Road safety: objective of the European Union for 2010 and assessment criteria.

A few years ago the European Union proposed that its member states take steps to reduce the number of road accidents and their health and social consequences (number deceased, injured, handicapped, etc.). The main objective of this ongoing challenge is a 50% reduction of mortality by these events by 2010. The European Union closely monitors, also through dedicated workshops, projects and achievements of member states. In our opinion, however, too much attention seems to be dedicated to a reduction in the percentage of mortality. It undoubtedly merits attention, but lacking other elements, there is the danger of providing data, in terms of assessment and communication, which may lead to a distortion of the facts. This paper clarifies our point of view and shows why the reduction in the percentage of mortality per accident as well as the starting mortality index should be considered in order to provide a more accurate picture of the trend in the various countries working towards this objective.

[Prevalence estimate of three dichotomic characteristics by the analysis of pools, with an application for simulation of the joint detection of cocaine, cannabis and alcohol]. / Stima della prevalenza di tre caratteristiche dicotomiche tramite analisi di pool, con un'applicazione per simulazione alla ricerca congiunta di cocaina, cannabis ed alcol.

In this paper a method is introduced for estimating from analytical results obtained from pools of individual samples, the prevalences of three substances and their associations. The treated data are dichotomic, i.e. presence-absence of every substance in the analyzed pool. In fact, this method is the extension to three characteristics of the PERM (Politomic Erased Respondent Method), of which the previous version considered only two characteristics. Besides the theoretical development of the method, a simulated application to checks for driving under the influence of alcohol, cocaine and cannabis, is reported. The general agreement among the estimates obtained from the analytical results of the pools and those obtained from the results of the individual samples, is close (within few percent points). As expected this agreement improves when the number of analyzed pools increases. The proposed method could find an interesting application in the checks related to road safety, but also in those regarding work safety and sport safety.

[Measuring blood alcohol concentration on the road as a tool for early identification of subjects with alcohol-related problems]. / I controlli alcolemici su strada quale strumento per l'identificazione precoce di soggetti con problemi alcol-correlati.

This paper deals with some considerations showing the phenomenon 'alcohol and driving' doesn't have primary character. Instead, it springs from the individual's state leading him to drink over and over again too much alcoholic beverages. The fact that such a subject will drive in state of drunkenness afterwards is accidental, even if frequent. Therefore, to improve the road safety, as well as the social safety, action on the individual as regards its excessive alcohol consumption is needed. Nevertheless, for different reasons (bad information, underestimation of the risk, social reproval), who has problems with alcohol tends to hide himself; therefore problematic subjects are not easy to be identified. To get round this impediment, we propose to use BAC (Blood Alcohol Concentration) drivers' controls on the road to identify such as subjects, taking as cutoff a BAC greater than 1.5 g/l, or at least twice overcoming the legal limit (0.5 g/l), apart from the BAC value in itself In this way it would be possible to offer an early chance of specialistic assistance beforehand to help them to settle their own problem with the alcohol. This approach could be a successful strategy since among the subjects that would come so identified many are clearly in acceptable psycophysical state (as they can drive); many are young people (therefore subjects at the beginning of drinker's career); practically all have a good grounds for solving their problem (to get driving licence back). Of course, if this program had to have put into effect it would be necessary to strengthen the specialised Alcohol Services and therefore to bear the cost of it. Nevertheless, the outcomes would have significant spin-off not only on the road safety but, in more broad terms, on the social safety too.

[Impact of increasing number of road alcohol controls on the prevalence of driving under the influence in Italy]. / L'aumento del numero dei controlli alcolemici su strada e i suoi effetti sulla prevalenza della guida in stato di ebbrezza in Italia.

In Italy the number of road controls for the driving under the influence of alcohol is significantly grown in the last years. In 2006 these controls have been around 250,000; in 2007, around 800,000. On the grounds of the data currently available one can estimate around 1,500,000 controls in 2008. At the same time a lowering percentage of drivers with blood alcohol concentration greather than the legal limit (equal to 0.5 g/l in Italy) has been recorded. Aforesaid percentage amounted to 15% and 6% in 2006 and 2007 respectively, with a lessening of 9 percent points. This reduction could plausibly be the outcome of the increased controls number on the italian roads. Likely, increased perception to be checked by the police has induced to a greater caution the drivers. However the controls are not random controls, but based on a 'well-founded suspicion', that is when the police is right to hold by their behavior that the drivers can be in state of drunkenness. This procedure prevents us from properly estimating the true effect. Therefore, carry out a suitable number of random controls besides the well-founded controls seems needed to quantify in accurate statistical way the proportion of drivers in state of drunkenness as well as its temporal trend.

