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There is evidence that mobile phone use while driving (including hands-free) is associated with motor vehicle crashes. However, whether the effects of mobile phone use differ from that of passengers in the vehicle remains unclear. The aim of this research was to estimate the risk of crash associated with passenger carriage and compare that with mobile phone use. A case-control study ('passenger study') was performed in Perth, Western Australia in 2003 and 2004. Cases were 274 drivers who attended hospital following a motor vehicle crash and controls were 1096 drivers (1:4 matching) recruited at service stations matched to the location and time and day of week of the crash. The results were compared with those of a case-crossover study ('mobile phone study') undertaken concurrently (n=456); 152 cases were common to both studies. Passenger carriage increased the likelihood of a crash (adjusted odds ratio (adj. OR), 95% confidence interval (95% CI), 1.6, 1.1-2.2). Drivers carrying two or more passengers were twice as likely to crash as unaccompanied drivers (adj. OR 2.2, 95% CI 1.3-3.8). By comparison, driver's use of a mobile phone within 5 min before a crash was associated with a fourfold increased likelihood of crashing (OR 4.1, 95% CI 2.2-7.7). Passenger carriage and increasing numbers of passengers are associated with an increased likelihood of crash, though not to the same extent as mobile phone use. Further research is needed to investigate the factors underlying the increased risks.

The diagnosis of disseminated intra-abdominal malignancy in women with ovarian involvement can be problematic. Whilst both blood tumor markers and use of immunohistochemical staining on tissue can help decide the origin of the tumor, this is done separately. This study looked at the blood and tissue marker profiles of 198 cases of disseminated malignancy to construct a model, which may help to determine tumor origin. The original histology material from 198 cases of disseminated intra-abdominal epithelial malignancy were reviewed, blind, and reassessed as to the likely site of origin. These cases had immunohistochemical (IHC) staining for cytokeratins (CK) 7 and 20, carcinoembryonic antigen (CEA) and CA125. Blood values for CEA and CA125 were also known at diagnosis. The histologic types of the tumors in this pilot study were of ovarian type morphologically in 130 cases (65.7%), nonovarian in 32 (16.1%), and not assigned in 36 cases (18.2%). The majority of the nonovarian cases were of mucinous type or too poorly differentiated to classify. Analysis showed an overall sensitivity and specificity of 93% and 69%, and positive predictive and negative predictive value of 92% and 71%, respectively, for a diagnosis of ovarian vs nonovarian origin using histology alone vs histology and IHC. Use of an ordinal regression developed a model which uses tissue staining for CK 7 and CEA along with blood levels of CEA to help determine the site of tumor origin.

Purpose: To examine internal consistency, refine the response scale, and obtain a linear scoring system for the visual function instrument, the Daily Living Tasks Dependent on Vision (DLTV)., Methods: Data were available from 186 participants with a clinical diagnosis of AMD who completed the 22-item DLTV (DLTV-22) according to four-point ordinal response scale. An independent group of 386 participants with AMD were administered a reduced version of the DLTV with 11 items (DLTV-11), according to a five-point response scale. Rasch analysis was performed on both datasets and used to generate item statistics for measure order, response odds ratios per item and per person, and infit and outfit mean square statistics. The Rasch output from the DLTV-22 was examined to identify redundant items and for factorial validity and person item measure separation reliabilities., Results: The average rating for the DLTV-22 changed monotonically with the magnitude of the latent person trait. The expected versus observed average measures were extremely close, with step calibrations evenly separated for the four-point ordinal scale. In the case of the DLTV-11, step calibrations were not as evenly separated, suggesting that the five-point scale should be reduced to either a four- or three-point scale. Five items in the DLTV-22 were removed, and all 17 remaining items had good infit and outfit mean squares. PCA with residuals from Rasch analysis identified two domains containing 7 and 10 items each. The domains had high person separation reliabilities (0.86 and 0.77 for domains 1 and 2, respectively) and item measure reliabilities (0.99 and 0.98 for domains 1 and 2, respectively)., Conclusions: With the improved internal consistency, establishment of the accuracy and precision of the rating scale for the DLTV and the establishment of a valid domain structure we believe that it constitutes a useful instrument for assessing visual function in older adults with age-related macular degeneration.

The study's objectives were to determine the prevalence and types of distracting activities involved in serious crashes, and to explore the factors associated with such crashes. We interviewed 1367 drivers who attended hospital in Perth, Western Australia between April 2002 and July 2004 following a crash. A structured questionnaire was administered to each driver and supplementary data were collected from ambulance and medical records. Over 30% of drivers (433, 31.7%) cited at least one distracting activity at the time of crashing and driver distraction was reported to have contributed to 13.6% of all crashes. The major distracting activities were conversing with passengers (155, 11.3%), lack of concentration (148, 10.8%) and outside factors (121, 8.9%). Using logistic regression, a distracting activity at the time of a crash was significantly more likely among drivers with shorter driving experience (0-9 years, 38.3% versus >or=30 years, 21.0%, p<0.001). Distracting activities at the time of serious crashes are common and can cause crashes, and the types of activities reported are varied. Increased driver awareness of the adverse consequences of distracted driving with a focus on novice drivers, enforcement of existing laws (e.g. those requiring a driver to maintain proper control of a vehicle), and progress on engineering initiatives (such as collision warning systems) are needed to reduce injury.

Aim: To investigate whether two methods of measuring macular pigment-namely, heterochromatic flicker photometry (HFP) and resonance Raman spectroscopy (RRS)--yield comparable data., Methods: Macular pigment was measured using HFP and RRS in the right eye of 107 participants aged 20-79 years. Correlations between methods were sought and regression models generated. RRS was recorded as Raman counts and HFP as macular pigment optical density (MPOD). The average of the top three of five Raman counts was compared with MPOD obtained at 0.5 degrees eccentricity, and an integrated measure (spatial profile; MPODsp) computed from four stimulus sizes on HFP., Results: The coefficient of variation was 12.0% for MPODsp and 13.5% for Raman counts. MPODsp exhibited significant correlations with Raman counts (r = 0.260, p = 0.012), whereas MPOD at 0.5 degrees did not correlate significantly (r = 0.163, p = 0.118). MPODsp was not significantly correlated with age (p = 0.062), whereas MPOD at 0.5 degrees was positively correlated (p = 0.011). Raman counts showed a significant decrease with age (p = 0.002) and were significantly lower when pupil size was smaller (p = 0.015)., Conclusions: Despite a statistically significant correlation, the correlations were weak, with those in excess of 90% of the variance between MPODsp and Raman counts remaining unexplained, meriting further research.

