian failure and may not have even attempted pregnancy. In a comparison group composed of sisters of childhood cancer survivors, 10.8 percent experienced infertility. This translates to a roughly 50 percent higher risk of infertility among the survivors of childhood cancer.The new study is based on data from the Childhood Cancer Survivor Study, a cohort study of five-year survivors from 26 institutions who were under 21 when diagnosed with cancer between 1970 and 1986. Researchers studied 3,531 sexually active female survivors, age 18-39, and a control group of 1,366 female siblings of participants in the large-scale survivor study.”This is the first study to examine direct questions about infertility and the use of infertility services,” said lead author Sara Barton, MD, a clinical fellow of reproduction and infertility at Brigham and Women’s Hospital at the time of the research. …

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Understanding the motivations of mass shooters is key to successful law enforcement strategies

July 12, 2013 — A detailed statistical study of mass shootings in the USA suggests that training law enforcement officers to recognize the psychology and behavioral patterns of perpetrators could improve officers’ ability to deal with an on-site shootout or suicide.The study – “Mass Shooters in the USA, 1966-2010: Differences Between Attackers Who Live and Die” by Adam Lankford, published in the June 2013 issue of the academic journal Justice Quarterly — is the first largescale academic analysis of “active shooters,” defined by the US Department of Homeland Security as: “an individual actively engaged in killing or attempting to kill people in a confined and populated area.”Approximately 38% of mass shooters commit suicide by their own hand, and up to 10% successfully orchestrate “suicide by cop.” In addition, it is thought that a significant percentage of attackers who survive are also clinically suicidal, but they failed in their attempts to die or changed their minds at the last moment although, as Adam Lankford notes, this is difficult to prove because suicidal intent is so difficult to measure. He writes:”It may be impossible to know how many mass shooters who died at the hands of law enforcement were intentionally orchestrating ‘suicide by cop,’ or how many of those who were ultimately arrested had originally intended to perish instead.”Previous research suggests that there are fundamental psychological and behavioral differences between offenders who commit murder and offenders who commit murder-suicide. Lankford’s study goes further, because it assesses mass shooters as a coherent offender type, basing its analysis on information from one data-set, rather than several different sources, which enhances the accuracy of the regression analysis technique.The data source for Lankford’s study is a New York City Police Department (NYPD) report of mass shooting incidents worldwide from 1966 to 2010. From this, Lankford excluded all non-USA attacks and all attacks that yielded fewer than two casualties. The remaining 185 incidents were then analysed using chi-square (w2) and ANOVA tests to determine whether or not the average differences between mass shooters who lived or died could be attributed to mere chance.Lankford’s analysis identifies numerous differences that have an impact on whether the perpetrator is taken into custody or dies as a result of the attack. He postulates that two factors may influence the outcome of a mass shooting event: training officers to recognize which mass shooters are most likely to commit suicide by their own hand or attempt “suicide by cop”; and providing officers with detailed information about the attack (such as the offender’s number of weapons, number of victims killed, and decision to attack at an open commercial site, factory, or warehouse).Crucially, Lankford points out that attack resolution outcomes may not be solely determined by offenders’ individual psychology — outcomes may also be the product of situational factors when the event is underway. For instance, it was not possible to assess, from the NYPD data, whether law enforcement behavior is essentially a constant in the determination of whether mass shooters live or die, or actually an explanatory variable itself.Lankford postulates that, because officer discretion is an inevitable part of policing it is conceivable that some officers would have felt more threatened, angry or vengeful and therefore may react differently when responding to some mass shooting incidents than others.The article, which includes a detailed review of existing literature on the subject, and an appendix listing all the offenders and attack location types, concludes:”… law enforcement officers must be careful not to overreact … or allow their actions to become overly predetermined. Ultimately, they should respond to each incident with the level of force dictated by the situation itself.”

