Effectiveness of cataract surgery in reducing driving-related difficulties: a systematic review and meta-analysis.

OBJECTIVES: To assess the effects of cataract surgery in improving vision and driving performance while reducing driving-related difficulties. DESIGN: Systematic review and meta-analysis. DATA SOURCES: Twelve electronic databases were searched from the date of inception of each database to May 2007. Other sources of potentially relevant information were also identified and examined. REVIEW METHODS: Eligible study designs included randomized controlled trials (RCT), non-RCT, quasi-experimental, case-control, controlled-before-and-after, and cohort studies that examined driving-related indicators in patients undergoing cataract surgery. MAIN OUTCOME MEASURES: The outcome measures included any type of driving-related indicator. A secondary outcome measure was motor vehicle (MV) crash involvement. RESULTS: Seven studies were included in the review and five in the meta-analysis. The overall pooled odds ratio (OR) was 0.12 (95% CI 0.10 to 0.16). Results suggest that the risk of driving-related difficulties was reduced by 88% following cataract surgery. CONCLUSIONS: Cataract surgery is associated with an 88% reduction in the risk of driving-related difficulties. This supports the efficacy of cataract surgery to improve driving in older people, as well as positive implications for a reduction in MV crashes, overall traffic safety, and individual well-being.

Compulsory child restraint seat law and motor vehicle child occupant deaths and injuries in Japan 1994-2005.

The purpose of child restraint seats (CRS) is to reduce the number of individuals killed or injured in motor vehicle (MV) crashes. Japanese Road Traffic Law 17-3-4 (April 2000) specifies a requirement that CRS be used for all children aged 0-5 years. The objective of this evaluation was to determine the legislative impact on fatalities in Japan for the period 1994-2005. Data were obtained from the Institute for Traffic Accident Research and Data Analysis. A time-series Poisson regression model was used to analyse the change (6 years pre/post) in incidence rate ratios of fatality and injury in MV crashes among children ages 0-5 years. Despite increases in CRS use, fatalities failed to decrease significantly after enactment of the law (incidence rate ratio: 0.80; 95% CI: 0.49-1.31). In 2005, 67% of children aged 0-5 years, who were killed as MV occupants were not seated in CRS. Between 2000 and 2005, the lack of CRS led to 43% of front seat passenger deaths, 54% of rear seat deaths, 143 children died in total and 500 + children were seriously injured. It was found that the compulsory CRS law enacted in April 2000 did not result in a statistically significant reduction in child MV occupant fatalities and injuries in Japan.

Impact of lowering the legal blood alcohol concentration limit to 0.03 on male, female and teenage drivers involved alcohol-related crashes in Japan.

In June of 2002, a revision to part of the Road Traffic Act drastically increased the penalties for drinking and driving offences in Japan. Most notably, the legal blood alcohol concentration (BAC) limit for driving was lowered from 0.05 mg/ml to 0.03 mg/ml. The rationale for the new lower BAC limit was predicated on the assumption that drinking drivers will comply with the new, lower limit by reducing the amount of alcohol they consume prior to driving, thereby lowering their risk of crash involvement. This, in turn, would lead to fewer alcohol-related crashes. A key limitation of previous lower BAC evaluation research in determining the effectiveness of lower legal BAC limit policies is the assumption of population homogeneity in responding to the laws. The present analysis is unique in this perspective and focuses on the evaluation of the impact of BAC limit reduction on different segments of the population. The chief objective of this research is to quantify the extent to which lowering the legal limit of BAC has reduced male, female and teenager involvement in motor vehicle crashes in Japan since 2002. Most notably, the introduction of reduced BAC limit legislation resulted in a statistically significant decrease in the number of alcohol-impaired drivers on the road in Japan, indicating responsiveness to the legal change among adults and teenagers. In addition, this preliminary assessment appears to indicate that the implementation of 0.03 BAC laws and other associated activities are associated with statistically significant reductions in alcohol-involved motor vehicle crashes. In comparison, the rates of total crashes showed no statistically significant decline nor increase in the period following the introduction of the BAC law, indicating that the lower BAC limit only had an effect on alcohol-related crashes in Japan. The evidence suggests that the lower BAC legal limit and perceived risk of detection are the two most important factors resulting in a sustained change in drinking and driving behaviour in Japan. It is recommended that future research and resources in other countries be focused on these factors as determinants to reduced alcohol-related crashes.