Objective: To explore the use and effects of using mobile phones while driving., Design: Cross-sectional survey., Setting: New South Wales and Western Australia, 20 October to 7 November 2003., Participants: 1347 licensed drivers aged 18 to 65 years. Data were weighted to reflect the corresponding driving population in each state., Main Outcome Measures: Mobile phone use while driving (hand-held, hands-free and text messaging); adverse effects of use., Results: While driving, an estimated 57.3% +/- 1.5% of drivers have ever used a mobile phone and 12.4% +/- 1.0% have written text messages. Men, younger drivers and metropolitan residents were more likely to use a phone while driving and to report a higher frequency of use. Enforcement of hand-held phone restrictions was perceived to be low (69.0% +/- 1.5%) and an estimated 39.4% +/- 2.1% of people who phone while driving use a hand-held phone. Half of all drivers (50.1% +/- 1.6%) did not agree with extending the ban to include hands-free phones. Among drivers aged 18-65 years in NSW and WA, an estimated 45 800 +/- 16 466 (0.9% +/- 0.3%) have ever had a crash while using a mobile phone and, in the past year, 146 762 +/- 26 856 (3.0% +/- 0.6%) have had to take evasive action to avoid a crash because of their phone use., Conclusions: Phone use while driving is prevalent and can result in adverse consequences, including crashes. Despite legislation, a significant proportion of drivers continue to use hand-held mobile phones while driving. Enhanced enforcement is needed.

Background and Objective: Research on young drivers directly linking risk factors to serious injury and death outcomes is required. The DRIVE Study was established to facilitate this aim. This paper outlines the study methods and describes the population that has been recruited, in order to demonstrate that the necessary heterogeneity in risk factors has been attained., Design, Setting and Participants: Drivers aged 17-24 years holding their first-stage provisional driver's licence from New South Wales, Australia, were recruited into a prospective cohort study. The participants were contacted by mail and asked to complete the study questionnaire at an online site or via a mailed questionnaire. Baseline data collection involved a questionnaire with questions to drivers about their training, risk perception, driver behavior, sensation-seeking behavior and mental health. Participants gave consent for prospective data linkage to their data on licensing, crashes and injuries, held in routinely collected databases., Results: 20 822 drivers completed the baseline questionnaire, of whom 45.4% were men, 74.3% resided in capital cities and 25.7% in regional or remote areas. The recruited study population showed a wide variation in the risk factors under examination. For example, almost 40% of drivers reported drinking alcohol at hazardous levels and about 32% of participants seemed to be at a high or very high risk of psychological distress. Participants reported a mean of 67.3 h (median 60 h) of supervised driver training while holding their learner's permit., Conclusions: The DRIVE Study has a robust study design aimed at minimizing bias in the collection of outcome data. Analyses of baseline data showed substantial heterogeneity of risk factors in the study population. Subsequent prospective linkages comparing relative differences in exposures at baseline with the outcomes of interest have the potential to provide important new information needed to develop targeted interventions aimed at young drivers.

Objectives: To investigate the rate of helmet use among motorcycle drivers in Hai Duong province of Vietnam during winter/spring 2005, and to compare the rates of helmet use by road types., Method: Population-based observational surveys., Results: 16,560 motorcyclists were observed across 37 road sites (incorporating 5 road categories). The overall weighted average of helmet use for motorcyclists was 29.94%, with male drivers more likely to wear helmets than female drivers (odds ratio (OR) 1.64, 95% confidence interval (CI) 1.53 to 1.76). Male pillion passengers were less likely to wear helmets than female pillion passengers (OR 0.78, 95% CI 0.72 to 0.85). The number of adult drivers using helmets is larger as compared with that of young drivers (OR 8.56, 95% CI 5.93 to 12.19). The rates of helmet use were significantly higher (p<0.001) on compulsory roads and were 59.01%, 39.97%, 24.22%, 12.7% and 9.54% for national, provincial, district, commune and Hai Duong inner-city roads, respectively., Conclusion: Helmet legislation has increased the rate of helmet use by motorcycle drivers on compulsory roads. Elsewhere, rate of helmet use is very low, indicating that in the absence of legislation and enforcement, motorcyclists in Vietnam will not wear a helmet.

Purpose: To examine the relationship between short-wavelength-sensitive (SWS) resolution acuity and epidemiologically defined stages of early age-related maculopathy (ARM)., Methods: Subjects consisted of 88 adults aged 51 to 87 years. Psychophysical testing was undertaken in only one eye of each subject (the study eye). All study eyes had a LogMAR acuity of 0.30 (20/40 Snellen) or better. SWS and achromatic grating resolution acuity were measured at 6 degrees eccentricity from the fovea. Stereoscopic color fundus photographs centered on the macula were taken on both eyes of each subject and were graded using the Wisconsin Age-Related Maculopathy Grading System (WARMGS). After grading, features of ARM were combined to assign a severity stage from 0 to 5 using the methods described by the Rotterdam Eye Study. Relationships between visual function, study eye ARM stage, and fellow eye status were examined with the use of standard statistical analysis., Results: Although SWS resolution acuity was significantly reduced in eyes classified as having any ARM compared with eyes classified as having no ARM (P = 0.002), there was no relationship between the severity of functional deficits and the morphologic severity from stage 1 to stage 4. On reassigning subject eyes to a revised severity staging (stage 0, stages 1 to 4 combined, and stage 5), SWS acuity was significantly different among these three groups (P < 0.001). No significant relationship was found between achromatic resolution acuity and ARM staging. The status of the fellow eye (advanced macular degeneration present or absent) was not significantly related to visual function in the study eye., Conclusions: Significant functional deficits in SWS resolution acuity were found in eyes with ARM features, but the severity of functional loss did not correlate well with the currently accepted method of assigning a morphologic severity stage. Longitudinal studies may reveal further information on the relationships between functional deficits, ARM status, disease progression, and outcome.

This study piloted a survey suitable to generate statewide prevalence estimates for injury prevention practices and/or behaviours. A number of prevalence estimates of injury prevention practices and/or behaviours were generated in the pilot. For example, the prevalence of a household smoke alarm was high (732/1000 households) and yet only 44% of households had tested the functionality of the alarm in the 12 months preceding the survey. Findings of this kind point to an increasing need for primary care practitioners to play a leading role in targeting preventive strategies for injury. In addition, the survey methods and approach highlight the value of such information to health departments and non-government agencies in terms of targeting priority injury risk behaviours and the evaluation of injury-related intervention programmes. The survey has been designed so the methods can be applied nationally and internationally.

