Helmets, injuries and cultural definitions: motorcycle injury in urban Indonesia.

This paper examines motorcycle helmet use and injuries in a developing country with a helmet law. Data were collected by systematic street observations and interviews with motorcyclists and supplemented with motorcycle injury data from a 1 month study of all patients coming to emergency departments in Yogyakarta, Indonesia. Observations show that 89% of motorcycle drivers (N = 9242) wore helmets; only 20% of the passengers (N = 3541) did. However, only 55% of the drivers wore helmets correctly (e.g. with chin strap buckled). Differences in time and place were noted in interviews when motorcyclists reported wearing helmets least at night and when no police were around; various reasons for not wearing helmets included physical discomfort and absence of police surveillance. Data from emergency departments found that motorcycles were involved in 64% of all traffic accident injuries, comprising 33% of total trauma patients presenting to emergency departments. Injury Severity Scores were calculated for the 26% of motorcycle injuries which were admitted to the hospital, with 60% having scores of 1-8, 27% 9-15, and 9% > 15. We conclude that although motorcycle drivers appear to comply with the motorcycle helmet law, it is a "token compliance." Less than 50% of riders were maximally protected by helmets and very little safety consciousness was found among drivers. Suggestions for improving helmet use that take cultural definitions of wearing helmets into account are presented for future research.

Comparison of the efficacy between flunarizine and nifedipine in the prophylaxis of migraine.

BACKGROUND: Several calcium channel blockers have been evaluated in controlled clinical studies and some hold considerable promise for future. Efficacy in migraine prophylaxis has been claimed for drugs belonging to all three classes of calcium channel blockers (nifedipine-like, verapamil-like, and flunarizine-like), but the extent and quality of the evidence varies, and a comparison of efficacy between different calcium channel blockers has not been reported. OBJECTIVE: The objective of the study is to assess the comparison of efficacy and safety of flunarizine and nifedipine in migraine prophylaxis. PATIENTS AND METHODS: The study was conducted in a prospective, double-blind, randomized controlled trial, parallel group design. 78 patients were studied for a 1-month period during which all patients received placebo followed by a 3-month experimental period. Headache response to medication was measured monthly by compilation of migraine-scores derived from quantitative data recorded by patients in a daily diary. Student's t-test was used to compare results from the flunarizine (10 mg) and nifedipine (20 mg) group for each month. RESULTS: Both groups showed a significant reduction in the migraine-scores after 3-months. No significant differences were detected between groups, but there was a clinical significantly different reduction of migraine-scores between the groups in the first month after the run-in period (58% vs 38%). It shows that the beneficial effect of flunarizine was more rapidly manifest than that of flunarizine. Tachycardia more frequently occurred in the nifedipine group than in the flunarizine treatment group. CONCLUSION: It concluded that flunarizine is a potentially more useful agent in the prophylaxis of migraine headache.