Air pollution and daily mortality in London: 1987-92.

OBJECTIVE--To investigate whether outdoor air pollution levels in London influence daily mortality. DESIGN--Poisson regression analysis of daily counts of deaths, with adjustment for effects of secular trend, seasonal and other cyclical factors, day of the week, holidays, influenza epidemic, temperature, humidity, and autocorrelation, from April 1987 to March 1992. Pollution variables were particles (black smoke), sulphur dioxide, ozone, and nitrogen dioxide, lagged 0-3 days. SETTING--Greater London. OUTCOME MEASURES--Relative risk of death from all causes (excluding accidents), respiratory disease, and cardiovascular disease. RESULTS--Ozone levels (same day) were associated with a significant increase in all cause, cardiovascular, and respiratory mortality; the effects were greater in the warm seasons (April to September) and were independent of the effects of other pollutants. In the warm season an increase of the eight hour ozone concentration from the 10th to the 90th centile of the seasonal change (7-36 ppb) was associated with an increase of 3.5% (95% confidence interval 1.7 to 5.3), 3.6% (1.04 to 6.1), and 5.4% (0.4 to 10.7) in all cause, cardiovascular, and respiratory mortality respectively. Black smoke concentrations on the previous day were significantly associated with all cause mortality, and this effect was also greater in the warm season and was independent of the effects of other pollutants. For black smoke an increase from the 10th to 90th centile in the warm season (7-19 microg/m3) was associated with an increase of 2.5% (0.9 to 4.1) in all cause mortality. Significant but smaller and less consistent effects were also observed for nitrogen dioxide and sulphur dioxide. CONCLUSION--Daily variations in air pollution within the range currently occurring in London may have an adverse effect on daily mortality.     

Psychiatric consequences of road traffic accidents.

OBJECTIVE--To determine the psychiatric consequences of being a road traffic accident victim. DESIGN--Follow up study of road accident victims for up to one year. SETTING--Emergency department of the John Radcliffe Hospital, Oxford. SUBJECTS--188 consecutive road accident victims aged 18-70 with multiple injuries (motorcycle or car) or whiplash neck injury, who had not been unconscious for more than 15 minutes, and who lived in the catchment area. MAIN OUTCOME MEASURES--Present state examination "caseness"; post-traumatic stress disorder and travel anxiety; effects on driving and on being a passenger. RESULTS--Acute, moderately severe emotional distress was common. Almost one fifth of subjects, however, suffered from an acute stress syndrome characterised by mood disturbance and horrific memories of the accident. Anxiety and depression usually improved over the 12 months, though one tenth of patients had mood disorders at one year. In addition, specific post-traumatic symptoms were common. Post-traumatic stress disorder occurred during follow up in one tenth of patients, and phobic travel anxiety as a driver or passenger was more common and frequently disabling. Emotional disorder was associated with having pre-accident psychological or social problems and, in patients with multiple injuries, continuing medical complications. Post-traumatic syndromes were not associated with a neurotic predisposition but were strongly associated with horrific memories of the accident. They did not occur in subjects who had been briefly unconscious and were amnesic for the accident. Mental state at three months was highly predictive of mental state at one year. CONCLUSIONS--Psychiatric symptoms and disorder are frequent after major and less severe road accident injury. Post-traumatic symptoms are common and disabling. Early information and advice might reduce psychological distress and travel anxiety and contribute to road safety and assessing "nervous shock."     

Injuries to pedestrians in road traffic accidents.

Although there have been many reports on injuries to occupants of cars in road traffic accidents, there have been few prospective studies of injuries to pedestrians in such accidents. For this reason a two year prospective study of pedestrians in road traffic accidents in the Oxford region was carried out. The incidence of death in pedestrians was significantly higher than in car occupants or motorcyclists. The principal determinant of death was the weight of the vehicle concerned. The most common site of injury was the head because of a high incidence of brief concussion, but the most common site of serious injuries was the leg. Injuries to all regions of the body increased with age and with the weight of the vehicle in the collision. Accidents most often concerned young children or the elderly.     

Influence of the position on the bicycle on the frontal area in road cyclists

The aims of the present study were to determine whether the estimations of the frontal area of the combined cyclist-bicycle (APCB) obtained with the Heil's non-logarithmic prediction equations (NPE) in the stem position (SP), brake hoods position (BHP) and drops position (DP) are comparable to the measured APCB with the computerized planimetry (CP) method, and to analyse with the CP method and the NPE the influence of the body position on the APCB. Nineteen participants competing in the Spanish Road Cycling First division took part in the study. The NPE overestimated the APCB in the BHP and in the DP compared with the measured APCB with the CP method (6.9% and 5.1%, respectively; p<0.05). Significant differences among the three positions were obtained with the CP method. The overestimation of the APCB with the NPE in the BHP and in the DP and the less sensitivity of the NPE to show significant differences between the SP and DP suggest that the NPE are not appropriate to accurately predict the APCB.     