Identification of candidate cerebrospinal fluid biomarkers in parkinsonism using quantitative proteomics.

INTRODUCTION: Neurodegenerative parkinsonian syndromes have significant clinical and pathological overlap, making early diagnosis difficult. Cerebrospinal fluid (CSF) biomarkers may aid the differentiation of these disorders, but other than α-synuclein and neurofilament light chain protein, which have limited diagnostic power, specific protein biomarkers remain elusive. OBJECTIVES: To study disease mechanisms and identify possible CSF diagnostic biomarkers through discovery proteomics, which discriminate parkinsonian syndromes from healthy controls. METHODS: CSF was collected consecutively from 134 participants; Parkinson's disease (n = 26), atypical parkinsonian syndromes (n = 78, including progressive supranuclear palsy (n = 36), multiple system atrophy (n = 28), corticobasal syndrome (n = 14)), and elderly healthy controls (n = 30). Participants were divided into a discovery and a validation set for analysis. The samples were subjected to tryptic digestion, followed by liquid chromatography-mass spectrometry analysis for identification and relative quantification by isobaric labelling. Candidate protein biomarkers were identified based on the relative abundances of the identified tryptic peptides. Their predictive performance was evaluated by analysis of the validation set. RESULTS: 79 tryptic peptides, derived from 26 proteins were found to differ significantly between atypical parkinsonism patients and controls. They included acute phase/inflammatory markers and neuronal/synaptic markers, which were respectively increased or decreased in atypical parkinsonism, while their levels in PD subjects were intermediate between controls and atypical parkinsonism. CONCLUSION: Using an unbiased proteomic approach, proteins were identified that were able to differentiate atypical parkinsonian syndrome patients from healthy controls. Our study indicates that markers that may reflect neuronal function and/or plasticity, such as the amyloid precursor protein, and inflammatory markers may hold future promise as candidate biomarkers in parkinsonism.

Severity of alcohol-related motor vehicle crashes in British Columbia: case - control study.

The objective of the present study was to compare the injury severity and vehicle damage severity rates of alcohol-related crashes with rates of non-alcohol-related crashes in British Columbia (BC). Injury severity rates and vehicle damage severity rates were taken from 2002 Insurance Corporation of British Columbia traffic collision data. The data were computed in order to compare the differences in injury severity and vehicle damage severity rates of alcohol-related vs. non-alcohol-related motor vehicle crashes. Case - control methods were used in this study to analyse the risk of alcohol-related crashes compared to non-alcohol-related crashes in BC. Odds ratios (OR) and 95% CI were calculated to estimate relative risks. In the case - control analysis, the risk of fatal collision was increased for those drinking and driving compared with those driving sober (OR 4.70; 95% CI 3.15 - 7.01). Risk of injury collision was increased for those drinking and driving compared with those driving sober (OR 1.32; 95% CI 1.19 - 1.37). Importantly, the risk of vehicle damage severity was increased for those drinking and driving compared with those driving sober (write-off vehicle OR 4.24; 95% CI 3.70 - 4.86, severely damaged vehicles OR 1.98; 95% CI 1.77 - 2.21). The study reinforces existing literature to suggest that current evidence is sufficient to show an increased risk of injury and fatality to drivers and occupants in alcohol-related crashes. This paper not only emphasizes this well-known relationship, but also such consequences as increased vehicle damage severity. The connection between drinking and severity of motor vehicle crashes is popularly believed and has now received substantial scientific support. There is strong justification for injury prevention experts and policy-makers to step up motor vehicle crash injury prevention advocacy by implementing evidence-based policies to reduce rates of alcohol-impaired driving in the province of BC. Most unintentional injuries in BC are related to motor vehicle crashes. Significant improvements can be made in these statistics by: increasing the use of occupant protection (safety belt and child restraint seats); reducing alcohol-related injuries through multiple strategies including corrections in the physical environment, extensive enforcement of drinking and driving laws and health promotion/education.

