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Vidyya, from the Sanskrit "vaidya," a practitioner who has come to understand the science of life.

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Back To Vidyya JAMA Highlights


Risk Of Death Due To Alcohol-Related Crashes For Children

Context  The overall percentage of motor vehicle deaths associated with alcohol consumption declined between 1991 and 1996, but the risk of death due to alcohol-related crashes for children warrants analysis.

Objective  To examine the association between alcohol use by drivers and mortality of children who were passengers, pedestrians, and bicyclists.

Design and Setting  Analysis of data from the Fatality Analysis Reporting System, a nationwide US registry of motor vehicle deaths, for 1991-1996.

Subjects  A total of 16,676 children younger than 16 years who were passengers, pedestrians, or bicyclists and whose death was due to a motor vehicle crash.

Main Outcome Measure  Alcohol use by drivers involved in crashes in which children died, assessed by age and sex of the child and driver and type of crash.

Results  A total of 3310 deaths (19.9%) involved alcohol-related crashes. The percentage declined from 21.6% in 1991 to 17.8% in 1996. Considering only crashes in which the alcohol-use status of the child's driver was relevant, the decline was less marked, from 18.8% in 1991 to 15.1% in 1995, with an increase to 16.4% in 1996. Among crashes involving alcohol, the child's own driver had been drinking in 66.3% of cases, varying from 58.0% to 70.7% over time. Drivers younger than the legal drinking age of 21 years who had been drinking alcohol accounted for 30.3% of alcohol-related passenger deaths among children.

Conclusion  While the overall percentage of alcohol-related motor vehicle deaths for children declined between 1991 and 1996, experiences for passengers, pedestrians, and bicyclists differ. Selected characteristics of children and drivers that elevate the risk of an alcohol-related motor vehicle death point to the need for further policy and clinical interventions.

JAMA. 2000;283:2245-2248

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Characteristics Of Crashes Involving Child Passenger - Deaths And Injuries Associated With Drinking Drivers

Context  Motor vehicle–related injury is the leading cause of death for children and young adults aged 1 to 24 years in the United States. Approximately 24% of child traffic deaths involve alcohol.

Objective  To examine characteristics of crashes involving child passenger deaths and injuries associated with drinking drivers to identify opportunities for prevention.

Design, Setting, and Participants  Descriptive epidemiological analysis of 1985-1996 data from the Fatality Analysis Reporting System on deaths among US child passengers (aged 0-14 years) and 1988-1996 data from the General Estimates System on nonfatal injuries.

Main Outcome Measures  Child passenger death or injury by driver characteristics (eg, driver age, blood alcohol concentration, and driving history).

Results  In 1985-1996, there were 5555 child passenger deaths involving a drinking driver. Of these deaths, 3556 (64.0%) occurred while the child was riding with a drinking driver; 67.0% of these drinking drivers were old enough to be the parent or caregiver of the child. Of all drivers transporting a child who died, drinking drivers were more likely than nondrinking drivers to have had a previous license suspension (17.1% vs 7.1%) or conviction for driving while intoxicated (7.9% vs 1.2%). Child restraint use decreased as both the child's age and the blood alcohol concentration of the child's driver increased. In 1988-1996, an estimated 149,000 child passengers were nonfatally injured in crashes involving a drinking driver. Of these, 58,000 (38.9%) were riding with a drinking driver when injured in the crash.

Conclusions  These data indicate that the majority of drinking driver–related child passenger deaths in the United States involve a child riding unrestrained in the same vehicle with a drinking driver. Typically, the drinking driver transporting the child is old enough to be the child's parent or caregiver.

JAMA. 2000;283:2249-2252

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Consensus Statement : Plague As A Biological Weapon

Objective  The Working Group on Civilian Biodefense has developed consensus-based recommendations for measures to be taken by medical and public health professionals following the use of plague as a biological weapon against a civilian population.

Participants  The working group included 25 representatives from major academic medical centers and research, government, military, public health, and emergency management institutions and agencies.

Evidence  MEDLINE databases were searched from January 1966 to June 1998 for the Medical Subject Headings plague, Yersinia pestis, biological weapon, biological terrorism, biological warfare, and biowarfare. Review of the bibliographies of the references identified by this search led to subsequent identification of relevant references published prior to 1966. In addition, participants identified other unpublished references and sources. Additional MEDLINE searches were conducted through January 2000.

Consensus Process  The first draft of the consensus statement was a synthesis of information obtained in the formal evidence-gathering process. The working group was convened to review drafts of the document in October 1998 and May 1999. The final statement incorporates all relevant evidence obtained by the literature search in conjunction with final consensus recommendations supported by all working group members.

Conclusions  An aerosolized plague weapon could cause fever, cough, chest pain, and hemoptysis with signs consistent with severe pneumonia 1 to 6 days after exposure. Rapid evolution of disease would occur in the 2 to 4 days after symptom onset and would lead to septic shock with high mortality without early treatment. Early treatment and prophylaxis with streptomycin or gentamicin or the tetracycline or fluoroquinolone classes of antimicrobials would be advised.

JAMA. 2000;283:2281-2290

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