[Drivers' random controls and population's recent drug use monitoring]. / I controlli casuali dei conducenti di veicoli a motore quale base per il monitoraggio dell'uso recente di droghe nella popolazione.

Substance abuse, particularly among young people, does not seem to have the tendency to decrease. Our knowledges on this phenomenon are manifold and they validly compete to address the actions of contrast. Nevertheless, it would seem profit to be able to have further informations, to place side by side to those already existing, with the aim to improve the surveillance of the phenomenon. For this purpose, in the present paper we propose a monitoring model based on the results of random controls on road, carried out by the Police (or by the Hospital) in relationship to the road safety. The representativeness of the data that we could get this way appears elevated as an hight percentage of the population own the driver's licence. As it is shown, these controls could be both individual and related to drivers' pools of biological samples. This last approach would seem to be more practicable since problems relating to the drivers' privacy would be avoided.

The urgency of establishing a rapid monitoring system for mortality due to traffic accidents (as well as for all mortality due to violence and accidents).

The data regarding the number of deaths from road accidents per year in Italy is presently available only after extensive time, in the range of years. This situation originates from problems related to data collection as well as to the subsequent management of the information. The two sources which allow the quantification of this mortality are: statistic of "Road Accidents documented by the Police Force", consisting in accidents reported by the Police and involving deceased or injured victims; general mortality statistics The first source presents problems related to quality and completeness; the second, problems related to dimensions: reports of mortality due to traffic accidents (presently about 6000 reports per year) end up, as they should, in the flow of general mortality (more than 560,000 reports per year), which necessarily lengthens response time. This excessive time interval between notification of deaths from traffic accidents and their actual availability in terms of statistics has, as of today, a negative impact not only on the prompt knowledge of the phenomenon, but also on the necessary appraisal in light of reaching the objectives proposed by the European Union by 2010 (reduction of 50% health consequences of traffic accidents). This article aims to show that it would be easy to set up a Rapid Monitoring System for deaths due to traffic accidents by creating an appropriate sub-flow of the general mortality statistics. Based on reported appraisals, we aim to show that it seems highly practicable (and convenient) to extend this system to all accidental and violent mortality, inclusive of drug-related mortality (presently underestimated). The authors feel that the System herein described could, in a matter of months, provide, at very low costs, useful and reliable information regarding health and social issues. It is worthwhile pointing out that what hereby proposed does not interfere in any way with the flow of general mortality currently in use and may also be used for parallel collection of data which is currently not being recorded.

[A method to estimate one's own blood alcohol concentration when the ministerial tables are not avaible]. / Un metodo per stimare la propria alcolemia quando non si disponga delle tabelle ministeriali.

To reduce the prevalence of driving under the influence, tables allowing to estimate one's own blood alcohol concentration (BAC) by type and quantity of alcoholic drinks intake have been enacted by decree in Italy. Such tables, based on a modified Widmark's formula, are now put up in all public concerns serving alcoholic beverages. Aim of this initiative is to try to get subjects which consume alcoholics and then will drive a vehicle take in account their own estimated BAC and, on this base, put into effect, if needed, suitable actions (to avoid or to limit a further consumption, to wait more time before driving, to leave driving a sober subject). Nevertheless, many occasions exist in which these tables are not available. To allow anybody to rough estimate his own BAC in these cases too, a proper method has been developed. Briefly, the weight (in grams) of consumed alcohol has to be divided by half her own weight, if female drunk on an empty stomach (by the 90% of her own weight, if she drunk on a full stomach); by 70% of his own weight, if male drunk on an empty stomach (by 120% of his own weight, if he drunk in a full stomach). Consistency between BAC values estimated by the proposed method and those shown in the ministerial tables is very narrow: they differ in a few hundredth of grams/liter. Unlike the ministerial tables, the proposed method needs to compute the grams of ingested alcohol. This maybe involves some difficulties that, nevertheless, can be overcome easily. In our opinion, the skillfulness in computing the grams of assumed alcohol is of great significance since it provides the subject with a strong signal not only in road safety terms, but also in health terms. The ministerial tables and the proposed method should be part of teaching to issue the driving licence and to recovery of driving licence taken away points. In broad terms, the school should teach youngs to calculate alcohol quantities assumed by drink to acquaint them with the risks paving the way for a more aware drinking when they will come age.