Understanding clusters of risk factors across different environmental and social contexts for the prediction of injuries among Canadian youth.

BACKGROUND: Among Canadian youth, injury is the most common reason for presentation to the emergency department. Youth who commonly engage in multiple risk-taking behaviours are at greater risk for injury, but is it unknown if this phenomenon is more pronounced in different contexts. We aimed to study relationships between risk-taking behaviours and injury, and variations in such relationships between different environmental and social contexts, among youth in Canada. METHODS: Risk-taking behaviour and injury outcome data were collected from grade 9 to 10 students using the 2009-2010 (Cycle 6) of the Health Behaviour in School-Aged Children Survey (n=10,429). Principal components analysis was used to identify clusters of risk-taking behaviours. Within each identified cluster, the degree of risk-taking was categorized into quartiles from lowest to highest engagement in the behaviours. Risk ratios with 95% confidence intervals were calculated to determine the association between the risk of any injury and the degree of risk-taking behaviour specific to the cluster. Clusters were then examined across home, school, neighbourhood and sport contexts. RESULTS: Four clusters of risk-taking behaviour were identified which were labelled as "gateway substance use", "hard drugs and weapons", "overt risk-taking", and "physical activity". Each cluster was related to injury occurrence in a graded fashion. Clusters of risk behaviour were most strongly associated with injuries sustained in neighbourhood settings, and expectedly, increasing physical activity behaviours were associated with increased risk of sport injuries and injuries occurring at school. CONCLUSIONS: This study furthers understanding of clustered risk-taking phenomena that put youth at increasing levels of injury risk. Higher risks for injury and associated gradients were observed in less structured contexts such as neighbourhoods. In contrast, clustered physical activity behaviours were most related to school injury or sport injury and were more likely to be sustained in a supervised context. Understanding the clustered and cumulative nature of risk-behaviours, and how these vary by environmental and social context, helps to explain potential mechanisms of injury as well as modifiable factors that may be important avenues for intervention.

Hemochromatosis and male infertility.

BACKGROUND: The clinical association of hemochromatosis and infertility is rare. Hemochromatosis may affect fertility through a variety of mechanisms. CASE: A 44-year-old man and his 36-year-old wife presented with primary infertility of 7 years' duration. The husband was diagnosed as having idiopathic hemochromatosis, abnormal glucose tolerance, and hypogonadism accompanied by impotence, retrograde ejaculation, and azoospermia. Treatment consisted of phlebotomies followed by gonadotropins, which corrected retrograde ejaculation and improved semen characteristics. Concomitant pelvic factors in the woman were corrected endoscopically. After failure of pregnancy with ovulation stimulation and intrauterine inseminations, a singleton pregnancy was achieved by in vitro fertilization, augmented with intracytoplasmic sperm injection. CONCLUSION: This case underscores the need to consider advanced reproductive technologies after the failure of specific, first-line therapeutic options in infertile couples.

Fertilization rates using intracytoplasmic sperm injection are greater than subzonal insemination but are dependent on prior treatment of sperm.

OBJECTIVE: To determine a suitable method of sperm preparation for use in micromanipulation. To compare the fertilization rates of sibling oocytes inseminated by intracytoplasmic sperm injection (ICSI) and subzonal insemination (SUZI). DESIGN: Two methods of gamete micromanipulation to overcome male factor infertility were compared. Within this study, three trials were conducted to determine the most suitable method of sperm preparation. This method then was used to complete the study. SETTING: Procedures were performed in a teaching hospital research environment. PATIENTS: Ninety-six patients were recruited for this study, undergoing 99 stimulation cycles. INTERVENTIONS: Sibling oocytes were inseminated by subzonal sperm or intracytoplasmic injection. MAIN OUTCOME MEASURES: Fertilization, zygote development, and pregnancy rates. RESULTS: In the absence of manipulative pretreatment of sperm (trial 1), there was no difference in normal fertilization rates between ICSI and SUZI (19% and 25%, respectively). In the second trial there again was no sperm pretreatment for SUZI but, for ICSI, a polyvinylpyrrolidone (PVP) solution was used to reduce sperm velocity and the sperm tails were incised before injection. The fertilization rates were significantly different between ICSI (44%) and SUZI (17%). In the third trial, PVP was added to the sperm used for both types of insemination and the sperm tails also were incised for the ICSI insemination. Fertilization was again significantly different (16% for SUZI and 44% for ICSI). The trial 2 method of sperm preparation then was used to complete the study (trial 4) and confirmed the results of trial 2 (21% for SUZI and 42% for ICSI). The results suggest that ICSI can give improved fertilization compared with SUZI provided the sperm are treated before injection. No significant differences were found in the development rates of zygotes suitable for transfer or cryopreservation between the two micromanipulation methods.