This paper identifies the risk and protective factors for injury in non-elite netball. Three-hundred and sixty-eight non-elite netballers completed a baseline questionnaire at the commencement of the 1997 preseason. Participants were telephoned each month during the 1997 and 1998 playing seasons to provide details of their exposure at training and games and any injury experiences in the previous 4 weeks. The incidence of injury in this study was 14 injuries per 1000 player hours. The risk factors for injury were identified as: not warming up before a game (IRR 1.11, 95% CI 1.00-1.23) and not being open to new ideas (IRR 1.04, 95% CI 1.00-1.07). Training for 4 or more hours per week (IRR 0.66, 95% CI 0.45-0.98) and not sustaining an injury in the previous 12 months (IRR 0.58, 95% CI 0.43-0.79) were found to be protective against injury. The risk and protective factors for injury identified in this study can be used as the basis for the development of evidence-based injury prevention strategies that seek to reduce the risk of injury in sport. Injury prevention strategies should focus on the development of effective training programs that include netball-specific skills, activities and movements. Further investigation into the mechanisms associated with the risk and protective factors identified would provide further understanding of why these factors increase or decrease the risk of injury.

Objectives: To compare the injury profiles of the Indigenous population in New South Wales with that of the non-Indigenous population., Design and Setting: Descriptive analysis of NSW Health data obtained from the Health Outcomes Information and Statistical Toolkit (HOIST) database. Hospitalisation data were collected for the period 1 July 1999 to 30 June 2003. Mortality data were collected for the period 1 January 1999 to 31 December 2002., Main Outcome Measures: Hospitalisation and death rates due to injury by age, sex, injury mechanism and Indigenous status. Rate ratios for comparison between Indigenous and non-Indigenous populations., Results: Rates of death from injury were higher for all age groups in the Indigenous population, except people older than 65 years. Indigenous people aged 25-44 years were twice as likely to be hospitalised as their non-Indigenous counterparts (rate ratio [RR], 2.09; 95% CI, 2.03-2.14), and five times as likely to be hospitalised for interpersonal violence (RR, 5.19; 95% CI, 4.98-5.40)., Conclusion: The higher rates of injury-related hospitalisation and death in the Indigenous population in NSW are consistent with data reported for other parts of Australia. Of particular concern is the number of Indigenous deaths and hospitalisations due to interpersonal violence.

Aim: To examine the Daily Living Tasks Dependent on Vision (DLTV), a visual function questionnaire for domain structure, and redundancy., Method: 235 subjects underwent full ophthalmic assessment and completed the DLTV questionnaire by interview. Principal component analysis with varimax rotation and item response theory (IRT) were used to assign the items to domains. The internal consistency of each domain was examined using Cronbach's alpha. Redundancy was assessed by regressing each item in a domain against the remainder of items in that domain., Results: Four domains were identified. Domain 1 was formed by nine items, which after applying IRT were seen to be among the most difficult questions in the instrument. Domain 2 contained eight items, all of which fell in the easier half of the instrument on applying IRT. Domain 3 contained only three items, all of which were among the easier questions and appear to deal with peripheral vision function. Domain 4 consisted of two items dealing with adaptation to light and dark conditions. Cronbach's alpha for each domain was 0.96, 0.93, 0.73, 0.66. Redundancy was found to be present in domain 1, which was therefore reduced by two items, with little effect on internal consistency., Conclusions: The authors believe using the domains identified in this report will optimise the information provided by patients on their ability to function on visually demanding tasks.

Objectives: To explore the effect of drivers' use of mobile (cell) phones on road safety., Design: A case-crossover study., Setting: Perth, Western Australia., Participants: 456 drivers aged > or = 17 years who owned or used mobile phones and had been involved in road crashes necessitating hospital attendance between April 2002 and July 2004., Main Outcome Measure: Driver's use of mobile phone at estimated time of crash and on trips at the same time of day in the week before the crash. Interviews with drivers in hospital and phone company's records of phone use., Results: Driver's use of a mobile phone up to 10 minutes before a crash was associated with a fourfold increased likelihood of crashing (odds ratio 4.1, 95% confidence interval 2.2 to 7.7, P < 0.001). Risk was raised irrespective of whether or not a hands-free device was used (hands-free: 3.8, 1.8 to 8.0, P < 0.001; hand held: 4.9, 1.6 to 15.5, P = 0.003). Increased risk was similar in men and women and in drivers aged > or = 30 and < 30 years. A third (n = 21) of calls before crashes and on trips during the previous week were reportedly on hand held phones., Conclusions: When drivers use a mobile phone there is an increased likelihood of a crash resulting in injury. Using a hands-free phone is not any safer.

Aims: To determine whether or not self reported visual functioning and quality of life in patients with choroidal neovascularisation caused by age related macular degeneration (AMD) is better in those treated with 12 Gy external beam radiotherapy in comparison with untreated subjects., Methods: A multicentre single masked randomised controlled trial of 12 Gy of external beam radiation therapy (EBRT) delivered as 6 x 2 Gy fractions to the macula of an affected eye versus observation. Patients with AMD, aged 60 years or over, in three UK hospital units, who had subfoveal CNV and a visual acuity equal to or better than 6/60 (logMAR 1.0)., Methods: Data from 199 eligible participants who were randomly assigned to 12 Gy teletherapy or observation were available for analysis. Visual function assessment, ophthalmic examination, and fundus fluorescein angiography were undertaken at baseline and at 3, 6, 12, and 24 months after study entry. To assess patient centred outcomes, subjects were asked to complete the Daily Living Tasks Dependent on Vision (DLTV) and the SF-36 questionnaires at baseline, 6, 12, and 24 months after enrolment to the study. Cross sectional and longitudinal analyses were conducted using arm of study as grouping variable. Regression analysis was employed to adjust for the effect of baseline co-variates on outcome at 12 months and 24 months., Results: Both control and treated subjects had significant losses in visual functioning as seen by a progressive decline in mean scores in the four dimensions of the DLTV. There were no statistically significant differences between treatment and control subjects in any of dimensions of the DLTV at 12 months or 24 months after study entry. Regression analysis confirmed that treatment status had no effect on the change in DLTV dimensional scores., Conclusions: The small benefits noted in clinical measures of vision in treated eyes did not translate into better self reported visual functioning in patients who received treatment when compared with the control arm. These findings have implications for the design of future clinical trials and studies.

Bivariate time series of counts with excess zeros relative to the Poisson process are common in many bioscience applications. Failure to account for the extra zeros in the analysis may result in biased parameter estimates and misleading inferences. A class of bivariate zero-inflated Poisson autoregression models is presented to accommodate the zero-inflation and the inherent serial dependency between successive observations. An autoregressive correlation structure is assumed in the random component of the compound regression model. Parameter estimation is achieved via an EM algorithm, by maximizing an appropriate log-likelihood function to obtain residual maximum likelihood estimates. The proposed method is applied to analyze a bivariate series from an occupational health study, in which the zero-inflated injury count events are classified as either musculoskeletal or non-musculoskeletal in nature. The approach enables the evaluation of the effectiveness of a participatory ergonomics intervention at the population level, in terms of reducing the overall incidence of lost-time injury and a simultaneous decline in the two mean injury rates.

