Alcohol a major
factor in bicycling injuries and deaths
In a government-supported study of more than 300 fatal and non-fatal bicycle accidents, Johns Hopkins researchers found that alcohol was a factor in at least a third of the deaths.
"Alcohol may have an even greater impact on cyclists than on motorists," said Guohua Li, the study's lead author and an assistant professor of emergency medicine at Hopkins. "Riding a bicycle requires more physical coordination and concentration than driving a car, and biking performance declines more rapidly as the rider's blood-alcohol level increases."
Although cycling--drunken or sober--accounts for only a small percentage of all traffic-related trauma in the United States, it is the nation's leading cause of recreational injury, resulting each year in about 600,000 emergency department visits, 20,000 hospitalizations, 900 deaths and $1 billion in medical care. Hopkins researchers say cycling safety programs that include warnings against intoxication could reduce the estimated 60,000 alcohol-related cycling injuries, 300 deaths and $250 million treatment price tag nationwide each year.
"It's been shown consistently that alcohol use increases the likelihood of risky behavior by drivers, and our results suggest this is also true for cyclists," Li said. The results were published in the December issue of Alcoholism: Clinical and Experimental Research.
In both fatal and non-fatal cases, intoxication was more common among men ages 20 to 39 and those injured while cycling at night. Among those testing positive for alcohol, 74 percent of the fatalities and 78 percent of the non-fatalities had blood- alcohol concentrations of 0.10 percent or higher.
"Previous research on bicycling injury was conducted predominantly in children and focused on the effectiveness of safety helmets, but our results suggest that preventing intoxicated biking should be incorporated into helmet campaigns and other bicycling safety programs," said Susan Baker, a co-author and professor of health policy and management at Hopkins.
The study's estimates probably are conservative because blood-alcohol tests frequently were not given to cyclists until several hours after the accidents, and because medical examiners do not report that motorists were involved in fatal bicycle accidents, Li said.
More than 100 million bicycles are in use in the United States, primarily for recreation, and more than 45 percent of Americans ride bicycles at least occasionally. Helmets greatly reduce the risk of head injury, which contributes to most bicycle-related deaths, but more than 80 percent of U.S. cyclists do not wear helmets.
Communication patterns between doctors and patients are 'autopsied'
Is your doctor a "paternalistic" communicator? A "consumerist" communicator? A "technical interpreter"?
Debra Roter, a professor in the department of Health Policy and Management in the School of Public Health, recently analyzed the content of patient-physician communication and identified five communication patterns that directly have an impact on both patient and physician satisfaction, as well as the quality of care. The study appeared in the Jan. 22 issue of the Journal of the American Medical Association.
A study of 537 audio tapes of medical interviews between 127 physicians and patients revealed five patterns of communication. Verbal dominance and verbal control on the part of the physicians in each interview was evaluated and coded. Both physicians and patients were later surveyed about their satisfaction with the medical interview.
While most physicians tended toward the "paternal," dominating the interview with biomedical questions, the "bio-psychosocial" pattern--where patient and doctor freely discussed a range of physical and emotional questions--lowered physician verbal dominance and control but raised the satisfaction for both patient and physician.
The "narrowly biomedical" pattern, dominated by physicians asking medical questions--and by far the most common pattern--was least pleasing to both patients and physicians.
"It was less pleasing to both patients and doctors, yet this kind of visit is the norm," Roter said. "Which means that something is wrong with the system."
Many doctors considered the "consumerist" pattern interviews--where doctors only answered patient questions--the best use of their time.
"Given the dramatic changes in healthcare delivery, our findings must be given full and serious consideration for conceptualizing the physician-patient relationship of the future," Roter said.
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