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Study on fragile newborns challenges current practices

June 20, 2013 — One of the largest clinical trials done in infants with congenital (present at birth) heart diseases, published in the New England Journal of Medicine, shows that the increasingly common practice of using the drug clopidogrel (Plavix®) to reduce shunt-related blood flow issues is not effective in the dose studied.”Once again, pediatric-specific research shows that newborns and infants are not little adults,” said David Wessel, MD, Chief Medical Officer, Children’s National Medical Center, and lead author on the international study published in the June 20, 2013 issue of the New England Journal of Medicine. “The take away message for pediatric cardiac care providers is to reconsider use of Plavix® in certain cases. In pediatric medicine, the assumption is that smaller doses of a drug that works in adults will work in infants, but our study shows that this is not true for these young patients. For the parents of these fragile newborns, it is important to understand that research informs best practices, and they need to be informed advocates for their children.”The objective of this international trial, which included more than 900 patients seen across 134 centers in 33 countries, was to evaluate the efficacy of Plavix® compared with placebo for the reduction of all-cause mortality and shunt-related morbidity in neonates and infants with cyanotic congenital heart disease palliated with systemic-to-pulmonary artery shunts. Many forms of congenital heart disease can be repaired in early infancy, and pulmonary blood flow with shunts is an important consideration during initial treatment that may include reconstructive heart surgery for defects in heart ventricles.As the authors note, effective prevention for thrombosis (blood clots) in neonates and infants with these heart conditions had not been previously tested, although aspirin treatment was associated with significantly lower risk of mortality and shunt thrombosis in a separate registry developed before this trial. Preventive treatment in adult patients who develop clots in coronary arteries often combines aspirin and Plavix®. As happens with many drugs approved for use in adults, Plavix® use is spreading into pediatric practice without sound evidence, according to study authors. In fact, they continue, use of this drug has increased 15-fold from 2001 to 2009 in children’s hospitals in the US.This study showed no benefit from adding Plavix® to current treatment, which often includes aspirin. As noted in the study, the use of Plavix® to address thrombosis in newborns and infants being palliated with systemic-to-pulmonary artery shunts does not reduce all-cause mortality or shunt-related morbidity.Further analysis (not part of the original trial design) supports the notion that aspirin alone may be effective at reducing the risk of clot formation in these infants. The study authors point out that the trial suggests that switching from aspirin alone to Plavix® alone at the dose studied is not a good idea.”This is a good illustration of the successful collaboration between industry and academia to conduct clinical research in children under the written request process of FDA’s Best Pharmaceuticals for Children Act (BPCA), noted Edward Connor, MD, MBE, Director of Innovation Development at Children’s National and internationally recognized expert on drug development. …

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Heroin availability increasing across Washington state

June 12, 2013 — New data from the University of Washington’s Alcohol and Drug Abuse Institute indicates increases in heroin availability, abuse and deaths across the state, particularly among young adults ages 18-29. These increases are concerning because of the high risks of overdose and contracting infectious diseases associated with heroin use.Police drug evidence testing, particularly in 2011 and 2012, points to dramatic increases in heroin. The largest increases were outside of metropolitan areas; the number of pieces of police evidence positive for heroin totaled 842 in 2007 and increased to 2,251in 2012 statewide.”We are hearing about heroin as a major and increasing problem from law enforcement across Washington in 2012,” reports Dave Rodriguez, director of the Northwest High Intensity Drug Trafficking Areas group, a coordinating center for federal and local law enforcement.In 2012, 64 percent of people entering publicly funded treatment for the first time were heroin users ranging in age from 18 to 29.”Opiate addiction is a chronic disease that leads to increased hospitalizations and even death, so we want to provide a scope of interventions and treatment,” said Chris Imhoff, director of the Washington State Division of Behavioral Health and Recovery in the Department of Social and Health Services. “For those who become addicted, counseling, medication-assisted treatment and recovery support are proven to save lives and reduce future healthcare costs.”Statewide, the rate of accidental deaths involving heroin and other unspecified opiates increased during the period between 2009 and 2011 compared to the previous decade. In King County, which has data through 2012, heroin- involved deaths increased substantially in 2012 due to increases in deaths among people under the age of 30. Between 1997 and 2012 in King County, almost three-quarters of drug- caused deaths involved heroin and/or a prescription-type opiate.”All opiate overdoses are preventable and many can be reversed prior to becoming fatal if medical aid is sought, “said Dr. Daniel Lessler, the chief medical officer of Washington State’s Health Care Authority. “Anyone at risk for having or anticipating an opiate overdose can be prescribed the antidote naloxone in Washington. It is intended for people at risk of an overdose whether they are taking opiate pain medicines or are dealing with opiate addictions.””People need to be aware of the 911 Overdose Good Samaritan law that provides legal immunity from prosecution for drug possession charges to an overdose victim and anyone who seeks medical help during an overdose,” said Caleb Banta-Green, author of the report and a researcher at the Alcohol and Drug Abuse Institute at the University of Washington.Full report: http://adai.uw.edu/pubs/InfoBriefs/ADAI-IB-2013-02.pdf

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