Manual handling is the greatest contributor to non-fatal injury and disease in the workplace, commonly accounting for one-third of national injury counts. Interventional strategies that have focused on selecting or modifying the worker have been ineffective in reducing injury risk. In recent times, participatory ergonomics has been widely adopted as a process to reduce the risk of injury from manual handling but it is not well validated as an intervention. This study evaluated the effectiveness of a participatory ergonomics risk assessment approach in reducing the rate and severity of injuries from manual and non-manual handling sustained by a cohort of 137 cleaners within a hospital setting. The date of injury and the workers' compensation claim cost and hours lost from work were obtained for each injury incurred during the 4-year pre-intervention and 3-year intervention period. The age, gender and hours worked were ascertained for every cleaner whether injured or not. Using generalized linear mixed modelling analysis, reductions of rate of injury by two-thirds, workers' compensation claim costs by 62% and hours lost by 35% for manual handling injuries were found to be associated with the intervention period. Although the cleaners experienced a significant intervention period reduction in non-manual handling injury rate, the corresponding changes in severity of injury were not significant. The success of the intervention supports the adoption of a participatory ergonomics approach in reducing the rate and consequence of injuries in the workplace.

Aim: To study the relation between visual impairment and ability to care for oneself or a dependant in older people with age related macular degeneration (AMD)., Method: Cross sectional study of older people with visual impairment due to AMD in a specialised retinal service clinic. 199 subjects who underwent visual function assessment (fully corrected distance and near acuity and contrast sensitivity in both eyes), followed by completion of a package of questionnaires dealing with general health status (SF36), visual functioning (Daily Living Tasks Dependent on Vision, DLTV) and ability to care for self or provide care to others. The outcome measure was self reported ability to care for self and others. Three levels of self reported ability to care were identified--inability to care for self (level 1), ability to care for self but not others (level 2), and ability to care for self and others (level 3)., Results: People who reported good general health status and visual functioning (that is, had high scores on SF36 and DLTV) were more likely to state that they were able to care for self and others. Similarly people with good vision in the better seeing eye were more likely to report ability to care for self and others. People with a distance visual acuity (DVA) worse than 0.4 logMAR (Snellen 6/15) had less than 50% probability of assigning themselves to care level 3 and those with DVA worse than 1.0 logMAR (Snellen 6/60) had a probability of greater than 50% or for assigning themselves to care level 1. Regression analyses with level of care as the dependent variable and demographic factors, DLTV subscales, and SF36 dimensions as the explanatory variables confirmed that the DLTV subscale 1 was the most important variable in the transition from care level 3 to care level 2. The regression analyses also confirmed that the DLTV subscale 2 was the most important in the transition from care level 3 to care level 1., Conclusions: Ability to care for self and dependants has a strong relation with self reported visual functioning and quality of life and is adversely influenced by visual impairment. The acuity at which the balance of probability shifts in the direction of diminished ability to care for self or others is lower than the level set by social care agencies for provision of support. These findings have implications for those involved with visual rehabilitation and for studies of the cost effectiveness of interventions in AMD.

Background: Changes in the immune and inflammatory response are induced by smoking tobacco but underlying mechanisms remain to be elucidated., Objective: This study investigated the effect of nicotine agonists on histamine release from human basophils., Methods: Peripheral blood basophils were obtained from healthy volunteers. The effect of the nicotine agonists [-]-1-methyl-2-[3-pyridyl]pyrrolidine and (+)-nicotine di-p-toluoyltartrate salt on cell viability and anti-IgE induced histamine release was investigated., Results: Cell viability was not altered by preincubation with the agents for 15 min. Anti-IgE induced histamine release was significantly inhibited by preincubation (15 min, 37 degrees C) with [-]-1-methyl-2-[3-pyridyl]pyrrolidine at the highest concentration tested 10(-)3 M (p<0.01). Preincubation (15 min, 37 degrees C) with (+)-nicotine di-p-toluoyltartrate salt significantly inhibited anti-IgE induced histamine release at 10(-3)M and 10(-5) M (p<0.05)., Conclusions: This study has demonstrated that nicotine agonists inhibit histamine release from human basophils. Further studies examining the effect of smoking on basophil activation are required.

Objectives: To analyze the morphometric composition of lesion components in exudative age-related macular degeneration and to study the relationships between individual lesion components and choroidal neovascularization (CNV) subtype, at 2 time points., Methods: Morphometric analysis of 98 sets of angiograms separated by an interval of at least 3 weeks, with no treatment delivered in the intervening period between angiograms. Area measurements of individual lesion components were made from digitally captured angiograms. Choroidal neovascularizations were classified into subtypes based on the proportions of classic CNV. Fully corrected distance visual acuity measured on logMAR Early Treatment of Diabetic Retinopathy Study charts was available at baseline and at a subsequent visit in 78 subjects. Data were analyzed using parametric and nonparametric tests, linear regression, and McNemar test of equal proportions., Results: Wholly and predominantly classic CNVs were significantly smaller at initial presentation than minimally classic or occult with no classic CNVs. Lesions containing blood and lipid were also significantly larger than lesions not exhibiting these features. Lesions containing any classic CNV expanded at a significantly greater rate than lesions without classic CNV. Approximately 40% of lesions categorized as wholly classic CNV converted to predominantly classic CNV between baseline and the next follow-up visit., Conclusion: The presence of classic leakage in exudative age-related macular degeneration is the most important risk factor for rapid expansion of CNV.

Purpose: Rofecoxib and celecoxib have been recently introduced and promoted as 'safer' non-steroidal anti-inflammatory drugs (NSAIDs) regarding gastric toxicity. The primary aim was to measure their uptake and any impact on conventional NSAID prescribing. A secondary aim was to assess any change in proton pump inhibitor (PPI) prescribing., Methods: Prescribing data in terms of defined daily doses (DDDs) were pooled from 1997 onwards. Linear trends in the data were tested for using regression analyses. Direct comparisons were made between the April-June quarter of the year 1999 (i.e. before the introduction of rofecoxib and celecoxib) and the same quarter 3 years later., Results: Overall NSAID prescribing in Northern Ireland was found to be increasing linearly at an estimated rate of 154,000 DDDs per quarter since the introduction of celecoxib and rofecoxib. The rate of increase in the volume of prescribing of the two new drugs was found to be four times the rate of decrease in prescribing of the 'older' NSAIDs. Overall prescribing of anti-inflammatory agents had increased from 37.8 to 47.7 DDDs/1000 patients/day over 3 years with no effect on the upward trend in PPI prescribing., Conclusions: The introduction of rofecoxib and celecoxib has increased prescribing volume of anti-inflammatory agents by 26% in Northern Ireland over the 3-year period. This could pose safety problems in the future as more people are being prescribed anti-inflammatory agents.