Use of a bioassay for embryo-derived platelet-activating factor as a means of assessing quality and pregnancy potential of human embryos.

The production of an embryo-derived platelet-activating factor (PAF) was recently shown to have a correlation with embryo quality and viability. The detection of this factor was used as a means of examining the effect of various aspects of the in vitro fertilization and embryo transfer procedure on human preimplantation embryo quality. Embryos that resulted in pregnancy produced significantly higher levels of embryo-derived PAF in vitro than embryos that failed to result in pregnancy. Of a further 85 embryos, 43% had a level of embryo-derived PAF that fell in the same range as the embryos that resulted in pregnancy. The production of embryo-derived PAF was related to the type of treatment used to induce follicular development (with clomiphene citrate and human menopausal gonadotropin commencing on day 5 giving best results); the size and estradiol production of the follicles producing the embryo; the age of the embryo culture medium; and the morphology and cell number of the embryos.

Subzonal insertion of multiple sperm is a treatment for male factor infertility.

OBJECTIVE: To determine whether subzonal insemination of multiple sperm is an effective treatment for male factor infertility. DESIGN: Subzonal insemination by micromanipulation of sperm and oocytes for male factor patients. PATIENTS: Two hundred eight patients were selected on previous fertilization history and/or semen parameters. They could be assigned to one of three groups: group A had previous IVF failure, group B had a low fertilization rate with previous IVF, and group C had insufficient sperm for IVF. INTERVENTIONS: Oocytes were inseminated by subzonal insertion of multiple sperm. MAIN OUTCOME MEASURES: Fertilization and pregnancy rates. RESULTS: There have been 208 patients treated through 332 treatment cycles. Of 2,789 oocytes inseminated, 784 oocytes were fertilized (28%) and 516 of these (66%) were monospermic. This represents normal fertilization in 207 cycles (62% of total patient cycles). These 207 cycles produced an average of 2.6 +/- 1.8 embryos. The resultant 487 embryos were either transferred or cryopreserved for future transfer. A total of 42 pregnancies (21% per ET) resulted from 200 ET procedures with 397 embryos. Miscarriages or elective terminations have occurred (11/42 pregnancies, 26% to date) and 21 deliveries have resulted in 26 babies. There are nine ongoing pregnancies. Three of the pregnancies have been from cryopreserved embryos. Group B patients had the highest fertilization rate (23%) but the lowest pregnancy rate (7%). No other significant relationships between patient group and outcome were found. CONCLUSIONS: Subzonal insemination of multiple sperm is an effective treatment for some forms of male factor infertility.

Failure of implantation in human in vitro fertilization and embryo transfer patients: the effects of altered progesterone/estrogen ratios in humans and mice.

Daily blood samples were taken for progesterone (P) and estradiol (E2) measurements from women who showed a platelet response consistent with the presence of viable embryos after in vitro fertilization and embryo transfer procedures. A comparison of steroid levels between those women who became pregnant and those who did not revealed the following: at and after the time of transfer, women who failed to become pregnant had significantly higher E2 levels and a lower ratio of P/E2 than women who became pregnant. The P/E2 ratio was a better predictor of implantation failure than was the absolute level of either hormone. Experiments were done in mice to test the hypothesis that P could protect implantation of the embryo against the inhibitory effects of high E2. In mice, implantation was inhibited by relatively high levels of E2. This effect was overcome by concomitant administration of P. There was a significant dose-response-related interaction of P with the E2.

