Risk factors for race-day fatality in flat racing Thoroughbreds in Great Britain (2000 to 2013)

A key focus of the racing industry is to reduce the number of race-day events where horses die suddenly or are euthanased due to catastrophic injury. The objective of this study was therefore to determine risk factors for race-day fatalities in Thoroughbred racehorses, using a cohort of all horses participating in flat racing in Great Britain between 2000 and 2013. Horse-, race- and course-level data were collected and combined with all race-day fatalities, recorded by racecourse veterinarians in a central database. Associations between exposure variables and fatality were assessed using logistic regression analyses for (1) all starts in the dataset and (2) starts made on turf surfaces only. There were 806,764 starts in total, of which 548,571 were on turf surfaces. A total of 610 fatalities were recorded; 377 (61.8%) on turf. In both regression models, increased firmness of the going, increasing racing distance, increasing average horse performance, first year of racing and wearing eye cover for the first time all increased the odds of fatality. Generally, the odds of fatality also increased with increasing horse age whereas increasing number of previous starts reduced fatality odds. In the ‘all starts’ model, horses racing in an auction race were at 1.46 (95% confidence interval (CI) 1.06–2.01) times the odds of fatality compared with horses not racing in this race type. In the turf starts model, horses racing in Group 1 races were at 3.19 (95% CI 1.71–5.93) times the odds of fatality compared with horses not racing in this race type. Identification of novel risk factors including wearing eye cover and race type will help to inform strategies to further reduce the rate of fatality in flat racing horses, enhancing horse and jockey welfare and safety

Adult and paediatric mortality patterns in a referral hospital in Liberia 1 year after the end of the war

The aim of this study was to describe and analyse hospital mortality patterns after the Liberian war. Data were collected retrospectively from January to July 2005 in a referral hospital in Monrovia, Liberia. The overall fatality rate was 17.2% (438/2543) of medical admissions. One-third of deaths occurred in the first 24h. The adult fatality rate was 23.3% (241/1034). Non-infectious diseases accounted for 56% of the adult deaths. The main causes of death were meningitis (16%), stroke (14%) and heart failure (10%). Associated fatality rates were 48%, 54% and 31% respectively. The paediatric fatality rate was 13.1% (197/1509). Infectious diseases caused 66% of paediatric deaths. In infants <1 month old, the fatality rate was 18% and main causes of death were neonatal sepsis (47%), respiratory distress (24%) and prematurity (18%). The main causes of death in infants > or =1 month old were respiratory infections (27%), malaria (23%) and severe malnutrition (16%). Associated fatality rates were 12%, 10% and 19%. Fatality rates were similar to those found in other sub-Saharan countries without a previous conflict. Early deaths could decrease through recognition and early referral of severe cases from health centres to the hospital and through assessment and priority treatment of these patients at arrival

Children’s travel as pedestrians: an international survey of policy and practice

A survey of OECD member countries was carried out to provide high level data on a consistent basis to identify and account for current patterns of child road safety . This paper reports the findings relating to children, aged 0-14 years, as pedestrians. Key survey elements included analyses of fatality data, relationships between socio-economic, demographic factors and fatality rates, and a questionnaire based survey. League tables based on average child pedestrian fatality rates were constructed for each OECD member country participating in our questionnaire enabling identification of the top five countries with the lowest pedestrian fatality rate as Sweden, The Netherlands, Finland, Germany, and Denmark. Few countries had quantitative information about children’s travel and its absence means that assessments are difficult about children’s safety and the relative risks they face, especially as pedestrians. There are large variations in the amount of walking between countries and growing car use is becoming an issue in one third of OECD countries. The main findings from the questionnaire survey were that the majority of countries did not have information on high risk groups but of those that did, the cross cutting themes of socio-economic and ethnic minority groups, young children and urban areas were identified. Three characteristics distinguish top countries in the League table from those doing less well: a strong approach to the introduction of infrastructure measures for pedestrian safety, including low speed limits in residential areas; conducting road safety campaigns at least once a year; and having legislation which assumes driver responsibility in an accident involving a child pedestrian. Having compulsory road safety education for children aged 6-9 years was a characteristic shared by most countries, as was the promotion of child pedestrian education and training initiatives and the commissioning of research. However there is lower research activity in less well performing countries

Sex differences in incidence, mortality, and survival in individuals with stroke in Scotland, 1986 to 2005