Purpose: High myopia in childhood is associated with important ocular and systemic conditions. However in the UK, high myopia in early childhood is not specifically identified in current ophthalmology, optometry, or orthoptic protocols for screening, referral, or investigation. An ongoing study in the West Midlands, UK, is investigating high myopia presenting to community health care clinics with the aim of compiling guidelines for assessment and subsequent referral., Methods: Children with high myopia were identified from community optometric and orthoptic sources and invited for an ophthalmology and optometry examination to ascertain possible ocular or systemic disease., Results: High myopia with no associated ocular or systemic condition was present in 15 (56%) of the children. In seven children (25%), associated ocular problems were found including unrecognized retinal dystrophies and amblyopia. Systemic disorders associated with high myopia were found in five children (19%) and included Sticklers syndrome, Weill-Marchesani syndrome, and homocystinuria. In one child, the diagnosis made before this study was found to be incorrect, and in another child, the results were inconclusive. In two cases, the diagnosis of a systemic condition in the child led to the identification of the disease in at least one relative., Conclusions: There is a high prevalence of ocular and systemic abnormality in young children seen in the community. Optometric and ophthalmologic assessment of children less than 10 years with myopia > or =5 D is likely to identify significant ocular or systemic disease, a proportion of which will respond to medical intervention. Detection and prompt referral of these cases by community health care services may be expected to prolong vision and possibly life expectancy.

Aim: To examine the relation between the type of choroidal neovascularisation (CNV) in the first eye and age related maculopathy (ARM) severity in the fellow eye., Methods: Colour fundus photographs and fluorescein angiograms from 67 subjects with a clinical diagnosis of CNV in one eye were scrutinised. CNV was classified as wholly classic, predominantly classic, minimally classic, or occult based on the proportion of classic leakage within the lesion. ARM changes in the fellow eye were assigned a severity stage using the system described by the Rotterdam Eye Study. Logistic regression analysis was employed to examine the association between CNV subtype and ARM stage., Results: Of subjects with classic or predominantly classic CNV in the first eye 78% exhibited least no or early ARM features in the fellow eye. By contrast, 85% of subjects with minimally classic or occult CNV in the first eye exhibited more advanced ARM features in the fellow eye. Kruskall-Wallis one way ANOVA by ranks showed that this was highly significant (p = 0.002). Logistic regression analysis showed that as the proportion of occult CNV increased in the first eye, fellow eyes of subjects in this category were more likely to have been assigned to a higher ARM stage (p = 0.019). The area occupied by the CNV in the first eye also influenced severity of ARM changes in the fellow eye., Conclusion: The type and extent of CNV in the first affected eye has a distinct relation to ARM severity in the fellow eye. Fellow eyes of subjects with minimally classic or occult CNV in the first affected eye show widespread ARM changes suggestive of retinal pigment epithelial dysfunction. These findings suggest that classic CNV may be focal disease while occult CNV is essentially a more widespread retinal pigment epithelial disorder.

Background: Environmental, cultural and health care differences may account for variation among countries in the prevalence of asthma and respiratory symptoms in teenagers., Objective: To examine the prevalence of respiratory symptoms and the level of diagnosis, and to compare determinants of asthma and severe wheeze in two countries., Methods: Self-completion questionnaires based on the International Study of Asthma and Allergies in Childhood (ISAAC) protocol were provided to school children in Ireland (Republic and Northern Ireland). In the Republic of Ireland, all children in classes largely aged 13-14 years from 30 post-primary schools were selected by random sampling stratified by school size, composition and Health Board in Spring 1995. In Northern Ireland, all children largely aged 13-14 years of age from 26 post-primary schools were selected by random sampling stratified by school type, composition and Education and Library Board in Spring 1996., Results: Questionnaires were completed by 2,364 children from Northern Ireland and 2,671 from the Republic, about 90% of those eligible to participate. The prevalences of wheeze at various levels of severity, of diagnosed asthma and of treated wheeze were very similar in Northern Ireland and the Republic of Ireland. A significant proportion of those reporting more severe symptomatology (four or more attacks of wheeze in the past 12 months and/or one or more nights disturbed and/or moderate or greater disruption of daily activities and/or speech restriction due to wheeze) had been neither diagnosed nor treated for asthma (20-37%). To investigate the determinants of the more severe symptomatology of asthma or treated wheeze a series of stepwise multiple regression analyses was performed. A history of atopy, cigarette smoking, the possession of a furry pet other than a dog or cat and age were each independently associated with severe wheeze, whilst atopy, a furry pet (as above) and gender were each independently associated with asthma or treated wheeze., Conclusions: Cigarette smoking is closely associated with the reporting of significant respiratory symptoms together with atopy and exposure to furry pets. Some 20-37% of severe symptoms were neither diagnosed nor treated as asthma.

Objective: To determine whether teletherapy with 6-mV photons can reduce visual loss in patients with subfoveal choroidal neovascularization in age-related macular degeneration., Design: A multicenter, single-masked, randomized controlled trial of 12 Gy of external beam radiation therapy delivered to the macula of an affected eye vs observation only., Setting: Three United Kingdom-based hospital units., Participants: Patients with age-related macular degeneration, aged 60 years and older, who had subfoveal choroidal neovascularization and a visual acuity of 20/200 (logMAR 1.0) or better., Methods: Two hundred three patients were randomly assigned to radiotherapy or observation. Treatment was undertaken at designated radiotherapy centers, and patients assigned to the treatment group received a total dosage of 12 Gy of 6-mV photons in 6 fractions. Follow-up was scheduled at 3, 6, 12, and 24 months. After excluding protocol violators, the data from 199 patients were analyzed., Main Outcome Measures: The primary outcome measure was mean loss of distance visual acuity in the study eye at 12 and 24 months. Other outcome variables analyzed were near visual acuity and contrast sensitivity. The proportions of patients losing 3 or more or 6 or more lines of distance and near acuity and 0.3 or more or 0.6 or more log units of contrast sensitivity at each follow-up were also analyzed., Results: At all time points, mean distance visual acuity was better in the radiotherapy-treated group than in the control group, but the differences did not reach statistical significance. At 24 months, analysis of the proportions of patients with loss of 3 or more (moderate) (P =.08) or 6 or more (severe) (P =.29) lines of distance vision showed that fewer treated patients had severe losses, but there was no statistically significant difference between groups. For near visual acuity, although there was no evidence of treatment benefit at 12 and 24 months, a significant difference in favor of treatment was present at 6 months (P =.048). When analyzed by the proportions of patients losing 3 lines of contrast sensitivity, there was a significant difference in favor of treatment at 24 months (P =.02). No adverse retinal effects were observed during the study, but transient disturbance of the precorneal tear film was noted in treated patients., Conclusion: The results of the present trial do not support the routine clinical use of external beam radiation therapy in subjects with subfoveal choroidal neovascularization in age-related macular degeneration.