Colon cancer prevention in Italy: cost-effectiveness analysis with CT colonography and endoscopy.

BACKGROUND: Colorectal cancer (CRC) is a major cause of mortality in Italy. Although prevention of CRC is possible, its cost-effectiveness when applied to the Italian population is unknown. Recently, computerized tomographic colonography (CTC) has been proposed for CRC screening. AIM: To compare the efficacy and cost-effectiveness of CTC screening in a simulated Italian population with those of colonoscopy and flexible sigmoidoscopy (FS). METHODS: The cost-effectiveness of different screening strategies was compared using a Markov process computer model, in which in a hypothetical population of 100,000 50 year-olds were investigated by CTC, colonoscopy or FS every decade. Outcomes were projected to the Italian national level. RESULTS: CRC incidence reduction was calculated at 40.9%, 38.2%, and 31.8% with colonoscopy, CTC and FS, respectively. As compared to no screening, all screening programs were shown to be cost-saving, allowing a saving of 11 Euro, 17 Euro, and 48 Euro per person with colonoscopy, FS and CTC, respectively. FS appeared to be less cost-effective than CTC, whilst colonoscopy appeared to be an expensive option as compared to CTC. Undiscounted national expenditure was calculated to be 1,042,489,512 Euro, 1,093,268,285 Euro, and 1,198,783,428 Euro for FS, CTC and colonoscopy, respectively, as compared to 695,818,078 Euro without screening. CONCLUSION: CRC screening is cost-saving in Italy, irrespective of the technique applied. CTC appeared to be more cost-effective than FS, and it may also become a valid alternative to colonoscopy.

Quantitative Erased Respondent Method (QERM): using quantitative group data as an alternative to quantitative individual data. A simulated application to road checks for drivers under the influence of cocaine.

The Erased Respondent Method (ERM) allows the prevalence of a characteristic to be estimated without needing to know the state of the individual statistical units. A recent extension of the method, which also did not make use of individual data, also estimated the prevalence of two or more characteristics in the same individual (PERM, Politomic ERM). In this paper, ERM is extended further to quantitative data coming from analytical determinations, considering pools of samples instead of individual samples. The extension of the method above described, we named it with the acronym QERM (Quantitative ERM), allows to estimate (only on the ground of analytical determinations made from pools of individual samples) the average and the standard deviation of the distribution of the determinations concerning only positive individual samples. By referring to road controls for driving under the influence of abuse drugs that constitute pools of biological material from more drivers, with the ERM we are able to estimate the prevalence of subjects that are positive for a certain substance, while with the QERM we can estimate the mean and standard deviation of the quantity of the substance measured in biological liquids only from the subjects that are positive to the substance. In order to better clarify this new method, an application to a road check for driving under the influence of cocaine will also be presented that was obtained by simulation. The application fields in Public Health for ERM, PERM and QERM are many; however in our opinion the most interesting areas of application are road traffic, occupational and sport safety.

Politomic Erased Respondent Method (PERM) for the joint assessment of two dichotomous characteristics, with an application to the polydrug use of cocaine and cannabis by simulation.

The recently introduced ERM (Erased Respondent Method) allows the prevalence of a characteristic to be estimated in a certain population by using the results obtained from groups of subjects rather than the data from single subjects. In the case of qualitative analytical surveys, the method allows the said prevalence to be estimated on the basis of the results derived from the analyses of pools of single samples. In this way, the knowledge of the individual data is not longer needed for the purpose of the estimates. This is particularly useful when there is sensitive data. In this work, it is shown how the ERM can also be applied to polytomic-type responses (e.g. negative, positive to A, positive to B, positive to A and B) in relation to qualitative analytical surveys. It is therefore possible to also estimate the prevalence of positive subjects to more characteristics on the basis of this extension of the ERM, we named it PERM (Politomic ERM). An application of the method is given by simulation in this work: an hypothetical street check in which one can estimate the prevalence of drivers under the influence of cocaine and/or cannabis (estimate of the prevalence of the users of a single substance and the prevalence of polydrug users). An important application of the method seems up to now to be in the casual street monitoring of the driver of a vehicle under the influence of alcohol and/or drugs of abuse.