Actions of platelet activating factor (PAF) on gametes and embryos: clinical aspects.

Platelet activating factor (PAF) is a phospholipid widespread in body tissues. Previous reviews have discussed its production by preimplantation embryos and the evidence implicating it as an autocrine mediator in aspects of gamete and embryo physiology. Human spermatozoa contain variable amounts of PAF, the amount contained depending on the source and method of preparation of the sperm. Incubation of human sperm with PAF tends to increase their forward velocity, especially in samples with slow motility. PAF treatment causes an increase in the proportion of acrosome-reacted sperm and in their ability to penetrate both zona-free hamster ova and cervical mucus. PAF has been found in human follicular fluid at ovulation. A role for PAF in ovulation has been suggested, because PAF antagonists reduce the rate of ovulation in rats. In some studies, modest improvements to mouse in vitro fertilization (IVF) rates have been achieved with PAF supplementation of media under specific conditions. Furthermore, in the rabbit and mouse, PAF antagonists have been reported to inhibit fertilization in vivo and in vitro respectively. However, addition of PAF to human IVF medium, but only at the time of insemination and fertilization, had no effect on either fertilization or pregnancy rates. Sensitive bio- and immuno-assays have shown that PAF is secreted by human embryos into their fluid milieu. PAF secretion by these zygotes during culture, although markedly variable, has been correlated with the achievement of pregnancy and pregnancy outcome. Although the secretion of PAF by the mouse embryo decreases during culture in vitro, exogenous PAF enhances embryo viability during culture. Similarly, culture of human zygotes in PAF-supplemented medium prior to embryo transfer significantly increases the chance of achieving pregnancy. Both the implantation and live-birth rates are increased in human IVF by addition of PAF to the medium.

Injection of multiple sperm into the perivitelline space as a treatment of male infertility.

This paper reports the outcome of 274 treatment cycles using multiple injection of sperm into the perivitelline space as a treatment of male factor infertility. A total of 170 couples underwent this form of treatment; 59.1% of cycles had at least one oocyte normally fertilized with an overall normal fertilization rate of 17.2%. The development rate of normally fertilized embryos was high (98.5%) and resulted in a pregnancy rate (positive human chorionic gonadotrophin 18 days after embryo transfer) of 21.4% per embryo transfer procedure (a maximum of 3 embryos were transferred per procedure). The relationship between the number of sperm injected and the fertilization rate and other factors affecting the outcome are discussed.

Clinical intracytoplasmic sperm injection (ICSI) results from Royal North Shore Hospital.

The technique of intracytoplasmic sperm injection (ICSI) was first introduced to the Royal North Shore Hospital in April 1993 as part of a controlled study of 100 patient cycles in which sibling oocytes were inseminated by either subzonal insemination (SUZI) or ICSI. This trial showed direct sperm injection to be superior in terms of fertilization. In that study, 58 embryo transfers of 101 ICSI-derived embryos resulted in 10 pregnancies. No miscarriages have occurred and a total of 10 fetal hearts (9.8% per embryo transferred) were detected on ultrasound. There have been 10 deliveries of 10 babies. Since the beginning of 1994, intracytoplasmic injection has been used exclusively for patients requiring micromanipulation to achieve fertilization. There have been 200 patient cycles with 1650 oocytes collected (8.8 oocytes per cycle). Of these oocytes, 1548 were mature (94%) and were subjected to ICSI, and normal fertilization occurred in 874 (56%) of the injected oocytes. The number of oocytes which cleaved and were suitable for fresh transfer or cryopreservation was 818 (94%). There have been 153 fresh embryo transfers of 326 embryos. Twenty-six pregnancies (17% per embryo transfer) have resulted, 22 of which proceeded to ultrasound examination in which 23 fetal hearts were detected (7% per embryo transferred). Three miscarriages have occurred, leaving 19 ongoing pregnancies. There have been 127 cryopreservation procedures involving 492 embryos. To date, there have been 47 embryo thaw cycles, and 93 of the 115 (81%) thawed embryos survived and were transferred. These 47 embryo transfers resulted in 10 pregnancies (21% per embryo transfer), one of which one has miscarried.(ABSTRACT TRUNCATED AT 250 WORDS)

The nutritional consequences of pregnancy sickness : A critique of a hypothesis.