Much of the data collected on motor vehicle crashes is count data. The standard Poisson regression approach used to model this type of data does not take into account the fact there are few crash events and hence, many observed zeros. In this paper, we applied the zero-inflated Poisson (ZIP) model (which adjusts for the many observed zeros) and the negative binomial (NB) model to analyze young driver motor vehicle crashes. The results of the ZIP regression model are comparable to those from fitting a NB regression model for general over-dispersion. The findings highlight that driver confidence/adventurousness and the frequency of driving prior to licensing are significant predictors of crash outcome in the first 12 months of driving. We encourage researchers, when analyzing motor vehicle crash data, to consider the empirical frequency distribution first and to apply the ZIP and NB models in the presence of extra zeros due, for example, to under-reporting.

Objectives: To identify demographic and socioeconomic determinants of need for acute hospital treatment at small area level. To establish whether there is a relation between poverty and use of inpatient services. To devise a risk adjustment formula for distributing public funds for hospital services using, as far as possible, variables that can be updated between censuses., Design: Cross sectional analysis. Spatial interactive modelling was used to quantify the proximity of the population to health service facilities. Two stage weighted least squares regression was used to model use against supply of hospital and community services and a wide range of potential needs drivers including health, socioeconomic census variables, uptake of income support and family credit, and religious denomination., Setting: Northern Ireland., Main Outcome Measure: Intensity of use of inpatient services., Results: After endogeneity of supply and use was taken into account, a statistical model was produced that predicted use based on five variables: income support, family credit, elderly people living alone, all ages standardised mortality ratio, and low birth weight. The main effect of the formula produced is to move resources from urban to rural areas., Conclusions: This work has produced a population risk adjustment formula for acute hospital treatment in which four of the five variables can be updated annually rather than relying on census derived data. Inclusion of the social security data makes a substantial difference to the model and to the results produced by the formula.

Purpose: A recent study indicated that patients with cataracts and early age-related maculopathy may benefit from cataract extraction. To ascertain whether cataract extraction in the presence of concurrent advanced age-related maculopathy was also associated with a clear benefit, we studied visual function and self-reported visual functioning in a cohort of 12 patients pre- and post-phakoemulsification. METHODS. All 12 patients had a diagnosis of advanced age-related maculopathy in the eye scheduled for cataract surgery. Preoperative assessment included refraction and recording of best corrected distance and near acuity and contrast sensitivity in both eyes. The Daily Living Tasks Dependent on Vision questionnaire was administered. After phakoemulsification and intraocular lens implantation, all patients were reviewed and assessed., Results: After surgery, improvement in acuity was recorded in nine operated eyes, whereas acuity remained unchanged in three eyes. Improvement in contrast sensitivity in the operated eye occurred in 10 patients, but in two patients contrast was reduced postoperatively. In terms of self-reported visual functioning, improvement in the ability to undertake many daily living tasks dependent on vision was recorded after cataract surgery., Conclusions: Significant improvements in specific areas of self-reported visual functioning and measures of vision were recorded after cataract surgery. During the follow-up period, none of the operated eyes suffered a fall in visual acuity. There was also no evidence of worsening of the pre-existing macular lesion as judged by clinical examination and fundus photography.

Objective: To describe the driver and behavioural factors that predispose young drivers to crash in the first 12 months of driving and to compare whether these factors differ between young urban and rural drivers., Methods: A cohort comprising 1,796 newly licensed urban and rural drivers from Western Australia was recruited and followed over the first 12 months of driving. Using Cox proportional hazard analysis, driver and behavioural factors were assessed to determine whether they predicted the likelihood of a crash., Results: The incidence rate for a motor vehicle crash was marginally higher for urban drivers compared with rural drivers (Urban: IR=4.2/10,000 driving days; Rural: IR=3.7/10,000 driving days). There was no significant difference in the time to crash between urban and rural drivers. Two factors, namely the frequency of driving before obtaining a learner-driver permit and the driver's level of risk taking, were significantly associated with a motor vehicle crash in the first year of driving., Conclusion: Irrespective of whether the driver is licensed in a rural or urban area, high risk-taking drivers are at an elevated risk of a motor vehicle crash in the first 12 months of driving., Implications: Aspects of Graduated Driver Training and Licensing Programs (GDTLP) could be effective in targeting this at-risk group.

Objective: To clarify the usefulness, acceptability, sensitivity, and validity of version 4 of the Health of the Nation Outcome Scale (HoNOS), a scale developed to meet the requirement for a clinically acceptable outcome scale for routine use in mental illness services., Design: Patients with a range of mental illnesses were rated on the HoNOS at the beginning and end of an episode by interviews with mental health professionals., Subjects: 934 patients from eight diagnostic categories were rated by 129 mental health professionals at 17 sites; 250 were also rated on a range of comparison scales., Outcome Measures: Comparison of patients' scores at the beginning and end of an episode using individual item scores, dimensional subscores, and the total score., Results: HoNOS scores decreased by almost 50% between the beginning and end of episodes. They varied with the severity of the setting and discriminant analysis showed that the HoNOS had a moderate level of discriminatory power. Correlation analysis showed acceptable levels of agreement with independent scales, although the accuracy of ratings of some items at the beginning of an episode was affected by information deficits., Conclusion: The findings indicate that HoNOS is sensitive to change across time and to differences in illness type and severity, and has a sufficient degree of both construct and criterion related validity to fulfil the requirements of a mental health outcome scale for routine use in clinical settings.

Aims: To examine the relation between measures of vision and ability to perform daily living tasks in those visually impaired with macular degeneration., Methods: A visual functioning index (daily living tasks dependent on vision: DLTV) was used to evaluate patients' perception of their ability to perform vision dependent tasks. Distance visual acuity, near visual acuity, reading speed, and contrast sensitivity were measured in all patients. In addition, a new measure of reading ability was derived, designated the reading index. This takes into account both the size of the text read and the time to read it and is equivalent to the reading speed in words per minute divided by text size in M., Results: The reading index was found to show best associations with the majority of items within the DLTV. Stepwise regression identified the combination of reading index and distance visual acuity as having the best associations with DLTV items. The present study also demonstrated that specific levels of vision as measured by acuity, reading index, and contrast sensitivity corresponded with different perceived amounts of difficulty in the performance of daily living tasks., Conclusions: This study showed that reading index is valuable in predicting the ability to perform daily living tasks and therefore may be useful in the visual assessment of the visually impaired individual. In addition, this study identified specific levels of vision at which individuals reported different degrees of difficulty in performing daily living tasks.