Contribution of alcohol to deaths in road traffic accidents in Tayside 1982-6

In Britain the precise number and relative proportions of deaths among drivers, passengers, and pedestrians in road traffic accidents related to alcohol are not known. These data were obtained in Tayside by cross matching police accident records with blood alcohol concentrations at necropsy. Of 71 alcohol-related deaths 30 were the drivers (or motorcyclists) themselves, nine were their passengers, 23 were pedestrians with raised blood alcohol concentrations, and nine were innocent victims.The high blood alcohol concentrations of the intoxicated drivers, passengers, and pedestrians, which may point to alcoholism, suggest that publicity campaigns will be of little value in reducing the number of deaths in road traffic accidents related to alcohol. The time at which these accidents occurred was related to licensing hours, and this should be taken into account when considering changes in licensing laws.     

Deaths under 50. Medical Services Study Group of the Royal College of Physicians of London.

The Medical Services Study Group has started a collaborative study in the Mersey, West Midlands, and Grampian regions to examine the causes of death among medical inpatients aged 1 to 50. The cause of death is determined from the case notes and the consultant''s opinion. The rate of ascertainment of cases was initially low, though it is increasing; despite this limitation an analysis of the first 250 cases showed one important finding. No fewer than 98 patients contributed to their own deaths through overeating, drinking, smoking, or not complying with treatment. Despite the present statistical limitations of the study, it has been valuable in enlisting the good will of the participating physicians, which will help to ensure the success of other projects, and it has avoided the problems inherent in determining the cause of death from death certificates alone.     

Short-term effects of lumbopelvic complex stability training in elite female road cyclists

Objectives:The purpose of this study was to determine the effects of short-term lumbopelvic stability training on muscular endurance and stability in elite female cyclists.Methods:Twenty-four female road cyclists were randomly allocated to a core training group (CTG, n=12) or control group (CG, n=12). In addition to their scheduled training the CTG performed a core training program, that consisted of 6 core exercises performed in a session every other day until a total of 8 training sessions were completed. The CG did not receive the core training program and completed their scheduled training. The lumbopelvic-hip complex was assessed pre- and post-core program included the following exercises: single leg deadlift (SLD), bird-dog (BD), plank test (PT), and side-bridge plank test (SPT).Results:In comparison to CG, CTG significantly improved the time to failure in PT, SPT-Left, and SPT-Right (p<0.05). Further, CTG resulted in a significant decrease in SLD (p<0.05) compared to CG for the three accelerometry measures.Conclusion:The present results indicate that following 8 sessions of lumbopelvic stability training muscular endurance and core stability were enhanced.     

Deaths of drug addicts in the United Kingdom 1967-81.

A search of the Home Office index of notified drug addicts identified 1499 deaths during 1967-81, of which 226 (15%) were of therapeutic addicts--that is, patients who had become addicted during medical treatment with a notifiable drug--and 1273 (85%) were of non-therapeutic addicts. The crude mortality fell from 23.5/1000/year for the period 1968-70 to 18.4/1000/year for 1978-80. Altogether 416 addicts aged under 50 at notification died after 1972, which was 16 times the number of deaths expected in a population with a similar age and sex composition. A more detailed examination of the cohorts of addicts notified each year showed little variation between them in the first two years of follow up. Nineteen addicts (1.6%) had died by 31 December of the year of their notification and 39 (3.3%) one year later. These figures may be an indication of the clinical course of addiction. Most deaths of non-therapeutic addicts in which a drug was implicated (939 cases (74%] were due to medically prescribed drugs--barbiturates at first and later opiates such as dipipanone hydrochloride and dextromoramide. Heroin was implicated in only 65 (7%) of these deaths. The Home Office index is a valuable source for identifying drugs of abuse and serious problems of addiction. The fact that prescribed drugs are causing the death of so many addicts demands a response from the medical profession.     

Conflicting traffic: characterization of the hazards of birds flying across an airport runway

Bird–aircraft collisions cost millions of dollars to aviation globally and cause deaths. We designed and tested a protocol to study the hazards to aircraft from birds flying across runways where aircraft rotate and climb during take‐off. We recorded birds and flight height of birds flying across runway 03L at OR Tambo International Airport, South Africa. A total of 7,938 birds of pigeon size or larger crossed a 400 m length of runway during 14 h and 15 min, a rate of 8.8 birds per minute; there were 200 aircraft taking off during this period. The biggest bird–aircraft collision hazard is posed by African Sacred Ibis and Grey‐headed Gull. Respectively, these species contribute a mean of 111 kg per 10 min and 47.2 kg per 10 min biomass flying across the runway. We identify possible management options to reduce the hazard of bird–aircraft collisions. Our survey protocol and data treatment is easy to use, will add additional and important definition to existing activities to reduce bird–aircraft collisions and can provide comparable hazard information to aerodrome authorities and pilots.