The purpose of this paper is to assess Profet's (1992) and others' hypothesis that nausea and vomiting in pregnancy (NVP) is adaptive. A number of studies have found an association between NVP and a decreased risk for early fetal loss (<20 weeks). It is assumed that the adaptive benefits of improved survivorship associated with NVP outweigh the minimal nutritional consequences. However, in populations that experience marginal levels of nutrition, NVP may have important nutritional consequences. To test these potential consequences, a study on NVP, nutritional status, and pregnancy outcome was conducted among Turkana pastoralists, who experience seasonal and chronic nutritional stress. Interviews and anthropometric assessments were conducted on 68 pregnant Turkana women of Kenya during a 1993-1994 field season. The results from the case study suggest that women who experience NVP do encounter nutritional consequences in the later stages of pregnancy and are more likely to experience poor pregnancy outcomes. These results suggest that NVP may not be adaptive in all environmental settings, particularly among marginally nourished populations.

Developing injury indicators for First Nations and Inuit children and youth in Canada: a modified Delphi approach.

INTRODUCTION: The purpose of this research was to take the initial step in developing valid indicators that reflect the injury issues facing First Nations and Inuit children and youth in Canada. METHODS: Using a modified-Delphi process, relevant expert and community stakeholders rated each indicator on its perceived usefulness and ability to prompt action to reduce injury among children and youth in indigenous communities. The Delphi process included 5 phases and resulted in a refined set of 27 indicators. RESULTS: Indicators related to motorized vehicle collisions, mortality and hospitalization rates were rated the most useful and most likely to prompt action. These were followed by indicators for community injury prevention training and response systems, violent and inflicted injury, burns and falls, and suicide. CONCLUSION: The results suggest that a broad-based modified-Delphi process is a practical and appropriate method, within the OCAP™ (Ownership, Control, Access and Possession) principles, for developing a proposed set of indicators for injury prevention activity focused on First Nations and Inuit children and youth. Following additional work to validate and populate the indicators, it is anticipated that communities will utilize them to monitor injury and prompt decisions and action to reduce injuries among children and youth.

TITRE: Élaboration d'indicateurs de blessures chez les enfants et les jeunes des Premières nations et inuits au Canada grâce à une méthode de Delphes modifiée. INTRODUCTION: Le but de cette recherche était de franchir la première étape de l'élaboration d'indicateurs valides et représentatifs des blessures chez les enfants et les jeunes des Premières nations et Inuits du Canada. MÉTHODOLOGIE: À l'aide d'une méthode de Delphes modifiée, des intervenants des collectivités et des experts ont évalué chaque indicateur en fonction de son utilité perçue et de sa capacité à inciter à l'action dans le but de réduire les blessures chez les enfants et les jeunes des collectivités autochtones. Le processus s'est déroulé en 5 étapes et a permis d'obtenir un ensemble de 27 indicateurs. RÉSULTATS: Les indicateurs évalués comme étant les plus utiles et les plus susceptibles d'inciter à l'action ont été ceux liés au taux de collision de véhicules à moteur, au taux de mortalité et au taux d'hospitalisation. Ont été sélectionnés ensuite les indicateurs de la formation en prévention des blessures et programmes communautaires d'intervention, ceux des blessures intentionnelles, ceux des brûlures et des chutes et enfin ceux du suicide. CONCLUSION: Les résultats indiquent qu'utiliser une méthode de Delphes modifiée avec participation élargie est efficace et pertinent pour élaborer un ensemble d'indicateurs visant à guider les activités de prévention des blessures chez les enfants et les jeunes des Premières nations et Inuits, tout en respectant les principes PCAP™ (propriété, contrôle, accès et possession). Une fois achevés les travaux complémentaires de validation des indicateurs et la collecte des données associées, ces indicateurs vont pouvoir servir aux collectivités pour la surveillance des blessures et pour la prise de décisions et de mesures efficaces de réduction des blessures chez les enfants et les jeunes.