Background: Several epidemiologic and clinical factors have been shown to predict long term outcome in major depressive disorder (MDD). The value of biological predictors has not been extensively studied. This study examined whether plasma norepinephrine may be useful in predicting outcome in MDD., Methods: Forty patients were followed up 8 years after an index major depressive episode. Three outcome variables were assessed: time to first recurrence (the primary outcome measure), the Lee and Murray criteria and the Depression Outcome Scale (DOS). The results were examined against plasma norepinephrine value, at the index episode, using survival analysis and linear regression., Results: High plasma norepinephrine at the index episode was positively and significantly associated with time to first recurrence for patients with nonpsychotic MDD (n = 31, chi 2 = 8.38, on 1 df, p < .01). Similarly, plasma norepinephrine was significantly associated with good global outcome, both using Lee and Murray criteria (n = 34, adjusted R2 = .24, p < .01) and DOS criteria (n = 31, adjusted R2 = .17, p < .01) for this group of patients. In contrast, plasma norepinephrine was not significantly related to outcome for MDD with psychotic features., Conclusions: Plasma norepinephrine at index episode seems to be a predictor of outcome in MDD.

Aim: To develop and evaluate a new vision specific functional index for use in individuals with age related macular degeneration (AMD)., Methods: Following consultation with patients with AMD and healthcare professionals, a questionnaire entitled the Daily Living Tasks Dependent on Vision (DLTV) was constructed. It was administered by interview to three separate groups of individuals aged 50 years or older: people with AMD, people with cataract, and people with no visual disability. The relations between DLTV, distance visual acuity, and disorder were examined using Pearson's product moment correlation coefficients, stepwise regression, and principal component analysis., Results: There was a positive correlation between DLTV items and distance visual acuity in the better eye. Principal component analysis showed that the DLTV has a major single dimension within it. This first principal component accounted for 59% of the variation and correlated well with distance visual acuity in the better eye. Other components were found, one of which correlated with the difference in vision in the two eyes and one which featured in the differentiation of AMD subjects from individuals with cataracts., Conclusions: The DLTV provided information on visual impairment in patients over and above that obtained from a measure of visual acuity. It also showed that patients with AMD experience greater difficulty with daily living tasks for any given level of acuity than do patients with cataract.

Objectives: To evaluate the bone density in the mandibles of young Australian adults of Mongoloid and Caucasoid descent., Methods: A panoramic radiograph (Orthophos C, Siemens AG, Bensheim, Germany) was obtained of 79 dental students from the School of Oral Health Sciences, The University of Western Australia. Exposure factors were varied for males and females. The films were automatically processed in a single batch and the optical density measured blindly at two locations by two examiners. The optical density was compared by race and sex to detect bone density differences. Individual lifestyle habits (exercise, alcohol consumption, smoking and diet) was recorded in a self-administered questionnaire. Multiple regression analysis was used to analyse the effects of physical, environmental and medical characteristics., Results: The Mongoloid subjects were found to have approximately 20% higher bone density at the angle of mandible than Caucasoid subjects (P = 0.0094 for males, P = 0.0004 for females)., Conclusion: Race is the most important variable associated with bone density. Mongoloid subjects should be given a higher exposure for panoramic radiography than that normally used for Caucasoid subjects.

This paper outlines the commonalties and unique differences in injury experience among the indigenous people in the United States and Australia. Injury mortality rates among Indigenous people in the United States and Australia are approximately 2-3 times greater than rates for the non-Indigenous population in each country. Motor vehicle-related injuries accounted for one-third of the injury deaths for Native Americans and Australian Aboriginals. Suicide accounted for more deaths in Native Americans (15.5 per 100,000) than it did for Australian Aboriginals (11.1 per 100,000), whereas the injury death rate in Australian Aboriginals due to poisoning was almost twice that of Native Americans. Culturally appropriate interventions tailored to specific local settings and problems will be necessary to reduce injury mortality among Indigenous people.

Purpose: To assess the awareness of the existence of quality of life (QOL) instruments and their perceived relative merit in the management of various eye conditions among ophthalmologists in the United Kingdom., Methods: A self-administered questionnaire was circulated among various grades of ophthalmologists attending a major UK ophthalmology conference. The respondents were asked to rank from a list in order of importance various tests of visual function in different ophthalmic conditions., Results: Distance and near visual acuity were consistently rated high with mean ranks lower than 4.0. Contrast sensitivity and reading speed were consistently rated as low in importance with mean ranks ranging from 4 to 5.8. QOL instruments were deemed to be of some importance in the management of cataract and to a lesser extent in the management of age-related macular degeneration. Only 2 respondents of 36 could name either a generic or a vision-specific QOL instrument., Conclusion: UK ophthalmologists appear to be unfamiliar with QOL measures, despite the fact that in health economics they have become the standard means of assessing the results of health care interventions and of prioritizing funding. Notwithstanding the evolution of a variety of tests for the assessment of visual function, ophthalmologists still rely primarily on distance and, to a lesser extent, near visual acuity to plan their patient management. It is important to identify those tests of visual function that correlate best with the patient's ability to function in the seeing world, and to develop appropriate QOL instruments for use in ophthalmic disorders.

Daily patterns of pedestrian activity in young children have important health implications, primarily because of the risk of road traffic injury, but also because they may reflect the commencement of exercise habits with long-term consequences. A cross-sectional survey in two Australian cities, Melbourne and Perth, aimed to collect, by parent self-administered questionnaire, population-based data on modes of travel, numbers of street crossings (both accompanied and unaccompanied by an adult), and sociodemographic factors for six- and nine-year-old children. Results indicate that 35 per cent (95 per cent confidence interval (CI) 31 to 39 per cent) and 31 per cent (CI 28 to 34 per cent) walk to school in Melbourne and Perth respectively, while over 60 per cent are driven to school by car, with very small proportions riding bicycles or taking public transport. A higher level of walking was associated with lower levels of several indicators of socioeconomic status. Logistic regression analysis showed that the strongest predictor of walking activity was school type (government versus independent), and after adjusting for this, lesser car ownership, non-English-speaking background and lower occupational category were associated with walking to school, while a different set of predictors--age, sex and maternal education--was associated with the unaccompanied crossing of streets. There was little difference in overall walking levels between boys and girls, but boys were significantly more likely to cross streets unaccompanied (adjusted odds ratio 1.41, CI 1.14 to 1.72), providing a partial explanation of documented sex differences in injury rates.

