ABSTRACT
BACKGROUND: Although the Jamaica road traffic act mandates motorcycle riders to wear approved helmets, opponents suggest that the local road conditions obviate any benefits from helmet use that have been proven in Developed countries. They suggest that the narrow, winding, poorly surfaced, congested local highways do not allow motorcyclists to sustain high velocity travel. The accidents then tend to occur at lower speeds and are accompanied by less severe injuries. This study was carried out to determine the impact of helmet use on traumatic brain injuries from motorcycle collisions in patients admitted to a tertiary referral hospital in Jamaica. METHODS: A prospectively collected trauma registry maintained by the Department of Surgery at the University Hospital of the West Indies in Jamaica was accessed to identify all motorcycle collision victims from January 2000 to January 2007. The therapeutic outcomes of traumatic brain injuries were compared between helmeted and un-helmeted riders. The data was analyzed using SPSS Version 12. RESULTS: Of 293 motorcycle collision victims, 143 sustained brain injuries. There were 9 females (6.3%) with an average age of 23 +/- 7.3 years and 134 males (93.7%) at an average age of 33.4 +/- 11.2 years (mean +/- SD). Only 49 (34.3%) patients wore a helmet at the time of a collision. Helmet use at the time of a collision significantly reduced the severity of head injuries (28.6% vs 46.8%, P = 0.028) and the likelihood of sustaining intra-cranial lesions (26.5% vs 44.7%, P = 0.03) from head injuries. CONCLUSION: Wearing a helmet at the time of a motorcycle collision reduces the severity of head injuries. However, the prevalence of helmet use at the time of a collision is unacceptably low.
ABSTRACT
Comparative analysis of alternative systems of delivery of health care, in the prevailing environment of limited health budgets is of paramount importance. This study involved diabetic residents (n=32) from an eldely care home in Jamaica, and essentially analysed the cost-effectiveness of the use of a in-house glucometer in the monitoring of blood glucose in the institutionalized diabetic vis-a-vis that of monitoring by transportation of residents to public hospital laboratories. The cost-effectiveness of the two systems as reflected by the attendant costs and the corresponding increase in quality adjusted life-years was examined. The use of the in-house glucometer resulted in a greated proportion of diabetics being controlled and at lower costs. The difference in mean glycosylated haemoglobin levels of diabetic residents for each system was statistically significant (p<0.001). There was also an established trend for elevated blood glucose to be reduced to control levels using the in-house glucometer (p<0.001). Cost-effectiveness ratios were compared and the system using the glucometer was in this respect advantageous. It is hoped that due consideration will now be given to the use of the in-house glucometer as a cost-effective alternative in the delivery of care to the elderly diabetics at this institution. More importantly, decision-makers nationally, should consider this option as they grapple with the problems of institutionalized elderly diabetics in the primary care setting (AU)