&lt;p&gt;&lt;b&gt;Background and Purpose:&lt;/b&gt; The aim of this study was to examine the effect of sex across different age groups and over time for stroke incidence, 30-day case-fatality, and mortality.&lt;/p&gt; &lt;p&gt;&lt;b&gt;Methods:&lt;/b&gt; All first hospitalizations for stroke in Scotland (1986 to 2005) were identified using linked morbidity and mortality data. Age-specific rate ratios (RRs) for comparing women with men for both incidence and mortality were modeled with adjustment for study year and socioeconomic deprivation. Logistic regression was used to model 30-day case-fatality.&lt;/p&gt; &lt;p&gt;&lt;b&gt;Results:&lt;/b&gt; Women had a lower incidence of first hospitalization than men and size of effect varied with age (55 to 64 years, RR=0.65, 95% CI 0.63 to 0.66; 85 years, RR=0.94, 95% CI 0.91 to 0.96). Women aged 55 to 84 years had lower mortality than men and again size of effect varied with age (65 to 74 years, RR=0.79, 95% CI 0.76 to 0.81); 75 to 84 years, RR=0.94, 95% CI 0.92 to 0.95). Conversely, women aged 85 years had 15% higher stroke mortality than men (RR=1.15, 95% CI 1.12 to 1.18). Adjusted risk of death within 30 days was significantly higher in women than men, and this difference increased over the 20-year period in all age groups (adjusted OR in 55 to 64 year olds 1.23, 95% CI 1.14 to 1.33 in 1986 and 1.51, 95% CI 1.39 to 1.63 in 2005).&lt;/p&gt; &lt;p&gt;&lt;b&gt;Conclusions:&lt;/b&gt; We observed lower rates of incidence and mortality in younger women than men. However, higher numbers of older women in the population mean that the absolute burden of stroke is greater in women. Short-term case-fatality is greater in women of all ages and, worryingly, these differences have increased from 1986 to 2005.&lt;/p&gt

Alcohol Advertising Bans and Alcohol Abuse: An International Perspective

The purpose of this paper is to empirically examine the effect on alcohol abuse of banning broadcast advertising of alcoholic beverages. The effect of a ban cannot be studied using data from one country because the adoption of new advertising bans is an infrequent event and requires many years for adjustment. However, an international data set can be used since there is considerable variation in the use of advertising bans across countries. The data used in this study are a pooled time series from 17 countries for the period 1970 to 1983. The empirical measures of alcohol abuse are alcohol consumption, liver cirrhosis mortality rates, and highway fatality rates. The cultural factors which influence alcohol use are measured by sets of country dummy variables. The empirical results show that countries with bans on spirits advertising have about 10 percent lower alcohol consumption and motor vehicle fatality rates than countries with no bans. The results also show that countries with bans on beer and wine advertising have about 23 percent lower alcohol consumption and motor vehicle fatality rates than countries with only bans on spirits advertising.

Banning open carry of unloaded handguns decreases firearm-related fatalities and hospital utilization.

BackgroundSince 1967, in California it has been illegal to openly carry a loaded firearm in public except when engaged in hunting or law enforcement. However, beginning January 1, 2012, public open carry of unloaded handguns also became illegal. Fatal and non-fatal (NF) firearm injuries were examined before and after adoption of the 2012 ban to quantify the effect of the new law on public health.MethodsState-level data were obtained directly from California and nine other US state inpatient and emergency department (ED) discharge databases, and the Centers for Disease Control Web-Based Injury Statistics Query and Reporting System. Case numbers of firearm fatalities, NF hospitalizations, NF ED visits, and state-level population estimates were extracted. Each incident was classified as unintentional, self-inflicted, or assault. Crude incidence rates were calculated. The strength of gun laws was quantified using the Brady grade. There were no changes to open carry in these nine states during the study. Using a difference-in-difference technique, the rate trends 3 years preban and postban were compared.ResultsThe 2012 open carry ban resulted in a significantly lower incident rate of both firearm-related fatalities and NF hospitalizations (p&lt;0.001). The effect of the law remained significant when controlling for baseline state gun laws (p&lt;0.001). Firearm incident rate drops in California were significant for male homicide (p=0.023), hospitalization for NF assault (p=0.021  male; p=0.025 female), and ED NF assault visits (p=0.04). No significant decreases were observed by sex for suicides or unintentional injury. Changing the law saved an estimated 337 lives (3.6% fewer deaths) and 1285 NF visits in California during the postban period.DiscussionOpen carry ban decreases fatalities and healthcare utilization even in a state with baseline strict gun laws. The most significant impact is from decreasing firearm-related fatal and NF assaults.Level of evidenceIII, epidemiology

Past Influenza pandemics and their effect in Malta

The influenza virus type A has caused repeated pandemics throughout the 19th and 20 th century causing significant morbidity and mortality on a worldwide scale. The worst pandemic on record during the 20th century was that which occurred during 1917-19, the virus being assisted in its spread by the massive movement of persons brought on by World War I. The present increasing international travel has led to increasing alarm of the possible effects of an emerging pandemic with the WHO issuing guidelines to ensure the preparedness of health authorities. The various Influenza Type A pandemics of the late 19th and 20th century have had a varying effect on the Maltese community with influenza reaching epidemic proportions during the 1889-90 Asiatic Flu, 1917-19 Spanish Flu, 1957-58 Asian Flu pandemics, and 1968-69 Hong Kong flu, but no apparent effect during the 1977-78 Russian Flu pandemic.peer-reviewe