This paper reports on a series of studies of the validity of children's self-reported exposure to traffic. The studies were conducted within a larger case-control study carried out in the metropolitan area of Perth, Western Australia. For these validity studies, subjects were randomly selected from the original pool of case (n = 100) and control (n = 400) subjects. Three techniques were used to assess the validity of the self-reported 'habitual exposure', namely, the 'moving observer' technique, pedestrian diaries, and a test of construct validity. The child's regular walking activities during the course of a typical week was considered the child's 'habitual exposure'. The 'moving observer' technique involved either the researcher or research assistant following a random sample of children on their walking trips. A further sample of children maintained a 'diary' of their weekly walking trips, and a number of constructs, in this case variables which related, indirectly, to the child's level of exposure to the road environment, were included in the interview schedule. As two researchers were involved in all aspects of this study, intra- and inter-rater reliability were assessed and tape-recordings of the interviews were used to determine the reliability of the coded data. No significant differences were found between the child's reported exposure to the road environment and either the observed exposure or exposure recorded in pedestrian diaries. For some exposure variables, namely, the number and duration of walking trips, children tended to underestimate their exposure (when compared to the observations of the researchers). For case subjects, the number of roads crossed was also underestimated. The test of construct validity indicated that time spent in 'out-of-home activities' (activities other than going to or from school, which involved time spent in the road environment) does not correlate strongly with 'habitual exposure'. Intra- and inter-rater reliability and the reliability of transcribed data from taped interviews were all found to be very sound. The studies indicate that children's self-reported 'habitual exposure' data is a valid measure of his or her actual exposure in the road environment.

In 1992, motor vehicle-related injury was the leading cause of injury-specific death in the United States for children aged zero to fourteen years. In the five to nine years age group, childhood pedestrian injury was exceeded only by motor vehicle occupant injuries as the leading cause of death. The prevention of these injuries is a multifactorial problem involving individual characteristics of the child, environmental design, and the mutual dependence between the child and his or her environment. This article considers the plethora of descriptive and analytical research and proposes suitable strategies to reduce the rate of child pedestrian injury.

Background: Pedestrian injuries in children constitute an important cause of mortality and morbidity. Specific hazards which contribute to these injuries need to be identified to enable the development of preventive strategies., Methods: A population-based case-control study was conducted in which 40 aspects of traffic and road environment that contribute to the likelihood of childhood pedestrian injury were examined. The factors of interest were measured at 100 places of injury and 200 control sites between December 1991 and December 1993., Results: The volume of traffic (odds ratio [OR] = 2.16 for an increase of 100 vehicles per hour) in combination with the proportion of vehicles exceeding the speed limit (OR = 1.04) for each 1% increase in average speed, and the presence of footpaths (OR = 11.0) were associated with significant increase in the risk of injury. A graded inverse relationship was present between socioeconomic status and the odds of pedestrian injury., Conclusions: These findings have obvious implications for public health as features of the physical environment are potentially modifiable.

Objective: To examine the characteristics of childhood pedestrian injuries in the Perth metropolitan area from 1980 to 1989., Design: Retrospective descriptive study., Setting: Perth metropolitan area, Western Australia., Participants: Child pedestrians aged 0 to 14 years who were injured during the period 1 January 1980 to 31 December 1989., Main Outcome Measures: An extensive database which reported fatal and non-fatal motor vehicle collisions was used to obtain details on the child pedestrian, the vehicle involved in the collision, and the environmental factors related to these injuries., Results: A total of 1282 child pedestrian injuries were reported in the 10 year period. Children aged between 5 and 9 years, and were overrepresented among those injured. This study also demonstrated a similar proportion of injuries involving the 10-14 year age group. Injuries frequently occurred mid block, on local urban roads, between the hours of 3 p.m. and 7 p.m., and a greater than expected proportion of drivers involved in these collisions were in the under-21 age category. To describe the pattern of childhood pedestrian injuries we calculated both age-specific injury rates, and injury rates based on the number of registered motor vehicles. The latter revealed a greater than 20-fold variation between local government areas., Conclusions: Further analytical research, incorporating a measure of the child pedestrian's exposure to roads and traffic is required to identify those features in the individual and the environment which have a significant influence on the likelihood of a collision. Such research is required to institute effective preventive measures.

Pedestrian-motor vehicle collisions that involved children aged 0 to 14 years in Perth, Western Australia were examined for the period 1980-1989 in order to identify factors which contribute to the severity of injury. Nearly half (49%) of the 1,282 children injured during this period required hospitalization, with a further 46% of the children requiring some form of medical treatment. Multivariate analysis indicated that children aged 0 to four years had a higher risk of sustaining a severe injury compared with children aged five to nine and ten to 14 years, with relative risks of 1.6 and 1.7 respectively. A greater proportion of more severe injuries occurred after 3 pm. Injuries tended to be more severe when the collision occurred on a highway or main road, and when the child was actually on the road at the point of impact. Further research on more comprehensive datasets, which consider the child's behavior at the time of injury as well as driver attributes, will provide greater insight into factors contributing to the severity of injury.

The present study investigated the relationship between self-reported sex-role characteristics and attitudes toward homosexuality using the Bem Sex Role Inventory, the Personal Attributes Questionnaire and the Attitudes toward Homosexuality Scale. Relationships occur for both males and females who are exhibiting greater amounts of cross-sex traits. Females with more instrumental characteristics were more accepting while males with more expressive characteristics were more rejecting. These findings are discussed in relation to those of Weinberger and Millham (1979) who also investigated this relationship, as well as to research investigating the relationship between attitudes toward homosexuality and attitudes toward sex roles and feminism.

A meta-analysis was based on every available study that has compared father-present and father-absent children on a measure of sex typing. 67 studies produced 222 estimates of effect size. Owing to the inappropriateness of conventional statistics, Hedges's approach to meta-analysis was employed. Results show that published studies produced larger estimates of effect size than dissertations and conference papers. Effect-size estimates based on clinical and incarcerated samples were significantly different from those based on more typical samples. Generalizable differences between father-present and father-absent females were conspicuously absent. Preschool father-absent boys were shown to make less stereotypical choices of toys and activities when compared to father-present age-mates. When compared to father-present boys, older father-absent boys were more stereotypical in their overt behavior, particularly in terms of aggression. Discussion focused on interpretation of the results within a multidimensional conception of sex role.

Calcium and phosphous metabolism was investigated in 20 patients with diabetes mellitus when their diabetes was under poor metabolic control and again once optimal glycaemic control was achieved with aggressive insulin therapy. Ten of the twenty uncontrolled diabetics had hypercalciuria; insulin therapy returned calcium excretion to normal in five. Twenty-four hour calcium excretion fell in all but two patients when optimal diabetic control was achieved and calcium excretion was positively correlated with glucose excretion. Urinary cyclic AMP excretion, which was in the high normal range during poor control, decreased significantly during optimal insulin therapy. These data suggest that the hypercalciuria of uncontrolled diabetes may be a form of renal hypercalciuria which could result in parathyroid stimulation which might contribute to the development of osteopenia in patients with diabetes mellitus.